The paper, entitled “What is Occupational Therapy?”, presents a thorough definition and explanation of occupational therapy. It also provides a summary of the profession’s history and the key individuals who have influenced it. The paper delves into the diverse work settings in this field, as well as the required education and certifications. Moreover, it explores the various associations affiliated with occupational therapy. It should be emphasized that occupational therapy adopts a holistic approach instead of solely addressing individual components.
The therapist can treat the client holistically, rather than focusing on individual parts. This approach can enhance the therapeutic process by incorporating beneficial and innovative activities for psychological or physical rehabilitation. Occupational Therapy (OT) involves utilizing treatments to improve, restore, or sustain the daily living and job-related abilities of individuals with physical, cognitive, or developmental disorders. It emphasizes prioritizing the client’s goals and providing client-centered care.
Interventions are designed to improve engagement and effectiveness in everyday tasks through adjustments to the environment, alterations to tasks, skill teaching, and educating clients and their families. These activities can be conducted individually or in group settings. Employment options span different areas such as medical, social, psychological, comprehensive care, private practice, and unconventional settings. Biological settings include hospitals, clinics, industrial workplaces, home health care establishments, and skilled nursing facilities.
The sociological settings include schools (public, special visual/hearing impairment, cerebral palsy), day treatment centers, hippotherapy centers, workshops, Special Olympics, and summer camps. The psychological settings consist of institutions (psychiatric/mental retardation), community mental health services, teen centers, supervised living facilities, and after school programs. Long-term care falls under the all-inclusive category. Private practice settings are self-defined. Non-traditional settings encompass correctional facilities, hospice centers, and national societies (Hussey, Sabonis-Chafee and O’Brien, 2007).
The demand for occupational therapy services in various settings is increasing due to changing demands. These services aim to improve the health and well-being of individuals who currently have or may develop an illness, injury, disease, disorder, condition, impairment, disability, or limitations in participation (Hussey et al., 2001). This therapy focuses on addressing physical, cognitive, and psychosocial factors that can impact an individual’s performance. The goal is to engage clients in meaningful daily activities and improve their overall quality of life.
Incorporating the client and their family throughout the therapeutic process is essential. The therapist uses their expertise to help individuals engage in meaningful daily activities during rehabilitation. The therapist’s goal is to enhance independence by developing, improving, sustaining, or restoring necessary skills. Consulting with caregivers and other individuals involved in the client’s life is crucial. This consultation assists in the development and evaluation of treatments, ultimately helping the client participate in fulfilling activities.
Evaluation also includes assessing an individual’s capability to perform activities in their preferred environment, aiming to help them function effectively in their community and surroundings. In terms of history, the use of occupations as a therapeutic approach can be traced back to ancient times. Around 100 BCE, Greek physician Asclepiadas introduced compassionate treatment for mentally ill patients through therapeutic baths, massage, exercise, and music. Following that, Roman Celsus recommended music, travel, conversation, and exercise as therapeutic interventions for his patients.
During the late 1700s and early 1800s, there was a growing enlightenment movement that led to an increase in social awareness, as stated by Peloquin (1989). This time period also saw the emergence of occupational therapy as a field. This newfound knowledge sparked a reconsideration of how individuals with mental illnesses were treated. Previously, these individuals had been subjected to cruel treatment such as imprisonment, chaining, and isolation from society due to their perceived danger. They often experienced abuse and neglect. The prevailing belief at that time was that those with mental illness were possessed by demons (Butcher, Mineka, and Hooley,2011).
The concept of Moral Treatment emerged as a response to cruel and inhumane behavior. It advocates for the belief that every individual, regardless of their abilities, deserves empathy and consideration. This movement was initiated by Phillippe Pinel, a French physician, philosopher, and scholar, as well as Willaim Tuke, an English Quaker. Together, they aimed to challenge society’s perceptions of the mentally ill. Pinel introduced the idea of “work treatment” for the insane, viewing moral treatment as a means to address emotional issues by engaging individuals in productive activities that would redirect their thoughts away from disturbances.
Pinel and Tuke both shared dissatisfaction with the treatment of the mentally ill. Pinel used literature, music, physical exercise, and work to alleviate emotional stress and enhance daily functioning. Similarly, Tuke believed in treating the mentally ill with compassion and kindness, favoring moral treatment over medication and restraints. Tuke established the York Retreat in York, England, where he introduced occupation and purposeful activities as part of the treatment program (Hussey, Sabonis-Chafee and O’Brien, 2007).
The York Retreat fostered a sense of family. Tuke believed that giving patients meaningful tasks to do would improve their mental illness and overall function. He wanted them to learn and develop by participating in different jobs or activities that held their interest. Pinel and Tuke shared information about moral treatment, which led hospitals in England and the United States to adopt this approach. Engaging patients in work tasks improved their health. Benjamin Rush was the pioneering physician who introduced moral treatment in the United States.
In the early 1900s, John Ruskin and William Morris initiated the Arts and Crafts movement in England (Hussey, Sabonis-Chafee and O’Brien, 2007). This movement aimed to cultivate relaxation and a sense of productivity. Ruskin, an author, poet, artist, and art critic, collaborated with Morris, a poet, designer, and social reformer. Harvard Medical School graduate Herbert Hall integrated arts and crafts into medical treatments. In 1904, he established a facility in Marblehead, Massachusetts, where arts and crafts were utilized as a form of therapy for patients with neurasthenia.
Opposition to the “rest cure” and the development of the “work cure” were significant developments in the early 1900s in the United States. These advancements laid the foundation for the occupational therapy profession (Hussey, Sabonis-Chafee and O’Brien, 2007). Individuals from various backgrounds, including psychiatry, medicine, architecture, nursing, arts and crafts, rehabilitation, teaching, and social work, shared the belief that occupation was a useful treatment. During this period, multiple names were used for treatments such as ergotherapy, activity therapy, occupational treatment, moral treatment, and work treatment.
William Rush Dunton is known as the “father” of occupational therapy and was the first to use the term. In 1912, Eleanor Clarke Sleagle, a social worker, became the director of the department of Occupational Therapy at Henry Phipps Psychiatric Clinic of John Hopkins Hospital. She introduced a concept called “habit training,” which aimed to re-educate individuals to overcome disorganized habits while modifying existing habits and building new ones.
The aim is to heal and preserve well-being. Sleagle founded the initial professional school for occupational therapy practitioners (Hussey, Sabonis-Chafee, and O’Brien, 2007). In recognition of her contributions, the American Occupational Therapy Association established the Eleanor Clarke Sleagle Lectureship award. Meanwhile, Susan Tracy, a nursing instructor, was developing occupational programs and post-graduate coursework for nurses. She authored the first documented book on occupational therapy titled Studies in Invalid Occupations (Hussey, Sabonis-Chafee, and O’Brien, 2007).
Tracy believed that only nurses were qualified to practice occupation. On the other hand, Susan Cox Johnson, who was a designer and arts and crafts teacher, had the belief that occupation could have a morally uplifting effect and could improve the mental and physical well-being of patients and inmates in hospitals and almshouses. Johnson was also an advocate for high education standards and training for practitioners. In 1914, George Edward Barton, an architect by trade, opened the Consolation House in Clifton Springs, New York, where he implemented moral treatment (Hussey, Sabonis-Chafee and O’Brien, 2007).
Barton experienced multiple disabling conditions, leading to the need for a foot amputation. In addition, he worked as an understudy under William Morris. The next year, Dr. William Rush Dunton released Occupational Therapy: A Manual for Nurses, which provided nurses with guidance on simple activities for patients (Hussey, Sabonis-Chafee and O’Brien, 2007). He also played the roles of president and treasurer for the National Society for the Promotion of Occupational Therapy. Shortly after, Thomas Kidner, a Canadian architect and friend of George Barton, began constructing buildings catered to individuals with disabilities.
His facilities included designated spaces for various professions and he was actively engaged in assisting individuals with tuberculosis. Kidner contributed to the establishment of hospitals in both Canada and the United States. The National Society for the Promotion of Occupational Therapy was officially established on March 15th, 1917, during a significant meeting in Clifton Springs, New York. Key figures involved in this founding were George Barton, William Dunton, Eleanor Clarke Sleagle, Susan Cox Johnson, and Thomas Kinder (Hussey et al., 2007).
In September of that year, about half a year after its founding, the organization grew to 26 members and held its first meeting. Adolf Meyer, a Swiss physician and psychiatry professor at John Hopkins University, gave the main speech at the fifth annual meeting. In his address, Meyer highlighted the philosophical foundation of the profession and stressed the need for a comprehensive approach to dealing with mental illness. He emphasized viewing individuals as complete entities instead of separate parts or issues that require control.
He believed that engaging in meaningful activities was a natural human trait that promoted health, and this belief prompted the formation of the organization. Shortly after, the United States joined World War I, and the military established reconstruction programs to help injured soldiers recover for their return to active duty or civilian employment. Occupational therapy aides (OTA) participated in these programs. The program’s success led to its attainment of military status during World War II. The growing demand for aides resulted in a greater need for training, leading to an influx of expedited training courses.
At the end of the war, many courses were invalidated. In 1920, shortly after the war ended, the federal government passed the Soldier’s Rehabilitation and Civilian Vocational Rehabilitation Act (Hussey, Sabonis-Chafee and O’Brien, 2007). Occupational Therapy practitioners assisted soldiers and civilians with physical disabilities in reintegrating into a productive life. Both acts were financially supported by the federal government. A year later, the National Society for the Promotion of Occupational Therapy changed its name to the American Occupation Therapy Association (AOTA) (Hussey, Sabonis-Chafee and O’Brien, 2007).
The AOTA and the American Medical Association partnered to set minimum standards for the occupational therapy profession. These standards included completing coursework, medical and craft training, and hospital-based clinical work. Schools that did not meet these requirements were not accredited. To inform the public about accredited schools, the AOTA created a registry. The progress of occupational therapy was greatly supported by journal publications, which later became known as the American Journal of Occupational Therapy.
During the 50’s and 60’s, the profession experienced rapid growth and significant changes. The rehabilitation movement led to a shift toward a more specialized approach, where patients began receiving treatment with drugs and the use of wheelchairs, orthotics, and advanced prosthetics became common. As a result, practitioners needed proper training in these areas. In response, the AOTA decided to introduce the Occupational Therapy Assistant (OTA) practitioner.
The program was implemented in technical schools and community colleges requiring an Associates Degree. The World Federation of Occupation Therapist was formed in 1952, its purpose being to promote, advocate and establish minimum educational standards for member countries. In 1965, the federal government began Medicare, which allowed persons 65 and older to receive payment for health care services that also positively impacted the growth of the profession (Hussey, Sabonis-Chafee and O’Brien, 2007). The American Occupation Therapy Foundation (AOTF) was founded also in that year.
The purpose of this profession is to provide financial support for research. This field experienced growth in the 1970s and 1980s due to an increase in drug and alcohol abuse, the emergence of new diseases, and the widespread use of computers. During this time, there was a shift from large institutions that cared for people with mental disabilities to community-based facilities known as Deinstitutionalization. Additionally, the federal government introduced several acts to assist individuals with disabilities including the Rehabilitation ACT in 1973, the Education for All Handicapped Children Act in 1975, and the Handicapped Infants and Toddlers Act in 1986. Technological advancements also occurred during this period.
The Related Assistance for Individuals with Disabilities Act, enacted in 1988, led to a higher demand for occupational therapy services. In 1983, President Reagan introduced the Prospective Payment System (PPS) to handle payment for each impatient stay and diagnosis related groupings (DRGs), resulting in reduced hospital payments. Consequently, there was a rise in the use of long-term care facilities and home health facilities where occupational therapy practitioners are employed.
The American Occupational Therapy Association (AOTA) chose to distance itself from the certification process three years later, with the National Board of Certification in Occupational Therapy (NBCOT) taking over as the certifying body. In 2007, Hussey, Sabonis-Chafee, and O’Brien established the Accreditation Council for Occupational Therapy Education (ACOTE) to regulate entry-level education standards. However, each state has its own licensing requirements and procedures. Throughout this period, Phil Shannon and other therapists sought to revive the profession’s initial philosophy and focus on a humanistic and holistic approach to treatment.
Legislation in the 90s brought about multiple acts that included the Americans with Disabilities Act in 1990, the Individuals with Disabilities Education Act in 1991, and the Balanced Budget Act of 1997. The American Occupational Therapy Political Action Committee (AOTPAC) provides professionals with information on pertinent legislation to ensure occupational therapy services are encompassed in new acts (Hussey, Sabonis-Chafee and O’Brien, 2007). Consequently, there have been significant improvements in education and qualifications needed for entry-level practitioners as time has progressed.
The current requirements for an entry-level occupational therapist include earning a Masters degree, completing 24 weeks of level II fieldwork, and conducting a basic research project. OTA’s, on the other hand, are required to obtain an Associate degree and complete 16 weeks of level II fieldwork. It is essential for institutions to have ACOTE accreditation. After finishing the coursework, individuals must take and pass an exam administered by NBCOT in order to be certified to practice in the profession. Lastly, individuals must apply for licensing in their chosen state of practice.
Practitioners are recommended to maintain their competence. The NBCOT requires certification renewal every three years, with a requirement of 36 hours of professional development units (PDU) (Hussey, Sabonis-Chafee and O’Brien, 2007). State licensure must also be renewed, with the specific duration determined by each state. In summary, this profession was established with the aim of helping individuals enhance their lives through occupation. The pioneers of the profession challenged societal views, attitudes, and behaviors.
By starting a movement that brought hope to marginalized individuals, the pioneers of this profession created an enduring impact that has spanned generations. Their commitment to helping and treating those who were disregarded and imprisoned contributed to the growth of the field. With the emergence of new settings, the profession will continue to expand, providing both challenges and opportunities. As client diversity increases, there will be a demand for diverse practitioners. Embracing diversity and anticipating growth, I am excited about my future practice in this field.
