Final Paper Assignment OTA 101 April 22, 2013 Reggie Thompson Abstract This paper is entitled “What is Occupational Therapy? ” This paper will include an in depth definition and meaning of occupational therapy and over view of the profession. Where it began and who helped mold it into the current practice. Also the paper will discuss the various employment settings, the education requirements and the appropriate accreditations as well as the numerous organizations affiliated with the practice of occupational therapy. Occupational therapy (OT) takes holistic approach rather than a reductionistic view.
This allows the therapist to treat the client as a whole and not person comprised of several separate parts. This can help in the therapeutic process. During this process the therapist will utilize useful and creative activities to promote psychological or physical rehabilitation. OT is the use of treatments to develop, recover or maintain the daily living and work skills of clients with physical, cognitive or developmental conditions. It is a client-centered practice that places a high level of importance on progressing towards a client’s goals.
Interventions focus on adapting the environment, modifying the task, teaching the skill and educating the client and family members. This will increase participation and the performance of the daily activities. Activities can be performed with individuals or in groups. Employment settings vary and categorized as biological (medical), sociological (social), psychological, all-inclusive, private practice and non-traditional. Hospitals, clinics, worksites (industry), home health, and skilled nursing facilities are examples of biological settings.
Schools (public, special visual/hearing impairment, cerebral palsy), day treatment, hippotherapy centers, workshops, Special Olympics, summer camps make up the sociological settings. Institutions (psychiatric/mental retardation), community mental health, teen centers, supervised living, and after school programs are part of the psychological settings. Long-term care is in the all-inclusive category. Self-defined represents private practice settings. Correctional facilities, hospice and national societies are non-traditional settings (Hussey, Sabonis-Chafee and O’Brien, 2007).
Non- traditional settings are growing due to the evolving and diverse need for occupational therapy, services. Services are provided for the purpose of promoting health and wellness to those who have or at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, limited or restricted in participation (Hussey,Sabonis-Chafee and O’Brien,2001). Therapy deals with physical, cognitive, psychosocial and other aspects that may impact performance. The goal is to engage clients into everyday meaningful occupations and improving their quality of life.
This can be achieved by incorporating the client and family through out the entire therapeutic process. During rehabilitation the therapist applies specific knowledge to enable people to engage in activities of daily living that have personal meaning and value. Therapist will develop, improve sustain or restore independence. It’s critical to consult with caregivers and any other people that are involved in a client’s life. Consulting aids in the development and evaluation of treatments and will increases the client’s ability to participate in satisfying activities.
Evaluation will also address the person’s capacity to perform an activity in their chosen environment. The end result should be a client acquiring the necessary skills, which allow them to function in their communities and surroundings. History The earliest evidence of using occupations as a method of therapy can be found in ancient times. In c. 100 BCE, Greek physician Asclepiadas initiated humane treatment of patients with mental illness using therapeutic baths, massage, exercise and music. Later the Roman Celsus prescribed music, travel, conversation and exercise to his patients.
In the late 1700s and early 1800s people were becoming enlighten, which sparked social consciousness(Peloquin,1989). It was during this period that occupational therapy began to emerge. This new awareness took a closer look at how people with a mental illness were treated. Prior to this period of enlightenment the mentally ill were treated inhumane. They were treated like prisoners, chained and locked away from society and considered to be a danger. Often abused and ignored. Many believed the mentally ill were possessed by devils (Butcher, Mineka, and Hooley,2011).
Cruel and inhumane behavior lead to the concept Moral Treatment, which is a belief that all people, even the most challenged are entitled to consideration and human compassion. Phillippe Pinel (a French physician, philosopher, and scholar) and Willaim Tuke (an English Quaker) began the Moral Treatment movement. They challenged society’s beliefs concerning the mentally ill. Pinel initiated “work treatment” for the insane. He believed that moral treatment meant treating one’s emotions, and using occupation as way to direct their minds away from emotional disturbances.
Pinel incorporated literature, music, physical exercise and work as away to help with emotional stress, and would improve a person’s ability to perform daily activities. During this time William Tuke was also equally dissatisfied with the treatment of the mentally ill. Tuke believed they should be treated with consideration and kindness (Hussey, Sabonis-Chafee and O’Brien, 2007). He thought moral treatment would be more beneficial than drugs and restraints. In York, England he established the York Retreat and implemented the use of occupation and purposeful activities.
York Retreat had a family atmosphere. Tuke thought occupation and purposeful activities would maximize function and minimize symptoms of the patient’s mental illness. He wanted patients to learn and grow by engaging in various employment or amusement that would keep their interest. Pinel and Tuke published information on moral treatment. Hospitals in England and the United States began to adopt this philosophy and practice. Patients were being engaged in work tasks, which resulted in better health. Benjamin Rush was the first physician to use moral treatment in the United States.
In the early 1900s John Ruskin and William Morris began the Arts and Crafts movement in England (Hussey, Sabonis-Chafee and O’Brien, 2007). This movement promoted relaxation and feelings of productivity. Rush was an author, poet, artist and art critic. Morris was a poet, designer and social reformer. Herbert Hall a graduate from Harvard Medical School used arts and crafts for medical treatments. In 1904 he opened a facility in Marblehead, Massachusetts, where he used arts and crafts as treatment for patients with neurasthenia.
He was opposed to the “rest cure” and developed the “work cure”. Also in the early 1900s individuals in the United States who shared the same belief that occupation was a useful treatment began to lay the foundation for the profession (Hussey, Sabonis-Chafee and O’Brien, 2007). These people came from various backgrounds that included psychiatry, medicine, architecture, nursing, arts and crafts, rehabilitation, teaching and social work. Many name were used for treatments during this period such as ergotherapy, activity therapy, occupational treatment, moral treatment and work treatment.
William Rush Dunton who is considered the “father “of OT was the first to use the term occupational therapy(Hussey, Sabonis-Chafee and O’Brien, 2007). Eleanor Clarke Sleagle a social worker, who is often considered the “mother” of OT, was appointed director of the department of Occupational Therapy at Henry Phipps Psychiatric Clinic of John Hopkins Hospital in 1912. She developed a concept titled “habit training” which is a re-education program designed to over come disorganized habits, while modifying other habits and constructing new ones(Hussey, Sabonis-Chafee and O’Brien,2007).
The goal is to restore, and maintain health. Sleagle organized the first professional school for occupational therapy practitioners (Hussey,Sabonis-Chafee and O’Brien, 2007). Many years later the American Occupational Therapy Association honored her efforts establishing the Eleanor Clarke Sleagle Lectureship award. Around this time Susan Tracy a nursing instructor, was developing occupational programs and post-graduate course work for nurses. She wrote the first known book on occupational therapy. The published work was entitled Studies in Invalid Occupations (Hussey, Sabonis-Chafee and O’Brien, 2007).
Tracy believed only nurses were qualified to practice occupation. Susan Cox Johnson was a designer and arts and crafts teacher. Johnson’s belief was that occupation would be morally up lifting and could improve the mental and physical state of patients and inmates in hospitals and almshouses. She 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, and implemented moral treatment (Hussey, Sabonis-Chafee and O’Brien, 2007).
Barton suffered from many disabling conditions, which resulted in a foot amputation. He also was an under study of William Morris. The following year Dr. William Rush Dunton published Occupational Therapy: A Manual for Nurses (Hussey, Sabonis-Chafee and O’Brien, 2007). The manual informed nurses of simple activities that could be administered to patients. His other contribution was serving as president and treasurer of the National Society for the Promotion of Occupational Therapy. The following Thomas Kidner a Canadian architect and friend of George Barton began constructing buildings for individuals with disabilities.
His facilities included areas specifically for occupation. Kidner was very involved with people suffering from tuberculosis. He helped design hospitals in his native Canada and United States. March 15th 1917 is the date of the first official meeting and formation of the National Society for the Promotion of Occupational Therapy (Hussey, Sabonis-Chafee and O’Brien, 2007). This monumental event took place in Clifton Springs, New York. The people involved in the formation were George Barton, William Dunton, Eleanor Clarke Sleagle, Susan Cox Johnson, and Thomas Kinder.
Roughly six months later the organization grew to 26 members, which resulted in the 1st annual meeting in September of that year. Adolf Meyer a Swiss physician and professor of psychiatry at John Hopkins University was the keynote speaker at the organizations fifth annual meeting. Meyer gave a speech on what would eventually form philosophical base of the profession. He believed in a holistic approach when dealing with mental illness, and that each person should be viewed as a complete and unified whole and not series of parts and problems to be managed.
With this he felt engaging in meaningful activities was innate human characteristic thus promoting health. Shortly after the formation of the organization the United States entered into World War I. Reconstruction programs were developed by the military to rehabilitate injured soldiers for the purpose of returning to active duty or for civilian employment. Occupational therapy aides (OTA) were involved in this program. The program proved successful and eventually achieved military status during World War II. The high demand for aides increased the need for training, which caused an influx of quick training courses.
Many of the courses were negated at the conclusion of the war. Soon after the war ended federal legislation enacted the Soldier’s Rehabilitation and Civilian Vocational Rehabilitation Act in 1920 (Hussey, Sabonis-Chafee and O’Brien, 2007). Occupational Therapy practitioners played a role helping soldiers and civilians with physical disabilities in returning to a productive life. The federal government helped fund both acts. A year later the National Society for the Promotion of Occupational Therapy changed their name to American Occupation Therapy Association (AOTA) (Hussey, Sabonis-Chafee and O’Brien, 2007).
The AOTA began setting minimum standards for the profession with the help of the American Medical Association. A minimum of one year of course work, eight to nine months of medical and craft training and three to four months of clinical work in hospitals. Schools that did not meet this standard were not accredited. The AOTA published a registry to inform the public of accredited schools. Journal publications were used to grow and help establish the profession. These publications were later titled American Journal of Occupational Therapy.
The profession grew rapidly during the 50’s and 60’s and changes began to happen. The rehabilitation movement started a move toward a more specialized approach. Patients were now being treated with drugs and the use of wheelchairs, orthotics and advanced prosthetics became prevalent (Hussey, Sabonis-Chafee and O’Brien, 2007). Practitioners had to properly trained in these areas. The AOTA decided to introduce the Occupational Therapy Assistant (OTA) practitioner (Hussey, Sabonis-Chafee and O’Brien, 2007).
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 promote, advocate and establish minimum educational standards for member countries. 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 function is to promote research through financial support. The profession continued to grow in the 70s and 80s due to increased drug and alcohol abuse the rise of disease and the use of computers. Large institutions for the mentally disabled were being closed and patients were transitioned to community facilities this was known as Deinstitutionalization. The federal government implemented the Rehabilitation ACT in 1973, Education for All Handicapped Children Act in 1975, the Handicapped Infants and Toddlers Act in 1986, and the Technology
Related Assistance for Individuals with Disabilities Act in 1988. These acts increased demand for occupational therapy services. President Reagan implemented the Prospective Payment System (PPS) in 1983 (Hussey, Sabonis-Chafee and O’Brien, 2007). PPS regulated how much would be paid for each impatient stay and the diagnosis related groupings (DRGs). This fixed payment shorted hospitals, which increased use of long-term care facilities and home health facilities. Practitioners work in both settings.
Three years later AOTA decided to separate themselves from the certification process and the National Board of Certification in Occupational Therapy (NBCOT) certifies all practitioners. The Accreditation Council for Occupational Therapy Education (ACOTE) was created to regulate entry-level education standards (Hussey, Sabonis-Chafee and O’Brien, 2007). However each state has their licensing requirements and procedures. During this period Phil Shannon and other therapist wanted to return the profession back to its roots and original philosophy of a humanistic and holistic view for treatment.
Legislation continued to be added during the 90s. The first was, Americans with Disabilities Act in 1990, Individuals with Disabilities Education Act in 1991, and the Balanced Budget Act of 1997. The American Occupational Therapy Political Action Committee (AOTPAC) keeps the profession abreast of all legislation pertaining to the field and to insure that occupational therapy services are included in new acts (Hussey, Sabonis-Chafee and O’Brien, 2007). Education/credentials Over the years the education and credentials for entry-level practitioners has evolved vastly.
The current standards for an entry-level occupational therapist consists of a Masters degree, 24 weeks of level II fieldwork, and basic research project. OTA’s are required to earn an Associate degree, and16 weeks of level II fieldwork. Institutions must be ACOTE accredited. After completing the course work an exam administered by NBCOT must be taken and pass to be certified to practice in the profession. Finally one must apply for licensing in the state in which he/she chooses to practice.
Practitioners are advised to continue competence. Every three years one must renew their certification with the NBCOT, 36 hors of professional development units (PDU) are required (Hussey, Sabonis-Chafee and O’Brien, 2007). State licensure also must be renewed each state determines the duration for renewal. Conclusion Since the conception this profession was founded on helping people achieve a better life, through the use of occupation. The founding fathers challenged the views, attitudes and behaviors of society.
In doing so they were able to start a movement that would affect generations, and give hope to people who were discarded and locked away. Helping those who cannot help themselves and treating them with kindness and consideration. I believe these beliefs ignited the growth of the profession. Growth will continue as more settings emerge. These new settings will bring forth new challenges and opportunities to expand the field. Client diversity will impact who will provide services thus causing the need for diverse practitioners. I support diversity and growth and look forward to practicing.