Historical Landmarks and the Future of Occupational Therapy WOTA, October 7, 2017 Franklin Stein, PhD, OTR/L, FAOTA, Editor, Annals of International Occupational Therapy 5/28/2018

Learning Objectives discuss: Historical Transformation of Occupational Therapy as an Independent Healthcare Profession Current Issues in Health Care in the United States Paradigms of Clinical Practice in Occupational Therapy Five key issues impacting on clinical practice World wide movement in occupational therapy The future of occupational therapy 5/28/2018

Current Issues in Health Care Cost Containment Population demography changes Increased home health services Specialized vs. generalist roles Evidence-based practice High technology Social class gap Complementary/Alternative medicine 5/28/2018

What are the Changes Occurring in Occupational Therapy that impact Clinical Practice? The increasing number of occupational therapists in health care. The number of occupational therapy programs. Reimbursement and insurance plans such as Medicare and Medicaid. Primary settings for clinical practice. Rising practice of home healthcare. Application of evidence-based practice 5/28/2018

Changes in Occupational Therapy 7. Rise of complementary and alternative medicine 8. Increased use of of physical agent modalities 9. Decrease of occupational therapists in primary mental health settings. 10. Increase in standardized testing for reimbursement and efficacy. 11. Philosophical shift from humanism to corporate model. 12. Rise of international occupational therapy. 5/28/2018

Paradigms of Clinical Practice in Occupational Therapy: Early History (1910-1945) The 3rd Phase of Medicine Hospitals as primary environment for care General goals of treatment Application of arts and crafts in treatment Education as generalist Craft workshop 5/28/2018

Susan E. Tracy, 1910 “Perhaps the most essential element in the success of an occupation room in an institution or in the use of manual work as a therapeutic agent with the individual patient in the home or elsewhere …is the teacher”. 5/28/2018

Purposes of Reconstruction Aides in 1917 (WWI) … to hasten the recovery of the patients … promote contentment and make the atmosphere of these hospitals such that the time spent in convalescence will pass more pleasantly because the minds and hands of the patients are properly occupied in profitable pursuits. 5/28/2018

George Barton, (1918). Occupational therapy as a Healing Profession “It is necessary to realize first that the great fundamental upon which re-education (occupational therapy) rests is not the making of an object, but the making of a man”. 5/28/2018

Louis J. Haas, 1925 Application of Arts and Crafts “It is because occupation can create a real work world in which man can live and engage in activities to the extent that he is conscious of the satisfaction of having done an interesting days work that occupation can help him gain control of himself again”. 5/28/2018

Emma C. Wallach, 1935, Diversional Purpose of OT “Occupational therapy is a vital necessity in every hospital. It reduces the amount of worry and anxiety by keeping the mind and hands pleasantly occupied without it the period of convalescence would seem unduly long and tiresome”. 5/28/2018

Paradigms in Early History continued (1945-1965) Multidisciplinary treatment teams Observation of improvement Treatment of individuals with chronic disabilities Physician referral and prescription Knowledge base came from clinical medicine and social sciences 5/28/2018

M.L. Franciscus, 1946, Definition of Occupational Therapy “…let me give you the accepted definition of occupational therapy. It is treatment by mental or physical activity prescribed by a doctor and supervised by a therapist for the distinct purpose of hastening recovery from disease or injury”. 5/28/2018

Henrietta McNeary, 1947, Holistic Approach “Occupational therapy can be of greatest service only when the patient is considered as a whole individual and his disabilities are minimized by helping him in the development of both physical and mental capabilities”. 5/28/2018

Adjuvant Role of Occupational Therapists (1948) “…but occupational therapy, no doubt is important in making it easier for the patient to get a grip on the situation …after the insulin treatment …” “… occupational therapy has important tasks as an adjunct to the new somatic treatments in psychiatry.” Kalinowski, L. (1948) The function of the occupational therapist as an adjuvant in shock therapies and prefrontal lobotomy. AJOT: 261-266 OT’s role is adjunctive to medical treatment. 5/28/2018

Wanda Edgerton, 1954, General Goals of Occupational Therapy Adapt activity to working position of patient Adapt to physical needs of patient, e.g. ROM Grade activity , e.g. simple to complex Freedom from danger Appeal (Patient Choice) Stimulate Creative Expression Suitability to budget and space Application to work and leisure Use of purposeful and meaningful activities 5/28/2018

Emergent Paradigms and Future Trends 1, (1965-2000) Prevention, habilitation and rehabilitation Community care and home health Specificity in functional outcome Assistive technology and physical agent modalities Emphasis in education on clinical reasoning and problem solving Treatment in public school, industry, home 5/28/2018

American Occupational Therapy Association, 1968 Occupational Therapy is the art and science of directing man’s response to selected activity to promote and maintain health, to prevent disability, to evaluate behavior and to treat or train patients with physical or psychological dysfunction Introduce scientific research into OT practice 5/28/2018

AOTA, 1977 …Specific occupational therapy services include…ADL, design, fabrication and application of splints; sensorimotor activities; the use of …crafts; …adaptive equipment; prevocational evaluation and training; adaptation of physical environments … Extension of OT to hand therapy, SI, ergonomics, 5/28/2018

Occupational Therapy Frames of Reference, 1993 Behavioral Biomechanical Cognitive Disability Developmental Neurodevelopmental Sensory Integration Model of Human Occupation Rehabilitation Psychodynamic Spatiotemporal Occupational Adaptation 5/28/2018

Emergent Paradigms and Future Trends 2, (2000-Present) Complementary/Alternative Medicine Interventions Evidence-based practice, triangulation in assessing outcome, Ergonomics, universal design, occupational justice Acute rehabilitation, injured worker, child with disability in public school, prevention Independent practitioner role of occupational therapist Entry level doctorate 5/28/2018

AOTA’s Centennial Vision, 2006 We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs. 5/28/2018

What are the Goals of Occupational Therapy Education in 2017? Foster clinical reasoning and problem solving Understand the humanistic core values underlining occupational therapy Learn how to learn with an emphasis on life-long education Learn how to use evidence-based practice Develop scientific practitioners 5/28/2018

Educational Goals (2017) Develop communication skills: interviewing clients, relating to families, presenting case studies to colleagues, presenting at conferences, publishing research Apply a holistic approach in treatment considering nutrition, exercise, stress management, psycho-social, ergonomics Incorporate complementary and alternative medicine in practice 5/28/2018

Five key issues impacting on Occupational Therapy Today and in the Future Applying client centered approach with humanistic caring Teaching client self-regulation Providing equality of health Care Emphasizing primary prevention Designing holistic treatment programs based on EBP 5/28/2018

International Trends World Federation of Occupational Therapy (WFOT) established in 1952, Ten countries In 2017 there are over 80 countries represented in WFOT In the USA there are over 150,000 practitioners There are over 400,000 OTs in the world and growing 5/28/2018

Summary Occupational therapy is an evolving and expanding healthcare profession requiring a graduate education, based on a humanistic philosophy of treatment, using holistic intervention methods and evidence-based practice 5/28/2018

Questions for the audience What is your vision of the future of occupational therapy? Should occupational therapists integrate their knowledge and services into the medical model? What are the major issues in healthcare and what are the major roles for occupational therapists? How can occupational therapists assist in improving the healthcare systems in developing nations? Will Universal Healthcare benefit the patient? 5/28/2018

References American Occupational Therapy Association (AOTA). (1972). Occupational Therapy: Its Definition and Functions. AJOT:26, 204-205.  AOTA (1977). Uniform Terminology for Occupational Therapy. AOTA Official Documents Rockville, MD.  Barton, G.E. (1918). Reconstruction. New York: Macmillian.  Edgerton, W.M. (1954). Activities in occupational therapy. . In Occupational Therapy, Willard, H. & Spackman, Principles of Occupational Therapy. pp. 43-60.  Franciscus, M.L. (1946). Occupational therapy: Where? How? Why? Occupational Therapy and Rehabilitation: 4: 137-140. 5/28/2018

References Haas, L.J. (1925). Occupational Therapy for the Mentally and Nervously Ill. Milwaukee: Bruce.  Hopkins, H. & Smith, H. (1993). Willard and Spackman’s Occupational Therapy 8th edition. Phila: Lippincott, pp. 62-91.  Hospitals designated for reconstruction of disabled American soldiers and policy to be pursued outlined by Surgeon General. (1917). Official Bulletin, 2(273), 8. McNeary, H. (1947). The scope of occupational therapy. In Occupational Therapy, Willard, H. & Spackman, Principles of Occupational Therapy. pp. 10-39  Kalinowsky, L.B. (1948). The function of occupational therapy as an adjuvant in shock therapies and prefrontal lobotomy. AJOT:2, 261-266. 5/28/2018

References continued Tracy, S.E. (1910). Invalid Occupations. Boston: Whitcomb and Barrows.  Wallach, E.C. (1935). Evaluation of occupational therapy by patient. Occupational Therapy and Rehabilitation: 3: 213-222.  Willard, H.S. & Spackman, C.S. (1947). Principles of Occupational Therapy. Phila.:J.B. Lippincott Co.  Willard H.S. & Spackman, C.S. (1954). Principles of Occupational Therapy 2nd ed. Phila.:J.B. Lippincott. 5/28/2018