Occupational therapy
Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.[1]
Not to be confused with Occupational medicine.
The American Occupational Therapy Association defines an occupational therapist as someone who "helps people across their lifespan participate in the things they want and/or need to do through the therapeutic use of everyday activities (occupations)".[2] Definitions by other professional occupational therapy organizations are similar.
Common interventions include:
Typically, occupational therapists are university-educated professionals and must pass a licensing exam to practice.[3] Currently, entry level occupational therapists must have a master's degree while certified occupational therapy assistants require a two-year associate degree to practice in the United States. Individuals must pass a national board certification and apply for a state license in most states. Occupational therapists often work closely with professionals in physical therapy, speech–language pathology, audiology, nursing, nutrition, social work, psychology, medicine, and assistive technology.
History[edit]
Early history[edit]
The earliest evidence of using occupations as a method of therapy can be found in ancient times. In c. 100 BCE, Greek physician Asclepiades treated patients with a mental illness humanely using therapeutic baths, massage, exercise, and music. Later, the Roman Celsus prescribed music, travel, conversation and exercise to his patients. However, by medieval times the use of these interventions with people with mental illness was rare, if not nonexistent.[4]
In 18th-century Europe, doctors such as Philippe Pinel and Johann Christian Reil reformed the hospital system. Instead of the use of metal chains and restraints, their institutions used rigorous work and leisure activities in the late 18th century. This became part of what was known as moral treatment.[5] Although it was thriving in Europe, interest in the reform movement fluctuated in the United States throughout the 19th century.
The Arts and Crafts movement that took place between 1860 and 1910 also impacted occupational therapy. The movement emerged against the monotony and lost autonomy of factory work in the developed world.[6] Arts and crafts were used to promote learning through doing, provided a creative outlet, and served as a way to avoid boredom during long hospital stays.
Development into a health profession[edit]
The early twentieth century was a time in which the rising incidence of disability related to industrial accidents, tuberculosis, and mental illness brought about an increasing social awareness of the issues involved.
The health profession of occupational therapy was conceived in the early 1910s as a reflection of the Progressive Era. Early professionals merged highly valued ideals, such as having a strong work ethic and the importance of crafting with one's own hands with scientific and medical principles.[4]
American social worker Eleanor Clarke Slagle (1870-1942) is considered to be the "mother" of occupational therapy. Slagle proposed habit training as a primary occupational therapy model of treatment. Based on the philosophy that engagement in meaningful routines shape a person's wellbeing, habit training focused on creating structure and balance between work, rest and leisure. Although habit training was initially developed to treat individuals with mental health conditions, its basic tenets are apparent in modern treatment models that are utilized across a wide scope of client populations.
Occupations[edit]
According to the American Occupational Therapy Association's (AOTA) Occupational Therapy Practice Framework: Domain and Process, 4th Edition (OTPF-4), occupations are defined as "everyday activities that people do as individuals, and families, and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do".[24] Occupations are central to a client's (person's, group's, or population's) health, identity, and sense of competence and have particular meaning and value to that client.[25]
Practice settings[edit]
According to the 2019 Salary and Workforce Survey by the American Occupational Therapy Association, occupational therapists work in a wide-variety of practice settings including: hospitals (28.6%), schools (18.8%), long-term care facilities/skilled nursing facilities (14.5%), free-standing outpatient (13.3%), home health (7.3%), academia (6.9%), early intervention (4.4%), mental health (2.2%), community (2.4%), and other (1.6%). According to the AOTA, the most common primary work setting for occupational therapists is in hospitals. Also according to the survey, 46% of occupational therapists work in urban areas, 39% work in suburban areas and the remaining 15% work in rural areas. [26]
The Canadian Institute for Health Information (CIHI) found that as of 2020 nearly half (46.1%) of occupational therapists worked in hospitals, 43.2% worked in community health, 3.6% work in long-term care (LTC) and 7.1% work in "other", including government, industry, manufacturing, and commercial settings. The CIHI also found that 68% of occupational therapists in Canada work in urban settings and only 3.7% work in rural settings.[27]
Education[edit]
Worldwide, there is a range of qualifications required to practice as an occupational therapist or occupational therapy assistant. Depending on the country and expected level of practice, degree options include associate degree, Bachelor's degree, entry-level master's degree, post-professional master's degree, entry-level Doctorate (OTD), post-professional Doctorate (DrOT or OTD), Doctor of Clinical Science in OT (CScD), Doctor of Philosophy in Occupational Therapy (PhD), and combined OTD/PhD degrees.
Both occupational therapist and occupational therapy assistant roles exist internationally. Currently in the United States, dual points of entry exist for both OT and OTA programs. For OT, that is entry-level Master's or entry-level Doctorate. For OTA, that is associate degree or bachelor's degree.
The World Federation of Occupational Therapists (WFOT) has minimum standards for the education of OTs, which was revised in 2016. All of the educational programs around the world need to meet these minimum standards. These standards are subsumed by and can be supplemented with academic standards set by a country's national accreditation organization. As part of the minimum standards, all programs must have a curriculum that includes practice placements (fieldwork). Examples of fieldwork settings include: acute care, inpatient hospital, outpatient hospital, skilled nursing facilities, schools, group homes, early intervention, home health, and community settings.
The profession of occupational therapy is based on a wide theoretical and evidence based background. The OT curriculum focuses on the theoretical basis of occupation through multiple facets of science, including occupational science, anatomy, physiology, biomechanics, and neurology. In addition, this scientific foundation is integrated with knowledge from psychology, sociology and more.
In the United States, Canada, and other countries around the world, there is a licensure requirement. In order to obtain an OT or OTA license, one must graduate from an accredited program, complete fieldwork requirements, and pass a national certification examination.
The philosophy of occupational therapy has evolved over the history of the profession. The philosophy articulated by the founders owed much to the ideals of romanticism,[79] pragmatism[80] and humanism, which are collectively considered the fundamental ideologies of the past century.[81][82][83]
One of the most widely cited early papers about the philosophy of occupational therapy was presented by Adolf Meyer, a psychiatrist who had emigrated to the United States from Switzerland in the late 19th century and who was invited to present his views to a gathering of the new Occupational Therapy Society in 1922. At the time, Dr. Meyer was one of the leading psychiatrists in the United States and head of the new psychiatry department and Phipps Clinic at Johns Hopkins University in Baltimore, Maryland.[84][85]
William Rush Dunton, a supporter of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation is a basic human need, and that occupation is therapeutic. From his statements came some of the basic assumptions of occupational therapy, which include:
These assumptions have been developed over time and are the basis of the values that underpin the Codes of Ethics issued by the national associations. The relevance of occupation to health and well-being remains the central theme.
In the 1950s, criticism from medicine and the multitude of disabled World War II veterans resulted in the emergence of a more reductionistic philosophy. While this approach led to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs.[86][87] As a result, client centeredness and occupation have re-emerged as dominant themes in the profession.[88][89][90] Over the past century, the underlying philosophy of occupational therapy has evolved from being a diversion from illness, to treatment, to enablement through meaningful occupation.[18]
Three commonly mentioned philosophical precepts of occupational therapy are that occupation is necessary for health, that its theories are based on holism and that its central components are people, their occupations (activities), and the environments in which those activities take place. However, there have been some dissenting voices. Mocellin, in particular, advocated abandoning the notion of health through occupation as he proclaimed it obsolete in the modern world. As well, he questioned the appropriateness of advocating holism when practice rarely supports it.[91][92][93] Some values formulated by the American Occupational Therapy Association have been critiqued as being therapist-centric and do not reflect the modern reality of multicultural practice.[94][95][96]
In recent times occupational therapy practitioners have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational injustice stemming from sources other than disability.[97] Examples of new and emerging practice areas would include therapists working with refugees,[98] children experiencing obesity,[99] and people experiencing homelessness.[100]
Global occupational therapy[edit]
The World Federation of Occupational Therapists is an international voice of the profession and is a membership network of occupational therapists worldwide. WFOT supports the international practice of occupational therapy through collaboration across countries. WFOT currently includes over 100 member country organizations, 550,000 occupational therapy practitioners, and 900 approved educational programs.[120]
The profession celebrates World Occupational Therapy Day on the 27th of October annually to increase visibility and awareness of the profession, promoting the profession's development work at a local, national and international platform.[121] WFOT has been in close collaboration with the World Health Organization (WHO) since 1959, working together in programmes that aim to improve world health.[121] WFOT supports the vision for healthy people, in alignment with the United Nations 17 Sustainable Development Goals, which focuses on "ending poverty, fighting inequality and injustice, tackling climate change and promoting health".[122] Occupational therapy is a major player in enabling individuals and communities to engage in "chosen and necessary occupations" and in "the creation of more meaningful lives".[122]
Occupational therapy is practiced around the world and can be translated in practice to many different cultures and environments. The construct of occupation is shared throughout the profession regardless of country, culture and context. Occupation and the active participation in occupation is now seen as a human right and is asserted as a strong influence in health and well-being.[122]
As the profession grows there is a lot of people who are travelling across countries to work as occupational therapists for better work or opportunities. Under this context, every occupational therapist is required to adapt to a new culture, foreign to their own. Understanding cultures and its communities are crucial to occupational therapy ethos. Effective occupational therapy practice includes acknowledging the values and social perspectives of each client and their families. Harnessing culture and understanding what is important to the client is truly a faster way towards independence.[123]