Copyright
by
Arely Cruz
2019
Occupational Therapy Relevance to Healthcare
by
Arely Cruz
______
A Research Study
presented to the
Faculty of the Department of Public Policy and Administration School of Business and Public
Administration
CALIFORNIA STATE UNIVERSITY BAKERSFIELD
In Partial Fulfillment of the Requirements for the Degree of
MASTER OF SCIENCE – HEALTH CARE ADMINISTRATION
SPRING 2019
OCCUPATIONAL THERAPY v
Acknowledgements
I want to thank my family and friends for all the support they have given me, specially my mom and dad for always supporting and encouraging me. I am the first generation to attend a university. The completion of this Masters brings pride and joy to my family. I would also like to thank all the professors and committee members for their time and support. OCCUPATIONAL THERAPY vi
Abstract
The purpose of this research was to explore the direction of occupational therapy, by exploring
the history of occupational therapy and establishing the state of the profession. The idea of
occupational therapy is founded on visionary ideas about the nature of human beings and their
vital need for activity. The practice of occupational focuses on what matters to you, not what is
the matter with you. Evidence from the literature review showed the demand for occupational
therapy services in a wide range of settings; schools, hospitals, skilled nursing facilities, home
health, outpatient rehabilitation clinics, psychiatric facilities, and community health programs.
The practice framework between children and the aging population differs, as does the increasing
need. Occupational therapy employment is projected to increase by 24% by 2026. Factors
contributing to this demand include the aging population and an increase in morbidity rates due
to chronic health condition. Hermeneutics is a credible, rigorous, and creative research method
that was used to address aspects of professional practice through the review of texts. The trend
analysis and history of development will help to analyze change over time. It may project the
future of occupational therapy. The findings determined the status of occupational therapy as a
true profession, determined where occupational therapy has been and where the profession
stands now. The findings are supported by approximately 60 article and valuable data sources.
Among the findings six themes were identified that shaped the profession of occupational
therapy. Overall four recommendations were made benefiting occupational therapy as a whole.
Re-engineering the practice of occupational therapy to accommodate different realms of the profession will facilitation exposure to the career. Also, creating a bridge between occupational therapy and other parts of the healthcare system would generate interest and increase the labor Running head: OCCUPATIONAL THERAPY vii
market need. Lastly, establishing strong leadership that will represent the profession in terms of health policy and legislation.
OCCUPATIONAL THERAPY viii
Table of Contents Acknowledgements ...... v Abstract ...... vi Chapter One: Introduction ...... 1 Statement of the Problem ...... 2 The Importance of the Problem ...... 2 Chapter Two: Literature Review ...... 3 History...... 3 Development Into a Health Profession ...... 5 Practice Framework ...... 6 Domain and process...... 7 Client-centered practice...... 9 Occupations and daily life activities...... 10 Practice Settings ...... 11 Licensure and regulation...... 12 Service to children and youth...... 13 Service to the Aging...... 15 Education ...... 17 Careers in occupational therapy...... 17 Occupational therapy and primary care...... 18 Goodes Characteristics of a True Profession ...... 19 Summary ...... 20 Chapter Three: Methods ...... 22 Research Design ...... 22 Sample Frame ...... 22 Sample Size ...... 23 Data Collection ...... 23 Data Analysis ...... 23 Methodological Rigor ...... 24 IRB Approval ...... 24 Chapter Four: Findings ...... 25 Increased Interest ...... 26 Running head: OCCUPATIONAL THERAPY ix
War stimulates occupational therapy...... 26 Legislature, regulation, and policies...... 28 Diagnostic spurs...... 30 Aids...... 30 Suppression of the Profession ...... 31 Educational requirements...... 31 Lack of exposure...... 31 Control of discipline...... 32 Goode’s Characteristics of a True Profession ...... 33 Chapter Five: Recommendations ...... 36 Recommendation One:...... 36 Recommendation Two: ...... 36 Recommendation Three: ...... 37 Recommendation Four: ...... 37 References ...... 38 Appendix A ...... 43 Appendix B ...... 44 Appendix C ...... 45 Appendix D ...... 46 Appendix E ...... 47 Appendix F...... 48 Appendix G ...... 49
Chapter One: Introduction
Occupational therapy helps people of all ages participate in the things they want and need
to do through the therapeutic use of everyday activities or occupations. Unlike other professions,
occupational therapy helps people learn to function in all of their environments while addressing
the physical, psychological and cognitive aspects of their well-being through engagement in
occupation (The American Journal Of Occupational Therapy, 2017). Occupational therapy is an
evidence-based, science-driven profession that applies the most up-to-date research to service delivery (American Occupational Therapy Association, 2018 a). According to the American
Occupational Therapy Association, occupational therapy services provide habilitation, rehabilitation and the promotion of health and wellness to those who have or are at risk for developing an illness, injury, disease, disorder, condition or impairment (American Journal of
Occupational Therapy, 2017).
The idea of occupational therapy was founded on visionary ideas about the nature of human beings and their vital need for activity (Yerxa, 1992). The practice of occupational therapy asks, “What matters to you?” not, “What’s the matter with you?” Occupational therapists help people across the lifespan to participate fully in school and social situations alongside, helping people recover from injury to regain skills lost. As previously defined, occupational therapy is an essential professional and career. The demands for occupational therapy are anticipated to increase due to the number of Americans ages 65, and older is projected to more than double from 46 million to over 98 million by 2060 (Mather, 2016).
What is happening to this career field? Are occupational therapists (OT) disappearing in the healthcare field? The data signifies that the demand for occupational therapists is outpacing OCCUPATIONAL THERAPY 2
the supply of occupational therapists. Prevalence rates of autism disorder have substantially
increased over time within a single-age group and increase from year to year within birth cohorts
(Gurney, 2016). Additionally, the large number of children born between 1946 and 1964 will
reach their 65th birthdays between 2011 and 2029 (The Impact of the Aging Population on the
Health Workforce in the United States, 2006).
The aim of the research is a 25-year retrospective trend analysis of occupational therapy
as a profession and career path outcomes. According to the Bureau of Labor Statistics, the need
for occupational therapists is expected to increase as the large baby-boom generation ages, and
people remain active later in life (Bureau of Labor Statistics, 2019). The number of occupational
therapists should be expected to increase because of the professions increasing demand.
Statement of the Problem
The American Occupational Therapy Association (AOTA) has identified the work and the industry as a critical practice area in the 21st century. It is essential to identify the career field and explore the trends as well as any potential threats to the growth of the profession. Moreover, identifying the interest in the career, the number of expected graduates, and the factors associated with the increasing demand will predict where occupational therapy is going as a profession.
The Importance of the Problem
The purpose of this study is to understand occupational therapy as a profession and explain the relevance to the healthcare arena. Furthermore, seeing how professionals can best integrate themselves into the healthcare arena. Is the profession of occupational therapy growing at the same rate? How is the career of Occupational Therapist meeting served population challenges?
Chapter Two: Literature Review
Chapter Two covers the literature review that will identify the history, practical
frameworks, occupations, areas of practice, and education. History will show where occupational
therapy started as a profession and show how it has developed over time. Practical frameworks
will break apart how the concept of occupational therapy works and what it consists of in regards
to theories and practice methods used. Occupations and lifestyle changes will identify the
potential for careers and the demand for occupational therapists. Areas of practice will describe
the different types of specialties concerning occupational therapists. Lastly, education is a crucial
component. Recognizing the level of education needed to be a successful occupational therapist
is crucial to observe a trend pertaining to the usefulness of this profession.
History
Occupational therapy was founded upon visionary ideas about the nature of human
beings and their vital need for activity. Historically, occupational therapy started as a treatment
for patients with mental or emotional disorder (Top Occupational Therapy Schools, 2018). It was
first used by a Greek physician named Asclepiades, who used therapeutic massages, exercises,
baths, and music to heal stress and soothe minds. Later, another Greek philosopher Celsus, used
similar therapies such as a conversation, travel suggestions, and music with his patients ( Top
Occupational Therapy Schools, 2018). Moving on to the 18th century, two Europeans, Phillippe
Pinel and Johann Christian Rell, adopted this method (Top Occupational Therapy Schools,
2018). During this era, the practitioners dropped mental chains as a practice method and involved
some relaxing activities and meticulous work in their procedure of treating patients.
During 1860-1910 which was known as the arts and craft movement occupational therapy
was significantly impacted. In the United States, a recently industrialized country, the arts and OCCUPATIONAL THERAPY 4
crafts societies emerged against the monotony and lost autonomy of factory work (Peloquin,
2005). Arts and crafts were used as a way of promoting learning through doing, providing a creative outlet, and served as a way to avoid boredom during extended hospital stays (Peloquin,
2005). For example, knitting, pottery, and gardening were considered curative alternatives.
Occupational therapy emerged as a profession in 1917 in the United States, when the
National Society for Promotion of Occupational Therapy, now known as the American
Occupational Therapy Association (AOTA), was established. The profession officially took the name of Occupational Therapy in 1920. The association found the belief in the remedial properties of human occupation and that meant having the properties of medicine, curative, and remedial medicinal properties. Furthermore, this particular type of therapy played a vital role in the treatment of patients suffering from AIDS, polio, and tuberculosis (Top Occupational
Therapy Schools, 2018).
Eleanor Clarke Slagle was considered to be the mother of Occupational Therapy. She was a founding member of the American Occupational Therapy Association (AOTA) and one of the profession’s earliest proponents (American Occupational Therapy Association, 2019). The association was started by Slagle while, attending a course sponsored by the Chicago School of
Civics and Philanthropy and Hull House that taught occupations and amusements to staff working at state institutions (American Occupational Therapy Association, 2019). Slagle directed occupational therapy research for the State of Illinois, trained therapists at the Henry B.
Favill School of Occupations, and overall served as the Director of the Bureau of Occupational
Therapy, New York Department of Mental Hygiene (American Occupational Therapy
Association, 2019). Slagle went on to serve as both the American Occupational Therapy
Association president and secretary. Because of Slagle’s contributions, the American OCCUPATIONAL THERAPY 5
Occupational Therapy Association went on to create the Eleanor Clarke Slagle Lectureship
Award in her honor. The award recognizes someone who has creatively contributed to the
development of the body of knowledge of the profession through research, education, and
clinical practice.
Development Into a Health Profession
Throughout history, occupational therapy has sought to maintain a balance between autonomy and cooperation in its relationship to medicine. During World War II, occupational therapy underwent stress due to the development of physical medicine (Colman, 1992). Physical
medicine meant prescribing a dose that would provide instant relief over curative alternatives. In
the early 1930s, the American Occupational Therapy Association has established guidelines and
accreditation procedures. In creating the guidelines, the AOTA Board of Managers debated its
vision for determining the qualified occupational therapist, and assessing the variety of practice
settings, and the medical system within which its practitioners worked (Colman, 1992). The
guidelines led to a cooperative relationship between AOTA and the American Medical
Association.
During the mid-1930s the majority of occupational therapists were employed in mental
health settings, yet a small but growing number of occupational therapists were working in
rehabilitation programs (Colman, 1992). During this era, physical therapists and physical therapy physicians dominated the field. In order for these physical therapy physicians to pursue status within the American Medical Association, it became imperative for them to stake a claim to a single territory. Thus, physicians sought control of occupational therapy and physical therapy departments and attempted to define occupational therapy as a physical therapy specialization
(Colman, 1992). Because of this movement, the AOTA Board resisted efforts and pursued OCCUPATIONAL THERAPY 6
independence in administration and practice for occupational therapy (Colman, 1992).
Occupational therapists fought hard to stand alone as a profession, especially within a growing field of medicine and an increasing need due to the effects of WWII.
By the end of World War II, occupational therapy had made great strides in advancing a level of professionalism and affecting autonomy from medicine (Colman, 1992). These efforts resulted in upgrading the status of occupational therapy in the army alongside, the election of the first female registered occupational therapist. Slagle, later became known as President of AOTA and the initiation of an in-house edited and administered journal, the American Journal of
Occupational Therapy (Colman, 1992). Physical medicine wanted to control occupational therapy and give it some clinical status. In 1950, the AOTA Education Committee released a report that included a sanction initiation. The initiation stated that there would be penalties enforced supporting boundaries between the relationship of AOTA and physical medicine
(Colman, 1992). AOTA continuously worked to stop physical medicine from taking over education subsequently writing a policy that clarified occupational therapy’s philosophy, its relationship with physicians, and the scope and nature of occupational therapy entry-level education and certification procedures (Colman, 1992).
Practice Framework
One in five Americans experience disabilities that affect their daily functions due to impairments in mobility, impairments in cognitive function, sensory impairment, or communication impairment (National Institutes of Health Research Plan on Rehabilitation,
2017). Between 53 and 57 million Americans have a disability and 33 million Americas have a disability that makes it difficult to carry out daily activities ranging from attending school or work to daily physical care (National Institutes of Health Research Plan on Rehabilitation, 2017). OCCUPATIONAL THERAPY 7
The range of disabilities, whether in mobility, cognitive, sensory impairment, or communication,
represents a significant public health challenge. When occupational therapy began in the early
part of this century, it was for moral reasons, by (Baum & Law, 1997). In the period before
drugs were used for the treatment of mental illness, people were institutionalized without the
means of occupying themselves. Finding ways to address the needs of people through
occupational therapy was a significant stride (Baum & Law, 1997).
The framework of occupational therapists was initially developed to articulate
occupational therapy’s distinct perspective and contribution promoting the health and
participation of persons, groups, and populations through engagement in occupation (American
Journal of Occupational Therapy, 2017). The purpose of a framework is to provide a structure or base on which to build a system or a concept; it is used to guide occupational therapy practice in
conjunction with the knowledge and evidence relevant to occupation and occupational therapy
((American Journal of Occupational Therapy, 2017). The Occupational Therapy Practice
Framework: Domain and Process. 3rd edition, is an official document from the American
Occupational Therapy Association. The document is intended for occupational therapy practitioners, students, other healthcare professionals, educators, researcher, payers and consumers. The framework presents a summary of interrelated constructs that describes the practice of occupational therapy.
Domain and process. The Occupational Therapy practice framework has two parts:
domain and process, which describes the central concepts that ground occupational therapy
practice and builds a common understanding of the basic tenets and vision of the profession
(American Journal of Occupational Therapy, 2017). The domain outlines the profession’s
purview and the areas in which its members have an established body of knowledge and OCCUPATIONAL THERAPY 8
expertise. The process focuses on the actions practitioners take when providing services that are client-centered and focused on engagement in occupations (American Journal of Occupational
Therapy, 2017). These concepts guide practitioners to support clients’ participation in daily
living that results from the dynamic intersection of clients, their desired engagement, and the
context and environment (American Journal of Occupational Therapy, 2017). Even though the domain and process are described separately in reality, the processes are linked in a transitional relationship. The aspects that constitute the domain and those that constitute the process exist in constant interaction with one another during the delivery of occupational therapy services
(American Journal of Occupational Therapy, 2017). Through these two concepts and simultaneous attention to the client’s body functions and structures. Such as, skills, roles, habits, routines, and context; do individuals achieve health, well-being, and participation in life through engagement in occupation. Outcomes such as occupational performance, role competence, and participation in daily life are achieved.
Achieving health well-being and participation in life through engagement in occupation is the overarching statement that describes the domain and process of occupational therapy in its fullest sense (American Journal of Occupational Therapy, 2017). This statement acknowledges the profession’s belief that active engagement in occupation promotes, facilitates, supports, and maintains health and participation. For the aspects of the domain, the dynamic includes occupations, client factors, performance skills, performance patterns, and context and environment. These are of equal value, and together they interact to affect the client’s occupational identity, health, well-being and participation in life (American Journal of
Occupational Therapy, 2017). OCCUPATIONAL THERAPY 9
A process is undertaken by occupational therapy practitioners when providing service to
clients. The occupational therapy process is the client-centered delivery of occupational therapy
services (American Journal of Occupational Therapy, 2017). The process includes evaluation
and intervention to achieve targeted outcomes. Occurring within the purview of the occupational
therapy domain and is facilitated by the distinct perspective of occupational therapy
practitioners, when engaging in clinical reasoning, analyzing activities, occupations, and
collaborating with clients (American Journal of Occupational Therapy, 2017). The process
theory is organized into four broad areas: 1) an overview of the process as it is applied within the
professions domain, 2) the evaluation process, 3) the intervention and process, and 4) the process
of targeting outcomes (American Journal of Occupational Therapy, 2017). In order for clients to
achieve desired outcomes, occupational therapy practitioners facilitate interactions among the
clients, in their environments and contexts, and the occupations in which they engage in
(American Journal of Occupational Therapy, 2017). The perspective is based on the theories, knowledge, and skills generated and used by the profession. Regardless of the service delivery
model, the individual client may not be the exclusive focus of the intervention. When addressing
the needs of an at-risk infant, the impetus for intervention, may be addressing the concerns and
priorities of the parents, extended family, and funding agencies.
Client-centered practice. With that said, occupational therapy practice has evolved over
the decades to meet the needs of people with disabilities. In the early years, the practice was
based in mental institutions and postwar rehabilitation in curative workshops (Baum & Law,
1997). It has matured into addressing the needs of persons in several environments, including health institutions, schools, work sites, and the community (Baum & Law, 1997). Occupational therapy practices address person performance components rather than their occupational OCCUPATIONAL THERAPY 10
performance need. The professions need to access information that requires occupational therapy
practitioners to work collaboratively to meet client needs. Occupational therapy practice is based
on concepts of client-centeredness, which engages clients in the occupational therapy process
and leads to increased adherence and satisfaction with therapy over a service focused only on
what the therapist perceives as a problem.
Client-centered care defined an approach to service that incorporates respect for and
partnership with clients, actively engages participants in the therapy process. This approach
emphasizes client’s knowledge and experience, strengths, capacity for choice, and overall
autonomy (American Journal of Occupational Therapy, 2017). Client-centered practice creates a
caring, dignified, and empowering environment in which clients direct the course of their care. In
this particular type of approach, clients and therapists work together to define the nature of the
occupational performance problem, focus and need for intervention, and the preferred outcomes
of therapy (Baum & Law, 1997). The underlying assumptions of a client-centered approach are
1) clients and their family members know themselves best, 2) all clients and family members are different and unique, and 3) optimal clients performance occurs within a supportive family and community context (Baum & Law, 1997). Because of this method clients and therapists can focus on their unique contribution and responsibilities to building a client-centered partnership.
In this partnership, clients expect to lead the decision-making process. Overall clients expect to receive a service in a timely manner and to be treated with respect and dignity during the occupational therapy process. It differs from other health care professions in that occupational therapists work to address what matters.
Occupations and daily life activities. At times occupational therapy practitioners use the term occupation and activity interchangeably to describe participation in daily life pursuits OCCUPATIONAL THERAPY 11
(American Journal of Occupational Therapy, 2017). The AOTA denotes occupation as life engagements that are constructed of multiple activities. Occupations can be goal-directed, task- oriented, purposeful, culturally relevant, role-specific, individually tailored, and community- oriented (American Journal of Occupational Therapy, 2017). All of this depends on values, beliefs, context, and environment. Occupations are central to a client’s identity and sense of competence and have a particular meaning and value to the client (American Journal of
Occupational Therapy, 2017). Participation in occupations is considered the end result of the intervention process (American Journal of Occupational Therapy, 2017).
Practice Settings
The demand for occupational therapy services is strong. According to the American
Occupational Therapy Association, occupational therapy services typically include: an individualized evaluation during which the client and family, and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and outcomes evaluation to ensure that the goals are met, and make changes to the intervention plan (American Occupational Therapy, 2018d). Surveys indicate an estimate of 137,000 active occupational therapy practitioners (American
Occupational Therapy Association, 2018b). This includes approximately 102,500 occupational therapists and 34,500 occupational therapy assistants (American Occupational Therapy
Association, 2018b). Recent American Occupational Therapy Association surveys indicate that
92% of practitioners are female, and more than three-quarters are employed full-time in the profession, and the median level of professional experience is thirteen years (American
Occupational Therapy Association, 2018b). OCCUPATIONAL THERAPY 12
Occupational therapy practitioners work in a wide range of settings including schools,
hospitals, skilled nursing facilities, home health, outpatient rehabilitation clinics, psychiatric
facilities, and community health programs (American Occupational Therapy, 2018d). School
systems, hospitals, and long-term care facilities are the primary work settings for occupational
therapists and occupational therapy assistants (American Occupational Therapy Association,
2018b). According to Data USA, the number of people employed as occupational therapists has been growing at a rate of 7.89% from 103,613 people in 2015 to 111,791 in 2016( Data USA,
2018). Table 1.0 illustrates the share of occupational therapists employed by various industries.
Table 1.0
Occupation Therapists work setting Trends 2014 2010 2006 2000 Academia 6.1% 5.8% 6.1% 6.6% Community 2% 1.8% 1.6% 2.2% Early 4.6% 5.2% Included with schools Intervention Freestanding 10.8% 10.2% 11.2% 11.6% Outpatient Home Health 6.8% 5.9% 7.2% 6.6% Hospital (Non- 26.6% 28.1% 23.5% 24.6% Mental Health) LTC/SNF 19.2% 15.8% 15.4% 12.9% Mental Health 2.4% 3.0% 3.6% 5.2% Schools 19.9% 21.7% 29.6% 29.2% Other 1.7% 2.5% 1.9% 1.7% Note: Percentages do not add to 100 due to rounding. More than 55% of occupational therapy assistants surveyed work in LTC/SNF. Find the workplace setting trends for OTAs below.
Licensure and regulation. The practice of occupational therapy is regulated in all 50
states, the District of Columbia, Puerto Rico, and Guam. Licensure is required in 48 of 50 OCCUPATIONAL THERAPY 13
jurisdictions for occupational therapists, and 47 jurisdictions for occupational therapy assistants
(American Occupational Therapy, 2018d). After the completion of a Master of Science in
occupational therapy the requirement and eligibility to sit for the national certification in
occupational therapy (NBCOT) is granted.
Service to children and youth. Occupational therapists make a significant impact in the
lives of children with special needs (McManus, Prosser, & Gannotti, 2016). Data shows that 43-
62% of children with special healthcare needs are living in the United States and depend on State
Children’s Health Insurance Program (SCHIPS) (McManus, Prosser, & Gannotti, 2016). Ever
since the expansion of Medicaid and extension of the SCHIP under the Affordable Care Act,
fewer children with special healthcare needs might be uninsured or underinsured. There is a
population of unmet needs for therapy and mobility aids in the that about one in five children
with caregiver-reported therapy needs had a reported unmet need of 17.7 % (McManus, Prosser,
& Gannottii, 2016). This unmet need was reported across ages of children less than three years
old, having the lowest reported unmet need for therapy at 15.8% (McManus, Prosser, &
Gannottii, 2016). Children between ages three and five have the highest reported unmet need for therapy, at 20.9% (McManus, Prosser, & Gannottii, 2016). An estimated 17.7% of children with special healthcare needs in the United States have caregiver-reported unmet therapy needs, and an estimated 7.7% have caregivers-reported unmet mobility aid needs (McManus, Prosser, &
Gannottii , 2016).
School occupational therapists are vital contributors within the education team and
support a student’s ability to participate in desired daily school activities. Therapists contribute
by, helping to fulfill the roles of students by supporting their academic achievement and promote
positive behaviors necessary for learning (American Occupational Therapy Association, 2016b). OCCUPATIONAL THERAPY 14
Occupational therapists also support academic, and non-academic outcomes, including social
skills, math, reading and writing, behavior management, recess, participating in sports, self-help skills, prevocational and vocational participation, transportation, and more (American
Occupational Therapy Association, 2016b). Additionally, they play a critical role in educating parents, educators, administrators and other staff members in the needs of the student (American
Occupational Therapy Association, 2016b).
Occupational therapy practitioners have specific knowledge and expertise to increase
participation in school routines, throughout the day. Interventions include:
• Conducting activities and environmental analysis and making recommendations to
improve the fit for greater access, progress, and participation.
• Providing assistive technology to support student success.
• Reducing barriers that limit student participation within a school environment.
• Helping to identify long-term goals for appropriate post-school outcomes.
• Supporting the needs of students with significant challenges, such as by helping to
determine methods for alternate educational assessment and learning.
• Helping to plan relevant instructional activities for ongoing implementation in the
classroom.
• Preparing students for successfully transitioning into appropriate post-high school
employment, independent living, and/or further education. (American Occupational
Therapy Association, 2016b)
These goals can be achieved by occupational therapy services for students with special needs.
The needs are determined through the individual evaluation process (IEP). Occupational
therapists work with other members of the school-based team to help determine what is needed OCCUPATIONAL THERAPY 15
for a student to receive a free and, appropriate public education in the least restrictive
environment (American Occupational Therapy Association, 2016b). Active participation of
caregivers and families in their children’s lives is crucial to helping them achieve their highest
potential.
Service to the Aging
Slips, trips, and falls in and around the home are frequently the cause of injuries to older
adults. In 2012 an estimated 3.2 million older adults received medical treatment for injuries
related to falls, with many of these injuries resulting in decreased mobility and independence
(Burns, Stevens, & Lee, 2016). Occupational therapists possess the critical skills needed to
address fall prevention with older adults. Recommendations often include a combination of
interventions that target improving physical abilities to safely perform daily tasks, modifying the
home and changing activity patterns and behaviors. In addition to care for older adults, therapists can assist in falls prevention on a larger scale through consultation to staff of community centers, nursing homes, and assisted living facilities (Burns, Stevens, & Lee, 2016).
Occupational therapy practitioners work with aging adults and their caregivers to promote the safe performance of occupations at home and in the community. Older adults have different healthcare needs than younger age groups, and affects the demands placed on the healthcare system in the future (The Impact of the Aging Population on the Health Workforce in the United States, 2006). Additionally, older adults have more limitations in terms of performing daily living activities than those younger people, due to higher rates of physical and cognitive disability. An estimated 35% of those age 65 and older have an activity limitation, compared to about 6% of those age 18 through 44 (The Impact of the Aging Population on the Health
Workforce in the United States, 2006). Alongside, older adults require the services of health OCCUPATIONAL THERAPY 16
professionals as a result of injuries and illnesses due to greater physical vulnerability (The
Impact of the Aging Population on the Health Workforce in the United States, 2006). For
example, breaking bones because of falls; they are more likely to contract pneumonia as a consequence of influenza.
Occupational therapists work with aging adults and their caregivers to promote the safe performance of occupations at home and in the community. Professionals distinctly focus on productive aging by promoting health and quality of life, supporting aging in place, preserving meaningful roles and occupations, promoting engagement in managing personal health and wellness, and maintaining or increasing participation in meaningful occupations in the community (American Occupational Therapy Association, 2016a). Some practice areas in productive aging include: aging in place, fall prevention, driving and community mobility, primary care, post-acute care, and palliative care (American Occupational Therapy Association,
2016a).
The elder population needs and demands related to healthcare are changing. With that said occupational therapists will play an essential role because of their focus on achieving and maintaining independence through self-care, productivity, and leisure (Wilkins & Rosenthal,
2001). However, occupational therapists continue to experience a shortage mainly involved with service to older clients, as well as in research and teaching related to gerontology and geriatrics
(Collins & Carr, 2018). The suggested reason for being the constant shortage of occupational therapists working with elders is associated with the negative attitudes toward older people
(Collins & Carr, 2018). Occupational therapists value their work, but research shows they are more prone to work with children over the aging population. Occupational therapists working in pediatrics are respected over therapists working with the elderly population (Collins & Carr, OCCUPATIONAL THERAPY 17
2018). The opportunity structure among occupational therapists includes the availability of
working in a particular area, and the opportunities for continuing education and promotion
(Collins & Carr, 2018).
Education
Worldwide, there is a range of qualifications required to practice occupational therapy.
Requirements to be an occupational therapist include a bachelor’s degree, a master’s degree, and more recently a doctorate. The American Occupational Therapy Association provides an annual data report of academic programs. For the academic year of 2017-2018 the number of accredited programs, number of students enrolled, program retention rates, program graduates, and first practice area. (see Appendices A- D for complete details)
Careers in occupational therapy.
Occupational therapy is one of the best healthcare jobs in the United States (Collins &
Carr, 2018). The number of occupational therapists in the United States continues to grow.
Employment is projected to increase by 24% for an occupational therapist by 2026 (Collins &
Carr, 2018). Factors contributing to this demand include an aging population and an increase in morbidity rates due to chronic health conditions like arthritis, obesity, and diabetes (Collins &
Carr, 2018). It is important to note that provisions of the Patient Protection and Affordable Care
Act have influenced the growth among occupational therapists (Collins & Carr, 2018). Collins and Carr (2018) have identified the lack of diversity among occupational therapists. The growth of occupational therapists is disproportionate to the need. Despite the increasing diversity among the U.S. population there had not been a proportionate increase in the number of occupational therapists who are African American, Hispanic/Latino, or American Indian/ Alaskan Native OCCUPATIONAL THERAPY 18
heritage (Collins & Carr, 2018). Among the career, these population groups continue to classify
as underrepresented minorities in the medical and allied health professions (Collins & Carr,
2018). Increasing the number of underrepresented minority practitioners is problematic when one
considers the stagnation or decline in the number of underrepresented minors currently enrolled
in occupational therapy programs. It is difficult enough choosing a career that can be influenced
by many factors, such as age, gender, race, socioeconomic factors, and culture (Collins & Carr,
2018). Career education programs report an effective strategy in educating high school and
college students about careers in the health profession and improving career self-efficacy
(Collins & Carr, 2018). However, there is limited documentation exposure, knowledge of, and
interest in the profession of occupational therapy (Collins & Carr, 2018).
Occupational therapy and primary care. Occupational therapy can be vital in order for
patients to avoid hospitalization and decrease long-term disability (Pergolotti, Lavery, Reeve, &
Dusetzina, 2018). As the healthcare system continues to change, occupational therapy is also
changing. As primary care demands increase occupational demands increase. Occupational
therapy providers have seized opportunities in primary care and worked to resolve numerous
barriers in this area, notably, reimbursements and recognition (Leland, Fogelberg, Halle, &
Mroz, 2017). Occupational therapy practitioners have addressed health management, wellness,
and prevention, as well as cover the roles of occupational therapy (Leland, Fogelberg, Halle, &
Mroz, 2017). Since the Affordable Care Act policies and prospects related to occupational
therapy, have increased at exponential rates (Leland, Fogelberg, Halle, & Mroz, 2017).
Occupational therapy actively contributes to national efforts in order to improve population health through the delivery of high quality, safe, and efficient care (Leland,
Fogelberg, Halle, & Mroz, 2017). Occupational therapy help to primary care in order to OCCUPATIONAL THERAPY 19
achieving goals that address the patient’s risk of hospital readmission, assisting patients with adherence to treatment regimens, and helping people maintain their independence (Leland,
Fogelberg, Halle, & Mroz, 2017). It is ideal that occupational therapists grow alongside the
primary care professional by increasing the quality of care and balancing the needs of patients.
The insurer’s perspective is that the majority of the cost of outpatient care is for adults
with strokes needing rehabilitation (Pergolotti, Lavery, Reeve, & Dusetzina, 2018). Insurers do
not address that the need is there in order to prevent high cost in the future. Occupational
therapists reduce readmission, increase mobility, and prevent increasing costs. The initial cost of
occupational therapy is high, and a potential barrier to receiving services, but these treatments ultimately prove cost-effective by decreasing disability and improving quality of life in the long run (Pergolotti, Lavery, Reeve, & Dusetzina, 2018). Moreover, many patients who could benefit from occupational therapy services do not receive them. Nearly one in three adults with strokes were discharged from acute inpatient rehabilitation and recommended to receive outpatient occupational therapy and did not receive any services (Pergolotti, Lavery, Reeve, & Dusetzina,
2018).
Goodes Characteristics of a True Profession
In order to adequately identify occupational therapy as a true profession, it is essential to identify the characteristics of a true profession. William J. Goode established structural relations between professionals. Goodes studied the professional community; the characteristics of each established profession and a goal of each aspiring occupation is the concept of a profession seen as a community. Each profession is a community without physical locus and like other communities with heavy in-migration, one whose founding fathers are linked only rarely by blood with the present generation (Goode, 1957). He identified characteristics consisting of: OCCUPATIONAL THERAPY 20
1. Prolonged training in a body of knowledge
2. Orientation towards providing a service
3. Formalized social relationships-govern intentions
4. Delivers own education and training
5. Social standards
6. Licensure
7. Profession shapes legislation
8. A profession of practice and legal control (Goode, 1957).
Summary
Research showed a long history of occupational therapy as a practice. The literature review identified the history, practice frameworks, areas of practice, and education. In 1917 occupational therapy emerged as a profession in the United States. It was followed by the start of
the American Occupational Therapy Association in 1920. The association found healing
properties of human occupation and that meant having the properties be curative. By the mid-
1930s the majority of occupational therapists were employed in mental health settings, while a
small growing number were employed in rehabilitation programs. Occupational therapy sought out boundaries between the relationship of AOTA and physical medicine. In 1950 a sanction initiation was released creating that boundary.
Evidence shows the demand for occupational therapy services in a wide range of settings; schools, hospitals, skilled nursing facilities, home health, outpatient rehabilitation clinics, psychiatric facilities, and community health programs. The practice framework between children and the aging population differs, as does the increasing need. Occupational therapy employment OCCUPATIONAL THERAPY 21
is projected to increase by 24% by 2026. Factors contributing to this demand include the aging population and an increase in morbidity rates due to chronic health condition.
Research also identified William J. Goode characteristics of a true profession. A true profession allows professionals to classify as more prestige, with no outside accountability.
When working with a broad spectrum of people, it is vital to measure occupational therapy as a prestige profession with strong characteristics.
Chapter Three: Methods
This chapter will describe the methods that will be used to collect and analyze the data
for Occupational Therapy careers, trends and potential increasing need. The chapter will cover
the components associated with research design such as; sample frame, sample size, data
collection, and data analysis. Overall the data analysis will determine the need for occupational
therapists and potential fluctuation. It will identify the career field and any potential threats to the
growth of the profession. Additionally, identifying the number of graduates and determining if
the career is still a field of interest.
Research Design
In an attempt to identify the trends in occupational therapy, it was important to gather textbook material to analyze the occupational therapy profession. The hermeneutics approach will address the need for occupational therapists, and current and future career demand.
(Paterson & Higgs, 2005). Hermeneutics is a credible, rigorous, and creative strategy used to address aspects of professional practice through a review of texts (Paterson & Higgs, 2005).
Hermeneutics is the theory and practice of interpretation that knowledge is constructed through the research of texts (Paterson & Higgs, 2005). The trend analysis and history of development will help to analyze change over time. It may project the future direction of an occupational therapist alongside Goode’s characteristics of a true profession.
Sample Frame
The sample frame will include, all possible text related to occupational therapy. Filtering text by language, date, and country. Additionally, the sample frame will also be essential to
identify jobs of occupational therapists, graduation rates, patients that have suffered from strokes
and need of occupational therapists, and lastly the growing elder populations. OCCUPATIONAL THERAPY 23
Sample Size
Sample size will be determined by the phenomenon known as saturation. Saturation is
achieved when all data being analyzed starts to show the same repetitive analysis. When the
analysis no longer provides any new information, the sample size is determined to be saturated
with information (Morse, 2005, p. 535). As Morse states, “when ongoing analysis reveals no new
information appearing and no new categories emerging, sampling may cease.” (Morse, 2005,
p.535).
Data Collection
Data collection methods will include research on the internet, and research of
newspapers, several textbooks, and other scholarly peer-reviewed articles. For the purpose of this research project, California State University, Bakersfield electronic library databases will be used. The databases included in the research are Academic Search Premier and ProQuest. The terms that will be used to find articles relating to the topic are occupational therapy: trends, children, history, methods, insurance coverage, educational requirements.
In addition to the databases previously mentioned, this research will use data from the
U.S. Bureau of Labor Statistics, California Postsecondary Commission, The American Journal of
Occupational Therapy, The American Occupational Therapy Association and several scholar journals related explicitly to Occupational Therapy.
Data Analysis
In order to adequately analyze the data, the researcher will use content analysis. The content analysis aims to organize “large amounts of text into an efficient number of categories that represent similar meanings” (Hsieh & Shannon, 2005, p.1287). “The goal of the content OCCUPATIONAL THERAPY 24
analysis is to provide knowledge and understanding of the phenomenon under study.” (Hsieh &
Shannon, 2005, p.1287).
Methodological Rigor
Perhaps the most significant limitations of this study will be the access to data and information available. Another critical limitation will be associated with the limit of available data on children diagnosed with autism and receiving occupational therapy. Also having information on the average number of caseloads assigned to occupational therapists.
IRB Approval
Before the start of this research project, approval was requested from the Institutional
Research Board (IRB) at California State University, Bakersfield. The researcher passed the IRB certification test via the Collaborative Institutional Training Initiative courses. This research has no involvement with human subjects. The IRB authorization letter can be found in the Appendix section.
Chapter Four: Findings
This chapter oversees the analysis and interpretation of the data gathered. The research aims to 1) determine the status of Occupational Therapy as a true profession, and 2) determine where occupational therapy has been and where the profession stands now. The researcher reviewed material from the past sixty years. Of approximately 60 articles, 27 provided the most valuable information. Keywords used were occupational therapy professionals, occupational therapy statistics, occupational therapy and autism, occupational therapy and AIDS, history of occupational therapy, occupational therapy legislation, and occupational therapy educational requirements. The most valuable data sources were DATA USA, Bureau of Labor Statistics,
Center for Disease Control, the Association of Occupational Therapy, and the Journal of
Occupational Therapy. After data analysis six themes were identified that have affected the profession of occupational therapy (figure 1.2). Aside from those impacts, identifying whether occupational therapy is considered to be a true profession, using Goode’s characteristics of a true profession, was ideal.
Increased interest in occupational therapy started with World War II and continues to be a field of interest because of the Middle Eastern War. Secondly, the increase in the diagnose of autism and acquired immune deficiency syndrome (AIDS) is a significant contributor to the growth of the profession. Additionally, legislature and regulation policies have negatively and positively impacted occupational therapy as a profession. Lastly, the lack of exposure and educational requirements also took a toll on the profession.
OCCUPATIONAL THERAPY 26
Table 1.1
What has Effected the Profession of Occupational Therapy in the past 60 years
Themes Categories Increased interest Kickstarted by Wars (WWII, Vietnam, Middle Eastern) New and increasing diagnosis (Autism, AIDS)
Health Policy Attention Balance Budget Act Patient Protection Affordable and Care Act Community and Mental Health Act
Suppression of the Profession Control of Discipline Educational Requirements Lack of Exposure
Increased Interest
War stimulates occupational therapy. World War II was a global war that lasted from
1939-1945. WWII was the kick start of occupational therapy, the Art and Crafts Movement
became well established as did curative workshops, which positively influenced the profession
(Friedland, 1998). Once home, war veterans longed for occupational freedom. Occupational
freedom meant seeking the ability to choose and participate in activities that are meaningful to an
individual. Veteran lives were compromised as they reintegrate into the civilian life after service
(Plach & Sells, 2013). The need for occupational therapists increased after World War II,
Vietnam and the war in the Middle East.
Since 2001, an estimated 1.64 million U.S troops were deployed to the Middle Eastern
War (Plach & Sells, 2013). Approximately one-third of these veterans will struggle with at least one of the following injuries: post-traumatic stress disorders, traumatic brain injury, and major OCCUPATIONAL THERAPY 27
depression (Plach & Sells, 2013). Young veterans are found all around us, in the workplace, community settings, and institutions of higher education. Occupational therapists play a crucial role with veterans by providing interventions for individuals and groups, as well as opportunities for peer support and a sense of belonging. Occupation therapists make an impact in veteran lives by:
• Supporting veterans’ health and well-being is imperative for clinical practice and
research in all occupational therapy settings (e.g., mental health, physical
rehabilitation, pediatrics, older adults, ergonomics).
• The therapeutic relationship provides an avenue for recognizing the signature
wounds of war, as presented in this study. Occupational therapy practitioners
should address these wounds as appropriate. Therapists get trained in areas in
which they are less familiar and refer clients to a specialist when the concerns
extend beyond their scope of practice.
• The traumas of war have implications for all members of a veteran’s family. For
parents of young children such as the occupational therapist in pediatric or
school-based settings can play a vital role in recognizing how transitions and loss
contribute to behavioral or learning challenges.
• The inception of occupational therapy practice began with veterans. Occupational
therapy practitioners can continue to uphold this history by researching
interventions, disseminating the results, continuing their education, and applying
their skills to aid in successful, healthy transitions for veterans and their families.
(Plach & Sells, 2013) OCCUPATIONAL THERAPY 28
Legislature, regulation, and policies. The first piece of legislature to affect the
profession was the Balance Budget Act (BBA). In 1997, the U.S Congress passed the Balanced
Budget Act with a primary goal of reducing the rapid growth in Medicare’s post-acute care
expenditures (PAC). The PAC included a host of chronic care services provided in different
settings, including skilled rehabilitation services (Branchtesende, 2005). Until 1997, the demand
for occupational therapists had eclipsed the supply for decades. Practitioners generally had the
pick of multiple job offers upon graduation. Practitioners enjoyed increasing salaries and strong
benefits and had the security of knowing another job could be found if the existing one did not
work out. The BBA made several changes to control spending, provide incentives for agencies to
deliver care more efficiently, and acquire the use of the home health benefit to deliver long-term
personal care (Branchtesende, 2005). The BBA caused occupational therapy a significant job
decline as well as a dramatic decrease in student enrollment. Including changes to occupational therapy assistant programs in the years following (Branchtesende, 2005). Due to budgetary constraints at many organizations, occupational therapists were laid off by the hundreds in a single day (Branchtesende, 2005).
Current legislation, such as the Bipartisan Budget Act of 2018, triggered multiple changes to federal Medicare reimbursement policy such as the repeal of the Medicare outpatient therapy cap. Additionally, the Bipartisan Budget Act made changes to home health payment models and changes to future OTA reimbursements under Medicare Part B. These changes caused challenges for the American Occupational Therapy Association. Practitioners feared that history could potentially repeat itself with the BBA of 2018, which by comparison, included significant changes to the Medicare reimbursement. OCCUPATIONAL THERAPY 29
Aside from the negative political impacts of the BBA, the American Occupational
Therapy Association has achieved one of the most important long-term policy and organizational
goals when Congress permanently repealed the cap on Part B Medicare therapy. The gap was
threatening access to outpatient therapy services since its enactment in 1997.
As of 2020 changes to the occupational therapy, assistant reimbursements will face a
change. The new language affecting only Medicare Part B payments for occupational therapy
assistants has two parts. First, it requires that all occupational therapy or physical therapy service
claims to indicate whether the provider was an occupational therapist or occupational therapy
assistant. Overall language reduces payment for occupational therapy assistants and physical
therapy assistants by 85% of what is paid for services provided by a therapist, drawing a clear example between professionals and paraprofessionals payment (American Occupational Therapy
Association, 2018d). Negative political impacts are on salaries can affect the attraction to the profession. For example, young individuals might lose interest in the career due to the continuous changes in the legislature; such changes that can risk employment and future plans.
The Patient Protection and Affordable Care Act set forth a therapy cap exception. It provides for a one-year extension to the current exception process for Medicare Outpatient Part
B Therapy Services. The provision allows Medicare beneficiaries to get the medically necessary therapy services needed beyond the $1860 cap for 2010 on all occupational therapy services and an additional combined cap on physical therapy and speech-language pathology services.
The American Occupational Therapy Association worked closely with House and Senate offices to educate legislators about the role of occupational therapy. It was important to show the area of practice, convened committee staff, and the Senators involved; how the proposal would harm beneficiary access to occupational therapy services. Including the protection of OCCUPATIONAL THERAPY 30
occupational therapy’s practice of othrobotics and prosthetics and the reduction of a proposal to bundle post-acute care payments and provide the funding and control to an acute care hospital.
The plan was intended to address the problem of unnecessary readmissions by improving care coordination (AOTA- Healthcare reform: An OT Perspective).
Diagnostic spurs. According to the Center for Disease Control and Prevention (CDC),
diagnosing the autism spectrum disorder can be difficult because there is no medical test.
Doctors look at the child’s behavior and development to make a diagnosis. Autism is detected
between 18 months of age or younger; by age two a diagnosis by an experienced professional
can be considered very reliable.
About one in fifty-nine children have been identified with autism according to estimates
from the CDC. Autism can occur in all racial, ethnic, and socioeconomic groups. Between 2006-
2008 about one in six children in the United States had a developmental disability. Nationally,
one in fifty-nine children had a diagnosis of Autism Spectrum Disorder by age eight in 2014; a
15% increase over 2012. Occupational therapists play a vital role in the life of an autistic
individual. Autistic individuals need therapists in order to learn basic life skills such as, cooking,
cleaning, getting dressed.
Aids. The American Occupational Therapy Association state that one of the major
challenges for occupational therapists in the eighties was “keeping pace with changes in
healthcare delivery” (Denton, 1987, p.427). One of the changes in the delivery of health care has
been an alarming increase in the number of persons who have been diagnosed and hospitalized
with AIDS.
Occupational therapists intervene with AIDS because the comorbidities that result from
the disease; cancer, hemiplegia, adjustment reactions, and cognitive disorders. AIDS disorders OCCUPATIONAL THERAPY 31
do not require a change in occupational therapy intervention approaches, just the need to increase the availability of services. There are precautions to adhere to, observations to make, assessments to complete, and treatment plans and goals to be devised. When dealing with AIDS patients, therapists need to take extra precautionary measures such as, speaking slowly, repeating when necessary, or using visual cues. Therapists must cope with anger, wear gloves when in contact with patients’ blood or blood products. AIDS patients span a wide spectrum of ill health.
Treatment depends on factors such as the phase of illness the person is in, the support systems available to help carry out treatment programs, and the logistics of the treatment program. It is recommended that occupational therapy services be tailored to the particular needs of the patients and their disease state.
Therapists treating a person with AIDS need to become knowledgeable about the disease, the modes of transmission, its high-risk groups, and the universal protective precautions that are necessary for healthcare workers (Denton, 1987). People with AIDS are now living longer and need intervention due to cognitive disorders. These patients are now able to live and work with these impairments.
Suppression of the Profession
Educational requirements. In order to practice Occupational Therapy, on first must complete a bachelor’s degree program specifically in occupational therapy. From this point on it is crucial to complete a graduate degree program in an occupational therapy. Certification to practice occupational therapy is attained through the National Certification in Occupational
Therapy (NBCOT).
Lack of exposure. There is a growing concern within the profession that there will not be enough trained clinicians to fill the available positions for occupational therapists. Research OCCUPATIONAL THERAPY 32
shows that there is a lack of exposure to the profession of Occupational Therapy. Unlike
traditional careers, such as those in medicine, law or accounting, occupational therapy is not a
profession that children usually grow up knowing about (Cooperstein & Schwartz, 1992).
Therefore, the responsibility of the profession to ensure that young people are informed about the
existence of occupational therapy. If high-quality applicants are not actively sought, occupational
therapy education programs experience decreased enrollment and high drop-out rates
(Cooperstein & Schwartz, 1992). Literature shows that highest-ranked reasons for deciding to major in occupational therapy were 1) a desire to help the disabled, 2) contact with patients, and
3) interest in arts and crafts (Cooperstein & Schwartz, 1992). Applicants seek the satisfaction of helping others through occupational therapy.
The American Occupational Therapy Association has implemented a strategic plan in the
1990s. One strategic objective emphasized the importance that every therapist, from the time that they are students to the time they are practicing, help convey that occupational therapy is a career option with a future (Cooperstein & Schwartz, 1992).
Control of discipline. Throughout history, occupational therapy has sought to maintain a balance of autonomy and cooperation in its relationship with medicine. Occupational therapy is an autonomous profession. In the 1930s the American Occupational Therapy Association established educational guidelines and accreditations. The profession is relatively free of evaluation and control. The American Occupational Therapy Association determines its own standards of education and training. The American Medical Association controls physicians and physicians prescribe therapy and write orders for occupational therapy treatment. For many years physicians fought for control of occupational therapists. The AOTA board resisted these efforts seeking independence in administration and practice. OCCUPATIONAL THERAPY 33
Understaffed occupational therapy departments can compromise patient care due to overworked therapists who may burn out and ultimately leave the profession, thus perpetuating the shortage of occupational therapist. Occupational therapists rule themselves and have the support of the American Occupational Therapy Association.
Goode’s Characteristics of a True Profession
There are many ways of defining a profession. The simplest and most comprehensive method was enumerated by William J. Goode. He suggested we think of occupations as falling somewhere along a continuum of professionalism. The term “professional” serves to exclude as well as include. Ideally professionalism has shaped economic and social development and sees professionalism as the utilization of expert knowledge to solve problems (Goode, 1957). Goode developed ten characteristics of a true profession, which provided a distinguish between, the industrial workforce. If everyone is professional, the term loses its meaning. In the labor force, professionals find themselves surrounded by a group denying the validity of the professional status of the other. The core characteristics of a professional are prolonged specialize training in a body of abstract knowledge and a collectivity or service orientation (Hurd, 1967). As an occupation becomes professionalized, it acquires several features that may be viewed as sociologically derivative from the two just noted (Hurd, 1967).
1. The profession determines its own standards of education and training.
2. The student professional goes through more far-reaching adult socialization
experience than the learner in other occupations.
3. Professional practice is often legally recognized by some form of licensure.
4. Licensing and admission boards are manned by members of the profession.
5. Most legislation concerned with the profession is shaped by that profession. OCCUPATIONAL THERAPY 34
6. The occupation gains in income, power, and prestige ranking, and can demand high
caliber students.
7. The practitioner is relatively free of lay evaluation and control.
8. The norms of practice enforced by the profession are more stringent and legal
controls.
9. Members are more strongly identified and affiliated with the profession than are
members of other occupations with theirs.
10. The profession is more likely to be a terminal occupation. (Hurd, 1967)
Occupational Therapy is a true profession by Goodes framework (Table 2.0). It is a terminal occupation; once you start in the career path the chance of moving into something different is very unlikely. The American Occupational Therapy Association controls membership and has a public policy committee that works on the legislature. The profession determines its own standards of education and training as well as must complete higher education in order to practice.
OCCUPATIONAL THERAPY 35
Table 2
Chapter Five: Recommendations
The research project began by describing the history of occupational therapy over the last sixty years. Chapter Two provided more history of occupational therapy, the development into a health profession, the research’s practical framework, activities and occupational fields, practice settings, careers, and lastly a description of Goodes model of a true profession. Chapter three identified the tools of analysis and explained how they were useful. Based on results from
Chapter Four, the profession of occupational therapy can improve using and the following four recommendation:
Recommendation One:
It is essential to broaden the exposure for to occupational therapy. Those who are exposed to occupational therapy know occupational therapy. Meaning if one does not personally
deal with the profession, you are not likely to know it exists. Therefore, the pool of interested
students shrinks overtime.
It is important to introduce the career to students in middle school or high school. This
will kickstart the interest as a career. Arts and crafts, or home education classes introduce
students to the profession. Such classes would open the minds of students to learning and
completing daily life tasks. Raising the question of how people with disabilities get simple life
tasks done. Moreover, marketing services at an early stage in life can foster interest to explore the profession.
Recommendation Two:
Re-engineer the practice of occupational therapy. This will reframe the workflow of the profession to accommodate different realms, facilitation exposure to occupational therapy. Re- engineering the profession to meet the need to the elder population would also be ideal. The OCCUPATIONAL THERAPY 37
elder population is growing at an exponential rate and addressing the need of the population is
crucial. Influencing occupational therapists in the labor departments would provide incentives to
working with the elder generations.
Recommendation Three:
Occupational therapy is anchored in the healthcare system. It would be ideal to create a
bridge from occupational therapy to other parts of the healthcare system, home-life, and work- life. This would provide an opportunity to expose healthcare provides to consider occupational therapy in aiding patients with deficits to learn things that use to be taught at home, such as basic
life skills, cooking, cleaning, manners, manner behavior, and culture.
Recent generations are not exposed to basic life skills as much as past generations. It is important to integrate basic life skills in order to succeed and not be as co-dependent on others or social media. Creating a bridge between both systems would generate exposure, interest, and increase the labor market need of the profession.
Recommendation Four:
Establish strong leadership in terms of health policy and legislation. Creating strong leadership that will represent the profession in health policy and legislation will ensure occupational therapy is involved in future reforms. Frequently, occupational therapy as a profession has no representation when it comes to public policy reforms and changes. It is important to have representation defending, supporting, and speaking on behalf of the profession.
The American Occupational Therapy Association works to advocate federal and state legislative issues, but they are underrepresented among all other health professions. OCCUPATIONAL THERAPY 38
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Appendix A
Table 1.1 Number of accredited programs:
OT Doctoral OT Master’s OTA
Accredited 20 162* 215
Candidate 26 13 15
Applicant 41 14 16
246 Total 87 189
Notes:
* Of the 162 accredited master’s programs, 45 are transitioning to the doctorate and will withdraw from accreditation once the doctorate is accredited.
Accredited: The academic program is accredited by ACOTE®.
Candidate: The program has been granted candidate program status by ACOTE and can admit students, but has not yet completed the initial on-site evaluation that leads to granting accreditation.
Applicant: The academic program has submitted a letter of intent to apply for developing program status. Retrieved from Academic Program Annual Data Repot Academic year 2017-
2018 *OTA- Occupational Therapy Assistant OCCUPATIONAL THERAPY 44
Appendix B
Table 1.2 Number of students currently enrolled:
Students preparing for entry into practice as an occupational therapist:
Master’s 19,262 90%
Doctorate 2,086 10%
Total 21,348 100%
Students preparing for entry into practice as an occupational therapy assistant:
Total 9,580 100%
Retrieved from Academic Program Annual Data Repot Academic year 2017-2018 OCCUPATIONAL THERAPY 45
Appendix C
Table 1.3. Number of Program Graduates
Number of graduates:
Doctoral—OT Master’s—OT OTA
2013 108 5,439 4,313
2014 136 5,875 4,914
2015 184 6,153 5,020
5,472 2016 221 6,485
2017 396 6,846 4,939
OCCUPATIONAL THERAPY 46
Appendix D
Table 1.2 Certification exam new graduate pass rates.
Occupational therapy graduates:
2013 2014 2015 2016 2017
Passed 5,268 5,715 5,948 6,448 6,882
Candidates 5,396 5,848 6,052 6,549 6,987
Percentage 98% 98% 98% 98% 98%
(2016: OT Master’s = 98%, OT Doctorate = 100%) (2017: OT Master’s = 98%; OT Doctorate
= 100%) Retrieved from Academic Program Annual Data Repot Academic year 2017-2018. OCCUPATIONAL THERAPY 47
Appendix E
Table 1.4. First practice area
Employment as reported by programs:
Doctoral OT Master’s OT OTA
Early intervention 5% 7% 6%
Community <1% 2% 2%
Outpatient 24% 18% 12%
Home health 3% 4% 5%
Hospital 20% 16% 8%
Inpatient 9% 12% 9%
Long-term care 19% 21% 42%
Mental health 2% 2% 2%
School 13% 12% 10%
Other 5% 6% 4%
Retrieved from Academic Program Annual Data Repot Academic year 2017-2018 OCCUPATIONAL THERAPY 48
Appendix F
OCCUPATIONAL THERAPY 49
Appendix G