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The changing role of the occupational therapist 1972

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THE CHANGING ROLE OF THE OCCUPATIONAL THERAPIST by MARILYN LUELLA ERNEST B.S.R., University of B r i t i s h Columbia, 1972 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS (Adult Education) We accept t h i s thesis as conforming to the required standards. THE UNIVERSITY OF BRITISH COLUMBIA September 1972 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for references and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of Adult Education The University of B r i t i s h Columbia Vancouver 8 , Canada Date: September, 1972 ABSTRACT The purposes of t h i s study were to i d e n t i f y both the role development of the occupational therapist and the factors which have influenced and directed the role changes. It was assumed that these i d e n t i f i c a t i o n s would a s s i s t both the profession and educators of occupational therapists to evaluate the trends as to how and why the profession i s developing and to plan for appropriate professional and educational changes for the future. The role of the occupational therapist, an a l l i e d health professional, has changed from that of a craft-oriented medical technician to that of a professional c l i n i c i a n , researcher, educator^ and consultant. This contemporary therapist was found to be p r a c t i c i n g i n a number of areas both within and outside of the medical model of pr a c t i c e . The development of these new roles has resulted i n considerable concern, both outside of and within the profession, as to whether or not the t r a d i t i o n a l craft-oriented medical model of practice i s s t i l l v a l i d . As well, occupational therapists i n both the' United States and Canada have expressed the need to re-evaluate t h e i r r o l e s , t h e i r r e s p o n s i b i l i t i e s , and t h e i r education i n order to meet the needs of changing patterns i n the organization and delivery of contemporary health services. The study of the role development and i d e n t i f i c a t i o n of factors influencing the role changes was ca r r i e d out through a review of l i t e r a t u r e published between 1922 and 1972 plus a minimal number of unpublished papers related to the t o p i c . A b r i e f review of the 1970-1971 Canadian occupational therapy c u r r i c u l a was included i n an attempt to indicate the influences educational programs had on the role development of the occupational therapist. It was found that new roles developed i n response to present and proposed government l e g i s l a t i o n , changing needs and demands of society i n general, and changing emphases i n medical education and health care delivery. It was also found that the educational influences of occupational therapy programs were minimal, i f not i n h i b i t o r y , to the role develop- ment of the occupational therapist. Conclusions drawn from the review of the l i t e r a t u r e resulted i n the establishing of eighteen recommendations con- cerned with the role development, research needs, and educational needs of future occupational therapists i n Canada. I t was f e l t that these recommendations represented guidelines for change which must be implemented by the i n d i v i d u a l therapists, professional associations, and educators i f occupational therapy i s to remain a viable health profession. i i i DEDICATION To Dr. Bernice Russell Wylie i v ACKNOWLEDGEMENTS The writer wishes to express her appreciation to Dr. Coolie Verner, Dr. James Thornton, and Professor Margaret Hood for t h e i r assistance and support throughout the preparation of t h i s study. Grateful acknowledgement i s also made of the cooperation of Professor M. F. Trider, Director, Program i n Occupational Therapy, University of Western Ontario, i n helping to make the completion of t h i s study possible. v TABLE OF CONTENTS PAGE ABSTRACT i i ACKNOWLEDGEMENTS v TABLE OF CONTENTS vi LIST OF TABLES v i i CHAPTER I INTRODUCTION 1 Purpose Limitations Definition of Terms CHAPTER II HISTORICAL INTRODUCTION 7 Pre-19th Century Influences 19th Century Moral Treatment 19th Century Canadian Innovators Re-Birth of Moral Treatment World War I Influences Developments of Formal Education Profess ionali zation The Struggle for Recognition The Struggle for Independence CHAPTER III DESCRIPTION OF THE ROLES 19 The Clinician The Educator The Consultant The Researcher CHAPTER IV FACTORS INFLUENCING ROLE DEVELOPMENT 40 Legislative Influences Social Influences Medical Influences Educational Influences CHAPTER V RECOMMENDATIONS AND CONCLUSIONS 62 Summary Observations and Recommendations Conclusions BIBLIOGRAPHY 75 APPENDIX 90 v i LIST OF TABLES TABLE PAGE 1 Educational Program Content Related 57 to Requirements 2 Social Science Hours i n Occupational 59 Therapy Cur r i c u l a v i i CHAPTER I INTRODUCTION In 1962, an occupational therapy educator, Dr. Mary R e i l l y (133:4), stated that she had " l i t t l e t r u s t that we can continue to exis t as an arts and c r a f t s group which serves muscle dysfunction or as an a c t i v i t y group which serves the emotionally disabled. Society requires of us a much sharper focus on i t s needs" During the following ten years these needs changed as the growing affluence i n North America and the gradual introduction of new methods for financing health services lowered or re- moved f i n a n c i a l b a r r i e r s to the use of most health related services (25). Governments, i n attempting to meet s o c i e t i e s ' health needs, have expressed concern about both the education of those i n health service d i s c i p l i n e s and the u t i l i z a t i o n of th e i r services. According to the 1965 Federal Government's Royal Commission on Health Services (25), the expansion of community health services has emphasized the need to dovetail health services with other services i n the community which have been drawn into the medical f i e l d . These new patterns of health care delivery, and the teaching of s o c i a l or community medicine i n the medical schools, are re s u l t i n g i n the recognition of the need of such services as occupational therapy to help round out health services. Occupational therapists i n both the United States and Canada have expressed the need to re-evaluate t h e i r education, t h e i r r o l e s , and t h e i r r e s p o n s i b i l i t i e s so as to meet the needs 1 2. of the changing patterns i n the organization and delivery of health services (64, 160, 172). West (172) stated that the present role required i s very d i f f e r e n t from the ro l e of the t r a d i t i o n a l therapist of twenty years ago who brought c r a f t s and creative a c t i v i t i e s to long-term ward patients. She emphasized the need to enlarge the concept of occupational therapy from that of being a therapist to that of being a health agent. In 1971, R e i l l y (135:245) supported t h i s b e l i e f i n the therapist as a health agent: The commitment and hence the c a p i t a l i z a t i o n i n medicine i s directed toward the reduction and prevention of pathology and the treatment of acute phases of i l l n e s s . Occupational therapy makes i t s investment i n the health residual which follows pathology and hence focuses on the chronic aspect of the i l l n e s s and i s concerned with health rather than pathology. • While some therapists believe that the present role r e- quirements necessitate therapists being prepared to s p e c i a l i z e as educators, consultants, and researchers as well as to prac- t i c e as c l i n i c i a n s , b e l i e f i n these new roles i s by no means a consensus i n the profession. Cromwell (35:17) c l a r i f i e d the problem when she stated that "occupational therapists are t r y - ing to decide whether the t r a d i t i o n a l role i s s t i l l v a l i d , and how the necessary resources can be mustered to a l t e r r o l e s " . Other health service personnel such as doctors, nurses, psychologists, and s o c i a l workers express d e f i n i t e but c o n f l i c t - ing opinions as to the expected roles of the occupational thera- p i s t (2, 6, 19, 53, 57, 66, 109, 120, 143). Occupational.; therapy educators have also expressed a concerned awareness of the changing role of the therapist. According to R e i l l y (134 :222) , 3. the future of the profession " w i l l depend upon the adaptive responses?which both the c l i n i c i a n and the professional association makes to the challange of new demands". To date no comprehensive examination of the ro l e change of the occupational therapist has been car r i e d out i n order to define the role as i t has developed, nor have the r o l e s , i n the minds of many therapists, been legitimized. PURPOSE OF THE STUDY The purposes of t h i s study are, through an examination of the l i t e r a t u r e , to i d e n t i f y the role development of the occupational therapist and to i d e n t i f y the factors which have influenced and directed the role changes. This study should then a s s i s t both the profession and educators of occupational therapists to evaluate the trends as to how and why the profession i s developing and to plan for appropriate professional and educational changes for the future. LIMITATIONS OF THE STUDY In North America the profession of occupational therapy has been recognized for over f i f t y years. On the world scene there were twenty-three member countries i n the World Federation of Occupational Therapists i n 1970 whereas there were only ten founding member countries represented i n 1952. Because of 4 . the very nature of the profession, occupational therapy i s growing and developing n a t i o n a l l y , keeping i n mind the i n d i v i d u a l needs of t h e i r s o c i e t i e s . As the public often appears unaware of the differences between occupational and physical' therapy, i t i s emphasized here that t h i s study concerns only occupational therapy and has nothing whatever to say about the separate, independent pro- fession of physical therapy. Canada and the United States have been co-leaders i n the development of occupational therapy, and the education of therapists i n these countries has followed p a r a l l e l l l i n e s (93). In Canada the number of u n i v e r s i t y programs i n occupational therapy has increased from one i n 1950 to nine i n 1971. Because of t h i s rapid growth of occupational therapy i n Canada and the p a r a l l e l professional developments i n Canada and the United States, t h i s study w i l l be limited to the examination of the changing roles of the occupational therapist i n those two countries. The major emphasis, p a r t i c u l a r l y that concerning educational developments, w i l l be on the changing role of the occupational therapist i n Canada. DEFINITION OF TERMS At t h i s point i n the study eight terms w i l l be defined. Although there are several d e f i n i t i o n s for the term occupational therapy (5, 26), two d e f i n i t i o n s have been chosen as they represent the e a r l i e s t and the l a t e s t d e f i n i t i o n s available at 5. t h i s time. The termi physical therapy has been defined only to c l a r i f y the difference between physical and occupational therapy. Occupational Therapy; • i . E a r l i e s t D e f i n i t i o n : "any a c t i v i t y , mental or physical, d e f i n i t e l y prescribed and guided, for the d i s t i n c t purpose of contributing to and hastening recovery from disease or injur y . " (178:323) i i . Latest .Definition: "that d i s c i p l i n e which concerns i t s e l f with the assessment of occupational behaviour, and which guides the reconstitution or development of occupational ro l e s to produce new s k i l l s i n l i v i n g . I t may further be defined as the art and science of d i r e c t i n g man's response to selected a c t i v i t y to promote and maintain health, to prevent d i s a b i l i t y , and to reduce or eliminate incapacity r e s u l t i n g from physical or psychosocial dysfunction or environmental stress." (160:6) Physical Therapy: i s that science of treating physical d i s - a b i l i t y through the use of such physical modalities as heat, e l e c t r i c i t y , waterr and exercise. Role: i s the sum t o t a l of the c u l t u r a l patterns associated with a p a r t i c u l a r position - the attitudes, values, and behaviour ascribed by society to any and a l l persons as occupants of that p o s i t i o n . It i s a pattern of a c t i v i t y - what a person has to do (or thinks he has to do) i n order to validate his e l i g i b i l i t y for the position he holds (96). Community Health Service: i s "the t o t a l of a l l health services i n the community including the h o s p i t a l . " (25:39) 6. Health Team; i s a group of health professions with t h e i r respective associated technologists, technicians and other e s s e n t i a l personnel, whose o v e r a l l goals are the promotion of health, the prevention of disease, the diagnosis and treatment of i l l n e s s and the a l l e v i a t i o n of suffering (181). Occupational Role: i s a, s o c i a l r o l e assumed by every i n d i v i d u a l which i s a part of his l i f e cycle (163). Occupational Behaviour: i s the developmental tasks required by every i n d i v i d u a l as he assumes an occupational role (163) . Technician: A person s k i l l e d i n a branch of t r a i n i n g that depends more on s p e c i f i c practice than on general p r i n c i p l e s . CHAPTER II HISTORICAL INTRODUCTION Although the history of occupational therapy as an independent profession begins early i n the present 20th Century, the background of the profession can be traced as far back as the 20th Century B.C. The purpose of t h i s chapter w i l l be to provide a b r i e f overview of the h i s t o r i c a l development and influences which lead to the recognition of occupational therapy as an independent health profession. Pre-19th Century Influences The theory that manual occupation or mental diversion was b e n e f i c i a l to the sick i s one that has appeared from time to time throughout the history of medicine (6, 69, 178). About the 20th Century B.C., the Egyptians dedicated temples where "melancholies resorted i n great numbers", games and recreation were i n s t i t u t e d and " a l l the patient's time was taken up by some pleasurable occupation" (69:1). In the 9th Century B.C., Greek medicine appeared to recognize and u t i l i z e some p r i n c i p l e s underlying current approaches to the treatment of mental i l l n e s s . By the 4th Century B.C., Egyptian medicine had anticipated much of the present day therapeutic community concepts by providing t h e i r mentally i l l patients with pleasant surroundings and organizing programs which emphasized constant occupation, entertainment, and exercise. About 30 B.C., Seneca recommended employment for any kind of mental a g i t a t i o n , and i n A.D. 172, Galen, the Greek physician, wrote "employment i s i. • 7 8. nature's best physician and i s esse n t i a l to human happiness" (69:2). With the collapse of c l a s s i c a l c i v i l i z a t i o n s the standards of care for the mentally i l l declined s t e a d i l y i n a l l but a few regions. One of these rare examples was the Colony of Gheel i n Belgium. This 13th Century project's humanitarian approach and extensive use of "occupational therapy" did much to maintain the po s i t i v e therapeutic features of the c l a s s i c a l era (6). The dark ages of psychiatric care did not begin to brighten u n t i l the l a t t e r h a l f of the 18th and early 19th Centuries when occupation was used as a form of treatment by Pinel i n France as well as others i n I t a l y , Spain, England, and America. 19th Century Moral Treatment According to Bockoven, i t was undoubtedly the 19th Century that produced the greatest impetus for the development of occupational therapy as a profession today. He noted that "the hi s t o r y of moral treatment i n America i s not only synonymous with, but i s the history of occupational therapy before i t acquired i t s 20th Century name of occupational therapy" (19:223). The concepts of "moral treatment" and "occupational therapy" were based on respect for human i n d i v i d u a l i t y and on what Bockoven considered to be a fundamental perception of the indi v i d u a l ' s need to engage i n creative a c t i v i t y . The legacy of moral treatment was the b e l i e f that the mentally i l l person 9. could best recover his reason i n the company of mentally sound, kindly individuals who would help the patient by joining him i n d a i l y l i f e a c t i v i t i e s . Because of the a g r i c u l t u r a l orientation of 19th Century society, moral treatment hospitals were equipped with a variety of c r a f t shops and indoor recreational areas, garden areas, and outdoor game areas that were surrounded by farm land c u l t i v a t e d by the patients. Considering i t s era of introduction and growth, moral treatment could be described, both philo s o p h i c a l l y and p r a c t i c a l l y , as a comprehensive occupational therapy program. Bockoven f e l t that the philosophy of moral treatment was a r e s u l t of the p o l i t i c a l , cultural, and r e l i g i o u s attitudes of communities established primarily i n the north-eastern United States and Upper Canada. These attitudes were based on a b e l i e f that everyone should take part i n a l l aspects of the p o l i t i c a l and r e l i g i o u s l i f e of the community. Driver (41) f e l t that such attitudes were probably influenced by such humanitarian writers and thinkers of the time as John Stuart M i l l s . Moral treatment i s generally considered to have disappeared i n the United States before the 20th Century because of s o c i a l , i n s t i t u t i o n a l , and medical changes. There was an increase i n ethnic prejudices i n reaction to the large numbers of immigrants to America who began making up the large bulk of mental hospital patients. The i n s t i t u t i o n s themselves enlarged i n a few years to f i v e to ten times t h e i r previous size making personal p a t i e n t - s t a f f contact almost impossible. On top of these d i f f i c u l t i e s , the medical profession i t s e l f s h ifted i t s 10. view from a moral-emotional basis of mental i l l n e s s to a b e l i e f that c e l l u l a r brain pathology was the only s c i e n t i f i c basis of treatment (.19) . 19th Century Canadian Innovators There i s evidence that moral treatment did not e n t i r e l y disappear i n Canada during the 19th Century, and through the use of moral treatment one doctor could be considered to have pioneered occupational therapy. The London, Ontario, Lunatic Asylum opened i n 1870, and i n 1883 the Medical Superintendent, Dr. Bucke, hired a female attendant to work on one male ward. The asylum Inspector wrote i n his minute book of March 6, 1883, that "since t h i s lady's coming to the Asylum, a great t i d i n e s s in person, a greater a c t i v i t y i n employment, and a general brightening of the condition of those i n the male ward i s perceptible" (66:80). The Inspector authorized purchases of materials to permit such a c t i v i t i e s as cane seating, shoemaking, k n i t t i n g , and mat-making, and empowered the Superintendent to hire two more ladies to continue the comfort and health- promoting work being done. Before 1900, a si m i l a r type of occupational work was introduced to the Mountain Sanitorium for Tubercular patients i n Hamilton, Ontario. Re-Birth of Moral Treatment The r e - b i r t h of moral treatment i n the 20th Century was, i n part, supported by the p s y c h i a t r i s t , Sigmund Freud, who claimed that "work has a greater e f f e c t than any other technique of l i v i n g , i n the d i r e c t i o n of binding the i n d i v i d u a l 11. c l o s e l y to r e a l i t y ; i n his work at l e a s t he i s securely attached to a part of r e a l i t y , the human community" £6:119). The r e - b i r t h of moral treatment did not produce an i d e n t i c a l philosophy to that of the o r i g i n a l moral treatment. Driver (41) observed influences i n t h i s period which not only had an impact on the pre-occupational therapy r e - b i r t h of moral treatment but also on present-day occupational therapy treatment. She pointed out that early moral treatment hospitals hired occupational workers to guide patients i n normal community a c t i v i t i e s such as farming, gardening, hospital i n d u s t r i e s , and recreation. With the new moral treatment era one finds a s h i f t from r e a l i s t i c work settings and a c t i v i t i e s to a c t i v i t i e s such as cane-seating, basket-weaving, knitting, and sewing that could take place i n occupational rooms within the i n s t i t u t i o n . Driver's hypothesis was that t h i s change from r e a l i s t i c work to a dependence on arts and c r a f t s was at least p a r t i a l l y a r e s u l t of a change i n s o c i a l thinking brought about by such writers as Carl Marx. The e x p l o i t a t i o n of the patient as a worker was to be deplored and rejected, and as a r e s u l t , arts and c r a f t s were emphasized since they were, at that time at l e a s t , s i g n i f i c a n t to and an i n t e g r a l part of normal l i v i n g i n a semi-mechanized society. This s o c i a l l y - influenced change of the therapist to an arts and c r a f t s worker i s an image therapists are s t i l l t r y i n g to diminish, and i t i s a major philosophical problem both inside and outside of the profession of occupational therapy. World War I Influences The r e - b i r t h of moral treatment was only one of two forces that led to the formal beginnings of occupational therapy. The second force was the return of a vast number of severely wounded soldiers from the F i r s t World War. It was the e l i t e of the medical profession who joined the forces and caused the m i l i t a r y to develop r e h a b i l i t a t i o n programs for wounded servicemen. One American doctor, F. Williams, went to Washington to ask for "occupational therapists" to go overseas with his u n i t , but already an unfavourable image of occupa- t i o n a l therapy had been established. Dr. William's request was denied because the m i l i t a r y "could not understand that he wanted a program of vocational t r a i n i n g rather than basket- weaving" (182:227). Despite t h i s problem, he was able to get some women prepared to do r e h a b i l i t a t i o n work i n his unit under the category of "scrubwomen". Within weeks t h e i r work became obviously invaluable and the Surgeon General cabled for a thousand more aides as soon as they could be made ready. As a re s u l t , 116 women, nurses, physiotherapists, d i e t i t i a n s , and c i v i l i a n aides were assembled, trained with three lectures on the meaning of the word "neuropsychiatric", and sent overseas to e s t a b l i s h programs to r e h a b i l i t a t e the wounded (182) . Development of Educational Programs As Canada also made preparations to suppy similar aides to help r e h a b i l i t a t e the wounded servicemen, the problem of education of the aides arose. According to Haworth and 13. McDonald (6 9), up to the time of the F i r s t World War there had been l i t t l e i n the way of occupational treatment except i n the hospital industries. The successful attempt by a few individuals to treat patients through the use of occupation led a u t h o rities i n various hospitals to consider the necessity of d e f i n i t e t r a i n i n g for these workers. The f i r s t school i n the United States was the School of Occupational Therapy i n Chicago. It opened i n 1914 under the di r e c t i o n of Mrs. Eleanor Clarke Slagle (43) , and i t s f i r s t course was six weeks i n length. The f i r s t course i n Canada was given at Hart House, The University of Toronto, i n 1918. The outline of t h i s f i r s t six week course was drawn up by Professor Haultain and a committee of the Faculty of Applied Science and Engineering. Each succeeding course was extended to three months i n length and included a large number of manual s k i l l s and hospital etiquette (94). These f i r s t "ward aides" soon became known as "vocational aides" because of the s k i l l s they acquired i n these early courses. Over three hundred women were trained i n 1918 and 1919, and were sent to m i l i t a r y hospitals across Canada. The admission requirement for women entering the f i r s t University of Toronto courses i s probably unique i n the history of Canadian u n i v e r s i t i e s . The requirement was that the students had to have "charm", a requirement that perhaps inadvertently implied that male students would not be considered (43). Later q u a l i f i c a t i o n s for the newly-named "reconstruction aides" included general education from a secondary school but Normal School and college graduates were preferred. Personal 14. q u a l i f i c a t i o n s were mainly those of good teachers (154). Not u n t i l the two-year course was established at the University of Toronto i n 1926 were the admission requirements the same as for the Faculty of Arts (36). Pro f e s s i o n a l i z a t i o n of Occupational Therapy The i d e n t i t y of occupational therapy was developed gradually over a period of two decades i n Canada. The occu- pational therapy "aides" formed two organizations: one i n i t i a t e d i n 1920 at the Toronto Curative Workshop and a s i m i l a r , s h o r t - l i v e d , Canadian Society of Occupational Therapy of Manitoba i n 1921. In 1921, the Ontario Society of Occupational Therapy obtained i t s charter as a professional organization e x i s t i n g for the therapists rather than for service to patients. This group was responsible for the forma- t i o n of the Canadian Association of Occupational Therapy which held i t s f i r s t annual meeting i n 1930, published i t s f i r s t journal i n 1933, and obtained a Dominion Charter i n 1934. The Canadian Association was formed because of the a c t i v i t y of the early aides while the American Association was formed through the a c t i v i t y of other professionals. In 1915, Dr. William Rush Dunton published a book, Occupational Therapy, A Manual for Nurses. This was read by George Barton, an a r c h i t e c t and tuberculous patient, who had already become con- vinced of the curative value of patient occupation. Barton contacted Dr. Dunton regarding the p o s s i b i l i t y of establishing an American association for occupational therapy. Thus, Barton can be credited with establishing the o f f i c i a l name for the 15. profession and Dunton credited with establishing the American Occupational Therapy Association i n 1916 (165). In both countries i t was f e l t that the new d i s c i p l i n e needed the prestige of the medical profession. For most of i t s f i r s t t h i r t y years the American association was led by physicians with the exception of Mr. Barton, the f i r s t president, and Mrs. Slagle, the president from 1919 to 1920. The Canadian association presidents were physicians u n t i l 1966: Howland from 1930 to 1948; Campbell from 1948 to 1960; and Swanson from 1960 to 1966. In 1966,.an occupational therapist, Mrs. Thelma Cardwell, was elected the f i r s t therapist-president of the Canadian Association of Occupational Therapists. The Struggle for Recognition By 1925 doctors had assumed the leadership of the profession i n Canada and they were strongly supported by the Ontario Government which was aware of the need for expanding occupational therapy services i n Pr o v i n c i a l mental hospitals (94). Dr. Goldwin Howland, President of the Canadian association for many years, led the fi g h t for the recognition of occupational therapy as a profession. This desire for recognition was evident many years before o f f i c i a l sanction was given to occu- pational therapy. In the July 14 , 1923, issue of the Winnipeg Evening Tribune, an a r t i c l e generously proclaimed, "War Experiment Now Ranks as a Profession" (166); however, present therapists might doubt that the following content of the a r t i c l e t r u l y supported the promise of the headline: 16. Occupational therapy teaches work for work's sake. . . . It conceives of man as a doing animal, and perceives that idleness i s an abnormal condition. . . . "No l i f e i s complete without work" an occupational therapist said to the Tribune. "In order to keep l i f e ' s balance, there must be work, rest, and play. If the work i s very agreeable, less play i s needed." Despite t h i s early enthusiasm, i t was not u n t i l 1944 that Dr. Howland f e l t occupational therapy had attained pro- fessional status. He and the Board of Directors of the Canadian association had fought for two p r i n c i p l e s : (a) that a l l occupational therapists must be graduates of a school recognized by the Canadian association; and (b) that the scope and f i e l d of t h i s form of treatment must be primarily thera- peutic and not recreational. He claimed that . . . these two p r i n c i p l e s have been d e f i n i t e l y established amid many d i f f i c u l t i e s , with considerable opposition a r i s i n g both outside and ' inside our organization. But now with the dawn of 1944, you may rest s a t i s f i e d , knowing that the battle i s won and you occupational therapists are regarded both today, and for a l l future time, in your proper spheres as members of a re- cognized profession^ (80:3). This professional recognition was re-enforced when Dr. Howland convinced the Government of Canada to allow occu- pational therapists to e n l i s t as f u l l y commissioned o f f i c e r s during World War I I . From 1943 to 1946 over 70 therapists e n l i s t e d , almost half serving with the Canadian Army Over- seas (41) . 17. The Struggle for Independence Despite the claim by Dr. Howland that occupational therapy was now a recognized profession, i t was apparent that a t r a d i t i o n of unequal r e l a t i o n s h i p with physicians was well established i n the years between 1910 and 1929. Woodside (182:229) c l e a r l y pointed out that the physicians were administratively h e l p f u l but praised the therapist's heart while questioning her knowledge and s k i l l s : The early journals i l l u s t r a t e d how tenaciously the doctors clung to the necessity of a medical pr e s c r i p t i o n and/or r e f e r r a l to an occupational therapist for t h e i r patients. . . . Most of t h i s time they presided over the national association and undoubt- edly occupational therapists p r o f i t t e d much from t h e i r vast organizational and medical knowledge while s t i l l being very much subservient to t h e i r leader- ship. Forty years l a t e r , therapists are s t i l l f e e l i n g the e f f e c t s of t h i s long established hierarchy and are struggling for the r i g h t to work with doctors rather than under them. The profession's dependence on the medical profession and lack of autonomy was based on a need for status. Now, despite uncertainty within the profession, the desire for autonomy and the recognition of an earned status i s gradually spreading across the country. Trider (160:3) claims that "our t r a d i t i o n a l dependency status i s being rejected as an un- necessary burden by Big Daddy (organized medicine) and our i n - t e l l e c t u a l and academic achievements are being exposed for what they too often are, the posturing of a would-be profession s t i l l i n many ways c l i n g i n g to an outmoded pre- and post-war aura of g e n t i l i t y and lady-like-ness". She further claimed that 18. "this debuntante syndrome i s hardly appropriate for a profession purporting to be a useful part of the tough-minded, s c i e n t i f i c health industry of today". The image and role of the occupational therapist as the "craft-lady" was established very early i n the development of the profession. Later years saw the role of the therapist develop new patterns of behaviour and r e s p o n s i b i l i t y and a number of specialized roles emerged for the occupational therapist. CHAPTER III DESCRIPTION OF THE ROLES The role of the occupational therapist has evolved from that of a medically-oriented therapeutic technician to the more sophisticated roles of c l i n i c i a n , educator, consultant, and researcher. The purpose of t h i s chapter w i l l be to describe the evolution of these roles and indicate the i n t e r n a l factors which have either encouraged or i n h i b i t e d the development of the new r o l e s . THE CLINICIAN According to Dr. Anne Cronin Mosey (118:235), u n t i l the 1960's "occupational therapists functioned as technicians, not as professional persons.. . . An a n c i l l a r y , almost handmaid of the Lord, role seemed to be w i l l i n g l y accepted.. . . There i s s t i l l l i t t l e change i n our manner of functioning as we enter the '70's." This early role as c l i n i c i a n was at least p a r t i a l l y defined i n 1922 by Dr. Hubert H a l l (67:163): Occupational therapy's f i r s t concern i s to arouse ambition i n those who are d i s - couraged or apathetic. Its f i n a l purpose i s through the use of l i g h t handicrafts to develop patience and application, so that even the i n e r t i a of quite severe handicap may be overcome. The early l i t e r a t u r e indicated that the therapist worked only under the d i r e c t guidance of a physician, and the des- 19 20. c r i p t i o n of treatment media indicated the technical nature of the therapist's r o l e . In 1940, Bickle (16:81) explained that the p h y s i c a l l y or mentally disabled patient "received treatment through such c r a f t s as rug making,vbasketry, chair caning, papier mache and needlework" as well as weaving, leatherwork and woodwork. However, the early therapist was not considered to be only a teacher of c r a f t s . Heaton (71:60) added to the description of the therapist's occupational role when he described her as "a student of occupational methods, record keeper, vocational counsellor and placement o f f i c e r " . The emphasis on the occupational therapist's role as being production and craft-oriented continued for many years (50, 54, 140); however, the descriptions of the role were as varied as the descriptors. For example, a p s y c h i a t r i s t (7:14) described the occupational therapist as an "instructor i n arts and c r a f t s and tutor i n special work", while a nurse (53) f e l t that the therapist's purpose was to stimulate i n t e r e s t , ambition, con- fidence, and the desire to accomplish. Despite the evidence of the 1930's and 1940's supporting the therapist's role as a craft-oriented, i n s t i t u t i o n a l i z e d technician, there were a few individuals who presented a d i f f e r e n t point of view. McGhie and Myers (103) f e l t that the therapist had to do more than teach handcrafts; that there was no longer any excuse for placing emphasis on the finished product. Instead, they f e l t that the emphasis of the therapist should be on the creating of an environment to improve the mental health of the patient. LeVesconte (93:12) emphasized community involvement and f e l t that sheltered workshops for the p h y s i c a l l y disabled should be c a l l e d community centres. Smith (147) questioned the use of handcrafts as being appropriate i n some treatment sit u a t i o n s . She described the new 1940 treatment program for injured workmen i n which they were offered not c r a f t s , but exercise which approximated as c l o s e l y as possible the type of work to which they would return. As early as 1933, Dr. Howland (73) emphasized that there had to be an advance i n the scope of occupational therapy i f i t were ever to become a p r i n c i p a l therapeutic method of treatment, and i t appears that his advice was taken to heart by the profession. The l i t e r a t u r e of the 1940's, 1950's, and 1960*s indicated that the scope of occupational therapy increased to such an extent that the role of the c l i n i c i a n became definable only i n terms of the individual's position and function, a s i t u a t i o n recognized as one l i k e l y to cause confusion i n role i d e n t i f i - cation (73:34). Attempts to define the role of the therapist in the I960*s produced descriptions which indicated the con- fusion and nebulous character of the therapist's r o l e . For example, Jones (84:6) stated that the "occupational therapist no longer has only the role of a technician teaching c e r t a i n manual s k i l l s to patients but uses i n addition her personal att r i b u t e s as a c t i v e l y and f l e x i b l y as possible". De La Charite (38:101) indicated the i n a b i l i t y to define the roles noting that "the role of the occupational therapist as a team member . . . must be defined by the whole team . . . that s i t s down and defines the t o t a l needs or losses of each i n d i v i d u a l patient". This problem of i d e n t i f y i n g role becomes even more evident i n the l i t e r a t u r e as i t indicated that the c l i n i c i a n appeared to be everything to everyone. The therapist was expected to have expertise i n supervision and/or administra- tion (8, 34, 97, 171); assessment and/or diagnosis (13, 32, 104, 115, 120); home care and/or community therapy (9, 10, 82, 112, 174); vocational r e h a b i l i t a t i o n (14, 39, 77, 83, 117); a r c h i t e c t u r a l and/or environmental change (36, 63, 146, 155, 171); group therapy (32, 49, 56, 84, 138); education (62, 64, 83, 117 , 14 2);, evaluation (34, 63, 146, 155, 171); and l e i s u r e - time a c t i v i t i e s and/or di v e r s i o n a l therapy (70, 81, 115, 146). The occupational therapist was also considered to be a counsellor (23), a consultant (77, 83, 97, 171), a researcher (63, 64, 83, 117, 171), and an o r t h o t i s t and inventor (37, 112, 117). Th i r t y years af t e r Howland encouraged an expansion i n the scope of occupational therapy, Burke (23:4) commented on the r e s u l t i n g role confusion: "Yet t h i s very broadness and multifaceted competence has contributed i n a large manner to much of the present confusion that envelopes occupational therapy i n the 1960 1 s-:". In spite of the confusion, the late 1960's and early 1970's produced a number of attempts to cut through the con- fusion and point out trends and areas of concern to contemporary therapists. A review of eight points which r e f l e c t current thinking may help the profession re-evaluate and c l a r i f y the present problems and furture roles of the occupational therapy c l i n i c i a n . The f i r s t point i s an evaluative statement concerning the therapist-patient r e l a t i o n s h i p . Medical p r a c t i t i o n e r s such as Nichols (120) and Burke (23) as well as therapists such as Cromwell (34) and Moore (117) agree on the concept that because of the occupational therapist's broad type of educational background, t h i s therapist i s the p r a c t i t i o n e r best prepared to see, understand, and p a r t i c i p a t e i n the h o l i s t i c approach to patient care. The second point involves the re-evaluation of the re- l a t i o n s h i p of the occupational therapist to the r e h a b i l i t a - t i o n movement. Mosey (118:235) explained that the rush of the therapists to be a part of the r e h a b i l i t a t i o n movement was an action " t y p i c a l for a group that lacks a strong i d e n t i t y and seeks recognition". As varying degrees of role b l u r r i n g occurred, Mosey claimed that i t was a sign of "uncertainty regarding one's appropriate r o l e , poor t r a i n i n g , and/or a way of avoiding the issue of r e s p o n s i b i l i t y " . At the same time that Mosey was explaining why therapists joined the r e h a b i l i t a t i o n movement, R e i l l y (135:224-225) was i n the pro- cess of evaluating t h i s same movement. In her opinion, " r e h a b i l i t a t i o n , of which occupational therapy^is considered to be a substructure, has no organized body of knowledge and no profession concerned with i t s ethnics. It has no r a t i o n a l preparation for i t s practice and no monitoring of i t s aftereffects."Q R e i l l y f e l t that therapists "must disentangle themselves from the unconscious associations they have made with the r e h a b i l i t a t i o n movement because i t i s now regressed to a low-grade substitute for the health care of the c h r o n i c a l l y disabled". A t h i r d point under consideration by contemporary therapists i s a review of the dependency re l a t i o n s h i p between occupational therapists and the medical profession. Peake (127:407) described t h i s r e l a t i o n s h i p as follows: We have experienced within the areas of physical medicine and r e h a b i l i t a t i o n , an uncomfortable r e l a t i o n s h i p with the physician. . . . Our primary role has been . . . under the administrative and professional control of the p h y s i a t r i s t . . •'. a role i n which we have been forced to function . . . as a "technician" to the physician; unrecognized i n our basic professional preparation as i n - dividuals prepared to function as a l l i e s to many medical s p e c i a l t i e s , and to other health professions. Peake further states that "a t r u l y c o l l a b o r a t i v e , pro- fessi o n a l r e l a t i o n s h i p does e x i s t i n some working r e l a t i o n - ships, but generally, t h i s i s not the case". Dr. Nickel indicated that the practice of requiring detailed written prescriptions from the doctor has supported t h i s dependency status of the therapist and i n h i b i t e d the application of the therapist's knowledge. He believed that "such prescriptions have been, and are, a millstone around the neck of the occupational therapists as well physicians" (121:87). Dr. Bockoven (19:224), on the other hand, c l e a r l y lays the blame for the continuation of the dependency re l a t i o n s h i p at the feet of the therapists: It would be most unfortunate for a l l society . . . i f occupational therapy were to l i m i t i t s e l f by continuing to be s a t i s f i e d with running dinky l i t t l e sideshows i n large mental i n s t i t u t i o n s . . . . It i s time for occupational therapists to l i s t e n to the idea that t h e i r profession has been the c h i l d of medicine long enough and to consider that i t i s ready to go o f f on i t s own as the next step toward f u l l maturity and f u l l s o c i a l effectiveness. Occupational therapists as well as medical p r a c t i t i o n e r s see t h i s dependency as i n h i b i t i n g to professional progress, but Mosey (.118) feels that, i n -spite of seeing the s i t u a t i o n , occupational therapy has been passively u n c r i t i c a l i n i t s acceptance of the close t i e s with medicine. Moore (117:23), i n denouncing t h i s state of passive dependency, stated that " i f the occupational therapist i s responsible to a physician for her practice, she w i l l remain a 'technician' 'iV. As early as 1966, Johnson and Smith (83) f e l t that therapists were already de- creasing t h e i r dependency on medical supervision. There appears now to be no s i g n i f i c a n t disagreement that only by being responsible for t h e i r own a c t i v i t i e s w i l l occupational therapists progress as professional health workers. Despite the desire of doctors and therapists to break the dependency r e l a t i o n s h i p , there remains the problem of l e g a l r e s p o n s i b i l i t y which therapists must consider. Friedmann's (57) statement that the doctor had to have the sole moral and lega l r e s p o n s i b i l i t y for the well-being of the patient was challanged by S i l l e r , who f e l t that Friedmann's perception of le g a l r e s p o n s i b i l i t y was a r e s u l t of his "looking where his associate d i s c i p l i n e s were rather than where they are," and that t h i s l e g a l r e s p o n s i b i l i t y o r i g i n a l l y grew from the. need to protect the public from quackery (143:411-412). S i l l e r spoke for many occupational therapists when he claimed that "although the formal t r a i n i n g requirements for the other r e h a b i l i t a t i o n professions may require fewer years than for medicine or psychology, the p r i n c i p l e of systematic learning, e t h i c a l operation, and professional accountability should operate for a l l " . A fourth point being considered i s the growing emphasis on prevention as a legitimate service of occupational therapy. A number of therapists (.64, 160, 171) point out that emerging patterns of health care delivery are leading to the need for new settings, new methods, new services, and a new emphasis on the prevention of dysfunction. West (174:231) stated that although therapists are now functioning i n new settings and are developing restorative and secondary preventive services, occupational therapists "have not as yet f u l f i l l e d a p o t e n t i a l role i n primary prevention". She f e l t . t h a t the therapist's involvement i n primary.prevention services would be new to the profession, yet " e n t i r e l y consonant with one of our oldest philosophies - that occupational therapy i s concerned, not only with the individual's physical a b i l i t i e s , but also with his mental, emotional, s o c i a l , and economic needs". The f i f t h area of review relevant to the changing r o l e of the c l i n i c i a n concerns the medical versus the non-medical model of pra c t i c e . Therapists such as Gordon (64) and R e i l l y (135) state emphatically that occupational therapy i s concerned, and always has been concerned, with health rather than pathology of i l l n e s s . West (172:14> 174:227) c l a r i f i e d t h i s concern: There i s an increasing need to i d e n t i f y with the f i e l d of health, thus broadening our t r a d i t i o n a l , more limited i d e n t i f i - cation with medicine; to enlarge our con- cept from that of being a therapist to one of functioning as a health agent . . . with some r e s p o n s i b i l i t y for id e n t i f y i n g environmental as well as b i o l o g i c a l causes of disease and dys- function, for p a r t i c i p a t i n g i n the planning of health services, and for helping to ensure normal growth and development. Rerek (137) f e l t that a c r i t i c a l period of development in occupational therapy occurred during the 1930's when the profession accepted the idea that only the medical model was available to them. Since the occupational therapist i s con- cerned with health rather than i l l n e s s , Rerek claimed that the use of the medical model for the delivery of health services, by d e f i n i t i o n , m i l i t a t e s against the development of the health- oriented services of occupational therapy;, that through the medical model "growth can only be i n the d i r e c t i o n of services to the sick, or 'sick services'" (137:232). Diaso (39:239;) believed that "occupational therapists took a grand step away from the medical model when they defined function and dysfunction as t h e i r professional parameters of concern". Occupational therapists have not completely discarded the medical model,, but they are questioning i t s v a l i d i t y for t h e i r profession and suggesting model alt e r n a t i v e s . For example, Mosey (118) has suggested that education might provide a more useful model to follow than medicine, while Diaso (39) noted that many therapists i n graduate schools found they could r e l a t e more to the behavioural science model than they could to the medical model. Diaso (39:239) claimed that "this change i n emphasis . . . reinforced more strongly than before the 28. conviction that patients' or c l i e n t s ' problems could not be cast s o l e l y i n medical terms". Despite these statements of opinion on the occupational therapy versus medical model rel a t i o n s h i p Rerek's (137:233) question remains to be answered: " . . . Can we disengage ourselves from i n s t i t u t i o n s for the delivery of 'sick services' that prevent us from our delivery of health services?"- A s i x t h area of concern to the c l i n i c i a n s ' role i s the re-evaluation of the t r a d i t i o n a l modalities of treatment. Conte (32:149), a physician, expressed his concern and i n t e r e s t : The a c t i v i t i e s used t r a d i t i o n a l l y i n occupational therapy should be re- evaluated i n terms of t h e i r meaningful- ness i n the newer social-psychological- c u l t u r a l approach to programming. There needs to be an increased awareness of what kinds of a c t i v i t i e s have meaning and therapeutic value i n the d a i l y l i v i n g experience of patients. Therapists are now examining the whole subject of treatment modalities. It i s f e l t that most c u r r i c u l a emphasize too many c r a f t s (176); that there i s a trend toward functional, less craft-oriented programs (83) ; and that standards have already s h i f t e d from arts and c r a f t s to the basic sciences (118). Shimeld (142:10) r e f l e c t e d much of the current thinking on the re-evaluation of t r a d i t i o n a l modalities of treatment: It w i l l be important that we learn to use the therapeutic potential of a much broader range of human a c t i v i t i e s than the standard repertoire of arts and c r a f t s . In doing so, we w i l l have to collaborate with others possessing the s k i l l s we wish to use to help our patients. No longer w i l l i t be possible for the therapist to be p r o f i c i e n t i n a l l the a c t i v i t i e s used as treatment media for patients. The seventh area of consideration i s that of the image of the therapist and occupational therapy. Trider (60) arid Cardwell (27) express concern about the therapist's image of both himself and his profession, but i t i s Diazo (39:240-241) who has most f u l l examined t h i s image: " . . . Many occupational therapists continue to hold a damaged self-image of t h e i r profession despite the advances of the ^60's . . ." and the damaged image i s at least p a r t i a l l y the r e s u l t of the lack of professional development. Diazo asserts that t h i s lack of develop- ment i s a r e s u l t of "undeclared contracts" which therapists must break. The f i r s t such contract involved the position of the therapist within i n s t i t u t i o n a l power structures. Diazo f e l t that the more experienced therapists were finding that t h e i r achieved roles outran the roles ascribed to them, a s i t u a t i o n leading to f r u s t r a t i o n among those therapists not allowed to innovate or use t h e i r f u l l range of s k i l l s . Diazo anticipated a problem i n that a change i n t h i s i n h i b i t o r y contract would l i k e l y be seen as threatening to the system as a whole. Diazo's second undeclared contract involves the re- l a t i o n s h i p of"occupational therapy to organized medicine. She sees t h i s as a double problem involving, primarily, the fact that the national medical associations s t i l l control the occupational therapy c u r r i c u l a , and secondly, a r o l e c o n f l i c t within the medical profession: The majority of physicians remain unaware of the occupational therapist's t r a i n i n g and s k i l l s . . . yet most would s t i l l assert the need to control 'paramedicals'. 30. Despite assertions by the medical profession (57, 68) that doctors are now much better educated as to the roles of the other professionals, the 1969 study by Tuminelly (161) concluded that over one-third of the final-year medical student respondents were not at a l l aware of the role of the occupational therapist and most of the students had received very l i t t l e , i f any, information about the profession i n medical school. The role c o n f l i c t of medicine, then, concerns the doctor believing that he should, and does, know enough about another profession to control i t , while senior medical students admit that, i n f a c t , they learn almost nothing about t h i s profession they w i l l t r a d i t i o n a l l y expect to control. Diazo 1s point i s that "occu- pational therapists must become aware of these role c o n f l i c t s i f t h e i r co-optation by medicine i s to cease" and the second undeclared contract broken or abolished. Diazo's t h i r d undeclared contract concerns occupational therapists holding second-class status as professionals because t h e i r organization i s comprised primarily of women. As well as a l l orders and decisions being made by a male dominated medical profession, she asserts that "throughout our history u n t i l recent times, the submissiveness and conformity so strongly reinforced i n occupational therapy r o l e s , p a r a l l e l e d expected sex-role behaviour i n society". Not only did t h i s role stereotyping influence the therapists behaviour, but Diaso (39:240) f e l t i t also influenced the use of treatment media: Training schools, h a s t i l y set up for women only, had a strong influence i n moving therapists away from the wide scope of educational, r e c r e a t i o n a l , vocational, and other a c t i v i t i e s that characterized the early history of occupational therapy. . . . Viewed h i s t o r i c a l l y , a sole emphasis on arts and c r a f t s i n occupational therapy represented a temporary aberration derived p a r t i a l l y from the sex-role stereotyping. Despite t h i s t r a d i t i o n a l stereotyping, Diazo f e l t that, i n f a c t , there was no t h e o r e t i c a l or l o g i c a l reason why occupational therapy should ever have been considered a woman' profession. The eighth area of concern i n the re-evaluation of the present and future therapist's role i s that of the trend to move occupational therapists out of i n s t i t u t i o n s and into the community. As recent as 1966, therapists working i n the areas of both physical dysfunction, such as Johnson and Smith (83), and psycho-social dysfunction, such as Conte (32), confirmed that the trend to community-based treatment had begu According to Conte, t h i s trend meant that therapists would have a broader range of treatment requirements to handle an increasing number of patients. Shimeld (142:10) r e f l e c t e d a growing philosophy concerning the therapist's role i n the community: As therapists, we must open our eyes and our minds to the world to which we are t r y i n g to help our patients return. Our treatment has to carry over into that world, and the patients' "mastery of his environment" has to extend beyond the walls of the c l i n i c and h o s p i t a l . R e i l l y (135:246) e n t h u s i a s t i c a l l y supported these community service trends: "For the young therapist, the r e a l action in the 1970's w i l l be the conversion of the occupational therapists' services from the hospital to the community." It would appear that the return of the therapist to community service w i l l not come about e f f o r t l e s s l y . Moore (117) f e l t that therapists would not be able to expand to any extent into the community because there would not be adequate numbers of c l i n i c i a n s available to meet the community needs. She re- commended that therapists should s p e c i a l i z e i n one of only two or three areas instead of the dozens of areas they are tr y i n g to be s p e c i a l i s t s i n now. Johnson and Smith (83) concluded that as therapists provide services to community programs they would require improved s k i l l s i n specialty areas such as education, research and consultation. These areas of s p e c i a l i - zation are presently being implemented and evaluated by the profession. THE EDUCATOR Although many therapists consider themselves to be medically-oriented, treating only pathology or psycho-social dysfunction, Gallagher (58:29) re-inforced one of the e a r l i e s t b e l i e f s i n the role of the occupational therapist as an educator when he asserted that "our aim i s to educate, not merely to provide humane treatment for the handicapped". That therapists accepted t h i s role as early as 1918 was established by a paper, "The Remuneration of the Teacher", presented at the second annual meeting of the National Association for the Promotion of Occupational Therapists, (22). 33. Over the years doctors (2), psychologists (130), nurses (86), and therapists (142) referred to r e h a b i l i t a t i o n as being the personal learning experience taking place following the medical correction of the physical d i s a b i l i t y . The aim of therapy i s to d i r e c t t h i s learning experience, and numerous therapists referred to t h e i r function as that of teaching the c h i l d or his parents, the hemiplegic, the aged or the amputee patient (60, 86, 115, 130, 157). As well as general references, there are s p e c i f i c references to the teaching r o l e of the occupational therapist. Dunlop (44) stated that i n order to practice occupational therapy successfully one must know how to teach and use her knowledge of teaching as a means to therapy. G i l l e t t e (62) said that although occupational therapists are seen as teachers, they are improperly seen as teachers of a c t i v i t i e s rather than teachers of behavioural change. Despite references to the therapist functioning as a teacher, there has been l i t t l e attention paid to the actual s k i l l s required by t h i s therapist i n order to teach. In one of the few references in d i c a t i n g the s p e c i f i c knowledge therapists should have i n order to teach, Peters (129) i n - dicated the need for therapists to know about how adults learn since the involvement of the patient i n the learning process was the basis for a successful treatment program. Therapists see t h e i r role not only as educators of patients, but also educators of other professionals, members of para-medical professions, the community, and student interns within t h e i r own profession (82, 83, 85, 149, 168). Johnson and Smith (83:270-271) attempted to look at the future /role of the occupational therapist as an educator. They predict that hospitals w i l l function as "educational health centers", and a l l c l i n i c a l occupational therapists w i l l be teaching i n whatever role they f u l f i l l . As the role of the occupational therapist expands to include a specialized role of educator, these writers emphasize that the education of the therapist must be changed; the modern curriculum should include methodology of education and the psychology of learning. In both the United States and Canada the national professional associations have accepted d i r e c t r e s p o n s i b i l i t y for education of therapists or therapy assistants. Between 1959 and 1967, the Canadian Association of Occupational Therapists sponsored a two-year Special Course i n Occupational Therapy to q u a l i f y therapists quickly at a time when there was a shortage of both therapists and educational f a c i l i t i e s for therapists i n Canada. The American Occupational Therapy Association -accepted the r e s p o n s i b i l i t y for setting standards and objectives for a t r a i n i n g program for occupational therapy assistants. They were able to do t h i s with the assistance of M. Ritvo, a t r a i n i n g consultant at the Human Relations Center, Boston University, and Dr. Malcolm Knowles, professor of education and general consultant.in adult education at Boston University (33). L i t t l e has been written concerning the educational preparation of the university faculty teaching occupational therapy. There were, i n 1970-1971, two two-year teaching diploma courses at Canadian u n i v e r s i t i e s , only one of which required education courses from a Faculty of Education. No 35. u n i v e r s i t y program i n occupational therapy i n Canada requires a teaching diploma for faculty members. The usual requirement to be a fu l l - t i m e educator of occupational therapists i s a variable number of years experience, demonstrated a b i l i t y , and a desire to teach. Those faculty members with teaching diplomas have found that u n i v e r s i t y administrations generally do not consider i t to be of value when evaluating the fac u l t y member's q u a l i f i c a t i o n s for promotion or tenure. Whether i t i s because of a lack of motivation or lack of opportunity on the part of the educators, a higher teaching q u a l i f i c a t i o n i s one of the major areas of deficiency when*, considering the s p e c i a l i s t role of the occupational therapist as an educator i n Canada. THE CONSULTANT The specialized role of the occupational therapy consultant i s not emphasized i n the l i t e r a t u r e u n t i l the middle of the 1960*s. West (170, 173) stated that since health care moved increasingly from the i n s t i t u t i o n to the community, the role of every occupational therapist had a consultative function. Ainsley (1), Howe and Dippy (77), and Johnson and Smith (83) support Cromwell's (35:17) opinion that the education and role of the occupational therapist must change and emphasize consultancy " i n order to produce con- temporary therapists prepared to meet future demands". She f e l t that these future demands would include more patients, hospitals, schools, chronic i l l n e s s e s , l e i s u r e time, public medicine, community medicine., ambulatory care, and more emphasis on prevention i n health care, a l l i n d i c a t i n g an increased need for consultants. Howe and Dippy (77) indicated that the trend points to therapists becoming increasingly concerned with health and prevention of dysfunction i n terms of in d i v i d u a l s , f a m i l i e s , groups, communities, and society as a whole. They report that therapists are now functioning as consultants to community centre a c t i v i t y programs, community care homes, half-way houses, adult education programs and youth groups. They also f e l t that private-practice consultants have helped develop the growth of occupational therapy as a profession. Erhardt (47) i l l u s t r a t e d t h i s growth i n her description of occupational therapy consultants' practice i n North Dakota which she f e l t had expanded occupational therapy beyond the t r a d i t i o n a l medical model of practice. Therapists there function as con- sultants i n three school programs for children with perceptual handicaps. They accept r e f e r r a l s from Public Health Nurses, vocational r e h a b i l i t a t i o n , schools, c l i n i c s , and hospital s o c i a l service departments as well as d i r e c t medical r e f e r r a l s . Although there i s a growing need for therapists who can accept the s p e c i a l i s t role of consultant, many therapists w i l l not formally accept t h i s r o l e . Leopold (90) has ex- amined the role of the consultant and explained that the consultation r e l a t i o n s h i p d i f f e r e d from the therapist-patient r e l a t i o n s h i p i n that the consultant generally lacks the opportunity for deep personal g r a t i f i c a t i o n available to the 37. c l i n i c a l therapist. Many therapists would be unable or unwilling to lose t h i s part of the therapist's i d e n t i f i c a t i o n , the core of t h e i r professional l i v e s . Mazer (111) sees the ide a l consultant's r o l e as one demanding s k i l l and knowledge of the occupational therapy treatment process, awareness and s k i l l i n the supervisory r e l a t i o n s h i p , a conviction of the need for research, and a high degree of s k i l l as an educator. Such a consultant may well be considered a therapist to the community rather than to the i n d i v i d u a l patient. The new role of the occupational therapist as a consultant has been well established over the past f i f t e e n years. General acceptance of t h i s role requires a change i n the education of therapists (83) , and Gordon (65) suggests a core curriculum ess e n t i a l to future consultants. This curriculum includes human r e l a t i o n s , communications, research and s t a t i s t i c s , teaching and curriculum construction, counseling, and admin- i s t r a t i o n . Moore (117:24) presented a challange to educators of future consultants when she said that the "present education i s no longer enough to prepare occupational therapists for the variety of roles we have chosen to perform". THE RESEARCHER In 1961, Sommers (152:25), a research psychologist, Said that "no profession can r e l y i n d e f i n i t e l y on members of another profession for concepts and a th e o r e t i c a l foundation. In the 38. next decade the need w i l l be for occupational therapists to engage i n research as an i n t e g r a l part of the occupational therapist's job". Sommers was not the f i r s t non-therapist to encourage occupational therapists to engage i n research. As early as 1922, Dr. Burnette (24:182) commented that, since the F i r s t World War, occupational therapy i n Canada had "done l i t t l e but regress i n terms of s c i e n t i f i c advances i n treatment of the mentally i l l " . He suggested that what the profession needed was some "quiet, earnest research work". Over the decades that followed, l i t t l e was accomplished in what might be c a l l e d research, but a great deal more was written on the need for research. The University of Toronto graduating class of 1940 wrote a paper on the need for research into suitable occupations or recreation for men i n submarine crews (166), a problem which therapists are now looking into i n terms of the manned space programs (29). There appears to be no lack of advice as to possible areas of research for occupational therapists. Fisher (55), a psychologist, suggested that occupational therapists could contribute to the f i e l d of learning by working out a taxonomy of psycho-motor s k i l l s , and R e i l l y (134), one of the few occupational therapists with a doctorate who remained i n the profession, emphasized that research i s necessary to provide a t h e o r e t i c a l basis of occupational therapy. A number of Canadian therapists have car r i e d out and published small studies on such diverse subjects as colour preference of older p s y c h i a t r i c patients (36), treatment of patients i n groups (48)., and the electromyographical study of neuromuscular a c t i v i t y (144). Despite some attempts to carry out research, West (168, 170) f e l t that, generally speaking, most therapists are content to proceed p r o f e s s i o n a l l y on a la r g e l y empirical basis. She observed that often both physicians and therapists f e l t that occupational therapists had no role i n research, however, West believes that occupa- t i o n a l therapists are now obtaining higher degrees, t r a i n i n g , and knowledge of research design and methodology which w i l l help overcome the problem which Cross (36:11) defined so accurately: "Occupational therapists - have always been urged to undertake research regardless of the fact that the majority have no t r a i n i n g i n research and s t a t i s t i c s ^ " , . There has been some attempt to a l l e v i a t e t h i s deficiency at the undergraduate l e v e l i n some Canadian u n i v e r s i t y programs i n occupational therapy, a small i n d i c a t i o n of pro- fessional acceptance of the role of the occupational therapist as a researcher. The development of specialized roles for the occupational therapist occurred gradually over a f i f t y year period, mainly through the e f f o r t s of in d i v i d u a l therapists rather than the profession as a whole. The role of the c l i n i c i a n has expanded to a point where i t i s impossible to define the role of an occupational therapy c l i n i c i a n . On the other hand, the special i z e d roles of educator, consultant, and researcher are only beginning to be developed, but already appear to have the approval of the profession as being legitimate areas of professional development. CHAPTER IV FACTORS INFLUENCING ROLE DEVELOPMENT Although new roles for the occupational therapist have developed and expanded the profession, the development would probably not have taken place without the pressures of i n - fluences outside of the profession. The purpose of t h i s chapter i s to give a b r i e f overview of some of l e g i s l a t i v e , s o c i a l , and medical factors which have influenced the role development within the profession. LEGISLATIVE INFLUENCES In Canada and the United States both present and future l e g i s l a t i o n has had, and w i l l have, an e f f e c t on the practice of occupational therapy. Such United States l e g i s l a t i o n as T i t l e XV111, Medicare, has, i n e f f e c t , forced the therapist to extend his services to the patient's home> and increased the need for services i n such agencies as nursing homes, penal i n s t i t u t i o n s , and extended care f a c i l i t i e s (74) . Such progressive l e g i s l a t i o n does produce some d i f f i c u l t i e s since no comparable l e g i s l a t i o n has been introduced to make pro- visions for increasing the supply of personnel to s t a f f these new programs (172). The introduction of a universal medical-care plan i n Canada has resulted i n s i m i l a r d i f f i c u l t i e s . There i s an increase i n the use of health services, and areas previously 40 considered to l i e e n t i r e l y within the spheres of s o c i a l adjustment, subject to education or correction rather than health services, have been drawn into the medical f i e l d (25) This has meant that the few available occupational therapist had to attempt to expand services into many areas that had not e a r l i e r been considered a legitimate area of practice (123). In Canada, both P r o v i n c i a l and Federal Governments have, or plan to have, l e g i s l a t i o n e f f e c t i n g the practice of occupational therapy. Three provinces, namely Manitoba, Nova Scotia, and Saskatchewan have l e g i s l a t i o n making the pr o v i n c i a l occupational therapy associations the lis c e n c i n g bodies for the profession. .-In Ontario, l e g i s l a t i o n i s about to be presented which appears w i l l r e s u l t i n the establishing of a College of Occupational Therapy which w i l l be responsible for li s c e n c i n g p r a c t i t i o n e r s i n that province At the National Conference on Education of Health Manpower held i n Ottawa i n October, 1971, speakers at the m i n i s t e r i a l and deputy-ministerial lev e l s indicated that recommended future federal l e g i s l a t i o n would have an e f f e c t on the practice of occupational therapy (160). They stated that, i n the future, the delivery of health services would take place to an increasing degree i n the community rather than i n chronic and acute care i n s t i t u t i o n s ; that federal money would increasingly go to predominately out-patient community health centres. The area of the education of health workers was not omitted from the Federal Government's area of concern. They f e l t that a far greater emphasis would be placed on prevent- ion i n health services, and educationally there would be proportionally more emphasis on the behavioural sciences while the emphasis on the physical sciences would be reduced. Of i n t e r e s t to occupational therapists i s the fact that the Federal Government proposes to be involved i n standards of education. Trider's (160:4) report on the National Conference mentioned that "the roles of a l l health workers w i l l be redefined according to the need for t h e i r services and t h e i r competency to provide the services". The Federal Government of Canada has also indicated concern with the present accreditation of a l l health professions. That occupational therapy as a profession w i l l be.included i n helping to form Federal Government po l i c y i s indicated i n a l e t t e r of A p r i l 21, 1972, from the o f f i c e of the Deputy Minister of Health to the President of the Canadian Association of Occupational Therapists (C.A.O.T.) in which the Minister explained that he was writing "to seek your advice and comments on means by which accredita- t i o n a c t i v i t i e s i n education i n the health d i s c i p l i n e s and provision of health services may be improved, with a view to achieving national standards, p o r t a b i l i t y of q u a l i f i c a - tions and c r e d i t s , and improved services i n the public i n t e r e s t " . In July, 1972, the President of the C.A.O.T. indicated that the C.A.O.T. was seriously considering the implications of future Federal intervention i n accreditation procedures. The present Basis of Approval of occupational therapy programs was drawn up j o i n t l y by the C.A.O.T. and, the Canadian Medical Association about 1959, and i s i n need of review i n any case, thus presenting a timely opportunity for discussion between the Government and the C.A.O.T. An area of l e g a l concern to occupational therapists can best be introduced by Dr. Friedmann's (57:405) thesis that " i t i s important for the man morally and l e g a l l y responsible for the care of the patient to be the man con- t r o l l i n g the care". This thesis has been accepted as fact by many therapists; that doctors are l e g a l l y responsible for a l l professional actions of the therapist and therefore the therapist i s obliged by law to work under medical d i r e c t i o n (4 3). However, consultation with a lawyer* indicated the f a l l a c y of t h i s commonly held b e l i e f . In f a c t , there i s no statute, as such, i n the United States or Canada, making the physician l e g a l l y responsible for the actions of an occupational therapist. In case law or common law, " t o r t law" deals with the r e s p o n s i b i l i t y of the i n d i v i d u a l and c i v i l wrongs. In t o r t law, the doctrine of respondeat superior relates to the r e s p o n s i b i l i t y of a p r i n c i p l e for the actions of his agent. However, t h i s r e s p o n s i b i l i t y i s true only when there i s very close control and supervision of the agent by the p r i n c i p l e , and i n the courts such r e s p o n s i b i l i t y i s decided on an i n d i v i d u a l basis. Thus, according to t o r t law, a physician i s responsible for the actions of an occupational therapist only i f i t can be shown * Personal communication. that there has been very close control and supervision of the therapist by the doctor, i n practice, an uncommon working re l a t i o n s h i p . If t h i s very close supervision and control i s not present, i t i s most probable that the therapist himself could be held responsible for his own actions and may be held accountable i n a court of law i n case of malpractice. According to t o r t law, Dr. Friedmann's claim that physicians alone are l e g a l l y responsible for a l l aspects of patient care must be re-evaluated by therapists and the r e s u l t i n g i m p l i - cations recognized. SOCIAL INFLUENCES Throughout the early developmental years of occupational therapy, the professional roles and functions adapted to the changing pressures and needs of society. Some of those pressures were: the two World Wars (39, 43, 154, 182),. the 1930 depression years (39, 154); i n d u s t r i a l i z a t i o n and urbanization (18, 35, 118); and the increasing f i n a n c i a l requirements for public health and welfare programs (84, 118, 154, 171). The l a t e r developmental years of occupational therapy were influenced by society re-examining i t s own needs i n terms of the r i g h t s of the i n d i v i d u a l (25, 148, 159, 164, 171); attitudes toward work and l e i s u r e (39, 83, 142, 166); and new social-medical r e s p o n s i b i l i t i e s (25, 146). The F i r s t and Second World Wars produced some sim i l a r influences on the development of occupational therapy r o l e s . The large numbers of wounded servicemen created the impetus for the profession not only to increase i t s numbers but to increase and develop new s k i l l s and techniques for tre a t i n g both the ph y s i c a l l y and mentally disabled v/ho were surviving because of improved medical care. Following the acute- treatment post-war periods, large numbers of therapists were no longer required i n the m i l i t a r y h ospitals. They moved out into mental hospitals, general hospitals, and community sheltered workshops where further new roles had to be developed. Shortly a f t e r the F i r s t World War, there was an era of economic prosperity and enlightened s o c i a l conscience. This, combined with the improvement i n medical sciences, resulted i n the establishing of large i n s t i t u t i o n s to care for the increasing numbers of ph y s i c a l l y ;or mentally chronica i l l , and further challenged the development of occupational therapy r o l e s . The depression years of the 1930's were troubled years for the developing profession. Although the number of therapists increased, budgets were cut and many therapists could not be hired, p a r t i c u l a r l y by small i n s t i t u t i o n s . As a r e s u l t , many therapists temporarily volunteered t h e i r services to larger i n s t i t u t i o n s i n order to prove t h e i r value as p o t e n t i a l employees. -After the depression, therapists were established mainly i n large mental i n s t i t u t i o n s , sanitoriums, and general hospitals. The Second World War casualties again encouraged therapists to re-evaluate t h e i r roles and develop new methods and techniques of treatment. By the end of the war they found themselves i n a new role;, no longer were they the sole a c t i v i t y g eneralists, But instead, one of many a n c i l l a r y therapists s p e c i a l i z i n g i n the area of physical medicine under the d i r e c t i o n of a new medical s p e c i a l i s t , the P h y s i a t r i s t . As a r e s u l t of war influences, the therapist's role had become narrow and controlled; she mow treated a part of the patient's body and provided a part of his a c t i v i t y needs, thereby relinquishing both part of the patient to others and much of her previous service to him as a human being. I n d u s t r i a l i z a t i o n and urbanization, and the concomitant r i s i n g cost of medical care, resulted i n the c l u s t e r i n g of major medical f a c i l i t i e s i n the larger metropolitan areas. Large spec i a l t y i n s t i t u t i o n s , such as r e h a b i l i t a t i o n hospital were developed, and therapists developed new specialty roles to f i t the needs of the i n s t i t u t i o n s . According to Mosey (118), these large i n s t i t u t i o n s came into being i n reaction to a breakdown i n established s o c i a l i n s t i t u t i o n s such as the family, the school, and organized medicine. The new urban mobile family could no longer provide custodial care to aged or disabled family members; the educational system was not oriented to managing or teaching the handicapped c h i l d ; and organized medicine's primary concern was the s p e c i a l i s t ' s treatment of acute i l l n e s s . As a r e s u l t , the i n d i v i d u a l therapist's role grew, and he flourished as a spec i a l i s t i n whatever new s i t u a t i o n he found himself. Concern with the r i s i n g costs of health and welfare 47. services was also responsible for changes i n health care services and delivery, both influencing role development. The r e h a b i l i t a t i o n movement, of which occupational therapy i s and was a part, was encouraged i n i t s development by insurance c a r r i e r s , governments, and private agencies for l a r g e l y f i n a n c i a l reasons. New drugs and su r g i c a l techniques were saving l i v e s but producing disabled indi v i d u a l s who had to be f i n a n c i a l l y supported, often by the public. It was observed that i f the handicapped could be r e h a b i l i t a t e d , many of them could be removed from public maintenance programs and become independent, contributing members of society. Agencies such as the Workman's Compensation Board found i t economically to t h e i r advantage, even as early as the 1920's, to e s t a b l i s h r e h a b i l i t a t i o n centres i n order to get the injured workman back on the job as quickly as possible and o f f compensation. These new developments opened other areas i n which therapists developed new roles and techniques. To a large extent f i n a n c i a l considerations were responsible for the development of delivery systems such as day-care hospitals and community health programs, a l l new areas of occupational therapy involvement. Although there were other factors contributing to the changes i n health care de l i v e r y , i n economic terms the changes were considered a good s o c i a l investment which would help to break into the poverty-sickness cycle and decrease the pote n t i a l f i n a n c i a l costs to society. The f i n a n c i a l factor has not been the only consideration as to why society i s encouraging and supporting changes i n o 48. health care delivery. A more recent phenomenon i s that of increased s o c i a l awareness of the health and s o c i a l needs of the i n d i v i d u a l , regardless of his a b i l i t y to pay, and an increased s o c i a l re-evaluation and acceptance of new medical problems and s o c i a l e t h i c s . For example, siociety has now accepted as a medical r e s p o n s i b i l i t y such problems as drug addiction and alcoholism, both previously considered l e g a l r e s p o n s i b i l i t i e s . As a r e s u l t , occupational therapists (146) are attempting to develop new therapy practices to a s s i s t with the problems of heroin d e t o x i f i c a t i o n . Therefore, occupa- t i o n a l therapy, having become involved i n new community programs, i s now concerned with the health need of the i n d i v i d u a l as a s o c i a l being, a s i t u a t i o n reminiscent of the moral treatment era. Another s o c i a l influence i s the present examination of work and the work ethic i n contemporary society. Diazo (39) pointed out that technological advances are having a marked e f f e c t on society and have implications for a l l occu- pational therapists, p a r t i c u l a r l y those working i n the areas of vocational r e h a b i l i t a t i o n . I t now takes a considerable length of time to acquire marketable work s k i l l s , and even then they quickly become obsolete; there are pressures for e a r l i e r retirement from work and an increase i n l e i s u r e time even for those who are working. According to Diazo, by 1980, the half of the population under twenty-five years of age and twenty percent of the population over retirement age w i l l a l l be consumers, not producers, i n society. Martin (108:26) has presented occupational therapists with some guidelines for working with patients or c l i e n t s i n the l i g h t of technological advances: If we set our goals c o r r e c t l y , automation and any other advances w i l l f a l l into perspective. . . . The most important of these goals are enhancement of motiva- t i o n , i n d i v i d u a l i t y and creative use of l e i s u r e time. The handicapped w i l l then f i t i n the community be i t at the l e v e l of open employment or leading a s a t i s f a c t o r y existence within his c a p a b i l i t i e s . These changes have encouraged society to re-evaluate the old t r a d i t i o n a l values of achievement through work. P a r t i - c u l a r l y concerned with the work values are the younger members of society who f e e l that "tools and machines man uses are no more, and not meant to be more, than extensions of his personality; and that with these tools man should only reach beyond the range of his l i m i t a t i o n s to serve human values" (142:9). The question put fort h i s whether occupational therapy can keep i n tune with such changes i n s o c i a l thinking which w i l l continue to change i n the future. To date, these s o c i a l influences have had "profound implications for the kinds of services occupational therapists provide for patients or c l i e n t s because of the close r e l a - tionship with patterns of work, l e i s u r e , and various r o l e - related and developmental a c t i v i t i e s that define occupational therapy practice" (39:238). MEDICAL INFLUENCES As a health profession c l o s e l y a l l i e d to medicine, 50. occupational therapy could not remain untouched by develop- ments and changes within the practice of medicine. One change occurred i n the 1940's when emphasis on medical s p e c i a l i z i n g produced a new role within the medical profession i t s e l f . The increasing number of patients with, physical d i s a b i l i t i e s and increased s k i l l s required to treat them produced the phys- i a t r i s t , or s p e c i a l i s t i n physical medicine and r e h a b i l i t a t i o n . This new s p e c i a l i s t depended to a great extent on the support of various kinds of therapists to carry out his d i r e c t i o n s for treatment of the patient. The p h y s i a t r i s t was the back-bone of the r e h a b i l i t a t i o n movement and therapists, including the occupational therapist, were, and are, the back-bone of t h i s medical specialty. A review of the l i t e r a t u r e has indicated three further major areas of change in medical practice which have i n f l u - enced p a r a l l e l changes i n the practice of occupational therapy: 1) changes and developments i n the s c i e n t i f i c practice of medicine; 2) changes and developments i n the philosophical practice of medicine; and 3) changes i n methods of health care delivery. According to Spackman (154) , a number of s c i e n t i f i c advances i n medicine following the F i r s t and Second World Wars stimulated the development of new occupational therapy roles and practices. For example, the discovery of a vaccine for p o l i o m y e l i t i s i n 1955 resulted i n an almost complete drop-off i n the number of. acute polio patients requiring treatment. Prio r to t h i s major s c i e n t i f i c discovery, the most common form of treatment involved surgical procedures 51. followed by a prolonged ' r e h a b i l i t a t i o n ' period. Within ten years of the cessation o f r p o l i o epidemics, few working therapists ever saw an acute polio patient. The medical discovery of a n t i b i o t i c s i n the 1930's and 40's also affected the development of occupational therapy. The use of a n t i b i o t i c s resulted i n an increase i n the li f e - s p a n of the general population and an increase i n treatment and care required for both the well and c h r o n i c a l l y - i l l aged. A n t i - b i o t i c s and improved surgical techniques also produced major problems which had not previously been i n evidence to any extent. They saved l i v e s which might previously have been l o s t , and what was l e f t was often maimed bodies and minds of quadraplegics, paraplegics, severe stroke patients, and cerebral palsied children, most of whom are now a treatment r e s p o n s i b i l i t y of the occupational therapist. The increase i n the production of new medical-pharmaceutical products produced the infamous thalidomide tragedies which occupational therapists are attempting to t r e a t . Insulin saved l i v e s but resulted i n more amputees for the therapist to t r e a t . Medical-technical developments such as home d i a l y s i s units for renal patients have moved therapists from the i n - s t i t u t i o n into the patients' home (88). The development of large numbers of drugs used to treat mental i l l n e s s e s has resulted i n both a greater number of treatable psychiatric patients for the occupational therapist and a need for the therapist to develop improved methods of treatment i n collaboration with an increasing number of other types of treatment personnel. R e i l l y (133) pointed out studies on sensory deprivation which indicate the need of an e f f i c i e n t l y functioning mind for constant environmental s t i m u l i , a discovery that both she and Shimeld (142) agree " i s a basic need that occupational therapy ought to be serving". Medical s c i e n t i s t s ' research i n neuro-physiology and the psychologists' research into learning have resulted i n a new function for occupational therapists treating perceptual motor dysfunction and learning d i s a b i l i t i e s . These are only a few of the obvious s c i e n t i f i c advances i n the practice of medicine which have had great influences on the growing and developing roles within the practice of occupa- t i o n a l therapy. From these examples, i t would appear that occupational therapy developed to a large extent as a solution to the many new and d i f f e r e n t problems a r i s i n g from s c i e n t i f i c advances i n the practice of medicine. The changes and developments i n the philosophical practice of medicine have also had considerable influence on the practice of occupational therapy. The two words, "prevention" and "community" might be considered the central core of concern i n new medical philosophy. According to the report of the 1965 Royal Commission on Health Services, "prevention i n the form of physical and mental f i t n e s s i s gradually evolving as a r e s p o n s i b i l i t y of the health services . . . " (25:11). It also reported that with new emphasis on home care and community care "the objectives of,modern general practice . . . seem to merge gradually with those of s o c i a l medicine, pre- ventative medicine, and the newly emerging concept of what t r a d i t i o n a l l y has been referred to as public health" (25:13). 53. Zamir (185:193). pointed out that one s i g n i f i c a n t concept i n the new philosophy as i t influences occupational therapy i s "health professions ceasing to be medical professions devoted to treating patients i n i n s t i t u t i o n s , but rather . . . expanding to health services to members of the community i n a v a r i e t y of s o c i a l , educational, and professional settings". Wiemer and West do not see t h i s prevention and community- oriented model of practice as either a substitute or replace- ment for the t r a d i t i o n a l medical model. Instead, they see i t as "an extension of occupational therapists' t r a d i t i o n a l role consistent with p a r a l l e l extensions of t r a d i t i o n a l roles of medicine and contemporary with consumer needs as they are now i d e n t i f i e d " (178:327). It i s pointed out that despite the fact that medical s p e c i a l i s t s such as p e d i a t r i c s and psychistry are already moving i n the d i r e c t i o n of the community and prevention, physicians, as yet, are not un- animous i n the desire to implement these approaches to medical care. However, many therapists are moving with the medical innovators into the areas of community and prevention. Therapists who may f e e l that t h i s new model does not concern them might well consider McWhinney's (106) admonition to medical students that i f they f a i l to meet the demonstrated needs of the public, society w i l l f i n d a way of meeting the need by turning to p r a c t i t i o n e r s outside of medicine. The t h i r d influence i n medicine which has affected role development i n occupational therapy i s that of health care de l i v e r y . As early as 1964, the Canadian Association of Occupational Therapists became concerned that changing patterns 54. of patient care were changing the role of the occupational therapist (105). T r a d i t i o n a l health care has been con- cerned with large, short-stay, acutercare general medical or surg i c a l i n s t i t u t i o n s and large, long-term chronic-care psy c h i a t r i c i n s t i t u t i o n s (35) . There are at lea s t three apparent reasons for the change i n emphasis from t h i s t r a d i - t i o n a l method to newer methods of health care de l i v e r y . Two have been mentioned, namely, the change and advances i n medical sciences and technology, and the change i n the philosophy of the practice of medicine. The t h i r d reason for the change i n emphasis involves f i n a n c i a l costs of health services. According to Nixon (123:190), the new health insurance plans or s o c i a l i z e d medicine "dramatize and exacerbate the inadequacies of the exi s t i n g d e l i v e r y systems and i t s painfu l shortages of manpower and f a c i l i t i e s " . It became obvious that for f i n a n c i a l reasons not everyone needing medical treatment could, or should, be admitted to acute care hospitals or even emergency departments or out-patient c l i n i c s . The less c o s t l y solution appeared to be that of taking the services to the people where they l i v e d (178). A number of methods of implementing the required new health care delivery systems have been suggested and t r i e d . The most common method involves a central medical centre surrounded by "outreach" c l i n i c s and services not considered to be a part of acute care f a c i l i t i e s (59, 35, 178). S a t e l l i t e c l i n i c s , neighbourhood service centres, group and family practice centres, nursing homes, and home care teams are new health care delivery areas i n which the modern occupational therapist i s finding a r o l e . Occupational therapy, i n l i n e with the new r e a l i t i e s of medical care programs and health care delivery systems, i s moving away- from a sole concern with i n s t i t u t i o n a l i z e d medicine In order to do so, occupational therapy has had to develop new roles to keep i t s services v i a b l e . Some therapists have re- jected these r o l e s , believing that occupational therapy i s moving away from medicine while other therapists express enthusiasm at the role developments, understanding that occu- pational therapy i s moving with medicine into the community. Wiemer and West demonstrate a profound understanding of and respect for the many experienced therapists who are finding the new, developing roles of the occupational therapist hard to accept. The new d e f i n i t i o n of occupational therapy implies a professional scope for which neither t h e i r education nor experience have prepared them. The emphasis on health, prevention, and community roles are undoubtedly foreign con- cepts to many of these experienced therapists. However, . . . i s i n r e l a t i o n s h i p to other medical and health related pro- fessions and t h e i r evolving roles i n the health partnership thslt occupational therapists w i l l mark out the boundaries of t h e i r true purpose and confirm the wisdom of the t r a d i t i o n a l , newer, or as-yet-unwritten d e f i n i t i o n of occupational therapy" (178:324). EDUCATIONAL NEEDS L e g i s l a t i v e , s o c i a l , and medical factors have influenced the r o l e development of the occupational therapist i n such a way as to r e s u l t i n the emergence of specialty roles such as consultant, educator, and researcher. They have also had an influence on d i r e c t i n g the c l i n i c i a n back into the community and have decreased the emphasis on the medical model of practice. The educational programs are responsible for preparing therapists to function within these new roles and functional settings. A b r i e f examination of the 1970 - 1971 educational programs i n Canada w i l l give some in d i c a t i o n as to whether or not these programs are f u l f i l l i n g the educational needs of future occupational therapists. T r a d i t i o n a l C1inica1 Reguirernents An examination of the 1970 - 1971 univer s i t y calendars would indicate that a l l eight u n i v e r s i t y programs are teaching c l i n i c a l therapeutic techniques appropriate to the t r a d i t i o n a l role d e f i n i t i o n of the occupational therapist (see Table 1 ) . New Role Requirements An examination of the new, developing roles indicate new areas of learning which are necessary to prepare therapists to f u l f i l l the requirements of these new r o l e s . These areas of learning include community and preventative occupational therapy s k i l l s and the e f f e c t of environmental influences on the practice of occupational therapy; research methodology and/or " s t a t i s t i c s ; teaching methods; learning theory; techniques of consultation; and increased emphasis TABLE 1 EDUCATIONAL PROGRAM CONTENT RELATED TO ROLE REQUIREMENTS Old Role New Occupational Therapy Roles Requirements* Requirements* Community, Research Techniques C l i n i c a l Prevention, and/or Teaching Learning of Therapeutic University Environment S t a t i s t i c s Methods Theory ConsultatiorJ Techniques Alberta no yes no yes no yes B r i t i s h Columbia no no no yes no yes Laval no no no yes no yes Manitoba no no yes yes no yes McGill no no no yes no yes Montreal no yes yes yes no yes Queen's no yes no yes no yes Toronto no no yes yes no yes * A l l information taken from o f f i c i a l 1970-1971 univesity calendars. 58. i n the area of the s o c i a l sciences. 1. Community, Prevention, and Environment: In 1970 - 1971, no Canadian educational programs indicated any emphasis on teaching students s k i l l s s p e c i f i c a l l y related to community or preventative occu- pational therapy or the e f f e c t s of environmental stress on the practice of occupational therapy (see Table 1). 2. Research Methodology and/or S t a t i s t i c s : In 1970 - 1971, only three of the eight professional programs i n Canada indicated that the teaching of s t a t i s t i c s and/or research methodology was part of the c u r r i c u l a (see Table 1). 3' Learning Theory: In 1970 - 1971, a l l eight univ e r s i t y programs indicated that t h e i r c u r r i c u l a included at l e a s t one course involving the teaching of learning theory (see Table 1). The majority of these courses were given by the psychology f a c u l t y . 4. Teaching Methods: In 1970 - 1971, only three of eight programs i n - dicated that they included teaching methods i n t h e i r undergraduate c u r r i c u l a (see Table 1). 5. Techniques of Consultation: In 1970 - 1971, no educational programs indicated the teaching of techniques of consultation to t h e i r occupational therapy students (see Table 1). 6. Emphasis on Social Sciences: In 1970 - 1971, the percentage of hours i n the TABLE 2 SOCIAL SCIENCE HOURS IN OCCUPATIONAL THERAPY CURRICULA University Total Number of Curriculum Hours c Number Social and Percentage of Science Hours L a v a l a 3024 0 (0%) Toronto 1 3 2639 103 • (4%) B r i t i s h Columbia 3* 3 2270 144 ( 6%) Queen's 3 2731 270 ( 9%) Manitoba 3 2910 330 (11%) Montreal 1568 240 (15%) . A l b e r t a 3 2795 429 (15%) M c G i l l 3 2538 450 (17%) a Options available which could be i n s o c i a l sciences. b Combined physical-occupational therapy programs. c A l l numbers are approximate as c r e d i t hours vary s l i g h t l y . 6 0 . s o c i a l sciences as compared to the t o t a l curriculum hours during the school year varied from zero percent to seventeen percent (see Table 2). It would appear that the Canadian educational programs are f i l l i n g the needs of the t r a d i t i o n a l occupational therapist. However, the majority of the programs are doing very l i t t l e , i f anything, to f i l l the new and developing needs of the contemporary therapist. An experimental occu- pational therapy program* i n i t i a t e d i n 1971 appears to be making a greater attempt than the t r a d i t i o n a l programs to f i l l the new needs of the therapist. Its 1971 - 1972 calendar indicated the following: a) Twenty-four percent of i t s curriculum was devoted to s o c i a l science content. b) Emphasis i s placed on community, preventive, and environ- mental occupational therapy. c) Both teaching methods and learning theory were included i n the curriculum. d) Research s t a t i s t i c s and methodology were included i n the curriculum. e) The teaching of t r a d i t i o n a l therapeutic techniques has been p a r t i a l l y replaced by the teaching of occupational r o l e and behaviour analysis and the s o c i a l , psychological, and k i n e t i c analysis of a c t i v i t y . * Program i n Occupational Therapy, the University of Western Ontario, London, Canada. The present plan of the experimental program i s to revise i t s curriculum as necessary in i t s attempt to f i l l the educational needs of therapists who w i l l be carrying out the new and changing roles of the occupational therapist as demanded by social, medical, and legislative factors. Although new roles for the occupational therapist have been developed by a minority of individual therapists, i t would appear that these individuals have reacted, to a great extent, to factors outside of the profession even more than to internal influences. Social, legislative, and medical influences have indicated the need for change which relatively few therapists and few educational programs have recognized. It would appear that the profession w i l l remain viable only so long as i t recognizes and reacts to the changing needs and requirements of society and the profession. CHAPTER V CONCLUSIONS AND RECOMMENDATIONS In both the United States and Canada there has been considerable concern expressed over the changing role of the occupational therapist. There i s presently no consensus within the profession as to the appropriateness or legitimacy of the roles as they appear to-have developed. Both therapists and non-therapists have expressed,the need to examine and re-evaluate the ro l e s , r e s p o n s i b i l i t i e s , and educational programs for occupational therapists. SUMMARY The purposes of t h i s study were to describe the role development of the occupational therapist, and to i d e n t i f y some of the factors which have influenced and directed the ro l e changes. An examination of the l i t e r a t u r e indicated that both generalist and s p e c i a l i s t roles of the occupational therapist have evolved or developed i n response to changing needs within society. It has been shown that s o c i a l , l e g i s l a t i v e , medical, and educational factors, and the evolutionary changes of these factors to meet new s o c i a l conditions and needs, have strongly influenced the legitimate role changes of the occupational therapist. I t was assumed that i f these role changes and t h e i r 62 influencing factors could be i d e n t i f i e d , t h i s study would then be of value to both the profession and the educators of therapists. Such an i d e n t i f i c a t i o n could a s s i s t them 1) to i d e n t i f y and evaluate trends influencing the ro l e development; 2) to i d e n t i f y some areas i n need of immediate research; and 3) to give some temporary guidelines as to changes that may be required i n the profession i f i t i s to remain viable. OBSERVATIONS AND' RECOMMENDATIONS An analysis of the review of the l i t e r a t u r e on the changing role of the occupational therapist has resulted i n observations and recommendations, which have implications for both the professions and the educators of the professionals. These w i l l be discussed under three headings: 1) role development; 2) research needs; and 3) educational needs. Role Development Observation 1: Within the medical model of pra c t i c e , the p h y s i a t r i s t i s only one of the many medical s p e c i a l i s t s with whom the occupational therapist can work. There i s no evidence in d i c a t i n g any v a l i d reason why therapists must work under the d i r e c t i o n of a p h y s i a t r i s t rather than with him except that i t has been t r a d i t i o n to do so. I t i s to the p h y s i a t r i s t s 1 advantage to stress t h i s t r a d i t i o n as i t supports them i n t h e i r own role c o n f l i c t s i t u a t i o n . 64. Recommendation: a) That therapists who submissively support t h i s t r a d i t i o n , i n h i b i t i n g t h e i r own professional development and that of the profession as a whole, examine t h e i r attitudes and seriously consider the necessity of supporting not only therapists, but the many physicians, o f f i c i a l medical associations, and governments who support o f f i c i a l recognition of occupational therapy as an independent profession. Attempts by tradition-bound therapists to i n h i b i t the profession i n i t s attempts to acquire independ- ence from the medical profession can only be a r e s u l t of a misunderstanding of the true s i t u a t i o n . b) That therapists must become more aware that the medical model of practice i s only one of several models i n which the occupational therapist can now function. Although the medical model i s not obsolete as an area of practice, therapists can help enhance t h e i r image by acknowledging the fact that they have chosen to work as professional equals i n t h i s area of practice rather than i n another available area of p r a c t i c e . Observation 2: Occupational therapy i s an e c l e c t i c profession, taking knowledge from many f i e l d s and d i s c i p l i n e s to develop new areas and theories of therapeutic treatment. Although some therapists are disturbed because occupational therapy does not appear to have a d i s t i n c t i v e and unique body of knowledge, i t must be noted that no developing profession today has a unique basis for i t s existence. To develop and grow, each must learn from the theory of other d i s c i p l i n e s . Recommendation: Since occupational therapy, as an e c l e c t i c profession, i s well suited to grow and to develop i t s own roles by drawing on knowledge of many other, more established d i s c i p l i n e s , therefore occupational therapists must become more aware of developments i n f i e l d s other than medicine i f they are to grow as professionals and develop t h e i r legitimate r o l e s . Observation 3: Changes i n i n s t i t u t i o n a l administration are necessary i f the profession i s to develop f u l l y . Recommendation: That once Chiefs of Occupational Therapy Services expect to be, and are, responsible to i n s t i t u t i o n administrators, the Chiefs should be responsible for encouraging professional development of therapists. In t h i s way the problem of achieved roles outrunning ascribed roles could be overcome. Observation 4: Sex-role stereotyping of the occupational therapist has been l a r g e l y the r e s p o n s i b i l i t y of the profession i t s e l f , and i t w i l l be up to the profession to change t h i s a t titude, both within and out of the profession. Recommendation: That as therapists become less submissive and conforming, occupational therapy should be less concerned with the necessity of r e c r u i t i n g males to the profession and more 66. concerned with r e c r u i t i n g the best i n d i v i d u a l s , regardless of sex, i n order to improve the image of occupational therapy. Observation 5: Health care delivery systems are changing. There i s l i t t l e i n d i c a t i o n that anyone w i l l approach occupational therapy asking for services i f he i s not aware of the pote n t i a l services of the therapist. Recommendation: That there i s a need for occupational therapists to evaluate t h e i r own services which could be implemented i n community programs, community c l i n i c s , and family practice units. I t w i l l be a r e s p o n s i b i l i t y of the profession to point out to administrators and governments the services therapists have to o f f e r which would help round out health services to t h e i r c l i e n t s . Observation 6: The changes i n s o c i a l attitudes towards the importance of work indicates a need for the re-evaluation of therapists' attempts to prepare the severely handicapped to take a vocational place i n a society which has accepted a remarkably high rate of unemployment among the non-disabled. Recommendation: That the theory behind, and the purpose of, r e h a b i l i t a - t i o n or sheltered workshops and the concomitant r o l e of the occupational therapist, must be re-evaluated. The l i t e r a t u r e appears to indicate a need for less emphasis on u n r e a l i s t i c attempts at vocational preparation and more emphasis on l e i s u r e and developmental a c t i v i t i e s . Observation 7 : Ethnical operation and professional accountability i s as true for occupational therapy as for any other profession. Trends i n d i c a t i n g that therapists w i l l be moving into the community and into private practice indicate a need for therapists to be aware of professional r e s p o n s i b i l i t i e s i n r e a l a t i o n to the law. Recommendation: That one i n d i c a t i o n of professional acceptance of t h i s r e s p o n s i b i l i t y might be the willingness of the professional association at the national l e v e l to support a group malpractice insurance plan for therapists throughout the country. Research Needs Observation 8: At present a l l curriculum r e v i s i o n s , and they are made a l l too infrequently, can be based only on an experimental and empirical basis which cannot be considered a s o l i d foundation for the building of a developing profession. This study has indicated two major professional areas requiring immediate research. The f i r s t i s i n the area of establishing a t h e o r e t i c a l basis for occupational therapy. Once t h i s has been established, the second area of research must be carried out, that of curriculum development for 68. occupational therapy programs. U n t i l a t h e o r e t i c a l basis has been established, there w i l l be no means of establishing, even t h e o r e t i c a l l y , what content, or how much of what content, should be included i n any occupational therapy curriculum. Recommendation: a) That unive r s i t y programs and faculty co-ordinate t h e i r e f f o r t s to do basic and applied research i n occupational therapy. b) That the primary emphasis i n research be the establishing of a t h e o r e t i c a l basis for occupational therapy followed by research into curriculum development. Observation 9: Most therapists are not q u a l i f i e d or capable of carrying out v a l i d research which i s the l i f e - b l o o d of a developing profession. Both the lack of professional research and the lack of opportunity for therapists to learn how to do research would indicate that the educational programs have been for too long followers of, rather than leaders i n , professional development. Recommendation: a) That educational programs must consider ways and means of including research methodology and s t a t i s t i c s i n t h e i r c u r r i c u l a as soon as possible. b) That faculty members of un i v e r s i t y programs have a r e s p o n s i b i l i t y to do research that w i l l a s s i s t i n both t h e i r own development and the development of the profession. c) That further opportunity f o r professional research be established i n the development of graduate programs at the Masters l e v e l i n occupational therapy i n Canada. These programs w i l l not be established u n t i l the present programs are upgraded to honours l e v e l standing within the u n i v e r s i t i e s . Educational Needs Observation 10: Although i t has been established that the occupational therapist i s an educator however he functions, at present the education of the therapist as an educator appears to be inadequate. Recommendation: That teaching methods and s k i l l s as well as p r i n c i p l e s of learning be incorporated i n a l l undergraduate programs. Observation 11: The present shortage of pot e n t i a l occupational therapy faculty i s exacerbated by the attitudes of experienced therapists who f e e l that they do not know how to teach and therefore have no i n t e r e s t i n teaching. Recommendation: That students at the undergraduate l e v e l become more aware of the fact that, while carrying out any function as a therapist, she w i l l be f u l f i l l i n g the role of an educator, or teacher. If t h i s concept were emphasized by educators, more therapists might be w i l l i n g to consider the r o l e of educator as a l o g i c a l area of occupational therapy s p e c i a l i z a t i o n . 70. Observation 12: Of the two Diploma teaching courses functioning i n 1970 - 1971, one had obligatory courses for students within the Faculty of Education while the other appeared to have a learn-by-doing o r i e n t a t i o n . Recommendation: That post-graduate programs i n occupational therapy have closer t i e s to u n i v e r s i t y education and/or adult education departments so that the experienced therapists may have access to the learning opportunities necessary for capable and confident teaching. Observation 13: Accreditation procedures for educational programs are now best carried out under the d i r e c t i o n of the national administrative body for occupational therapists. Recommendation: That an accreditation advisory body should be composed mainly of therapists, but with representation from other health professions and the community. Observation 14: As the therapist's roles expand, the number of therapists required to f i l l these new roles i s increasing. There presently appears to be no adequate system for educating the numbers of highly q u a l i f i e d therapists that are required to f i l l the role of consultant. The s k i l l s of the consultant require a specialized breadth of knowledge. Few s k i l l s required by the consultant are being taught i n the t r a d i t i o n a l educational programs. Recommendation: That students be prepared at the undergraduate l e v e l to par t i c i p a t e to a greater extent as potential consultants. As a consultant, one therapist could provide a service to several f a c i l i t i e s instead of to one. With a background of th e o r e t i c a l knowledge, experience, and s k i l l s i n education and consultancy, the therapist could teach many other non- professionals to carry out part of the services that the therapist would previously have attempted to do alone. Observation 15: Schools and educational programs have encouraged sex-role stereotyping i n the past. A number of programs have made i t known that they do not have f a c i l i t i e s for male students and most have emphasized the teaching of therapeutic a c t i v i t i e s which themselves were considering to be stereotyped, female occupations. Recommendation: That educators seriously consider the p o s s i b i l i t y that they may be attempting to produce therapists i n t h e i r own image, thus inadvertently encouraging the sex-role stereotyped image so common to the profession. Observation 16: There i s a need for more emphasis on the behavioural sciences and less on the physical sciences for future health 72. science p r a c t i t i o n e r s . Recommendation: That an assumption be made that there are no longer v a l i d reasons why a therapist must wait for an opportunity to carry out postgraduate work i n the s o c i a l sciences i n order to f i l l a basic need he has found i n his professional experience. Observation 17: The continually raised question of the need for pro- fessi o n a l programs to assign hundreds of hours to the teaching of arts and c r a f t s s k i l l s must rais e serious doubts i n the minds of the educators. To continue to emphasize the need for students to learn how to s k i l l f u l l y construct products from beginning to end reinforces the role of the therapist as a technician rather than a professional. A non-arts-and- c r a f t s trend has been emphasized i n the l i t e r a t u r e , but to date only the experimental course has implemented t h e o r e t i c a l and p r a c t i c a l k i n e t i c - a n a l y s i s i n i t s curriculum i n place of the emphasis on teaching expertise i n s p e c i f i c c r a f t s k i l l s . Recommendation: . v- That to educate the student i n the p r i n c i p l e s of s o c i a l , psychological, and k i n e t i c analysis would appear to be a sound p o l i c y which would better prepare the student to focus on the needs of the patient or c l i e n t . It would also free hundreds of curriculum hours which could be used to i n - corporate previously indicated new content requirements. Observation 18: There are both, l e g i s l a t i v e and s o c i a l indications that the future emphasis i n the health sciences w i l l include prevention, community services, and the education of competent general p r a c t i t i o n e r s . Recommendation: That occupational therapy examine and re-define i t s role and function i n the community and adapt i t s educational programs to prepare more students to be competent i n the growing community service programs. If t h i s self-examination does not take place, someone else w i l l do i t and f i n d occu- pational therapy lacking i n competencies to j o i n with the other medical or health professions i n community health services. CONCLUSIONS The roles of the occupational therapist are changing i n response to l e g i s l a t i v e , s o c i a l , and medical influences. Although the c l i n i c i a n , or generalist, i s acknowledged to be the backbone of the profession, i t has been found that s p e c i a l i s t r o l e s , such as educator, researcher, and con- sultant, are becoming more prevalent. These s p e c i a l i s t roles have developed i n response to s o c i a l and professional needs which cannot be f i l l e d by the present inadequate numbers of c l i n i c i a n s . It has also been found, p a r t i c u l a r l y i n Canada, that professional programs have not adequately educated therapists to f i l l these new r o l e s . The administrators and f a c u l t y of educational programs' appear to be r e t i c e n t i n introducing changes i n t h e i r c u r r i c u l a which, r e f l e c t i n g present and future trends, might better prepare the future therapists to f i l l the new and developing r o l e s . Of the eight programs in Canada i n 1970 - 1971, none contained content related to community, prevention, or the environment. Only three programs include s t a t i s t i c s and/or,research methods, three include content on teaching methods, and none include any content on techniques of consultation. On the other hand, a l l eight spend hundreds of hours teaching s p e c i f i c "therapeutic techniques", or c r a f t s k i l l s which, according to the l i t e r a t u r e , are becoming obsolete modalities of treatment for occupational therapists. I t becomes increasingly evident that the profession, the i n d i v i d u a l therapist, and p a r t i c u l a r l y the educators, must re-examine t h e i r roles i n the l i g h t of the new l e g i s l a t i v e , medical, and s o c i a l trends i n society. Professional and educational changes must take place soon i f occupational therapy i s to remain a viable health profession. SELECTED BIBLIOGRAPHY Ainsley, J . ; Barnes, S.; Grove, E.; Johnson, T.; Koorman, C ; and Stephens, C. "On Change," American Journal of Occupational Therapy, 23:186-189 (1968). Aitken, A.N. "Rehabilitation Therapy i n a Sanitorium," American Journal of Occupational Therapy, 1:10-17 (1947). American Occupational Therapy Association. Descriptions of Function i n Occupational Therapy, New York: The American Occupational Therapy Association, 1969. American Occupational Therapy Association. Professional Reactivation i n Occupational Therapy, Dubuque, Iowa: Kendall-Hunt Publishing Company, 1969. American Occupational Therapy Association. "Occupational Therapy: Its D e f i n i t i o n and Functions," American Journal of Occupational Therapy, 26:204-205 (1972). Andrews, W. "Occupational Therapy Programmes and the P s y c h i a t r i s t , " Canadian Journal of Occupational Therapy, 32:119-120 (1965). Angus, L. R. "Some Newer Methods i n Occupational Therapy as Practiced at the Neuro-Psychiatric Ins t i t u t e of the Hartford Retreat," Canadian Journal of Occupational Therapy, 1:9-16 (1933). Aranoff, P. "Occupational Therapy and Ch i l d Psychiatry," Canadian Journal of Occupational Therapy, 34:5 (1967) . • ' Arkansas Rehabilitation Research & Training Center. "Community Involvement," i n Report of Current and Future Trends i n Rehabilitation as They A f f e c t Occupational Therapy i n Rehabilitation , Arkansas, p.70 (February, 1967). Baker, F.; O'Brian, G.M.; and Sheldon, A. "Reference Groups of Occupational Therapists: Role Orientation i n a Mental Hospital." American Journal of Occupational Therapy. 22:197-202 (1968) . 76. Bannister, H.F. "Legislative.Changes and Their Implications," Report of Current and; Future" - Trends i n Rehabilitation as They Affe c t Occupational Therapy i n Rehabilitation , Hot Springs National Park, Arkansas, pp.13-19 (February, 1967). Barager, C.A. "Occupational Therapy as Seen by a P s y c h i a t r i s t , " Canadian Journal of Occupational Therapy. 2:3-9 (1934). Bayne, J. "The Role of Occupational Therapy i n Sheltered Workshops," Canadian Journal of Occupational Therapy, 37:108-112 (1970). Bernd, Joan. "The Challenge of Rehabilitation Workshops, Canadian Journal of Occupational Therapy, 34:151 (1967). Berteling, Mary K. "Occupational Therapy at Walter Reed General Hospital," Canadian Journal of Occupa- t i o n a l Therapy. 12:4 (1945). Bickl e , Mildred, R. "The Hamilton Workshop," Canadian Journal of Occupational Therapy, 7:81 (1940). Biddle, B. and Thomas, E. Role Theory: Concepts and Research. New York: John Wiley & Sons, Inc. 1966. Bockoven, J.S. "Challenge of New C l i n i c a l Approaches," American Journal of Occupational Therapy, 22:23-25 (1968). " — . "Legacy of Moral Treatment - 1800's to — 1910," American Journal of Occupational Therapy, 25:223-225 (1971). Brackett, E.G. "Scope of Occupational Therapy," Archives of Occupational Therapy, 1: (1922). Brown, Lawrie. "Rehabilitation Foundation for the Disabled," Canadian Journal of Occupational Therapy, 31:19-21 (1964). Brunyate, Ruth. "Powerful Levers," American Journal of Occupational Therapy. 12:195 (1958). Burk, Richard D. "General Trends i n Rehabilitation Centres," Report of Current and Future Trends i n Rehabilitation as They Affe c t Occupational Therapy i n Rehabilitation , Hot Springs National Park, Arkansas, pp.4-7 (February, 1967). Burnette, Norman L. "The Status of Occupational Therapy in Canada," Archives of Occupational Therapy, 2:179-182 (1922). Canada. Emerging Patterns i n Health Care, edited by Robert Kohn, Royal Commission on Health Services, Ottawa: Queen's Pr i n t e r , pp.3-68 (1965). _________ Canadian Census C l a s s i f i c a t i o n , Professional and Technical Occupations, Ottawa: Queen's Print e r , 1961 (revised, 1967). Cardwell, Thelma. "President's Address," Canadian Journal of Occupational Therapy, 33:139 (1966). Carpendale, M.T.F. "Does Rehabilitation Work?," Canadian Journal of Occupational Therapy, 32:132 (1965). Catterton, Marianne M. "Dimensions of Occupational Therapy," Canadian Journal of Occupational Therapy. 32:153-164 (1965). Charters, A.N. "Continuing Education i n the Professions," Handbook of Adult Education, New York: The MacMillan Company, pp.490-491 (1970). Colbert, James N. "Philosphia Habilatus," Journal of Rehabilitation , pp.18-19 (Sept.-Oct. 1969). Conte, W.R. and Meuli, A.L. "Occupational Therapy i n Community Mental Health," American Journal of Occupational Therapy, 20:147-150 (1966). Crampton, M.W. "Educational Upheaval for Occupational Therapy Assistants," American Journal of Occupational Therapy, 21:317-320 (1967). Cromwell, Florence S. "Occupational Therapist - Observer or Evaluator?," Canadian Journal of Occupational Therapy. 33:63' (1966). • . "Trends i n Occupational Therapy," Proceedings of Workshop for Improvement of Educational Techniques of Occupational Therapy C l i n i c a l Supervising Personnel, University of North Dakota,. Grand Forks, N.D., pp. 17-21 (January, 1971). Cross, D.S. "Colour Preference of Older Patients," Canadian Journal of Occupational Therapy, 27:9-11 (1960). 78. Dancey, Freda K. "Have You an Idea?," Canadian Journal of Occupational Therapy, 31:51 (1964). De La Charite, S i s t e r Jean. "The Neglected Phase of Rehabilitation," Canadian Journal of Occupational Therapy, 29:101 (1962). Diasio, Karen. "The Modern Era - 1960 to 1970," American Journal of Occupational Therapy, 25:237-242 (1971). D i l l y , H. "Changing Patterns of Health Care Services," American Journal of Occupational Therapy, 24:403-408 (1970). Driver, Muriel F. "A Philosophic View of the History of Occupational Therapy i n Canada," Canadian Journal of Occupational Therapy, 35:53-60 (1968). _. "Seek we Status or Stature," Canadian Journal of Occupational Therapy, 34 :57 (1967). ~ ~ Dunlop, W.J. "A B r i e f History of Occupational Therapy," Canadian Journal of Occupational Therapy, 1:6 (1933). . _. "The Occupational Therapist as a Teacher," Canadian Journal of Occupational Therapy, 2:11-12 (1934). . ; LeVesconte, H.P.; de Brisay, A.; et a l . "Report of Committee on Education," Canadian Journal of Occupational Therapy. 7:82 (1940). Ebner, J . ; King, L.; Monical, B.; Monkhouse, E.; Sc h l o r f f , V.; and Wallace, L. "A Statement on Occupational Therapy and Physical Therapy i n Community Health," American Journal of Occupational Therapy, 24:46-47 (1970) . Erhardt, R.P. "The Occupational Therapist as a School Consultant for Perceptual-Motor Programming," American Journal of Occupational Therapy, 35:411-414 (1972). [ ; Ernest, Marilyn. "Occupational Therapy Study on Treatment i n Groups," Canadian Journal of Occupational Therapy, 33:148-150 (1966). " "Continuing Education and Occupational Therapy," Canadian Journal of Occupational Therapy, 37:69-70,76 (1970). 79. 50. Farrar, C.B. "Rehabilitation i n Nervous and Mental Cases Among Ex-Soldiers," Canadian Journal of Occupational Therapy, 7:25 (1940). 51. F i d l e r , G a i l S. "A Guide to Planning," American Journal of Occupational Therapy, 18:240-243 (1964). 52. - "Learning as a Growth Process," America'n Journal of Occupational Therapy, 20:1-8 (1966). 53. F i d l e r , N.D. "Occupational Therapy from the Nursing Standpoint," Canadian Journal of Occupational Therapy, 2 :114-117 (1935). 54. F i e l d s , B. "What i s Realism i n Occupational Therapy?," American Journal of Occupational Therapy. 10:9-10,34 (1956). 55. Fisher, Lawrence. "Upheaval i n Education," American Journal of Occupational Therapy. 21:362-367 (1967). 56. Friedland, J . and Murphy, Marge. "A Group Approach i n Psychiatric O.T.," Canadian Journal of Occupational Therapy, 32:110 (19637": 57. Friedmann, Lawrence W. "Medicine, Nursing,and Physical Therapy," Archives of Physical Medicine and Rehabilitation , pp.404-406 (Sept., 1971). 58. Gallagher, James. "Cooperation for Service," Journal of Rehabilitation , p.29 (Mar.-Apr., 1969). 59. G a r f i e l d , S. "The Delivery of Medical Care," S c i e n t i f i c American, Vol. 222, No. 4, pp.15-23 (1970). 60. Gaylard, Anne. "Treatment of Children with Perceptual Problems. An Introduction to the Role of the Occupational Therapist," Canadian Journal of Occupational Therapy, 33:53 (1966). 61. Gibbon, Marion. "History of Occupational Therapy i n the Maritimes," Canadian Journal of Occupational Therapy, 7:73 (1940). 62. G i l l e t t e , N.P. "Changing Methods i n the Treatment of Psychosocial Dysfunction," American Journal of Occupational Therapy, 22:230-233 (1967). 63. Goble, Rita E.A. "The Role of the Occupational Therapist i n Disabled Living Research," American Journal of Occupational Therapy, 33:145-152 (1969). 80. Gordon, Beth. "Why Occupational Therapy?," Canadian Journal of Occupational Therapy. 37:141-144 (1970). Gordon, D.W. "The Function of a Consultant," Nursing Outlook. 1:575 (.1953). Greenland, C y r i l . "What's New? Occupational Therapy i n 1883," Canadian Journal of Occupational Therapy. 29:80 (1962). H a l l , Herbert J . "American Occupational Therapy Association," Archives of Occupational Therapy, 1:163-165 (1922). Harwood, J.H. and McLaughlin, B. "Nature, Extent and Scope of the Health Needs i n North Dakota and Resources Available to Meet These Needs," Proceedings of Workshop for Improvement of Educational Techniques of Occupational Therapy C l i n i c a l Supervising Personnel, University of North Dakota, Grand Forks, N.D., pp.10-11 (January, 1967). ' Haworth, Norah A. and MacDonald, E. Mary. Theory of Occupational Therapy, London: B a i l l i e r e , T i n d a l l & Cox, pp.1-5 (1940). Heath, Sheldon. "Uses and Misuses of Psychiatric O.T.: O.T. as a Haven," American Journal of Occupational Therapy, 22:19-22 (1968). Heaton, T.G. "Occupational Therapy for the Tuberculous," Canadian Journal of Occupational Therapy and Physiotherapy, 4:54-61 (1937). Hebert, B.; Beaudoin, J . ; Hutchison, J . ; and Jan e l l e , C. "Problems Physiques et Psycho-Sociaux des Hemiplegiques Ages," Canadian Journal of Occupational Therapy, 34:113 (1967). Henry, Nelson B., ed. The Dynamics of Instructional Groups, National Society for the Study of Education, Chicago: The University of Chicago Press, pp. 33-34 (1960). Hightower, Mae D. "The Extensions of Occupational Therapy Services into the Community," Report of Current and Future Trends i n Rehabilitation as They Affe c t Occupational Therapy i n Rehabilitation , Arkansas, pp. 37-42 (February, 1967). 81. 75. Hood, Margaret, R. "Report on the Fourth International Congress of the World Federation of Occupational Therapists," Canadian Journal of Occupational Therapy, 33:151 (1966). 76. Houle, C y r i l 0. "The Role of Continuing Education i n Current Professional Development," American Library Association B u l l e t i n , 61:263-264 (Mar., 1967) . 77. Howe, M. and Dippy, C. "The Role of O.T. i n Community Therapy, 22:521-524 (1968). 78. Howland, G.W. "President's Address," Canadian Journal of Occupational Therapy, 1:4-6 (1933). 79. . "President's Address," Canadian Journal of Occupational Therapy, 7:60 (1940) . 80. . "President's Address," Canadian Journal of Occupational Therapy, 11:3 (1944). 81. Huston, J . "Occupational Therapy i n the F i e l d of Physical D i s a b i l i t i e s , " Canadian Journal of Occupational Therapy, 33:101 (1966). 82. Jenson, Inez. "The Occupational Therapist i n a Home Care Program," American Journal of Occupational Therapy, 20:288-301 (1966). 83. Johnson, Terry, and Smith, Margaret. "Changing Concepts of Occupational Therapy i n a Community Rehabilitation Center," American Journal of Occupational Therapy. 20:267-273 (1966). 84. Jones, Arthur M. "Occupational Therapy i n a Day Hospital," Canadian Journal of Occupational Therapy, 27:5 (1960). , 85. Kahmann, W.C. "Organization and Administration of Occupational Therapy," Canadian Journal of Occupational Therapy. 3:69-74 (1935). 86. Klorke, Toben. "The Role of Nursing Management i n the Behavioural Change of Hemiplegia," Journal of Rehabili t a t i o n . p.24 (July-Aug., 1969). 87. Kovell, Joyce. "A Home Care Program," American Journal of Occupational Therapy, 18:255-259 (1964). 88. Lake, Susan. "The Kidney D i a l y s i s Center and the Role of Occupational Therapy," American Journal of Occupational Therapy. 22:269-274 (1968). 82. 89. Laurencelle, P. "An Analysis of the Social and Socio l o g i c a l Implications of Rehabilitation," American Journal of Occupational Therapy, 22:329-331 (1968). 90. Leopold, Robert L. "Consultant and Consuitee: An Extraordinary Human Relationship," American Journal of Occupational Therapy, 22:78-81 (1968). 91. Letchworth, A l i c e . "Committee Report: Registration Committee," American Journal of Occupational Therapy, 1:38 (1947). 92. Le Vesconte, H.P. "The Place of Occupational Therapy i n Social Work Planning," Canadian Journal of Occupational Therapy, 2:13-16 (1934). 93. : "Expanding F i e l d s i n O.T.," Canadian Journal of Occupational Therapy, 3:4-12 (1935). — " 94. . "The American Occupational Therapy Association Celebrates i t s T h i r t i e t h Birthday during 1947," American Journal of Occupational Therapy. 1:37-52 (1947). 95. Lind, A. "An Exploratory Study of Predictive Factors for Success i n the C l i n i c a l A f f i l i a t i o n Experience," American Journal of Occupational Therapy, 24:222-226 (1970). 96. Linton, Ralph. The Cu l t u r a l Background of Personality, New York: Appleton-Century Co., 1945. 97. Llorens, Lela A. "Changing Methods i n Treatment i n Psychosocial Dysfunction," American Journal of Occupational Therapy. 22:26-29 (1968). 98. Lynes, P.G.; Kingsmill, E.; and Greenland, C. "Remoti- vation Project," Canadian Journal of Occupational Therapy. 28:5 (1961). 99. MacBain, P a t r i c i a . "O.T.'s on Wheels," Canadian Journal of Occupational Therapy, 37:63-68 (1970). 100. McCordick, Lyn. "Education and the Future Role," Canadian Journal of Occupational Therapy, 38:37 (1971). 101. McCreary, J.F. "Address to Canadian Congress of Physical and Occupational Therapists, Vancouver, 1960," Canadian Journal of Occupational Therapy. 27:70 (1960). 83. McDonald, Ladd. "Psychiatric Rehabilitation, Resource in a Revolution," Journal of Rehabilitation , pp.21-23 (July-Aug., 1969). McGhie, B.T. and Myers, E.R. "Occupational Therapy i n a Mental Hospital Service," Canadian Journal of Occupational Therapy, 1:11-12 (1933) . McLeod, Mary. "Psychiatric Refresher Course - 1963," Canadian Journal of Occupational Therapy. 30:153 (1963). McQueen, Margaret E. "Education Committee Report," Canadian Journal of Occupational Therapy, 31:167 (1964). McWhinney, Ian R. An Introduction to Family Medicine, Preliminary ed. London, Ontario: University of Western Ontario, 1970. Mansfield, N. "The Occupational Therapy Assistants' Course," Canadian Journal of Occupational Therapy, 26:51-54 (1959). Martin, J.K. "How Automation W i l l A f f e c t the Future Vocational Goals of the Multiply Handicapped Chil d , " Canadian Journal of Occupational Therapy, 34:22-27 (1967). Mase, Darrel J . "The Dimensions of Change," American Journal of Occupational Therapy, 21:129-136 (1967). Master and Servant. Medical Post (Oct., 1969). Mazer, June L. "The Occupational Therapist as Consultant," American Journal of Occupational Therapy, 23:417-421 (1969) . Mendoza, Norma. "The Role of an Occupational Therapist i n a Home Setting," American Journal of Occupational Therapy, 23:141-144 (1969). Messick, H. Elizabeth. "The Future of Occupational Therapy i n the Army," American Journal of Occupational Therapy, 1:26 (1947). Mial, H. C u r t i s . "What i s a Consultant?," Public Relations Journal, (Nov. , 1959). Michaels, L. "Rehabilitation i n Patients with Strokes. The Role of the Physician," Canadian Journal of Occupational Therapy, 32:18-19 (1965). 84. 116. Minard, Christopher M. "The Occupational Therapist as an Innovator," American Journal of Occupational Therapy, 22:190 - 194 (1968). 117. Moore, Josephine C. "Changing Methods i n the Treatment of Physical Dysfunction," American Journal of Occupational Therapy, 21:18-28 (iyb7). 118. Mosey, Anne Cronin. "Involvement i n the Rehabilitation Movement - 1942-1960," American Journal of Occupational Therapy, 25:234-236 (1971). 119. Munroe, A. "Occupational Therapy and the Chi l d with Congenital Deformities of the Upper Extremity," Canadian Journal of Occupational Therapy, 28:71-75 (1961). 120. Nichols, P.J.R. "The Place of Paramedical Personnel i n C l i n i c a l Research," Annals of Physical Medicine, 10:7 (1969). 121. Nickel, V.L. "The Orthopedic Surgeon and the Occupational Therapist," American Journal of Occupational Therapy, 22:86-88 (1968). 122. Nixon, Russell A. "Rehabilitation - Human Reinforcement in a Troubled World," Journal of Rehabilitation, p.14 (Mar.-Apr., 1969). 123. ; • "The C r i s i s and Challenge of Human Services i n the New Decade," American Journal of Occupational Therapy. 25:187-192 (1971). 124. Overs, Robert P. " A t t i t u d i n a l Barriers to Using Research Findings," Journal of Rehabilitation, p.22 1 (Sept.-Oct., 1969). 125. Owen, Carolyn M. "An Analysis of the Philosophy of Occupational Therapy," American Journal of Occupational Therapy, 22:502-505 (1968). 126. Parker, Ardythe, A. "Institute on Child Prosthetics," Canadian Journal of Occupational Therapy. 30:115-116,124 (1963) . 127. Peake, Laurence N. "Occupational Therapy, Nursing, and Physical Therapy," Archives of Physical Medicine and Rehabilitation , pp.406-408 (Sept., 1971). 128. Per Mentem et Manus ad Sanitatem, Canadian Journal of Occupational Therapy, 31:4 (1964). 85. 129. Peters, Henry N. "Learning as a Treatment Method i n Chronic Schizophrenia," American Journal of Occupational Therapy. 9:185-189 (1955). 130. Pincus, A l l e n . "New Findings on Learning i n Old Age: Implications for Occupational Therapy," American Journal of Occupational Therapy, 22:300-302 (1968). 131. Pochert, Lois. "Our New Role Challenge: The Occupational -Therapy Consultant," American Journal of Occupational Therapy, 24:106-110 (1970). 132. R e i l l y , Mary. "The Role of the Therapist i n Protective and Functional Devices," American Journal of Occupational Therapy. 10:132-133 (1956). 133. • "Occupational Therapy Can Be One of the Great Ideas of 2 0th Century Medicine," American Journal of Occupational Therapy, 16:1-9 (1962). 134. . "The Challenge of the Future to an Occupational Therapist," American Journal of Occupational Therapy. 20:221-225 (1966). 135. "The Modernization of Occupational Therapy," American Journal of Occupational Therapy, 25:243-246 (1971). 136. Report of the F i r s t Student-Faculty Conference on Interprofessional Education, Vancouver, B r i t i s h Columbia: University of B r i t i s h Columbia, p.4 (1968). 137. Rerek, Margaret D. "The Depression Years - 1929-1941," American Journal of Occupational Therapy, 25:231-233 (1971). 138. Richards, L. "Group Therapy i n a Rehabilitation Centre," Canadian Journal of Occupational Therapy, 33:141-147 (1966). 139. Roberts, C.A. "Healing the Sick, Responsibility or P r i v i l e g e , for the Patient or the Professional Therapist," Canadian Journal of Occupational Therapy. 29:5-14 (1962). 140. Rood, Margaret S. "A Program for Paraplegics," American Journal of Occupational Therapy, 1:22-25 (1947). 141. Schoen, K. "A Climate of Expectation," American Journal of Occupational Therapy. 26:119-124 (1972). 86. 142. Shimeld, Arlene. "Youth of Today and Their Influences on the Practice of Occupational Therapy," Canadian Journal of Occupational Therapy, 38:3-13 (1971). 14 3. S i l l e r , Jerome. "A Summary: On the Delineation of Boundaries of Professional Practice i n Rehabili- t a t i o n , " Archives of Physical Medicine and Rehabilitation , pp.410-412 (Sept., 1971). 144. Simard, Therese. "Electromyographie du Membre Superieur," Canadian Journal of Occupational Therapy. 37:55-62 (1970). 145. Slagle, E.C. "Development of Occupations for the Insane," American Journal of Occupational Therapy, 12:196 (1958). 146. Slobetz, F.W. "The Role of Occupational Therapy i n Heroin Detoxification," American Journal of Occupational Therapy, 24:340-342 (197). 147. Smith, Hetty V. "Workmen's Compensation Board, Occupational Therapy Workshop," Canadian Journal of Occupational Therapy, 7:26 (1940). 148. Snider, A.J. "Nursing Home Speed Death of Aged Patients, Panel Says," The Vancouver Sun, p.3 (Nov.19, 1970) 14 9. Sokolov, J . "Working as a Team," American Journal of Occupational Therapy. 9 :270-271,296 (.1955). 150. Solomon, A l f r e d P. "Occupational Therapy, A Psychiatric Treatment," American Journal of Occupational Therapy. 1:1 (1947). 151. Sommer, Robert. "A Model Experiment i n Occupational Therapy," Canadian Journal of Occupational Therapy. 27:103-104 (1960). 152. . "Professionalization and Occupational Therapy," Canadian Journal of Occupational Therapy. 28:25-28 (1961). 153. Spackman, C. "The World Federation of Occupational Therapists: 1952-1967," American Journal of Occupational Therapy. 21:301-309 (1967). 154. . "A History of the Practice of Occupational Therapy for Restoration of Physical Function: 1917-1967," American Journal of Occupational Therapy. 22:67-71 (1968). 87. 155. Stacey, Beverley. "Industrial Therapy,1' Canadian Journal of Occupational Therapy, 30:105-106, 114 (1963) . 156. Stevenson, G.H. "Modern Methods i n Occupational Therapy i n Mental Hospitals," Canadian Journal of Occupational Therapy. 11:7-10 (1944). ~ 157. Sutherland, J. "Suction Socket with an Above-Elbow Amputee," Canadian Journal of Occupational Therapy, 27:75-76 (1960). 158. . "Occupational Therapy i n the Re-Establish- ment of the Physically Handicapped," Canadian Journal of Occupational Therapy. 31:143-144 (1964). 159. Szasz, G. Second Interim Report of the Committee on Interprofessional Education i n the Health Sciences, Vancouver, B r i t i s h Columbia: University of B r i t i s h Columbia, 1968. 160. Tr i d e r , Margaret F. "The Future of Occupational Therapy," Canadian Journal of Occupational Therapy, 39:3-8 (1972). 161. Tuminelly, Carol. "Result of Questionnaire on Medical Students' Concept of Occupational Therapy," Unpublished student paper, University of North Dakota, Grand Forks, pp.1-6 (1969). 162. United States Department of Health, Education and Welfare. "Teacher Influence, Pupil Attitudes and Achievement," by Ned A. Flanders. Cooperative Research Monograph, No. 12, Washington, D.C: Government Pr i n t i n g O f f i c e , p.6 (1965). 163. Verner, Coolie and Booth, Alan. Adult Education, The Center for Applied Research i n Education, Inc., New York, pp.22-23 (1964). 164. Vineberg, Shalom. "Rehabilitation: A Means to What End?," Report of Current and Future Trends i n Rehabilitation as They Affe c t Occupational Therapy i n Rehabilitation , Hot Springs^National Park, Arkansas, pp.32-34 (February, 1967). 165. Wallace, La Verna. "Educational Functions of Occupa- t i o n a l Therapy i n a M u l t i - D i s c i p l i n a r y , University- Based Home Care Program," American Journal of Occupational Therapy, 20:286-287 (1966). 88. 166. War Experiment Now Ranks as a Profession. Winnipeg Evening Tribune, July 14, 1923. 167. "War Therapy: Occupational Hints for Submarine Crews." Canadian Journal of Occupational Therapy, 7:46 (1940). 168. Watanabe, Sandra Gold. "The Developing Role of Occupational Therapy i n a Psychiatric Home Service," American Journal of Occupational Therapy, 21:353-356 (1967). 169. Welles, Car l o t t a . "Administration," American Journal of Occupational Therapy, 16:72-73 (1962). 170. . "The Implications of L i a b i l i t y ; Guidelines for Professional Practice," American Journal of Occupational Therapy, 23:18-26 (1969). 171. West, W. "The Occupational Therapist's Changing Responsibility to the Community," American Journal of Occupational Therapy, 21:312-316 (1967). 172. _. "Professional Responsibility i n Times of Change," American Journal of Occupational Therapy, 22:9-15 (1968). 173. . "Statement to the Committee on Health Manpower," American Journal of Occupational Therapy, 22:89-93 (1968). 174. . "The Growing Importance of Prevention," American Journal of Occupational Therapy, 23:226-231 (1969). 175. West, W. and McNary, H. "A Study of the Present and Potential Role of Occupational Therapy i n Rehabilitation," American Journal of Occupational Therapy, 10:103.(1956). 176. __. "The Present and Potential Role of Occupational Therapy i n Rehabilitation," American Journal of Occupational Therapy, 10:150 (1956). 177. Whitten, G.B. "Effects of Automation on Handicapped People," Rehabilitation , No. 71, pp.21-26 (Oct.-Dec., 1969). 178. Wiemer, Ruth B. and West W. "Occupational Therapy i n Community Health Care," American Journal of Occupational Therapy, 24:323-327 (1970). 89. 179. Williams, D.H. F i r s t Annual Report on Continuing Medical Education, Vancouver, B r i t i s h Columbia: University of B r i t i s h Columbia, 1961. 180. . "The Physician and Life-Long-Learning," The Journal of Education, No. 10, Vancouver, The University of B r i t i s h Columbia, p.63, 1964. 181. . F i r s t Annual Report, Continuing Education i n the Health Sciences, Vancouver, B r i t i s h Columbia: University of B r i t i s h Columbia, 1969. 182. Woodside, H.H. "The Development of Occupational Therapy 1910-1929," American Journal of Occupational Therapy, 25:226-230 (1971). 183. World Federation of Occupational Therapists. E s t a b l i s h - ment of a Program for the Education of Occupational Therapists, Glasgow, Scotland: Council of the World Federation of Occupational Therapists, 1958. 184. Zamir, L e l i a . "The Consultative Process," Physical Therapy, 68:777-779 (1968). 185. . "Perspectives i n Occupational Therapy Education," American Journal of Occupational Therapy, 24:192-195 (1970). 186. Zimmerman, T.F. "Laddering and L a t t i c i n g : Trends i n A l l i e d Health," American Journal of Occupational Therapy, 24:102-105 (1970). 90. APPENDIX In 1926 the f i r s t two year course i n occupational therapy was established at the University of Toronto. For over twenty years i t was the only educational program for occupational therapists i n Canada. The following pages are duplicates of the o r i g i n a l Preliminary C i r c u l a r of Information which i s presently the only known Preliminary C i r c u l a r remaining i n existence. This rare document was made available for duplication and inc l u s i o n i n t h i s study as an item of inte r e s t to a l l Canadian Therapists through the courtesy of the present owner of the document, Miss H. P. LeVesconte, Toronto, Ontario. Preliminary Circular of Information on the Two-Years' Course in Occupational Therapy Should those interested wish to ask any questions, the answers to which are not contained in this preliminary circular, they should write at once to W. J. Dunlop, Director, University Extension, University of Toronto. Toronto 5, Canada. Correspondence is invited. 93 . , U N I V E R S I T Y O F T O R O N T O ' (The P r o v i n c i a l Un i ve r s i t y of Ontario) Occupational Therapy Beginning with the University Session, 1926-27, the University of Toronto pro- poses, if there appears to be a reasonable demand for it, to offer a course in Occu- pational Therapy. The purpose of the new Course is to train young women sd that they may be qualified to act as therapists in government institutions, asylums, homes for incurables, and general hospitals. The work of a duly qualified occupational therapist consists in rehabilitating patients by providing them with interesting 'occu- pations designed not only to exercise and _o to restore limbs which may have been / y — ^K-V* injured but also to-keet> the mind engaged (rt&l~Y*s*j VfcM and so to prfycnt thn nntifnt rin nnminc / _ T mc__se^ By expert attention to these two allied aims injured men, women and children are frequently brought back to ?<L___£-*_/ health and have been able to resume their — — - ^regular occupations when otherwise' a . / , phyoioal and UHIlHat recovery would have been possible. «~ 4-c>-w sLuL*^ - Occupational Therapy is, therefore, a valuable supplement to the work of the physician and surgeon and the demand for qualified aides seems to be growing. Here il must be pointed out, however, that, while offering the training for this work, the University of Toronto does not in thi least degree undertake to secure positions for those who complete the course. The details of the Course in Occupa- tional Therapy are as follows:— 1. The course is to cover two academic years. 2. Complete Pass Matriculation, or the academic equivalent thereof as deter- mined by the Registrar of the University of Toronto, is the entrance requirement. 3. Subjects of study: First Year: (a) Anatomy, Physiology, Hygiene, Physical Drill, French, English, Sociology and Psychology, (b) Art, Applied Art, Woodwork, Weaving, Basketry, Needlework, Lcatherwork. Second Year: (a) Medical subjects, Psychology, Sociology* Kinesthetics, Remedial exercises, French, English. (b) Art, Metal, Book- binding, Modelling and cord work. (c) Clinical work in hos- ' pitals and asylums. 4. Students will attend the regular classes in University subjects already established in Arts, Social Service, and Public Health Nursing. Lectures and practi- cal work will occupy both forenoons arid afternoons throughout the Session. 5. Annual fee—$100 payable in advance, or, if paid in instalments, $50.00 on or before October 15th and $51.00 on or before January 15th. A penalty of $1.00. per month is imposed if fees are not paid on dates specified. Student will be required to purchase such materials as may be necessary for prac- tical work. The cost of these will be approximately $60.00. 6. The course will be given if a sufficient enrolment is secured, and may be dis- continued at any time in the future if the demand for aides seems to have been satisfied. 7. The course will commence on Septem-. ber 28th. In order that the necessary arrangements can be made in good time, applications should be sent in as early as possible, and in no case later than August 15th, 1926. 1 For the form of application and further information write to W, J. Dunlop, Director, University Extension, University of Toronto, Toronto/ 5,. Ontario. Trinity 5000,

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