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The changing role of the occupational therapist Ernest, Marilyn Luella 1972

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THE CHANGING ROLE OF THE OCCUPATIONAL THERAPIST by  MARILYN LUELLA ERNEST B.S.R., U n i v e r s i t y o f 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 a c c e p t t h i s t h e s i s as conforming t o the required standards.  THE UNIVERSITY OF BRITISH COLUMBIA September 1972  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  the  requirements f o r an advanced degree a t the U n i v e r s i t y  of  B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r references  and  study.  I f u r t h e r agree  t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may  be granted by the Head o f my  or by h i s r e p r e s e n t a t i v e s .  I t i s understood t h a t copying  or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n be allowed without my  Department of A d u l t  written  permission.  Education  The U n i v e r s i t y of B r i t i s h Columbia Vancouver 8 , Canada  Date:  September,  1972  Department  shall  not  ABSTRACT The  purposes of t h i s study were to i d e n t i f y both the  r o l e development of the o c c u p a t i o n a l t h e r a p i s t and  the f a c t o r s  which have i n f l u e n c e d and d i r e c t e d the r o l e changes. assumed t h a t these p r o f e s s i o n and  It  was  i d e n t i f i c a t i o n s would a s s i s t both the  educators  the trends as to how  of o c c u p a t i o n a l t h e r a p i s t s t o  and why  evaluate  the p r o f e s s i o n i s d e v e l o p i n g  t o p l a n f o r a p p r o p r i a t e p r o f e s s i o n a l and  and  e d u c a t i o n a l changes  f o r the f u t u r e . The  r o l e of the o c c u p a t i o n a l t h e r a p i s t , an a l l i e d  health  p r o f e s s i o n a l , has changed from t h a t o f a c r a f t - o r i e n t e d medical  t e c h n i c i a n t o t h a t of a p r o f e s s i o n a l c l i n i c i a n ,  r e s e a r c h e r , educator^ and c o n s u l t a n t . t h e r a p i s t was  T h i s contemporary  found to be p r a c t i c i n g i n a number of areas  w i t h i n and o u t s i d e of the medical model of p r a c t i c e . development of these new concern,  both  The  r o l e s has r e s u l t e d i n c o n s i d e r a b l e  both o u t s i d e o f and w i t h i n the p r o f e s s i o n , as t o  whether or not the t r a d i t i o n a l c r a f t - o r i e n t e d medical model of practice i s s t i l l valid.  As w e l l , o c c u p a t i o n a l t h e r a p i s t s  i n both the' U n i t e d S t a t e s and Canada have expressed  the need  to r e - e v a l u a t e 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 education  their  i n o r d e r to meet the needs of changing p a t t e r n s i n  the o r g a n i z a t i o n and d e l i v e r y of contemporary h e a l t h s e r v i c e s . The  study of the r o l e development and  f a c t o r s i n f l u e n c i n g the r o l e changes was  i d e n t i f i c a t i o n of  c a r r i e d out  a review o f l i t e r a t u r e p u b l i s h e d between 1922  and  through  1972  plus  a minimal number of unpublished  papers r e l a t e d to the t o p i c .  A b r i e f review of the 1970-1971 Canadian o c c u p a t i o n a l c u r r i c u l a was  therapy  i n c l u d e d i n an attempt to i n d i c a t e the i n f l u e n c e s  e d u c a t i o n a l programs had on the r o l e development of  the  occupational therapist. I t was present  found t h a t new  r o l e s developed i n response to  and proposed government l e g i s l a t i o n , changing needs  and demands of s o c i e t y i n g e n e r a l , and changing emphases i n medical  education  and h e a l t h care d e l i v e r y .  I t was  t h a t the e d u c a t i o n a l i n f l u e n c e s o f o c c u p a t i o n a l  a l s o found  therapy  programs were minimal, i f not i n h i b i t o r y , t o the r o l e  develop-  ment of the o c c u p a t i o n a l t h e r a p i s t . Conclusions  drawn from the review of the  r e s u l t e d i n the e s t a b l i s h i n g of eighteen cerned  literature  recommendations con-  with the r o l e development, r e s e a r c h needs, and  needs of f u t u r e o c c u p a t i o n a l t h e r a p i s t s i n Canada. t h a t these recommendations represented  educational  I t was  g u i d e l i n e s f o r change  which must be implemented by the i n d i v i d u a l t h e r a p i s t s , p r o f e s s i o n a l a s s o c i a t i o n s , and educators therapy  i f occupational  i s to remain a v i a b l e h e a l t h p r o f e s s i o n .  iii  felt  DEDICATION  To Dr. B e r n i c e R u s s e l l Wylie  iv  ACKNOWLEDGEMENTS  The  w r i t e r wishes t o express her a p p r e c i a t i o n t o  Dr. C o o l i e Verner, Dr. James Thornton, and P r o f e s s o r Margaret Hood f o r t h e i r a s s i s t a n c e and support the p r e p a r a t i o n o f t h i s  throughout  study.  G r a t e f u l acknowledgement i s a l s o made o f the c o o p e r a t i o n o f P r o f e s s o r M. F. T r i d e r , D i r e c t o r , Program i n Occupational Therapy, U n i v e r s i t y o f Western O n t a r i o , the completion o f t h i s study p o s s i b l e .  v  i n h e l p i n g t o make  TABLE OF CONTENTS PAGE ABSTRACT ACKNOWLEDGEMENTS TABLE OF CONTENTS LIST OF TABLES CHAPTER I  i i v vi vii 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 The The The The CHAPTER IV  DESCRIPTION OF THE ROLES  19  Clinician Educator Consultant Researcher 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  vi  LIST OF TABLES TABLE  PAGE  1  E d u c a t i o n a l Program Content to Requirements  2  S o c i a l Science Hours i n O c c u p a t i o n a l Therapy C u r r i c u l a  vii  Related  57 59  CHAPTER I INTRODUCTION  In 1962, an o c c u p a t i o n a l therapy educator, Dr. Mary Reilly  (133:4),  s t a t e d t h a t she had " l i t t l e t r u s t t h a t we can  continue t o e x i s t as an a r t s and c r a f t s group which serves muscle d y s f u n c t i o n o r as an a c t i v i t y group which serves the emotionally disabled.  S o c i e t y r e q u i r e s o f us a much  sharper  focus on i t s needs" During the f o l l o w i n g t e n years these needs changed as the growing a f f l u e n c e i n North America and the gradual i n t r o d u c t i o n o f new methods f o r f i n a n c i n g h e a l t h s e r v i c e s lowered  or r e -  moved f i n a n c i a l b a r r i e r s t o the use o f most h e a l t h r e l a t e d services  (25). Governments, i n attempting  h e a l t h needs, have expressed  concern  t o meet s o c i e t i e s '  about both the education  o f those i n h e a l t h s e r v i c e d i s c i p l i n e s and the u t i l i z a t i o n o f their services.  A c c o r d i n g t o the 1965 F e d e r a l Government's  Royal Commission on Health S e r v i c e s (25), the expansion o f community h e a l t h s e r v i c e s has emphasized the need t o d o v e t a i l h e a l t h s e r v i c e s w i t h o t h e r s e r v i c e s i n the community which have been drawn i n t o the medical f i e l d .  These new p a t t e r n s o f  h e a l t h care d e l i v e r y , and the t e a c h i n g o f s o c i a l o r community medicine  i n the medical  s c h o o l s , a r e r e s u l t i n g i n the r e c o g n i t i o n  of the need o f such s e r v i c e s as o c c u p a t i o n a l therapy t o h e l p round out h e a l t h s e r v i c e s . O c c u p a t i o n a l t h e r a p i s t s i n both the U n i t e d S t a t e s and Canada have expressed  the need t o r e - e v a l u a t e 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 t o meet the needs  1  2.  o f the changing  p a t t e r n s i n the o r g a n i z a t i o n and d e l i v e r y o f  h e a l t h s e r v i c e s (64, 160, 172). West (172) s t a t e d t h a t the present r o l e r e q u i r e d i s very d i f f e r e n t from t h e r o l e o f the t r a d i t i o n a l t h e r a p i s t o f twenty years ago who brought c r a f t s and c r e a t i v e a c t i v i t i e s t o long-term ward p a t i e n t s .  She  emphasized the need t o enlarge the concept o f o c c u p a t i o n a l therapy from t h a t o f being a t h e r a p i s t t o t h a t o f being a h e a l t h 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  t h e r a p i s t as a h e a l t h 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 d i r e c t e d toward the r e d u c t i o n and p r e v e n t i o n o f pathology and the treatment o f acute phases o f i l l n e s s . Occupational therapy makes i t s investment i n the h e a l t h r e s i d u a l which f o l l o w s pathology and hence focuses on the c h r o n i c aspect o f the i l l n e s s and i s concerned w i t h h e a l t h r a t h e r than pathology. • While some t h e r a p i s t s b e l i e v e t h a t the p r e s e n t r o l e r e quirements n e c e s s i t a t e t h e r a p i s t s being prepared  to specialize  as educators, c o n s u l t a n t s , and r e s e a r c h e r s as w e l l as t o p r a c 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 r o l e s i s by no means a consensus i n the p r o f e s s i o n .  Cromwell  (35:17) c l a r i f i e d the  problem when she s t a t e d t h a t " o c c u p a t i o n a l t h e r a p i s t s a r e t r y i n g t o decide whether the t r a d i t i o n a l r o l e i s s t i l l v a l i d , and how the necessary r e s o u r c e s can be mustered t o a l t e r Other h e a l t h s e r v i c e personnel  roles".  such as d o c t o r s , nurses,  p s y c h o l o g i s t s , 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 i n g o p i n i o n s as t o the expected pist  r o l e s o f the o c c u p a t i o n a l t h e r a -  (2, 6, 19, 53, 57, 66, 109, 120, 143). Occupational.; therapy  educators have a l s o expressed changing  a concerned  r o l e o f the t h e r a p i s t .  awareness o f the  According to R e i l l y  (134 :222) ,  3.  the f u t u r e o f the p r o f e s s i o n " w i l l depend upon the adaptive responses?which both the c l i n i c i a n and the p r o f e s s i o n a l a s s o c i a t i o n makes t o the c h a l l a n g e o f new demands". To date no comprehensive examination o f the r o l e change of the o c c u p a t i o n a l t h e r a p i s t has been c a r r i e d out i n order t o d e f i n e t h e r o l e as i t has developed, nor have t h e r o l e s , i n the minds o f many t h e r a p i s t s , been l e g i t i m i z e d .  PURPOSE OF THE STUDY  The  purposes o f t h i s study a r e , through an examination o f  the l i t e r a t u r e , t o i d e n t i f y the r o l e development o f the o c c u p a t i o n a l t h e r a p i s t and t o i d e n t i f y the f a c t o r s which have i n f l u e n c e d and d i r e c t e d the r o l e changes.  T h i s study  then a s s i s t both the p r o f e s s i o n and educators  should  of occupational  t h e r a p i s t s t o e v a l u a t e the trends as t o how and why the p r o f e s s i o n i s developing  and t o p l a n f o r a p p r o p r i a t e p r o f e s s i o n a l  and e d u c a t i o n a l changes f o r the f u t u r e .  LIMITATIONS OF THE STUDY  In North America the p r o f e s s i o n o f o c c u p a t i o n a l has been r e c o g n i z e d  f o r over f i f t y y e a r s .  therapy  On the world  there were twenty-three member c o u n t r i e s i n the World of Occupational  scene  Federation  T h e r a p i s t s i n 1970 whereas there were o n l y  ten founding member c o u n t r i e s represented  i n 1952.  Because o f  4.  the very nature of the p r o f e s s i o n , o c c u p a t i o n a l therapy growing and developing  is  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  societies.  As the p u b l i c o f t e n appears unaware of the d i f f e r e n c e s between o c c u p a t i o n a l and p h y s i c a l ' therapy,  i t i s emphasized  here t h a t t h i s study concerns only o c c u p a t i o n a l therapy nothing whatever to say about the separate, fession of p h y s i c a l Canada and  and  has  independent p r o -  therapy.  the United S t a t e s have been c o - l e a d e r s  development of o c c u p a t i o n a l therapy, t h e r a p i s t s i n these c o u n t r i e s has  and  the education  followed p a r a l l e l l  i n the of  lines  (93).  In Canada the number o f u n i v e r s i t y programs i n o c c u p a t i o n a l therapy  has  i n c r e a s e d from one  i n 1950  t o nine i n 1971.  of t h i s r a p i d growth of o c c u p a t i o n a l therapy  Because  i n Canada and  p a r a l l e l p r o f e s s i o n a l developments i n Canada and  the  United  S t a t e s , t h i s study w i l l be l i m i t e d t o the examination o f changing r o l e s of the o c c u p a t i o n a l t h e r a p i s t i n those countries.  The major emphasis, p a r t i c u l a r l y t h a t  the  the  two  concerning  e d u c a t i o n a l developments, w i l l be on the changing r o l e of  the  o c c u p a t i o n a l t h e r a p i s t i n Canada.  DEFINITION OF TERMS  At t h i s p o i n t i n the study e i g h t terms w i l l be  defined.  Although there are s e v e r a l d e f i n i t i o n s f o r the term o c c u p a t i o n a l therapy  (5, 26), two  d e f i n i t i o n s have been chosen as  they  r e p r e s e n t 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 a v a i l a b l e at  5. t h i s time.  The  termi p h y s i c a l therapy  has been d e f i n e d o n l y to  c l a r i f y the d i f f e r e n c e between p h y s i c a l and  occupational  therapy. Occupational i.  Therapy;  •  Earliest Definition:  "any  a c t i v i t y , mental or p h y s i c a l ,  d e f i n i t e l y p r e s c r i b e d and guided, o f c o n t r i b u t i n g to and hastening injury." ii.  f o r the d i s t i n c t purpose recovery  from d i s e a s e or  (178:323)  Latest .Definition:  "that d i s c i p l i n e which concerns  with the assessment of o c c u p a t i o n a l behaviour, guides  the r e c o n s t i t u t i o n or development of  r o l e s t o produce new  skills  d e f i n e d as the a r t and  in living.  which  occupational  I t may  f u r t h e r be  s c i e n c e of d i r e c t i n g man's response  to s e l e c t e d a c t i v i t y to promote and m a i n t a i n prevent  and  itself  d i s a b i l i t y , and  health, to  to reduce or e l i m i n a t e i n c a p a c i t y  r e s u l t i n g from p h y s i c a l or p s y c h o s o c i a l d y s f u n c t i o n or environmental s t r e s s . " (160:6) P h y s i c a l Therapy:  i s that science of t r e a t i n g p h y s i c a l d i s -  a b i l i t y through the use o f such p h y s i c a l m o d a l i t i e s heat, e l e c t r i c i t y , water and r  Role:  i s the sum  as  exercise.  t o t a l of the c u l t u r a l p a t t e r n s a s s o c i a t e d  with a p a r t i c u l a r p o s i t i o n - the a t t i t u d e s , v a l u e s , behaviour a s c r i b e d by s o c i e t y to any occupants o f t h a t p o s i t i o n . what a person has t o do  and  and a l l persons as  I t i s a p a t t e r n of a c t i v i t y  (or t h i n k s he has to do)  i n order  t o v a l i d a t e h i s e l i g i b i l i t y f o r the p o s i t i o n he holds Community Health S e r v i c e :  -  (96).  i s "the t o t a l of a l l h e a l t h s e r v i c e s  i n the community i n c l u d i n g the h o s p i t a l . "  (25:39)  6. Health Team;  i s a group o f h e a l t h p r o f e s s i o n s with  their  r e s p e c t i v e a s s o c i a t e d t e c h n o l o g i s t s , t e c h n i c i a n s and o t h e r e s s e n t i a l p e r s o n n e l , whose o v e r a l l g o a l s are the promotion o f h e a l t h , the p r e v e n t i o n o f d i s e a s e , the d i a g n o s i s and treatment o f i l l n e s s and t h e a l l e v i a t i o n o f suffering Occupational  (181).  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 p a r t o f h i s l i f e c y c l e Occupational  Behaviour:  (163).  i s the developmental tasks r e q u i r e d  by every i n d i v i d u a l as he assumes an o c c u p a t i o n a l r o l e Technician:  A person s k i l l e d i n a branch o f t r a i n i n g t h a t  depends more on s p e c i f i c p r a c t i c e than on g e n e r a l principles.  (163) .  CHAPTER I I HISTORICAL INTRODUCTION  Although the h i s t o r y o f o c c u p a t i o n a l therapy as an independent p r o f e s s i o n begins e a r l y i n the present 20th Century, the background  o f the p r o f e s s i o n can be t r a c e d as f a r  back as the 20th Century B.C.  The purpose o f t h i s chapter w i l l  be t o p r o v i d e a b r i e f overview o f the h i s t o r i c a l  development  and i n f l u e n c e s which l e a d t o the r e c o g n i t i o n o f o c c u p a t i o n a l therapy as an independent h e a l t h p r o f e s s i o n .  Pre-19th Century I n f l u e n c e s The t h e o r y t h a t manual o c c u p a t i o n o r mental  diversion  was b e n e f i c i a l t o the s i c k i s one t h a t has appeared to time throughout the h i s t o r y o f medicine  from time  (6, 69, 178).  About the 20th Century B.C., the Egyptians d e d i c a t e d temples where "melancholies r e s o r t e d i n g r e a t numbers", games and r e c r e a t i o n were i n s t i t u t e d and " a l l the p a t i e n t ' s time was taken up by some p l e a s u r a b l e o c c u p a t i o n " (69:1).  In the 9th  Century B.C., Greek medicine appeared t o r e c o g n i z e and u t i l i z e some p r i n c i p l e s u n d e r l y i n g c u r r e n t approaches t o the treatment of mental i l l n e s s .  By the 4th Century B.C., E g y p t i a n medicine  had a n t i c i p a t e d much o f the present day t h e r a p e u t i c community concepts by p r o v i d i n g t h e i r m e n t a l l y i l l  p a t i e n t s with p l e a s a n t  surroundings and o r g a n i z i n g programs which emphasized o c c u p a t i o n , entertainment, and e x e r c i s e .  constant  About 30 B.C., Seneca  recommended employment f o r any k i n d o f mental a g i t a t i o n , and i n A.D. 172, Galen, the Greek p h y s i c i a n , wrote i.  •  7  "employment i s  8. nature's b e s t p h y s i c i a n and i s e s s e n t i a l t o human happiness"  (69:2).  With the c o l l a p s e o f 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 c a r e f o r the m e n t a l l y i l l few r e g i o n s .  d e c l i n e d s t e a d i l y i n a l l but a  One o f these r a r e examples was the Colony o f  Gheel i n Belgium.  T h i s 13th Century p r o j e c t ' s humanitarian  approach and e x t e n s i v e use o f " o c c u p a t i o n a l therapy" d i d much to maintain the p o s i t i v e therapeutic features of the c l a s s i c a l era (6). The dark ages o f p s y c h i a t r i c care d i d not b e g i n t o b r i g h t e n u n t i l the l a t t e r h a l f o f t h e 18th and e a r l y 19th C e n t u r i e s when o c c u p a t i o n was used as a form o f treatment by P i n e l i n France as w e l l as o t h e r s i n I t a l y , Spain, England, and  America.  19th Century Moral  Treatment  A c c o r d i n g t o Bockoven, i t was undoubtedly t h e 19th Century t h a t produced t h e g r e a t e s t impetus  f o r t h e development o f  o c c u p a t i o n a l therapy as a p r o f e s s i o n today.  He noted t h a t  "the h i s t o r y o f moral treatment i n America i s not o n l y synonymous w i t h , but i s the h i s t o r y o f o c c u p a t i o n a l therapy before i t a c q u i r e d i t s 20th Century name o f o c c u p a t i o n a l therapy"  (19:223).  The concepts o f "moral treatment" and " o c c u p a t i o n a l therapy" were based on r e s p e c t f o r human i n d i v i d u a l i t y and on what Bockoven c o n s i d e r e d t o be a fundamental p e r c e p t i o n o f the i n d i v i d u a l ' s need t o engage i n c r e a t i v e a c t i v i t y .  The l e g a c y o f  moral treatment was the b e l i e f t h a t t h e m e n t a l l y i l l  person  9. c o u l d b e s t r e c o v e r h i s reason i n the company of m e n t a l l y sound, k i n d l y i n d i v i d u a l s who  would h e l p the p a t i e n t by j o i n i n g  in daily 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  o r i e n t a t i o n of 19th Century s o c i e t y , moral treatment were equipped with a v a r i e t y of c r a f t shops and r e c r e a t i o n a l areas, garden were surrounded  him  hospitals  indoor  a r e a s , and outdoor game areas t h a t  by farm land c u l t i v a t e d by the p a t i e n t s .  C o n s i d e r i n g i t s e r a o f i n t r o d u c t i o n and growth, moral  treatment  c o u l d be d e s c r i b e d , both p h i l o 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 o c c u p a t i o n a l therapy program. Bockoven f e l t t h a t the p h i l o s o p h y of moral was of  treatment  a r e s u l t of the p o l i t i c a l , c u l t u r a l , and r e l i g i o u s  attitudes  communities e s t a b l i s h e d p r i m a r i l y i n the n o r t h - e a s t e r n  United S t a t e s and Upper Canada. a b e l i e f t h a t everyone  These a t t i t u d e s were based  on  should take p a r t i n a l l aspects o f 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.  D r i v e r (41)  f e l t t h a t such a t t i t u d e s were probably i n f l u e n c e d by  such  humanitarian w r i t e r s and t h i n k e r s of the time as John S t u a r t Mills. Moral treatment i s g e n e r a l l y c o n s i d e r e d t o have disappeared i n the U n i t e d S t a t e s before the 20th Century because of i n s t i t u t i o n a l , and medical changes.  There was  social,  an i n c r e a s e i n  e t h n i c p r e j u d i c e s i n r e a c t i o n to the l a r g e numbers of immigrants  to America who  mental h o s p i t a l p a t i e n t s .  began making up the l a r g e bulk of The i n s t i t u t i o n s themselves  enlarged  i n a few years t o f i v e t o ten times t h e i r p r e v i o u s s i z e making p e r s o n a l p a t i e n t - s t a f f c o n t a c t almost i m p o s s i b l e . these d i f f i c u l t i e s , the medical p r o f e s s i o n i t s e l f  On top of shifted i t s  10. view from a moral-emotional b a s i s of mental t h a t c e l l u l a r b r a i n pathology was treatment  i l l n e s s to a b e l i e f  the o n l y s c i e n t i f i c b a s i s o f  (.19) .  19th Century Canadian  Innovators  There i s evidence t h a t moral treatment d i d not  entirely  d i s a p p e a r i n Canada d u r i n g the 19th Century, and through the use of moral treatment one d o c t o r c o u l d be c o n s i d e r e d t o have pioneered o c c u p a t i o n a l therapy. Asylum opened i n 1870,  The London, O n t a r i o , L u n a t i c  and i n 1883  the M e d i c a l Superintendent,  Dr. Bucke, h i r e d a female attendant t o work on one male ward. The asylum  I n s p e c t o r wrote i n h i s minute book of March 6,  1883,  t h a t " s i n c e t h i s l a d y ' s coming t o the Asylum, a g r e a t t i d i n e s s i n person, a g r e a t e r a c t i v i t y i n employment, and a g e n e r a l b r i g h t e n i n g of the c o n d i t i o n of those i n the male ward i s perceptible"  (66:80).  The I n s p e c t o r a u t h o r i z e d purchases of  m a t e r i a l s t o permit such a c t i v i t i e s as cane s e a t i n g , shoemaking, k n i t t i n g , and mat-making, and empowered the Superintendent t o h i r e two more l a d i e s to continue the comfort and promoting work being done. o c c u p a t i o n a l work was  Before 1900,  health-  a s i m i l a r type of  i n t r o d u c e d t o the Mountain  Sanitorium  f o r T u b e r c u l a r p a t i e n t s i n Hamilton, O n t a r i o .  R e - B i r t h of Moral  Treatment  The r e - b i r t h of moral treatment i n the 20th Century i n p a r t , supported by the p s y c h i a t r i s t , Sigmund Freud,  was,  who  claimed t h a t "work has a g r e a t e r e f f e c t than any o t h e r technique o f l i v i n g , i n the d i r e c t i o n of b i n d i n g the  individual  11. c l o s e l y t o r e a l i t y ; i n h i s work at l e a s t he i s s e c u r e l y attached  to a p a r t o f r e a l i t y , the human community"  The  r e - b i r t h of moral treatment d i d not produce an  i d e n t i c a l philosophy Driver had  £6:119).  t o t h a t of the o r i g i n a l moral treatment.  (41) observed i n f l u e n c e s i n t h i s p e r i o d which not  an impact on the p r e - o c c u p a t i o n a l  therapy r e - b i r t h o f  moral treatment but a l s o on present-day o c c u p a t i o n a l treatment.  She  pointed  hired occupational  only  therapy  out t h a t e a r l y moral treatment h o s p i t a l s  workers to guide p a t i e n t s i n normal community  a c t i v i t i e s such as farming, gardening, h o s p i t a l i n d u s t r i e s , and  recreation.  With the new  moral treatment e r a one  s h i f t from r e a l i s t i c work s e t t i n g s and such as c a n e - s e a t i n g ,  a c t i v i t i e s to  basket-weaving, k n i t t i n g , and  c o u l d take p l a c e i n o c c u p a t i o n a l D r i v e r ' s h y p o t h e s i s was  rooms w i t h i n the  finds a activities  sewing t h a t institution.  t h a t t h i s change from r e a l i s t i c work  t o a dependence on a r t s and  c r a f t s was  at l e a s t p a r t i a l l y  a r e s u l t o f a change i n s o c i a l t h i n k i n g brought about by such w r i t e r s as C a r l Marx. as a worker was a r t s and  The  to be deplored  e x p l o i t a t i o n o f the and  r e j e c t e d , and  patient  as a r e s u l t ,  c r a f t s were emphasized s i n c e they were, a t t h a t  time a t 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 p a r t o f  normal l i v i n g i n a semi-mechanized s o c i e t y .  This  i n f l u e n c e d change o f the t h e r a p i s t to an a r t s and i s an image t h e r a p i s t s are s t i l l  c r a f t s worker  t r y i n g t o d i m i n i s h , and  a major p h i l o s o p h i c a l problem both i n s i d e and p r o f e s s i o n of o c c u p a t i o n a l  socially-  therapy.  outside of  i t is the  World War I I n f l u e n c e s The  r e - b i r t h o f moral treatment  t h a t l e d t o the formal beginnings The  was o n l y one o f two f o r c e s  of occupational  therapy.  second f o r c e was the r e t u r n o f a v a s t number o f s e v e r e l y  wounded s o l d i e r s from the F i r s t World War.  I t was the e l i t e  of the medical p r o f e s s i o n who j o i n e d the f o r c e s and caused the m i l i t a r y t o develop servicemen.  r e h a b i l i t a t i o n programs f o r wounded  One American d o c t o r , F. W i l l i a m s , went t o  Washington t o ask f o r " o c c u p a t i o n a l t h e r a p i s t s " t o go overseas with h i s u n i t , but a l r e a d y an unfavourable t i o n a l therapy had been e s t a b l i s h e d .  image o f occupa-  Dr. W i l l i a m ' s request was  denied because t h e m i l i t a r y "could not understand  t h a t he  wanted a program o f v o c a t i o n a l t r a i n i n g r a t h e r than weaving"  basket-  (182:227).  D e s p i t e t h i s problem, he was a b l e t o g e t some women prepared  t o do r e h a b i l i t a t i o n work i n h i s u n i t under the  category o f "scrubwomen".  W i t h i n weeks t h e i r work became  o b v i o u s l y i n v a l u a b l e and the Surgeon General  cabled f o r a  thousand more a i d e s as soon as they c o u l d be made ready.  As a  r e s u l t , 116 women, nurses, p h y s i o t h e r a p i s t s , d i e t i t i a n s , and c i v i l i a n a i d e s were assembled, t r a i n e d with t h r e e l e c t u r e s on the meaning o f the word " n e u r o p s y c h i a t r i c " , and sent t o e s t a b l i s h programs t o r e h a b i l i t a t e the wounded  overseas  (182) .  Development o f E d u c a t i o n a l Programs As Canada a l s o made p r e p a r a t i o n s t o suppy s i m i l a r  aides  to help r e h a b i l i t a t e t h e wounded servicemen, t h e problem o f e d u c a t i o n o f t h e a i d e s arose.  According  t o Haworth and  13. McDonald  (6 9),  had been l i t t l e  up t o the time o f the F i r s t World War t h e r e i n the way o f o c c u p a t i o n a l treatment  the h o s p i t a l i n d u s t r i e s .  The s u c c e s s f u l attempt by a few  i n d i v i d u a l s t o t r e a t p a t i e n t s through led of  the use o f o c c u p a t i o n  a u t h o r i t i e s i n various h o s p i t a l s t o consider the necessity d e f i n i t e t r a i n i n g f o r these workers. The  first  s c h o o l i n the U n i t e d S t a t e s was t h e School o f  O c c u p a t i o n a l Therapy i n Chicago. d i r e c t i o n o f Mrs.  I t opened i n 1914 under the  E l e a n o r C l a r k e S l a g l e (43) , and i t s f i r s t  course was s i x weeks i n l e n g t h . was  except i n  The f i r s t course i n Canada  g i v e n a t Hart House, The U n i v e r s i t y o f Toronto,  The o u t l i n e o f t h i s f i r s t  i n 1918.  s i x week course was drawn up by  P r o f e s s o r H a u l t a i n and a committee o f the F a c u l t y o f A p p l i e d Science and E n g i n e e r i n g . to  Each succeeding  course was extended  t h r e e months i n l e n g t h and i n c l u d e d a l a r g e number o f manual  s k i l l s and h o s p i t a l e t i q u e t t e (94).  These f i r s t  "ward a i d e s "  soon became known as " v o c a t i o n a l a i d e s " because o f the s k i l l s they a c q u i r e d i n these e a r l y c o u r s e s . women were t r a i n e d i n 1918 and 1919,  Over t h r e e hundred and were sent t o m i l i t a r y  h o s p i t a l s a c r o s s Canada. The  admission  requirement  U n i v e r s i t y o f Toronto of  f o r women e n t e r i n g t h e f i r s t  courses i s probably unique i n the h i s t o r y  Canadian u n i v e r s i t i e s .  The requirement  had t o have "charm", a requirement  was t h a t the students  t h a t perhaps i n a d v e r t e n t l y  i m p l i e d t h a t male students would not be c o n s i d e r e d  (43).  L a t e r q u a l i f i c a t i o n s f o r the newly-named " r e c o n s t r u c t i o n a i d e s " i n c l u d e d g e n e r a l education from a secondary School and c o l l e g e graduates  school but Normal  were p r e f e r r e d .  Personal  14. q u a l i f i c a t i o n s were mainly those o f good teachers u n t i l the two-year course was o f Toronto  i n 1926  Not  e s t a b l i s h e d a t the U n i v e r s i t y  were the admission  as f o r the F a c u l t y o f A r t s  (154).  requirements  the same  (36).  P r o f e s s i o n a l i z a t i o n o f O c c u p a t i o n a l Therapy The  i d e n t i t y o f o c c u p a t i o n a l therapy was  developed  g r a d u a l l y over a p e r i o d o f two decades i n Canada. p a t i o n a l therapy i n i t i a t e d i n 1920  The  " a i d e s " formed two o r g a n i z a t i o n s :  occu-  one  a t the Toronto C u r a t i v e Workshop and  a  s i m i l a r , s h o r t - l i v e d , Canadian S o c i e t y o f O c c u p a t i o n a l Therapy o f Manitoba i n 1921.  In 1921,  the O n t a r i o S o c i e t y o f  O c c u p a t i o n a l Therapy obtained i t s c h a r t e r as a p r o f e s s i o n a l o r g a n i z a t i o n e x i s t i n g f o r the t h e r a p i s t s r a t h e r than f o r service to p a t i e n t s .  T h i s group was  r e s p o n s i b l e f o r the forma-  t i o n of the Canadian A s s o c i a t i o n of O c c u p a t i o n a l Therapy which h e l d i t s f i r s t annual meeting i n 1930, f i r s t j o u r n a l i n 1933,  published i t s  and o b t a i n e d a Dominion C h a r t e r i n  The Canadian A s s o c i a t i o n was  1934.  formed because o f the  a c t i v i t y o f the e a r l y a i d e s while the American A s s o c i a t i o n was formed through  the a c t i v i t y o f o t h e r p r o f e s s i o n a l s .  In  1915,  Dr. W i l l i a m Rush Dunton p u b l i s h e d a book, O c c u p a t i o n a l Therapy, A Manual f o r Nurses.  T h i s was  read by George Barton,  a r c h i t e c t and t u b e r c u l o u s p a t i e n t , who  an  had a l r e a d y become con-  v i n c e d o f the c u r a t i v e value o f p a t i e n t o c c u p a t i o n .  Barton  c o n t a c t e d Dr. Dunton r e g a r d i n g the p o s s i b i l i t y of e s t a b l i s h i n g an American a s s o c i a t i o n f o r o c c u p a t i o n a l therapy.  Thus, Barton  can be c r e d i t e d w i t h e s t a b l i s h i n g the o f f i c i a l name f o r the  15. p r o f e s s i o n and Dunton c r e d i t e d w i t h e s t a b l i s h i n g the American Occupational  Therapy A s s o c i a t i o n i n 1916 (165).  In both c o u n t r i e s  i t was f e l t  t h a t the new  needed t h e p r e s t i g e o f the medical p r o f e s s i o n .  discipline F o r most o f i t s  f i r s t t h i r t y years the American a s s o c i a t i o n was l e d by p h y s i c i a n s with the exception  o f Mr. Barton, the f i r s t  p r e s i d e n t , and Mrs. S l a g l e , the p r e s i d e n t  from 1919 t o 1920.  The Canadian a s s o c i a t i o n p r e s i d e n t s were p h y s i c i a n s u n t i l 1966: Howland from 1930 t o 1948; Campbell from 1948 t o 1960; and Swanson from 1960 t o 1966. Mrs.  Thelma C a r d w e l l ,  In 1966,.an o c c u p a t i o n a l  was e l e c t e d t h e f i r s t  o f the Canadian A s s o c i a t i o n o f Occupational  The S t r u g g l e  therapist,  therapist-president Therapists.  f o r Recognition  By 1925 d o c t o r s  had assumed t h e l e a d e r s h i p o f the  p r o f e s s i o n i n Canada and they were s t r o n g l y supported by the Ontario  Government which was aware o f t h e need f o r expanding  occupational  therapy s e r v i c e s i n P r o v i n c i a l mental h o s p i t a l s (94).  Dr. Goldwin Howland, P r e s i d e n t many y e a r s ,  l e d the f i g h t  o f the Canadian a s s o c i a t i o n f o r  f o r the r e c o g n i t i o n o f o c c u p a t i o n a l  therapy as a p r o f e s s i o n .  T h i s d e s i r e f o r r e c o g n i t i o n was  evident many years before  official  p a t i o n a l therapy. Evening Tribune,  s a n c t i o n was g i v e n t o occu-  In t h e J u l y 14 , 1923, i s s u e o f t h e Winnipeg an a r t i c l e generously p r o c l a i m e d , "War  Experiment Now Ranks as a P r o f e s s i o n "  (166); however,  present  t h e r a p i s t s might doubt t h a t t h e f o l l o w i n g content o f the a r t i c l e truly  supported the promise o f the h e a d l i n e :  16. Occupational therapy teaches work f o r work's sake. . . . I t c o n c e i v e s o f man as a doing animal, and p e r c e i v e s t h a t i d l e n e s s i s an abnormal c o n d i t i o n . . . . "No l i f e i s complete without work" an o c c u p a t i o n a l t h e r a p i s t s a i d to the Tribune. "In order t o keep l i f e ' s balance, there must be work, rest, and p l a y . I f the work i s very agreeable, l e s s p l a y i s needed." Despite t h a t Dr.  t h i s e a r l y enthusiasm, i t was  Howland f e l t o c c u p a t i o n a l  fessional status.  He  and  Canadian a s s o c i a t i o n had a l l occupational recognized and  not u n t i l  therapy had  attained  the Board of D i r e c t o r s of fought f o r two  t h e r a p i s t s must be graduates o f a  pro-  the  principles:  by the Canadian a s s o c i a t i o n ; and  1944  (a)  that  school  (b) t h a t the  scope  f i e l d o f t h i s form of treatment must be p r i m a r i l y t h e r a -  p e u t i c and  '  not r e c r e a t i o n a l .  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 e s t a b l i s h e d amid many d i f f i c u l t i e s , with c o n s i d e r a b l e o p p o s i t i o n a r i s i n g both o u t s i d e and i n s i d e our o r g a n i z a t i o n . But now with the dawn of 1944, you may r e s t s a t i s f i e d , knowing t h a t the b a t t l e i s won and you o c c u p a t i o n a l t h e r a p i s t s are regarded both today, and f o r a l l f u t u r e time, i n your proper spheres as members of a r e cognized p r o f e s s i o n ^ (80:3).  T h i s p r o f e s s i o n a l r e c o g n i t i o n was  re-enforced  when Dr.  Howland convinced the Government of Canada to a l l o w  occu-  p a t i o n a l t h e r a p i s t s to e n l i s t as f u l l y  officers  d u r i n g World War  II.  From 1943  to 1946  commissioned over 70  therapists  e n l i s t e d , almost h a l f s e r v i n g w i t h the Canadian Army Overseas (41) .  17. The  Struggle Despite  therapy was  f o r Independence the c l a i m by Dr. Howland t h a t now  a recognized  occupational  p r o f e s s i o n , i t was  apparent t h a t  a t r a d i t i o n of unequal r e l a t i o n s h i p w i t h p h y s i c i a n s was e s t a b l i s h e d i n the years between 1910  and  1929.  well  Woodside  (182:229) c l e a r l y p o i n t e d out t h a t the p h y s i c i a n s were a d m i n i s t r a t i v e l y h e l p f u l but p r a i s e d the t h e r a p i s t ' s h e a r t while questioning  her knowledge and  skills:  The e a r l y j o u r n a l s i l l u s t r a t e d how t e n a c i o u s l y the doctors c l u n g to the n e c e s s i t y o f a medical p r e s c r i p t i o n and/or r e f e r r a l t o an o c c u p a t i o n a l therapist for their patients. ... Most o f t h i s time they p r e s i d e d over the n a t i o n a l a s s o c i a t i o n and undoubtedly occupational therapists p r o f i t t e d much from t h e i r v a s t o r g a n i z a t i o n a l and medical knowledge w h i l e s t i l l being very much s u b s e r v i e n t to t h e i r l e a d e r s h i p . F o r t y years l a t e r , t h e r a p i s t s are s t i l l f e e l i n g the e f f e c t s o f t h i s long e s t a b l i s h e d h i e r a r c h y and are s t r u g g l i n g f o r the r i g h t to work with d o c t o r s r a t h e r than under them. The and  p r o f e s s i o n ' s dependence on the medical  l a c k of autonomy was  profession  based on a need f o r s t a t u s .  Now,  d e s p i t e u n c e r t a i n t y w i t h i n the p r o f e s s i o n , the d e s i r e f o r autonomy and spreading  the r e c o g n i t i o n o f an earned s t a t u s i s g r a d u a l l y  across  the c o u n t r y .  Trider  t r a d i t i o n a l dependency s t a t u s i s being  (160:3) c l a i m s  that  r e j e c t e d as an  necessary burden by B i g Daddy (organized medicine) and t e l l e c t u a l and  academic achievements are being  "our  unour i n -  exposed f o r what  they too o f t e n a r e , the p o s t u r i n g o f a would-be p r o f e s s i o n in  many ways c l i n g i n g to an outmoded p r e - and  o f g e n t i l i t y and  lady-like-ness".  She  post-war aura  f u r t h e r claimed  that  still  18. " t h i s debuntante syndrome i s h a r d l y a p p r o p r i a t e profession purporting  for a  to be a u s e f u l p a r t of the tough-minded,  s c i e n t i f i c h e a l t h i n d u s t r y of today". The  image and  r o l e of the o c c u p a t i o n a l  t h e r a p i s t as  the  " c r a f t - l a d y " was  e s t a b l i s h e d very e a r l y i n the development o f  the p r o f e s s i o n .  L a t e r years saw  develop new  patterns  the r o l e of the t h e r a p i s t  of behaviour and  r e s p o n s i b i l i t y and  number o f s p e c i a l i z e d r o l e s emerged f o r the therapist.  occupational  a  CHAPTER I I I DESCRIPTION OF THE  The  r o l e of the o c c u p a t i o n a l  that of a medically-oriented  ROLES  t h e r a p i s t has  therapeutic  t e c h n i c i a n to  more s o p h i s t i c a t e d r o l e s o f c l i n i c i a n , educator, and  researcher.  The  evolved  from the  consultant,  purpose of t h i s chapter w i l l be t o  the e v o l u t i o n of these r o l e s and  describe  i n d i c a t e the i n t e r n a l f a c t o r s  which have e i t h e r encouraged or i n h i b i t e d the development of the new  roles.  THE  According  CLINICIAN  to Dr. Anne C r o n i n Mosey (118:235), u n t i l  1960's " o c c u p a t i o n a l  t h e r a p i s t s functioned  as p r o f e s s i o n a l persons.. . . An of the Lord, is s t i l l  not  a n c i l l a r y , almost handmaid  r o l e seemed to be w i l l i n g l y accepted.. . . There we  '70's."  T h i s e a r l y r o l e as c l i n i c i a n was defined  as t e c h n i c i a n s ,  l i t t l e change i n our manner of f u n c t i o n i n g as  e n t e r the  the  i n 1922  by Dr. Hubert H a l l  at l e a s t p a r t i a l l y  (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 a p a t h e t i c . I t s f i n a l purpose i s through the use of l i g h t h a n d i c r a f t s to develop patience and a p p l i c a t i o n , so t h a t even the i n e r t i a o f q u i t e severe handicap may be overcome. The  e a r l y l i t e r a t u r e i n d i c a t e d t h a t the t h e r a p i s t worked  o n l y under the d i r e c t guidance of a p h y s i c i a n , and 19  the  des-  20. c r i p t i o n of treatment media i n d i c a t e d the t e c h n i c a l nature of the t h e r a p i s t ' s r o l e .  In 1940,  Bickle  (16:81) e x p l a i n e d  the p h y s i c a l l y or m e n t a l l y d i s a b l e d p a t i e n t  "received  that  treatment  through such c r a f t s as rug making,vbasketry, c h a i r c a n i n g , papier and  mache and  woodwork.  needlework" as w e l l as weaving, leatherwork  However, the e a r l y t h e r a p i s t was  to be o n l y a teacher o f c r a f t s .  Heaton  not  considered  (71:60) added to  d e s c r i p t i o n o f the t h e r a p i s t ' s o c c u p a t i o n a l  r o l e when he  described  methods,  her  as "a student of o c c u p a t i o n a l  keeper, v o c a t i o n a l  counsellor  emphasis on the o c c u p a t i o n a l and  and  record  placement o f f i c e r " .  The  t h e r a p i s t ' s r o l e as being p r o d u c t i o n  c r a f t - o r i e n t e d continued f o r many years  (50,  54,  140);  however, the d e s c r i p t i o n s of the r o l e were as v a r i e d as descriptors. occupational and  t h e r a p i s t as an  t h e r a p i s t ' s purpose was and  the  For example, a p s y c h i a t r i s t (7:14) d e s c r i b e d " i n s t r u c t o r i n a r t s and  t u t o r i n s p e c i a l work", w h i l e a nurse  fidence,  the  to s t i m u l a t e  the d e s i r e to  (53)  the  crafts  f e l t that  the  i n t e r e s t , ambition, con-  accomplish.  D e s p i t e the evidence of the  1930's and  1940's s u p p o r t i n g  the t h e r a p i s t ' s r o l e as a c r a f t - o r i e n t e d , i n s t i t u t i o n a l i z e d t e c h n i c i a n , t h e r e were a few d i f f e r e n t p o i n t of view.  i n d i v i d u a l s who  McGhie and  presented a  Myers (103)  t h e r a p i s t had  to do more than t e a c h h a n d c r a f t s ;  no  excuse f o r p l a c i n g emphasis on the  l o n g e r any  product.  f e l t that  the  that there  was  finished  Instead, they f e l t t h a t the emphasis o f the  should be on the c r e a t i n g of an environment to improve mental h e a l t h of the p a t i e n t . community involvement and  LeVesconte  therapist the  (93:12) emphasized  f e l t t h a t s h e l t e r e d workshops f o r  the p h y s i c a l l y d i s a b l e d should be c a l l e d community c e n t r e s . Smith (147)  questioned  appropriate  i n some treatment s i t u a t i o n s .  new  1940  the use of h a n d c r a f t s  as  She  being described  the  treatment program f o r i n j u r e d workmen i n which they  were o f f e r e d not c r a f t s , but e x e r c i s e which approximated  as  c l o s e l y as p o s s i b l e the type of work to which they would return. As e a r l y as 1933, had  Dr. Howland  (73) emphasized t h a t there  to be an advance i n the scope of o c c u p a t i o n a l therapy i f  i t were ever to become a p r i n c i p a l t h e r a p e u t i c method o f treatment, and  i t appears t h a t h i s advice was  taken to heart  by the p r o f e s s i o n . The  l i t e r a t u r e of the 1940's, 1950's, and  t h a t the scope of o c c u p a t i o n a l therapy  1960*s i n d i c a t e d  i n c r e a s e d to such an  extent t h a t the r o l e of the c l i n i c i a n became d e f i n a b l e o n l y i n terms o f the i n d i v i d u a l ' s p o s i t i o n and recognized cation  as one  (73:34).  function, a situation  l i k e l y to cause c o n f u s i o n i n r o l e  identifi-  Attempts to d e f i n e the r o l e of the t h e r a p i s t  i n the I960*s produced d e s c r i p t i o n s which i n d i c a t e d the conf u s i o n and nebulous c h a r a c t e r of the t h e r a p i s t ' s r o l e .  For  example, Jones (84:6) s t a t e d t h a t the " o c c u p a t i o n a l t h e r a p i s t no l o n g e r has o n l y the r o l e o f a t e c h n i c i a n t e a c h i n g c e r t a i n manual s k i l l s to p a t i e n t s but uses i n a d d i t i o n her  personal  a t t r i b u t e s as a c t i v e l y and  De  Charite  f l e x i b l y as p o s s i b l e " .  La  (38:101) i n d i c a t e d the i n a b i l i t y to d e f i n e the r o l e s  n o t i n g t h a t "the r o l e of the o c c u p a t i o n a l t h e r a p i s t as a team member . . . must be d e f i n e d by the whole team . . . t h a t s i t s down and d e f i n e s the t o t a l needs o r l o s s e s of each  individual patient". T h i s problem of i d e n t i f y i n g r o l e becomes even more e v i d e n t i n the l i t e r a t u r e as i t i n d i c a t e d t h a t the appeared t o be e v e r y t h i n g to everyone.  The  therapist  expected to have e x p e r t i s e i n s u p e r v i s i o n and/or tion  (8, 34,  104,  115,  112,  174);  97, 171);  120);  clinician  administra-  assessment and/or d i a g n o s i s  (13,  home care and/or community therapy  vocational rehabilitation  (14, 39,  was  32,  (9, 10,  77, 83,  117);  a r c h i t e c t u r a l and/or environmental change (36, 63, 146, 171);  group therapy  (32, 49,  83, 117 , 14 2);, e v a l u a t i o n  56,  84,  (34, 63,  138);  146,  155,  time a c t i v i t i e s and/or d i v e r s i o n a l therapy The  o c c u p a t i o n a l t h e r a p i s t was  (23), a c o n s u l t a n t 117,  171),  (77, 83,  171);  (62,  and  64,  leisure146).  to be a c o u n s e l l o r  a researcher  inventor  155,  (70, 81, 115,  a l s o considered  97, 171),  and an o r t h o t i s t and  education  82,  (37, 112,  (63, 64,  83,  117).  T h i r t y years a f t e r Howland encouraged an expansion i n the scope of o c c u p a t i o n a l therapy, the r e s u l t i n g r o l e c o n f u s i o n :  Burke  (23:4) commented on  "Yet t h i s very broadness  and  m u l t i f a c e t e d competence has c o n t r i b u t e d i n a l a r g e manner t o much of the present c o n f u s i o n t h a t envelopes o c c u p a t i o n a l therapy  i n the 1960 s-". 1  :  In s p i t e of the c o n f u s i o n , the l a t e 1960's and e a r l y 1970's produced a number of attempts to c u t through the conf u s i o n and p o i n t out trends and  areas of concern to contemporary  therapists.  A review of e i g h t p o i n t s which r e f l e c t  t h i n k i n g may  help the p r o f e s s i o n r e - e v a l u a t e and c l a r i f y  present  problems and  clinician.  current  f u r t u r e r o l e s of the o c c u p a t i o n a l  the  therapy  The  f i r s t p o i n t i s an e v a l u a t i v e statement  concerning  the t h e r a p i s t - p a t i e n t 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 N i c h o l s  as w e l l as t h e r a p i s t s  such as Cromwell  (120) (34)  and  Burke  (23)  and Moore (117)  t h a t because of the o c c u p a t i o n a l educational  concept  t h e r a p i s t ' s broad type o f  background, t h i s t h e r a p i s t i s the p r a c t i t i o n e r  best prepared to see, understand, and h o l i s t i c approach to p a t i e n t The  agree on the  p a r t i c i p a t e i n the  care.  second p o i n t i n v o l v e s the r e - e v a l u a t i o n of the  l a t i o n s h i p of the o c c u p a t i o n a l t i o n movement.  t h e r a p i s t to the  Mosey (118:235) e x p l a i n e d  re-  rehabilita-  t h a t the rush  of  the t h e r a p i s t s to be a p a r t of the r e h a b i l i t a t i o n movement was  an a c t i o n " t y p i c a l f o r a group t h a t l a c k s a strong i d e n t i t y  and  seeks r e c o g n i t i o n " .  As v a r y i n g degrees of r o l e b l u r r i n g  occurred,  Mosey claimed  regarding  one's a p p r o p r i a t e  way  of a v o i d i n g  t h a t i t was  a sign of  r o l e , poor t r a i n i n g , and/or a  the i s s u e of r e s p o n s i b i l i t y " .  time t h a t Mosey was  "uncertainty  e x p l a i n i n g why  r e h a b i l i t a t i o n movement, R e i l l y  At the same  therapists joined  (135:224-225) was  cess of e v a l u a t i n g t h i s same movement.  In her  the  i n the  opinion,  " r e h a b i l i t a t i o n , o f which o c c u p a t i o n a l  therapy^is  to be a s u b s t r u c t u r e ,  body o f knowledge  has  no organized  no p r o f e s s i o n concerned with i t s e t h n i c s . preparation  f o r i t s p r a c t i c e and  aftereffects."Q  pro-  I t has  considered and  no r a t i o n a l  no m o n i t o r i n g o f i t s  R e i l l y f e l t t h a t t h e r a p i s t s "must  disentangle  themselves from the unconscious a s s o c i a t i o n s they have made w i t h the r e h a b i l i t a t i o n movement because i t i s now to a low-grade s u b s t i t u t e f o r the h e a l t h care of  regressed the  chronically  disabled".  A t h i r d p o i n t under c o n s i d e r a t i o n by contemporary t h e r a p i s t s i s a review o f the dependency r e l a t i o n s h i p between occupational  t h e r a p i s t s and the medical p r o f e s s i o n .  Peake (127:407) d e s c r i b e d  t h i s r e l a t i o n s h i p as f o l l o w s :  We have experienced w i t h i n the areas of p h y s i c a l 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 w i t h the p h y s i c i a n . . . . Our primary r o l e has been . . . under the a d m i n i s t r a t i v e and p r o f e s s i o n a l c o n t r o l o f the p h y s i a t r i s t . . •'. a r o l e i n which we have been f o r c e d t o f u n c t i o n . . . as a " t e c h n i c i a n " to the p h y s i c i a n ; unrecognized i n our b a s i c p r o f e s s i o n a l p r e p a r a t i o n as i n d i v i d u a l s prepared t o f u n c t i o n as a l l i e s to many medical s p e c i a l t i e s , and t o other health professions. Peake f u r t h e r s t a t e s t h a t "a t r u l y c o l l a b o r a t i v e , p r o f e s s i 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  relation-  s h i p s , but g e n e r a l l y , t h i s i s not the case". Dr. N i c k e l i n d i c a t e d t h a t the p r a c t i c e o f r e q u i r i n g d e t a i l e d w r i t t e n p r e s c r i p t i o n s from the doctor  has supported  t h i s dependency s t a t u s o f the t h e r a p i s t and i n h i b i t e d the a p p l i c a t i o n o f the t h e r a p i s t ' s knowledge.  He b e l i e v e d  that  "such p r e s c r i p t i o n s have been, and a r e , a m i l l s t o n e around the neck o f the o c c u p a t i o n a l (121:87).  Dr. Bockoven  t h e r a p i s t s as w e l l  physicians"  (19:224), on the other hand, c l e a r l y  l a y s the blame f o r the c o n t i n u a t i o n o f the dependency r e l a t i o n s h i p a t the f e e t o f the t h e r a p i s t s : I t would be most u n f o r t u n a t e f o r a l l s o c i e t y . . . i f o c c u p a t i o n a l therapy were t o l i m i t i t s e l f by c o n t i n u i n g t o be s a t i s f i e d w i t h running dinky l i t t l e sideshows i n l a r g e mental i n s t i t u t i o n s . . . . I t i s time f o r o c c u p a t i o n a l  t h e r a p i s t s t o l i s t e n t o the idea t h a t t h e i r p r o f e s s i o n has been the c h i l d o f medicine long enough and t o c o n s i d e r t h a t i t i s ready t o go o f f on i t s own as the next step toward f u l l m a t u r i t y and f u l l s o c i a l e f f e c t i v e n e s s . Occupational  t h e r a p i s t s as w e l l 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 t o p r o f e s s i o n a l p r o g r e s s , but Mosey (.118) f e e l s t h a t , i n -spite o f seeing the s i t u a t i o n , occupational  therapy has been p a s s i v e l y u n c r i t i c a l i n i t s  acceptance o f the c l o s e t i e s with medicine.  Moore (117:23), i n  denouncing t h i s s t a t e o f p a s s i v e dependency, s t a t e d t h a t " i f the o c c u p a t i o n a l  therapist i s responsible to a physician f o r  her p r a c t i c e , she w i l l remain a ' t e c h n i c i a n ' 'iV. Johnson and Smith  As e a r l y as 1966,  (83) f e l t t h a t t h e r a p i s t s were a l r e a d y de-  c r e a s i n g t h e i r dependency on medical s u p e r v i s i o n .  There appears  now t o be no s i g n i f i c a n t disagreement t h a t o n l y by being responsible  f o r t h e i r own a c t i v i t i e s w i l l o c c u p a t i o n a l  therapists  progress as p r o f e s s i o n a l h e a l t h workers. Despite  the d e s i r e o f d o c t o r s  and t h e r a p i s t s t o break the  dependency r e l a t i o n s h i p , there remains the problem o f l e g a l r e s p o n s i b i l i t y which t h e r a p i s t s must c o n s i d e r . (57)  statement t h a t the doctor  had t o have the s o l e moral and  l e g a l r e s p o n s i b i l i t y f o r the w e l l - b e i n g challanged  Friedmann's  o f the p a t i e n t was  by S i l l e r , who f e l t t h a t Friedmann's p e r c e p t i o n o f  l e 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 o f h i s " l o o k i n g where h i s a s s o c i a t e d i s c i p l i n e s were r a t h e r than where they a r e , " and t h a t 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 p r o t e c t the p u b l i c from quackery for  many o c c u p a t i o n a l  (143:411-412).  t h e r a p i s t s when he claimed  Siller  that  spoke  "although  the formal t r a i n i n g requirements f o r the o t h e r r e h a b i l i t a t i o n professions  may  require  fewer years than f o r medicine or  psychology, the p r i n c i p l e of systematic operation,  and  learning, ethical  p r o f e s s i o n a l a c c o u n t a b i l i t y should operate f o r  all". A f o u r t h p o i n t being c o n s i d e r e d on p r e v e n t i o n  as a l e g i t i m a t e s e r v i c e of o c c u p a t i o n a l  A number o f t h e r a p i s t s patterns new  i s the growing emphasis  (.64,  160,  171)  therapy.  p o i n t out t h a t emerging  of h e a l t h care d e l i v e r y are l e a d i n g to the need f o r  s e t t i n g s , new  the p r e v e n t i o n  methods, new  of d y s f u n c t i o n .  although t h e r a p i s t s are now  a new  She  philosophies  as y e t f u l f i l l e d a p o t e n t i a l f e l t . t h a t the  " e n t i r e l y consonant with one  - that occupational  and  services,  therapist's  involvement i n p r i m a r y . p r e v e n t i o n s e r v i c e s would be new profession, yet  that  settings  secondary p r e v e n t i v e  t h e r a p i s t s "have not  r o l e i n primary p r e v e n t i o n " .  emphasis on  West (174:231) s t a t e d  f u n c t i o n i n g i n new  are d e v e l o p i n g r e s t o r a t i v e and occupational  s e r v i c e s , and  of our  to  the  oldest  therapy i s concerned, not  only  with the i n d i v i d u a l ' s p h y s i c a l a b i l i t i e s , but a l s o with h i s mental, emotional, s o c i a l , and The  economic needs".  f i f t h area of review r e l e v a n t to the changing r o l e  of the c l i n i c i a n concerns the medical versus the model o f p r a c t i c e . (135) and  Therapists  state emphatically  always has  of i l l n e s s .  such as Gordon  that occupational  non-medical  (64)  and  Reilly  therapy i s concerned,  been concerned, with h e a l t h r a t h e r than pathology  West (172:14> 174:227) c l a r i f i e d t h i s concern:  There i s an i n c r e a s i n g need to i d e n t i f y with the f i e l d of h e a l t h , thus broadening  our t r a d i t i o n a l , more l i m i t e d i d e n t i f i c a t i o n with medicine; t o e n l a r g e our concept from t h a t o f being a t h e r a p i s t t o one o f f u n c t i o n i n g as a h e a l t h agent . . . with some r e s p o n s i b i l i t y f o r i d e n t i f y i n g environmental as w e l l as b i o l o g i c a l causes o f d i s e a s e and dysf u n c t i o n , f o r p a r t i c i p a t i n g i n the p l a n n i n g o f h e a l t h s e r v i c e s , and f o r h e l p i n g t o ensure normal growth and development. Rerek  (137) f e l t t h a t a c r i t i c a l p e r i o d o f development  i n o c c u p a t i o n a l therapy o c c u r r e d d u r i n g the 1930's when the p r o f e s s i o n accepted the i d e a t h a t o n l y the m e d i c a l model was a v a i l a b l e t o them.  Since the o c c u p a t i o n a l t h e r a p i s t i s con-  cerned w i t h h e a l t h r a t h e r than i l l n e s s , Rerek c l a i m e d t h a t t h e use o f the medical model f o r the d e l i v e r y o f h e a l t h s e r v i c e s , by d e f i n i t i o n , m i l i t a t e s a g a i n s t the development o f the h e a l t h o r i e n t e d s e r v i c e s o f o c c u p a t i o n a l therapy;, t h a t through the medical model "growth can o n l y be i n the d i r e c t i o n o f s e r v i c e s to the s i c k , o r ' s i c k s e r v i c e s ' "  (137:232).  Diaso  (39:239;)  b e l i e v e d t h a t " o c c u p a t i o n a l t h e r a p i s t s took a grand step away from the m e d i c a l model when they d e f i n e d f u n c t i o n and d y s f u n c t i o n as t h e i r p r o f e s s i o n a l parameters  o f concern".  O c c u p a t i o n a l t h e r a p i s t s have not completely d i s c a r d e d the medical model,, but they are q u e s t i o n i n g i t s v a l i d i t y f o r t h e i r p r o f e s s i o n and suggesting model a l t e r n a t i v e s .  F o r example,  Mosey (118) has suggested t h a t e d u c a t i o n might p r o v i d e a more u s e f u l model t o f o l l o w than medicine, while Diaso t h a t many t h e r a p i s t s i n graduate  (39) noted  s c h o o l s found they c o u l d r e l a t e  more t o the b e h a v i o u r a l s c i e n c e model than they c o u l d t o the medical model.  Diaso  (39:239) claimed t h a t " t h i s change i n  emphasis . . . r e i n f o r c e d more s t r o n g l y than before the  28.  c o n v i c t i o n t h a t p a t i e n t s ' o r c l i e n t s ' problems c o u l d not be c a s t s o l e l y i n medical terms".  D e s p i t e these statements o f  o p i n i o n on the o c c u p a t i o n a l therapy versus medical model r e l a t i o n s h i p Rerek's answered:  (137:233) q u e s t i o n remains t o be  " . . . Can we disengage o u r s e l v e s from  institutions  f o r t h e d e l i v e r y o f ' s i c k s e r v i c e s ' t h a t prevent us from our delivery of health  services?"-  A s i x t h area o f concern t o the c l i n i c i a n s ' r o l e i s the r e - e v a l u a t i o n o f the t r a d i t i o n a l m o d a l i t i e s o f treatment. Conte  (32:149), a p h y s i c i a n , expressed h i s 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 o c c u p a t i o n a l therapy should be r e e v a l u a t e d i n terms o f t h e i r meaningfulness i n the newer s o c i a l - p s y c h o l o g i c a l c u l t u r a l approach t o programming. There needs t o be an i n c r e a s e d awareness o f what k i n d s o f a c t i v i t i e s have meaning and t h e r a p e u t i c v a l u e i n the d a i l y l i v i n g experience o f p a t i e n t s .  T h e r a p i s t s a r e now examining t h e whole s u b j e c t o f treatment modalities. many c r a f t s  I t i s f e l t t h a t most c u r r i c u l a emphasize t o o (176); t h a t t h e r e i s a t r e n d toward  functional,  l e s s c r a f t - o r i e n t e d programs (83) ; and t h a t standards have a l r e a d y s h i f t e d from a r t s and c r a f t s t o t h e b a s i c s c i e n c e s (118).  Shimeld  (142:10) r e f l e c t e d much o f t h e c u r r e n t  t h i n k i n g on the r e - e v a l u a t i o n o f t r a d i t i o n a l m o d a l i t i e s o f treatment: I t w i l l be important t h a t we l e a r n t o use the t h e r a p e u t i c p o t e n t i a l o f a much broader range o f human a c t i v i t i e s than t h e standard r e p e r t o i r e o f a r t s and c r a f t s . In doing so, we w i l l have t o c o l l a b o r a t e with o t h e r s p o s s e s s i n g t h e s k i l l s we wish t o use t o h e l p our p a t i e n t s . No l o n g e r w i l l i t be p o s s i b l e f o r t h e t h e r a p i s t t o 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 f o r patients.  The  seventh area of c o n s i d e r a t i o n  of the t h e r a p i s t and Cardwell  (27)  both h i m s e l f who  occupational  i s t h a t of the  therapy.  Trider  image  (60)  arid  express concern about the t h e r a p i s t ' s image of and  h i s p r o f e s s i o n , but  i t i s Diazo  has most f u l l examined t h i s image:  "...  Many  t h e r a p i s t s continue to hold a damaged self-image p r o f e s s i o n d e s p i t e the advances of the  ^60's  (39:240-241)  of  occupational their  . . ." and  damaged image i s at l e a s t p a r t i a l l y the r e s u l t o f the p r o f e s s i o n a l development.  the  l a c k of  Diazo a s s e r t s t h a t t h i s l a c k of develop-  ment i s a r e s u l t of "undeclared c o n t r a c t s " which t h e r a p i s t s must break.  The  first  such c o n t r a c t i n v o l v e d the p o s i t i o n of  the t h e r a p i s t w i t h i n i n s t i t u t i o n a l power s t r u c t u r e s . felt  Diazo  t h a t the more experienced t h e r a p i s t s were f i n d i n g t h a t  t h e i r achieved  r o l e s outran the r o l e s a s c r i b e d t o them, a  s i t u a t i o n l e a d i n g t o f r u s t r a t i o n among those t h e r a p i s t s not allowed t o innovate or use  their f u l l  range of s k i l l s .  Diazo  a n t i c i p a t e d a problem i n t h a t a change i n t h i s i n h i b i t o r y c o n t r a c t would l i k e l y be seen as t h r e a t e n i n g  t o the system as  a whole. Diazo's second undeclared c o n t r a c t i n v o l v e s the lationship of"occupational  therapy to organized  re-  medicine.  sees t h i s as a double problem i n v o l v i n g , p r i m a r i l y , the t h a t the n a t i o n a l medical a s s o c i a t i o n s s t i l l occupational  therapy c u r r i c u l a , and  control  She  fact  the  secondly, a r o l e c o n f l i c t  w i t h i n the medical p r o f e s s i o n : The m a j o r i t y o f p h y s i c i a n s remain unaware o f the o c c u p a t i o n a l t h e r a p i s t ' s t r a i n i n g and s k i l l s . . . yet most would s t i l l a s s e r t the need to c o n t r o l 'paramedicals'.  30. Despite doctors  a s s e r t i o n s by the m e d i c a l p r o f e s s i o n  are now  (57, 68)  much b e t t e r educated as to the r o l e s of  other p r o f e s s i o n a l s , the 1969  study by Tuminelly  (161)  that  the concluded  t h a t over o n e - t h i r d of the f i n a l - y e a r m e d i c a l student respondents were not at a l l aware of the r o l e of the o c c u p a t i o n a l and most of the students had information  r e c e i v e d very l i t t l e ,  he should,  i f any,  about the p r o f e s s i o n i n medical s c h o o l .  c o n f l i c t o f medicine, then, concerns the doctor and  therapist  The  role  b e l i e v i n g that  does, know enough about another p r o f e s s i o n  to  c o n t r o l i t , while s e n i o r medical students admit t h a t , i n f a c t , they l e a r n almost nothing  about t h i s p r o f e s s i o n they w i l l  t r a d i t i o n a l l y expect to c o n t r o l .  Diazo s point i s that 1  "occu-  p a t i o n a l t h e r a p i s t s must become aware o f these r o l e 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  undeclared c o n t r a c t broken or  second-class  because t h e i r o r g a n i z a t i o n As w e l l as a l l orders  and  second  abolished.  Diazo's t h i r d undeclared c o n t r a c t concerns therapists holding  the  s t a t u s as  occupational  professionals  i s comprised p r i m a r i l y of women. d e c i s i o n s being made by a male  dominated medical p r o f e s s i o n , she a s s e r t s t h a t "throughout h i s t o r y u n t i l recent times, the submissiveness and so s t r o n g l y r e i n f o r c e d i n o c c u p a t i o n a l  Diaso  conformity  therapy r o l e s , p a r a l l e l e d  expected s e x - r o l e behaviour i n s o c i e t y " . role stereotyping  our  Not  only d i d t h i s  i n f l u e n c e the t h e r a p i s t s behaviour,  but  (39:240) f e l t i t a l s o i n f l u e n c e d the use of treatment media: T r a i n i n g s c h o o l s , h a s t i l y set up f o r women o n l y , had a strong i n f l u e n c e i n moving t h e r a p i s t s away from the wide scope of e d u c a t i o n a l , r e c r e a t i o n a l ,  v o c a t i o n a l , and other a c t i v i t i e s t h a t c h a r a c t e r i z e d the e a r l y h i s t o r y of o c c u p a t i o n a l therapy. . . . Viewed h i s t o r i c a l l y , a s o l e emphasis on a r t s and c r a f t s i n o c c u p a t i o n a l therapy represented a temporary a b e r r a t i o n d e r i v e d p a r t i a l l y from the s e x - r o l e stereotyping. Despite  t h i s t r a d i t i o n a l s t e r e o t y p i n g , Diazo f e l t  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  o c c u p a t i o n a l therapy  that,  why  should ever have been c o n s i d e r e d  a woman'  profession. The present  e i g h t h area o f concern i n the r e - e v a l u a t i o n of and  f u t u r e t h e r a p i s t ' s r o l e i s t h a t of the t r e n d to  move o c c u p a t i o n a l t h e r a p i s t s out o f i n s t i t u t i o n s and community.  the  As r e c e n t as 1966,  i n t o the  t h e r a p i s t s working i n the  areas o f both p h y s i c a l d y s f u n c t i o n , such as Johnson and (83), and p s y c h o - s o c i a l d y s f u n c t i o n , such as Conte  Smith  (32),  confirmed  t h a t the t r e n d to community-based treatment had  According  to Conte, t h i s t r e n d meant t h a t t h e r a p i s t s would  begu  have a broader range of treatment requirements t o handle an i n c r e a s i n g number of p a t i e n t s .  Shimeld  a growing philosophy  the t h e r a p i s t ' s r o l e i n the  concerning  (142:10) r e f l e c t e d  community: As t h e r a p i s t s , we must open our eyes and our minds to the world to which we are t r y i n g to h e l p our p a t i e n t s r e t u r n . Our treatment has to c a r r y over i n t o t h a t world, and the p a t i e n t s ' "mastery of h i s environment" has t o extend beyond the w a l l s o f the c l i n i c and h o s p i t a l . Reilly  (135:246) e n t h u s i a s t i c a l l y supported  service trends:  these  community  "For the young t h e r a p i s t , the r e a l a c t i o n  i n the 1970's w i l l be the c o n v e r s i o n o f the  occupational  t h e r a p i s t s ' s e r v i c e s from the h o s p i t a l t o t h e community." I t would appear t h a t the r e t u r n o f the t h e r a p i s t t o community s e r v i c e 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 t h a t t h e r a p i s t s would not be able t o expand t o any e x t e n t i n t o the community because there would not be adequate numbers o f c l i n i c i a n s a v a i l a b l e t o meet the community needs.  She r e -  commended t h a t t h e r a p i s t s should s p e c i a l i z e i n one o f o n l y two or three  areas i n s t e a d o f the dozens o f areas they a r e t r 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  t h a t as t h e r a p i s t s p r o v i d e s e r v i c e s t o community programs they would r e q u i r e improved s k i l l s i n s p e c i a l t y areas such as education, research  and c o n s u l t a t i o n .  These areas o f s p e c i a l i -  z a t i o n a r e p r e s e n t l y being implemented and evaluated  by t h e  profession.  THE  EDUCATOR  Although many t h e r a p i s t s c o n s i d e r medically-oriented, dysfunction,  themselves t o be  t r e a t i n g o n l y pathology o r p s y c h o - s o c i a l  Gallagher  (58:29) r e - i n f o r c e d one o f the e a r l i e s t  b e l i e f s i n the r o l e o f t h e o c c u p a t i o n a l educator when he a s s e r t e d  that  t h e r a p i s t as an  "our aim i s t o educate, not  merely t o p r o v i d e humane treatment f o r the handicapped". That t h e r a p i s t s accepted t h i s r o l e as e a r l y as 1918 was e s t a b l i s h e d by a paper, "The Remuneration o f t h e Teacher", presented a t the second annual meeting o f the N a t i o n a l Association  f o r the Promotion o f O c c u p a t i o n a l T h e r a p i s t s ,  (22).  33. Over the years d o c t o r s  (2), p s y c h o l o g i s t s (130),  nurses  (86), and t h e r a p i s t s (142) r e f e r r e d t o r e h a b i l i t a t i o n as being the p e r s o n a l l e a r n i n g experience t a k i n g p l a c e f o l l o w i n g t h e medical c o r r e c t i o n o f the p h y s i c a l d i s a b i l i t y .  The aim o f  therapy i s t o d i r e c t t h i s l e a r n i n g experience, and numerous t h e r a p i s t s r e f e r r e d t o t h e i r f u n c t i o n as t h a t o f t e a c h i n g t h e c h i l d o r h i s p a r e n t s , the h e m i p l e g i c , the aged o r the amputee patient  (60, 86, 115, 130, 157). As w e l l as g e n e r a l r e f e r e n c e s ,  there are s p e c i f i c r e f e r e n c e s t o the t e a c h i n g r o l e o f t h e occupational therapist.  Dunlop  p r a c t i c e o c c u p a t i o n a l therapy  (44) s t a t e d t h a t i n o r d e r t o  s u c c e s s f u l l y one must know how t o  teach and use her knowledge o f t e a c h i n g as a means t o therapy. Gillette  (62) s a i d t h a t although o c c u p a t i o n a l t h e r a p i s t s a r e  seen as t e a c h e r s , they a r e improperly  seen as t e a c h e r s o f  a c t i v i t i e s r a t h e r than teachers o f b e h a v i o u r a l change. D e s p i t e r e f e r e n c e s t o t h e t h e r a p i s t f u n c t i o n i n g as a t e a c h e r , t h e r e has been l i t t l e  a t t e n t i o n p a i d t o the a c t u a l  s k i l l s r e q u i r e d by t h i s t h e r a p i s t i n order t o t e a c h .  In one  of the few r e f e r e n c e s i n d i c a t i n g the s p e c i f i c knowledge t h e r a p i s t s should have i n order t o t e a c h , P e t e r s  (129)  in-  d i c a t e d t h e need f o r t h e r a p i s t s t o know about how a d u l t s l e a r n s i n c e the involvement  o f the p a t i e n t i n the l e a r n i n g process  was the b a s i s f o r a s u c c e s s f u l treatment  program.  T h e r a p i s t s see t h e i r r o l e not o n l y as educators o f p a t i e n t s , but a l s o educators o f o t h e r p r o f e s s i o n a l s , members of para-medical  p r o f e s s i o n s , the community, and student i n t e r n s  w i t h i n t h e i r own p r o f e s s i o n (82, 83, 85, 149, 168). Johnson and Smith  (83:270-271) attempted t o look a t t h e f u t u r e /role  of the o c c u p a t i o n a l t h e r a p i s t as an educator. that hospitals w i l l and  They p r e d i c t  f u n c t i o n as " e d u c a t i o n a l h e a l t h c e n t e r s " ,  a l l c l i n i c a l occupational therapists w i l l  whatever r o l e they f u l f i l l .  be t e a c h i n g i n  As the r o l e of the  occupational  t h e r a p i s t expands to i n c l u d e a s p e c i a l i z e d r o l e of these w r i t e r s emphasize t h a t the education  of the t h e r a p i s t  must be changed; the modern c u r r i c u l u m should of education  and  educator,  i n c l u d e methodology  the psychology of l e a r n i n g .  In both the U n i t e d S t a t e s and Canada the n a t i o n a l p r o f e s s i o n a l a s s o c i a t i o n s have accepted for  education  1959  and  of t h e r a p i s t s or therapy  1967,  direct  responsibility  assistants.  the Canadian A s s o c i a t i o n o f  Between  Occupational  T h e r a p i s t s sponsored a two-year S p e c i a l Course i n  Occupational  Therapy to q u a l i f y t h e r a p i s t s q u i c k l y at a time when there a shortage  of both t h e r a p i s t s and e d u c a t i o n a l f a c i l i t i e s f o r  t h e r a p i s t s i n Canada. A s s o c i a t i o n -accepted  The American O c c u p a t i o n a l  Therapy  the r e s p o n s i b i l i t y f o r s e t t i n g  standards  and o b j e c t i v e s f o r a t r a i n i n g program f o r o c c u p a t i o n a l assistants. M.  Boston U n i v e r s i t y , and  Center,  Dr. Malcolm Knowles, p r o f e s s o r of  and g e n e r a l c o n s u l t a n t . i n a d u l t education  education  at Boston  (33).  L i t t l e has been w r i t t e n concerning  the  educational  p r e p a r a t i o n of the u n i v e r s i t y f a c u l t y t e a c h i n g therapy.  therapy  They were able t o do t h i s with the a s s i s t a n c e of  R i t v o , a t r a i n i n g c o n s u l t a n t at the Human R e l a t i o n s  University  was  There were, i n 1970-1971, two  diploma courses  occupational  two-year t e a c h i n g  at Canadian u n i v e r s i t i e s , o n l y one  r e q u i r e d education  courses  of which  from a F a c u l t y of E d u c a t i o n .  No  35. u n i v e r s i t y program i n o c c u p a t i o n a l therapy a t e a c h i n g diploma f o r f a c u l t y members. to be a f u l l - t i m e educator  The u s u a l requirement  of occupational therapists i s a  v a r i a b l e number o f years experience, and a d e s i r e t o teach.  i n Canada r e q u i r e s  demonstrated  ability,  Those f a c u l t y members with  teaching  diplomas have found t h a t u n i v e r s i t y a d m i n i s t r a t i o n s g e n e r a l l y do not c o n s i d e r i t t o be o f value when e v a l u a t i n g the f a c u l t y member's q u a l i f i c a t i o n s f o r promotion o r tenure.  Whether i t  i s because o f a l a c k o f m o t i v a t i o n o r l a c k o f o p p o r t u n i t y on the p a r t o f the educators,  a higher teaching  qualification  i s one o f the major areas o f d e f i c i e n c y when*, c o n s i d e r i n g the s p e c i a l i s t r o l e o f the o c c u p a t i o n a l t h e r a p i s t as an  educator  i n Canada.  THE CONSULTANT  The  s p e c i a l i z e d r o l e o f the o c c u p a t i o n a l  therapy  c o n s u l t a n t i s not emphasized i n the l i t e r a t u r e u n t i l the middle o f the 1960*s.  West (170, 173) s t a t e d t h a t s i n c e  h e a l t h care moved i n c r e a s i n g l y from t h e i n s t i t u t i o n t o the community, the r o l e o f every o c c u p a t i o n a l t h e r a p i s t had a consultative function.  A i n s l e y (1), Howe and Dippy (77),  and Johnson and Smith (83) support t h a t t h e education  (35:17) o p i n i o n  and r o l e o f the o c c u p a t i o n a l t h e r a p i s t must  change and emphasize consultancy temporary t h e r a p i s t s prepared f e l t t h a t these  Cromwell's  " i n o r d e r t o produce con-  t o meet f u t u r e demands".  She  f u t u r e demands would i n c l u d e more p a t i e n t s ,  h o s p i t a l s , s c h o o l s , c h r o n i c i l l n e s s e s , l e i s u r e time, p u b l i c medicine, community medicine., ambulatory c a r e , and more emphasis on p r e v e n t i o n  i n h e a l t h c a r e , a l l i n d i c a t i n g an  i n c r e a s e d need f o r c o n s u l t a n t s . Howe and Dippy  (77) i n d i c a t e d t h a t the t r e n d p o i n t s t o  t h e r a p i s t s becoming i n c r e a s i n g l y concerned with h e a l t h and p r e v e n t i o n o f d y s f u n c t i o n i n terms o f i n d i v i d u a l s , groups, communities, and s o c i e t y as a whole.  families,  They r e p o r t t h a t  t h e r a p i s t s a r e now f u n c t i o n i n g as c o n s u l t a n t s t o community c e n t r e a c t i v i t y programs, community care homes, half-way houses, a d u l t education  programs and youth groups.  They a l s o  f e l t t h a t p r i v a t e - p r a c t i c e c o n s u l t a n t s have helped develop the growth o f o c c u p a t i o n a l therapy  as a p r o f e s s i o n .  E r h a r d t (47)  i l l u s t r a t e d t h i s growth i n her d e s c r i p t i o n o f o c c u p a t i o n a l therapy  c o n s u l t a n t s ' p r a c t i c e i n North Dakota which she f e l t  had expanded o c c u p a t i o n a l therapy medical model o f p r a c t i c e .  beyond the t r a d i t i o n a l  T h e r a p i s t s t h e r e f u n c t i o n as con-  s u l t a n t s i n three school programs f o r c h i l d r e n with handicaps.  They accept  perceptual  r e f e r r a l s from P u b l i c H e a l t h Nurses,  v o c a t i o n a l r e h a b i l i t a t i o n , s c h o o l s , c l i n i c s , and h o s p i t a l s o c i a l s e r v i c e departments as w e l l as d i r e c t medical  referrals.  Although there i s a growing need f o r t h e r a p i s t s who can accept t h e s p e c i a l i s t r o l e o f c o n s u l t a n t , many t h e r a p i s t s w i l l not f o r m a l l y accept  this role.  Leopold  (90) has ex-  amined the r o l e o f the c o n s u l t a n t and e x p l a i n e d t h a t the c o n s u l t a t i o n r e l a t i o n s h i p d i f f e r e d from the t h e r a p i s t - p a t i e n t r e l a t i o n s h i p i n t h a t the c o n s u l t a n t g e n e r a l l y l a c k s the opportunity  f o r deep p e r s o n a l g r a t i f i c a t i o n a v a i l a b l e t o the  37. c l i n i c a l therapist.  Many t h e r a p i s t s would be unable o r  u n w i l l i n g t o lose t h i s part of the t h e r a p i s t ' s i d e n t i f i c a t i o n , the core o f t h e i r p r o f e s s i o n a l l i v e s . Mazer  (111) sees the i d e a l c o n s u l t a n t ' s r o l e as one  demanding s k i l l  and knowledge o f t h e o c c u p a t i o n a l  treatment p r o c e s s , awareness and s k i l l  therapy  i n the s u p e r v i s o r y  r e l a t i o n s h i p , a c o n v i c t i o n o f the need f o r r e s e a r c h , and a high degree o f s k i l l w e l l be c o n s i d e r e d  as an educator.  Such a c o n s u l t a n t may  a t h e r a p i s t t o the community r a t h e r than t o  the i n d i v i d u a l p a t i e n t . The  new r o l e o f t h e o c c u p a t i o n a l t h e r a p i s t as a c o n s u l t a n t  has been w e l l e s t a b l i s h e d over the past f i f t e e n y e a r s .  General  acceptance o f t h i s r o l e r e q u i r e s a change i n the education o f therapists  (83) , and Gordon  (65) suggests a core  essential to future consultants.  This curriculum  curriculum includes  human r e l a t i o n s , communications, r e s e a r c h and s t a t i s t i c s , t e a c h i n g and c u r r i c u l u m c o n s t r u c t i o n , c o u n s e l i n g , and administration.  Moore (117:24) presented  a c h a l l a n g e t o educators  of f u t u r e c o n s u l t a n t s when she s a i d t h a t t h e "present  education  i s no longer enough t o prepare o c c u p a t i o n a l t h e r a p i s t s f o r the v a r i e t y o f r o l e s we have chosen t o perform".  THE  RESEARCHER  In 1961, Sommers (152:25), a r e s e a r c h p s y c h o l o g i s t , Said t h a t "no p r o f e s s i o n can r e l y i n d e f i n i t e l y on members o f another p r o f e s s i o n f o r concepts and a t h e o r e t i c a l f o u n d a t i o n .  In the  38. next decade the need w i l l be f o r o c c u p a t i o n a l t h e r a p i s t s t o engage i n r e s e a r c h as an i n t e g r a l p a r t o f the t h e r a p i s t ' s job".  Sommers was  occupational  not the f i r s t n o n - t h e r a p i s t  encourage o c c u p a t i o n a l t h e r a p i s t s t o engage i n r e s e a r c h . e a r l y as 1922,  Dr. Burnette  F i r s t World War, little  o c c u p a t i o n a l therapy  needed was  ill".  He  i n Canada had  "done  advances i n treatment  suggested t h a t what the p r o f e s s i o n  some " q u i e t , earnest r e s e a r c h work".  Over the decades t h a t f o l l o w e d , l i t t l e was  accomplished  i n what might be c a l l e d r e s e a r c h , but a g r e a t d e a l more w r i t t e n on the need f o r r e s e a r c h . graduating  As  (24:182) commented t h a t , s i n c e the  but r e g r e s s i n terms o f s c i e n t i f i c  o f the m e n t a l l y  to  c l a s s of 1940  i n t o s u i t a b l e occupations  The  was  U n i v e r s i t y o f Toronto  wrote a paper on the need f o r r e s e a r c h or r e c r e a t i o n f o r men  i n submarine  crews (166), a problem which t h e r a p i s t s are now  looking into  i n terms o f the manned space programs  (29).  There appears to be no l a c k of advice as to p o s s i b l e areas o f r e s e a r c h f o r o c c u p a t i o n a l t h e r a p i s t s .  Fisher  (55),  a p s y c h o l o g i s t , suggested t h a t o c c u p a t i o n a l t h e r a p i s t s c o u l d c o n t r i b u t e to the f i e l d of l e a r n i n g by working out a taxonomy o f psycho-motor s k i l l s , and R e i l l y  (134), one  o c c u p a t i o n a l t h e r a p i s t s with a d o c t o r a t e who  of the  remained i n the  p r o f e s s i o n , emphasized t h a t r e s e a r c h i s necessary a t h e o r e t i c a l b a s i s of o c c u p a t i o n a l  to  preference  provide  therapy.  A number o f Canadian t h e r a p i s t s have c a r r i e d out published  few  and  small s t u d i e s on such d i v e r s e s u b j e c t s as c o l o u r of o l d e r p s y c h i a t r i c p a t i e n t s  p a t i e n t s i n groups (48)., and  (36), treatment o f  the e l e c t r o m y o g r a p h i c a l  study  o f neuromuscular a c t i v i t y  (144).  Despite  some attempts t o  c a r r y out r e s e a r c h , West (168, 170) f e l t t h a t , g e n e r a l l y speaking,  most t h e r a p i s t s are content  on a l a r g e l y e m p i r i c a l b a s i s .  t o proceed p r o f e s s i o n a l l y  She observed t h a t o f t e n both  p h y s i c i a n s and t h e r a p i s t s f e l t t h a t o c c u p a t i o n a l t h e r a p i s t s had no r o l e i n r e s e a r c h , however, West b e l i e v e s t h a t occupat i o n a l t h e r a p i s t s are now o b t a i n i n g higher degrees, t r a i n i n g , and knowledge o f r e s e a r c h design and methodology which w i l l h e l p overcome the problem which Cross accurately: to  "Occupational  (36:11) d e f i n e d so  t h e r a p i s t s - have always been urged  undertake r e s e a r c h r e g a r d l e s s o f the f a c t t h a t the m a j o r i t y  have no t r a i n i n g i n r e s e a r c h and s t a t i s t i c s ^ " , . There has been some attempt t o a l l e v i a t e t h i s d e f i c i e n c y 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 o c c u p a t i o n a l therapy,  a small i n d i c a t i o n o f p r o -  f e s s i o n a l acceptance o f the r o l e o f the o c c u p a t i o n a l t h e r a p i s t as a r e s e a r c h e r . The  development o f s p e c i a l i z e d r o l e s f o r the o c c u p a t i o n a l  t h e r a p i s t o c c u r r e d g r a d u a l l y over a f i f t y year p e r i o d , mainly through the e f f o r t s o f i n d i v i d u a l t h e r a p i s t s r a t h e r than the p r o f e s s i o n as a whole. to  The r o l e o f the c l i n i c i a n has expanded  a p o i n t where i t i s impossible t o d e f i n e the r o l e o f an  o c c u p a t i o n a l therapy  clinician.  s p e c i a l i z e d r o l e s o f educator, o n l y beginning  On the other hand, the c o n s u l t a n t , and r e s e a r c h e r a r e  t o be developed, but a l r e a d y appear t o have the  approval o f the p r o f e s s i o n as being l e g i t i m a t e areas o f p r o f e s s i o n a l development.  CHAPTER IV FACTORS INFLUENCING ROLE DEVELOPMENT  Although new r o l e s f o r the o c c u p a t i o n a l  t h e r a p i s t have  developed and expanded the p r o f e s s i o n , the development would probably not have taken p l a c e without the pressures f l u e n c e s o u t s i d e o f the p r o f e s s i o n .  of i n -  The purpose o f t h i s  chapter i s t o g i v e a b r i e f overview o f some o f l e g i s l a t i v e , s o c i a l , and medical f a c t o r s which have i n f l u e n c e d the r o l e development w i t h i n the p r o f e s s i o n .  LEGISLATIVE INFLUENCES  In Canada and the United  States both present  and f u t u r e  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 p r a c t i c e 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 , f o r c e d the t h e r a p i s t t o extend h i s s e r v i c e s t o the p a t i e n t ' s home> and i n c r e a s e d the need f o r s e r v i c e s i n such agencies as n u r s i n g 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 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  no comparable l e g i s l a t i o n has been i n t r o d u c e d v i s i o n s f o r i n c r e a s i n g the supply these new programs The  (74) .  Such since  t o make p r o -  o f personnel t o s t a f f  (172).  i n t r o d u c t i o n o f a u n i v e r s a l medical-care plan i n  Canada has r e s u l t e d 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  i n c r e a s e i n the use o f h e a l t h s e r v i c e s , and areas p r e v i o u s l y 40  c o n s i d e r e d t o l i e e n t i r e l y w i t h i n the spheres o f s o c i a l adjustment, s u b j e c t t o education o r c o r r e c t i o n r a t h e r than h e a l t h s e r v i c e s , have been drawn i n t o the medical  f i e l d (25)  T h i s has meant t h a t the few a v a i l a b l e o c c u p a t i o n a l t h e r a p i s t had  t o attempt t o expand s e r v i c e s i n t o many areas t h a t had  not e a r l i e r been c o n s i d e r e d  a l e g i t i m a t e area o f p r a c t i c e  (123). In Canada, both P r o v i n c i a l and F e d e r a l Governments have, o r p l a n t o have, l e g i s l a t i o n e f f e c t i n g the p r a c t i c e o f o c c u p a t i o n a l therapy.  Three p r o v i n c e s , namely Manitoba,  Nova S c o t i a , and Saskatchewan have l e g i s l a t i o n making the p r o v i n c i a l o c c u p a t i o n a l therapy bodies  a s s o c i a t i o n s the l i s c e n c i n g  f o r the p r o f e s s i o n . .-In O n t a r i o , l e g i s l a t i o n i s  about t o be presented  which appears w i l l r e s u l t i n the  e s t a b l i s h i n g o f a College o f Occupational  Therapy which w i l l  be r e s p o n s i b l e f o r l i s c e n c i n g p r a c t i t i o n e r s i n t h a t At the N a t i o n a l Conference on Education  province  o f Health  Manpower h e l d i n Ottawa i n October, 1971, speakers a t the m i n i s t e r i a l and d e p u t y - m i n i s t e r i a l l e v e l s i n d i c a t e d t h a t recommended f u t u r e f e d e r a l l e g i s l a t i o n would have an e f f e c t on the p r a c t i c e o f o c c u p a t i o n a l therapy  (160).  They s t a t e d  t h a t , i n the f u t u r e , the d e l i v e r y o f h e a l t h s e r v i c e s would take p l a c e t o an i n c r e a s i n g degree i n the community r a t h e r than i n c h r o n i c and acute care i n s t i t u t i o n s ; t h a t f e d e r a l money would i n c r e a s i n g l y go t o predominately  out-patient  community h e a l t h c e n t r e s . The omitted  area o f the education o f h e a l t h workers was not from the F e d e r a l Government's area o f concern.  They  f e l t t h a t a f a r g r e a t e r emphasis would be p l a c e d on i o n i n h e a l t h s e r v i c e s , and  prevent-  e d u c a t i o n a l l y there would  p r o p o r t i o n a l l y more emphasis on the b e h a v i o u r a l  sciences  while the emphasis on the p h y s i c a l s c i e n c e s would be Of i n t e r e s t to o c c u p a t i o n a l  be  reduced.  t h e r a p i s t s i s the f a c t t h a t  the  F e d e r a l Government proposes to be i n v o l v e d i n standards o f education.  Trider's  (160:4) r e p o r t on the  National  Conference mentioned t h a t "the r o l e s of a l l h e a l t h workers w i l l be r e d e f i n e d according and  to the need f o r t h e i r  t h e i r competency to provide The  the s e r v i c e s " .  F e d e r a l Government of Canada has  concern with the present professions. be.included  also indicated  a c c r e d i t a t i o n of a l l h e a l t h  That o c c u p a t i o n a l  therapy as a p r o f e s s i o n  will  i n h e l p i n g to form F e d e r a l Government p o l i c y i s  i n d i c a t e d i n a l e t t e r of A p r i l the Deputy M i n i s t e r o f Health  21,  1972,  i n which the M i n i s t e r e x p l a i n e d seek your advice  and  from the o f f i c e  to the P r e s i d e n t of  Canadian A s s o c i a t i o n o f Occupational  Therapists  t h a t he was  of  the  (C.A.O.T.)  writing  "to  comments on means by which a c c r e d i t a -  t i o n a c t i v i t i e s i n education  i n the h e a l t h d i s c i p l i n e s  p r o v i s i o n o f h e a l t h s e r v i c e s may  c r e d i t s , and  and  be improved, w i t h a view  to a c h i e v i n g n a t i o n a l standards, p o r t a b i l i t y of t i o n s and  services  qualifica-  improved s e r v i c e s i n the p u b l i c  interest". In J u l y , 1972,  the P r e s i d e n t  t h a t the C.A.O.T. was of future Federal The  present  of the C.A.O.T. i n d i c a t e d  s e r i o u s l y c o n s i d e r i n g the  implications  i n t e r v e n t i o n i n a c c r e d i t a t i o n procedures.  B a s i s of Approval of o c c u p a t i o n a l  therapy programs  was drawn up j o i n t l y by the C.A.O.T. and, the Canadian  Medical  A s s o c i a t i o n about 1959, and i s i n need o f review i n any case, thus p r e s e n t i n g  a timely opportunity  for discussion  between the Government and the C.A.O.T. An area o f l e g a l concern t o o c c u p a t i o n a l can best be i n t r o d u c e d  by Dr. Friedmann's  t h a t " i t i s important f o r t h e man m o r a l l y responsible  therapists  (57:405) t h e s i s and l e g a l l y  f o r t h e care o f the p a t i e n t t o be the man con-  t r o l l i n g the care".  T h i s t h e s i s has been accepted as f a c t by  many t h e r a p i s t s ; t h a t d o c t o r s  are l e g a l l y responsible  for a l l  p r o f e s s i o n a l a c t i o n s o f t h e t h e r a p i s t and t h e r e f o r e the t h e r a p i s t i s o b l i g e d by law t o work under medical d i r e c t i o n (4 3).  However, c o n s u l t a t i o n w i t h a lawyer* i n d i c a t e d t h e  f a l l a c y o f t h i s commonly h e l d b e l i e f . s t a t u t e , as such, i n t h e U n i t e d physician l e g a l l y responsible occupational law"  therapist.  In f a c t , t h e r e  i s no  S t a t e s o r Canada, making the  f o r the a c t i o n s o f an  In case law o r common law, " t o r t  d e a l s w i t h t h e r e s p o n s i b i l i t y o f the i n d i v i d u a l and  c i v i l wrongs.  In t o r t law, t h e d o c t r i n e o f respondeat  s u p e r i o r r e l a t e s t o the r e s p o n s i b i l i t y o f a p r i n c i p l e f o r the a c t i o n s o f h i s agent. t r u e o n l y when there  However, t h i s r e s p o n s i b i l i t y i s  i s very c l o s e c o n t r o l and s u p e r v i s i o n  o f t h e agent by the p r i n c i p l e , and i n t h e c o u r t s r e s p o n s i b i l i t y i s decided according  t o t o r t law, a p h y s i c i a n i s r e s p o n s i b l e  a c t i o n s o f an o c c u p a t i o n a l  * Personal  on an i n d i v i d u a l b a s i s .  communication.  such Thus, f o r the  t h e r a p i s t o n l y i f i t can be shown  t h a t t h e r e has  been very c l o s e c o n t r o l and  t h e r a p i s t by the d o c t o r , relationship. not p r e s e n t ,  f o r h i s own  accountable i n a c o u r t of law  must be r e - e v a l u a t e d  himself  a c t i o n s and may  i n case o f  be  held  malpractice.  Dr. Friedmann's c l a i m t h a t  alone are l e g a l l y r e s p o n s i b l e  cations  control i s  i t i s most probable t h a t the t h e r a p i s t  to t o r t law,  the  i n p r a c t i c e , an uncommon working  I f t h i s very c l o s e s u p e r v i s i o n and  c o u l d be h e l d r e s p o n s i b l e  According  s u p e r v i s i o n of  physicians  f o r a l l aspects o f p a t i e n t  by t h e r a p i s t s and  care  the r e s u l t i n g i m p l i -  recognized.  SOCIAL INFLUENCES  Throughout the e a r l y developmental years o f therapy, the p r o f e s s i o n a l r o l e s and changing pressures pressures 1930  were:  depression  urbanization  and  years  (18,  35,  f u n c t i o n s adapted t o  needs o f s o c i e t y .  the two  118);  and  171).  The  154,  182),. the  industrialization the i n c r e a s i n g  requirements f o r p u b l i c h e a l t h and w e l f a r e 154,  and  financial  programs (84,  l a t e r developmental years o f  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,  and  a t t i t u d e s toward work and  new The  l e i s u r e (39, 83,  social-medical r e s p o n s i b i l i t i e s F i r s t and  (25,  118,  occupational  therapy were i n f l u e n c e d by s o c i e t y re-examining i t s own  171);  the  Some of those  World Wars (39, 43,  (39, 154);  occupational  159,  142,  needs 164, 166);  146).  Second World Wars produced some s i m i l a r  i n f l u e n c e s on the development of o c c u p a t i o n a l  therapy r o l e s .  The  l a r g e numbers o f wounded servicemen c r e a t e d the impetus  f o r t h e p r o f e s s i o n not o n l y t o i n c r e a s e i t s numbers but t o i n c r e a s e and develop  new s k i l l s and techniques  for treating  both the p h y s i c a l l y and m e n t a l l y d i s a b l e d v/ho were s u r v i v i n g because o f improved medical treatment  care.  F o l l o w i n g the acute-  post-war p e r i o d s , l a r g e numbers o f t h e r a p i s t s were  no longer r e q u i r e d i n t h e m i l i t a r y h o s p i t a l s .  They moved out  i n t o mental h o s p i t a l s , g e n e r a l h o s p i t a l s , and community s h e l t e r e d workshops where f u r t h e r new r o l e s had t o be developed. S h o r t l y a f t e r t h e F i r s t World War, t h e r e was an e r a o f economic p r o s p e r i t y and e n l i g h t e n e d s o c i a l  conscience.  T h i s , combined with the improvement i n medical  sciences,  r e s u l t e d i n the e s t a b l i s h i n g o f l a r g e i n s t i t u t i o n s t o care f o r t h e i n c r e a s i n g numbers o f p h y s i c a l l y ;or m e n t a l l y ill,  chronica  and f u r t h e r c h a l l e n g e d t h e development o f o c c u p a t i o n a l  therapy The  roles. d e p r e s s i o n years o f t h e 1930's were t r o u b l e d years  f o r the d e v e l o p i n g p r o f e s s i o n .  Although  the number o f  t h e r a p i s t s i n c r e a s e d , budgets were c u t and many t h e r a p i s t s c o u l d n o t be h i r e d , p a r t i c u l a r l y by small  institutions.  As a r e s u l t , many t h e r a p i s t s t e m p o r a r i l y v o l u n t e e r e d  their  s e r v i c e s t o l a r g e r i n s t i t u t i o n s i n order t o prove t h e i r  value  as p o t e n t i a l employees. - A f t e r t h e d e p r e s s i o n , t h e r a p i s t s were e s t a b l i s h e d mainly  i n l a r g e mental  institutions,  s a n i t o r i u m s , and g e n e r a l h o s p i t a l s . The  Second World War c a s u a l t i e s again encouraged  t h e r a p i s t s t o r e - e v a l u a t e t h e i r r o l e s and develop  new  methods and  techniques o f treatment.  By the end  they found themselves i n a new  role;, no  s o l e a c t i v i t y g e n e r a l i s t s , But  i n s t e a d , one  therapists  Physiatrist.  l o n g e r were they  the  o f many a n c i l l a r y  medical s p e c i a l i s t ,  As a r e s u l t of war  become narrow and  o f the p a t i e n t ' s  body and  i n f l u e n c e s , the  c o n t r o l l e d ; she mow  the therapist's  treated a  p r o v i d e d a p a r t of h i s  much o f her p r e v i o u s s e r v i c e to him  part  activity  needs, thereby r e l i n q u i s h i n g both p a r t o f the p a t i e n t o t h e r s and  war  s p e c i a l i z i n g i n the area of p h y s i c a l medicine  under the d i r e c t i o n of a new  r o l e had  o f the  to  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 c o s t of medical care, r e s u l t e d i n the c l u s t e r i n g o f major m e d i c a l f a c i l i t i e s i n the  l a r g e r metropolitan areas.  Large s p e c 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 h o s p i t a l were developed, and  t h e r a p i s t s developed new  to f i t the needs of the  institutions.  specialty roles  A c c o r d i n g to Mosey  (118), these l a r g e i n s t i t u t i o n s came i n t o being i n r e a c t i o n to a breakdown i n e s t a b l i s h e d the  f a m i l y , the  school,  and  urban mobile f a m i l y c o u l d to aged o r d i s a b l e d was  not o r i e n t e d  c h i l d ; and  no  s o c i a l i n s t i t u t i o n s such as  o r g a n i z e d medicine.  f a m i l y members; the e d u c a t i o n a l  to managing o r t e a c h i n g  the  i n d i v i d u a l t h e r a p i s t ' s r o l e grew, and s i t u a t i o n he  he  found  As  system  handicapped  o r g a n i z e d medicine's primary concern was  i n whatever new  new  l o n g e r p r o v i d e c u s t o d i a l care  s p e c i a l i s t ' s treatment of acute i l l n e s s .  ialist  The  the  a r e s u l t , the  f l o u r i s h e d as a spec himself.  Concern with the r i s i n g c o s t s o f h e a l t h  and  welfare  47. s e r v i c e s was a l s o r e s p o n s i b l e f o r changes i n h e a l t h care s e r v i c e s and d e l i v e r y , both i n f l u e n c i n g r o l e development. The r e h a b i l i t a t i o n movement, o f which o c c u p a t i o n a l therapy i s and was a p a r t , was encouraged i n i t s development by insurance c a r r i e r s , governments, and p r i v a t e agencies f o r l a r g e l y f i n a n c i a l reasons.  New  drugs and s u r g i c a l techniques were  saving l i v e s but producing d i s a b l e d i n d i v i d u a l s who f i n a n c i a l l y supported, o f t e n by the p u b l i c .  had t o be  I t was observed  t h a t i f the handicapped c o u l d be r e h a b i l i t a t e d , many o f them c o u l d be removed from p u b l i c maintenance programs and become independent, c o n t r i b u t i n g members o f s o c i e t y .  Agencies such  as the Workman's Compensation Board found i t e c o n o m i c a l l y t o t h e i r advantage, even as e a r l y as the 1920's, t o e s t a b l i s h r e h a b i l i t a t i o n c e n t r e s i n order t o get the i n j u r e d workman back on the job as q u i c k l y as p o s s i b l e and o f f compensation. These new developments opened o t h e r areas i n which t h e r a p i s t s developed new r o l e s and t e c h n i q u e s . To a l a r g e extent f i n a n c i a l c o n s i d e r a t i o n s were r e s p o n s i b l e f o r the development o f d e l i v e r y systems such as day-care h o s p i t a l s and community h e a l t h programs, a l l areas o f o c c u p a t i o n a l therapy involvement.  new  Although t h e r e  were o t h e r f a c t o r s c o n t r i b u t i n g t o the changes i n h e a l t h care d e l i v e r y , i n economic terms the changes were c o n s i d e r e d a good s o c i a l investment which would h e l p t o break i n t o the p o v e r t y - s i c k n e s s c y c l e and decrease the p o t e n t i a l  financial  costs to society. The f i n a n c i a l f a c t o r has not been the o n l y c o n s i d e r a t i o n as t o why  s o c i e t y i s encouraging and s u p p o r t i n g changes i n  o  48. h e a l t h care d e l i v e r y .  A more r e c e n t phenomenon i s t h a t o f  i n c r e a s e d s o c i a l awareness of the h e a l t h and s o c i a l needs of the i n d i v i d u a l , r e g a r d l e s s o f h i s a b i l i t y t o pay, and i n c r e a s e d s o c i a l r e - e v a l u a t i o n and acceptance problems and  social ethics.  of new  an medical  For example, siociety has  now  accepted as a m e d i c a l r e s p o n s i b i l i t y such problems as drug a d d i c t i o n and a l c o h o l i s m , both p r e v i o u s l y c o n s i d e r e d l e g a l responsibilities.  As a r e s u l t , o c c u p a t i o n a l t h e r a p i s t s  are attempting t o develop new  therapy p r a c t i c e s t o a s s i s t  the problems o f h e r o i n d e t o x i f i c a t i o n .  concerned  with  T h e r e f o r e , occupa-  t i o n a l therapy, having become i n v o l v e d i n new programs, i s now  (146)  community  w i t h the h e a l t h need o f the  i n d i v i d u a l as a s o c i a l b e i n g , a s i t u a t i o n r e m i n i s c e n t o f the moral treatment  era.  Another s o c i a l i n f l u e n c e i s the present examination work and the work e t h i c i n contemporary s o c i e t y .  of  Diazo  (39) p o i n t e d out t h a t t e c h n o l o g i c a l advances are having a marked e f f e c t on s o c i e t y and have i m p l i c a t i o n s f o r a l l occup a t i o n a l t h e r a p i s t s , p a r t i c u l a r l y those working i n the of  vocational rehabilitation.  I t now  l e n g t h o f time t o a c q u i r e marketable  areas  takes a c o n s i d e r a b l e work s k i l l s , and  even  then they q u i c k l y become o b s o l e t e ; t h e r e are p r e s s u r e s f o r e a r l i e r r e t i r e m e n t from work and an i n c r e a s e i n l e i s u r e even f o r those who 1980,  are working.  A c c o r d i n g t o Diazo,  time  by  the h a l f o f the p o p u l a t i o n under t w e n t y - f i v e years o f  age and twenty percent o f the p o p u l a t i o n over r e t i r e m e n t w i l l a l l be consumers, not producers, i n s o c i e t y .  Martin  (108:26) has presented o c c u p a t i o n a l t h e r a p i s t s w i t h some  age  g u i d e l i n e s f o r working w i t h p a t i e n t s or c l i e n t s i n the  light  o f t e c h n o l o g i c a l advances: I f we s e t our g o a l s c o r r e c t l y , automation and any o t h e r advances w i l l f a l l i n t o perspective. . . . The most important o f these g o a l s are enhancement o f motivat i o n , i n d i v i d u a l i t y and c r e a t i v e 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 a t the l e v e l o f open employment or l e a d i n g 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 s o c i e t y to r e - e v a l u a t e the o l d t r a d i t i o n a l v a l u e s o f achievement through work. c u l a r l y concerned  Parti-  w i t h the work v a l u e s are the younger  members o f s o c i e t y who  f e e l t h a t " t o o l s and machines  uses are no more, and not meant t o be more, than o f h i s p e r s o n a l i t y ; and t h a t w i t h these t o o l s man  man  extensions should  o n l y r e a c h beyond the range o f h i s l i m i t a t i o n s t o serve human v a l u e s "  (142:9).  The q u e s t i o n put f o r t h i s whether  o c c u p a t i o n a l therapy can keep i n tune w i t h such changes i n s o c i a l t h i n k i n g which w i l l continue t o change i n the f u t u r e . To date, these s o c i a l i n f l u e n c e s have had  "profound  i m p l i c a t i o n s f o r the kinds o f s e r v i c e s o c c u p a t i o n a l t h e r a p i s t s p r o v i d e f o r p a t i e n t s or c l i e n t s because of the c l o s e r e l a t i o n s h i p with p a t t e r n s o f work, l e i s u r e , and v a r i o u s r o l e r e l a t e d and developmental therapy p r a c t i c e "  a c t i v i t i e s that define occupational  (39:238).  MEDICAL INFLUENCES  As a h e a l t h p r o f e s s i o n c l o s e l y a l l i e d t o medicine,  50. occupational ments and  therapy c o u l d not  remain untouched by  develop-  changes w i t h i n the p r a c t i c e o f medicine.  o c c u r r e d i n the produced a new  One  change  1940's when emphasis on medical s p e c i a l i z i n g r o l e w i t h i n the m e d i c a l p r o f e s s i o n  itself.  i n c r e a s i n g number o f p a t i e n t s with, p h y s i c a l d i s a b i l i t i e s increased  s k i l l s required  t o t r e a t them produced the  The and  phys-  i a t r i s t , or s p e c i a l i s t i n p h y s i c a l medicine and r e h a b i l i t a t i o n . T h i s new  s p e c i a l i s t depended t o a great  of various  extent on the  support  kinds of t h e r a p i s t s t o c a r r y out h i s d i r e c t i o n s f o r  treatment o f the p a t i e n t .  The  p h y s i a t r i s t was  of the r e h a b i l i t a t i o n movement and occupational  t h e r a p i s t , were, and  the  back-bone  therapists, including  the  a r e , the back-bone o f t h i s  medical s p e c i a l t y . A review of the l i t e r a t u r e has  indicated three  further  major areas o f change i n medical p r a c t i c e which have i n f l u enced p a r a l l e l changes i n the p r a c t i c e of o c c u p a t i o n a l  therapy:  1) changes and  of  developments i n the  medicine; 2) changes and p r a c t i c e of medicine; and  s c i e n t i f i c practice  developments i n the  philosophical  3) changes i n methods o f h e a l t h  care  delivery. A c c o r d i n g t o Spackman (154) , a number o f advances i n medicine f o l l o w i n g the F i r s t and Wars s t i m u l a t e d r o l e s and  the development o f new  practices.  Second World  occupational  For example, the d i s c o v e r y  f o r p o l i o m y e l i t i s i n 1955 drop-off  scientific  of a vaccine  r e s u l t e d i n an almost complete  i n the number of. acute p o l i o p a t i e n t s  treatment.  therapy  requiring  P r i o r to t h i s major s c i e n t i f i c d i s c o v e r y ,  most common form o f treatment i n v o l v e d  the  s u r g i c a l procedures  51. followed  by a prolonged  years o f t h e c e s s a t i o n  ' r e h a b i l i t a t i o n ' period.  o f p o l i o epidemics, few working r  t h e r a p i s t s ever saw an acute p o l i o p a t i e n t . discovery  The m e d i c a l  o f a n t i b i o t i c s i n t h e 1930's and 40's a l s o  a f f e c t e d the development o f o c c u p a t i o n a l a n t i b i o t i c s r e s u l t e d i n an i n c r e a s e general population required  Within ten  and an i n c r e a s e  therapy.  The use o f  i n the l i f e - s p a n o f the i n treatment and care  f o r both the w e l l and c h r o n i c a l l y - i l l aged.  Anti-  b i o t i c s and improved s u r g i c a l techniques a l s o produced major problems which had not p r e v i o u s l y t o any e x t e n t .  been i n evidence  They saved l i v e s which might p r e v i o u s l y  have  been l o s t , and what was l e f t was o f t e n maimed bodies and minds o f q u a d r a p l e g i c s , p a r a p l e g i c s , and  severe stroke  patients,  c e r e b r a l p a l s i e d c h i l d r e n , most o f whom are now a  treatment r e s p o n s i b i l i t y o f the o c c u p a t i o n a l increase  therapist.  The  i n the p r o d u c t i o n o f new m e d i c a l - p h a r m a c e u t i c a l  products produced t h e infamous t h a l i d o m i d e t r a g e d i e s occupational  t h e r a p i s t s are attempting t o t r e a t .  which  Insulin  saved l i v e s but r e s u l t e d i n more amputees f o r t h e t h e r a p i s t to t r e a t .  Medical-technical  units for renal patients  developments such as home d i a l y s i s  have moved t h e r a p i s t s from the i n -  s t i t u t i o n i n t o the p a t i e n t s ' home The  (88).  development o f l a r g e numbers o f drugs used t o t r e a t  mental i l l n e s s e s has r e s u l t e d i n both a g r e a t e r treatable psychiatric patients and  number o f  for the occupational  therapist  a need f o r t h e t h e r a p i s t t o develop improved methods o f  treatment i n c o l l a b o r a t i o n w i t h an i n c r e a s i n g number o f o t h e r types o f treatment p e r s o n n e l .  Reilly  (133) p o i n t e d out  s t u d i e s on sensory d e p r i v a t i o n which i n d i c a t e the need o f an e f f i c i e n t l y f u n c t i o n i n g mind f o r constant  environmental  s t i m u l i , a d i s c o v e r y t h a t both she and Shimeld " i s a b a s i c need t h a t o c c u p a t i o n a l serving". and  Medical  motor d y s f u n c t i o n  i n neuro-physiology  i n t o l e a r n i n g have r e s u l t e d  i n a new f u n c t i o n f o r o c c u p a t i o n a l perceptual  therapy ought t o be  s c i e n t i s t s ' research  the p s y c h o l o g i s t s ' r e s e a r c h  (142) agree  therapists treating  and l e a r n i n g d i s a b i l i t i e s .  These  are o n l y a few o f t h e obvious s c i e n t i f i c advances i n t h e p r a c t i c e o f medicine which have had g r e a t growing and developing t i o n a l therapy. occupational  i n f l u e n c e s on the  r o l e s w i t h i n t h e p r a c t i c e o f occupa-  From these examples, i t would appear t h a t  therapy developed t o a l a r g e extent  as a s o l u t i o n  t o the many new and d i f f e r e n t problems a r i s i n g from  scientific  advances i n the p r a c t i c e o f medicine. The  changes and developments i n the p h i l o s o p h i c a l p r a c t i c e  o f medicine have a l s o had c o n s i d e r a b l e p r a c t i c e of occupational and  therapy.  "community" might be considered  i n f l u e n c e on t h e  The two words,  "prevention"  the c e n t r a l core o f  concern i n new medical p h i l o s o p h y .  According  to the report o f  the 1965 Royal Commission on Health  S e r v i c e s , "prevention i n  the form o f p h y s i c a l and mental f i t n e s s i s g r a d u a l l y as a r e s p o n s i b i l i t y o f t h e h e a l t h s e r v i c e s I t also reported community care  evolving  . . . " (25:11).  t h a t w i t h new emphasis on home care and  "the o b j e c t i v e s of,modern g e n e r a l  practice . . .  seem t o merge g r a d u a l l y w i t h those o f s o c i a l medicine,  pre-  v e n t a t i v e medicine, and the newly emerging concept o f what t r a d i t i o n a l l y has been r e f e r r e d t o as p u b l i c h e a l t h "  (25:13).  53. Zamir (185:193). p o i n t e d out t h a t one i n the new is  philosophy  s i g n i f i c a n t concept  as i t i n f l u e n c e s o c c u p a t i o n a l  " h e a l t h p r o f e s s i o n s c e a s i n g to be medical  therapy  professions  devoted t o t r e a t i n g p a t i e n t s i n i n s t i t u t i o n s , but r a t h e r . . . expanding t o h e a l t h s e r v i c e s t o members of the community i n a v a r i e t y o f s o c i a l , e d u c a t i o n a l , and p r o f e s s i o n a l s e t t i n g s " . Wiemer and West do not see t h i s p r e v e n t i o n  and  community-  o r i e n t e d model o f p r a c t i c e as e i t h e r a s u b s t i t u t e or r e p l a c e ment f o r the t r a d i t i o n a l medical model. it  Instead, they  see  as "an e x t e n s i o n of o c c u p a t i o n a l t h e r a p i s t s ' t r a d i t i o n a l  r o l e c o n s i s t e n t w i t h p a r a l l e l extensions  of  traditional  r o l e s o f medicine and contemporary with consumer needs as they are now  identified"  (178:327).  d e s p i t e the f a c t t h a t medical  I t i s p o i n t e d out  that  s p e c i a l i s t s such as p e d i a t r i c s  and p s y c h i s t r y are a l r e a d y moving i n the d i r e c t i o n of the community and p r e v e n t i o n , p h y s i c i a n s , as y e t , are not  un-  animous i n the d e s i r e t o implement these approaches to medical  care.  However, many t h e r a p i s t s are moving with  medical  innovators  T h e r a p i s t s who  may  i n t o the areas o f community and f e e l t h a t t h i s new  students  t h a t i f they f a i l  needs o f the p u b l i c , s o c i e t y w i l l  prevention.  model does not concern  them might w e l l c o n s i d e r McWhinney's (106) medical  the  admonition t o  to meet the demonstrated f i n d a way  o f meeting  the  need by t u r n i n g t o p r a c t i t i o n e r s o u t s i d e of medicine. The  t h i r d i n f l u e n c e i n medicine which has a f f e c t e d r o l e  development i n o c c u p a t i o n a l therapy delivery.  As e a r l y as 1964,  Occupational  i s t h a t o f h e a l t h care  the Canadian A s s o c i a t i o n of  T h e r a p i s t s became concerned t h a t changing  patterns  54. of p a t i e n t care were changing the r o l e o f the o c c u p a t i o n a l therapist  (105).  Traditional  h e a l t h care has been con-  cerned with l a r g e , s h o r t - s t a y , a c u t e r c a r e g e n e r a l m e d i c a l o r s u r g i c a l i n s t i t u t i o n s and l a r g e , long-term c h r o n i c - c a r e psychiatric institutions  (35) .  There are a t l e a s t t h r e e  apparent reasons f o r the change i n emphasis from t h i s  tradi-  t i o n a l method t o newer methods o f h e a l t h care d e l i v e r y .  Two  have been mentioned, namely, the change and advances i n medical s c i e n c e s and technology, and the change i n the p h i l o s o p h y o f the p r a c t i c e o f medicine.  The t h i r d reason f o r  the change i n emphasis i n v o l v e s f i n a n c i a l c o s t s o f h e a l t h services.  A c c o r d i n g t o Nixon  (123:190),  insurance plans o r s o c i a l i z e d medicine  the new h e a l t h  "dramatize and exacerbate  the inadequacies o f the e x i s t i n g d e l i v e r y systems and i t s p a i n f u l shortages o f manpower and f a c i l i t i e s " .  I t became  obvious t h a t f o r f i n a n c i a l reasons not everyone  needing  medical treatment c o u l d , o r should, be admitted t o acute care h o s p i t a l s o r even emergency departments o r o u t - p a t i e n t c l i n i c s . The l e s s c o s t l y s o l u t i o n appeared  t o be t h a t o f t a k i n g t h e  s e r v i c e s t o t h e people where they l i v e d A number o f methods o f implementing  (178). the r e q u i r e d new  h e a l t h care d e l i v e r y systems have been suggested and t r i e d . The most common method i n v o l v e s a c e n t r a l medical c e n t r e surrounded  by "outreach" c l i n i c s and s e r v i c e s not c o n s i d e r e d  to be a p a r t o f acute care f a c i l i t i e s S a t e l l i t e c l i n i c s , neighbourhood  (59, 35, 178).  s e r v i c e c e n t r e s , group and  f a m i l y p r a c t i c e c e n t r e s , n u r s i n g homes, and home care teams are new h e a l t h c a r e d e l i v e r y areas i n which the modern  occupational therapist i s finding a r o l e . O c c u p a t i o n a l therapy, i n l i n e w i t h the new  r e a l i t i e s of  medical care programs and h e a l t h care d e l i v e r y systems, i s moving away- from a s o l e concern with i n s t i t u t i o n a l i z e d  medicine  In o r d e r t o do so, o c c u p a t i o n a l therapy has had t o develop r o l e s t o keep i t s s e r v i c e s v i a b l e .  new  Some t h e r a p i s t s have r e -  j e c t e d these r o l e s , b e l i e v i n g t h a t o c c u p a t i o n a l therapy i s moving away from medicine while o t h e r t h e r a p i s t s enthusiasm  express  a t the r o l e developments, understanding t h a t occu-  p a t i o n a l therapy i s moving with medicine Wiemer and West demonstrate  i n t o the community.  a profound understanding of  and r e s p e c t f o r the many experienced t h e r a p i s t s who  are  f i n d i n g the new,  d e v e l o p i n g r o l e s of the o c c u p a t i o n a l t h e r a p i s t  hard t o accept.  The new  d e f i n i t i o n o f o c c u p a t i o n a l therapy  i m p l i e s a p r o f e s s i o n a l scope f o r which n e i t h e r t h e i r e d u c a t i o n nor experience have prepared them.  The emphasis on h e a l t h ,  p r e v e n t i o n , and community r o l e s are undoubtedly  foreign  con-  cepts t o many o f these experienced t h e r a p i s t s .  However, . . .  i s i n r e l a t i o n s h i p t o other medical and h e a l t h r e l a t e d p r o f e s s i o n s and t h e i r e v o l v i n g r o l e s i n the h e a l t h p a r t n e r s h i p thslt o c c u p a t i o n a l t h e r a p i s t s w i l l mark out the boundaries o f t h e i r t r u e purpose  and c o n f i r m the wisdom of the  traditional,  newer, or a s - y e t - u n w r i t t e n d e f i n i t i o n of o c c u p a t i o n a l therapy"  (178:324).  EDUCATIONAL NEEDS  L e g i s l a t i v e , s o c i a l , and medical  f a c t o r s have i n f l u e n c e d  the r o l e development o f the o c c u p a t i o n a l t h e r a p i s t i n such a way as t o r e s u l t i n the emergence o f s p e c i a l t y r o l e s such as c o n s u l t a n t , educator,  and r e s e a r c h e r .  They have a l s o had  an i n f l u e n c e on d i r e c t i n g the c l i n i c i a n back i n t o the community  and have decreased  model o f p r a c t i c e .  the emphasis on the medical  The e d u c a t i o n a l programs a r e r e s p o n s i b l e  f o r p r e p a r i n g t h e r a p i s t s t o f u n c t i o n w i t h i n these new r o l e s and  functional settings.  A b r i e f examination o f the 1970 -  1971 e d u c a t i o n a l programs i n Canada w i l l g i v e some i n d i c a t i o n as t o whether o r not these programs a r e f u l f i l l i n g the e d u c a t i o n a l needs o f f u t u r e o c c u p a t i o n a l t h e r a p i s t s . T r a d i t i o n a l C1inica1  Reguirernents  An examination o f the 1970 - 1971 u n i v e r s i t y c a l e n d a r s would i n d i c a t e t h a t a l l e i g h t u n i v e r s i t y programs a r e t e a c h i n g c l i n i c a l t h e r a p e u t i c techniques  a p p r o p r i a t e t o the t r a d i t i o n a l  r o l e d e f i n i t i o n o f the o c c u p a t i o n a l t h e r a p i s t (see Table  1).  New Role Requirements An examination o f the new, d e v e l o p i n g new areas o f l e a r n i n g which are necessary  roles indicate t o prepare  t h e r a p i s t s t o f u l f i l l t h e requirements o f these new r o l e s . These areas o f l e a r n i n g i n c l u d e community o c c u p a t i o n a l therapy  and p r e v e n t a t i v e  s k i l l s and the e f f e c t o f environmental  i n f l u e n c e s on the p r a c t i c e o f o c c u p a t i o n a l therapy;  research  methodology and/or " s t a t i s t i c s ; t e a c h i n g methods; l e a r n i n g theory; techniques  o f c o n s u l t a t i o n ; and i n c r e a s e d emphasis  TABLE 1 EDUCATIONAL PROGRAM CONTENT RELATED TO ROLE REQUIREMENTS Old Role Requirements*  New O c c u p a t i o n a l Therapy Roles Requirements*  University  Community, Research Techniques Clinical P r e v e n t i o n , and/or Teaching Learning of Therapeutic Environment S t a t i s t i c s Methods Theory ConsultatiorJ Techniques  Alberta  no  yes  no  yes  no  yes  British 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 i n f o r m a t i o n taken from o f f i c i a l  1970-1971 u n i v e s i t y c a l e n d a r s .  58. i n the area of the s o c i a l s c i e n c e s . 1.  Community, P r e v e n t i o n , and In 1970  - 1971,  Environment:  no Canadian e d u c a t i o n a l programs  i n d i c a t e d any emphasis on t e a c h i n g students  skills  s p e c i f i c a l l y r e l a t e d t o community or p r e v e n t a t i v e p a t i o n a l therapy or the e f f e c t s o f environmental on the p r a c t i c e of o c c u p a t i o n a l therapy 2.  occustress  (see Table  1).  Research Methodology and/or S t a t i s t i c s : In 1970  - 1971,  o n l y t h r e e of the e i g h t p r o f e s s i o n a l  programs i n Canada i n d i c a t e d t h a t the t e a c h i n g o f s t a t i s t i c s and/or r e s e a r c h methodology was curricula 3'  (see Table  1).  L e a r n i n g Theory: In 1970  - 1971,  a l l e i g h t u n i v e r s i t y programs  i n d i c a t e d t h a t t h e i r c u r r i c u l a i n c l u d e d at l e a s t  one  course  (see  i n v o l v i n g the t e a c h i n g o f l e a r n i n g theory  Table 1 ) .  The m a j o r i t y of these courses were g i v e n  the psychology 4.  p a r t of the  Teaching  by  faculty.  Methods:  In 1970  - 1971,  o n l y t h r e e of e i g h t programs i n -  d i c a t e d t h a t they i n c l u d e d t e a c h i n g methods i n t h e i r undergraduate c u r r i c u l a 5.  (see Table  Techniques of C o n s u l t a t i o n : In 1970  - 1971,  no e d u c a t i o n a l programs i n d i c a t e d  the t e a c h i n g o f techniques o c c u p a t i o n a l therapy 6.  1).  Emphasis on S o c i a l In 1970  - 1971,  of c o n s u l t a t i o n to t h e i r  students  (see Table  1).  Sciences: the percentage of hours i n the  TABLE 2 SOCIAL SCIENCE HOURS IN OCCUPATIONAL THERAPY CURRICULA  University  T o t a l Number o f C u r r i c u l u m Hours  Number and Percentage o f S o c i a l Science Hours  c  3024  0  2639  103  2270  144  ( 6%)  2731  270  ( 9%)  2910  330  (11%)  Montreal  1568  240  (15%) .  Alberta  2795  429  (15%)  2538  450  (17%)  Laval  a  Toronto  13  British  Columbia * 3  Queen's  3  Manitoba  McGill  3  3  3  3  a  Options a v a i l a b l e which c o u l d be i n s o c i a l  sciences.  b  Combined p h y s i c a l - o c c u p a t i o n a l 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 .  (0%) •  (4%)  60. social  s c i e n c e s as compared t o the t o t a l  curriculum  hours d u r i n g the school year v a r i e d from zero (see Table  percent  to  seventeen percent  2).  It  would appear t h a t the Canadian e d u c a t i o n a l programs  are f i l l i n g  the needs of the t r a d i t i o n a l  therapist.  However, the m a j o r i t y of the programs are  very l i t t l e ,  i f anything,  to f i l l  the new  needs o f the contemporary t h e r a p i s t . p a t i o n a l therapy  and  program* i n i t i a t e d i n 1971  needs of the t h e r a p i s t .  I t s 1971  doing  developing  An experimental  a g r e a t e r attempt than the t r a d i t i o n a l new  occupational  occu-  appears to be making  programs to f i l l - 1972  the  calendar  i n d i c a t e d the f o l l o w i n g : a)  Twenty-four percent of i t s c u r r i c u l u m was social  b)  science  content.  Emphasis i s p l a c e d on community, p r e v e n t i v e , and mental o c c u p a t i o n a l  c)  environ-  therapy.  Both t e a c h i n g methods and the  d)  devoted t o  l e a r n i n g theory were i n c l u d e d i n  curriculum.  Research s t a t i s t i c s and methodology were i n c l u d e d i n the curriculum.  e)  The  t e a c h i n g of t r a d i t i o n a l  t h e r a p e u t i c techniques  been p a r t i a l l y r e p l a c e d by the t e a c h i n g o f r o l e and behaviour a n a l y s i s and and k i n e t i c a n a l y s i s of  has  occupational  the s o c i a l , p s y c h o l o g i c a l ,  activity.  * Program i n O c c u p a t i o n a l Therapy, the U n i v e r s i t y of Western O n t a r i o , London, Canada.  The present plan of the experimental revise i t s curriculum as necessary  program i s to  i n 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 s o c i a l , medical, and l e g i s l a t i v e f a c t o r s . Although new roles f o r 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.  S o c i a l , l e g i s l a t i v e , and medical  influences have indicated the need f o r change which r e l a t i v e l y 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 S t a t e s and Canada t h e r e has been c o n s i d e r a b l e concern expressed occupational therapist.  over t h e changing r o l e o f the  There i s p r e s e n t l y no consensus  w i t h i n t h e p r o f e s s i o n as t o the a p p r o p r i a t e n e s s  or legitimacy  o f t h e r o l e s as they appear to-have developed.  Both t h e r a p i s t s  and n o n - t h e r a p i s t s have expressed,the need t o examine and r e - e v a l u a t e t h e r o l e s , r e s p o n s i b i l i t i e s , and e d u c a t i o n a l programs f o r o c c u p a t i o n a l t h e r a p i s t s .  SUMMARY  The  purposes o f t h i s study were t o d e s c r i b e the r o l e  development o f the o c c u p a t i o n a l t h e r a p i s t , and t o i d e n t i f y some o f t h e f a c t o r s which have i n f l u e n c e d and d i r e c t e d t h e r o l e changes. An examination o f t h e l i t e r a t u r e i n d i c a t e d t h a t both g e n e r a l i s t and s p e c i a l i s t r o l e s o f the o c c u p a t i o n a l t h e r a p i s t have evolved o r developed i n response t o changing needs within society.  I t has been shown t h a t s o c i a l ,  legislative,  medical,  and e d u c a t i o n a l f a c t o r s , and the e v o l u t i o n a r y changes  of these  f a c t o r s t o meet new s o c i a l c o n d i t i o n s and needs,  have s t r o n g l y i n f l u e n c e d the l e g i t i m a t e r o l e changes o f t h e occupational therapist. I t was assumed t h a t i f these r o l e changes and t h e i r 62  i n f l u e n c i n g f a c t o r s c o u l d be i d e n t i f i e d , t h i s study would then be o f v a l u e t o both the p r o f e s s i o n and the educators o f therapists.  Such an i d e n t i f i c a t i o n c o u l d a s s i s t them  1) t o i d e n t i f y and e v a l u a t e t r e n d s i n f l u e n c i n g the r o l e development; 2) t o i d e n t i f y some areas i n need o f immediate r e s e a r c h ; and 3) t o g i v e some temporary g u i d e l i n e s as t o changes t h a t may be r e q u i r e d i n the p r o f e s s i o n i f i t i s t o remain v i a b l e .  OBSERVATIONS AND' RECOMMENDATIONS  An a n a l y s i s o f the review o f the l i t e r a t u r e on the changing r o l e o f the o c c u p a t i o n a l t h e r a p i s t has r e s u l t e d i n o b s e r v a t i o n s and recommendations, which have  implications  f o r both the p r o f e s s i o n s and the educators o f the p r o f e s s i o n a l s . These w i l l be d i s c u s s e d under t h r e e headings:  1) r o l e  development; 2) r e s e a r c h needs; and 3) e d u c a t i o n a l needs. Role  Development  O b s e r v a t i o n 1: W i t h i n the medical model o f p r a c t i c e , the p h y s i a t r i s t i s o n l y one o f the many medical s p e c i a l i s t s w i t h whom the o c c u p a t i o n a l t h e r a p i s t can work.  There i s no evidence  indicating  any v a l i d reason why t h e r a p i s t s 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 r a t h e r than with him except t h a t i t has been t r a d i t i o n t o do so.  I t i s t o the p h y s i a t r i s t s  1  advantage t o  s t r e s s 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 r o l e conflict  situation.  64. Recommendation: a)  That t h e r a p i s t s who  i n h i b i t i n g t h e i r own  submissively  support t h i s  p r o f e s s i o n a l development and  tradition, t h a t of  p r o f e s s i o n as a whole, examine t h e i r a t t i t u d e s and consider  the n e c e s s i t y o f supporting  seriously  not o n l y t h e r a p i s t s , but  many p h y s i c i a n s , o f f i c i a l medical a s s o c i a t i o n s , and who  support o f f i c i a l  r e c o g n i t i o n of o c c u p a t i o n a l  independent p r o f e s s i o n .  the  governments  therapy as  Attempts by t r a d i t i o n - b o u n d  to i n h i b i t the p r o f e s s i o n i n i t s attempts t o a c q u i r e  an  therapists independ-  ence from the medical p r o f e s s i o n can o n l y be a r e s u l t o f a misunderstanding o f the t r u e b)  situation.  That t h e r a p i s t s must become more aware t h a t the medical  model o f p r a c t i c e i s o n l y one occupational  o f s e v e r a l models i n which the  t h e r a p i s t can now  model i s not o b s o l e t e  function.  Although the medical  as an area of p r a c t i c e , t h e r a p i s t s  can  help enhance t h e i r image by acknowledging the f a c t t h a t they have chosen to work as p r o f e s s i o n a l equals i n t h i s area  of  p r a c t i c e r a t h e r than i n another a v a i l a b l e area o f p r a c t i c e .  Observation  2:  Occupational  therapy i s an e c l e c t i c p r o f e s s i o n ,  knowledge from many f i e l d s and areas and  d i s c i p l i n e s to develop  t h e o r i e s of t h e r a p e u t i c  treatment.  t h e r a p i s t s are d i s t u r b e d because o c c u p a t i o n a l not appear to have a d i s t i n c t i v e and i t must be noted t h a t no developing unique b a s i s f o r i t s e x i s t e n c e . must l e a r n from the theory  taking new  Although some therapy does  unique body of knowledge, p r o f e s s i o n today has  a  To develop and grow, each  of other  disciplines.  the  Recommendation: Since o c c u p a t i o n a l  therapy, as an e c l e c t i c  i s w e l l s u i t e d t o grow and  t o develop i t s own  profession,  r o l e s by  drawing on knowledge o f many o t h e r , more e s t a b l i s h e d d i s c i p l i n e s , therefore occupational  t h e r a p i s t s must become  more aware o f developments i n f i e l d s other than medicine i f they are to grow as p r o f e s s i o n a l s and develop t h e i r legitimate roles.  Observation  3:  Changes i n i n s t i t u t i o n a l a d m i n i s t r a t i o n the p r o f e s s i o n i s to develop  are necessary i f  fully.  Recommendation: That once C h i e f s of Occupational to be,  and  expect  are, r e s p o n s i b l e to i n s t i t u t i o n a d m i n i s t r a t o r s ,  C h i e f s should  be r e s p o n s i b l e  development of t h e r a p i s t s . achieved  Therapy S e r v i c e s  the  f o r encouraging p r o f e s s i o n a l In t h i s way  the problem o f  r o l e s outrunning a s c r i b e d r o l e s c o u l d be overcome.  Observation Sex-role  4: s t e r e o t y p i n g of the o c c u p a t i o n a l  therapist  been l a r g e l y the r e s p o n s i b i l i t y o f the p r o f e s s i o n i t s e l f ,  has and  i t w i l l be up to the p r o f e s s i o n to change t h i s a t t i t u d e , both w i t h i n and out of the  profession.  Recommendation: That as t h e r a p i s t s become l e s s submissive and occupational  therapy should  be l e s s concerned w i t h  conforming, the  n e c e s s i t y of r e c r u i t i n g males to the p r o f e s s i o n 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 , r e g a r d l e s s of sex, i n order t o improve the image o f o c c u p a t i o n a l  Observation  5:  H e a l t h care d e l i v e r y systems are changing. little  therapy.  There i s  i n d i c a t i o n t h a t anyone w i l l approach o c c u p a t i o n a l  therapy  asking f o r s e r v i c e s i f he i s not aware o f the  p o t e n t i a l s e r v i c e s o f the t h e r a p i s t . Recommendation: That t h e r e i s a need f o r o c c u p a t i o n a l t h e r a p i s t s t o e v a l u a t e t h e i r own  s e r v i c e s which c o u l d be implemented i n  community programs, community c l i n i c s , units.  and  family practice  I t w i l l be a r e s p o n s i b i l i t y of the p r o f e s s i o n t o  p o i n t out t o a d m i n i s t r a t o r s and governments the s e r v i c e s t h e r a p i s t s have t o o f f e r which would h e l p round out h e a l t h s e r v i c e s to t h e i r  Observation The  clients.  6:  changes i n s o c i a l a t t i t u d e s towards the  importance  of work i n d i c a t e s a need f o r the r e - e v a l u a t i o n o f t h e r a p i s t s ' attempts to prepare  the s e v e r e l y handicapped t o take a  v o c a t i o n a l p l a c e i n a s o c i e t y which has accepted high r a t e o f unemployment among the  a remarkably  non-disabled.  Recommendation: That the theory behind,  and the purpose o f , r e h a b i l i t a -  t i o n or s h e l t e r e d workshops and the concomitant r o l e of the o c c u p a t i o n a l t h e r a p i s t , must be r e - e v a l u a t e d . appears to i n d i c a t e a need f o r l e s s emphasis on  The  literature  unrealistic  attempts a t v o c a t i o n a l  preparation  l e i s u r e and  developmental  Observation  7:  E t h n i c a l operation  on  activities.  and  as t r u e f o r o c c u p a t i o n a l  and more emphasis  professional  accountability i s  therapy as f o r any  other  profession.  Trends i n d i c a t i n g t h a t t h e r a p i s t s w i l l be moving i n t o community and  the  i n t o p r i v a t e p r a c t i c e i n d i c a t e a need f o r  t h e r a p i s t s t o be aware o f p r o f e s s i o n a l 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 p r o f e s s i o n a l acceptance o f t h i s  r e s p o n s i b i l i t y might be the w i l l i n g n e s s o f the  professional  a s s o c i a t i o n at the n a t i o n a l l e v e l to support a group malpractice  insurance p l a n  f o r t h e r a p i s t s throughout  the  country.  Research Needs Observation  8:  At present a l l c u r r i c u l u m a l l too and  i n f r e q u e n t l y , can  r e v i s i o n s , and  they are made  be based o n l y on an  experimental  e m p i r i c a l b a s i s which cannot be c o n s i d e r e d a s o l i d  f o u n d a t i o n f o r the b u i l d i n g of a d e v e l o p i n g T h i s study has  i n d i c a t e d two  r e q u i r i n g immediate r e s e a r c h .  Once t h i s has must be  been e s t a b l i s h e d ,  c a r r i e d out,  major p r o f e s s i o n a l  The  establishing a theoretical basis  profession.  f i r s t i s i n the  for occupational the  second area of  that of curriculum  areas  area o f therapy. research  development f o r  68.  o c c u p a t i o n a l therapy  programs.  U n t i l a theoretical basis  has been e s t a b l i s h e d , t h e r e w i l l be no means o f e s t a b l i s h i n g , even t h e o r e t i c a l l y , what content, or how much o f what c o n t e n t , should be i n c l u d e d i n any o c c u p a t i o n a l therapy  curriculum.  Recommendation: a)  That u n i v e r s i t y programs and f a c u l t y c o - o r d i n a t e  their  e f f o r t s t o do b a s i c and a p p l i e d r e s e a r c h i n o c c u p a t i o n a l therapy. b)  That the primary  emphasis i n r e s e a r c h be the e s t a b l i s h i n g  of a t h e o r e t i c a l b a s i s f o r o c c u p a t i o n a l therapy  f o l l o w e d by  r e s e a r c h i n t o c u r r i c u l u m development.  Observation  9:  Most t h e r a p i s t s are not q u a l i f i e d or capable o f c a r r y i n g out v a l i d r e s e a r c h which i s the l i f e - b l o o d of a d e v e l o p i n g profession.  Both the l a c k o f p r o f e s s i o n a l r e s e a r c h and the  l a c k o f o p p o r t u n i t y f o r t h e r a p i s t s t o l e a r n how t o do r e s e a r c h would i n d i c a t e t h a t the e d u c a t i o n a l programs have been f o r too l o n g f o l l o w e r s o f , r a t h e r than l e a d e r s i n , p r o f e s s i o n a l development. Recommendation: a)  That e d u c a t i o n a l programs must c o n s i d e r ways and means  o f i n c l u d i n g r e s e a r c h 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 p o s s i b l e . b)  That f a c u l t y members o f u n 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 t o do r e s e a r c h t h a t w i l l a s s i s t i n both  their  own development and the development of the p r o f e s s i o n . c)  That f u r t h e r o p p o r t u n i t y f o r p r o f e s s i o n a l r e s e a r c h be  e s t a b l i s h e d i n the development o f graduate programs a t the Masters  l e v e l i n o c c u p a t i o n a l therapy i n Canada.  These  programs w i l l not be e s t a b l i s h e d u n t i l the present programs are upgraded t o honours l e v e l s t a n d i n g w i t h i n the u n i v e r s i t i e s .  E d u c a t i o n a l Needs Observation  10:  Although  i t has been e s t a b l i s h e d t h a t the o c c u p a t i o n a l  t h e r a p i s t i s an educator however he f u n c t i o n s , a t present the e d u c a t i o n o f the t h e r a p i s t as an educator appears  t o be  inadequate. Recommendation: That t e a c h i n g methods and  s k i l l s as w e l l as p r i n c i p l e s  of l e a r n i n g be i n c o r p o r a t e d i n a l l undergraduate  Observation  programs.  11:  The present shortage of p o t e n t i a l o c c u p a t i o n a l therapy f a c u l t y i s exacerbated by the a t t i t u d e s of experienced t h e r a p i s t s who  f e e l t h a t they do not know how  t o teach  and  t h e r e f o r e have no i n t e r e s t i n t e a c h i n g . Recommendation: That students a t the undergraduate  l e v e l become more  aware o f the f a c t t h a t , while c a r r y i n g out any f u n c t i o n as a t h e r a p i s t , she w i l l be f u l f i l l i n g the r o l e o f an educator, or teacher.  I f t h i s concept were emphasized by e d u c a t o r s , more  t h e r a p i s t s might be w i l l i n g t o c o n s i d e r the r o l e o f as a l o g i c a l area of o c c u p a t i o n a l therapy  educator  specialization.  70. Observation  12:  Of the two 1970  - 1971,  Diploma t e a c h i n g  one  had  courses f u n c t i o n i n g i n  o b l i g a t o r y courses f o r students w i t h i n  the F a c u l t y o f E d u c a t i o n while the other appeared to have a learn-by-doing  orientation.  Recommendation: That post-graduate programs i n o c c u p a t i o n a l have c l o s e r t i e s t o u n i v e r s i t y education  therapy  and/or a d u l t  departments so t h a t the experienced t h e r a p i s t s may t o the  and  teaching.  Observation  13:  A c c r e d i t a t i o n procedures f o r e d u c a t i o n a l now  have access  l e a r n i n g o p p o r t u n i t i e s necessary f o r capable  confident  education  programs are  best c a r r i e d out under the d i r e c t i o n of the  a d m i n i s t r a t i v e body f o r o c c u p a t i o n a l  national  therapists.  Recommendation: That an a c c r e d i t a t i o n a d v i s o r y  body should  mainly of t h e r a p i s t s , but with r e p r e s e n t a t i o n health professions  Observation  and  the  be  from  composed other  community.  14:  As the t h e r a p i s t ' s r o l e s expand, the number of t h e r a p i s t s r e q u i r e d to f i l l  these new  roles i s increasing.  There  p r e s e n t l y appears to be no adequate system f o r educating  the  numbers of h i g h l y q u a l i f i e d t h e r a p i s t s t h a t are r e q u i r e d  to  fill  the r o l e o f c o n s u l t a n t .  The  s k i l l s of the  r e q u i r e a s p e c i a l i z e d breadth of knowledge.  Few  consultant skills  r e q u i r e d by the c o n s u l t a n t a r e being taught  i n the t r a d i t i o n a l  e d u c a t i o n a l programs. Recommendation: That students  be prepared  a t t h e undergraduate l e v e l t o  p a r t i c i p a t e t o a g r e a t e r extent as p o t e n t i a l c o n s u l t a n t s . As a c o n s u l t a n t , one t h e r a p i s t c o u l d p r o v i d e a s e r v i c e t o s e v e r a l f a c i l i t i e s i n s t e a d o f t o one. With a background o f t h e o r e t i c a l knowledge, experience, and c o n s u l t a n c y ,  and s k i l l s  i n education  the t h e r a p i s t c o u l d teach many other non-  p r o f e s s i o n a l s t o c a r r y out p a r t o f t h e s e r v i c e s t h a t t h e t h e r a p i s t would p r e v i o u s l y have attempted t o do alone.  Observation 15: Schools  and e d u c a t i o n a l programs have encouraged s e x - r o l e  s t e r e o t y p i n g i n the p a s t .  A number o f programs have made i t  known t h a t they do not have f a c i l i t i e s  f o r male students and  most have emphasized t h e t e a c h i n g o f t h e r a p e u t i c  activities  which themselves were c o n s i d e r i n g t o be s t e r e o t y p e d ,  female  occupations. Recommendation: That educators  s e r i o u s l y c o n s i d e r the p o s s i b i l i t y  they may be attempting  that  t o produce t h e r a p i s t s i n t h e i r own  image, thus i n a d v e r t e n t l y encouraging the s e x - r o l e  stereotyped  image so common t o t h e p r o f e s s i o n .  Observation 16: There i s a need f o r more emphasis on the b e h a v i o u r a l s c i e n c e s and l e s s on t h e p h y s i c a l s c i e n c e s f o r f u t u r e h e a l t h  72. science p r a c t i t i o n e r s . Recommendation: That an assumption v a l i d reasons why  be made t h a t t h e r e are no l o n g e r  a t h e r a p i s t must wait f o r an o p p o r t u n i t y t o  c a r r y out postgraduate work i n the s o c i a l s c i e n c e s i n o r d e r to  fill  a b a s i c need he has found i n h i s p r o f e s s i o n a l  experience.  Observation  17:  The c o n t i n u a l l y r a i s e d q u e s t i o n o f the need f o r p r o f e s s i o n a l programs t o a s s i g n hundreds of hours t o the t e a c h i n g of  a r t s and c r a f t s s k i l l s must r a i s e s e r i o u s doubts i n the  minds o f the educators. for  To continue to emphasize the need  students t o l e a r n how  t o s k i l l f u l l y c o n s t r u c t products  from beginning t o end r e i n f o r c e s the r o l e of the t h e r a p i s t a t e c h n i c i a n r a t h e r than a p r o f e s s i o n a l .  A  as  non-arts-and-  c r a f t s t r e n d has been emphasized i n the l i t e r a t u r e , but t o date o n l y 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 c u r r i c u l u m i n p l a c e o f the emphasis on t e a c h i n g e x p e r t i s e i n s p e c i f i c c r a f t Recommendation: That t o educate  .  skills.  v-  the student i n the p r i n c i p l e s of  s o c i a l , p s y c h o l o g i c a l , and k i n e t i c a n a l y s i s would appear t o be a sound p o l i c y which would b e t t e r prepare the student t o focus on the needs of the p a t i e n t or c l i e n t .  I t would a l s o  f r e e hundreds of c u r r i c u l u m hours which c o u l d be used t o i n c o r p o r a t e p r e v i o u s l y i n d i c a t e d 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 i n d i c a t i o n s t h a t the f u t u r e emphasis i n the h e a l t h s c i e n c e s w i l l  include  p r e v e n t i o n , community s e r v i c e s , and the e d u c a t i o n o f competent general p r a c t i t i o n e r s . Recommendation: That o c c u p a t i o n a l therapy examine and r e - d e f i n e i t s r o l e and f u n c t i o n i n the community and adapt i t s e d u c a t i o n a l programs t o prepare more students t o be competent i n the growing  community s e r v i c e programs.  I f t h i s self-examination  does not take p l a c e , someone e l s e w i l l do i t and f i n d p a t i o n a l therapy l a c k i n g i n competencies  occu-  t o j o i n with the  o t h e r medical or h e a l t h p r o f e s s i o n s i n community h e a l t h services.  CONCLUSIONS  The r o l e s o f the o c c u p a t i o n a l t h e r a p i s t are changing i n response t o l e g i s l a t i v e , s o c i a l , and m e d i c a l  influences.  Although the c l i n i c i a n , or g e n e r a l i s t , i s acknowledged t o be the backbone o f the p r o f e s s i o n , i t has been found t h a t s p e c i a l i s t r o l e s , such as educator, r e s e a r c h e r , and s u l t a n t , are becoming more p r e v a l e n t .  con-  These s p e c i a l i s t  roles  have developed i n response t o s o c i a l and p r o f e s s i o n a l needs which cannot be f i l l e d by the p r e s e n t inadequate numbers of  clinicians. I t has a l s o been found, p a r t i c u l a r l y i n Canada, t h a t  p r o f e s s i o n a l programs have not adequately educated t h e r a p i s t s to f i l l  these new  educational  roles.  The  administrators  and  f a c u l t y of  programs' appear t o be r e t i c e n t i n i n t r o d u c i n g  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  f u t u r e t r e n d s , might b e t t e r prepare the f u t u r e t h e r a p i s t s to fill  the new  and developing  i n Canada i n 1970  - 1971,  community, p r e v e n t i o n ,  roles.  Of the e i g h t programs  none contained  content r e l a t e d to  o r the environment.  Only  three  programs i n c l u d e s t a t i s t i c s and/or,research methods, t h r e e i n c l u d e content on t e a c h i n g methods, and content on techniques of c o n s u l t a t i o n .  none i n c l u d e On  a l l e i g h t spend hundreds o f hours t e a c h i n g "therapeutic  techniques",  the other  or c r a f t s k i l l s which,  according  the i n d i v i d u a l t h e r a p i s t , and  p a r t i c u l a r l y the  profession, educators,  must re-examine t h e i r r o l e s i n the l i g h t of the new and  educational  s o c i a l trends  of  therapists.  I t becomes i n c r e a s i n g l y e v i d e n t t h a t the  medical,  hand,  specific  to the l i t e r a t u r e , are becoming o b s o l e t e m o d a l i t i e s treatment f o r o c c u p a t i o n a l  any  in society.  Professional  legislative, and  changes must take p l a c e soon i f o c c u p a t i o n a l  therapy i s t o remain a v i a b l e h e a l t h  profession.  SELECTED  BIBLIOGRAPHY  A i n s l e y , J . ; Barnes, S.; Grove, E.; Johnson, T.; Koorman, C ; and Stephens, C. "On Change," American J o u r n a l o f O c c u p a t i o n a l Therapy, 23:186-189 (1968). A i t k e n , A.N. " R e h a b i l i t a t i o n Therapy i n a S a n i t o r i u m , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 1:10-17 (1947). American O c c u p a t i o n a l Therapy A s s o c i a t i o n . D e s c r i p t i o n s o f F u n c t i o n i n O c c u p a t i o n a l Therapy, New York: The American O c c u p a t i o n a l Therapy A s s o c i a t i o n , 1969. American O c c u p a t i o n a l Therapy A s s o c i a t i o n . P r o f e s s i o n a l R e a c t i v a t i o n i n O c c u p a t i o n a l Therapy, Dubuque, Iowa: Kendall-Hunt P u b l i s h i n g Company, 1969. American O c c u p a t i o n a l Therapy A s s o c i a t i o n . "Occupational Therapy: I t s D e f i n i t i o n and F u n c t i o n s , " American J o u r n a l o f O c c u p a t i o n a l 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 J o u r n a l o f O c c u p a t i o n a l Therapy, 32:119-120 (1965). Angus, L. R. "Some Newer Methods i n O c c u p a t i o n a l Therapy as P r a c t i c e d a t the N e u r o - P s y c h i a t r i c I n s t i t u t e o f the H a r t f o r d R e t r e a t , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 1:9-16 (1933). A r a n o f f , P. "Occupational Therapy and C h i l d P s y c h i a t r y , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 34:5 (1967) . • ' Arkansas R e h a b i l i t a t i o n Research & T r a i n i n g C e n t e r . "Community Involvement," i n Report o f C u r r e n t and Future Trends i n R e h a b i l i t a t i o n as They A f f e c t O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , Arkansas, p.70 (February, 1967). Baker, F.; O'Brian, G.M.; and Sheldon, A. "Reference Groups o f O c c u p a t i o n a l T h e r a p i s t s : Role O r i e n t a t i o n i n a Mental H o s p i t a l . " American J o u r n a l o f O c c u p a t i o n a l Therapy. 22:197-202 (1968) .  76.  B a n n i s t e r , H.F. " L e g i s l a t i v e . C h a n g e s and T h e i r I m p l i c a t i o n s , " Report o f C u r r e n t and; F u t u r e " Trends i n R e h a b i l i t a t i o n as They A f f e c t O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , Hot Springs N a t i o n a l Park, Arkansas, pp.13-19 (February, 1967). Barager, C.A. " O c c u p a t i o n a l Therapy as Seen by a P s y c h i a t r i s t , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 2:3-9 (1934). Bayne, J . "The Role o f O c c u p a t i o n a l Therapy i n S h e l t e r e d Workshops," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 37:108-112 (1970). Bernd, Joan. "The Challenge o f R e h a b i l i t a t i o n Workshops, Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 34:151 (1967). B e r t e l i n g , Mary K. "Occupational Therapy a t Walter Reed General H o s p i t a l , " Canadian J o u r n a l o f Occupat i o n a l Therapy. 12:4 (1945). B i c k l e , M i l d r e d , R. "The Hamilton Workshop," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 7:81 (1940). B i d d l e , B. and Thomas, E. Role Theory: Concepts and Research. New York: John Wiley & Sons, Inc. 1966. Bockoven, J.S. "Challenge o f New C l i n i c a l Approaches," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:23-25 (1968). "— —  . "Legacy o f Moral Treatment - 1800's t o 1910," American J o u r n a l o f O c c u p a t i o n a l Therapy, 25:223-225 (1971).  B r a c k e t t , E.G. "Scope o f O c c u p a t i o n a l Therapy," A r c h i v e s of O c c u p a t i o n a l Therapy, 1: (1922). Brown, Lawrie. " R e h a b i l i t a t i o n Foundation f o r the D i s a b l e d , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 31:19-21 (1964). Brunyate, Ruth. "Powerful L e v e r s , " American J o u r n a l o f O c c u p a t i o n a l Therapy. 12:195 (1958). Burk, R i c h a r d D. "General Trends i n R e h a b i l i t a t i o n C e n t r e s , " Report o f C u r r e n t and F u t u r e Trends i n R e h a b i l i t a t i o n as They A f f e c t O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , Hot Springs N a t i o n a l Park, Arkansas, pp.4-7 (February, 1967).  B u r n e t t e , Norman L. "The Status o f O c c u p a t i o n a l Therapy i n Canada," A r c h i v e s o f O c c u p a t i o n a l Therapy, 2:179-182 (1922). Canada. Emerging P a t t e r n s i n H e a l t h Care, e d i t e d by Robert Kohn, Royal Commission on H e a l t h S e r v i c e s , Ottawa: Queen's P r 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 , P r o f e s s i o n a l and T e c h n i c a l Occupations, Ottawa: Queen's P r i n t e r , 1961 ( r e v i s e d , 1967).  C a r d w e l l , Thelma. " P r e s i d e n t ' s Address," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 33:139 (1966). Carpendale, M.T.F. "Does R e h a b i l i t a t i o n Work?," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 32:132 (1965). C a t t e r t o n , Marianne M. "Dimensions o f O c c u p a t i o n a l Therapy," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 32:153-164 (1965). C h a r t e r s , A.N. "Continuing Education i n the P r o f e s s i o n s , " Handbook o f A d u l t E d u c a t i o n , New York: The MacMillan Company, pp.490-491 (1970). C o l b e r t , James N. " P h i l o s p h i a H a b i l a t u s , " J o u r n a l o f R e h a b i l i t a t i o n , pp.18-19 (Sept.-Oct. 1969). Conte, W.R. and M e u l i , A.L. "Occupational Therapy i n Community Mental H e a l t h , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 20:147-150 (1966). Crampton, M.W. " E d u c a t i o n a l Upheaval f o r O c c u p a t i o n a l Therapy A s s i s t a n t s , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 21:317-320 (1967). Cromwell, F l o r e n c e S. "Occupational T h e r a p i s t - Observer o r E v a l u a t o r ? , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 33:63' (1966). •  . "Trends i n O c c u p a t i o n a l Therapy," Proceedings o f Workshop f o r Improvement o f E d u c a t i o n a l Techniques o f O c c u p a t i o n a l Therapy C l i n i c a l Supervising Personnel, U n i v e r s i t y of North Dakota,. Grand Forks, N.D., pp. 17-21 (January, 1971).  C r o s s , D.S. "Colour P r e f e r e n c e o f Older P a t i e n t s , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 27:9-11 (1960).  78.  Dancey, Freda K. "Have You an Idea?," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 31:51 (1964). De La C h a r i t e , S i s t e r Jean. "The Neglected Phase o f R e h a b i l i t a t i o n , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 29:101 (1962). D i a s i o , Karen. "The Modern E r a - 1960 to 1970," American J o u r n a l of O c c u p a t i o n a l Therapy, 25:237-242 (1971). D i l l y , H. "Changing P a t t e r n s of H e a l t h Care S e r v i c e s , " American J o u r n a l of O c c u p a t i o n a l Therapy, 24:403-408 (1970). D r i v e r , M u r i e l F. "A P h i l o s o p h i c View of the H i s t o r y of O c c u p a t i o n a l Therapy i n Canada," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 35:53-60 (1968). _. "Seek we Status o r S t a t u r e , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 34 :57 (1967). ~~ Dunlop, W.J. "A B r i e f H i s t o r y of O c c u p a t i o n a l Therapy," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 1:6 (1933). . _ . "The O c c u p a t i o n a l T h e r a p i s t as a Teacher," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 2:11-12 (1934). . ; LeVesconte, H.P.; de B r i s a y , A.; e t a l . "Report o f Committee on E d u c a t i o n , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy. 7:82 (1940). Ebner, J . ; King, L.; M o n i c a l , B.; Monkhouse, E.; S c h l o r f f , V.; and Wallace, L. "A Statement on O c c u p a t i o n a l Therapy and P h y s i c a l Therapy i n Community H e a l t h , " American J o u r n a l of O c c u p a t i o n a l Therapy, 24:46-47 (1970) . E r h a r d t , R.P. "The O c c u p a t i o n a l T h e r a p i s t as a School C o n s u l t a n t f o r Perceptual-Motor Programming," American J o u r n a l o f O c c u p a t i o n a l Therapy, 35:411-414 (1972). [ ; E r n e s t , M a r i l y n . "Occupational Therapy Study on Treatment i n Groups," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 33:148-150 (1966). " "Continuing Education and O c c u p a t i o n a l Therapy," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 37:69-70,76 (1970).  79. 50.  F a r r a r , C.B. " R e h a b i l i t a t i o n i n Nervous and Mental Cases Among E x - S o l d i e r s , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 7:25 (1940).  51.  F i d l e r , G a i l S. "A Guide t o P l a n n i n g , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 18:240-243 (1964).  52.  "Learning as a Growth Process," America'n J o u r n a l o f O c c u p a t i o n a l Therapy, 20:1-8 (1966).  53.  F i d l e r , N.D. "Occupational Therapy from the Nursing Standpoint," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 2 :114-117 (1935).  54.  F i e l d s , B. "What i s Realism i n O c c u p a t i o n a l Therapy?," American J o u r n a l o f O c c u p a t i o n a l Therapy. 10:9-10,34 (1956).  55.  F i s h e r , Lawrence. "Upheaval i n E d u c a t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy. 21:362-367 (1967).  56.  F r i e d l a n d , J . and Murphy, Marge. "A Group Approach i n P s y c h i a t r i c O.T.," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 32:110 (19637":  57.  Friedmann, Lawrence W. "Medicine, Nursing,and P h y s i c a l Therapy," A r c h i v e s o f P h y s i c a l Medicine and R e h a b i l i t a t i o n , pp.404-406 (Sept., 1971).  58.  G a l l a g h e r , James. "Cooperation f o r S e r v i c e , " J o u r n a l o f R e h a b i l i t a t i o n , p.29 (Mar.-Apr., 1969).  59.  G a r f i e l d , S. "The D e l i v e r y o f M e d i c a l Care," S c i e n t i f i c American, V o l . 222, No. 4, pp.15-23 (1970).  60.  G a y l a r d , Anne. "Treatment o f C h i l d r e n w i t h P e r c e p t u a l Problems. An I n t r o d u c t i o n t o the Role o f the O c c u p a t i o n a l T h e r a p i s t , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 33:53 (1966).  61.  Gibbon, Marion. " H i s t o r y o f O c c u p a t i o n a l Therapy i n the Maritimes," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 7:73 (1940).  62.  G i l l e t t e , N.P. "Changing Methods i n the Treatment o f P s y c h o s o c i a l D y s f u n c t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:230-233 (1967).  63.  Goble, R i t a E.A. "The Role o f the O c c u p a t i o n a l T h e r a p i s t i n D i s a b l e d L i v i n g Research," American J o u r n a l o f O c c u p a t i o n a l Therapy, 33:145-152 (1969).  80.  Gordon, Beth. "Why O c c u p a t i o n a l Therapy?," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 37:141-144 (1970). Gordon, D.W. "The F u n c t i o n o f a C o n s u l t a n t , " N u r s i n g Outlook. 1:575 (.1953). Greenland, C y r i l . "What's New? O c c u p a t i o n a l Therapy i n 1883," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 29:80 (1962). Hall,  Herbert J . "American O c c u p a t i o n a l Therapy A s s o c i a t i o n , " A r c h i v e s o f O c c u p a t i o n a l Therapy, 1:163-165 (1922).  Harwood, J.H. and McLaughlin, B. "Nature, E x t e n t and Scope o f the H e a l t h Needs i n North Dakota and Resources A v a i l a b l e t o Meet These Needs," Proceedings o f Workshop f o r Improvement o f E d u c a t i o n a l Techniques o f O c c u p a t i o n a l Therapy C l i n i c a l Supervising Personnel, U n i v e r s i t y of North Dakota, Grand F o r k s , N.D., pp.10-11 (January, 1967). ' Haworth, Norah A. and MacDonald, E. Mary. Theory of O c c u p a t i o n a l Therapy, London: Bailliere, T i n d a l l & Cox, pp.1-5 (1940). Heath, Sheldon. "Uses and Misuses o f P s y c h i a t r i c O.T.: O.T. as a Haven," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:19-22 (1968). Heaton, T.G. " O c c u p a t i o n a l Therapy f o r the Tuberculous," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy and Physiotherapy, 4:54-61 (1937). Hebert, B.; Beaudoin, J . ; Hutchison, J . ; and J a n e l l e , "Problems Physiques e t Psycho-Sociaux des Hemiplegiques Ages," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 34:113 (1967).  C.  Henry, Nelson B., ed. The Dynamics o f I n s t r u c t i o n a l Groups, N a t i o n a l S o c i e t y f o r the Study o f E d u c a t i o n , Chicago: The U n i v e r s i t y o f Chicago P r e s s , pp. 33-34 (1960). Hightower, Mae D. "The E x t e n s i o n s of O c c u p a t i o n a l Therapy S e r v i c e s i n t o the Community," Report o f C u r r e n t and Future Trends i n R e h a b i l i t a t i o n as They A f f e c t O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , Arkansas, pp. 37-42 (February, 1967).  81. 75.  Hood, Margaret, R. "Report on the Fourth I n t e r n a t i o n a l Congress o f t h e World F e d e r a t i o n o f O c c u p a t i o n a l T h e r a p i s t s , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 33:151 (1966).  76.  Houle, C y r i l 0. "The Role o f C o n t i n u i n g Education i n Current P r o f e s s i o n a l Development," American L i b r a r y A s s o c i a t i o n B u l l e t i n , 61:263-264 (Mar., 1967) .  77.  Howe, M. and Dippy, C. "The Role o f O.T. i n Community Therapy, 22:521-524 (1968).  78.  Howland, G.W. " P r e s i d e n t ' s Address," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 1:4-6 (1933).  79.  . " P r e s i d e n t ' s Address," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 7:60 (1940) .  80.  . " P r e s i d e n t ' s Address," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 11:3 (1944).  81.  Huston, J . "Occupational Therapy i n the F i e l d o f P h y s i c a l D i s a b i l i t i e s , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 33:101 (1966).  82.  Jenson, Inez. "The O c c u p a t i o n a l T h e r a p i s t i n a Home Care Program," American J o u r n a l o f O c c u p a t i o n a l Therapy, 20:288-301 (1966).  83.  Johnson, T e r r y , and Smith, Margaret. "Changing Concepts of O c c u p a t i o n a l Therapy i n a Community R e h a b i l i t a t i o n Center," American J o u r n a l o f O c c u p a t i o n a l Therapy. 20:267-273 (1966).  84.  Jones, A r t h u r M. "Occupational Therapy i n a Day H o s p i t a l , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 27:5 (1960). ,  85.  Kahmann, W.C. " O r g a n i z a t i o n and A d m i n i s t r a t i o n o f O c c u p a t i o n a l Therapy," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 3:69-74 (1935).  86.  K l o r k e , Toben. "The Role o f Nursing Management i n the B e h a v i o u r a l Change o f Hemiplegia," J o u r n a l o f R e h a b i l i t a t i o n . p.24 (July-Aug., 1969).  87.  K o v e l l , Joyce. "A Home Care Program," American J o u r n a l of O c c u p a t i o n a l Therapy, 18:255-259 (1964).  88.  Lake, Susan. "The Kidney D i a l y s i s Center and the Role of O c c u p a t i o n a l Therapy," American J o u r n a l o f O c c u p a t i o n a l Therapy. 22:269-274 (1968).  82.  89.  L a u r e n c e l l e , P. "An A n a l y s i s o f the S o c i a l and S o c i o l o g i c a l Implications of R e h a b i l i t a t i o n , " American J o u r n a l of O c c u p a t i o n a l Therapy, 22:329-331 (1968).  90.  L e o p o l d , Robert L. "Consultant and C o n s u i t e e : An E x t r a o r d i n a r y Human R e l a t i o n s h i p , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:78-81 (1968).  91.  Letchworth, A l i c e . "Committee Report: R e g i s t r a t i o n Committee," American J o u r n a l o f O c c u p a t i o n a l Therapy, 1:38 (1947).  92.  Le Vesconte, H.P. "The P l a c e o f O c c u p a t i o n a l Therapy i n S o c i a l Work P l a n n i n g , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 2:13-16 (1934).  93.  : "Expanding F i e l d s i n O.T.," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 3:4-12 (1935). " —  94.  . "The American O c c u p a t i o n a l Therapy Association Celebrates i t s T h i r t i e t h Birthday d u r i n g 1947," American J o u r n a l of O c c u p a t i o n a l Therapy. 1:37-52 (1947).  95.  L i n d , A. "An E x p l o r a t o r y Study o f P r e d i c t i v e F a c t o r s f o r 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 J o u r n a l o f O c c u p a t i o n a l Therapy, 24:222-226 (1970).  96.  L i n t o n , Ralph. The C u l t u r a l Background o f P e r s o n a l i t y , New York: Appleton-Century Co., 1945.  97.  L l o r e n s , L e l a A. "Changing Methods i n Treatment i n P s y c h o s o c i a l D y s f u n c t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy. 22:26-29 (1968).  98.  Lynes, P.G.; K i n g s m i l l , E.; and Greenland, C. "Remotiv a t i o n P r o j e c t , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 28:5 (1961).  99.  MacBain, P a t r i c i a . "O.T.'s on Wheels," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 37:63-68 (1970).  100.  McCordick, Lyn. "Education and the Future Role," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 38:37 (1971).  101.  McCreary, J.F. "Address t o Canadian Congress o f P h y s i c a l and O c c u p a t i o n a l T h e r a p i s t s , Vancouver, 1960," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 27:70 (1960).  83. McDonald, Ladd. " P s y c h i a t r i c R e h a b i l i t a t i o n , Resource i n a R e v o l u t i o n , " J o u r n a l of R e h a b i l i t a t i o n , pp.21-23 (July-Aug., 1969). McGhie, B.T. and Myers, E.R. "Occupational Therapy i n a Mental H o s p i t a l S e r v i c e , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 1:11-12 (1933) . McLeod, Mary. " P s y c h i a t r i c Refresher Course - 1963," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 30:153 (1963). McQueen, Margaret E. "Education Committee Report," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 31:167 (1964). McWhinney, Ian R. An I n t r o d u c t i o n to Family Medicine, P r e l i m i n a r y ed. London, O n t a r i o : U n i v e r s i t y o f Western O n t a r i o , 1970. M a n s f i e l d , N. "The O c c u p a t i o n a l Therapy A s s i s t a n t s ' Course," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 26:51-54 (1959). M a r t i n , J.K. "How Automation W i l l A f f e c t the Future V o c a t i o n a l Goals of the M u l t i p l y Handicapped C h i l d , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 34:22-27 (1967). Mase, D a r r e l J . "The Dimensions of Change," American J o u r n a l o f O c c u p a t i o n a l Therapy, 21:129-136 (1967). Master and Servant. M e d i c a l Post  (Oct., 1969).  Mazer, June L. "The O c c u p a t i o n a l T h e r a p i s t as C o n s u l t a n t , " American J o u r n a l of O c c u p a t i o n a l Therapy, 23:417-421 (1969) . Mendoza, Norma. "The Role of an O c c u p a t i o n a l T h e r a p i s t i n a Home S e t t i n g , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 23:141-144 (1969). Messick, H. E l i z a b e t h . "The Future of O c c u p a t i o n a l Therapy i n the Army," American J o u r n a l of O c c u p a t i o n a l Therapy, 1:26 (1947). M i a l , H. C u r t i s . "What i s a C o n s u l t a n t ? , " P u b l i c R e l a t i o n s J o u r n a l , (Nov. , 1959). M i c h a e l s , L. " R e h a b i l i t a t i o n i n P a t i e n t s with S t r o k e s . The Role of the P h y s i c i a n , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 32:18-19 (1965).  84. 116.  Minard,  117.  Moore, Josephine C. "Changing Methods i n the Treatment o f P h y s i c a l D y s f u n c t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 21:18-28 ( i y b 7 ) .  118.  Mosey, Anne C r o n i n . "Involvement i n the R e h a b i l i t a t i o n Movement - 1942-1960," American J o u r n a l o f O c c u p a t i o n a l Therapy, 25:234-236 (1971).  119.  Munroe, A. "Occupational Therapy and t h e C h i l d with C o n g e n i t a l D e f o r m i t i e s o f the Upper E x t r e m i t y , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 28:71-75 (1961).  120.  N i c h o l s , P.J.R. "The P l a c e o f Paramedical Personnel i n C l i n i c a l Research," Annals o f P h y s i c a l Medicine, 10:7 (1969).  121.  N i c k e l , V.L. "The Orthopedic Surgeon and the O c c u p a t i o n a l T h e r a p i s t , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:86-88 (1968).  122.  Nixon, R u s s e l l A. " R e h a b i l i t a t i o n - Human Reinforcement i n a Troubled World," J o u r n a l o f R e h a b i l i t a t i o n , p.14 (Mar.-Apr., 1969).  123.  124.  C h r i s t o p h e r M. "The O c c u p a t i o n a l T h e r a p i s t as an Innovator," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:190 - 194 (1968).  • "The C r i s i s and Challenge o f Human S e r v i c e s i n the New Decade," American J o u r n a l of O c c u p a t i o n a l Therapy. 25:187-192 (1971). ;  Overs, Robert P. " A t t i t u d i n a l B a r r i e r s t o Using Research F i n d i n g s , " J o u r n a l o f R e h a b i l i t a t i o n , p.22 (Sept.-Oct., 1969). 1  125.  Owen, C a r o l y n M. "An A n a l y s i s o f t h e Philosophy o f O c c u p a t i o n a l Therapy," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:502-505 (1968).  126.  Parker, Ardythe, A. " I n s t i t u t e on C h i l d P r o s t h e t i c s , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 30:115-116,124 (1963) .  127.  Peake, Laurence N. "Occupational Therapy, Nursing, and P h y s i c a l Therapy," A r c h i v e s o f P h y s i c a l Medicine and R e h a b i l i t a t i o n , pp.406-408 (Sept., 1971).  128.  Per Mentem e t Manus ad Sanitatem, Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 31:4 (1964).  85. 129.  P e t e r s , Henry N. "Learning as a Treatment Method i n Chronic S c h i z o p h r e n i a , " American J o u r n a l o f O c c u p a t i o n a l Therapy. 9:185-189 (1955).  130.  P i n c u s , A l l e n . "New F i n d i n g s on Learning i n O l d Age: I m p l i c a t i o n s f o r Occupational Therapy," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:300-302 (1968).  131.  Pochert, L o i s . "Our New Role C h a l l e n g e : The O c c u p a t i o n a l -Therapy C o n s u l t a n t , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 24:106-110 (1970).  132.  R e i l l y , Mary. "The Role o f the T h e r a p i s t i n P r o t e c t i v e and F u n c t i o n a l Devices," American J o u r n a l of O c c u p a t i o n a l Therapy. 10:132-133 (1956).  133.  • "Occupational Therapy Can Be One o f the Great Ideas of 2 0th Century Medicine," American J o u r n a l o f O c c u p a t i o n a l Therapy, 16:1-9 (1962).  134.  . "The Challenge o f the Future t o an O c c u p a t i o n a l T h e r a p i s t , " American J o u r n a l of Occupational Therapy. 20:221-225 (1966).  135.  "The Modernization of O c c u p a t i o n a l Therapy," American J o u r n a l o f O c c u p a t i o n a l Therapy, 25:243-246 (1971).  136.  Report o f the F i r s t S t u d e n t - F a c u l t y Conference on I n t e r p r o f e s s i o n a l E d u c a t i o n , Vancouver, B r i t i s h Columbia: U n i v e r s i t y of B r i t i s h Columbia, p.4 (1968).  137.  Rerek, Margaret D. "The Depression Years - 1929-1941," American J o u r n a l o f O c c u p a t i o n a l Therapy, 25:231-233 (1971).  138.  R i c h a r d s , L. "Group Therapy i n a R e h a b i l i t a t i o n Centre," Canadian J o u r n a l o f Occupational Therapy, 33:141-147 (1966).  139.  Roberts, C.A. "Healing the S i c k , R e s p o n s i b i l i t y or P r i v i l e g e , f o r the P a t i e n t o r the P r o f e s s i o n a l T h e r a p i s t , " Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 29:5-14 (1962).  140.  Rood, Margaret S. "A Program f o r P a r a p l e g i c s , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 1:22-25 (1947).  141.  Schoen, K. "A Climate of E x p e c t a t i o n , " American J o u r n a l of Occupational Therapy. 26:119-124 (1972).  86. 142.  Shimeld, A r l e n e . "Youth of Today and T h e i r I n f l u e n c e s on the P r a c t i c e of O c c u p a t i o n a l Therapy," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 38:3-13 (1971).  14 3.  S i l l e r , Jerome. "A Summary: On the D e l i n e a t i o n of Boundaries of P r o f e s s i o n a l P r a c t i c e i n R e h a b i l i t a t i o n , " A r c h i v e s of P h y s i c a l Medicine and R e h a b i l i t a t i o n , pp.410-412 (Sept., 1971).  144.  Simard, Therese. "Electromyographie du Membre S u p e r i e u r , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy. 37:55-62 (1970).  145.  S l a g l e , E.C. "Development of Occupations f o r the Insane," American J o u r n a l o f O c c u p a t i o n a l Therapy, 12:196 (1958).  146.  S l o b e t z , F.W. "The Role o f O c c u p a t i o n a l Therapy i n Heroin D e t o x i f i c a t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 24:340-342 (197).  147.  Smith, Hetty V. "Workmen's Compensation Board, O c c u p a t i o n a l Therapy Workshop," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 7:26 (1940).  148.  S n i d e r , A . J . "Nursing Home Speed Death of Aged P a t i e n t s , Panel Says," The Vancouver Sun, p.3 (Nov.19, 1970)  14 9.  Sokolov, J . "Working as a Team," American J o u r n a l of O c c u p a t i o n a l Therapy. 9 :270-271,296 (.1955).  150.  Solomon, A l f r e d P. "Occupational Therapy, A P s y c h i a t r i c Treatment," American J o u r n a l of O c c u p a t i o n a l Therapy. 1:1 (1947).  151.  Sommer, Robert. "A Model Experiment i n O c c u p a t i o n a l Therapy," Canadian J o u r n a l of O c c u p a t i o n a l Therapy. 27:103-104 (1960).  152.  153.  154.  . " P r o f e s s i o n a l i z a t i o n and O c c u p a t i o n a l Therapy," Canadian J o u r n a l of O c c u p a t i o n a l Therapy. 28:25-28 (1961). Spackman, C. "The World F e d e r a t i o n of O c c u p a t i o n a l Therapists: 1952-1967," American J o u r n a l of O c c u p a t i o n a l Therapy. 21:301-309 (1967). . "A H i s t o r y of the P r a c t i c e o f O c c u p a t i o n a l Therapy f o r R e s t o r a t i o n of P h y s i c a l F u n c t i o n : 1917-1967," American J o u r n a l o f O c c u p a t i o n a l Therapy. 22:67-71 (1968).  87.  155.  Stacey, B e v e r l e y . " I n d u s t r i a l Therapy, ' Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 30:105-106, 114 (1963) .  156.  Stevenson, G.H. "Modern Methods i n O c c u p a t i o n a l Therapy i n Mental H o s p i t a l s , " Canadian J o u r n a l of O c c u p a t i o n a l Therapy. 11:7-10 (1944). ~  157.  S u t h e r l a n d , J . " S u c t i o n Socket with an Above-Elbow Amputee," Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 27:75-76 (1960).  158.  1  . "Occupational Therapy i n the R e - E s t a b l i s h ment of the P h y s i c a l l y Handicapped," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy. 31:143-144 (1964).  159.  Szasz, G. Second I n t e r i m Report of the Committee on I n t e r p r o f e s s i o n a l Education i n the H e a l t h S c i e n c e s , Vancouver, B r i t i s h Columbia: U n i v e r s i t y of B r i t i s h Columbia, 1968.  160.  T r i d e r , Margaret F. "The Future of O c c u p a t i o n a l Therapy," Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 39:3-8 (1972).  161.  T u m i n e l l y , C a r o l . "Result of Q u e s t i o n n a i r e on M e d i c a l Students' Concept o f O c c u p a t i o n a l Therapy," Unpublished student paper, U n i v e r s i t y of North Dakota, Grand Forks, pp.1-6 (1969).  162.  U n i t e d S t a t e s Department o f H e a l t h , Education and Welfare. "Teacher I n f l u e n c e , P u p i l A t t i t u d e s and Achievement," by Ned A. F l a n d e r s . Cooperative Research Monograph, No. 12, Washington, D.C: Government P r i n t i n g O f f i c e , p.6 (1965).  163.  Verner, C o o l i e and Booth, A l a n . A d u l t E d u c a t i o n , Center f o r A p p l i e d Research i n E d u c a t i o n , New York, pp.22-23 (1964).  164.  Vineberg, Shalom. " R e h a b i l i t a t i o n : A Means to What End?," Report of Current and Future Trends i n R e h a b i l i t a t i o n as They A f f e c t O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , Hot S p r i n g s ^ N a t i o n a l Park, Arkansas, pp.32-34 (February, 1967).  165.  Wallace, La Verna. " E d u c a t i o n a l F u n c t i o n s o f Occupat 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 , U n i v e r s i t y Based Home Care Program," American J o u r n a l o f O c c u p a t i o n a l Therapy, 20:286-287 (1966).  The Inc.,  88. 166. 167.  War Experiment Now Ranks as a P r o f e s s i o n . Evening T r i b u n e , J u l y 14, 1923.  Winnipeg  "War Therapy: O c c u p a t i o n a l H i n t s f o r Submarine Crews." Canadian J o u r n a l o f O c c u p a t i o n a l Therapy, 7:46 (1940).  168.  Watanabe, Sandra Gold. "The Developing Role o f O c c u p a t i o n a l Therapy i n a P s y c h i a t r i c Home S e r v i c e , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 21:353-356 (1967).  169.  Welles, C a r l o t t a . " A d m i n i s t r a t i o n , " American J o u r n a l of O c c u p a t i o n a l Therapy, 16:72-73 (1962).  170.  171.  . "The I m p l i c a t i o n s o f L i a b i l i t y ; G u i d e l i n e s f o r P r o f e s s i o n a l P r a c t i c e , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 23:18-26 (1969). West, W. "The O c c u p a t i o n a l T h e r a p i s t ' s Changing R e s p o n s i b i l i t y t o the Community," American J o u r n a l o f O c c u p a t i o n a l Therapy, 21:312-316 (1967).  172.  _. " P r o f e s s i o n a l R e s p o n s i b i l i t y i n Times o f Change," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:9-15 (1968).  173.  . "Statement t o the Committee on H e a l t h Manpower," American J o u r n a l o f O c c u p a t i o n a l Therapy, 22:89-93 (1968).  174.  . "The Growing Importance o f P r e v e n t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 23:226-231 (1969).  175.  176.  West, W. and McNary, H. "A Study of the Present and P o t e n t i a l Role o f O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 10:103.(1956). _ _ . "The Present and P o t e n t i a l Role o f O c c u p a t i o n a l Therapy i n R e h a b i l i t a t i o n , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 10:150 (1956).  177.  Whitten, G.B. " E f f e c t s o f Automation on Handicapped People," R e h a b i l i t a t i o n , No. 71, pp.21-26 (Oct.-Dec., 1969).  178.  Wiemer, Ruth B. and West W. "Occupational Therapy i n Community Health Care," American J o u r n a l o f O c c u p a t i o n a l Therapy, 24:323-327 (1970).  89. 179.  W i l l i a m s , D.H. F i r s t Annual Report on C o n t i n u i n g M e d i c a l Education, Vancouver, B r i t i s h Columbia: U n i v e r s i t y of B r i t i s h Columbia, 1961.  180.  . "The P h y s i c i a n and L i f e - L o n g - L e a r n i n g , " The J o u r n a l of E d u c a t i o n , No. 10, Vancouver, The U n i v e r s i t y of B r i t i s h Columbia, p.63, 1964.  181.  . F i r s t Annual Report, C o n t i n u i n g E d u c a t i o n i n the H e a l t h S c i e n c e s , Vancouver, B r i t i s h Columbia: U n i v e r s i t y o f B r i t i s h Columbia, 1969.  182.  Woodside, H.H. "The Development of O c c u p a t i o n a l Therapy 1910-1929," American J o u r n a l o f O c c u p a t i o n a l Therapy, 25:226-230 (1971).  183.  World F e d e r a t i o n o f O c c u p a t i o n a l T h e r a p i s t s . E s t a b l i s h ment of a Program f o r the Education o f O c c u p a t i o n a l T h e r a p i s t s , Glasgow, S c o t l a n d : C o u n c i l o f the World F e d e r a t i o n o f O c c u p a t i o n a l T h e r a p i s t s , 1958.  184.  Zamir, L e l i a . "The C o n s u l t a t i v e P r o c e s s , " P h y s i c a l Therapy, 68:777-779 (1968).  185.  186.  . " P e r s p e c t i v e s i n O c c u p a t i o n a l Therapy Education," American J o u r n a l o f O c c u p a t i o n a l Therapy, 24:192-195 (1970). Zimmerman, T.F. "Laddering and L a t t i c i n g : Trends i n A l l i e d H e a l t h , " American J o u r n a l o f O c c u p a t i o n a l Therapy, 24:102-105 (1970).  90.  APPENDIX  In 1926 therapy  was  the f i r s t two  year course  i n occupational  e s t a b l i s h e d a t the U n i v e r s i t y of Toronto.  over twenty years  i t was  For  the only e d u c a t i o n a l program f o r  o c c u p a t i o n a l t h e r a p i s t s i n Canada.  The  f o l l o w i n g pages are  d u p l i c a t e s of the o r i g i n a l P r e l i m i n a r y C i r c u l a r of Information  which i s p r e s e n t l y the o n l y known P r e l i m i n a r y  C i r c u l a r remaining  i n existence.  made a v a i l a b l e f o r d u p l i c a t i o n and  T h i s r a r e document inclusion in this  was study  as an item o f i n t e r e s t t o a l l Canadian T h e r a p i s t s through the c o u r t e s y o f the present owner of the document, Miss H. P. LeVesconte, Toronto, O n t a r i o .  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.  , UNIVERSITY OF TORONTO ' ( T h e P r o v i n c i a l U n i v e r s i t y of O n t a r i o )  Occupational Therapy Beginning with the University Session, 1926-27, the University of Toronto proposes, if there appears to be a reasonable demand for it, to offer a course in Occupational 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 'occupations designed not only to exercise and _o to restore limbs which may have been injured but also to-keet> the mind engaged and so to prfycnt thn nntifnt ri nminc mc__se^ By expert attention to these two allied aims injured men, women and children are frequently brought back to health and have been able to resume their ^ r e g u l a r occupations when otherwise' a /, phyoioal and UHIlHat recovery would  (rt& ~Y*s*j l  /_T  nn  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 Occupational Therapy are as follows:— 1. The course is to cover two academic years.  /y—^K-V*  VfcM  ?<L___£-*_/ — — .  -  2. Complete Pass Matriculation, or the academic equivalent thereof as determined 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, Bookbinding, 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 practical 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 practical 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 discontinued 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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