Occupational Therapy

1. Occupational Therapy 1940 - 1969

2. The 1940s • World War II- increased demand for OTs • Changes in Occupational Therapy Education • The Structure and Focus of Occupational Therapy • Medical Advancements • Important Individuals: Clare Spackman, Helen Willard, Wilma West

3. World War II • Large numbers of injured soldiers • Women working

4. Growth in OT schools • Accreditation • Expansion- 1947: USC introduces first Master’s Degree program • Revision of Essentials for accreditation • More flexibility in specialties

5. Medical Model • Disability is deficiency or abnormality • Disability is negative • Disability is in the individual body • Remedy for disability-related problems: cure or normalization • Change strategy: surgery, medication, medical technology and intervention • Agent of remedy: the professional • Independence seen as individual physical, cognitive, and mental ability to perform and capacity to make decisions • (Willard & Spackman, p. 871)

6. OT Practical Design • By 1940, the medical model’s influence on the practical outlook of healthcare had begun to exert pressure on occupational therapy. • Self-repair through activity was discounted in favor of applications that had more of a base in psychology, physiology and anatomy. • Over the next decade, occupational therapy redefined its mission, integrating practice with a new paradigm and professional culture built upon a scientific approach and fact.

7. 1940s Advances in Medicine • Antibiotics- penicillin and streptomyocin • Vaccinations- eradication of many childhood diseases • Improvement in quality of healthcare • Federal government funds research and passes laws regarding delivery of healthcare • Life expectancy increases

8. Wilma West • Head of orthopedics occupational therapy at the Walter Reed General Hospital 1943-4

9. Helen Willard & Clare Spackman

10. Publication of the first OT textbook in 1947

11. The 1950s • Post-war Effects • Social Context: Women’s Roles, Civil Rights Movement • The Structure and Focus of Occupational Therapy • Polio Epidemic • Treatment of Mental Health • Important Individuals: Sister Elizabeth Kenny

12. Post-war Effects • Baby boom • Economic prosperity

13. Women’s Roles • Housewife- ideal of femininity • Discouraged from working • Continued to work, mostly in low paying jobs (“pink-collared work”)

14. Civil Rights Movementearly 1950s • Korean War- desegregation of armed forces • 1954: Brown v. Board of Education- Supreme Court rules segregation unconstitutional, desegregation of schools • Non-violent protests • Civil disobedience • 1955-56: Rosa Parks and Montgomery Bus boycotts

15. 1950s OT changes • 1956: Certified Occupational Therapy Assistant (COTA) position created • 1958: Pi Epsilon Theta founded at UNH

16. OT Practical Design • The Mechanistic Paradigm emerges • Confidence was instilled in the profession as treatment objectives encompassed more Freudian-based psychological conceptualization informing treatment of patients. • The occupational therapist became a vehicle for resolution, a mechanism for the patient to utilize. • Disability was seen as the abnormal expression of repression within • Incorporation of neurological knowledge into practice

17. OT Methodology Change • Over the course of this decade, the practice of splinting and prescribing adaptive devices flourished. • Discrete analysis of requirements needed for activity became more integral to practice • Medical model adherence promoted the emphasis on the patient returning to healthy functioning • Respect for objective measurement and scientific precision was gained • Knowledge of how internal processes and body structure informed function expanded

18. World Federation of Occupational Therapists • Founded in 1952 • 1959: WFOT entered into relations with WHO Mission: • To promote occupational therapy as an art and science • To develop and use occupational therapy worldwide • International cooperation

19. WFOT Focus Program Areas: Education & research Standards & quality International Cooperation Executive programs Promotion & development

20. WFOT 1952 USA • United Kingdom • Canada • South Africa • Sweden • New Zealand • Australia • Israel • India • Denmark

21. WFOT 1969 USA • United Kingdom • Canada • South Africa • Sweden • New Zealand • Australia • Israel • India • Denmark • Belgium • France • Germany • Netherlands • Norway • Philippines • Portugal • Switzerland • Venezuela

22. Poliomyelitis • Known as Infantile Paralysis • Most cases of polio are symptom-free • When the virus enters the blood stream, it attacks the CNS • causes muscle weakness & paralysis of the legs • Bulbar polio affects nerves responsible for breathing, swallowing and speech

23. Polio in the Media

24. “Plague Season” • In 1952, there were 57,000 cases of polio in the US • Targeted children from 5-9 years old • 21,000 permanent paralysis • 3,000 deaths • 1955: the Salk Vaccine is distributed in mass quantities • Children of the 1950’s are today’s baby boomers

25. Working with Mental Patients • Do not work on causative factors of behaviors—correct symptoms • Do not stress activity over relationship with patient • Use graduation & persuasion to overcome distasteful habits • Select tasks within ability level to assure success • Give patient choice of activity • Develop patient’s sense of responsibility • Hold “community sing”

26. Video • Mental Health Rehabilitation in 1950s

27. The 1960s • Social Context: Civil Rights Movement Continues, Women’s Empowerment • The Structure and Focus of Occupational Therapy • Medicare/Medicaid • Important Individuals: Gail Fidler, Mary Reilly, Wilma West, Elizabeth Yerxa, A. Jean Ayres

28. Civil Rights Movement • Presidents Kennedy and Johnson set tone by making civil rights a priority of their administration • Nonviolent protests continue • 1960: sit-in protests • 1964: Civil Rights Act passed- outlaws discrimination based on race

29. Women’s Liberation Movement • 1964: Civil Rights Act- outlaws sex discrimination • Empowerment of women • More educated • More economically secure • More willing speak up about their ideas

30. OT Practical Design • By the end of the 1960s, occupational therapy’s role in mediating client illness and disability was clarified in accordance with the medical model. The psychology of the effect of pathological conditions on patients was better understood by the profession and the use of technology to intercede with dysfunction increased.

31. OT Practical Conflict • This embrace of practical shift in the profession enhanced practice but also threw the field into conflict • As therapeutic interventions focused less on confidence building activity through participation in occupational interests, the field turned from its holistic foundation to therapy based in concrete scientific rationale • The interventions previously focused on balanced living became mechanized and lost meaning in favor of achieving purpose

32. Call for a new Paradigm? • Therapists used to practicing under the original, moral paradigm of practice had difficulty adjusting to the more concrete scientific approach of the medical model • A realization by practitioners that the profession needed to ameliorate its differences was recognized • By the end of this era, occupational therapy was valued with respect to conformity with the medical model but practitioners were not united • As the times dictated, social upheaval, redefining roles and the importance placed on science informed occupational therapy practice

33. 1960s Changes • More work with pediatrics and developmental delays • Beginning of de-institutionalization • Working to integrate formerly institutionalized clients into society as independent and productive members

34. Medicare/Medicaid • Established in 1965- Inpatient occupational therapy services covered

35. Mary Reilly • Active in the 1960s • Re-evaluation of mechanistic model • Advocated a more interdisciplinary approach

36. Elizabeth Yerxa • “the scientific attitude is not incompatible with concern for the client as a human being but may be one of the best foundations for acting upon that concern” • Advocate of client choices

37. Gail Fidler • Wanted to recognize the professional commitment to learning, critical thinking, and creativity • Advocated teaching more than just technical skills

38. Wilma West • President of AOTA from 1961 to 1964 • Wanted to address changing needs of society and adapt OT accordingly • Wanted OT to have a new role of “health agent” in order to focus on prevention in the health care system

39. A. Jean Ayres • Developed sensory integration approach • Influenced by Piaget

40. Influences from the 40s-60s that we see today • Occupation-based therapy • Client has choices • De-institutionalization

41. Timeline 1945- WWII ends 1947- Willard & Spackman published 1951- Karen Jacobs was born 1952- Polio epidemic 1952- World Federation of Occupational Therapists founded 1956- COTA position created 1958- Pi Epsilon Theta founded at UNH 1965- Social Security Acts, Medicare cover inpatient OT

42. Questions?

43. Occupational Therapy • Move away from Arts & Crafts Movement • Positive attitude towards work • Patients are motivated through personal interests & material goods • Goals: • 1. Meet person’s interests and abilities • 2. Use activity with physical/mental objective