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Presentation by Katrina Tunget
1800's
Moral Therapy. Retrieved from www.lib.uwo.ca
/archives/virtualexhibits/londonasylum/moralintro.html
Moral treatment involved structuralized activities for patients in an institution. An example is shown in the image above of female patients working on a farm in the 1800's. Being involved in activities gave the patients a more normal life. Philippe Pinel, a french physician, and William Tuke, an englishman, are responsible for the movement of moral treatment of all people in the late 1700's and early 1800's. They believed in treating all people with compassion. Pinel recommended "work treatment" for those who were institutionalized, and Tuke founded the York Retreat, where he treated everyone with kindness rather than "using drugs and restraints" (O'Brien, 2018, p. 10). Both Tuke and Pinel published their work in the early 1800's. Benjamin Rush was the first physician to practice moral treatment of patients in the United States. Occupational Therapy would evolve from the concept of moral treatment.
1850's -
1900
Pshyciatric Hospital OT. Retrieved from
kellynesbitt.com/occupational-therapist/
During the mid 1800's and early 1900's, society saw the rise of the Industrial Era. Tools and machines became commonplace in production. The Arts and Crafts Movement emphasized the use of one's hands to create goods. John Ruskin and William Morris, both English, led this movement. They believed that crafting items "connected people to their work, physically and mentally, and thus was healthier" (O'Brien, 2018, p. 11). This theory spread to institutions and was eventually implemented in the treatment of patients.`````````````````````````````````````````````````````
There were many influential people to the practice of occupational therapy. Herbert Hall, George Barton, Dr. William Rush Dunton Jr., Eleanor Clarke Slagle, Susan Edith Tracy, Susan Cox Johnson, Thomas Kidner, and Adolf Meyer are just a few of these people. Some of these people were directly responsible for the creation of the organization of NSPOT.
(2013-2015). NSPOT Logo. Retrieved from accronymsand
slang.com/definition/3238620/NSPOT-meaning.html
(2017). Herbert Hall. Reterieved from www.
otcenttennial.org/the-100-people/hall
Herbert Hall, a physician, created a facility in 1904 to treat neurasthenia. According to O'Brien, neurasthenia was a disorder of weakness during work activities that was traditionally treated with rest (2018, p.12). Hall treated this condition with the gradual increase of participation in arts and craft activities. He deemed this method to be a "work cure for regulating life and interests" (Herbert James Hall, MD. (2017). Retrieved from www.otcentennial.com/the-100-people/hall). In 1906, he received a grant for his work in neurasthenia. He published his findings and was recognized for his work by other founders of occupational therapy. He served as president of the National Society for the Promotion of Occupational Therapy from 1920 to 1923 (O'Brien, 2018, p. 12).
George Edward Barton. Retrieved from www.aotf.
org/Portals/0/documents/News/Research-Resources
/AOTF%20Research%20Resources%20April%202012.pdf
George Edward Barton was an architect who personally suffered may detrimental physical ailments, including paralysis and amputation of his foot. He came to Boston and established the Boston Society of Arts and Crafts. His own disabilities lead him to aspire to improve the lives of others. In 1914, he created the Consolation House for convalescent patients in New York. According to O'Brien, Barton "recommended the term" occupation therapy "be changed to occupational therapy" (2018, p. 11). His enthusiasm for the "work cure" inspired many others around him.
Dr. William Rush Dunton Jr. Retrieved from http://ajp.psychiatry
online.org/doi/abs/101176/ajp.123.12.1604?journalCode=ajp
Dr. William Rush Dunton Jr. was a psychiatrist in the early 1910's. He was regarded as the father of occupational therapy. In fact, the origination of the term occupation therapy is associated with Dunton. In 1915, he published Occupational Therapy: A Manuel for Nurses. In this manual, he specified activities for a patient to participate in for rehabilitation. He believed in treating patients scientifically. He served as both president and treasurer of NSPOT. He also edited the journal for twenty-one years (O'Brien, 2018, p. 12).
(2012). Eleanor Clarke Slagle. Retrieved from femilogue.
blogspot.com/201210/eleanor-clarke-slagle.html
According to O'Brien, the mother of occupational therapy was known as Eleanor Clarke Slagle (2018, p.13). She founded habit training, "a re-education program designed to overcome disorganized habits, to modify other habits, and to construct new ones, with the goal of restoring and maintaining health" (O'Brien, 2018, p. 13). Habit training was a structured program that was gradually increased as the patient's tolerance increased. In 1912, Adolf Meyer asked her to oversee the OT department in Baltimore at the Henry Phipps Psychiatric Clinic of John Hopkins Hospital. After 1914, she moved and constructed the Henry B. Favill School of Occupations, the first school for OT. She served in every office of the AOTA (American Occupational Therapy Association), including acting as the executive secretary for fourteen years.
(2017). Susan Edith Tracy. Retrieved from www.
otcentennial.org/the-100-people/tracy
Susan Tracy taught nurses at a nursing school at the Adams Nervine Asylum in 1905. Here, she focused her teachings on the treating patients with arts and crafts activities. She is responsible for writing the first book on occupational therapy, Studies in Invalid Occupations. She trained nurses in occupations and pushed to make occupational therapy a nursing specialty. She served as the chair of the Committee of Teaching Methods in the NSPOT.
(2017). Susan Cox Johnson. Retrieved from www.
otcentennial.org/the-100-people/johnson
At the Montefiore Home and Hospitals in New York, Susan Cox Johnson tried to show that "occupation could be morally uplifting, that it could improve the mental and physical state of patients..." (O'Brien, 2018, p. 14). She designed arts and crafts activities and joined Columbia University to teach occupational therapy to nursing students. She focused on training nurses who were competent, instead of training a large amount of people. As a teacher and proponent of crafting, she was influential on occupational therapy.
(2017). Thomas Kidner. Retrieved from www
.otcentennial.org/the-100-people/kidner
Thomas Kidner was a Canadian architect. He designed buildings that were handicapped-friendly. In 1915, he became the vocational secretary of the Canadian Military Hospitals Commission. Kidner proposed a system of "vocational rehabilitation" for Canadian veterans of World War I. He also suggested moving tuberculosis patients to hospitals and designed the hospitals for the treatment of them (O'Brien, 2018, p. 14). In his designs, he included occupational therapy workshops. Thus, he helped promote OT.
(2017). Adolf Meyer. Retrieved from www.
otcentennial/the-100-people/meyer
Adolf Meyer was a psychiatry professor at John Hopkins University. He advocated a holistic approach to treating mental illness. He focused on treating a patient as a whole person and involving the person in meaningful and purposeful activity. At the fifth meeting of NSPOT, in 1921, he delivered the keynote address, the Philosophy of Occupational Therapy. It was published in the NSPOT's first journal in 1922. In it, he stated "There are many... rhythms which we must be attuned to: the larger rhythms of night and day, of sleep and waking hours ... and finally the big four-- work and play and rest and sleep, which our organism must be able to balance even under difficulty. The only way to attain balance in all this is actual doing, actual practice, a program of wholesome living as the basis of wholesome feeling and thinking and fancy and interests" (O'Brien, 2018, p. 15-16). He recognized that being involved in activities was healthy.
George Barton, William Dunton, Eleanor Clark Slagle, Susan Cox Johnson, and Thomas Kinder and his wife - Isabel Newton convened and created NSPOT in March of 1917. By September of 1917, twenty-six people from varied backgrounds met and set forth Dunton's Principals of Occupational Therapy:
1918
World War I
World War I brought on the need for treatment of veterans suffering "shell shock." The U.S. military created reconstruction aides to rehabilitate these veterans. Orthopedic professionals directed the program which "included OT aides, physiotherapy aides, and vocational educators" (O'Brien, 2018, p. 16). The OT aides treated orthopedic and psychiatric patients with arts and crafts. The U.S. military recognized the usefulness of these aides and demand for them increased. Several programs and schools were created to meet this new demand for trained reconstruction aides. After the end of World War I, the need for reconstruction aides decreased and schools closed. However, OT aides were linked with physical disabilities thereafter.
1920's-
1930's
In 1918, the Soldier's Rehabilitation Act was passed. It was also known as the Smith- Sears Veteran's Rehabilitation Act. With the increase of disabled young soldiers, came the need for treatment of disabilities. This act created a program of rehabilitation for soldiers who were disabled, but still on active duty. Occupational therapists were involved in the rehabilitation of soldiers to return to their "industrial responsibilities" in regular life (O'Brien, 2018. p. 16).
Lavalley, Ryan. (2012). WWI Amputees 1919. Retrieved from adifferentsortofliving.
blogspot.com/2012/10/occupational-therapy-profession-born.html
Congress passed the Civilian Vocational Rehabilitation Act (Public Law [PL] 66-236) in 1920, also known as the Smith-Fess Act. This law was the first time that the government got involved in providing health-care funding. The government provided "federal funds to states on a 50-50 matching basis to provide vocational rehabilitation services to civilians with physical disabilities" (O'Brein, 2018, p. 16). Vocational rehabilitation consisted of job training and placement. It also considered areas of adjustment and prosthetic devices, roles that an occupational therapist would help with.
The members of NSPOT changed the name to the American Occupational Therapy Association in 1921. During this time period, eight schools of OT existed. In 1923, the AOTA adopted the Minimum Standards for Courses of Training in Occupational Therapy. These standards for training OT's helped unify the field. They called for a minimum of one year of training, with eight or nine months of medical and craft training and three or four months of fieldwork in a hospital setting (O'Brien, 2018, p. 17). The AOTA used these standards to endorse occupational therapy schools.
(2018). AOTA Logo Vector. Retrieved from http://www.logosvgpng.com
/american-occupational-therapy-association-aota-logo-vector/
Created in 1929, the national registry listed occupational therapists who had completed the AOTA's standards of education. The AOTA requested that the American Medical Association (AMA) be responsible for accrediting schools of OT in 1935. Five more schools were accredited in 1938. The AMA assumed this responsibility until 1994.
Publication had an enormous impact on Occupational Therapy. The AOTA published a journal after only five years of it's creation. The Archives of Occupational Therapy was released in 1922. Dr. William Rush Dunton Jr. served as it's editor from 1922 to 1947. In 1925, the journal's name changed to Occupational Therapy and Rehabilitation. By 1947, it's name changed again to the American Journal of Occupational Therapy. The journal is informally called AJOT. Despite the journal's many name changes, it has been widely known through out the years and has impacted the path of OT.
(2018). AJOT. https://www.aota.org/Publications-News/AmericanJournalOfOccupationalTherapy.aspx
1940's-
1950's
When World War II broke out, the need for occupational therapists increased as soldiers returned home from war. Since the army did not have time to wait for occupational therapy practitioners to undergo eighteen months of training, it created War Emergency Courses. This significantly increased the amount of practicing occupational therapists. In 1945, the AOTA shows 2,177 members (O'Brien, 2018, p. 18). As so many new members arose, the AOTA required an examination to be taken to be registered as an OT. This exam was initially formatted as an essay. Now it is in the format of an objective test.
The Rehabilitation Movement was a time period from 1942 to 1960. It was during this period that the Veterans Hospital Administration (VA) was established. The VA served to rehabilitate disabled veterans of wars. In 1947, the army created the Women's Medical Specialist Corps where civilian women who practiced rehabilitative therapy were commissioned as officers in the army. It later became the Army Medical Specialist Corps to include men. The creation of the VA gave rise to a growth in occupational therapy and expanded its role from arts and crafts to all aspects of daily living.
The polio epidemic also gave rise to the growth in health-care (O'Brien, 2018, p. 18). Due to the new technologies of this time period, more people were surviving diseases like polio. This meant more people were living with disabilities. States needed more facilities and hospitals to care for these people. President Truman signed the Hill-Burton Act in 1945. It was created to help states determine their need and provide grants for facilities. This had a great affect on health care and those living with disabilities.
In 1965, Medicare was enacted. This provided permanently disabled people or people over sixty-five years old with health care assistance. Medicare listed occupational therapy for people under extended services, but only in an inpatient setting. It gave limited coverage in outpatient settings. In 1988, the legislation on Medicare changed to provided service for independent occupational therapy practitioners. With the invention of medicare, more disabled people were able to access occupational therapy. Thus, the demand increased.
Medicare Logo. Retrieved from mrhealthinsurance.
net/medicare-supplemental-plans-minnesota/
Occupational therapy shifted to a more technical focus during this time period. This shift was called the reductionist model and it focused on specialization. In 1965, the AOTF was founded. It existed as a means to provide education and research support to programs and individuals through grants and scholarships (O'Brien, 2018, p. 83). With this new scientific approach, occupational therapy strayed from its beginnings in arts and crafts.
(2018). AOTF Logo. Retrieved from www.ahtf.org
With so many occupational therapists focusing on rehabilitation, a shortage occurred in psychiatric settings. This shortage led to the rise of a new level of OT, the Occupational Therapist Assistant (OTA) (O'Brien, 2018, p. 19). In 1958, hospitals began training OTA's. The three month training focused on psychiatry. By 1960, a general training course was included. In coming years, these courses would also be offered in schools. In 1964, the first directory of OTA's was published with 553 names listed (O'Brien, 2018, p. 19). Thus, Occupational Therapy Assistants were born.
The 70's were a period of time of social change. Disabled people may have been inspired by the Civil Rights Movement to impact legislature on rehabilitation. At any rate, The Rehabilitation Act of 1973 came about and set forth several important principles that affected disabled people. These principles are: prioritization of services for the most severely disabled person, completion of an individualized written rehabilitation program (IWRP) specifying each client's goals, development of a set of standards by which progress could be measured, the need for rehabilitation research, and prohibition of employment and academic discrimination (O'Brien, 2018, p. 19). In Section 504, the discrimination of a disabled person who is in any federally funded program is prohibited. Disabled children in public schools would be enormously impacted by this. In fact, all of these principles would have a huge impact on those living with disabilities.
Before the creation of this law many handicapped children did not attend schools. This law gave these kids the right to a "free and appropriate" education (O'Brien, 2018, p. 19). It required a written individualized education program (IEP) to be developed and implemented to obtain a child's educational goals. It also included occupational therapy as a service in the schools.
Education For All Children. Retrieved from
www.sutori.com/item/untitled-ddf0-010f
The Education for All Handicapped Children Act was amended in 1986 to include children from the age of three to five. This amendment also paved the way for early intervention services for children from birth to three years old. Occupational Therapy is considered to be a primary service in this field. These revisions increased the access of services to children and further incorporated occupational therapists into the school systems (O'Brien, 1018, p. 19).
(2007-2018). Education of the Handicapped Ammendments. Retrieved from
www.timetoast.com/timelines/special-education-legislation--6
The Technology-Related Assistance for Individuals with Disabilities Act made assistive devices more available to those with disabilities. Occupational Therapists often support patients in the selection and usage of assistive technology devices.
(2018). Assistive Technology. Retrieved from www.
techaccess-ri.org/what-is-assistive-technology/
Health-care costs rose in the 1970's, prompting President Ronald Reagan to establish the law of the Social Security Amendments. These amendments established the Medicare Prospective Payment System (PPS). This affected what the government would pay for. The biggest effect was on the length of a patient's stay in an acute care facility. Since the patient's stay was shortened, long-term care facilities and home health services increased (O'Brien, 2018, p. 19). The increase in these types of facilities and treatments led to new avenues for occupational therapy practitioners to pursue.
Reagansm. Retrieved from
www.ssa.gov/history/reagansm.html
Because of the massive federal changes occurring during this time, the AOTA began lobbying to protect the profession of Occupational Therapy. During the 1970's and 1980's, new books and publications also sprung up. The Occupational Therapy Journal of Research was one of these. Graduate degree programs began to increase too. In 1986, the AOTA chose to no longer cover board certification of its members. This task was delegated to the National Board for Certification (NBCOT). AOTA's Representative Assembly supported state licensure of practitioners in 1975 (O'Brien, 2018, p. 20). These changes were implemented to ensure that practitioners were qualified.
According to O'Brein, this is "one of the most significant pieces of legislature passed during the 1990s", as it provided civil rights to All disabled people (2018, p. 21). Some of the rights covered under it are: equal access to employment opportunities, transportation, public accommodations, telecommunications, and state and local government. Granting these equal rights had a tremendous effect on those with disabilities. This law also opened a new role for occupational therapists, that of a consultant for agencies needing to meet these guidelines.
Americans with Disabilities Act. Retrieved from www.cmich.edu/ess/studentaffairs/SDS/Pages/Laws-and-Regulations.aspx
The Education for All Handicapped Children Act of 1975 was changed in 1991 and renamed Individuals with Disabilities Act. Included in these changes was the requirement to educate children in the least restrictive environment (LRE) possible to ensure they were educated to the fullest extent. This meant that disabled children would be included in a regular classroom. It also required the school to provide children with assistive technology devices when needed. This law was further improved, in 1997, upon the signing of the IDEA 97 Amendments. These amendments served to improve education by implementing an IEP team to formulate a child's IEP according to assistive technology needs and other special factors. This team factors in the input of parents too. Because of the passage of this law, occupational therapy services increased dramatically within schools (O'Brien, 2018, p. 21).
Also know as Medicare Part B, the Balanced Budget Act had the intention of reducing government spending on health-care, creating incentives for managed health-care plans, encouraging enrollment in managed health-care plans, and limiting fee-for-service payment programs (O'Brien, 2018, p. 21). This law put a limit of $1,500.00 per year on occupational therapy services, which led to more practitioners working in community-based programs. Here, occupational therapists focus on preventative health measures and quality of life of the aging populace.
(2018). Balanced Budget. Retrieved from rogerbenge.com/2015/02/28/myth-of-the-balanced-household-budget/
The Affordable Care Act is also known as Obamacare. Signed in 2010, it provides health insurance to all who apply. It limits out-of-pocket expenses and encompasses preventative care. This was done in an effort to further reduce government spending on health-care. It hopes to decrease the amount of emergency room visits a person will make. According to O'Brien, it "promotes inter-professional collaboration and funds community centers" (2018, p. 22). Since occupational therapy covers preventative health and quality of life concerns, it is effected by the ACA.
ACA Logo. Retrieved from www.interfaithhealthclinic.
org/affordable-care-act.html
In 2017, the AOTA put forth the Centennial Vision on the 100th anniversary of the occupational therapy profession. Evidence-based practice and diversity of clients and practitioners were the focus of the Centennial Vision. It emphasized the need for science-based practices to support occupational therapy.
(2017). Centennial Vision Logo.
Retrieved from www.otcentennial.org
AOTA's Vision 2025 focuses on the need to return to the roots of the profession: occupation (O'Brien, 2018, p. 22). Occupational therapy is to focus on getting the client to reengage in occupations of living, not merely on the individual parts of those occupations. In other words, occupational therapy will consider the bigger picture of a client's life. This will help distinguish occupational therapy from other health-care services.
(2018). Vision 2025 Logo. Retrieved from
www.aota.org/AboutAOTA/vision-2025.aspx