Occupational Therapy History Notes
Shellshock and Reconstruction Aides Eleanor Clarke Slagleificant issue during World War I, causing panic, nervous shock, and impaired function in soldiers.
In 1917, the U.S. War Department appointed reconstruction aides, who were civilian women, to work in military hospitals.
Lena Hitchcock was among the first occupational therapy reconstruction aides in France in 1918.
These aides, called "Blue Birds" due to their unattractive blue uniforms (designed that way for safety), used handicrafts and vocational skills to help injured soldiers.
Their work aimed to distract patients, increase physical activity, and improve morale.
Moral Treatment and Early Influences
The 19th-century moral treatment movement, along with the arts and crafts movements, influenced the use of occupation-based activities in patient care.
Physicians, nurses, and social workers recognized the importance of engaging patients' minds and hands.
Dr. Herbert Hall, through his "Work Cure" theory at his workshop for nervous invalids, prescribed arts and crafts to promote self-esteem and health.
Boston nurse Susan Tracy noted the benefits of occupation in relieving nervous tension and offered training courses for occupational nursing.
Psychiatrist William Rush-Dunton embraced occupational therapy for its healing effects through purposeful activities.
Founding of the National Society for the Promotion of Occupational Therapy
George Edward Barton opened Consolation House in 1914 to rehabilitate himself and others, advocating for occupational therapy.
The National Society for the Promotion of Occupational Therapy was founded on March 15, 1917, at Consolation House.
Key figures included:
George Edward Barton (first President)
Isabel Newton (first secretary)
William Rush-Dunton
Susan Cox Johnson
Thomas B. Kidner
Eleanor Clarke Slagle
The society recognized occupation as essential as food and drink, promoting both physical and mental engagement for healing.
Key Figures in Early Occupational Therapy
Susan Cox Johnson: Known for her work at Blackwells Island Hospital and teaching at Columbia University.
Thomas B. Kidner: Developed programs for bedridden soldiers in Canada, focusing on occupations to return them to productive work.
Eleanor Clarke Slagle: A pivotal figure, directing the Occupational Therapy Department at the Phipps psychiatric clinic (Johns Hopkins Hospital) and organizing the Henry B. Favill School of Occupations (the first professional school for Occupational Therapists).
Early Development and Growth
A 1918 government bulletin defined occupational therapy as the science of healing by occupation.
Occupational therapy schools opened in Milwaukee, Boston, Philadelphia, and St. Louis.
This marked a transition from handicrafts to college-educated therapists.
Dr. Adolph Meyer integrated community-based activities to develop daily living skills, emphasizing opportunities rather than prescriptions.
Post-World War I Expansion
The success of reconstruction aides led to permanent rehabilitation roles in American medicine.
Ora Ruggles at Fort McPherson emphasized finding occupations to take patients' minds off their misfortunes.
The focus was on reaching the heart as well as the hands.
The Roaring Twenties and AOTA's Progress
The 1920s saw economic prosperity and advancements for women, leading to milestones for AOTA.
In 1920, AOTA had 190 members and held its conference in Philadelphia.
In 1922, Eleanor Clarke Slagle established AOTA's first official headquarters in Manhattan.
The Archives of Occupational Therapy, AOTA's first professional journal edited by Dr. Dunton, was published in 1922 and later renamed Occupational Therapy and Rehabilitation.
By 1923, the organization finalized its name as the American Occupational Therapy Association (AOTA), and Eleanor Clarke Slagle became its first Executive Director.
The Great Depression and AOTA's Continued Advancement
Despite the challenges of the Great Depression in the 1930s, AOTA continued to advance the profession.
In 1933, AOTA sought accreditation for occupational therapy programs in collaboration with the American Medical Association (AMA).
In 1935, AOTA and AMA adopted the Essentials of an Acceptable School of Occupational Therapy, which evolved into today's Educational Standards.
Annual conferences were held with the American Hospital Association to increase visibility and connections with physicians and hospital leaders.
Eleanor Clarke Slagle's Retirement and Recognition
At the 1937 AOTA Conference, Eleanor Clarke Slagle was honored upon her retirement, passing the torch to the next generation.
First Lady Eleanor Roosevelt attended and praised Slagle's work and its impact on many individuals.
World War II and Occupational Therapy
In 1942, President Roosevelt called on everyone to contribute to the war effort.
Occupational therapists played a crucial role in military hospitals, addressing orthopedic disabilities and psychiatric needs.
Accelerated 12-month war emergency courses were introduced to quickly train OTs.
Winifred "Winnie" Kahmann, Chief of the Surgeon General's Occupational Therapy branch, elevated OT to a professional classification.
In 1944, the Women's Army Corps implemented an occupational therapy assistants training course.
By 1945, 899 OTs and apprentices, and 278 OT assistants were working in Army hospitals.
Post-War Developments
In 1947, Winnie Kahmann became the first occupational therapist elected AOTA President.
AOTA launched the American Journal of Occupational Therapy (AJOT), with Charlotte Bone as the first editor.
Helen Willard and Clare Spackman released their textbook Principles of Occupational Therapy, now in its 12th edition.
The 1950s and 1960s: Economic Expansion and Social Reforms
Occupational therapy became more technical and specialized, still under physician direction.
During the 1952 polio epidemic, occupational therapists began working in pediatrics, treating children with polio and cerebral palsy.
AOTA advanced the profession, with Eva Otto Munzesheimer receiving AOTA's first award of merit in 1950 and Florence Stattel receiving the first Eleanor Clarke Slagle award in 1955.
AOTA formed a medical advisory committee and published its first outline of Administrative Practices and Personnel Policies.
On a global scale, AOTA became a founding member of the World Federation of Occupational Therapists (WFOT), with Willard and Spackman playing instrumental roles.
Raising Educational Standards and COTA Development
The Curriculum Directors, part of AOTA's education committee, sought to raise educational standards.
In 1958, AOTA adopted educational standards for Certified Occupational Therapy Assistants (COTAs).
The first COTA programs focused on psychiatric facilities (12 weeks), expanding to general practice by 1960.
Shift from Medical Model
In the 1960s, OT practice shifted from the medical model to focus on psychological and social aspects and quality health care.
Innovations and Key Therapists
Fred Sammons designed devices to assist individuals with disabilities, founding the Fred Sammons company.
Mary Reilly received the Eleanor Clarke Slagle lecture award in 1961, emphasizing the influence of hand use on health.
Her famous quote is:
"That man, through the use of his hands, as they are energized by mind and will can influence the state of his own health."
Mary Reilly advocated for helping people live full lives and laid the groundwork for advocacy in OT.
Community Mental Health Act and Mental Health OT
The 1963 Community Mental Health Act transformed public care from institutions to community-based care.
Leaders like Lorna Jean King, Gail Fidler, and Anne Cronin Mosey shaped mental health occupational therapy.
Wilma West and Broader Focus
Wilma "Willie" West emphasized that occupational therapy addresses physical, mental, emotional, social, and economic needs.
Medicare and Medicaid and AOTA Advocacy
The origin of the geriatric consumerism movement led to federal legislation such as Medicare and Medicaid.
In 1965, Medicare and Medicaid established programs covering occupational therapy services.
AOTA began policy and advocacy efforts in Washington, DC, and state capitals.
American Occupational Therapy Foundation (AOTF)
The American Occupational Therapy Foundation (AOTF) was chartered as a nonprofit organization to advance occupational therapy science.
A. Jean Ayres and Sensory Integration
A. Jean Ayres pioneered sensory integration theory, emphasizing the nervous system's role in directing human behavior.
Lela Llorens and Occupational Science
In 1969, Dr. Lela Llorens became the first person of color to receive the Slagle Lecture award.
Occupational science is the systematic study of occupation and its impact on health and well-being.
Holistic Roots and Community Focus
From the 1970s through the 1990s, occupational therapy embraced holistic approaches, focusing on quality of life and optimal function beyond hospitals.
New practice areas emerged, including Prevention and Wellness, Ergonomic and Work Programs, Assistive Technology, and services for the aging.
AOTA Headquarters Relocation
In 1972, AOTA headquarters moved to Rockville, Maryland, to be closer to Congress and the National Institutes of Health.
In 1994, AOTA moved to Bethesda, Maryland.
Legislative Acts and Expanded Opportunities
Throughout the 1970s, 80s, and 90s, legislative acts in the United States increased demand and opportunities for OT services.
The 1975 Education for All Handicapped Children Act expanded practice in school systems.
The 1990 Individuals with Disabilities Education Act (IDEA) stipulated rights to individualized education in the least restrictive environment.
School-based practitioners began to address bullying prevention, social and emotional skills, and mental health.
Medicare Part B and Models of Practice
In 1986, occupational therapy gained separate coverage as a distinct Medicare Part B benefit, expanding services to skilled nursing facilities and rehab agencies.
Scholars explored new models for practice, including:
The Model of Human Occupation (Kielhofner, Burke) emphasizing motivations, habits, capabilities, and environments.
The Person-Environment-Occupation Model (Mary Law) recognizing the impact of environments and occupations on performance.
Americans with Disabilities Act (ADA)
The 1990 Americans with Disabilities Act (ADA) guaranteed civil rights for people with disabilities, promoting community participation and accessibility.
Educational Standards and Entry-Level Education
In 1994, the Accreditation Council for Occupational Therapy Education (ACOTE) took over responsibility for overseeing OT educational programs from the American Medical Association.
AOTA's Representative Assembly voted to move entry-level education for OTs to the post-baccalaureate level by 2007.
Balanced Budget Act and Recovery
In 1997, the federal Balanced Budget Act caused significant cuts to Medicare, impacting occupational therapy.
The profession recovered due to its commitment, dexterity, and advocacy.
Centennial Vision
In 2002, AOTA developed a Centennial Vision to unify the profession.
Increase of aging population, more children being diagnosed earlier, and rise of chronic diseases all contributed to a higher demand.
Centennial Vision Goals
Increase practitioner and student confidence
Influence grassroots
Advocates on the hill to create radiating effects throughout the health care environment.
Current Focus and Practice
Occupational therapy addresses societal needs, with a renewed focus on mental health.
AOTA's Occupational Therapy Practice Framework puts clients at the center of services.
AOTA's Centennial Vision (2006)
“We envision that occupational therapy is a powerful, widely recognized, science driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs.”
Current Status
A license to practice is required in all 50 states and 3 jurisdictions.
Occupation is the core domain of occupational therapy.
Centennial and Growth
AOTA has grown from 6 people in 1917 to 60,000 members today.
Contributions to Independence Restoration
Occupational therapy helps individuals regain independence, lives, and love after challenges like the Boston Marathon bombing and for wounded warriors.
Conclusion
Occupational therapists are dedicated to a profession where science, creativity, and compassion meet.
The feeling of contributing to society is passed down through generations.
The profession of occupational therapy will continue to survive and flourish.