Lori T. Andersen | Kathlyn L.

Reed

The History of
Occupational
Therapy
The First Century

SLACK Incorporated
 Lori T. Andersen, EdD, OTR/L, FAOTA

Kathlyn L. Reed, PhD, OTR, FAOTA, MLIS

www.Healio.com/books

Copyright © 2017 by SLACK Incorporated

Dr. Kathlyn L. Reed and Dr. Charles H. Christiansen have no financial or proprietary interest in the materials presented herein.
Dr. Lori T. Andersen has received a professional development grant from Florida Gulf Coast University.

The History of Occupational Therapy: The First Century includes ancillary materials specifically available for faculty use. Included are
PowerPoint slides and Instructor’s Manual. Please visit http://www.efacultylounge.com to obtain access.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher, except for
brief quotations embodied in critical articles and reviews.

The procedures and practices described in this publication should be implemented in a manner consistent with the professional
standards set for the circumstances that apply in each specific situation. Every effort has been made to confirm the accuracy of
the information presented and to correctly relate generally accepted practices. The authors, editors, and publisher cannot accept
responsibility for errors or exclusions or for the outcome of the material presented herein. There is no expressed or implied
warranty of this book or information imparted by it. Care has been taken to ensure that drug selection and dosages are in accor-
dance with currently accepted/recommended practice. Off-label uses of drugs may be discussed. Due to continuing research,
changes in government policy and regulations, and various effects of drug reactions and interactions, it is recommended that
the reader carefully review all materials and literature provided for each drug, especially those that are new or not frequently
used. Some drugs or devices in this publication have clearance for use in a restricted research setting by the Food and Drug and
Administration or FDA. Each professional should determine the FDA status of any drug or device prior to use in their practice.

Any review or mention of specific companies or products is not intended as an endorsement by the author or publisher.

SLACK Incorporated uses a review process to evaluate submitted material. Prior to publication, educators or clinicians provide
important feedback on the content that we publish. We welcome feedback on this work.

Published by: SLACK Incorporated

6900 Grove Road
Thorofare, NJ 08086 USA
Telephone: 856-848-1000
Fax: 856-848-6091
www.Healio.com/books

Contact SLACK Incorporated for more information about other books in this field or about the availability of our books from
distributors outside the United States.

Library of Congress Cataloging-in-Publication Data

Names: Andersen, Lori T., 1954- author. | Reed, Kathlyn L., author.
Title: The history of occupational therapy : the first century / Lori T.
Andersen, Kathlyn L. Reed.
Description: Thorofare, NJ : SLACK Incorporated, [2017] | Includes
bibliographical references and index.
Identifiers: LCCN 2016053330| ISBN 9781617119972 (hardback : alk. paper) |
ISBN 9781630914486 (epub) | ISBN 9781630914493 (web)
Subjects: | MESH: Occupational Therapy--history | History, 20th Century |
Occupational Therapy--trends
Classification: LCC RM735 | NLM WB 555 | DDC 615.8/515--dc23 LC record available at
https://lccn.loc.gov/2016053330

For permission to reprint material in another publication, contact SLACK Incorporated. Authorization to photocopy items
for internal, personal, or academic use is granted by SLACK Incorporated provided that the appropriate fee is paid directly to
Copyright Clearance Center. Prior to photocopying items, please contact the Copyright Clearance Center at 222 Rosewood Drive,
Danvers, MA 01923 USA; phone: 978-750-8400; website: www.copyright.com; email: [email protected]
 Dedication
This book is dedicated to all the history makers—past, present, and future.
 Contents
Dedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Foreword by Charles H. Christiansen, EdD, OTR, FAOTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Chapter 1 The Formative Stages: Ancient Times to 1900s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 2 Conception and Formal Birth: 1900s to 1917 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Chapter 3 World War I: 1917 to 1920s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Chapter 4 Standard Setting: 1920s to 1940s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Chapter 5 Rapid Growth and Expansion: 1940s to 1960s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Chapter 6 Turning Points: 1960s to 1970s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Chapter 7 Back to Philosophical Base: 1970s to 1980s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Chapter 8 Search for a Unifying Theory: 1980s to 1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter 9 Time of Conflict: 1990s to 2000s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Chapter 10 Looking to the Future: 2000s to 2010s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Chapter 11 On the Road to the Centennial Vision and Beyond. . . . . . . . . . . . . . . . . . . . . . . . . 325

Appendix A Presidents of NSPOT and AOTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359

Appendix B Executive Officers of NSPOT and AOTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Appendix C Locations of Headquarters for NSPOT and AOTA . . . . . . . . . . . . . . . . . . . . . . . . . 363
Appendix D Official Organ/Journal of NSPOT and AOTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Appendix E Annual Meetings of NSPOT and AOTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Appendix F Eleanor Clarke Slagle Lecturers and Lectures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Appendix G AOTA Award of Merit Recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Appendix H AOTA Membership Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377

The History of Occupational Therapy: The First Century includes ancillary materials specifically available for faculty use. Included are
PowerPoint slides and Instructor’s Manual. Please visit http://www.efacultylounge.com to obtain access.
 Acknowledgments
Special acknowledgement is given to the chairs and co-chairs of the AOTA History Committee
over the years, who repeatedly started the task of getting a book written on the history of occupa-
tional therapy but could not finish the task for one reason or another. These former chairs include
Mary Merritt, Myra McDaniel, Robert K. Bing, Marianne Catterton, Helen Hopkins, Ruth Griffin,
Carolyn Baum, and Ruth Levine Schemm.
Special acknowledgement is also given to the Junior Leagues of America, who provided the
funds to buy equipment and supplies needed to start and maintain occupational therapy programs
throughout the United States, provided countless volunteer hours in the clinics, and sometimes
paid the salary of early occupational therapy practitioners. Without the help of the Junior Leagues,
fewer occupational therapy service programs would have been started and survived. Many thanks
are due to the members of Junior Leagues over the past 100 years for their interest, service, and
support.
The authors also express their appreciation to the AOTF/AOTA for their willingness to share
archival materials from the Wilma L. West Library. A special thank you is extended to Mindy
Hecker and Helene Ross for their hospitality during our visits to the Wilma L. West Library and
assistance in obtaining resource materials and artifacts.
 About the Authors
Lori T. Andersen, EdD, OTR/L, FAOTA, received her Bachelor of Science degree in Rehabilitation
Services from Springfield College, her Master of Science degree in Occupational Therapy from the
Medical College of Virginia, and her Doctorate in Education from Nova Southeastern University.
She has more than 15 years of experience in clinical practice and more than 20 years in academia.
Her academic positions in occupational therapy have included the following: Associate Professor
at Florida Gulf Coast University, Professor at Nova Southeastern University, Visiting Clinical
Associate Professor at Florida International University, and Professor at Brenau University. She
is now enjoying retirement, pursuing such passions as traveling and researching the history of
occupational therapy.

Kathlyn (Kitty) L. Reed, PhD, OTR, FAOTA, MLIS, is Associate Professor Emeritus, School of
Occupational Therapy, Texas Woman’s University, Houston, Texas. She completed her basic educa-
tion in occupational therapy at the University of Kansas, received a master’s degree in occupational
therapy from Western Michigan University, obtained a doctorate in special education from the
University of Washington, and was awarded a second master’s in information and library studies
from the University of Oklahoma. She has been active in occupational therapy for over 50 years
as a practitioner, educator, and consultant. Reed has authored several textbooks in occupational
therapy and co-authored textbooks in physical therapy and speech-language pathology. She was
named a fellow of the American Occupational Therapy Association (AOTA) in 1975, received the
AOTA Award of Merit in 1983 and presented the Eleanor Clarke Slagle lectureship at the AOTA
annual conference in 1986. She has served in the AOTA Delegate and Representative Assemblies
representing three different state associations and was chair of the AOTA Ethics Commission. She
is a member of the Texas Occupational Therapy Association, the World Federation of Occupational
Therapists and the Society for the Study of Occupation. Her interests include tracking assessments
developed by occupational therapists, analyzing models of practice in occupational therapy, and
studying the philosophy and history of the profession.
 Foreword
The past is never dead. It’s not even past.
—William Faulkner (1953, p. 73)

In this quote, William Faulkner calls forth a haunting truth about how history waits for us
around the next corner; how it reminds us that its lessons should be heeded if we are wise. But too
often it seems humans fall prey to the naïve and impatient conceit of youth and are fooled by the
illusion that there is nothing from the past that is worth knowing.
Of course, ideas and events from the past do live on, often lurking in the shadows of the famil-
iar or the taken-for-granted. The poet/philosopher David Whyte makes the keen observation that
“alertness is the hidden discipline of familiarity” (2003). He suggests that the familiar (established
habits and ideas) can teach us if we let them, since they too were informed by earlier conversa-
tions —the dialogues that take place with ourselves or with others as we make sense of the world.
Fortunately, life provides occasions that remind people (as individuals or groups) to acknowl-
edge the important lessons of the past. In the present case, it is the timely publication of this
fascinating and important book, inspired by the 100th anniversary of occupational therapy.
Centennial celebrations are like family reunions in that they naturally invite useful reflections and
memories, calling forth reminders that everything we know, sense, and understand is ultimately
the result of someone or some group whose footprints once graced the paths we now tread.
Awareness of history enables us to recognize the story lines of our past, to appreciate the genius,
inspiration, persistence and work of our forebears, and to understand the importance of context,
since progress often results from the alignment of ideas, opportunities, individuals, and chance.
Yet, simply being alert to a profession’s history may be insufficient to provide useful guidance
for the paths ahead. Unwary professions can fail to recognize the distinctions between the past
and present and the potential implications of planned changes on current and future practice.
Care is needed to avoid the assumption that innovations necessarily equate with improvements or
progress. Similarly, in the global environment of the 21st century, it is useful to make distinctions
between the developments of a profession in one country in contrast to that of others. Although
occupational therapy began in the United States, it has evolved quite differently in other countries
with different social and political contexts. Some might argue, with justification, that progress in
some other countries has equaled or surpassed that made in the United States.
This well documented historical volume is a monumental and timely contribution to the litera-
ture of occupational therapy. It carefully describes changes in the profession that have been influ-
enced by events such as wars, legislation, economics, reimbursement practices, regulatory changes,
and educational standards. It also deftly describes the evolution of concepts influencing practice,
drawing upon the well-regarded expertise of Kathlyn Reed in this area.
The editors have been careful to avoid extraneous commentary about the personalities of key
figures and the stories of conflict and character that provide the color (and often the explanations)
for why some things happened and others did not. While group living is imperative to human sur-
vival, it is imperfect to be sure, and the inevitable conflict that occurs within groups often causes
distractions from the tasks at hand. This can sometimes lead to inattention in important areas,
prolonged disagreement, delayed decision-making, or misdirected and uninspired leadership.
xiv Foreword

Perhaps also, it is useful to devote attention to the values that guide decisions and actions of
a profession over time. Questions have and can be made with legitimacy about the profession’s
inconsistencies when it comes to values and actions—that is, what is said versus what is actually
done (Hammel, 2009; Kielhofner, 2005). Or, why new practice concepts may be insufficiently
debated or challenged (e.g., Mocellin, 1995, 1996)?
In the United States, Peloquin (1994, 2005, 2007) and Yerxa (1994) have been notable among
those who been courageous and thoughtful contributors to an important conversation about the
core values, aspirations, and beliefs that influenced occupational therapy’s founding and how
these remain relevant over time. Questions about values, ethics, and professional responsibilities
serve importantly as a profession’s moral compass. Current questions might include: Why does a
relative lack of diversity persist among the profession’s practitioners in the United States (Abreu &
Peloquin, 2004; US Department of Health and Human Services, 2013)? And, since mental health is
such a compelling national issue, how did organized occupational therapy in the United States ever
allow itself to abandon its rich traditions in this area (Bonder, 1987)? More important, perhaps,
are observations by the late Maralynne Mitcham (2014) regarding the lack of clarity and focus in
the structure and pedagogies of educational curricula around occupation as the central concept of
occupational therapy.
As suggested earlier, a profession’s inattention to its founding ideas can result in navigational
errors, eroding its heritage and compromising it ethics and responsibility to the public. Thoughtful
leaders should be alert to potential implications of changes on core values such as therapeutic use
of self, or client-centered care based on a full appreciation of the everyday lives of clients and their
personal narratives. Even the use of the term client to identify recipients of care has been seen as
an erosion of the field’s ethos (Sharrot & Yerxa, 1985).
This volume also notes the increased attention to research that has been ushered in by man-
aged care and the calls for evidence-based practice (e.g., Tickle-Degnen, 1999). To be sure, it is
understandable and necessary for a health profession to improve its practices as research validates
or disproves theories and techniques that were previously based only on clinical traditions. While
the evolution of evidence-based practice in occupational therapy during the 21st century is gener-
ally seen as a positive development, it is not without its critics. Some argue that studies focusing
only on things that can be readily measured too often overlook qualitative dimensions of care that
are not easily reduced to numbers (e.g., Hammell, 2001). For example, failure to study dimensions
of personal meaning for the client could ultimately diminish occupational therapy’s claims to
authenticity, relevance, and distinct value (Engelhardt, 1977, 1983; Kielhofner, 2005; Yerxa, 1967).
Toward the end of his life, American poet William Carlos Williams, who worked as a physician
to support his passion for writing, penned a beautiful poem to his wife. Two lines in that composi-
tion, called “Asphodel, That Greeny Flower” (1994) seem relevant here:

It is difficult to get the news from poems

yet men die miserably every day for lack of what is found there.

In a world currently torn by violence, ideological conflict, and social injustices, there is a
manifest need for health care that embraces the World Health Organization’s definition of health,
unconstrained as it is by economic motives and myopic distinctions between body, mind, and soul.
Many years ago, I wrote that I welcomed the 21st century as an era where occupational therapy’s
promise would be fully realized by embracing the inspiring ideas of its founders, grounded as they
were in the healing potential of human occupation (Christiansen, 1999). The AOTA Centennial
Vision effort, which I had the privilege of helping to lead, took care to include goals intended to
advance the profession while preserving its ethos (AOTA, 2007; Moyers, 2007). As occupational
therapy moves ahead, one hopes that future leaders in the United States and elsewhere will be alert
 Foreword xv

and courageous in protecting occupational therapy’s rich heritage.

One day perhaps, ages hence, there will be a sequel to this important book, in whatever medi-
ated form exists at that time. My earnest hope is that it documents that the territory inhabited by
the profession has become as large as its language; inspired as it has been by ideas and people borne
of courage, imagination, practicality, compassion, and a deeply rooted sense of social justice.

Charles H. Christiansen, EdD, OTR, FAOTA

Retired CEO, American Occupational Therapy Foundation
Clinical Professor, The University of Texas Medical Branch at Galveston
Principal and Founder, StoryCrafting, LLC
Rochester, Minnesota

References
Abreu, B. C., & Peloquin, S. M. (2004). The issue is-embracing diversity in our profession. American Journal of
Occupational Therapy, 58(3), 353-358.
American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American
Journal of Occupational Therapy, 61(6), 613-614.
Bonder, B. R. (1987). Occupational therapy in mental health: Crisis or opportunity? American Journal of Occupational
Therapy, 41(8), 495-499.
Christiansen, C. H. (1999). Defining lives: Occupation as identity: An essay on competence, coherence, and the cre-
ation of meaning, 1999 Eleanor Clarke Slagle lecture. American Journal of Occupational Therapy, 53, 547–558.
Engelhardt, H. T. (1977). Defining occupational therapy: The meaning of therapy and the virtues of occupation.
American Journal of Occupational Therapy, 31(10), 666-672.
Engelhardt, H. T. (1983). Occupational therapists as technologists and custodians of meaning. In G. Kielhofner (Ed.),
Health Through Occupation: Theory and Practice in Occupational Therapy (pp. 139-145). Philadelpha, PA: F.A.
Davis.
Faulkner, W. (1953). Requiem for a nun. New York, NY: Random House.
Hammell, K. W. (2001). Using qualitative research to inform the client-centred evidence-based practice of occupa-
tional therapy. The British Journal of Occupational Therapy, 64(5), 228-234.
Hammell, K. W. (2009). Sacred texts: A sceptical exploration of the assumptions underpinning theories of occupation.
Canadian Journal of Occupational Therapy, 76(1), 6-13.
Kielhofner, G. (2005). Scholarship and practice: Bridging the divide. American Journal of Occupational Therapy, 59(2),
231-239.
Mitcham, M. D. (2014). Education as Engine. American Journal of Occupational Therapy, 68(6), 636-648.
Mocellin, G. (1995). Occupational therapy: a critical overview, part 1. The British Journal of Occupational Therapy,
58(12), 502-506.
Mocellin, G. (1996). Occupational therapy: a critical overview, part 2. The British Journal of Occupational Therapy,
59(1), 11-16.
Moyers, P. A. (2007). A legacy of leadership: Achieving our centennial vision. The American Journal of Occupational
Therapy, 61(6), 622.
Peloquin, S. M. (1994). Moral treatment: How a caring practice lost its rationale. American Journal of Occupational
Therapy, 48(2), 167-173.
Peloquin, S.M. (2005). Embracing our ethos, reclaiming our heart. American Journal of Occupational Therapy, 59,
611–625.
Peloquin, S. M. (2007). A reconsideration of occupational therapy’s core values. American Journal of Occupational
Therapy, 61(4), 474.
Sharrott, G. W., & Yerxa, E. J. (1985). Promises to keep: Implications of the referent “patient” versus “client” for those
served by occupational therapy. American Journal of Occupational Therapy, 39(6), 401-405.
Tickle-Degnen, L. (1999). Organizing, evaluating, and using evidence in occupational therapy practice. American
Journal of Occupational Therapy, 53(5), 537-539.
US Department of Health and Human Services. (2013). The US Health Workforce Chartbook. National Center for
Health Workforce Analysis. Rockville, MD: Health Resources and Services Administration.
xvi Foreword

Whyte, D. (2003). Everything is waiting for you. Langley, WA: Many Rivers Press.
Williams, W. C. (1994). Asphodel, That Greeny Flower and Other Love Poems. New York, NY: New Directions
Publishing Corporation.
Yerxa, E. J. (1967). 1966 Eleanor Clarke Slagle lecture. Authentic occupational therapy. American Journal of
Occupational Therapy, 21(1), 1.
Yerxa, E. J. (1994). Dreams, dilemmas, and decisions for occupational therapy practice in a new millennium: An
American perspective. American Journal of Occupational Therapy, 48(7), 586-589.
 Introduction
To understand who we are and where we are going,
we first need to understand who we were and where we came from.

In studying the history of occupational therapy, one may see first, only interesting
events, second, a series of records left by medical authorities of the past which help to
establish the value of this treatment for the sick today, and finally, we may, through
these events, examine the forces which contributed to development in the past and may
affect progress in the future. (Haas, 1944, p. 3)

This quote underscores the importance of understanding history to appreciate the efforts
of those who came before to foster the development of occupational therapy and to learn from
the lessons of the past to effectively plan for the future. We are reminded by Bob Bing (1961,
pp. 296-297) that “the names, the pictures, the thoughts of those who came before us are indeed
a profound reminder of the possibility that someday, someone may be looking back and may be
wondering who we were and what we did.” The eve of the Centennial Celebration, the commemo-
ration of the first 100 years of occupational therapy, calls for a historical review and reflection and
a renewed effort to set the direction for the next 100 years.
This book was written for all occupational therapy practitioners and occupational therapy
students who want to learn more about the history of occupational therapy, especially about the
people, activities, and influences that shaped the development of the profession. The objective of
this scholarly book is to provide these readers with the historical context of the profession, from
the formative stages in the 18th century to the eve of the Centennial Celebration in 2017, as well
as a glimpse into the future. Extensive use of photographs of pioneers, leaders, and advocates of
occupational therapy; pictures of occupational therapy artifacts, including newspaper clippings
and historical documents; maps showing historical locations in occupational therapy practice and
education; and sidebars that give glimpses into personalities and events add visually stimulating
and educational perspective to the contextual history.
The chapters follow a chronological timeline, providing discussions and reflections on the influ-
ence of highlighted personalities, key places and times, sociocultural events and issues, political events
and legislation, economic and technological issues, educational factors that led to the progressive
maturation of the profession, changes in practice over the years, and development of the national asso-
ciation and related organizations. In the early chapters, the prominent personalities of the profession—
including the backgrounds and experiences they brought to the table, the foundations they laid, and
the crises and battles they faced—are the central focus of the discussion. In later chapters, the issues
and problems that faced the profession in the modern world become more central to the discussion.
All history must be viewed from the perspective of the present and is thus a changing target.
What was important to our founders may seem trivial to us today. What seems important to us
today may seem unimportant to future generations of occupational therapy practitioners. We have
tried to present a fair and unbiased approach to writing the history but recognize that our eyes
and minds are rooted in today and that tomorrow may bring a different set of eyes and minds that
analyze the same issues from a different angle. Nevertheless, we hope our efforts provide readers
with a better understanding of their professional roots and stimulate further study and research
into the historical details of occupational therapy.

Lori T. Andersen, EdD, OTR/L, FAOTA

Kathlyn L. Reed, PhD, OTR, FAOTA, MLIS
xviii Introduction

References
Bing, R. K. (1961). William Rush Dunton, Junior—American psychiatrist, a study in self (Doctoral dissertation).
College Park, MD: University of Maryland. Available from ProQuest Dissertations and Theses database. UMI
no. 6305931.
Haas, L. (1944). Practical occupational therapy for the mentally and nervously ill. Milwaukee, WI: The Bruce
Publishing Company.
 1
The Formative Stages
Ancient Times to 1900s

Key Points
● The health benefits of activity and occupation were first recognized in ancient times.
● Shifting paradigms of scientific knowledge, sociocultural beliefs, and religious beliefs influ-
enced medical treatment through the years.
● The Industrial Revolution was a significant milepost in the history of civilization, affecting
the daily life of communities, families, and individuals.
● A number of social and political movements and reforms, including the Progressive Era, the
Arts and Crafts Movement, and the establishment of settlement houses, were precursors to the
development of the profession of occupational therapy.
● Occupational therapy developed from a confluence of established ideas and influences that
developed over hundreds of years, not new knowledge or technology.

Highlighted Personalities Key Places

● Phillipe Pinel ● Bicêtre Asylum and Salpêtrière Hospital
● William Tuke and Henry Tuke in France
● Benjamin Rush ● York Retreat in England
● Amariah Brigham ● Pennsylvania Hospital in the United States
● Thomas Story Kirkbride ● Hull House in Chicago
● Dorothea Dix
● John Ruskin and William Morris
● Jane Addams

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 1-13).
-1- © 2017 SLACK Incorporated.
2 Chapter 1

Key Times/Events Sociocultural Events/Issues

● Medieval times ● Moral treatment
● Age of Enlightenment ● Change from an agrarian to a manufac-
● Industrialization Revolution turing society
● Progressive Era ● Move from rural to urban areas
● Wave of immigration
● Progressive Movement
Political Events/Issues ● Arts and Crafts Movement
● Progressive Movement ● Settlement houses

Economic Events/Issues Technological Events/Issues

● Industrialization Revolution ● Shifting medical paradigms with advances
in scientific knowledge
● Industrialization

Introduction
Credo:
That occupation is as necessary to life as food and drink.
That every human being should have both physical and mental occupation.
That sick minds, sick bodies, sick souls, may be healed thru occupation.
–Dr. William Rush Dunton, Jr., 1919

T
he year 1917 stands as a historic year in the establishment of occupational therapy in
the United States; however, the seeds for the development of occupational therapy were
planted hundreds of years ago. With strong roots in psychiatry, the philosophy of occu-
pational therapy is entrenched in the beliefs and values of the treatment of individuals with mental
illness.
From ancient times, the treatment of those with mental illness was influenced by changes in
sociocultural and religious beliefs, advances in scientific knowledge, current political issues, and
current economic concerns. In more modern times, several social and political reform movements
contributed directly or indirectly to the evolution of occupational therapy, including the use of
moral treatment, which began in the Age of Enlightenment, the Arts and Crafts Movement, the
Settlement House Movement, the Progressive Movement, and the Mental Hygiene Movement, all
of which began in the late 19th and early 20th centuries.
 The Formative Stages: Ancient Times to 1900s 3

The Rise of Moral Treatment

Strongly rooted in psychiatry, occupational therapy emerged from the successful use of
occupation in the treatment of mental illness hundreds of years ago. In ancient times, as early
as 2000 B.C., the therapeutic benefit of occupation was recognized when music and dance
were used to soothe troubled minds and lift one from depressed states and morbid moods
(Haas, 1944, p. 3). During the first century, Galen, a prominent Greek physician, also promoted
the benefit of occupation, stating, “employment is nature’s best physician and is essential to human
happiness” (Dunton, 1947, p. 1; Haas, 1944, p. 3).
In medieval times, physical and mental illnesses were thought to be caused by disturbances
in body fluids and humors, including blood, phlegm, and yellow and black bile. Physicians of
the time believed that restoration of balance in the body humors through bloodletting, purging,
and enemas would help to alleviate symptoms of physical and mental disorders. Additionally,
people with mental illness were said to be possessed by demons and were being punished for their
heretical religious beliefs (Pinel, 1806, p. xxi). Not of rational mind, these people were deemed to
be a danger to themselves and oth-
ers. They were placed in asylums
to separate them from society
and were forced to live in condi-
tions that were overcrowded and
unsanitary. Inhumane care was
typical of the lunatic asylums in
medieval times. Often constrained
in shackles, the mentally ill were
frequently tortured to excise the
demons and punish them for their
sins. One of the worst asylums of
the day was the Hospital of Saint
Mary of Bethlem in London, also
known as Bethlem Royal Hospital.
The nickname of the asylum,
Bedlam, an antiquated term for a
Figure 1-1. William Hogarth’s painting of the Rake’s Progress, Plate lunatic asylum, became synony-
VIII, The Madhouse, depicts a man in Bedlam asylum in London being mous with the chaos, confusion,
laughed at by aristocratic visitors who paid for the opportunity to see and irrational nature of asylums
the lunatics.
(“Bedlam,” n.d.) (Figure 1-1).
The Age of Enlightenment, or
Age of Reason, began at the end of the 17th century and continued through the 18th century. This
new age brought cultural and intellectual movements with contemporary beliefs and perspectives.
Society embraced individualism, reason, and advanced knowledge through science rather than
relying on tradition and religious beliefs. Intellectuals turned to science as a way to understand
human behavior and mental illness. Although many physicians continued to believe in a physi-
cal cause of mental illness, a belief in a psychological basis or moral cause for mental illness was
emerging. Society and the medical community gradually shifted their view of mental illness
toward a more humanistic view, in which all people, even those with mental illness, were perceived
to be capable of rational thought. The new theory stated that the stresses of life caused people with
mental illness to lose their ability to reason. These people, having no control over these stresses,
the moral causes of lunacy, were not to blame for their illness. This belief in a moral reason or
moral cause of mental illness gave rise to moral treatment. The shifts in sociocultural, religious,
and political beliefs that emphasized the value and worth of an individual and the equality of
individuals supported the rise of moral treatment and compassionate care (Bockoven, 1963, p. 11).
4 Chapter 1

In late 18th century

Europe, a number of insti-
tutions for the mentally ill
began to incorporate the
principles of moral treat-
ment, improving the treat-
ment of people with mental
illness. Most prominent of
these were the York Retreat
in England and the Bicêtre
Asylum and Salpêtrière
Hospital in Paris. Dr. Philippe
Pinel served as superinten-
dent of Bicêtre Asylum and
Salpêtrière Hospital. In his
essay, “Treatise on Insanity,”
Pinel provides a historical Figure 1-2. Tony Robert-Fleury’s painting Philippe Pinel à la Salpêtrière
shows Pinel unshackling a patient.
discussion on the causes and
treatments of mental illness.
He included some of his observations on treating people with kindness and firmness, and on
the beneficial effects of participation in “laborious or amusing occupations” (Pinel, 1806, p. 193).
During his time as superintendent at Bicêtre Asylum and Salpêtrière Hospital, Pinel unshackled
patients from chains, provided more sanitary living conditions, and encouraged participation in
activities (Paterson, 2002) (Figure 1-2).
William Tuke and Henry Tuke, father and son, founded York Retreat in 1796 following the
sudden death of a family friend. The friend, Hannah Mills, had been placed in an asylum, isolated
from family and friends. The Tukes expressed concern that the substandard treatment in the asy-
lum might have caused her death. The Tukes, who were Quakers, social reformers, and humanitar-
ians, believed that those with mental illness were spiritual beings still capable of rationale thought
if provided with kind yet firm treatment. All patients at the York Retreat were called Friends
according to the Quaker tradition. Consistent with religious and political beliefs of the time, the
Quakers considered those afflicted with mental disorders as valued individuals and equals entitled
to humane treatment and not as people possessed by demons deserving of torture and punishment
for their sins (Charland, 2007). Although the Tukes embraced moral treatment at York Retreat,
traditional medical treatment of balancing body humors with purging and bloodletting were also
used. Located on a country estate, York Retreat provided a healthy, peaceful environment to mini-
mize the stresses of daily life (Figure 1-3). A structured regime of exercise, work, and leisure shaped
daily routines. Patients were expected to display socially appropriate behavior in their dress, at
meals, and in interactions with others. The Quaker influence of York Retreat also encouraged
spiritual reflection as part of treatment (Charland, 2007).
Samuel Tuke, William’s grandson, touted the benefits of participation in activities to occupy
minds with healthy thoughts in a book about the York Retreat.
Every means is taken to seduce the mind from its favourite but unhappy musings,
by bodily exercise, walks, conversations, reading, and other innocent recreations.
The good effect of exercise, and of variety of object, has been very striking in several
instances at this Institution. (Tuke, 1813, p. 98)
York Retreat’s census was small, just 30 patients. The high staff-to-patient ratio allowed for
more individualized care to facilitate recovery from mental illness. Systematic clinical obser-
vations supported the fact that the conditions of patients at the Retreat improved with moral
 The Formative Stages: Ancient Times to 1900s 5

Figure 1-3. Drawing showing the estate and original building of York Retreat.

treatment (Charland, 2007). The reputation of York Retreat spread, and many from as far away as
the United States came to see this model of practice first hand (Quiroga, 1995, p. 21).
Dr. Benjamin Rush of Philadelphia, a noted physician and signer of the Declaration of
Independence, was a proponent of moral treatment in the United States in the late 18th century.
Many considered Dr. Rush, a politician, reformer, educator, and physician, to be the father of
American psychiatry (Figure 1-4). As an intellectual and a man of science, he attempted to find
explanations for the causes of diseases and to categorize diseases of the mind rather than relying
on tradition and religious beliefs. He sought evidence to support the effectiveness of treatments
for diseases of the mind. As the superintendent of Pennsylvania Hospital in Philadelphia, one of
the first hospitals in the United States to embrace moral treatment for individuals with mental
illness, he took immense pride in eliminating
shackles and cruel treatments in favor of more
humane care. Pennsylvania Hospital’s philosophy
provided kind yet firm treatment that expected
patients to adhere to social norms in a comfort-
able environment with fresh air and light. Patients
were encouraged to participate in such activities
as reading, listening to stories, exercise, games,
and work activities to divert their minds from the
deranged ideas and thoughts that were thought
to cause their mental illness. Although he imple-
mented moral treatment at Pennsylvania Hospital,
Dr. Rush also continued to use physical interven-
tions focused on balancing the body humors and
Figure 1-4. The plaque honoring Benjamin Rush fluids (Reed & Sanderson, 1999, pp. 20-21; Rush,
at his gravesite at Christ Church Burial Ground in
Philadelphia. At the Fourth Annual Meeting of the
1812, pp. 174-180, pp. 241-244).
National Society for the Promotion of Occupational A number of other mental institutions that
Therapy in Philadelphia, President Eleanor Clarke embraced the philosophy of moral treatment
Slagle credited Benjamin Rush with starting the first opened their doors in the early 19th century, includ-
occupational therapy work in America. (Copyright ©
Dr. Lori T. Andersen. Reprinted with permission.) ing McLean Asylum (Hospital) in Massachusetts,
6 Chapter 1

Frankford Insane Asylum in Pennsylvania,

Bloomingdale Asylum in New York, Hartford
Retreat for the Insane in Connecticut, Kentucky
Lunatic Asylum in Kentucky, Worcester Insane
Asylum (State Hospital) in Massachusetts, and
Vermont Asylum for the Insane (Brattleboro
Retreat) in Vermont. Others, such as New York
State Lunatic Asylum at Utica, followed in the
1840s.
Dr. Amariah Brigham became superinten-
dent of New York State Lunatic Asylum in Figure 1-5. Plaque indicating the year Utica State
1843 (Hunt, 1858) (Figure 1-5). He was among Hospital opened. The hospital was originally known as
New York State Lunatic Asylum at Utica.
a number of asylum superintendents at that
time who championed moral treatment as an
effective cure for mental disorders. Many of these superintendents collaborated to establish the
Association of Medical Superintendents of American Institutions for the Insane, the forerunner
to the American Psychiatric Association (Luchins, 1988). The official journal of the association,
the Journal of Insanity, was edited by Dr. Brigham. Also a frequent contributor to the journal, Dr.
Brigham often wrote about moral treatment. According to Dr. Brigham, moral treatment involved:
Removal of the insane from home and former association, with respectful and kind
treatment, under all circumstances, and in most cases manual labor, attendance on
[sic] religious worship on Sunday, the establishment of regular habits and of self-
control, diversion of the mind from morbid trains of thought… (Brigham, 1847, p. 1)
In a description of New York State Lunatic Asylum and activities, Brigham indicated:
Attached to the Asylum, is an excellent farm, of above one hundred and forty acres,
affording pasturage and hay for the cows and horses that will be necessary, and good
land for raising all the vegetables required by the household. The patients, in good
weather, perform much labor on the farm, and in the garden, by which they are grati-
fied and improved. Some also work in the joiners’ shop, some make and repair mat-
tresses, and several work at making and mending shoes. The women make clothing,
bedding, and do the ironing, and assist in various household duties. They also manu-
facture many useful and fancy articles for sale. (Brigham, 1844, pp. 5-6)
Many of these activities, such as farming and other manual labors, provided not only thera-
peutic activities for the patients but also income and support to enable asylums to become self-
sufficient, self-sustaining communities (Haas, 1944, p. 10).
The superintendents of the asylums believed that a person’s environment, with social and moral
problems and other stresses of life, contributed to his or her mental illness. Therefore, a move from
a stressful environment to a peaceful environment was hypothesized to facilitate recovery. Asylums
were located on rural estates away from urban centers to provide a stress-free environment. In the
1840s, the Association of Medical Superintendents of American Institutions for the Insane consid-
ered the structural design of a building to be of paramount importance (Luchins, 1988). Thomas
Kirkbride, superintendent of Pennsylvania Hospital in the 1840s, developed the Kirkbride Plan, an
architectural plan for asylum buildings. The architectural design of Kirkbride buildings generally
consisted of a center building with long wings, allowing for a pleasant environment with plenty of
fresh air and light (Figure 1-6). The Kirkbride Plan was used to build asylums all over the coun-
try. The first one built, New Jersey State Hospital at Trenton, formerly known as New Jersey State
Lunatic Asylum, was built in 1848. Other Kirkbride hospitals include the following:
●Pennsylvania State Lunatic Asylum at Harrisburg
●Taunton State Hospital at Taunton, Massachusetts
 The Formative Stages: Ancient Times to 1900s 7

Figure 1-6. Drawing showing the layout of a typical Kirkbride building.

● Northampton State Lunatic Asylum at Northampton, Massachusetts

● Institute of Pennsylvania Hospital at Philadelphia (Kirkbride’s Hospital)
● Hudson River State Hospital for the Insane at Poughkeepsie, New York
● St. Joseph State Hospital at St. Joseph, Missouri (formerly known as Missouri State Hospital
for the Insane)
● Athens State Hospital for the Insane at Athens, Ohio
● Clarinda State Hospital at Clarinda, Iowa
● Independence State Hospital at Independence, Iowa
● Fergus Falls Regional Treatment Center State Hospital at Fergus Falls, Minnesota
● Broughton State Hospital at Morganton, North Carolina (formerly known as the Western
Carolina Insane Asylum)
● Oregon State Hospital at Portland, Oregon
● Northern Michigan Asylum for the Insane at Traverse City, Michigan
● St. Elizabeth’s Hospital at Washington, D.C. (formerly known as Government Hospital for
the Insane)
● Kankakee State Hospital in Kankakee, Illinois
● Sheppard Pratt Hospital at Towson, Maryland
Some Kirkbride hospitals are still in existence today (Geller & Morrissey, 2004; McElroy, n.d.).
In spite of efforts to improve treatment for those with mental illness, problems continued.
Dorothea Dix, a mid-19th century reformer, was intent on securing the protection of people with
mental illness (Figure 1-7). A person of strong opinions, critical nature, and bold, imperious
manner, she exposed the fact that many of the insane were housed inappropriately in prisons and
almshouses. Dix’s graphic first-hand accounts of the horrific conditions that people with mental
8 Chapter 1

illness faced in prisons and almshouses convinced fed-

eral and state governments to provide funding to build
new asylums and expand existing ones (Parry, 2006).
Her efforts triggered the transfer of the insane from pris-
ons and almshouses to asylums, where initially people
with mental illness received more humane treatment in
safe environments (Luchins, 1988). Unfortunately, her
valiant efforts caused a flood of patients to be admit-
ted to asylums, resulting in overcrowding. Asylums
subsequently became understaffed, and care was com-
promised. The humane, personal aspect of moral treat-
ment that encouraged patients to participate in occupa-
tions could no longer succeed under these conditions
(Bockoven, 1963, pp. 38-39; Peloquin, 1994). With the
decline in recovery rates came the demise of moral Figure 1-7. “Man is not made better by being
treatment and return to substandard living situations in degraded.” Photograph of social reformer
asylums (Bockoven, 1963, p. 31). Dorothea Dix.

The Decline of Moral Treatment

Moral treatment continued to decline in the latter half of the 19th century due to a number of
sociocultural, scientific, demographic, political, and economic factors. In addition to the influx
of patients from prisons and almshouses, families who no longer wanted to care for aging family
members with dementia had them admitted to asylums. The wave of immigration in the mid-19th
century also had an effect. With limited ability to speak English, immigrants often had difficulty
adjusting to life in America. Society viewed immigrants with suspicion because of their differ-
ing sociocultural values, political beliefs, and habits. Many thought that foreign countries were
encouraging emigration of their undesirables. Immigrants were often deemed to be mentally ill
because of their different habits, routines, and traditions. Placed in asylums, immigrants began
to make up an increasingly higher percentage of the patient populations. As these immigrants
were not raised with the traditions and habits of Americans, many doubted that moral treat-
ment, which encouraged good habits, hygiene, and routines, would benefit these immigrants
(Bockoven, 1963, p. 24; Luchins, 1988).
In the latter half of the 19th century, advances in scientific and medical knowledge and
the growth of neurology, a new medical specialty, prompted a paradigm shift. Neurologists
believed that mental illness was organic—caused by a brain lesion—and as such could not be
cured. Moral treatment, no longer based on current science, became obsolete. Asylum super-
intendents faced criticism because they were out of touch with current knowledge (Luchins,
1988; Peloquin, 1994). This shift came at a time when many of the early proponents, such as
Dr. Amariah Brigham, had either left their posts or passed away, leaving few to advocate for
the benefits of moral treatment (Bockoven, 1963, pp. 20-21). In 1854, Dr. John Gray, who was
appointed superintendent of Utica State Hospital, also became editor of the American Journal of
Insanity, positions previously held by Dr. Brigham (Bockoven, 1963, p. 41). Brigham’s and Gray’s
philosophies on mental illness differed drastically. Dr. Brigham believed mental illness was inor-
ganic—a disease of the mind. Dr. Gray believed mental illness was organic—a disease of the brain
(Bockoven, 1963, p. 41; Lidz, 1985, p. 36). The shift in thinking became evident in the premier
psychiatric journal of the day, as well as in the treatment philosophies of institutions.
The effectiveness of moral treatment was no longer supported by the annual reports of asylums,
which had previously touted a high cure and discharge rates. Additionally, politicians recognized
that asylums built according to Kirkbride’s architectural requirements were very expensive. As
 The Formative Stages: Ancient Times to 1900s 9

a result, legislators no longer wanted to provide funding to build additional asylums (Bockoven,
1963, pp. 20-21; Luchins, 1988).

Arts and Crafts Movement

The Industrial Revolution, a significant turning point in history, began in England in the 18th
century and slowly expanded to other countries. It was a time of great progress, with technological
innovations such as the printing press, the steam engine, powered machine tools, improved pro-
cesses to make iron, and manufacturing processes for mass production. The ripple effect of these
innovations included advances in transportation systems, agriculture, and knowledge through
distribution of print materials. A number of sociocultural and economic changes occurred, includ-
ing an increase in the population, an increase in per capita income, a shift from rural to urban
areas as people moved to work in factories, and a shift from an agricultural society to an industrial
society. Mass production enabled more people to purchase goods as prices decreased.
The Industrial Revolution made great strides in advancing civilization, but it also brought some
drawbacks. Prior to the Industrial Revolution, most goods, clothing, furniture, and foods were
produced by individuals in their homes. There was a pride of workmanship in making handcrafted
goods and a satisfaction in creating a well-made product that contributed to quality of life. Most
viewed manufactured goods as being of a lesser quality than handmade goods in both design and
construction. Factory workers had little to no control over the design or outcome of a finished
product and therefore could not gain any personal satisfaction from a machine-made product
(Levine, 1986, 1987; Schemm, 1994). The move to an industrial society caused a major concern that
it would cause a decline in standards and moral values when people began to value materialism
more than quality work (Schemm, 1994).
John Ruskin and William Morris, both social reformers, started the Arts and Crafts Movement
in England as a reaction to the problems caused by the Industrial Revolution. The Arts and Crafts
Movement embraced the belief that the action of making handmade goods integrated the mind
and body, providing intrinsic satisfaction to the craftsman. As such, the Arts and Crafts Movement
embraced a return to an appreciation of traditional design and craftsmanship (Schemm, 1994).
Arts and crafts societies formed in various cities as part of the Arts and Crafts Movement in the
United States. The aim of these societies was to ensure that artistic ability and technical ability
to make handcrafted goods was not lost. Societies sponsored exhibitions to display handcrafted
utilitarian objects of art and competitions to encourage higher standards. Societies also sponsored
lectures, craft books, and other publications to educate people on making various crafts.
One of these societies, the Chicago Arts and Crafts Society, was incorporated at Hull House, a
settlement house in Chicago, on October 22, 1897. The objectives of this society included:
To recognize and encourage handicraft among its members, and through them in
others, in order that the stimulation derived from this means may be a helpful factor
in the development of those new ideals which present conditions, to-wit, industrial
organization and the machine render necessary.

To consider the present state of the factories and the workmen therein, and to devise
lines of development which shall retain the machine in so far as it relieves the work-
man from drudgery, and tends to perfect his product; but which shall insist that the
machine no longer be allowed to dominate the workman and reduce his production to
a mechanical distortion. (Chicago Arts and Crafts Society, 1897)
The Society of Arts and Crafts (Boston) was formally incorporated on June 28,
1897 (Eaton, 1949). The mission of the Society, in concert with the Arts and Crafts Movement,
was to “develop and encourage higher standards in the handicrafts” (Society of Arts and Crafts,
2014). This society still exists today. Architect George Edward Barton, one of the incorporators,
10 Chapter 1

later became one of the founders and incorporators of the National Society for the Promotion
of Occupational Therapy (NSPOT), the precursor to the American Occupational Therapy
Association (AOTA) (Eaton, 1949).

Progressive Movement
The last decade of the
19th century guided in the
Progressive Era, a time of tre-
mendous social, economic,
political, and technological
change. Driven in part by
the Industrial Revolution, the
Progressive Era began as a
social movement but evolved
into a political movement to
address some of the nega-
tive consequences brought on
by the Industrial Revolution,
including a lack of concern
for worker safety, poor work
conditions, poor wages, and Figure 1-8. Photograph of children laboring in a textile factory in Macon,
the onslaught of child labor Georgia.
in factories (Figure 1-8). This
era also witnessed corruption in government and industry, political scandals, and corporate
monopolies that sacrificed the public good for profits.
Progressives, the name given to the social and political reformers of this era, wanted to institute
reforms to make the United States a better place to live. Their goal was to promote social justice
and improved quality of life for all. Progressives firmly believed in the value of science, technology,
and education. They set out to improve the environment and conditions of life for all people, push-
ing a series of reforms in the areas of medicine, public health, education, business, and banking by
setting standards and regulating certain professions and industries. One reform of the Progressive
Era, the setting of standards for medical education, resulted from the Flexner Report of 1910.
With the objective of improving medical care, a committee of the American Medical Association
(AMA) asked Abraham Flexner to study the state of medical education in the United States.
Flexner surveyed 155 medical schools’ admissions requirements, curricula, facilities, methods of
assessment, and graduation requirements. Based on these findings, the Flexner Report of 1910
made recommendations to reform medical education, setting standards strongly based in science
(Kunitz, 1974). This emphasis on standard setting had future implications for a number of medical
professions, including occupational therapy.

Settlement House Movement

The elite middle class of this era, especially women, felt a sense of duty and obligation to work
for social reform, and they did so through various types of philanthropic activities. Jane Addams,
a well-known reformer representative of these philanthropic women, worked hands-on to improve
the condition of the working class. Born to privilege, Jane, a very charismatic woman with a strong
sense of duty, worked and led others to improve the living and working conditions of citizens. Like
others, including Eleanor Roosevelt, wife of President Franklin Roosevelt, Jane Addams partici-
pated in establishing and running settlement houses to promote social and political reform.
 The Formative Stages: Ancient Times to 1900s 11

In the United States, settlement

houses were modeled after Toynbee
Hall in England, one of the first
settlement houses established in the
world. Settlement houses served as
neighborhood centers that provid-
ed living arrangements and a place
for people of different social classes
and cultures to gather to learn from
organized educational programs
and from each other. Discussions
to foster the understanding of dif-
fering sociocultural backgrounds
were encouraged at these gather-
ings (Reed & Sanderson, 1999, p.
23). Settlement houses also served Figure 1-9. Front door at Hull House, Chicago, Illinois. (Hull-House
as research centers that scientifi- Photograph Collection, Special Collections and University Archives,
University of Illinois at Chicago.)
cally examined social, economic,
and educational problems (Stritt,
2014). The founders of settlement houses intended to use this information to identify issues and
influence social policy.
In the United States, settlement houses were established in urban neighborhoods where the
working poor and newly arrived immigrants lived. To help immigrants assimilate into American
society and adjust to their new country’s language, customs, and values, settlement houses pro-
vided classes in language, social, and work skills (Quiroga, 1995, pp. 37-38).
Women like Lillian Wald and Jane Addams were well known for the settlement houses they
established. Wald established Henry Street Settlement in New York City and Jane Addams estab-
lished Hull House in Chicago, one of the most famous settlement houses (Figure 1-9). The Chicago
Arts and Crafts Society was established at Hull House, which was a good match because Hull
House and the proponents of the Arts and Crafts Movement had a similar focus on social reform.
The Chicago Arts and Crafts Society sought to counteract the worker alienation that resulted from
the mass production of goods. At the same time, Hull House offered demonstrations and classes in
making crafts so people could understand the processes and experience the pride and satisfaction
in using one’s hands to create beautiful, functional objects (Quiroga, 1995, pp. 41-42) (Figure 1-10).
Lillian Wald, Jane Addams,
and others associated with the
Settlement House Movement grad-
ually became politically active to
further their goals. They recog-
nized the need to influence govern-
ment to solve social problems facing
the poor, workers, and immigrants.
Jane Addams and her colleagues
quickly became political forces in
Chicago, advocating for social jus-
tice and influencing public policy.
Lillian Wald and Florence Kelley
became political forces in New York
Figure 1-10. Boy’s cobbling class at Hull House. (Hull-House Photograph City and Philadelphia, respectively.
Collection, Special Collections and University Archives, University of
Illinois at Chicago.)
Concerned with children’s welfare,
they were instrumental in getting
12 Chapter 1

federal legislation passed in 1912 to establish the Children’s Bureau. This federal bureau was estab-
lished to safeguard the welfare of children and dealt with such social issues as infant mortality,
juvenile delinquency, and child labor. A friend and colleague of Jane Addams at Hull House, Julia
Lathrop, became the first director of this federal program (Brown, 2001, pp. 14-22).

Reflection
The origin and development of occupational therapy, rooted in psychiatry, was influenced by
sociocultural values, religious beliefs, political attitudes, economic issues, and scientific knowledge
that shaped the treatment of those with mental illness. As society emerged from medieval times,
religious beliefs and sociocultural values changed. There was a renewed willingness to accept sci-
ence and knowledge instead of holding fast to traditional beliefs. During the Renaissance, society
adopted a humanistic view of man, recognizing all people as individuals with moral worth and
deserving of respect. Mental illness, once thought to be caused by demons, was now believed to be
caused by the ills and stresses of living in certain unhealthy environments. From the Renaissance
to the 19th century, many of the principles of occupational therapy began to form through the
work of reformers such as Philippe Pinel, William and Henry Tuke, Benjamin Rush, Amariah
Brigham, Dorothea Dix, and Jane Addams. Through sheer force of desire and persistence, these
advocates of change worked tirelessly to improve the social welfare of people with mental illness.
In the mid-19th century, moral treatment was derailed due to political and economic issues.
Asylums were overcrowded with society’s castoffs, including a significant percentage of immi-
grants coming to the United States in the late 19th century. Asylums became more expensive to
build and operate. In a change in scientific beliefs, mental illness was thought to be organic with
no cure. Additionally, lack of evidence supporting the benefit of moral treatment contributed to
its demise.
In the late 19th century, the Industrial Revolution, a major turning point in the history of civi-
lization, triggered numerous sociocultural, technological, economic, and political changes, some
good and some bad. The Arts and Crafts Movement, the Progressive Movement, and the Settlement
House Movement, reactions to the ills of the Industrial Revolution, endeavored to improve quality
of life for all. Occupational therapy emerged in this early 20th century environment, embracing
many of the values of these movements. The Arts and Crafts Movement originated out of the desire
to restore the worth of individuals by promoting the value of handmade goods. The Progressive
Movement embraced science, social justice, political reform, and the sharing of knowledge. Finally,
settlement houses served as research centers to study social, economic, and educational problems
and advocated for social justice and social reforms. The influence of these movements helped to
shape the values, beliefs, principles, and direction of the profession of occupational therapy.

References
Bedlam. (n.d.). Merriam-Webster’s online dictionary. Retrieved from http://www.merriam-webster.com/dictionary/
bedlam
Bockoven, J. S. (1963). Moral treatment in American psychiatry. New York, NY: Springer Publishing Company, Inc.
Brigham, A. (1844). Article I: Brief notice of the New York State Lunatic Asylum at Utica. American Journal of
Insanity, 1, 5-6. Retrieved from http://archive.org/details/psyamericanjourn01ameruoft
Brigham, A. (1847). Article I: The moral treatment of insanity. American Journal of Insanity, 4, 1. Retrieved from
https://archive.org/details/americanjournalo4184amer
Brown, V. B. (2001). Addams, Jane. In R. L. Schultz & A. Hast (Eds.), Women building Chicago 1790-1990: A biographi-
cal dictionary (pp. 14-22). Bloomington, IN: Indiana University Press.
Charland, L. C. (2007). Benevolent theory: Moral treatment at the York Retreat. History of Psychiatry, 18(1), 61-80.
doi:10.1177/0957154X07070320
Chicago Arts and Crafts Society. (1897). Chicago Arts and Crafts Society constitution. Chicago, IL: Author.
 The Formative Stages: Ancient Times to 1900s 13

Dunton, W. R. (1947). History and development of occupational therapy. In H. S. Willard & C. S. Spackman (Eds.),
Principles of occupational therapy (pp. 1-9). Philadelphia, PA: J. B. Lippincott Company.
Eaton, A. H. (1949). Handicrafts of New England (pp. 281-294). New York, NY: Harper Brothers.
Geller, J. L., & Morrissey, J. P. (2004). Asylum within and without asylums. Psychiatric Services, 55(10), 1128-1130.
Haas, L. (1944). Practical occupational therapy for the mentally and nervously ill. Milwaukee, WI: The Bruce
Publishing Company.
Hunt, E. (1858). Biographical sketch of Amariah Brigham, late superintendent of the New York State Lunatic Asylum,
Utica, N.Y. Utica, NY: W. O. McClure.
Kunitz, S. J. (1974). Professionalism and social control in the Progressive Era: The case of the Flexner Report. Social
Problems, 22(1), 16-27.
Levine, R. E. (1986). Historical research: Ordering the past to chart our future. Occupational Therapy Journal of
Research, 6(5), 259-269.
Levine, R. E. (1987). The influence of the arts-and-crafts movement on the professional status of occupational therapy.
American Journal of Occupational Therapy, 41(4), 249-254.
Lidz, T. (1985). Adolf Meyer and the development of American psychiatry. Occupational Therapy in Mental Health,
5(3), 33-53.
Luchins, A. S. (1988). The rise and decline of the American asylum movement in the 19th century. Journal of
Psychology: Interdisciplinary and Applied, 122(5), 471-486.
McElroy, E. (n.d.). Kirkbride buildings. Retrieved from http://www.kirkbridebuildings.com/
Parry, M. S. (2006, April). Dorothea Dix (1802-1887). American Journal of Public Health, 96(4), 624-625. doi:10.2105/
AJPH.2005.079152
Paterson, C. F. (2002). A short history of occupational therapy in psychiatry. In J. Creek (Ed.), Occupational therapy
and mental health (3rd ed., pp. 3-14). London, UK: Churchill Livingstone.
Peloquin, S. M. (1994). Looking back: Moral treatment: How a caring practice lost its rationale. American Journal of
Occupational Therapy, 48(2), 167-173.
Pinel, P. H. (1806). A treatise on insanity. Sheffield, UK: W. Todd. Retrieved from http://archive.org/details/treatis-
eoninsani00pine
Quiroga, V. A. M. (1995). Occupational therapy: The first 30 years: 1900 to 1930. Bethesda, MD: American Occupational
Therapy Association.
Reed, K. L., & Sanderson, S. N. (1999). Concepts of occupational therapy (4th ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
Rush, B. (1812). Medical inquiries and observations, upon the diseases of the mind. Philadelphia, PA: Kimber &
Richardson. Retrieved from http://archive.org/details/medicalinquiries1812rush
Schemm, R. L. (1994). Bridging conflicting ideologies: The origins of American and British occupational therapy.
American Journal of Occupational Therapy, 48(11), 1082-1088.
Society of Arts and Crafts. (2014). The Society of Arts and Crafts: Background and history. Retrieved from http://
www.societyofcrafts.org/about/about.asp
Stritt, S. (2014). The first faith-based movement: The religious roots of social progressivism in America (1880-1912)
in historical perspective. Journal of Sociology and Social Welfare, 41(4), 77-105.
Tuke, S. (1813). Description of the retreat, an institution near York for insane persons. Philadelphia, PA: Isaac Peirce.
Retrieved from http://collections.nlm.nih.gov/muradora/objectView.action?pid=nlm:nlmuid-2575045R-bk
 2
Conception and Formal Birth
1900s to 1917

Key Points
● Functional and pragmatic psychology viewpoints influenced the thinking of Adolf Meyer
and his new science of psychobiology—the inseparable mind-body connection—one of the
principles of occupational therapy today.
● The Arts and Crafts Movement, moral treatment, the Progressive Movement, and the Mental
Hygiene Movement influenced the formal birth of occupational therapy.
● The Progressive Era of the early 20th century, with its sharing of ideas, progressive thought,
and emphasis on science, brought the early proponents of occupation together.
● The early founders brought different skills, abilities, and values to the table.
● Occupational therapy was born of a confluence of ideas, not one paradigm.
● Key events and people shaped the profession of occupational therapy.

Highlighted Personalities
● William James ● Herbert Hall
● Thomas Dewey ● Susan Cox Johnson
● Adolf Meyer ● Thomas Bessell Kidner
● Julia Lathrop ● Isabel Gladwin Newton
● George Edward Barton ● Eleanor Clarke Slagle
● William Rush Dunton, Jr. ● Susan E. Tracy

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 15-49).
- 15 - © 2017 SLACK Incorporated.
16 Chapter 2

Key Places Key Times/Events

● Devereux Mansion in Massachusetts ● Progressive Era
● Adams Nervine Hospital in Jamaica ● Founding meeting of National Society of
Plains, Massachusetts the Promotion of Occupational Therapy
● Sheppard and Enoch Pratt Hospital in
Towson, Maryland Sociocultural Events/Issues
● Occupational Experiment Station in
● Moral treatment
Chicago, Illinois
● Pragmatism
● Chicago School of Civics and
Philanthropy in Chicago, Illinois ● Functional psychology
● Hull House in Chicago, Illinois ● Progressive Movement
● Henry B. Favill School of Occupations in ● Arts and Crafts Movement
Chicago, Illinois ● Settlement House Movement
● Consolation House in Clifton Springs, ● Mental Hygiene Movement
New York ● Manual training
● Industrial Room, Clifton Springs
Sanitarium
● Experiment Station for the Study of
Economic Events/Issues
Invalid Occupations in Jamaica Plains, ● Industrialization
Massachusetts
Technological Events/Issues
Political Events/Issues ● Medical technology: x-ray, electrocardiogram
● Progressive Movement ● Communication technology: telegraph,
● Government regulation radio, telephone
● Consumer protection (anti-trust legislation) ● Transportation technology: railroad,
automobile, airplane
Association Issues
● Founding of the profession
● Initial Contemplation of Educational
Standards

Introduction
“Never doubt that a small group of thoughtful, committed citizens
can change the world. Indeed, it is the only thing that ever has.”
–Margaret Mead

A
t the turn of the century, the Progressive Movement was in full swing, led by Presidents
Theodore Roosevelt, William Howard Taft, and Woodrow Wilson. Consumer protec-
tion, regulation of commerce, anti-trust legislation, workers’ rights movements, the
women’s suffrage movement, and development of the national park system were all initiatives and
 Conception and Formal Birth: 1900s to 1917 17

movements intended to improve quality of life for citizens. Advances in science and new inven-
tions furthered development of the railroad transportation system, the telephone system, and the
use of radios. Electricity was now lighting cities. Henry Ford implemented the assembly line. As a
result, his Ford automobiles become more affordable. The Panama Canal, an engineering marvel,
was built. The United States assembled a powerful navy, including powered submarines. Renewed
interest in science initiated reforms in intellectual thinking and education. Within the context of
these advances and reforms, the opportunity and desire to develop the new profession of occu-
pational therapy took shape. The productive 3-day inaugural meeting of the National Society for
the Promotion of Occupational Therapy (NSPOT) was the beginning of the founders’ and leaders’
vision and work to establish a strong foundation for the Society and profession.

Intellectual Thinking
A renewed interest in science and systematic investigation was ushered in by the Progressive
Era in the late 19th and early 20th centuries. The economic, political, and social reform of the
Progressive Movement of the early 20th century also brought educational reform and, along with
it, the gradual emergence of research universities and a new group of intellectual thinkers. These
intellectuals challenged traditional thinking and focused their efforts on advancing knowledge
in various fields and professions, including the social sciences, which sought to answer social
problems.
William James and John Dewey were two of the leading thinkers of the late 19th and early 20th
centuries. William James is considered the father of American psychology, and John Dewey is
best known as an educational reformer with a belief in learning by doing. Both James and Dewey
were psychologists and philosophers. Both were proponents of philosophy of pragmatism, which
provided the underpinnings for functional psychology.
In the early 20th century, there were two opposing philosophical schools of thought shaping
philosopher’s view of the world: structuralism (the primary school of thought) and pragmatism.
According to the structuralism school of thought, everything, including human behavior, could be
broken into parts and analyzed, and the mind (psychology) and the body (physical) were separate
entities. In contrast, pragmatism described human behavior in terms of a system approach wherein
human thought or action was influenced by life experiences and the environment. Pragmatism
viewed the mind, body, and context as inextricably intertwined and emphasized the importance
of context in human behavior. These differing viewpoints had implications for research on human
behavior. Structuralism searched for universal laws and principles of human behavior through
introspection of a person in controlled laboratory studies, whereas the hallmark of pragmatism
was naturalistic study because context and individual differences were considered to be of prime
importance (Serrett, 1985).
In concert with the pragmatism school of thought, the central tenet of functional psychology is
that mental processes are used to adjust to environmental demands and are needed to think, learn,
and live. Mind and body form an inseparable system that give humanity purpose, function, and
life. Dewey saw the importance of the mind-body connection and strongly believed that a man’s
mind and his hands were crucial for successful adaptation to life (Serrett, 1985).
Best known as an educational reformer, Dewey’s doctrine, learning by doing, is emblematic
of this philosophical viewpoint and was a shift away from learning by rote. This way of learn-
ing was not focused on learning a specific trade or skill, but rather on developing problem-
solving ability, “which reproduces, or runs parallel to, some form of work carried on in social
life” (Dewey, 1915, p. 131). Dewey saw this as a means to develop skills to survive in life. A person
facing a problem or difficulty must determine the best way to solve the problem. This requires the
ability to plan, to “project mentally the result to be reached,” and to determine strategies and steps
to be taken (Dewey, 1915, pp. 133-134). Learning takes place through this process. This pragmatic
18 Chapter 2

and functional psychology view was also addressed by Burnham (1924) when he wrote: “In the
individual, integration and the power of adjustment may be developed, physically, by coordinating
activity, and mentally, in the doing of purposeful tasks” (p. 677). This doing of tasks helps develop
attitudes and influence behavior; in other words, through the doing of tasks, one learns.
The work of James and Dewey greatly influenced the work of their friend and colleague, Adolf
Meyer, a psychiatrist. Meyer in turn greatly influenced the central tenets of occupational therapy
(Hooper & Wood, 2002; Serrett, 1985). With the philosophical viewpoint that melded the mind
and body, Meyer began a new scientific discipline called psychobiology. The premise of psycho-
biology is seen in Meyer’s Philosophy of Occupation Therapy (Meyer, 1922/1977), in which he
provides an example of the mind-body connection. He recognized this connection when observing
patients participating in activities in an asylum:
A pleasure in achievement, a real pleasure in the use and activity of one’s hands and
muscles and a happy appreciation of time began to be used as incentives in manage-
ment of our patients instead of abstract exhortations to cheer up and to behave accord-
ing to abstract or repressive rules. (Meyer, 1922/1977, p. 640)
He further explained that man is not of separate physical or psychological structures, but that
man is a live organism whose function cannot be analyzed by looking at its structural parts:
Our body is not merely so many pounds of flesh and bone figuring as a machine, with
an abstract mind or soul added to it. It is throughout a live organism pulsating with its
rhythm of rest and activity, beating time (as we might say) in ever so many ways, most
readily intelligible and in full bloom of its nature when it feels itself as one of those
great self-guiding energy-transformers which constitute the real world of living beings.
(Meyer, 1922/1977, p. 641)
William James was also known for his philosophy of habit. He believed that there was a physi-
cal basis for habits and promoted the viewpoint that “an acquired habit, from the physiological
point of view, is nothing but a new pathway of discharge formed in the brain, by which the cer-
tain incoming currents ever after tend to escape” (James, 1892/1985, p. 55). James described the
practical effect of habits as simplifying movements and requiring less conscious attention, thereby
reducing fatigue from cognitive exertion. People perform many tasks automatically without much
conscious effort. James believed that the plasticity of the brain allows for the eventual shaping of
habits and changing of habits. He believed that the nervous system could be an ally in education,
especially in early life, through repetition of activities and a daily regime to form good habits. He
also believed that, based on the plasticity of the brain, there was an opportunity to change hab-
its through continual repetition (James, 1892/1985). This philosophy became the basis for habit
training used by Adolf Meyer and Eleanor Clarke Slagle at the Phipps Psychiatric Clinic at Johns
Hopkins.

Resurgence of Moral Treatment

“It should be remembered that the term applied to this form of therapy was in
those days moral treatment or labor. The term occupation came in somewhat later.”
(Dunton, 1917, p. 382)
Based on moral treatment’s principles of individuality and the need to participate in occupa-
tion, “the history of moral treatment in the United States…is the history of occupational therapy
before it acquired its 20th century name” (Bockoven, 1971, p. 223). These principles were rooted
in the political, cultural, and religious beliefs of the early 19th century, when moral treatment
flourished. After its demise in the late 19th century, there was a renaissance of the concept of
 Conception and Formal Birth: 1900s to 1917 19

moral treatment in the first decades of the 20th century. This renaissance gave momentum to the
development of occupational therapy.
Although moral treatment had lost its footing just a quarter century before, many men and
women still living had personal contact with or knowledge of moral treatment proponents of the
past (Bockoven, 1971). Benjamin Rush, who implemented humane care for the mentally ill in
Pennsylvania Hospital, was a second cousin to William Rush Dunton Jr.’s grandmother. Dunton
attended university with Thomas Kirkbride’s son, Franklin. It is possible that connections such as
these helped transmit knowledge and the values of moral treatment to Dunton in the next genera-
tion. At the founding meeting of the NSPOT, William Rush Dunton Jr. spoke about such notables
as Benjamin Rush and Thomas Kirkbride advocating for engaging patients in work for therapeutic
purposes (Dunton, 1917). His extensive reading of the literature on moral treatment was the basis
of his paper, but it is likely that his interest in moral treatment was sparked by his personal con-
nection to Benjamin Rush and Thomas Kirkbride.

Mental Hygiene Movement

In 1900, Clifford W. Beers, a graduate of Yale University, suffered a mental breakdown. He was
shuttled around to various insane asylums for treatment of his manic-depressive episodes. He was
subjected to horrendous conditions and ill treatment in these asylums. In 1907, Beers decided to
write an autobiographical book to expose the deplorable state of affairs in insane asylums. While
writing the book, he sought the advice of William James and Adolf Meyer. Meyer was supportive,
editing the book for Beers and suggesting that Beers use this opportunity to promote social change
by increasing awareness and understanding of mental illness. Taking this suggestion, Beers began
to organize supporters to work toward social reforms to improve the care for those with mental
illness. It was Meyer who suggested the term mental hygiene as a name for Beers’ movement.
Beer’s book, A Mind That Found Itself, was published in 1908. It was a huge success and gal-
vanized the public for reform. A heightened awareness of social problems and a belief that the
government should be responsible for the care and safety of the mentally ill set the stage for the
development of the Mental Hygiene Movement. The National Committee for Mental Hygiene
was formally established on February 19, 1909 (Lief, 1948, pp. 280-281). William James and Julia
Lathrop of Hull House, who had taken an interest in mental health after reading Beers’ book,
were among those attending the founding meeting at the old Hotel Manhattan in New York City
(Meyer, 1935/1948, p. 313).
The Connecticut Society for Mental Hygiene was founded May 6, 1908, by the National
Committee founders, and it served as a model for other state societies. The second and third state
societies to organize were the Illinois Society for Mental Hygiene, which formed in July 1909, and
the New York State Society for Mental Hygiene, which formed in May 1910 (National Committee
for Mental Hygiene, 1912, pp. 6-7). The Mental Hygiene Movement facilitated change through
education of physicians and the public, as well as implementation of public health initiatives that
focused on the prevention of mental illness. Additionally, the Mental Hygiene Movement prompt-
ed improved care for patients in asylums, including use of occupations, individualized care, and
better living environments (Peloquin, 1991a).

Conception and Birth

of the New Profession
In the early years of the 20th century, many people became involved in the science, practice,
and promotion of the therapeutic use of occupation. Occupational therapy was beginning to be
practiced in parts of the United States. Consistent with the values of the Progressive Movement
20 Chapter 2

and the development of various professions, many began to share ideas on the therapeutic use of
occupation.
Prominent psychiatrist Adolf Meyer was a major proponent of the therapeutic use of occupa-
tion. Although not active in the formation of a professional society, he was a strong supporter and
advocate. A group of six professionals—including physician William Rush Dunton Jr., architects
George Edward Barton and Thomas Bessell Kidner, social worker Eleanor Clarke Slagle, arts and
crafts instructor Susan Cox Johnson, and secretary Isabel Newton—were responsible for the for-
mal birth of the professional society to promote the therapeutic use of occupation. They gathered
together from March 15 to 17, 1917, in Clifton Springs, New York, for the inaugural meeting of the
NSPOT. Susan E. Tracy, a nurse, and Herbert James Hall, a physician, were not at the founding
meeting but were instrumental in the early development of the Society. As such, both are consid-
ered by many to be near founders. The founders and near founders each brought different skills,
values, beliefs, and experiences to shape the new profession of occupational therapy. Many others
throughout the country worked on behalf of the new profession, sharing the common belief that
meaningful work and occupation could facilitate restoration of health.

Adolf Meyer
Adolf Meyer, an alienist (an early term for psychiatrist), was a lifelong proponent of occupa-
tional therapy. His paper, “Philosophy of Occupation Therapy,” describes his introduction to the
therapeutic use of occupation and his own experiences with using occupation in psychiatric facili-
ties (Meyer, 1922/1977) (Figure 2-1). Many of the principles he espoused—including the need for
man to adapt to his environment; the need to develop habits through training; and the need to
understand the effect of life history on health, time use, and balance—still form the basis for the
principles of occupational therapy.
Born on September 13, 1866, in Switzerland, Meyer studied neurology and psychiatry. After
graduating in 1892, he immigrated to the United States because he believed he would have better
professional opportunities there. He moved to Chicago, where he opened a neurology practice
and taught at the University of Chicago. While in Chicago, he met John Dewey and Julia Lathrop,
both of whom had a profound effect on his thinking and professional life. Meyer and Lathrop
became close colleagues after she arranged a meeting
with him to learn about social services in Europe. Their
close relationship was evident in some of their actions.
When Meyer was recovering from a fall, Lathrop invited
him to stay for a week at Hull House (Lief, 1948, p. 49).
Later, Meyer named his daughter, born in 1916, Julia
Lathrop Meyer. John Dewey also had a close professional
relationship with Adolf Meyer while in Chicago. They
reconnected at the turn of the century when both moved
to New York City, dining together on a weekly basis to
continue their intellectual discourse.
In 1893, Meyer took a job as a neuropathologist at
the Eastern State Hospital for the Insane in Kankakee,
Illinois. There he performed autopsies on patients to
determine whether there was a correlation between
brain lesions and mental illness. Frustrated by the
lack of record keeping documenting patients’ symp-
toms and behaviors while alive, Meyer instituted pro-
cesses to record physical, mental, and developmental Figure 2-1. Adolf Meyer, psychiatrist. (Printed
life histories and living environments of patients to with permission from the Archive of the
further his research. As a result, at Meyer’s insistence, American Occupational Therapy Association,
Inc.)
 Conception and Formal Birth: 1900s to 1917 21

documentation of life histories became an important part of a patient’s evaluation. To ensure he

had adequate information for his research, Meyer established a method for standardized docu-
mentation for case records. Believing that mental illness was not just a disease of the brain, Meyer
began to develop his theories of psychobiology and to investigate how life experiences and abil-
ity to adapt were factors in mental illness (Lidz, 1966/1985; Scull & Schulkin, 2009). Dr. Meyer’s
research provided the theoretical basis for the therapeutic effects of occupation.
Meyer moved to Worcester State Hospital for the Insane in Worcester, Massachusetts,
in 1895 to become the director of research and then moved on to the Pathological Institute
of the New York State Hospitals in 1902, where he met and married Mary Potter Brooks
(Lidz, 1966/1985; Scull & Schulkin, 2009). Meyer’s wife helped to ignite her husband’s interest in
the therapeutic use of occupation. She successfully implemented a program using occupations to
facilitate recovery of patients housed in the psychiatric hospital on Ward’s Island in New York City.
Considered the first psychiatric social worker, Mrs. Meyer visited patients in their homes to learn
about their living environments. Examination of the living environments of patients as a potential
factor contributing to their illness was furthered by Mrs. Meyer’s home visits. By working with
patients in the community, Mrs. Meyer could better understand the cultural and social environ-
ments of individual patients. She used this information to assist patients adapt to the different
circumstances in their environments.
Meyer moved to Baltimore in 1910 to serve as Chair of the Psychiatry Department at
Johns Hopkins Medical School and as the director of the newly established Henry Phipps
Psychiatric Clinic. Endowed by philanthropist Henry Phipps, the clinic officially opened on
April 16, 1913. Phipps was inspired to provide funding for the clinic after reading Clifford W.
Beers’ book, A Mind That Found Itself, an autobiographical exposé on life and abuses in an insane
asylum. Meyer was able to entice Eleanor Clarke Slagle, a social worker from Chicago, to move to
Baltimore to work at the Phipps Psychiatric Clinic (Baum, 2002; Peloquin, 1991a).
Meyer believed that mental problems were problems of living and disorganized habits (Meyer,
1922/1977). With Slagle’s help, he instituted a program of habit training at the clinic. As part of this
program, patients followed prescribed daily routines and were encouraged to use time appropriately
to organize and balance daily activities of work, play, rest, and sleep (Meyer, 1922/1977; Peloquin,
1991b; Reed, 1993, p. 36). Meyer’s conviction in the importance of time use and balance is empha-
sized in this statement from his well-known address, “The Philosophy of Occupation Therapy”:
Our conception of man is that of an organism that maintains and balances itself in
the world of reality and actuality by being in active life and active use, i.e. using and
living and acting its time in harmony with its own nature and the nature about it. It
is the use that we make of ourselves that gives the ultimate stamp to our every organ.
(Meyer, 1922/1977, p. 641)

George Edward Barton

George Edward Barton was a major force in the organization of the inaugural meeting of the
NSPOT. He was elected the first President of the Society at the founding meeting. Born on March
7, 1871, in Brookline, Massachusetts, Barton studied to be an architect. A man of many talents
and interests, Barton spent time in Great Britain near the end of the 19th century. There he met
William Morris, one of the leaders of the Arts and Crafts Movement. Morris’ influence sparked
Barton’s interest in studying social problems brought on by industrialization. In 1897, Barton
became an incorporator and secretary the Boston Arts and Crafts Society, one of the many formed
in the United States as an outgrowth of the Arts and Crafts Movement (Figures 2-2 and 2-3).
Barton was diagnosed with tuberculosis in 1901. He suffered recurring attacks from that time
until the end of his life in 1923. He eventually moved to Denver, a place deemed to have a healthy
climate that helped people recover from tuberculosis. Rest, a good diet, fresh air, and sunshine
22 Chapter 2

were the conventional treatments of many

tuberculosis sanitariums at that time. While
residing in Colorado, George Barton married
Agatha Farrington, a divorcee with two chil-
dren, on November 25, 1911. They divorced
in 1915 (Colorado State Archives, 1911, 1915;
Engagement, 1911).
Once Barton recovered his health, he con-
tinued his architectural practice in Colorado.
One of his major projects was developing plans
for the Myron Stratton Home in Colorado
Springs. The Myron Stratton Home was not
a single building, but rather a small village
with a number of cottages and dormitories
Figure 2-2. George Edward Barton (left) and the famous to house poor children and older adults who
English actor George Arliss (right). (Printed with permis- were physically unable to earn a living. The
sion from the Archive of the American Occupational buildings and grounds were carefully planned
Therapy Association, Inc.)
to ensure ample space and facilities for living,
learning, and working. The complex included
playgrounds, a swimming pool, a gymnasium, a farm, a dairy, recreation and reading rooms, and
school rooms. The intent was to provide employment to all residents, young and old. The young
boys would learn trades such as carpentry, brick laying,
metal work, plumbing, farming, and typesetting. The
young girls would receive instruction in sewing, cook-
ing, and other domestic trades (Barton, 1911, pp. 22-34;
“Homes for Unfortunates,” 1914, pp. 698-700).
In 1912, the Governor of Colorado asked Barton to
examine the effects of famine on Kansas farmers. It was
during this mission that his left foot froze. He devel-
oped gangrene in his foot, requiring amputation of two
toes. While recovering from the surgery, Barton devel-
oped hysterical paralysis on his left side. In 1913, Barton
was referred to Dr. James G. Mumford, Superintendent
at Clifton Springs Sanitarium in upstate New York, for
help. He spent a year resting and regaining his health at
the sanitarium. Unable to participate in simple tasks and
frustrated with the lack of encouragement from physi-
cians to regain his functional ability, Barton turned
to Dr. Elwood Worcester of the Emmanuel Church
and founder of the Emmanuel Movement in Boston
for consultation. Dr. Worcester started the Emmanuel
Movement in response to the perceived inadequacies
of medical care, a perception shared by many at the
time. Scientific advances had prompted the medical
profession to focus primarily on the physical aspect
of illness. Seeing a need to treat the whole person, Dr. Figure 2-3. George Edward Barton wrote the
Worcester believed religion could treat the mental and play “The Pipe of Desire” in 1905. It became the
emotional aspects of illness. A clinic was established at libretto for an opera written by Frank Converse
and was the first opera to be presented at the
the Emmanuel Church that offered both medical and Metropolitan Opera House that was written by
psychological services, including individual and group Americans and given in English. (Copyright ©
counseling. The clinic offered moral, educational, and Dr. Lori T. Andersen. Reprinted with permission.)
 Conception and Formal Birth: 1900s to 1917 23

psychological treatments, which were provided by both

religious and medical professionals (Green, 1934).
Barton, disappointed in the lack of support or
assistance provided by physicians to restore him to a
productive life, was grateful for Dr. Worcester’s guid-
ance. Dr. Worcester encouraged Barton to prove that
people could overcome disabilities, first by overcom-
ing his own disabilities and then by teaching others
how to do so. In effect, Dr. Worcester was encouraging
Barton to regain his health by helping the other fellow
regain his health.
Barton wanted to change the hospital system to
not only restore health to people, but to return them
to independence and productive work. He purchased
a house next to Clifton Springs Sanitarium and reno-
vated it to make it more accessible and comfortable
for him. He also built facilities on the property for
the purpose of rehabilitating other people who lacked
independence. An adjacent lot was converted into a
garden, and the barn was converted into a workshop Figure 2-4. Consolation House in Clifton Springs,
with numerous tools that could be carefully selected New York. (Printed with permission from the
for use by patients, grading activities, and a choice Archive of the American Occupational Therapy
Association, Inc.)
of tools appropriate to each patient’s ability. Barton
continued to learn about the medical aspects of dis-
ability through self-study and by taking classes with the nurses at Clifton Springs Sanitarium. To
further his understanding of human movement, he studied the work of Frank and Lillian Gilbreth,
both motion efficiency experts. Barton saw the need to analyze motions required for a patient to
perform a task, the motions the patient was able to perform, and the motions that needed to be
encouraged to select an appropriate occupation for a patient. Barton also thought it important
to choose an occupation that stimulated the patient’s interest and to analyze the environment in
which a task was to be performed (Newton, 1917a, p. 325).
Barton’s house, known as Consolation House, officially opened on March 7, 1914 (Figure 2-4).
Physicians began to refer patients to Barton once they saw how he had regained his physical
abilities (Barton, 1968; Reed & Sanderson, 1999, pp. 423-425). He accepted patients only through
a physician referral (Newton, 1917a). It is likely that Barton experienced the magic of occupational
therapy through his efforts to help the
other fellow, an effort that was also thera-
peutic for him.
SIDEBAR 2-1 Interested in the therapeutic value of
occupation, Barton began to look into
Early Use of the Term the work of Dr. Herbert Hall and Susan
Occupational Therapy Tracy, who were also using occupation
to heal (Barton, 1914). In November
In his book Teaching the Sick, George Edward
1914, Barton corresponded with Susan
Barton states that he first used the term occu- Tracy and William Rush Dunton, Jr.,
pational therapy on December 28, 1914, at a about their occupation work and their
conference of hospital workers called by the desire to organize those with similar
Massachusetts State Board of Insanity (p. 17). interests (Dunton, 1926). Dunton, eager
to promote occupation work, wrote a let-
ter requesting Barton to submit a paper
on his work for publication in the Maryland Psychiatric Quarterly (Dunton, 1914). Their corre-
spondence continued through the founding of the professional association (Sidebars 2-1 and 2-2).
24 Chapter 2

SIDEBAR 2-2
Curious Companions

In a newspaper article published in the Geneva Times on Friday, May 9, 1958, Bill de
Lancey recounts a story about George Edward Barton s travels in England as a young archi-
tect. Barton was bicycling through the English countryside to visit and make sketches of a
number of lesser-known churches designed by a well-established architect. Barton, known
to be quirky, had purchased a pair of gaudy trousers for his trip. While bicycling, he encoun-
tered an English gentleman on a bicycle who joined him for several hours. The gentleman
commented on Barton s garish outfit and was admonished by Barton for this slight. The
gentleman did join in when Barton began to whistle operatic arias, followed by singing. At
the end of their time together, the gentleman declared, I ve enjoyed this very much, but I
hope we never meet again. Barton did see the Englishman again. The Englishman was King
Edward VII.

William Rush Dunton, Jr.

William Rush Dunton Jr., a physician and psychiatrist, is considered the father of occupational
therapy. Born on July 24, 1868, he lived a long, productive life, passing away at the age of 98 on
December 23, 1966 (Figures 2-5 and 2-6). Through the years, Dunton, with his level head and steady
hand, was the glue that held the association together. Dunton was known to be kind, full of wisdom,
and possessed of a sparkling wit (American Occupational Therapy Association [AOTA], 1967).
In 1895, 2 years after earning his medical degree, Dunton began his 29-year tenure at newly estab-
lished Sheppard Asylum in Towson, Maryland. It was here that Dunton learned about moral treat-
ment and the therapeutic use of occupation. In 1857, businessman Moses Sheppard’s will provided
$600,000 for the construction of Sheppard Asylum. After learning of the poor treatment of the daugh-
ter of an employee received in an asylum, Sheppard hoped to remedy this by constructing an asylum
in which “courteous treat-
ment and the comfort of all
patients” was given prior-
ity in the construction of
buildings, the designing of
grounds, and the provision
of medical care. The asy-
lum’s purpose was to pro-
vide treatment that would
cure, “combining science
and experience” to this
end (Forbush & Forbush,
1986, p. 15). All patient resi-
dences were to have “pri-
vacy, sunlight, and fresh air”
(Forbush & Forbush, 1986,
p. 15). The Civil War and
financial constraints of the Figure 2-5. William Rush Dunton, Jr., Figure 2-6. William Rush Dunton, Jr.,
at age 12. (Printed with permission with his grandson William Dunton
endowment (only the inter- from the Archive of the American Furst in 1925. (Printed with permis-
est from the endowment was Occupational Therapy Association, sion from the Archive of the American
to be used for construction Inc.) Occupational Therapy Association, Inc.)
 Conception and Formal Birth: 1900s to 1917 25

Figure 2-7. Calvert Vaux’s architectural design proposal showing the front elevation of the Sheppard Asylum.

and operation) delayed construction for several decades. The asylum finally opened in 1891 under
the direction of Edward N. Brush, MD, previously the Assistant Superintendent of the Pennsylvania
Hospital for the Insane. The financial stability and future of asylum was secured in 1896 when a sec-
ond benefactor, businessman Enoch Pratt, bequeathed $2 million to the facility. His only stipulation
was that the name be changed to the Sheppard and Enoch Pratt Hospital (Figure 2-7).
Dr. Dunton was hired by Dr. Brush to head the clinical and pathology laboratory at Sheppard
Asylum. Frustrated that his research was not producing significant results, Dr. Brush suggested
that full-scale efforts may not be warranted at that time. He recommended that Dunton become
involved in clinical work with patients. Following this advice, Dunton divided his time between
patient care and his research on the topic of dementia praecox (Bing, 1961, pp. 128-129). He began
to publish his findings and present his research at professional conferences, gaining professional
recognition in the field of psychiatry. In 1905, Johns Hopkins University Medical School gave him
a part-time clinical appointment to teach psychiatry and neurology (Bing, 1961, p. 149).
In 1912, having established his reputation as a psychiatrist and researcher of dementia praecox,
Dunton’s interests turned to use of occupations as a therapeutic measure for those with mentally
illness. The Casino Building, built in 1902 on the grounds of Sheppard and Enoch Pratt Hospital,
was a center for occupations and recreation (Figure 2-8). Dunton had minimal involvement in
these activities from 1902 to 1912 but had always been drawn to Dr. Brush’s belief in the “judicious
regimen of activity” for patients (Bing, 1961, p. 130). While previously occupation had been used
for occupation’s sake without concern for the
best therapeutic choice for the individual, Dr.
Brush believed that, for the best outcome, the
careful selection of activities and implementa-
tion of a regimen of activities should be based
on the individual needs of each patient (Bing,
1961, p. 131).
Dr. Dunton was put in charge of the occu-
pations program at Sheppard and Enoch Pratt
Hospital in 1912. He set his research agenda
to study the therapeutic benefits of occu-
pation, beginning with a review of the lit-
erature. He used the medical library of Dr.
Edward Brush, the Superintendent of Sheppard
Asylum, to research the history of psychiatry,
moral treatment, and the use of occupation
Figure 2-8. The Gatehouse was the primary entrance to
the Sheppard and Enoch Pratt Hospital until 2001.
26 Chapter 2

in the treatment of mental illness. Dunton believed

that difficulty in focusing attention was symptom-
atic of those with mental illness and that those with
dementia had difficulty forming clearly organized
ideas, those with depression had a narrow focus on
depressive thoughts, and those in an excited stage
had difficulty organizing the rapid-fire thoughts
entering the mind. Participation in occupation would
help them refocus attention and facilitate recovery
by substituting healthy thoughts in place of delu-
sions, hallucinations, and/or depressive thoughts.
New activities were also useful in arousing new ideas
and interests to take one’s mind off of problems
(Bing, 1961, p. 167; Dunton, 1921, pp. 27-28).
Dunton understood the importance of history. It is
because of his efforts that we have a wealth of docu-
ments and artifacts from the early years of National
Society for the Promotion of Occupational Therapy
and American Occupational Therapy Association.
Figure 2-9. In 1946, William Rush Dunton self- He saved his correspondence with other found-
published a book on quilts titled Old Quilts. The ers and was the editor of the first official journals
book is now a collector’s item, prized by occupa- association. The Maryland Psychiatric Quarterly, the
tional therapists and quilters. (Copyright © Dr. Lori
T. Andersen. Reprinted with permission.) Archives of Occupational Therapy, and Occupational
Therapy and Rehabilitation published many of the
early occupational therapy papers, as well as many of
the proceedings of the association meetings. Preferring to work quietly in the background, he used
his persistent yet gracious manner to gently press George Edward Barton to organize the inaugural
meeting of NSPOT.
Recognizing the importance of having trained per-
sonnel to direct activity programs, Dunton read Susan
E. Tracy’s book, Studies in Invalid Occupations, a text-
book for training nurses and aides in therapeutic use of
occupations. Dr. Brush encouraged Dunton to develop
training classes for the nurses at Sheppard and Enoch
Pratt Hospital. Nurses learned a number of handicrafts,
including leatherwork, reed basketry, book binding,
embroidery, and metal work. His course materials were
published in his book, Occupation Therapy: A Manual
for Nurses, in 1915 (Bing, 1961, p. 170). Dunton, a prolific
writer, published a number of journal articles and books,
including a self-published book on quilts (Figure 2-9).

Eleanor Clarke Slagle

Eleanor Clarke Slagle is known as the mother of
occupational therapy and has the most recognizable
name of all the founders (Figure 2-10). The prestigious
American occupational therapy lectureship, the Eleanor
Clarke Slagle lecture, was named after her. Born Ella Figure 2-10. Young Eleanor Clarke Slagle.
May Clarke in Hobart, New York, in 1870 (1875 New (Printed with permission from the Archive
York State Census; 1880 U.S. Federal Census), she of the American Occupational Therapy
Association, Inc.)
 Conception and Formal Birth: 1900s to 1917 27

married Robert E. Slagle in 1894. Robert and Eleanor moved to Chicago after the wedding. They
also lived in St. Louis and Kansas City, Missouri, during their marriage. Robert and Eleanor sepa-
rated around 1910, about the same time Robert Slagle moved to Nampa, Idaho (1910 U.S. Federal
Census). They divorced around 1914 or 1915 (United States Corporation Bureau, 1914, p. 819). The
circumstances surrounding the separation and divorce are not known. Robert Slagle remarried in
1915 (1920 U.S. Census; Idaho Press-Tribune, 1986).
Slagle is described as “a woman with a strong personality [who] possessed broad vision,
charm, dignity, and a presence which commanded admiration and respect” (AOTA, 1967, p. 292).
While in Chicago, she became interested in social service work with the mentally and physically
handicapped. She enrolled as a social work student in 1908 at the Chicago School of Civics and
Philanthropy, a forerunner of the University of Chicago School of Social Service Administration
(Dobschuetz, 2001). The Chicago School of Civics and Philanthropy was established in 1908 as an
outgrowth of the Settlement House Movement. Graham Taylor, head of Chicago Commons, a set-
tlement house, was the first president, and Julia Lathrop of Hull House was the first vice president.
Part of the Progressive Movement, the aim of the school was “to promote through instruction,
training, investigation and publication the efficiency of civic, philanthropic and social work, and
the improvement of living and working conditions” (Chicago School of Civics and Philanthropy,
1909, p. 9). The belief was that humanitarian work was skilled professional service that required
specialized training, including education in research methods to help determine solutions for
social ills (Chicago School of Civics and Philanthropy, 1909, p. 9). It heralded the start of new
professions such as social work.
Site visits to public and private facilities were part of each educational program. During obser-
vational visits to Kankakee State Hospital, Slagle was struck by the poor conditions and lack of
meaningful activities for patients (Loomis, 1992). This had a profound influence on her. In view
of Slagle’s newfound interest in care of institutionalized patients with mental illness, Julia Lathrop
suggested she enroll in a special course in occupations and educational methods at the Chicago
School of Civics and Philanthropy. This 6-week course, started by Julia Lathrop in the summer of
1908 (Loomis, 1992), taught crafts to hospital attendants working with the mentally ill. Lathrop
had been inspired to start the course by Adolf Meyer, her friend and colleague, and was assisted by
Rabbi Emil Hirsch and artisans from the Chicago Arts and Crafts Society. The course applied the
philosophy of the Arts and Crafts movement to the treatment of the mentally ill (Levine, 1987).
Slagle completed this special course in occupations for attendants in institutions for the insane
in the summer of 1911. She assisted in teaching the course the next year during the summer of
1912 (Chicago School of Civics and Philanthropy, 1912, p. 39). After completing this course, Slagle
spent 6 months at Upper Peninsula State Hospital in Newberry, Michigan, and 6 months at Central
Islip State Hospital in Long Island organizing and conducting occupational therapy classes for
nurses, attendants, and patients at those institutions. The course Slagle took at the Chicago School
of Civics and Philanthropy served as a model for the courses she developed (Dobschuetz, 2001).
In 1912, Adolf Meyer recruited Slagle to move to Baltimore to work at the newly established
Phipps Psychiatric Clinic at Johns Hopkins University. From 1912 to 1914, she organized and
directed the department of occupational therapy. She also offered a 3-week course to nurses in
training at Johns Hopkins, a course that oriented student nurses to the therapeutic use of occupa-
tions (Peloquin, 1991b). Soon after Slagle’s arrival in Baltimore, William Rush Dunton, hearing of
Slagle’s expertise in occupation work, arranged to meet her. They became close friends and col-
leagues, frequently dining together and sharing knowledge and ideas, including the idea to form a
society for sharing experiences in using occupation for therapeutic purposes.
In 1915, Slagle was recruited by the Illinois Society for Mental Hygiene to conduct a work-
shop for patients with mental and physical disabilities. She was appointed as the Director of
Occupations for the Illinois Society for Mental Hygiene. In this role, she established and ran the
Occupational Experiment Station in Chicago. During this time, Slagle also lectured at the Chicago
School of Civics and Philanthropy.
28 Chapter 2

The purpose of the Occupational

Experiment Station was two-fold: it pro-
vided a community-sheltered workshop
for discharged patients who needed sup-
portive employment in work rooms for
the handicapped, and it provided class-
es for training teachers of occupations
(Thomson, 1914, 1917; Slagle, 1919b, p. 121).
The patients referred to this workshop includ-
ed borderline “mental cases” and orthopedic
“cripples” (Slagle, n.d.). The workshop was a
success. More space was needed, so a second
location was opened. Additionally, during
the summer of 1915, Hull House granted
use of their workshops to provide even more
space to accommodate the work being done.
From October 1, 1915, to October 1, 1916, the
Occupational Experiment Station was suc-
cessful in returning 31% of patients to gainful
employment. Of the 77 individuals treated at
the workshop, 24 returned to wage-earn-
ing positions outside the department. Only
Figure 2-11. Chicago School of Civics and Philanthropy
16 were not helped at all (Thomson, 1917). Announcement of Special Courses in Curative Occupations
In 1917, Slagle was appointed as General and Recreation.
Superintendent of Occupational Therapy by
the Illinois Department of Public Welfare
(Slagle, n.d.). She also continued her role with the Illinois Society of Mental Hygiene as direc-
tor of the workshop and school for occupation workers (Slagle, n.d.). On October 24, 1917, the
Illinois Society for Mental Hygiene named the society’s occupational department the Henry B.
Favill School of Occupations in honor of Dr. Henry B. Favill, the highly respected physician. Dr.
Favill, who died in 1916, was instrumental in organizing the Illinois Society of Mental Hygiene
and served as the first vice president (Favill, 1917, p. 87). In January 1918, the Illinois Department
of Public Welfare, in collaboration with the Henry B. Favill School, the Illinois Society of Mental
Hygiene, and the Chicago School of Civics and Philanthropy, established a training school for
occupational therapists (Chicago School of Civics and Philanthropy, 1917; “Training school,” 1918,
p. 635) (Figure 2-11). This 5-month special course in curative occupations and recreation in coop-
eration was designed to teach students how to care for those with physical and mental disabilities,
including disabled soldiers. Classes were held at Hull House and at the Chicago School for Civics
and Philanthropy. Many of the students completed their practice training work at Elgin State
Hospital and Chicago State Hospital to help fulfill the mission of the State of Illinois to provide
services to those in state mental institutions (Slagle, 1919a, pp. 29-32). The Henry B. Favill School
is considered to be the first training school for occupational therapists in the United States.

Susan Cox Johnson

Susan Cox Johnson was born in Corsicana, Texas, on December 29, 1875. Johnson is described
as a woman with an “attractive personality and a charming, gracious manner which won her many
friends” (Occupational Therapy Notes, 1932, p. 152). Although she is the founder who is least
known, she was very involved in moving the profession forward through the setting of educational
standards. A designer and arts and crafts teacher, Johnson wrote a textbook titled Textile Studies,
published in 1912. She worked as a high school teacher in Berkeley, California, and then moved
 Conception and Formal Birth: 1900s to 1917 29

Figure 2-13. The Octagon Tower Plaque designating the

tower as a city, state, and national landmark. (Reprinted
with permission from Dr. Carol A. Lambdin-Pattavina.)

Figure 2-12. The Octagon Tower, former entrance to

Metropolitan Hospital on Blackwell’s Island, still stands as
the entrance to luxury waterfront residences on Roosevelt
Island. (Reprinted with permission from Dr. Carol A.
Lambdin-Pattavina.)

to the Philippines in 1912 to teach arts and crafts (Quiroga, 1995, p. 129). Johnson returned to the
United States 2 years later.
In August 1916, Johnson accepted a position in New York City as Director of Occupations for
the Department of Public Charities. The Commissioner of Public Charities had established this
committee on occupations to demonstrate the benefit of providing occupations to patients and
inmates of public hospitals and almshouses. Once in her position, Johnson hired two teachers
and began a program teaching handicrafts to patients with nervous disorders at the Central and
Neurological Hospital on Blackwell’s Island and to patients with tuberculosis at the Metropolitan
Hospital, also on Blackwell’s Island. In the early 1900s, asylums, sanitariums, and penitentiaries
were often built on islands or other areas away from the rest of society. Blackwell’s Island, located
in the East River on the east side of Manhattan, housed an asylum, sanitarium, and penitentiary at
various times in history. Blackwell’s Island was renamed Welfare Island in 1921 and again renamed
Roosevelt Island in 1973. Part of the old asylum, the Octagon Building was renovated in 2006 and
is now the entrance to luxury waterfront residences (Figures 2-12 to 2-14).
At the hospitals on Blackwell’s Island, patients participated in rug making, basket weaving, knit-
ting, crocheting, and toy making. Johnson observed that depressed patients participating in occupa-
tions became cheerful and more social. Important to patient success was the “thoughtful selection of
materials and designs and … careful supervision of the patient’s efforts” (Johnson, 1917, p. 414). The
products created were made available for sale, adding to patient satisfaction and self-esteem knowing
they were more self-sufficient. Tennis nets, one of the main products manufactured by the patients,
were commercially available (Johnson, 1917; Public Welfare Committee, 1917, pp. 51, 68). Johnson
also taught occupations courses for the Department of Nursing and Health at Teachers College,
Columbia University. The courses taught a number of crafts such as basketry, leather work, and chair
caning to nurses and social workers. The courses provided medical, psychological, and economic
perspectives of therapeutic use of occupations to help patients become self-sufficient (Quiroga, 1995,
p. 130).
30 Chapter 2

Blackwell’s Island

Ward’s
Island Lunatic
Asylum

Work
Manhattan House

Alm’s
House for
Men &
Women
nd
sla
s I

Queens
ell ’
ck w
Bla

Penitentiary

Hosptial

Figure 2-14. Map of New York City area showing the location of Blackwell’s
Island and Wards Island. Susan Cox Johnson worked on Blackwell’s Island.
Adolf Meyer’s wife, Mary Potter Brooks Meyer, worked on Wards Island.

Thomas Bessell Kidner

Thomas Bessell Kidner was born in Bristol, England, in 1866. He was educated as an archi-
tect. As part of his training, Kidner took classes in building construction and manual arts such
as carpentry and joinery. This was consistent with the beliefs of the Arts and Crafts Movement,
which deemed it was important to learning these skills to fully appreciate the artistic quality of
the materials (Friedland, 2007; Friedland & Davids-Brumer, 2007). After graduating, he accepted
a technical education teaching position at a high school in Bristol. Kidner was “a man of fine pres-
ence, rather formal in dress, clear and concise in his way of speech” (AOTA, 1967, p. 292).
As the world’s economy slowly moved from agriculture to industry, Sir William MacDonald,
a Canadian and wealthy owner of the MacDonald Tobacco Company, saw the need to develop a
workforce with practical skills for industry. He offered to pay the salaries of selected manual train-
ing teachers to develop technical education programs in Canadian elementary schools. Kidner,
with his teaching experience in technical education, was selected by the MacDonald Manual
Training Fund to go to Canada and develop these programs. In 1900, he moved his family to Nova
Scotia. There he worked for the province as Director of Technical Education. He stayed in Canada
past the 3-year commitment, holding similar positions in New Brunswick and Calgary.
Kidner embraced the philosophy of learning by doing championed by John Dewey. Manual
training, a new progressive aspect of general education, consisted of participation in handwork
 Conception and Formal Birth: 1900s to 1917 31

or crafts, which was believed to develop brain centers

as well as physical skills (Kidner, 1910, p. 10). Kidner
believed that manual training (elementary level) pre-
pared one for technical education (secondary level)
and a vocation. Kidner became a noted expert in the
area of manual training and technical education. His
book, Educational Handwork, provides graded craft
activities for schoolchildren. In his book, he wrote:
The acquisition of dexterity and skill of hand;
the training of the eye to a sense of form and
beauty; the formation of habits of accuracy,
order, and neatness; the inculcation of a love
of industry and habits of patience, persever-
ance and self-reliance, are some of the results
which may be claimed as peculiarly belonging
to work with the hands as a means of education.
(Kidner, 1910, p. 9)
World War I began in Europe in the sum-
mer of 1914. Although the United States did not Figure 2-15. Thomas Bessell Kidner (left) and
enter the war until April 1917, Canada, as part William Rush Dunton (right) at the train station.
of the British Commonwealth, entered in (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)
August 1914. Too old to enlist and desiring to do his
part for the war effort, Kidner volunteered his time
to work with returning injured soldiers. He decided
that manual training would be helpful in returning soldiers to some form of work. As part of his
efforts, he first interviewed the returning soldiers to understand their needs and employment his-
tory. Next, he carefully selected activities that would help them return to productive work, whether
it was their previous work or new work.
World War I lasted longer than the Canadians had expected. Initially believing that con-
valescence would take place in England, Canada was not prepared for the returning soldiers
who were disabled. Canada established the Military
Hospitals Commission when it became apparent that
a significant number of returning soldiers would
need continued care. In December 1915, because of
his work in technical education and his volunteer
work, Kidner was appointed Vocational Secretary
of the Military Hospitals Commission. He moved
to Ottawa to assume his new position, taking on
the responsibility of training and placing ward
aides and developing and placing soldiers in work
settings. The occupation work consisted of craft
activities similar to those used in manual train-
ing. These activities were provided bedside, on the
wards, and in curative workshops. The returning
soldiers progressed to vocational training when they
were ready (Friedland, 2007; Friedland & Davids-
Brumer, 2007; Friedland & Silva, 2008) (Figure
Figure 2-16. Article reporting the wedding of George
2-15). Kidner was invited by George Barton to the
Edward Barton and Isabel G. Newton on Monday, founding meeting of NSPOT as an international
May 6, 1918, as a quiet wedding at high noon. representative. Soon after, the Canadian government
32 Chapter 2

loaned Kidner to the United States as a

consultant on developing reconstruction SIDEBAR 2-3
programs. Kidner moved to the United
States, where he lived for the rest of his Founders and Near Founders
life. After serving as a consultant to
the United States government, Kidner
worked for the National Tuberculosis In a letter to Mrs. John A. Greene (Marjorie),
Director, Boston School of Occupational
Association. He also served a number of
Therapy, dated May 10, 1938, Eleanor Clarke
years as President of the AOTA.
Slagle named the five founders of AOTA: George
Edward Barton, William Rush Dunton, Susan Cox
Isabel Gladwin Newton Johnson, Thomas Kidner, and Eleanor Clarke
Slagle. Slagle clarified that although Herbert
Barton Hall was an early member, he was not a founder,
and that Susan Tracy was not a founder but was
Although not noted for her work in
elected an active member and given all the
the advancement of science and prac-
rights and privileges of an incorporator at the
tice in occupational therapy, Isabel G. first meeting (Slagle, 1938a). In retrospect, in
Newton Barton has a sacred place in the light of their contributions to the profession,
history of the occupational therapy pro- Peloquin (1991a, 1991b) considers Tracy and Hall
fession in the United States as a founder. to be near founders.
She was born on July 21, 1891, in New
York. In August 1916, 7 months before
the inaugural meeting, Isabel was hired
by George Barton as his secretary. She commuted every day from her home in Geneva, New York,
to Consolation House in Clifton Springs, New York, on the Auburn Branch of the New York
Central Railroad. Isabel was immediately attracted to Barton’s personality, his boyish nature, and
his sense of humor (Barton, 1968). George Barton and Isabel Newton married on May 6, 1918
(Figure 2-16). They had one son, George Gladwin Barton, who was born on October 16, 1920.
Initially, Barton did not count Isabel as one of the notables who would attend the founding
meeting. Later, Barton ensured Isabel’s place in history when he wrote to Dunton designating
Isabel eligible for active membership in the new society (Barton, 1917b). In March 1917, along with
the other notables, Isabel G. Newton became one of the signers of the Articles of Incorporation for
the National Society for the Promotion of Occupational Therapy.
As secretary of the new society, Isabel handled Barton’s correspondence and maintained the
society’s records. Isabel also assisted Barton with his writing. The 1920 U.S. Census lists her as an
author and a collaborator for technical works. George Barton acknowledged Isabel as his collabo-
rator in his book, Teaching the Sick (1919). Isabel, the last survivor of the founding meeting, died
on November 4, 1975 (Sidebar 2-3).

Susan E. Tracy
As a nursing student, Susan E. Tracy observed that patients on surgical wards who were occu-
pied in some type of work were happier than those who were not. This impressed her and set her
on her life’s work. Tracy was characterized as having a warm personality, a big heart, a spontane-
ous nature, and an unbridled enthusiasm for her work. She graduated from the Massachusetts
Homeopathic Hospital in Boston in 1898 (Cameron, 1917). In 1905, after completion of course-
work in home economics at Teachers College, she was hired as Director of the Training School for
Nurses at Adams Nervine Asylum, located in the Boston area. At the asylum, she used occupations
in her work with people with mild mental health issues. She also taught nurses how to select, adapt,
and teach crafts based on each patient’s needs and conditions and based on the patient’s setting or
environment, including patients confined to hospital rooms or in restricted positions. She believed
that it was important that a person teaching crafts to an invalid have not only knowledge of the
 Conception and Formal Birth: 1900s to 1917 33

craftwork, but also medical knowledge (Tracy, 1910,

p. 18).
Tracy stressed the importance of therapeutic use
of self in interactions with patients when she wrote:
The value of wise human sympathy, of cheer-
fulness in work and mien, of tactful dealing
with unreasonableness and irritability, of skill-
ful diversion of thought from pessimistic chan-
nels, and many other desirable qualifications
are emphasized as essential parts of the trained
nurse’s equipment for her work. (Tracy, 1910,
pp. 9-10)
This sentiment was supported by Dr. Daniel H.
Fuller, Superintendent of Adams Nervine Asylum,
when he wrote, “The personality of the teacher and
Figure 2-17. Susan E. Tracy. (Printed with per- nurse therefore becomes an important factor. Her
mission from the Archive of the American
Occupational Therapy Association, Inc.)
real enthusiasm and love for the work react most
powerfully on the patient” (Fuller, 1910, p. 5).
William Rush Dunton credited Susan E. Tracy
with providing the first course on occupational therapy (Dunton, 1921, p. 15). From 1910 to 1913,
Tracy occasionally provided special lectures for nursing students at Teachers College at Columbia
University (Slagle, 1938b). She also taught a course in occupation at Massachusetts General
Hospital in the spring of 1911 (Dunton, 1921, p. 16). In a letter to Dunton, Tracy indicated that the
“occupation study became a recognized part of the curriculum in Adam Nervine Training School
for Nurses in the year 1906” (Tracy, 1914). Interest in this course grew through 1912, at which time
Tracy left to establish the Experiment Station for the Study of Invalid Occupations. The purpose
of the Experiment Station was two-fold. First, it served as a resource center, collecting records
and case studies for use by others who were investigat-
ing the therapeutic benefit of occupation. Second, Tracy
offered coursework, including “demonstrations, exhibi-
tions, [and] private instruction” at Experiment Station for
anyone who was interested in learning about this occupa-
tion work for invalids (Tracy, 1914).
Whereas some saw economic or commercial value in
the sale of objects created by patients, Tracy believed in
the therapeutic value of the patient making a purposeful
product, not the commercial value (Peloquin, 1991a). In
1910, Tracy published her lectures in the first occupa-
tional therapy textbook, Studies in Invalid Occupations.
Focusing in part on teaching courses for the teacher of
occupations, it became a widely used textbook in the
early 20th century. Dunton (1917) credits Tracy’s book
with helping to reignite interest in the therapeutic use of
Figure 2-18. Herbert James Hall was
occupation (Figure 2-17).
born March 12, 1870 in Manchester, New
Tracy was unable to attend the founding meeting Hampshire where he grew up. Graduating
because she was in Chicago developing a program at the from the Harvard Medical School in 1895, he
Presbyterian Hospital of the City of Chicago (Cameron, opened a medical practice in Marblehead,
Massachusetts two years after completing
1917; Tracy, 1917). Nevertheless, the other founders elect- his residencies (Printed with permission from
ed her as an “active member with all the rights and privi- the Archive of the American Occupational
leges of an incorporator” (Newton, 1917b, p. 19). Therapy Association, Inc.)
34 Chapter 2

Herbert James Hall

The handicrafts combine mild mental effort with simple physical processes, they
require the hand and eye to follow the impulse of the mind, and so begin to reestab-
lish the fundamentals of successful living. Occupational therapy may be used with
the simple idea of improving morale or for special purposes, such as the develop-
ment of strength and suppleness in parts which have been injured by accident or
disease. (Hall, 1923, p. 3)
Herbert James Hall was born March 12, 1870, in Manchester, New Hampshire. Graduating from
Harvard Medical School in 1895, he opened a medical practice in Marblehead, Massachusetts,
2 years after completing his residencies. In December 1897, Hall married Eliza Pitman Goldthwait,
who came from a wealthy Boston family. Her brother, Dr. Joel E. Goldthwait, was a well-known
orthopedic surgeon (Figure 2-18). Hall was recognized for his untiring work, his keen sense of
humor, and his broad-mindedness (AOTA, 1967, p. 292).
Hall was well known for his work with patients suffering from neurasthenia, a nervous condi-
tion believed to be brought on by the stresses of daily life, including a faster life pace and increased
demands—products of the shift from an agrarian to an industrial society. Many physicians of the
times believed that the rest cure, developed by Dr. S. Weir Mitchell, was the best remedy for these
stressed conditions. In contrast, Hall theorized that the rest cure, which consisted of a prolonged
period of seclusion and restriction from participation in activities, contributed to illnesses. Lack
of physical activity allowed one to grow weaker, and lack of participation in activities allowed a
person more time to dwell on problems. The work cure, developed by Hall, engaged the mind
and hands of patients to help them focus on productive, creative work to forget their problems
(Anthony, 2005a; Quiroga, 1995, p. 96; “The Work Cure,” 1914). Hall acknowledged the success of
asylums that had patients participate in simple work, housekeeping, laundry, kitchen, and farming.
Participation in these activities provided a therapeutic benefit to the patient, and also an economic
benefit to the institution because it saved the cost of hiring workers to perform these tasks. Hall
believed that patients in a higher socioeconomic class would not be interested in these types of
work activities. He believed that these patients would find craft activities more appealing. He also
believed that these patients should benefit directly from the sale of their craft products (Hall &
Buck, 1915, pp. ix-x).
Hall’s work cure integrated the arts and crafts philosophy with medicine. By chance in
1904, Hall met Jessie Luther, an artisan who previously worked as director of the Hull House
Labor Museum teaching a variety of crafts, including basket weaving, woodcarving, metal work,
and pottery. They had a conversation about the treatment of neurasthenia in which they concep-
tualized a workshop to provide medical treatment to those suffering from neurasthenia. Together
they started the Handcraft Shop in Marblehead, Massachusetts. The workshop was first located
in an old cobbler shop; then, as more space was required, it was relocated to the Bay View Yacht
Club. Luther taught weaving, and other skilled artisans taught basketry, metal work, and pottery
to patients.
In an apprentice model, patients worked side by side with skilled artisans making craft prod-
ucts. In the economic-driven society of the times, Hall strongly believed in the importance of
creating products to sell. According to Hall, “the more useful the work, the better its therapeutic
effect; and conversely, the more trivial and valueless the product of the work, the less effective
will it be in the therapeutic sense” (1917, p. 383). Focusing on the process and product, the patient
received the benefit of creating an aesthetic piece through use of his or her hands as well as the
self-respect of knowing the product had monetary value. Selling products also provided partial
income to the patient and took some burden off the family and society for the patient’s care
(Anthony, 2005a, 2005b; Cabot, 1914; Hall & Buck, 1915; “The Work Cure,” 1914).
 Conception and Formal Birth: 1900s to 1917 35

In 1905, Hall hired Arthur E. Baggs, a skilled potter, to oversee the pottery program at
the Handcraft Shop. Although the pottery program was profitable, by 1908 it became appar-
ent that this craft was too difficult for patients. Marblehead Pottery, a commercial venture,
was established from the original program to help provide financial support for the Handcraft
Shop. Hall eventually sold the Marblehead Pottery business to Arthur Baggs. Recognized by
the Marblehead Pottery insignia imprinted on the bottoms of pieces—a rigged sailing ship
flanked by the letters M and P for Marblehead Pottery—these pieces have since become valuable
art products (Anthony, 2005a; Marblehead Pottery, 2015). Cement work took the place of the
pottery program. Molds were used to create cement flower pots, birdbaths, and stepping stones.
This venture also proved to be profitable. The Burke Foundation Convalescent Home in White
Plains, New York, successfully implemented a similar cement work program for patients with
cardiac problems. In the Burke program, cement work activities were graded to provide needed
exercise to strengthen, but not overwork, the heart. The program helped return patients to gainful
employment (Hall & Buck, 1915, pp. xii-xiii).

Table 2-1
PERSONAL CONTEXTS OF FOUNDERS AND NEAR FOUNDERS
FOUNDER BIRTHPLACE RESIDENCE IN PROFESSION INTERESTS BROUGHT TO
1917 THE TABLE

George Edward Barton MA (East) NY (East) Architect, author Environment (architec-

(March 7, 1871‒ ture, physical context)
April 27, 1923) work simplification,
activity analysis (via
friendship with Frank
Gilbreth)
William Rush Dunton Jr. PA (East) MD (East) Physician/psychia- Moral treatment
(July 24, 1868‒ trist, author, journal
December 23, 1966) editor, quilter

Eleanor Clarke Slagle NY (East) IL (Midwest) Social worker, arts Habit training
(October 13, 1870‒ and crafts teacher
September 18, 1942)
Thomas Bessell Kidner England Canada Architect, educator, Vocational rehabilita-
(1866‒June 14, 1932) vocational secretary tion, manual training

Susan Cox Johnson TX NY (East) Arts and crafts Arts and crafts knowl-
(December 29, 1875‒ (Southwest) teacher edge
January 18, 1932 )
Isabel Gladwin Newton NY (East) NY (East) Secretary, author Assisted George Barton
Barton with starting NSPOT
(July 21, 1891‒
November 4, 1975)
Susan E. Tracy MA (East) MA (East) Nurse Moral treatment, arts
(January 22, 1864‒ and crafts knowledge
September 12, 1928)
Herbert James Hall NH (East) MA (East) Physician Work cure
(March 12, 1870‒
February 19, 1923)
36 Chapter 2

Dr. Hall was awarded a $1,000 grant by Harvard’s Proctor Fund in 1905 to study the effective-
ness of his work cure and a second grant in 1909 (Anthony, 2005a; Quiroga, 1995, p. 96; Reed,
2005). In 1912, he opened Devereux Mansion in the Devereux section of town. Devereux Mansion,
which belonged to the Goldthwait family, was once used as a seaside resort. The family offered
the resort to Hall to use as a sanatorium. The mansion had ample rooms and a barn to accom-
modate the variety of craft activities offered in the Handcraft Shop. One of occupational therapy’s
early theorists, Hall described a number of concepts used in occupational therapy practice. These
included the concepts of grading activities, energy conservation, transferable skills, substitution
of new interests in place of old interests associated with illness, and provision of engaging occupa-
tions to facilitate participation (Reed, 2005). Dr. Hall’s practice primarily treated an upper-class
clientele. At times, this caused strained relationships with his peers, who perceived Devereux
Mansion to be a resort for the privileged class (Quiroga, 1995, p. 99).
Hall had personal contact with some of the other founders prior to the inaugural meeting. In
November 1914, Hall wrote to William Rush Dunton about the possibility of having one of his
teachers travel to Sheppard and Enoch Pratt Hospital to instruct workers there about cement work.
In this letter, Hall mentioned that Eleanor Clarke Slagle had visited Marblehead to learn about
the work and might also provide this instruction at Sheppard and Enoch Pratt (Hall, 1914). Not
favored by George Edward Barton, Hall was not invited to the inaugural meeting of NSPOT in
Clifton Springs. Hall was elected as an active member by the founders at that meeting (Newton,
1917b). Nevertheless, as a strong, early advocate of occupational therapy, Hall is considered a near
founder (Peloquin, 1991a; Schwartz, 2009) (Table 2-1).

Inaugural Meeting of
the National Society for the
Promotion of Occupational Therapy
The interest in occupational therapy work was spreading throughout the country. Many of
those involved with occupation work shared their knowledge, programs, ideas, and successes
through various publications, networking, and at professional meetings. One day in 1913, while
sharing an evening meal at Dunton’s home, William Rush Dunton and Eleanor Clarke Slagle “dis-
covered that each was maintaining an active correspondence with other people throughout the
country who were also working in occupational therapy” (Bing, 1961, p. 176). Dunton and Slagle
discussed the idea of developing a national organization of the many people engaged in occupa-
tional therapy work as a way to exchange ideas and experiences (Bing, 1961, pp. 176-177; Dunton,
1926). Dunton was excited about the possibility of starting an organization promoting occupation
work. He already had experience starting organizations such as the Maryland Psychiatric Society
and the Haverford Society of Maryland, a group for alumni from his alma mater Haverford College
(Bing, 1961, p. 177).
Although Slagle, Dunton, and a few others had entertained the idea of forming an organiza-
tion, it was the efforts of George Edward Barton and William Rush Dunton that brought the idea
to fulfillment. Barton first wrote to Dunton on November 15, 1914, about organizing a conference
of those working in invalid occupations (Dunton, 1926). They corresponded for 3 years before the
founding meeting of NSPOT. Their letters were delivered across the great distance separating them
by trains. A letter from Dunton, a resident of Baltimore, could be delivered to Barton, a resident of
Clifton Springs, New York, in 2 days. Frequently, they would respond to a letter they received with
an immediate response. The first line of their letter would usually mention the most recent letter
received from the addressee. At first, they used formal salutations, addressing each other as Mr.
 Conception and Formal Birth: 1900s to 1917 37

Figure 2-19. In a January 12, 1917, letter to Dunton, Barton boldly declared that he
believed that “what we are starting will go rolling on like a snow-ball, getting bigger
and bigger for generations to come…” (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)

Barton and Dr. Dunton. In time, they became less formal, addressing each other simply as Barton
and Dunton.
Barton had very definite ideas about the forming of an organization of occupation workers,
including where the first meeting should be held, who should attend, and how the development of
the organization should proceed. At one point when correspondence had slowed, Dunton made
suggestions about the time and place for a conference to move plans along but was rebuffed by
Barton, who, believing his authority had been undermined, threatened to withdraw from the
efforts. Dunton’s main focus was to get a conference underway, so he assured Barton that he meant
no offense and would accept Barton’s recommendations. Finally, in January 1917, plans were in
place for the meeting to be held that March (Figure 2-19).
Although Barton felt it was best to organize on a local level first, he finally agreed with Dunton’s
viewpoint that an established national organization could serve as a model to aid the development
of state and local associations (Dunton, 1926). Barton believed that to ensure an organization
focused on the therapeutic aspects of occupation rather than promoting just an arts and crafts
society, it would be advantageous to invite a small number of hand-selected people with similar
viewpoints (Barton, 1916a; Dunton, 1926). Both Barton and Dunton agreed to invite Eleanor
Clarke Slagle and Susan E. Tracy to the inaugural meeting. Dr. Herbert Hall was considered, but
38 Chapter 2

Figure 2-20. Founders of the National Society for the Promotion of Occupational Therapy. Bottom row, left to right:
Susan Cox Johnson, George Edward Barton, Eleanor Clarke Slagle. Top row, left to right: William Rush Dunton, Jr., Isabel
Gladwin Newton, Thomas Bessell Kidner. (Printed with permission from the Archive of the American Occupational
Therapy Association, Inc.)

SIDEBAR 2-4 SIDEBAR 2-5

Barton Arranged for a Founders Photograph
Photograph of the
Founders of the National In her article about Consolation
Society for the Promotion of House and the founding meeting,
Occupational Therapy Isabel Barton reveals that George
Edward Barton presented Eleanor
Clarke Slagle and Susan Cox Johnson
Understanding the need to publicize the with corsages at the meeting. Mrs.
fledgling association, Barton wrote in a letter Slagle wore her corsage for the pho-
on February 28, 1917, I am arranging to have tograph of the founders, whereas Miss
a photograph taken of us all, on one day in Johnson kept her corsage in water in
order to satisfy the thirst of the newspapers her room. Isabel Barton believed this
for graphic representation of people who are was a commentary on their personali-
doing the world s work (Barton, 1917d). This ties. Although Isabel believed both to
is now the iconic photograph of the found- be strong women, she felt that Mrs.
ers of the National Society for the Promotion Slagle had more of a flair for style
of Occupational Therapy. while Miss Johnson was more conser-
vative (Barton, 1968).
 Conception and Formal Birth: 1900s to 1917 39

Barton and Dunton were not keen on him, questioning

the therapeutic value of his work with privileged clien-
tele. Barton suggested Susan Cox Johnson as a better
alternative in view of her position as the Director of
Occupations for the Department of Public Charities in
New York City. Barton asserted that Johnson’s position
was “by all odds the most important job in the world”
(Barton, 1916b). In correspondence leading to the inau-
gural meeting, Barton refers to the hand-selected group
as the Big Five and the Great Five—Barton, Dunton,
Slagle, Johnson, and Tracy.
One of the Big Five, Susan E. Tracy, sent her regrets.
Although enthusiastically in support of forming the soci-
ety, she was already obligated to work in Chicago at the
Presbyterian Hospital during that time. Thomas Kidner,
the Vocational Secretary of the Canadian Military
Hospitals Commission, had contacted Barton with a
request to meet to discuss Barton’s work, so Barton took
this opportunity to invite Kidner to the meeting. Barton
believed that Kidner’s presence would garner interna-
tional recognition and would be “a feather in our cap”
(Barton, 1917c).
Barton insisted the meeting take place in Clifton
Springs, writing that “Consolation House, though situ- Figure 2-21. Miss Winifred Brainerd (right) and
a nurse from the Clifton Springs Sanitarium.
ated in a small upstate village, is after all one of the (Printed with permission from the Archive
most centrally located places in the United States….” of the American Occupational Therapy
(Barton, 1917a). The meeting was originally scheduled Association, Inc.)
to start on March 1, 1917, but Eleanor Clarke Slagle
requested a delay until mid-March due to a prior com-
mitment; therefore, the meeting was rescheduled to start on March 15, 1917. Dunton, Johnson,
Kidner, and Slagle arrived in Clifton Springs by train, the main mode of transportation at the
time. They were housed in Warfield’s Boarding House directly across the street from Consolation
House. As usual, Isabel Newton, as Barton’s employee, commuted from her home in Geneva
(Figure 2-20; Sidebars 2-4 and 2-5).
The agenda for the inaugural meeting was ambitious. On the first day, Barton opened the
meeting with a lengthy talk on the “Therapeutic Value of Modeling and Drawing.” That evening,
application forms for incorporation of NSPOT were completed and submitted to an attorney. On
the second day, the founders focused on the organizational structure of NSPOT. Prior to the meet-
ing, Barton planned the general structure of the association and decided who should head up each
of the necessary committees based on his perception of their strengths and capabilities. A draft of
the constitution was presented. Barton and Dunton had developed the draft prior to the meeting.
After discussion, the constitution was adopted. Officers were elected, committees were established,
and committee chairs were appointed per Barton’s plan. The founders elected 39 people to active
membership, 23 as associate members, 15 as sustaining members, and four as honorary members
(Newton, 1917b).
On the third day, March 17, the other papers were read and the Articles of Incorporation were
signed. A dinner was held at Clifton Springs Sanitarium on Saturday for the founders. The din-
ner was hosted by Dr. Woodbury, superintendent of the sanitarium; his wife; and Miss Winifred
Brainerd, an occupational worker at the sanitarium. Table decorations, including toy wooden ani-
mals used as place card holders, had been constructed by patients in the Industrial Room, the craft
40 Chapter 2

SIDEBAR 2-6
Agenda for the Founding Meeting

The Geneva Daily Times (March 12, 1917) and the minutes from the founding meeting
(Newton, 1917b) recorded the agenda of the founding meeting:

Thursday, March 15
● Morning: Arrivals and acquaintances

● Afternoon: A commemorative photograph was taken of the members of the con-

ference. [G. E. Barton, informal exposition of the Therapeutic Value of Drawing and
Modeling, and Preparation of Patients for the Inoculation of the Bacillus of Work]
● Evening: Making out application for Incorporation

Friday, March 16
● Morning: Informal discussion of Constitution

● Afternoon: Business meeting̶adoption of the Constitution

● Evening: Election of officers

Saturday, March 17
● Morning: One half hour for each member, informal talk on own work

● Afternoon: Guests of Clifton Springs Sanitarium for midday dinner and inspection of

Industrial Department
● Evening: Departures (Newton, 1917b)

SIDEBAR 2-7
Election of Officers and Committee Chairs

The following were elected to office at the founding meeting:

● George E. Barton̶President

● Eleanor Clarke Slagle̶Vice President

● Isabel G. Newton̶Secretary

● William Rush Dunton, Jr.̶Treasurer

Committees formed at the founding meeting were as follows:

● Committee on Research and Efficiency̶George Edward Barton

● Committee on Installations and Advice̶Mrs. Eleanor Clarke Slagle

● Committee on Finance, Publicity, and Publications̶Dr. William Rush Dunton, Jr.

● Committee on Admissions and Positions̶Miss Susan Cox Johnson

● Committee on Teaching Methods̶Miss Susan E. Tracy

● International Committee̶Mr. Thomas B. Kidner

Interestingly, these assignments, with the exception of Kidner s assignment, were pre-
determined by George Edward Barton in a letter to Dunton on February 13, 1917 (Barton,
1917d).
 Conception and Formal Birth: 1900s to 1917 41

SIDEBAR 2-8
Papers Presented at the Inaugural Meeting

● The Therapeutic Value of Drawing and Modeling, and Preparation of Patients for
Inoculation of the Bacillus of Work̶George Edward Barton
● History of Occupational Therapy̶William Rush Dunton, Jr.
● The Work of the Occupational Experiment Station in Chicago ̶Eleanor Clarke Slagle
● The Occupational Work on Blackwell s Island̶Susan Cox Johnson
● The Difficulties and Results of Re-education of the Crippled Soldier in Canada̶
Thomas Bessell Kidner
● A New Occupation for the Crippled Soldier: The Conservation of the World s Teeth̶
Frank B. and Lillian M. Gilbreth (The Gilbreths were not in attendance; the paper was
read on their behalf.)

shop at the sanitarium (Dunton, 1917/1967). Kidner, impressed by Miss Brainerd’s work, inquired
about her availability for work in Canada (Brainerd, 1967) (Figure 2-21; Sidebars 2-6 to 2-8).
The inaugural meeting and activities of the new society were announced in several well-read
publications. An advance notice of the meeting was published in the March 8, 1917, edition of the
bi-weekly Clifton Springs, New York, newspaper (Figure 2-22), and a summary of the meeting fol-
lowed in the March 22, 1917, edition. Articles announcing the new society and summaries of the
meeting were also published in a number of journals, including Modern Hospital (“Leaders in,”
1917), Trained Nurse and Hospital Review (“A Committee,” 1917; “Consolation House Conference,”
1917), and Maryland Psychiatric Quarterly (Dunton, 1917/1967).

Organizing the Society

Once the society was formally organized
and incorporated, the mundane adminis-
trative tasks necessary to get it up and run-
ning were started. Consolation House, the
official headquarters of the fledgling soci-
ety, was designated to serve as a reference
library and a clearinghouse for those seek-
ing information about occupational therapy.
People were asked to send relevant publica-
tions to Consolation House to assist in the
development of a reference library (Dunton,
1917/1967). Employers interested in finding
qualified workers and workers interested
in finding open positions were directed to
contact Consolation House to share this
information.
Figure 2-22. The March 8, 1917, edition of the Clifton Springs
Press, a bi-weekly newspaper in Clifton Springs, New York, George Edward Barton and William
published advanced notice of the “First Consolation House Rush Dunton worked to choose the colors
Conference,” the inaugural meeting of the National Society and letterhead for the official stationery
for the Promotion of Occupational Therapy. (Barton, 1917f). They settled on a green color
42 Chapter 2

Figure 2-23. The first letterhead used by the National Society for the Promotion of Occupational Therapy. (Printed
with permission from the Archive of the American Occupational Therapy Association, Inc.)

Figure 2-24. Approved membership application of Ethel Bowman, Head Aide at Walter
Reed General Hospital. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)
 Conception and Formal Birth: 1900s to 1917 43

Figure 2-25. National Society for the Promotion of Occupational Therapy Aims/
Membership Dues. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)

Figure 2-26. Membership card of Mrs. William Rush Dunton, Jr., a

sustaining member. (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)

scheme (Newton, 1917c) (Figure 2-23). Dunton and Isabel Newton collaborated on an application
form for membership and a method to maintain a registry of members. Significant effort was put
forth by the founders and other supporters to recruit and register new members. The founders
wanted to emphasize the therapeutic focus of occupational therapy to distinguish NSPOT from
other craft societies and the perception that occupational therapists were merely craft ladies.
Therefore, although anyone interested in occupational therapy was eligible to apply for member-
ship, applications were reviewed and approved to ensure the applicants had the experience and
background to provide a therapeutic focus in their work (Figure 2-24). The annual membership
fees were set at $2 for active members, $1 for associate members, and $10 for sustaining members
44 Chapter 2

(Figures 2-25 and 2-26). The Maryland

Psychiatric Quarterly, the journal started
and edited by Dr. Dunton, became the
official organ of NSPOT (Figure 2-27).
The quarterly was deemed a member
benefit (Bing, 1961, p. 182).

Moving
Forward
Although the United States did not
declare war until April 6, 1917, there was a
heightened state of awareness in the coun-
try, and preparations were being made for
war readiness. The newly formed NSPOT
was one of the many organizations anx-
ious to help in the war effort, in part to
prove the value of occupational therapy
to society. On March 24, 1917, 1 week
after the founding meeting and 2 weeks
before the United States declared war
against Germany, George Barton sent a
letter to Dr. Dunton asking his opinion
on offering NSPOT’s services to the war
effort. Barton had heard a rumor that
the Red Cross was contemplating start-
ing a Department of Re-education. He Figure 2-27. Cover of the Maryland Psychiatric Quarterly. This
believed that this proposed department publication, edited by William Rush Dunton, was the official jour-
nal of the National Society for the Promotion of Occupational
had similar aims to occupational therapy Therapy from 1917 through 1921. (Printed with permission from
(Barton, 1917e). Dunton suggested that the Archive of the American Occupational Therapy Association,
Barton should use his discretion to con- Inc.)
tact the Surgeon General to offer assis-
tance. In a number of letters over the
next few months, Barton requested assistance and advice from Frank Gilbreth, Thomas Kidner,
and William Rush Dunton on the potential role of NSPOT in the war effort (Barton 1917h, 1917i,
1917j). He had little luck making contact with any official involved in the war effort, with the
exception of a communication with Elliot Wadsworth, Acting Chairman of the American Red
Cross. Wadsworth stated that he would bring NSPOT’s offer to the attention of Colonel Kean,
Director of the Bureau of Medical Services in the United States Army (Barton, 1917g).
The date and place of the first annual NSPOT conference was set at the founding meeting as
the first Monday in September 1917 at Consolation House; however, in the summer of 1917, Susan
Cox Johnson suggested that New York City would provide a better venue and was more accessible.
Dunton was in agreement with the location change; Barton was not. Whether prompted by a
perceived slight or by ill health as he claimed, Barton wrote to Dunton indicating he was stepping
down as president and suggested that Dunton run for this office (Barton, 1917k). From that time
forward, Barton maintained an interest in NSPOT but not an active role. The first annual meeting
was held on Labor Day weekend in September 1917 at the Russell Sage Building at 130 East 22nd
Street in New York City. Holding the meeting on Labor Day was Dunton’s idea. He believed that
attendees would be more likely to attend if they missed fewer work days. This did not hold true
 Conception and Formal Birth: 1900s to 1917 45

because only 26 people attended. Realizing that people did not want to give up their holiday, the
plan for subsequent annual conferences to be held on Labor Day weekend was abandoned.
Determined to define and promote the role of occupational therapy in the war effort, the theme
for the first annual meeting was care of the war wounded. Susan E. Tracy, Susan Cox Johnson,
Herbert J. Hall, and William Rush Dunton Jr. all read papers at this conference. Dunton’s paper
outlined a plan for vocational education for disabled soldiers (Bing, 1961, p. 185). A natural orga-
nizer with a strong desire to see this new society grow and flourish, William Rush Dunton Jr.
accepted the nomination and election as the second president of NSPOT. Eleanor Clarke Slagle was
re-elected as vice president; Louis Haas from Bloomingdale Hospital, White Plains, New York, was
elected secretary; and Marion R. Taber from the State Charities Aid Association (New York) was
elected treasurer (Bing, 1961, pp. 183, 186).
Dunton, Slagle, Kidner, and a few other attendees met with Dr. Thomas W. Salmon, a neuro-
psychiatrist and Medical Director of the National Committee on Mental Hygiene, for lunch dur-
ing the conference (Dunton, 1955). Dr. Salmon was actively involved in planning and organizing
medical services for the war effort and was a strong advocate of occupational therapy. This meet-
ing and the leaders’ relationship with Dr. Salmon helped to secure occupational therapy’s role in
World War I working with soldiers suffering from war neuroses.
The work to promote occupational therapy’s role in the war effort continued after the first annual
meeting. Barton, Slagle, and Johnson all had communications with the Medical Department of the
Army. Slagle consulted with the Surgeon General’s office and worked with the Red Cross. Dunton
consulted with the Nursing Division of the Counsel for Defense. A role for occupation workers
was established, and the need was great: 1,000 per General John Pershing’s request. Having helped
establish a role, the new society worked to meet the need (Report of the President, 1918).

Reflection
The Progressive Era in the early 20th century brought a new group of intellectual thinkers,
including William James, John Dewey, and Adolf Meyers. These intellectuals developed the
philosophical schools of thought of pragmatic psychology; functional psychology, the educational
doctrine that emphasized learning by doing; and psychobiology, which provided the basis for the
central tenets of occupational therapy. One of the hallmarks of the Progressive Era, the advance-
ment of knowledge, was promoted through experiments, such as the development of programs
designed to improve the quality of life of individuals.
Improved economic conditions and changes in the sociocultural and political environments
facilitated the development of occupational therapy. Increased emphasis on social responsibility
promoted the altruistic activities of upper-class women who worked to help improve quality of
life for the disadvantaged. Many of these women became occupation workers or teachers who
espoused the ideals of the Arts and Crafts Movement and the Mental Hygiene Movement.
The founders—including two architects (Barton and Kidner), a physician (Dunton), a social
worker (Slagle), an arts and crafts teacher (Johnson), and a secretary (Newton)—and the near
founders—a nurse (Tracy) and a psychiatrist (Hall)—brought different experiences to the table.
Many of the founders were influenced by the thinking of James, Dewey, and Meyers, and in some
cases had personal relationships with them. In an era that encouraged sharing of knowledge, the
founders gathered to form a new society to share experiences and promote the therapeutic use of
occupation. The Founding Vision of NSPOT, as stated in the Certificate of Incorporation (NSPOT,
1917), is reflective of the Progressive Era’s emphasis on science and research and the founders’
desire to promote the benefits of occupational therapy through networking, conferences, corre-
spondence, and publications in various medical and social service journals (Sidebar 2-9).
Occupational therapy developed from a confluence of ideas with varied rationales behind
the therapeutic use of occupations. Occupations were prescribed to exercise certain muscles and
46 Chapter 2

promote certain movements, to occupy

the mind to help improve focus and sub- SIDEBAR 2-9
stitute healthy thoughts, to develop habits
and routines for better living, and to Founding Vision:
improve self-esteem and self-sufficiency National Society for the Promotion
through the sale of handmade products
valued by others. The importance of cli-
of Occupational Therapy
ent centeredness and therapeutic use of
self was also emphasized as important The particular objects for which this corpo-
in achieving successful outcomes. The ration is formed are as follows: The advance-
practice of patient participation in occu- ment of occupation as a therapeutic measure;
pations or work as an economic necessity for the study of the effect of occupation upon
for the operation of some insane asylums the human being; and for the scientific dispen-
soon shifted to the practice of individual- sation of this knowledge. (NSPOT, 1917)
ized treatment planning in which patients
received an economic benefit from sale of
their handmade products.
The founders sought to align the new profession with the male-dominated medical profession
in an attempt to seek legitimacy. Additionally, it was believed that the sponsorship of the medical
profession would help with efforts to provide a scientific basis for the benefits of occupation work
and distinguish the female-dominated occupation workers from craft ladies. The therapeutic use
of occupation was valued in the Progressive Era. Occupation workers and teachers provided ser-
vices in a variety of settings, including sheltered workshops, state hospitals, general hospitals, and
home services under the direction of physicians. Patient conditions in these settings included neu-
rological and musculoskeletal injuries, crippling diseases, mild to severe mental disorders, cardiac
problems, genetic disorders, and systemic diseases such as tuberculosis. Within this context, a firm
foundation for occupational therapy was established.

References
1875 New York State Census. Town of Stamford, Delaware County, William. J. Clark household, Line 14, June 9, 1875,
p. 10.
1880 U.S. Census. Delhi, 1st District, County of Delaware, State of New York, enumeration district (ED) 64, William
J. Clark household, Line 8, June 19, 1880, p. 22.
1910 U.S. Census. Washington County, Idaho, Weiser City, enumeration district (ED) 283, Image 1188, Sheet 2B, Line
74, April 1910.
1920 U.S. Census. Washington County, Idaho, City of Weiser, enumeration district (ED) 189, Image 1188, Sheet 1B,
Line 95, Slagle household, January 3, 1920.
A committee on therapeutics of occupation. (1917, April). Trained Nurse and Hospital Review, 58(4), 226.
Anthony, S. H. (2005a). Dr. Herbert J. Hall: Originator of honest work for occupational therapy 1904-1923 [Part I].
Occupational Therapy in Health Care, 19(3), 3-19.
Anthony, S. H. (2005b). Dr. Herbert J. Hall: Originator of honest work for occupational therapy 1904-1923 [Part II].
Occupational Therapy in Health Care, 19(3), 21-32.
American Occupational Therapy Association. (1967). Presidents of the American Occupational Therapy Association.
American Journal of Occupational Therapy, 21(5), 290-298.
Barton, G. E. (1911). An analysis of the conditions influencing the building of the Myron Stratton Home and recom-
mendations for its foundation and development. Colorado Springs, CO: Trustees of the Myron Stratton Home.
Barton, G. E. (1914). A view of invalid occupation. Trained Nurse and Hospital Review, 52(6), 327-330.
Barton, G. E. (1916a, December 5). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1916b, December 9). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917a, January 12). [Letter to William Rush Dunton re: suggested location of meeting]. Archives of the
American Occupational Therapy Association (Series 1, Box 1, Folder 12), Bethesda, MD.
 Conception and Formal Birth: 1900s to 1917 47

Barton, G. E. (1917b, January 24). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917c, February 13). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917d, February 28). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917e, March 24). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917f, April 11). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917g, June 15). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917h, June 26). [Letter to Frank B. Gilbreth]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917i, June 27). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917j, July 6). [Letter to Thomas B. Kidner]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1917k, July 23). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Barton, G. E. (1919). Teaching the sick. Philadelphia, PA: W. B. Saunders Company.
Barton, I. G. (1968). Consolation house, fifty years ago. American Journal of Occupational Therapy, 22(4), 340-345.
Baum, C. M. (2002). Adolph Meyer’s challenge: Focus on occupation in practice and in science. Occupational Therapy
Journal of Research, 22(4), 130-131.
Bing, R. K. (1961). William Rush Dunton, Junior—American psychiatrist, a study in self (Doctoral dissertation).
College, Park, MD: University of Maryland.
Bockoven, J. S. (1971). Occupational therapy—a historical perspective. Legacy of moral treatment—1800s to 1910.
American Journal of Occupational Therapy, 25(5), 223-225.
Burnham, W. H. (1924). The normal mind: An introduction to mental hygiene and the hygiene of school instruction.
New York, NY: D. Appleton-Century Company Incorporated.
Cabot, R. C. (1914, October 3). Sub-standard workers: Dr. Hall’s attack on their problem. The Survey, 33, 15-18.
Cameron, R. G. (1917, January). An interview with Miss Susan Tracy. Maryland Psychiatric Quarterly, 6(3), 65-66.
Chicago School of Civics and Philanthropy. (1909, July). Announcements 1909-1910 (Bulletin, Vol. 1, No. 1). Chicago,
IL: Author. Retrieved from http://babel.hathitrust.org/cgi/pt?id=mdp.39015010775784;view=1up;seq=1
Chicago School of Civics and Philanthropy. (1912, March). Year Book 1912-1913 (Bulletin, Vol. 15). Chicago, IL:
Author. Retrieved from http://babel.hathitrust.org/cgi/pt?id=mdp.39015010775784;view=1up;seq=1
Chicago School of Civics and Philanthropy. (1917, December). Special bulletin. In B. Loomis & B. D. Wade (Eds.),
Chicago, occupational therapy beginnings: Hull House, the Henry B. Favill School of Occupations and Eleanor
Clarke Slagle (p. 8). Chicago, IL: University of Illinois Department of Occupational Therapy.
Colorado State Archives. (1911). Record: Marriage license—Agatha J. Farrington and George Edward Barton.
Retrieved from https://www.colorado.gov/pacific/archives/archives-search
Colorado State Archives. (1915). Record: Court case—George Edward Barton divorce from Agatha J. Barton.
Retrieved from https://www.colorado.gov/pacific/archives/archives-search
Consolation House conference. (1917, May). Trained Nurse and Hospital Review, 58(5), 288.
Dewey, J. (1915). The school and society. Chicago, IL: University of Chicago Press.
Dobschuetz, B. (2001). Slagle, Eleanor Clarke. In R. L. Schultz & A. Hast (Eds.), Women building Chicago 1790-1990:
A biographical dictionary (pp. 803-805). Bloomington, IN: Indiana University Press.
Dunton, W. R. (1914, December 2). [Letter to George Edward Barton]. Archives of the American Occupational
Therapy Association (Series 1, Box 1, Folder 12), Bethesda, MD.
Dunton, W. R. (1917). History of occupational therapy. Modern Hospital, 8(6), 380-382.
Dunton, W. R. (1917/1967). Occupations and amusements. American Journal of Occupational Therapy, 21(5), 287-289.
(Reprinted from Maryland Psychiatric Quarterly, 1917, 6[4], 91-94.)
Dunton, W. R. (1921). Occupation therapy: A manual for nurses. Philadelphia, PA: W. B. Saunders.
Dunton, W. R. (1926). A historical note. Occupational Therapy and Rehabilitation, 5(6), 427-439.
Dunton, W. R. (1955, June 2). [Letter to Mrs. Frances Shuff]. Archives of the American Occupational Therapy
Association (Series 6, Box 47, Folder 320), Bethesda, MD.
Engagement. (1911, November 22). Colorado Springs, CO: Colorado Springs Gazette.
Favill, J. (1917). Henry Baird Favill. Chicago, IL: Privately printed.
48 Chapter 2

Forbush, B., & Forbush, B. (1986). Gatehouse: The evolution of the Sheppard and Enoch Pratt Hospital, 1853-1986.
Baltimore, MD: J. B. Lippincott.
Friedland, J. (2007). Thomas Bessell Kidner and the development of occupational therapy in the United Kingdom:
Establishing the links. British Journal of Occupational Therapy, 70(7), 292-300.
Friedland, J., & Davids-Brumer, N. (2007). From education to occupation: The story of Thomas Bessell Kidner.
Canadian Journal of Occupational Therapy, 74(1), 27-37.
Friedland, J., & Silva, J. (2008). Evolving identities: Thomas Bessell Kidner and occupational therapy in the United
States. American Journal of Occupational Therapy, 62(3), 349-360.
Fuller, D. H. (1910). The need of instruction for nurses in occupations for the sick. In S. E. Tracy (Ed.), Studies in
invalid occupations (pp. 1-15). Boston, MA: Whitcomb & Barrow.
Green, J. G. (1934, September). The Emmanuel Movement: 1906-1929. The New England Quarterly, 7(3), 494-532.
Hall, H. J. (1914, November 10). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 2, Folder 15), Bethesda, MD.
Hall, H. J. (1917). Remunerative occupations for the handicapped. Modern Hospital, 8(6), 383-386.
Hall, H. J. (1923). O.T.—A new profession. Concord, MA: Rumford Press.
Hall, H. J., & Buck, M. M. C. (1915). The work of our hands: A study of occupations for invalids. New York, NY: Moffat,
Yard & Company.
Homes for unfortunates. (1914, April). Journal of American Bankers, 6(10), 698-700.
Hooper, B., & Wood, W. (2002). Pragmatism and structuralism in occupational therapy: The long conversation.
American Journal of Occupational Therapy, 56(1), 40-50.
James, W. (1892/1985). Habit. In Occupational Therapy in Mental Health, 5(3), 55-67. (Reprinted from Psychology, pp.
134-151, by James, W., 1892, New York, NY: Henry Holt and Company)
Johnson, S. C. (1917). Occupational therapy in New York City institutions. Modern Hospital, 8(6), 414-415.
Kidner, T. B. (1910). Educational handwork. Toronto, CA: The Educational Book Company of Toronto, Limited.
Leaders in work therapy form society. (1917). Modern Hospital, 8(5), 356-357.
Levine, R. E. (1987). Looking back: The influence of the arts-and-crafts movement on the professional status of occu-
pational therapy. American Journal of Occupational Therapy, 41(4), 248-254.
Lidz, T. (1966/1985). Adolf Meyer and the development of American psychiatry. Occupational Therapy in Mental
Health, 5(3), 33-53. (Reprinted from American Journal of Psychiatry, 1966, 12[3], pp. 320-332)
Lief, A. (1948). The commonsense psychiatry of Dr. Adolf Meyer. New York, NY: McGraw-Hill Book Company, Inc.
Loomis, B. (1992). The Henry B. Favill School of Occupations and Eleanor Clarke Slagle. American Journal of
Occupational Therapy, 46(1), 34-37.
Marblehead Pottery. (2015). Marblehead pottery history. Retrieved from http://marbleheadpottery.net/marblehead_
pottery_site/HISTORY.html
Meyer, A. (1922/1977). The philosophy of occupation therapy. American Journal of Occupational Therapy, 31(10), 639-
642. (Reprinted from Archives of Occupational Therapy, 1922, 1, pp. 1-10)
Meyer, A. (1935/1948). The birth and development of the hygiene movement. In A. Lief (Ed.), The commonsense
psychiatry of Dr. Adolf Meyer (pp. 313-319). New York, NY: McGraw-Hill Book Company, Inc. (Reprinted from
Mental Hygiene, January 1935, 19, pp. 29-36)
National Committee for Mental Hygiene. (1912). Origins, objects and plans of the National Committee for Mental
Hygiene: Part II. The mental hygiene movement: State societies for mental hygiene. New York, NY: National
Committee for Mental Hygiene.
National Society for the Promotion of Occupational Therapy. (1917). Certificate of Incorporation. Clifton Springs,
New York: Author.
Newton, I. G. (1917a). Consolation House. Trained Nurse and Hospital Review, 59(6), 321-326.
Newton, I. G. (1917b). Report of the secretary: Minutes of the first Consolation House conference. Proceedings of the
First Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 19-23). Towson,
MD: Spring Grove Hospital Press.
Newton, I. G. (1917c, April 11). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 2, Folder 13), Bethesda, MD.
Obituary: Gertrude C. Slagle. (1986, April 22). Idaho Press-Tribune.
Occupational Therapy Notes. (1932, April). Obituary: Susan C. Johnson. Occupational Therapy and Rehabilitation,
11(2) 152-153.
Peloquin, S. M. (1991a). Looking back: Occupational therapy service: Individual and collective understandings of the
founders, part 1. American Journal of Occupational Therapy, 45(4), 352-360.
Peloquin, S. M. (1991b). Looking back: Occupational therapy service: Individual and collective understandings of the
founders, part 2. American Journal of Occupational Therapy, 45(8), 733-744.
Public Welfare Committee. (1917). Humanizing the greater city’s charity: The work of the Department of Public
Charities of the City of New York. New York, NY: Public Welfare Committee.
 Conception and Formal Birth: 1900s to 1917 49

Quiroga, V. A. M. (1995). Occupational therapy: The first 30 years: 1900 to 1930. Bethesda, MD: American Occupational
Therapy Association.
Reed, K. L. (1993). The beginnings of occupational therapy. In H. L. Hopkins & H. D. Smith (Eds.), Willard and
Spackman’s occupational therapy (8th ed., pp. 26-43). Philadelphia, PA: J. B. Lippincott Company.
Reed, K. L. (2005). Dr. Hall and the work cure. Occupational Therapy in Health Care, 19(3), 33-50.
Reed, K. L., & Sanderson, S. N. (1999). Concepts of occupational therapy (4th ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
Report of the President. (1918). In Proceedings of the Second Annual Meeting of the National Society for the
Promotion of Occupational Therapy (pp. 15-16). Towson, MD: Sheppard and Enoch Pratt Hospital.
Schwartz, K. B. (2009). Reclaiming our heritage: Connecting the founding vision to the centennial vision. American
Journal of Occupational Therapy, 63(6), 681-690.
Scull, A., & Schulkin, J. (2009). Psychobiology, psychiatry, and psychoanalysis: The intersecting careers of Adolf
Meyer, Phyllis Greenacre, and Curt Richter. Medical History, 53(1), 5-36.
Serrett, K. D. (1985). Another look at occupational therapy’s history: Paradigm or pair-of-hands? Occupational
Therapy in Mental Health, 5(3), 1-31.
Slagle, E. C. (n.d). Experience of Eleanor Clarke Slagle. Bethesda, MD: Archives of the American Occupational
Therapy Association.
Slagle, E. C. (1919a). Department of occupational therapy. Institutional Quarterly, 10(3), 29-32.
Slagle, E. C. (1919b). Occupational therapy. In Proceedings of Twentieth New York State Conference of Charities and
Corrections, November 11-13, 1919 (pp. 121-135). Syracuse, NY: Organization of the Twentieth New York State
Conference of Charities and Corrections.
Slagle, E. C. (1938a, May 10). [Letter to Mrs. John A. Greene]. Archives of the American Occupational Therapy
Association (Series 5, Box 24, Folder 162), Bethesda, MD.
Slagle, E. C. (1938b). Occupational therapy. Trained Nurse and Hospital Review, 100, 375-382.
The Work Cure. (1914). Trained Nurse and Hospital Review, 52(1), 42-43.
Thomson, E. E. (1914, October 17). Illinois opportunity for preventive work in mental hygiene. The Survey, 33, 68-69.
Thomson, E. E. (1917). Occupation and its relation to mental hygiene. Modern Hospital, 8(6), 397-398.
Tracy, S. E. (1910). Studies in invalid occupation: A manual for nurses and attendants. Boston, MA: Whitcomb &
Barrows.
Tracy, S. E. (1914, September 18). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 2, Folder 21b), Bethesda, MD.
Tracy, S. E. (1917, April 22). [Letter to William Rush Dunton]. Archives of the American Occupational Therapy
Association (Series 1, Box 2, Folder 21b), Bethesda, MD.
Training school for occupational therapists. (1918). Mental Hygiene, 2(4), 635-636.
United States Corporation Bureau. (1914). Table of cases. National Corporation Reporter, 47, p. 819.
 3
World War I
1917 to 1920s

Key Points
● Occupational therapy sought legitimacy as a medical profession, aligning with and often
working under the supervision of the medical profession.
● In World War I, for the first time in history, the United States government provided reconstruc-
tion services for disabled soldiers and sailors to return them to productive, satisfying lives.
● The War Department and Surgeon General’s Office established a civilian personnel category
of reconstruction aide in occupational therapy to provide services to soldiers and sailors with
the American Expeditionary Forces in Europe and for those in the United States.
● Emergency war courses were established to meet the need for reconstruction aides.
● These reconstruction aides, pioneers in occupational therapy, helped to establish the new
profession of occupational therapy in the United States.

Highlighted Personalities Key Places

● Reconstruction aides in occupational ● Pioneer schools in Boston, Philadelphia,
therapy St. Louis, and Milwaukee
● Dr. Elliott G. Brackett, orthopedic surgeon ● Walter Reed General Hospital
● Dr. Joel E. Goldthwait, orthopedic surgeon ● Base hospitals in France
● Dr. Thomas W. Salmon, neuropsychiatrist ● Base and general hospitals in the United
● Elizabeth Greene Upham Davis States
● Lena Hitchcock, reconstruction aide
● Mrs. Clyde McDowell Myres, reconstruc-
tion aide (frequently misspelled as Myers)
● Bird T. Baldwin, psychologist

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 51-88).
- 51 - © 2017 SLACK Incorporated.
52 Chapter 3

Key Times/Events Sociocultural Events/Issues

● World War I ● Government acceptance of Responsibility
● Rehabilitation legislation to Soldiers
● American Red Cross involvement in
Political Events/Issues/ World War I
● Junior League funding/support of occu-
Legislation pational therapy
● War Risk Insurance Act Amendment
(Public Law 65-90) Economic Events/Issues
● National Defense Act of 1916 (Public Law ● Economic prosperity in early 1920s
64-85)
● Vocational Education Act of 1917, also
known as the Smith-Hughes Act (Public Technological Events/Issues
Law 64-347)
● Development/advancement of medical
● Vocational Rehabilitation Act of 1918, also
equipment such as the x-ray
known as the Soldiers Rehabilitation Act
and the Smith-Sears Act (Public Law 65-178) ● Invention of motorized ambulances
● Vocational (Industrial) Rehabilitation Act ● Improved medical treatment for infection
of 1920 (Public Law 66-236), also known as control, use of antibiotics
the Civilian Rehabilitation Act, the Smith- ● Development of increasingly destructive
Fess Act, and the Smith-Bankhead Act weapons of war: highly explosive shells,
● United States Veterans Bureau Act of chemical weapons, poison gases
1921 (Public Law 67-47)

Educational Issues Practice Issues

● Establishing educational qualifications ● Start of profession’s sponsorship by
for reconstruction aides and occupational medicine
therapists ● Start of physical medicine and rehabilita-
tion
Association Issues ● Differentiation from physical therapy and
vocational rehabilitation
● Association governed by a Board of five
members (1917-1920)

Introduction
“Occupational therapy will someday rank with anesthetics in tak-
ing the suffering out of sickness and with antitoxin in shortening its
duration.”
–Dr. Thomas W. Salmon, 1922

W
ar clouds were on the horizon for the United States in March 1917 when the inau-
gural meeting was held. Most of Europe was engaged in fighting the Great War,
whereas the United States was trying to maintain neutrality. However, less than a
 World War I: 1917 to 1920s 53

month after the founding meeting, the United States declared war on Germany. The founders of
the National Society for the Promotion of Occupational Therapy (NSPOT) saw an opportunity for
the new society and profession and a responsibility to contribute to the war effort. With the sup-
port of physicians advocating for the inclusion of occupational therapy in reconstruction services
for disabled soldiers and sailors, they convinced the Medical Department of the Army to estab-
lish a new category of personnel: reconstruction aides in occupational therapy. The activities of
these reconstruction aides with the American Expeditionary Forces in Europe and at home in the
United States impressed many, giving recognition to the new profession.

America Prepares for War

The assassination of Archduke Franz Ferdinand of Austria and his wife Sophie on
July 28, 1914, ignited war in Europe. The Central Powers—Germany and Austria-Hungary—were
engaged in a war with the Allies, including Russia, France, and the United Kingdom. During the
early years of the war in Europe, the United States government maintained a policy of noninter-
vention and tried to broker peace between the warring nations with little success. Hostile German
aggression against American shipping interests and the sinking of the British ocean liner Lusitania
in 1915, killing more than 1,100 innocent civilians (including 120 Americans), helped turn public
opinion against the stance of neutrality. Anticipating war, many government and private organi-
zations began war preparations. By 1916, the American Red Cross and the United States military
were working together on a plan to organize medical personnel and secure equipment and supplies
should war break out.
Colonel Jefferson R. Kean, in the new Department of Military Relief, worked with the American
Red Cross to organize teams of personnel in various cities and towns in the United States. Many
teams were organized in preparation for deployment overseas. When deployed, these teams
became mobile units setting up hospital units in various locations for a period of time, then mov-
ing to other locations as needed. These teams usually comprised local medical personnel who
already worked together. New York Hospital’s medical personnel formed one of the first of many
base hospital teams organized by Colonel Kean. The desire of the medical personnel to serve was
so great that New York Hospital had to decide who could serve in order to maintain adequate staff-
ing at the hospital. The Board of Governors decided that the youngest and oldest workers would
be among those chosen to go, leaving a number of middle-aged people to continue to provide
services to the home community. Primarily an orthopedic hospital team, this group was deployed
to France in August 1917. Base Hospital No. 9, as this group was known, was eventually stationed
in Chateauroux, France (Brown, 1920, p. 27).
The American Red Cross played a significant role in raising funds to secure medical equipment
and supplies to aid in the care of the sick and wounded soldiers and sailors. In fact, most United
States base hospital units deployed to France were organized by the American Red Cross and were
often referred to as Red Cross Hospitals (Lynch, Weed, & McAfee, 1923, p. 102). On July 5, 1917, as
the Medical Department of the United States Army prepared for war, President Woodrow Wilson
officially accepted the American Red Cross offer of assistance (Crane, 1927, p. 229).
On April 6, 1917, the United States was finally provoked to declare war on Germany. Germany’s
sinking of seven United States merchant ships and the Zimmerman telegram in which the German
foreign minister asked Mexico to join Germany in an alliance against the United States were the
last straws. The declaration of war resulted in a great expansion of work for all in the military. The
combination of the sheer volume of work and overwork of employees resulted in delays, confusion,
and errors as America mobilized for war.
In 1917, most travel was by train or ship. Commercial air travel was still in its infancy. The first
transatlantic flight by Charles Lindbergh in May 1927 was still a full decade away. However, the
Medical Department of the United States Army was more prepared for war than at any other time
54 Chapter 3

in history. In spite of this, much

more planning and preparation
were needed to mobilize for this
war overseas. The number and
type of medical personnel, the
number and sites of hospitals,
and the logistics of transport-
ing medical personnel over-
seas needed to be determined.
Planning was needed for supply
lines and the housing and feed-
ing of personnel. Preparations
and procedures for providing
medical care to soldiers, evacu-
Figure 3-1. Photograph of a standard Ford ambulance.
ation of soldiers from the front
lines, and the assignment and
transportation of the wounded to base hospitals were also necessary practical and logistical
considerations. The United States had a limited number of ships available to transport military
personnel and supplies to Europe. As such, space for military personnel and supplies on these
ships was at a premium. Finally, on June 25, 1917, more than 2 months after declaring war, the first
American troops of the American Expeditionary Forces reached France.
Technological advances in the early
1900s affected the provision of medical
care to injured and ill soldiers and sail-
ors in World War I in both negative and
positive ways. World War I weapons were
more destructive than ever before. Highly
explosive shells and shell fragments,
machine guns, and poisonous gases could
cause horrific injuries or death (Manring,
Hawk, Calhoun, & Andersen, 2009). In
contrast, other technological advances
helped to save lives. Motorized ambu-
lances were able to more quickly transport
injured soldiers to first aid stations and
hospitals to receive needed care (Figure
3-1). The use of the Thomas splint, a
newly developed traction device used to
treat fractured femurs, reduced mortality
rates from 80% to 20% (Manring et al.,
2009). A new understanding of causes
and prevention of infections resulted in
new infection control procedures being
implemented, saving lives. The new x-ray
machine was used for “locating bullets
and reading the condition of internal tis-
sues” (“Photography’s Aid,” 1919), greatly
assisting medical care (Figure 3-2).
Figure 3-2. Advertisement for an x-ray machine.
 World War I: 1917 to 1920s 55

Reconstruction Services
in the Military
The Medical Department of the United States Army had the overall responsibility of organiz-
ing medical services for wounded soldiers, including acute medical services and reconstructive
services designed to return soldiers to maximum functioning. In the spring of 1917, the Surgeon
General, Major General William C. Gorgas, and a number of orthopedic surgeons and neuropsy-
chiatrists traveled to England, France, and Canada to survey these allied countries’ reconstruction
programs. Occupations and activities were provided to convalescents in these programs with great
success. Additionally, because the use of occupations and activities were also successful in civilian
facilities in the United States, the Medical Department wanted to include these types of services in
United States wartime reconstruction programs.
The structures and functions of divisions and departments being established in the Surgeon
General’s Office were often ill defined and in a constant state of change. Workloads of the office
staff had increased significantly, resulting in time delays and errors. A lack of coordinated efforts
between divisions and departments compounded the problems. In August 1917, the Surgeon
General, having decided that there should be a broad plan of reconstruction comprising all depart-
ments of medicine and surgery involved in the problem, created the Division of Special Hospitals
and Physical Reconstruction, later renamed the Division of Physical Reconstruction. The division
engaged in numerous studies and extensive planning for the reconstruction of soldiers and sailors.
Information and literature were gathered about the various medical, vocational, and educational
services that might possibly aid in the educational preparation of personnel, the development of
facilities, and the securing of equipment that would be required to provide effective reconstruc-
tion services. With this information, the Surgeon General’s Office developed an extensive plan for
physical reconstruction and vocational training.
In January 1918, the Secretary of War, believing the Surgeon General’s comprehensive plan
would overlap with the programs of other agencies, directed all these agencies to coordinate
plans. Representatives from a number of agencies, including the United States Public Health
Service, the American National Red Cross, the War Risk Insurance Bureau, and the Federal
Board for Vocational Education, met with the Surgeon General’s Office for the first time on
January 14, 1918. They continued to meet over the next few months (Crane, 1927, p. 36). In August
1918, the final approved plan determined that the military was to restore disabled soldiers and
sailors to “full or limited military service.” After discharge from the military, the Federal Board
of Vocational Education would provide vocational training for disabled soldiers and sailors
(Crane, 1927, p. 41).
Initially, the Federal Board of Vocational Education was established to provide for public
vocational education to assist the development of semi-skilled workers in agriculture, trades, and
industry. When their mission was expanded to include vocational services to disabled soldiers and
sailors, the Federal Board of Vocational Education secured the services of Thomas B. Kidner as a
Special Adviser on Rehabilitation to assist the establishment of a system of vocational education for
disabled soldiers and sailors. Kidner had the experience to advise the United States in setting up a
system for the rehabilitation of soldiers and sailors in the United States because he had served as
the Vocational Secretary of the Canadian Military Hospitals Commission with the responsibility
for rehabilitation of disabled soldiers (Editorial, 1922).
56 Chapter 3

Legislation Related to
Reconstruction and
Rehabilitation Services
Prompted by the progressive thinking of the time, the United States Congress passed a series
of laws authorizing a number of educational and rehabilitative programs. With the changes in the
early 20th century, these laws took into consideration the need to improve the skill sets of workers
to work in new industries, the need to promote economic growth, and the need to improve the
quality of life for citizens (Table 3-1).
As war was being fought in Europe, the United States recognized the possibility of being drawn
into the conflict. Recognizing the government’s social and economic responsibility to ensure a
standard of living and quality of life for servicemen and their families, Congress passed a num-
ber of laws. The National Defense Act of 1916 (Public Law No. 64-85) provided the opportunity
for those in active service to receive instruction “to increase their military efficiency and enable
them to return to civil life better equipped for industrial, commercial, and general business
occupations.” This law also authorized civilian teachers to assist the Army in providing this type
of instruction, primarily consisting of vocational education in agriculture or the mechanic arts
(National Defense Act, 1921, p. 24).

Table 3-1
LEGISLATION RELATED TO RECONSTRUCTION AND REHABILITATION SERVICES
YEAR LEGISLATION PURPOSE
1916 National Defense Act of 1916 (Public Passed to ensure the country was prepared in case of
Law No. 64-85) war; provided opportunity for those in active service to
receive instruction to improve military efficiency and
develop skills for industrial, commercial, and business
occupations in civilian life; provided foundation for voca-
tional re-education
1917 War Risk Insurance Amendments of Provided for rehabilitation, re-education, and vocational
1917 (Public Law 65-90) training for soldiers and sailors; provided for supplies
such as artificial limbs, trusses, and similar appliances
1917 Vocational Education Act of 1917 Established the Federal Board of Vocational Education,
(Public Law 64-347); also known as which eventually studied the vocational needs of dis-
the Smith-Hughes Act abled soldiers and sailors and provided vocational re-
education
1918 Vocational Rehabilitation Act of 1918 Provided for vocational rehabilitation and return to civil
(Public Law 65-178); also known as employment of disabled persons discharged from mili-
the Soldiers Rehabilitation Act and tary or naval forces of the United States
the Smith-Sears Act
1920 The Vocational (Industrial) Provided vocational rehabilitation services to civilians
Rehabilitation Act of 1920 (Public Law physically injured in industrial or occupational accidents
66-236); also known as the Civilian
Rehabilitation Act, the Smith-Fess
Act, and the Smith-Bankhead Act
1921 United States Veterans Bureau Act of Consolidated veterans benefits from the War Risk
1921 (Public Law 67-47) Insurance Bureau, the United States Public Health Service,
and the Federal Board of Vocational Education under the
Veteran s Bureau.
 World War I: 1917 to 1920s 57

The War Risk Insurance Act, first passed in 1914 and amended in 1917 (Public Law 65-90),
provided a number of benefits for World War I veterans disabled in the line of duty. Benefits
authorized by this law included compensation in cases of service connected disability or death
and “courses of rehabilitation, re-education, and vocational training.” Additional benefits included
“reasonable governmental medical, surgical, and hospital service and with such supplies, includ-
ing artificial limbs, trusses, and similar appliances as the director may determine to be useful and
reasonably necessary.” Another amendment in December 1919 authorized the bureau to furnish
“wheeled chairs” if reasonably necessary (Public Law 66-104). This law was the first authorize ser-
vices to assist disabled servicemen return to as productive a life as possible through rehabilitation,
re-education, and vocational training (Douglas, 1918).
The Vocational Education Act of 1917 (Public Law 64-347), also known as the Smith-Hughes
Act, was passed to provide for public vocational education to assist the development of semi-skilled
workers in agriculture, trades, and industry, including the preparation of teachers for vocational
education. The Federal Board of Vocational Education (FBVE) was established by this act as fed-
eral oversight for state programs. Although when this legislation was passed it did not authorize
provision of vocational services to disabled soldiers and sailors, in January 1918 Congress directed
the FBVE to study the vocational needs of disabled soldiers and sailors and recommend a plan for
their reconstruction.
The Vocational Rehabilitation Act of 1918 (Public Law 65-178), also known as the Soldiers
Rehabilitation Act and the Smith-Sears Act, provided for “vocational rehabilitation and return
to civil employment of disabled persons discharged from military or naval forces of the United
States.” Originally, all medical treatment and rehabilitation services were to be provided by the
specific military hospitals and centers located in different areas of the country. Once maximum
functional potential was achieved, the serviceman would be discharged from the military and
could enter a vocational rehabilitation program. Most servicemen were anxious to return home
as soon as possible and requested discharge when the war ended, going home instead of to the
military hospitals. The Vocational (Industrial) Rehabilitation Act of 1920 (Public Law 66-236),
also known as the Civilian Rehabilitation Act, the Smith-Fess Act, and the Smith-Bankhead Act,
provided the same vocational rehabilitation services to civilians physically injured in industrial or
occupational accidents. Funds were appropriated to assist states to provide these services.

Federal Board for

Vocational Education
The FBVE was directed to provide information on the rehabilitation and vocational re-edu-
cation of injured soldiers and sailors by the United States Senate in January 1918. In response,
the FBVE developed a report titled “Training of Teachers for Occupational Therapy for the
Rehabilitation of Disabled Soldiers and Sailors.” The report was written by Elizabeth Greene
Upham, from Milwaukee, Wisconsin. Having overcome a disability of her own, she developed an
interest in helping those with disabilities. She was the force behind the start of a training course in
invalid occupations at Milwaukee-Downer College in 1913 (Jones, 1988). Upham wrote the report
when she was working as a research assistant for the FBVE. She understood that the benefits of
occupational therapy were more abstract, of greater variety, and more complex than those of
physiotherapy (massage, exercise, hydrotherapy, and electrotherapy), so in addition to providing
curricular information, the report effectively described the benefits of occupational therapy and
clarified the difference between occupational therapy and vocational education.
The report described three phases of recovery: (1) the acute stage, (2) the convalescence stage,
and (3) the vocational training or education stage. The acute stage primarily involved medical
and/or surgical care, and therapy in this phase consisted of invalid, bedside, or ward occupations,
58 Chapter 3

which were mainly diversional in nature to improve mental outlook. Occupational therapy was
of utmost importance in the second phase, the convalescence stage, to enable the disabled sol-
dier to regain functional control of the body, both physical and mental, and to help prepare the
soldier for vocational training and/or for civilian life. Once the disabled soldier had sufficiently
recovered, he entered the third stage, the vocational training stage, to participate in a prescribed
course of study to learn a vocation. Occupational therapy provides the vital link between medi-
cal treatment and vocational training, enabling the soldier to participate in vocational training
(Upham, 1918, pp. 11-13). Canadian statistics from the war indicated that 80% of disabled soldiers
were able to return to a former occupation after treatment in a curative workshop. Twenty percent
needed full or partial vocational training (Upham, 1918, p. 18). The report by Elizabeth Greene
Upham advocated the need for occupational therapists, not only as a war measure but as essential
for industrial accidents and civilian disabilities such as mental illness (Upham, 1918, p. 68).

Reconstruction Aides in
Occupational Therapy
The reconstruction aides in occupational therapy were known by a variety of names: occupa-
tional aides, occupational therapists, occupational therapeutists, occupational teachers, recon-
struction aides in occupational therapy, and re-aides (Sidebar 3-1).
A memo from the Surgeon General dated January 5, 1918, makes the first mention of occupa-
tional aides. The memo describes occupational aides’ services as purely medical and necessary
to provide “early ward occupation” to prepare convalescents for subsequent vocational treat-
ment (Crane, 1927, p. 57). Although the work was described as a purely medical function, these
occupational aides were placed under the supervision of an educational director, in contrast to
physiotherapy, which was under medical direction. Instructions provided by the Surgeon General

SIDEBAR 3-1
Alternate Names for
Occupational Therapy

The following are names sometimes used to describe occupation as a therapeutic agent before the term

occupational therapy became widely accepted.

Work cure Activity therapy

Curative work Ergotherapy
Curative occupation Reconstruction therapy (part
Invalid occupations of WWI Army program)
Diversional occupation Curative therapy
Diversional therapy Work therapy
Cheer-up work Industrial therapy
Therapeutic diversion Functional therapy
Reconstructive activities Therapeutic occupation
Re-education Occupational remediation
Finger therapy Remedial occupation
 World War I: 1917 to 1920s 59

in March 1918 stated that “all therapeutic work, excluding physiotherapy, was to be classed as
occupational therapy…” (Crane, 1927, p. 79). Reconstruction work took place in hospitals, general
hospitals, and base hospitals set up in the United States and Europe. The types of occupation work
included the following: “(a) bedside occupations to take the patient’s attention from his disability
and occupy his mind. At first diversional … these became … vocational, economic or social in
value, (b) Ward, shop, or farm occupations and study to occupy the patient’s time in worth-while
work, and thus develop in him a good mental attitude toward his disability, his treatment, and
the hospital, (c) Ward, classroom, or farm operations and study in preparation for reeducation…”
(Crane, 1927, p. 86).
There were three classifications of occupational therapy aides: (1) Class A were experts in one or
more lines of work, including social work and library service, and were teachers in “industrial and
fine arts, general science, English, commercial branches, free-hand drawing and design, mechani-
cal drawing, telegraphy and signalling, French, manual training, agriculture (gardening and flo-
riculture), music, plays, and games, mathematics”; (2) Class B were teachers or craftsmen in “one
or more lines of knitting (hand, machine, rake), weaving, clay and papier-maché modeling, wood
carving and toy making, metal working, jewelry, and engraving”; and (3) Class C were informed
on “military procedures in hospitals, the War Department’s program for physical reconstruction
of disabled soldiers, regulations as to insurance, pensions, and other benefits, under the War
Risk Insurance Bureau, and opportunities offered by the Federal Board for Vocational Training”
(Crane, 1927, p. 58; Haggerty, 1918).
Curative shops were established in connection with each hospital to provide light
work for disabled soldiers in preparation for retraining in new occupations or vocations
(Crane, 1927, p. 29). Occupational therapy was to be medically prescribed.
No patient was to be assigned ward occupational work until the ward surgeon had entered
on his clinical record the fact that he was physically fit for such work, and no patient was to be
assigned to work in the shop, on farms, etc., except on written prescription of the proper medi-
cal officer, such prescription to state the functional result to be obtained, the length of time the
patient should work, whether the work should be light or heavy, and whether indoors or outdoors
(Crane, 1927, p. 79).
The original plan specified that men should teach “manual activities required by occupations,”
preferably men who had overcome a similar disability, or at least men with experience in the
occupation to be taught (Crane, 1927, p. 21). Although the Army allowed for female nurses, the
belief was that nurses had the appropriate education and qualifications, whereas other women,
including those providing reconstructive and therapeutic services, would be detrimental to the
discipline and morale of troops (Crane, 1927, p. 32; Russell, 1918). With a shortage of men to
fill these positions, by December 1917, after careful study, the Medical Department decided to
employ Women’s Auxiliary Medical Aides as civilian personnel to carry out this reconstructive
work in hospitals (Crane, 1927, p. 57). To fill the need for these occupational aides, the Division
proposed to establish educational programs to train 1,000 women for occupational work by
October 1, 1918 (Crane, 1927, pp. 57-58; Lynch et al., 1923, p. 474). These civilian employees were
commonly known as reconstruction aides. Male civilians were also approved for hire as recon-
struction aides (Table 3-2, Sidebar 3-2, Figure 3-3).

Neuropsychiatric Services
With war officially declared, Dr. Thomas W. Salmon, a psychiatrist and the Medical Director
of the National Committee on Mental Hygiene, recognized the need to plan for medical care of
soldiers and sailors suffering from psychiatric disorders (Figure 3-4). He wrote to the Rockefeller
Foundation on May 1, 1917, asking for funds and support to visit England and France to learn how
the Allies dealt with the nervous and mental disorders suffered by soldiers and sailors sent to war
(Salmon, 1917b). The Rockefeller Foundation granted Dr. Salmon’s request.
60 Chapter 3

Table 3-2
MILITARY TIMELINE FOR RECONSTRUCTION SERVICES
April 6, 1917 The United States declares war on Germany
Spring 1917 General Gorgas, the Surgeon General of the United States; neuropsychiatrists; and ortho-
pedic surgeons visit England, Canada, and France to learn about those countries recon-
struction programs for soldiers. The focus is to learn specifically about the organization of
programs and problems encountered (McDaniel, 1968, p. 69).
June 25, 1917 The first American troops, the American Expeditionary Forces, reach France.
July 1917 The American Orthopedic Association officially offers their services to the Surgeon
General (Lynch et al., 1923, p. 424).
July 12, 1917 In a letter from a military official to the military director of the Red Cross regarding plan-
ning for reconstruction services, the concept of reconstruction aides is introduced (Lynch
et al., 1923, p. 431).
August 22, 1917 The Division of Special Hospitals and Physical Reconstruction organizes, with Major Edgar
King named as Chief. Later, Colonel Frank Billings becomes Chief. This Division includes
the Special Section of Education, which includes curative workshop functions and occu-
pational therapy, and the Special Section of Physiotherapy (Lynch et al., 1923, p. 474).
November 7, 1917 Original plan for the reconstruction of soldiers is submitted, specifying that enlisted men
with disabilities teach those with like disabilities.
December 1917 The War Department approves of hiring women and men as reconstruction aides. These
reconstruction aides will be employees at large of the Medical Department cooperating
with the Division of Orthopedic Surgery (Lynch et al., 1923, p. 474).
December 1917 The neuropsychiatric service of the American Expeditionary Forces begins under the
supervision of Dr. Thomas Salmon.
January 5, 1918 A memo from the Surgeon General makes the first mention of occupational aides. A
proposal is submitted to establish educational programs to train 1,000 women for occu-
pational work by October 1, 1918 (Crane, 1927, pp. 57-58).
January 1918 Physical therapist Marguerite Sanderson, a former employee of Dr. Joel Goldthwait, is
appointed first supervisor of reconstruction aides in occupational therapy and physical
therapy. Her primary duties include recruiting and training personnel.
January 30, 1918 In response to a Senate resolution, a report written by Elizabeth Greene Upham titled
Training of Teachers for Occupational Therapy for the Rehabilitation of Disabled Soldiers
and Sailors is submitted to the United States Senate.
February 15, 1918 Dr. Elliott Gray Brackett (Chief, Division of Orthopedic Surgery) initiates occupational ther-
apy services in Walter Reed Army Hospital with three occupational therapy aides (Crane,
1927, p. 96; McDaniel, 1968, p. 77).
April 1918 First described as a purely medical function in a January 5, 1918, memo, the Surgeon
General places occupational aides under the direction of the educational service, com-
pared with physiotherapy, which is under medical direction (Crane, 1927, p. 58).
April 29, 1918 The designation occupational therapy for therapeutic work, mental or manual, is discard-
ed, being thereafter included in the term curative workshop schedule.
May 1918 Reconstruction programs start at Fort McHenry, Maryland; Fort McPherson, Georgia; and
Lakewood, New Jersey. By July, an additional 21 sites are selected to participate in the
program.
May 18, 1918 Base Hospital No. 117, a specialized neuropsychiatric hospital unit comprising five recon-
struction aides in occupational therapy, sails for Europe. They arrive in La Fauche, France,
on June 16, 1918.
July 1918 Dr. Joel Goldthwait writes a letter stressing the need for large numbers of aides trained in
bedside occupations.
(continued)
 World War I: 1917 to 1920s 61

Table 3-2 (continued)

MILITARY TIMELINE FOR RECONSTRUCTION SERVICES
July 31, 1918 The Surgeon General s Office designates 26 general hospitals for the rehabilitation of
soldiers in the United States, including Walter Reed General Hospital, Fort McHenry
#2 (MD), Fort McPherson #6 (GA), Otisville #8 (NY); Lakewood #9 (NJ), Oteen #19 (NC),
Whipple Barracks #20 (AZ), Fort Des Moines #26 (IA), Fort Sheridan #28 (IL), Fort Snelling
#29 (MN), and Carlisle #31 (PA). In August 1918, additional sites are added, including Fort
Sam Houston (TX), Fort Riley (KS), Camp Custer (MI), Camp Gordon (GA), Camp Grant (IL),
Camp Jackson (SC), Camp Kearney (CA), and Camp Dix (NJ).
August 13, 1918 Requested by Chief Surgeon of the American Expeditionary Forces, Dr. Joel Goldthwait,
27 reconstruction aides (13 occupational therapy and 14 physical therapy) arrive at Base
Hospital #9 in Chateauroux, France. On September 15, 1918, seven reconstruction aides in
occupational therapy transferred to Base Hospital #14 in Beau Desert (Crane, 1927, p. 65).
August 1918 Dr. Thomas Salmon requests more reconstruction, writing, The Reconstruction Aides,
especially those working in handicrafts, are worth their weight in gold (McDaniel, 1968,
p. 85; Myers, 1948). General Pershing, at the behest of Surgeon General Gorgas, cables,
Send over a thousand of these aides as soon as you can get them ready (Myers, 1948;
Quiroga, 1995, p. 164).
November 11, 1918 Armistice Day; World War I ends. (For the purposes of the history of the Medical
Department of the United States Army in the World War, the period of war activities
extends from April 6, 1917, to December 31, 1919 [Bailey, Williams, & Komora, 1929, p. v].)
June 20, 1919 The Division of Physical Reconstruction ceases to exist, becoming the Section on
Physical Reconstruction in the Division of Hospitals in the U.S. Public Health Service
(Crane, 1927, p. 50).
January 1922 Reconstruction aides transfer to the United States Veterans Bureau within the U.S. Public
Health Service.
December 1926 The Surgeon General recommends the term reconstruction aide be abolished, in part
to eliminate confusion about the respective roles of occupational therapy and physical
therapy (McDaniel, 1968, p. 91).

SIDEBAR 3-2
Carry On Magazine

Carry On: A Magazine on the Reconstruction of Disabled Soldiers

and Sailors, was a collaborative effort of the American Red Cross
and the Surgeon General s Office. The main purpose was to educate

disabled soldiers and sailors and the public about the benefits of

restoring the soldiers and sailors to meaningful, productive lives

through rehabilitation. The first issue was published in June 1918

and the last in July 1919 (see Figure 3-3).

Figure 3-3. Cover of Carry On magazine,

Volume 1, Issue 7, with Creed of the Disabled.
62 Chapter 3

Soldiers suffering from shell

shock were of foremost concern
to Dr. Salmon. Technologically
advanced highly explosive shells
were now being used in battle. The
use of highly explosive shells has
implications not only for physi-
cal injury and death, but for psy-
chological damage from the shell
shock. Initially it was believed that
the concussion from these highly
explosive shells physically affected
soldiers’ nervous systems, causing a
nervous disorder. Closely examin-
ing hundreds of cases, Dr. Salmon
found that soldiers who had not
been involved in battle and were
not exposed to bursting shells also
suffered from nervous disorders. In Figure 3-4. Dr. Thomas W. Salmon.
his view, the term shell shock was a
misnomer because a definitive physiological or psychological etiology had not been determined
(Salmon, 1917a). The more acceptable medical term for soldiers’ nervous disorders was war neuro-
ses or functional war neuroses (Crane, 1927, p. 162; Salmon, 1917a). The term shell shock continued
to be used, often with a broad brush to label soldiers suffering from mental and nervous disorders
as a result of the stresses of war. A century later, posttraumatic stress disorder is the preferred medi-
cal term.
In World War I, some suffering from war neuroses were thought to be malingerers. Worse,
some who, under the stress of war, froze in place or fled their posts were charged with cowardice
or desertion and were executed. The British military executed 306 British soldiers for cowardice or
desertion in World War I. Ninety years later, many of these soldiers executed were believed to have
suffered from war neuroses. All were pardoned posthumously in 2006 by the British government
(Taylor-Whiffen, 2011). No American soldiers were executed in World War I for cowardice or deser-
tion, in part because of Dr. Salmon’s recognition of the need for medical care, not punishment.
In Britain, as of April 30, 1916, 1,300 officers and 10,000 soldiers were admitted to hospitals
for shell shock. The disorder resulted in “one-seventh of the discharges for disability from the
British Army, or one-third if discharges for wounded are excluded” (Salmon, 1917a). Salmon
was acutely aware of not only the human aspect of this disability, but also the economic impact
from loss of fighting military personnel
and the cost to provide medical care.
SIDEBAR 3-3 Salmon believed it was vitally important
for troop morale and staffing to provide
Shell Shock effective medical treatment for these
soldiers as soon as possible to return
them to the front or discharge them to a
Dr. Salmon, illustrating how the effects of battle can affect a man s behavior and
productive civilian life (Salmon, 1917a)
the fine line between heroism and cowardice, was quoted as saying:
(Sidebar 3-3).
When a man breaks he starts to run; when he runs toward the enemy he is
The symptoms of war neuroses
shot by them and dies a hero; when he runs toward his own lines he is shot
included hysterical paralysis, hys-
by his comrades and dies a coward. The impulse is the same in both cases.
terical blindness, hysterical deafness,
(Johnson, 1945) tics, tremors, gait disturbances, dis-
orders of speech, confusion, amnesia,
 World War I: 1917 to 1920s 63

hallucinations, and anxiety.

Salmon advocated for the use of
occupations to treat soldiers suffer-
ing from war neuroses. He believed
that using meaningful occupations,
using the principle of learning by
doing, would help in re-education
and in restoring thought, will, feel-
ing, and lost or impaired functions
(Salmon, 1917a).
Dr. Thomas Salmon was a strong
advocate of the occupational thera-
pists’ role with soldiers suffering
from war neuroses. He insisted that
occupational therapy be included
Figure 3-5. Grounds of Base Hospital No. 117 in La Fauche, France.
as part of the neuropsychiatric ser-
vices. Dr. Salmon was personally
and professionally acquainted with Eleanor Clarke Slagle. He, as many others, recognized her as
an authority in occupational therapy work. Desiring to offer the best occupational therapy ser-
vices, he offered Slagle “…a position in charge of all re-educational work with over-seas psychiatric
cases” to work under his direction (Slagle, n. d.). Slagle decided she would better serve the war
effort by staying in the United States to help establish training schools (Slagle, n.d.). She stayed in
the United States and established the Red Cross School in Chicago.
Base Hospital No. 117 was organized in March 1918, at Camp Crane, Pennsylvania, to serve as a
neuropsychiatric base hospital. Under the supervision of Dr. Salmon, the hospital team consisted of
officers, enlisted men, and nurses who had had previous experience with mental and nervous dis-
eases. The unit trained at Camp Crane until May 17, 1918, when it proceeded by rail to the port of
embarkation in Hoboken, New Jersey. The unit set sail from Ellis Island on May 18, 1918. Traveling
via England, they finally arrived at their destination of La Fauche, France, on June 16, 1918. La
Fauche, a village southeast of Paris in the foothills of the Vosges Mountains, was a mere 30 miles
from the front lines. The base hospital group included five civilian reconstruction aides, among the
first to arrive in France. The group of reconstruction aides in occupational therapy consisted of Mrs.
Clyde McDowell Myres, who had volunteered at Blackwell’s Island and worked at Bloomingdale
Hospital for mental patients; Amy Drevenstedt, who taught the History of Art at Hunter College;
Corrine Dezeller, who taught woodworking to exceptional children in a New York City public
school; Laura LaForce, a graduate nurse who taught basket making and weaving in New York City
Hospital for Children; and Eleanor Hope Johnson, a psychologist (Johnson, 1945; Myers, 1948).
Mrs. Myres, a 43-year-old widow,
was placed in charge of the aides.
In time, additional reconstruction
aides in occupational therapy were
sent to work at Base Hospital No.
117 (Figures 3-5 and 3-6).
Predicting that there would be
a lack of tools and supplies avail-
able in France, these women had
gathered what they could in the
United States, including hammers,
saws, soldering irons, pliers, files,
looms, yarns, paints, and brushes.
On arriving in La Fauche, and with Figure 3-6. Bird’s eye view of Base Hospital No. 117.
64 Chapter 3

building supplies in short

supply, they set up shop,
making use of discarded
materials such as trashed
beds and wooden boxes
to make work and seating
areas. Luckily, a short time
after the initial workshop
was set up, a representative
of the Red Cross arranged
for a new Red Cross hut
and occupational therapy
workshop outfitted with Figure 3-7. Red Cross hut and occupational therapy workshop at Base Hospital
new tools (Myers, 1948; No. 117.
Schwab, 1919) (Figure 3-7).
The soldiers suffering psy-
chological and physical effects (e.g., hysterical paralysis, tics, tremors) of war neuroses participated
in a range of activities such as wood carving, metal work, weaving, painting, sketching, building
the base hospital roads, and farming (Schwab, 1919). Recovering soldiers engaged in tinsmith-
ing, where they made tin candlesticks, flower holders, cookie cutters, toys, ashtrays, and other
creative products. With limited supplies,
the reconstruction aides made use of trash
such as empty tin cans for construction of
craft projects (Myers, 1948). Mrs. Clyde
Myres, called Mother Myres by the soldiers,
recalled the endless supply of empty tin cans
used for craft projects in the occupational
therapy workshop (Dallas Woman’s Work,
1958; Thatcher, 1919, pp. 9-11). Although
the work of the soldiers in the occupation-
al therapy workshop produced numerous
types of craft projects, Mrs. Myres firmly
believed that “the great thing fashioned in
Figure 3-8. Soldiers making toys and other creative objects that shop was not toy or souvenir, but steadi-
out of tin cans.
ness of hand, power of concentration, ability
to make manual and moral adjustments,
and renewal of self-confidence and courage”
(Myres, 1919, p. 138) (Figures 3-8 and 3-9).
Initially, Dr. Salmon had difficulty con-
vincing the military authorities that this
type of therapeutic service was needed;
however, once the reconstruction aides
arrived, the workshop at Base Hospital No.
117 was an immediate success. In addition
to observation of improved troop morale
and increased participation in occupations,
reports indicated that 93% of soldiers admit-
ted to Base Hospital No. 117 were returned
Figure 3-9. Tin Army truck made entirely of tin cans. to duty, with 20% returning to field duty.
Only 7% were sent home to the United States
(Thayer, 1919). Meta Anderson, one of the
 World War I: 1917 to 1920s 65

reconstruction aides assigned to Base Hospital No. 117, described the activities at the workshop
as follows:
The workshop was considered a sort of specialized therapy directed to a more definite end,
planned to treat some definite symptom or to meet some special indication, while the other work
was regarded as a kind of therapeutic background underlying the whole scheme of curative effort.
The physiological and psychological needs were met by the use of muscular effort in the produc-
tion of tangible articles. The handling of the tools and the various movements of sawing, nailing,
screwing, and hammering, and the finer and more coordinated movements of wood carving,
metal work of various kinds, weaving, and tinning as well as much more delicate and more emo-
tionally inspired technique of painting, sketching, and printing, supplied the essential training
that the paralysis, tremors, and other symptoms needed (McDaniel, 1968, p. 90).
Dr. Salmon sang the praises of occupational therapy. In August 1918, he sent a request for
more occupational therapists, writing, “The Reconstruction Aides, especially those working in
handicrafts, are worth their weight in gold” (McDaniel, 1968, p. 85; Myers, 1948). Dr. Salmon
maintained his supportive relationship with the profession of occupational therapy after the war
ended, frequently speaking at state and national association meetings. Sadly, occupational therapy
lost a strong advocate when Dr. Thomas Salmon was lost in a sailing accident in 1927.

Orthopedic Services
In the summer of 1916, the orthopedic section of the American Medical Association (AMA)
and the American Orthopedic Association (AOA) formed committees to study the preparedness of
the United States to provide orthopedic services in the event of war. The committees were charged
with determining the needs of orthopedic hospitals with regard to equipment and supplies as well
as a plan to reconstruct or rehabilitate disabled soldiers (Lynch et al., 1923, p. 424). Both commit-
tees were chaired by Dr. Joel E. Goldthwait of Boston (Crane, 1927, p. 3; Goldthwait, 1917a; Orr,
1921, p. 12). Goldthwait was commissioned as a major in the Medical Reserve Corps of the United
States Army in May 1917 and sent to Europe to study the provision of orthopedic services by the
British Army (Crane, 1927, p. 4). His brother-in-law, Dr. Herbert J. Hall, provided occupational
therapy services at Devereaux Mansion, a home that had belonged to the Goldthwait family for
generations.
During World War I, the Canadian government was one of the first to accept responsibil-
ity for the reconstruction, rehabilitation, and re-education of disabled soldiers and sailors. Dr.
Goldthwait was among the first in the United States to advocate for a similar commitment. In view
of humanitarian and economic considerations, Goldthwait argued that it was important to provide
not only acute medical care to save lives but also reconstruction services to help disabled soldiers
and sailors lead productive lives again. Through reconstruction, injured soldiers and sailors
might return to active military duty, or, if not able to return to active duty, reconstruction would
enable disabled soldiers or sailors to learn new occupations and vocations. Rather than remaining
dependent on others and deteriorating mentally, these injured soldiers and sailors could become
productive citizens leading full lives.
Goldthwait asserted that providing occupation to disabled soldiers in curative workshops
would help “lessen the monotomy” experienced during long periods in recovery and, if the occu-
pation were carefully selected and graded, it would provide a “distinct benefit to the affected
part” (Goldthwait, 1917b, p. 682). Goldthwait maintained that using an injured extremity in an
occupation helps to “stimulate circulation and general tone”; for example, for a patient who has a
stiff wrist, “the use of a carpenter’s plane will necessitate the use of the fingers as well as the use
of the wrist” (Goldthwait, 1917b, p. 683). Repeated strokes of the plane can encourage increased
movement (Goldthwait, 1917b, p. 683). Dr. Goldthwait hand-selected the orthopedic surgeons for
Base Hospital No. 9 in Chateauroux, France. Base Hospital No. 9 became the orthopedic center
of the American Expeditionary Forces (Brown, 1920, p. 73). In August 1918, 13 reconstruction
66 Chapter 3

aides in occupational ther-

apy arrived to work at Base
Hospital No. 9 (Hoppin, 1933,
p. 51) (Figure 3-10).
Dr. Elliott Brackett agreed
that engagement in an occu-
pation to prevent “mental
inertia” kept soldiers in a
better mental state for recov-
ery and return to function
and that the physical ben-
efit of mobilization of joints
and using muscles facilitated
return to function (Brackett,
1919, p. 163). Brackett recog-
nized that special knowledge
Figure 3-10. Fourth of July celebration on the grounds of Base Hospital No. 9
was needed to provide care- in Chateauroux, France.
fully selected occupations
and specially adapted tools
for exercise that focused on making a tangible end product (Brackett, 1919). Brackett maintained
that “the effect of a distinct occupation on these men, who are necessarily detained in medical
institutions for protracted periods, sometimes for many months, is seen in the eagerness and in the
quickness with which they take up their occupation after their discharge” (Brackett, 1919, p. 166).
Colonel Brackett started an occupational therapy program at Walter Reed General Hospital in
February 1918 as an experiment. This experiment was designed as a model program to determine
the standards for an occupational therapy shop and school. Major Bird T. Baldwin, a psychologist,
was named the director. The goal of occupational therapy was to assist each patient with improv-
ing physical function, making him self-reliant and self-respecting and enabling him to work to
contribute to society economically.
The Department of Occupational Therapy consisted of five sections: (1) an administrative sec-
tion, (2) a psychological and statistical section, (3) a general or academic section, (4) a technical
section, and (5) a recreational section. The psychological section was responsible for complet-
ing evaluations on the patients. These evaluations consisted of interviews, surveys, psychologi-
cal tests, vocational surveys and tests, and measurements of movement. The technical section
provided vocational training and craft activities, including “chair caning, cardboard construc-
tion work, woodwork, block printing, rush seating, brush making, bookbinding, modeling, rug
making, stenciling, mop making, designing post cards, plasticine modeling, drawing, leather
work, hand knitting, rake knitting, frame knitting, machine knitting, weaving, basketry, bead
work, making colonial mats, netting, cord work, crocheting, and embroidery” (Baldwin, 1919b;
Crane, 1927, pp. 91-97).
Baldwin was one of the first to advance the use of the biomechanical model in occupational
therapy. When using the biomechanical model, treatment activities were selected based on spe-
cific, repetitive movements required by the activity—movements that would increase range of
motion and strength. The activities were also selected based on one of the tenets of occupational
therapy: engaging occupations, including play, activities of daily living, and work activities, are
most effective to improve function. An advantage of using carefully selected activities was that
“the patient’s attention is repeatedly called to the particular remedial movements involved; at the
same time the movements have the advantage of being initiated by the patient and of forming an
 World War I: 1917 to 1920s 67

integral and necessary part of a larger and more complex series of motions,” in contrast to pas-
sive mechano-therapy, which usually focused on individual movements (Baldwin, 1919a, p. 5).
Baldwin developed an apparatus to measure joint range of motion (now known as a goniometer).
This apparatus was modified to measure motion of various joints. Measurements were taken at
regular intervals to record progress and to document the effectiveness of occupational therapy.
By monitoring these regular assessments, patients were provided with hope and motivation for
recovery (Baldwin, 1919a, pp. 11-15).
A school was started at Walter Reed in 1918 to train the reconstruction aides in occupational
therapy. The curriculum included lectures and practical experience under the supervision of more
experienced aides. The school’s existence was short lived. First, the planned start of the school was
delayed by the influenza epidemic. Then, the school was discontinued in late 1918 when the armi-
stice was signed (Baldwin, 1919b). Still, many of the aides who gained experience at Walter Reed
went on to serve in general and base hospitals in Europe and United States.

Tuberculosis Care
Tuberculosis was a significant public health problem during World War I. Concerned about
the spread of this infectious disease through the troops, the Medical Department of the Army
set out to examine 1.2 million soldiers for the disease. By March 1918, they recommended the
discharge of 9,600 diagnosed with tuberculosis. Of the 2 million men who were drafted for the
service after the end of March 1918, 12,500 were found to have tuberculosis and were not accepted
for service (Lynch et al., 1923, p. 373). From September 1917 through June 1919, there were 1,600
military deaths attributed to tuberculosis (Lynch et al., 1923, p. 377). By 1922, compensation was
given to more than 36,000 World War I veterans who contracted tuberculosis while in the service
(Drolet, 1945).
The Medical Department established nine special hospitals for soldiers with tuberculosis, select-
ing sites in areas where the climate was thought to be favorable for recovery (Crane, 1927, p. 192).
Between December 1918 and April 1919, a total of 10,036 soldiers suffering from pulmonary
tuberculosis were registered for educational work (including occupational therapy), second only to
soldiers with orthopedic injuries, who numbered 17,062 (Crane, 1927, p. 261). Prior to World War I,
occupational therapy was incorporated into treatment programs of a number of tuberculosis sana-
toriums, such as Arequipa Sanatorium in California, which embraced Herbert J. Hall’s work cure.
The work of reconstruction aides in occupational therapy with soldiers with tuberculosis solidified
the role of occupational therapy in treatment for patients with tuberculosis.
Patients with tuberculosis were classified by physical condition. Reconstruction aides in occu-
pational therapy provided graded activities, under medical supervision, based on this classifica-
tion. Class D patients had extensive inactive lesions and persistent temperatures above 99° and
were confined to bed. These patients were provided with bedside handicrafts such as knitting,
embroidery, crocheting, and raffia weaving. Class C patients had dyspnea, excessive coughing, and
extensive inactive lesions and also participated in bedside handicrafts, although for longer periods
of time. Class B patients with little evidence of active disease and participated in workshop activi-
ties and outdoor activities such as carpentry, wood carving, plumbing, gardening, and automobile
repair. Class A patients had no evidence of active disease and participated in graded work activities
to facilitate return to full work (Crane, 1927, pp. 189, 192-194).
68 Chapter 3

Recruitment of
Reconstruction Aides in
Occupational Therapy
Qualifications
Initially, the military sought candidates for reconstruction aides in occupational therapy with
the following qualifications:
Good teachers, knowledge and skill in the (specific) occupation to be taught, attractive,
and forceful personality, teaching ability, sympathy, tact, judgment, [and] industry.” By
June 1918, hospital training was required. Additionally, candidates needed to be United
States citizens, 25-40 years of age, 60-70 inches in height, between 100 and 195 pounds,
and have the ability to pass the Army Nurse Corps physical exam. (Haggerty, 1918;
McDaniel, 1968, p. 72) (Exceptions to the age range were made on occasion.)
Both single and married women were eligible to apply; however, if appointed, married
women were primarily assigned in the United States. By August 1918, to ensure higher standards
and competence, graduation from a secondary school was required. Applicants who gradu-
ated from normal school or college with comparable technical training were given preference
(Haggerty, 1918; McDaniel, 1968, p. 72).

Classification and Salaries

Reconstruction aides in occupational therapy were selected by the Surgeon General’s Office and
issued a letter of appointment. Generally, appointments were made for the duration of the war. The
reconstruction aides were considered civilian employees and had no military status. There were
two classes of occupational therapy aides: those working with patients with orthopedic injuries
and those working with patients with war neuroses. The starting salary was $50 per month for
regular aides and $65 per month for head aides. Overseas duty warranted an additional $10 per
month. Reconstruction aides were provided with meals, lodging, and laundry. An allowance of
$62.50 per month was allowed if meal, lodging, or laundry was not available. Travel allowances
were also provided (Haggerty, 1918; McDaniel, 1968, p. 72).

Uniforms
Reconstruction aides were required to have a street uniform and a hospital uniform. The Red
Cross supplied uniforms to those reconstruction aides who were going overseas (Figure 3-11). The
street uniform was a dark gray Norfolk suit with a dark brimmed hat. The hospital uniform was
a belted blue chambray dress with detachable white collars and cuffs covered by a white butcher’s
apron (Figures 3-12 to 3-14). The uniform was often described by reconstruction aides as less than
attractive. Reconstruction aide Lena Hitchcock opined that “some misguided male in the Surgeon
General’s office designed our hideous street uniforms” (Hitchcock, n.d., p. VIII).
 World War I: 1917 to 1920s 69

Figure 3-11. Instructions for reconstruction aides—overseas service re: obtaining required clothing.
(Printed with permission from the Archive of the American Occupational Therapy Association, Inc.)
70 Chapter 3

Figure 3-12. Reconstruction aide in Figure 3-13. Reconstruction aide in

occupational therapy Mildred Pierce occupational therapy Mildred Pierce
in a street uniform. (Printed with in a hospital uniform. (Printed with
permission from the Archive of the permission from the Archive of the
American Occupational Therapy American Occupational Therapy
Association, Inc.) Association, Inc.)

Experiences of
Reconstruction Aides in
Occupational Therapy
Reconstruction aides came from many different areas of the country and had a variety of expe-
riences and backgrounds. Whereas some reconstruction aides had experience in health care and/
or craftwork, some were just out for the adventure of traveling and working in a new profession.
Reconstruction aides were assigned to general hospitals (Figure 3-15, Sidebar 3-4) in the United
States and to base hospitals in Europe (Figure 3-16, Sidebar 3-5). Initially, reconstruction aides
were not well received at military hospitals because the nature of the work was not understood
or appreciated. Further, it was believed that the presence of these women would be disruptive.
This was quickly debunked as the reconstruction aides proved their
worth (Crane, 1927, p. 81). The worldwide influenza pandemic of 1918
resulted in a significant number of civilian and military deaths. The
influenza outbreaks and other illnesses often required reconstruction
aides to work as nursing assistants, caring for the sick rather than
providing therapeutic activities (Crane, 1927, p. 64). Reconstruction
aides at Base Hospital No. 8 in Savenay, France, were often assigned Figure 3-14. A reconstruc-
tion aide pin that belonged
to make plaster bandages and gauze dressings for the injured soldiers to Winifred Brainerd, OTR.
(Crane, 1927, p. 72). (Copyright © Dr. Lori T.
Andersen.)
 World War I: 1917 to 1920s 71

Figure 3-15. Selected general, base, camp, and other hospitals in the US where reconstruction aides worked.

SIDEBAR 3-4
Selected General, Base, Camp, and Other Hospitals in the US
Atlanta, GA - Camp Gordon Lakewood, NJ - General Hospital No. 9

Atlanta, GA - Fort McPherson, General Hospital No. 6 Little Rock, AR - Camp Pike

Ayers, MA - Camp Devens Louisville, KY - Camp Zachary Taylor

Baltimore, MD - Evergreen ‒ Roland Park, General Hospital No. 7 New Haven, CT - General Hospital No. 16

Baltimore, MD - Fort McHenry, General Hospital No. 2 Oswego, NY - Fort Ontario, General Hospital No. 5

Bayard Station, NM - Fort Bayard Oteen, NC - General Hospital No. 19

Bergen County, NJ - Camp Merritt Pierce County, WA - Camp Lewis

Biltmore, NC - General Hospital No. 12 Pittsburgh, PA - Parkview Station, General Hospital No. 24

Boston, MA - Parker Hill, General Hospital No. 10 Plattsburg, NY - Plattsburgh Barracks, General Hospital No. 30

Buffalo, NY - Fort Porter Pocantico Hills, NY ‒ Eastview, General Hospital No. 38

Cape May NJ - General Hospital No. 11 Prescott, AZ - Whipple Barracks, General Hospital No. 20

Carlisle, PA - Carlisle Barracks Rahway, NJ ‒ Colonia, General Hospital No. 3

Chicago IL - Fort Sheridan, General Hospital No. 28 Rockford, IL - Camp Grant

Chillicothe, OH - Camp Sherman San Diego County, CA - Camp Kearney

Columbia, SC - Camp Jackson San Antonio, TX - Camp Travis

Denver, CO - Fitzsimmons General Hospital, General Hospital No. 21 San Antonio, TX - Fort Sam Houston, General Hospital No. 1

Des Moines, IA - Camp Dodge San Francisco, CA - Letterman General Hospital, at the Presidio

Des Moines, IA - Fort Des Moines, General Hospital No. 26 Spartanburg, SC - Camp Wadsworth, General Hospital No. 42

Detroit, MI - Ford Hospital, General Hospital No. 36 St. Louis MO - Jefferson Barracks, General Hospital No. 40

Fort Oglethorpe, GA - General Hospital No. 14 St. Paul, MN - Fort Snelling, General Hospital No. 29

Hampton, VA - General Hospital No. 43, Debarkation Hospital No. 51 Staten Island, NY - Fox Hills, General Hospital No. 41

Indianapolis, IN - Fort Benjamin Harrison, General Hospital No. 25 Suffolk County, NY - Camp Upton

Kalamazoo, MI - Camp Custer Washington, DC - Walter Reed General Hospital

72 Chapter 3

Great Britain

Germany

Coblenz

Paris
Savenay
Angers
LaFauche
Beau Desert

Nantes

Cháteauroux

France

Figure 3-16. Selected base, camp and evacuation hospitals in Europe where reconstruction aides worked.

SIDEBAR 3-5
Selected Base, Camp, and Evacuation Hospitals in Europe
Angers, France - Base Hospital No. 85 Chateauroux, France - Base Hospital No. 9

LaFauche France (Neuropsychiatric Service) - Base Hospital No. 117 Savenay, France - Base Hospitals No. 8, No. 69, No. 88

Beau Desert, France - Base Hospitals No. 14, No. 114, No. 121 Coblenz, Germany - Evacuation Hospitals No. 16, No. 27

Nantes, France - Evacuation Hospital No. 31 Savenay, France (Neuropsychiatric Service) - Base Hospital No. 214

The reconstruction aides who went overseas with the American Expeditionary Forces were
often put in harm’s way. Two reconstruction aides in occupational therapy told of harrowing times
traveling to France via Liverpool, England. Mrs. Clyde Myres’ ship performed evasive zig-zag
maneuvers toward the end of its transatlantic voyage to avoid being torpedoed by a submarine
(Myers, 1948). Twenty-nine-year-old Lena Hitchcock sailed to Europe on the British ship Walmer
Castle, fortunately surviving a submarine attack (Hoppin, 1933, p. 51) (Figure 3-17, Figure 3-18).
Eva McLagan (Mrs. Burrell B. Mink) of Drain, Oregon, a reconstruction aide in physiotherapy
who was assigned to a base hospital in France, described the devastation of war:
The work of salvaging was not yet complete, and to unaccustomed eyes, the desolation
was almost unbelievable. Where graveyards had been blown up by explosives, human
bones, partly clothed in some instances, were lying about, and the earth pock-marked by
a mass of deep shell holes. Heaps of barbed-wire entanglements, wrecked tanks, piles of
scrapped war machinery were in evidence, and as we followed along the line of advance,
piles of bricks marked the places where houses had been. (Hoppin, 1933, p. 70)
Space was limited in hospital facilities, so the occupational therapy rooms and curative work-
shops were often confined to corners of small rooms. These areas were often converted to hos-
pital rooms when convoys of injured soldiers arrived. Limited equipment and supplies required
 World War I: 1917 to 1920s 73

Figure 3-17. The Walmer Castle, the British ship that reconstruction aide Lena Hitchcock sailed on,
was one of the dazzle ships painted with a geometric pattern as a camouflage. This camouflage
made it difficult for German warships to determine the speed and direction of these dazzle ships.

reconstruction aides to be resourceful in finding materials, at times using personal funds to pur-
chase supplies. Stationed at Base Hospital No. 9 in Chateauroux, France, Lena Hitchcock described
the state of affairs there:
We were sent to Base 9, Chateauroux, where we were not at first wanted …. At first we
did nothing but Nurses’ Aide duty, gradually working in as O.T.s, salvaging tin, wood
(cigar boxes), old linen (which we dyed), and other materials from the dump heap. Our
community box containing tools and materials had disappeared in transit. I had taken
wood tools, leather tools, nut picks, and a small bead and bed loom in my trunk. These
tools we copied in the blacksmith shop, begged others from the Engineers and Aviation
Camp nearby, and out of our own pockets bought the necessary things and materials.
(Hoppin, 1933, p. 51) (Figure 3-19)
Hitchcock reported that although initially scorned, the reconstruction aides soon gained the
respect of the military (Figures 3-20 to 3-23):
We never received any money for materials from the Government the entire time my
group worked overseas yet the work turned out in spite of obstacles, was of a very high
order, and on the strength of the good achieved by this small group of O.T.s, curatively
and by way of morale—after an inspection by the Chief Surgeon of the A.E.F., General
Ireland, Dr. Goldthwait was permitted to cable home for additional aides. (Hoppin,
1933, p. 51)
Ward work included knitting, simple weaving, block printing, bead work, wood carv-
ing, leatherwork, embroidery, plaques, tiles, worsted and raffia work on canvas, and bead-
ing. Shop work included tin work, brass work, and wood carving. Proceeds from the sale of
products were often used to buy more supplies. Initially confined to ward work, reconstruction
aides were gradually allowed to run classes in the curative workshops. Given one free afternoon
each week, the reconstruction aides often spent this time shopping for the patients in the nearby
village of Chateauroux. Sunday was a day of rest for all (Crane, 1927, p. 68-69).
The spirit, sense of adventure, and humor of these pioneers in occupational therapy are evident
in a number of accounts given by reconstruction aides (Carlova & Ruggles, 1961; Hoppin, 1933). Ora
Ruggles, a reconstruction aide in occupational therapy, credits her pioneering spirit to her parents,
who settled in western Nebraska in the late 1800s (p. 14). Ora was recruited to serve as a reconstruc-
tion aide and was assigned to Fort McPherson in Georgia, where she worked with soldiers with
tuberculosis and those who had undergone amputations. Her arrival at Fort McPherson was met with
resistance by doctors and officers, who believed that she would not be able to do any good for the sol-
diers (p. 51). Undeterred, Ora set about developing an occupational therapy program but soon ran into
74 Chapter 3

Figure 3-18. Lena Hitchcock’s letter of appointment as a reconstruction aide. The letter is signed by
Marguerite Sanderson, Supervisor of Reconstruction Aides. Miss Sanderson, a physical therapist, was a
former employee of Dr. Joel Goldthwait. (OHA 97: Angier and Hitchcock Collection. Otis Historical Archives,
National Museum of Health and Medicine.)

another roadblock: a lack of crafts supplies. Determined, resourceful, and rebellious, she worked
around Army red tape to find a source for the supplies (p. 54).
Frances Lafaye Locke of Fort Lyon, Colorado, described the camaraderie among the aides and
the hardships they endured:
Sent to Camp Travis, January 15, 1919 …. We lived in a long dormitory and none of
us got much sleep. There was always someone coming in and we all got up to listen
to their experiences …. It was an adventure. We never thought that getting up before
 World War I: 1917 to 1920s 75

Figure 3-19. Reconstruction aide Lena Hitchcock providing bedside occupation

therapy to a soldier at Base Hospital No. 9 in Chateauroux, France. The soldier,
having lost his right arm in battle, is using a one-handed loom. (OHA 97: Angier
and Hitchcock Collection. Otis Historical Archives, National Museum of Health and
Medicine.)

daylight in a cold room, your shoes so damp that they were hard to get on, and poor
food were hardships. (Hoppin, 1933, p. 63)
Eunice M. Cates of Aspinwall, Pennsylvania, spoke humorously of her dedication to her work:
On my tombstone (if one should be erected in my memory) I expect the inscription
to read something like this: ‘Eunice M. Cates, Faithful Unto Death—A Re-Aide O.T.,’
while, instead of the symbolic cross and crown, the angel will hold in one hand a
leather pocketbook, a reed tray or a pair of book ends, perhaps, in the other—‘Form
1216.’ (Hoppin, 1933, p. 24)
The reference to Form 1216, a change of address form, is apparently a reference to her many
moves while in service. This humorous request was not fulfilled; Eunice M. Cates’ tombstone only
includes her name, year of birth, and year of death.
Marie E. Ryan (Mrs. Meredith B. Murray) of River Forest, Illinois, also spoke of numerous relo-
cations while serving, some due to the closing of hospitals as patients were discharged:
Entered the Army March 15, 1919 …. Ordered to Ft. Oglethorpe; helped to organize
school there. Hospital closed in June. Ordered to Parker Hill, as Head Aide; found
it closed and after a skirmish trying to get straightened out ordered to Plattsburg
Barracks to stay until it closed in September. Then to Colonia for a brief six week; off
again when it closed to Fort Bayard where I had charge of Ward and School academic
work. Stayed until it was taken over by P. H. in June 1920…. (Hoppin, 1933, p. 88)
Helen Bradley, a reconstruction aide in physical therapy from Kansas City, Missouri, shed
some light on how reconstruction aides in occupational therapy were regarded. She traveled with
a group of reconstruction aides in physical therapy to Fort Sam Houston in San Antonio, Texas:
It was only after they got to the old Army post that the high pitch of their enthusiasm
was dropped and then not for long. No one from the C.O. to the Chief Nurse had
expected them. One good looking young lieutenant said he’d heard of them—that
they taught the boys to make little baskets. And that idea was so fixed in the doctors’
minds that they were most disappointed, and felt that these PT girls should at least
76 Chapter 3

try to do OT work. It was some time

before the first of the OTs arrived and
the PTs were awfully glad to see them
and to help share the problems with
which they were confronted (Hoppin,
1933, p. 17).

War Emergency
Schools
Although occupational therapy was
not an entirely new profession, but rath-
er one that “gradually developed by jus-
tifying itself over a long period of years”
(Upham, 1918, p. 48), no standard qualifi-
cations for people providing occupational
therapy nor standards for length or content
of courses had been set. The Chicago School
of Civics and Philanthropy, the Henry B.
Favill School, the program at Teachers
College of Columbia University, and the
school at Sheppard and Enoch Pratt were
Figure 3-20. Reconstruction aides in occupational therapy at a few of the programs and schools offering
Base Hospital No. 9, Chateauroux, France. Pictured from left training for occupational workers. At the
to right are Louise L. Green, Hope Gray, Susan Hills (center), inaugural meeting of NSPOT, the founders
Elizabeth Melcer, Lena Hitchcock, and Daphne Dunbar. decided that membership would be restrict-
ed to those with certain qualifications and
knowledge to ensure a therapeutic focus. To this end, a teaching committee was appointed to
establish standards for education and training; however, the war broke out prior to completion of
their charge.
After the Surgeon General’s Office called for reconstruction aides in occupational therapy,
several war emergency courses were established. The call for these aides offered an opportu-
nity for a number of schools and pro-
grams to develop programs and enroll
students. However, with the lack of set
standards, there was no quality control
on the training. To seek legitimacy in
enrolling students, many of these schools
and programs sought the approval of
the Surgeon General’s Office (Russell,
1918). The Surgeon General’s Office ini-
tially approved the program at Teachers
College, Columbia University, directed
by Susan Cox Johnson; the Boston School
of Occupational Therapy, directed by
Mrs. Joel Goldthwait; the War Services
Classes in New York City, directed by Figure 3-21. Reconstruction aides making preparations in
Mrs. Howard Mansfield (Figure 3-24); the occupational therapy workshop at Base Hospital No. 9,
and the program at Walter Reed Hospital Chateauroux, France.
 World War I: 1917 to 1920s 77

Figure 3-22. Class in occupational therapy at Base Hospital No. 9 in Chateauroux, France.

Figure 3-23. Occupational therapy in the hospital garden at Base Hospital No. 9 in
Chateauroux, France.

(Crane, 1927, p. 59; McDaniel, 1968, p. 76). In January 1918, the Surgeon General’s Office offered
guidance for the development of a curriculum to train reconstruction aides in occupational ther-
apy. The suggested curriculum described a basic 10-week course that included 310 hours in craft
work, including weaving, wood carving, woodworking, basketry, bookbinding, and leatherwork.
By September 1918, the Surgeon General’s Office recognized that the suggested curriculum needed
to be expanded to include more time and course work in medical disorders, hospital practice, and
theory to ensure that reconstruction aides in occupational therapy had the knowledge and skills
to work with injured and ill soldiers (McDaniel, 1968, pp. 75-76).
In April 1918, James E. Russell, the Dean of Teachers College, Columbia University, was named
as head of the Education Section in the Division of Physical Reconstruction (Crane, 1927, p. 45).
One of the first tasks he encountered was handling the large number of requests for approval of
war emergency curriculums for reconstruction aides in occupational therapy. With a lack of staff
to review such requests and no solid information about training/educational standards and stan-
dard qualifications, he suspended the Surgeon General’s Office involvement in any recognition or
78 Chapter 3

Figure 3-24. Draft of a bulletin recruiting students for Mrs. Howard Mansfield’s
war emergency course. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)
 World War I: 1917 to 1920s 79

certifications. He appealed to the National Society for the Promotion of Occupational Therapy to
develop standards for training schools to assist the Surgeon General’s Office in finding qualified
candidates (Russell, 1918).

War Emergency Courses

and Pioneer Schools
Many of the war emergency courses and early pioneer schools had short lives. The schools
that survived the early years and later became accredited schools include the Boston School
of Occupational Therapy, the school at Milwaukee-Downer College, the St. Louis School of
Occupational Therapy, and the Philadelphia School of Occupational Therapy.

Boston School of Occupational Therapy

In 1918, General Gorgas, in consultation
with Colonel Elliott G. Brackett, formed a
committee to set up a training school for
reconstruction aides in occupational therapy.
Notable members of the committee included
Herbert J. Hall; Mrs. Joel Goldthwait, wife
of Dr. Joel E. Goldthwait and sister-in-law of
Herbert Hall; and Miss Minnie Brackett, Dr.
Elliott Brackett’s sister. The committee estab-
lished the Boston School of Occupational
Therapy and became the first board of trust-
ees. Mrs. Joel Goldthwait served as chairper-
son of the school (McDaniel, 1968, p. 76). The
committee developed a 12-week curriculum
that included “training in simple crafts and
lectures on hospital procedure,” in spite of
the Army’s desire for a shorter 8-week cur-
riculum to quickly meet the urgent need
(Robinson, 1943, p. 2). All 123 women who
completed the program served in a military
hospital. Open for about 12 months, the
school closed its doors when the war ended
and the emergency was over (Robinson,
1943, pp. 1-2) (Figure 3-25).
Recognizing the benefit of occupa-
tional therapy and the civilian popula-
tion’s need for occupational therapy ser-
vices, the school was reopened in the fall
of 1919 with Miss Ruth Wigglesworth and
Mrs. John (Marjorie) Greene as directors.
When Miss Wigglesworth left in 1924 to
get married, Mrs. Greene, secretary of the
original Boston School of Occupational
Therapy, became the sole director. The cur-
Figure 3-25. Boston School of Occupational Therapy recruit-
riculum was expanded to 12 months, includ- ment poster. (Printed with permission from the Archive of the
ing 3 months of practical work experience American Occupational Therapy Association, Inc.)
80 Chapter 3

under supervision to more fully prepare graduates. The first 9 months were dedicated to medical,
social science, and craft work. Anatomy, kinesiology, physiology, psychology, social service lec-
tures, and instruction in a number of crafts were included in the curriculum. Students learned
about principles and theories of occupational therapy, ethics, and record keeping. Practical work
consisted of experiences in settlement houses, psychopathic hospitals, tuberculosis hospitals, gen-
eral hospitals and district work. In particular, the work in settlement houses was deemed important
for students “to learn of the actual home and community life, habits, and traditions of the various
nationalities that make up America” (Greene & Wigglesworth, 1921, p. 568; Robinson, 1943). The
Boston School of Occupational Therapy is now part of Tufts University.

Milwaukee-Downer College
In September 1918, at the urging of Elizabeth Greene Upham Davis, Milwaukee-Downer
College opened an 18-week war emergency course in occupational therapy with Charlotte
Partridge as director. Hilda Goodman from Canada was hired to run the fieldwork program. The
students learned about design and crafts, in addition to having a number of prominent physicians
and specialists provide medical lectures. One-half day per week was spent observing practical
application of occupational therapy concepts in a general hospital setting. Recognizing the need
for occupational therapy beyond reconstruction of soldiers and sailors, Milwaukee-Downer
College continued to offer a course of study in occupational therapy after the war emergency
ended. In 1921, the curriculum expanded to 32 weeks at the graduate level, plus a 12-week affili-
ation. Coursework included physiology (applied anatomy, kinesiology, medical lectures on heart
disease, tuberculosis, and orthopedics), abnormal psychology, and occupational therapy theory
and administration (Partridge, 1921). In 1931, Milwaukee-Downer College offered the first bac-
calaureate degree in occupational therapy (“A step forward in the education,” 1931; Jones, 1988).
The program at Milwaukee-Downer College was discontinued in 1972.

St. Louis School of Occupational Therapy

First known as the St. Louis Training School for Reconstruction Aides, the St. Louis School of
Occupational Therapy started in December 1918 under the direction of the Missouri Association
of Occupational Therapy. The St. Louis chapter of the Junior League, an organization of socially
connected young women, donated $5,000 to help start the school (Medicine in St. Louis Hospital,
1919, p. 3). Initially, Dr. G. Canby Robinson, who was Dean of Washington University School of
Medicine, and Mrs. Elias Michael (nee Rachel Stix), chairperson of the instruction committee of
the St. Louis Women’s Committee of the Council of National Defense, assisted in organizing a
board of trustees for the occupational therapy school. The committee requested Eleanor Clarke
Slagle to review the school plans and curriculum they had developed. Slagle visited the school on
November 7, 1918, approved the plans and curriculum, and recommended a director for the school:
Alice H. Dean, a graduate of the Henry B. Favill School.
In spite of the fact that the armistice ending World War I was signed 4 days later on November
11, 1918, the group continued with plans to open the school, believing that the need for occupa-
tional therapy would continue. The school was renamed St. Louis School of Occupational Therapy
in early December 1918, shortly after the first class started. The curriculum “consisted of 40 hours
of lectures in medical and socio-vocational topics, nine weeks of hospital practice, and nine weeks
of craft classes” (“Occupational therapy in St. Louis,” 2009). Starting in June 1919, the school
was directed by the Missouri Association of Occupational Therapy. In September 1920, program
length increased to 6 months, followed by 3 months of hospital work (Kidder, 1921; Missouri
Association for Occupational Therapy, 1923; Occupational therapy in St. Louis, 2009). The St.
Louis School of Occupational Therapy is now part of Washington University School of Medicine
in St. Louis (Figure 3-26).
 World War I: 1917 to 1920s 81

Philadelphia School of
Occupational Therapy
The Philadelphia School of
Occupational Therapy opened in the
spring of 1918 to educate women for
service as reconstruction aides through
intensive coursework (Quiroga, 1995,
p. 82). In 1921, the school expanded
the length of the curriculum, offering a
9-month course in occupational therapy,
with Florence Wellsman Fulton serving
as the chairperson. Seven months were
spent on campus attending lectures in
anatomy, kinesiology, and personal and
social hygiene. Students also spent a con-
siderable number of hours learning crafts
such as weaving, reed basketry, wood
construction, chair caning, pottery, block
printing, and book binding. Two months
of field experience in general and tubercu-
losis hospital settings and work with the
Visiting Nurse Society followed (Fulton,
1921). For many years, the authors/editors
of the well-known textbook Principles
of Occupational Therapy (later editions
were known as Willard and Spackman’s
Occupational Therapy) were mainstays
of the school. Helen Willard was chair-
person and Clare Spackman served on
the faculty. Eventually the Philadelphia
Figure 3-26. St. Louis School brochure, 1923. (Copyright © Dr.
Lori T. Andersen. Reprinted with permission.)
School became part of the University of
Pennsylvania. The school was discontin-
ued in 1981.

Armistice: November 11, 1918

The process to mobilize for war was far from complete but well under way when the Armistice,
signaling the end of World War I, was signed on November 11, 1918. Prior to the Armistice, few
reconstruction aides were needed in the United States because disabled soldiers and sailors were
not yet returning home in large numbers. With the Armistice, anticipating that wounded and ill
servicemen would now be returning home, the Medical Department of the Army shifted focus
to ensure general hospitals and camp hospitals in the United States were prepared to receive and
care for these men. Reconstruction aides began to return from Europe (Crane, 1927, p. 54). At
the beginning of 1919, there were 1,700 soldiers receiving services under the Bureau of War Risk
Insurance. By the end of the year, 50,000 soldiers had been discharged from military service due to
neuropsychological disorders and another 24,500 due to tuberculosis. With the Armistice and the
change in priorities, the Army set in motion the plan for continued medical care and reconstruc-
tion services to accommodate the influx of returning soldiers. This included setting up general and
base hospitals in the United States (Crane, 1927, p. 249).
82 Chapter 3

Ideally, soldiers and sailors were

to be sent to general hospitals or
camps closest to their homes. Some
of the hospitals were general in
nature, providing services for var-
ied diagnoses. Other hospitals and
camps provided specialized ser-
vices for those with speech defects,
hearing disorders, blindness, and
tuberculosis. Mrs. T. Harrison
Garrett offered her estate Evergreen
in Roland Park, Maryland, to the
government. United States General
Hospital No. 7 in Roland Park pro-
vided rehabilitation for soldiers
Figure 3-27. Reconstruction aides in occupational therapy in uniform who were blinded (Zimmerman,
at Camp Grant, Rockford, Illinois, in April 1919. From left to right are
Carolyn Bean, Otilla Koehler, and Jeannette Moody. (Printed with 1918). Other general hospitals such
permission from the Archive of the American Occupational Therapy as Fort Bayard (Bayard Station) in
Association, Inc.) New Mexico provided care for those
with tuberculosis (Crane, 1927, p. 7)
(Figures 3-27 and 3-28).
Initially, the Medical Department’s projected need for reconstruction aides was significant;
they anticipated the need for 1,000 in 1918 and another 4,000 within the next year (Russell,
1918, p. 115). This changed with the signing of the Armistice. Just as the war effort had gradually
ramped up in 1917, in 1919 it began to ramp down. Instead of being sent overseas to work with the
American Expeditionary Forces, reconstruction aides were assigned to work in general hospitals
in the United States. Reconstruction aides returning from Europe went to general hospitals in the
United States or, if requested, were discharged from military service.
Although the exact number of reconstruction aides in occupational therapy who served is not
known, various reports from World War I give an indication of the numbers. Mrs. Eleanor R.
Wembridge, working in the Surgeon General’s Office as the supervisor of reconstruction aides in
occupational therapy, reported that on January 1, 1919, there were 455 reconstruction aides. Of this
number, 358 were serving in the United States and 97 were serving with the American Expeditionary
Forces (McDaniel, 1968, p. 91). At the end of February 1919, 22 occupational therapy aides were
serving in various base hospitals in France, including Angers, Nantes, and Savenay (Crane, 1927,
p. 66). On April 30, 1919, there were
a total of 1,070 reconstruction aides
serving (Billings, 1920, p. 9), and
by July 1919, there were more than
1,300 in service (Crane, 1927, p. 60).
Soldiers and sailors were dis-
charged to general Army hospitals
and from the military when they
recovered or reached maximum
functional gains. As the census in a
hospital decreased, the hospital was
closed. Many times when a hospital
closed, reconstruction aides were Figure 3-28. Reconstruction aides often used baskets to transport sup-
relocated to a hospital that was plies to hospital wards and patient bedsides. It was a quiet way to trans-
still open. In March 1919, congres- port supplies to the wards and helped maintain a quiet, comfortable
environment for recovery. (Printed with permission from the Archive of
sional action authorized transfer of the American Occupational Therapy Association, Inc.)
 World War I: 1917 to 1920s 83

the general hospitals and medical activi-

ties of the Medical Department of the
Army to the United States Public Health
Service. On June 20, 1919, the Division of
Physical Reconstruction in the Medical
Department of the Army ceased to exist,
and its functions were transferred to the
Section on Physical Reconstruction in the
Division of Hospitals in the United States
Public Health Service (Crane, 1927, p. 50)
(Figure 3-29).
In a time when few women worked
outside the home, many reconstruction
aides in occupational therapy contin-
ued in the workforce after World War I,
Figure 3-29. Helen Willard (holding basket) at Edward Hines some in the hospitals that the Medical
Hospital in Maywood, Illinois, circa 1924. Edward Hines Hospital
was first one of the United States Public Health Service hospitals, Department of the Army had transferred
then part of the Veterans Bureau, and finally part of the Veterans to the United States Public Health Service.
Administration Hospital system. (Printed with permission from A number were discharged from military
the Archive of the American Occupational Therapy Association, service to continue careers, start new
Inc.)
careers, or get married and start families
(Table 3-3; Figures 3-30 and 3-31).
United States Veterans Bureau Act of 1921 (Public Law 67-47) consolidated the benefits that vet-
erans received from various federal agencies, including the War Risk Insurance Bureau, the United
States Public Health Service, and the Federal Board of Vocational Education. With this change,
reconstruction aides in occupational therapy, who first worked for the Medical Department of the
United States Army and then for the United States Public Health Service, finally worked for the
United States Veterans Bureau.

Reflection
The new profession of occupational therapy, beginning to flourish during the Progressive Era,
was further propelled when the United States entered World War I. A spirit of patriotism swept
the country. Many organizations were anxious to help with the war effort, including the new
profession of occupational therapy. The founders reached out to the government to offer services,
believing that participation in the war effort would promote the new profession.
The United States government, recognizing its social responsibility and the economic benefit
to be gained from caring for soldiers disabled in war, passed legislation that provided for recon-
struction services. Although at times it was a political battle, the Medical Department of the Army
worked with a number of other government and private agencies to establish programs for the
rehabilitation of those disabled in war. Several physicians, including Dr. Thomas Salmon, Dr. Joel
Goldthwait, and Dr. Elliott Brackett, advocated for and successfully facilitated the inclusion of
occupational therapy services in base hospitals in Europe and the United States. With this, occu-
pational therapy’s alignment with and sponsorship by the medical profession became solidified.
The Medical Department of the Army created a new category of civilian personnel called recon-
struction aides in occupational therapy to provide rehabilitation services to injured and ill soldiers.
Initially, because of gender issues, the Army was reluctant to hire women as reconstruction aides.
Later, because of lack of manpower and the need to provide care, the Army accepted women in
these positions, at least for the duration of the war. Initially rebuffed, the reconstruction aides
working with the American Expeditionary Forces in Europe, as well as those working in general
84 Chapter 3

Table 3-3
ACTIVITIES OF INDIVIDUAL RECONSTRUCTION AIDES IN
OCCUPATIONAL THERAPY DURING AND AFTER WORLD WAR I
Mrs. Mary L. Abbey of Served in Fort Sheridan…in the spring of 1923, went to Great Lakes Naval Hospital
Chicago, Illinois where 607 ex-service men were hospitalized…
Eleanor Abrams of New Walter Reed. Artist, illustrating covers for the Literary Digest. The Italian Garden,
York City Easter Lilies, and Bermuda Garden were some of the subjects.
Julia Standish Alexander Entered service October 11, 1918. Sailed for France on November 11, 1918.
of New York City Stationed at Savenay, Base No. 8 and Base No. 88, and Mesves, Base No. 24. Sent
to Army of Occupation, Coblenz, April 16, 1919. Stationed at Evacuation Hospital
No. 26, Bad-Neuenahr, Germany. Sailed for U.S. on July 2, 1919. At Fort McHenry,
resigned from service and received discharge October 28, 1919. Other positions
since 1919: O.T. Dept., New York Neurological Institute, N.Y.C. Civil Service, Public
Health Hospitals‒Polyclinic and Marine, Head Aide.
Jennie K. Allen of Carlisle and Camp Bouregard…in charge of O.T. Department at Cook County
Chicago, Illinois Hospital, the largest hospital in the world, and President of the Illinois Ass n of
Occupational Therapy.
Madeleine Ashley (Mrs. Graduate of the Boston School of Occupational Therapy. Stints at Colonia, Camp
John Owen Carter) of Gordon, Fort McPherson, Fox Hills, Polyclinic Hospital (U.S. Public Health Service),
Los Angeles, California U.S. Veteran s Hospital in Bronx, NY, U.S. Naval Hospital in Chelsea, MA … taught
craft work for one year to sub-normal children in one of the Los Angeles Public
Schools…[taught] chair caning and weaving in the State of California Industrial
Work Shop for the Blind, in Los Angeles.
Carolyn Bean of Camp Grant, 1919, and Fort Sheridan…in charge of special service work at
Milwaukee, Wisconsin Mendota State Hospital, Mendota, Wis. (see Figure 3-28).
Mildred Orr Beaton First graduate, St. Louis School of Occupational Therapy. Camp Lee and Oteen.
(Mrs. Calvin Hemingway
Burks) of Charles City,
Iowa
Ethel Bowman of Walter Reed…Chief Aide in charge of O.T. Department…professor of psychology
Baltimore, Maryland at Goucher College, Baltimore, Md.
Belva Cuzzort of Walter Reed, 1918; Fort Sheridan…first president of the National Association of
Washington, DC Ex-Military Aides … 1920 to 1925.
Mabel Corinne Dezeller A.E.F., Base Hospitals 117 and 114, March 4, 1918, to June 1919; Fox Hills, June 1919 to
(Mrs. Henry M. Lucas) of June 1920.
Cleveland Heights, Ohio
Amy Drevenstedt of Head Aide, Coblenz, 1919. Artist and illustrator. Her original greeting cards and
New York City illustrations are well known. (She also served at Base Hospital No. 117.)
Hope Gray of Boston, Appointed June 19, 1918. Base 9, Chateauroux, France, August 5, 1918, to February
Massachusetts 1, 1919. Base 69, Savenay, France, February 1 to February 24, 1919. Base 114, Beau
Desert, near Bordeaux, February 24 to May 11, 1919. Hampton, Va., May 24 to June
14, 1919. Honorable discharge about June 16, 1919 (see Figure 3-21).
Louise L. Green of A.E.F., Base 9, Chateauroux. Head Aide, O.T., Base 8, Savenay, France (see Figure
Detroit, Michigan 3-22).
Susan W. Hills of In 1921 was doing work in O.T. for Dr. Goldthwait of Boston. (O.T. Head Aide at Base
Newton Highlands, Hospital No. 9 in Chateauroux, France [see Figure 3-21].)
Massachusetts
Lena Hitchcock of Walter Reed…Base 9, Chateauroux…Base 114, Beau Desert, Bordeaux (see Figures
Washington, DC 3-16, 3-20, and 3-21).
Nellie Holland of Oak Fort Sheridan, 1919 to December 31, 1920…Edward Hines Jr. Hospital, Hines, Ill.,
Park, Illinois 1921. St. Louis School of O.T., 1924.
(continued)
 World War I: 1917 to 1920s 85

Table 3-3 (continued)

ACTIVITIES OF INDIVIDUAL RECONSTRUCTION AIDES IN
OCCUPATIONAL THERAPY DURING AND AFTER WORLD WAR I
Eugenia Hume of Oteen, 1918 to 1919. Established a department at Decatur, Ga., in the Masonic
Atlanta, Georgia Home for Crippled Children.
Otilla Koehler of Served at Camp Grant (see Figure 3-28).
Davenport, Iowa
Geraldine Lermit of In January 1917, enrolled in a 6-month Bedside Occupations course given at the
St. Louis, Missouri American Red Cross training center. Assigned to Fort Porter, October 1918 to
January 1919, then to Camp Pike. Worked for U.S. Public Health Service at General
Hospital No. 4 in Chicago, then for the US Veterans Bureau Hospital No. 30 in St.
Louis. Director of the Missouri Association for Occupational Therapy and the St.
Louis Training School of Occupational Therapy.
Gracia Loehl (Mrs. Camp Devens…Fort McPherson…Fort Sam Houston…director of O.T. at Glen Lake
Gerald J. Maloney) of Sanatorium, a T.B. institution near Minneapolis.
St. Peter, Minnesota
Jessie Luther of Chief Aide at Butler Hospital, Providence, R. I. (She previously worked with Dr.
Providence, Rhode Herbert J. Hall at the Handcraft Shop in Marblehead, Massachusetts.)
Island
Mary E. Merritt of A.E.F, fall of 1918; Army of Occupation, summer of 1919. Public Health Service and
Westfield, New Jersey Veteran s Bureau; Director of O.T. Department, Bellevue Hospital, N.Y.C.
Marjory Moffatt (Mrs. Camp Custer, February 25 to April 29, 1919; Fort Porter, April 30 to October 24,
Frank F. Spierling) of 1919; Hampton, October 29 to December 6, 1919; Chicago P. H. Hospital, January to
Chicago, Illinois October 1920.
Marie Mohr of Buffalo, Camp Custer, January 13, 1919. Eastview, April 18, 1919. Fort Porter, July 18, 1919.
New York Fort McHenry, October 26, 1919 to April 14, 1920.
Jeannette L. Moody of Served at Camp Grant, February 1919; Colonia, October 1919 to 1922; P.H.S. 41, New
Meriden, Connecticut Haven, Conn., March 1922 to 1924…Special Classes for Mentally Retarded Children,
Meriden, Conn. (see Figure 3-28).
Elizabeth Wells Hospital for Shell-Shocked Soldiers, Magill University, Montreal, Canada, under
Robertson of Highland direction of Invalided Soldiers Com. of Canada, summer of 1918. Head Aide, Fort
Park, Illinois Sheridan…Supervisor of Art, Districts 11 and 12, Chicago.
Harriet Robeson of Camp Custer, Eastview and Colonia, November 1919 to October 1920. Director of
Boston, Massachusetts Aides, P.H.S., Washington, DC…with the State Dept. of Mental Hygiene, N.Y.C.
Ora G. Ruggles of Olive Fort McPherson, 1918…Americanization Dept. of the Los Angeles City School
View, California System.
Meta N. Rupp (Mrs. Camp Upton, January 1 to July 1, 1919. Fox Hills, July 1, 1919 to June 1, 1920.
Humphrey M. Cobb) After discharge, associated with the Amer. O. T. Ass n. (Meta Cobb later became
of Waverly Place, New Executive Director of the American Occupational Therapy Association in 1938.)
York City
Helen Tanquary Smith Mrs. Smith was the first O.T. Aide. She began service at Walter Reed in February
(Mrs. Frank Smith) of 1918…Cape May, January to April 1919…Carlisle, April to July 1919. She now has a
Washington, DC very attractive studio, at 2 Dupont Circle, in Washington. She specializes in lamp
shades, traveling to Europe to procure rare parchments and other unusual materi-
als for her work.
Mary Louise Speed of Served from October 31, 1918, to August 18, 1919. Assigned to Oteen, then in
Louisville, Kentucky Public Health Service, Greenville, South Carolina, then Lake City, Florida. Resigned
in May 1922 to travel in Europe. Received B.S. in Landscape Architecture…Gave
a 10-day course in Garden Making for the Occupational Therapist at the Boston
School of O.T.…writes for garden magazines.
(continued)
86 Chapter 3

Table 3-3 (continued)

ACTIVITIES OF INDIVIDUAL RECONSTRUCTION AIDES IN
OCCUPATIONAL THERAPY DURING AND AFTER WORLD WAR I
Marjorie Taylor of Lakewood.
Milwaukee, Wisconsin,
Milwaukee-Downer
College
Helen Willard of Ambler, Entered the service October 1918. Assigned to Boston for special course in P.T. at
Pennsylvania Harvard Medical School and Children s Hospital. Served at Robert Breck Brigham
Hospital, Parker Hill, from December 1918 to February 1919; Camp Meade from
February to April 1919; Fort Oglethorpe from April to June 1919; Ford Hospital in
Detroit from June to July 1919; and Walter Reed. Discharged from military service
September 1919. October 1920, assigned to Edward Hines Jr. Hospital, Hines, IL, as
Assistant Superintendent of Aides in charge of both physical therapy and occu-
pational therapy departments. In 1923, qualified with Civil Service as Chief Aide in
Occupational Therapy and became Occupational Director as well as Chief Aide in
Physical Therapy (see Figure 3-30).
Elizabeth K. Wise of In 1921 promoted O.T. in Rochester, N.Y., under the Rochester Tuberculosis
Rochester, New York Association. (Elizabeth K. Wise endowed a scholarship for occupational therapy
students.)
Excerpts taken from Laura Brackett Hoppin s book The History of World War Reconstruction Aides, 1933.

Figure 3-30. Photograph from the collection of Lena Hitchcock. Victory Figure 3-31. After World War I, Lena
notes were sold to help pay for the war. [OHA 97: Angier and Hitchcock Hitchcock worked at Walter Reed General
Collection. Otis Historical Archives, National Museum of Health and Hospital; Children’s Hospital in Washington,
Medicine.] DC; and as Director of Occupational
Therapy for the DC Society for Crippled
Children. She also served as President
of the Women’s Overseas League. She
was proud that her experience in occu-
pational therapy had gained her regis-
tration with the American Occupational
Therapy Association. (Photo from Lloyd
Notes and Facts, Volume II, Second Edition,
2010, courtesy of the authors.)
 World War I: 1917 to 1920s 87

and base hospitals in the United States, established the worth of the profession. These reconstruc-
tion aides made great strides toward defining the role of occupational therapy in treatment of
patients with neuropsychiatric problems, orthopedic problems, and tuberculosis. They established
the worth of the profession and made great strides in defining the role of occupational therapy in
the treatment of patients with neuropsychiatric problems, orthopedic problems, and tuberculosis.
The projected need for reconstruction aides in occupational therapy offered opportunities
and economic incentives for schools to develop instructional training programs. Many programs
and schools were established throughout the country, if only temporarily. However, a lack of set
educational standards left many graduates ill prepared to provide occupational therapy services.
This in turn spurred the start of efforts to establish educational standards to ensure competence
of graduates.
The Army was very influential in defining the role of occupational therapy in the early years
of the profession. Part of the Division of Special Hospitals and Physical Reconstruction in the
Medical Department of the Army, occupational therapy was considered a medical service.
Reconstruction aides in occupational therapy worked in a medical model, supervised by physi-
cians who wrote prescriptions for treatment. Occupational therapy was part of the Division of
Special Hospitals and Physical Reconstruction’s Educational Department along with academic
and vocational training and education. There was some confusion between the role delineation
of occupational therapy and vocational trainers in preparing the disabled soldiers and sailors to
return to work. The Division clarified these roles, indicating that occupational therapy provided
prevocational activities to prepare patients for vocational education programs.

References
A step forward in the education of occupational therapists. (1931). Occupational therapy notes. Occupational Therapy
and Rehabilitation, 10, 204-206.
Bailey, P., Williams, F. E., & Komora, P. O. (1929). The Medical Department of the United States Army in the World
War: Volume X: Neuropsychiatry in the United States. Washington, D.C.: U. S. Government Printing Office.
Baldwin, B. T. (1919a). Occupational therapy applied to the restoration of the function of disabled joints. Walter Reed
Monograph printed by the Department of Occupational Therapy, Walter Reed General Hospital. Printed on the
authority of the Surgeon General of the Army.
Baldwin, B. T. (1919b, January 30). Report of the Department of Occupational Therapy: Walter Reed General
Hospital. Tacoma Park, DC: Published by Authority of the Commanding Officer.
Brackett, E. G. (1919, March). Productive occupational therapy in the treatment of the disabilities of the extremities.
Pacific Coast Journal of Nursing, 15(3), 163-167.
Brown, R. S. (1920). Base Hospital No. 9 A.E.F.: A history of the work of the New York hospital unit during two years of
active service. New York, NY: New York Hospital.
Carlova, J., & Ruggles, O. (1961). The healing heart: The story of Ora Ruggles, pioneer in occupational therapy. New
York, NY: Julian Messner, Inc.
Crane, A. G. (1927). The medical department of the United States Army in the World War: Volume XIII: Part One:
Physical reconstruction and vocational education. Washington, DC: U.S. Government Printing Office.
Dallas woman’s work: Craft therapy began at end of first war. (1958, October 15). Dallas Morning News, p. 19.
Douglas, P. H. (1918, May). War Risk Insurance Act. Journal of Political Economy, 26(5), 461-483.
Drolet, G. J. (1945, July). World War I and tuberculosis: A statistical summary and review. American Journal of Public
Health, 35(7), 689-697.
Editorial. (1922). A brief account of the sixth annual meeting of the American Occupational Therapy Association held
at Atlantic City, N.J., September 25 to 29, 1922. Archives of Occupational Therapy, 1(5), 419-427.
Fulton, F. W. (1921). The Philadelphia School of Occupational Therapy. Modern Hospital, 16(6), 572-574.
Greene, M. B., & Wigglesworth, R. (1921). Boston School of Occupational Therapy. Modern Hospital, 16(6), 568-570.
Goldthwait, J. E. (1917a). Correspondence: The orthopedic preparedness of the nation. American Journal of
Orthopedic Surgery, 15(3), 219-220.
Goldthwait, J. E. (1917b). The place of orthopedic surgery in war. American Journal of Orthopedic Surgery, 15(10),
679-686.
Haggerty, M. E. (1918). Where can a woman serve?: A big field is open for reconstruction aides. Carry On, 1(3), 26-29.
88 Chapter 3

Hitchcock, A. L. (n.d.). The great adventure: Being the tale of Hope Gray and Lena Hitchcock: The elephant’s nest, cross-
ing the sea, the A.E.F. and finally the end of the great adventure. Unpublished manuscript.
Hoppin, L. B. (1933). History of the World War reconstruction aides. Millbrook, NY: William Tyldsley.
Jones, J. L. (1988). Early occupational therapy education in Wisconsin: Elizabeth Upham Davis and Milwaukee-
Downer College. American Journal of Occupational Therapy, 42(8), 527-533.
Johnson, E. H. (1945). Reminiscences of World War I: Base Hospital 117. American Journal of Orthopsychiatry, 15(4),
607-620.
Kidder, I. (1921). St. Louis School Occupational Therapy. Modern Hospital, 17(1), 65-67.
Lynch, D., Weed, F. W., & McAfee, L. (1923). The Medical Department of the United States Army in the world war:
Volume I: The Surgeon General’s Office. Washington, DC: United States Government Printing Office.
Manring, M. M., Hawk, A., Calhoun, J. H., & Andersen, R. C. (2009). Treatment of war wounds: A historical review.
Clinical Orthopaedics and Related Research, 467(8), 2168-2191.
McDaniel, M. L. (1968). Occupational therapists before World War II (1917-1940). In R. S. Anderson, H. S. Lee, & M.
L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 69-97). Washington, DC: Office of the Surgeon General,
Department of the Army.
Medicine in St. Louis Hospital. (1919, February 16). St. Louis Post-Dispatch, pp. 3, 13.
Missouri Association for Occupational Therapy. (1923). Bulletin of the St. Louis School of Occupational Therapy. St.
Louis, MO: Author.
Myers, C. (1948). Pioneer occupational therapists in World War I. American Journal of Occupational Therapy, 2(4),
208-215.
Myres, C. M. (1919). The occupational therapist in overseas service, Neuropsychiatric Division. In Proceedings of the
Third Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 133-139). Towson,
MD: Sheppard and Enoch Pratt Hospital.
National Defense Act. (1921). The National Defense Act approved June 3, 1916. Washington, DC: Government
Printing Office.
National Defense Act of 1916 (Public Law 64-85) (1916).
Occupational Therapy in St. Louis. (2009). Bernard Becker Medical Library Digital Collection. Retrieved from http://
beckerexhibits.wustl.edu/mowihsp/health/OTstl.htm
Orr, H. W. (1921). An orthopedic surgeon’s story of the Great War. Norfolk, NE: The Huse Publishing Co.
Partridge, C. R. (1921). Milwaukee-Downer College gives O.T. course. Modern Hospital, 17(1), 64-65.
Photography’s aid in the mending of men. (1919, January). Modern Hospital, 12(1), 109.
Quiroga, V. A. M. (1995). Occupational therapy: The first 30 years: 1900 to 1930. Bethesda, MD: American Occupational
Therapy Association.
Robinson, R. A. (1943). The Boston School of Occupational Therapy: Alumnae Luncheon, May 22, 1943. Bethesda,
MD: Archives of the American Occupational Therapy Association. (Series 12, Box 101, Folder 732).
Russell, J. E. (1918). Occupational therapy in military hospitals. American Journal of Care for Cripples, 7(2), 112-116.
Salmon, T. W. (1917a). Care and treatment of mental diseases and war neuroses (‘shell shock’) in the British Army.
Mental Hygiene, 1(4), 509-547.
Salmon, T. W. (1917b). Personal correspondence to The Rockefeller Foundation on May 1, 1917. Retrieved from http://
rockefeller100.org/files/original/151dd97bd0530e402e49faf420b82f4d.pdf
Schwab, S. I. (1919). The experiment in occupational therapy at Base Hospital 117, A.E.F. Mental Hygiene, 3, 580-593.
Slagle, E. C. (n.d.). Experience of Eleanor Clarke Slagle. Bethesda, MD: Archives of the American Occupational
Therapy Association (Series 1, Box 1, Folder 11).
Taylor-Whiffen, P. (2011, March 3). Shot at dawn: Cowards, traitors or victims? BBC. Retrieved from http://www.bbc.
co.uk/history/british/britain_wwone/shot_at_dawn_01.shtml
Thatcher, E. (1919). Making tin can toys. Philadelphia, PA: J. B. Lippincott Company.
Thayer, W. S. (1919, December). The medical aspects of reconstruction. American Journal of the Medical Sciences,
158(6), 765-773.
United States Veterans Bureau Act of 1921 (Public Law 67-47)(1921).
Upham, E. G. (1918). Training of teachers for occupational therapy for the rehabilitation of disabled soldiers and
sailors. Washington, DC: Federal Board for Vocational Education.
Vocational Education Act of 1917 (Public Law 64-347) (1917).
Vocational Rehabilitation Act of 1918 (Public Law 65-178) (1918).
Vocational (Industrial) Rehabilitation Act of 1920 (Public Law 66-236) (1920).
War Risk Insurance Act Amendment (Public Law 65-90) (1917).
Zimmerman, W. H. (1918). Our first blinded soldier: He is being re-educated and will make good. Carry On, 1(1),
13-14.
 4
Standard Setting
1920s to 1940s

Key Points
● The desire to upgrade professional status prompted the move to establish minimum standards
for courses of training in occupational therapy.
● The Society worked to distinguish occupational therapy as a medical profession, separating
themselves from crafts persons.
● The National Register and a procedure for the accreditation of training schools were put in
place as mechanisms to ensure the high standards of the profession.
● Due to the economic conditions of the Great Depression, the military was ill prepared to pro-
vide occupational therapy services at the start of World War II.

Highlighted Personalities Key Places

● Susan E. Tracy ● New York City—Association headquarters
● Susan Cox Johnson ● Boston School of Occupational Therapy
● William Rush Dunton, Jr., President, ● Philadelphia School of Occupational
September 1917 to 1919 Therapy
● Eleanor Clarke Slagle, President, 1919 to ● St. Louis School of Occupational Therapy
1920 ● Milwaukee-Downer College
● Herbert J. Hall, President, 1920 to 1923
● Thomas Kidner, President, 1923 to 1928

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 89-123).
- 89 - © 2017 SLACK Incorporated.
90 Chapter 4

Key Times/Events Sociocultural Events/Issues

● Name of the Society changed to the ● Improved social and political status for
American Occupational Therapy women
Association in 1921 ● Military status for occupational therapy
● Occupational Therapy Pledge adopted in
1926
● Eleanor Clarke Slagle resigned as
Economic Events/Issues
American Occupational Therapy ● Increased consumerism in early 1920s, an
Association Secretary-Treasurer in 1937 age of prosperity and excess
● Annual meetings held in conjunction ● Stock market crash of 1929
with American Hospital Association from ● The Great Depression of the 1930s
1922 to 1937

Political Events/Issues Technological Events/Issues

● First solo transatlantic flight completed
● Health care for reconstruction aides by Charles Lindbergh in 1927
● 19th Amendment to the Constitution ● Start of commercial air travel
ratified in 1920, giving women the right
● Widespread use of radio and talking pic-
to vote
tures (movies) for entertainment
● National Economy Act of 1933 (Public
Law 73-2)
● Social Security Act of 1935 (Public Law Practice Issues
74-271) ● Principles of Occupational Therapy writ-
ten in 1918
Educational Issues ● Differentiation of occupational therapy
from crafts teachers
● Minimum Standards for Courses of
Training in Occupational Therapy adopt- ● Sponsorship by medical profession
ed in 1923, revised in 1927 and 1930
● National Register established in 1931 Association Issues
● First National Directory published in 1932 ● Association managed by a 10-member
● American Medical Association’s Council Board of Management
on Medical Education and Hospitals pub-
lished Essentials of an Acceptable School
of Occupational Therapy and began
accrediting schools

Introduction
“If a normal man cannot be idle without becoming mentally and
physically unfit, how much more important is it that people who are
slowly convalescent or chronically ill should have the opportunity for
wholesome work. It seems inconceivable that we should have so long
missed this vital point in our care of invalids.”
–Editor of Modern Hospital (1922)
 Standard Setting: 1920s to 1940s 91

P
ost-World War I ushered in the Roaring Twenties with a spirit of optimism; movements
in support of women’s rights, including women’s right to vote; and the advancement of
manufacturing, transportation, and communication technologies. Talking movies and
radio were major forms of entertainment. By the end of the 1920s, with President Herbert Hoover
in office, the economy went into a recession. The stock market crashed in 1929, causing the Great
Depression, which would last until
the start of World War II. The diffi-
cult economic times had significant
implications for all, including occu-
pational therapy. Unemployment
reached 25% throughout the nation
and as high as 80% to 90% in
some cities. Hoovervilles, poorly
constructed shanty towns, began
to emerge in many areas to house
the unemployed (Figure 4-1).
The election of Franklin Delano
Roosevelt in 1932 brought hope to
the country with his promise of
a New Deal—a series of domestic
programs designed to get the coun-
Figure 4-1. With 25% unemployment in the Great Depression, many
try back on its feet. Additionally, people out of work ended up living in Hoovervilles, so called because
President Roosevelt’s wife, Eleanor, of the anger toward President Herbert Hoover, under whose watch the
had an agenda and a national stage Great Depression occurred.
for promoting social justice. In this
environment, the leaders of occupational therapy set a course to obtain improved professional
status for the profession by starting a professional journal and establishing standards of training,
a National Register, and a method of accrediting training schools.

Establishing a Firm Foundation

William Rush Dunton Jr., Eleanor Clarke Slagle, Herbert J. Hall, MD, and Thomas B. Kidner
all provided dedicated leadership guiding the fledgling Society through the formative years. When
George Edward Barton decided not to run for reelection, Dr. Dunton agreed to step in to keep the
Society going. He served for 2 years, from September 1917 to September 1919. He continued serv-
ing on various committees and as editor of the official journals of the Society until he was in his
80s. At the third annual meeting, Eleanor Clarke Slagle was the first woman elected President of
the National Society for the Promotion of Occupational Therapy (NSPOT, 1919, p. 36) (Figure 4-2).
Nominated for a second term at the fourth annual meeting, she was defeated by Dr. Herbert Hall
by one vote (NSPOT, 1920c, p. 26). Hall, honoring his opponent in his first speech as President,
noted the closeness of the election and mentioned that the late vote cast for Slagle would have
resulted in a tie (NSPOT, 1920a, p. 39). In 1921, Mrs. Slagle was elected Secretary-Treasurer just as
the offices were combined (Second Day—Afternoon Session, 1922, p. 223). She held this office on
a volunteer basis until her resignation in 1937.
Dr. Hall’s illness in 1922 required that Thomas Kidner step in to fulfill the presidential duties.
When Hall died in February 1923, Kidner was elected outright as President and served through
1928. He was succeeded by Dr. C. Floyd Haviland (Figure 4-3). The untimely death of Haviland
on New Year’s Day 1930, coupled with the death of Vice President Dr. Burt W. Carr 2 weeks later,
required Kidner to fill in once again until the election of new officers (Figure 4-4). Dr. Joseph
Doane was President from 1930 to 1938. A past President of the American Hospital Association
(AHA), he helped to strengthen the alliance between AHA and the American Occupational
92 Chapter 4

Figure 4-2. The pages from this 1920 conference program represent conference goers through the years who have
attended conferences to participate in new experiences. In the upper right-hand corner, this conference goer has pen-
ciled in the program: “Skipped this + went sight-seeing.” (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)

Therapy Association (AOTA, 1967b). Early attempts to

establish a House of Delegates as part of the Society’s man-
agement structure met with difficulties in determining
representation of various groups. Additionally, because of
the limited ability of delegates to travel to attend meetings,
it was decided to have a 10-member Board of Management,
comprising nine members and the President, run the asso-
ciation (Editorial, 1922b). The House of Delegates was later
reinstated in 1938 to act as a recommending body to the
Board of Management (AOTA, 1938; Jones, 1992).

Developing Principles of Occupational

Figure 4-3. Dr. C. Floyd Haviland served
Therapy as President of the AOTA from 1928 to
1930. Haviland was a close professional
William Rush Dunton Jr. began the discussion of colleague of Eleanor Clarke Slagle whom
formalizing the profession’s underlying principles when he recruited to the position of Director of
he read a paper titled “The Principles of Occupational Occupational Therapy for the New York
State Department of Mental Hygiene. A
Therapy” at the second annual meeting in 1918 (Dunton, visionary and enthusiastic leader with
1918). After his address, Dunton moved to appoint a com- common sense and unselfish devotion,
mittee to formally establish the principles of the profes- Dr. Haviland died unexpectedly of pneu-
sion. Eleanor Clarke Slagle; Dr. William L. Russell of monia in 1930 while traveling in Egypt.
(Printed with permission from the Archive
Bloomingdale Hospital in White Plains, New York; and Mr. of the American Occupational Therapy
Norman L. Burnette of the Invalided Soldiers Commission Association, Inc.)
 Standard Setting: 1920s to 1940s 93

in Toronto, Canada, were appointed to

the committee. Fifteen principles were
developed based on Dr. Dunton’s paper
(Dunton, 1919a). Many of these principles
still apply today (Figure 4-5; Sidebar 4-1).

Society Name Change

In 1920, Herbert Hall suggested chang-
ing the name of the Society (Dunton, 1955;
Editorial, 1946). As President of NSPOT
in 1920, Eleanor Clarke Slagle presented
this suggestion to the membership at the
fourth annual meeting held at the Hotel
Rittenhouse in Philadelphia, Pennsylvania
(Figure 4-6). In recounting the activi-
ties of NSPOT and the tasks at hand,
she questioned the name of the Society:
“Do we longer need the descriptive phrase
‘for the promotion’ of occupational thera-
py?” (Slagle, 1920b, p. 2). Following up on
Slagle’s suggestion, Louis Haas, Secretary
of NSPOT, requested members to provide
Figure 4-4. In an unusual set of circumstances, both the
President, Dr. C. Floyd Haviland, and the Vice President, Dr. Burt
suggestions for a new name for the Society.
W. Carr of AOTA, died in a period of 2 weeks. Thomas B. Kidner Haas noted that at this time in the life of
once again stepped in to fulfill the role of President. (Printed NSPOT, “we do not need to be promoted
with permission from the Archive of the American Occupational nearly as much as we need development”
Therapy Association, Inc.)
(Haas, 1920, p. 4). Later in the meeting,
Thomas B. Kidner moved to empower the
Board of Directors to “receive suggestions as to a better name, shorter, more convenient name, with
power to act; that is to say, to decide on a name” so that it could be presented and voted on at the next
annual meeting (Kidner, 1920b, pp. 24-25).
In preparation for the upcoming annual meeting scheduled to be held in Baltimore, Maryland,
the July 1921 issue of the Maryland Psychiatric Quarterly published the proposed constitutional
changes for members to consider. President Herbert J. Hall highlighted the name change: “You will
note that the name of the Society is changed to the American Occupational Therapy Association,
certainly an advantage over the old cumbersome designation” (Hall, 1921, p. 18). At the annual
meeting, although there was much discussion about the proposed constitutional changes affecting
governance of the Society, there is no record of any discussion about the name change. The mem-
bers voted on the morning of October 20, 1921, to accept the amended constitution, and as such,
a new name for the Society: the American Occupational Therapy Association (AOTA, 1921; First
Day—Morning Session, 1922, p. 64) (Figures 4-7 to 4-10).

Activities of the Founders

George Barton and Isabel Newton Barton curtailed their activities in the new Society within the
first year. Susan Cox Johnson and Susan Tracy were very active initially, both major forces in shap-
ing educational standards. Thomas Kidner was instrumental in establishing a National Register
and initiating efforts to start an accreditation program for training schools. Eleanor Clarke Slagle
and William Rush Dunton continued to be involved in Association activities for many years, shap-
ing the Association and the new profession.
94 Chapter 4

Figure 4-5. Photograph of typed list of 15 principles. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)

Eleanor Clarke Slagle

Eleanor Clarke Slagle earned the title Mother of Occupational Therapy by virtue of her dedica-
tion and work to promote the profession. By the early 1920s, Slagle had already served a number of
years as the Chairperson of the Committee on Installations and Advice. In this role, Slagle advised
organizations about developing occupational therapy programs and training schools, assisted
 Standard Setting: 1920s to 1940s 95

SIDEBAR 4-1
Definition of Occupational Therapy

Occupational therapy may be defined as any activity, mental or physical,

definitely prescribed and guided for the distinct purpose of contributing to and
hastening recovery from disease or injury. (Pattison, 1922)
After presenting his paper at the fifth annual conference, Pattison asked for feedback on
his definition of occupational therapy: I want to know if there is not someone who wants
to put up a rifle and shoot holes through that definition… Discussion ensued about the
necessity of a medical prescription and whether that was a qualification to make occupation
therapeutic (Second Day̶Morning Session, 1922, p. 158).

with placement of capable occupational therapists in open positions, and gave numerous talks to
various clubs, organizations, and schools. Requests for information about occupational therapy
came from all over the United States and from a number of foreign countries. Through her vol-
unteer activities in the Society and her work activities, Slagle developed an extensive professional
network. She was appointed consultant to the Department of Reconstruction in the Public Health
Service in 1920, providing her with the opportunity to meet with numerous government officials
and promote occupational therapy (Slagle, 1918, 1919, 1920a). She
continued in an ambassador role for occupational therapy with
her election as Secretary-Treasurer of AOTA in 1921.
On July 1, 1922, Slagle was appointed Director of Occupational
Therapy for the New York State Department of Mental Hygiene.
Slagle had been recruited to the position by C. Floyd Haviland, a
psychiatrist who later became President of AOTA (AOTA, 1967b)
(Sidebar 4-3).
Returning to her home state, Slagle took up residence in New
York City. For a time, she managed Association affairs from her
apartment, keeping documents and files in her kitchen. Finally,
the Board of Managers voted to rent office space to establish an
official headquarters. The Association leased a room in an office
building from the National Health Council. The building, located
at 370 Seventh Avenue in New York City, housed a number of
other health organizations, including the National Committee
for Mental Hygiene, the National Tuberculosis Association, the
National Organization for Public Health Nursing, the National
League of Nursing Education, and the American Social Hygiene
Association. The close proximity to these organizations offered
opportunities for networking and strategic alliances (Report of
Secretary-Treasurer, 1922, pp. 49-50). In November 1925, the
office was moved to the Flatiron Building at 23rd Street and 5th Figure 4-6. An NSPOT conference
Avenue because that location was easier to find and offered a ribbon from the scrapbook of Dr.
larger office and more exposure (Board of Management, 1926a). William Rush Dunton Jr. (Printed
with permission from the Archive of
Slagle continued to respond to requests about occupation- the American Occupational Therapy
al therapy, handle membership applications, and correspond Association, Inc.)
with a number of states seeking to establish state societies
of occupational therapy. She also continued with speaking
96 Chapter 4

Figure 4-7. Program from the fifth annual Figure 4-8. Program from the sixth annual meeting
meeting showing the name as the Society. showing the name change of the Society to the American
(Printed with permission from the Archive Occupational Therapy Association. (Printed with permis-
of the American Occupational Therapy sion from the Archive of the American Occupational
Association, Inc.) Therapy Association, Inc.)

Figure 4-9. (A) This AOTA confer-

ence ribbon is from the scrapbook
of Dr. William Rush Dunton Jr. of
Baltimore, Maryland. (B) A closer
view shows “Member American
Hospital Association” embossed Figure 4-10. AOTA Button – 1922
around the insignia at the top of is from the 5th Annual Meeting
the ribbon holder. Several AOTA held in Atlantic City, NJ after the
conferences were held in conjunc- name was changed from NSPOT
tion with the American Hospital to AOTA. (Printed with permission
Association. (Printed with per- from the Archive of the American
mission from the Archive of the Occupational Therapy Association,
American Occupational Therapy Inc.)
Association, Inc.)
 Standard Setting: 1920s to 1940s 97

Figure 4-12. An early occupational thera-

py pin that belonged to Winifred Brainerd.
(Copyright © Dr. Lori T. Andersen.)

engagements and visits to institu-

tions, public gatherings, clubs,
and associations. As Secretary-
Treasurer of AOTA and Director of
Occupational Therapy for the New
York State Department of Mental
Hygiene, Slagle connected with
a number of important people in
health care institutions and agen-
Figure 4-11. Pledge and Creed. (Printed with permission from the
Archive of the American Occupational Therapy Association, Inc.)
cies (Report of Secretary-Treasurer,
1922).
Slagle knew the importance of
networking and collaborating with
SIDEBAR 4-2
community organizations. Mrs.
George Hewitt, a friend and col-
Pledge and Creed for league of Slagle, was president of
Occupational Therapists the New York State Federation of
Women’s Clubs. This organization
In December 1924, Mrs. Marjorie B. Greene of the was one of the state federations of
Boston School of Occupational Therapy wrote to the General Federation of Women’s
President Thomas Kidner expressing the desire to Clubs, a philanthropic and edu-
adopt a Pledge and Creed for occupational therapists cational organization. In a speech
(Greene, 1924). Modeled after the Pledge and Creed given at the fourth annual meeting
of the American Hospital Association, the Pledge and of NSPOT, Mrs. Hewitt noted that
Creed was formally adopted by the AOTA Board of the Federation and Society shared
Management at its 10th annual meeting in Atlantic similar purposes, such as improv-
City, September 26, 1926 (Board of Management,
ing child welfare and public health.
1926b) (Figure 4-11).
At a time when women had just
won the right to vote, Mrs. Hewitt
understood the political power of
the state federation with 275,000 members and the national organization with 2 million members.
She offered the Federation’s support to NSPOT in any legislative initiatives (First Day—Afternoon
Session, 1920, pp. 32-33). Slagle took charge of the Occupational Therapy Committee of the
General Federation. A highly sought-after speaker, she gave talks throughout the United States on
the benefits and successes of occupational therapy (Sidebar 4-4; Figure 4-13).
98 Chapter 4

SIDEBAR 4-3
The Parole Carpet

A 1926 article written by Florence Kelley and published in the New York Times tells the
story of the parole carpet, a hooked rug craft project constructed out of used garments
by psychiatric patients in a state hospital. Patients worked together on this project as part
of their occupational therapy to help them regain health so that they could be paroled, or
allowed to go home. The project gained the interest of the patients who wanted to work on
it. The activity facilitated cooperation and resocialization because several could work on it at
one time. It also provided motivation and incentive. One day, Eleanor Clarke Slagle, Director
of Occupational Therapy for the State Hospital Commission, encountered a patient working
feverishly on a simple task. When she inquired about his hurried pace, he replied:
I must get this done first and then there are two other things I must do before I ll be
ready to work on the parole carpet. And after I work on that I can go home! I must
hurry and finish this! (Kelley, 1926)

SIDEBAR 4-4
“Former Hobart Girl Is Honored”

A newspaper article in the Stamford Mirror-Recorder

(New York) on January 8, 1931, reported that Eleanor
Clarke Slagle was honored for her work in occupational
therapy at a recent national conference held in New
Orleans. The presiding official at the meeting predict-
ed that because of her work, Mrs. Slagle s name would
stand out in history ( Former Hobart girl honored,
1931) (Figure 4-13). It has!

Dr. William Rush Dunton

Dr. Dunton’s work life at Sheppard and Enoch Pratt Hospital
began to change in 1918. On December 21, 1918, a disgruntled
physician, Dr. Noboru Ishida, shot and killed another physi-
cian, Dr. George B. Wolff, in Dr. Dunton’s office. The Board
of Trustees were critical of the hospital Superintendent, Dr.
Edward N. Brush, for not recognizing signs of mental illness
in Dr. Ishida. This prompted Dr. Brush’s resignation, effective
Figure 4-13. The Thursday, January
April 1, 1920. The new Superintendent, Dr. Ross Chapman, 8, 1931, issue of the Stamford Mirror-
wanted to make administrative changes throughout the hos- Recorder in Stamford, New York, pub-
pital. He replaced Dunton as Director of the Occupational lished this prophetic article: “Former
Therapy Department and assigned him to be in charge of Hobart Girl Honored.” Her name does
stand out in history: the Eleanor Clarke
research (Bing, 1961, pp. 210-211). Dr. Chapman then hired Dr. Slagle Lectureship.
Henry Stack Sullivan, a rising psychiatrist, in 1922. This sig-
naled a paradigm shift in the treatment of those with mental
 Standard Setting: 1920s to 1940s 99

illness because Sullivan favored the

psychodynamic theories proposed
by Sigmund Freud, which were gain-
ing popularity. Freud believed that
the etiology of mental illness was
within the person. This was not
consistent with Dr. Dunton’s views,
which considered the environment
or context to contribute to men-
tal illness. Sullivan developed his
own theory of psychiatry based in
part on Freud’s teachings. Sullivan’s
theory emphasized the importance
of interpersonal relationships. Poor
interpersonal relationships were
believed to be the cause of mental
illness. Dr. Sullivan had difficulty
Figure 4-14. Physicians on staff at Sheppard and Enoch Pratt Hospital
with interpersonal relationships
in 1918. From left to right: Dr. George Franklin Sargent; Dr. Noboru with his coworkers. He was per-
Ishida; Dr. Edward N. Brush, Superintendent; Dr. George Baney Wolff ceived to be critical, demanding,
(murdered by Dr. Ishida); Dr. William Rush Dunton Jr.; and Dr. L. Gibbons and sarcastic (Forbush & Forbush,
Smart. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)
1986, p. 61). The differences in ideol-
ogy and poor working relationships
prompted Dr. Dunton to resign his
position at Sheppard and Enoch Pratt Hospital in 1924. A new opportunity quickly presented itself
when he was offered the opportunity to become the Medical Director of Harlem Lodge, a small, pri-
vate psychiatric sanitarium in Catonsville, Maryland (Bing, 1961, pp. 211-212) (Figure 4-14).
In spite of the difficulties at work, Dr. Dunton maintained active participation in AOTA. As
Chair of the Committee on Publicity and Publications, Dunton began and was editor of Archives
of Occupational Therapy, published by Williams & Wilkins, from 1922 to 1924. Individuals could
subscribe to the journal for $5 per year. Previously, articles about occupational therapy had been
published in journals such as Modern Hospital, Trained Nurse and Hospital Review, and Maryland
Psychiatric Quarterly; however, it became increasingly difficult to get these journals to accept
occupational therapy papers. The goal of Archives of Occupational Therapy was to provide a jour-
nal to preserve the important papers and discussions of AOTA and to give occupational therapists
access to professional literature specific to occupational therapy (Committee on Publicity and
Publications, 1922; Editorial, 1922a). In 1924, the name of the journal was changed to Occupational
Therapy and Rehabilitation. The name change was meant to communicate the expanded scope of
the journal, which was to provide a resource and forum for all people involved in rehabilitation
services (Dunton, 1925c). Subscription fees were incorporated into membership dues by a vote of
the membership at the annual meeting in 1925 (Committee on Publicity and Publications, 1925)
(Figures 4-15 and 4-16).

Setting Educational Standards

Amid the backdrop of World War I, the newly formed NSPOT was gaining its footing, defining
directions and tasks to move the Society and profession forward. As the Society desired to empha-
size the therapeutic nature of occupation, active membership was restricted to those “actually
using occupation as a therapeutic agent, or who are teaching, supervising, or superintending such
work.” A person who was “desirous of doing such work—i.e., pupils, social workers, nurses, etc.”
could apply for associate membership (NSPOT, 1917, pp. 1-2).
100 Chapter 4

Figure 4-15. Announcement of a new journal: Archives of Occupational Therapy. The

Archives were published from 1922 through 1924. (Printed with permission from the
Archive of the American Occupational Therapy Association, Inc.)

Two standing committees established by NSPOT’s constitution played significant roles in set-
ting qualifications for occupational therapists and educational standards for training schools.
First, the Committee on Teaching Methods, chaired by Susan E. Tracy, was formed to “investigate
the different methods in vogue, to prepare outlines of methods of teaching, both in public classes
and in nurses’ training schools, etc.” (NSPOT, 1917, p. 10). Second, the Committee on Admissions
and Positions, chaired by Susan Cox Johnson, was formed to “receive all applications for admission
to the Society and after proper consideration to present them, if eligible, to the Board” (p. 9). This
committee was also designated to be an employment bureau, placing members in institutions in
need of an occupational teacher.
Shortly after the founding meeting, Susan E. Tracy named her committee members and
provided an outline of a training curriculum to Dr. Dunton (Tracy, 1917). To accomplish their
charge, Tracy’s committee began to survey institutions about the therapeutic use of occupation in
their facilities and gathered information about the types of facilities and organizations, programs
offered, methods (activities) used by occupation workers, types of patients seen, and number
of hours spent providing treatment (Committee on Teaching Methods, 1917, 1918, 1919). Tracy
 Standard Setting: 1920s to 1940s 101

believed that understanding the scope of occupational therapy practice was preliminary to devel-
oping educational standards.
Susan Cox Johnson asked for clarification of duties of the Chair and Committee on Admissions
and Positions at the annual meeting in 1918, indicating that she was gravitating to establishment
of standards for training. Johnson stated:
If the word ‘Positions’ is to be more widely interpreted to cover all matters concerning
the fitness of teachers to fill positions creditably and the conditions under which they
serve, or in other words to set standards for qualifications of teachers and terms of
service, then the present Chairperson would find herself more closely allied with her
interests and general duties and so the more able to serve the society.” (Committee on
Admissions and Positions, 1918, p. 18)
The Board of Management approved her request to charge the Committee with the duty “To
formulate and present to the Board of Management for approval, standards by which teachers shall
be judged as qualified to hold certain positions in the field of occupational therapy…” (p. 19).
Discussion ensued on
whether occupational therapy
should be provided by spe-
cially trained nurses who had
a strong medical background
or by people who had strong
knowledge and expertise
in crafts. Reba G. Cameron,
Superintendent of Nurses
and occupational instruc-
tor at Taunton State Hospital,
Massachusetts (Cameron,
1915), and Adelaide Nutting,
Director of the Department
of Nursing and Health of
Columbia University, consid-
ered occupational therapy as
a special branch of nursing
training that should be taken
after general education has
given the student nurse a firm
foundation (Dunton, 1919b, p.
80). Cameron (1917), a friend
and colleague of Susan E.
Tracy, wrote that “Miss Tracy
is firmly of the opinion that
occupational therapy is nurse’s
work, and she also believes that
every training school for nurses
should, as part of the curricu-
lum, include a course in occu-
pation” (p. 66).
Susan Cox Johnson had a
background in design, worked
as an arts and crafts teach- Figure 4-16. Cover page of Occupational Therapy and Rehabilitation, the
official journal of AOTA from 1925 through 1946. (Printed with permission
er, and taught occupations from the Archive of the American Occupational Therapy Association, Inc.)
102 Chapter 4

courses. She believed the field of occupational therapy was becoming a distinct specialty as the war
caused occupation to be swept out of the hands of the nurses and to a group foreign to hospitals
(Johnson, 1918). Nurses no longer had the time to devote to extra training in therapeutic use of
occupations, nor the time to implement occupation programs in hospitals (Johnson, 1917). There
was a need to train a new classification of worker, one with medical knowledge and skill in crafts
and teaching (Adams, 1922).
In trying to bring two factions together, Johnson asserted:
What seems to be a difference of opinion among those who are working with the same
ends in view, is often NOT A REAL difference but is due to the failure to keep always
before us, the several natural divisions of the work and the different purposes of each,
as well as the fact, that each must overlap and mere one into the other instead of being
separate and aloof. No standards for training teachers can be set without recognition
of these different elements. (Johnson, 1918, p. 44)
Johnson also wanted to avoid alienating reconstruction aides, most of whom trained in time-
limited war emergency courses to fill an urgent need. Eager to move the profession forward,
Johnson acknowledged:
Whereas the Committee appreciates the excellent work accomplished through the
emergency courses for reconstruction aides, it feels that if occupational therapy is to
serve its purpose and hold its place as a therapeutic agent in civilian hospitals of vari-
ous types, it should become a real profession which must be dignified by a long and
adequate course of training for those who enter it. (Committee on Admissions and
Positions, 1919, p. 18)
Johnson also urged that training programs should be provided by colleges and schools that
already had established value and reputations. This would improve the professional status of occu-
pational therapy. Many courses required to train occupational therapists were already provided by
colleges and schools. Sharing of faculty and facilities would provide additional economic benefits.
Johnson qualified her position on providing training through colleges and schools, indicating that
training should also include supervised hospital experience (NSPOT, 1920b, pp. 54-55).
Johnson’s committee described the essentials of adequate training for occupational therapists
as follows:
(1) Knowledge and skill in a fairly wide range of handcrafts, games and recreations,
drawing and design, and certain academic and commercial subjects; (2) understanding
of the more commoner mental and physical conditions from which patients suffer and
the general principles of hygiene and therapeutic treatment required for occupation
work; (3) understanding of the social and economic conditions commonly related to
hospital problems; (4) understanding and practice of teaching methods which would
be employed with the sick and handicapped and general on hospital organization and
regime. (Committee on Admissions and Positions, 1919, p. 19)
The committee outlined a standard course of study based on these essentials, recommending that
the Society adopt it as a guide only and recognizing that “the methods and principles of teaching the
sick were still in a state of unorganized knowledge” (Committee on Admissions and Positions, 1919,
p. 24). No action was taken (Committee on Admissions and Positions, 1919; NSPOT, 1920b, p. 52).

Minimum Standards for Courses of Training in

Occupational Therapy
The Society became more earnest in developing standards for training, recognizing that the
reputation of the profession was based on the work of occupational therapists and that inadequate
 Standard Setting: 1920s to 1940s 103

preparation of occupational therapists would reflect poorly on the profession’s image as a whole.
In 1921, Dr. Herbert J. Hall, NSPOT President, appointed Susan Cox Johnson as chair of a new
Committee on Education charged with the duty to work “toward the establishment of uniform
standards in the training and certification of aides and the advancement of professional sta-
tus of the occupation aide” (Committee on Admissions and Positions, 1922, p. 76). Miss Ruth
Wigglesworth, Director of the Boston School of Occupational Therapy, replaced Susan E. Tracy as
Chairperson of the Committee on Teaching Methods.
Miss Wigglesworth’s committee also took to task the charge of developing uniform standards.
The 10 members of the committee, all school representatives, went to work gathering information
about existing schools and opinions regarding the requirements for entrance, minimum length for
a course of study, and length of practical work (Committee on Teaching Methods, 1922; Round
Table on Training Courses, 1923).
At a roundtable discussion on training courses, it became clear that the Association wanted to
differentiate between occupation therapists who had required training and crafts teachers who
did not (Round Table on Training Courses, 1923). To make this distinction, Miss Wigglesworth
advised that:
Schools must emphasize the fact that they are not training teachers of occupation
therapy, but occupation therapists. Nurses are not teachers in the sense indicated, and
this phrase used by some, again implies teaching teachers of crafts and not that we
are training medical workers. Now is the tie to make the point clear. (Committee on
Teaching Methods, 1922, p. 64)
Discussion and debate continued as the Association sought to achieve a middle ground, perhaps
best defined by Miss Idelle Kidder, Director of the Missouri Association for Occupational Therapy
and affiliated with the St. Louis School of Occupational Therapy. Kidder expressed that “courses
should not be lengthened too rapidly to seriously hinder hospitals in being able to open occupa-
tional therapy departments, nor the standards be lowered by shortening courses so that existing
and future departments cannot continue with well-trained aides” (Third Day, Morning Session,
1922, p. 228).
To move the issue of training forward, Mr. Kidner, who had taken over as President for the
ailing Hall, worked with Mrs. Slagle and Miss Wigglesworth to develop a draft of the Minimum
Standards of Training. The draft was based on the numerous reports, discussions, and suggestions
received over the past several years. The draft was discussed and revised at the June 1923 Board
meeting and approved by the membership at the annual meeting in Milwaukee on October 30,
1923 (Board of Management, 1923; AOTA, 1924).
The adoption of the Minimum Standards required that candidates for admission to training
courses have a high school education or equivalent and be at least 20 years old at graduation.
The length of training programs was set at no less than 12 months, including at least 8 months
of theoretical and practical work and at least 3 months of supervised hospital practice training.
The Board also proposed that, in the future, it would be advisable to establish short postgraduate
training courses (AOTA, 1924).
The Board of Managers had indicated that from time to time, the Minimum Standards would
need to be revised. This occurred in 1927, when the Minimum Standards were revised to increase the
practice training from 3 months to 6 months (Kidner, 1928). The Minimum Standards were revised
again in 1930 to increase the total length of the educational program from a minimum of 12 months
to 18 months, which included 9 months of theoretical and technical work and at least 9 months of
hospital practice training under competent supervision (New Minimum Standards…, 1930).
Two of the founders who had taken on the monumental task of moving the profession forward
by setting Minimum Standards of Training stopped participating in Society activities in the early
1920s. Miss Susan E. Tracy dropped out of Association activities approximately 1 year before pas-
sage of the Minimum Standards, and Miss Susan Cox Johnson around the time the Minimum
104 Chapter 4

Standards were approved. Tracy was likely very involved with her teaching activities around the
country. Johnson lost her teaching position at Teacher’s College in 1924 when the occupational
therapy program was closed due to lack of enrollment (Quiroga, 1995, p. 221). Tracy died in 1928
of a stroke (Presbyterian Hospital of Chicago, 1929), and Johnson died in 1932 of pneumonia
(Occupational Therapy Notes, 1932).

Establishing a National Register

The Society recognized that the first step in establishing a National Register was to develop
Minimum Standards for Courses of Training in Occupational Therapy (Kidner, 1930). Once this
was accomplished and the Minimum Standards were promulgated, the Board of Managers strongly
recommended that a National Register or directory be established to ensure high standards for the
profession (AOTA, 1924). Now, with the adoption of the Minimum Standards, there was a measure
to determine the quality of training schools, and Mrs. Slagle, in her role as Secretary-Treasurer, was
able to respond to requests to approve training schools. However, this was on a voluntary basis, and
there was not a real mechanism to ensure adherence to standards. The move to establish a National
Register would provide a more effective mechanism to enforce the Minimum Standards.
Everett S. Elwood, Managing Director of the National Board of Medical Examiners and
later President of AOTA (1938 to 1947), was among those advocating for the profession to move
toward a National Register. A member of AOTA since 1923, Elwood (1927) recommended that the
Association:
…take advantage of your position by making certain the back door is carefully fas-
tened against pretenders, that others do not crawl in under the fence, and that those
who are permitted to enter the front door have the proper credentials for admission.
(pp. 341-342)
The Committee on Teaching Methods recommended that the Association appoint a special
committee to prepare and submit a proposal for a National Register. President Thomas Kidner
did so, charging the special committee with the task of proposing a plan to establish a National
Register and to rate and inspect training schools. Graduates of these approved schools would be
qualified to be included in the Register (Kidner, 1925). In view of similar concerns to set standards
and prevent unqualified people from practicing, the Massachusetts Society for Occupational
Therapy had established a registration system in the early 1920s (Brackett, 1922). Now the national
Association set out to establish a plan for a National Register. The purpose of the Register was to
“protect patients from unqualified persons by maintaining high professional standards, while at
the same time, safe-guarding properly qualified workers” (Kidner, 1930, p. 224) and “for the pro-
tection of hospitals and institutions from unqualified persons posing as occupational therapists”
(AOTA, 1932, p. 7).
The appointed committee was slow to act. Kidner was anxious to move plans for a Register
forward, so he and Mrs. Slagle gathered information about methods and procedures used by other
organizations who had established registers. Although the intent of the Register was to require
graduation from schools meeting Minimum Standards to be a main requirement of eligibility, it
was acknowledged that, for a period of time, eligibility requirements should also include those with
training and experience prior to establishment of the Minimum Standards. These workers would
be grandfathered in if an application was submitted within 3 years of establishment of the National
Register. Admission to the National Register based on successfully passing an examination was
considered but deemed to be impractical at that time (Board of Management, 1927, 1928, 1929).
A plan for the National Register was finally approved by the Board of Management and by
members at the 1930 annual meeting (Kidner, 1930). The register was started in 1931, funded in
part by the efforts of a voluntary committee of AOTA that collected funds to pay for startup costs
 Standard Setting: 1920s to 1940s 105

(Board of Management, 1931b). There were

two divisions to the Register: a main Register
and a secondary Register. The qualifications
for the Register were as follows:
1. Main Register (eligible to use the desig-
nation O.T. Reg.)
Three categories of personnel could
qualify for the main register.
A. Category A—graduates of train-
ing schools that met the Minimum
Standards of Training and have at
least one year of successful work
experience in occupational therapy.
B. Category B*—at least four years’ suc-
cessful work experience in occupa-
tional therapy work and high school
education or equivalent.
C. Category C*—training and experi-
ence in application of specialty area
as a curative treatment for sick and
disabled, high school education or
equivalent, and classes on theory
Figure 4-17. Photograph of the cover of the 1932 National
and practice of occupational therapy, Directory. The names of those admitted to the National
or submit short thesis on subject as Register were printed in the National Directory. The 1932
deemed necessary. National Directory included such information as name of
training school attended, experience, present position, and
*Admission to the register based on suc- birth year. It was the only National Directory that included
cessful experience ceased to be in effect registrants’ birth years. (Printed with permission from the
after December 31, 1933. Archive of the American Occupational Therapy Association,
Inc.)
2. Secondary Register—(eligible to use the
designation O. T. Asst. Reg.)—at least
four years’ successful work experience in occupational therapy and completed at least eighth
grade public school education or equivalent. (AOTA, 1932)
In 1931, an amendment to the constitution established the Committee on Registration to “carry
out regulations for admission to the National Register … and to submit changes to the regulations
from time to time” as deemed necessary (American Occupational Therapy Association, 1932, p.
5). The committee was also charged with the duty “to examine and pass all applications” for the
Register (American Occupational Therapy Association, 1932, p. 5). The first Register, printed in
1932, contained the names of “three hundred and eighteen therapists … all qualified by a rigid set
of standards.” Thirteen names were also included in the secondary Register (AOTA, 1932, 1967a)
(Figures 4-17 to 4-19). Initially, those admitted to the Register used the designation O.T. Reg. A
vote of the membership at the 1940 business meeting officially changed the designation to O.T.R.
(AOTA, 1940).
106 Chapter 4

Figure 4-18. Photograph of Jennie K. Allen’s Registration Certificate. Miss Allen served as Head
of the Occupational Therapy Department of Cook County Hospital in Chicago and President of
the Illinois Association of Occupational Therapy. (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)

1
1
1 2
1 1 MA - 32
1 14 80
1 RI - 5
10
33 CT - 8
2
6 NJ - 12
17 6
2 1
10 10 4 MD - 8
8
2
D.C. - 13
1 2 2 2

1 1 2
Canada - 5
4 2 England - 1
India - 2
Puerto Rico - 1

Figure 4-19. Map showing the distribution of the 318 occupational therapists listed in the 1932 National Directory by
state.
 Standard Setting: 1920s to 1940s 107

Accreditation of
Training Schools Through
the American Medical Association
With the National Register established, the Association took steps to develop a plan for the
inspection of training schools. Mrs. Slagle was the sole person in charge of determining whether
schools met Minimum Standards, the basis for allowing graduates to be admitted to the Register.
Slagle brought concerns or problems with specific
schools to the attention of the Board of Management
for further direction. However, to avoid the perception
of a conflict of interest, the Association decided that
an outside agency should take charge of the inspection
program. In 1931, Thomas Kidner quietly approached
the American Medical Association (AMA) to discuss the
possibility of the AMA’s Council on Medical Education
and Hospitals (AMA-CMEH) taking responsibility for
inspection of occupational training courses. The AMA
had experience setting standards for medical education.
The association also believed that this oversight by the
AMA would bring increased legitimacy and status to
the profession. Dr. Joseph C. Doane, President of AOTA
(1930 to 1938), formally requested the AMA take respon-
sibility for the inspection of occupational therapy train-
ing programs on March 10, 1931 (Figure 4-20).
In June 1933, recognizing that occupational therapists
worked under the direction of the medical profession,
the AMA agreed to this role. AOTA wanted the AMA- Figure 4-20. Dr. Joseph C. Doane served
CMEH to use the Minimum Standards for Courses as president of the American Occupational
Therapy Association from 1930 to 1938 during
of Training in Occupational Therapy as the guide for the time of the Great Depression. With his
inspections (Board of Management, 1931a). The AMA- charming personality, Dr. Doane was skilled at
CMEH began to survey occupational therapy train- presiding at meetings, and influencing ideas
ing schools at the end of 1933 to consider Minimum and opinions. (Printed with permission from
the Archive of the American Occupational
Standards. Following this survey, the AMA-CMEH, in Therapy Association, Inc.)
collaboration with AOTA, proposed new Mi nimum
Standards. These standards were accepted in June 1935
as the “Essentials of an Acceptable School of Occupational Therapy” and published in the May
4, 1935; August 31, 1935; and August 29, 1936, editions of the Journal of the American Medical
Association (Report of the Council on Medical Education and Hospitals, 1935). In addition to
revision of admission and curricular requirements established by the Minimum Standards, the
Essentials also set requirements for the program’s organization, administration, resources, and
faculty. It was recommended, but not required, that occupational therapy schools be affiliated with
a college, university, or medical school. Faculty were required to be well trained and well qualified
(Report of the Council on Medical Education and Hospitals, 1935, p. 1632). The AMA-CMEH
wanted to publish a list of schools that met these standards by January 1939. Early publication
of the Essentials provided time for schools to come into compliance with the new standards and
allowed time to receive suggestions for any needed changes. The Essentials were revised in 1938,
primarily for clarification and the addition of a section on clinical training standards (Board of
Management, 1936b; Report on survey of occupational therapy schools, 1938).
108 Chapter 4

Figure 4-21. The old Philadelphia School of Occupational Therapy is listed on the U.S.
National Register of Historic Places. Mrs. Pope Yeatman built the building specifically
for the Philadelphia School in the early 1930s. The building was used until the late
1950s.

Figure 4-22. The plaque from Yeatman House. After completion of the new building for
the Philadelphia School of Occupational Therapy, the old school building was used as a
dormitory for the occupational therapy students. The dormitory was named the Yeatman
House in honor of Mrs. Yeatman, a long-time supporter and President of the Board of
Directors of the Philadelphia School. (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)

Five schools made the first list of approved schools published in the Journal of the American
Medical Association in March 1938, including the Boston School of Occupational Therapy, the St.
Louis School of Occupational and Recreational Therapy, the Philadelphia School of Occupational
Therapy, the Department of Occupational Therapy at Milwaukee-Downer College, and the
Department of University Extension at the University of Toronto. Kalamazoo State Hospital
School of Occupational Therapy was given tentative approval (Report on survey of occupational
therapy schools, 1938) and final approval in 1939 (Board of Management, 1939) (Figures 4-21 and
4-22).
Up until this time, graduation from a school that met the Minimum Standards for Courses of
Training in Occupational Therapy was a requirement for admission to the National Register. With
the move to accreditation of schools by the AMA-CMEH, graduation from an accredited school
was now required for admission to the Register. To accommodate those who graduated prior to the
 Standard Setting: 1920s to 1940s 109

Figure 4-23. The first registration examination given by AOTA for candidates applying for admission to the Register
based on training and experience. The application for registration was $10, and the examination fee was $10. Five dol-
lars of the registration fee would be refunded if the candidate did not pass the examination. (Printed with permission
from the Archive of the American Occupational Therapy Association, Inc.)

accreditation program, AOTA clarified that any occupational therapist in active in practice who
graduated from a school that met the AOTA Minimum Standards at the time the student was in
training was eligible for admission to the Register (Board of Management, 1936a).
The opportunity for occupational therapists to apply for admission to the Register based on
training and experience ended on December 31, 1933. AOTA recognized that although many of
these occupational therapists had missed the deadline, they were still qualified to practice. In this
time of a manpower shortage, AOTA wanted to offer them one last chance to be admitted to the
Register. A committee formed to devise a plan to allow admission to the Register recommended
that these therapists take an examination to demonstrate their competence to engage in high stan-
dards of practice. A Board of Examiners was appointed to develop the examination (Admission
to the Register by Examination, 1939; Lermit, Bartlett, & Naylor, 1938). More than 60 candidates
applied to take this examination, which was given on November 18, 1939 (Board of Management,
1939) (Figure 4-23). Keeping in line with other medical and social professions, the planning com-
mittee also suggested that the Board of Examiners should, in the future, establish an examination
that all candidates would be required to take to be admitted to the Register (Lermit et al., 1938).
110 Chapter 4

Establishing
Occupational Therapy Programs
One of the concerns of early practitioners was finding ways to fund occupational therapy ser-
vices. Although the government covered the costs in military and veteran hospitals, there was no
medical insurance to cover costs in civil hospitals. Hospitals themselves often had limited funding
to cover operating expenses of occupational therapy services. Many community organizations
were instrumental in the starting occupational therapy programs in hospitals and other facilities.
One of the first was the Women’s Auxiliary Board of the Presbyterian Hospital of Chicago. This
Board provided the funds to hire Susan E. Tracy to travel to Chicago in 1917 to consult on start-
ing an occupational therapy program. It was during Tracy’s 5-month stay that the Presbyterian
Hospital’s occupational therapy program was started. The Board continued to fund the program as
it grew (Bacon, 1932; Brainerd, 1932). The Presbyterian Hospital was just one example. A survey of
community hospitals in New England indicated that many of the occupational therapy programs
in those hospitals were also financed by ladies’ auxiliaries (Adams, 1922).
The Junior League was another organization that helped to establish and maintain occupa-
tional therapy programs throughout the country. Inspired by the Settlement House movement,
19-year-old Mary Harriman, a New York debutante, founded the Junior League for the Promotion
of Settlement Movements in 1901. Her goal was to organize an endless supply of volunteers from
debutantes who would work to improve the social conditions in New York City, especially for
immigrants. Her friend, a shy Eleanor Roosevelt, joined the New York Junior League as a volunteer
in 1903, getting her first taste of public service by working for social justice. The Junior League idea
started to spread throughout the United States, and in 1921, the Association of Junior Leagues of
America was founded. Many of the Junior Leagues helped to establish health care facilities to meet
the needs of children and adults (Association of Junior Leagues International, Inc., 2015).
The Junior League of the City of New York began doing occupational work with crippled chil-
dren and other patients in hospitals including City Hospital, Bellevue Hospital, St. Luke’s Hospital,
and the Hospital for the Ruptured and Crippled starting in 1916. In 1917, the New York Junior
League provided a course to train volunteers to help with occupation work in these hospitals.
The Junior League funded salaries for two therapists in 1923 and for an additional therapist in
1929. A special committee, the Occupational Therapy Committee, was formed in 1931 to provide
networking and educational opportunities for the occupational therapists and volunteers in New
York City. The aim of this committee was to facilitate sharing of ideas and solving of common
problems. From 1937 to 1940, the New York Junior League provided a training course to fill the
need for trained volunteers in occupational therapy. In hard economic times and with limited
budgets, these volunteers were trained to assist occupational therapists in their work. Volunteers
participated in this course for 2 hours per week over the span of 3 months (Howard, 1939).
The Indianapolis Junior League provided funding to establish occupational therapy programs
in the three Indiana University hospitals, including the general hospital, Coleman Hospital for
Women, and Riley Hospital for Children in the 1920s. The Junior League earned the funds to
support the occupational therapy programs through sales at gift shops, secondhand stores, and
an annual entertainment event. The Indianapolis Junior League also facilitated and sponsored the
first organizational meeting of the Indiana state society for occupational therapy (MacDonald,
1930).
There are many other examples of Junior Leagues helping to start occupational therapy programs.
In addition to donating $5000 to help start the St. Louis School of Occupational Therapy (Medicine
in St. Louis Hospital, 1919, p. 3), the Junior League of St. Louis started the Occupational Therapy
Workshop in 1917 to help with the war relief effort (State Historical Society of Missouri, n.d.). In
1919, the Junior League of Milwaukee equipped and financed an occupational therapy department
at Columbia Hospital in Milwaukee, which was directed by Hilda B. Goodman (Junior League of
 Standard Setting: 1920s to 1940s 111

Figure 4-24. AOTA Exhibit Hall in 1932. The AHA played a significant role in encouraging hos-
pitals to start occupational therapy programs. AOTA and AHA held joint conferences from 1922
through 1937. This arrangement allowed occupational therapists to exhibit photographs and
provide live demonstrations at the conference so hospital administrators could see what occu-
pational therapy did and discuss issues and concerns with therapists. (Printed with permission
from the Archive of the American Occupational Therapy Association, Inc.)

Milwaukee, 1921; Phillips, 1928). The Junior League of Bridgeport, Connecticut, established an
occupational therapy program at Bridgeport Hospital in the 1920s (Junior League of Eastern
Fairfield County, 2015), and the Detroit Junior League started an occupational therapy program
for those injured in the war. The goods made by disabled servicemen in Detroit were sold in the
League shop (Gordon & Reische, 1982).
AOTA maintained a close relationship with the Junior Leagues. In the late 1920s, Junior
Leagues in Albany, New York; Dayton, Ohio; Englewood, New Jersey; and Winnipeg, Canada, all
requested information from AOTA on developing occupational therapy programs (Slagle, 1930).
The support of the Junior League in developing, equipping, and funding occupational therapy
programs throughout the United States has continued through the years (Figure 4-24).

Practice and Research

In pursuit of the Founding Vision, the Committee on Research and Efficiency was charged
“to gather together information upon the subject of the effects of occupation upon the human
being, and to keep in touch with the development of the work in the institutions in this country
and abroad” (NSPOT, 1917). Despite the request of insurance companies for statistical evidence
to justify payment, the lack of a sound scientific measure of improvement hindered research
efforts (Editorial, 1923; House of Delegates, 1922). Much of the early research was exploratory and
descriptive in nature.
112 Chapter 4

George Barton, first Chair of the Committee on Research and Efficiency, collected informa-
tion and literature about occupation work throughout the United States and the world (Barton,
1917). Similarly, Susan E. Tracy’s Committee on Teaching Methods surveyed facilities to identify
the extent of occupational therapy practice. Thomas Kidner, taking over as Chair of Committee
on Research and Efficiency from Barton, and as part of his work with the National Tuberculosis
Association, surveyed sanatoria in the United States to determine the extent of occupational ther-
apy in these facilities. Of the 500 surveys sent, 122 were returned representing state (20), county
(39), municipal (12), federal (7), charitable or semi-charitable (4), private (25), and miscellaneous
(15) institutions. Of these, 37 indicated they provided some type of occupational therapy service
(bedside, war, and/or classrooms/workshops). Many of the other institutions were hopeful about
eventually providing occupational therapy (Kidner, 1920a).
In his role as Institutional Secretary of the National Tuberculosis Association, Kidner published
a report that outlined plans for the building of modern sanatoria. In the report, he advocated for
space to be allocated to occupational therapy activities, suggesting that an occupational therapy
aide is needed for every 20 patients. In advocating for occupational therapy services, Kidner was
among those who asserted that the prevocational services offered by occupational therapy should
be covered under the provisions of the Federal Vocational Rehabilitation Act because occupational
therapy was vital in preparing the patients for vocational education (Kidner, 1921, 1922a). Despite
a number of people advocating for a more liberal interpretation, the Federal Board of Vocational
Rehabilitation maintained the posture that vocational rehabilitation did not include mental or
physical restoration “although such work may be a necessary preliminary to or accompaniment of
vocational rehabilitation” (Cahn, 1924, p. 674) and occupational therapy was not a covered service
except if provided for “definite preparation for a specific occupation” (Cahn, 1924, p. 673). Despite
the fact that occupational therapy services were not covered under the Vocational Rehabilitation
Act, Kidner was able to use his position with the National Tuberculosis Association to expand
occupational therapy services in sanatoriums for those with tuberculosis.
The Association continued to gather information about the spread of occupational therapy to
hospitals in the United States. In his 1931 Presidential Address, Dr. Joseph C. Doane provided
statistics on the number of occupational therapists and the number of facilities providing occupa-
tional therapy services in the United States (Doane, 1931). Doane’s report included numbers from
27 states. Doane indicated there were a total of 1287 occupational therapy workers (677 trained
and 610 untrained) working in 383 hospitals, including 46 federal hospitals, 120 state hospitals,
48 county hospitals, 42 city hospitals, and 127 private hospitals. Included in these numbers were
163 mental hospitals, 72 facilities for tuberculous care, 90 general hospitals, 18 for orthopedic care,
16 for pediatric care, 13 for convalescent patients, and three correctional facilities (Doane, 1931).
More than half of the hospitals in which occupational therapy services were provided were for
mental health care and tuberculous care. Occupational therapists also worked with people with
cardiac problems, industrial accident cases, children with cerebral palsy, the blind, crippled chil-
dren, people with chronic diseases, and children with infantile paralysis (poliomyelitis).
The focus of Dr. Herbert Hall’s research at his experimental workshop in Marblehead was on
the design and use of wooden toy projects in the workshop. Hall was considering which wooden
toy projects could be adapted to the needs of patients in various settings and would result in a
product of such quality that it could be easily sold (Kidner, 1922b). This was in concert with Hall’s
belief that, although the process of participating in the project was important, the economic value
obtained from selling a finished product was therapeutic.
Louis Haas, the Director of Men’s Therapeutic Occupations at Bloomingdale’s Hospital in
White Plains, New York, also studied the adaptability of specific crafts such as basketry, chair can-
ing, blacksmithing, cement work, weaving, jewelry making, and printing. Characteristics of these
crafts, including the amount of physical exertion, coordination, and cognitive ability required, as
well as the number of tools and precautions, were identified in the study. Haas also looked at the
cost effectiveness of various crafts, considering such factors as the number of patients a therapist
 Standard Setting: 1920s to 1940s 113

could supervise at one time when constructing proj-

ects, the cost of materials, and the value of the finished
product. His department discontinued the use of cer-
tain crafts if they proved too difficult for patients, were
not engaging, required excess staff time, or were too
expensive (Haas, 1922). Dunton, in his series of articles
on the economic study of crafts, provided a cost analy-
sis as well as a description of characteristics of crafts
(Dunton, 1925a, 1925b, 1926a, 1926b). The Committee
on Installations and Advice followed with a series of
articles that analyzed various craft activities (Robeson et
al., 1928a, 1928b, 1928c). The research of Haas, Dunton,
and the Committee on Installations and Advice formed
the basis of what is now known as activity analysis.

Reconstruction
Aides After Figure 4-25. Re-Aides’ Post was the official
publication of the World War Reconstruction
World War I Aides Association. It was published from 1920
to 1950. The first issues from 1920 to 1926 were
published as newspapers. Beginning in 1926,
After World War I, in 1920, the reconstruction Re-Aides’ Post was published as a small jour-
aides formed the World War Reconstruction Aides nal. On the cover were two figures dressed in
Association to maintain friendships made during their working reconstruction aide uniforms: the one
on the left represents occupational therapy
service, preserve the history of the reconstruction aides, and the one on the right represents physical
and provide support (Figure 4-25). Many reconstruction therapy. The content addressed recollections
aides continued in occupational therapy work and often of activities as reconstruction aides, updates
attended the annual meetings. In 1925, two disabled on people’s current lives, activities and meet-
ings of the 14 units, and business activities of
reconstruction aides requested assistance to obtain hos- the Association. The journal was discontinued
pitalization and compensation benefits from the fed- when the organization was disbanded in 1949.
eral government. In her role as Secretary-Treasurer, Mrs. (Printed with permission from the Archive
Slagle wrote to the Surgeon General of the Army and the of the American Occupational Therapy
Association, Inc.)
director of the Veterans’ Bureau. Both responded, stat-
ing that the reconstruction aides in occupational therapy
were hired by the Army as civilian employees and there-
fore were not covered by the War Risk Insurance Act. Only military employees were eligible for
benefits (Board of Management, 1925). Through lobbying efforts of the reconstruction aides and
other groups, the United States Congress amended the War Risk Insurance Act in 1926 to provide
limited coverage for reconstruction aides who served in base hospitals overseas.
For death or disability resulting from personal injury or disease contracted in the mili-
tary or naval service on or after April 6, 1917, and before July 2, 1921, or for an aggravation
or recurrence of a disability existing prior to examination, acceptance, and enrollment
for service, when such aggravation was suffered or contracted in, or such recurrence was
caused by, the military or naval service on or after April 6, 1917, and before July 2, 1921
… the United States shall pay to such commissioned officer or enlisted man, member of
the Army Nurse Corps (female), or the Navy Nurse Corps (female), or women citizens of
the United States who were taken … by the United States Government and who served
in base hospitals overseas….
114 Chapter 4

In addition to the compensation above provided, the injured person shall be provided
by the United States Veterans’ Bureau such reasonable governmental care or medical,
surgical, dental and hospital services, etc. (Public Law 69-448)
There was still some confusion after this amendment passed, so Mrs. Slagle appealed to her
brother, John Davenport Clarke, a Representative to the United States Congress (R-NY) (Slagle,
1929). Representative Clarke helped navigate through government channels to inquire about and
ensure the compensation of disabled reconstruction aides (Clarke, 1929).

Effect of
the National Economy
Act of 1933 on Occupational Therapy
Franklin Delano Roosevelt, the Governor of New York, ran for President of the United States
in 1932 with the promise to balance the federal budget. Shortly after taking office, he kept his
promise by pushing legislation through Congress to slash the federal budget. This legislation, the
National Economy Act, was passed on March 20, 1933. The purpose of this act was to reduce the
federal deficit and maintain the credit of the United States. With passage of this act, government
agencies were closed, and the salaries of civilian and federal workers were cut. Veterans’ benefits, a
significant part of the federal budget, were reduced by 50%. Specifically, Section 17 of the National
Economy Act stated:
All public laws granting medical or hospital treatment, domiciliary care, compensa-
tion, and other allowances, pension, disability allowance, or retirement pay to veterans
and the dependents of veterans of ... the World War ... are hereby repealed, and all laws
granting or pertaining to yearly renewable term insurance are hereby repealed.
Effectively, the benefits provided by of the War Risk Insurance legislation were gutted. The ser-
vices of occupational therapists, physical therapists, and dieticians were terminated when Veterans’
Administration funds, authorized by the War Risk Insurance legislation, were no longer available.
In 1924, Walter Reed Hospital instituted a 6-month training course for occupational therapists
to provide advanced training specific to military hospitals for graduates. The length of the pro-
gram increased to 9 months in 1932. With the passage of the National Economy Act and severe
budget cuts, the therapy departments and training programs at Walter Reed General Hospital
closed (McDaniel, 1968, pp. 92-93). Robert Patterson, Surgeon General of the Army (1931 to 1935),
spoke at the graduation of the last occupational therapy training class at Walter Reed, expressing
“great regret at the temporary restrictions placed upon these courses of training at this hospital”
(Patterson, 1933). The Act allowed the president to reestablish benefits at a later time through
Executive Order. Courses resumed for physical therapists and dieticians in 1934, but not for occu-
pational therapists (McDaniel, 1968, p. 93).
Some military programs had experienced severe cuts or had been closed due to economic rea-
sons prior to the Great Depression. Fort Sam Houston and Brooke General Hospital discontinued
their occupational therapy programs in 1926 because of financial concerns. The general and neu-
ropsychiatric clinics at Fitzsimons General Hospital in Denver closed in June of 1933, reopening in
1934 on a very limited basis. The Army and Navy General Hospital occupational therapy programs
in Hot Springs, Arkansas, noted for treatment of arthritis, closed in 1936. Also in 1936, Letterman
General Hospital in San Francisco experienced severe cuts and reduced personnel and programs
(McDaniel, 1968, pp. 95-96).
 Standard Setting: 1920s to 1940s 115

Military Status for

Occupational Therapists
In 1931, the supervisors of occupational therapists (Miss Alberta Montgomery), dieticians (Miss
Grace H. Hunter), and physical therapists (Miss Emma Vogel) at Walter Reed General Hospital
recommended to upgrade the professional status and increase salaries for the civilian Army per-
sonnel whom they supervised. The professional status and salaries of civilian Army personnel
had not changed since World War I. Seeking the same professional status and benefits accorded
to nurses, these three supervisors recommended the establishment of a Medical Auxiliary Corp,
similar to the Army Nurse Corps (Vogel & Gearin, 1968, p. 3). The Army did not follow the recom-
mendation, indicating that the economic conditions of the Great Depression would not allow it.
In 1937, United States Representative Carl Vinson (D-GA) requested the Surgeon General to
consider commissioned military status for physical therapists. The Surgeon General indicated
that military status would not be granted to physical therapists, nor to dieticians or occupational
therapists with whom they were on par. The Surgeon General also indicated that these groups
would not be afforded military status because they would not have to enter a war zone (Vogel &
Gearin, 1968, pp. 4-5).
Senator Morris Sheppard (D-TX) introduced a bill in 1939 to afford military status to female
occupational therapy aides, physical therapy aides, and dieticians. The Surgeon General supported
military status for physical therapy aides and dieticians. The Secretary of War concurred. The bill
did not pass because of economic reasons but was reintroduced excluding occupational therapy
aides from the language of the bill. Undeterred, Senator Sheppard reintroduced the bill in 1940
and again 1941 (Vogel & Gearin, 1968, pp. 5-6). In an effort to include occupational therapy in
these bills, AOTA President Everett S. Elwood (1939 to 1947) attempted to gain the support of
the Surgeon General James C. Magee (1939 to 1943). Magee indicated that it was “undesirable” to
include occupational therapy aides because just nine were employed in military hospitals. Of these,
six served Veterans Administration patients, two served Civilian Conservation Corps patients,
and only one served military patients (Magee, 1940).
Persisting in efforts to include occupational therapy in this legislation, the occupational therapy
community mobilized. AOTA House of Delegates passed a resolution justifying military status
for occupational therapy aides and requesting support. Marjorie Fish, Speaker of the House of
Delegates, forwarded the resolution to the Chairman of the American Red Cross, the Secretary
of War, the Surgeon General, and Senator Morris (Fish, 1940). State associations and individu-
als petitioned and wrote to the congressional committee members considering this legislation
and to their U.S. Congressmen. Mrs. John Greene (Marjorie), Director of the Boston School of
Occupational Therapy, called on personal contacts in power. She wrote to U.S. Representative
Richard Wigglesworth, who had helped with the incorporation of the Boston School of
Occupational Therapy years before (Greene, 1940). Representative Wigglesworth was the brother
of Ruth Wigglesworth (Whitney), Mrs. Greene’s former codirector at the Boston School. He for-
warded her letter, which explained the development of occupational therapy as a profession since
World War I, including increased educational standards and wider acceptance in civilian hospi-
tals (Wigglesworth, 1940). Unfortunately, both attempts to pass Senator Sheppard’s legislation to
achieve military status for any of the groups was still unsuccessful (Vogel & Gearin, 1968, pp. 5-6).
116 Chapter 4

Figure 4-26. (A-C) A testimonial banquet was held at

the 1937 AOTA conference in Atlantic City, New Jersey,
in honor of Eleanor Clarke Slagle’s retirement. (Printed
with permission from the Archive of the American
Occupational Therapy Association, Inc.)
 Standard Setting: 1920s to 1940s 117

Figure 4-27. Eleanor Clarke Slagle, Eleanor Roosevelt, and Edgar C.

Hayhow (a well-known health care administrator and 14th Chairman
of the American College of Healthcare Executives) on the boardwalk
at the Atlantic City conference in 1937. (Courtesy of the New York State
Historical Association Library, Cooperstown, New York, John Davenport
Clarke Papers, Coll. No. 12, Box 7.)

Figure 4-28. (A) Eleanor Clarke Slagle’s grave-

stone in the family plot in Locust Hill Cemetery
located in Hobart, New York. Note that the
birthdate is inaccurate. Although documents
such as census records, church records, and
ship passenger lists are inconsistent identify-
ing Slagle’s birth year, she was most likely born
in 1870. (B) The Clarke family main headstone.
(C) The Clarke family plot. Eleanor Clarke
Slagle’s gravestone is third from the bottom.
(Reprinted with permission from Lorna Puleo.)
118 Chapter 4

Slagle Resigns as
Secretary-Treasurer of AOTA
Slagle resigned from her position as Secretary-
Table 4-1
Treasurer of AOTA in 1937. She was honored by the
Association later that year at the annual meeting in AOTA MEMBERSHIP DATA—
Atlantic City, New Jersey, with a testimonial banquet.
Adolf Meyer and Eleanor Roosevelt paid tribute to her
1920 TO 1940
at the banquet (Figures 4-26 and 4-27). Having served YEAR NUMBER OF MEMBERS
in this volunteer position since 1921, her friends and 1920 190
AOTA membership honored her with a gift of $2000, 1925 749
a substantial sum at that time. The gift was inscribed:
1930 883
Eleanor Clarke Slagle – She has been the cor- 1935 831
ner stone in the development and promotion of
1940 1,207
occupational therapy. Now we in turn ask that
she accept our gift as the corner stone of her new
home which we hope will be the place of rest and happiness and release from the ardu-
ous duties. We offer it with deep affection and profound gratitude for her twenty-one
years of untiring service in our behalf. (Pollock, 1942)
Proud of her service as a founder and officer who help to build the profession, Slagle turned
the work over to others with the inspiring message, “The integrity of the profession is in your
hands. I bid you Godspeed in your work” (Slagle, 1937). Slagle purchased her new country home,
Philipse Manor, in Westchester County, New York. She continued to work for the New York State
Department of Mental Hygiene until her death in 1942 (Editorial, 1942; Pollock, 1942) (Figure
4-28). Maud Plummer was named Executive Secretary, taking over many of Slagle’s duties.
Plummer resigned at the end of 1937. Meta R. Cobb was hired as the Executive Secretary, a paid
position, to replace Miss Plummer (Board of Management, 1938).

War Clouds
War clouds were once again looming in Europe. In September 1939, Germany invaded Poland.
England and France declared war on Germany. Although the United States maintained neutrality,
President Roosevelt declared a limited national emergency on September 8, 1939. The decrease in
funding post-World War I, the economic situation caused by the Great Depression, and the lull of
peacetime made America ill prepared for war. Supplies, equipment, and facilities were limited, in
poor condition, and outdated. The ranks of the civilian personnel serving in the military, includ-
ing occupational therapists, physical therapists, and dieticians, were very limited (Table 4-1).
AOTA began to organize to promote occupational therapy in the war effort.

Reflection
The dedicated and tireless efforts of the leaders of occupational therapy advanced the profes-
sional status of the profession. Over the decades of the 1920s and 1930s, Minimum Standards for
Courses of Training in Occupational Therapy had been established and revised to continually
advance high standards. Next, the National Register was established to provide for enforcement
of standards, allowing admission only to those who met high standards of graduation from an
approved school and 1 year of experience. Finally, at the request of AOTA, the AMA accepted
responsibility for the inspection and accreditation of training schools to ensure the high standards
 Standard Setting: 1920s to 1940s 119

of the profession. AOTA actively sought the sponsorship of the medical profession, a larger and
more powerful organization, to obtain the benefits of their manpower and expertise and to gain
recognition and status; however, this arrangement also allowed the medical profession more con-
trol of occupational therapy and further tied the profession to the medical model.
Whereas World War I had provided momentum for the growth of the profession, the end of the
war brought a decreased need for occupational therapists in military hospitals. The poor economic
situation in the late 1920s significantly reduced the number of occupational therapists working
with military patients because the military looked to eliminate unnecessary expense. The military
considered occupational therapists to be expendable. Lacking professional status and recognition,
the role of occupational therapy in the military had been virtually eliminated by the start of World
War II.

References
Adams, J. D. (1922). The training of the occupational aide. Archives of Occupational Therapy, 1(3), 187-192.
Admission to the Register by Examination. (1939, February). Occupational Therapy and Rehabilitation, 18(1), 61-62.
American Occupational Therapy Association. (1924). Minimum standards for courses of training in occupational
therapy. Archives of Occupational Therapy, 3(4), 295-298.
American Occupational Therapy Association. (1932). 1932 national directory of qualified occupational therapists
enrolled in 1931 in the National Register. New York, NY: Author.
American Occupational Therapy Association. (1938). Constitution. Occupational Therapy & Rehabilitation, 17(6),
439-442.
American Occupational Therapy Association. (1940). Minutes of the business session, September 16, 1940. Archives
of the American Occupational Therapy Association (Series 3, Box 13, Folder 84), Bethesda, MD.
American Occupational Therapy Association (1967a). 50th Anniversary: Occupational therapy—Then…1917 and
now…1967. New York, NY: Author.
American Occupational Therapy Association. (1967b). Presidents of the American Occupational Therapy Association.
American Journal of Occupational Therapy, 21(5), 290-298.
American Occupational Therapy Association. (1921). American Occupational Therapy Association is New Name,
Modern Hospital, 17(6), 554.
Association of Junior Leagues International, Inc. (2015). Founder Mary Harriman: A spirited reformer ahead of her
time. Retrieved from https://www.ajli.org/
Bacon, A. S. (1932). The place of occupational therapy in the Presbyterian Hospital of Chicago, Illinois. Occupational
Therapy and Rehabilitation, 11(1), 31.
Barton, G. E. (1917). Report of the Committee on Research and Efficiency. In Proceedings of the First Annual Meeting
of the National Society for the Promotion of Occupational Therapy (pp. 24-27). Towson, MD: Spring Grove State
Hospital and the Sheppard Hospital Press.
Bing, R. K. (1961). William Rush Dunton, Junior—American psychiatrist, a study in self (Doctoral dissertation).
College, Park, MD: University of Maryland.
Board of Management. (1923, June 9). Minutes of the meeting of Board of Managers. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 80), Bethesda, MD.
Board of Management. (1925). Disabled ex-service O.T. Aides. Minutes of the meeting of Board of Managers. Archives
of the American Occupational Therapy Association (Series 3, Box 13, Folder 80), Bethesda, MD.
Board of Management. (1926a, September 26). Headquarters office. Minutes of the meeting of Board of Managers.
Archives of the American Occupational Therapy Association (Series 3, Box 13, Folder 81), Bethesda, MD.
Board of Management. (1926b, September 26). Pledge and Creed. Minutes of the meeting of Board of Managers.
Archives of the American Occupational Therapy Association (Series 3, Box 13, Folder 81), Bethesda, MD.
Board of Management. (1927, October 9). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association (Series 3, Box 13, Folder 81), Bethesda, MD.
Board of Management. (1928, August 5). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association (Series 3, Box 13, Folder 81), Bethesda, MD.
Board of Management. (1929, January 7). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association (Series 3, Box 13, Folder 81), Bethesda, MD.
Board of Management. (1931a, January 3). Minutes of the Board of Management. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 82), Bethesda, MD.
120 Chapter 4

Board of Management. (1931b, September 28). Minutes of the Board of Managers. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 82), Bethesda, MD.
Board of Management. (1936a, January 11). Minutes of the Board of Management. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 83), Bethesda, MD.
Board of Management. (1936b, January 20). Minutes of the Board of Management. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 83), Bethesda, MD.
Board of Management. (1938, January 3). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association (Series 3, Box 13, Folder 84), Bethesda, MD.
Board of Management. (1939). Minutes of the Board of Managers. Occupational Therapy and Rehabilitation, 18(6),
399-410.
Brackett, E. G. (1922). Scope of occupational therapy and requirements for the training of occupational aides. Archives
of Occupational Therapy, 1(3), 179-185.
Brainerd, W. (1932). The evolution of an occupational therapy department in a general hospital. Occupational Therapy
and Rehabilitation, 11(1), 33-40.
Cahn, R. D. (1924, December). Civilian vocational rehabilitation. Journal of Political Economy, 32(6), 665-689.
Cameron, R. G. (1915, December). Occupational therapy. Trained Nurse and Hospital Review, 55(6), 342-345.
Cameron, R. G. (1917, January). An interview with Miss Susan Tracy. Maryland Psychiatric Quarterly, 6(3), 65-66.
Clarke, J. D. (1929). Personal correspondence to Eleanor Clarke Slagle on March 25, 1929. Archives of the American
Occupational Therapy Association (Series 5, Box 24, Folder 161), Bethesda, MD.
Committee on Admissions and Positions. (1918). Report of the Committee on Admissions and Positions. In
Proceedings of the Second Annual Meeting of the National Society for the Promotion of Occupational Therapy
(pp. 18-19). Towson, MD: Sheppard and Enoch Pratt Hospital.
Committee on Admissions and Positions. (1919). Report of the Committee on Admissions and Positions. In
Proceedings of the Third Annual Meeting of the National Society for the Promotion of Occupational Therapy
(pp. 16-25). Towson, MD: Sheppard and Enoch Pratt Hospital.
Committee on Admissions and Positions. (1922). The Fifth Annual Meeting of the National Society for the Promotion
of Occupational Therapy: Report of the Committee on Admissions and Positions. Archives of Occupational
Therapy, 1(1), 74-76.
Committee on Publicity and Publications. (1922). Report of the Committee on Publicity and Publications: First
Day—Morning Session. Proceedings of the Fifth Annual Meeting of AOTA. Archives of Occupational Therapy,
1(1), 64-66.
Committee on Publicity and Publications. (1925). Report of the Committee on Publicity and Publications in Minutes
of the Ninth Annual Meeting of the American Occupational Therapy Association. Occupational Therapy and
Rehabilitation, 4(6), 470-471.
Committee on Teaching Methods. (1917). Report of the Committee on Teaching Methods. In Proceedings of the First
Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 34-41). Towson, MD:
Spring Grove State Hospital and Sheppard and Enoch Pratt Hospital.
Committee on Teaching Methods. (1918). Report of the Committee on Teaching Methods. In Proceedings of the
Second Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 20-25). Towson,
MD: Sheppard and Enoch Pratt Hospital.
Committee on Teaching Methods. (1919). Report of the Committee on Teaching Methods. In Proceedings of the
Third Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 29-35). Towson,
MD: Sheppard and Enoch Pratt Hospital.
Committee on Teaching Methods. (1922). The Sixth Annual Meeting of the National Society for the Promotion of
Occupational Therapy: Report of Committee on Teaching Methods. Archives of Occupational Therapy, 2(1),
63-65.
Doane, J. C. (1931). Presidential address. Occupational Therapy and Rehabilitation, 10, 363-368.
Dunton, W. R. (1918). Principles of occupational therapy. In Proceedings of the Second Annual Meeting of the
National Society for the Promotion of Occupational Therapy (pp. 26-30). Towson, MD: Spring Grove State
Hospital and Sheppard and Enoch Pratt Hospital.
Dunton, W. R. (1919a). N.S.P.O.T. Maryland Psychiatric Quarterly, 8(3), 68-74.
Dunton, W. R. (1919b). Reconstruction therapy. Philadelphia, PA: W. B. Saunders Company.
Dunton, W. R. (1925a). Economic studies of crafts. I. Upholstery. Occupational Therapy & Rehabilitation, 4(3), 219-
222.
Dunton, W. R. (1925b). Economic studies of crafts. II. Metal Work; III. Woodwork; IV. Toy making. Occupational
Therapy and Rehabilitation, 4(6), 441-446.
Dunton, W. R. (1925c). Editorial. Occupational Therapy and Rehabilitation, 4(3), 227-228.
 Standard Setting: 1920s to 1940s 121

Dunton, W. R. (1926a). Economic studies of crafts, V. Chip Carving, VI. Domestic Crafts, VII. Crocheting, VIII.
Miscellaneous (Women). IX Specials, X. Disturbed Women, XI. Basketry, XII. Pine Needle Basketry, XIII. Raffia
Basketry. Occupational Therapy and Rehabilitation, 5(2), 135-142.
Dunton, W. R. (1926b). Economic studies of crafts: XIV. Weaving; XV, Leather; XVI Bookbinding; XVII. Batik;
XVIII. Block Printing; XIX Miscellaneous (men); XX Painting; XXI. Sealing Wax. Occupational Therapy and
Rehabilitation, 5(4), 293-308.
Dunton, W. R. (1955, June 2). [Letter to Mrs. Frances Shuff]. Archives of the American Occupational Therapy
Association (Series 6, Box 47, Folder 320), Bethesda, MD.
Editor. (1922). Leisure and idleness. Modern Hospital, 18(2), 188.
Editorial. (1922a). Archives of Occupational Therapy, 1(1), 87.
Editorial. (1922b). The sixth annual meeting. Archives of Occupational Therapy, 1(5), 419-427.
Editorial. (1923). The need for research. Archives of Occupational Therapy, 2(3), 249-250.
Editorial. (1942). Eleanor Clarke Slagle memorial. Occupational Therapy and Rehabilitation, 21(5), 373-374.
Editorial. (1946). Occupational Therapy and Rehabilitation, 25(6), 267-268.
Elwood, E. S. (1927). The National Board of Medical Examiners and Medical Education, and the possible effect of the
Board’s program on the spread of occupational therapy. Occupational Therapy and Rehabilitation, 6(5), 341-348.
First Day—Afternoon Session. (1920). In Proceedings of the Fourth Annual Meeting of the National Society for the
Promotion of Occupational Therapy (pp. 27-39). Towson, MD: Spring Grove State Hospital and Sheppard and
Enoch Pratt Hospital.
First Day—Morning Session. (1922). Proceedings of the Fifth Annual Meeting of AOTA. Archives of Occupational
Therapy, 1(1), 51-64.
Fish, M. (1940). Memo to Chairman of the American Red Cross Mr. Norman H. Davis, Secretary of War Henry L.
Stimson, Surgeon General James C. Magee, Senator Morris Sheppard on December 12, 1940. Archives of the
American Occupational Therapy Association (Series 4.1, Box 25, Folder 168), Bethesda, MD.
Forbush, B., & Forbush, B. (1986). Gatehouse: The evolution of the Sheppard and Enoch Pratt Hospital, 1853-1986.
Baltimore, MD: J. B. Lippincott, Co.
Former Hobart Girl honored. (1931, January 8). Stamford Mirror-Recorder [New York]. Retrieved from http://www.
fultonhistory.com/Fulton.html
Gordon, J., & Reische, D. (1982). The volunteer powerhouse. New York: The Rutledge Press.
Greene, M. B. (1924). Personal correspondence to Thomas B. Kidner on December 8, 1924 [Letter]. Archives of the
American Occupational Therapy Association (Series 5, Box 23, Folder 155), Bethesda, MD.
Greene, M. A. (1940). Personal correspondence to Honorable Richard Wigglesworth on March 28, 1940 [Letter].
Archives of the American Occupational Therapy Association (Series 5, Box 25, Folder 168), Bethesda, MD.
Haas, L. J. (1920). Report of the secretary. In Proceedings of the Fourth Annual Meeting of the National Society for
the Promotion of Occupational Therapy (pp. 3-4). Towson, MD: Spring Grove State Hospital and Sheppard and
Enoch Pratt Hospital.
Haas, L. J. (1922). Crafts adaptable to occupational needs: Their relative importance. Archives of Occupational
Therapy, 1(6), 443-455.
Hall, H. J. (1921, July). A remodeled constitution. Maryland Psychiatric Quarterly, 11(1), 18-19.
Hall, H. J. (1922). Editorial: The medical workshop. Archives of Occupational Therapy, 1(3), 243-246.
House of Delegates. (1922). Meeting of the Board Members and the House of Delegates of the American Occupational
Therapy Association. Archives of Occupational Therapy, 1(4), 317-355.
Howard, F. M. (1939, December). Growth of the Occupational Therapy Committee of the Junior League of the City of
New York. Occupational Therapy and Rehabilitation, 18(6), 395-398.
Johnson, S. C. (1917). The teacher in occupation therapy. In Proceedings of the First Annual Meeting of the National
Society for the Promotion of Occupational Therapy (pp. 45-51). Towson, MD: Spring Grove State Hospital and
Sheppard and Enoch Pratt Hospital.
Johnson, S. C. (1918). Educational Aspects of Occupation Therapy. In Proceedings of the Second Annual Meeting of
the National Society for the Promotion of Occupational Therapy (pp. 44-49). Towson, MD: Spring Grove State
Hospital and Sheppard and Enoch Pratt Hospital.
Jones, J. L. (1992). Therefore be it resolved: 25 years of delegate assembly/representative assembly legislation. American
Journal of Occupational Therapy, 46(1), 72-78.
Junior League of Eastern Fairfield County. (2015). Our history: Serving the community for over 90 years. Retrieved
from https://www.jlefc.org/?nd=history
Junior League of Milwaukee. (1921). Annual Report of the Junior League of Milwaukee 1917-1921. Milwaukee, WI:
Junior League of Milwaukee.
Kelley, F. F. (1926, August 15). Busy hands help sickened minds: New therapy methods correct maladies by teaching
patients to make things. New York Times, p. X6.
122 Chapter 4

Kidner, T. B. (1920a). Report of the Committee on Research and Efficiency. In Proceedings of the Fourth Annual
Meeting of the National Society for the Promotion of Occupational Therapy (pp. 5-9). Towson, MD: Spring Grove
State Hospital and the Sheppard and Enoch Pratt Hospital.
Kidner, T. B. (1920b). Report of the Committee on the Revision of the Constitution. In Proceedings of the Fourth
Annual Meeting of the National Society for the Promotion of Occupational Therapy (pp. 24-25). Towson, MD:
Spring Grove State Hospital and Sheppard and Enoch Pratt Hospital.
Kidner, T. B. (1921, June 17). Notes on tuberculosis sanatorium planning. Public Health Reports, 36(24), 1371-1392.
Kidner, T. B. (1922a). Editorial: American Occupational Therapy Association. Archives of Occupational Therapy, 1(6),
499-502.
Kidner, T. B. (1922b). Report of the Committee on Research and Efficiency: The Fifth Annual Meeting of the National
Society for the Promotion of Occupational Therapy. Archives of Occupational Therapy, 1(1), 76-78.
Kidner, T. B. (1925, November 14). Memo: The members of the Board of Management. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 80), Bethesda, MD.
Kidner, T. B. (1928). Professional training in occupational therapy. Psychiatric Quarterly, 2(2), 184-188.
Kidner, T. B. (1930). The progress of occupational therapy. Occupational Therapy and Rehabilitation, 9, 221-224.
Lermit, G. R., Bartlett, K., & Naylor, C. (1938, June). Report of Committee for the study of plan for admission of
therapists to the register by means of examination. Occupational Therapy and Rehabilitation, 17(3), 179-180.
MacDonald, J. H. (1930). Curative occupational therapy as conducted by the Junior League of Indianapolis in the
Indiana University Hospitals. Occupational Therapy and Rehabilitation, 10(1), 39-44.
Magee, J. C. (1940). Personal correspondence to Everett S. Elwood on April 1, 1940. Archives of the American
Occupational Therapy Association (Series 4.1, Box 25, Folder 168), Bethesda, MD.
McDaniel, M. L. (1968). Occupational therapists before World War II (1917-1940). In R. S. Anderson, H. S. Lee, & M.
L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 69-97). Washington, DC: Office of the Surgeon General,
Department of the Army.
Medicine in St. Louis Hospital. (1919, February 16). St. Louis Post-Dispatch, pp. 3, 13.
National Society for the Promotion of Occupational Therapy. (1917). Constitution of the National Society for the
Promotion of Occupational Therapy. Towson, MD: Sheppard Hospital Press.
National Society for the Promotion of Occupational Therapy. (1919). Report of the nominating committee. In
Proceedings of the Third Annual Meeting of the National Society for the Promotion of Occupational Therapy
(pp. 35-36). Towson, MD: Sheppard and Enoch Pratt Hospital.
National Society for the Promotion of Occupational Therapy. (1920a). Address by President-elect Dr. Herbert J. Hall.
In Proceedings of the Fourth Annual Meeting of the National Society for the Promotion of Occupational Therapy
(p. 39). Towson, MD: Spring Grove State Hospital and Sheppard and Enoch Pratt Hospital.
National Society for the Promotion of Occupational Therapy. (1920b). A general discussion on training of teachers. In
Proceedings of the Fourth Annual Meeting of the National Society for the Promotion of Occupational Therapy
(pp. 51-62). Towson, MD: Spring Grove State Hospital and Sheppard and Enoch Pratt Hospital.
National Society for the Promotion of Occupational Therapy. (1920c). Report of the nominating committee. In
Proceedings of the Fourth Annual Meeting of the National Society for the Promotion of Occupational Therapy
(pp. 25-26). Towson, MD: Spring Grove State Hospital and Sheppard and Enoch Pratt Hospital.
New Minimum Standards… (1930, October). New minimum Standards of Training for occupational therapists who
desire to qualify for registration. Archives of the American Occupational Therapy Association (Series 3, Box 13,
Folder 81), Bethesda, MD.
Occupational Therapy Notes. (1932, April). Obituary—Susan C. Johnson. Occupational Therapy and Rehabilitation,
11(2) 152-153.
Patterson, R. U. (1933, December). Remarks to the graduating classes of dieticians, physiotherapy aides, and occupa-
tional therapy aides at the Army Medical Center, June 29, 1933. Occupational Therapy and Rehabilitation, 12(6),
365-371.
Pattison, H. A. (1922). The trend of occupational therapy for the tuberculous. Archives of Occupational Therapy, 1(1),
19-24.
Phillips, R. F. (1928, August). The Junior League’s occupational therapy work for children in Milwaukee: Organization
and Financing. Occupational Therapy & Rehabilitation, 7(4), 261-266.
Pollock, H. M. (1942). In Memoriam: Eleanor Clarke Slagle—1876-1942. American Journal of Psychiatry, 99(3), 472-
474.
Presbyterian Hospital of Chicago. (1929, June). Susan E. Tracy. In The Presbyterian Hospital Bulletin—No. 68 (pp.
4-6). Chicago, IL: The Presbyterian Hospital of Chicago.
Quiroga, V. A. M. (1995). Occupational therapy: The first 30 years: 1900 to 1930. Bethesda, MD: American Occupational
Therapy Association.
Report of the Council on Medical Education and Hospitals. (1935). Journal of the American Medical Association, 104,
1631-1633.
 Standard Setting: 1920s to 1940s 123

Report of Secretary-Treasurer. (1922). Minutes of the Sixth Annual Meeting of the American Occupational Therapy
Association. Archives of Occupational Therapy, 2(1), 49-59.
Report on survey of occupational therapy schools. (1938). Journal of the American Medical Association, 110, 979-981.
Robeson, H. A., Dunton, W. R., Haas, L. J., Kidner, T. B., Lindberg, B., Sample, G.…Tompkins, A. B. (1928a). Analysis
of crafts: Continuation of the report of Committee on Installations and Advice. Occupational Therapy and
Rehabilitation, 7(2), 131-136.
Robeson, H. A., Dunton, W. R., Haas, L. J., Kidner, T. B., Lindberg, B., Sample, G.,…Tompkins, A. B. (1928b). Analysis
of crafts: Continuation of the report of Committee on Installations and Advice. Occupational Therapy and
Rehabilitation, 7(3), 211-216.
Robeson, H. A., Dunton, W. R., Haas, L. J., Kidner, T. B., Lindberg, B., Sample, G.,…Tompkins, A. B. (1928c). Report
of Committee on Installations and Advice: Making a physical analysis of crafts. Occupational Therapy and
Rehabilitation, 7(1), 29-43.
Round Table on Training Courses. (1923). Round table on training courses. Archives of Occupational Therapy, 2(2),
119 -132.
Second Day—Afternoon Session. (1922). Proceedings of the Fifth Annual Meeting of AOTA. Archives of Occupational
Therapy, 1(3), 219-242.
Second Day—Morning Session. (1922). Proceedings of the Fifth Annual Meeting of AOTA. Archives of Occupational
Therapy, 1(1), 153-162.
Slagle, E. C. (1918). Report of the Committee on Installations and Advice. In Proceedings of the First Annual Meeting
of the National Society for the Promotion of Occupational Therapy (p. 28). Towson, MD: Spring Grove State
Hospital and Sheppard and Enoch Pratt Hospital.
Slagle, E. C. (1919). Report of the Committee on Installations and Advice. In Proceedings of the Third Annual
Meeting of the National Society for the Promotion of Occupational Therapy (pp. 26-28). Towson, MD: Spring
Grove State Hospital and Sheppard and Enoch Pratt Hospital.
Slagle, E. C. (1920a). Report of the Committee on Installations and Advice. In Proceedings of the Fourth Annual
Meeting of the National Society for the Promotion of Occupational Therapy (p. 22). Towson, MD: Spring Grove
State Hospital and Sheppard and Enoch Pratt Hospital.
Slagle, E. C. (1920b). Report of the president. In Proceedings of the Fourth Annual Meeting of the National Society
for the Promotion of Occupational Therapy (pp. 1-3). Towson, MD: Spring Grove State Hospital and Sheppard
and Enoch Pratt Hospital.
Slagle, E. C. (1929). Personal correspondence to John D. Clarke on February 15, 1929. Archives of the American
Occupational Therapy Association (Series 5, Box 24, Folder 161), Bethesda, MD.
Slagle, E. C. (1930). Report of the secretary-treasurer. Occupational Therapy and Rehabilitation, 9(6),379-393.
Slagle, E. C. (1937). Editorial: From the heart. Occupational Therapy and Rehabilitation, 16(5), 343-345.
State Historical Society of Missouri. (n.d.). The Junior League of St. Louis, Records, 1914-2000. Retrieved from http://
shs.umsystem.edu/stlouis/manuscripts/s0628.pdf
Third Day—Morning Session. (1922). The Fifth Annual Meeting of the National Society for the Promotion of
Occupational Therapy. Archives of Occupational Therapy, 1(3), 221-230.
Tracy, S. E. (1917). Personal correspondence to William Rush Dunton on April 22, 1917. Archives of the American
Occupational Therapy Association (Series 1, Box 1, Folder 21b), Bethesda, MD.
United States Department of the Interior National Park Service. (2003). National register of historic places registra-
tion form: Philadelphia School of Occupational Therapy. Washington, DC: Author.
Vogel, E. E., & Gearin, H. B. (1968). Events leading to the formation of the Women’s Medical Specialist Corps. In R. S.
Anderson, H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 1-11). Washington, DC: Office
of the Surgeon General, Department of the Army.
Wigglesworth, R. B. (1940). Personal correspondence to Mrs. John (Marjorie) A. Greene on March 29, 1940 [Letter].
Archives of the American Occupational Therapy Association (Series 5, Box 25, Folder 168), Bethesda, MD.
 5
Rapid Growth and Expansion
1940s to 1960s

Key Points
● Occupational therapy needed to reestablish its role in the military after an economic decline
and setbacks during the Depression years.
● The Women’s Medical Specialist Corps, established in 1947, granted military status to occu-
pational therapists.
● Manpower shortages spurred the increase in the number of occupational therapy schools,
the start of war emergency courses, and the establishment of a curriculum for occupational
therapy assistants.
● With the end of the Arts and Crafts Movement and medicine’s focus on a biomedical model,
occupational therapy shifted from a paradigm of occupation to reductionism

Highlighted Personalities Key Places

● Winifred Conrick Kahmann, OTR, ● Location of occupational therapy
President, 1947-1952 schools
● Henrietta McNary, OTR, President, 1952-1955
● Ruth A. Robinson, OTR, President, 1955-1958
● Helen S. Willard, OTR, President, 1958-1961
● Wilma West, Executive Director, 1948-1951;
President, 1961-1964
● Marjorie Fish, Executive Director, 1951-1963

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 125-160).
- 125 - © 2017 SLACK Incorporated.
126 Chapter 5

Key Times/Events Sociocultural Events/Issues

● World War II ● Women in the workforce
● War emergency courses, 1943-1945 ● The Rehabilitation Movement
● Conflict with physical medicine
● World Federation of Occupational Economic Events/Issues
Therapists organized in 1952
● Economic boom and continued prosperity
initiated by World War II
Political Events/Issues
● Federal Vocational Rehabilitation Act of Technological Events/Issues
1943 (Public Law 78-113)
● Innovations in pharmacology
● Servicemen’s Readjustment Act of 1944,
also known as the GI Bill (Public Law ● Interstate highway system developed
78-346)
Hospital Survey and Construction Act of
●

1946 (Public Law 79-725), also known as

Practice Issues
the Hill-Burton Act ● Paradigm shift in practice from occupa-
● National Mental Health Act of 1946 tion to reductionism
(Public Law 79-487) ● Tuberculosis now controlled by drugs;
● Army-Navy Nurses Act of 1947 (Public tuberculosis sanatoriums open
Law 80-36) ● Increased emphasis on rehabilitation
● Vocational Rehabilitation Act Amendment including neurorehabilitation and activi-
of 1954 (Public Law 83-565) ties of daily living training
● Mental Health Study Act of 1955 (Public
Law 84-182)
Association Issues
● Passing the registration exam required for
Educational Issues admission to the National Register—1945
● Increase in the number of schools
● A Kellogg grant in 1944 funded the posi-
tion of Educational Field Secretary
● Occupational therapy assistant education
established in 1958 ● Winifred Conrick Kahmann was the first
OTR to be elected President—1947
● First discussions of graduate-level educa-
tion began in 1958 ● American Journal of Occupational Therapy
first published in 1947—first official jour-
nal owned by the American Occupational
Therapy Association
 Rapid Growth and Expansion: 1940s to 1960s 127

Introduction
“In these days … the continuity of purpose seems overshadowed by
doctrines of change….”
–Eleanor Clarke Slagle (1938, p. 14)

B
y the end of the 1930s, President Franklin Roosevelt was finishing his second term in
office as the United States was still struggling to get out of the Great Depression. The
United States maintained neutrality when the Nazi aggression in Europe started World
War II. Roosevelt ran for an unprecedented third term. He believed that he was most qualified
to govern during this difficult time of economic depression and the potential for another war.
Finally, the attack on Pearl Harbor in 1941 drew the United States into the war. The war fueled an
economic recovery with the increased need for manufacturing of goods and materials for war and
the need for manpower to serve in and provide for the military. The country quickly went from
significant unemployment to manpower shortages. With the men going off to war, women were
needed to fill positions in shipyards and factories to manufacture ships, planes, tanks, and other
military equipment, jobs traditionally filled by men (Figure 5-1). Roosevelt was elected to a fourth
term in 1944 but died of a cerebral hemorrhage in April
1945. Germany surrendered in May 1945, but Japan con-
tinued to fight in the Pacific. Harry S. Truman, sworn
in as president when Roosevelt died, made the difficult
decision to end the war and save countless American
lives by dropping atomic bombs on Hiroshima and
Nagasaki. Japan surrendered a few days later, and the
war was finally over.
The economic boom started by the war would last
well beyond the war years. Truman was succeeded
by the hero of World War II, Dwight D. Eisenhower.
Eisenhower started the interstate highway system,
improving transportation and commerce in the United
States. The GI Bill made it possible for veterans to receive
an education and to obtain loans to purchase homes and
farms and start businesses.
Occupational therapy lost a founder and a founda-
tion of the American Occupational Therapy Association Figure 5-1. Rosie the Riveter represented the
(AOTA) when Eleanor Clarke Slagle passed away in thousands of women who went to work in
1942. Dr. William Rush Dunton Jr. was the only surviv- World War II. With the men off to war, there
ing founder. He continued to serve on various AOTA was a need for women to work in shipyards
and factories to build ships, planes, and muni-
committees until he bid farewell in 1954 when he was tions needed for war. Traditionally men’s work,
86 years old (Dunton, 1955). Dr. Dunton’s lifetime of women proved to be very capable of what was
service was honored by the Association. He was named traditionally considered men’s work. Some see
honorary board member and also given the right to use this as the start of a huge influx of women into
the workforce.
the designation OTR after his name.
Everett S. Elwood, AOTA president from 1938 to 1947,
guided the Association through the war years. The year 1947 brought a new era in the Association
when the first registered occupational therapist and the first woman since Eleanor Clarke Slagle
was elected president of AOTA. Winifred C. Kahmann, OTR (1947-1952), was followed by
Henrietta W. McNary, OTR (1952-1955), Colonel Ruth Robinson, OTR (1955-1958), and Helen
Willard, OTR (1958-1961). In the mid-1930s, during the Depression, the membership dipped to
128 Chapter 5

below 900. World War II jump-started the economy

and spurred growth of the profession. The number of Table 5-1
accredited professional training schools increased and
the number of occupational therapists doubled in the
AOTA MEMBERSHIP DATA—
1940s. Membership continued to increase through the 1941 TO 1960
1950s (Table 5-1). Despite the growing acceptance of YEAR NUMBER OF MEMBERS
occupational therapy, and despite the increase in the
1941 1,326
number of occupational therapy programs and occu-
pational therapists, filling manpower needs became a 1945 2,177
major concern. In a predominantly female profession, 1950 2,967
marriage was seen as the greatest threat to manpower 1955 3,896
needs as women dropped out of the profession to get 1960 4,938
married and raise a family.

United States Entry

Into World War II
When Germany invaded Poland on September 1, 1939, England and France declared war on
Germany. The United States maintained a neutral stance for the most part, yet provided supplies
to the Allies (England and France) as authorized by the Lend Lease Act. On December 7, 1941, the
surprise attack at Pearl Harbor turned the tide of American opinion. Congress quickly declared
war on Japan on December 8, 1941. Germany, who was in a pact with Japan, subsequently declared
war on the United States.
As in World War I, with the war looming, many organizations had started to prepare for war.
AOTA President Everett Elwood wrote to Surgeon General James C. Magee offering the services of
AOTA in meeting manpower needs for the war effort should the need arise. In the letter, Elwood
described the development of schools in World War I to train occupational therapists at the request
of Surgeon General Gorgas. Elwood also discussed the growth and development of the profession
and training schools since World War I (Elwood, 1939) (Figure 5-2).
A report given by Harriet Robeson at the Board of
Management in January 1940 informed the group that the
Surgeon General was interested in the services of occupational
therapy and had requested the Red Cross to establish a reserve
of occupational therapists. To establish a reserve, the American
Red Cross sent a survey to all occupational therapists inquir-
ing about their willingness to serve in the medical depart-
ments of the Army and Navy should a war emergency occur
(AOTA, 1940a). Robeson felt confident that AOTA require-
ments for registration would be met (Board of Management,
1940a). When the requirements were announced, the Surgeon
General and the American Red Cross required an occupation-
al therapist to be a graduate of an accredited training program,
one that conformed to the American Medical Association’s
Figure 5-2. Everett Elwood provided Council on Medical Education and Hospitals (AMA-CMEH)
wise and dignified leadership. With
his calm personality he helped guide
“Essentials of an Acceptable School of Occupational Therapy.”
the association through the stress- Because the accreditation program had been in effect for a rel-
ful war years. (Printed with permis- atively short time, the Red Cross requirement for enrollment
sion from the Archive of the American would essentially eliminate all occupational therapists except
Occupational Therapy Association, Inc.)
those graduates of the class of 1939, approximately 50 gradu-
ates (AOTA, 1940b; Board of Management, 1940b). AOTA’s
 Rapid Growth and Expansion: 1940s to 1960s 129

House of Delegates and Board of Managers appealed to the American Red Cross and Surgeon
General to change the requirements to also include those occupational therapists who were regis-
tered with AOTA, essentially grandfathering in those who had graduated from an approved school
(Board of Management, 1940b; Fish, 1940) (Figure 5-3).

AOTA Committee on National Defense

To help the association prepare for war, the AOTA formed a Committee on Occupational
Therapy in National Defense in January 1941 with Helen S. Willard appointed chairperson.
Throughout its existence, this committee was known by several names including the National
Defense Committee, the Committee on Occupational Therapy and War Defense, the War Defense
Committee. One of the many duties the committee undertook was to determine the occupa-
tional therapy manpower available should war break out. This was separate from the Red Cross
Survey, completed in part because the committee had some doubts that the Red Cross informa-
tion on available occupational therapists would be accurate (AOTA, 1941). The National Defense
Committee survey found 504 active occupational therapists were available for Army service. The
names of those available to serve were forwarded to the American Red Cross, the United States
Civil Service, the Surgeon General’s Office, and Veterans Administration in hopes of facilitating
placement of therapists (Willard, 1941a).
The Surgeon General’s Office planned to have 14 general hospitals and projected the need
for 30 occupational therapists in these hospitals—a minimal number of therapists at best. The
Surgeon General’s Office plan was that:
…men injured in the selective service camps who are disabled for further service
will be transferred to veteran’s facilities if their disability arises as a result of military
service. Otherwise, in most instances, their discharge will take effect and they will be
transferred to civilian institutions in their own communities. This applies especially to
psychiatric cases. Very few cases will be held in Army hospitals for prolonged treatment.
It has, therefore, seemed impractical to establish occupational therapy departments in
the various military hospitals at the present time. (National Defense Committee, 1941)
The Red Cross enrollment of
32 occupational therapists was
deemed adequate to meet the
needs of the military (National
Defense Committee, 1941).
As Chair of the Committee
on National Defense, Helen
Willard was confronted by
numerous issues. First, there
was the issue of military sta-
Figure 5-3. (A) AOTA chose an armband insig- tus and subprofessional status
nia from 29 designs submitted (AOTA, 1940c, for occupational therapists.
November). (Printed with permission from Second, there was the issue of
the Archive of the American Occupational
the military’s misunderstand-
Therapy Association, Inc.) (B) The chosen
insignia was used for arm bands/patches ing of the professional stan-
that could be worn by registered therapists. dards and value of occupation-
(Copyright © Dr. Lori T. Andersen. Reprinted al therapy. Third, there was the
with permission.)
infringement on occupational
therapy from other agencies,
such as the Gray Ladies, who
worked with the American
130 Chapter 5

Red Cross. And finally, there was the manpower shortage. It was estimated that 1,000 occupa-
tional therapists would be needed for military service (Kahmann & West, 1947, p. 335) with only
1,300 occupational therapists listed in the National Register nationwide. Solving the manpower
shortage would help to stem the tide of encroachment by the Gray Ladies and others who lacked
training because appropriately trained occupational therapists would then be available to fill posi-
tions (Sidebar 5-1).

SIDEBAR 5-1
White House Reception

The AOTA conference was held in Washington, DC, from August 31, 1941, through
September 5, 1941. A special event awaited conference-goers that year:
The Convention Committee has arranged a surprise for you. Mrs. Anna Eleanor
Roosevelt has invited you to attend a reception at the White House, Washington,
DC, on Tuesday afternoon, September second, nineteen hundred and forty-one,
at four-thirty o clock. (White House Reception, 1941, July)

Military Status for

Occupational Therapists
Throughout the 1920s and 1930s, AOTA took great strides to increase the professional status
of occupational therapy and promote the profession. Minimum Standards for Courses of Training
of Occupational Therapists were set, a National Register was established, and the AMA started to
accredit occupational therapy training schools. Despite these efforts, on the eve of World War II,
top military leaders lacked an understanding of the complexity of occupational therapy, seeing it
as little more than cheer-up work that could be done by volunteers.
Efforts to secure permanent military status for occupational therapists, physical therapists, and
dieticians started in the late 1930s and continued into the 1940s. These groups argued that the
requirement to serve as civilian employees in the military without the same protections and ben-
efits of War Risk Insurance program and other benefits given to military personnel would impact
the ability to recruit needed manpower. The military’s position was that none of these civilian
employees would be sent overseas; therefore, they would not be in harm’s way, so the same protec-
tions were not necessary. Further, the Secretary of War indicated that occupational therapists were
only needed in wartime, so permanent military status was not justified for them (Vogel & Gearin,
1968, pp. 1-5; Vogel, Manchester, Gearin, & West, 1968a, p. 102).
Military needs changed as the United States became involved in the war. Physical therapists
and dieticians were sent overseas as early as 1942; therefore, Surgeon General James C. Magee
(1939-1943) finally agreed that physical therapists and dieticians should have the same protec-
tions from risks and hazards as other military personnel. In 1942, a bill designed to improve the
military status of the Army Nurse Corps was under consideration, so physical therapists and
dieticians were simply added to the bill. The occupational therapy community mobilized to try
to secure inclusion in this bill by writing to congressional representatives. AOTA leadership took
steps to have occupational therapy included in the bill. On October 13, 1942, Helen S. Willard,
Chairman of AOTA’s War Service Committee, testified before the United States House Military
Affairs Committee strongly recommending the inclusion of occupational therapy in the proposed
 Rapid Growth and Expansion: 1940s to 1960s 131

legislation. Still, the military held fast to the position that occupational therapists would not be sent
overseas; rather, disabled soldiers would be returned to the United States for occupational therapy
treatment. Therefore, because occupational therapists would not be serving overseas, they did not
need the protections of the War Risk Insurance Act (Vogel & Gearin, 1968, p. 7).
On December 22, 1942, with the passage of Public Law 77-828, physical therapists and
dieticians were given military status, but only for the duration of the war and 6 months after.
Occupational therapists were not included in the bill and therefore remained civilian employ-
ees. This adversely affected the military’s ability to hire occupational therapists during the war.
In an effort to secure the services of occupational therapists, the Surgeon General proposed
to have them serve in the Women’s Army Corps (WACs). Under this proposal, occupational
therapists would be given military status in the WACs but would be assigned duty in the Medical
Department. Occupational therapists did not consider this to be on par with the military status
granted to physical therapists and dieticians. In the end, the War Department rejected this pro-
posal also (Vogel et al., 1968b, p. 102). The military status of physical therapists and dieticians was
upgraded again with the passing of Public Law 78-350 on June 22, 1944, giving them full commis-
sioned status. Occupational therapists remained civilian employees.
Although not able to achieve military status, occupational therapists did achieve victory in
upgrading their civil service status from subprofessional to professional. Because the Medical
Department required occupational therapists to be graduates of an accredited program or regis-
tered with AOTA, Major Walter E. Barton
was able to assist in pushing through a
reclassification of occupational therapists
from trades and industry to the medical
section (Kahmann, 1943; Vogel et al., 1968b,
pp. 106-117). This reclassification went into
effect in September 1945 (Kahmann & West,
1947, p. 339).
By the end of the war, it became apparent
that because of the exemplary service of occu-
pational therapists, physical therapists, and
dieticians in military service during wartime,
their continued service would benefit the
Army during peacetime. A permanent work-
force would also eliminate future problems
with the recruitment and mobilization of Figure 5-4. President Harry S. Truman signed Public Law
80-36 establishing the Women’s Medical Specialist Corps and
these personnel should the need arise again. giving permanent commissioned status to dieticians, physi-
Therefore, the Surgeon General of the Army, cal therapists, and occupational therapists.
Major General Norman T. Kirk (1943-1947),
recommended establishment of a Women’s
Medical Specialist Corps, which would give permanent status for these groups. Legislation was draft-
ed in accordance with the Surgeon General’s recommendation, and on April 16, 1947, Public Law
80-36 (Army-Navy Nurses Act of 1947) was passed by Congress, authorizing the Women’s Medical
Specialist Corps and regular Army status for nurses, dietitians, physical therapists, and occupational
therapists (Vogel & Gearin, 1968, p. 11) (Figure 5-4). The WMSC was overseen by a Chief and three
Assistant Chiefs representing each of the professions. The first Chief of the WMSC was Colonel
Emma E. Vogel, a physical therapist. Lieutenant Colonel Ruth A. Robinson, OTR, was appointed as
assistant chief of the Occupational Therapist Section. Colonel Robinson later served as Chief of the
Army Medical Specialist Corps (AMSC) from 1958 through 1962 (Figure 5-5).
In World War II, women who served as occupational therapists were civilian employees, com-
pared with male occupational therapists, who were enlisted military personnel. In 1955, Public
Law 84-294 was passed, amending the Army-Navy Nurses Act of 1947 to include male nurses and
132 Chapter 5

medical specialists as eligible for the same commissioned

status as women. This affected six male occupational thera-
pists serving at that time. With this change, the Corps was
more appropriately renamed the Army Medical Specialist
Corps (Hartwick, 1993, pp. 32-33) (Table 5-2).

Occupational
Therapy in
World War II
On December 7, 1941, there were eight qualified occupa-
tional therapists and four occupational therapy assistants
on duty in five Army hospitals (Vogel, Manchester, Gearin,
& West, 1968b, p. 159). A number of factors contributed Figure 5-5. Colonel Ruth A. Robinson was
to the limited number of occupational therapists serv- the first occupational therapist to attain
ing military hospitals, including the economic cutbacks the permanent grade of Colonel in the
in the military forced by the Great Depression; the lull United States Army. She served as Chief
of the Army Medical Specialist Corps from
of peacetime; the military’s reluctance to include women 1958 to 1962. In addition to the many
in their ranks, including those from the predominantly awards from AOTA, Colonel Robinson was
female profession of occupational therapy; and the Surgeon awarded the Legion of Merit Award from
General’s misconception of occupational therapy as merely the United States Army (AOTA, 1967b).
Ruth Robinson maintains that her greatest
diversional. In addition, the lack of occupational therapy contribution to the profession was help-
schools limited the number of graduates and therefore ing to establish educational programs for
the number of occupational therapists available. With the certified occupational therapy assistants.
resolute effort of leaders in AOTA, by V-J Day (Victory (Printed with permission from the Archive
of the American Occupational Therapy
in Japan Day, August 14, 1945), there were 899 occupa- Association, Inc.)
tional therapists and apprentices working in 76 general,
convalescent, regional, and station hospitals in the United
States (Vogel et al., 1968a, p. 159). This included 452 apprentices and 447 graduate occupational
therapists. Only 204 occupational therapists had volunteered service to the Army. The remainder
were graduates of the war emergency courses, subsidized by the Army (West, 1947). In addition to
the occupational therapists serving in the Army, 71 occupational therapists served in the Navy in
World War II (Navy program, 1945) (Sidebar 5-2).

Occupational Therapy Branch—Surgeon General’s Office

In May 1942, a conference on occupational therapy was convened by the National Research
Council’s Division of Medical Sciences. The conference, a series of four meetings that took place
from May 15, 1942, through June 2, 1943, was held at the request of the Surgeon General of the
Navy. The focus of these meetings was to develop recommendations on the organization of occupa-
tional therapy services in the military. Dr. Winfred Overholser, a psychiatrist and Superintendent
of St. Elizabeth’s Hospital in Washington, DC, was named Chairman, and Winifred C. Kahmann,
OTR, who had replaced Helen Willard as Chairperson of AOTA on the War Service Committee,
was named Secretary of the conference. The conference recommendations stated that each Army
and Navy veteran should have an occupational therapy service under direct medical supervision,
along with physical therapy (Vogel et al., 1968b, p. 104).
Two subcommittees were appointed by the President of AOTA to assist the conference in
planning for occupational therapy services. One committee, whose members included Marjorie
Greene, Director of the Boston School of Occupational Therapy; Helen S. Willard, Director of the
 Rapid Growth and Expansion: 1940s to 1960s 133

Table 5-2
TIMELINE FOR OBTAINING MILITARY STATUS FOR OCCUPATIONAL THERAPISTS
AND DEVELOPING OCCUPATIONAL THERAPY SERVICES IN WWII
● April 1938 ‒ Physical therapists seek to propose legislation to gain military status but were opposed by
the Surgeon General s Office (Vogel & Gearin, 1968, p. 5).
● 1939 ‒ Legislation first proposed in the US Congress to give military status to PT, OT, and dieticians. OT
was dropped from language of the bill. This legislation did not pass (Vogel & Gearin, 1968, p. 5-6).
● December 7, 1941 - there were eight qualified OTs and 4 occupational therapy assistants on duty in five
Army hospitals (Vogel, Manchester, Gearin, & West, 1968b, p. 159).
● October 13, 1942 - Helen Willard, Chairman of the War Service Committee of AOTA strongly recom-
mended inclusion of OT in proposed legislation to give military status to PT and dieticians (McDaniel,
1968, p. 97).
● December 22, 1942 - P. L. 77- 828 was passed giving PTs and dieticians military status for duration of war
and six months after (Vogel & Gearin, 1968, p. 7).
● April 1943 ‒ A central organization for occupational therapy established in the Surgeon General s Office
(Vogel, Manchester, Gearin, & West, 1968a, p. 106).
● August 19, 1943 ‒ Reconditioning Division in the Surgeon General s Office (which included occupational
therapy) was established with Major Walter E. Barton as director. (Vogel, Manchester, Gearin, & West,
1968a, p. 107).
● November 18, 1943 - Major Barton appointed Winifred Kahmann as chief of the newly established
Occupational Therapy Branch (Vogel, Manchester, Gearin, & West, 1968a, p. 107).
● Sept 1, 1945 ‒ The Surgeon General ordered all positions be reclassified from sub-professional to profes-
sional (Vogel, Manchester, Gearin, & West, 1968a, p. 118).
● June 2, 1944 ‒ P. L. 78-350 passed giving full commissioned status to PTs and dieticians (Vogel & Gearin,
1968, p. 8).
● January 29, 1946 ‒ The Surgeon General s Office recommends establishment of Women s Medical
Specialist Corps. (Vogel & Gearin, 1968, p. 9-10)
● April 16, 1947 ‒ Public Law 80-36 was signed by President Harry Truman establishing the Women s
Medical Specialist Corps and giving permanent commissioned status to dieticians, physical therapists,
and occupational therapists (Vogel & Gearin, 1968, p. 10-11).

SIDEBAR 5-2
Occupational Therapy Association of Hawaii, January 1942

About 6 weeks after the bombing of Pearl Harbor, AOTA headquarters received a let-
ter from Mrs. Laura Nott Dowsett of Honolulu (President of the Occupational Therapy
Association of Hawaii) dated January 16, 1942. The following excerpt was published in the
American Occupational Therapy Newsletter:
Just a line to let you know that we are all safe, well and very busy. Following
the tragedy of Dec. 7, all accredited therapists in the islands were asked to
sign up for volunteer service with the Nursing Service Bureau. A large number
responded and I am particularly happy to report the splendid spirit of coopera-
tion shown by the graduates of our training course. The work in the department
at the moment relates closely to the emergency needs. Surgical dressings have
become an interesting occupation for patients and volunteers alike. We have
opened a Red Cross knitting unit for nurses, patients and technicians, which is an
excellent service, as well as a treatment for war jitters. (Dowsett, 1942)
134 Chapter 5

Philadelphia School of Occupational Therapy; and Marjorie Fish, Director of the Occupational
Therapy Course at Columbia University, researched methods of recruitment and classification
of personnel. The other committee, whose members included Winifred C. Kahmann; Charlotte
Briggs, Director of Occupational Therapy at Niagara Tuberculosis Sanatorium; H. Elizabeth
Messick, OTR, from the District of Columbia Health Department; Margaret S. Rood, Chief
Occupational Therapist from the Cerebral Palsy Clinic at Indiana University Medical Center; and
Virginia Scullin, Chief of Occupational Therapy at Pilgrim State Hospital in New York, considered
other administrative aspects such as staff organization, equipment, and supplies. These two sub-
committees recommended the following:
1. Appointment of a field director
2. Short course to orient occupational therapists to Army procedures
3. A medical officer to oversee occupational therapy treatment
4. Red Cross volunteers to provide recreational and diversional activities to patients under the
supervision of occupational therapists
5. Establishing two occupational therapy units, neuropsychiatry and orthopedics, with five
major types of treatment programs, to include physical injuries, neuropsychiatric conditions,
tuberculosis, general medicine, and blindness
Establishment of occupational therapy in the military in World War II experienced a slow start,
similar to that in World War I. A central organization for occupational therapy was established
in April 1943, prompted by Colonel Roy D. Halloran, Director of the Neuropsychiatry Branch,
Surgeon General’s Office, and Major Walter E. Barton, a Halloran appointee. Colonel Halloran
was a president of the Massachusetts Association for Occupational Therapy and a strong advocate
for occupational therapy (Vogel et al., 1968b, pp. 104-105).
Colonel Halloran assigned Major Walter
E. Barton to organize the occupational thera-
py services in the Neuropsychiatric Branch and
subsequently, with reorganization of military
units, a new Reconditioning Division. Winifred
C. Kahmann was appointed chief of the newly
established Occupational Therapy Branch in the
Reconditioning Division on November 18, 1943.
Two assistants for the Occupational Therapy
Branch, Wilma L. West, OTR, and H. Elizabeth
Messick, OTR, were appointed on June 6 and
August 27, 1944, respectively (Vogel et al., 1968b,
pp. 106-107).
Kahmann was an excellent choice to head the
Occupational Therapy Branch, with her clini-
cal and administrative experience as director of
occupational therapy at the James Whitcomb
Riley Hospital for Children and then as Director
of Occupational Therapy and Physical Therapy at
the Indiana University Medical Center, as well as
her leadership roles in AOTA (Figure 5-6). Now Figure 5-6. Winifred C. Kahmann OTR was the first
registered occupational therapist elected president
with the structure established, the recruitment of the American Occupational Therapy Association.
of occupational therapists began in earnest. An Mrs. Kahmann was described as a strong leader
urgent call for occupational therapists to fulfill with excellent interpersonal relationships and a live-
their patriotic duty and work for the Army was ly sense of humor. (Printed with permission from
the Archive of the American Occupational Therapy
published in the occupational therapy newsletter Association, Inc.)
 Rapid Growth and Expansion: 1940s to 1960s 135

and journal (Barton, 1943a; Kahmann, 1944a). It gradually became more apparent that the deci-
sion of Major General James C. Magee, the Surgeon General of the Army, not to commission
occupational therapists but to appoint them as civilian employees of the Medical Department was
interfering with recruitment.
The need for occupational therapists was at first underestimated by the Surgeon General’s
Office at one occupational therapist per 1,000 beds. A survey by the AMA was more realistic,
indicating a range from 400 to 660 therapists (Vogel et al., 1968b, p. 111). In early 1944, the pro-
jected need for occupational therapists was set at 1,000 (Kahmann & West, 1947, p. 335). It was
unrealistic to assume that this need would be filled by the existing pool of trained occupational
therapists because there were only 1,300 occupational therapists listed in AOTA’s National Register
(Vogel et al., 1968a, p. 159).

War Emergency Courses

Helen Willard, Chairperson of AOTA’s National Defense Committee, was in receipt of numer-
ous letters complaining about the American Red Cross Gray Ladies doing occupational therapy
(Willard, 1942a). With a lack of appropriately trained manpower, the untrained American Red
Cross Gray Ladies were filling the void. Helen S. Willard and the national office received numer-
ous concerns from occupational therapists around the country about the work of the Gray Ladies,
who were providing handicrafts to disabled soldiers. Helen S. Willard corresponded with Eleanor
Vincent of the American Red Cross to express their concerns:
Much of the work done by trained occupational therapists is largely diversional and
has been recognized in our civilian hospitals as of medical value. There is, therefore,
I am afraid, some danger of misunderstanding and damage to our profession in the
giving of handicraft activities to men who are sick and disabled by persons who are not
professionally accredited. (Willard, 1941c)
After dealing with the issue of military and professional status and encroachment by untrained
people, Helen Willard recognized the need to increase manpower and called for the Education
Committee to organize war emergency courses:
I feel that it is urgently necessary that at the Education Committee on January 17th
in Indianapolis, we should be prepared to set up the organization of war emergency
courses and should probably plan for a Committee to proceed to Chicago on January
19th to confer with the American Medical Association in regard to these. The pres-
sure is becoming terrific and I believe that our professional status is at stake. (Willard,
1941d)
The Association had just transitioned the educational standards from the Minimum Standards
adopted in 1930, which required a total of 18 months of preparation, including 9 months of
academic instruction and 9 months practical training to the new Essentials of an Approved
Occupational Therapy School. These Essentials set by the AMA-CMEH in 1935 and implemented
in 1939 required a total of 25 months of preparation, including 16 months of academic instruc-
tion and 9 months of practical training. To fill manpower needs as quickly as possible during the
war emergency, the Occupational Therapy Branch of the Army Reconditioning Division and the
AOTA Committee on Education outlined a compressed educational program. The proposed war
emergency courses could be completed in 12 months. This new curriculum required 4 months of
didactic coursework and 8 months of practical experience in selected Army hospitals under the
supervision of an occupational therapist. During practical training period in an Army hospital,
the student was considered an occupational therapy apprentice. In this way, the Army would have
a person providing occupational therapy services, under supervision, in a relatively short period of
time (Figures 5-7 and 5-8). On completion of a war emergency course, these students were allowed
to sit for the national examination (AOTA, 1944). The curriculum for the war emergency courses
136 Chapter 5

Figure 5-7. An occupational ther-

apy apprentice patch worn by stu-
Figure 5-8. Occupational therapy apprentices participating in class at
dents enrolled in war emergency
Battey General Hospital in Rome, Georgia.
courses who were completing
practical training. (Copyright © Dr.
Lori T. Andersen. Reprinted with
permission.)

was approved by the Occupational Therapy Branch, Surgeon General’s Office; the AOTA War
Manpower Commission; and the AOTA Committee on Education and was subsequently approved
by the Surgeon General in May 1944 (Vogel et al., 1968a, p. 160). The Surgeon General’s Office con-
tracted with eight accredited civilian schools to provide these war emergency courses. The contract
stipulated that the accredited programs provided the academic coursework under the direction of
the Surgeon General’s Office while 40 selected Army hospitals provided the apprenticeship oppor-
tunities. The federal government subsidized the war emergency courses (Sidebar 5-3).
The war emergency courses ran
from July 1944 to June 1946. A total of
667 students enrolled in a war emer- SIDEBAR 5-3
gency course, and 545 completed the
course by June 1946 (West, 1947). Schools Providing
Upon completion of the academic
phase of schoolwork and permission
War Emergency Courses
of the curriculum director, 55 stu-
dents who had enrolled in regular
Eight accredited schools, in collaboration with the
occupational therapy training pro- Surgeon General of the United States Army, pro-
grams opted to complete the practical vided war emergency courses from July 1, 1944, to
training portion of their education in June 30, 1944 (AOTA, 1944):
the Army program (Army program, Philadelphia School of Occupational Therapy
1945). University of Illinois, Urbana, Illinois
The war emergency course cur- Milwaukee-Downer College, Milwaukee,
riculum was never formally approved Wisconsin
by the AMA-CMEH. Although the University of Southern California, Los Angeles,
courses did not meet the Essentials of California
an Acceptable School of Occupational Boston School of Occupational Therapy
Therapy with the requirement of Richmond Professional Institute, Richmond,
25 months of coursework, AOTA’s Virginia
Committee on Education took Mills College, Oakland, California
the position that higher prerequi-
Columbia University, New York, New York
site requirements qualified the war
 Rapid Growth and Expansion: 1940s to 1960s 137

emergency courses to meet the Minimum Standards. These higher prerequisites required students
to have a college degree in a related field and coursework in the biological sciences, psychology,
and sociology. In some cases, comparable experience could be substituted for a college degree.
More than 90% of students had bachelor’s degrees, and more than 3% had master’s degrees (Vogel
et al., 1968a, p. 160; West, 1947). After the war, the rigor and status of the war emergency courses
became an issue. Some in the Association wanted to restrict the registration of war emergency
graduates, whom they believed did not meet the same standards as regular school graduates.
After discussion, AOTA granted full registration rights to graduates of war emergency courses
(Education Committee, 1945).

Occupational Therapy Volunteer

Assistant Training Courses Program
Fiorello La Guardia, the flamboyant mayor of New York City, was appointed Director of the
Office of Civilian Defense by President Roosevelt in 1941. One of the programs started by this
office was an initiative to involve women and young people in the war effort through volunteering.
The Junior League, well-known for organizing volunteer service programs, loaned Miss Wilmer
Shields, a field social worker with the Association of Junior Leagues, to the Office of Civilian
Defense to help. Eleanor Roosevelt also signed on to assist this initiative. La Guardia wanted to
secure the assistance of national private social and health agencies, including AOTA, to work on
a plan to recruit, train, and place volunteers. He invited AOTA Executive Secretary Meta Cobb to
attend an organizational meeting for this national volunteer service program (La Guardia, 1941).
The AOTA Committee on National Defense was tasked to assist this effort of the Office of
Civilian Defense. Chair of the committee, Helen Willard, concerned about encroachment from
such groups as the Gray Ladies and determined to uphold the high standards of the profession,
took steps to ensure that AOTA would have control of the training course for occupational therapy
volunteers. She sought the support of Eleanor Roosevelt and was able to secure an appointment,
writing to Meta Cobb, Executive Secretary, “I have just had word from Mrs. Roosevelt’s secretary
that she will see me in New York on the afternoon of Thursday, November 6th” (Willard, 1941a).
In a memo to Roosevelt, Willard requested the Office of Civilian Defense channel applications for
occupational therapy volunteer assistant courses through the AOTA- or AMA-approved occupa-
tional therapy schools to ensure training by qualified people (Willard, 1941b).
Helen Willard and her committee members, Marjorie Taylor, Winifred Kahmann, Marion
Spear, Geraldine R. Lermit, and H. Elizabeth Messick, prepared outlines for the courses to train
volunteer occupational therapy assistants. Sponsored by both the Office of Civilian Defense and
the American Red Cross, the courses were given in various locations throughout the country
(Willard, 1941e) (Figure 5-9). It was hoped that the Occupational Therapy Volunteer Assistant
Training Course would help to meet the anticipated expanded need for occupational therapy ser-
vices in the event of war. Volunteers were required to have a high school education, be between
18 to 50 years old, and pledge to volunteer services for a minimum of 150 hours. The syllabus for
these courses included lectures on the occupational therapy history, the scope and practical appli-
cation of occupational therapy, patient conditions, hospital organization, ethics and etiquette, craft
instruction, and practical training. The course was designed to be a minimum of 58 hours over the
span of 8 to 10 weeks—40 hours of lectures and 18 hours of practical training (AOTA, 1942a; U.S.
Office of Civilian Defense, 1942).
On completion of the course, AOTA sent the volunteers a card certifying completion and an
emblem to be worn on upper left sleeve of their uniform. Volunteers were responsible for purchas-
ing the natural linen-color coat-smock–style uniform (Willard, 1942b) (Figure 5-10). Twenty-two
courses were given, and 670 volunteer assistants trained between January 1943 and February 1944
138 Chapter 5

Figure 5-9. (A, B) Brochure from the Office of Civilian Defense listing volunteer opportunities for civilians in World War
II. (Printed with permission from the Archive of the American Occupational Therapy Association, Inc.)

Figure 5-10. (A) Occupational therapy volunteer assistant card and (B) patch. (Printed
with permission from the Archive of the American Occupational Therapy Association,
Inc.)

(Willard, 1944, p. 5). The Occupational Therapy Volunteer Assistant courses continued to be given
in some areas past the end of World War II because of manpower needs in civilian and military
hospitals. By 1948, the New York State Occupational Therapy Association had provided nine
courses, training a total of 469 volunteers (Oppenheimer, 1948).

Legislation Impacting Health

Care and Occupational Therapy
Social and economic influences in the 1940s and 1950s prompted passage of a number of laws
that provided funding for rehabilitation services and facilities, research activities to improve and
 Rapid Growth and Expansion: 1940s to 1960s 139

expand knowledge, and education and training for medical professionals. The Federal Vocational
Rehabilitation Act of 1943, also known as the Barden–LaFollette Act (Public Law 78-113), amended
the first Federal Vocational Rehabilitation Act of 1920, the Smith-Fess Act. Advances in medicine
helped people survive illnesses and injuries that previously resulted in poor prognoses. These
survivors needed continued care and rehabilitation. The rise in rehabilitation and the desire to
return disabled soldiers and civilians to the workforce to help provide manpower for the war
effort provided stimulus for this law. The Barden–LaFollette Act added coverage of medical and
rehabilitative services to enable soldiers, sailors, and civilians with disabilities to participate in a
remunerative occupation. In addition to vocational rehabilitation, this act allowed medical ser-
vices, including “corrective surgery or therapeutic treatment necessary to correct or substantially
modify a physical condition which … constitutes a substantial handicap to employment” if the
physical condition could be corrected or modified within a reasonable time frame. Prosthetic
devices essential to employment were also covered, as were services for people with mental ill-
ness and intellectual disabilities. State vocational rehabilitation bureaus (Offices of Vocational
Rehabilitation) were authorized by this act to administer vocational rehabilitation programs.
The National Mental Health Act of 1946 (Public Law 79-487) sought to develop and provide
“the most effective methods of prevention, diagnosis, and treatment of psychiatric disorders.”
Grant funds were made available to aid research activities to improve health care for those with
disabilities. Funds were also provided for education and training of mental health personnel and
the establishment of the National Institute of Mental Health. The purpose of the Hospital Survey
and Construction Act of 1946, also known as the Hill-Burton Act (Public Law 79-725), was to
ensure adequate health care facilities for the public, including those in small communities and
rural areas. To achieve this goal, funds were provided to plan, construct, or modify health care
facilities and hospitals. Representative of the times, hospitals receiving grants were required to pro-
vide services to people in the area, regardless of creed or color or ability to pay, although providing
separate but equal facilities would meet the requirements.
The Vocational Rehabilitation Act Amendment of 1954 (Public Law 83-565) authorized funding
to provide, improve, and expand vocational rehabilitation programs and to significantly increase
the number of people with disabilities served. Included in this initiative were funds to build and
expand rehabilitation facilities, to conduct research and/or demonstration projects, and to educate
and train rehabilitation specialists, including occupational therapists. This Act eventually led to
the establishment of the National Institute for Disability and Rehabilitation Research (NIDRR).
The Mental Health Study Act of 1955 called for “an objective, thorough, nationwide analysis and
re-evaluation of the human and economic problems of mental health.” The focus was on better
utilization of resources to decrease the “incidence and duration of mental illness” and minimize
the “emotional and financial drain on families … and economic resources of the States and of the
Nation.” Funding was authorized for special projects to study the diagnostic and treatment prac-
tices and use of resources for rehabilitating those with mental illness (Table 5-3).

The Challenge by Physical Medicine

The occupational therapy profession and the medical profession enjoyed an amicable relation-
ship even before the time of the formal organization of the National Society for the Promotion of
Occupational Therapy (NSPOT) and AOTA. Most of the early Presidents of the profession were
physicians or men who held high positions in medical organizations. Many other physicians,
strong supporters of occupational therapy, helped promote the profession. The relationship with
medicine helped to secure occupational therapy’s professional standing and was furthered when,
in 1935, the AMA-CMEH agreed to assist with the accreditation of occupational therapy train-
ing programs. This amicable relationship was challenged in the late 1940s when the new medical
140 Chapter 5

Table 5-3
LEGISLATION RELATED TO REHABILITATION SERVICES
YEAR LEGISLATION PURPOSE
1943 Vocational Rehabilitation Act Amendments Provided funds for physical restoration services, includ-
of 1943 (Public Law 78-113); also known as ing occupational therapy, as part of vocational rehabili-
the Barden-LaFollette Act tation programs. Helped create the Office of Vocational
Rehabilitation.
1946 National Mental Health Act (Public Law Provided funds for research on the cause, diagnoses,
79-487) and treatment of psychiatric disorders. Provided for
training of personnel in mental health. Authorized
establishment of the National Institute of Mental
Health.
1946 Hospital Survey and Construction Act Authorized federal grants to states for the planning
(Public Law 79-725); also known as the Hill- and construction and modernization of hospitals
Burton Act throughout the United States.
1954 Vocational Rehabilitation Act Amendment Authorized funds to expand vocational rehabilitation
of 1954 (Public Law 83-565) programs and services, to conduct research, and to
educate and train rehabilitation specialists.
1955 The Mental Health Study Act of 1955 Authorized funds to study the problems related to
(Public Law 84-182) mental illness to better use resources.

specialty of physical medicine sought to secure their own professional standing within the medical
profession.
In 1943, Bernard M. Baruch, a philanthropist, financed the Baruch Committee on Physical
Medicine in memory of his father, Dr. Simon Baruch, a surgeon in the Confederate Army. He
wanted to further his father’s work in the practice of hydrotherapy. The committee undertook a
study to determine ways to advance physical medicine as a medical specialty, the overall purpose
of the committee (Folz, Opitz, Peters, & Gelfman, 1997).
Dr. Frank Krusen, initially a member of the Baruch Committee and later Chairperson, believed
that physical medicine should include both physical therapy and occupational therapy. As defined
in the Baruch Committee report, “physical medicine includes the employment of the physical and
other effective properties of light, heat, cold, water, electricity, massage, manipulation, exercise,
and mechanical devices for physical and occupational therapy, in the diagnosis or treatment of
disease” (Krusen, 1944). Krusen had earlier suggested that physical therapy and occupational
therapy training programs should be combined to enable technicians to practice both therapies
(Krusen, 1934). Recommendations from the final report of the Baruch Committee published in
April 1944 included the following:
1. Develop adequate programs to teach physical medicine to medical students as well as adequate
programs to train occupational therapy technicians and physical therapy technicians
2. Establish more extensive programs in basic research and clinical research
3. Promote physical rehabilitation, including strategies to meet manpower needs for physiatrists,
occupational therapy technicians, and physical therapy technicians
4. Provide medical direction in occupational therapy departments
5. Develop a program to teach occupational therapy as part of a physical medicine course in
medical schools (Krusen, 1944)
 Rapid Growth and Expansion: 1940s to 1960s 141

In December 1944, the name of the AMA’s Committee on Physical Therapy, a committee of
physicians specializing in physical therapy, was changed to the Committee on Physical Medicine,
thereby establishing the new medical specialty (Krusen, 1944).
Bernard M. Baruch gave more than $1 million to establish academic and clinical teaching
and research centers in select universities to help implement the committee’s recommendations
(Krusen, 1944). The need to train physiatrists, occupational therapists, and physical therapists was
a high priority during the war years. Additionally, the rise in the Rehabilitation Movement and
increased emphasis on the “restoration of people handicapped by disease, injury, or malformation
as nearly as possible to a normal physical and mental state” supported the need to train these medi-
cal professionals (Folz et al., 1997).
The funds to establish these academic, clinical, and research centers provided solutions to the
problems of limited number of schools for training occupational therapists and limited research
in occupational therapy. In World War II, as they had in World War I, occupational therapists
worked closely with orthopedic physicians and neurosurgeons treating soldiers with fractures,
amputations, and peripheral nerve injuries and central nervous system injuries (West, 1992). An
increasing number of occupational therapists were working with patients with physical disabilities
so a close relationship with physical medicine seemed a natural fit. The additional professional
and financial support was very enticing for occupational therapy schools and practices desiring to
develop further. Nevertheless, AOTA President Winifred Kahmann gave a cautious warning in her
opening address at the AOTA annual conference in 1947:
Occupational therapy is now on the threshold of an extensive and phenomenal devel-
opment in physical medicine and medical rehabilitation. We must proceed cautiously
and make no mistakes if we are to contribute treatment service of value within these
organized groups. (Kahmann, 1947)
The new specialty area of physical medicine already had control of physical therapy education
through the accreditation process, as well as control of the physical therapy registry. Unilaterally,
physical medicine took steps to take occupational therapy into their fold by including occupational
therapy as part of the physical medicine definition and promoting teaching occupational therapy
in schools of physical medicine (Reggio, 1947). At the same time, physical medicine was fighting
an internal battle with the medical profession to gain increased recognition and improve its own
status by endeavoring to become a permanent committee in the AMA, a section on physical medi-
cine. Some believed that claiming supervisory control of another profession, in this case occupa-
tional therapy, would justify their request. Physical medicine was granted permanent committee
status in June 1949. Another internal dispute between the specialties of physical medicine and
medical rehabilitation was resolved with the creation of the American Board of Physical Medicine
and Rehabilitation in 1950 (Gelfman, Peters, Opitz, & Folz, 1997).
The Board of Trustees of the University of Illinois Medical School in Chicago referred mem-
bers of the Baruch Committee, who wanted to discuss the establishment of a physical medicine
division, to Beatrice Wade, who was Head of the Occupational Therapy Department, and to the
Head of the Orthopedics Department. The physiatrists revealed their intent to take control of
occupational therapy education and registry. Although enticed with grant support for a clinical
director, Miss Wade was warned by some physical therapists about any arrangement with physical
medicine. The physical therapists indicated that their relationship with physical medicine limited
their ability to raise educational and practice standards (Colman, 1992).
Wade alerted Winifred Kahmann, President of AOTA, about the physiatrists’ plan. In a meet-
ing with Kahmann, Helen Willard, and Henrietta McNary, the physiatrists again presented their
plan, which was summarily dismissed by the women. Among their concerns was the potential for
the mental health component of occupational therapy to be lost (Colman, 1992). The physiatrists
tried to circumvent the national organization by petitioning the administration of the University
of Illinois to place the occupational therapy department under their control. In view of Wade’s
142 Chapter 5

strong stand against this, the administration of the University

of Illinois rejected the physiatrists’ requests (Colman, 1992)
(Figure 5-11).
In 1949, Helen Willard, Chair of the Education Committee,
reported that “the relationship between occupational therapy
and physical medicine had become a matter of great concern”
(Willard, 1950, p. 36). The physiatrists pressed on through
the AMA Council on Physical Medicine, recommending to
the AMA-CMEH that “(1) occupational therapists should be
known as occupational therapy technicians, and that (2) a
physician or physiatrist should be medical director of a school
of occupational therapy” (Willard, 1949, 1950, p. 36). AOTA
countered that the term technician implied a subprofessional
status at a time when many civil service agencies had just
upgraded occupational therapy to professional status by virtue Figure 5-11. Bea Wade was appoint-
of education and training. Luckily, the AMA-CMEH sup- ed Head of the Occupational Therapy
Department at the University of
ported AOTA’s desire to retain the term occupational therapist Illinois in 1951. (Printed with permis-
(Willard, 1950). In a compromise, the 1949 revision of the sion from the Archive of the American
Essentials of an Acceptable School of Occupational Therapy Occupational Therapy Association, Inc.)
required:
1. Occupational therapy schools should be established only in medical schools approved by
CMEH or accredited colleges or universities affiliated with acceptable hospitals.
2. The director of an occupational therapy program should be a qualified occupational thera-
pist with an academic degree, registered or eligible for registration, and have a minimum of
3 years’ clinical experience.
3. The clinical training portion of entry-level education should be directed by a physician or
a committee of physicians whose qualifications are acceptable to CMEH. (Colman, 1992;
Council on Medical Education and Hospitals, 1950)
The 1949 Essentials explicitly stated that therapists were being trained to work under the direc-
tion of qualified physicians (Council on Medical Education and Hospitals, 1950) (Table 5-4).
Wilma West (1992) credits Beatrice Wade with identifying the principles that outlined the rela-
tionships and responsibility of occupational therapists to medical specialties and physicians. These
principles included the following:
1. Occupational therapy should be a service available to all medical specialties.
2. Occupational therapists are accountable to the physician who referred the patient for treatment.
3. Occupational therapy services are accountable to any intermediate service (e.g., physical
medicine, psychiatry) under which it is organized.
In 1950, AOTA developed a key policy statement that reflected these principles, describing
occupational therapy’s “professional and allied relationships” (Kahmann, 1950) (Sidebar 5-4).

The Rehabilitation Movement

The Rehabilitation Movement started in the early 1940s, prompted by a social movement and a
concern to assist those disabled in World War II and civilians with disabilities to live productive
lives. Other external forces furthering the Rehabilitation Movement included the rise of physical
medicine and the efforts of Dr. Frank Krusen, the activities and advocacy of Dr. Howard A. Rusk,
and federal legislation, specifically the Vocational Rehabilitation Act Amendments of 1943, the
Hill-Burton Act of 1946, and the Vocational Rehabilitation Act Amendment of 1954.
 Rapid Growth and Expansion: 1940s to 1960s 143

Table 5-4
HISTORY OF EDUCATIONAL STANDARDS FOR OCCUPATIONAL THERAPISTS
YEAR STANDARD PURPOSE/REQUIREMENT
1923 Minimum Standards for Courses Candidates must have high school education or equivalent
of Training in Occupational and be at least 20 years old. Total program must be at least
Therapy adopted 12 months in length: at least 8 months theoretical and practical
and at least 3 months of supervised hospital practice training.
1927 Minimum Standards revised Length of practice training increased from 3 to 6 months
1930 Minimum Standards revised Total program length increased to at least 18 months, with
9 months of hospital practice training
1931 National Register established To serve as an enforcement mechanism; only those graduat-
ing from schools meeting Minimum Standards plus 1 year of
experience and/or grandfathered in, would be admitted to the
Register and have right to use designation O.T. Reg.
1935 Essentials of an Acceptable AMA-CMEH designated to accredit schools. Minimum length
School of Occupational Therapy of program should be 100 weeks, with at least 64 weeks of
adopted theoretical and technical instruction and 36 weeks of hospital
practice. Established requirements for organization, administra-
tion, and physical resources for programs. Set qualifications for
faculty.
1939 Essentials of an Acceptable Five schools inspected: four accredited and one given provi-
School of Occupational Therapy sional accreditation.
now fully developed and
enforced
1945 National examination started Graduates of accredited schools required to successfully pass
the national examination for admission to the National Registry.
One-year experience requirement for admission to the Registry
was eliminated.
1949 Essentials of an Acceptable Occupational therapy schools to be established in medical
School of Occupational Therapy schools of accredited universities. Occupational therapy school
revised directors to have an academic degree and be a qualified OTR.
Required clinical training in the areas of psychiatric conditions,
physical disabilities, tuberculosis, pediatrics, and general medi-
cine and surgery (other than physical disabilities).
1958 Essentials of an Acceptable Length of program at least 12 weeks. Didactic instruction and
School of Certified Occupational supervised practical training to take place in AMA-approved
Therapy Assistants adopted hospitals.

Both Dr. Frank Krusen and Dr. Howard Rusk saw the need for medical treatment beyond the
acute stage of illness or injury. The Baruch Committee, which included Dr. Krusen as a member,
defined medical rehabilitation as restoration of people with disabilities “as nearly as possible to a
normal physical and mental state” (Krusen, 1944, p. 1094). The committee explained that “medi-
cal rehabilitation fills the gap between the customary end point of medical attention and the real
necessities of many patients” (Krusen, 1944, p. 1094). The need was significant. In 1940, four
million people had permanent physical disabilities, with 800,000 more becoming permanently
disabled each year. World War II greatly increased the number of those with disabilities (Krusen,
1944). Along with social responsibility for the care of those with disabilities, Krusen understood
the economic benefit as well. He stated, “For every dollar spent for rehabilitation, $47 is returned
to society” (Krusen, 1944, p. 1094).
Dr. Howard A. Rusk was known as the Father of Comprehensive Rehabilitation (Blum & Fee,
2008, p. 257). An internist in private practice, Rusk joined the U.S. Air Force when the United
144 Chapter 5

SIDEBAR 5-4
Statement Policy on Occupational Therapy, 1950

Note: This policy statement was an attempt to state in positive language that occu-
pational therapy worked with several types of physicians, not just physical medicine and
rehabilitation specialists (physiatrists), and that direct contact with the referring physician
was important.
OCCUPATIONAL THERAPY is a professional service which uses purposeful activi-
ties to aid the patient in recovery from and/or adjustment to disease or injury.
It is prescribed by the patient s physician and administered by the occupational
therapist with consideration not only of the specific disability but also of the
patients physical, mental, emotional, social and economic needs.
Relationship With the Physician
In the fields of psychiatry, pediatrics, tuberculosis and other medical special-
ties it is essential that the patient s physician prescribe occupational therapy in
relation to the total treatment program. In order to insure continued guidance
it is necessary that there be frequent contact between the therapist and the
physician.
The Education of the Occupational Therapist
The education of the occupational therapist has been determined by the
demand of the various fields of medicine in which the service is needed. Balance
in emphasis on the medical specialties must therefore, be maintained.
The American Occupational Therapy Association Education Program
The American Occupational Therapy Association believes that its professional
courses can be most effectively directed by qualified occupational therapists in
accordance with the essentials established by the American Medical Association
for acceptable schools of occupational Therapy. Advisory committees made up
of representatives of the medical and allied professional fields are invaluable to
the administration of the educational program.
Registration
Professional registration is an integral part of the educational program and
as such has been established and is maintained under the jurisdiction of the
American Occupational Therapy Association.
Prepared by the Education Committee, 1949 (Kahmann, 1950)

States entered World War II. Stationed at Jefferson Barracks in St. Louis, Rusk developed a com-
prehensive rehabilitation program after recognizing the need to provide activity for the convalesc-
ing patients (Blum & Fee, 2008; Gelfman et al., 1997). Rusk emphasized “integrated rehabilitation
teams … focused on maximizing the psychological and social functioning of the disabled, in
addition to maximizing their physical and vocational capabilities” (Gelfman et al., 1997, p. 558).
After World War II, Rusk worked to develop a new specialty of medical rehabilitation and expand
his comprehensive medical rehabilitation programs to the civilian population. Both physical medi-
cine and medical rehabilitation were seeking recognition and improved status in the mid-1940s.
Because of the similarities, medical rehabilitation merged with physical medicine to become a
single specialty area of physical medicine and rehabilitation (Gelfman et al., 1997). Rusk went on to
found the Institute of Physical Medicine and Rehabilitation at New York University in 1948, with
 Rapid Growth and Expansion: 1940s to 1960s 145

$1 million donated by Bernard Baruch (Pace, 1989). The Institute was renamed the Rusk Institute
of Rehabilitation Medicine in 1984.

Expansion of
Occupational
Therapy
Schools
By 1940, five schools had been accred-
ited by the AMA-CMEH. In 1941, four
more schools had started courses in occu-
pational therapy: Columbia University
and New York University, both in New
Figure 5-12. Boston School of Occupational therapy Class of York; Michigan State College in Ypsilanti,
1941 included two leaders of the profession: Carlotta Welles and Michigan (later called Eastern Michigan
Wilma West. Assigned seats alphabetically, Welles and West sat
next to each other in class (Peters, 2011, p. 209). Carlotta Welles is
University); and Mary Mount College
back row, fourth from left. Wilma West is front row, second from in Milwaukee, Wisconsin (Board of
left. (Printed with permission from the Archive of the American Management, 1941). A total of 17 new
Occupational Therapy Association, Inc.) courses in occupational therapy had been
accredited and/or initiated between 1940
and 1945 (Figure 5-12). Fourteen more
had been accredited and/or initiated
between 1950 and 1967 (AOTA, 1967a)
(Figures 5-13 to 5-16).
Just as World War I had, World War
II spurred a manpower shortage, result-
ing in a number of new schools develop-
ing programs to fill manpower needs.
In contrast to World War I, educational
programs now had to meet specific stan-
dards. In spite of this, the Committee on
Education expressed concerns with some
of the new schools. The committee was
specifically concerned about the limited
importance placed on medical content
and clinical practice in some schools’ cur-
riculums (Board of Management, 1944).
The Association decided to create a series
of guides to assist the increasing numbers
of new schools with developing curricu-
lums. Included were guides to help stan-
dardize curriculums and didactic course
content, as well as guides to establish clini-
cal training programs (West, 1951b). To
have input into the accreditation process
and to ensure schools’ compliance with
Figure 5-13. Colleges and Universities offering courses, 1917-
1967. (Printed with permission from the Archive of the American standards, the Committee on Education
Occupational Therapy Association, Inc.) requested the AMA-CMEH to “designate
146 Chapter 5

a competent occupational
therapist to accompany and
2
assist the representative of 1
the council in the inspec- 2
tion of schools and courses 3 3
3 NH - 1
in occupational therapy” 1 2 MA - 2
1 1 1
(Kahmann, 1944b, p. 37)
4 1 1 1 1
(Sidebar 5-5; Figure 5-17).
The Association was
also able to obtain fund-
Puerto Rico - 1
ing from the Kellogg 2
Foundation to establish
an educational adviso-
ry service and to hire an
Educational Field Secretary
Figure 5-14. The number and location of occupational therapy educational pro-
to assist new schools seek- grams offered by colleges and universities that were accredited and/or initiated
ing accreditation. Initially between 1918 and 1967. Occupational therapists tended to stay and work in
the funding was for a period areas where they received their education. As a result, areas and states that did
of 6 months; however, the not have educational programs had a lack of occupational therapists.
Kellogg Foundation agreed
to support and fund the Education Office through 1951 (Nationally speaking, 1949). Additionally,
the Kellogg Foundation provided grants for student scholarships and loans helping to recruit
students (Board of Management, 1944).
Marjorie Fish, OTR, was appointed the
first Educational Field Secretary. In her
position, she established a close work-
ing relationship with the AMA-CMEH,
completing supplementary inspection
visits and sending reports to the CMEH
(Fish, 1945) (Figure 5-18).
The idea of establishing graduate-
level education started in the late 1940s.
The University of Southern California
started the first master’s degree program
in occupational therapy in 1947 (AOTA,
1977). In the mid-1950s, the Association
formed a committee to consider the
issue of graduate degrees in occupation-
al therapy. In 1958, this committee pre-
pared a “Guide for the Development of
Graduate Education Leading to Higher
Degrees in Occupational Therapy”
(AOTA, 1958). This committee started
the discussion on the mandate for an
entry-level master’s degree in occupa-
tional therapy, which would culminate
40 years later when the Representative
Assembly of AOTA voted to mandate a
Figure 5-15. Signed first edition of Willard & Spackman’s Principles master’s entry level.
of Occupational Therapy, the first occupational therapy text of
modern times. (Copyright © Dr. Lori T. Andersen. Reprinted with
permission.)
 Rapid Growth and Expansion: 1940s to 1960s 147

Figure 5-16. Advertising brochure for the first Willard & Spackman’s Principles of Occupational Therapy.
(Copyright © Dr. Lori T. Andersen. Reprinted with permission.)
148 Chapter 5

SIDEBAR 5-5
Career Romance Novels

In the 1940s and 1950s, a number of career books were published to help young girls
learn about career opportunities available to them. Included among these were three books
about the new profession of occupational therapy.
Betty Blake, OT: The Story of Occupational Therapy (Dodd, Mead, & Company, 1940),
written by Edith M. Stern in collaboration with Meta R. Cobb, OTR (see Figure 5-17)
Joan Chooses Occupational Therapy (Dodd, Mead, & Company, 1944), written by Meta
Cobb and Holland Hudson
Hillhaven (Longmans, Green, and Co., 1949), written by Mary Wolfe Thompson
Dr. Joan Rogers, retired Chairperson of the Department of Occupational Therapy at the
University of Pittsburgh, credits the book Joan Chooses Occupational Therapy with shaping
her career in occupational therapy (Pitt s next chapter, 2015).

Figure 5-17. Betty Blake, OT: A Story of Figure 5-18. Marjorie Fish served
Occupational Therapy was written by Edith as Speaker of the House of Delegates,
M. Stern in collaboration with Meta R. first Educational Field Secretary, and
Cobb, OTR, Executive Secretary of AOTA, as Executive Director of AOTA from 1951 to
a method to attract recruits to the profes- 1963. Miss Fish also coauthored a book,
sion of occupational therapy. (Copyright © Occupational Therapy and Rehabilitation of
Dr. Lori T. Andersen. Reprinted with per- the Tuberculous, with Mr. Holland Hudson.
mission.) (Printed with permission from the Archive
of the American Occupational Therapy
Association, Inc.)
 Rapid Growth and Expansion: 1940s to 1960s 149

Examination and Registration

Membership in the Association had risen to 1,240 members by 1940. The Board of
Management approved a motion to tie membership and registration together in August 1941.
After October 1, 1941, only those who were AOTA members in good standing would be eligible
for registration or re-registration. Those failing to re-register would need to pay lapse fees to be
reinstated to the register. In 1941, the Board approved giving reciprocity to registered Canadian
occupational therapists, granting them registration with AOTA (Board of Management, 1941)
(Figure 5-19).
In October 1942, the Board of
Management approved a motion
to require graduates of approved
schools to pass an examination for
admission to the Register. Tentative
plans were made to start adminis-
tering an examination if war con-
ditions permitted (AOTA, 1942b;
Examination, 1943). Finally, on
January 1, 1945, the Examination
Committee had established a plan.
The examination was to be admin-
istered twice per year, approximate-
ly 6 months apart. The examination
was to be of 5 to 6 hours in length Figure 5-19. Record of membership dues. In the early years of the
and consist of a section of true-false Association, membership records were kept on index cards. (Printed with
questions, a question on organiza- permission from the Archive of the American Occupational Therapy
Association, Inc.)
tion, essay questions, and a practi-
cal examination to be graded based
on reports from a hospital head therapist. A card file of questions was maintained from which
questions were taken by a committee of three designated people to construct the examination.
Students were charged a fee of $10 to take the examination. The first national examination was
given on June 22, 1945 (Subcommittee on Examination, 1945). In 1947, the examination format
changed to a two-part objective examination of 300 multiple-choice questions given in two sepa-
rate sittings (Brandt, 1956; Otto, 1948).
A new policy requiring successful passage of the examination as one of the qualifications to be
admitted to the National Register was approved in 1946. The policy stated:
To become a Registered Occupational Therapist in the American Occupational
Therapy Association a therapist must take and pass the Registration Examination.
Anyone wishing to take the examination, may do so, only upon presentation of their
certificate or diploma from a school whose course in Occupational Therapy is accred-
ited by the American Medical Association. (Board of Management, 1946, p. 87)
Registered Canadian therapists, who had been given reciprocity, were now also required to pass
the examination (Board of Management, 1946). In 1950, the University of Toronto and McGill
University developed a combined occupational therapy/physical therapy curriculum. Expressing
disapproval of this new combined curriculum, AOTA cancelled its reciprocity agreement with the
Canadian Association of Occupational Therapy (Education Committee, 1951).
State licensure for occupational therapists became an issue in 1951 when some state legislatures
considered introducing licensure bills. AOTA was not in support, deeming licensure “neither
desirable nor practical at the present time” (West, 1951a, p. 63). The Association believed that
the accreditation and registration processes already in place assured high professional standards,
150 Chapter 5

evidenced by the fact that there were no incidences of unqualified people compromising the high
standards. The fear was that state licensure would give each individual state control of standard
setting and a state may not recognize standards set by AOTA and the AMA-CMEH. Different
standards in different states would restrict mobility and would have the potential to restrict other-
wise qualified people from practicing. Additionally, licensing fees would be an additional expense
for occupational therapists (West, 1951a) (Sidebar 5-6).

SIDEBAR 5-6
Establishment of the Award of Merit and
the Eleanor Clarke Slagle Lectureship

The Award of Merit was established by the Board of Management at their April
1950 Board Meeting. Miss Eva Otto, the first recipient, was honored for her exemplary ser-
vice as the Educational Field Secretary. Miss Otto had just submitted her resignation letter at
the time of the Board vote. Along with this honor, the Board extended their best wishes for
her approaching marriage, at which time her name changed to Mrs. Eva Otto Munzesheimer
(AOTA, 1950, p. 236).
The Eleanor Clarke Slagle Lectureship was established by vote of the House of Delegates
and Board of Management in 1953 to recognize meritorious service to the profession.
Originally, the Slagle lecturer was chosen by a vote of the AOTA membership. Florence M.
Stattel, OTR, from New Jersey was awarded the Slagle lectureship in 1954. She presented the
very first Eleanor Clarke Slagle Lecture at the annual conference in 1955 (AOTA, 1954, p. 24).

Paradigm Shift from

Occupation to Reductionism
A confluence of events marked the shift of occupational therapy practice from a paradigm of
occupation to a paradigm of reductionism. The professional image of occupational therapy that
the early leaders had worked so hard to establish was in jeopardy in the early 1940s. The context
in which the profession was founded had changed. Both the Arts and Crafts Movement and the
Settlement House Movement had faded. The Progressive Era and hope of improving quality of
life for society gave way to the Great Depression, creating severe economic difficulties and hard-
ship for many. Occupational therapy was facing difficulty re-establishing its role in the military.
Major Walter E. Barton, a psychiatrist, gave the profession a wake-up call when he questioned
the value of occupational therapy in the Army. He pointed out that research efforts to “prove the
value of occupational therapy in the recovery from disease and illness” were virtually nonexis-
tent (Barton, 1943b, p. 264). Major Barton admonished the profession for failing “to adapt its thera-
peutic occupations to the changing demands of a new war” (Barton, 1943b, p. 264). The traditional
crafts of weaving, basketry, reed work, rug hooking, knitting, and embroidery were not appropriate
for men, the soldiers in World War II. He suggested that occupations such as more practical projects
in woodworking, landscaping, and electrical work, would be more appropriate and interesting for
men.
Advances in medicine, pharmacology, and technology helped to improve the survival rates of
patients who suffered head injuries, strokes, and spinal cord injuries. Patients who would have suc-
cumbed to their injury or illness in a short time now survived but with limited physical abilities
that required continued care and rehabilitation services. In contrast, tuberculosis, once a major
 Rapid Growth and Expansion: 1940s to 1960s 151

disease affecting a significant percentage of the population, was now being treated effectively with
drugs. With the declining number of people suffering from the disease, tuberculosis sanatoriums
were slowly closing. The Salk vaccine against polio became available in the mid-1950s, halting the
polio epidemic. Although those who were stricken with polio still required care and rehabilitation,
there were no new victims of polio.
In the 1940s and 1950s, there was a push for medicine to be more scientific and evidence
based. During that same time frame, physical medicine and rehabilitation adopted a biomedical
model that focused on pathology and the disease process. Illness was viewed purely as a biological
problem, not influenced by psychological, social, or environmental problems. To restore health,
the pathological condition in the patient, specifically the diseased body part, needed to be fixed.
With the shift to the biomedical model, the drive to be more scientific, and the impetus for more
research, medicine became more reductionistic. The reductionistic philosophy looked at a person’s
ability to function in more easily measured, discrete parts.
During World War II and the start of the Rehabilitation Movement, occupational therapists
started to work more closely with physiatrists and orthopedic physicians. As such, the number
of occupational therapists practicing in physical disabilities settings and physical medicine and
rehabilitation clinics increased. In such settings, occupational therapists accepted the reduc-
tionistic philosophy of medicine, a paradigm perceived as more scientific than the previously
accepted paradigm of occupation. The paradigm of reductionism guided the profession through
the 1950s and 1960s (Kielhofner & Burke, 1977; Gillette & Kielhofner, 1979).
In the changing sociocultural context, the waning of the Arts and Crafts Movement and
the rise of the Rehabilitation Movement, occupational therapists wanted to dispel their image
as crafts teachers (Editorial, 1951). Occupational therapy began to expand to include activities
of daily living (ADL), work simplification, work tolerance, pre-vocational activities, progres-
sive resistive exercises, adaptive equipment and aids, orthotic devices, and prosthetic training
(Dirette, 2013; Kielhofner & Burke, 1977).
The concept of ADL was
developed by Dr. George Deaver,
Medical Director at the Institute
for the Crippled and Disabled in
New York City. Concerned that
patients who came to the Institute
for vocational training lacked the
ability to perform simple self-care
activities, Deaver, along with physi-
cal therapist Mary Eleanor Brown,
developed a number of ADL assess-
ments. Used to guide development
of treatment plans to help patients
become self-sufficient, these ADL
assessments became the founda-
tion of the rehabilitation services
(Flanagan & Diller, 2013).
Figure 5-20. Wilma West playing chess with a soldier.
Whereas in the past carefully
selected craft activities helped
improve a patient’s underlying abil-
ities to enable participation in ADL, occupational therapists realized that teaching a specific ADL
task would also help increase independence (Zimmerman, 1963, p. 320). With this new focus,
occupational therapists incorporated new interventions into treatment programs, including train-
ing in the use of prosthetic devices, fabrication of splints, and construction of and education in
the use of adaptive equipment to facilitate independence in ADL (Figure 5-20). Adaptations for
152 Chapter 5

Figure 5-21. Soldier using a printing press as Figure 5-22. Soldiers using prostheses to play pool, circa 1945.
part of therapy program to strengthen lower (Printed with permission from the Archive of the American
extremity musculature, circa 1944. (Printed Occupational Therapy Association, Inc.)
with permission from the Archive of the
American Occupational Therapy Association,
Inc.)

homemaking and for self-help devices increased. Occupational therapy also focused on more
mechanistic treatment, such as metric occupational therapy, which gradually increased activity
to improve work tolerance, and kinetic occupational therapy, which was used to improve range of
motion, muscle strength, and muscle control (Martella & Gibavic, 1949) (Figures 5-21 and 5-22).
With these changes in philosophy and practice, occupational therapy education began to shift
away from an emphasis on crafts and toward an emphasis on the basic sciences.
The intrapsychic pathology of mental illness was also reductionistic (Kielhofner & Burke, 1977).
The psychodynamic theories initially developed by Sigmund Freud and furthered by Henry Stack
Sullivan continued to inform mental health practice through the 1950s. Freud and Stack believed
that the etiology of mental illness was within the person and caused by poor interpersonal relation-
ships. Gail Fidler, a well-known occupational therapist, and her husband, Jay Fidler, a psychiatrist,
interpreted the concepts of psychoanalytic theory and the psychodynamic frame of reference to
occupational therapy practice. The Fidlers’ use of crafts and activities allowed patients to nonver-
bally communicate feelings and thoughts. Puppetry, psychodrama, storytelling, and role-playing
were used for this purpose (Moll & Cook, 1997; Phillips, 1996; Wade & Franciscus, 1954, p. 92).
Occupational therapists also used groups and provided training to improve interpersonal relation-
ships, communication skills, coping skills, social skills, and assertiveness (Moll & Cook, 1997;
Wade & Franciscus, 1954, p. 77). Because poor interpersonal relationships were believed to be
the root of the problem, the therapeutic relationship and the therapeutic use of self were of prime
importance in treatment (Fidler & Fidler, 1954, p. 10).
With scientific advances in knowledge, specifically knowledge of the nervous system and motor
control, new treatment models developed. Margaret Rood began developing her sensorimotor
approach, Rood techniques, and Berta and Karel Bobath continued developing their neurodevel-
opment treatment approach with the focus of improving movement. Both of these neurophysio-
logical treatment approaches posited that sensory input influenced motor output and incorporated
the use of activities and adaptive equipment in treatment to improve skilled movement. Much of
the focus of these treatment approaches is to use sensory input to facilitate and/or inhibit muscle
tone and movement.
 Rapid Growth and Expansion: 1940s to 1960s 153

American Journal of Occupational

Therapy Introduced in 1947
Charlotte Bone became the first editor
of the American Journal of Occupational
Therapy in 1947. Bone had voiced a num-
ber of concerns about the Association’s
official journal, Occupational Therapy &
Rehabilitation. She was specifically con-
cerned about the lack of timeliness of the
journal, noting that dates of published events,
such as the annual conference, had often
passed before members even received the
journal. Bone felt the journal should be edit-
ed by an occupational therapist and include
articles more relevant to current practice.
Plans to revive the current journal did not
work out. Dr. William Rush Dunton owned
the journal but the “name and contents were
copyrighted … and therefore owned by the
publishers,” Williams & Wilkins Company
(Bone, 1971). The Board of Management
decided to fund a new official publication of
AOTA. Although she was not looking to take
on the job as editor of a new journal, when
AOTA asked, Bone agreed.

Figure 5-23. Cover of the first American Journal of

Occupational Therapy (AJOT), published in February 1947.
(Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)

Initially, Bone was going to co-edit the new journal

with Dr. Sidney Licht, who worked with Dr. Dunton on
Occupational Therapy & Rehabilitation. After considering
Journal of the American Occupational Therapy Association
as the name for the new journal, they settled on American
Journal of Occupational Therapy as the new name, believ-
ing that AJOT would be an easy acronym to remember.
In a change of plans, Licht opted to stay on as editor of
Occupational Therapy & Rehabilitation, covering content in
all branches of medical rehabilitation. Occupational Therapy Figure 5-24. Charlotte Bone OTR, First
& Rehabilitation later changed its name to the American Editor of AJOT. (Printed with permis-
Journal of Physical Medicine and Rehabilitation (Bone, 1971) sion from the Archive of the American
Occupational Therapy Association, Inc.)
(Figures 5-23 and 5-24).
Charlotte Bone took on the job of editor of the new journal
while she was teaching full time at the Boston School of Occupational Therapy. The editorial
office was in her bedroom, and her living room served as “the mailing office.” Charlotte Bone
154 Chapter 5

SIDEBAR 5-7
World Federation of
Occupational Therapists

Fifty-five occupational therapists from the United States attended the very first Congress
of the World Federation of Occupational Therapists held in Edinburgh, Scotland, in August
1954. A total of 400 therapists representing 22 countries from around the world attended
this first gathering (WFOT, 1954). The World Federation of Occupational Therapists aimed to
promote occupational therapy practice and advance standards worldwide, facilitate coopera-
tion and exchange of information among occupational therapy associations and other allied
health groups, and advance the practice and standards of occupational therapy (History, 2015).
Helen Willard and Clare Spackman helped to establish the World Federation of Occupational
Therapists. Spackman served as the first Secretary-Treasurer and in 1956 was elected as the
second President of World Federation of Occupational Therapists (see Figure 5-25).

Figure 5-25. In 1958, the Congress of the World Federation of Occupational Therapists,
the second WFOT Congress, was held in Copenhagen, Denmark. Attendees includ-
ed (from left to right) Clare Spackman, OTR, President of the World Federation of
Occupational Therapy; unknown gentleman; the Countess Bernadotte; HRH Princess
Margaretha of Denmark; Helen Willard; Glyn Owens from England; and Ingrid Pahlsson
from Denmark. (Printed with permission from the Archive of the American Occupational
Therapy Association, Inc.)

was known as someone who was precise in speech and writing. She served as editor for two years
taking great pride in her work (Bone, 1971, 1983).

Certified
Occupational Therapy Assistants
A number of other initiatives were undertaken to alleviate the shortage of occupational thera-
pists nationwide during and after World War II. Although the Army’s war emergency courses had
started in mid-1944, it would be a full year before the first class would graduate. In December
 Rapid Growth and Expansion: 1940s to 1960s 155

1944, to fill immediate needs, the Army began providing a 1-month course for occupational
therapy assistants. A total of 11 classes were given at Halloran General Hospital on Staten Island,
New York. The program was discontinued in October 1945 after graduating a total of 278 students
(Vogel et al., 1968a, pp. 181-182). In 1950, with the start of U.S. involvement in the Korean War,
the Army initiated an occupational therapist’s technician course, along with a course for occu-
pational therapists. The 12-week technician’s course, including 8 weeks of didactic coursework
and 4 weeks of practical training, would prepare Army personnel to assist occupational therapists
(McDaniel, 1968, pp. 503-506).
Significant shortages of occupational therapy personnel were also experienced in psychiatric
facilities, and, in some cases, unqualified personnel were hired to fill these positions. The idea
for a standardized course for training occupational therapy assistants was first proposed by Guy
Morrow, an occupational therapist at Cleveland State Hospital. His proposal for a 1-year training
program was referred to the AOTA Committee on Psychiatry of the Sub-Committee on Research
and Services for study (Willard, 1949).
In March 1953, the AOTA Board of Management voted to appoint a committee “to make a
study and report at the 1953 conference relative to recommendations for proposed standards of
training, accreditation, and recognition of non-registered personnel (OT assistants and aides) in
the OT program. This study [was] to consider the
re-establishment of an auxiliary registry” (New
Business, 1953, p. 230). Florence Stattel, OTR, was
appointed to chair the special committee charged
to study the issue of nonregistered personnel
(Recommendations of the Special Committee,
1953). Based on the report of this committee, the
House of Delegates recommended the appoint-
ment of a committee to study and present a plan
for developing a league of practical OT workers
(Speaker of the House of Delegates, 1954). AOTA
President Henrietta McNary appointed President-
Elect Colonel Robinson to co-chair a committee
with Gail Fidler to develop a plan for the imple-
mentation of recognition of nonprofessional per-
sonnel in occupational therapy (Johnson, 1988)
(Figure 5-26).
Figure 5-26. Helen S. Willard, President of AOTA,
The committee submitted its recommenda- presenting the Award of Merit to Colonel Ruth A.
tions to the Board in October 1955. A 12-week Robinson in 1959. (Printed with permission from
program conducted in AMA-approved hospitals the Archive of the American Occupational Therapy
under the supervision of an occupational therapist Association, Inc.)
included didactic instruction, specialty skills, and
supervised practical training. The plan also allowed for grandfathering of those who had worked
in occupational therapy for at least 2 years and who submitted positive recommendations from
a current supervisor and two other qualified people. The option to substitute experience for
education for admission to the auxiliary registry would expire 3 years after implementation of
training programs (Fidler & Robinson, 1956). On October 20, 1957, after much discussion and
revision, the Board of Management approved the plan. The plan was implemented in October 1958
(Catteron et al., 1958; Cottrell, 2000).
The original plan provided for the training and certification of occupational therapy assistants
only in the specialty area of psychiatry. The first two classes of certified occupational therapy
assistants graduated from Westboro State Hospital in Massachusetts and Marcy State Hospital in
New York in 1960 (Cottrell, 2000). In 1960, AOTA established a curriculum to qualify certified
156 Chapter 5

occupational therapy assistants for general practice (Cottrell, 2000; Johnson, 1988; Schwagmeyer,
1969).

Reflection
Despite efforts in the 1920s and 1930s to set professional standards to increase professional
status and recognition, the poor economic conditions and misperception of the value of occupa-
tional therapy by military leaders at the start of World War II set the profession back. Occupational
therapists walked a fine line between holding out for upgrades in military and professional status
and doing one’s patriotic duty by participating in the war effort under the status quo. The leaders
recognized that efforts to upgrade military and professional status would have significant implica-
tions for occupational therapy in civilian hospitals after the war. The Association worked closely
with the military to re-establish the role of occupational therapy in the military and to alleviate
manpower shortages. War emergency courses, courses to train occupational therapy volunteer
assistants, and the development of occupational therapy assistant programs were helpful in easing
manpower shortages during and after the war.
Legislation spurred the Rehabilitation Movement, making funding available for rehabilitation
facilities, for provision of therapy services, and for training of professionals, including occupa-
tional therapists. The role of women in society had an impact on the profession at a time when
manpower needs increased. Women educated as occupational therapists usually dropped out of
the profession to marry and raise a family, a societal role expectation. In spite of this, more women
were entering the workforce with a greater variety of job opportunities available. Women started to
take leadership roles in the Association, transitioning from the norm of men holding these leader-
ship roles. A change in the sociocultural context, the end of the Arts and Crafts Movement, and
the move of medicine to adopt a biomedical model and increase emphasis on science prompted
occupational therapy to shift from a paradigm of occupation to a paradigm of reductionism—a
paradigm that would dominate the profession for several years.

References
American Occupational Therapy Association. (1940a, March). Notice—medical technologists. American Occupational
Therapy News Letter, 11(1), 1.
American Occupational Therapy Association. (1940b, September 16). Minutes of the business session. Archives of the
American Occupational Therapy Association (Series 3, Box 13, Folder 84), Bethesda, MD.
American Occupational Therapy Association. (1940c, November). Insignia. News Letter, 11(1), 3.
American Occupational Therapy Association. (1941, January 17). Proceedings of the American Occupational Therapy
Association board meeting. Archives of the American Occupational Therapy Association (Series 3, Box 13, Folder
85), Bethesda, MD.
American Occupational Therapy Association. (1942a). Guide for training course: Occupational therapy volunteer
assistants. New York: Author.
American Occupational Therapy Association. (1942b). Minutes of meeting of Board of Management—October 10,
1942. Occupational Therapy & Rehabilitation, 21(6), 363-368.
American Occupational Therapy Association. (1944). Announcement of emergency course in occupational therapy.
News Letter, 6(3), 1-2.
American Occupational Therapy Association. (1950). Meetings of the Board of Management: Report of the
Educational Field Secretary. American Journal of Occupational Therapy, 5(2), 235-238.
American Occupational Therapy Association. (1954). Annual reports: Meeting of the House of Delegates. American
Journal of Occupational Therapy, 8(1), 24-35.
American Occupational Therapy Association. (1958). A guide for the development of graduate education leading to
higher degrees in occupational therapy. American Journal of Occupational Therapy, 12(6), 334-335.
American Occupational Therapy Association. (1967a). 50th anniversary: Occupational therapy—Then…1917 and
now…1967. New York, NY: Author.
 Rapid Growth and Expansion: 1940s to 1960s 157

American Occupational Therapy Association. (1967b). Presidents of the American Occupational Therapy Association.
American Journal of Occupational Therapy, 21(5), 290-298.
American Occupational Therapy Association. (1977). 60th anniversary 1917-1977. Rockville, MD: Author.
Army-Navy Nurses Act of 1947 (Public Law 80-36) (1947).
Army program. (1945, September). American Occupational Therapy Association News Letter, 5(2), 1.
Barton, W. E. (1943a). The army expands its occupational therapy program. Occupational Therapy & Rehabilitation,
22(5), 247-248.
Barton, W. E. (1943b). The challenge to occupational therapy. Occupational Therapy & Rehabilitation, 22(6), 262-269.
Blum, N., & Fee, E. (2008). Howard A. Rusk (1901-1989): From military medicine to comprehensive rehabilitation.
American Journal of Public Health, 98(2), 256-257.
Board of Management. (1940a, January 3). Minutes of the meeting of Board of Managers. Archives of the American
Occupational Therapy Association (Series 3, Box 13, Folder 84), Bethesda, MD.
Board of Management. (1940b, March 19). Memorandum for the Surgeon General. Archives of the American
Occupational Therapy Association (Series 5, Box 25, Folder 168), Bethesda, MD.
Board of Management. (1941, August 31). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association (Series 3, Box 13, Folder 85), Bethesda, MD.
Board of Management. (1944, March 21). Minutes of the Board of Managers. Archives of the American Occupational
Therapy Association, Bethesda, MD. Unpublished document.
Board of Management. (1946). Minutes of the meeting of the Board of Management, May 10, 1946, and committee
reports. Occupational Therapy & Rehabilitation, 25(3), 80-88.
Bone, C. D. (1971). Origin of the American Journal of Occupational Therapy. American Journal of Occupational
Therapy, 25(1), 48-52.
Bone, C. D. (1983). Interview transcript. Archives of the American Occupational Therapy Association: Bethesda, MD.
Brandt, H. (1956). The AOTA registration examination. American Journal of Occupational Therapy, 10(6), 281-287,
309.
Catteron, M., Dobranske, V. C., Messick, H. E., Peoples, M. W., Piper, B., Robinson, R. A. & Crampton, M. W. (1958).
The recognition of occupational therapy assistants. American Journal of Occupational Therapy, 7(5), 221.
Colman, W. (1992). Maintaining autonomy: the struggle between occupational therapy and physical medicine.
American Journal of Occupational Therapy, 46(1), 63-70.
Cottrell, R. P. (2000). COTA education and professional development: a historical review. American Journal of
Occupational Therapy, 54(4), 407-412.
Council on Medical Education and Hospitals. (1950). Essentials of an acceptable school of occupational therapy.
American Journal of Occupational Therapy, 4(3), 125-128.
Dirette, D. P. (2013). Trading in our paradigm shifts for a staircase. Open Journal of Occupational Therapy, 1(4), 1-7.
Dowsett, L. N. (1942, January). News from Hawaii [Letter]. American Occupational Therapy Newsletter, 3(2), 2.
Dunton, W. R. (1955, June 2). [Letter to Mrs. Frances Shuff]. Archives of the American Occupational Therapy
Association (Series 6, Box 47, Folder 320), Bethesda, MD.
Editorial. (1951). Disemphasizing crafts. American Journal of Occupational Therapy, 4(1), 39.
Education Committee. (1945). Excerpts from the minutes of meeting, Education Committee, AOTA. Occupational
Therapy and Rehabilitation, 24(2), 109-118.
Education Committee. (1951). Meetings of the Board of Management—Monday, October 16 and Thursday, October
19, 1950. American Journal of Occupational Therapy, 5(2), 72-73.
Eleanor Clarke Slagle. (1938). Psychiatric Quarterly, 12(1), 8-15.
Elwood, E. S. (1939, October 12). [Letter to Major General James C. Magee, Surgeon General]. Archives of the
American Occupational Therapy Association (Series 5, Box 29, Folder 168), Bethesda, MD.
Examination. (1943, July). News Letter, 5(2), 2.
Federal Vocational Rehabilitation Act of 1943 (Public Law 78-113) (1943).
Fidler, G. S., & Fidler, J. W. (1954) Introduction to psychiatric occupational therapy. New York, NY: Macmillan
Company.
Fidler, G. S., & Robinson, R. A. (1956). Report of the Committee to Plan Implementation of Recognition of Non-
professional Personnel in the field of occupational therapy. American Journal of Occupational Therapy, 10(1),
27-28.
Fish, M. (1940, December 12). [Memo to Chairman of the American Red Cross Mr. Norman H. Davis, Secretary
of War Henry L. Stimson, Surgeon General James C. Magee, and Senator Morris Sheppard]. Archives of the
American Occupational Therapy Association (Series 4.1, Box 25, Folder 168), Bethesda, MD.
Fish, M. (1945). Report of the Educational Field Secretary. Occupational Therapy & Rehabilitation, 24(1), 44-63.
Flanagan, S. R., & Diller, L. (2013). Dr. George Deaver: The grandfather of rehabilitation medicine. Physical Medicine
and Rehabilitation, 5(5), 355-359.
158 Chapter 5

Folz, T. J., Opitz, J. L., Peters, J., & Gelfman, R. (1997). The history of physical medicine and rehabilitation as
recorded in the diary of Dr. Frank Krusen: Part 2. Forging ahead (1943-1947). Archives of Physical Medicine and
Rehabilitation, 78, 446-450.
Gelfman, R., Peters, J., Opitz, J. L., & Folz, T. J. (1997). The history of physical medicine and rehabilitation as recorded
in the diary of Dr. Frank Krusen: Part 3. Consolidating the position (1948-1953). Archives of Physical Medicine
and Rehabilitation, 78, 556-561.
Gillette, N., & Kielhofner, G. (1979). The impact of specialization on the professionalization and survival of occupa-
tional therapy. American Journal of Occupational Therapy, 33(1), 20-28.
Hartwick, A. M. R. (1993). Army medical specialist corps: The 45th anniversary. Washington, DC: Center of Military
History, United States Army.
History. (2015). World Federation of Occupational Therapy history. Retrieved from http://www.wfot.org/AboutUs/
History.aspx
Hospital Survey and Construction Act of 1946 (Public Law 79-725) (1946).
Johnson, J. A. (1988). Certified occupational therapy assistants: reflections on their thirtieth anniversary.
Occupational Therapy in Health Care, 5(2/3), 213-220.
Kahmann, W. C. (1943). War service report. American Occupational Therapy News Letter, 5(2), 1.
Kahmann, W. C. (1944a). Demand urgent for occupational therapists. American Occupational Therapy News Letter,
6(1), 1.
Kahmann, W. C. (1944b). Report of the Committee on Education. Occupational Therapy & Rehabilitation, 23(6),
36-38.
Kahmann, W. C. (1947). President’s opening address at the twenty-seventh annual convention. American Journal of
Occupational Therapy, 1(6), 379-380.
Kahmann, W. C. (1950). Nationally speaking. American Journal of Occupational Therapy, 4(3), 111-112.
Kahmann, W. C., & West, W. A. (1947). Occupational therapy in the United States Army Hospitals, World War II. In
H. S. Willard & C. S. Spackman (Eds.), Principles of Occupational Therapy (pp. 329-384). Philadelphia, PA: J. B.
Lippincott Company.
Kielhofner, G., & Burke, J. P. (1977). Occupational therapy after 60 years: An account of changing identity and knowl-
edge. American Journal of Occupational Therapy, 31(10), 675-689.
Krusen, F. H. (1944). The future of physical medicine with special reference to the recommendations of the Baruch
Committee on physical medicine. Journal of the American Medical Association, 125(16), 1093-1097.
Krusen, F. M. (1934). The relationship of physical therapy and occupational therapy. Occupational Therapy &
Rehabilitation, 13(2), 69-77.
La Guardia, F. H. (1941, September 2). [Letter to Meta R. Cobb]. Archives of the American Occupational Therapy
Association (Series 5, Box 25, Folder 169), Bethesda, MD.
Martella, J., & Gibavic, A. N. (1949). A rehabilitation program for the tuberculous through occupational therapy.
American Journal of Occupational Therapy, 3(5), 232-237.
McDaniel, M. L. (1968). Occupational therapy educational programs, April 1947 to January 1961. In R. S. Anderson,
H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 481-509). Washington, DC: Office of the
Surgeon General, Department of the Army.
McDaniel, M. L. (1968). Occupational therapists before World War II (1917-40). In R. S. Anderson, H. S. Lee, & M.
L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 69-97). Washington, DC: Office of the Surgeon General,
Department of the Army.
Mental Health Study Act of 1955 (Public Law 84-182) (1955).
Moll, S., & Cook, J. V. (1997). “Doing” in mental health practice: Therapists’ beliefs about why it works. American
Journal of Occupational Therapy, 51(8), 662-670.
National Defense Committee. (1941, August 31). Minutes of the meeting of the National Defense Committee of the
AOTA, August 31, 1941. Archives of the American Occupational Therapy Association (Series 5, Box 25, Folder
169), Bethesda, MD.
National Mental Health Act of 1946 (Public Law 79-487) (1946).
Nationally speaking. (1949). Kellogg Foundation Grant. American Journal of Occupational Therapy, 3(1), 31.
Navy program. (1945, September). American Occupational Therapy Association News Letter, 5(2), 1.
New business. (1953). Committee reports: Meeting of the Board of Management, March 15, 1953. American Journal
of Occupational Therapy, 7(5), 227-230.
Oppenheimer, E. D. (1948, May 14). Report for the annual meeting of the NYSOTA of the OTVATC—May 14, 1948.
Archives of the American Occupational Therapy Association (Series 5, Box 24, Folder 166), Bethesda, MD.
Otto, E. M. (1948). Committee reports: Registration Committee report September 1948. American Journal of
Occupational Therapy, 2(5), 310-311.
Pace, E. (1989, November 5). Howard Rusk, 88, dies; Medical pioneer. The New York Times.
 Rapid Growth and Expansion: 1940s to 1960s 159

Peters, C. O. (2011). Powerful occupational therapists: A community of professionals, 1950-1980. Occupational

Therapy in Mental Health, 27, 199-410.
Phillips, M. E. (1996). The use of drama and puppetry in occupational therapy during the 1920s and 1930s. American
Journal of Occupational Therapy, 50(3), 229-233.
Pitt’s next chapter. (2015, Spring). Occupational Therapy Newslink, 4(3), 1.
Recommendations of the Special Committee. (1953). Recommendations of the Special Committee of the American
Occupational Therapy Association. Bethesda, MD: Archives of the American Occupational Therapy Association
(Series 6, Box 50, Folder 340).
Reggio, A. W. (1947). Federal security agency, U.S. Public Health Service. American Journal of Occupational Therapy,
1(6), 390.
Schwagmeyer, M. (1969). The certified occupational therapy assistant today. American Journal of Occupational
Therapy, 23(1), 69-74.
Servicemen’s Readjustment Act of 1944 (Public Law 78-346) (1944).
Speaker of the House of Delegates. (1954). Report of the Speaker of the House of Delegates: Minutes of the mid-year
meeting of the Board of Management, March 28, 1954. American Journal of Occupational Therapy, 8(5), 221.
Subcommittee on Examination. (1945, October). Minutes of the meeting of the Board of Management, June 27, 1945,
and committee reports. Occupational Therapy & Rehabilitation, 24(5), 212-217.
U.S. Office of Civilian Defense. (1942). Volunteers in health, medical care and nursing. Washington, DC: Author.
Vocational Rehabilitation Act Amendment of 1954 (Public Law 83-565) (1954).
Vogel, E. E., & Gearin, H. B. (1968). Events leading to the formation of the Women’s Medical Specialist Corps. In R. S.
Anderson, H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 1-11). Washington, DC: Office
of the Surgeon General, Department of the Army.
Vogel, E. E., Manchester, K. E., Gearin, H. B., & West, W. L. (1968a). Training in World War II. In R. S. Anderson,
H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 137-182). Washington, DC: Office of the
Surgeon General, Department of the Army.
Vogel, E. E., Manchester, K. E., Gearin, H. B., & West, W. L. (1968b). Wartime organization and administration. In R.
S. Anderson, H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 101-136). Washington, DC:
Office of the Surgeon General, Department of the Army.
Wade, B. D., & Franciscus, M. L. (1954). Occupational therapy for the mentally ill. In H. S. Willard & C. S. Spackman
(Eds.), Principles of occupational therapy (2nd ed., pp. 76-116). Philadelphia, PA: J. B. Lippincott Company.
West, W. L. (1947). The future of occupational therapy in the army. American Journal of Occupational Therapy, 1(2),
89-91.
West, W. L. (1951a). From the executive director. American Journal of Occupational Therapy, 5(2), 60-63.
West, W. L. (1951b). From the executive director. American Journal of Occupational Therapy, 5(4), 164-165.
West, W. L. (1989). Ruth A. Robinson. American Journal of Occupational Therapy, 43(7), 481-482.
West, W. L. (1992). Ten milestone issues in AOTA history. American Journal of Occupational Therapy, 46(12), 1066-
1074.
WFOT. (1945). American Occupational Therapy Association News Letter, 13(10), 1.
White House reception. (1954). American Occupational Therapy News Letter, 2(3), 1.
Willard, H. S. (1941a, October 21). [Letter to Meta R. Cobb]. Archives of the American Occupational Therapy
Association (Series 5, Box 25, Folder 169), Bethesda, MD.
Willard, H. S. (1941b, November 5). [Memo to Mrs. Roosevelt]. Archives of the American Occupational Therapy
Association (Series 5, Box 25, Folder 169), Bethesda, MD.
Willard, H. S. (1941c, December 20). [Letter to Miss Eleanor Vincent]. Archives of the American Occupational
Therapy Association (Series 5, Box 25, Folder 169), Bethesda, MD.
Willard, H. S. (1941d, December 22). [Letter to Marjorie Fish]. Archives of the American Occupational Therapy
Association (Series 5, Box 25, Folder 169), Bethesda, MD.
Willard, H. S. (1941e). Occupational therapy and defense. American Occupational Therapy Newsletter, 3(1), 3.
Willard, H. S. (1942a, February 21). [Letter to Meta R. Cobb]. Archives of the American Occupational Therapy
Association (Series 5, Box 24, Folder 165), Bethesda, MD.
160 Chapter 5

Willard, H. S. (1942b, June). [Letter to Presidents of State Associations re: uniforms and emblems]. Archives of the
American Occupational Therapy Association (Series 5, Box 24, Folder 165), Bethesda, MD.
Willard, H. S. (1944). Meeting of the Board of Management: Volunteer courses. American Occupational Therapy News
Letter, 6(2), 1-8.
Willard, H. S. (1949). Committee reports: Education committee. American Journal of Occupational Therapy, 3(4), 221.
Willard, H. S. (1950). Committee reports: Report of the education committee. American Journal of Occupational
Therapy, 4(1), 35-36.
Zimmerman, M. E. (1963). Occupational therapy in the A.D.L. program. In H. S. Willard & C. S. Spackman (Eds.),
Principles of occupational therapy (3rd ed., pp. 320-357). Philadelphia, PA: J. B. Lippincott Company.
 6
Turning Points
1960s to 1970s

Key Points
● The professional Association celebrated 50 years as an organization in 1967.
● American Occupational Therapy Association (AOTA) bylaws were revised in 1964 to accom-
modate the increased activities of the Association.
● The recruitment of students to address manpower shortages continued to be a major focus of
concern.
● The American Occupational Therapy Foundation was created in 1965 to house entities that
could be tax exempt.
● The concept of working under a prescription was changed to a referral as occupational therapy
continued the process of decreasing control of occupational therapy services by medicine and
physicians.

Highlighted Personalities
● A. Jean Ayres, theorist
● Gail S. Fidler, theorist
● Mary P. Reilly, theorist
● Wilma L. West, AOTA Executive Director, 1950-1951, and President, 1961-1964
● Ruth Brunyate (Wiemer), AOTA President, 1964-1967
● Florence S. Cromwell, AOTA President, 1967-1970 (first term)
● Marjorie (Marj) Fish, AOTA Executive Director, 1952-1963
● P. Francis Helmig, AOTA Executive Director, 1964-1968
● Harriett J. Tiebel, AOTA Executive Director, 1968-1971

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 161-194).
- 161 - © 2017 SLACK Incorporated.
162 Chapter 6

Key Places Key Times/Events

● Clifton Springs, New York—Site of 50th ● Plaque placed on Consolation House in
anniversary celebration Clifton Springs, New York, where found-
ing meeting of the Association was held

Political Events/Issues Sociocultural Events/Issues

● Community Mental Health Act, 1963 ● Deinstitutionalization started in California
● Medicare, Title 18, Social Security Act, 1965 when Ronald Reagan was governor
● Medicaid, Title 19, Social Security Act, 1966 ● Community-based practice for mental
● Allied Health Act, 1966 health and intellectual disabilities (mental
retardation) was promoted to reduce the
cost of institutional care in state budgets
Economic Events/Issues ● Paradigm shift occurred in psychiatry to
psychoanalytic and psychodynamic theo-
● Grant monies, especially from the ries (talking cures) in mental health
Vocational Rehabilitation Agency (VRA), ● Increased interest nationally and world-
became a major source of funding for the
wide in physical rehabilitation
Association.
● VRA grants supported two field consul-
tants: one in rehabilitation and one in
psychiatry. Practice Issues
● Physical disabilities overtook mental
health/psychiatric occupational therapy as
Educational Issues the major area of practice
● Essentials of an Accredited Program in ● Practice shifted to biomedical models as
Occupational Therapy revised in 1965. opposed to social and temporal aspects
Affiliations divided into physical and psy- of arts and crafts models used in mental
chosocial disabilities totally 6 months and health and tuberculosis settings
there was a de-emphasis on crafts. ● Practice in tuberculosis and poliomyelitis
● Master’s degree programs started decreased; practice in neurological disor-
ders such as stroke and spinal cord injury
● Increased focus on continuing education
increased
to update knowledge and skills
● Practice in pediatrics expanded with the
development of perceptual and sensory
motor theories
Technological Events/Issues ● Manpower shortages limited expansion of
● Rapid increase in the use of pharmacologic occupational therapy services
agents to treat a variety of health conditions ● Increased focus on continuing competency
● Development of new splinting materials to practice beyond initial certification
expanded the use of splints
 Turning Points: 1960s to 1970s 163

Association Issues Foundation Issues

● Major reorganization of the Association, ● Authorization to form the Foundation
1964 established at annual conference in 1964
● Last meeting of House of Delegates, 1964 ● The Foundation was incorporated in the
● First meeting of Delegate Assembly, 1965 state of Delaware in 1965 for charitable,
● Statement on Referral adopted, 1969 scientific, literary, and education purposes
● Standards for Occupational Therapy ● Two percent of Association dues forward-
Service Programs adopted, 1969 ed to the Foundation approved in 1969
● Guide for the Development and Use of
Personnel Policies adopted in 1967 and
revised in 1969
● Statement of Basic Philosophy Principles
and Policy adopted, 1969

Introduction
“Occupational therapy can be one of the great ideas of the 20th
century medicine.”
–Mary Reilly (1962)

J
ohn F. Kennedy became President of the United States in 1961. The Cuban missile crisis
occurred in 1962 as the specter of nuclear war arose after photographs confirmed the
presence of Soviet missiles in Cuba. On November 22, 1963, Kennedy was assassinated
in Dallas, Texas. Lyndon B. Johnson became President during a swearing-in ceremony aboard
Air Force One during the flight back to Washington, DC, and served from 1963 to 1969. The
1963 March on Washington included more than 200,000 people gathered for a peaceful dem-
onstration calling for more action on civil rights. The marchers were addressed by Rev. Martin
Luther King Jr., who gave his “I Have a Dream” speech. King would be assassinated in 1968.
During the 1968 Democratic National Convention in Chicago, there was a youthful rebellion
and social uprising of anti-Vietnam War protesters. In 1968, Sesame Street started on the Public
Broadcasting System as a series designed to teach educational and social concepts to preschoolers.
In July 1969, astronauts Neil Armstrong and Buzz Aldrin became the first humans to set foot on
the moon.
In the 1960s, occupational therapy practice in physical disabilities overtook mental health (psy-
chiatric occupational therapy) as the dominant area of practice. In a 1968 article, the percentage
of graduates working in psychiatric settings is given as 25% (Howe & Dippy, 1968, p. 524). Many
changes were occurring in the practice of physical disabilities, including the development of physi-
cal medicine and rehabilitation departments and clinics as a result of success during World War II
in treating physical injuries. At the same time, changes in mental health (neuropsychiatry, mental
illness) moved practice from a chronic setting (government-run hospital) to a short-term commu-
nity center or supportive outpatient service. The changing practice patterns in mental health often
did not include occupational therapy services.
During the same time period, models of practice were being developed by occupational thera-
pists, and some were based on core occupational therapy philosophy and concepts, increasing the
potential for professional autonomy and decreased reliance on sponsorship by other health-related
164 Chapter 6

professions. Examples include the communication process (Fidler & Fidler, 1963), occupational
behavior (Reilly, 1966), and sensory integration (Ayres, 1968).
The 1960s marked the era of the New Frontier and the Great Society envisioned by President
Johnson. The torch had been passed, as the nation’s new President proclaimed, to a new genera-
tion, one with new ideas and a renewed drive to move toward a progressive future. It was an age
of limitless possibilities and growing social consciousness. Medicare exemplified the changing
contract between the government and American society. The Association and the profession of
occupational therapy stood on the threshold of a half-century of growth and service. But more
action was needed. The Association needed to respond to
external factors such as the ideas that lead to the passage
of the Medicare and Medicaid. Occupational therapy prac-
titioners needed to influence government policy, not just
respond to it. Changes in the Association’s structure would
be needed to permit lobbying on behalf of ideas important
to occupational therapy as a profession and organization.
Theory and practice were also evolving. Psychiatric occu-
pational therapy was transforming from psychoanalytic
theory based on insight to community psychiatry designed
to address community living problems. Theory and prac-
tice in physical rehabilitation was rapidly expanding as
ideas developed during and after World War II become
commonly accepted and facilities were built to accommo-
date rehabilitation services and clinics. Occupational ther- Figure 6-1. Symbol celebrating the 50-year
anniversary of the founding of the profes-
apy education shifted from diagnosis-based lectures and sional Association: 1917-1967. (Reprinted
student training to focusing on the person with a disability with permission from the American
who needed to function in the community and society. Occupational Therapy Association.)
The Association celebrated 50 years since its founding
by placing a marker on the house in Clifton Springs, New York, where the founding meeting was
held in March 1917 (Figure 6-1). New bylaws adopted in 1964 changed the organization structure
to permit the Association to address external issues affecting the practice of occupational therapy,
specifically federal legislation. The Association hired a paid lobbyist for the first time in 1968 to
represent the Association and occupational therapy to Congress. Tax law required that to main-
tain aspects of tax-exempt status, two organizations would be needed, and thus a foundation was
formed to carry on certain activities related to education, scholarship, and research.

Education
Revision of the Essentials
In December 1965, the Essentials of an Accredited Curriculum for Occupational Therapists
were approved (AOTA, 1965b). However, the document was never published in the American
Journal of Occupational Therapy. The official publication was the Guidebook for an Accredited
Curriculum in Occupational Therapy (AOTA, 1965b). Several important changes were incorpo-
rated. Under the 1949 Essentials, students completed 8 to 12 months of clinical affiliations in
five different specialty areas: psychiatric conditions, physical disabilities, tuberculosis, pediatrics,
and general medicine and surgery. Under the 1965 Essentials, the number of months of clinical
experience (hospital affiliation, clinical experience, field work) were reduced from 8 to 10 months
to 6 months (24 weeks). The clinical affiliation in tuberculosis was dropped completely, and the
6 months were divided in two major categories: psychosocial dysfunction and physical dysfunction.
Experience in working with tuberculosis was dropped because many hospitals and sanitariums
 Turning Points: 1960s to 1970s 165

that treated persons with tuberculosis had closed as treatment using sulfa drugs became more
effective. The change in labeling the clinical affiliations (fieldwork) was a deliberate attempt to
view clients’ problems broadly or generically rather than based on diagnostic specific criteria. The
change also provided more flexibility for educational program faculty to place students in a variety
of settings rather than being restricted to specific diagnostic categories.
Another major change in the Essentials statement is that the section on occupational therapy
skills does not mention handicrafts or any specific art or craft by name, although there is a list in
the explanatory paragraph that woodwork, weaving, ceramics, fine art, and leather are frequently
used. The actual requirement of nine semester credits lists creative and manual skills, vocational
and avocational activities, daily living skills, and teaching methods. Dropping specific references
to crafts by name began the process of reducing the focus on handicrafts as therapeutic occupa-
tions and increasing the focus on activities of daily living, productive occupations, and play-leisure
pursuits. The change also allowed educational programs more flexibility in organizing course
content in skill acquisition and therapeutic application. Craft content could be offered within the
occupational therapy curriculum rather than using established courses in the art, fine arts, educa-
tion, or home economics departments that taught skills such as weaving, ceramics, or woodwork-
ing but not therapeutic application to occupational therapy practice.
Overall, the concept of pathology was changed to six semester credits in physical and psychoso-
cial dysfunction. The concept of evaluation and treatment procedures for problems of psychosocial
and physical dysfunction was introduced. These changes are in agreement with the concepts of the
basic approach discussed under the section on education in which the focus is on the individual
as a person, not on the disease entity. Finally, another important change is that the Council of
Physical Medicine and Rehabilitation is no longer listed as a partner with the American Medical
Association (AMA) and the AOTA in setting the standards for education. The Association had
won the dispute to avoid control by physiatrists over the educational standards.

Number and Distribution of Educational Programs

The number of educational programs in occupational therapy did not change significantly
despite the documented need for more practitioners. In 1960, there were 31 programs, and in 1969,
there were 32. Twenty-one states had an occupational therapy education program, but 29 did not.
Most of the programs were in Eastern or Midwestern states. Only five were located in Western
states. Most of the programs were not filled to capacity. Total capacity as listed by the AMA was
835 slots, but only 726 were filled. The need for better recruitment techniques and better knowl-
edge about occupational therapy was evident.
One solution to increase the number of educational programs was to provide grant funds to
colleges and universities. In 1966, the Allied Health Professions Act was passed by Congress to
increase the number of support personnel available to help physicians provide better health care
(Mase, 1968). This Act provided the funds to establish allied health departments to provide educa-
tion in fields associated with medicine, including occupational therapy, physical therapy, medi-
cal technology, medical record library science, radiological technology, inhalation (respiratory)
therapy, and cytotechnology. The funding allowed programs to develop in colleges and universi-
ties instead of in hospitals or as subspecialties under nursing (Mase, 1968). Although occupational
therapy education already required a college or university degree, the increased funding would
increase the number of programs available in the coming years.

Curriculum Study
The Association formally began the Curriculum Study in 1958, but most of the work was done
in during the 1960s. In 1958, the Association was awarded a grant from the National Foundation
166 Chapter 6

for Infantile Paralysis (AOTA, 1958b). This project was the first comprehensive self-study of the
profession of occupational therapy. The project was designed to provide:
● A job analysis of occupational therapy performance in selected departments to ascertain
and define current job requirements to answer the question: “What is the job required of the
graduate occupational therapist?”
● A curriculum survey of all occupational therapy schools and selected student affiliation cen-
ters to delineate the specific knowledge and techniques acquired by students in their profes-
sional education to answer the question: “What knowledge and skills are the schools teaching
the student occupational therapist?”
● A matching of the instructional pattern against job demands to determine the functional
status of the current curriculum to answer the questions: “What is the functional status
of the curriculum?” or “How should education be revised to better equip us for function?”
(AOTA, 1958a)
Personnel hired to complete the grant’s activities included Wilma West, who initiated the proj-
ect, and Marguerite Abbott, who served as the Project Director the first year but was unable to
continue due to health reasons. Ms. West took over as Project Director. Carlotta Welles completed
the job analysis phase, and Mary Booth completed the academic survey phase. All 31 schools were
evaluated, as were numerous student affiliation sites. The project was designed for 3 years but
took 5 years to complete. Ultimately, 16 reports were written and released from the original study
ending in 1963.
The second part of the Curriculum Study was funded by Vocational Rehabilitation
Administration (VRA) grant 123-T-66 (AOTA, 1966a). Generally, the purpose was to explore the
implications of the original study in five areas: patient evaluation in physical and psychosocial
dysfunction, treatment planning in physical and psychosocial dysfunction, treatment methods
and activities in physical and psychosocial dysfunction, supervision, and administration. The
participants were to consider four points:
● The individual occupational therapy student’s need for a curriculum in which his or her best
potential can grow and develop, rather than one which fits him or her into a rigid pattern
● The individual school’s need for a curriculum and curriculum guidelines that not only pro-
vide minimal essentials but foster maximal efforts
● The need of the individual practicing therapist to be taught in the schools and encouraged in
the clinics so that he or she will develop and not simply adjust to practices
● The patient’s need for primary consideration in the setting up of his or her treatment goals
and plans
At the same time, participants were warned that (1) the period of preparation always will be
limited, (2) increasing knowledge always will necessitate establishing a cutoff point, (3) this cut-
off point may fall short of what is desirable knowledge, (4) each new occupational therapist must
take a personal responsibility for continuing his or her own education, and (5) the experienced
therapist must find ways to help him- or herself continue his or her education. The results of the
study group’s efforts are a list of objectives divided into those considered common to health-related
professions and a second list of objectives specific to occupational therapy published in AJOT
(Kilburn, 1966). A total of 92 objectives are listed in the two large categories: 19 health-related
objectives and 73 specific to occupational therapy. Each is subdivided into three subgroups: (1) to
acquire knowledge and understanding, (2) to develop skills and abilities and (3) to cultivate atti-
tudes and interests. For the health-related objectives, the numbers for the three subgroups were
9, 4, and 6. For the specific occupational therapy objectives, the numbers for the three subgroups
were 23, 27, and 23. Thus, a relative balance of objectives per subgroup was obtained.
In a second article, there are 96 recommendations and ideas listed. The number for each entity
is as follows: the Council on Standards (16 objectives), Committee on Basic Professional Education
(24 objectives), Council on Practice (17 objectives), the Association (8 objectives), individual
 Turning Points: 1960s to 1970s 167

members (27 objectives), and the planning committee in charge of the VRA grant (3 objectives)
(AOTA, 1967a). A more complete list of educational objectives appeared the following year and
marked the first time a list of educational objectives was made available to all practitioners and
anyone else interested in occupational therapy education (AJOT, 1968). The objectives are orga-
nized into six categories: normal growth and development, pathology, basic concepts in the theory
and practice of occupational therapy, evaluation, treatment planning and treatment procedures,
and supervision and administration. The objectives for normal growth and development and for
pathology list only those related to knowledge and understanding. No objectives for developing
skill and ability or for cultivating attitudes are listed because those sections were not formulated.
The sections on basic concepts, evaluation, treatment planning, and supervision and adminis-
tration are more completely developed into the three subcategories. Although the labels have
changed over the years, the general categories of objectives remain identifiable in the format of
the standards in force. These objectives also permit evaluation of course content as opposed to the
Essentials document, which primarily lists resources that are available for occupational therapy
students and faculty but do not state how the resources are to be used or evaluated.
An important note is that none of the objectives are about the philosophy, assumptions, or
theoretical rationale of occupation as a unique concept or as the principal medium for interven-
tion. The focus is on principles borrowed from psychology, sociology, and medicine, but not on the
theoretical base of occupation. One objective does address the theoretical basis for the practice of
occupational therapy, but none of the objectives address the philosophical and theoretical rationale
for the use of occupation as a therapeutic or intervention approach, nor the role of occupation in
maintaining health and wellness or in reducing dysfunction.

Adoption of the Basic (General) Approach to Education

The discussion of a basic or general approach to occupational therapy education grew out of
an idea expressed at the 1955 Regional Institute. The statement was made that “the general occu-
pational therapy approach be referred to the Educational and Clinical Procedures Committee
and their component parts for further study, evaluation, mechanics, and implementation”
(AOTA, 1955, p. 73). The idea was to shift the “emphasis from the use of diagnostic categories to
the concept of treatment of patients in terms of their basic needs” (AOTA, 1968b, p. 540).
In October 1958, a report to the Medical Advisory Council meeting stated the “association
has officially endorsed the basic approach in the practice of occupational therapy, i.e., treat-
ment of the patient as a whole [person], rather than in relation to a particular disease entity”
(AOTA, 1958c, p. 1). The following points were added related to educating occupational therapy
students:
● That emphasis should be placed on commalities [sic (commonalities)] rather than disease
entities
● That consideration should be given to patients as predominantly psychiatric or predominantly
physical problems; that studies should include all age groups, all disease entities, stages of ill-
ness, varieties of treatment situations and availability of, and type of, facilities
● That developmental opportunities for the therapist should be provided, and full cognizance
given to the importance of the therapist’s personality in relation to her function (AOTA,
1958c, p. 1)
After 2 years of study by three subgroups across the country, three recommendations were
stated in the final report: (1) the subject of the basic approach should be discussed more exten-
sively so that all therapists could participate in the thinking, (2) the use of diagnosis should be
discarded as the basis of assigning clinical affiliations, and (3) schools should teach theory on the
basis of commonalities and differences rather than by diagnosis (Matthews, 1959). As noted in the
discussion of the 1965 Essentials, recommendations 2 and 3 were adopted in the revision. The first
168 Chapter 6

recommendation was not followed specifically, although its concepts were inherent in the revision
of the Essentials.
Part of the participants’ concern was directed at the list of clinical training requirements and
the need in the educational programs to have course content designed to prepare the student for
each of the different clinical training diagnostic categories. The Essentials of an Acceptable School
of Occupational Therapy (American Medical Association–Council on Medical Education and
Hospitals [AMA-CMEH], 1949) required the student to complete clinical training in five diag-
nostic areas—orthopedics or physical disabilities, psychiatry, pediatrics, general medicine and
surgery, and tuberculosis—for a total of not less than 9 months. Anderson (1959) calls the problem
the five-disability approach to professional education. As the number of students increased, find-
ing placements for all the students became difficult, and there was a certain number of repetitive
work assignments the students were required to complete. Reducing the diagnoses to two primary
areas, physical and psychiatric, reduced the number of training sites needed for each student and
the amount of overlap in student assignments. Related, although not cited in the literature, was the
closure of many tuberculosis sanatoriums as the treatment of tuberculosis became more manage-
able on an outpatient basis, making student placement in tuberculosis facilities increasing difficult
to accomplish.
A second concern was teaching theory and application based on commonalities rather than
differences. This issue could be called the 40-diagnosis approach to teaching students about apply-
ing occupational therapy to specific diagnoses. Forty is the number of diagnoses described in the
manual The Objectives and Functions of Occupational Therapy, published in 1958. Students were
expected to know the specifics of treating each of the difference diagnoses listed in the manual.
The proponents of the basic approach suggested teaching the commonalities of media, methods,
and techniques used in the application of occupational therapy rather than teaching the applica-
tion to each different diagnosis. The rationale was that understanding the principles of occupa-
tional therapy was more important than memorizing details related to a diagnosis. The underlying
philosophy was to treat the person, not the diagnosis.
The impact of the basic approach is seen in the 1965 revision of the Essentials, when the clinical
experience was changed to “one three-month period or an equivalent amount of time must be in
the area of psychosocial dysfunction … and one three-month period … in the area of physical dys-
function” (AMA-CMEH, n.p.). Course preparation was changed to six semester credits in physical
and psychosocial dysfunction. Gone were the references to specific diagnostic categories in both
the course preparation and clinical training.

Practice
The Changing Role and Function of Occupational Therapy
As Chair of the Legislative Committee under the Council on Development, Ruth Brunyate
prepared a report to review the status of occupational therapy (AOTA, n.d.). She outlined changes
that had occurred over time in the role, focus, objectives, relationship to the patient, relationship
to medicine, and function of the occupational therapist, assistant, and aide. She stated that the tra-
ditional role of occupational therapy had been treatment of the ill or handicapped and/or support
of patients receiving other forms of treatment, such as surgery or psychotherapy, but that the new
role included screening evaluation, programming consulting, and health planning. The traditional
focus of occupational therapy had been on the ill and disabled, but the new focus was on health
needs as scientific and technological advances increased both leisure hours and degree of stress.
The objectives of intervention traditionally had been to correct mental or physical illness in indi-
vidual patients or hospital populations. The new objectives included prevention and correction of
deficits, disease, and disability; case finding; and the improvement of individual and social health.
 Turning Points: 1960s to 1970s 169

The traditional relationship to the patient was in a hospital with one-to-one coverage in physical
disabilities and ward coverage in psychiatry. The new relationship to patient included hospitals
and one-to-one relationships but had expanded to include clinics, home or community, and group
or consultancy. The traditional relationship to medicine had been based on prescription, through
which the physician specified objectives, techniques, and procedures to be used and determined
admission to and discharge from occupational therapy. The new relationship was one of collabo-
ration, in which occupational therapy practitioners worked jointly with the physician and other
professional personnel and either party could initiate the contact.
In direct service for a specific pathology, the occupational therapist determines the suitabil-
ity of services for the patient, evaluates patient performance, and selects occupational therapy
goals, treatment plan and techniques, and discharge. The therapist “contributes to the physician’s
diagnostic armamentarium, to patient management and health planning decisions, all with dis-
crete clear recognition that the physician holds ultimate authority and responsibility for medi-
cal management” (Brunyate, n.d., p. 2). In consultant service, the therapist (1) functions upon a
request from other professors, (2) initiates contribution when those components of professional
knowledge, judgment, and skill unique to occupational therapy are not otherwise available, or
(3) initiates contributions when the knowledge, judgment, and skills the individual therapist holds
are unavailable to the patient or for society’s benefit. The function of the occupational therapist
was traditionally that of a clinician. New functions included educator, administrator, researcher,
academician, and consultant, with supervision occurring at all levels appropriate to experience
and personal and professional skills. The function of the assistant was traditionally that of a crafts-
man prior to certification. The new functions included clinician, administrator, and participant
in research, education, and consultation, all at the technical level of competency with professional
supervision appropriate to experience and personal and professional skills. The function of an
occupational therapy aide was traditionally that of a handyman or orderly. The new functions
included supporting the mechanics of the therapy program, transporting patients, and ensuring
patient safety and order in the department. The aide does not provide treatment, even under pro-
fessional supervision.

Defining Occupational Therapy

Although occupational therapy practitioners had been describing occupational therapy for
many years, no official statement had been adopted by the Association that could be used as a
general statement. Pattison’s definition from 1922 had often been used as the default statement, but
by the 1960s, it was not an accurate description or definition of current practice. A series of semiof-
ficial definitions appears beginning in 1960 (Table 6-1). A manual designed to guide physicians in
the use of occupational therapy published in 1960 focused on the concept of selected activity for
physical and psychological problems and emphasized that therapists are “professionally skilled:
to administer programs in occupational therapy”. A fact sheet describing occupational therapy
published in 1961 listed the types of activities and stated the objective or outcome expected from
occupational therapy. In 1963, a description of occupational therapy practice appeared as part of
the document on philosophy, principle, and policy (AOTA, 1963). However, the description was
not designed as a standalone statement. In 1965, the Delegate Assembly adopted the definition pre-
pared by the World Federation of Occupational Therapists for the 1958 meeting (AOTA, 1966b).
This definition was comprehensive but still did not meet the needs of the Association for a short,
formal definition.
At the urging of Ruth Brunyate, a formal, but short, definition of occupational therapy was
adopted by the Executive Board and published in 1968 (AOTA, 1968a) (see Table 6-1). This defini-
tion would be revised and expanded many times over the coming years to meet the needs for leg-
islation, especially state licensure laws. Common themes covered in the definition of occupational
therapy are the unique features of the profession (activity or occupation), statement of the major
170 Chapter 6

Table 6-1
DEFINITIONS OF OCCUPATIONAL THERAPY
1960 Occupational therapy is a program of selected activity conducted as treatment under medical
direction for physical and psychological problems. The activity undertaken by the patient, the atmo-
sphere in which he performs, and his relationships with the professional staff are the dynamic fac-
tors in occupational therapy. (AOTA, 1960b, p. 3)
1961 Occupational therapy is treatment of a patient by a registered occupational therapist through
individual or group participation in restorative activity. The therapy may be needed because the
patient has been disabled by an accident or disease, is physically or mentally ill; handicapped by a
birth defect or the infirmities of age. The treatment program may include the use of creative and
manual arts, recreation, education and social activities; prevocational testing and training; or training
in everyday activities such as personal care and homemaking. The objective of occupational therapy
is to make the patient as independent and well-adjusted as possible, through improving or restoring
emotional, physical or vocational capacities and promoting and sustaining social and psychological
function. (AOTA, 1961)
1963 The unique contribution of occupational therapy is that it uses a program of normal activity to aid
in the psychosocial adjustment of the patient, as specific treatment or as a simulated work situation.
Thus it relates to the patient s everyday life and provides the link between hospitalization and return
to the community. (Spackman, 1963)
1963 Occupational therapy is particularly concerned with man and his ability to meet the demands of
his environment. The therapist administered treatment for the patient designed to: (1) evaluate and
increase his physical function in relation to activities of daily living, the needs of his family, and the
requirements of his job; (2) improve his self-understanding and psychosocial function as a total
human being. Treatment involves the scientific use of activity process and/or controlled social rela-
tionship to meet the specific needs of the individual patient. (AOTA, 1963, p. 159)
1965 Occupational therapy is a rehabilitative procedure guided by a qualified occupational therapist
who, under medical prescription, uses self-help, manual, creative, reactional and social, educational,
prevocational, and industrial activities to gain from the patient the desired physical function and/or
mental response. (AOTA, 1966b)
1968 Occupational therapy is a professional health service that is a vital part of the rehabilitative team. It
is concerned with the use of purposeful activity in the medical‒psychological treatment of persons
disabled from physical or emotional disability. (Franciscus & Abbott, 1968, p. 13)
1968 Occupational therapy is the art and science of directing man s response to selected activity to pro-
mote and maintain health, to prevent disability, to evaluate behavior and to treat or train patients
with physical or psychosocial dysfunction. (AOTA, 1969a, p. 1)

outcomes (objectives, goals, purposes), description of the population of clients served (age, type
of disability, disorders), a summary of the service programs offered through occupational therapy
(individual, group, consultation), the process model used to deliver services (evaluation, planning,
intervention, re-evaluation, discharge), and the means through which the results are achieved
(media, modalities, methods, techniques) (Reed & Sanderson, 1980). Other useful descriptors are
the type of profession occupational therapy is assumed to be (medical subspecialty, independent
health, health related, rehabilitation), educational criteria (bachelor’s degree required in the 1960s;
now master’s or doctorate degree required) and credentialing process (registration required in the
1960s; now state licensure required).

Medical Diagnoses and Treatment

During the 1960s, changes in medical practice resulted in changes in occupational therapy
practice. For example, tuberculosis was successfully treated with the drug isoniazid and led to a
significant decrease in the need to hospitalize people for treatment. As a result, sanatoriums closed
because more patients could be treated by short-term hospitalization or as outpatients. The practice
 Turning Points: 1960s to 1970s 171

of occupational therapy in tuberculosis decreased.

The last article in AJOT on tuberculosis appeared in A
1960 (Appleby, Morton, Lawson, Loudon, & Brown,
1960). Editions of Willard & Spackman’s textbook on
occupational therapy covered tuberculosis through
the first three editions but did not include a chapter
in the fourth edition. As noted previously, the clini-
cal affiliation (fieldwork) assignment in tuberculosis
was discontinued with the implementation of the
1965 Essentials. Another diagnosis that was success-
fully treated was poliomyelitis (polio), with a vaccine
available beginning in 1955. The last article in AJOT
on treating acute polio appeared in 1957 and was a
personal account rather than a description of a treat-
ment program (Halford, 1957). Likewise, vaccination
decreased the incidence of rheumatic fever, reducing B
the number of children often called “cardiac cripples”
as a result of rheumatic fever. The last article in AJOT
on rheumatic fever appeared in 1953 (Yasumarua &
Baldwin, 1953).
Psychiatric occupational therapy (mental health
practice) was also changing. Government-funded
institutions designed for long-term care were closing
in favor of community mental health centers and out-
patient clinics. Insurance carriers reduced coverage
and put lifetime limits on total number of days to be
paid under the insurance policy. Use of drug treat-
ment and behavioral therapy approaches increased.
Ideas about mental problems as myth, faulty learning,
or diagnostic condition were discussed. Psychologists
took over treatment formerly controlled by physicians
Figure 6-2. (A, B) Napkins from the 1962 AOTA
(Albee, 1969; Grinker, 1969; Sloane, 1969). convention printed with occupational therapy
In contrast to the loss of practice areas, there was cartoons. (Copyright © Dr. Lori T. Andersen.
an increase in articles on stroke and the treatment Reprinted with permission.)
of hemiplegia, spinal cord injuries (especially quad-
riplegia), and other neuromuscular disorders as drug
treatments improved, including the wide use of antibiotics that reduced the incidence of infection.
Cerebrovascular disease, including stroke and hemiplegia due to a stroke, would become the major
disorder seen by occupational therapy practitioners (Figure 6-2).

Current Practice as Seen in Slagle Lectures

Owen (1968) began the study of why and how occupational therapy works in practice. She ana-
lyzed eight Eleanor Clarke Slagle lectures presented in the 1960s using three philosophical ques-
tions: What is real? What is true? What is good? The analysis suggested that answers are derived
from three schools of philosophical thought: Realism, Existentialism, and Pragmatism. Reality
for occupational therapy is based in socioeconomic, cultural, and biological forces, according to
West (1968). For Ayres (1963b), reality is based in neurology and perceptual-motor abilities. For
Yerxa (1967), reality is an authentic existence. For Fidler (1966), reality is based on experience
and meaning derived from that experience. Wegg (1960) has a similar view based on employment
as a learning experience. Reilly (1962) suggests reality occurs or is achieved through the use of a
172 Chapter 6

person’s hands because those hands are energized by the person’s mind and will. Ackley (1962) sees
reality as a union of mind and body. Zimmerman (1960) adds the concept of observation to note
function and performance. Truth for West is based in normal and abnormal growth and develop-
ment. Ayres focused on neurological function and dysfunction. Both respected the laws of nature
as sources of truth. For Yerxa, truth is individually determined. For Fidler and Wegg, the interac-
tion of society and the individual provide the consensual validation for truth. Reilly and Ackley
focus on the interaction of mind and body to achieve truth. Zimmerman suggests that the concept
of truth changes as an individual experiences struggles, necessities, and tragedies in life. Good,
according to West and Ayres, is a well-functioning body. For Yerxa, good is the attainment of self-
actualization. For Fidler and Wegg, good is awareness of society and the individual’s attainment of
the highest level of independent functioning. The concept of good for Reilly and Ackley is tied to
productivity activated by mind and body and modulated by purposefulness and symbolism, which
promotes health and well-being. Zimmerman adds the concept of beauty and the idea that good-
ness can extend beyond the physical body. The philosophy of occupational therapy has expanded
as the practice has changed from occupying the sick to retard dysfunction (regression and atrophy)
to encompassing the ideas of preventing disability and promoting health and well-being.
A study of Wisconsin occupational therapists in 1967 showed that the most common areas of
practice were in general hospitals (44), special hospitals for the emotionally disturbed (39), nurs-
ing home/extended care facilities (24), and outpatient rehabilitation clinics (19) (Poole & Kassalow,
1968). Their work titles were either director, chief, or staff therapist. The work settings for occupa-
tional therapy assistants were not reported.

Prescription Versus Referral

The Occupational Therapy Reference Manual for Physicians (AOTA, 1960e) stated that the
“treatment plan is the responsibility of the attending physician or the physiatrist” and that a writ-
ten prescription should include the following information:
● Necessary identifying information, including the patient’s name, age, ward, and chart number
● Diagnosis or provisional impression, including pertinent history and physical findings
● Treatment objectives
● Frequency and length of treatment
● Precautions and/or limitations to be observed
● Signature of referring physician (pp. 7-8)
These variations in type of prescription presented a problem of consistency among occupa-
tional therapy practitioners, which led to an ongoing discussion about the communication process
between physicians and therapists. Barton agreed that the preparation of many physicians did not
fit them for an understanding of occupational therapy. Physicians were known to let the nursing
supervisors select patients. Some physicians saw occupational or recreational therapy as diversion-
al, and hence a luxury and not essential. Being unaware of the treatment potential, the physicians’
instruction was to “keep them busy.” Barton stated that it was difficult to interest physicians in
learning more about the contribution that occupation therapy could make and, as a consequence,
occupational therapy received a very low priority in physician thinking.
The communication gap between physician and therapist led to a discussion as to whether there
was any value in writing a prescription. Mazer and Goodrich (1958) described the use of the pre-
scription as an outdated and essentially useless procedure that hindered communication, fostered
an authoritative-dependent relationship, oversimplified the occupational therapy experience, and
had a tendency to confine the role of occupational therapy to that of a “technical assistant” rather
than a collegial relationship. Nichols (1960) agreed, stating that prescriptions in the classical sense
did a great deal of harm because they wasted valuable time while the physician wrote the prescrip-
tion and because “the system foster[ed] a lack of initiative on the part of the occupational therapist”
 Turning Points: 1960s to 1970s 173

(p. 4). According to Nichols (1960), when the therapist was “allowed a great deal of professional
leeway,” the therapist almost always rose to the challenge, had a good knowledge of the patient, and
became “truly a member of the treatment team” (p. 4).
Conte (1960) reemphasized the problem of the prescription, stating that the “occupational
therapy prescription must go, because it serves as a device which keeps us apart” (p. 3). Instead,
colleagues had to work together to develop a therapeutic team. Fidler (1963) summarized the
issue of why the mechanism of a medical prescription and the concept of medical supervision
were undergoing revision by stating that the “treatment planning is too complex to be specifically
prescribed and strict adherence to the medical prescription inhibits therapeutic potential because
of the limitations it places upon the therapist’s on-going decision making and on patient-therapist
interaction and response” (pp. 122-123). In place of the prescription, she suggested “active partici-
pation clinical conferences, face to face discussion with the physician and others, and review of the
medical record” (Fidler, 1963, p. 123). The transfer of a diagnosis into occupational therapy goals
and processes is the responsibility of the occupational therapist, according to Fidler.
The shift in thinking as to who is responsible for what aspects of the therapeutic process set in
motion the shift from the concept of a prescription as an authoritative relationship between physi-
cian and therapist to that of a referral as a reciprocal, collaborative relationship with all members
of the therapeutic team. Therefore, during the 1950s, the terms prescription and referral are both
used (Spackman, 1952, p. 169). However, the description of information to be included on the form
as described by Spackman is consistent with the concept of prescription, not referral.
To refer is “to direct for information or anything required” (Barnes & Noble, 1996, p. 1620).
Referral is “the act of directing a patient to a therapist, physician, agency, or institution for evalu-
ation, consultation, or treatment” (VanderBos, 2007). Referral as defined in occupational therapy
literature is “the practice of requesting occupational therapy services and delegating the respon-
sibility for, or the application of the practice of Occupational Therapy to a qualified occupational
therapists and subsequent staff” (AOTA, 1986).
Although the process of transitioning from prescription to referral was in place, the process of
fully moving to the thinking of a referral took some time. For example, Spackman (1963) states:
The occupational therapist may accept patients for treatment only upon a written
referral from a physician. The physician in referring a patient should state the diagno-
sis, if known, the present condition of the patient, the limitations or the precautions to
be observed, the prognosis, the results to be achieved and the frequency and the length
of treatment. It is the occupational therapist’s responsibility to select suitable activities
which should serve to attain the physician’s treatment objectives. (p. 8)
She further states that the “physician, in referring patients for occupational therapy, should
select only those who are in need of a medically directed, planned program of activity”
(Spackman, 1963b, p. 116). Examples are those needing long-term care; those with psychological
problems or with illness of psychosomatic origin; those needing special services, such as activities
of daily living or adapted equipment; and sometimes those with a terminal diagnosis. Spackman
continues this line of thinking in the 1971 edition of Willard & Spackman’s textbook, stating that
“the occupational therapist’s responsibility is to select suitable activities which should serve to
attain the physician’s treatment objectives” (p. 7). Spackman restricts the referral process to the
physician and therapist to develop a therapeutic rationale to the exclusion of other team mem-
bers and continues to view the physician as the only controlling authority for the initiation of a
therapeutic program. The mixed messages practitioners were receiving regarding the referral as
a substitute for a physician’s prescription vs. referral as a mechanism for decision making among
colleagues probably did not help the profession move forward on a smooth track.
In June 1969, the Association adopted the first of three statements on referral “to clarify publicly
the position of the profession relative to referral for occupational therapy service and responsibil-
ity to the medical management plan of the patients treated” (AOTA, 1969e, p. 530). For the first
174 Chapter 6

time, a statement was made that implied that occupational therapy practitioners may accept a
referral from other professionals. The statement was that occupational therapy practitioners
“respond to a request for service whatsoever the source” and that the practitioner “enters a case
at his own professional discretion and on his own cognizance” (AOTA, 1969e, p. 531). The state-
ment also implied that in certain situations, such as activity programs for diversional, social, or
recreation purposes, the practitioner did not need a referral but only the “physician’s knowledge”
(AOTA, 1969e, p. 531). Three issues would dominate the discussion of referral in the coming years:
who can refer to occupational therapy, how much information is needed from the referring source,
and when or under what circumstances (diagnoses, disor-
ders, injuries, conditions) is a referral needed or not needed.

Practice Models
The practice models in physical disabilities began to
be focused more on perceptual motor (development of the
sensorimotor systems) and neurorehabilitation (based on
neurophysiology and facilitation) as opposed to the social
or temporal aspects of arts and crafts. A third focus was on
the use of activities of daily living. Ayres (1963a) outlined
the development of perceptual-motor abilities in her Slagle
lecture. Her work on perceptual-motor abilities would
evolve into her theory of sensory integration (Ayres, 1968)
(Figure 6-3; Table 6-2). Ayres also wrote three chapters on
neuromuscular integration in the third edition of Willard
& Spackman’s textbook (1963b). Zimmerman (1963) wrote
on developing programs using activities of daily living, also
in Willard & Spackman. Figure 6-3. A. Jean Ayres, PhD, OTR.
The emphasis in psychiatric occupational therapy was (Printed with permission from the Archive
of the American Occupational Therapy
still primarily on psychoanalytical practice based on Freud Association, Inc.)
(Diasio, 1967). Fidler began a trend toward including
media and methods of occupational therapy with her
book on communication in occupational therapy (Fidler & Fidler, 1963) (Table 6-3; Figure 6-4).
Other influences were learning theory based on operant conditioning and behavior modification
(Smith & Tempone, 1967) and developmental theories (Llorens et al., 1964; Mosey, 1967).
Mary Reilly began a new trend in thinking about theory in the 1960s, from following theories
developed in other professions to creating theory based on assumptions and concepts from the
practice of occupational therapy. In 1966, she published an article on her theory of occupational
behavior based on the concept that occupational therapy should be concerned with the concept of
such occupational roles as student, homemaker, worker, and hobbyist, to name a few (Reilly, 1966).
Her theory was the first to focus on the unique role of occupational therapy in supporting occupa-
tional performance as the primary outcome of occupational therapy practice (Figure 6-5; Sidebars
6-1 and 6-2; see Table 6-2).

Legislation
Medicare and Occupational Therapy
The Social Security Act of 1935 was amended by the addition of Title 18 (Public Law 89-97)
in July 1965, otherwise known as Medicare. The purpose was to provide health care coverage to
persons aged 65 years and older. There were originally two sections. Part A was called Hospital
 Turning Points: 1960s to 1970s 175

Table 6-2
PRESIDENTIAL BIOGRAPHIES
A. (ANNA) JEAN AYRES
January 18, 1920‒December 16, 1988
Born in Visalia, California. She received her bachelor s degree in occupational therapy from the University of
Southern California (USC) in 1946 and her master s degree from USC in 1954. Her doctorate degree is from USC
in educational psychology in 1961. From 1964 to 1966, she did postdoctoral study at the Brain Research Institute
at the University of California, Los Angeles (UCLA). In addition to her degree in occupational therapy, she was
also a licensed psychologist. She worked at the Birmingham Veterans Administration Hospital in Van Nuys,
California, from 1946 to 1947; at the Pasadena (name changed to Braewood) Sanitarium in Pasadena, California,
from 1947 to 1948; at Kabat-Kraiser Institute (named changed to California Rehabilitation Center), Santa Monica,
California, from 1948 to 1953; and at United Cerebral Palsy, Los Angeles, California, from 1954 to 1955. She was
Assistant Professor, Occupational Therapy Department, USC, from 1955 to 1964; Special Education, USC, from
1966 to 1973; and Visiting Associate (Adjunct) Professor, Occupational Therapy, from 1976 to 1988. She was in
private practice from 1977 to her retirement.
Ayres began publishing in 1949, with an article on the analysis of crafts for electroshock patients and then on
work behavior and habits. She began her study on perceptual-motor behavior during her postdoctoral studies
and developed her theory of sensory integration in the late 1960s and early 1970s. She published many articles
and two books: Sensory Integration and Learning Disorders (1973, Western Psychological Services, Los Angeles,
CA) and Sensory Integration and the Child (1970, Western Psychological Services, Los Angeles, CA). She also
published several assessments that were grouped together in the Southern California Sensory Integration Tests
(1980, Western Psychological Services, Los Angeles, CA) and a revised version called the Sensory Integration and
Praxis Tests (1989, Western Psychological Services, Los Angeles, CA).
She was awarded the Eleanor Clarke Slagle lectureship in 1963, was named to the Roster of Fellows in 1973, and
was a charter member of the Academy of Research in 1983.
GAIL MAXINE SPANGLER FIDLER
September 18, 1916‒April 26, 2005
Born in Lebanon, Pennsylvania. She received a Bachelor of Arts degree in 1938 from Lebanon Valley College
in Annville, Pennsylvania, and her certificate in occupational therapy in 1942 from the Philadelphia School
of Occupational Therapy. While attending occupational therapy classes, she worked at the Smith Memorial
Playground in Philadelphia. After graduation, she worked at the state hospital in Norristown, Pennsylvania,
from 1942 to 1943 and at Walter Reed General Hospital in Washington, DC, from 1943 to 1944; was Chief
Occupational Therapist at the Convalescence Hospital at Fort Story, Virginia, from 1944 to 1946; and was Chief
of the Occupational Therapy Service at the Veterans Hospital in Lyons, New Jersey, from 1946 to 1950. She was
a special consultant to the Pennsylvania Department of Welfare from 1952 to 1953 and special instructor at the
Philadelphia School of Occupational Therapy. She was Coordinator of the Office of Vocational Rehabilitation
Institute grant in 1955 and the project in psychiatry at AOTA from 1955 to 1956
In 1959, she accepted a position at Columbia University College of Physicians and Surgeons, and at the New
York State Psychiatric Institute where she worked until 1968. From 1964 to 1967, she was Clinical Director of the
master s program at New York University. She served on the Executive Board of the Association from 1969 to
1971; as Associate Executive Director for Practice, Education, and Research from 1971 to 1975; and as Interim
Executive Director for 8 months in 1975. In 1990, she was the interim Director of the Occupational Therapy
Program at College Misericordia in Pennsylvania. She received the Eleanor Clarke Slagle lectureship in 1965,
was named to the Roster of Fellows in 1973, was given the Award of Merit in 1980, and received the President s
Commendation in 2012.
She is best known for her work in psychiatric occupational therapy and her mentorship. With her husband, Jay
W. Fidler, she published two books: Introduction to Psychiatric Occupational Therapy (1954, Macmillan, New
York, New York) and Occupational Therapy: A Communication Process in Psychiatry (1963, Macmillan, New
York, New York). In 2002, she authored Lifestyle Performance: A Model for Engaging the Power of Occupational
Therapy (SLACK Incorporated, Thorofare, New Jersey) with Beth Velde (Figure 6-17).
(continued)
176 Chapter 6

Table 6-2 (continued)

PRESIDENTIAL BIOGRAPHIES
MARY REILLY
October 11, 1916‒February 28, 2012
Born in Boston, Massachusetts. She received a certificate in occupational therapy from the Boston School of
Occupational Therapy in 1940. She later received a Bachelor of Science degree in occupational therapy from
the University of Southern California in 1951, a master s degree from San Francisco State College, and a degree
in education from the University of California, Los Angeles, in 1959. Her dissertation was entitled A Theoretical
Basis for Planned Change in Professional Education, which would set the course for her later ideas about profes-
sional education and theory of practice.
She was named a charter member of the American Occupational Therapy Foundation Academy of Research
and was also named to the Roster of Fellows in 1973. Her Eleanor Clarke Slagle lecture delivered in 1961 is one
of most cited in the occupational therapy literature. She served on various Committee on Education subcom-
mittees during the 1950s. Her first job was at the Sigma Gamma Hospital School in Detroit, Michigan, where
she worked with children with cerebral palsy. She then served in the U.S. Army and as a civilian therapist in the
program that would become the United States Army Medical Specialists, was eventually promoted to the rank
of Captain, and earned the Army Meritorious Serve Award and Letterman Army Certificate of Achievement. She
was an occupational therapy consultant for the Service Command Surgeon s Office, Fourth Service Command,
Atlanta, Georgia, from 1944 to 1945. Her work included supervising occupational therapy programs in 11 gen-
eral, two convalescent, and six regional station hospitals. She was Professor and Graduate Coordinator of the
Occupational Therapy Program at the University of Southern California in Los Angeles from 1955 to 1978. She
first published on the theory of Occupational Behavior in 1966.
WILMA (WILLIE) LOUISE WEST
November 16, 1916‒December 17, 1996
Born in Rochester, New York. In 1939, she graduated from Mount Holyoke College with a major in economics
and sociology. After attending a lecture by Marjorie Fish on occupational therapy, she applied to the Boston
School of Occupational Therapy in the advanced standing course and graduated in 1941. One of her classmates
was Carlotta Wells. From 1941 to 1943, she was employed at the Robert Brigham Hospital in Boston, where
she worked with clients with arthritis, cardiac conditions, and rheumatic fever. She next joined the staff of the
Walter Reed General Hospital as an assistant and then Head of the Orthopedic Section. From June 1944 to
August 1946, she worked as an assistant to Mrs. Kahmann in the Occupational Therapy Branch of the Surgeon
General s Office doing recruiting, processing, selecting and assigning to schools the students selected for train-
ing in the war emergency courses, visiting occupational therapy schools that were giving the Army courses
and consulting with them about the program, directing student training in Army hospitals, inspecting Army
hospital occupational therapy departments, compiling a standard equipment and supply list, and writing in
collaboration with others the War Department Technical Manual of Occupational Therapy.
She received the Meritorious Civilian Service Award from the War Department for her service and was
Commissioned as Captain in the Women s Medical Specialist Corps, United State Army Reserve. She served as
the Educational Field Secretary in the National Office of the Association beginning in July 1947. Soon after, she
was asked to assume the duties of Executive Director, a position she held until 1951. A scholarship by the Baruch
Committee on Physical Medicine allowed her to attend the University of Southern California to complete the
master s program as the first graduate of the program started in 1946. In 1953, she returned to the Army during
the Korean War and served as Director of Occupational Therapy at Fort Sam Houston, Texas. For several years
she worked part-time, including chairing the Curriculum Study from 1960 to 1964. In 1964, she became a con-
sultant in occupational therapy for the Office of Maternal and Child Health, Department of Health, Education,
and Welfare until her retirement in 1977.
From 1961 to 1964, she served as president of AOTA. From 1972 to 1982, she served as President of the AOTF.
She received the Award of Merit in 1951, was the Eleanor Clarke Slagle lecturer in 1967, was a charter member
of the Roster of Fellows in 1973, and received the first AOTA/AOTF Presidents Commendation for a lifetime of
service to the profession in 1990. Other awards included a HEW Superior Service Award in 1972 and a Certificate
of Appreciation from the U.S. Army Surgeon General in 1981.
(continued)
 Turning Points: 1960s to 1970s 177

Table 6-2 (continued)

PRESIDENTIAL BIOGRAPHIES
RUTH W. BRUNYATE WEIMER
April 11, 1916‒October 14, 2008
Born in Orange, New Jersey. She graduated from Hollins College, Roanoke, Virginia, in 1938 with a degree in
psychology. She received her certificate in occupational therapy from the Philadelphia School of Occupational
Therapy in 1940. Her master s degree in education was from Johns Hopkins University in Baltimore, and she was
awarded an Honorary Doctor of Letters from Towson University in 1980. She worked as an occupational thera-
pist at the Seashore House in Atlantic City, New Jersey. From 1943 to 1961, she served as Director of Occupational
Therapy at the Children s Rehabilitation Institute in Reisterstown, Maryland, which became the Kennedy-Kreiger
Institute of Johns Hopkins Hospital. In 1962, she became an Assistant Professor of Occupational Therapy at the
Milwaukee-Downer College in Milwaukee. In the same year, she was employed as a consultant in occupational
therapy by the State of Maryland. In 1966, she became Chief of the Division of Occupational Therapy for the
Maryland Department of Health, until her retirement in 1980.
She presented the Eleanor Clarke Slagle lectureship in 1957, was named as a charter member to the Roster
of Fellows in 1973, and was given the Award of Merit in 1968, the Lindy Boggs Award in 1983, and the AOTA/
AOTF Wilma West award for lifetime of service. Other awards were the establishment of the Ruth W. Brunyate
Lectureship by the community College of Baltimore, a Presidential Commendation in 1979, and an Honorary
Doctor of Humane Letters by Towson University. She was a member of the National Health Council Board.
She was President of AOTA from 1964 to 1967. Weimer knew Dr. Dunton because she worked in the state of
Maryland and was a member of the Maryland Occupational Therapy Association.
FLORENCE STUART CROMWELL
May 14, 1922‒November 5, 2016
Born in Pennsylvania and raised in Ohio. She attended Miami University, where she received a bachelor s degree
in education before receiving a second bachelor s degree in occupational therapy from Washington University
in St. Louis in 1949 and a master s degree in occupational therapy from the University of Southern California in
1952. Cromwell served in the Navy from 1943 to 1946. Some of her leadership experiences in the Navy provided
her with skills that were useful when she served two terms as President of AOTA, from 1967 to 1970 and 1970 to
1973. She served as Acting Chair at USC from 1973 to 1976. She worked at Los Angeles County General Hospital;
Goodwill Industries of Southern California; Vising Nurse Association of Philadelphia; Research Therapists, OVR
Project, United Cerebral Palsy Association of Los Angeles County; part-time instructor, Occupational Therapy
Department, USC; and Consultant, Master s Degree Pilot Program. She was named as a charter member to the
Roster of Fellows in 1973 and was given the Award of Merit in 1974. She was editor of the journal Occupational
Therapy in Health Care. She was interested in interprofessional relationships.
MARJORIE FISH
October 20, 1905‒November 27, 1994
Born in St. Louis, Missouri. She received a degree from Swarthmore College in Swarthmore, Pennsylvania, and
her diploma in occupational therapy from the Boston School of Occupational Therapy. She worked at Danvers
State Hospital in Massachusetts, then returned to the Boston School to serve as Assistant Director and Field
Secretary. She became the Director of the Occupational Therapy Education Program at Columbia University
starting in 1941. She went to Sydney, Australia, to start another education program. She was the first Educational
Field Secretary of the Association and then served as Executive Director from 1951 to 1963, when it was head-
quartered in New York City. West said of Fish upon her retirement: Your tireless efforts and unending interest
in executing the myriad responsibilities inherent in your position are the hallmark of your devotion. Later, Fish
worked as a training consultant in rehabilitation for the U.S. Department of Health, Education, and Welfare. She
was also active in the World Federation of Occupational Therapists.
(continued)
178 Chapter 6

Table 6-2 (continued)

PRESIDENTIAL BIOGRAPHIES
P. (PALENIA) FRANCES HELMIG
May 9, 1911‒July 21, 1980
Born in Atlantic City, New Jersey. She received her Bachelor of Arts degree from the New Jersey State
Teachers College in Upper Montclair and became a mathematics teacher. She received a master s degree
from the University of Southern California in 1952. She graduated from the Advanced Standing Course at
the Philadelphia School of Occupational Therapy in 1941 and stayed there a year as Assistant Director of the
Curative Workshop. She joined the Navy in October 1942 and was the first WAVE officer assigned in the U.S.
Naval Hospital in Philadelphia, where she headed the hospital s Occupational Therapy Department from
1942 to 1946. She held the rank of Commander in the U.S. Naval Reserve, Medical Service Corps. From 1949 to
1950, she was a consultant in Chicago to the National Society for Crippled Children and Adults. From 1952 to
1953, she was a consultant in rehabilitation to the Health and Welfare Council in Philadelphia. From 1946 to 1949
and 1953 to 1959, she was director of the Rochester Rehabilitation Center. From 1959 to 1961, she was Director
of Occupational Therapy at the Emily P. Bissell Hospital in Wilmington, Delaware. During her tenure as Executive
Director of AOTA, she was severely injured in an automobile accident in California. Although she resumed her
duties after her recovery, she resigned 3 years later.
HARRIET JONES TIEBEL
May 6, 1915‒September 15, 2006
Born in Berwyn, Illinois. She attended Barnard College and received a diploma from the Philadelphia School of
Occupational Therapy. She worked at the Payne Whitney Clinic and Goldwater Memorial Hospital in New York
City. She became a WAVES officer and served at the United States Naval Hospital in St. Albans, New York. An
interest in American history led to further study at Columbia University, where she received a master s degree.
She served as the New York State Delegate to the House of Delegates from 1946 to 1948 and was Speaker of
the House of Delegates in 1958. She was Executive Director of AOTA from 1968 to 1972.
SIDNEY LICHT
April 18, 1907‒March 1, 1979
Born in New York City. He graduated from New York university in 1931. Dr. Licht s career in physical medicine
included employment in Boston, and New Haven, Connecticut. He became Editor of Occupational Therapy and
Rehabilitation in 1951 upon Dr. Dunton s retirement and changed the name to the American Journal of Physical
Medicine because the journal was no longer primarily devoted to occupational therapy. Dr. Licht severed on
the Board of Management as a Board Fellow and severed as a consultant in medical journalism to AJOT from
1969 to 1979. He edited the monograph entitled Occupational Therapy Source Book (1948, Williams & Wilkins,
Philadelphia, PA), a collection of early articles on occupational therapy, and co-edited with Dr. Dunton two edi-
tions of the textbook Occupational Therapy: Principles and Practices (1950, 1957, Charles C. Thomas, Springfield,
IL). He was the guest lecturer at the luncheon in Clifton Springs to celebrate the 50th year of the Association.
Adapted from:
American Occupational Therapy Association (1967). Presidents of the American Occupational Therapy Association (1917-
1967). American Journal of Occupational Therapy, 21(5), 290-298.
American Occupational Therapy Association (1979). Sidney Licht ‒ 1907-1979. American Journal of Occupational Therapy,
33(12), 762.
American Occupational Therapy Association (1968). Mrs. Tiebel assumes duties of executive director. American Journal of
Occupational Therapy, 22(2), 65.
Cromwell, F.S. (1968). Nationally speaking. American Journal of Occupational Therapy, 22(3), 155-159.
American Occupational Therapy Association (1947). Meritorious civilian service awards. American Journal of Occupational
Therapy, 1(1), 33.
In memoriam, Sidney Licht̶1907-1979. (1979). American Journal of Occupational Therapy, 33(12), 762.
Marjorie Fish, O.T.R. (1947). American Journal of Occupational Therapy, 1(2), 101.
Meet our headquarters: New Executive Director. (1964). American Journal of Occupational Therapy, 18(4), 164.
People you should know (1950). American Journal of Occupational Therapy, 4(5), 228.
Remembering former executive director Marjorie Fish. (1994). OT Week, 9(2), 62.
 Turning Points: 1960s to 1970s 179

Table 6-3
STATEMENT OF POLICY
1. Maintain and control the voluntary registration of its practitioners
2. Regulate, in conjunction with the Council on Medical Education and Hospitals of the American Medical
Association, the education of occupational therapists to prepare them for their treatment function
3. Establish and maintain standards of clinical practice in occupational therapy which will improve patient
treatment
4. Foster continuing growth in the professional competence of occupational therapists
5. Encourage and facilitate increase in the body of specific occupational therapy knowledge available to
physicians
6. Protect the standards of occupational therapy and the environment in which the occupational therapist
functions
7. Strongly oppose and protest any administrative policy or structure which ignores or weakens the treat-
ment function of occupational therapy.
(First statement adopted by Board of Management in 1949, published in AJOT in 1950 and revised in 1960.)
AOTA Board of Management. (1961). Statement of policy. American Journal of Occupational Therapy, 15(1), 24.

Insurance, and Part B was called Medical Insurance. An informa-

tion insert to AOTA’s newsletter was called Notes on Medicare for
the Occupational Therapist. The insert stated that for inpatient
hospital services, occupational therapy was not a required service,
but if such a service was “ordinarily furnished by such hospital for
the care and treatment of inpatients,” the reasonable cost of the
services was covered (AOTA, 1966c). For post-hospital extended
care, the insert quoted a passage from the law: “occupational
therapy furnished by the extended care facility or by others under
arrangement with them made by the facility” was covered. Home
health services were stated as specified in the definition of home
health services. Occupational therapy in outpatient diagnostic
services was to be covered if it
was one of diagnostic services
“ordinarily furnished” by the Figure 6-4. Gail S. Fidler, OTR.
hospital to outpatients. (Printed with permission from
Although the initial assess- the Archive of the American
Occupational Therapy Association,
ment of occupational therapy Inc.)
coverage appeared satisfactory,
problems were soon identi-
fied as the Social Security Administration began interpret-
ing the law differently from the Association. A report entitled
“Statement of Position on Medicare Legislation” and dated
September 12, 1968, was prepared by the Legislative Committee
and identified the Association’s policy regarding Medicare.
The Council on Development minutes report that there was no
provision of services without a physician referral or by quali-
Figure 6-5. Mary P. Reilly, EdD, fied occupational therapists in independent or private practice.
OTR. (Printed with permission
from the Archive of the American
Recommended additions to the policy were that:
Occupational Therapy Association,
Inc.)
180 Chapter 6

SIDEBAR 6-1
Mary Reilly—Slagle Lecturer

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 (1962, p. 2)

In an oral history interview with Chris Peters, Bob Bing related a story about Mary Reilly s
selection as a Slagle lecturer.
The story is that Willard and Spackman took Mary for a walk around the hotel after
she had been selected and before it was announced. They tried to talk her out of
it because they felt she was far too controversial. Good old Mary held her ground
and delivered probably the most quoted lecture of all. (Peters, 2011, p. 262)

SIDEBAR 6-2
Lela Llorens—Slagle Lecturer

Llorens relates a story in which she, as a Black woman, was not able to attend meetings
or stay in the conference hotel at the 1961 AOTA conference in (segregated) New Orleans
because a state statute prohibited Blacks and Whites to associate in this way. This prompted
AOTA to establish an anti-discrimination policy, refusing to hold Association meetings at
facilities that discriminated (Peters, 2011, p. 379).
Eight years later, Llorens delivered her Slagle Lecture at the 1969 AOTA conference in
Dallas, Texas. The auditorium was filled by the attendees and the balcony was filled with
cooks, bellhops, and maids, Black people who worked in the hotel (Peters, 2011, p. 380).
They came to offer their support to the Black woman who was delivering a lecture to an
audience of primarily White women.

● The services of qualified occupational therapists be provided to those in need of that service,
directly without the requirements of a physician’s referral
● Qualified occupational therapists as independent practitioners be included under the supple-
mentary medical insurance program (Part B) and thus be eligible to receive direct payment
for services (AOTA, 1969c)
The amendments were submitted to Congress but were not adopted.
The problems continued to mount as interpretations of the law were not in occupational
therapists’ favor. Cromwell (AOTA, 1969) reported to the members of the Delegate Assembly that
recent interpretations made by the Social Security Administration placed occupational therapy at
a disadvantage of being the lone service in home health agencies. The interpretation continues to
be an issue.

Association Response to External Events: Lobbying

The passage of the Medicare and Medicaid legislation brought to the attention of the Association
that external events could have significant effect on the practice of occupational therapy. Because
 Turning Points: 1960s to 1970s 181

occupational therapists were not active in lobbying members of Congress at the time Medicare
and Medicaid were passed, occupational therapy had no recognized status as a service provider
in the new legislation. To correct the lack of lobbying presence at hearings for congressional bills,
President Brunyate recommended a lobbyist be hired. In 1967, Russell J. N. Dean, Director of the
Washington Consulting Service, was hired to represent the Association before Congress.

Other Legislation
Other legislation important to occupational therapy was the passage of the Community Mental
Health and Mental Retardation Act in 1963 (Public Law 88-164), which provided money to estab-
lish community-based services for persons with psychiatric disorders and intellectual disabilities
in place of institutionalization. This Act ultimately led to a reduction in size or closing of many state
mental health facilities and the loss of jobs in mental health practice. Community-based facilities
were funded on a sliding scale in which the federal government would pay most of the initial costs
and the state was to pick up funding by the end of 7 years. Many states did not pick up funding,
and the facility services were scaled back or closed, further reducing jobs for occupational therapy
practitioners in mental health. In 1965, the Heart Disease, Cancer, and Stroke Amendments to
the Regional Medical Programs (P.O. 89-239) was passed. The Act was designed to increase the
study and research on the three conditions, all of which indirectly benefited occupational therapy
practice. However, the focus on stroke was probably the greatest benefit. In 1966, the Allied Health
Professions Act (Public Law 89-749) was passed, which provided funds to universities to start or
strengthen allied health professional education. Many occupational therapy educational programs
took advantage of the funding to initiate or expand the curriculum in occupational therapy.

Technology
During the 1960s, splinting materials improved with the introduction of more flexible plas-
tics. Royalite (PolyOne) and Bakelite (Union Carbide) were the early versions. These plastics
were less brittle and more flexible than the early acrylic and nitrocellulose plastics. However,
the plastics did require heating to temperatures of 300° F to 350° F to become malleable. Such
high temperatures limited forming the splint directly on the client because the skin would be
burned (Koepke, Feallock, & Feller, 1963). Later, Prenyl (Larson Medical Products) and Orthoplast
(Patterson Medical) became available (Kester, 1966; Willis, 1969). These plastics were the early
low-temperature splinting materials that could be molded at temperatures around 150° F allowing
the splint to be formed directly on the client.

Research
Research methods and studies began to change in the 1960s. Most research studies prior to the
1960s were survey questionnaires, program descriptions, or craft analyses. Beginning in the 1960s,
articles in AJOT began to discuss methods of research and the attitude and skill sets necessary to con-
duct experimental research. For example, Reilly (1960, p. 206) stated there are three factors needed to
nurture a climate for occupational therapy research : (1) at the clinical level, our minds should become
dominated by the attitudes and methods of science; (2) at the school level, our curricula should contain
knowledge both substantive and appropriate to the problems that are the responsibility of our profes-
sion to solve; and (3) at the administrative level, our national association should be so organized that
our collective resources could be directed with more validity to the improvement of the occupational
therapy service, which is to fill the health needs of patients for activity. She suggested that the research
should focus on the assumptions that “man has a vital need for activity, and that activity enhances
convalescence” (Reilly, 1960, p. 208). However, she also noted that occupational therapy practice
182 Chapter 6

lacked a theoretical base to organize its assumptions. She also stated that research requires a specific
thinking process that occupational therapists would have to learn. To facilitate the learning process,
Paolino (1962) discussed in detail how to take observational notes on a clinical session in occupational
therapy. Llorens et al. (1964) reported the systematic evaluation of children using standardized tests of
perceptual motor skills. Ayres (1966) reported the interrelationships among perceptual motor func-
tions. Fox (1966) reported the computer simulation of neurophysiological processes. Although limited
in scope, a research tradition was starting to grow within the profession.

Association
During the 1960s, the Association was concerned with maintaining and strengthening the
objectives on which the organization was founded: educational and practice standards, credential-
ing (registration) of practitioners, and support of research. The policy statement in Table 6-3 pres-
ents the concerns expressed by the Board of Management. The primary concern was registration of
qualified practitioners, followed by standards for educating therapists. Standards for occupational
therapy programs and professional competence followed. Increasing the body of knowledge in
general, and specifically to physicians, was viewed as important. Finally, the Association saw it

Table 6-4
PRESIDENTIAL INFLUENCES
Wilma West, 1961-1964
Major accomplishment: Bylaws that reorganized the Association.
As a profession we should return to the principles of our founders who valued the therapeutic
effect of occupations on health. Secondly, we need to return to the principle that education leads
to practice, not vice versa. (AOTA, 1992)
Ruth Brunyate Wiemer, 1964-1967
Major accomplishment: Reorganized Association, moved to new quarters, and acquired more staff to provide
better membership services.
I think the association s greatest achievement was our move from a single agency to a business
league and foundation… because it has enabled us to speak out on health issues and to facilitate
our inclusion in significant legislation. At the same time it has helped us focus on research and
therefore enhance our ability to clarify our philosophical base, our science, and our art. (AOTA, 1992)
Florence Cromwell, 1967-1973
Major accomplishment: Moving the Association headquarters from New York City to Washington, DC, increas-
ing the profession s visibility and participation in federal legislation matters.
The major accomplishment of AOTA and its members in 75 years is our return to the philosophy
of our founders̶believing in the curative effects of occupation̶and a growing willingness to
champion that principle in health maintenance and illness prevention. (AOTA, 1992)
Adapted from:
1969 election brochure
AOTA (1992). AOTA s hall of leaders. OT Week, 6(21), 40-43.
American Occupational Therapy Association (1967). Presidents of the American Occupational Therapy Association (1917-
1967). American Journal of Occupational Therapy, 21(5), 290-298.
American Occupational Therapy Association (1967). Presidents of the American Occupational Therapy Association (1917-
1967). American Journal of Occupational Therapy, 21(5), 290-298.
 Turning Points: 1960s to 1970s 183

Figure 6-6. Wilma L. West, OTR, FAOTA. Figure 6-7. Ruth W. Brunyate Figure 6-8. Florence S. Cromwell,
(Printed with permission from the (Wiemer), MEd, OTR, FAOTA, MA, OTR, FAOTA, President of
Archive of the American Occupational President of AOTA, 1964-1967. AOTA, 1967-1973. (Printed with per-
Therapy Association, Inc.) (Printed with permission from mission from the Archive of the
the Archive of the American American Occupational Therapy
Occupational Therapy Association, Association, Inc.)
Inc.)

Figure 6-9. Marjorie B. Fish, OTR, Figure 6-10. Frances Helmig, OTR, Figure 6-11. Harriet J. Tiebel, OTR,
Executive Director of AOTA, 1952-1964. Executive Director of AOTA, 1964- Executive Director of AOTA, 1968-
(Printed with permission from the 1968. (Printed with permission 1971. (Printed with permission
Archive of the American Occupational from the Archive of the American from the Archive of the American
Therapy Association, Inc.) Occupational Therapy Association, Occupational Therapy Association,
Inc.) Inc.)

as a mission to consider the importance of environmental conditions in which practitioners and

clients lived and worked, while continuing to focus on the direct treatment interaction between the
practitioner and client. The Association was still concerned about any attempt by another health
care organization to take over occupational therapy practice or practitioners.
There were three Presidents of the Association during the 1960s: Wilma L. West (1961-1964),
Ruth Brunyate (1964-1967), and Florence S. Cromwell (1967-1970 [first term]) (Table 6-4; Figures
6-6 to 6-8; see Table 6-2). There were also three Executive Directors during the 1960s: Marjorie
184 Chapter 6

Figure 6-13. Consolation House plaque. (Printed with permis-

sion from the Archive of the American Occupational Therapy
Association, Inc.)

Figure 6-12. Consolation House, 16 Broad Street,

Clifton Springs, New York. (Printed with permission
from the Archive of the American Occupational
Therapy Association, Inc.)

Fish (1952-1964), Frances Helmig (1964-

1968), and Harriet Tiebel (1968-1971)
(Figures 6-9 to 6-11; see Table 6-2).

Founders’ Day, 1967—50th

Anniversary Celebration Figure 6-14. Dignitaries attending the 50th anniversary lun-
cheon. From left to right: President Florence S. Cromwell; Mrs.
On March 15, 1967, in Clifton Springs, Isabel Barton, widow of George Edward Barton; Dr. Sidney Licht,
New York, there was a chill in the air. The special guest; immediate Past President Ruth W. Brunyate; and
Executive Director Mrs. Harriet Tiebel. (Printed with permis-
last evidence of a late winter snow was sion from the Archive of the American Occupational Therapy
being washed away by a warm drizzle. By Association, Inc.)
10 a.m., people began assembling in front
of the large white house at 16 Broad Street
(Figure 6-12). George Barton had bought the house in 1912 and named it Consolation House,
and there he offered services to those with disabling conditions. “The weather and quiet setting
must have lent a surreal air to the gathering, a sense that the ghosts of people long gone were
present once more. It was, as many would say later, a time for remembering” (AOTA at 70, 1987).
However, to a passerby, the only evidence that something of significance might be happening was
a “red velvet cloth covering a three-foot square on the wall of the front porch” (Neuhaus, 1968,
p. 337; Figure 6-13). Guests were greeted at the door by Mr. and Mrs. Wright, the present owners
of Consolation House (Neuhaus, 1968). It was Founders’ Day, commemorating the first half-
century of the Association. Those assembled included Isabel Goodwin Barton, George Barton’s
widow and the last survivor of the foundering members; Florence S. Cromwell, current AOTA
President; Sidney Licht, MD, a long-time supporter of occupational therapy; Harriet Tiebel, AOTA
Executive Director; Ruth Brunyate (later Wiemer), immediate past President; and about 45 other
people (Figure 6-14). The purpose was to place a plaque on the right side of the door. At 11 o’clock,
Mrs. Isabel Barton, President Florence Cromwell, and Margaret Zinsley, a student from the State
 Turning Points: 1960s to 1970s 185

University of New York at Buffalo

representing the future of the pro-
fession, stepped onto the porch to
remove the velvet cloth over the
plaque that would commemorate
the place where the founders had
met on March 15, 1917 (Figure
6-15). A reception followed at the
Clifton Springs Hospital, originally
a tuberculosis sanitarium where
George Barton received treatment
for his tuberculosis (Figure 6-16).

Bylaws of 1964
New bylaws were adopted at Figure 6-15. Dedication of 50th anniversary plaque at Consolation
House. From Left to right: Florence S. Cromwell, AOTA President; Mrs.
the 1964 annual meeting (AOTA, Isabel Barton, wife of founder George Edward Barton; and Margaret
1964, 1965a). These bylaws changed Zinsley, occupational therapy student at SUNY Buffalo. They represent-
the organization and structure of ed the past, present, and future of occupational therapy. (Printed with
the Association. New functions permission from the Archive of the American Occupational Therapy
Association, Inc.)
and powers listed in Article II of
the bylaws were to improve and
advance the practice of occupational therapy, improve and advance the education and qualifica-
tion of occupational therapists, establish standards of performance, foster the research and study
of occupational therapy, and engage in other activities to further the dissemination of knowledge
of the practice of occupational therapy (AOTA, 1965a, p. 37). Emphasis was placed on the practice
of occupational therapy as the first and foremost function of the Association. The Constitution
in 1955 had a stated objective “to promote the use of occupational therapy” but did not specifi-
cally state the concept of improving and advancing the practice of occupational therapy. Also, a
new function was added “to establish standards of performance” in occupational therapy prac-
titioners in a variety of rules and functions in occupational therapy facilities. The emphasis on
standards of education and training and on research remained the same. Other changes were that
the House of Delegates became the
Delegate Assembly, which became a
legislative body to formulate policy,
not just a recommending body as
the House of Delegates had been.
The Board of Management was
renamed the Executive Board.
The committee structure was
streamlined from 36 separate
committees listed on an orga-
nization chart in 1960 into four
Councils: Development, Finance,
Practice, and Standards (AOTA,
1960a, 1965a). The Council on
Development included the AHA/
AOTA Joint Committee, AJOT,
Figure 6-16. 50th anniversary luncheon celebration held at the Clifton
Springs Sanitarium (now Hospital) in Clifton Springs, New York. (Printed History, International, Legislation,
with permission from the Archive of the American Occupational Recognitions, Recruitment,
Therapy Association, Inc.) and Publicity. In a nutshell, the
186 Chapter 6

objectives of the Council on Development were to attract members, retain members, and make
the profession more widely known (AJOT, 1968). The Council on Finance had three commit-
tees: Foundation, Investments, and Scholarship. Later the scholarships would be transferred
to the Foundation. The Council on Practice was to “be concerned with treatment theories and
methodologies, clinical studies and research, and planning and projection for future professional
development and practice” (AJOT, 1968). Ten regions were created across the country, with a per-
son representing each region as a member of the Council on Practice. The Council on Standards
included the subcommittees on the standards for the profession, continuing education, basic pro-
fessional education, occupational therapy assistants, registration and certification, and graduate
education. The Council on Standards was to be concerned with the development of criteria for
occupational therapy programs, including personnel, policies, administration, salaries, and all
other aspects that provide the framework for clinical practice (AJOT, 1968). Of importance is the
de-emphasis on education and the elevation of practice and practice-related issues. The previous
Council on Education had four subcommittees and was a central reporting format for activities in
the Association. Under the new structure, practice was given a prominent role.
The last House of Delegates meeting was held in Denver, Colorado, on October 25, 1964, with
39 member associations attending. The first Delegate Assembly was held in Miami Beach, Florida,
on October 30, 1965, with 39 representatives of affiliated associations and four officers pres-
ent (AOTA, 1967b, p. 9). The House of Delegates had been an advisory group to the Board of
Management. The new Delegate Assembly had policy-making responsibilities, which resulted in
the development of a number of documents (Table 6-5).

Amnesty and Reinstatement

In 1967, Resolution 121 was adopted for the purpose of encouraging therapists who had not
been practicing for a while or had let their registration lapse to rejoin the profession to increase
the number of practicing therapists. The resolution read as follows: “There will be a one-time only
opportunity for all occupational therapists having at any time, met the qualifications for and been
registered, to be granted during one membership years, eligibility for registered membership”
(AOTA, 1968a, p. 112). The year was set for 1970 to allow preparation time. The total number of
therapists who took advantage of the amnesty program was 378 (Neuhaus, 1971). States with the
largest number of therapists reinstated were California, Wisconsin, New York, Massachusetts, and
Pennsylvania, accounting for approximately 40% of the amnesty returnees.
To assist in the retry process, courses and textbooks were prepared. For example, a Refresher
Course was given by the Southern California Occupational Therapy Association for 6 weeks to
13 nonpracticing therapists (AJOT, 1968). Publications prepared to assist in the amnesty program
included the Professional Reactivation in Occupational Therapy (AOTA, 1969d) and the Reference
Handbook on Continuing Education of Occupational Therapists (AOTA, 1970).

Registration and Membership

In 1964, there were 39 state associations represented in the House of Delegates. The total number
of registered occupational therapists was 6,602; 4,527 occupational therapists and 768 occupational
therapy assistants were members of AOTA. States with the highest number of registered occupa-
tional therapists were California (1,029), New York (723), Michigan (388), Illinois (378), Wisconsin
(332), and Pennsylvania (300). States with the largest number of occupational therapy assistants
were California (688), New York (487), Michigan (273), Illinois (272), and Pennsylvania (214).

Association Grants
Many activities of the Association were started and funded by grant money. In 1967, the
Association received 4.2 million in grants and contracts. It was grant money that originally funded
 Turning Points: 1960s to 1970s 187

Table 6-5
ASSOCIATION DOCUMENTS
YEAR DOCUMENT SOURCE
1960 Student s Report on Student Affiliation Center Cited in American Journal of Occupational
Therapy, 16(1), 40
1963 A Statement of Basic Philosophy, Principle & Policy American Journal of Occupational
Therapy, 17(4), 159 and American Journal of
Occupational Therapy, 18(2), 88
1964 Guidelines for Developing a Training Program for the Cited in American Journal of Occupational
Occupational Therapy Assistant Therapy, 18(1), 45
1964 Report of Performance in Student Affiliations Manual for Supervision of Student
Affiliations, 1966
1965 Guidebook for an Accredited Educational Program for the New York: American Occupational Therapy
Occupational Therapist Association
1967 Eligibility for Writing the Examination for Registration Delegate Assembly minutes
1967 Guide for Development and Use of Personnel Policies American Journal of Occupational Therapy,
21(6), 406-408
1968 Classification Standards for Occupational Therapy Personal
● Minimal Occupational Therapy Classification Standards
for Staff Level Personnel: Staff Occupational Therapist I, II,
& III and One Therapist Department
● Minimal Occupational Therapy Classification Standards
for Supervisory Administrative Level: Supervising
Occupational Therapist I, II, and III
● Minimal Occupational Therapy Classification Standards
for Occupational Therapy Assistant I, II, & III
● Minimal Occupational Therapy Classification Standards
for Occupational Therapy Aide
1968 Objectives of Occupational Therapy Education AOTA, 1968b

1968 Standards for Occupational Therapy Service Programs American Journal of Occupational Therapy,
23(1), 81-82
1969 Statement of Occupational Therapy Referral AOTA, 1969b
ASSOCIATION DOCUMENTS
1960 Occupational Therapy Reference Manual for Physicians AOTA, 1960e
1962 Manual for Supervision of Student Affiliations (revised 1966) Published by Wm. C. Brown, Dubuque, IA
1963 Proceedings of Workshop on Graduate Education in New York: AOTA (VRA Training Grant OVR
Occupational Therapy 62-80)
1963 Students Affiliations Published by Wm C. Brown, Dubuque, IA
1966 Occupational Therapy Teachers Institute: Concept of the Wayne State University (VRA 66-66)
Effective Teacher
1966 Bulletin on Practice Published by the Council on Practice (dis-
continued 1971)
1966 Information Enclosure Published by the Council on Development
(discontinued 1969)
1967 The Application of Educational Objectives in Curriculum University of Illinois (VRA 367-T-67)
Construction
1967 Summer Experience in Occupational Therapy: Manual for New York: AOTA (Ed. B. Neuhaus)
Organizing a Program
1969 Methods and Media for Academic and Clinical Teaching, New York: AOTA (VRA 367-T-69)
University of Utah
188 Chapter 6

the education and continuing education programs. In fact, there were several years during the 1970s
and 1980s when AOTA had more in grants than it did in its internal budget. Many of the func-
tions of the Association were started with grants and later incorporated into annual budgets. Grant
money was a double-edged sword. The money allowed the Association to start many programs
that would not have been possible within the existing budget of the Association. However, when
the grant money terminated, a decision had to be made to find money in the Association’s budget
or terminate the activity. Membership dues had to be increased and other sources of income found
so that many of the services begun under various grants could be continued (AOTA at 70, 1987).

Changing Focus of the Association

The Association increasing transformed from a unifying force designed to serve the member
needs for setting educational standards, certifying qualified practitioners, and providing place-
ment services (job finding) to an advocate and leader in the health care community. Under the new
bylaws (1964), the structure of the Association had changed. AOTA essentially became a business
league composed of professionals serving common interests. The Association became a dynamic
lobbyist on behalf of health-related legislation in which the profession had an active interest, such
as legislation and regulatory guidelines supportive of occupational therapy and people with dis-
abilities. The Association also was reorganized to allow the newly formed Foundation to respond
to the need to meet an expanding mission to promote and sponsor scientific, literary, and educa-
tional programs to support the profession. In short, AOTA recognized it had a dual mission: to
meet day-to-day membership needs and to plan for the long-range growth of the profession as a
whole (AOTA at 70, 1987).

Recruitment and Manpower

A VRA grant (367-T-66) continued the work on recruitment (AOTA, 1966a). Four objectives
are listed: (1) groundwork for two new and two repeat summer work experiences in occupational
therapy programs for high school and college students, (2) continued liaison with the state and
regional recruitment committees through telephone conferences, (3) contact with state health
career councils, and (4) development of a new photograph library for loan or purchase by state
associations. The summer work experience was report by Neuhaus (1965, 1969) as a success but
was time consuming. In spite of the Association’s efforts, manpower continued to be a major prob-
lem. An example is the study by Poole and Kassalow (1968), which reports that of those replying
to the survey, 51% were not employed. Of the 177 respondents not working, only 104 indicated any
interest in returning to the field sometime in the future. The current position held by a majority
of respondents was housewife. In the 1960s, many women did not work after they were married
and had children.

Consultants in Physical Disabilities and Neuropsychiatry

In 1957, the Association received a grant from the Office of Vocation Rehabilitation in the
Health, Education, and Welfare Department to establish a position for a Field Consultant for a
5-year period in both physical disabilities and neuropsychiatry (AOTA, 1957). During the first
3 years, the grant money sponsored Irene Hollis, OTR, as a consultant in physical disabilities
through 1960. The last 2 years were to fund a consultant in psychiatry. Mary Alice Coombs, OTR,
served from 1960 until her death in 1964, and June Mazer served when the grant was renewed from
1964 to 1968 (AOTA, 1968a).
 Turning Points: 1960s to 1970s 189

Graduate Traineeships
In 1960, the Association
announced that a grant from
the Office of Vocational
Rehabilitation (later renamed
the Vocational Rehabilitation
Administration) had been
received to make traineeships
available to occupational ther-
apists who were interested in
advanced study on the master’s
or doctoral level. The area of
study could be in occupational
therapy or a related field that
would “enable therapists to
acquire the advanced knowl-
edge and skills needed for
teaching, clinical supervision, Figure 6-17. New occupational therapy pin, 1968. (Printed with permission
research, or other leadership from the Archive of the American Occupational Therapy Association, Inc.)
positions in the field” (AOTA,
1960d). VRA grant 237-T-65
continued the funding for graduate traineeships (AOTA, 1966a). The traineeships were admin-
istered through the AOTA Committee on Graduate Study and continued to be available until
1972. Among the first-year recipients was Jerry Ann Johnson, future AOTA President, for master’s
degree study (AOTA, 1960c).

AOTA Membership in Other Organizations

In 1967, the Delegate Assembly passed Resolution 173, which gave authority to the Executive
Board to select which external organizations and associations AOTA would join as members or
which meetings and conferences they would attend (AOTA, 1968a). The task of selection was
viewed as impractical for the Delegate Assembly to attempt. Thereafter, the Executive Board
made the decision not to affiliate with or attend meetings of activity-based groups, such as those
for recreation or music. Instead the focus was on organizations dealing with health, disability, or
rehabilitation (Figure 6-17).

Foundation
At the annual conference in Denver in October 1964, the Association authorized the formation
of a foundation for the purpose of education and research (AOTA, 1964). At the midyear meeting
in Des Moines, Iowa, the Foundation Committee submitted a report and incorporation papers to
the Executive Board. The Executive Board was to serve as the incorporators, and the Foundation
was incorporated in the state of Delaware on April 14, 1965 (AOTA, 1965c). The purpose of the
Foundation was stated as follows:
The corporation is organized exclusively for charitable, scientific, literary and educational
purposes, including for such purposes the making of distributions to organizations that qualify as
exempt organization under Section 401(c) (3) of the Internal Revenue Code of 1954. The particular
business and objects of the corporation shall be to advance the science of occupational therapy and
increase the public knowledge and understanding thereof by the encouragement of the study of
190 Chapter 6

occupational therapy (1) through the provision of scholarships, (2) by engaging in studies, surveys
and research, and (3) by all proper means.” (Annual report to the membership, 1965, p. 14)
The Foundation is a classified under the Internal Revenue Service (IRS) tax code as a charitable
organization for the profession, meaning its activities were tax exempt under the IRS code. The
Association is classified as a business organization under the IRS tax code for the profession and
is subject to taxation because it serves its members. All business activities as defined in the IRS
code are conducted through the Association, including lobbying Congress to include occupational
therapy in various bills and provide funds for occupational therapy services. The Foundation is
able to conduct activities such as fund raising, receiving bequests, and administering grants related
to education and research activities, including housing the AOTA/AOTF library and computer-
ized database search system. Such activities are considered tax exempt. The history is reported
in the minutes of the annual business meeting on November 1, 1965. A lawyer raised the issue
when reviewing the concept of the single-fee structure. He said the objectives of the Association
were changed in the 1955 Constitution, which could make the Association liable for back taxes; he
recommended division into a business league and charitable organization. The original Directors
were Dean Tyndall and Florence Cromwell (1965), Alice Jantzen and Ethel Huebner (1966), and
Ruth Brunyate and Janet Stone (1967).
Minutes from 1968 state that the Foundation was “established in order to advance the science
of occupational therapy and increase the public knowledge and understanding of occupational
therapy in the service of mankind” (AOTA, 1968a). The Association established the Foundation
to encourage the professional growth of occupational therapy by providing financial support for
research education and professional publications. By housing such activities in the Foundation,
the Association was able to establish itself as a business league. This designation “means that the
Association can devote more of its resources to activities of direct benefit to its membership in
such areas as legislation, personnel policies, etc.” (p. 121). In 1969, the Delegate Assembly adopted
Resolution 229, which states that 2% of Association dues would go to the Foundation to establish
a financial base for the Foundation (AOTA, 1969b).
The American Occupational Therapy Foundation was designed to serve the profession rather
than individual members and therefore sponsor educational and research programs designed to
expand the contributions of occupational therapy to society and secure the profession’s future
position in the non-health care community. The Foundation could award scholarships and pro-
duced publications designed to promote greater awareness of the benefits of occupational therapy
(AOTA at 70, 1987).

Reflection
The 1960s were a time of rapid change in the profession and the Association. Disorders that
had formed a large portion of the client population seen by occupational therapy practitioners
decreased substantially, such as tuberculosis and acute poliomyelitis, but other disorders such
as neurological disorders, especially stroke and an emphasis on acute care facilities, increased.
Education of therapists changed to focus more on dysfunction occurring as a consequence of a dis-
ease rather than on the disease itself. Clinical affiliations (field work) were changed to align with
the concept of dysfunction and were shortened. Legislation related to health care, such as Medicare
and the Community Mental Health Act, would change the focus of the Association from an
internal direction to an external outlook. Lobbying on behalf of member interests would create a
new outlook on what the Association needed to do to help members provide occupational therapy
services and increase employment. The federal tax code created a need to divide the focus between
membership services and professional development. The Foundation was created as a charitable
organization on behalf of the professional research and education, whereas the Association con-
centrated on enhancing membership services.
 Turning Points: 1960s to 1970s 191

References
Ackley, N. (1962). The challenge of the sixties. American Journal of Occupational Therapy, 15(6), 273-281.
Albee, G.W. (1969). Emerging concepts of mental illness and models of treatment: The psychological point of view.
American Journal of Psychiatry, 125(7), 42-48.
American Medical Association, Council on Medical Education and Hospitals. (1949). Essentials of an acceptable
school of occupational therapy. Journal of the American Medical Association, 141(16), 1167.
American Occupational Therapy Association. (1955). Proceedings of the Occupational Therapy Institute: A reassessment
of professional education and practice in occupational therapy as related to rehabilitation. New York, NY: Author.
American Occupational Therapy Association. (1957). OVR grant for field consultant in psychiatry. Newsletter, 19(11), 2.
American Occupational Therapy Association. (1958a). Curriculum study gets under way. Newsletter, 18(8), 1.
American Occupational Therapy Association. (1958b). Curriculum study staff. Newsletter, 18(7), 2.
American Occupational Therapy Association. (1958c). Summary of Medical Advisory Council meeting. New York,
NY: Author.
American Occupational Therapy Association. (1960a). AOTA organization chart. New York, NY: Author.
American Occupational Therapy Association. (1960b). Occupational therapy reference manual for physicians.
Dubuque, IA: Wm. C. Brown Book Co.
American Occupational Therapy Association. (1960c). OVR traineeship awards. Newsletter, 20(7), 2.
American Occupational Therapy Association. (1960d). OVR traineeships available. Newsletter, 20(3), 1.
American Occupational Therapy Association (1960e). The occupational therapy reference manual for physicians.
Dubuque, IA: Wm. C. Brown
American Occupational Therapy Association. (1961). Facts…about occupational therapy. New York, NY: Author.
American Occupational Therapy Association. (1963). A statement of basic philosophy, principle and policy. American
Journal of Occupational Therapy, 17(4), 159.
American Occupational Therapy Association. (1964). Report of the 1964 annual conference in Denver. Newsletter,
24(11), 1.
American Occupational Therapy Association. (1965a). Bylaws of American Occupational Therapy Association.
American Journal of Occupational Therapy, 19(1), 37-41.
American Occupational Therapy Association. (1965b). Guidebook for an accredited curriculum in occupational
therapy. New York, NY: Author.
American Occupational Therapy Association. (1965c). AOTA Annual report to the membership. New York, NYC:
Author.
American Occupational Therapy Association. (1966a). AOTA-VRA grants. Newsletter, 26(1), 1.
American Occupational Therapy Association. (1966b). Delegate Assembly minutes. American Journal of Occupational
Therapy, 20(1), 49-53
American Occupational Therapy Association (1966c). Notes on Medicare for the occupational therapist. New York,
NY: Author.
American Occupational Therapy Association. (1967a). Highlights of the curriculum study conference, Part II.
American Journal of Occupational Therapy, 21(3), 179-181.
American Occupational Therapy Association. (1967b). 50th Anniversary: Then - and now!: 1917-1967. New York, NY:
Author.
American Occupational Therapy Association. (1968a). Minutes of the annual business meeting. American Journal of
Occupational Therapy, 22(2), 109-123.
American Occupational Therapy Association. (1968b). Objectives of occupational therapy education- edited 1968.
American Journal of Occupational Therapy, 22(6), 540-542.
American Occupational Therapy Association. (1969a). AOTA Executive Board. Official definition. Newsletter, 22(2), 1.
American Occupational Therapy Association. (1969b). Delegate Assembly minutes. American Journal of Occupational
Therapy, 23(6), 520-531.
American Occupational Therapy Association (1969c). Delegate Assembly minutes. American Journal of Occupational
Therapy, 23(2), 162-185.
American Occupational Therapy Association (1969d). Professional reactivation in occupational therapy. Dubuque,
IA: Kendall/Hunt Publishing
American Occupational Therapy Association. (1969e). Statement on occupational therapy referral. American Journal
of Occupational Therapy, 23(6), 530-531.
American Occupational Therapy Association (1970). Reference handbook on continuing education of occupational
therapists. Dubuque, IA: Kendall/Hunt Publishing
192 Chapter 6

American Occupational Therapy Association. (1986). 1980 Statement of occupational therapy referral. In: Reference
manual of the official documents of the American Occupational Therapy Association (p. IX.1). Rockville, MD:
Author.
American Occupational Therapy Association. (1992). AOTA’s hall of leaders. OT Week, 6(21), 40-43.
American Occupational Therapy Association at 70. (1987). Occupational Therapy News, 41(11), 7.
Anderson, A. G. (1959, October). Report of the “basic approach” committee. New York, NY: American Occupational
Therapy Association.
Appleby, L., Morton, J. E., Lawson, R. E., Loudon, R. G., & Brown, J. (1960). Toward a therapeutic community in a
tuberculosis hospital. American Journal of Occupational Therapy, 14(1), 117-120.
Ayres, A. J. (1963a). The development of perceptual-motor abilities: A theoretical basis for treatment of dysfunction.
American Journal of Occupational Therapy, 17(6), 221-225.
Ayres, A. J. (1963b). Occupational therapy directed toward neuromuscular integration. In H. S. Willard & C. S.
Spackman (Eds.), Occupational therapy (pp. 358-466). Philadelphia, PA: Lippincott.
Ayres, A.J. (1966). Interrelations among perceptual-motor abilities in a group of normal children. American Journal
of Occupational Therapy, 20(6), 288-292.
Ayres, A. J. (1968). Sensory integrative processes and neurophysiological learning disabilities. In J. Hellmuth (Ed.),
Learning disabilities (Vol. 3, pp. 41-68). Seattle, WA: Special Child Publications.
Barnes & Noble (1996). Webster’s new universal unabridged dictionary. New York: Barnes & Noble Books.
Barton, W.E. (1955). Medical supervision in occupational therapy. American Journal of Occupational Therapy,
9(2, Pt. 1), 53-56, 79
Brunyate, R. (n.d.). Review of the status of occupational therapy. New York: American Occupational Therapy
Association.
Conte, W.R. (1960). The occupational therapists as a therapist. American Journal of Occupational Therapy, 14(1) 1-3,
12.
Diasio, K. (1967). Psychiatric occupational therapy: Search for a conceptual framework in light of psychoanalytic ego
psychology and learning theory. American Journal of Occupational Therapy, 22(5), 400-407.
Fidler, G.S. (1963). Nationally speaking: The prescription in occupational therapy. American Journal of Occupational
Therapy, 17(3), 122-124.
Fidler, G. S. (1966). Learning as a growth process: A conceptual framework for professional education. American
Journal of Occupational Therapy, 22(1), 1-8.
Fidler, G.S., & Fidler, J.W. (1963). Occupational therapy: A communication process in psychiatry. New York: Macmillan.
Fox, F. H. (1966). Computer simulation of neurophysiological processes: Implications for research in occupational
therapy. American Journal of Occupational Therapy, 20(6), 274-279.
Franciscus, M.L. & Abbott, M. (1968). Opportunities in occupational therapy. New York, NY: Vocational Guidance
Manuals.
Grinker, R. R. (1969). Emerging concepts of mental illness and models of treatment: The medical point of view.
American Journal of Psychiatry, 125(7), 37-41.
Halford, M. A. (1957). I had polio. American Journal of Occupational Therapy, 11(3), 129-130, 166.
Howe, M., & Dippy, K. (1968). The role of occupational therapy in community mental health. American Journal of
Occupational Therapy, 22(6), 521-524.
Kester, D. L. (1966). New product makes splinting easier. American Journal of Occupational Therapy, 20, 43-44,
Kilburn, V. (1966). Highlights of the curriculum study conference: Part 1. American Journal of Occupational Therapy,
21(2), 102-105.
Koepke, G. H., Feallock, B., & Feller, I. (1963). Splinting the severely burned hand. American Journal of Occupational
Therapy, 17, 147-150.
Llorens, L. A., Rubn, E. Z., Braun, J., Beck, G., Mottley, N., & Beall, D. (1964). A preliminary report on training in
cognitive-perceptual-motor functions. American Journal of Occupational Therapy, 18(5), 202-208.
Mase, D. J. (1968). The growth and development of the allied health schools. Journal of the American Medical
Association, 206(7), 1548-1550.
Matthews, M. E. (1959, April). Basic approach in occupational therapy: Final report. New York, NY: American
Occupational Therapy Association.
Mazer, J. & Goodrich, W. (1958). The prescription: An anachronistic procedure in psychiatric occupational therapy.
American Journal of Occupational Therapy, 12(4, Pt. 1), 165-170
Mosey, A. J. (1967). Recapitulation of ontogenesis: A theory for practice of occupational therapy. American Journal of
Occupational Therapy, 22(5), 426-432.
Neuhaus, B. E. (1965). Recruiting occupational therapy students through a vacation work program. Journal of
Rehabilitation, 31, 26-27.
Neuhaus, B. E. (1968). Founders’ day at Clifton Springs. American Journal of Occupational Therapy, 22(4), 337-339.
 Turning Points: 1960s to 1970s 193

Neuhaus, B. E. (1969). Summer experience: A positive approach to the manpower dilemma. American Journal of
Occupational Therapy, 23(1), 65-68.
Neuhaus, B. E. (1971). Implementation of Resolution #121. American Journal of Occupational Therapy, 25(7), 378-380.
Owen, C. M. (1968). An analysis of the philosophy of occupational therapy. American Journal of Occupational
Therapy, 22(6), 502-505.
Nichols, V.L. (1960). Keynote address: The therapist and the profession. In: Proceedings of the 1960 annual conference
(pp. 1-4). New York: American Occupational Therapy Association.
Paolino, A. F. (1962). Prospects for research in occupational therapy. American Journal of Occupational Therapy,
16(4), 167-170.
Peters, C. O. (2011). Powerful occupational therapists: A community of professionals, 1950-1980. Occupational
Therapy in Mental Health, 27, 199-410.
Poole, M. A., & Kassalow, S. (1968). Manpower survey report: Wisconsin Occupational Therapy Association.
American Journal of Occupational Therapy, 22(4), 304-306.
Reed, K. L., & Sanderson, S. R. (1980). Defining occupational therapy. In Concepts of occupational therapy (pp. 1-8).
Baltimore, MD: Williams & Wilkins.
Reilly, M. (1960). Research potentiality of occupational therapy. American Journal of Occupational Therapy, 14(4),
206-209.
Reilly, M. (1962). Occupational therapy can be one of great ideas of 20th century medicine. American Journal of
Occupational Therapy, 16(1), 1-9.
Reilly, M. (1966). A psychiatric occupational therapy program as a teaching model. American Journal of Occupational
Therapy, 20(2), 61-67.
Sloane, R.B. (1969). The converging paths of behavior therapy and psychotherapy. International Journal of Psychiatry,
7(7), 493-501.
Smith, A. R., & Tempone, V. J. (1967). Psychiatric occupational therapy within a learning theory context. American
Journal of Occupational Therapy, 22(5), 415-420.
Spackman, C.S. (1952). Occupational therapy for patients with physical disabilities. Par 1. In H.S. Willard & C.S.
Spackman (Eds.), Principles of occupational therapy (pp. 169-255). Philadelphia: Lippincott
Spackman, C. S. (1963). Co-ordination of occupational therapy with other allied medical and related services. In H. S.
Willard & C. S. Spackman (Eds.), Occupational Therapy (3rd ed., pp. 1-14). Philadelphia, PA: Lippincott.
Spackman, C.S. (1963b). Occupational therapy as a supportive measure in the general hospital. In H.S. Willard & C.S.
Spackman (Eds.), Occupational Therapy (3rd ed., pp. 115-138). Philadelphia: Lippincott.
Spackman, C.S. (1971). Occupational therapy—Its relation to allied medical services. In H.S. Willard & C.S.
Spackman (Eds.), Occupational therapy (4th ed., pp. 1-11). Philadelphia: Lippincott.
VanderBos, G.R. (Ed.). (2007). APA Dictionary of psychology. Washington, D.C.: American Psychological Association.
Wegg, L. S. (1960). The essentials of work evaluation. American Journal of Occupational Therapy, 14(2), 65-70.
West, W. L. (1968). Professional responsibility in times of change. American Journal of Occupational Therapy, 22(1),
9-15.
Willis, B. (1969). The use of Orthoplast Isoprene splints in the treatment of the acutely burned child: Preliminary
report. American Journal of Occupational Therapy, 23, 57-61.
Yasumura, M., & Baldwin, J. S. (1953). Occupational therapy for rheumatic and cardiac children. American Journal of
Occupational Therapy, 7(2, Part 1), 62-67, 80.
Yerxa, E. J. (1967). Authentic occupational therapy. American Journal of Occupational Therapy, 21(1), 1-8.
Zimmerman, M. E. (1960). Devices: Development and direction. In Proceedings of the 1950 annual conference of
the American Occupational Therapy Association (pp. 17-24). New York, NY: American Occupational Therapy
Association.
Zimmerman, M. E. (1963). Occupational therapy in the A.D.L. program. In H. S. Willard & C. S. Spackman (Eds.),
Occupational therapy (pp. 329-357). Philadelphia, PA: Lippincott.
194 Chapter 6

Bibliography
American Occupational Therapy Association. (1958). The objectives and functions of occupational therapy. Dubuque,
IA: Wm. C. Brown.
American Occupational Therapy Association. (1969). Delegate Assembly minutes. American Journal of Occupational
Therapy, 23(2), 162-185.
American Occupational Therapy Association. (1969). 1969 annual election. New York, NY: Author.
Anderson, A. G. (1960). A discussion of the pilot study on basic approach. Proceedings of the 1960 annual conference.
New York, NY: American Occupational Therapy Association.
Medical Education, Section V. (1969). Educational programs in areas allied with medicine. Journal of the American
Medical Association, 210(8), 1524-1529.
Robinson, R. A. (1958). A general approach in occupational therapy. In Proceedings of the 1956 Regional Occupational
Therapy Institutes: Denver, Los Angeles, Madison, Richmond and Annual Institute, Minneapolis (p. 4). Dubuque, IA:
Wm. C. Brown.
 7
Back to Philosophical Base
1970s to 1980s

Key Points
● The national office moved from New York City to Rockville, Maryland, in 1972.
● The Philosophical Base Project was implemented to identify assumptions and principles of
occupational therapy.
● The Association adopted a positive stance toward state licensure, and states began passing
legislation to license occupational therapy personnel.
● A lobbyist was hired by the Association to advocate for congressional legislation favorable to
occupational therapy.
● Code of Ethics statements were separated from bylaws to create a standalone document in 1977.
● The Uniform Terminology document adopted in 1979 became a forerunner of the Occupational
Therapy Practice Framework.
● The number of therapists increased significantly during the 1970s.
● The number of educational programs increased significantly for both therapists and assistants.
● The Roster of Fellows and Roster of Honor were created in 1970s. Other award programs followed.
● The Association became a major publisher of occupational therapy literature.

Highlighted Personalities
● Lela Augustine Llorens, theorist ● James Garibaldi, AOTA Executive Director
● Anne Cronin Mosey, theorist ● Phillip Shannon, Chair of Philosophical
● Florence S. Cromwell, AOTA President, Base Project
1970-1973 (second term) ● Alice C. Jantzen, AOTF President
● Jerry Ann Johnson, AOTA President, ● Elizabeth J. Yerxa, AOTF President
1973-1976 ● Myra L. McDaniel, AOTF President
● Mae Dorothy Hightower Vandamm, ● Nancy V. Snyder, AOTF President
AOTA President, 1976-1982 ● Wilma L. West, AOTF President
● Leo Fanning, AOTA Executive Director

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 195-228).
- 195 - © 2017 SLACK Incorporated.
196 Chapter 7

Key Places Key Times/Events

● Rockville, Maryland—New headquarters ● Meeting of Slagle lecturers to discuss phil-
office on Executive Boulevard in the Wilco osophical base
Building, 1972

Political Events/Issues Sociocultural Events/Issues

● Florida and New York passed legislation ● Task Force reports were published on
to license occupational therapists in 1975. social issues, target populations, and men-
● Between 1976 and 1979, nine more states tal health.
passed state licensure laws. ● Terminology adopted by the National
● The Rehabilitation Act of 1973 (Public Commission on Accreditation changed
Law 93-112) was passed, which included the concept of registration to certification:
Section 504 on architectural design and Registration Exam became Certification
provision of independent living. Exam.
● Education for All Handicapped Children ● The Coalition of Independent Health
Act passed in 1975 Professions was created in 1970.

Economic Events/Issues Technological Events/Issues

● Passage of the Education for All ● Early computer-assisted programs began
Handicapped Children expanded job appearing in the literature.
opportunities for occupational therapy
personnel in schools.
● The Health Maintenance Organization
Practice Issues
was created to limit health care costs in ● The number of practicing therapists
1973. increased 135% between 1972 and 1982.
● Various agencies of the federal govern- ● The issue of qualifications to maintain
ment continued to provide grant money to competency of practice was discussed
the Association for several projects. throughout the 1970s.
● The first Uniform Terminology document
was adopted in 1979.
Educational Issues ● The Code of Ethics document was adopted
● Essentials of an Accredited Education in 1977.
Program for the Occupational Therapist ● The Role Delineation Study was completed.
were revised in 1972.
Standards and Guidelines of an
●

Occupational Therapy Affiliation Program

Foundation Issues
were adopted in 1973. ● The Foundation began awarding scholar-
● Document of Advanced Professional ships.
Education in Occupational Therapy was ● The Foundation published its first public
adopted in 1972. information brochure.
● The number of educational programs con- ● A paid funding coordinator was hired to
tinued to increase. relieve volunteers of some responsibilities
of running the Foundation.
 Back to Philosophical Base: 1970s to 1980s 197

Association Issues
● The Association’s national office was moved to Rockville, Maryland, to be closer to Capitol
Hill and the seat of the U.S. government.
● The Delegate Assembly passed Resolution 400 supporting the adoption of state licensure
legislation for occupational therapy personnel in 1974.
● The Delegate Assembly became the Representative Assembly in 1977.
● The Council on Standards developed plans to maintain eligibility for certification (re-
certification program).
● The Model Practice Act to guide state associations in writing licensure legislation was
adopted in 1975.
● The Association created the Legislative Affairs Division in 1972 to address issues related to
occupational therapy practice in congressional legislation. (The name has changed several
times since.)
● Career mobility criteria were developed for assistants to sit for the therapist certification
examination.
● A study of entry-level functions of therapists, assistants, and aides was completed.
● A terminology report was accepted changing the term registration to certification in 1973.
● Proficiency Testing and Career Laddering programs were developed but were ultimately
rejected by the Representative Assembly in the 1980s.
● The bylaws formally recognized affiliate associations as entities; prior status was primarily
concerned with determining delegate eligibility—1972
● The bylaws created the Committee of State Association Presidents in 1976.
● The bylaws created Special Interest Sections in 1976.

Introduction

T
he United States celebrated 200 years of independence—the Bicentennial—in 1976. The
Vietnam War finally came to an end in 1975 after 15 years of warfare. The Camp David
Accords were signed in 1978 by Egyptian President Anwar al Sadat and Israeli Prime
Minister Menachem begin to reach a settlement between Israel and Egypt, with President Jimmy
Carter presiding over the event. Iran took 63 Americans hostage in November 1979; they were not
released until January 1981.
A major decision for occupational therapy practitioners in the 1970s was accepting licensure
after 2 decades of active opposition by the national Association. State licensure decreased the
therapists’ dependency on the continuing certification but increased the demand on the state
associations to initiate and then monitor the licensure process. Many state associations were small
and struggling. Licensure, however, provided a potential unifying effect because all practitioners
were affected by the licensure law in their state or jurisdiction.
In 1977, the Representative Assembly created the Special Interest Sections (SIS) to support the
advancement of special practice areas. Five specialty areas were initially approved: developmen-
tal disabilities, gerontology, mental health, physical disabilities, and sensory integration. Others
would be added later.
198 Chapter 7

The occupational therapy workforce grew 230% between 1966 and 1978, according to data col-
lected for the manpower study conducted in 1984 (American Occupational Therapy Association
[AOTA], 1985).
For the profession there would be a continued process of growth and change. Part of the pro-
cess was related to the general recognition by society of the potential contributions of the different
members of the health care team, but a major part was the result of efforts within the profession
itself. Increased emphasis on improving standards, competency, and education for the members of
the profession and greater effectiveness in the overall administration of the Association contrib-
uted to the growth and viability of the profession and the Association.
Publications would increase the literature base of the profession. Mosey (1970) published a book
describing three theories or frames of reference for occupational therapy practitioners to apply
in the practice of mental health. Ayres (1972) published a book describing the theory of practice
called sensory integration to address problems described as sensory integration dysfunction. The
fourth edition of the textbook by Helen Willard and Clare Spackman was published in 1971, the
last edition by the original authors and editors. The fifth edition published in 1978 was edited by
new authors, Helen Hopkins and Helen Smith. A textbook devoted to the practice of occupational
therapy for physical dysfunction edited by Catherine Trombly and Anna Scott was published in
1977.
As one effort to address the shortage of therapists, the Delegate Assembly designated 1970 as
an amnesty or reinstatement year for therapists who had let their registration (now certification)
lapse. Formerly registered therapists could re-register without having to take the registration (now
certification) examination again. According to the final report, 378 therapists took advantage of
the offer (Neuhaus, 1971). In the same year, the presidents of the state associations developed a
propose and function document to create a meeting format at the annual conference to discuss
issues of mutual concern, share information and ideas, and make recommendations for actions
to the Delegate Assembly and Executive Board. The following year, 1971, the Delegate Assembly
passed Resolution 300 on continuing certification and registration because there was growing
concern about the maintenance of qualifications to practice beyond the point of initial creden-
tialing. Harriet Tiebel resigned as Executive Director in 1971, and Leo Fanning, the first non-
therapist to lead the Association, started his tenure the following year. To better access Congress,
the Association move its headquarters to Rockville, Maryland, in 1972, ending 46 years of having
a New York City address for the official office. Also in 1972, a formal definition of occupational
therapy was adopted and published (AOTA, 1972c). The next year, 1973, the Delegate Assembly
approved a resolution encouraging states to seek licensure laws to describe the practice of occupa-
tional therapy and credentials of qualified practitioners for the benefit and protection of consum-
ers. The same year, the first group of therapists was named to the Roster of Fellows and began using
the initials FAOTA behind their names. The Occupational Therapy Newspaper began publication
in 1973, and the old News Letter or Newsletter, published from 1938 to 1973, was discontinued.
By 1979, 13 states and the District of Columbia would pass licensure laws. The Delegate Assembly
would become the Representative Assembly and, in 1977 for the first time, all 50 states plus the
District of Columbia and Puerto Rico would have a Representative seated in the Representative
Assembly, making for a truly nationwide representation of occupational therapists and assis-
tants. The Representative Assembly adopted for the profession the first official Code of Ethics as
a separate document from the bylaws in 1977. A major challenge was to keep up with the rapid
expansion of educational program at all three levels: assistant, master’s, and post-professional.
Cordelia Myers retired as editor of American Journal of Occupational Therapy in 1975, and Elaine
Viseltear became editor. Recruitment changed from a lack of applicants to an overabundance of
applications in the early 1970s (Fanning, 1972). A major problem in education became a lack of
qualified faculty.
 Back to Philosophical Base: 1970s to 1980s 199

Education
Educational Programs
Educational opportunity in occupational therapy was expanding. In 1970, there were 36 accred-
ited educational programs for occupational therapists, and by 1979 there were 53. There were
43 occupational therapy assistant programs in 1979. Thirty states had an occupational therapy
program, and 24 states had an occupational therapy assistant program. However, 28 states had
neither an occupational therapy nor an occupational therapy assistant program within the state
borders. Lack of educational programs in each state continued to be a barrier in developing occu-
pational therapy service programs throughout large parts of the country, especially the Western
states. There were no occupational therapy educational programs at either the professional or tech-
nical level in 10 Western states, including Iowa, Nebraska, South Dakota, Utah, Montana, Idaho,
Nevada, Arizona, New Mexico, and Wyoming.

Revision of the Essentials

The Essentials of an Acceptable Education Program for the Occupational Therapist was revised
for the fourth time in 1973. Essentials for the occupational therapy assistant were developed with
the American Medical Association (AMA) in 1976.
The Ad Hoc Committee on Education created by the Executive Board in 1977 identified six
issues and made 16 recommendations. The six issues related to (1) faculty characteristics and
responsibilities, (2) faculty shortage, (3) multiple entry routes leading to certification as an OTR,
(4) lack of research, (5) external influences and forces, and (6) AOTA member readiness to decide
on semiprofessional or professional status. The recommendations were:
● The AOTA Commission on Education (COE) and the Division of Education (in the National
Office) should immediately identify external resources needed to better prepare faculty members
and curriculum directors for their functions and responsibilities in university environments.
● The Essentials should reflect the necessity and importance of (a) faculty research involvement in
patient practice or related areas, and (b) faculty engagement in research and scholarly endeavors.
● The Essentials must delineate more clearly the functions, responsibilities, and value orienta-
tions for faculty in university settings.
● Faculty members should identify the qualifications and criteria utilized by their colleges and
universities to award tenure, grant promotions, and recognize faculty and program competence.
● Clinical and educational representatives to COE and their colleagues should explore the costs,
efficacy, and liability of retaining current field work patterns.
● It is recommended that fieldwork experience be a requirement for certification rather than for
graduation and that it become a responsibility of AOTA rather than of the individual occupa-
tional therapy programs. (Note: This recommendation was never implemented.)
● Members of AOTA should develop, adopt, and implement a coherent educational system
leading from entry into the profession through various stages or steps to the highest desirable
levels, with one step leading logically to another.
● A 2-year moratorium should be placed upon the establishment and/or recognition of new
programs for occupational therapy assistants or occupational therapists at the associate of arts
and baccalaureate degree levels.
● Additional data about occupational therapists should be obtained, including the attrition
rates of OTRs and COTAs and reasons for attrition (raising families with intent to return to
practice later versus leaving the profession).
200 Chapter 7

● Review and reconsider the functions and educational preparation of COTAs, including the
possibility of a return to specialty training for COTAs. Preparation of the OTR for entry into
the profession should continue to focus on generalist professional education, with a liberal arts
base. Advanced professional education should lead to specialization and research.
● Evaluate the various options for entry into the profession, including the proficiency examina-
tion, especially in relation to the data base being collected about occupational therapists.
● Postpone decision of whether or not to adopt a proficiency examination as a mode of entrance
until such time as the data requested in this report are available and the members of the
Association can make basic decisions about entry into the profession.
● Faculty members, particularly in graduate programs, should emphasize the need for faculty
and graduate research related to direct and indirect services as opposed to opinion polls, atti-
tude surveys, and studies.
● It is recommended that members of AOTA adopt the concept of moving toward full profes-
sional status.
● It is recommended that the master’s degree be considered as the point of professional entry
into occupational therapy.
● The Commissions of Education and Practice should promote utilization of therapists within
a realistic reliable and viable framework and should be charged to develop a master plan for
levels of function and performance of occupational therapy. (Johnson, 1978)

Revision of the Certification Examination

In 1975, the content, format, and type of questions used on the certification (registration)
examination for occupational therapists was substantially modified for the first time since the
examination process was developed in 1947 (AOTA, 1975d). The old content consisted of three
sections of approximately equal weight: Basic Knowledge, Clinical Conditions, and Occupational
Therapy Principles and Practice. The new content was divided into four sections with several
subsections. The four major sections and percentage of questions were: Occupational Therapy
Services–Evaluation (30%), Occupational Therapy Services–Planning (30%), Occupational Therapy
Services–Implementation (30%), and Program Support Services/Professional Development (10%).
Evaluation included occupational performance, performance components (developmental, mea-
surable, or gradable functions), and life space. Planning included goal setting, selection of objec-
tives, and methodology for attainment of identified performance in selected occupation and per-
formance component tasks. Implementation included development, maintenance, and restoration
of function in identified occupations and performance components. Program support included
management, communication, and professional development. The change was designed to better
reflect the process of occupational therapy practice as opposed to a collection and accumulation
of facts, data, and information.
The format of questions changed from a focus on knowledge and memorization to a focus on
application and problem solving. In other words, knowledge was considered necessary but not
sufficient to practice occupational therapy. The practitioner must be able to apply the knowledge
to a problem (dysfunction, disorder, condition) presented by the client, develop an intervention
plan, and implement the intervention plan to address the client’s problem. In the example below,
the first question (old format) can be answered by reading the information in a standard textbook,
which anyone with appropriate reading skills could do. No application or problem-solving skills
are needed. The second question (new format) requires an understanding of the problem (dysfunc-
tion) experienced by a person with the disorder of carpal tunnel syndrome and what intervention
plan and intervention strategy or strategies an occupational therapy practitioner could use to
address or correct the problem. Focusing questions on application as opposed to knowledge alone
 Back to Philosophical Base: 1970s to 1980s 201

was an attempt to make the examination more closely align with the real world of occupational
therapy practice. The sample questions are as follows:

Old format:
What nerve is affected by carpal tunnel syndrome?
A. Radial
B. Ulnar
C. Median*
D. Musculocutaneous

New format:
Treatment after carpal tunnel syndrome repair should concentrate on strengthening:
A. Gross grasp
B. Precision finger skills*
C. Wrist extension
D. Wrist flexion

Although the changes in content, format, and type of question were developed for the
occupational therapist examination, the changes were incorporated in the development of the
examination for occupational therapy assistants. Prior to June 1977, there was no uniform
requirement for assistants to pass a written examination. In 1975, the Delegate Assembly passed
Resolution 471-76, which established the new certification requirement that assistants, as well
as occupational therapists, take a certification examination to practice occupational therapy
(AOTA, 1976a).

Practice
Practice by the Numbers
According to the 1977 AOTA membership survey, the most common diagnoses seen by occu-
pational therapists were stroke/hemiplegia (26.7%), cerebral palsy and psychosis (12.4%), and
intellectual disability (10.2%). For occupational therapy assistants, the most common diagnoses
seen were cerebrovascular accident/hemiplegia (23.7%), arteriosclerosis (12.9%), mental retarda-
tion (11.6%), and psychosis (9.5%). Note the changing terminology in Table 7-1. Cerebrovascular
accident (CVA) is more commonly called stroke, mental retardation is now called intellectual dis-
ability, and arteriosclerosis was a general term for dementia. Although practitioners saw a range of
ages in clients, occupational therapists saw more children, and assistants saw more elderly clients.
Combining categories results in the following: 76.8% physical disabilities and 23.2% mental health
problems seen by occupational therapists and 72.8% physical disabilities and 27.2% mental health
problems seen by assistants (AOTA, 1978a). Additional factors and figures about practitioners
from 1971 are presented in Table 7-1 and from 1977 are presented in Table 7-2.

State and Jurisdiction Licensure

In 1969, the Delegate Assembly adopted a position of neutrality (AOTA, 1969a, p. 528). The
action was taken in response to a licensure bill passed in Puerto Rico. A formal statement was issued
in a position paper entitled “Licensing and Standards of Competency in Occupational Therapy”
202 Chapter 7

Table 7-1
THE PROFESSION BY THE NUMBERS (1971)
OCCUPATIONAL THERAPISTS OCCUPATIONAL THERAPY ASSISTANTS
Female 96% 89%
Average years of 7.64 7.04
experience
Major clinical ● Physical dysfunction, 39% ● Psychosocial dysfunction, 31%
interests ● Psychosocial dysfunction, 26.5% ● Physical dysfunction, 19%
● Perceptual-motor, 11% ● Mental retardation, 14%
● Chronic illness, 5% ● Community mental health, 8%
● Community mental health, 5% ● Medical/surgical, 7%
● Addiction/alcoholism, 5%
Primary age of ● Adults, 42% ● Mixed ages, 34%
clients ● Mixed ages, 27% ● Adults, 29%
● Pediatrics, 20% ● Aged, 27%
● Aged, 7% ● Pediatrics, 6%
● Adolescents, 4% ● Adolescents, 4%
Employment ● Working full-time, 50% ● Working full-time, 72%
status ● Not presently employed, 33% ● Not presently employed, 12%
● Employed part-time, 14% ● Employed part-time, 8%
● Student, 2% ● Other, 6%
● Self-employed, 1% ● Student, 2%
Employer type ● State facility, 22% ● Private, 37%
● Voluntary or proprietary, 22% ● State facility, 33%
● City or county facility, 21% ● City or county facility, 16%
● Federal facility, 11% ● Federal facility, 6%
● Educational facility, 9% ● Other, 8%
● Self-employed, 4%
● Other, 11%
Salary 81% of salaries between $7,000 and $12,500 69% of salaries between $4,800 and $8,000
Major function ● Clinical practice, 58% ● Provide treatment, 46%
● Administration, 18% ● Conduct activity program, 44%
● Education, 9% ● Administration, 5%
● Consultation, 8% ● Preparation, 2%
● Research, 1% ● Maintenance, 1%
● Other, 6% ● Other, 2%
Adapted from American Occupational Therapy Association. (1971). Reports to the Delegate Assembly: the Executive Director.
American Journal of Occupational Therapy, 25(7), 377-378.

(AOTA, 1969a). In 1971, a follow-up statement was written to further clarify the Association’s posi-
tion, entitled “Statement on Licensure of Occupational Therapists” (AOTA, 1971b).
Three years later, the position would be changes to support licensure as the states of New York
and Florida both passed licensure bills (AOTA, 1975c). The rationale in support was written as the
public need for occupational therapy services of uniformly high quality, contemporary problems
of obtaining reimbursement for occupational therapy services, and the need to protect the public
from unqualified practitioners (Johnson, 1975a).
To mitigate some of the concerns West had described in her statement of opposition to licen-
sure, a Model Practice Act was adopted, including a model definition of occupational therapy, to
guide therapists and legislators in preparing licensure bill (AOTA, 1969b). The Model Practice Act
was revised many times over the years and was never officially published after the initial version
but rather acted as a guide to respond to issues related to defining occupational therapy and others
terms commonly used in licensure laws, stating qualifications for practitioners, and suggesting the
 Back to Philosophical Base: 1970s to 1980s 203

Table 7-2
THE PROFESSION BY THE NUMBERS (1977)
OCCUPATIONAL THERAPISTS OCCUPATIONAL THERAPY ASSISTANTS
Female 95% 88%
Degree Baccalaureate degree, 89% Associate degree, 67%
Median age 31.5 years 25.5 years
Median salary $14,500 $10,500
Employed 75%
Provide direct service to 68% 86%
clients
Practice in a hospital setting 30%
Primary area of practice ● Physical disabilities, 65%
● Mental health, 35%
Employed by government 48% 41%
agency (city, county, state,
or federal)
Employed by private, 36% 35%
nonprofit organization
Adapted from: American Occupational Therapy Association. (1978-1979). Annual report. Rockville, MD: Author.

national certification examination be adopted as a major entry criterion. As a result, reciprocity

among occupational therapy practitioners has been more uniform, and the cost of preparing licen-
sure bills has been manageable by the states and jurisdictions seeking licensure.
By 1979, 13 states and two jurisdictions (Puerto Rico and the District of Columbia) were
licensed. Table 7-3 presents a summary by decade of the progress toward state and jurisdiction
licensure. Table 7-4 presents a brief summary of the actions by the Association regarding licensure.

Definitions of Occupational Therapy Practice

Adequate definitions to describe the essence of occupational therapy, while at the same
time describing the breadth and depth of the profession, continue to be a challenge. Several
definitions published during the 1970s are pre-
sented in Table 7-5. The definition used in the
Table 7-3 Occupational Therapy Handbook, a recruit-
P A
ROGRESS IN CHIEVING ICENSURE L ment brochure, describes occupational therapy
as a “health profession” that uses “selected activ-
L S
AWS IN TATES AND URISDICTIONS J ity” while working with a variety of health and
YEARS NO. OF NO. OF other professions to promote health, to evaluate
STATES JURISDICTIONS behavior, and to treat and prevent disability
1968-1979 13 2 (AOTA, 1970a). Mentioning team members is
1980-1989 22
not usual in the definition of occupational
therapy. The 1970 definition also uses the word
1990-1999 6 1
“participation,” which would be used frequently
2000-2009 7 in definitions published after the year 2000.
2010-2015 2 However, the context would be changed from
Total 50 3 (Guam, Puerto participation in activity to participation in daily
Rico, DC) life. In 1971, the definition of occupational
204 Chapter 7

Table 7-4
SUMMARY OF LICENSURE ACTIONS BY DATE
1951 West statement as Executive Director opposing licensure
AJOT, 5(2), 60-63

1969 Motion and Position paper (negative position continued)

AOTA, (1969a). Minutes of the Delegate Assembly, Resolution 230-69. AJOT, 23(6), p. 528 & AOTA. (1969b). Position
Paper. Licensing and standards of competency in occupational therapy. AJOT, 23(6), 529-530 (adopted by the
Delegate Assembly June, 1969)

1974 Resolutions 376-74 neutral on licensure and 400-74 supporting licensure

AOTA (1974). Minutes of the Delegate Assembly, Resolution 376 Licensure and other Credentialing Mechanisms
(neutral stand on licensure). AJOT, 28(9), 564.
Johnson, J.A. (1975). Nationally speaking. AJOT, 29(2), 73.
AOTA (1975). Minutes of the Delegate Assembly, Resolution 400-74 Licensure. (adoption of licensure). AJOT, 29(3),
154-155 Resolution 230-69 was rescinded

therapy appearing in the issue of the Journal of the American Medical Association (JAMA) on
medical education incorporated the term purposeful activity. Purposeful activity as a phrase began
appearing in the occupational therapy literature in 1922 when Edith Bowman, a psychologist,
explained that “the fundamental principle of occupational therapy is a psychological principle: the
substitution of a coordinated, purposeful activity, mental or physical, for scattered activities or the
idleness which comes with weakened body or mind” (Bowman, 1922, p. 172). The phrase purpose-
ful activity would appear frequently in definitions in the 1980s.
In 1972, the Legislation Committee developed an official statement on occupational therapy,
which was presented to the Committee on Ways and Means in the U.S. House of Representatives
as it considered national health insurance legislation. The legislation failed, but the work by the
Association to define occupational therapy to Congress was important in presenting occupational
therapy practice to external groups. Also in 1972, the Council on Standards developed a definition
that would be expanded and published in the 1973 Essentials of an Accredited Education Program
for the Occupational Therapist. In 1974, the Task Force on Social Issues created a definition spe-
cifically for the discussion of social issues, which stressed the scientific aspect of occupation as
a health determinant. In 1975, the first definition of occupational therapy was published to be
used as a model for state licensure laws. The focus on “work assessment” would be changed in
later definitions to a focus on activities of daily living, as noted in the 1977 revision. Note that the
1976 definition appearing in a publication not under the control of the Association still focuses on
occupational therapy as a “medically directed treatment” (U.S. House of Representatives, 1976).
No mention is made of the use of occupational therapy in educational environment because the
Education for All Handicapped Act had only been passed the previous year.

Practice Models
In 1977, Kielhofner and Burke attempted to explain the two major theoretical viewpoints that
had influenced the development of occupational therapy practice in mental health over the years,
which they labeled humanistic moral treatment school and scientific school (Kielhofner & Burke,
1977).
Under the humanistic tradition, the knowledge base for occupational therapy intervention was
governed by the process of studying and examining man’s behavior while acting in the environ-
ment. Thus, the view of man involved an environmental focus on the total organization of behav-
ior. Problems occurred as a result of wrong habits of living and reactions to stress. Intervention
 Back to Philosophical Base: 1970s to 1980s 205

Table 7-5
DEFINITIONS OF OCCUPATIONAL THERAPY IN THE 1970S
1970 Occupational therapy is a health profession which contributes to the physical and emotional inde-
pendence and well-being of an individual through the use of selected activity. The occupational
therapist evaluates each individual to determine the current level of functioning. As a member of the
treatment team, he works in collaboration with the physicians, the physical and speech therapists,
nurses, psychologists, social workers, vocational counselors and other specialists to plan a therapeu-
tic activity program with the following objectives:
● To promote and maintain health
● To evaluate behavior
● To treat physical and emotional disability
● To prevent further disability
Through participation in supervised activity, singly, or in groups, the individual is health to solve
some of his own programs (AOTA, 1970b).
1971 Occupational therapy is concerned with the use of purposeful activity in the promotion and mainte-
nance of health, the prevention of disability, the evaluation of behavior, and as treatment of persons
with physical or psychosocial dysfunction. This is accomplished by using a wide spectrum of treat-
ment procedures based on activities of a creative, social, self-care, educational, and vocational nature
(American Medical Association, 1971).
1972 Occupational therapy is the art and science of directing man s participation in selected tasks to
restore, reinforce and enhance performance, facilitate learning of the skills and functions essential
for adaption and productivity, diminish or correct pathology and to promote and maintain health
(AOTA, 1972d).
1972 Occupational therapists serve today at all levels of health care: in planning, in screening, in programs
preventing health deterioration or injury, in diagnostic, evaluative, treatment, rehabilitation, and
health advocacy services. They function in hospitals, extended-care facilities, clinics, public and spe-
cial schools, rehabilitation centers, and home health agencies. A wide variety of patients are referred
to occupational therapists including those who are blind, infants born with physical deformities or
brain dysfunction, persons whose life style has been permanently altered by serious illness, such as
cancer or stroke, those who are emotionally ill, those who are permanent or temporarily incapaci-
tated by accidents, persons who are mentally retarded, and many others. Occupational therapists
work with physicians, nurses, speech and audiology, physical therapy, nutrition, psychology and
social work (AOTA, 1972c).
1973 Occupational therapy is the art and science of directing man s participation in selected tasks to restore,
reinforce and enhance performance, facilitate learning of those skills and or correct pathology, and
to promote and maintain health. Reference to occupation in the title is in the context of man s goal-
directed use of time, energy, interest, and attention. Its fundamental concern is the development and
maintenance of the capacity throughout the life span, to perform with satisfaction to self and others
those tasks and roles essential to productive living and to the mastery of self and the environment
(AOTA, 1973c).
1974 Occupational therapy is the science of using occupation as a health determinant. Integration of the
individual s psychobiological systems is promoted through selected purposeful use of occupation.
Occupational therapy enhances an individual s ability to perform with satisfaction those tasks and
roles essential to productive, acceptable living (AOTA, 1974b).
(continued)

methodology focused on activity in normal, temporal, physical, and social settings. The goal was
to maintain and restore healthy habits of living.
In contrast, the scientific school of theory suggested that the knowledge base for intervention
should be governed by rules of rational inquiry called the scientific method. The view of man
focused on brain and body rather than the environment. Problems were described in terms of
diseases, such as neurological lesions. Intervention entitled drugs, surgery, and custodial care. The
goal was to alter brain tissues and cells through the use of one or more of the intervention protocols.
206 Chapter 7

Table 7-5 (continued)

DEFINITIONS OF OCCUPATIONAL THERAPY IN THE 1970S
1975 Occupational therapy means the application of knowledge of the effects of occupation upon human
beings to facilitate the integration of biological, social and psychological systems to help them attain
or maintain maximum functioning in their daily life tasks. It includes, but is not limited to such tech-
niques as work assessment, assessment of play and leisure performance, the manipulation of objects,
the development of self-care and capacity for independence through the dynamics of occupational
involvement such techniques being applied in the treatment of individual patients or clients, in groups,
or through social systems (AOTA, 1975g).
1976 Occupational therapy: medically directed treatment of physically and/or mentally disabled individu-
als by means of constructive activities designed and adapted by a professionally qualified occupa-
tional therapist to promote the restoration of useful function (U.S. House of Representatives, 1976).
1977 Occupational therapy is the application of occupation, any activity in which one engages, for evalua-
tion, diagnosis and treatment of problems interfering with functional performance in persons impaired
by physical illness or injury, emotional disorders, congenital or developmental disability, or the aging
process tin order to achieve optimum functioning and for prevention and health maintenance. Specific
occupational therapy services include but are not limited to, activities of daily living (ADL), the design,
fabrication and application of splints; sensorimotor activities; the use of specifically designed crafts;
guidance in the selection and use of adaptive equipment; exercises to enhance functional perfor-
mance; prevocational evaluation and training; and consultation concerning the adaptation of physi-
cal environments for the handicapped. These services are provided to individuals or groups through
medical, health, educational and social systems (AOTA, 1977d).

Occupational therapy practitioners were often caught

between the theoretical viewpoints. Were environmental
factors or brain functions more responsible for mental
illness? Could activity such as occupational performance
complete with drugs and surgery in improving mental
health? Kielhofner and Burke suggested that the crisis for
occupational therapy practitioners to solve revolved around
the concepts of holism versus reductionism—that is, does
a person function as an internal whole in adapting to both
internal and external environments, or does a person func-
tion as a collection of internal tissue parts without regard
for external environment influences? Kielhofner and Burke
favored the former viewpoint based on holism and human-
ism as a basis for future occupational therapy theory devel-
opment. Both were students of Mary Reilly, which likely
influenced their choice of theory construction.
Another strong influence on theory and practice were
the expanding ideas about the importance of human devel-
opmental theories on occupational therapy practice. Llorens Figure 7-1. Lela A. Llorens, PhD, OTR.
(1970) highlighted the potential use of developmental theo- (Printed with permission from the Archive
ries throughout the lifespan for organizing the process of of the American Occupational Therapy
evaluating, planning and intervening to influence behavior Association, Inc.)
expectations and adaptive skills (Figure 7-1). She expanded
her ideas in a follow-up article in 1977 in which she outlined 10 premises on which developmental
theory was based (Llorens, 1977). Clark (1979a, 1979b) expanded the use of human development
theory in her articles describing a practice model she entitled human development through occu-
pation. Clark suggested that human development and adaptation was facilitated by the capacity of
 Back to Philosophical Base: 1970s to 1980s 207

a person to purposefully affect his or her own world

of self, culture, and environment. The long-range
goal of occupational therapy was to enhance the indi-
vidual’s occupational role performance appropriate to
the person’s developmental stage.
The model of sensory integration was increasing
in popularity. In 1972, Ayres published the Southern
California Sensory Integration Tests (SCSIT), a com-
pendium of tests she had originally published as
separate instruments (Ayres, 1972). The SCSIT was
the first test battery published by an occupational
therapist (Figure 7-2).
Mosey (1970) attempted to organize three of the
major models of practice used by occupational thera-
pists in mental health (Figure 7-3). The models as she
named them were object relation analysis, a psycho-
analytic approach; action-consequence, a learning
Figure 7-2. Southern California Sensory Integration
Tests by A. Jean Ayres, published in 1972. (Printed
theory; and recapitulation of ontogenesis, a develop-
with permission from the Archive of the American mental theory.
Occupational Therapy Association, Inc.)
Mental Health Practice
In May 1974, the Executive Board created a Task Force on Mental Health that was charged with
identifying current issues of concern in the practice of occupational therapy in mental health and
to recommend solutions to the identified problems. The Task Force members quickly identified
that the major problem confronting mental health practitioners, and the profession as a whole, was
“a failure to delineate the foundation of our practice” (AOTA, 1976b, p. 6). In addition, there was
no clear delineation nor documentation in the occupational therapy literature for the theoretical
assumptions suggested by Reilly (1962) that man, through the use of his hands, could influence
the state of his health or that occupation was essential to human health and function. Although
all of the published models of practice promised improve-
ment, none had standardized clinical techniques that could
be used to establish the validity of the profession.
A core problem identified by the Task Force members
was undergraduate preparation, which provided practi-
tioners with skills to practice but not the skills to advance
the profession’s knowledge base. To address the problem
in mental health, the Task Force members suggested a
5-year program be implemented to refine the knowledge
base and strengthen the technology by selecting a target
population, such as schizophrenia, to be a focus of study.
Recommendations were also made that the preparation of
therapists move to master’s level entry, that the national
office create a position for a Research Coordinator, that
specialty practitioners be educated beyond entry level, and
that continuing education opportunities be focused on
mental health. Although the Task Force suggested dates Figure 7-3. Anne C. Mosey, PhD, OTR.
(Printed with permission from the Archive
for implementing that recommendations, the Association of the American Occupational Therapy
was unable to meet any of them by the date specified in the Association, Inc.)
report. Instead, the Task Force report added to the growing
body of evidence that work was needed in several areas to
208 Chapter 7

advance the profession. Master’s level entry would occur in 1999. Support for research would be a
target area in the Foundation, but not in the Association. Specialized education in mental health
would be recognized in the specialty certification program.

Legislation
According to the September 1979 Data Line, the passage of the Education of all Handicapped
Act (Public Law 94-142) in 1975 opened hundreds of positions throughout the country for practi-
tioners to work in school settings. Occupational therapy was classified as a related service. Another
piece of legislation with job opportunities for practitioners was the Rehabilitation, Comprehensive
Services, and Developmental Disabilities Amendments of 1978 (Public Law 95-602). Title III
related to Comprehensive Services for Independent Living provides for payment of services such
as occupational therapy for those clients who can increase their level of independence, although
they many have no vocation potential. One change in the regulations is a change in definition of a
developmental disability from a short list of diagnoses to a functional definition, thereby expand-
ing the covered population and thus the demand for occupational therapy services (AOTA, 1979b).
Table 7-6 summarizes the legislation affecting occupational therapy during the 1970s.

Technology
Articles on the use of computers in occupational therapy began appearing in the 1970s. One
of the first articles to discuss the use of computers in occupational therapy practice appeared in
1975 (English, 1975). English summarized examples of use such as recording functional status, use
of computers by individuals with disabilities to learn work tasks such as data entry, and adaptation
of computers to modify input and feedback to the user. The article predates the wider use of per-
sonal computers with Microsoft and Apple software. The use of FORTRAN (formula translation) or
COBOL (common business-oriented language) was discussed instead. The use of computers for data
entry by individuals with disabilities had been previously discussed by Smith (1973). Use of voice as a
modified input system is discussed by Glenn, Miller, and Broman (1976). Use of computer program-
ming for student placement in clinical settings is discussed by Hawkins and Hawkins (1978).

Association
Association Reorganization
During the 1970s, three people served as President of the Association: Florence Cromwell, 1970-
1973 (second term); Jerry A. Johnson, 1973-1978 (Figure 7-4); and Mae D. Hightower-Vandamm,
1978-1982 (Figure 7-5). A summary of their accomplishments appears in Table 7-7. Table 7-8 pro-
vides brief biographies. Figure 7-6 shows the members of the Executive Board during Cromwell’s
second term, and Figure 7-7 shows the six of the past Presidents of the Association: Ruth Brunyate
Wiemer, Wilma West, Helen Willard, Jerry Johnson, Ruth Robinson, and Florence Cromwell.
Two people served as Executive Director of AOTA during the 1970s: Leo Fanning, 1972-1975
(Figure 7-8); and James Garibaldi, 1975-1987 (Figure 7-9). Fanning and Garibaldi were not occu-
pational therapists. A significant change for the Association was moving the its headquarters from
New York City to Washington, DC, in 1972 (AOTA, 1972a). The new office building in shown in
Figure 7-10.
 Back to Philosophical Base: 1970s to 1980s 209

Table 7-6
LEGISLATION ADOPTED IN THE 1970S
THAT HAD EFFECTS ON OCCUPATIONAL THERAPY
1970 Developmental Disabilities Act (P.L. 91-517). Focus was on meeting needs of persons with develop-
mental disabilities by addressing gaps in service.
1970 Elementary and Secondary Education Act Amendments (P.L. 91-230). Created Title VI called
Education of the Handicapped, which consolidated special education programs.
1972 Social Security Act Amendments (P.L. 92-223). Intermediate care facilities could be created for people
with mental retardations.
1972 Social Security Act Amendment (P.L. 92-603). Established supplemental security income to people
on standardized assistance programs.
1973 Rehabilitation Act Amendment (P.L. 93-112). Two parts are important. First, the Architectural and
Transportation Barriers Compliance Board was established to enforce standards on publicly funded
buildings and transpiration. The Act prohibits discrimination against people with disabilities in any pro-
gram that receives federal funding. Employers could not discriminate and governments must provide
equal opportunity and access to programs. The standards in Section 504 established the groundwork
for the standards included in the Americans with Disabilities Act. Second, services were to focus on
independent living, aligning with the deinstitutionalization that occurred, and shifting control from the
provider to the consumer. Also, the term vocational was dropped from the title of the Act.
1973 Health Maintenance Organization Act (P.L. 93-222). Established foundation for managed care in the
insurance industry with a focus on controls for costs and coverage.
1974 Elementary and Secondary Education Act Amendments to Title VI (P.L. 93-380). Introduced the con-
cepts of due process, least restrictive environment, child find, nondiscriminatory testing/evaluation,
child identification, and full service goals.
1975 Developmental Disabilities Assistance and Bill of Rights Act (P.L. 94-103). Institutes with university-
affiliated facilities can provide full service to people with developmental disabilities. These facilities
also offered continuing education for professionals working in the industry. Created state systems for
protection and advocacy. Outlined rights of those who have developmental disabilities.
1975 Education for All Handicapped Children (P.L. 94-142). The Act increased the opportunity for occupa-
tional therapists to work with children with disabilities in schools, to help them participate in school
setting based upon their Individualized Education Program. Part D added training for special educa-
tion, related services, and early intervention providers.
1978 Rehabilitation Comprehensive Services and Developmental Disability Act (P.L. 95-602). National Institute
of Handicapped Researched was established for purpose of grants and research projects. Redefined
developmental disabilities to emphasize severity of impairment functions, NOT the diagnosis.
Adapted from:
Lohman, H. (2014). Payment for services in the United States. In B. A. Boyt Schell, G. Gillen, & M. E. Scaffa (Eds), Willard &
Spackman s occupational therapy (12th ed., pp. 1051-1067). Philadelphia, PA: Wolters Kluwer.
Reed, K. L. (1992). History of federal legislation for persons with disabilities. American Journal of Occupational Therapy, 46(5),
397-408.
Van Slyke, N. (2001). Legislation and policy issues. In M. Scaffa (Ed.), Occupational therapy in community-based practice set-
tings (pp. 85-94). Philadelphia, PA: F. A. Davis.

Mission and Goal Statement

In 1975, the Delegate Assembly adopted a mission and goal statement for the Association
(Resolution 437-75), which is “to serve as an advocate for occupational therapy to enhance the health
of the public in the medical, community, and education environments through research, education,
action, and service” (AOTA, 1975f; Johnson, 1975b, p. 261). Goals of the Association are:
● To provide opportunities for the expression of member concerns, to anticipate emerging
issues, to facilitate decision making, and to expedite the translation of those decisions into
action
210 Chapter 7

Figure 7-5. Mae Hightower-Vandamm,

Figure 7-4. Jerry A. Johnson, EdD, MBA,
OTR, FAOTA, President of AOTA, 1978-1982.
OTR, FAOTA, President of AOTA, 1973-1978.
(Printed with permission from the Archive
(Printed with permission from the Archive
of the American Occupational Therapy
of the American Occupational Therapy
Association, Inc.)
Association, Inc.)

Table 7-7
PRESIDENTS AND MAJOR ACCOMPLISHMENTS
Florence Cromwell, 1970-1973 (second term)
Cromwell continued to address the external organizations that interacted with the Association to develop
health care policy and set health care standards.
Jerry A. Johnson, 1973-1978
During her tenure, she identified issues related to entry level into the profession, ambivalence regarding
licensure, and a need for AOTA to be responsive to the needs and interests of all members. Her major goal
was to move entry to the profession to the master s level because she felt the change would contribute most
to professional growth. Dr. Johnson attended a meeting with President Ford as the AOTA representative of
the Coalition of Independent Health Professions (AOTA, 1976c, 1992b).
Mae D. Hightower-Vandamm, 1978-1982
Under her leadership, the vision for more membership rights and participation became reality. During her
tenure, the office building that houses both AOTA and the Foundation was purchased. Quote: We re rec-
ognized now as a vital profession to the treatment of almost every disability… I think we re headed toward
graduate level certification.
Adapted from AOTA, 1992; 1992b.

● To support the development of research and knowledge bases for the practice of occupational
therapy, and to promote the dissemination and sharing of such information
● To facilitate and support an educational system for occupational therapy which responds to
current needs, and anticipates, plans for, and accommodates to change
● To promote occupational therapy as a viable health profession
● To facilitate the formation of partnerships with consumers to promote optimal health condi-
tions for the public (Johnson, 1975b, p. 161)
Overall, the goals were consistent with the roles of the Association as outlined by Cromwell
(1972): (1) to establish standards of education for its practitioners, for their practice, and for
 Back to Philosophical Base: 1970s to 1980s 211

Table 7-8
PRESIDENTIAL BIOGRAPHIES
JERRY ANN JOHNSON
September 21, 1931‒November 23, 2012
Born in Lubbock, Texas. She attended Levelland High School in Lubbock and received her undergraduate
degree in occupational therapy from Texas Woman s University when the university was called Texas State
College for Women in Denton, Texas. She earned a Master s of Business Administration from Harvard Business
School and then a doctorate in education from Boston University. She received the Distinguished Alumni
award from Texas Woman s University in 1984. She was president from 1973 to 1978, gave the Eleanor Clarke
Slagle lecture in 1972, was a charter member of the Roster of Fellows in 1973, received the Award of Merit in
1979, and was named a Fellow in 1973. She was chair of the Department of Occupational Therapy at Boston
University, Director of the program in occupational therapy at Washington University in St. Louis, and taught
at Thomas Jefferson University in Philadelphia. She was a veteran of the U.S. Navy and served in the U.S. Naval
Reserve. She received the National Defense Serve Medal. She wrote several chapters and articles published in
the occupational therapy literature. Wellness was one of her favorite topics.
MAE DOROTHY HIGHTOWER-VANDAMM
November 11, 1926‒November 20, 2014
Born in Dublin, Georgia. She received a bachelor s degree from Wesleyan College and a master s degree from
Columbia University. She served as Association president from 1978 to 1982, served on the Finance and Budget
Committee, was named to the Roster of Fellows in 1976, and received the Award of Merit in 1983. She wrote
about independent living for the disabled. She served as Executive Director of the Delaware Curative Workshop
for more than 30 years. A building at the Workshop is named in her honor. She was a champion of the cause
of disabled children, and the Mae Hightower-Vandamm Pediatric Fund was formed in recognition of her com-
mitment. She was elected to the Hall of Fame of Delaware Women, served as a docent at the Delaware Art
Museum, and was a Supporter of the Brandywine Conservancy and Winterthur. She served on the board of
the First State Miniature Club and was a member of the National Association of Miniature Enthusiasts. She was
recognized for her award-winning needlework, serving on the Board of Directors of the Main Line Chapter of
the American Needlepoint Guild.

Figure 7-6. Executive Board. From left to right: Myra McDaniel, Fred Odner, Marion Crampton, Joane Wyrick,
Florence Cromwell, Nedra Gillette, Nancy Snyder, Robert Bing, Jerry Johnson, Gail Fidler, and Clyde Butz.
(Printed with permission from the Archive of the American Occupational Therapy Association, Inc.)
212 Chapter 7

Figure 7-7. Past Presidents of AOTA at an AOTA conference. From left to right:
Ruth Brunyate Wiemer, Wilma L. West, Helen S. Willard, Jerry A. Johnson, Ruth A.
Robinson, and Florence S. Cromwell. (Printed with permission from the Archive of
the American Occupational Therapy Association, Inc.)

Figure 7-8. Leo C. Fanning, Executive Figure 7-9. James Garibaldi, Executive
Director of AOTA. (Printed with permis- Director of AOTA. (Printed with permis-
sion from the Archive of the American sion from the Archive of the American
Occupational Therapy Association, Inc.) Occupational Therapy Association, Inc.)

their recognition to practice; (2) to provide ongoing support for excellence of practice; and (3) to
design, prepare for, and implement change strategies to keep the profession timely (p. 3A). Major
themes continued to be education, practice, research, and standards. The newly stated themes were
(1) addressing membership concerns, (2) viewing occupational therapy as a health profession, and
(3) fostering consumer partnerships to promote health. These goals were translated in priorities
for each year. An example is shown in Table 7-9.
 Back to Philosophical Base: 1970s to 1980s 213

Recognition of Student Members and State Association Presidents

The bylaw changes in 1976 (AOTA, 1977c) formalized the organization of two important
constituencies in the Association for the first time. Student members of the Association became
members of the Student Committee under the Representative Assembly.
The Student Committee shall conduct the business of the occupational therapy and
occupational therapy assistant student groups as it related to student issues and concerns
…. The committee shall be chaired by a student member of the Association … and shall
be a member of the Assembly with vote (AOTA Bylaws, Article 10, Section 1H).
Thus, student members had a recognized role within the Association. The second constit-
uency was the State Association
Presidents who were formally orga-
nized as the Committee of State
Association Presidents (CSAP)
under the Executive Board (AOTA
Bylaws, Article 10, Section 2C). All
presidents of state associations were
considered members. “The com-
mittee shall facilitate sharing of
plans and ideas, serve as a forum for
the discussion of relevant current
issues and serve as a centralized
source of information and materi-
als which may be utilized by State
Figure 7-10. National Office, Executive Boulevard, Rockville, Maryland, Association presidents” (Section
1972-1980. (Printed with permission from the Archive of the American
2C). Although informal sharing of
Occupational Therapy Association, Inc.)
ideas and materials had occurred
between states over the years, CSAP
provided a formal mechanism for sharing and also provided another link between members and
the officers of the Association. Ideas coming through the Delegate Assembly had to be presented
as formal motions called Resolutions, whereas ideas coming through CSAP could be presented as

Table 7-9
PRIORITIES IN 1971-1972
● More intensive public education relating occupational therapists service and roles to health and to the
evolving system of health care
● Increased engagement in external affairs̶where health planning and health systems are being dis-
cussed
● Extensive information sharing with members to broaden their perspectives about their own and the
profession s roles in the evolving health system
● Long-range planning for manpower needs̶kinds, levels, how to education, how to certify, how to uti-
lize urgently needed information to blend with community and national programs
● Encouragement of continued professionalization through more and intensified research in both educa-
tion and practice
● Better feedback systems throughout the Association and profession to reinforce self-confidence in these
turbulent times and to spark more innovative models of practice
● Continued attention to standards at all levels of function; update, improve, and disseminate them; and
give evidence of our interest in peer review and public audit
● Capitalization on our image change made possible by the community health model, our extra-hospital
engagement, our humanistic practitioner roles now becoming increasingly evident
Cromwell, F. S. (1972). Nationally speaking. American Journal of Occupational Therapy, 26(2), 3A-6A.
214 Chapter 7

items for discussion without presentation as a formal motion. Both sources increased the informa-
tion available to the Association to act and react to issues of concern to therapists and assistants.

Philosophy of the Profession Project

In 1979, the Representative Assembly adopted Resolution 531-79, entitled the Philosophical
Base of Occupational Therapy, and Resolution 531-79, entitled Occupation as the Common Core
of Occupational Therapy (AOTA, 1979a, p. 785). The philosophical statement includes eight points
in the form of assumptions about the basic philosophy of the profession:
● Man is an active being whose development in influenced by the use of purposeful activity.
● Human beings are able to influence their physical and mental health and their social and
physical environment through purposeful activity.
● Human life is a process of continuous adaptation.
● Adaptation is a change in function that promotes survival and self-actualization.
● Biological, psychological, and environmental factors may interrupt the adaptation process at
any time throughout the life cycle, causing dysfunction.
● Purposeful activity facilities an adaptive process.
● Purposeful activity (occupation), including its interpersonal and environmental components,
may be used to prevent and mediate dysfunction and to elicit maximum adaptation.
● Activity as used by the occupational therapist includes both an intrinsic and therapeutic purpose.
The second resolution on occupation as the core concept is as important as the first. For the
first time, the Association stated that occupation was the core concept of occupational therapy. At
the same time, the lack of clarity remains because the resolution used the term purposeful activity
rather than occupation. The failure to clarify terminology and underlying assumptions is an ongo-
ing issue within the profession itself, as well as within the professional association.
Discussion of philosophy began in 1977, with the formation of the Ad Hoc Committee for
Identifying the Philosophy of Occupational Therapy, chaired by Philip Shannon under the direction
of the Commission on Practice (AOTA, 1977a). The need had been identified in the Task Force on
Social Issues report (AOTA, 1972b). The purposes of the Committee were to define the parameters
of occupational therapy, develop an interface between practice and education and generate theory
from which multiple models might emerge, and provide direction for the association in legislative
issues (AOTA, 1979c).
The final report
was given to the
Representative Assem-
bly in 1983 (AOTA,
1983). Although the
Executive Board rec-
ommended publication
of the final report in
the journal, it was never
published. Part of the
problem occurred when
the 10 former Slagle
lecturers met in July
1982 to identify phi- Figure 7-11. Slagle lecturers who participated in the Philosophical Base Project. From
losophy (Figure 7-11). left to right: (back row) Ruth Wiemer, Jerry Johnson, Carolyn Baum, Wilma West,
Mary Reilly objected to and Mary Reilly; (front row) Betty Yerxa, Gail Fidler, Bob Bing, Muriel Zimmerman,
the transcripts of the and Lorna Jean King. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)
session being published
 Back to Philosophical Base: 1970s to 1980s 215

and made the Association promise not to publish the content for 25 years. Another problem was
the relatively negative tone of the report, suggesting the literature of occupational therapy did not
yield a very useful result.
A few general statements can be made about the outcome of the project. Philosophy was defined
as the “reason for existence, the broad thrust of a profession in relationship to society and the
individual” (AOTA, 1982b, p. 3). Statements from the literature were organized into five categories:
the relation of occupational therapy to man; the relationship of occupational therapy to society;
the role of occupational therapy; assumptions, hypotheses, proposition-supporting programs,
techniques, and methodologies; and Association policies. The review of literature was limited to
three publications: Archives of Occupational Therapy (1922-1924, 18 issues), Occupational Therapy
& Rehabilitation (1925-1951, 162 issues) and the American Journal of Occupational Therapy
(1947-1978, 220 issues). Articles published in other journals such as the Maryland Psychiatric
Quarterly, Trained Nurse and Hospital Review, and Modern Hospital were not reviewed, thus
excluding many early articles written by the founders when the formative ideas about occupational
therapy were first published.

Task Force Reports

The 1970s were the era of the Task Force Reports. There were three: Social Issues
(AOTA, 1972b), Target Populations #1 (AOTA, 1974a) and #2 (AOTA, 1974c), and Mental Health
(AOTA, 1976b). The Task Force on Social Issues was charged to identify and document social,
legislative, humanitarian, professional, political, education, and financial forces, trends, and other
issues that may have an impact on health care in the coming decades; to identify changes in the
health care system; and to identify present, emerging, and potential roles of occupational therapy
and propose recommendations for study and change to the Executive Board of the Association.
The number one issue was legislation, and the recommendation was that the Association, at all
levels of the organization, become more active in the decision-making and policy-making aspects
of legislation affecting health care delivery. The second issue was that occupational therapy prac-
titioners needed to become more active “in the development of accepted theoretical frames of
reference, theories, standardized evaluation and treatment procedures, research, special studies
and publication” (AOTA, 1972b, p. 355). The third issue was to increase involvement in identi-
fying conditions that contributed to illness and disability, especially those in the environment.
Occupational therapy practitioners could help develop new theories and intervention strategies
relating disability to environmental influences. The fourth issue was to assist practitioners to
identify employment opportunities in new areas and models of practice and to attain the skills
to perform the new roles. Fifth, education and practice needed to be based on theory rather than
being technique oriented, and Association documents on education and practice standards should
state and support the theoretical base. Sixth, manpower needed to be increased, but also the level
of performance needed to change from a technical level to a professional level. Occupational thera-
pists needed to know how to function in leadership roles and delegate responsibilities. Seventh,
communication about the Association needed to improve, and more information about occu-
pational therapy practice needed to be made available. Eighth, the gap between the Association
and individual members might be decreased if more activities occurred at a regional rather than
national level. As with other reports, many good ideas were generated to solve identified problems,
but acceptance and integration of the ideas into Association activities was slow.
In 1973, the Delegate Assembly adopted Resolution 367-73 to identify client populations need-
ing the expertise that occupational therapy was uniquely qualified to address to acknowledge pub-
licly the rank order of their priority, to influence Association legislation activities, and to establish
program development activities compatible with the established priorities (AOTA, 1974a). The
Task Force began by asking the following questions: What is an occupational therapist and what
does an occupational therapy do? The answers were organized into a set of assumptions that were
216 Chapter 7

illustrated in a diagram called the Occupational Therapy Process. Although the charge was to
identify client populations that occupational therapy was uniquely prepared to address, the Task
Force members recommended that the Association direct its energies instead to accomplishing the
following specific objectives:
● To undertake activities which will enable occupational therapy to become a uniquely defin-
able, independent health profession
● To further examine, refine, and validate theories related to the practice of occupational ther-
apy to strengthening the educational programs by ensuring the curricula and field placement
centers utilize such frames of reference as the foundation for educational planning
● To continue to identify and understand human health needs and those factors which influence
such needs, particularly as these impinge upon occupational performance
● To meet with competence and responsibility, the consumer health needs which are uniquely
responsive to occupational therapy services (American Journal of Occupational Therapy
[AJOT], 1974b)
Once again, the Association and the profession were directed to establish and delineate the
theoretical base and framework underpinning the practice of occupational therapy. The task force
could not identify the clients that occupational therapy was uniquely qualified to serve because
the profession had not sufficiently stated and supported through research and publication what it
was uniquely qualified to do. Because there was no list of client populations to be served, there was
no way to prioritize which clients should be served, to publicly announce the list, and to focus the
Association resources to that list.

Special Interest Sections

In 1975, the Council on Practice formed a task force to make recommendations regarding the
development of SIS as an organizational part of AOTA. Based on the information provided by
the Council on Practice, the Representative Assembly approved the establishment of the SIS in
October 1976. In January 1977, AOTA President Jerry Johnson appointed an Ad Hoc Committee
on Special Interest Sections to develop a workable structure for the SIS. Based on the Committee’s
work, a draft of the structure was development, including issues such as membership selection,
funding, and basic philosophy (AOTA, 1992a).
The Representative Assembly approved the development of five SIS initially: Developmental
Disabilities, Gerontology, Mental Health, Physical Disabilities, and Sensory Integration. President
Johnson appointed Chairs for the SIS in their initial year of operation. Thereafter, the Chairs were
to be elected by the SIS members. Membership in the SIS is a voluntary benefit that provides con-
tinuing education through presentations at the annual conference and a newsletter.
The Developmental Disabilities SIS provides information on habilitation and prevention issues
by promoting knowledge and skills in services for people who have developmental disabilities.
Practitioners in school-based settings could join the subsection on school systems.
The Gerontology SIS provides members with current information and resources on practice,
research, and legislation of interest to therapists working with elderly patients. Information and
activities include those related to education and training, practice models, intervention approach-
es, reimbursement, service delivery systems, and external organizations concerned with aging.
The Mental Health SIS includes the entire range of mental health practice services in multiple
settings for clients with mental illness and developmental disabilities. Topics covered include
practice models, clinical education, legislative issues, payment systems, research, and recruitment
and retention issues.
The Physical Disabilities SIS provides a forum for sharing information and ideas about physical
disabilities practice. The SIS promotes practice interests through its active members and steering
committee.
 Back to Philosophical Base: 1970s to 1980s 217

The Sensory Integration SIS represents the interests of therapists using Ayres’ sensory integra-
tion approach to evaluate and intervene across multiple age groups and diagnoses. The SIS offers
resources on practice trends, networking, and continuing education.

Registration and Membership

The total number of occupational therapists with membership in AOTA in 1970 was 9,688, and
the total number of occupational therapy assistants was 1,545. States with the largest occupational
therapist memberships were California (1,505), New York (977), Michigan (592), Illinois (495),
Wisconsin (476), and Pennsylvania (409). States with the largest number of occupational therapy
assistants were New York (297), Wisconsin (201), Minnesota (76), and Texas (56). Membership in
the Association continued to be concentrated in the Northeast, North Central, and California in
the far West.

Product Output Reporting System and

Uniform Terminology Project
In October 1977, Congress passed Public Law 95-142, the Medicare and Medicaid Anti-Fraud
and Abuse Amendments. As part of the Amendments, the Secretary of the Department of Health
and Human Services was required to establish regulations for uniform reporting systems for all
hospital departments. Specifically, the stipulations were that “in reporting under such a system,
hospitals shall employ such chart of accounts, definitions, principles, and statistics as the Secretary
may prescribe” (Public Law 95-142). At the time the law was passed, no national system for report-
ing productivity of hospital based occupational therapy services existed. Although the above
statement refers to hospitals, all services reimbursed by Medicare or Medicaid, including hospitals,
skilled nursing and intermediate care facilities, and home health agencies, were to have uniform
reporting systems (AOTA, 1986a).
As with any federal directives, it took a while for them to be put into action. At the July 1978
Board meeting, President Mae Hightower stated that she had received reports from Francis
Acquaviva, National Office Operations Research; letters from the Washington State Occupational
Therapy Association; and a phone call from John Farace, Chair of the Commission on Practice,
all concerned with actions being taken by the Health Care Financing Administration (HCFA)
to prepare the proposed Uniform Hospital Reporting Manual (AOTA, 1978b). Acquaviva had
been informed by Kathy McFarland from Washington State that the HCFA intended to use the
Washington State Relative Value System in the proposed Uniform Hospital Reporting Manual
to be used by all Medicare-certified providers. McFarland wanted the Association to be aware of
proposed HCFA action because the results would affect occupational therapy departments across
the country. Because the comment period regarding the proposed actions was short, comments
were solicited from each of the major Association commissions and committees, and Acquaviva
wrote a reply to HCFA stating membership concerns and requesting funding for a proposal to
complete a project aimed at validating, replicating, and/or developing uniform terminology and a
uniform reporting system for occupational therapy services. Major concerns were that (1) a system
developed in one state (Washington) was proposed to be implemented across the country with no
input or validation from any other state, (2) relative values were being assigned to various items of
terminology rather than numbers of treatment units, (3) the administrative costs of a new system
on occupational therapy departments that probably already had a reporting system would be high,
and (4) the new definition of occupational therapy for licensure adopted by the Association had
not been used.
In August 1978, the Executive Board charged the Commission on Practice to form a task force
to review the existing occupational therapy terminology and relative value reporting systems and
develop a proposal for a national occupational therapy product output report system (AOTA,
218 Chapter 7

1983). The task force was chaired by Sylvia Harlock, a member of the Commission on Practice and
the Washington State Occupational Therapy Association. The purpose of the task force was to
create a national system that could become part of the U.S. Health Care Finance Administration
Manual (AOTA, 1978-1979). The Occupational Therapy Product Output Reporting System,
including the Uniform Terminology System for Reporting Occupational Therapy Services, was
adopted by the Representative Assembly in April 1979 (AOTA, 1979a, p. 805). The document called
the Uniform Occupational Therapy Evaluation Checklist, adapted from the Uniform Terminology
System, was approved by the Representative Assembly in March 1981. The documents printed
in the Occupational Therapy Newspaper (AOTA, 1981) and in the Reference Manual of Official
Documents of the American Occupational Therapy Association in 1983 and 1986 (Hopkins &
Smith, 1983) but were never officially published in AJOT. The Uniform Terminology documents
were never published by the HCFA because the Uniform Hospital Reporting Manual, for which
the documents had been written, never materialized due to congressional concerns about antitrust
issues related to potential price fixing (AOTA, 1989). Although the initial rationale for a reim-
bursement reporting system did not occur, the projects was not a total loss because the Uniform
Terminology document helped create a base of consistent terminology that was used in many
documents to follow. The Uniform Terminology document itself was revised in 1989 and 1994
(AOTA, 1989, 1994).
The uniform terminology system was organized into seven categories of service: occupational
therapy assessment, occupational therapy treatment, patient/client-related conferences, travel,
patient treatment related, service management, and education and research. The first four catego-
ries were considered to be direct service care to patients or clients, whereas the remaining three
were viewed as indirect patient care. Treatment was subdivided into six components, including
independent living/daily living skills, sensorimotor, cognitive, psychosocial, therapeutic adapta-
tion, and prevention. A total of 84 terms were defined or described (AOTA, 1981, 1983, 1986a).

Proficiency Testing and Career Laddering for

Persons Not Educated as Occupational Therapists
In 1971, the Association became involved in the federal program called Proficiency Testing or
Competency-Based Qualification. The Association received a government contract (AOTA, 1972b).
The purpose was to develop an examination that a person could take to qualify as an occupational
therapist without having to complete the required educational program. Phase I was completed
in 1973. Field testing began 2 years later (AOTA, 1975e). A year later, the Association accepted
another Department of Health, Education, and Welfare contract for the final development of the
competency-based criterion-referenced examination (AOTA, 1977b). However, the membership
was not pleased with the results of either project. In 1978, the Representative Assembly voted
that “any grants or contracts applied for and awarded would not obligate the Association to use
or accept resulting products, methods or objectives inconsistent with existing policies and proce-
dures” (AOTA, 1978b). Finally, in 1979, the Representative Assembly voted that proficiency testing
was not an acceptable method of entry into the profession (AOTA, 1979a).
As West (1992) points out, accepting and completing the work of grants on proficiency and
competency testing “may not have been in the best interests of the profession” (p. 1068). In a
1985 “The Issue Is” article, Hinojosa states that competency-based education does not meet the
“needs of a profession regarding accountability and mastery of methodological techniques” and
does address a profession’s philosophical base, theoretical concerns, ethical issues, and affective
functions (p. 541). Credit is due to members of the Association to recognize and correct errors in
judgment (AOTA, 1975a).
 Back to Philosophical Base: 1970s to 1980s 219

Awards
The Representative Assembly established the Roster of Fellows in 1970 with resolution 263-70
and began in 1973 to honor those who had made a significant contribution to the Association
and the profession. From 1973 to 1979, 183 people were named Fellows and permitted to use
FAOTA (Fellow of the American Occupational Therapy Association) after their names. Other new
Association awards include the following:
● 1973—Certificate of Appreciation
● 1976—COTA Award of Excellence
● 1978—Roster of Honor for Occupational Therapy Assistants
● 1978—Cordelia Myers Writer’s Award

Continuing Certification (Resolution 300-71 and Recertification)

The continuing certification process started in 1965 with a motion made by Mildred
Sleeper adopted at the first Delegate Assembly, which stated that the Assembly was to “autho-
rize the appropriate Councils of the association to establish realistic standards for an effec-
tive means of maintaining eligibility for the annual renewal of registration and membership”
(AOTA, 1966, p. 50). A second motion (Resolution 155) that was defeated in 1967 contained a
proposal stating that the minimum requirements for registration were to be completed every 3
years. The responsibility for submitting proof of fulfillment of the requirements would remain
with the individual member. A Committee on Continuing Registration and Certification was to
be established to implement the policy of recertification (AOTA, 1968, p. 520). The issue of con-
tinuing certification was renewed in 1971 with the passage of Resolution 300-71. The aim of the
Resolution was “to improve, promote and insure, insofar as is possible, the provision of quality
care to consumers of occupational therapy services by competent, qualified occupational therapy
personnel” (Johnson, 1972).
In 1975, the report stated that the Continuing Certification Program staff had been working
with six task forces to develop general standards of practice in the areas of developmental disabili-
ties, mental health, and physical disabilities and specific standards in the areas of stroke, arthri-
tis and home health (AOTA, 1975a). A pilot study for a recertification program was to begin in
1976. Other portions of the program included the development of a self-assessment instructional
package for therapists practicing in mental health. The program was funded through a 2-year
Department of Health, Education, and Welfare contract (NO1-AH-44116).
Resolution 540-79 was adopted in April 1979 and stated that the recertification process was a
high priority. The process when fully implemented was to be “mandatory, attainable, accessible,
and cost effective all members and administratively manageable” (AOTA, 1979a, pp. 793-794).
Alternative means were to be allowed to demonstrate continuing competency such as courses
for credit, research, publication, professional participation, honors, exam(s), field work, continu-
ing education, self-study, and conducting workshops. Self-assessment materials were to be made
available to members as soon as possible. As part of the continuing study by the Recertification
Task Force created in 1980, they studied aspects related to feasibility and suitability of recerti-
fication methods, including mandatory continuing education, written examination, on-the-job
performance evaluation, and peer review/chart audit. A summary of the studies was printed in the
Occupational Therapy Newspaper from May through August 1981 (Recertification Study Reports,
1981). Two plans were presented: Plan A was Voluntary Recognition and Plan B was labeled
Research & Development to further study the ramifications of recertification.
In 1982, Resolution 582-82 brought an end to the study of continuing certification and recer-
tification, stating that (1) it was expensive to develop an acceptable and reliable recertification or
voluntary recognition program, (2) the recertification program may not be necessary in the field
of occupational therapy because there was little evidence that therapists or assistants were not
220 Chapter 7

maintaining their competency to practice, and (3) there were other growth-enhancing programs
and services that could be developed for the benefit of therapists and assistants. Therefore, the
resolution dictated that “no further AOTA studies on recertification methods be done until there
is an evidence need for such studies” (AOTA, 1982a, p. 813). Although not stated in the resolution,
another important factor was the increase in the number of states with licensure laws that would
set the requirements for renewing a license within that state. Such requirements would have greater
impact on the practice of occupational therapy than any program developed or implemented
by the Association. Other factors mentioned in final report in 1981 were the mixed reactions
regarding the acceptance by the membership, lack of validity of many of the suggested assess-
ment measurements, and uncertainty regarding public acceptance (Recertification Study Reports,
1981). Ultimately, the National Board for Certification in Occupational Therapy would develop a
voluntary recertification program, and state associations were able to use the accumulated data in
developing the requirements for recertification within each state.

Career Mobility Program

In 1971, the Delegate Assembly adopted Resolution 311-71, which directed the Council on
Standards to develop procedures whereby certified occupational therapy assistants could qualify
to sit for the registration examination and thus become registered occupational therapists with-
out having to return to a formal academic setting (AOTA, 1971a, p. 374). The Career Mobility
Program was developed in response to the resolution and was administered by the Career Mobility
Review Committee, a subcommittee of the Certification Committee. In addition, AOTA adopted
a Statement on Career Mobility in 1973 (AOTA, 1973b).
According to the Annual Report (AOTA, 1978-1979) from 1971 to 1978, 43 certified occu-
pational therapy assistants successfully met the work experience, field work, and examination
requirements to become registered occupational therapists through the Career Mobility Program.
Sixty certified occupational therapy assistants had applied and were participating in the program.
The Career Mobility Program was not without controversy. One concern was the criteria used
to determine successful completion of fieldwork experience. To correct some perceived weak-
nesses, additional resolutions were adopted in 1975 (Resolution 451-75). The criteria were changed
to require the following:
● Current certification by AOTA as an occupational therapy assistant
● Accumulation of not less than 4 years of occupational therapy practice as a certified occupa-
tional therapy assistantA
● Evidence of having fulfilled current fieldwork experience requirement stipulated in the
Essentials of an Accepted Educational Program for the Occupational Therapist, which may
have been fulfilled within the 4 years of occupational therapy practice (AOTA, 1975b, p. 559)

Role Delineation Study

The Role Delineation Study began in 1976. Its purpose was to serve as the basis for a criterion-
referenced entry examination for occupational therapy assistants under a grant contract with the
Department of Health, Education, and Welfare (Shapiro & Brown, 1981). As part of the contract,
both levels (therapists and assistants) of practice were described. In addition, Mae Hightower-
Vandamm, Association President, charged the investigators to delineate the differences and simi-
larities between the two levels of practice. The Professional Examination Service conducted the
study using several separate methodological steps: worker logs, observation/interview, supervisors’
structured checklists, role defined by experts, and role verification. The study results were summa-
rized into 108 tasks statements encompassing the role of occupational therapy practitioner prac-
ticing in entry-level positions where both therapists and assistants were working together. Fifty
tasks were considered to be a part of the evaluation function of occupational therapy practitioners,
 Back to Philosophical Base: 1970s to 1980s 221

12 tasks were considered a planning function, and 46 were labeled as intervention and program ter-
mination functions. Of the 108 tasks, 80 were reported as being done by both therapists and assis-
tants. Both levels were responsible for evaluation, planning, and intervention. However, assistants
performed the tasks under supervision of a therapist and were not responsible for determining that
the task needed to be done or how it was to be performed. Therapists were seen as involved more
often in intervention programs aimed at correcting, improving, or maintaining the components
of performance, whereas assistants were seen as involved more in programs aimed at improving
or maintaining function in occupational performance. Occupational performance was defined as
planning and participation in everyday activities such as self-care, work, academic, homemaking,
leisure, and play (AOTA, 1981, p. 310). Performance components were defined as “learned and/or
inherent elements of behavior that permit the planning and participation in everyday activities”
(AOTA, 1981, p. 311). The difference between the two levels was further articulated in the degree of
responsibility, amount of supervision required, and objective or goal of the intervention program.
Because the purpose of the study was to develop examinations based on entry-level skills only,
the study could not be used to generalize beyond the intent to prepare an examination process.
However, the same or similar methodology was used in a study of roles and functions in the edu-
cation of school-based practice (Gilfoyle & Hays, 1979) and student achievement in occupational
therapy courses (Borg & Bruce, 1981).

Delegate Assembly
In 1975, there were 44 associations represented at the Delegate Assembly meeting. The follow-
ing year, 1976, all 50 states had established state associations as part of the renamed Representative
Assembly. Those with two associations within one state boundary (California, Pennsylvania, and
New York) combined to form one association, and those representing two states (Dakota repre-
senting both North and South Dakota, and Alabama-Mississippi) were separated into individual
state associations (AOTA, 1976a). Finally, all states had functioning occupational therapy state
associations within the state boundary.
The Delegate Assembly become a functioning policy body and began adopting standards,
policy statements, and position papers on a number of topics related to issues of concern to occu-
pational therapy and practice. Table 7-10 summarizes the documents by year of adoption, title, and
location of published document, if known.

Register Publication and Registration Examination

Registers were published in 1970, 1972, and 1974-1975. The last Register was published in 1980.
Thus, the publication of the names of qualified practitioners, which had begun in 1932, ended.
The expense in terms of time and money was no longer considered cost effective. As states became
licensed, initial certification became less important as a statement of qualification because licen-
sure had to be renewed on a regular basis to practice in the state. In addition, state licensing boards
maintained a list of all licensed therapists and assistants in that state, further reducing the need
for a national list.
The registration examination process was transferred to an outside firm in 1972, marking the
first time the examination process was handled outside the Association (Cromwell, 1972, p. 4A).
The transfer was necessary because the process of getting examination questions together for each
examination; getting the examination forms printed; getting packets of examinations ready for
each school; making sure the packets arrived on time; getting packets returned and scored; and
222 Chapter 7

Table 7-10
DOCUMENTS PUBLISHED BY THE ASSOCIATION DURING THE 1970S
1970 ● Educating the Occupational Therapy Assistant: A Guide (AOTA, 19
 Back to Philosophical Base: 1970s to 1980s 223

Table 7-10 (continued)

DOCUMENTS PUBLISHED BY THE ASSOCIATION DURING THE 1970S
1977 ● Guide for Graduate Education in Occupational Therapy Leading to the Master s Degree (1986
Reference Manual)
● Guide to the Preparation of Fieldwork Objectives for Occupational Therapy Students &
Fieldwork Performance Report Form
● Principles of Occupational Therapy Ethics. Reference Manual of the Official Documents of the
American Occupational Therapy Association, 1980. (Revised 1979)
● Proposed policy statement ‒ National Health Insurance, AJOT, 31(2), 110
1978 ● The Role of the Occupational Therapist in the Promotion of Health and Prevention of
Disabilities
● Standards of Practice: Physical disabilities, Developmental Disabilities, Mental Health, Home
Health
1979 ● Enforcement Procedures for Principles of Occupational Therapy Ethics
● Occupational Therapy for Sensory Integrative Dysfunction
● The Role of Occupational Therapy in Home Health Care
● The Role of Occupational Therapy in the Vocational Rehabilitation Process

scoring, and notification made good sense. Occupational therapy practitioners were still involved
in writing the actual questions but experts in testing helped to edit the questions and organize the
content of the examination forms.

American Occupational Therapy

Political Action Committee
The American Occupational Therapy Political Action Committee (AOTPAC) was formed in
the spring of 1978 and announced in the May issue of the Occupational Therapy Newspaper.
The announcement stated the AOTPAC was the members’ “opportunity to bring the profession
of occupational therapy and its concerns to the attention of elected officials” (AOTA, 1978c, p.
1). All Association members were encouraged to donate to the AOTPAC because its purpose was
to be “the political action arm of AOTA” (AOTA, 1978d, p. 2). The primary focus was on influ-
encing passage of federal legislation that promoted the used of occupational therapy services.
Changes to Medicare to increase occupational therapy services was one of the primary objectives
(AOTA, 1978b) (Figure 7-12).

Figure 7-12. AOTPAC coffee mugs. AOTPAC sold coffee mugs at annual AOTA conferences for a number of years to
raise money for the PAC. (Copyright © Dr. Lori T. Andersen. Reprinted with permission.)
224 Chapter 7

Figure 7-13. Alice C. Jantzen, PhD, Figure 7-14. Elizabeth J. Yerxa, Figure 7-15. Myra L. McDaniel, Lt. Col.,
OTR, first President of AOTF, 1965- EdD, OTR, second President of AMSC, OTR, third President of AOTF.
1966. (Printed with permission AOTF, 1966-1968. (Printed with
from the Archive of the American permission from the Archive
Occupational Therapy Association, of the American Occupational
Inc.) Therapy Association, Inc.)

Figure 7-16. Nancy V. Snyder, OTR, Figure 7-17. Wilma L. West, OTR, fifth
fourth and seventh President of AOTF, President of AOTF, 1972-1982. (Printed
1969-1972 and 1986-1988. (Printed with permission from the Archive of
with permission from the Archive of the American Occupational Therapy
the American Occupational Therapy Association, Inc.)
Association, Inc.)

Foundation
In 1975, the Foundation had been functioning for 10 years. Five people had served as President
of the American Occupational Therapy Foundation (AOTF): Alice C. Jantzen, 1965-1966 (Figure
7-13); Elizabeth J. Yerza, 1966-1968 (Figure 7-14); Myra L. McDaniel, 1968-1969 (Figure 7-15);
Nancy V. Snyder, 1969-1972 (Figure 7-16); and Wilma L. West, 1972-1982 (Figure 7-17). The fund
balance had grown from $2,068 in 1955 to $156,488 in 1975. Scholarship awards started in 1969.
The first scholarship award, the OT Affiliate and Student Club Award, was given in June 1959. The
second was the Pauline Gundersen Scholarship for study in the field of psychiatry. In October 1959,
 Back to Philosophical Base: 1970s to 1980s 225

the Carolyn W. Kohn Scholarship Fund was announced. By 1975, 10 scholarship funds had been
established (AOTF, 1975). In 1970, the Foundation moved beyond its first two commitments—
education and research—and began to address the objective of increasing public knowledge and
understanding of the profession. The first publication was a pamphlet titled “The Child With
Minimal Brain Dysfunction” published in July 1974. By 1974, the work of the Foundation became
more than the volunteer officers and directors could handle. A full-time Funding Coordinator was
hired. Funding was shared with the Association.

Reflection
The 1970s were a time of rapid change for the profession and the Association. The headquarters
moved from New York City to Rockville, Maryland to facilitate interaction with Congress and
influence health care legislation favorable to occupational therapy education and practice. The
Association approved the concept of state licensure to better define the practice of occupational
therapy and describe the qualifications of practitioners to participate in state health care laws and
regulations. The number of educational programs and practitioners rose rapidly during the 1970s
as recruitment efforts began to have results and reimbursement through insurance increased reve-
nues for rehabilitation workers such as occupational therapy practitioners as a result of federal leg-
islation, especially Medicare, Medicaid and the Education for All Handicapped Act. Other events
included the philosophy of the profession project and the recognition of practitioners through the
establishment of the Roster of Fellows for therapists and the Roster of Honor for assistants.

References
American Medical Association Medical education. (1971). Occupational therapist. Journal of the American Medical
Association, 208(9), 1270.
American Occupational Therapy Association. (1966). Delegate Assembly minutes. American Journal of Occupational
Therapy, 20(1), 49-53.
American Occupational Therapy Association (1968). A new pin for the registered occupational therapist. American
Journal of Occupational Therapy, 22(6), 520.
American Occupational Therapy Association. (1969a). Licensing and standards of competency in occupational
therapy. American Journal of Occupational Therapy, 23(6), 529-530.
American Occupational Therapy Association. (1969b). Model occupational therapy practice act. Rockville, MD: Author.
American Occupational Therapy Association. (1970a). Occupational therapy handbook. New York, NY: Author.
American Occupational Therapy Association. (1970b). Occupational therapy handbook (p. 2). New York, NY: Author.
American Occupational Therapy Association. (1971a). Delegate Assembly minutes. American Journal of Occupational
Therapy, 25(7), 371-382.
American Occupational Therapy Association. (1971b). Statement on licensure of occupational therapists. Rockville,
MD: Author.
American Occupational Therapy Association. (1972a). From program development—contract awarded. Newsletter,
24(8), 2.
American Occupational Therapy Association. (1972b). Report of the task force on social issues. American Journal of
Occupational Therapy, 26(7), 332-359.
American Occupational Therapy Association (1972c). Report on legislation. New York: American Occupational
Therapy Association.
American Occupational Therapy Association: Council on Standards (1972d). Occupational therapy: Its definition and
functions. American Journal of Occupational Therapy, 26(4), 204-205.
American Occupational Therapy Association. (1973a). Reference manual for occupational therapy educators.
Rockville, MD: Author.
American Occupational Therapy Association. (1973b). Statement on career mobility. American Journal of Occupational
Therapy, 27(3), 157-158.
American Occupational Therapy Association. (1973c). Essentials of an Accredited Education Program for the
Occupational Therapist. American Journal of Occupational Therapy, 27(2), 117-120.
226 Chapter 7

American Occupational Therapy Association. (1974a). Association task force on target populations—report 1.
American Journal of Occupational Therapy, 28(3), 158-163.
American Occupational Therapy Association. (1974b). Association task force on target populations—report 1.
American Journal of Occupational Therapy, 28(3), 160.
American Occupational Therapy Association. (1974b). Association task force on target populations—report 2.
American Journal of Occupational Therapy, 28(4), 231-236.
American Occupational Therapy Association. (1975a). Annual report 1975. Rockville, MD: Author.
American Occupational Therapy Association. (1975b). Delegate Assembly minutes. American Journal of Occupational
Therapy, 29(9), 552-564.
American Occupational Therapy Association. (1975c). Delegate Assembly: Resolution 400-74 Licensure. American
Journal of Occupational Therapy, 29(3), 154-155.
American Occupational Therapy Association. (1975d). Exam changes for OTRs. Occupational Therapy Newsletter,
29(10), 3.
American Occupational Therapy Association. (1975e). Field testing of proficiency examinations for entry level OTs is
completed by PES, final report available. Occupational Therapy Newspaper, 29(4), 10.
American Occupational Therapy Association. (1975f). Delegate assembly minutes. American Journal of Occupational
Therapy, 29(3), 153-159.
American Occupational Therapy Association. (1975g). Model Occupational Therapy Practice Act. American Journal
of Occupational Therapy, 29(1), 48-49.
American Occupational Therapy Association. (1976a). Letters to the editor. American Journal of Occupational
Therapy, 30(2), 110-112.
American Occupational Therapy Association. (1976b). Report of the mental health task force. Occupational Therapy
Newspaper, 30(9), 6-7.
American Occupational Therapy Association. (1976c). President Ford addresses CIHP Members. Occupational
Therapy Newsletter, 30(5), 5.
American Occupational Therapy Association. (1977a). In search of a philosophy. Occupational Therapy Newspaper,
31(10), 11.
American Occupational Therapy Association. (1977b). Proficiency testing update. Occupational Therapy Newspaper,
31(2), 6.
American Occupational Therapy Association. (1977c). Bylaws. American Journal of Occupational Therapy, 31(2),
111-118.
American Occupational Therapy Association. (1977d). Representative Assembly Minutes. American Journal of
Occupational Therapy, 31(9), 585-606.
American Occupational Therapy Association. (1978a). 1977 membership data survey. Bethesda, MD: Author.
American Occupational Therapy Association. (1978b). Minutes of conference call (of the Executive Board) dated July
18, 1978. Bethesda, MD: AOTA/AOTF Library.
American Occupational Therapy Association. (1978c). Political action mailing. Occupational Therapy Newspaper,
32(5), 1.
American Occupational Therapy Association. (1978d). Political action—a tool for OT. Occupational Therapy
Newspaper, 32(7), 2.
American Occupational Therapy Association. (1978-1979). Annual report. Rockville, MD: Author.
American Occupational Therapy Association. (1979a). 1979 Representative Assembly, 59th Annual Conference.
American Journal of Occupational Therapy, 33(12), 780-813.
American Occupational Therapy Association. (1979b). Data Line: Manpower needs for OT personnel. Occupational
Therapy Newsletter, 33(9), 3.
American Occupational Therapy Association. (1979c). Project to identify the philosophy of occupational therapy.
Occupational Therapy Newsletter, 33(9), 1-6.
American Occupational Therapy Association. (1981). Uniform terminology for reporting occupational therapy
services and uniform occupational therapy evaluation checklist. Occupational Therapy Newspaper, 39(11), 9-12.
American Occupational Therapy Association. (1982a). 1982 Representative Assembly—62nd annual conference.
American Journal of Occupational Therapy, 36(12), 809-820.
American Occupational Therapy Association. (1982b). Introduction to AOTA project to identify the philosophy of
occupational therapy (p. 3). Rockville, MD: Author.
American Occupational Therapy Association. (1983). Development of proposed occupational therapy product
output reporting system. In Reference manual of the official documents of the American Occupational Therapy
Association (pp. 29-36). Rockville, MD: Author.
 Back to Philosophical Base: 1970s to 1980s 227

American Occupational Therapy Association. (1985). Occupational therapy manpower: A plan for progress. Rockville,
MD: Author.
American Occupational Therapy Association. (1986a). Development of proposed occupational therapy product
output reporting system. In Reference manual of the official documents of the American Occupational Therapy
Association (pp. VIII.19-21). Rockville, MD: Author.
American Occupational Therapy Association. (1986b). Occupational therapy product output reporting system and
uniform terminology for reporting occupational therapy services. In Reference manual of the official documents
of the American Occupational Therapy Association (pp. VIII.11-18). Rockville, MD: Author.
American Occupational Therapy Association. (1989). Uniform terminology for occupational therapy, 2nd edition.
American Journal of Occupational Therapy, 43(2), 808-815.
American Occupational Therapy Association. (1992a). An historical look at special interest sections. OT Week, 16, 6-7.
American Occupational Therapy Association. (1992b). AOTA’s Hall of leaders. OT Week, 6(21), 40-43
American Occupational Therapy Association. (1994). Uniform terminology for occupational therapy, 3rd edition.
American Journal of Occupational Therapy, 48(11), 1055-1059.
American Occupational Therapy Foundation. (1975). The first decade: 1965-1975. American Journal of Occupational
Therapy, 39(10), 636-640.
Ayres, A.J. (1972). Southern California Sensory Integration Tests. Los Angeles, CA: Western Psychological Services.
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services
Borg, B., & Bruce, M. A. (1981). Criterion-reference measurement in the college classroom. American Journal of
Occupational Therapy, 35(5), 321-327.
Bowman, E. (1922). Psychology of occupational therapy. Archives of Occupational Therapy, 1(3), 171-178.
Clark, P. N. (1979a) Human development through occupation: Theoretical frameworks in contemporary occupational
therapy practice—part 1. American Journal of Occupational Therapy, 33(8), 505-514.
Clark, P. N. (1979b). Human development through occupation: A philosophy and conceptual model for practice—part
2. American Journal of Occupational Therapy, 33(9), 577-585.
Cromwell, F. S. (1972). Nationally speaking. American Journal of Occupational Therapy, 26(2), 3A-6A.
English, C. B. (1975). Computers and occupational therapy. American Journal of Occupational Therapy, 39(1), 423-447.
Fanning, L. C. (1972). Executive director report – Mid year, p. 17. New York, NY: American Occupational Therapy
Association
Gilfoyle, E. M. N., & Hays, C. A. (1979). Occupational therapy roles and functions in the education of school-based
handicapped students. American Journal of Occupational Therapy, 33(9), 565-576.
Glenn, J. W., Miller, K. H., & Broman, M. T. (1976). Voice terminal may offer opportunities for employment to the
disabled. American Journal of Occupational Therapy, 30(5), 308-312.
Hawkins, J. M., & Hawkins, B. (1978). Clinical placements by computer program. American Journal of Occupational
Therapy, 32(6), 390-394.
Hinojosa, J. (1985). The issue is: Implications for occupational therapy of a competency-based orientation. American
Journal of Occupation Therapy, 39(8), 539-541.
Hopkins, H. & Smith, H.D. (Eds.). (1978). Occupational therapy, 3rd ed. Philadelphia, PA: Lippincott.
Hopkins, H., & Smith, H.D. (Eds.). (1983). Appendix D: Uniform terminology for reporting occupational therapy
services; Appendix E: Occupational therapy product output reporting system; Appendix F: Uniform occupa-
tional therapy evaluation checklist. In Willard and Spackman’s occupational therapy (6th ed., pp. 899-914).
Philadelphia, PA: J. B. Lippincott.
Johnson, J. A. (1972). Summary of interim planning committee activities for Resolution #300-71, June 1971–February
1972: Addendum to Executive Director report—Midyear conference. New York, NY: AOTA.
Johnson, J. A. (1975a). Nationally speaking: Licensure. American Journal of Occupational Therapy, 29(2), 73.
Johnson, J. A. (1975b). Nationally speaking: Mission and goal statements. American Journal of Occupational Therapy,
29(5), 261.
Johnson, J. A. (1978). Nationally speaking: Issues in education. American Journal of Occupational Therapy, 32(6),
355-358.
Kielhofner, G., & Burke, J. P. (1977). Occupational therapy after 60 years: An account of changing identify and knowl-
edge. American Journal of Occupational Therapy, 31(1), 675-689.
Lee, H. S., Robinson, R. A., Whitcomb, B., & Lovett, H. M. (1968). The period of stabilization, July 1953 to January
1961. In R. S. Anderson, H. S. Lee, & M. L. McDaniel (Eds.), Army Medical Specialist Corps (pp. 391-430).
Washington, DC: Office of the Surgeon General, Department of the Army.
Llorens, L. A. (1970). Facilitating growth and development: the promise of occupational therapy. American Journal of
Occupational Therapy, 24(2), 93-101.
228 Chapter 7

Llorens, L. A. (1977). A developmental theory revised. American Journal of Occupational Therapy, 31(10), 656-657.
Mosey, A. C. (1970). Three frames of reference for mental health. Thorofare, NJ: Charles B. Slack.
Neuhaus, B. E. (1971). Implementation of Resolution #221. American Journal of Occupational Therapy, 23(1), 65-68.
Recertification Study Reports (1981). Occupational Therapy Newspaper, 35(5), 1, 13; 35(6), 7; 35(7), 3, 35(8), 3; 35(9), 5.
Reilly, M. (1962). The Eleanor Clarke Slagle: Occupational therapy can be one of the great ideas of 20th century medi-
cine. American Journal of Occupational Therapy, 26(1), 1-9.
Shapiro, D., & Brown, D. (1981). The delineation of the role of entry-level occupational therapy personnel. American
Journal of Occupational Therapy, 35(5), 306-311.
Smith, E. I. (1973). The employment and functioning of the homebound disabled in information technology.
American Journal of Occupational Therapy, 27(5), 232-238.
Trombly, C.A. & Scott, A.D. (1977). Occupational therapy for physical dysfunction. Baltimore, MD: Williams &
Wilkins.
U.S. House of Representatives. Committee on Interstate and Foreign Commerce. (1976). A discursive diction of health-
care (p. 112). Washington, D.C.: Superintendent of Documents.
West, W. L. (1992). Ten milestone issues in AOTA history. American Journal of Occupational Therapy, 46(12), 1066-1074.
Willard, H.S. & Spackman, C.S. (Eds.). (1971). Occupational therapy, 4th ed. Philadelphia, PA: Lippincott.

Bibliography
American Occupational Therapy Association. (1973). Continuing certification program to involve practice interests,
membership. Occupational Therapy Newspaper, 27(2), 1.
American Occupational Therapy Association. (1976). Annual report. Rockville, MD: Author.
American Occupational Therapy Association. (1976). Delegate Assembly minutes. American Journal of Occupational
Therapy, 30(3), 168-180.
American Occupational Therapy Association. (1976). OTAs to take certification exam. Occupational Therapy
Newspaper, 30(6), 1.
American Occupational Therapy Association. (1986). Uniform occupational therapy evaluation checklist. In
Reference manual of the official documents of the American Occupational Therapy Association (pp. VIII.22-23).
Rockville, MD: Author.
 8
Search for a Unifying Theory
1980s to 1990s

Key Points
● The Association purchased a building to house national office activities and staff for the first time.
● Association membership increased significantly.
● The American Occupational Therapy Certification Board (AOTBC) was created in 1986.
(Forerunner of the National Board for Certification in Occupational Therapy.)
● Uniform Terminology II was published in 1989.
● There was an increased use of computers and physical agent modalities in occupational
therapy service delivery.
● The library was organized and materials catalogued to create an archive and library of occu-
pational therapy letters, documents, journals, books, and artifacts—1980.
● The Academy of Research was established by the Foundation in 1983.
● The number of journals focused on occupational therapy rapidly increased beginning in 1980.

Highlighted Personalities
● Gary Wayne Kielhofner, theorist ● Robert Kendall Bing, AOTA President,
● Elizabeth June Yerxa, theorist 1983-1986
● Claudia Kay Allen, theorist ● Elnora M. Gilfoyle, AOTA President,
● Carolyn Manville Baum, AOTA 1986-1989
President, 1982-1983 ● Jeannette Bair, AOTA Executive Director
● Martha Moersch, AOTF President

Key Places
● The Association bought a headquarters building in Rockville, Maryland.

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 229-260).
- 229 - © 2017 SLACK Incorporated.
230 Chapter 8

Political Events/Issues Key Times/Events

● Concern about anti-trust issues led to the ● Certification and membership fees sepa-
certification process being separated from rated in 1986: Membership dues could be
Association membership. paid without paying for continuing certi-
● The Omnibus Reconciliation Act of 1980 fication as state licensure became primary
included payment for occupational ther- means of establishing continuing compe-
apy services in comprehensive outpatient tence to practice.
rehabilitation facilities and home health.
● Occupational therapy was a qualifying Sociocultural Events/Issues
service for home health under Medicare
starting in 1981. ● Home computer age expanded rapidly
● Occupational therapy was covered in hos- with the introduction of the IBM model
pice care under Medicare in 1982. 8088.
● With an increase in geriatrics, there was
recognition that the population was aging.
Economic Events/Issues
● Reimbursement for occupational therapy
services Technological Events/Issues
● Diagnostic Related Groups (DRGs) imple- ● Computers become a major medium in
mented occupational therapy practice.
● Electronic media enhance self-care devices
Association Issues for client service.

● Manpower Study, 1983-1985 Educational Issues

● Policy on use of physical agent modalities
adopted by Representative Assembly ● Essentials and Guidelines of an Accredited
Education Program for the Occupational
● Occupational Therapy Directions for the
Therapist—revised in 1983
Future Project completed
● Essentials and Guidelines of an Approved
● Professional and Technical Role Analysis
Educational Program or the Occupational
(PATRA) project completed
Therapy Assistant—revised in 1983
● Task Force on OT/PT Issues reported find-
ings
● Uniform Occupational Therapy Evaluation Practice Issues
Checklist published in 1981
● Approximately 40% of hospitals and 30%
● Second edition of Uniform Terminology
of nursing homes offered occupational
document adopted, 1989
therapy services.
● Hospitals, school settings, and nursing
Foundation Issues homes were major employers.
● Archival materials, monographs (books), ● De-emphasis on the use of crafts in favor
and serials (journals) were formally orga- of modalities with more direct measure-
nized and catalogued into a library within ment potential, especially in physical dis-
the Foundation, 1980 abilities practice
● Computerized online database of library ● Theories based on principles of occupa-
materials created tional therapy were created.
● Academy of Research established in 1983
● Developing working relationship with the
Association
 Search for a Unifying Theory: 1980s to 1990s 231

“Occupational Therapy—A Vital Link to Productive Living”

–New slogan adopted by AOTA, 1986

Introduction

P
resident Ronald Reagan served two terms, from 1980 to 1988. During the 1980s, the Cold
War between the Soviet Union and the United States thawed out on the military front,
ending with the fall of the Berlin Wall in 1989. At the same time, interest heated up on the
space shuttle technology front. A new era of technology emerged with the creation of the first per-
sonal computer by IBM in 1981. The development of the Internet began to change communication
systems in ways not previously imagined possible. Technological advances led to improvements in
health care, but the costs of health care would greatly increase. New approaches to reimbursement
from per diem rates to per service costs would force occupational therapy practitioners to demon-
strate evidence that showed their services to be of value in promoting health and wellness as well
as decreasing the impact of disability. The challenge to explain increased as occupational therapy
practitioners both expanded their service roles and began to specialize in different areas of prac-
tice. The efforts made to establish a unifying scope of practice led to a paradigm shift away from
the mechanistic, biomedical view toward a more holistic and client-centered approach to practice
and serve delivery. New ideas such as the Model of Human Occupation (Kielhofner), clinical rea-
soning (Rogers), and occupation science (Yerxa) expanded the concepts about how occupational
therapy should be explained and what processes were needed to implement occupational therapy
services. State licensure continued to be an issue and further challenged occupational therapy
practitioners to identify what constituted occupational therapy service and what identified a
competent occupational therapy practitioner. The impact of Public Law 94-142 (Education for All
Handicapped; now Individuals with Disabilities Act) increased the role of occupational therapy in
the school system as the concept of self-care became important for children to function success-
fully in the school environment.

Changing Trends
Bair (1982) suggested there were 10 topics related to changes in practice affecting occupational
therapy in the 1980s:
● Age of the population: The population continues to age, growing from 10% in 1975 to an
expected 20% by 2030. The number of long-term care facilities will grow as a result. Treatment
focusing on home care will increase. For older individuals, the issues of self-reliance and
mobility are major considerations.
● Consumer awareness: Increased public education and awareness will result in people being
more aware of self-responsibility for personal health. Wellness and prevention concepts are
increasing accepted for both philosophical and economic reasons.
● Technology: Improved technology will help more people to survive catastrophic illness.
However, the cost may restrict access to new technology for some clients.
● Business influence: Business leaders favor a more competitive health care market as a means
of reducing or controlling costs. Businesses are providing more health maintenance programs
to employees. Strategic planning, marketing, productivity, and accountability are becoming
important aspects of the health care industry.
232 Chapter 8

● Environmental and economic disasters and dislocation: Concern that environmental disasters
and economic disasters could impact health care delivery, especially as people move to the
sun belt.
● Shift in personal values and lifestyles: There has been a gradual shift in Americans’ values
away from materialistic attainment toward more community-directed and spiritual goals.
More people are interested in holistic medicine, nutrition, exercise, and health promotion.
● Hospitals: More hospitals are becoming part of corporate groups to face complex regulatory
demands and cost constraints. In 1958, 200 hospitals were grouped in a formal system, but
by 1981, there were 34 investor-owned systems managing 900 hospitals and 300 not-for-profit
facilities. The number of acute beds is expected to decrease while the number of emergency
centers, wellness and fitness, and home health care programs is expected to increase.
● Long-term care: The number of long-term care facilities is expected to grow rapidly as the
elderly become a more powerful political and lobby group. There will more focus on the total
needs of the elderly.
● Psychiatric mental health facilities: The growth is in drug addiction and alcoholism programs.
● Hospice: From 1974 to 1981, the number of hospice programs grew from 1 to more than 800.
Most programs are free—standing even if they are hospital affiliated.
The challenges included keeping pace with the changes in health care delivery. Occupational
therapy personnel became more actively involved in cardiac rehabilitation, stress reduction, work-
ing with the elderly, pain management programs, and promoting early infant development. Other
challenges included the development and use of technological advances in rehabilitation such as
bioelectric limbs, computers, and computer-based communication systems.
In an article focusing on the growth of the profession during the 1980s, Gilfoyle (1987) outlined
the challenges facing the profession. The challenges have been reordered to group them together
into those that must be addressed within (I [internal]) the profession and those that require inter-
action with external groups (E). There should be an increased focus on:
● Demonstrating accountability for occupational therapy services, including effectiveness and
efficacy (I)
● Developing a scientific foundation regarding use of human occupation throughout the lifespan (I)
● Establishing new priorities to meet members’ needs to respond to a consumer-driven health
care environment supporting health promotion, disease prevention, and productive living (I)
● Decreasing dependence on the medical system for delivery of services as have been in the past:
focus on becoming a health-related and human service profession (I)
● Continuing to focus on standards of practice, Code of Ethics, and the credentialing process (I)
● Improving public’s awareness and understanding of occupational therapy services by reaching
out to various publics with whom we work (E)
● Engaging in interprofessional collaboration with other health and human service organizations (E)
● Focusing on consumer collaboration to advocate for the rights of special populations (E)

Education
Number and Location of Educational Programs
The number of educational programs increased from 57 professional programs (including
Puerto Rico) and 52 assistant-level programs in 1980 to 68 professional programs and 68 assistant
programs (AOTA, 1980-1981, 1989a). Thirty-three states plus the District of Columbia and Puerto
Rico had at least one professional level program operating within the state (AOTA, 1989a). Thirty
 Search for a Unifying Theory: 1980s to 1990s 233

states had an assistant-level program operating within the state. Western states composed the larg-
est group of states with no occupational therapy education program within the state at either the
professional or assistant level. Western states with no professional-level program included Alaska,
Idaho, Montana, Wyoming, South Dakota, Nevada, Utah, Arizona, New Mexico, and Iowa.
Eastern states included Kentucky, Mississippi, South Carolina, West Virginia, Vermont, Delaware,
and Rhode Island. Figures 8-1 and 8-2 show the location of the professional- and technical-level
programs.

2
1 1
1 2 1 MA - 3
3 8
3
5 CT - 1
1 2
3 2
NJ - 1
3 1 2 1
1 1 MD - 1
2
1 1 D.C. - 1
1
2 1
4 2
2

Puerto Rico - 1

Figure 8-1. Location of professional education in occupational therapy (AOTA, 1989a).

2
1
1 4 1 MA - 4
3 7
3
1 5 CT - 1
5 1 5
1 NJ - 2
1 1 2
MD - 1
1 2
1 1
1 1
4 1
1

Puerto Rico - 2

Figure 8-2. Location of occupational therapy assistant programs (AOTA, 1989a).

234 Chapter 8

Essentials Revision
In 1983, the Essentials and Guidelines of an Accredited Education Program for the Occupational
Therapists were revised for the fifth time the original document was developed in 1935
(AOTA, 1983a). Previous revisions since the original document was developed in 1935 were in
1943, 1949, 1965, and 1973. The Essentials and Guidelines of an Approved Educational Program
for the Occupational Therapy Assistant were also revised for the fifth time since the original docu-
ment was approved in 1958 (AOTA, 1983b). Previous revisions were in 1962, 1967, 1970, and 1975.
A major change in the 1983 document for the occupational therapist is the recognition that theo-
ries, not just theory, of occupational therapy need to be identified and taught. Theories and theo-
retical approaches include human performance and activity processes such as purposeful activity,
life tasks, and adaptation (AOTA, 1983a, 1983b). The shift from stating semester credits or hours
of instruction to listing subject matter and concept attainment continued from the 1973 revision.
The focus on techniques was less on task-specific skill attainment (learning to crochet) and more
on understanding and applying critical analysis skills (activity analysis). The focus continued to
be less on the diseases, disorders, or conditions themselves and more on the effects of dysfunc-
tion and problems in living that result from such conditions on human functioning, health, and
society. As theories in occupational therapy were included within the content, the language began
to shift away from medical terminology to terminology related to occupational therapy practice.
Intervention expanded to include health maintenance and prevention.

Practice
Definitions of Occupational Therapy
As the sample definitions in Table 8-1 suggest, a working definition that accurately described
the current state of occupational therapy was inconsistent at best. Whereas the Association strug-
gled to redefine the profession as focusing on health using a variety of media and methods, others
continued to define the profession solely in relation to medicine and focused on the application
of “objects” for remedial or diversional purposes (Kamenetz, 1983). Standard English dictionaries
described occupational therapy in such a variety of ways that the Representative Assembly adopted
a definition primarily for use in dictionaries (AOTA, 1986a). The national office was instructed
to send the definition to publishers whenever the definition of occupational therapy was not
descriptive of current practice. At the same time, the need for a more comprehensive definition
was needed for the revised Essentials (AOTA, 1983g) that described the profession in wording
consistent with the current view of the profession.

Models of Practice
Several significant models of practice were first published in the 1980s (Table 8-2). At the same
time, research about existing models used in practice was beginning to be discussed. DeGangi
(1983) published an article describing a research methodology for studying neurodevelopmental
treatment. The suggested method was criticized by Magrun, deBenabib, and Nelson (1983) as
unlikely to provide evidence of effective change in motor performance because baseline data were
not provided and the description of the play environment was not described in enough detail. A
crossover design was suggested. DeGangi replied by discussing the issues in selecting research
designs for young children, including controlling for maturational effects of the developing child
and selecting observations of motor performance that can be reliably observed for measurement
(DeGangi, 1983).
 Search for a Unifying Theory: 1980s to 1990s 235

Table 8-1
DEFINITIONS OF OCCUPATIONAL THERAPY IN THE 1980S
1981 Occupational therapy is the use of purposeful activity with individuals who are limited by physi-
cal injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and
cultural differences or the aging process in order to maximize independence, prevent disability and
maintain health, etc. (AJOT, 35(12) Resolution 572-81.)
1983 A system of medically prescribed activities, typically involving the use of objects to increase coor-
dination, range of motion, power, and function, or for diagnostic, psychiatric, or other therapeutic
purposes. (Kamenetz, H.L. (19783). Dictionary of rehabilitation medicine, p. 214. New York: Springer.)
1983 Occupational therapy is the art and science of directing man s participation in selected tasks to
restore, reinforce and enhance performance, facilitate learning of those skills and functions essential
for adaptation and productivity, diminish or correct pathology, and to promote and maintain health.
Reference to occupation in the title is in the context of man s goal-directed use of time, energy, inter-
est, and attention. Its fundamental concern is the development and maintenance of the capacity
throughout the life span, to perform with satisfaction to self and others those task and roles essential
to productive living and to the mastery of self and the environment. (Essentials and guidelines of an
accredited educational program for the occupational therapist, AJOT, 1983, 37(12), 817-823.)
1984 Occupational therapy is a specialized health care service whose practitioners treat people who
have physical, emotional and developmental disabilities. Occupational therapists and occupational
therapy assistants help disabled people of all ages acquire or regain the skills they need to live inde-
pendent, productive, and satisfying lives. (AJOT Calendar. The World of Occupational Therapy, 1984)
1986 Occupational therapy: Therapeutic use of self-care, work, and play activities to increase inde-
pendent function, enhance development, and prevent disability. May include adaptation of
task or environment to achieve maximum independence and to enhance quality of life. (AOTA
Representative Assembly minutes, AJOT 40(12), 852)

Table 8-2 Blakeney, Strickland, and

Wilkinson (1983) published an
MODELS OF PRACTICE article on the use of sensory inte-
grative techniques with adults
1980 Model of human occupation (Kielhofner et al.)
diagnosed with schizophre-
1981 Spatiotemporal adaptation (Gilfoyle & Grady) nia. Rosenthal (1983) cautioned
1982 Ecological systems model (Howe & Briggs) that other approaches may be as
1985 Cognitive disability (Allen) effective at improving adaptive
1988 Occupational form and occupational performance (Nelson)
responses such as improved pos-
ture and gait, decreased psycho-
1989 Occupational science (Yerxa et al.)
motor retarding, and normaliza-
tion of behavior in general. She
stated that a diagnostic-prescrip-
tive physical activity program
could produce similar results and
reminded the reader that sensory
integration should not be used as
a panacea.
Gary Kielhofner (Figure 8-3)
and colleagues published a series
of four articles presenting the
Model of Human Occupation
(MOHO) (Kielhofner, 1980a,
Figure 8-3. Gary Kielhofner, PhD, OTR. (Printed 1980b; Kielhofner & Burke,
with permission from the Archive of the American
Occupational Therapy Association, Inc.) 1980; Kielhofner, Burke, & Igi,
1980). Although Kielhofner was a
236 Chapter 8

Table 8-3
PERSONALITIES
GARY WAYNE KIELHOFNER
February 15, 1949‒September 2, 2010
Born in Oran, a small farming community in southeastern Missouri. He was the only boy with four sisters. He
earned a degree in psychology from St. Louis University in 1974, a master s degree in occupational therapy from
the University of Southern California in 1974, and a doctorate in public health from the University of California
Los Angeles in 1980. He was a faculty member at Virginia Commonwealth University and Boston University
before joining the faculty at the University of Illinois in Chicago in 1986 and becoming Head of the Department
of Occupational Therapy, a job he held for 20 years. He was a Wade/Meyer Chair in Occupational Therapy. He
learned about occupational therapy while working on a rehabilitation unit in a St. Louis hospital to fulfill the
obligation for community service as a conscientious objector during the Vietnam War. In 1980, he and Janice
Burke introduced a theoretical model called the Model of Human Occupation (MOHO), designed to fill a gap
in understanding and address clients with psychosocial challenges in the rehabilitation process. The model
provided a guide to assessment and a reasoning process to measure the impact of intervention. The model was
originally published in four articles in AJOT and later in four book editions. The model became popular and was
used widely across many countries. In addition to the model, he also published articles and books on research
techniques and books on conceptual models used in occupational therapy. He was named to the Roster of
Fellows in 1983 and to the Academy of Research in 1984.
(Braveman, B., Fisher, G., & Suerez-Balcazar, Y. (2010). Achieving the ordinary things : A tribute to Gary Kielhofner.
American Journal of Occupational Therapy, 64[6], 638-631.)
ELIZABETH JUNE YERXA
Born August 18, 1930
Born in Pasadena, California. She graduated from the University of Southern California with a bachelor s degree
in occupational therapy in 1952. She earned a master s in 1967 and a doctorate in 1970 in education psychol-
ogy from Boston University. She worked in the cerebral palsy unit of the Los Angeles Orthopedic Hospital
and for the California Elks Association cerebral palsy mobile unit in Lancaster, California. She was employed as
an instructor in occupational therapy at the University of Puget Sound in Tacoma, Washington. She worked
for 15 years as an instructor, educational coordinator, and research coordinator in the Occupational Therapy
Department of Rancho Los Amigos Hospital in Downey, California. She was professor and Chairperson,
Department of Occupational Therapy, University of Southern California, from 1976 to 1988. She served as
Chairman of the Committee on Student Affiliations; was a member of the Council on Education and the
Developmental Advisory Committee; was a member-at-large of the Board of Management; and was Vice
President of the Association. She presented the Eleanor Clarke Slagle lectureship in 1966 and was named to
the Roster of Fellows in 1973 and the Academy of Research as a charter member in 1983. She was the second
President of the AOTF in 1967.
(AJOT, 15(4), 174; 16(4), 210 and 22(2), 62. Photo AJOT, 1967, 21(5), 299)
CAROLYN MANVILLE BAUM
Born March 24, 1943
Born in Chicago, Illinois, and grew up in Winchester, Kansas. She graduated from Winchester High School
in 1961. She received her bachelor s degree in occupational therapy from the University of Kansas in 1965, a
master s degree in health management from Webster University in 1979, and a doctorate in social work from
Washington University in St. Louis, Missouri, in 1993. She worked at the University of Kansas Medical Center and
at the Research Medical Center in Kansas City until 1976, when she joined the faculty at Washington University
School of Medicine as the Director of Occupational Therapy Clinical Services. In 1988, she was appointed
Director of the Program in Occupational Therapy. She served as President twice: once in 1982-1983 to complete
the term of office for Mae Hightower-Vandamm when the bylaws were changed from a 2-year term to a 3-year
term, and then a full term from 2004-2007. She received the Eleanor Clarke Slagle lectureship in 1980 and was
named to the Roster of Fellows in 1975. She received the Award of Merit in 1984. She is also a member of the
AOTF Academy of Research. She has co-authored several textbooks with Charles Christiansen.
(continued)
 Search for a Unifying Theory: 1980s to 1990s 237

Table 8-3 (continued)

PERSONALITIES
ROBERT KENDALL BING
March 2, 1929‒May 15, 2003
Born in Cambridge, Nebraska. He graduated from Central High School in Cape Girardeau, Missouri, in 1947.
He attended college at Southeast Missouri State University and received a degree in occupational therapy at
the University of Illinois under Beatrice Wade. He served as President from 1983-1986 and was named to the
Roster of Fellows in 1973. He earned his Master of Arts degree at the Institute for Child Study at the University of
Maryland College Park in 1954 and his Doctor of Education degree from the University of Maryland in 1961. His
doctoral dissertation was a study of the life of William Rush Dunton, Jr., with whom he lived for several years. He
joined the U.S. Army Medical Service and worked at Fitzsimmons Army Medical Center in Denver. He taught on
the faculty at Richmond Professional Institute, University of Florida, and University of Illinois at Chicago, where
he was also Director of Activity Therapy at the Illinois State Psychiatric Institute. He was Dean of the first school
of Allied Health Sciences in the Southwestern states at the University of Texas Medical Branch in Galveston from
1968 to 1980 and was later awarded the title of Professor and Dean Emeritus. He taught briefly at Elizabethtown
College in Pennsylvania but remained active as Visiting Professor, Occupational Therapy, University of South
Dakota for several years. He was awarded the Eleanor Clarke Slagle lectureship in 1981, received the Award of
Merit in 1987, and was named a charter member of the Roster of Fellows in 1973. He was recognized for his
knowledge in the history of health, social welfare, and occupational therapy. In 1999, he established the Bing
Scholar scholarship program. He was a member of Phi Kappa Pi honorary fraternity.
ELNORA MAE CLAUSING GILFOYLE
Born May 19, 1934
Born in Tennessee. She graduated from the University of Iowa program in occupational therapy. She served as
President and Secretary of the Association. She received the Eleanor Clarke Slagle lectureship in 1984 and was
named a charter member of the Roster of Fellows in 1973. She received the Award of Merit in 1991. She worked
at the University of Colorado Health Sciences Center and then taught at Colorado State University. She served
as Dean of the College of Applied Human Sciences at Colorado State University and as Provost and Academic
Vice President of Colorado State University. She was inducted into the Colorado Women s Hall of Fame in
1994. She was interested in leadership and creative partnerships and established the Institute for Women and
Leadership at Colorado State University in 1995. With Ann P. Grady and Josephine C. Moore, she authored two
editions of Children Adapt: A Theory of Sensorimotor Development. She also wrote Mentoring Leaders with
Ann Grady and Cathy Nielson.

student of Mary Reilly at the University of Southern California,

MOHO would not be viewed as a successor to her model of
occupational behavior but as a new approach that Kielhofner
hoped would act as a unifying theory for the profession. A short
biographic sketch appears in Table 8-3.
Yerxa (Figure 8-4) and colleagues at the University of
Southern California published a model called occupational
science in 1989, which was designed to support the academic
discipline in the university setting by organizing the academic
subjects and their relationship to the education of practitioners
in occupational therapy (Yerxa et al., 1989) (see Table 8-3).

Problems in Practice
The Education for All Handicapped Children Act of
1975 was implemented in 1978. Many opportunities for occu- Figure 8-4. Elizabeth J. Yerxa, EdD,
pational therapy practitioners became available. However, OTR. (Printed with permission from the
some school officials stated that occupational therapy consti- Archive of the American Occupational
tuted “medical” treatment and therefore was not a responsibil- Therapy Association, Inc.)
ity of the school. Some therapists were instructed to bill the
238 Chapter 8

family’s medical insurer (Hightower-Vandamm, 1980a, p. 308). Still other school officials wanted a
prescription or referral from a physician for occupational therapy services, reinforcing the concept
of occupational therapy as a medical intervention. As Hightower-Vandamm cautioned, practice in
the school systems must support the education of the disabled child, and practitioners must dem-
onstrate that occupational therapy can support educational objectives or the role of occupational
therapy in the schools might decrease.
Teachers and educators also had mixed reactions to occupational therapy practitioners enter-
ing the schools (Hightower-Vandamm, 1980a, p. 309). Some teachers welcomed the added help
in identifying and addressing learning and behavior problems in the classroom, whereas others
did not think anyone but a teacher should be managing learning and behavior in the classroom.
Teachers who thought occupational therapy practitioners were going to “take over” the classroom
and its students and tell the teachers what to do were likely to resent any evaluation or interven-
tion by occupational therapy practitioners. In some cases, occupational therapy practitioners were
welcomed only if they acted as consultants or in-service instructors but did not actually see, talk
to, or touch a child.
At the same time, physicians were beginning to doubt and question the value of occupational
therapy for children with sensory integrative problems. Issues included the lack of recognition by
physicians that a sensory integration problem existed because physicians were not trained to evalu-
ate such dysfunction, lack of understanding of the potential relationship between sensory function
and learning, and resistance or reluctance to refer or give up some control to occupational therapy
practitioners because the physician did not believe in treatment effectiveness for sensory integra-
tive dysfunction (Hightower-Vandamm, 1980a, p. 308).
Another problem area was vocational and work-related evaluation. Although occupational
therapists had been active in evaluating potential for work and vocational training for many years,
as Hightower-Vandamm (1980a, p. 309) pointed out, the area of practice was increasingly being
lost to occupational therapy practitioners. Vocational evaluation was being performed by special-
ists with a master’s degree in vocational evaluation. The tools developed by occupational thera-
pists many years ago in psychiatric hospitals were now being used by persons trained in another
discipline.
Another area of practice that developed during the 1980s was that of facilitating independent
living because of the 1978 amendments to the Rehabilitation Act of 1973 that provided clients
with services for independent living even if no vocational goal was defined (Hightower-Vandamm,
1980a, p. 309). Occupational therapy practitioners needed to understand that the goal of indepen-
dent living was to move the person out of institutional settings such as state hospitals or nursing
homes. The goal was NOT to enable them to live alone, by themselves, without anyone else in the
household. For some clients, living alone may be the best solution, but for others, having a room-
mate or caregiver or both may be the best arrangement. The focus was on noninstitutional living,
not living “all by myself.”
Perhaps most significant was the change from large general hospitals to a variety of settings,
often in the community. Tables 8-5A and 8-5B show the trend away from institutions and in-
patient settings to community and outpatient settings.

Manpower
According to statistics reported by the American Hospital Association (AHA) in 1980, of the
6,965 registered hospitals in the United States, 31.1% (2,167) employed occupational therapists and
18.8% (1,307) employed occupational therapy assistants or aides (AHA, 1980). Unfortunately, the
survey did not differentiate between assistants and aides. Among hospitals employing occupa-
tional therapists, 21.9% had vacant positions and 11.5% had vacant positions for assistants or aides.
Among hospital-based therapists, 6,882 worked full-time and 10,367 worked part-time. Among
assistants and aides, 4,024 worked full-time and 454 worked part-time (AOTA, 1982a).
 Search for a Unifying Theory: 1980s to 1990s 239

From 1981 to 1987, the percentage of hospitals with occupational therapy services
increased over the country from 41.8% to 49%. The New England states had the highest
percentage at 74.7%, whereas the East South Central states had the lowest at 25.5%. Hawaii
has the highest percent at 95.5%, whereas Mississippi had the lowest at 14.3% (AHA, 1988). In
1982, the states with the largest percentage increase in occupational therapists from 1972 to 1982
were Louisiana (445%), Wyoming (418%), South Carolina (382%), Oklahoma (343%), and Utah
(300%). States with the largest number of occupational therapists were California (3,442), New
York (2,318), Michigan (1,531), Massachusetts (1,310), and Texas (1,288). States with the larg-
est number of certified occupational therapy assistants were New York (962), Minnesota (701),
Wisconsin (554), California (394), and Massachusetts (346).

Manpower Study
According to Acquaviva and Presseller (1983), nearly 40% of hospitals and about 30% of nursing
homes and home health agencies had occupational therapy services. These percentages are slightly
higher than those reported in data prepared by the AHA. The number of therapists per popula-
tion varied from 1 per 4,000 in New Hampshire to 1 per 59,000 in Mississippi. At the same time,
the growth of the professional education slowed substantially. Only 1,900 to 2,000 students were
graduating per year from 1975 to 1981. Faculty members stayed steady at about 520. The number of
qualified applicants declined. Some educational programs were not filling all available positions.
Langwell, Wilson, and Deane (1981) reported that approximately 56% of counties in the United
States had no registered occupational therapists working in those counties. The authors stated that,
based on the analysis of the data available, occupational therapists worked primarily in facilities
such as hospital departments, rehabilitation centers, nursing homes, or psychiatric inpatient facili-
ties. Therefore, employment patterns depended on the location of such facilities. In addition, the
distribution of occupational therapists was associated with per capita income of the population.
Counties with higher per capita incomes were more likely to have several occupational therapists
working in them and to have more facilities with occupational therapy departments. Client ability
to pay for services was suggested as a major factor. Thus, job opportunities were more likely to be
available in counties with higher per capita income and more health care facilities. Conversely,
counties with lower per capita incomes tended to have fewer facilities for health care services, no or
limited occupational therapy services, lack or limited payment for occupational therapy services,
and few opportunities for employment in occupational therapy service programs.
Recommendations of the Manpower Study (Masagatani, 1985) were the following:
● Increase the numbers of occupational therapy personnel
● Encourage the expansion of the occupational therapy education system
● Expand Association activities aimed at recruiting more students for occupational therapy
programs
● Increase the number of qualified occupational therapy faculty members
● Monitor the number and characteristics of the pool of field work centers
● Modify the credentialing politics to facilitate the movement of additional personnel into the
U.S. workforce
● Modify the characteristics of occupational therapy personnel to most effectively meet the
needs of the population and changing service delivery patterns
● Expand the Association’s efforts in continuing education
● Encourage the occupational therapy educational system to prepare graduates to practice in
new service delivery environments
● Review and document the current behavior of the health care system and its potential effect on
the number and characteristics of occupational therapy personnel as part of the Association’s
annual planning process
240 Chapter 8

● Increase research and promotional activities aimed at expanding the availability of occupa-
tional therapy services to meet the needs of persons presently unserved or underserved
● Produce valid information on the efficacy and cost of occupational therapy treatment that can
be used in promoting the development or expansion of services
● Focus promotion efforts on the most rapidly growing components of health care delivery
● Take a more active role in enhancing the public and professional awareness of the issues
involved in meeting the needs of minorities
Recommendations from the Manpower Study were summarized into the following three main
statements with several subtopics:
● Increase the number of occupational therapy personnel to meet population needs and unmet
demands through such means as increasing the number of educational programs, recruiting
more students, increasing the number of qualified faculty, monitoring the characteristics of
field work sites, and modifying credentialing mechanisms
● Modify the characteristics of occupational therapy personnel to most effectively meet popula-
tion needs and changing service delivery patterns through such means as expanding continu-
ing education offerings, engaging educational programs to prepare graduate to practice in new
service delivery environments, and reviewing changes in the health care system for potential
effect on occupational therapy
● Increase research and promotional activities aimed at expanding the availability of occu-
pational therapy services to meet the needs of persons presently unserved or underserved
through such means as producing valid information of the efficacy of occupational therapy
treatment, focusing on the most rapidly growing components of the health care delivery sys-
tem, and enhancing public and profession awareness of issued involved in meeting the needs
of minorities (Masagatani, 1985)

Work Settings
A survey of new graduates in 1989 showed that Table 8-4
entry-level occupational therapists were working
primarily in hospital settings (64%), followed by 1986 MEMBER DATA SURVEY:
school systems (12%), nursing homes (5%), and WORK SETTING
other (19%). Entry-level occupational therapy
Setting Percentage
assistants were also employed primarily in hos-
pitals (34%), followed by school systems (19%), General hospitals 22%
nursing homes (18%), and other (29%). Other School systems 17%
work settings included community mental health Rehabilitation centers 10.5%
centers, outpatient clinics, residential care facili-
Psychiatric settings 6.9%
ties, and sheltered workshops (Silvergleit, 1990).
Rehabilitation units 4.2%
The membership survey in 1986 provides a
more comprehensive list but does not separate Pediatrics 1.7%
occupational therapists from assistants (Table Othera 37.7%
8-4). Hospitals and school systems are the major aIncludes sheltered workshops, home health care,
work sites by category, but nearly 38% of practi- skilled nursing facilities, senior centers, early interven-
tion programs, and others.
tioners were working in settings not on the lists.

De-emphasis on Crafts
The de-emphasis on crafts is documented beginning in 1951, when an editorial appeared in
AJOT suggesting that practitioners should not discuss treatment media but treatment results. The
suggestion was the following:
 Search for a Unifying Theory: 1980s to 1990s 241

Pick two or three interesting work products and explain the results of the work in rela-
tion to the case treated. Did the patient get the desired muscle recovery through that
one activity or was another necessary to supplement the treatment, what effect on the
patient’s personality was evidenced by the activity? In other words, the practitioner
should express the work as a treatment medium in which you cooperated with the
physician for a desired result. (Editorial, 1951, p. 39)
To rephrase, the outcome should be stressed more than the medium or technique used to obtain
the desired results.
The concern about the role of crafts in occupational therapy practice increased during the
1980s. In a letter to the editor, Walker et al. (1982) stated that they “believe that the strong use of
craft activities seriously weakens our professional credibility” (p. 48). Craft activities were not seen
as real treatment media in medical settings. They further stated that “efficiency and cost effective-
ness dictate a sharp reduction in use of crafts, with substitution of activities that lend themselves
to reliable standardization” and that a return to a crafts emphasis would be impractical (p. 48). In
other words, craft activities were not viewed as being subject to critical measurement using the
same standards, such as of range of motion in degrees, muscle strength in pounds per square inch
of pressure, or endurance in minutes or hours of exercise or work activity. They summarize their
argument by stating that “it is enough of a dilemma for the practitioner to convince the patient,
physician, and administration of the credibility of occupational therapy as a medically oriented
discipline, rather than as a traditional diversional orientation, without feeling that the AOTA is
divided on the scope of our practice” (p. 49). They wanted the Association to support the practice
of therapy “as a well-defined treatment to improve patients’ daily life skills,” rather than encour-
aging what they believed to be a regressive step toward crafts therapy (p. 49). Clearly, craft activi-
ties were seen as lacking in the production of defined results that would be acceptable to medical
consumers, practitioners, payers, and administrators. In the authors’ view, crafts were diversional
in nature without redeeming qualities in reducing identified pathological conditions or facilitating
activities of daily living.
The reaction against crafts may have been in part the result of lack of education or lack of
learning objectives presented in lecture, laboratory, or fieldwork education. In a letter to the editor,
Clopton (1981) states that she was “expected to be an expert on the therapeutic aspects of crafts
without knowing why they were therapeutic unless it was to divert the mind from facing one’s
problems” (p. 669). The therapeutic value of crafts had been published in articles in Occupational
Therapy and Rehabilitation. The Committee on Installations and Advice (1928, 1929) published
a series of reports on the analysis of 12 crafts, including instructions on analyzing craft activities.
In his chapters on prescription, Dunton (1950, 1957) included a section on the use of crafts in
function restoration and examples of analysis. However, other textbooks on occupational therapy
published after 1929 did not include the information on analysis of crafts the Committee used or
examples of analyses.
Clopton (1981) also stated that when she returned to get additional education after raising a
family, the “new therapeutic techniques involving reflexes and development, as well as an expand-
ed view of neurology and perception, would make a return to the use of crafts as an exclusion
occupational therapy treatment medium prohibitive” (p. 669). The implication was that crafts were
the only medium or modality used in occupational therapy practice, a fact that may have been true
in some but not all practice settings.
In 1979, Eliason and Gohl-Giese did a survey of the use of media and modalities used in
occupational therapy. There were 76 replies from therapists working in physical dysfunction and
45 from those working in psychiatry. The media or modalities used by at least 90% or more of
respondents in psychiatric facilities were needlework, leatherwork, copper tooling, woodworking,
tile work, macramé, ceramics, sewing, and task groups. In facilities identified as specializing in
treating clients with physical dysfunction, the media and modality used by at least 90% or higher
of respondents were focusing on activities of daily living, passive range of motion, active range of
242 Chapter 8

motion activities, active range of motion without activity, resistive exercise with activity, facilita-
tion/inhibition (not qualified), facilitation/inhibition techniques with activity, homemaking train-
ing, and built-up tool handles. There was no overlap among the highest use media and modalities.
Psychiatric settings used crafts activities, whereas physical dysfunction settings used exercise,
facilitation or inhibition techniques, modified tools, activities of daily living, and homemaking. It
is possible that the some built-up tool handles were used to facilitate craft activities, but such data
were not reported in the study.
In a survey by Bissell and Mailloux (1981), respondents stated eight reasons why crafts were not
used in physical disabilities or physical dysfunction programs:
● Prefer treatment techniques that can be more precisely documented
● The use of crafts is difficult to justify to patient, to the therapist, insurance company, doctors,
other treatment team members and patient’s family
● It is difficult to document the use of crafts (assume in some measureable unit)
● Lack of sufficient space for craft use
● Crafts give occupational therapists a poor image
● Use of crafts is insulting to the patient
● Lack of sufficient budget for craft use
● Lack of sufficient staff for craft use
However, in the same survey, respondents identified eight objectives to which craft activities
could contribute:
● Improve fine-motor control
● Improve strength
● Enhance cognitive development
● Promote interests
● Improve self-esteem
● Improve decision-making capabilities
● Promote group socialization
● Facilitate prevocational training
Treatment techniques used instead of crafts included therapeutic exercise, self-care, neurode-
velopment technique, home skills, role performance skills, and prevocational training without
use of crafts (Bissell & Mailloux, 1981). The authors raised concerns about the use of some of the
techniques, stating that other team members could address problems in strengthening and self-
care, the most commonly used techniques, but there was a questions about who would address
home skills, role performance skills, and prevocational training. The authors concluded that as
scientific advancements and medical treatment progressed, changes occurred that emphasized a
focus on use of treatment modalities that appeared more precise and were therefore substituted for
craft activities. The nature of the precision appeared to move toward some idea of quantification
that counting stitches, rows completed, or time spent doing a craft activity could not satisfy. The
authors also suggested that “perhaps more theory should be included in the crafts skills classes in
order to provide the therapists with a clearer understanding of the purposes and dimensions of
craft activity” (Bissell & Mailloux, 1981, p. 374). This article was the last article on crafts to appear
in the professional journal.
Drake (1992) adds another reasons for de-emphasizing crafts, stating that “in a work-oriented
culture like ours, crafts have come to symbolize a leisure time activity rather than real work”
(p. 3). However, she also states that “crafts are a microcosm of life.” Crafts can teach many of the
tools and techniques for everyday living and how to put them all together. The concept of teaching
tasks and activities related to daily living makes crafts valuable therapeutic media for the modern
clinical setting.
 Search for a Unifying Theory: 1980s to 1990s 243

Rise of Physical Agent Modalities

In 1982, Trombly used the term adjunctive treatment to describe the use of splinting, electri-
cal stimulation splints, exercise, biofeedback, and sensory stimulation “to enable development of
motor ability needed to engage in tasks of daily life” (p. 467). Her point was that interpretations
of the term purposeful activity were “limited with regard to control of parameters of gradation
needed to effect an improvement in strength, range of motion, or motor control” (p. 467). She felt
AOTA should legitimize the use of techniques that did not fit the definition of purposeful activity.
English, Kasch, Silverman, and Walker (1982) used the term adjuncts in discussing the use of
“range of motion, therapeutic exercise, muscle strengthening and splinting for corrective, preven-
tive and functional purposes” (p. 199). The authors argued that the focus on purposeful activities
denied the additional skills of the restorative areas of physical disabilities practice.
Pedretti and Pasquinelli-Estrada (1985) summarized the restrictions that purposeful activity
would place on practice in physical disabilities as (1) jeopardizing reimbursement, (2) negating the
skills and knowledge achieved by experienced clinicians, (3) jeopardizing referrals, and (4) exclud-
ing techniques such as exercise, range of motion, splinting, and inhibition-facilitation techniques
(p. 7). They concluded that the issues stemmed from an unclear or unacceptable definition of
purposeful activity that excluded exercise.
Initially in 1983, the Representative Assembly adopted a policy on modalities in general
(AOTA, 1983c). The Policy defines modalities as “the employment of or the method of employment
of, a therapeutic agent” (p. 816). Qualifications and competencies were to be obtained through
accredited education programs, specific certifications, or experience. In 1991, the policy adopted
in 1983 was expanded to include the concept of using physical agent modalities, although the
term physical agent modalities does not appear in the policy (AOTA, 1991). In essence, the policy
states that therapists and assistants are qualified and competent to use a variety of modalities, that
modalities should be used only in preparation for purposeful activity to enhance occupational per-
formance, and that practitioners should only use modalities for which qualifications and compe-
tencies have been obtained. However, the Representative Assembly did adopt a separation motion
stating “physical agent modalities may be used by occupational therapy practitioners when used
as an adjunct to or in preparation for purposeful activity to enhance occupational performance
and when applied by a practitioners who has documented evidence of possessing the theoretical
background and technical skills for safe and competent integration of the modality into an occu-
pational therapy intervention plan” (AOTA, 1991). The statement and the policy were to be issued
together.

Legislation
Legislation affecting occupational therapy is listed in Table 8-5. A few government actions
deserve special mention. In 1988, the Health Care Financing Administration issued Medicare Part
B medical review guidelines, which clarified occupational therapy documentation requirements
(AOTA, 1988) (Table 8-6). The Veterans’ Administration Bill 1989 revised standards for occupa-
tional therapy (Boyer, 1990). Two amendments to the Education of the Handicapped Act (EHA)
included:
● P.L. 98-199, Education of the Handicapped Act Amendments (1983). Promoted transitional
services for handicapped youth to assist in moving from public school to vocational train-
ing and competitive employment. Also encouraged states to provide services to all preschool
children from birth.
● P.L. 99-457, Education of the Handicapped Act Amendments (1986). The Act spelled out
related services including occupational therapy and extended special education and related
services to preschoolers and handicaps, 3 through 5 years. Emphasized an early intervention
244 Chapter 8

Table 8-5
LEGISLATION RELEVANT TO OCCUPATIONAL THERAPY
1980 Omnibus Reconciliation Act of 1980 (P.L. 96-1479). Lindy Boggs helped get Congress to pass a bill
that would cover occupational therapy in rehabilitation facilities and independent of physical
therapy and speech services in home health. The Act included outpatient rehabilitation facility and
home health provisions.
(a) Home health amendment: If a physician certifies that a person is homebound and an overall
health care plan is established, occupational therapy services alone could qualify for Medicare.
(b) Comprehensive outpatient rehabilitation facility provision: Occupational therapy covered in free-
standing outpatient clinics that meet requirements. (Mallon, 1981; Reed, 1992)
1980 Social Security Amendments (P.L. 96-265). Act funded demonstration projects for developmentally
disabled persons that would allow them to continue to keep Social Security benefits while working
(Reed, 1992).
1981 Budget Reconciliation Act (P.L. 97-35). Removed occupational therapy as a qualifying service from
home health. As a result, nursing, speech therapy, and or physical therapy must qualify the patient
for skilled care before occupational therapy services can be provided (Lohman, 2014).
1982 Social Security Amendments (Katie Beckett Amendment; P.L. 97-248). Allowed disabled children to
live at home and receive services. They no longer were required to live in an institution (Reed, 1992).
1982 Comprehensive Outpatient Rehabilitation Facility (CORF) Regulations. COPFs were deemed the only
locations where mental health services would be covered by Medicare Part B by non-physician
health professionals such as occupational therapists (Peters, 1984).
1982 Tax Equality and Fiscal Responsibility Act (P.L. 97-248). Hospice benefits were enacted on a tempo-
rary basis. Occupational Therapists started working in hospice (Lohman, 2014).
1983 Education of the Handicapped Amendment (P.L. 98-199). Facilitates transition from school to work.
Established state planning grants. Preschool grants now include birth to age 5 (Reed, 1992).
1984 Developmental Disabilities Act Amendments (P.L. 98-527). Independence, integration, employment,
and employment-related activities were addressed. Supported deinstitutionalization and integra-
tion into the community (Reed, 1992).
1984 Carl D. Perkins Vocational Act (P.L. 98-210). 10% is allocated for vocational education for people with
disabilities (Reed, 1992).
1985 Consolidated Omnibus Budget Reconciliation Act (COBRA; P.L. 99-272). Passed to help people who
are at risk for being uninsured if they change employment or have been laid off from their jobs.
Hospice benefits became permanent, and occupational therapists continued to work in hospice
(Lohman, 2014).
1986 Rehabilitation Act Amendments (P.L. 99-506). Act addressed employability, supportive employment,
and rehabilitation engineering (Reed, 1992).
1986 Education of the Handicapped Act (P.L. 99-457). Early intervention services for children 3-5 years.
Occupational therapy is a primary service. It was independent of medical, health, or other special
education services (Reed, 1992; Van Slyke, 2001).
1986 Handicapped Children s Protection Act (P.L. 99-372). Parents can recover attorney fee costs if parents
are the prevailing party (Reed, 1992).
1987 Developmental Disabilities Assistance and Bill of Rights Amendments (P.L. 100-146).
Developmentally disabled persons receive necessary services. Monitoring system established.
Supported training projects to provide services in early intervention. Effort to help people with dis-
abilities to reach their maximum potential (Reed, 1992).
1988 Technology-Related Assistance for Individuals with Disabilities Act (P.L. 100-407). Provide funding to
states to develop and distribute assistive devices and modification options allowing people with
disabilities to use the services provided as a result of ADA. Assistive technology has made it feasible
to implement many provisions of ADA (Reed, 1992; Van Slyke, 2001).
(continued)
 Search for a Unifying Theory: 1980s to 1990s 245

Table 8-5 (continued)

LEGISLATION RELEVANT TO OCCUPATIONAL THERAPY
1988 Medicare Catastrophic Coverage Act (P.L. 100-360). Improve acute care benefits for the disabled and
elderly. Expanding benefits to include drug coverage and limit copayments for services that were
covered (Reed, 1992).
1988 Fair Housing Amendments (P.L. 100-420). Clarifies civil rights of the disabled in the arena of housing
(Reed, 1992).
1988 Civil Rights Restoration Act (P.L. 100-259). Those receiving federal funds have to comply with civil
rights laws in all areas, not just in the activity/area that received funding (Van Slyke, 2001).
References
Lohman, H. (2014). Payment for services in the United States. In B. A. Boyt Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard &
Spackman s occupational therapy (12th ed., pp. 1051-1067). Philadelphia, PA: Wolters Kluwer.
Mallon, F. J. (1981). History of the occupational therapy Medicare amendments. American Journal of Occupational Therapy,
35(4), 231-235.
Peters, M. E. (1984). Reimbursement for psychiatric occupational therapy services. American Journal of Occupational Therapy,
38(5), 307-312.
Reed, K. L. (1992). History of federal legislation for persons with disabilities. American Journal of Occupational Therapy, 46(5),
397-408.
Van Slyke, N. (2001). Legislation and policy issues. In M. Scaffa (Ed.), Occupational therapy in community-based practice set-
tings (pp. 85-94). Philadelphia, PA: Davis.

Table 8-6
MEDICARE COVERAGE
PART A
● Hospital inpatient: Occupational therapy is a covered service.
● Skilled Nursing Facility: Under Part 1, occupational therapy services are reimbursed to Medicare.
However, when Part A coverage is exhausted, and the person is transferred to Part B, occupational thera-
py services are no longer reimbursable.
● Home Health Care: Medicare beneficiaries may continue to receive occupational therapy services under
the home health benefit even after their need for skilled nursing, physical therapy or speech therapy
ends. However, the need for occupational therapy service alone will not qualify the person for Medicare
home health services.
● Hospice Care: occupational therapy is covered when provided to patients receiving hospice care.
PART B
● Home Health Settings: Medicare beneficiaries may continue to receive occupational therapy services
under Medicare Part B even after the need for skilled nursing, physical therapy, or speech therapy ends.
However, the need for occupational therapy services alone will not qualify the person for Medicare
home health services.
● Hospital Outpatient: In order for occupational therapy to be reimbursed for services provided to outpa-
tients, all of the following requirements must be met.
○ Service must have physician referral.
○ Services rendered must be by hospital personnel in the hospital or outside the hospital.
○ Services provided must be under the direct personal supervision of the physician who is treating
the patient.
● Incident to Physician Services: Reimbursable occupational therapy service incident to physician services
must meet all the following requirements:
○ Service must be provided in a private physician s office or in a physician-directed clinic, and the
occupational therapist must be employed full- or part-time by the physician or clinic.
○ Services rendered must be under the direct personal supervision of the physician, assisting the
physician in the performance f his or her professional services.
○ Services must be directly related to the condition the physician is treating.
○ The physician must include in the bill the charge for occupational therapy services.
● Comprehensive Outpatient Rehabilitation Facility
246 Chapter 8

program for handicapped infants (0 through 2 years) identifying occupational therapy as a

primary early intervention service. (New law provides occupational therapy for preschoolers.
AOTA, 1986b)

Revisiting the Reconstruction Aides

On July 1, 1981, the Secretary of Defense issued a memorandum stating that reconstruction
aides and dieticians who served during World War I would be considered active military service
personnel in the Armed Forces of the United States for purposes of all laws and services admin-
istered by the Veterans’ Administration and therefore were entitled to benefits administered by
the Veterans’ Administration. Prior to 1981, reconstruction aides and dieticians did not qualify
for veterans’ benefits, including health care, because they were not technically considered to be to
veterans. However, in 1978, Public Law 95-202 was enacted to allow the reconstruction aides to
apply for benefits. The reason they could not previously receive benefits as military personnel was
because they were women and women were not allowed to serve in the military. During World War
I, the reconstruction aides had served as civilian personnel because there were no statutory provi-
sions for women in the military, although they were required to follow, and were subject to, Army
regulations. When the rules were changed to allow women to serve in the military, the retroactive
status was possible.
In 1944, full military status was conferred on physical
therapists and dieticians but not on occupational therapists.
In 1947, the Women’s Medical Specialist Corp was formed
(now the Army Medical Specialist Corps). In 1981, the
Department of Defense Civilian/Military Service Review
Board (created by Public Law 95-202) concluded that absent
the congressional restrictions against women serving in the
military, the reconstruction aides and dieticians in World
War I would have been considered members of the Army
and would have been entitled to veterans’ benefits follow-
ing discharge from the service. Therefore, they were now
retroactively entitled because women were now allowed to
serve in the military. However, to receive veterans’ benefits,
reconstruction aides had to apply for and receive a discharge Figure 8-5. Lena Hitchcock, age 93, World
War I reconstruction aide at the 35th anni-
from the Army. Because the national records for the recon- versary celebration of the Army Medical
struction aides had been destroyed in a fire in 1949, each Specialist Corps at the Fort McNair Officer’s
individual aide had to supply her own records after securing Club, Washington, DC, April 16, 1982.
the necessary forms from the local Veterans’ Administration (Printed with permission from the Archive
of the American Occupational Therapy
office. A more significant problem was likely that many of Association, Inc.)
the reconstruction aides were well into their 80s or 90s or
had already died—and, besides, where were those call to duty
papers from 1918 and discharge papers from 1919 anyway? Figure 8-5 shows Lena Hitchcock at age
93, one of the few living reconstruction aides able to take advantage of the legislation.

Technology
The Apple computer became standard equipment in many occupational therapy services
(Figure 8-6). Innovations in hardware (add-on boards) and creative software programs provided
opportunities to supplement other intervention programs such as perceptual motor tasks or to
teach basic computer skills such as moving the mouse and clicking on a desired icon or using a
simple word processing program. Other electronic devices such as electronic switches to oper-
ate battery-powered toys or robotic arms (Figure 8-7) became part of the changing technology.
 Search for a Unifying Theory: 1980s to 1990s 247

Figure 8-6. Use of an Apple computer with a client who has a head injury to assist in
regaining attention, concentration, memory, and organizational skills. (Printed with
permission from the Archive of the American Occupational Therapy Association, Inc.)

Figure 8-7. Robotic arm designed as an assistive device to enable the client with a
spinal cord injury to feed himself. (Printed with permission from the Archive of the
American Occupational Therapy Association, Inc.)

Assistive technology became a recognized part of occupational therapy practice. Continuing

education courses were offered as the annual conference and manuals became available (Wright
& Nomura, 1985).

Association
Headquarters
In 1980, the Association moved the national office from 6000 Executive Boulevard to
1383 Piccard Drive in Rockville, Maryland, where it would remain for 14 years. The building rep-
resented the first time the Association owned the structure in which it operated and functioned
248 Chapter 8

(Figure 8-8). Previous office space had

always been rented. The Association
actually bought two buildings. One was
a two-story building that was initially
rented out and then sold. The other, a
three-story structure, was the main head-
quarters. Initially, the Association was
located on the third floor and the first
two floors were rented to other organi-
zations, but gradually Association and
Foundation business increased so that all
three floors were serving occupational
Figure 8-8. The national office from 1980 to 1994, located at
therapy–related activities. 1383 Piccard Drive, Rockville, Maryland. (Printed with permis-
sion from the Archive of the American Occupational Therapy
Presidents and Association, Inc.)

Executive Directors
Four people served as President of the Association during the 1980s: Mae D. Hightower-
Vandamm (1978-1982), Carolyn M. Baum (1982-1983), Robert K. Bing (1983-1986), and Elnora M.
Gilfoyle (1986-1989). Presidents Hightower-Vandamm, Baum, and Bing are pictured together in
Figure 8-9. Gilfoyle is pictured in Figure 8-10. Table 8-7 is a review of their accomplishments dur-
ing their presidencies. The long-range plan for the 1980s is listed in Table 8-8, and specific goals
for 1987 are listed in Table 8-9. Important documents adopted during the 1980s are listed in Table
8-10, and publications and projects are listed in Table 8-11.
James Garibaldi continued to serve as Executive Director until his retirement in 1987.
Occupational therapist Jeanette Bair (Figure 8-11) became Executive Director of AOTA after
16 years of non-therapist leadership. She would be the last occupational therapist to lead the
Association in the first 100 years of its existence.

Figure 8-9. Past, present, and future Presidents in 1982: Figure 8-10. Elnora M. Gilfoyle, ScD (Hon),
Mae Hightower-Vandamm, 1978-1982 (seated); Carolyn OTR, FAOTA, President of AOTA, 1986-1989.
M. Baum, 1982-1983 (standing); and Robert K. Bing, (Printed with permission from the Archive
1983-1986. (Printed with permission from the Archive of the American Occupational Therapy
of the American Occupational Therapy Association, Association, Inc.)
Inc.)
 Search for a Unifying Theory: 1980s to 1990s 249

Table 8-7
PRESIDENTS AND THEIR ACCOMPLISHMENTS
Carolyn M. Baum, 1982-1983
Major accomplishment: She led the transition from long-range planning to strategic planning focusing on
targeted use of resources and anticipation of changing environments.
Quotation: Our professional forebears have laid the groundwork to enable us to make an important contribu-
tion and now we need to take up that challenge and move forward.
Robert K. Bing, 1983-1986
Major accomplishment: The proposal to create the American Occupational Therapy Certification Board was
adopted by the Representative Assembly.
Quotatuion: In a world gone mad with technology, occupational therapy tenaciously clings to and advo-
cates an immutable belief held by our professional forebears. I think of it as the poetry of the commonplace.
Through work and play, the human spirit will prevail, succeed, and prolong itself in spite of biological, social,
or emotional adversities.
Eleanor M. Gilfoyle, 1985-1989
Major accomplishments: Promoting the concept of creative partnerships, facilitating new national office man-
agement structure, and the initial efforts to purchase OT Week to increase non-fee revenues.
(AOTA. (1992). AOTA s Hall of leaders. OT Week, 6(21), 40-43.)

Table 8-8
LONG-RANGE PLAN
● To provide opportunities for the expression of member concerns, to anticipate emerging issues, to facili-
tate decision making and to expedite the translation of those decisions into action
● To support the development of research and knowledge bases for the practice of occupational therapy,
and to promote the dissemination and sharing of such information
● To facilitate and support an educational system for occupational therapy which responds to current
needs, anticipates, plans for, and accommodates to change
● To promote occupational therapy as viable health profession
● To facilitate the formation of partnerships with consumers to promote optimal health conditions for the
public
(August, 1980, Membership Handbook, A-3-A-4)

Table 8-9
GOALS LISTED FOR 1987
● Providing critical information resources through Association publications
● Offering new and innovative continuing education resources
● Promoting leadership in practice and quality assurance
● Representing members in key legislative and policy areas
● Providing new and streamlined service and benefit programs
● Establishing a teamwork approach to leadership and management
(Occupational Therapy News, 1987, 41(9), 16.)
250 Chapter 8

Table 8-10
ASSOCIATION DOCUMENTS
1980 ● Certification Requirements
● Long-Range Plan
● Principles of Occupational Therapy Ethics, revised
● Standards of Practice: Schools
● Statement of Occupational Therapy Referral, revised
1981 ● Entry-Level Role Delineation for OTRs and COTAs
● Guidelines for Supervision of Occupational Therapy Personnel
● Occupational Therapy as an Education-Related Service. Also called The Role of Occupational
Therapy as an Education-Related Service
● Occupational Therapy s Role in Independent or Alternative Living Situations
● The Role of the Occupational Therapist in Home Health Care
1982 ● Bylaws Revision of the AOTA
● Eligibility Requirements for Foreign Graduates
● Roles and functions of the Occupational Therapist in the Treatment of Sensory Integrative
Dysfunction
1983 ● Essentials and Guidelines of an Accredited Educational Program for the Occupational
Therapist
● Essentials and Guidelines of an Approved Educational Program for the Occupational Therpay
Assistant
● Guidelines for an Occupational Therapy Fieldwork Experience ‒ Level II & Fieldwork
Performance Report
● Fieldwork Evaluation Form for Occupational Therapy Assistant Students and Raters Guide for
the Fieldwork Evaluation Form
● Purposeful Activities
● Roles and Functions of Occupational Therapy in Long-Term Care: Programs
● The Roles and Functions of Occupational Therapy Services for the Severely Disabled
● Standards of Practice for Occupational Therapy
1985 ● Guide for Supervision of Occupational Therapy Personnel
● Guide to Classification of Occupational Therapy Personnel
● Roles and Functions of Occupational Therapy in Burn Care Delivery
● Roles and functions of Occupational Therapy in Hand Rehabilitation
● Roles and Functions of Occupational Therapy in Mental Health
● Guidelines for Occupational Therapy Documentation
1986 ● Guidelines for Occupational Therapy Services in School Systems (revised, 1989)
● Occupational Therapy and Hospice
1987 ● Fieldwork Evaluation for the Occupational Therapist
● Roles of Occupational Therapists and Occupational Therapy assistants in Schools
1988 ● Occupational Therapy Services in Early Intervention and Prescho0ol Services
● Reference Guide Occupational Therapy Code of Ethics
1989 ● Guidelines for Occupational Therapy Services in School Systems, second edition
● Human Immunodeficiency Virus
● Occupational Therapy and Eating dysfunction
● Occupational Therapy in the Promotion of Health and the Prevention of Disease and Disability
 Search for a Unifying Theory: 1980s to 1990s 251

Table 8-11
PROJECTS AND PUBLICATIONS
● AOTA Member Handbook (1980)
● Directions for the Future: Extensive Study of Education, Practice and Research Within the Profession
● Fieldwork Evaluation form replaced the Field Work Performance Report, 1986
● Role Delineation study, 1981
● Professional and Technical Role Analysis (PATRA) project, approved by RA in 1985
● Occupational Therapy in Mental Health: A Guide to Outcomes Research (1987)
● Supervision Development of Therapeutic Competence (1987)
● Guidelines for Occupational Therapy Services in Hospice (1987)
● Guidelines for Occupational Therapy in Home Health (1987)
● The Chronically Mental Ill (proceedings) (1987)
● The Cost-Effectiveness of Rehabilitation: A Guide to Research Relevant to Occupational Therapy (1987)
● Occupation Therapy in Acute Care Settings: A Manual (1987)
● Problems With Eating: Interventions for Children and Adults With Developmental disabilities (1987)
● Learning Through Play (brochure) (1987)
● Time Traps for Parents (brochure) 1987
● Feeding and Caring for Infants and Children With Special Needs (1987)
● Quality Assurance Mentoring in Occupational Therapy (1987)
● Guide to the Archives of AOTA (1987)
● Guidelines for Occupational Therapy Services in School Systems (1987)
● Occupational Therapy News
● OT Week (1987)
● Special Interest Section Newsletters (five started in 1981: Developmental Disabilities, Gerontology, Mental
Health, Physical Disabilities, Sensory Integration)

National Office Organization

In 1982, there were three major departments in the national office: Professional Services,
Financial and Business Administration, and Member Services/Association Development (AOTA,
1982a). The Government and Legal Affairs Division reported directory to the Executive Director.
The organization included the Executive Director and
seven divisions: Communication, Credentialing, Education,
Financial and Business Management, Government and
Legal Affairs, Operations Research, and Professional
Development. Two people reported directly to the
Executive Director: the Editor of the American Journal of
Occupational Therapy and the Conference and Meeting
Section.

Occupational Therapy Directions for

the Future Project (1984-1987)
In 1984, the Representative Assembly charged the
Executive Board to entry-level educational preparation
for professional practice (Fleming, 1987). The Board cre-
ated the Entry-level Study Committee, chaired by Maureen
Fleming. In addition to the Study Committee, an External
Figure 8-11. Jeanette Bair, OTR, Executive Advisory Committee was created composed of agencies
Director of AOTA, 1987-1999. (Printed designated by the Representative Assembly and major
with permission from the Archive of groups identified by the Study Committee and national
the American Occupational Therapy
Association, Inc.)
office staff that might be affected by changes in academic
252 Chapter 8

requirements or standards. The External Advisory Committee opposed a recommendation being

considered by the Study Committee to mandate entry at the graduate level. The major reason for
opposition “appeared to be the absence of an identified and generally accepted academic discipline
and applied sciences of occupational therapy” (Fleming, 1987, p. v).

Special Interest Sections Added

The Administration and Management Special Interest Section (SIS) was approved in 1984,
and the Work Programs SIS was approved in 1985 (AOTA, 1992). The Administrative and
Management SIS addresses diverse concerns, including reimbursement, recruitment, personnel
management, budgeting, staff development, supervision of certified occupational therapy assis-
tants, fieldwork education, and ethical issues in management. A computerized network of indi-
viduals is maintained.
The Work Programs SIS provides a forum for therapists interested in work practice such as
fostering worker role entry or re-entry within a variety of practice areas, including industrial
rehabilitation, mental health, and physical or developmental disability.
Hightower-Vandamm (1980c) reported that 77% of AOTA members belonged to one of first five
SIS in 1980. Physical Disabilities had the largest percentage (22.6%), followed by Developmental
Disabilities (17.4%), Sensory Integration (15.7%), Mental Health (13%), and Gerontology (8.3%).

Professional and Technical Role Analysis Project

The Professional and Technical Role Analysis (PATRA) Project revised the Role Delineation
Study to include current roles and functions of entry-level registered occupational therapists and
certified occupational therapy assistants, incorporate major changes occurring in the health care
delivery stem, and address the need for knowledge, skills, attitudes, and abilities to be specified for
functions identified within the Role Delineation Study. The responsibility was given to the Inter-
Commission Council (AOTA, 1986c).

Task Force on Occupational and Physical Therapy Issues

The task force was charged to examine documents and policies within the Association that
needed clarification in relation to the practice of occupational and physical therapy. The task force
made eight recommendations (Huss, 1984):
● Define purposeful activity. The document Purposeful Activities was adopted by the
Representative Assembly in 1983 and published in AJOT (1983d, pp. 805-806).
● Develop documents which recognize
○The occupational therapist who has, through available education avenues, developed
additional expertise beyond the entry level. Specialty certification was started by the
Association in 1984.
○Areas of practice which require addition education leading to certification. Specialty certi-
fication was started by the Association in 1984.
○Possibility of joint certification with specialty groups. This motion was reviewed by the
Ethics Committee and Bylaws, Policies, and Procedures Committee. A follow-up report
was not found but the concept was not adopted.
● Develop a policy on the use of modalities. A policy statement was adopted in 1985 entitled
Occupational Therapists and Modalities and published in AJOT (1983e, pp. 815-816).
● Develop a policy regarding types of advertising accepted for publication and types of modali-
ties displayed at conference which is consistent with documents adopted by the Association.
The Executive Board was charged to study the issues of advertising.
 Search for a Unifying Theory: 1980s to 1990s 253

● Recommend that the revision of the educational Essentials include the concept of purposeful
activity throughout the education process. The Representative Assembly adopted the motion
and referred it to the Commission on Education to implement. The 1983 Essentials and
Guidelines of an Accredited Educational Program for the Occupational Therapist do include
the term purposeful activities under the section on the Educational Program (Section II, E,
3, b, [1]) (AOTA, 1983f, pp. 831-840). The term also appears in the 1991 version under Section
II, B, 3, b, (1).
● Recommend that the accreditation process include a more stringent review in relation
to instruction in purposeful activities and their application to treat. The Representative
Assembly adopted the motion and referred it to the Accreditation Committee to implement,
but the degree of implementation is not stated by the Accreditation Committee in subsequent
reports.
● Charge the Commission on Education to develop a mechanism for accreditation of fieldwork
centers. The national office staff had been studying the issue of accrediting fieldwork sites for
20 years and included that a cost-effective mechanism was not available. The suggestion was
made that educational programs establish a system of closer monitoring of fieldwork centers,
including a “field work educator” category.
● Establish a program for education of members regarding the implications of the occupational
therapy/physical therapy issues. The report of the task force was published (Huss, 1984).

Reimbursement for Occupational Therapy Services

Health insurance began to be available in the 1930s (Davy, 1984). Most of the coverage was
for inpatient hospitalization. As services expanded beyond inpatient services, insurance cover-
age often did not keep pace. Insurance companies did not want to increase premiums and thus
were reluctant to add new services. As a result, insurance coverage for outpatient services, home
health, and hospice care did not occur without direct interaction with health insurance provid-
ers. Occupational therapy services expanded rapidly during the 1970s and early 1980s beyond
inpatient settings, and thus practitioners found that reimbursement often was unavailable in the
expanded service areas. Occupational therapy services were a small part of the health care delivery
system, and there were few data to show that occupational therapy intervention was effective.

Separation of Certification From Membership

In 1986, the Association became a membership organization only. The American Occupational
Therapy Certification Board (AOTBC) was created to manage the certification process and cer-
tification examination (AOTA, 1986a). Over the past several years, there had been increasing
concern among the Association leadership that the Association was at risk of violating antitrust
or noncompetition law because the Association regulated both the accreditation of occupational
therapy educational programs and the credentialing of occupational therapy practitioners. The
control of both accreditation and credentialing could be viewed under the antitrust law as a closed
shop, which restrained potential access to the profession (restraint of trade or noncompetition).
Within the profession, members were concerned about paying for both membership and recertifi-
cation. They asked how much money was for membership benefits and how much money was for
recertification. Furthermore, did writing a check in any way demonstrate continuing competency
to practice occupational therapy? The solution to both external issues (antitrust, anticompetition
laws) and internal issues (membership versus recertification) was legal separation of the certifica-
tion process from the membership organization. The Association bylaws were changed in the sum-
mer of 1986, and the AOTCB formally took charge of initial certification, including administering
the certification examination and maintaining records of the individuals who had passed or failed
the examination.
254 Chapter 8

A simultaneous change was the recommendation that the Association policy be dropped
regarding lapsed certification. The policy had stated that anyone who allowed his or her certifica-
tion to lapse for 5 years or more had to retake the certification examination and pass it before being
reinstated. Additional payment of fees was also required. As state regulation via state licensure
increased, the need for a national policy decreased. State licensure boards could make the decisions
regarding continuing competency requirements such as requiring a certain number of continuing
education units.

Membership Data
Although the Association was growing, the number of members in any given state was still quite
small (Langwell et al., 1981). In 1980, only five states had over 1,000 therapists: California (2,887),
New York (1,878), Michigan (1,363), Massachusetts (1,061), and Wisconsin (1,049). Eighteen states
had less than 100 members living within the state who were members of the Association (p. 301).
A graph of membership by region of the country was presented in the 1984 Annual Report (Figure
8-12). These membership numbers are in contrast to the number of therapists actually living in
each state according to data collected in 1986 (AOTA, 1987). Eleven states had over 1,000 therapists
living there: California, Florida, Illinois, Massachusetts, Michigan, Minnesota, New York, Ohio,
Pennsylvania, Texas, and Wisconsin. The only state with more than 1,000 assistants was New York.
Twelve states had less than 100 therapists living in that state. Both sets of data were collected before
the separation of certification from membership.

Specialty Certification
The formal steps to create specialty certification began in 1982 when the Representative
Assembly charged the Association (Resolution 581-82) to develop a voluntary advanced-level rec-
ognition program for occupational therapists (AOTA, 1982b). The major purposes were to address
the need for the Association to formally acknowledge its role in the issue of continuing competency
and to provide practitioners with increased recognition in a specific area of practice within the
profession. The issue on continuing competency and/or quality assurance had been discussed for
many years but in earnest since 1971 with Resolution 300-71. Pediatrics was chosen as the first
practice area because about one-third of members worked with children. The first examination
was administered in 1992, and 130 candidates passed to become Board-Certified Pediatric OTs
(Javernick, 1992). The general area of pediatrics as a specialty was adopted, but specialty certifica-
tion in sensory integration and school-based practice were ultimately not adopted, although they
were discussed (Hightower-Vandamm, 1980b). Specialty certification was not designed to take the
place of continuing education requirements for state licensure, although activities or tasks used to
meet the requirements of specialty certification recognition might also be applied to requirements
for continued competency required by a state regulatory board.

Uniform Terminology of Occupational Therapy, Second Edition

Revision of the Uniform Terminology document developed in 1979 began in 1983 when the
Representative Assembly charged the Commission on Practice to update the document to reflect
current practice (AOTA, 1989b). Input was solicited from members and from the three states that
had adopted reimbursement systems based on the Product Output Reporting System developed by
the AOTA in 1979 (California, Maryland, and Washington). The following guidelines for revision
were established:
● To not replace the original document and to limit the revised document to defining occupa-
tional performance areas and occupational therapy performance components for occupation-
al therapy intervention (i.e., indirect services were deleted and the Product Output Reporting
System was not revised)
 Search for a Unifying Theory: 1980s to 1990s 255

NH - 438
(1.1) 216
1111 VT - 89 (0.6)
(2.9) (0.2)
83 272 MA - 1961
(0.2) (0.7) 1903 (5.1)
428 (5.0) 3821
(1.1) 2121 (10.0)
72 70 RI - 116
(5.5) 2130
(0.2) 57 (0.2) (0.5)
(5.6) 1869 CT- 677
(0.1) 336 (4.9)
144 (1.8)
(0.9) 1501
81 (0.4) 640 NJ- 1008
1733 (3.9) (2.6)
(0.2) 88 (1.7) 56
(4.5) 764
(0.2) 939 (0.1) DE- 75
644 730 174 (2.0) (0.2)
4337 (2.5)
(1.7) (1.9) (0.5) MD- 782
(11.3) 441
(1.2) (2.0)
291
324 (0.8) DC- 97
394 189 175 182
(0.8) (0.5) (0.3)
(1.0) (0.5) (0.5) 395
66 260
(1.0)
(0.2) (0.7)
1915
343
(5.0)
(0.9)
1183
(3.1)

88
(0.2)
Puerto Rico - 181
(0.5)
HI - 287
(0.7) Number of AOTA Members
Virgin Islands - 3
(Percent of Total Membership)
(0.0)

Figure 8-12. Occupational Therapy Manpower, December 1984. (Reprinted with permission from the American
Occupational Therapy Association.)

● To coordinate the revision process with other current AOTA projects such as the PATRA
● To develop a document that reflected current area of practice and facilitated uniformity of
definitions in the profession
● To recommend that the Association develop a companion document to define techniques,
modalities, and activities used in occupational therapy intervention and a document to define
specific programs that are offered by occupational therapy departments (AOTA, 1989b)
After several drafts, the revised Uniform Terminology document was expanded. The original
Uniform Terminology document had included 68 terms related to direct services and 16 related
to indirect services. The second edition contained 109 terms, an expansion of slightly over 50%.
Major expansion of terms occurred in the areas of work activities, sensory motor components, and
cognitive integration and components. Terms that were dropped included those under the heads
of therapeutic adaptation and prevention, which were probably viewed as techniques or modali-
ties. Overall, the document was reorganized into three performance areas—activities of daily liv-
ing, work activities, and play or leisure activities—and three performance components—sensory
motor, cognitive, and psychological. Definitions and descriptions were provided for the growing
list of terms.

Publications
Although the Association had been involved in publishing occupational therapy–related
manual and monographs since the 1960s, most of the early publications were proceedings of
conferences or reports of committee activities. In 1982, Executive Director Garibaldi announced
that a decision had been made to accelerate the Association’s book publishing program (AOTA,
1982c). Costs had been a major consideration. However, discussions with publishers had resulted
256 Chapter 8

in the idea of having selected publishers underwrite the initial cost of typesetting, graphics, and
printing and then selling copies of the book at a discount for the Association to resell to members.
The emphasis for the Association to publish came from members who wanted more timely access
to current information on expanding areas of practice and new developments in the profession.
The article announcing the plan did not mention another major reason for becoming a publishing
source. Occupational therapy was a small and specialized market by most publishers’ criteria. The
Association was in the best position to tap the market for authors and for reaching potential buy-
ers. Advertisements could be included in the Association’s journal and newspaper.

Foundation
During the 1980s, three people were president of the American Occupational Therapy
Foundation (AOTF): Wilma West completed her term in 1982, Martha S. Moersch served from
1982 to 1984, and Nancy V. Snyder completed a second term from 1986 to 1988. Photographs of
West and Snyder appeared in a previous chapter. Moersch’s photograph appears in Figure 8-13.
In 1980, the Foundation began to financially support the occupational therapy library. Prior
to the Foundation’s organization and cataloguing, the library had consisted of shelves in which
books, manuals, and journals were grouped as they appeared in the Association’s collective inbox.
The archival materials, including original letters received by Dr. Dunton and carbon copies of his
replies, were being stored offsite in a warehouse without climate control and were aging quickly.
Using the collection monographs and journals was difficult because there was no real organiza-
tional system. Using the archival materials required stacking and unstacking large boxes. Initially,
the archives were moved to the University of Texas Medical Branch in Galveston, Texas, because
the Foundation did not have a climate control system in the Association’s building. While in
Texas, the archives were organized into acid-free library boxes and all materials were cataloged.
The guide to the archives was prepared in 1987 by a trained librarian and continues to be updated
(Bowman, 1987). An online database called OT Source was started in 1989 to make the library
collection and archival materials available without having to travel to the Foundation office. The
online system would be modified and updated over the
coming years.
The Foundation began publishing the Occupational
Therapy Journal of Research in April 1981, with Charles
H. Christiansen at the first editor. The purposes of the
new journal were to encourage dynamic dialogue between
authors of published papers and discussants, thus provid-
ing a forum for research and debate; to represent a schol-
arly commitment to scientific research in the profession;
to stimulate more research by providing an additional
vehicle for publication; to further implement the research
mandate to the Foundation by the Representative Assembly
of AOTA; and to further strengthen relationships and joint
goals of AOTA and AOTF (Llorens, 1981, p. 5) In 1983,
the Foundation inaugurated the Academy of Research “to
recognize researchers who have made sustained contribu-
tions toward advancing the knowledge base of the field”
(AOTF, 1983, p. 3) The first three charter members were Figure 8-13. Martha S. Moersch, OTR,
A. Jean Ayres, Mary Reilly, and Elizabeth Yerxa. Recipients President of AOTF, 1982-1985. (Printed
received a gold pin with the logo of the Academy of Research with permission from the Archive of
the American Occupational Therapy
and their name engraved on a plaque for permanent display Association, Inc.)
in the AOTF office. Criteria for the award included “awards
 Search for a Unifying Theory: 1980s to 1990s 257

for scholarly excellence, the number and quality of publications from both within and outside the
field, apparent or documented influence on the development of occupational theory and practice,
and success in obtaining extramural funding for research” (AOTA, 1983h, p. 3). Initiating the
journal was part of the commitment to support research activities within the profession, which had
begun in earnest with the Research Seminar held in 1976 (West, 1981). Another part of the com-
mitment was the publication of a bibliography of completed research, sponsoring a research forum
at the AOTA annual conference, maintaining the regional research consultant program to assist
practitioners in developing research skills, and providing funding in the form of research grants.
By 1985, 182 grant requests had been received (AOTF, 1985). The largest number of grants funded
were in the area of physical disabilities (18), followed by developmental disabilities (14), education
(9), mental health (9), sensory integration (8), gerontology (3), and activities (1).
By 1985, the 20th anniversary of the Foundation, the total endowed scholarship funds totaled
$192,000. More than 240 scholarships had been awarded (AOTF, 1985). The primary source of
funds for scholarships was the state associations. In addition, the doctoral fellowship program
was initiated in 1981, with funds allocated by the AOTA Representative Assembly to support a fel-
lowship each year for 5 years so that an individual could devote time to completion of a doctoral
degree. In 1984, the Foundation inaugurated a Post-Doctoral Fellowship to provide research sup-
port for a scholar each year to complete a research program.
In June 1986, the Foundation hired its first Executive Director, Martha Kirkland (AOTF, 1986).
Kirkland had previously worked for the Association as Director of Continuing Education, so she
was familiar with national office activities and resources.

Reflection
By the end of the 1980s, the professional Association had achieved the basic requirements
needed to develop and maintain a profession, a professional association, a charitable foundation,
and an independent agency to manage certification. Standards for education and practice had
been established, a Code of Ethics was available, and mechanisms for initial certification were
in place. A new journal focusing on research had been initiated by the Foundation, whereas the
Association increased its commitment to publishing monographs relevant to the profession of
occupational therapy. Other issues began to occupy more time and effort, such as public awareness
and recognition; changing social concerns about health and wellness; accountability for services
offered, including efficacy, efficiency, and scientific support; and meeting membership needs for
information in a timely manner.
These years were characterized by a search for a unifying theory of occupational therapy and
the development of a unique body of knowledge as the profession sought to be recognized as a true
profession. The development of Gary Kielhofner’s Model of Human Occupation began during this
time. A number of assessment instruments and techniques created by occupational therapists were
also developed during this time. There was a desire to upgrade the profession through recognition
of continued competency and through recognition of those who engaged in research. There was
also more emphasis on a return to authentic occupational therapy, moving out of the reductionistic
paradigm. Collaboration with other disciplines, not just medicine, was accepted. This time period
also saw the birth of occupational science.

References
Acquaviva, F. A. (1985). Occupational therapy manpower: A plan for progress. Rockville, MD: American Occupational
Therapy Association.
Acquaviva, F. A., & Presseller, S. (1983). Nationally speaking: Occupational therapy manpower. American Journal of
Occupational Therapy, 37(2), 79-81.
258 Chapter 8

American Hospital Association. (1980). Hospital statistics, 1980 edition. Chicago, IL: Author.
American Hospital Association. (1988). Hospital statistics, 1988 edition. Chicago, IL: Author.
American Occupational Therapy Association. (1980-1981). Education programs in occupational therapy. Rockville,
MD: Author.
American Occupational Therapy Association. (1982a). Annual report. Rockville, MD: Author.
American Occupational Therapy Association. (1982b). The Association: 1982 Representative Assembly—62nd annual
conference. American Journal of Occupational Therapy, 36(12), 808-820.
American Occupational Therapy Association. (1982c). WWI aides qualify for VA benefits. Occupational Therapy
Newspaper, 36(8), 4.
American Occupational Therapy Association. (1983a). Essentials and guidelines of an accredited educational pro-
gram for the occupational therapist. American Journal of Occupational Therapy, 37(12), 817-823.
American Occupational Therapy Association. (1983b). Essentials and guidelines of an approved educational program
for the occupational therapy assistant. American Journal of Occupational Therapy, 37(12), 824-830.
American Occupational Therapy Association. (1983c). Policy: Occupational therapists and modalities. American
Journal of Occupational Therapy, 37(12), 816.
American Occupational Therapy Association. (1983d). Purposeful activities. American Journal of Occupational
Therapy, 37(12), 805-806.
American Occupational Therapy Association (1983e). Association policies. American Journal of Occupational
Therapy, 37(12), 815-816.
American Occupational Therapy Association (1983f). Representative Assembly. American Journal of Occupational
Therapy, 37(12), 831-840.
American Occupational Therapy Association (1983g). Essentials of an accredited educational program for the occu-
pational therapist. American Journal of Occupational Therapy, 37(12), 817-823.
American Occupational Therapy Association. (1983h). Fellows invited to nominate for 1984 Academy of Research.
Occupational Therapy Newspaper, 37(11), 3.
American Occupational Therapy Association. (1986a). AOTA certification structure changed: focus to be on mem-
bership. Occupational Therapy News, 40(6), 1.
American Occupational Therapy Association (1986b). New law provides occupational therapy for preschoolers.
Occupational Therapy News, 40(12), 6.
American Occupational Therapy Association. (1986c). PATRA project: What it is and is not. Occupational Therapy
News, 40(12), 9.
American Occupational Therapy Association. (1987). Dataline: Population ratios: A measure of supply and need for
occupational therapy personnel. Occupational Therapy News 41(8), 6-9.
American Occupational Therapy Association. (1988). HCFA issues final Medicare Instructions for OT. Federal
Report insert. Occupational Therapy News, 42(4), 9.
American Occupational Therapy Association. (1989a) Listing of educational programs in occupational therapy.
American Journal of Occupational Therapy, 43(12), 833-840.
American Occupational Therapy Association. (1989b). Uniform terminology for occupational therapy, second edi-
tion. American Journal of Occupational Therapy, 43(12), 808-815.
American Occupational Therapy Association. (1991). Association policies: Registered occupational therapists and
certified occupational therapy assistants and modalities. American Journal of Occupational Therapy, 45(12),
1112-1114.
American Occupational Therapy Association. (1992). An historical look at special interest sections. OT Week,
October 16, pp. 6-7.
American Occupational Therapy Foundation. (1983). Fellows invited to nominate for 1984 Academy of Research.
Occupational Therapy Newspaper, 37(11), 3.
American Occupational Therapy Foundation. (1985). Foundation celebrates 20th anniversary. Occupational Therapy
Newspaper, 39(3), 8-9.
American Occupational Therapy Foundation. (1986). AOTF names first executive director. Occupational Therapy
News, 40(8), 1.
Bair, J. (1982). Nationally speaking: Changing trends in practice. American Journal of Occupational Therapy, 36(11),
704-707.
Bissell, J. C., & Mailloux, Z. (1981). The use of crafts in occupational therapy for the physically disabled. American
Journal of Occupational Therapy, 35(6), 369-374.
Blakeney, A., Strickland, L. R., & Wilkinson, J. H. (1983). Exploring sensory integrative dysfunction in process schizo-
phrenia. American Journal of Occupational Therapy, 37(6), 399-406.
Bowman, I. (1987). Guide to the archives of the American Occupational Therapy Association. Rockville, MD: American
Occupational Therapy Association.
Boyer, J. (1990). Congress passes new standards for VA OTs. OT Week, 4(16), 6.
 Search for a Unifying Theory: 1980s to 1990s 259

Clopton, J. W. (1981). Craft use with physically disabled questioned. American Journal of Occupational Therapy,
35(10), 669.
Committee on Installations and Advice. (1928). Report and analysis of crafts. Occupational Therapy & Rehabilitation,
7, 29-43, 131-136, 211-216, 417-431.
Committee on Installations and Advice. (1929). Analysis of crafts. Occupational Therapy & Rehabilitation, 8, 339-352.
Davy, J. (1984). Nationally speaking: Status report on reimbursement for occupational therapy services. American
Journal of Occupational Therapy, 38(5), 295-198.
DeGangi, G. A. (1983). Letters to the editor: Author’s response. American Journal of Occupational Therapy, 37(12),
848-850.
DeGangi, G. A., Lurley, L., & Linscheid, T. R. (1983). Toward a methodology of the short-term effects of neurodevelop-
ment treatment. American Journal of Occupational Therapy, 37(7), 479-484.
Dunton, W. R. Jr. (1950). The prescription. In W. R. Dunton, Jr. & S. Licht (Eds.), Occupational therapy: Principles and
practice (pp. 20-44). Springfield, IL: Charles C. Thomas.
Dunton, W. R. Jr. (1957). The prescription. In W. R. Dunton, Jr. & S. Licht (Eds.), Occupational therapy: Principles and
practice (2nd ed., pp. 29-52). Springfield, IL: Charles C. Thomas.
Drake, M. (1992). Crafts in therapy and rehabilitation. Thorofare, NJ: SLACK Incorporated.
Editorial. (195I). Disemphasizing crafts. American Journal of Occupational Therapy, 5(1), 39.
Eliason, M. L., & Gohl-Glese, A. (1979). A question of professional boundaries: Implications for educational pro-
grams. American Journal of Occupational Therapy, 33(3), 175-179.
English, C., Kasch, M., Silverman, P., & Walker, S. (1982). The issue: On the role of the occupational therapist in physi-
cal disabilities. American Journal of Occupational Therapy, 36(3), 199-200.
Fleming, M. H. (1987). Occupational therapy: Directions for the future. Rockville, MD: American Occupational
Therapy Association.
Gilfoyle, E. (1987). AOTA at 70. Occupational Therapy News, 41(12), 6.
Hightower-Vandamm, M. D. (1980a). Nationally speaking: The perils of occupational therapy in several special are-
nas of practice. American Journal of Occupational Therapy, 34(5), 307-309.
Hightower-Vandamm, M. D. (1980b). National speaking. The perils of occupational therapy in several special arenas
of practice (continued). American Journal of Occupational Therapy, 34(6), 369-371.
Hightower-Vandamm, M.D. (1980c). National speaking: - Specialty sections – A mile-high dream. American Journal
of Occupational Therapy, 34(9), 499-502.
Huss, A. J. (1984). Nationally speaking: Whither thou goest? Report of the AOTA Task Force on OT/PT issues.
American Journal of Occupational Therapy, 38(2), 81-84.
Javernick, J. A. (1992). 130 OTs achieve board certification. OT Week, 6(30), 19.
Kamenetz, H.L. (1983). Dictionary of rehabilitation medicine. New York, NY: Springer Publishing.
Kielhofner, G. (1980a). A model of human occupation. Part 2. Ontogenesis from the perspective of temporal adapta-
tion. American Journal of Occupational Therapy, 34(10), 657-663.
Kielhofner, G. (1980b). A model of human occupation. Part 3. Benign and vicious cycles. American Journal of
Occupational Therapy, 34(11), 731-737.
Kielhofner, G., & Burke, J. P. (1980). A model of human occupation. Part 1. Conceptual framework and content.
American Journal of Occupational Therapy, 34(9), 572-581.
Kielhofner, G., Burke, J. P., & Igi, C. H. (1980). A model of human occupation. Part 4. Assessment and intervention.
American Journal of Occupational Therapy, 34(12), 777-788.
Langwell, K. M., Wilson, S. D., & Deane, R. T. (1981). Geographic distribution of occupational therapists. American
Journal of Occupational Therapy, 35(5), 299-305.
Llorens, L. A. (1981). Guest editorial: A journal of research in occupational therapy: The need, the response.
Occupational Therapy Journal of Research, 1(1), 3-6.
Magrun, W. M., deBenabib, R. M., & Nelson, C. (1983). Letters to the editor: More criticism—Article on neurodevel-
opmental treatment. American Journal of Occupational Therapy, 37(12), 846-848.
Masagatani, G. N. (1985). Nationally speaking: AOTA’s ad hoc commission on occupational therapy manpower. Part
2: Summary of recommendations. American Journal of Occupational Therapy, 40(8), 525-527.
Pedretti, L. W., & Pasquinelli-Estrada, S. (1985). Foundations for treatment of physical dysfunction. In L. W. Pedretti
(Ed.), Occupational therapy: Practice skills for physical dysfunction (2nd ed., pp. 1-10). St. Louis, MO: Mosby.
Rosenthal, S. (1983). Letters to the editor: Questions cause of change. American Journal of Occupational Therapy,
37(12), 850.
Silvergleit, I. (1990). Employment settings of new graduates. OT Week, 4(10), 9.
Trombly, C. A. (1982). Letters to the editor: Include exercise in “purposeful activity.” American Journal of Occupational
Therapy, 36(7), 467-468.
Walker, J. K., Lumpkin, B., RePoserly, T., Pratt, S., Stevens, L., Wente, S., & Whitney, K. (1982). Against crafts empha-
sis. American Journal of Occupational Therapy, 36(1). 48-49.
260 Chapter 8

West, W. L. (1981) Commentary: A journal of research in occupational therapy: The response, the responsibility.
Occupational Therapy Journal of Research, 1(1), 7-12.
Wright, C., & Nomura, M. (1985). From toys to computers: Access for the physically disabled child. San Jose, CA:
Authors.
Yerxa, E. J., Clark, F., Frank, G., Jackson, J., Parham, D., Pierce, D.,…Zemke, R. (1989). An introduction to occupa-
tional science, a foundation for occupational therapy in the 21st century. Occupational Therapy in Health Care,
6(4), 1-17.

Bibliography
Allen, C. K. (1982). Independence through activity: The practice of occupational therapy. American Journal of
Occupational Therapy, 36(11), 731-739.
American Occupational Therapy Association. (1981). Membership data 1980. American Journal of Occupational
Therapy, 35(5), 301.
American Occupational Therapy Association. (1982). Data Line. Occupational Therapy Newspaper, 36(8), 4.
American Occupational Therapy Association. (1987). AOTA at 70: The growth of a dynamic profession. Part X:
Yesterday and tomorrow. Occupational Therapy News, 41(12), 6-7.
American Occupational Therapy Association. (1992). Physical agent modalities? Position paper. American Journal of
Occupational Therapy, 46(12), 1090-1091.
Ayres, A. J. (1958). Basic concepts of clinical practice in physical disabilities. American Journal of Occupational
Therapy, 12(4), 300-302, 311.
Blakeney, A., Strickland, L. R., & Wilkinson, J. H. (1983). Letters to the editor: Author’s response. American Journal
of Occupational Therapy, 37(12), 850-951.
Grady, A. P., & Gilfoyle, E. M. (1989). The eighties: A decade of change. OT Week, 3(51), 2, 20.
 9
Time of Conflict
1990s to 2000s

Key Points
● Resolution J changed the entry level for occupational therapists to post-baccalaureate level in 1999.
● The Association sold its headquarters building in Rockville, Maryland, and bought a building
in Bethesda, Maryland, in 1994.
● The Accreditation Council for Occupational Therapy Education (ACOTE) formed in 1994.
● The National Board for Certification in Occupational Therapy (NBCOT) formed in 1996.
● A dispute between the Association and NBCOT over credentialing marks began in 1999.
● There was a discussion about cross-training and multiskilling personnel to perform duties or
activities typically performed by others in 1997.
● The Association began a new magazine called OT Practice in 1996.

Highlighted Personalities
● Winnie Dunn, theorist ● Mary Foto, AOTA president, 1995-1998
● Jeanette Schkade, theorist ● Karen Jacobs, AOTA president, 1998-2002
● Sally Schultz, theorist ● Elizabeth Devereaux, AOTF President
● Ann Patricia Grady, AOTA President, ● Maralynne Mitcham, AOTF President
1989-1992 ● Jane Davis Rourk, AOTF President
● Mary Margaret Evert, AOTA President, ● Florence Clark, researcher (well elderly
1992-1995 project)

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 261-292).
- 261 - © 2017 SLACK Incorporated.
262 Chapter 9

Key Places Key Times/Events

● The national office moved to 4720 ● Balanced Budget Act (1997) created caps
Montgomery Lane in Bethesda, Maryland. on Medicare Part B outpatient rehabilita-
tion services.
● Post-baccalaureate entry resolution was
Political Events/Issues adopted in 1999 and became effective in
2007.
● 1990—Americans with Disability Act
(ADA), P.L. 101-336, adopted
● 1996—Health Insurance Portability and Sociocultural Events/Issues
Accountability Act (HIPAA), P.L. 104-191, ● There was an increased need for occupa-
adopted tional therapy personnel to understand
● 1997—Individuals with Disabilities and respond to the influence of political
Education Act (IDEA), P.L. 108-446, and legislative actions on occupational
adopted therapy jobs, service delivery, and payment
● 1997—Balance Budget Act (BBA), P.L. systems.
105-33, changed payment systems ● The marketplace for occupational therapy
● Olmstead decision by Supreme Court: services grew rapidly.
States must place people with disabilities ● Social awareness of disability increased
in community settings rather than insti- with passage of the Americans with
tutions if appropriate. Disabilities Act.

Economic Events/Issues Practice Issues

● Increased governmental pressure to con- ● The Core Values and Attitudes of
trol costs Occupational Therapy Practice document
● Health maintenance organizations was adopted in 1993 (later integrated into
(HMOs) created the Code of Ethics).
● The Balanced Budget Act extended pro- ● Uniform Terminology III was adopted in
spective payment system to cover home in 1994.
health beginning in 2000, skilled nursing ● Guide to Occupational Therapy Practice
facilities beginning in 1999, and inpatient document was published in 1999.
rehabilitation units beginning in 2006 (13 ● Models of practice began focusing on the
medical conditions) concepts of person, environment, and
● Loss of occupational therapy jobs fore- occupation (PEO).
casted due to effects of the Balanced ● Encroachment of physical therapy on con-
Budget Act cept of functional limitation.
Educational Issues
● Essentials of an Accredited Program in
Occupational Therapy revised in 1965. Technological Events/Issues
Affiliations divided into physical and psy-
chosocial disabilities totally 6 months and
● Technology Related Assistance for
there was a de-emphasis on crafts. Individuals with Disabilities Amendments
(P.L. 103-218)
● Master’s degree programs started
● The Internet and World Wide Web
● Increased focus on continuing education
expanded online capabilities to integrate
to update knowledge and skills
graphics and text.
 Time of Conflict: 1990s to 2000s 263

Association Issues Foundation Issues

● Mission statement adopted in 1993; vision ● Reliable Source online database started in
statement adopted in 1998 1994
● Specialty certification program and board ● Centers for Scholarship and Research in
created in 1995 Occupational Therapy established
● Cross-training document adopted in 1997 ● Mission and goal statements clarified
● Human Genome Project started in 1999
● Continuation of the physical agent modal-
ity issue
● Skilled versus nonskilled services and
Medicare

National Board for Certification in Occupational Therapy

● NBCOT replaced AOTCB
● Trademark dispute between NBCOT and the Association

Introduction

I
n 1990, U.S. President George H. W. Bush (41st President) was finishing his term. Nelson
Mandela was released from a South African prison after 27 years. In 1994, he became
President of South Africa. The Persian Gulf War was fought from August 1990 to April
1991. President Bill Clinton assumed office in 1992. A text-based web browser became available. In
1995, the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma, was bombed, leaving
168 people dead. The O.J. Simpson trial was held in Los Angeles, California. The Internet became
a major part of many people’s lives as they learned to find information at their fingertips aided by
their computer.
Changes in the health care system continued as ideas and technology evolved. One change was
the expansion of Diagnostic Related Groups (DRG) designed to limit health care costs, which led
to a major growth in prospective payment systems in 1990s affecting home health, skilled nursing
facilities, and inpatient rehabilitation facilities. Computer-based technology was advancing with
the introduction of the World Wide Web, allowing graphics and text to be integrated seamlessly.
Information about a wide range of topics and opinions was available via a computer with an
Internet provider at any time of the day or night, and rapidly expanding the information available
to clients and to occupational therapy students.
During the 1990s, many models of practice began to shift to ideas based on the interaction of
occupation, person, and environment as an integrated explanation for how occupational therapy
could be conceptualized. Cognitive rehabilitation through occupational therapy frames of refer-
ence became more common. Focusing adapting the task or occupation was studied more, and
adapting the individual became less important.
The marketplace for occupational therapy grew rapidly. The passage of the Americans with
Disabilities Act of 1990 contributed, as did the effects of more coverage under Medicare, to better
reimbursement and the continued growth of practice in the school systems.
Major goals of the American Occupational Therapy Association (AOTA) were expediting
political activities, helping individuals to become change agents, enhancing public awareness of
264 Chapter 9

occupational therapy through marketing efforts and personal action, showing value of occupa-
tional therapy outcomes, initiating group and individual advocacy of occupational therapy ser-
vices, and increasing visibility of occupational therapy practitioners and leaders. The Association
increased its professional autonomy as well. On January 1, 1994, the Accreditation Council for
Occupational Therapy Education (ACOTE) became the accrediting agency independent of the
American Medical Association (AMA). The ACOTE became responsible for accrediting both the
professional (occupational therapist) and technical (occupational therapy assistant) level educa-
tional programs that were rapidly expanding across the country.

Education
Post-Baccalaureate Entry Required and Resolution J
At the Representative Assembly meeting in 1999, Resolution J was adopted and became RA
679-99 (AOTA, 1999a). Resolution J was entitled “Movement to Required Post-Baccalaureate Level
of Education.” The intent of the resolution was “to mandate that the entry to the professional level
of practice in occupational therapy be at the post-baccalaureate degree level” and that “the official
position of AOTA be one that supports post-baccalaureate education as the required level of pro-
fessional entry into the field of occupational therapy” (AOTA, 1999c). The statement of intent con-
tinued, “Preparing therapists at the post-baccalaureate level means those entering the profession
will be positioned to take on expanded responsibilities, assume leadership roles, and be players in
areas not only where services are provided, but also where decision are made.” A summary of the
rationale is provided in the following statements included in the Resolution:
● Contemporary practice areas require occupational therapists, including new graduates, to
demonstrate an unprecedented level of advanced clinical reasoning.
● New graduates, more than ever, need to define, demonstrate, and articulate the uniqueness
and value of occupational therapy.
● New graduates need to be capable of functioning as autonomous professionals and must be
encouraged to see themselves in this role.
● Practice arenas are shifting and therapists are challenged to establish programs in areas where
occupational therapy services have not previously been offered.
● New graduates enter settings and are challenged to make decision and engage in a level of
clinical decision making previously reserved for experienced clinicians.
● The move to the post-baccalaureate level is apt to clarify the delineation between professional
and technical education.
● Movement to post-baccalaureate entry is consistent with current trends in other related pro-
fessions.
● Analyses conducted by the Commission on Education Entry-Level Task Force confirm that
the environment reinforces current readiness to move to this level.
● Currently, many graduates of entry-level programs have essentially been confirmed the bac-
calaureate degree for the equivalent of masters level education.
● Preparation of more therapists at the post-baccalaureate degree level is likely to meet the cur-
rent and future needs for qualified faculty in our education programs.
● Preparation at the post-baccalaureate degree level would position occupational therapy to
better meet personnel needs in emerging practice arenas, including effective and efficient
staffing patterns.
● Movement to post-baccalaureate degree entry reflects and acknowledges the complexity of our
knowledge base and the high degree of professional judgment required for practice.
 Time of Conflict: 1990s to 2000s 265

● The preparation of occupational therapists at the post-baccalaureate level would address the
needs for more outcomes research supporting the tents of occupational therapy practice, effi-
cacy interventions and staffing models. (AOTA, 1999c, pp. RA9-RA10)
In essence, the push to move the profession to master’s-level entry had finally been reacted after
40 years of talk beginning in 1958. In summary, the issues were the following:
● The curriculum content for the occupational therapist had been for many years equivalent to
a master’s degree in other fields.
● Therapists needed to have better skills in autonomous clinical reasoning.
● Therapists needed to be able to develop and implement new service programs in new areas of
practice as new graduates.
● The profession needed more faculty trained with advanced degrees.
● Separation and clarity were needed between the levels of education for occupational therapists
and assistants.
● Potential students planning on a career of working in the profession would be more likely to
complete a master’s-level program.
● Therapists would be better recognized as knowledgeable team members with a higher degree
of education and training.
● A higher degree in some work environments equaled higher pay.
● Therapists needed to better understand the profession’s body of knowledge.
● More outcomes research was needed to support the tenets and assumptions of the profession.
● The profession needed to better demonstrate its efficiency and effectiveness in delivering services.
The date for implementation to the post-baccalaureate degree was set as January 1, 2007, to give
academic programs time to change the existing curriculum and program from an undergraduate-
to graduate-level program (AOTA, 1999b). Universities and colleges have different requirements
to granting undergraduate versus graduate degrees. Some colleges were not established to grant
graduate degrees. In such colleges, the occupational therapy program had to arrange to transfer
students to another university, change to offering an assistant-level program or close the program.
Ultimately, six bachelor’s degree programs closed because they could not transition to the post-
baccalaureate requirement (AOTA, 2008, p. 2).

Doctoral Degrees
Schools began offering doctoral degrees in occupational therapy: Boston University offered
a ScD in therapeutic studies, the University of Southern California offered a PhD in occupa-
tional science, and New York University offered a PhD in occupational therapy. Texas Woman’s
University would follow in offering a PhD, along with Nova Southeastern University.

Educational Programs
In 1992, there were 75 colleges or universities with occupational therapy programs and
74 community colleges or technical schools with occupational therapy assistant programs. Alaska,
Arizona, Hawaii, Idaho, Montana, Nevada, Utah, Vermont, West Virginia, and Wyoming did
not have professional educational programs. Alaska, Arizona, the District of Columbia, Idaho,
Indiana, Mississippi, Nebraska, Nevada, South Dakota, Vermont, and West Virginia did not have
technical education programs (Harsh, 1992). By 1999, 40 states plus the District of Columbia
and Puerto Rico had occupational therapy education programs within the state boundaries, and
48 states had an assistant-level program. Only Alaska had no educational program for occupa-
tional therapy personnel at either the professional or technical level. Although the gap in Western
states had decreased, there were still four states with no professional-level program within the state
boundaries, including Idaho, Montana, Nevada, and Utah.
266 Chapter 9

Accreditation
In 1993, the Representative Assembly approved a motion from the Executive Board to pursue
recognition of the Association as an independent accrediting agency, thus ending the partnership
with the AMA started in 1933 (Graves, 1994). The AMA was dissolving the Committee on Allied
Health Education and Accreditation (CAHEA), and the structure and funding of an alternative
umbrella organization was not yet determined (AOTA, 1993a, p. 25). Although the dissolution of
CAHEA was the last straw, the issue of becoming an independent accrediting agency was under
discussion by the Association. As Kyler-Hutchinson (1992) pointed out in a series of articles on
the accreditation process, the profession was not totally in charge of the criteria by which the
educational programs were accredited because the Essentials had to be approved by the AMA
and CAHEA. Also, when a program was accredited, notification was held up until the AMA
ratified the decision made by the Accreditation Committee of AOTA. Sometimes the process
caused time delays that were inconvenient for all concerned. Prior to the motion being adopted,
the Accreditation Council of AOTA, in collaboration with the AMA/CAHEA, accredited the
occupational therapy educational programs, and the Commission on Education developed the
Essentials outlining the criteria for an accepted program and curriculum, which were approved by
the Representative Assembly.
The new entity formed on January 1, 1994, was called the Accreditation Council for
Occupational Therapy Education (ACOTE). The ACOTE functioned as a standing committee
of the Association, with the Chairperson of the Commission on Standards and Ethics serving as
a liaison between the Executive Board and the ACOTE (Daigle, 1994). The ACOTE sought and
secured recognition from the U.S. Department of Education (USDE) and the Commission on
Recognition of Postsecondary Accreditation (CORPTA), a nongovernmental agency that basically
accredits the accreditors. The ACOTE also joined the Association of Specialized and Programmed
Accreditors (ASPA), the organization that carried out professional development, public relations,
publications, and accreditation data collection (Daigle, 1994). Another change was that ACOTE
became responsible for revising the documents known as the Essentials, which would change its
title to the Standards for Establishing and Maintaining an Occupational Therapy Educational
Program for Occupational Therapists or Assistants. An additional change was an added require-
ment for new or developing programs to submit a development plan as part of obtaining “develop-
ment program status” prior to admitting students (Graves, 1994). Thus, the accreditation process
for new programs had three steps as opposed to two steps under the system with the AMA. The
10-point application process was an attempt to increase the potential that the new program would
actually become an accredited program. Although program development in occupational therapy
had a good track record of attaining accreditation status, there was no guarantee that students
would have graduated from an accredited program and would therefore become eligible to take the
certification exam. By reviewing the program before students started, the ACOTE was in a better
position to decrease the possibility that the first class of students would not be the last.

Practice
Membership Survey
The 1990 AOTA membership survey, the last available, reported that the most common health
problems or diagnoses seen by occupational therapists were stroke/hemiplegia (27.1%), devel-
opmental delay (12.9%), cerebral palsy (9.7%), hand injury (9.5%) and learning disability (7.0%).
Combined diagnoses resulted in 83.4% related to physical disabilities and 16.6% related to mental
health. For occupational therapy assistants, the most common diagnoses were stroke/hemiplegia
(30.3%), intellectual disability (11.4%), developmental delay (8.9%), schizophrenic disorders (6.6%),
 Time of Conflict: 1990s to 2000s 267

and cerebral palsy (6.0%). Combining health programs resulted in 72% physical disabilities and
28% mental health. As previous membership reports had shown, occupational therapists are more
likely to work with children, whereas assistants are more likely to work with older clients. However,
many practitioners work equally with a wide range of client ages (AOTA, 1990).
Practice areas discussed were acute care, adults with developmental disabilities, geri-
atrics, graduate education, hand therapy, home health, Independent practice, industrial
rehabilitation/work hardening, mental health, military, rehabilitation, school systems, technol-
ogy, and vision therapy (AOTA, 1993b). Mean salary for occupational therapists was $36,470 and
for assistants was $21,282. Payment for services came primarily from the patient/client directly,
Medicare, Medicaid, private insurance, or workers’ compensation.
To summarize, the membership survey reported the following:
● A growing proportion of occupational therapy practitioners were employed either full- or
part-time.
● The proportion of practitioners working primarily with mental health problems continued to
decline.
● More occupational therapists and assistants were becoming self-employed or entering private
practice.
● The number of assistants working in schools systems had increased from 3.6% in 1972 to
17% in 1990, whereas the percentage of occupational therapists has rebounded over a percent-
age point to 18.6%.
● Salaries for practitioners increased at an average of 8% annually from 1986 to 1990.
● Occupational therapists were less likely to be certified or licensed in other fields than in the past.
● Occupational therapists were more likely to be employed in urban areas, whereas the propor-
tion of assistants was greater in rural areas.
● More than half of occupational therapists considered themselves specialists rather than gen-
eralists.
● About a third of occupational therapists and a quarter of assistants considered consultation to
be their secondary employment function.
● Most occupational therapists had a baccalaureate degree (82.3%), whereas most assistants had
an associate’s degree (70.8%).
The 1995 membership data showed the highest ratio of occupational therapists to population
in Colorado, Massachusetts, New Hampshire, North Dakota, and Wisconsin, with ratios above
20% per 100,000 population. Sixteen states had less than 10 therapists per 100,000 population,
including most of the Southern states and several Western states. Only North Dakota has a high
ration of assistants per 100,000 population. States with the highest membership number of occu-
pational therapists were California (3,520), New York (2,689), Florida (1,821), Pennsylvania (1,793),
and Michigan (1,721). States with less than 80 members included South Dakota, Vermont, and
West Virginia. The largest numbers of assistant members were in New York, Pennsylvania, Ohio,
California, and Illinois, whereas states with less than 10 members included Alaska and Vermont.

Definitions of Occupational Therapy

Table 9-1 lists some of the definitions developed during the 1990s. The dominant phrase is
purposeful activity, which continued to be difficult to explain to other health care professionals
and the public because there was no good explanation for what constituted an activity without a
purpose, or purposeless activity. How did occupational therapy practitioners know the difference
between a purposeful versus purposeless activity? What were the distinguishing characteristics?
Did the activity have to be purposeful to both the practitioner and the client or to just one or
the other? Was there a list of purposeful activities that could be used in an occupational therapy
intervention program? How was purposeful activity determined for infants, persons in a coma
268 Chapter 9

Table 9-1
DEFINITIONS OF OCCUPATIONAL THERAPY
1990 Occupational therapy is the application of purposeful, goal-oriented activity in the evaluation, diag-
nosis, and/or treatment of persons whose function is impaired by physical illness or injury, emotional
disorder, congenital or developmental disability, or the aging process, in order to achieve optimum
functioning, to prevent disability or to maintain health. (American Medical Association. [1990]. Allied
health education directory [14th ed., p. 112]. Chicago, IL: Author.)
1990 Occupational therapy is a vital health care service whose practitioners help to restore and sustain
the highest quality of productive life to persons recovering from illnesses or injuries or coping with
developmental disabilities or changes resulting from the aging process (About AOTA brochure.)
1991 Occupational therapy is the art and science of directing an individual s participation in selected
tasks to restore, reinforce, and enhance performance; facilitate learning of those skills and functions
essential for adaptation and productivity; diminish or correct pathology; and promote and maintain
health. Reference to occupation in the title is in the context of individuals goal-directed use of time,
energy, interest, and attention. Its fundamental concern is the development and maintenance of
the capacity throughout the life span to perform with satisfaction to self and orders those tasks
and roles essential to productive living and to the mastery of self and the environment. (ACOTE.
Essentials and Guidelines or an Accredited Educational Program for the Occupational Therapist.
Modification of definition in Essentials, 1973.)
1993 Occupational therapy is the use of purposeful activity or interventions to promote health and
achieve functional outcomes. Achieving functional outcomes means to develop, improve, or restore
the highest possible level of independence of any individual who is limited by a physical injury or ill-
ness, a dysfunctional condition, a cognitive impairment, a psychosocial dysfunction, a mental illness,
a developmental or learning disability or an adverse environmental condition. Assessment means
the use of skilled observation or evaluation by the administration and interpretation of standardized
or non-standardized tests and measurements to identify areas for occupational therapy services.
(Resolution 542-92. American Journal of Occupational Therapy, 47[12], 1119-1120.)
1993 Occupational therapy is the reasoned use of occupation to assist people in adapting to the chal-
lenges that accompany disabling conditions, as well as normal growth and development. Although
occupational therapy has a particularly profound effect on the lives of those with disabilities, it has
an equally important role in preventing illness and promoting wellness. In all contexts occupational
therapy enables people to participate in activities that give meaning to life and confer a sense of
well-being. (Fine & Kirkland, Envisioning the best for occupational therapy research and education.
OT Week, 7[8], 20.)
1995 Occupational therapy is the use of purposeful activity and interventions to achieve functional
outcomes. Achieving functional outcomes means to maximize the independence and the mainte-
nance of health of any individual who is limited by a physical injury or illness, a cognitive impairment,
a psychosocial dysfunction, a mental illness a developmental or learning disability, or an adverse
environmental condition. (American Medical Association. [1995]. Allied health education directory
[23rd ed., p. 125]. Chicago, IL: Author.)
1999 The Practice of Occupational Therapy means the therapeutic use of purposeful and meaningful
occupations (goal directed activities) to evaluate and treat individuals who have a disease or dis-
order, impairment, activity limitation, or participation restriction which interferes with their ability
to function independently in daily life roles, and to promote health and wellness. (Definition of OT
practice for the AOTA Model Practice Act. OT Week, 13[32], iii.)

or vegetative state, or others with limited communication skills? Without clarifying the term
purposeful activity, the definitions seemed to lack clarity of thought. Two definitions avoided the
issues of purposeful activity by focusing on other objectives. The revised Essentials (AOTA, 1991)
maintained the definition from 1971, which stated that “occupational therapy is the art and sci-
ence of directing an individual’s participation in selected tasks” and that use of the term occupa-
tion refers to the “individuals’ goal-directed use of time, energy, interest, and attention” Overall,
the definition provides a concise and understandable description of occupational therapy. The
other definition that avoided the term purposeful activity was created as part of a discussion of
 Time of Conflict: 1990s to 2000s 269

the functions of the Foundation in 1993. The phrase used to describe occupational therapy is “the
reasoned use of occupation to assist people in adapting….” Use of the term reasoned focuses on
the rationale or frame of reference for selecting an occupation or occupations and suggests there
may be theoretical base for why and how specific occupations are selected for individual clients.

Models of Practice
Table 9-2 lists the models of practice during the 1990s. A significant change is apparent in the
organization of concepts. Several of the models are organized around similar themes of person,
environment, and occupation (PEO). A person may be expressed as client, patient, resident, stu-
dent, worker, homemaker, retiree, or other identifier. Environment may be expressed as context,
place, space, room, workplace, workstation, indoors, outdoors, or other descriptor. Occupation
may be labeled as activity, activities, tasks, activities of daily living, instrumental activities of
daily living, work, job, employment, homemaking, chores, play, leisure, rest and sleep, or other
term specifying an occupation. The outcome from the occupational therapy perspective related
to attainment or improvement in occupational role performance and/or satisfaction with qual-
ity of life. The emphasis was dependent on the focus of the model. Some models were viewed as
overviews or grand models that focused on occupational therapy practice in general but provided
few details on specific techniques or strategies for intervention. Other models focused on a specific
area of practice of practice such as play and tended to provide more detail for intervention.

Table 9-2
EXAMPLES OF MODELS OF PRACTICE PUBLISHED FROM 1990-1999
YEAR MODEL OF PRACTICE REFERENCE
1991 Person‒environment‒occupational Christiansen, C., & Baum, C. (1990). Occupational therapy:
performance model intervention for life performance. In C. Christensen & C. Baum
(Eds.), Occupational therapy: Overcoming human perfor-
mance deficits (pp. 4-43). Thorofare, NJ: SLACK Incorporated.
1992 Occupational adaptation Schkade, J. K., & Schulz, S. (1992). Occupational adaptation:
Toward a holistic approach for contemporary practice. Part 1.
American Journal of Occupational Therapy, 46(9), 829-837.
1992 Multicontext treatment approach Toglia, J. P. (1992). A dynamic interactional approach to
cognitive rehabilitation. In: N. Katz (Ed.), Cognitive reha-
bilitation: Models for intervention in occupational therapy
(pp. 104-143). Boston, MA: Andover Medical Publishers.
1994 Ecology of human performance Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of
human performance: A framework for considering the effect of
context. American Journal of Occupational Therapy, 48, 597-607.
1995 Model of occupational functioning Trombly, C. A. (!995). Occupation: Purposefulness and mean-
ingfulness in therapeutic mechanisms. 1995 Eleanor Clarke
Slagle lecture. American Journal of Occupational Therapy,
49(10), 960-972.
1996 Person‒environment‒occupation Law, M., Cooper, B., Strong, S., et al. (1994). The Person‒
model Environment‒Occupational model: A transactive approach
to occupational performance. Canadian Journal of
Occupational Therapy, 65(1), 9-23.
1997 Playfulness Bundy, A. C. (2007). Play and playfulness: What to look for. In
L. D. Parham & L. S. Fazio (Eds.), Play in occupational therapy
for children (pp. 52-66). St. Louis, MO: Mosby.
270 Chapter 9

Encroachment and Licensure Laws

AOTA increased lobbying assistance to states to protect occupational therapy licensure laws,
including monitoring, analysis, consultation, and development of lobbying materials.
In 1997, the American Physical Therapy Association (APTA) published the Guide to Physical
Therapist Practice (APTA, 1997), which was revised in 1999 (APTA, 1999). The Association
responded in an article in OT Week (AOTA, 1998c). Terminology was one issue. To physical ther-
apy, the concept of money management meant the ability to physically manipulate coins, whereas
to occupational therapy, money management included tasks such as budgeting and paying bills.
Differences are explained in the white paper published in OT Week (Foto, 1998).
Another problem was the expansion of scope of practice to include functional training in
self-care, home management, and community or work integration (APTA, 1999, pp. 1-2). The
Association was concerned that the definition did not sufficiently define the limited context in
which physical therapy intervention addressed patient need and could inappropriately encroach
on the traditional domain of occupational therapy.
The Model Practice Act for Physical Therapy approved by the Federation of State Boards of
Physical Therapy (FSBPT; APTA, 1999) included four sections: (1) examining; (2) alleviating
impairment and functional limitation; (3) preventing injury, impairment, functional limita-
tion, and disability; and (4) engaging in consultation, education, and research. The Association
was primarily concerned with the second section on alleviating impairment and functional
limitation, which included two statements that read “function training in self-care and home
management (including activities of daily living and instrumental activities of daily living)” and
“functional training in community and work (job/school/play) integration or reintegration activi-
ties (including instrumental activities of daily living, work hardening, and work conditioning)”
(APTA, 1999, pp. 1-2). The Association suggested the words “in physical movement and mobility”
be added after words “functional limitation” (AOTA, 1999/2000).
AOTA voiced concern about the unqualified expansion of physical therapy scope of practice
because the expansion was not supported by education and training of physical therapists. A
review of the educational standards for occupational and physical therapy confirmed fundamen-
tal differences in education. The occupational therapy Standards specifically require students to
have a broad-based knowledge of behavioral sciences, whereas in the physical therapy Evaluative
Criteria, behavioral sciences are suggested. Human development is fundamental to the entire
program in occupational therapy, but there is no standard requiring study of human develop-
ment in the physical Evaluative Criteria. Training in evaluation and intervention techniques is
similar, but the foundation for understanding and applying the evaluations and interventions
beyond the biomechanical aspects or in context of the client’s roles and environment is absent
(AOTA, 1999/2000).

Managed Care
Technically managed care is not a new concept but an evolving concept that integrates financial
resource management with the actual cost of providing specific patient care services. Over the
years, the two concepts were separate. Patients received services, and facilities received payments.
The payments did not actually reflect the cost of providing the patient service because other fac-
tors such as overhead and pro bono or free care were lumped into the payment received by the
facility. The real cost of providing services for a person who had had a stroke, for example, was
not known nor considered important to know. As costs rose, beginning in the 1970s, insurance
providers were dealing with higher costs and pressure not to raise premiums. Various techniques
were tried, including prehospitalization certification, requiring second opinions before surgery,
 Time of Conflict: 1990s to 2000s 271

and utilization review (Christiansen, 1996). More recent techniques have been added, including
preferred provider organizations (PPOs) and health maintenance organizations (HMOs). PPOs are
networks of facilities with providers who discount fees in exchange for a larger volume of patient
referrals because their names are listed in the insurance carrier’s list of approved providers. HMOs
are characterized by comprehensive benefit packages, prepaid premiums, and integrate health care
delivery and insuring components (Christiansen, 1996). Rehabilitation programs were especially
difficult to determine actual costs of care because the process often occurred over several months
or years and may involve multiple interrelated diagnoses such as diabetes and hypertension leading
to a stroke—all of which must be managed using different approaches.

Legislation
Table 9-3 summarizes the legislation related to occupational therapy that was adopted during
the 1990s. The most significant legislation was the adoption of the American with Disabilities
Act (ADA) in 1990, the amendments to the Individuals with Disabilities Education Act (IDEA)
(new name for Education for the Handicapped Act), and the Balanced Budget Act (BBA) of

Table 9-3
LEGISLATION
1990 Americans with Disabilities Act (P.L. 101-336). Civil rights protection to persons with disabilities in
all goods, services, facilities (including those that are not funded/operated by the government).
Equal opportunity is the key, not equal treatment. Employers cannot discriminate. Reasonable
Modifications. Readily achievable standard and on opportunity to help facilities and organizations
achieve to become/remain ADA compliant. (Reed, 1992; Van Slyke, 2001)
1990 Individuals with Disabilities Education Act of 1990 (IDEA) (P.L. 101-476). Enforced services provided by
Part H & Part B of the Education of Handicapped Act of 1986, focusing on the importance of preven-
tion instead of remediation. Deficiencies IDEA funding exist. (Van Slyke, 2001; Cottrell, 2005)
1991 Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) Re-Organization Act (P.L. 102-321).
Amends the Title V of public health service Act to revise and restructure alcohol, drug, abuse, and
mental health administration. (Van Slyke, 2001)
1991 Individuals with Disabilities Education Act Amendments (P.L. 102-119). Reauthorized early interven-
tion and established the Interagency Coordinating council for each state to establish a comprehen-
sive system of early intervention services. (Baloueff & Cohn, 2003)
1992 Rehabilitation Act Amendments (P.O. 102-569). Provides for transition planning of high school gradu-
ates including coordination of assistive technology and rehabilitation services. (Baloueff & Cohn, 2003)
1994 School-to-Work Opportunities Act (P.L. 103-239). Provides school-to-work transition systems to pre-
pare students to move into the workforce. (Baloueff & Cohn, 2003)
1994 Head Start Reauthorization Act (P.L. 103-252). Created Early Head Start for infants and toddlers in low
income families, including young children with disabilities. (Baloueff & Cohn, 2003)
1996 Health Insurance Portability and Accountability Act (P.L. 104-191). Regulates the use and disclosure of
protected health information. (Lohman, 2014)
1997 Individuals with Disabilities Education Act Amendments (IDEA) (P.L. 108-446). Strength accountability
for education of children with disabilities. Occupational therapy provided under this act as a related
service. (Baloueff & Cohn, 2003; Lohman, 2014)
(continued)
272 Chapter 9

Table 9-3 (continued)

LEGISLATION
1997 Balanced Budget Act (P.L. 105-33). Legislation to control health care costs. Reduced occupational
therapy position, reduced occupational therapy applications, and several programs closed. A pro-
spective payment system for home health was started in 2000. Medicare Part A prospective pay-
ment plan for Skilled Nursing Facilities was scheduled to begin in 1999. Caps on Part B outpatient
rehabilitation services ($1500 for physical therapy and speech combined, occupational therapy sepa-
rate). Established prospective payment systems in inpatient rehab units. (Lohman, 2014)
1997 Children s Health Insurance Program (CHIP) (P.L. 111-3). Provide insurance for children who do not
qualify for Medicaid but cannot afford private insurance. It is jointly funded by the states and the
federal government. (Lohman, 2014)
1998 Assistive Technology Act (P.L. 108-364). Provides definitions for assistive devices and clarifies the ser-
vices provided. (Schoonover, Grove, & Swinth, 2010)
1999 Olmstead decision by Supreme Court. Ruled states must place clients in community settings instead
of institutions if appropriate. Services and activities for persons with disabilities must be provided in
the most integrated setting appropriate to needs of qualified individuals. (Cottrell, 2005)
1999 The Ticket to Work Incentives Improvement Act (P.L. 106-170). Removed disincentives to employment for
people with disabilities. Program is administered by the Social Security Administration. (Cottrell, 2005)
References
Baloueff, O., & Cohn, E. S. (2003). Introduction to the infant, child and adolescent population. In E. B. Crepeau, E. S. Cohn, &
B. A. Boyt Schell (Eds.), Willard & Spackman s occupational therapy (10th ed., pp. 691-698). Philadelphia, PA: Lippincott
Williams & Wilkins.
Cottrell, R. P. F. (2005). The Olmstead decision: Landmark opportunity or platform for rhetoric? Our collective responsibility for
full community participation. American Journal of Occupational Therapy, 59(5), 561-568.
Lohman, H. (2014). Payment for services in the United States. In B. A. Boyt Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard &
Spackman s occupational therapy (12th ed., pp. 1051-1067). Philadelphia, PA: Wolters Kluwer.
Reed, K. L. (1992). History of federal legislation for persons with disabilities. American Journal of Occupational Therapy, 46(5),
397-408.
Schoonover, J., Grove, R. E. A., & Swinth, Y. (2010). Influencing participation through assistive technology. In J. Case-Smith & J. C.
O Brien (Eds.), Occupational therapy for children (6th ed., pp. 583-619). St. Louis, MO: Mosby/Elsevier.
Van Slyke, N. (2001). Legislation and policy issues. In M. Scaffa (Ed.), Occupational therapy in community-based practice set-
tings (pp. 85-94). Philadelphia, PA: Davis.

1997. One Supreme Court decision (Olmstead) is also listed because it required clients to be
placed in the community rather than in institutions, further supporting the movement toward
deinstitutionalization.

Technology
During the 1990s, technology
improvements increased the use of occu-
pational therapy services. Examples are
seen here in the Figures. Figure 9-1 shows
a therapists working with a client wear-
ing an Ilizarov external fixator designed
to lengthen her arm by slowly stretching
her bone and tissues. The client had had
an infection as a small child, which lim-
ited growth in her arm. The therapist is Figure 9-1. Ilizarov external fixator. (Printed with permis-
monitoring motion and strength as the sion from the Archive of the American Occupational Therapy
Association, Inc.)
procedure progresses. Figures 9-2 and 9-3
 Time of Conflict: 1990s to 2000s 273

Figure 9-2. A child learning to use a prosthesis. (Printed Figure 9-3. An adult learning to use a prosthesis. (Printed
with permission from the Archive of the American with permission from the Archive of the American
Occupational Therapy Association, Inc.) Occupational Therapy Association, Inc.)

Figure 9-4. A client with a congenital amputation learn- Figure 9-5. A client learning to use adapted eating
ing to drive. (Printed with permission from the Archive devices. (Printed with permission from the Archive of the
of the American Occupational Therapy Association, Inc.) American Occupational Therapy Association, Inc.)

show a child and an adult with prosthetic limbs

designed to look as natural as possible but still
provide motion and function. Both clients are
practicing using their prostheses to perform
everyday occupations under the guidance of
the occupational therapist. Figure 9-4 shows a
client with a congenital amputation learning to
manage the adaptive driving devices that will
allow her drive independently.
Not all technology is high tech, requiring
advanced electronics to operate the desired
Figure 9-6. A client using a reacher to grab a laundry functions. Figure 9-5 shows a client wearing a
item. (Printed with permission from the Archive of the
cuff that allows devices such as a form or spoon
American Occupational Therapy Association, Inc.)
to be inserted because the client does not have
enough hand strength to hold the eating utensil
without assistance. There is also a clear plastic plate guard attached to the edge of the plate to keep
food from being spilled off the edge as the client scoops up the pieces of salad against the plate
rail. Another low-tech device called a reacher is shown in Figure 9-6 being used to retrieve items
from the laundry basket and place them in the washing machine without having to bend over or
lose the support provided by the walker. Yet another low-tech device is the mouth stick shown in
Figure 9-7 that allows the client to paint or draw as a leisure activity.
274 Chapter 9

Figure 9-7. A client using a mouth stick to Figure 9-8. A client using a bicycle jigsaw. (Printed
paint. (Printed with permission from the with permission from the Archive of the American
Archive of the American Occupational Therapy Occupational Therapy Association, Inc.)
Association, Inc.)

Finally, not all technology is new. Figure 9-8 shows a client using a bicycle jigsaw, with which
reciprocal movement of the feet power the motion of the jigsaw blade. Bicycle-powered jigsaws
were used during World War I to increase motion of the lower extremities while the client guided
a piece of wood to be cut by jigsaw blade.

Research
Outcomes research designed to determine the efficacy and efficiency of services such as
occupational therapy became a major focus of research in 1990s. Later, the term evidence-based
practice would evolve. Steib (1999) summarized several outcomes studies relevant to occupational
therapy practice, including reducing the risk of falling, increasing survival rates in the elderly,
reducing disability in people who have had strokes, improving outcomes for clients with hip frac-
tures, and reducing hospitalization costs. The Foundation began funding outcomes research in
1994 (AOTF, 1996a). Among the studies funded was the Well Elderly Study at the University of
Southern California. The study provided evidence that occupational therapy can improve quality
of life for older individuals living independently and is cost effective. The results were published
in the Journal of the American Medical Association (JAMA; Clark et al., 1997). In addition, the
materials used in the study were published in a manual published by the Association (Mandel,
Jackson, Zemke, Nelson, & Clark, 1999). Seven organizations were involved in funding the study,
including three government and four private—a fact that speaks to the cost of conducting quality
research projects.

Association
National Office Organization
Bair (1991) stated that there were 120 full-time employees working in the national office.
Twenty-one employees were occupational therapists. The national office was reorganized into
 Time of Conflict: 1990s to 2000s 275

five units—professional development, finance and operations, marketing, professional resources,

and professional relations—in addition to the Director’s office (Bair, 1992). The national office
moved from 1383 Piccard Drive in Rockville, Maryland, to 4720 Montgomery Lane in Bethesda,
Maryland, in November 1994 (Figure 9-9). The building has 13 floors and allowed all Association
activities to be housed under one roof. In 1998, the
Association created the State Policy Department to
increase the capacity to monitor and intervene in
state practice act issues, especially encroachment.

Association Presidents
Four people served as President of AOTA during
the 1990s: Ann P. Grady, 1989-1992 (Figure 9-10);
Mary M. Evert, 1992-1995 (Figure 9-11); Mary Foto,
1995-1998 (Figure 9-12); and Karen Jacobs, 1998-
2001 (Figure 9-13). Their accomplishments are sum-
marized in Table 9-4. Biographical sketches appear
in Table 9-5. Figure 9-14 shows a group photo-
graph of past Presidents, including Ruth Brunyate-
Wiemer, Robert K. Bing, Jerry A. Johnson, Florence
S. Cromwell, Elnora M. Gilfoyle, Carolyn M. Baum,
Ruth A. Robinson, and Wilma L. West. Figure 9-9. Association National Office,
Montgomery Lane, Bethesda, Maryland. (Printed
with permission from the Archive of the American
Mission and Vision Statements Occupational Therapy Association, Inc.)

A mission statement was adopted in 1993 by the

Executive Board. It reads: “The American Occupational Therapy Association advances the quality,
availability, use, and support of occupational therapy through standard-setting, advocacy, educa-
tion, and research on behalf of its members and the public” (AOTA, 1993a). The purpose was to
guide the development of strategic planning by creating major focus areas. Examples are seen in
the Strategic Plan for the years 1993 to 1996 (AOTA, 1994b).

Figure 9-10. Ann P. Grady, PhD, OTR, Figure 9-11. Mary M. Evert, MBA, OTR, Figure 9-12. Mary Foto, OTR, FAOTA,
FAOTA, President of AOTA, 1989-1992. FAOTA, President of AOTA, 1992-1995. President of AOTA, 1995-1998.
(Printed with permission from the (Printed with permission from the (Printed with permission from the
Archive of the American Occupational Archive of the American Occupational Archive of the American Occupational
Therapy Association, Inc.) Therapy Association, Inc.) Therapy Association, Inc.)
276 Chapter 9

● Goal 1: Professional Development: AOTA will promote

the development and integration of occupational thera-
py practice, education, and research, to further enhance
and promote the profession. Clarifying Statement:
There is an inextricable linkage among practice, educa-
tion, and research with each component interdependent
and equally valued.
● Goal II: Serves the Interest of Members: AOTA will
develop programs and services which address member
needs and promote member recruitment and retention.
Clarifying Statement: Members will perceive that they
have greater access to AOTA resources which meet their
needs and enable them to promote the profession.
● Goals III: Support the Professional Community: AOTA
will increase mutually beneficial relationships and
partnerships and state associations to enhance the Figure 9-13. Karen Jacobs, EdD, OTR/L,
professional community. Clarifying Statement: The CPE, FAOTA, President of AOTA, 1998-
2001. (Printed with permission from the
Association must be proactive in confronting societal Archive of the American Occupational
changes such as consumerism, education reform, health Therapy Association, Inc.)
care reform, and the independent living movement.
● Goal IV: External Relations and Access to Occupational Therapy: AOTA will develop pro-
grams to address external factors that impact the profession and the availability of occupa-
tional therapy services to the consumer.
In 1998, the Executive Board adopted a vision statement to accompany the mission statement.
The vision statement reads, “AOTA advances occupational therapy as the preeminent profession

Table 9-4
PRESIDENTIAL ACCOMPLISHMENTS
Ann P. Grady, 1989-1992
Major accomplishment: National office undertook a major reorganization to streamline operations.
Quotation: AOTA has provided a community for OT practitioners and leadership for the profession as a
whole. As we move toward our 100th anniversary, the Association and the members will play key roles in
shaping health care in America. (AOTA. [1992]. AOTAs Hall of leaders. OT Week, 6[21], 40-43.)
Mary M. Evert, 1992-1995
Major accomplishment: Focus on building a sense of community among occupational therapy practitioners.
Quotation: Ahead I see many OT practitioners as pivotal leaders in community-based teams of professionals
and community members who advocate and implement programs for healthier life-styles and disease pre-
vention, and for full community integration of people with functional limitations. (AOTA. [1992]. AOTAs Hall of
leaders. OT Week, 6[21], 40-43.).
Mary Foto, 1995-1998
OT Week was discontinued due to lack of advertisers. OT Practice started in November 1995 to focus on
practice issues. Major accomplishment during Foto s term was the focus on reimbursement for occupational
therapy services.
Karen Jacobs, 1998-2001
Association retrenches as membership decreased in response to concern over implications of the Balanced
Budget Act. The American Journal of Occupational Therapy returned to bimonthly publication. Major accom-
plishments during Jacobs term were the Back Pack initiative and focus on increased consumer and public
awareness of occupational therapy as a profession.
 Time of Conflict: 1990s to 2000s 277

Table 9-5
PRESIDENTIAL BIOGRAPHICAL SKETCHES
ANN PATRICIA GRADY
April 28, 1935‒March 18, 2012
Born in New Haven, Connecticut. She graduated from the College of New Rochelle with a bachelor s degree
in sociology. She received a certificate in occupational therapy for Columbia university, a master s degree from
the University of Denver and a doctoral degree in human communications from the University of Denver. She
began her career at Newington Children s Hospital in Newington, Connecticut. She moved to Colorado to work
as the director of the occupational Therapy Department at the Children s Hospital in Denver where she worked
from 1966 to 1993. She also taught in the graduate programs at Colorado State University and the University
of Colorado, Department of Pediatrics. She was president of the Association from 1989-1992, speaker of the
Representative Assembly from 1977-1979, vice-president from 1987-1989 and also served as vice president of the
American Occupational Therapy Foundation and was chairperson of its Research Development Committee.
She received the Eleanor Clarke Slagle lectureship in 1994, the Award of Merit in 2000, and was named a Fellow
in 1979 She also received the AOTF s Meritorious Service award. With Elnora Gilfoyle and Josephine C. Moore,
PhD, OTR, FAOTA she coauthored two editions of Children Adapt: A Theory of Sensorimotor Development
published by Slack, Inc. and the book Mentoring Leaders with Gilfoyle and Nielson published by AOTA Press.
Her passion was family-centered care but she was also interest in leadership and mentoring.
MARY MARGARET KUSZEWSKI EVERT
Born February 5, 1945
A California native, Mary received her B.S. degree from the College of St. Catherine in 1967. She also has a MBA
in Health Care Administration from National University in San Diego, CA, 1980 and an honorary doctor of sci-
ence degree. She was a staff therapist at Rancho Los Amigo Hospital from 1968-70 and was OT Supervisor at
Children s Hospital in San Diego. During the Reagan administration she worked for the federal government in
the U.S. Department of Health and Human Services. . She owns a consulting business in California. She was
president of the Association from 1992-95, served as Speaker of the Representative Assembly and was elected
delegate to the World Federation of Occupational Therapists. She has also served as president of the California
Occupational Therapy association and has been a member of California licensing board. She was named to the
Roster of Fellows in 1984 and received the Award of Merit in 2000. She married Richard Evert and has a son.
MARY ELIZABETH SMITH
Born September 1, 1941
Mary was born in Iowa Falls, Iowa but her family moved to California when she was a child. She graduated from
University of Southern California in 1966 with an undergraduate degree in occupational therapy. She is also a
certified case manager. She serves as chief executive officer of two companies. The Foto Group, Inc. provides
non-physician peer medical review and support system and Treat-it.com a software documentation and prac-
tice management package for non-physician rehabilitation and technology providers. She served as president
from 1995-98 and was named to the Roster of Fellows in 1989. She has also chaired the Tri-Alliance of Therapy
Professions and Coalition of Rehabilitation Therapies and has served on the AOTF Board. She is a member of the
Occupational Therapy association of California in which she has held many positions and received the Award of
Merit in 2008. She married Stephen Anthony Foto and has a daughter. She enjoys skiing.
KAREN JACOBS
Born January 15, 1951
Born in Massachusetts. She has a bachelor of arts in psychology from Washington University in 1973, a master s
of science in occupational therapy from Boston University in 1979 and a doctorate in education in Educational
Leadership in Schooling from the University of Massachusetts in 1993. She has served the Association as vice-
president and president. She was named to the Roster of Fellows in 1988, received the Eleanor Clarke Slagle
lectureship award in 2011 and the Award of Merit in 2003. She has also received the Award of Merit from
the Canadian Association of Occupational Therapists and was a recipient of the J. William Fulbright Foreign
Scholarship award in 2005. She is the founding editor of the interdisciplinary and international journal Work:
A Journal of Prevention, Assessment and Rehabilitation and is the author of Ergonomics for Therapists and
Occupational Therapy: Work-Related Programs and Assessments and coeditor of Quick Reference Dictionary
for Occupational Therapy, Occupational Therapy Essentials for Clinical Competence, and Occupational Therapy
Manager, 4th edition.
278 Chapter 9

Figure 9-14. AOTA Presidents. From left to right: (standing) Florence Cromwell, Elnora
Gilfoyle, Carolyn Baum, Ruth Robinson, Wilma West; (sitting) Ruth Brunyate Wiemer,
Robert Bing, Jerry A. Johnson. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)

in promoting the health, productivity, and quality of life of individuals and society through the
therapeutic application of occupation” (AOTA, 1998a). This statement added criteria for develop-
ing goals.

Specialty and Board Certification Programs

The Specialty Certification Program was formalized in 1994 with a bylaws change that formed
the Specialty Certification Board as a standing committee of the Executive Board (AOTA, 1995a).
Specialty certification in pediatrics had begun ahead of the formal development of the Specialty
Certification Board and had already developed criteria (AOTA, 1994a). The second certification
was in neurorehabilitation. Initially the certification programs were for therapists but were then
expanded to include assistants.

Special Interest Sections

The new Special Interest Sections (SIS) approved by Executive Board during the 1990s were the
Education, Technology, Home and Community Health, and School Systems. The total number
of SIS groups was now 11. The Education section provides opportunities for academicians, new
faculty, fieldwork supervisors, clinicians, and students to discuss the many issues involved in occu-
pational therapy education. This SIS provides a forum to address the art and science of teaching at
all levels of occupational therapy education, as well as developments in research.
The Technology SIS provides information on the latest clinical and research technology. The
section considers innovations that enhance therapy from low to high tech. It also provides a
forum for continuing education and facilitates networking among all areas of practice relating to
technology.
The Home and Community Health SIS provides members with networking on special clini-
cal consideration and are advised on current legislation and regulatory and employment issues.
The section conducts education programs, maintains a network of state leaders in home health,
and provides an ongoing newsletter. The group also consults with academic programs on home
health–specific curriculum.
 Time of Conflict: 1990s to 2000s 279

The School Systems SIS is dedicated to addressing the needs of school-based practitioners to
provide educationally related serves to infants, preschoolers, children, and adolescents. This SIS
promotes education, research, legislation, and policy making that will enhance practice in the
school systems and community (AOTA, 1994a).

Uniform Terminology for Occupational Therapy, Third Edition

In 1994, the Uniform Terminology document was revised for the third time (AOTA, 1994b).
The Third Edition was expanded to reflect current practice and to incorporate contextual aspects
of performance in addition to the performance areas and performance components used to orga-
nize terms in the Second Edition (AOTA, 1994c). Overall, the number of terms listed, defined, or
described increased from 109 to 122. The performance areas included 37 terms, the performance
components 75 terms, and the performance contexts 10 terms. The three performance areas
remained essentially the same as those in the Second Edition: activities of daily living, work and
productive activities, and play or leisure activities. The performance component remained the
same: sensory, cognitive, and psychosocial. The performance components that were added were
divided in temporal aspects and environment.
According to the President’s report in 1993, the AOTA Board of Directors initially declined the
invitation of the American Physical Therapy Association (APTA) to establish a joint occupational
therapy/physical therapy committee to write a white paper identifying the commonalities and
differences between the two professions. The focus, intent, and potential uses of the proposed
paper were not clear to members of the AOTA Board, and APTA’s Board of Directors was asked
to provide further clarification (AOTA, 1993a, p. 3). As stated in the white paper’s Preamble, the
APTA House of Delegates charged the APTA Board of Directors in 1992 to develop a document
with AOTA “to identify areas of commonalities and differences affecting the professions of physi-
cal therapy and occupational therapy … to include … needs of society, scope of practice, educa-
tion, marketing, and reimbursement” (APTA, 1994, p. 1). The target audience was identified as
members of both professions and as parties external to the two professions. The internal context of
use was specifically at the chapter (physical therapy) level as an educational tool to provide basic,
factual information about the two professions. The need for collaboration was acknowledged by
members of both Associations as affecting four perspectives: higher education, community based
practice, institution based clinical practice, and health care administration. After clarifying con-
cerns, AOTA’s Board charged the President to appoint representatives to the PT/OT Task Force,
and task force members were appointed. The AOTA Executive Board reviewed the final draft of
the paper in March 1994 (AOTA, 1994d). Much of the paper is a summary of issues common to
both professions, including a short history, employment demographics, number and ethnicity of
practitioners, education and accreditation, licensure, definitions of practice, codes of ethics, role
delineation, health care reform, research, and public awareness. Two points of discussion are of
special interest: physical agent modalities and the concept of function.
Under scope of practice, reference is made to a dispute between physical and occupational
therapy regarding the “ownership” of “therapeutic procedures or activities,” especially in relation-
ship to the use of physical agent modalities and functional activities. A statement clarifying the
issue is as follows:
Both APTA and AOTA believe that a procedure or activity is neither physical therapy nor occu-
pational therapy in and of itself. Instead, it is the knowledge and appropriate use and integration of
the procedure or activity into the therapeutic plan of care that is paramount. (APTA, 1994, p. 19)
This statement is an acknowledgement by both professions that supplies, equipment, media,
and modalities are not “owned” by either profession, or any other profession. What is “owned” is
the specific knowledge and skill integrated into therapeutic plan of care. The clarification helped
solve disputes in preparing and revising licensure laws in which physical agent modalities were
280 Chapter 9

referred as a category or by specific name. Occupational therapy licensure laws could include refer-
ence to physical agent modalities also listed in physical therapy licensure laws. Education, however,
was another matter. In the document, APTA’s Board of Directors maintains that “all non-physical
therapist providers who use physical agent modalities/electrotherapy devices should meet the same
minimum educational preparation standards as physical therapists and that licensure and regu-
latory requirements should also take into account these competences” (APTA, 1994, p. 20). This
statement does not take into account that another profession might be using the same modality
with a different goal in mind, which may require a different set of knowledge and skills.
The concept of function as used within the profession of occupational therapy is described as
follows:
The capacity of individuals to engage in daily occupational of self-care, work, and
play/leisure in a manner that enables them to derive satisfaction and meaning in their
lives…. Function represents occupational performance, which is both a core value and
a central concern of the occupational therapy profession. (APTA, 1994, p. 20)
The ideas regarding the concept of function were further refined in the position paper adopted
and published the following year, which includes a historical review of the concept of function in
the development of occupational therapy practice (AOTA, 1995d).

Physical Agent Modalities Issue

In 1990, Pedretti and Pasquinell proposed a solution to dilemma of whether the concept of pur-
poseful activity is broad enough to encompass of the therapeutic potential of the profession. They
suggested that occupational therapy intervention could be viewed as a continuum of four stages
within an occupational performance frame of reference. At the lowest stage would be adjunctive
methods, followed by enabling activities, then purposeful activities, and occupational perfor-
mance and community reintegration. Adjunctive methods would include “procedures that prepare
the patient for occupational performance but are preliminary to the use of the performance skills”
(Pedretti & Pasquinelli, 1990, pp. 3-4). Ayres had suggested the same or similar idea in 1958. She
defined purposeful motor function as follows:
… use of the motor system as a means toward accomplishing a goal which is inherent
in the nature of the activity demanding the function. These goals are separate from but
vital to the therapeutic objectives involving range of motion, coordination, endurance,
strength, use of the prosthetic or orthotic device, or performance of activities of daily
living. (p. 300)
Pedretti and Pasquinelli (1990) suggested the procedures may include “exercise, facilitation and
inhibition techniques, positioning, splinting, sensory stimulation, and selected physical modali-
ties” (p. 4). The focus of intervention is most likely concerned with assessing and remediating per-
formance components or skills that will be needed later for to achieve occupational performance
in activities of daily living. The second stage of enabling activities is again based on Ayres and is
defined as those that have “an autonomous or inherent goal beyond the motor function required
to perform the task” (Pedretti & Pasquinelli, 1990, p. 4). Examples of such media are “sanding
boards, stacking cones or blocks, practice boards for mastery of clothing fasteners and hardware,
driving and work simulators, and tabletop activities such as pegboards for training perceptual-
motor skills” (Pedretti & Pasquinelli, 1990, p. 4). Stage three includes purposeful activities that
have an inherent or autonomous goal and are relevant and meaningful to the client. Examples are
feeding, hygiene, dressing, mobility, communion, arts, crafts, games, sports, and work activities.
Stage four includes resuming the occupational roles associated with self-care, work, education, and
play or leisure performance by the client to maximum level of independence. This stage or levels
approach became a workable solution to incorporating physical agent modalities into the scheme
of acceptable intervention modalities within the practice of occupational therapy.
 Time of Conflict: 1990s to 2000s 281

The Representative Assembly adopted a position paper on physical agent modality in 1991. The
issue was controversial. Some members felt that physical agents should not be part of the modali-
ties used by occupational therapists. The following year, two resolutions sought to rescind or mod-
ify the statement adopted in 1991. Both were rejected because members, especially in hand therapy,
were already using physical agent modalities and state regulations permitted such use (Joe, 1992).

Cross-Training and Multiskilling

In 1991, the Representative Assembly initiated a charge to study issues related to personnel
(other than occupational therapy practitioners) who provided occupational therapy services
(Hansen, 1995). The main focus was initially on the use of aides to provide occupational therapy
services. Two documents were prepared in subsequent years: Service Delivery in Occupational
Therapy (AOTA, 1995c) and Use of Occupational Therapy Aides in Occupational Therapy Practice
(AOTA, 1995e). At issue was the pressure by stakeholders in the health care industry for service
delivery personnel to be more accountable and more cost effective. As Edward O’Neil, Executive
Director of the Pew Health Professions Commission, stated in 1996, “We’re not suggesting [the
Pew recommendations] happen as a preemptive strike against OT to force it into cross-training”
(Hettinger, 1996). However, the Pew commission was suggesting that occupational therapy prac-
titioners and other allied health professionals would be considered more valuable to the health
care system if they could carry out more functions. To that end, practitioners were being asked
to provide services that might be considered outside their scope of practice, such as occupational
therapy practitioners being trained to perform gait training or individuals being educated at entry
level to be multiskilled practitioners capable of assuming multiple roles and duties in health care
delivery, such as a person being educated as both an occupational therapist and a physical therapist
(Hansen, 1995).
A white paper was written in 1995 on occupational therapy and cross-training (AOTA, 1995f).
It discussed issues related to practitioners educated in occupational therapy providing services, not
aides or on-the-job trained personnel. Cross-training was defined as “the preparation of an indi-
vidual in one profession to perform skills (and tasks) typically associated with another profession”
(AOTA, 1995f, p. 32; AOTA, 1997d, p. 854). A practitioner was defined as “an individual who is a
graduate of an accredited occupational therapy preprogram and is certified” (AOTA, 1995f, p. 32).
A multiskilled practitioner was defined as “an individual from one profession who has established
competence in specific skills usually associated with another profession” (AOTA, 1995f, p. 32).
Occupational therapy practitioners were asked to consider the following questions in relations to
cross-training initiatives:
● Does the individual to be trained have the potential to achieve competency in the skill to be
delegated (background knowledge and/or experience)?
● Will the trainer and the trainee be given adequate time and resources for training?
● Will appropriate supervision be available?
● Is there any state regulation or institutional policy that prohibits the assignment of this skill
to another individual?
● Would participation in the proposed initiate result in a violation the profession’s code of ethics
or standards of practice?
● Will the trainee accept legal responsibility for performance of the skill once training is com-
pleted?
● Will the trainer accept legal responsibility of any services delegated to the trainee?
Perhaps a more important question was whether occupational therapy practitioners were seen
as staff workers with a potential extra pair of hands to walk patients or change light bulbs or
whether they were seen as having educated intellectual skills designed to help clients solve prob-
lems in everyday living. The hands-on nature of many aspects of occupational therapy services
282 Chapter 9

may lead those not trained in health care services to think the hands are the service rather than the
brain that directs the hands. According to an article by Collins (1997), there was a need to clarify
the terms to determine how multiskilling and cross-training would be taught in educational pro-
grams and how such personnel would be used in practice. However, the TriAlliance (1995) saw
no need to study the issue further because it did not support the concept of clinical multiskilled
personnel at either the professional or assistant levels. According to the TriAlliance, audiologists,
occupational therapists, physical therapists, and speech-language pathologists have distinct and
separate philosophical, educational, and scientific foundations. Asking them to act as multiskilled
personnel at the professional or assistant level “is likely to result in unacceptable levels of risk or
potential negligence that could result in harm to, or poor outcomes, for the recipient of services
(TriAlliance, 1996, p. 17). Nonetheless, the Association proceeded to produce a Cross-Training
Concept paper (AOTA, 1997d) outlining in detail the basic premises of cross-training; the advan-
tages and disadvantages of cross-training for the client, occupational therapy practitioners, and
administrators; factors to consider when implementing a cross-training program; and strategies
for dealing with the changing health care environment. This paper seems to answer all the ques-
tions because the issue of cross-training stops appearing in the occupational therapy literature.

Skilled Versus Nonskilled Services and Medicare

The discussion of cross training and multiskilling is germane to the discussion of skilled occu-
pational therapy services and nonskilled or caregiving services. Reimbursement under Medicare
requires that skilled occupational therapy services be provided. Nonskilled services are not reim-
bursable. Skilled occupational therapy was defined as follows:
… occupational therapist modifies the specific activity by using adapted equipment,
making changes in the environment and surrounding objects, altering procedures for
accomplishing the task, and providing specialized assistance to meet the client’s cur-
rent and potential abilities. Skilled services include, but are not limited to, reasonable
and necessary:
● Evaluation of the client
● Determination of effective goals and services with the client, family, caregiver,
or other medical professional
● Analysis and modification of functional tasks
● Provision of task instruction(s) to the client, family, or caregiver
● Periodic reevaluation of the client’s status, with corresponding readjustment of
the occupational therapy program (Health Care Financing Administration, n.d.)
Foto (1996a) quotes from a letter she received in 1992 to explain the conceptual framework that
defines skilled service as those requiring the “knowledge, skills, and judgement of a therapist for
the treatment and amelioration of impairment and disabilities caused by a medical condition.”
Knowledge involves a course of academic preparation specifically related to the services requires
by the medical conditions. Skills are a specific array of technical assessment and treatment inter-
vention appropriate to each population served that are acquired through an academic and clinical
training program, followed by a supervised clinical affiliation, continuing education, and clinical
experience. Judgment is the ability to apply professional practice standards to decide whether a
given client requires intervention and the knowledge and skills required to appropriately treat
a given condition and to decide when treatment should be discontinued. In other words, skilled
occupational therapy services are:
… based on a formal course of occupational therapy academic and clinical prepara-
tion, are related to a medical condition and are directed toward the amelioration
of impairment and disabilities for the purpose of reducing safety risks, preventing
 Time of Conflict: 1990s to 2000s 283

secondary complications and facilitating a client’s attainment of daily living indepen-

dence that is higher than his or her existing level of independence. (Foto, 1996a, p. 169)
The focus on skilled services under Medicare is in stark contrast to the recommendations of
the Pew Commission. Medicare requires hospital and facility personnel to provide skilled services
acquired through a specific educational, clinical training, and/or continuing educational program,
whereas the Pew Commission recommended that personnel should be educated and trained to
provide services that are potentially across several disciplines of knowledge, skill, and judgment.
In reality, some of both may occur. In another article, Foto (1996b) points out that one stroke reha-
bilitation program trained all team members to perform transfers, positioning, passive and active
range of motion, dysphagia feeding techniques, stress management, and methods to facilitate and
reinforcement communication. What is considered nonskilled in one setting may be considered
skilled in another, depending on the degree of specialized skills available among the personnel
assigned to the service unit. For example, the concept of multiskilling can be used to suggest that
occupational therapists add to their basic skills set by learning to be case managers or accepted as
a primary referral source (Foto, 1995). Finally, multiskilling may be seen as a step toward creating a
universal therapist—a therapist who, in theory, would be capable of providing any of the therapies
(physical, occupational, or speech-language). Of course, a universal therapist would likely have
to obtain multiple state licenses to practice in all three disciplines, plus maintain the continuing
education requirements. Such hurdles may act as barriers or disincentives to such practice.

Uniform Terminology, Third Edition

The third edition of the Uniform Terminology document was published in 1994 (AOTA, 1994b).
A major change in the Third Edition was the addition of the construct of Performance Contexts
to the existing constructs of Performance Areas and Performance Components. Performance
Contexts are:
… situations or factors that influence an individual engagement in desired and/
or required performance areas. Performance contexts consist of temporal aspects
(chronological age, developmental age, place in the life cycle, and health status) and
environmental aspects (physical, social and cultural considerations). (p. 1047)
The addition of Performance Contexts completes the PEO triad discussed under Models of
Practice. Performance Components are aspects of the person, Performance Contexts address the
environment, and Performance Areas are the occupations.
The three constructs are listed in order as Performance Areas, Performance Components, and
Performance Contexts. The Performance Areas maintain the same three subsections: activities
of daily living, work activities, and play or leisure activities. The Performance Components also
maintain the same three subsections: sensorimotor components, cognitive integration and cog-
nitive components, and psychosocial skills and psychological components. A few changes were
added or subtracted from the items listed under each subcategory to update understanding of
items in that subcategory.

Publication and Information

OT Week and OT Practice combined into one publication in 1995 called OT Practice. Revenue
from advertisements in OT Week had decreased from employers seeking practitioners or faculty
members. Documents approved and published by the Association are listed in Table 9-6.
284 Chapter 9

Table 9-6
ASSOCIATION DOCUMENTS
1990 ● Entry Level Role Delineation for Registered Occupational therapists (OTRs) and Certified
Occupational Therapy Assistants (COTAs). AJOT, 44(12), 1091-1102
● Supervision Guidelines for Certified Occupational Therapy Assistants, AJOT, 44(12), 1089-1090
1991 ● Essentials and Guidelines for an Accredited Education Program for the Occupational Therapist.
AJOT, 45(12), 1077-1084
● Essentials and Guidelines for an Accredited Educational Program for the Occupational Therapy
Assistant. AJOT, 45(12, 1085-1092
● Occupational Therapy and Assistive Technology. AJOT, 45(12), 1076
● Statement: The Occupational Therapist as Case Manager. AJOT, 45(12), 1065-1066
● Statement: Occupational Therapy Services Management of Persons with Cognitive
Impairments. AJOT, 45(12), 1067-1069
● Statement: Occupational Therapy Provision for Children with Learning Disabilities and/or Mild
to Moderate Perceptual and Motor Deficits. AJOT, 45(12), 1070-1074
● Official: AOTA Statement on Physical Agent Modalities. AJOT, 45(12), 1075
1992 ● Position Paper: Physical Agent Modalities. AJOT, 46(12), 190-1091.
● Standards of Practice for Occupational Therapy. AJOT, 46(12), 1082-1085
● Statement: Occupational Therapy Services in Work Practice. AJOT, 46(12), 1086-1988
● White Paper: Occupational Therapy and Long-Term Care. OT Week, 6(42), 24-24.
1993 ● Core Values and Attitudes of Occupational therapy Practice. AJOT, 47(12), 1086-1086
● Knowledge and Skills for Occupational Therapy Practice in the Neonatal Intensive Care Unit.
AJOT, 47(12), 1100-1105
● Occupational Therapy Roles. AJOT, 47(12), 1087-1099
● Position Paper: Occupational Therapy and the Americans with Disabilities Act (ADA). AJOT,
47(12), 1083-1084
● Position Paper: Purposeful Activity. AJOT, 47(12), 1081-1082
● Statement: The Role of Occupational therapy in the Independent Living Movement. AJOT,
47(12), 1079-1080
1994 ● Guide for Supervision of Occupational Therapy Personnel. AJOT, 48(11), 1045-1046
● Occupational Therapy Code of Ethics. AJOT, 48(11), 1037-1038
● Position Paper: Occupational Therapy and Long-Term Services and Supports. AJOT, 48(11),
1035-1036.
● Standards of Practice for Occupational Therapy. AJOT, 48(11), 1039-1044
● Statement of Occupational Therapy Referral. AJOT, 48(11), 1034
● Statement: Occupational Therapy Services for Persons with Alzheimer s Disease and Other
Dementias. AJOT, 48(11), 1029-1033
● Uniform Terminology for Occupational Therapy ‒ Third Edition. AJOT, 48(11), 1047-1055
● Uniform Terminology- Third Edition: Application of Uniform Terminology in Practice. AJOT,
48(11), 1055-1059
(continued)
 Time of Conflict: 1990s to 2000s 285

Table 9-6 (continued)

ASSOCIATION DOCUMENTS
1995 ● Concept Paper: Service Delivery in Occupational Therapy. AJOT, 49(10), 1029-1031.
● Elements of clinical Documentation (Revision). AJOT, 49(10), 1032-1035
● Position Paper: Broadening the Construct of Independence. AJOT, 49(10), 1014
● Position Paper: Occupation. AJOT, 49(10), 1015-1018
● Position Paper: Occupational Performance: Occupational Therapy s definition of Function.
AJOT, 49(10), 1019-1020
● Position Paper: The Psychosocial Core within Occupational Therapy. AJOT, 49(10), 1021-1022
● Position Paper: Use of Occupational Therapy Aides in Occupational Therapy Practice. AJOT,
59(10), 1023-1028
● Statement: Nondiscrimination and Inclusion Regarding Members of the Occupational Therapy
Professional Community. AJOT, 49(10), 1009-1010
● Statement: Psychosocial Concerns within Occupational Therapy Practice. AJOT, 49(10), 1011-1013
● White Paper: Occupational Therapy and Cross-Training Initiatives. OT Week, 9(10), 31-33
1996 ● Enforcement Procedures for Occupational Therapy Code of Ethics. AJOT, 50(10), 848-852.
● Occupational Therapy: A Profession in Support of Full Inclusion. AJOT, 50(10), 855
● Position Paper: Eating Dysfunction. AJOT, 50(10), 847-848
● Position Paper: Providing Services for Persons with HIV/AIDS and Their Caregivers. AJOT, 50(10),
853-854
● Statement: Purpose and Value of Occupational Therapy Fieldwork Education. AJOT, 50(10), 845
● White Paper: The Role of the Occupational Therapy Practitioner in the Implementation of Full
Inclusion. AJOT, 50(10), 856-857
1997 ● A Guide to Self-Appraisal. OT Week, 11(25), 27-34.
● Cross Training Concept Paper. AJOT, 51(10), 853-860
● Statement: Fundamental Concepts of Occupational Therapy: Occupation, Purposeful Activity,
and Function. AJOT, 51(10), 864-966
● Position Paper: Physical Agent Modality (Edited). AJOT, 51(10), 870-871
● Philosophy of Education, replaces 1980. AJOT, 51(10), 867
● Statement: Sensory Integration Evaluation and Intervention in School Based Occupational
Therapy. AJOT, 51(10), 861-863.
● Position Paper: The Psychosocial Core of Occupational Therapy, edited. AJOT, 51(10), 868-869
● White paper: AOTA and Development of Standards of Practice for the Profession of
Occupational Therapy. OT Week, 11(47), 16-17.
1998 ● Guidelines to the Occupational Therapy Code of Ethics. AJOT, 52(10), 881-884
● Position Paper: The Use of General Information and Assistive Technology Within Occupational
Therapy Practice. AJOT, 52(10), 870-871
● Standards of Practice for Occupational Therapy. AJOT, 52(10), 866-869
● Statement: Occupational Therapy and Hospice. AJOT, 52(10), 872-873
● Statement: Occupational Therapy for Individuals with Learning Disabilities, AJOT, 52(10), 874-880
● White paper: Professional evolution: Should health care environmental changes force OT and
PT practice into a new delivery model? OT Week, 12(15), 17-19.
(continued)
286 Chapter 9

Table 9-6 (continued)

ASSOCIATION DOCUMENTS
1999 ● Definition of OT Practice for the AOTA Model Practice Act. AJOT, 53(6), 608
● Guide for Supervision of Occupational Therapy Personnel in the Delivery of Occupational
Therapy Services. AJOT, 53(6), 592-594
● Guidelines for the Use of Aides in Occupational Therapy. AJOT, 53(6), 595-597
● Statement: Management of Occupational Therapy Services for Persons with Cognitive
Impairment. AJOT, 53(6), 601-608
● Position Paper: Occupational Therapy s Commitment to Nondiscrimination and Inclusion.
AJOT, 53(6), 598
● Standards for an Accredited Educational Program for the Occupational Therapist. AJOT, 53(6),
575-582
● Standards for an Accredited Educational Program for the Occupational Therapy Assistant.
AJOT, 53(6), 583-589
● Glossary: Standards for an Accredited Education Program for the Occupational Therapist and
the Occupational Therapy Assistant. AJOT, 53(6), 590-591
● Standards for Continuing Competence. AJOT, 63(6), 599-600

Foundation
In 1995, the Foundation was 30 years old. Major activities continued to focus on fellow-
ships, scholarships, education of faculty, and research grant support. The Foundation managed
37 named scholarships (24 state or district and 13 organizational) and awarded 67 scholarships.
Three Centers for Scholarship and Research in Occupational Therapy continued to be supported
(Boston University, University of Illinois at Chicago, and University of Southern California).
Seventy occupational therapy faculty members participated in workshops designed to promote
transition from clinical activities to an academic career. Support for research included award-
ing nine outcomes research projects, three innovative studies related to development of assess-
ments, and eight student research projects. The Wilma L. West Library received approximately
4,400 requests for information (AOTF, 1996a).

Presidents of the Foundation

Three people served as president of the AOTF during the 1990s: Elizabeth B. Devereaux,
1989-1993 (Figure 9-15); Maralynne Mitcham, 1994-1996 (Figure 9-16); and Jane Davis Rourk,
1997-2002 (Figure 9-17).

Mission and Goals

In 1996, the mission statement was restated to read: Through the use of fiscal and human
resources, AOTF expands and refines the body of knowledge of occupational therapy and promotes
the understanding of the value of occupation in the interest of the public good (AOTF, 1996b). The
goals focused on research, education, and securing financial resources and were stated as follows:
● Fund scientific and scholarly inquiry relevant to occupational therapy research, practice, and
education to develop new knowledge, test and refine existing knowledge, and validate theories.
● Promote excellence in education about occupation and occupational therapy by providing
resources to develop the corps of skilled faculty; educating practitioners about the relevance
 Time of Conflict: 1990s to 2000s 287

Figure 9-15. Elizabeth B. Devereaux, Figure 9-16. Maralynne Mitcham, PhD, Figure 9-17. Jane Davis Rourk, OTR/L,
MSW, OTR, FAOTA, President of OTR/L, FAOTA, President of the AOTF, BCP, FAOTA, President of the AOTF,
the AOTF, 1989-1993. (Printed with 1994-1996. (Printed with permission 1997-2002. (Printed with permission
permission from the Archive of the from the Archive of the American from the Archive of the American
American Occupational Therapy Occupational Therapy Association, Occupational Therapy Association,
Association, Inc.) Inc.) Inc.)

of research to practice; recognizing students who demonstrate excellence; and organizing the
disseminating information from scientific and scholarly inquiry.
● Secure financial resources to support programs and operations annually and to build the
endowment to ensure long-term viability.

Reliable Source
The database Reliable Source was initiated in 1994 to replace the original OT Source. The data-
base was overseen by the AOTF. Reliable Source was built on new software. It was designed to be
the most extensive collection of occupational therapy literature in existence (AOTA, 1995b).

National Board for Certification in

Occupational Therapy
Formation and Purpose
The National Board for Certification in Occupational Therapy (NBCOT) was the new name
given to the American Occupational Therapy Certification Board (AOTCB) in 1996. The name
was changed to reflect a broader mission to access the competency of occupational therapy practi-
tioners over the lifetime of the professional, not just the initial certification process and continued
listing of active practitioners over the years through payment of fees. At the time NBCOT was
formed, about 66,500 therapists had been certified (original term was registered) since the process
began in 1931, and about 23,000 assistants had been certified since the process for assistants began
in 1977 (NBCOT, 1996).
The NBCOT functions as an independent national credentialing agency that certifies eligible
persons as occupational therapists registered (OTR) and certified occupational therapy assistants
(COTA). Both OTR and COTA are registered marks. The mission of the NBCOT is “to serve the
288 Chapter 9

public interest by providing high standards for the certification of occupational therapy practitio-
ners” (NBCOT, 1996). To accomplish its mission, the NBCOT maintains a certification program,
a certification renewal program, and a disciplinary action program. The certification program
develops and administers the initial certification program. The renewal program is concerned
with continuing competency to practice, and the disciplinary action program is responsible for
disciplinary action against practitioners who do not maintain the behaviors specified in the Code
of Ethics developed by the NBCOT. Other activities of the NBCOT involve research on current
practice trends to update the certification examination focus and content, credential verification
for anyone interested in determining whether a practitioner has passed initial certification and/or
maintained certification with NBCOT, and partnership with state regulatory agencies to protect
the public and support quality practice in the provision of occupational therapy services.

Trademark Dispute Between NBCOT and AOTA

On March 2, 1999, a settlement agreement was signed regarding who owns the rights to the
trademarks OTR and COTA (NBCOT, 1999). The rights go with the initial certification exam and
thus belong to NBCOT. The signed agreement ended a 2-year dispute between the Association and
NBCOT over who owned the trademarks.
In March 1997, AOTA started legal proceedings against the NBCOT over the trademarks.
AOTA argued that the credentialing marks were generic and not unique to the profession of
occupational therapy. The NBCOT argued that the marks provided credibility and mobility to the
profession (NBCOT, 1997). The problem arose when the NBCOT started a certification renewal
program that was mandatory if the therapist or assistant wanted to continue to use the marks OTR
or COTA after their name (Foto, 1997).
The dispute began in October 1996, when AOTA became aware of two major issues: the
NBCOT’s use of the trademarks and the NBCOT’s alleged noncompliance with contracts between
the two organizations (Foto et al., 1997). Attempts in January 1997 to settle differences were not
successful. The NBCOT responded by sending state association presidents, members of the AOTA
Representative Assembly, and state licensure board members a publication outlining the certifica-
tion renewal program it had developed (AOTA, 1997b). On March 11, 1997, the Association filed
petitions with the U.S. Patent and Trademark Office to cancel federal registration of the trade-
marks Occupational Therapist Registered, OTR and Certified Occupational Therapy Association,
COTA claimed by the NBCOT (AOTA, 1997c). Another meeting was scheduled for March 17, but
NBCOT members refused to meet with AOTA members unless AOTA withdrew the petition filed
on March 11. On March 17, 1997, the NBCOT file a lawsuit in federal court in Maryland against
AOTA and its members for “injunctive relief and damages in connection with violation of Section
2 of the Sherman Act” (Steib, 1997, p. 7). The suit charged AOTA with breaching its October 1995
Licensing Agreement with the NBCOT by challenging NBCOT’s ownership of the certification
marks. The suit also alleged that AOTA and its members were conspiring to engage in an unlawful
group boycott of the NBCOT in violation of the Sherman Antitrust Act of 1890 by attempting to
recapture certification authority from the NBCOT and thus monopolize trade (Steib, 1997).
At issue was the right of therapists to use the title Occupational Therapist, Registered and ini-
tials OTR and of assistants to use the title Certified Occupational Therapist Assistant and initials
COTA. Under the NBCOT proposed renewal plan, only therapists and assistants who recertified
with the NBCOT would be allowed to use the title and initials. Therapists had been using the title
and initials since 1943, and assistants had been using the title and initials since 1958. In addition,
many state licensure laws and regulations incorporated the initials into approved signatures such
as OTR/L, LOTR, or COTA/L. Under the certification renewal program outlined by the NBCOT,
such use would not be permitted, and AOTA was concerned that some practitioners might lose
their employment if they could not use the title or initials (Steib, 1997). A second issue was the
development of the continuing certification program itself, what policies would be adopted, how
 Time of Conflict: 1990s to 2000s 289

the program would be administered, and by whom. The announcement by the NBCOT of their
certification renewal program was the catalyst for the dispute in the first place (Foto et al., 1997). A
third issue was that the NBCOT was a fee-for-service organization responsible to the public, not a
membership organization responsive to the needs and concerns of occupational therapy members.
The issue was “about who speaks for practitioners and how important policy matters affecting
practitioners ought to be decided” (AOTA, 1998c, p. 23). The NBCOT was functioning in 1997 as
a self-selected 15-member Board of Directors to whom its activities were responsible.
At the April 1997 meeting of the Representative Assembly, six principles for resolving the differ-
ences between the two organizations were adopted (AOTA, 1997a, p. 900). AOTA President Mary
Foto made attempts to use the principles in negotiating with NBCOT President Diana Ramsey
with little success.
● A clear distinction must be maintained between entry-level certification and continued com-
petency assessment.
● Any continuing competency assessment program should not imperil the practice or the liveli-
hood of qualified occupational therapy practitioners.
● The NBCOT should explore ways to become more representative of and accountable to the
occupational therapy profession.
● The current legal dimensions of the dispute should promptly be eliminated by NBCOT with-
drawing the trademark registrations relating to occupational therapist registered OTR and
certified occupational therapy assistant COTA, AOTA withdrawing its petitions to cancel the
registration of those marks and NBCOT dismissing its lawsuit against AOTA and its members.
○ When the steps in number 4 are accomplished, AOTA and the NBCOT will jointly develop
a collegial task force or commission to address the appropriate use of the designations OTR
and COTA.
● Establish by consensus standards and role delineations for competency assessment that reflect
appropriate professional expertise and roles for AOTA, NBCOT, AOTF, state regulatory bod-
ies, and practitioners.
● If these steps are not taken, the Executive Board is to seek negotiations with the NBCOT with
the assistance of a neutral mediator.
In February 1998, AOTA made four new proposals:
● Create a new joint AOTA and NBCOT entity to own the OTR and COTA marks
● Reformulate the NBCOT Board of Directors selection progress to be accountable to the public
and certificants according to National Commission on Certifying Agencies (NCCA) standards
● Amicably renegotiate the license agreement
● Establish new designations for practitioners or have the NBCOT simply give up the use of the
OTR and CORA marks for renewed certification so that the marks could continue to signify
initial certification (AOTA, 1998f)
The NBCOT’s negotiating members agreed to reformulate the Board of Directors to meet the
NCCA standards but did not agree to any attempts to modify the lawsuit claiming sole ownership
of the titles or initials. Although President Foto wrote four letters to President Ramsey, no other
progress was made during the rest of the year (AOTA, 1998f). Finally, on March 1, 1999, AOTA’s
Executive Board voted to settle the dispute, and the agreement ending the lawsuit was signed on
March 2, 1999, by President Karen Jacobs for AOTA and President Diana Ramsey for the NBCOT
(AOTA, 1998d; Ramsey, 1999). The settlement acknowledged the ruling by Judge Andre Davis
that the NBCOT owned the trademarks OTR and COTA, which it registered with the U.S. Patent
and Trademark Office in December 1995 and January 1996. Judge Davis ruled on September 30,
1998, that AOTA automatically transferred the trademarks when it created AOTCB, the prede-
cessor to NBCOT, in 1986 (AOTA, 1998b). As part of the settlement, the NBCOT agreed not to
initiate proceedings against any individuals who used the certification marks without meeting the
290 Chapter 9

certification requirements during the time of the dispute. Judge Davis also ruled that AOTA had
breached the License Agreement of 1995 by challenging the ownership and validity of trademarks
and by distributing pins and patches bearing the trademarks. However, AOTA did not wrongfully
interfere with the NBCOT’s voluntary certification program or disparage the NBCOT, as had been
claimed in the lawsuit (AOTA, 1998b).
Thereafter, NBCOT proceeded with the recertification program and restricted the use of the
titles and initials to those would recertified with NBCOT. State licensing boards had to change their
rules to eliminate titles and initials containing the trademarks. Instead, the titles had to be restricted
to licensed occupational therapist; OT, occupational therapy assistant licensed; OTA; or similar
designations. In addition, all AOTA documents that used the titles or initials had to be revised or
rescinded to eliminate use of the titles or initials to comply with the intent of the settlement.
The cost of the dispute is difficult to calculate because some costs are not provided. AOTA’s
business liability insurance covered most of the legal expenses (AOTA, 1998c). However, AOTA
reported that over 50,000 pages of copy were provided to the court to fulfill requests for informa-
tion (AOTA, 1998f). The cost of paper and staff time is not recorded.

Reflection
Conflict, highs, and lows characterized this decade. There was an increased need for occupa-
tional therapists and growth in the number of educational programs. There was healthy competi-
tion between schools. The educational entry level was upgraded to master’s level with the AOTA
Representative Assembly passing Resolution J at the 1997 annual conference in Indianapolis. As
quickly as the need for occupational therapists grew in the early 1990s, it crashed in the late 1990s
with the passing of the Balanced Budget Act in 1997. Many occupational therapists lost jobs, and
school enrollments declined for the next several years. Many educational programs closed for
occupational therapy assistants because of low enrollment and poor employment outlook. The end
of the 1990s saw the battle between AOTA and the NBCOT for the professions’ trademarks, a bat-
tle brought on by the age-old discussion on accountability and measures of continued competence.

References
American Occupational Therapy Association. (1990). Membership data. Rockville, MD: Author
American Occupational Therapy Association. (1991). Essentials and guidelines for an accredited education program
for the occupational therapist. American Journal of Occupational Therapy, 45(12), 1077-1084.
American Occupational Therapy Association. (1993a). 73rd annual business meeting. Seattle, WA: Author.
American Occupational Therapy Association. (1993b, April 23). A variety of settings under a unifying philosophy. OT
Week, Spring Student Edition, pp. 14-28.
American Occupational Therapy Association. (1994a). 74th annual business meeting. Bethesda, MD: Author.
American Occupational Therapy Association. (1994b). Building for the profession in the 21st century. 1994 annual
report. Boston, MA: Author.
American Occupational Therapy Association. (1994c). SIS variety reflex practice variety. OT Week’s Today’s Student,
Spring, pp. 8-9.
American Occupational Therapy Association. (1994d). Uniform terminology for occupational therapy, third edition.
American Journal of Occupational Therapy, 48(11), 1047-1054.
American Occupational Therapy Association. (1995a). 75th annual business meeting. Bethesda, MD: Author.
American Occupational Therapy Association. (1995b). AOTA’s reliable research tool. OT Week, 9(1), 22.
American Occupational Therapy Association. (1995c). Concept paper: Service delivery in occupational therapy.
American Journal of Occupational Therapy, 49(10), 1029-1031.
American Occupational Therapy Association. (1995d). Position paper: Occupational performance: Occupational
therapy’s definition of function. American Journal of Occupational Therapy, 49(10), 1019-1020.
American Occupational Therapy Association. (1995e). Position paper: Use of occupational therapy aides in occupa-
tional therapy practice. American Journal of Occupational therapy, 49(10), 1023-1025.
 Time of Conflict: 1990s to 2000s 291

American Occupational Therapy Association. (1995f). White paper: Occupational therapy and cross-training initia-
tives. OT Week, 9(10), 32-33.
American Occupational Therapy Association. (1997a). The 1997 Representative Assembly Summary of minutes.
American Journal of Occupational Therapy, 51(10), 898-901.
American Occupational Therapy Association. (1997b). AOTA board says NBCOT program raises questions about
future of the profession. OT Week, 11(12), 27-30.
American Occupational Therapy Association. (1997c). AOTA challenges certification board’s trademark registration.
OT Week, 11(12), 28-29.
American Occupational Therapy Association. (1997d). Cross-training concept paper. American Journal of
Occupational Therapy, 51(10), 853-860.
American Occupational Therapy Association. (1998a). 78th annual business meeting. Baltimore, MD: Author.
American Occupational Therapy Association. (1998b). News this week: Court issues split decision in NBCOT lawsuit.
OT Week, 12(42), 5.
American Occupational Therapy Association. (1998c). Questions and answers on the AOTA/NBCOT dispute. OT
Week, 12(11), 23-25.
American Occupational Therapy Association. (1998f). Update on the AOTA-NBCOT dispute. OT Week, 12(24), A1.
American Occupational Therapy Association. (1999a). The 1999 Representative Assembly summary of minutes.
American Journal of Occupational Therapy, 53(6), 628-630.
American Occupational Therapy Association. (1999b). ACOTE sets timeline for post baccalaureate degree programs.
OT Week, 13(33), i-iii.
American Occupational Therapy Association. (1999c). AOTA’s 1999 Representative Assembly proposed business
agenda. OT Week, 13(5), RA1-RA24.
American Occupational Therapy Association. (1999d). Questions and answers regarding the AOTA and NBCOT
settlement agreement. OT Week, 13(11), iii-iv.
American Occupational Therapy Association. (1999/2000). Challenging PT scope of practice expansion. State Policy
Department News, 1(4), 1-3.
American Occupational Therapy Association. (2008). Academic programs annual data report: Academic year 2007-
2008. Bethesda, MD: Author.
American Occupational Therapy Foundation. (1996a). 1995 annual report. OT Week, 10(11), A1-A12.
American Occupational Therapy Foundation. (1996b). 1996 annual report of the American Occupational Therapy
Foundation. Bethesda, MD: Author.
American Physical Therapy Association. (1994). Commonalities and differences between the professions of physical
therapy and occupational therapy: An American Physical Therapy Association white paper. Alexandria, VA: Author.
American Physical Therapy Association. (1997a). Guide to physical therapy practice. Physical Therapy, 77, 1163-1650.
American Physical Therapy Association. (1999). Guide to physical therapy practice, Revised. Alexandria, VA: Author
Bair, J. (1991). From my office. OT Week, 5(42), 2.
Bair, J. (1992). From my office. OT Week, 6(6), 2.
Christiansen, C. (1996). Nationally speaking: Managed care: Opportunities and challenges for occupational therapy
in the emerging systems of the 21st century. American Journal of Occupational Therapy, 50(6), 409-412.
Clark, F., Azen, S. P., Zemke, R., Jackson, J., Carlson, M., Mandel, D.,…Lipson, L. (1997). Occupational therapy for
independent-living older adults: A randomized controlled trial. Journal of the American Medical Association,
278(16), 1321-1326.
Collins, A. L. (1997). Multiskilling: a survey of occupational therapy practitioners’ attitudes. American Journal of
Occupational Therapy, 51(9), 748-753.
Daigle, W. W. (1994). Accreditation Council for Occupational Therapy Education. In American Occupational Therapy
Association 74th annual business meeting (pp. 56-57). Bethesda, MD: AOTA.
Foto, M. (1995). National speaking: New president’s address: The future—challenges, choices, and changes. American
Journal of Occupational Therapy, 49(10), 955-959.
Foto, M. (1996a). Nationally speaking: Delineating skilled versus nonskilled services: A defining point in our profes-
sional evolution. American Journal of Occupational Therapy, 50(3), 168-170.
Foto, M. (1996b). Nationally speaking: Multiskilling: Who, how, when, and why? American Journal of Occupational
Therapy, 50(1), 7-9.
Foto, M. (1997). Dear AOTA member [Letter]. OT Week, 11(15), 15.
Foto, M. (1998). White paper: Professional evolution: Should health care environmental changes force OT and PT
practice into a new delivery model? OT Week, 12(15), 17-19.
Foto, M., Jacobs, K., Knox, S. H., Ethridge, D. B., Barnes, L. C., Clerico, C.,…Boyt Schell, B. A. (1997). An open letter
to the members from the executive board about NBCOT’s certification renewal program. OT Week, 11(1), 1, 7.
Graves, S. (1994). Independent. OT Week, 8(18), 20-22.
292 Chapter 9

Hansen, R. (1995). For the record: Task force on cross-training. OT Week, 9(5), 6.
Harsh, C. (1992). Program development: Balancing quantity with quality. OT Week, 6(46), 16-17.
Health Care Financing Administration. (n.d.). Medical hospital manual 10 (HCFA Publication 13-3, Section 3906).
Bethesda, MD: Department of Health and Human Services.
Hettinger, J. (1996). Pew Commission: What is it, and why should OTs care? OT Week, 10(8), 18-20.
Joe, B. E. (1992). Efficiency pervades 1992 RA Meeting: Physical agent modality position stands. OT Week, 6(15), 14.
Kyler-Hutchison, P. (1992). Issues in accreditation. OT Week, 6(29), 7.
Mandel, D. R., Jackson, J. M., Zemke, R., Nelson, L., & Clark, F. A. (1999). Lifestyle redesign: Implementing the well
elderly program. Bethesda, MD: AOTA.
National Board for Certification of Occupational Therapy. (1996). National Board for Certification of Occupational
Therapy: What it is. What it does [Brochure]. Gaithersburg, MD: Author.
National Board for Certification of Occupational Therapy. (1997). NBCOT responds to AOTA legal action. [Letter].
Gaithersburg, MD: Author.
National Board for Certification in Occupational Therapy. (1999). NBCOT and AOTA sign agreement establishing
collaborative task force. Report to the Profession, 4(1), 1-2.
Pedretti, L. W., & Pasquinell, S. (1990). A frame of reference for occupational therapy in physical dysfunction. In. L.
W. Pedretti & B. Zoltan (Eds.), Occupational therapy skills for physical dysfunction (3rd ed., pp. 1-17). St. Louis,
MO: Mosby.
Ramsey, D. L. (1999). Dear colleague. Report to the profession, 4(1), 1.
Steib, P. A. (1997). News this week: NBCOT sues AOTA and its members. OT Week, 11(14), 7.
Steib, P. A. (1999). Occupational therapy works: The studies say so. OT Week, 13(37), 8-9.
TriAlliance of Health and Rehabilitation Professionals. (1995). Use of multiskilled personnel. OT Week, 10(78), 17.

Bibliography
American Occupational Therapy Association. (1993). AOTA’s 1993 Representative Assembly approved business
agenda. OT Week, 7(11), 1-32.
American Occupational Therapy Association. (1994). Uniform terminology, third edition: Application to practice.
American Journal of Occupational Therapy, 48(11), 1055-1059.
American Occupational Therapy Association. (1997). News this week: NBCOT refuses to negotiate. OT Week, 11(13), 7.
American Occupational Therapy Association. (1997). News this week: NBCOT sues AOTA and its members. OT
Week, 11(14), 7.
American Occupational Therapy Association. (1998). AOTA responds to APTA practice guidelines. OT Week, 12(35), 9.
American Occupational Therapy Association. (1998). News this week: NBCOT-AOTA litigation update. OT Week, 12(39), 5.
American Occupational Therapy Association. (1999). NBCOT and AOTA sign settlement agreement: Collaborative
tasks. OT Week, 13(10), i-iii.
American Occupational Therapy Association. (1999). Physical therapy profession: Scope of practice. Bethesda, MD:
Author.
American Occupational Therapy Association. (1999). Settlement proposed in the NBCOT-AOTA lawsuit. OT Week,
13(5), i-iii.
American Physical Therapy Association. (1997). Model definition of physical therapy for state practice acts. In Guide
to physical therapist practice (pp. 1-2). Alexandria, VA: Author.
Foto, M. (1998). A message from AOTA president Mary Foto. OT Week, 12(11), 22.
Hansen, R. (1996). The task force on cross-training. OT Week, 10(14), 15.
Nielson, C. S. (1997). NBCOT action usurps our democratic tradition. OT Week, 11(16), 61-52.
 10
Looking to the Future
2000s to 2010s

Key Points
● The Centennial Vision Statement was created with eight elements in 2006.
● The Occupational Therapy Practice Framework was adopted in 2002 and revised in 2008.
● Living Life to Its Fullest was adopted as the brand in 2008.
● The Association was reorganized to stress financial accountability.

Highlighted Personalities Key Places

● Barbara L. Kornblau, AOTA President, ● The national office was still located in
2001-2004 Bethesda, Maryland.
● Carolyn M. Baum, AOTA President,
2004-2007
● Penelope Moyers Cleveland, AOTA
President, 2007-2010
● Joseph Isaacs, AOTA Executive Director
● Frederick Somers, AOTA Executive
Director
● Martha Kirkland, AOTF Executive Director
● Charles Christiansen, AOTF Executive
Director
● Ruth Ann Watkins, AOTF President

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 293-323).
- 293 - © 2017 SLACK Incorporated.
294 Chapter 10

Key Times/Events Sociocultural Events/Issues

● The World Federation of Occupational ● The AOTA Societal Statement started in
Therapists was 50 years old in 2002. 2006 and included topics on health dis-
parities, stress, posttraumatic stress dis-
order, youth violence, nondiscrimination,
Political Events/Issues and inclusion.

● No Child Left Behind (NCLB; P.L. 107-

110) adopted in 2001 Practice Issues*
● Medicare Prescription Drug Improvement
and Modernization Act (P.L. 108-173)
● Promotion of Health and Prevention of
adopted in 2003 Disease and Disability
● Individual with Disabilities Improvement
● Providing Occupational Therapy Using
Act (P.L. 108-446) adopted in 2004 Sensory Integration Theory and Methods
● Deficit Reduction Act (P.L. 109-171)
● Occupational Therapy and Hospice
adopted in 2006 (replaced in 2011 by end-of-life document)
● Occupational Therapy Services in
Facilitating Work Performance (revised
Economic Events/Issues 2011)
● Occupational Therapy Services in Early
● AOTA published a workforce survey in
Childhood and School-Based Settings
2006 based on membership and non-
(revised 2011)
membership data.
● Scope of Services for Individuals With
● AOTA published a compensation survey
Autism (revised 2010)
in 2000 based on membership data.
● Occupational Therapy Services for
Individuals Who Have Experienced
Domestic Violence (revised 2011)
Educational Issues* ● Guidelines for Supervision, Roles, and
● Educational Standards and Guidelines Responsibilities During Delivery of
Revised, 2006 Occupational Therapy Services
● Value and Purpose of Field Work ● Occupational Therapy Services in
● Model Education Curriculum created Promotion of Psychological and Social
● Philosophy of Professional Education Aspects of Mental Health
● Scholarship ● Role of Occupational Therapy in Wound
● Specialized Knowledge and Skills of Management (revised 2013)
Occupational Therapy Educators ● Physical Agent Modalities (revised 2012)

Technological Events/Issues
● The use of social media begins.

* Adapted from AOTA, 2010c.

 Looking to the Future: 2000s to 2010s 295

Association Issues Foundation Issues

● The Association initiated the Centennial ● Reinstated support for dissertation research
Vision program in 2003. ● 25th anniversary of Wilma L. West library
● Eight elements were adopted for Centennial ● Research priorities adopted
Vision in 2006.
● The Code of Ethics was revised in 2005.
● Fact Sheets began being published in 2001.

National Board for Certification in Occupational Therapy

● Development of Continuing Certification Program
● Second practice analysis study completed

“Living Life to Its Fullest”

–AOTA branding statement
(2008c, p. 7)

Introduction

G
eorge W. Bush was President of the United States from 2000 to 2008. The war in
Afghanistan continued, and the war in Iraq began. Barack Obama became the first
Black president of the United States in 2008. The economy went into a severe depression
beginning in 2008, resulting in the loss of jobs and reducing the savings accounts of many families.
Hurricane Katrina in Louisiana and Mississippi and Hurricanes Rita and Ike in Texas ravaged the
Gulf Coast region, adding to the economic decline.
Occupational therapy as a profession was influenced by the revision of the World Health
Organization’s (WHO’s) publication of the International Classification of Impairments, Disabilities
and Handicaps (ICIDH), originally published in 1980. The revision was given a new name:
the International Classification of Functioning, Disability and Health and abbreviated ICF
(WHO, 2001). Health and disability are described as interrelated concepts, and disability occurs
to most people over a lifetime, not to just a few people with specifically named diseases or dis-
orders. The issue, however, is not the label but the degree to which disability results in body
structure (anatomical) or body function (physiological) impairments, activity restriction, and
participation restrictions in life situations. In addition, the document acknowledges that dis-
ability occurs as a result of contextual or environmental factors, not just medically diagnosed
conditions and biological factors. The term activity now had a working definition in relation to
a person’s health status: “the execution of a task or action by an individual” (WHO, 2001, p. 10).
In contrast, activity limitations are “difficulties an individual may have in executing activities”
(WHO, 2001, p. 10). Participation is defined as “involvement in a life situation,” and participation
restrictions are defined as “problems an individual may experience in involvement in life situa-
tions” (WHO, 2001, p. 10). Contextual factors include both environmental and personal factors
(WHO, 2001, p. 11). Environmental factors “make up the physical, social and attitudinal environ-
ment in which people live and conduct their lives” (WHO, 2001, p. 10). These changes and clari-
fications in terminology appeared in many definitions and descriptions of occupational therapy
practice and services as the effects of the ICF were integrated in published works.
The Association felt the effects of the 1997 Balanced Budget Act (BBA) as practitioners contin-
ued to lose jobs through the early years of the 21st century. Membership dropped significantly, and
296 Chapter 10

the loss of revenue required several budget adjustments, including reducing the number of issues
of the American Journal of Occupational Therapy (AJOT) from 12 to six per year. A turnaround
did not begin to occur until 2005, but membership numbers continue lag behind the benchmark
of 1996.
Occupational therapy was listed in a chart in U.S. News & World Report as a best career choice
for the years 2007 and 2008 (Nemko, 2007, 2008). In both years, the job market outlook was con-
sidered excellent. Median pay was listed as $60,855 in 2007 and $63,900 in 2008. Recognition of
the profession by the public media was beginning to occur.

Education
Blueprint for Entry-Level Education and Occupational Therapy
Model Curricula
The committees for the two documents were appointed by President Penelope Moyers Cleveland
(LaGrossa, 2008). The committees were appointed in response to motion adopted by the Board of
Directors in 2006 which included priorities established by a Zoomerang survey (AOTA, 2006b).
The Blueprint for Entry-Level Education was published (AOTA, 2010b). The Model Curricula for
occupational therapists and for assistants were not published.
The purpose of the Blueprint was to “identify the content knowledge that occupational thera-
pists and occupational therapy assistants should receive in their educational program” and make
the information available as a content guide (AOTA, 2010b, p. 186). Content considered important
addressed persons who were healthy, persons at risk for disability, and persons with chronic dis-
abilities. Four sections were created: (1) person-centered factors, (2) environment-centered factors,
(3) occupation-centered factors, and (4) professional and interpersonal factors. Key concepts, sci-
entific rationale, and skills to be developed were included, as well as the areas of practice related to
the concepts. The conceptual model used to organize the ideas was occupational performance. The
person was viewed in terms of cognitive, psychological, physiological, sensory, perceptual, motor
and spiritual aspects or skills. The environment was organized into social, cultural, natural, design
and technology, environmental support (assistive technology), and environment for occupational
performance. The concept of occupation-centered factors was organized into doing at the person
level, doing at the organization and population level, classification of occupational activity, and
core occupational therapy outcomes. Professional and interpersonal factors were divided into
ethics and advocacy, communication, culture, professional development, evidence-based practice,
and business fundamentals.
The Blueprint illustrates the change in thinking from the Curriculum Guide originally pub-
lished in 1950 and updated in 1958 (AOTA, 1958). The four organization themes were sciences,
clinical conditions, occupational therapy media, and application to occupational therapy practice.
The sciences were anatomy and physiology, kinesiology and growth, and development and gain-
ing. The clinical conditions related to psychiatry, neurology, orthopedics, cerebral palsy, general
medical and surgical conditions, tuberculosis, cardiac conditions and rheumatic fever, and visual
and auditory sensory disturbances. Media included art and design, block printing, ceramics,
general crafts, leatherwork, metal work, needlecrafts plastics, printing, recreational activities,
silk screening, stenciling, weaving, wood carving, woodworking and methods of instruction.
Application to occupational therapy included orientation to occupational therapy, organization
and administration, pediatric conditions, geriatric conditions, psychiatric conditions, mentally
deficient, physical disabilities, general medicine and surgery, tuberculosis and cardiac conditions,
and sensory disabilities.
 Looking to the Future: 2000s to 2010s 297

Figure 10-1. Design and development of a model curriculum. (Printed with permission
from the Archive of the American Occupational Therapy Association, Inc.)

The change in thinking is consistent with the changes seen in the accreditation documents over
the years. There is shift away from medical conditions and medical specialties to a focus on the
person performing occupations in the environment under a variety of conditions from healthy and
able to those with health conditions resulting in disability. The disease itself is no longer the focus.
Instead, the focus is on the disability that may disrupt occupational performance.
According to LaGrossa, the purpose of the model curricula documents was to raise the bar in
education to meet 21st century health care needs and ensure more consistency in the education
and training of occupational therapy and assistant-level students. The Model Curricula Guides
provide information of the issues that must be considered in creating or revising a course of study
or curriculum within an institution of higher learning (AOTA, 2009a, 2009b). Some issues are the
profession’s philosophy, vision, and trends; the program’s philosophy, mission, and vision within
the institution; curriculum design and threads of ideas; suitable prerequisite courses; course con-
tent; learning strategies; sequence of courses; and outcomes assessment. Figure 10-1 illustrates
the strategic plan for designing and developing a curriculum. Of particular importance is the
overall philosophy. As the model curriculum for the occupational therapist states, a curriculum
“may be organized according to the major diagnostic areas that occupational therapy addresses
in practice” (AOTA, 2009b, p. 4). The course sequence is then structured according to physical
and mental dysfunctions and the treatment strategies viewed as most effective in reducing the
consequence of identified dysfunction. Such a curriculum is actually stressing reductionistic
ideology and reinforcing a perspective that disability occurs as a result of the individual’s biology
while ignoring the environmental factors that may contribute to the dysfunction, including social
stigma, which may act as a restraint on achieving successful community living. Course content
tends to focused on courses that resemble a medical curriculum. In contrast, a philosophy could
298 Chapter 10

focus on health, wellbeing, and participation as a philosophy based on the concept of emergence
rather than reductionism. The curriculum could be organized around factors that facilitate suc-
cessful and satisfying community living, methods to decrease or prevent the effect of factors that
may act to restrict such living and the role of occupational therapy in promoting such living pat-
terns. Courses would focus on how healthy living supports well-being and participation and how
the environment and occupational tasks can be modified or adapted to support a person’s abilities
and minimize effects of disability. As changes occur over the person’s lifespan and changes occur
in the socio-politico-economic environment and preferred occupations, additional modifications
and changes can occur. Successful and satisfying living is viewed as an interactive and transactive
process between the person, environment, and occupation in support of maximum occupational
performance. Course content focuses on the unique aspects of occupational therapy as a health
promotion and prevention profession and the role of occupational therapy in providing leadership
to advocate for successful and satisfying living for all people. Within the document, a version of
such a philosophical view is stated as an example based on the concept of “occupational needs”
(AOTA, 2008e, p. 136).

Educational Programs
The number of accredited educational programs for the occupational therapists at the entry
level was 146 (four entry-level doctoral and 142 master’s) for the academic year 2009-2010
(AOTA, 2010a). Relatively few new programs were being developed; thus the number of programs
remained fairly constant since 2004. There were 131 accredited programs for the assistant, but 15
programs were in the developmental stage and 29 had applied as the job market began to open up
again following the loss of job opportunities due to the effects of the BBA of 1997. Sixty assistant
programs had closed during the turndown in employment opportunities for occupational therapy
practitioners from 2000 to 2007 (AOTA, 2010a). During the same time period of time, there were
no reported closures of occupational therapist programs as a result of reduced employment oppor-
tunities, although there were closures due to the change in requirements for post-baccalaureate
entry, which began January 1, 2007. The data suggest that assistant-level programs are more
sensitive to employment trends than occupational therapist–level programs. If the employment
market for practitioners is reduced due to legislation, the economy, or other factors, educational
programs for the assistant are likely to close, whereas those for the occupational therapist are likely
to continue.
The distribution of education programs continued to be unequal between the two levels of edu-
cation. Entry-level programs for the occupational therapist were most available in the Northeast
(48) and Midwest (39), followed by the South (36), West (15), and Southwest (13). In contrast, edu-
cational programs for the assistant were most available in the Midwest (43) and South (51), followed
by the Northeast (31), Southwest (19), and West (9). The difference is not explained by employment
trends or attitudes toward assistants. The last listing of educational programs in AJOT was in 2008.
At that time, educational programs for the occupational therapist were available in 44 states, the
District of Columbia, and Puerto Rico (AOTA, 2008a). Six states had no accredited educational
program listed at the professional level: Alaska, Delaware, Hawaii, Rhode Island, Montana, and
Vermont. A program is listed in the developing stage for Alaska as an extension campus from
Creighton University in Nebraska. Occupational therapy assistant–level programs were available
in 42 states, not including Alaska, Arkansas, Delaware, Idaho, Montana, Nebraska, Oregon, and
Vermont. The goal still has not been reached of having educational programs in each state for both
the occupational therapist and assistant to provide a steady and ready source of practitioners to
work in occupational therapy service programs.
 Looking to the Future: 2000s to 2010s 299

Education Standards Revision

The Standards were revised in 2006, published in 2007 in AJOT, and set to take effect in January
2008. Each of three sets of Standards included a list of expected outcomes in the Preamble, which
are summarized in Table 10-1. A major issue in the revision concerned the qualifications and
degree level earned by the program director and faculty members. In essence, the program director
was expected to have a doctoral degree at both the master’s and doctoral program levels, although
programs offering a master’s degree had until July 1, 2012, to install such a person. At the doctoral
level, the director was expected to have 8 years of experience in the profession, including 3 years in
an academic setting, whereas for the master’s level program, 6 years of experience was considered

Table 10-1
ACCREDITATION STANDARDS EXPECTED OUTCOMES FOR
THE OCCUPATIONAL THERAPIST
A graduate from an AOTE-Accredited master s-degree-level occupational therapy program must
● Have acquired, as a foundation for professional study, a breadth and depth of knowledge in the liberal
arts and sciences and an understanding of issues related to diversity
● Be educated as a generalist with a broad exposure to the delivery models and systems used in setting
where occupational therapy is currently practiced and where it is emerging as a service
● Have achieved entry-level competence through a combination of academic and fieldwork education
● Be prepared to articulate and apply occupational therapy theory and evidence-based evaluations and
interventions to achieve expected outcomes as related to occupation.
● Be prepared to be a lifelong learner and keep current with evidence-based professional practice
● Uphold the ethical standards, values, and attitudes of the occupational therapy profession
● Understand the distinct roles and responsibilities of the occupational therapist and occupational thera-
py assistant in the supervisory process
● Be prepared to advocate as a professional from the occupational therapy services offered and for the
recipients of those services
● Be prepared to be an effective consumer of the latest research and knowledge bases that support prac-
tice and contribute to the growth and dissemination of research and knowledge.
(Note: Additional requires apply to doctoral-degree-level programs. The occupational therapy assistance is
expected to achieve the first eight statements but not the ninth.)
ACOTE (2007). Accreditation standards for a master s-degree-level education program for the occupational therapist.
American Journal of Occupational Therapy, 61(6), 652.

minimum, including 2 years in academia. All full-time faculty teaching in the doctoral program
must hold doctorates. By July 1, 2012, the majority of full-time faculty teaching in the master’s-
level program must hold a doctoral degree. The date of 2012 was an extension of 2 years from the
draft published in 2005 (Olson, 2005).

Continuing Education Program

In 2002, the Representative Assembly adopted a motion to establish the Commission on
Continuing Competence and Professional Development (CCCPD or 3CPD), and the bylaws were
amended to include the CCCPD as a standing commission. The purpose of CCCPD was to recom-
mend standards for continuing competence and develop strategies for communicating informa-
tion about continuing competency to stakeholders. The purpose of the Association’s involvement
in promoting continuing competence was to foster the objective of promoting high professional
standards, a role the Association had maintained since adopting the Minimum Standards for
300 Chapter 10

Courses in Training of Occupational Therapists in 1923 (AOTA, 1924). Actually, the first
Standards for Continuing Competence were adopted in 1999 (AOTA, 1999).
In 2006, 42 states or jurisdictions required continuing education or continuing competence
requirements for licensure renewal for occupational therapy practitioners (AOTA, 2007b, p. 2)

Practice
Definitions of Occupational Therapy
Definitions began to focus on occupation as the core or unique concept of occupational therapy
rather than the vague terms of purposeful, meaningful, or goal-directed activity (Table 10-2).
Occupation meant “everyday life activities” in which people participated as they engaged in roles and
situation in their home, school, workplace, community, or other setting. The focus of occupational
therapy was directed was described in terms of health, wellness, participation, and quality of life.
Evaluation included instrumental activities of living for the first time as a category separate from
activities of daily living (AOTA, 2004a). Social participation was added reflecting the influence of
the ICF. Intervention might focus on one or more of the following depending on the client’s needs:
● Establishment, remediation, or restoration of a skills or ability that has not yet developed or
is impaired
● Compensation, modification, or adaptation of activity or environment to enhance performance
● Maintenance and enhancement of capabilities without which performance in everyday life
activities would decline
● Health promotion and wellness to enable or enhance performance in everyday life activities
● Prevention of barriers to performance, including disability prevention (AOTA, 2004a)

Table 10-2
OCCUPATIONAL THERAPY DEFINITIONS
2002 Occupational therapy: The art and science of applying occupation as a means to effect positive
measurable change in the health status and functional outcomes of the client by a qualified occu-
pational therapist and/or occupational therapy assistant (as appropriate). (AOTA. Glossary: Standards
for an accredited education program for the occupational therapists and occupational therapy assis-
tant. AJOT, 56(6), 667-668.)
2004 The practice of occupational therapy means the therapeutic use of everyday life activities (occupa-
tions) with individuals or groups for the purpose of participation in roles and situations in home,
school, workplace, community, and other settings. Occupational therapy services are provided for
the purpose of promoting health and wellness and to those who have or are at risk for developing
an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation
restriction. Occupational therapy addresses the physical, cognitive, psychosocial, sensory, and other
aspects of performance in a variety of contexts to support engagement in everyday life activities
that affect health, well-being, and quality of life. (AOTA, (2004). Policy 5.3.1. AJOT, 58(6), 694-695.)
2008 The Occupational Therapist Registered (OTR) is a professional who works with clients whose occu-
pational performance is impaired or at risk of impairment to facilitate engagement in meaningful
occupations across the lifespan. The OTR uses collaborative, client-centered strategies to obtain
information regarding personal and environmental factors that impact occupational performance
and formulates conclusions to develop an intervention plan. The OTR selects and implements inter-
ventions to support participation in basic and instrumental activities f daily living, education, work,
plan, leisure, and social participation. The OTR engages in professional development activities to
maintain competence and uphold standards of practice. (NBCOT 2008 Practice Analysis, p. 10)
2009 Occupational therapy is essentially an educative profession. (AOTA. (2009). Specialized knowledge
and skills of occupational therapy educators of the future. AJOT, 63(6), 804.)
 Looking to the Future: 2000s to 2010s 301

Practice Patterns
A survey initiated by the Association to
determine participation in the Association’s Table 10-3
activities also collected some data about prac-
tice (AOTA, 2009a). The data are based on
PRIMARY WORK SETTING
2,130 practitioners but are not separated by SETTING PERCENTAGE
occupational therapist or assistant. The three Schools/early intervention 24.7%
major work settings continue to be schools and
Hospital (non-mental health) 21.2%
early intervention programs, hospital settings
except for mental health, and long-term care Long-term care/skilled nursing 18.7%
or skilled nursing facilities. These three set- Academia 11/2%
tings plus academia account for 75% of work Freestanding outpatient 09.6%
settings. The percentages are listed in Table Home health 05.7%
10-3. Work time allocation is presented in Table
Mental health 03.0%
10-4. Because people working in academia are
included, the percentages probably do not accu- Community 02.6%
rately represent the amount of time practitio- Other (not specified) 03.3%
ners work with clients. Rather, the percentages AOTA. (2009). Member participation survey. Bethesda, MD:
reflect the total effort in time of all types of Author.

occupational therapy personnel whether they

work with clients, students, research subjects, or
other stakeholders. Table 10-4
WORK TIME ALLOCATION
Evidence-Based Practice SETTING PERCENTAGE
The concept of evidence-based practice Direct client intervention 55.8%
developed from evidence-based medicine. The
Indirect client work/administration 22.4%
concept of evidence-based medicine was an
Education 11.3%
attempt to increase the use of information col-
lected from research studies, especially studies Consultation 07.0%
in basic sciences, and translate the data into Research 03.3%
clinical practice as opposed to practitioners AOTA. (2009). Member participation survey. Bethesda, MD:
relying on rote routines developed by other Author.
practitioners who were regarded as experts but
may have little scientific basis for their protocols
(Sackett, Straus, Richardson, Rosenberg, & Hayes, 2000). Law (2000) paraphrased the definition
used by Sackett et al. (2000) in the first edition of their book as “conscientious, explicit and judi-
cious use of current best evidence in making decision about the care of individual patients. The
practice of evidence-based medicine means integrating individual clinical expertise with the best
available external clinical evidence from systematic research” (Sackett, Richardson, Rosenberg, &
Haynes, 1997, p. 2). In the second edition, Sackett et al. (2000) expand on the concept of evidence-
based (medicine) practice, stating that it is the “integration of best research evidence with clinical
experience and patient values” (p. 1). Of importance is the addition of patient values. In other
words, there are three factors to consider in evidence-based practice: research evidence, clinical
expertise, and patient/client values. Best research evidence means “clinically relevant research …
into the accuracy and precision of diagnostic tests (including the clinical examination), the power
of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and prevention
regiments.” Clinical expertise means the “ability to use clinical skills and past experience to iden-
tify each patient’s unique health state and diagnosis their individual risks and benefits of potential
interventions and their personal values and expectations.” Values mean the “unique preferences,
302 Chapter 10

concerns and expectation each patient brings to a clinical encounter and which must be integrated
into clinical decision if they are to serve the patient” (Sackett et al., 2000, p. 1).
Law (2000) summarizes four stages for the application to occupational therapy practice: (1) ask
a clinical question about a specific client’s problem, (2) search for information or evidence about
the problem, (3) critically appraise the evidence to determine whether it is useful, and (4) apply the
findings. To assist practitioners in evaluating research studies, the Association began publishing
an online series called AOTA Evidence Briefs. Topics ranged from stroke and substance abuse to
massage therapy and music therapy for infants and children (Lieberman, Scheer, & Erby, 2003).
Peterson (2003) reports that students could learn to apply the principles of evidence-based practice
in an article about working with older individuals at risk for falls.

Reimbursement and the Prospective Payment System

The prospective payment system (PPS) was part of the BBA of 1997 that caused a significant
reduction in employment opportunities and failure to renew membership in the Association. The
PPS changed the mechanisms for reimbursing facilities for services to Medicare clients, including
services provided by occupational therapy practitioners. Medicare had originally been set up as
a “cost-based reimbursement system” (Boerkoel, 2004). In other words, the Medicare program
reimbursed facilities for the cost of providing all covered services, including therapy, to Medicare
recipients. The more services needed, the more reimbursement provided. There was little, if any,
incentive to limit costs, and the budget for Medicare services was growing every year. The PPS was
designed to put some parameters on what services would be reimbursed. Boerkoel (2004) outlines
six minimum requirements:
● A competent, trained provider of these services (i.e., licensed provider)
● Ethical and moral standards (i.e., recognized standard of care)
● A limitation of the services (i.e., services could not be provided indefinitely)
● A demonstrated justification based on outcomes (i.e., evidence-based practice)
● Record keeping of the services provided
● A quality assurance process (i.e., review process)
Initially, facility managers were concerned that the PPS would reduce reimbursement sig-
nificantly and negatively impact their bottom line. As the PPS went into effect, facility managers
learned how to use the PPS and comply with the requirements. Practitioners also had to learn new
methods of justifying their services and demonstrating that services were outcome based with
support from published literature.

Encroachment and Turf Wars With Other Professions Regarding

Scope of Practice
In a memorandum to the state association presidents and legislative chairs in 2000, Fred
Somers, Karen Smith, and Charles Willmarth outlined four areas of concern: physical therapy,
orthotics and prosthetics, vision therapy, and psychological testing (Somers, Smith, & Willmarth,
2000). The issue with physical therapy continued to be the definition of physical therapy practice
in the Model Practice Act for Physical Therapy approved by the Federation of State Boards of
Physical Therapy. The issue in orthotics and prosthetics was laws that might exclude occupational
therapists in the design and fit of orthotic devices. The same issue applied to vision therapy; in
the state of New York, the practice of vision therapy was limited to those with a license as a vision
rehabilitation therapist. Of particular concern were restrictions on who could work with patients
on safety-related training activities. Psychologists in Indiana distributed a list of over 3,000 tests
and instruments that they proposed to restrict for use by psychologists only. Three of the tests
were authored by occupational therapists: FirstSTEP: Screening Test for Evaluation Preschoolers
 Looking to the Future: 2000s to 2010s 303

by Miller; the Miller Assessment of Preschoolers (MAP) by Miller; and the Sensory Integration
and Praxis Test by Ayres. Recreational therapy also encroached by defining itself in a bill before
the Iowa Senate in 2007 as “a treatment service designed to restore, remediate, or rehabilitate a
patient’s or client’s level of functioning and independence in life activities, or to reduce or elimi-
nate the life activity restriction caused by an illness or disability condition” (AOTA, 2007a). Other
professions’ practitioners who have proposed legislation that encroaches upon or limits occupa-
tional therapy practice include athletic trainers, developmental therapists, optometrists, speech-
language pathologists, and wheelchair suppliers and manufacturers (AOTA, 2007a). Audiology is
also mentioned (AOTA, 2007a) regarding who can treat balance disorders and engage in fall pre-
vention. A bill introduced to the Colorado legislature defined athletic training to include “serves
appropriate for the prevention, recognition, assessment, management, treatment, rehabilitation
and reconditioning of injuries and illnesses that are sustained in sports, recreation, games or
exercise or might affect an individual’s participation in those activities” (AOTA, 2006a). Athletic
trainers attempted to expand their scope of practice (AOTA, 2006a). The ICF (WHO, 2001) popu-
larized the words participation and activities, whereas Medicare popularized the word function
(functional or functioning).
Other professions are not the only threat to scope of practice. Occupational therapy practi-
tioners may be their own worst enemies. As job opportunities decreased, the possibly of finding
employment elsewhere may have encouraged practitioners to try new or different assessment or
intervention strategies that may or may not have fit within the occupational therapy scope of prac-
tice. Legal and ethics concerns led to the publication of two articles in OT Practice reviewing ques-
tionable examples of scope of practice and suggesting a decision-making process for determining
whether the action, practice, or intervention was within the occupational therapy scope of practice
(Slater, 2004; Slater & Willmarth, 2006) (Table 10-5).

Table 10-5
FRAMEWORK FOR DECISIONS ABOUT SCOPE OF PRACTICE
● Was this body of knowledge or skill part of my educational coursework or curriculum?
● Am I competent (and is it baseline or advanced competence) to perform this skill or provide this inter-
vention based on my past education, continuing or ongoing education, and experience?
● Is my knowledge current (evidence-based, meets accepted practice standards, AOTA standards, and
what most people consider accepted practice) and state of the art to provide competent service?
● Would most practitioners agree that this intervention qualifies as usual and customary practice? Does
it meet widely held standards?
● Have I sought clarification from the state licensure board (or other regulatory body) in interpreting less-
well-defined areas of the occupational therapy scope of practice?
● Have I sought resources like AOTA position papers or official documents relating to this area of practice,
or done a literature search to provide evidence for my intervention or practice?
● How does this intervention or practice relate to the philosophy of occupational therapy? Am I using
occupation to promote engagement in meaningful activities and participation in life roles?
Adapted from Slater, E. Y. (2004). Legal and ethical practice: A professional responsibility. OT Practice, 9(16), 13-16 and Slater, D. Y.,
& Willmarth, C. (2006). Understanding and asserting the occupational therapy scope of practice. OT Practice, 10(10), CE-1-CE-8.

Impact of Balanced Budget Act of 1997

The BBA (P.L. 105-33) of 1997 changed the method for reimbursement of inpatient rehabilitation
facilities, skilled nursing facilities, and home health agencies under Medicare Part A from a retro-
spective to a PPS. In addition, the BBA imposed a cap on the dollar amount for outpatient therapy
services incurred in a calendar year for services furnished in skilled nursing facilities, physician’s
304 Chapter 10

offices, and home health agencies under Medicare Part B. The limit on expenses applied to all
three rehabilitation services—occupational therapy, physical therapy, and speech-language pathol-
ogy—but the impact was felt most by occupational and physical therapy. Rehabilitation facilities
began laying off therapists, and hiring freezes occurred because managers were concerned about
future financial reimbursement. Reliance on Medicare had become widespread, and regulations
adopted by a major government program were often adopted by private insurance companies. The
financial status of the rehabilitation health care market was potentially unstable. The long-term
effects of managed care and changes in Medicare reimbursement were difficult to calculate, and
managers responded by cutting expenses, especially personnel. Unlike previous changes in gov-
ernment policies, the restriction of therapy services hit hard as the job market for therapists col-
lapsed. Occupational therapy assistants were affected more than occupational therapists because
more assistants worked in skilled nursing homes (Fisher & Cooksey, 2002).
The impact of changing reimbursement rules and procedures was felt throughout the occu-
pational therapy community, including Association membership. In 1997, before the impact
occurred, membership in the Association had grown to 59,371. Growth in Association member-
ship had been a given since the Association was formed in 1917. Even during the Great Depression
years of the 1930s, membership in the Association grew. But by January 2004, the lowest point,
membership had fallen for 7 straight years to a low of 34,303 (AOTA, 2004b). The reduction in
membership and income to the Association resulted in restricting the Association journal. Instead
of 12 issues a year, the journal was reduced to six, although the page number remained the same
(Hasselkus, 1999). Student enrollment was also affected. Potential students were told there were
no jobs available, so do not apply to an occupational therapy educational program. The highest
number of students enrolled in the occupational therapist programs occurred in 1999 (11,746), but
by 2004, the number had dropped to 10,117, a 42% decrease. For occupational therapy assistants,
the high point was 1998 (7,610) and the low point was 2002 (3,350, a 56% decrease). Educational
programs for the occupational therapist did not close as a result of the decreased enrollment. Five
closures were due to the change in degree requirements mandated by 2007 to move to a master’s
degree (AOTA, 2007/2008). However, occupational therapy assistant educational programs were
affected. In 2002, there were 172 programs, but by 2007, there were 128, a drop of 44 programs
(AOTA, 2007/2008). Actually, a total of 60 occupational therapy assistant programs closed between
2000 and 2007, but the totals do not reflect the openings and closings within each time period.
The job market began to stabilize in 2001 (Fisher & Cooksey, 2002). Over the years, a vari-
ety of legislation has reduced the impact of the therapy cap by initiating repeals or by placing
moratoriums on the implementation, and the managers of rehabilitation facilities began to adjust
their budgets to the changes in reimbursement procedures. The initial repeal on Medicare Part B
Outpatient occupational therapy became effective on January 1, 2000, after the Association lob-
bied effectively against blending the three therapy services (occupational therapy/physical therapy/
speech-language pathology) into one generic rehabilitation benefit. Money was also restored to the
skilled nursing facility funding, the home health rate reductions were postponed and the reim-
bursement rates were increased. In response, numbers in the occupational therapy world began to
improve. By 2005, Association membership began to increase again, due in part to membership
recruitment efforts. By 2007, the educational programs were on the increase in response to grow-
ing demands for practitioners (AOTA, 2008/2009). In 2009, membership had reached 38,894. The
number of accredited occupational therapist programs was 142 with 3 applicants, whereas the
number of assistant programs was 129 with six developing and 23 applicants.
So what was learned from a severe blow to the existence and psyche of occupational therapy
as a profession? One lesson was the characteristics employers wanted from therapists. Fisher and
Cooksy (2002) stated that desirable qualities included “the ability to promote and ‘sell’ occupation-
al therapy, strong communication skills, sufficient experience and initiative to require little super-
vision, flexibility, effective problem-solving ability, innovation, good documentation skills, and
professionalism” (p. 1). A second lesson was that new and expanding job markets were available,
 Looking to the Future: 2000s to 2010s 305

such as ergonomics consulting to reduce workplace injuries, home modification and accessibility
consulting, older driver assessment, assisted living facility consulting, technology development
and consulting, health and wellness consulting, low-vision rehabilitation, and caregiver training
for Alzheimer’s disease (Brachtesende, 2005). Expanding opportunities for school-based practice
also helped ease the job market shortage. A third lesson was to broaden the scope of services and
products available through the Association at reduced rates for members.

Numbers of Licensed or Regulated Therapists and Assistants

The five states with the largest number of therapists and assistants in 2009 were New
York (13,641), California (12,358), Texas (9,185), Pennsylvania (8,948), and Florida (7,340)
(AOTA, 2009b). Earlier, in 2006, the states with the largest number of employed practitioners had
been California, New York, Ohio, and Pennsylvania (AOTA, 2006a). Geographically, the South
Atlantic, North Central, and South Central regions of the country had seen the largest growth in
the number of practitioners, averaging 4% growth per year. The Mountain region had experience
the slowest growth, averaging 2.3% per year.

Workforce and Compensation

According to the 2006 AOTA Workforce and Compensation Survey, occupational therapists
were 95% female and 5% male; assistants were 97% female and 3% male. Median age of occupa-
tional therapists was 42 years, up from 36 years in 1990; for assistants, median age was 45 years,
up from 33 years in 1990 (AOTA, 2006c). The number of practitioners between the ages of 50 and
59 years was at its highest level ever, whereas the percentage of practitioners younger than 30 years
was 7.9%, compared with 23% in 1997. A major concern was that if the trend continued, the field
could experience a significant shortage of practitioners due to retirement. As the workforce aged,
the median years of professional experience increased to 13 years, up from 9.5 in 2000. Ten percent
of practitioners had at least 30 years of professional experience, and 3.2% had achieved advanced
practice certification or recognition, up from 15.4% in 2000. The median salary for a full-time
occupational therapist increased 24%, from $45,000 to $55,800 in 2006. For assistants, the salary
had increase 26.7% from $30,000 in 2000 to $38,000 in 2006.

Legislation
A Model Practice Act to provide a guide for state licensure legislation was first written in 1989
by the State Policy Department (AOTA, 2000). The Model Practice Act was revised in 1999, 2004,
and 2011 to update the definition of occupational therapy and other technical and legal changes.
Significant federal legislation is summarized in Table 10-6.

Technology
A useful development in technology was the creation of the certification program in assis-
tive technology (Lenker, 2000). Although the certification program was developed outside the
profession, it provided a benchmark for practitioners to identify their skill level in using assistive
technology. The certification program was developed by the Rehabilitation Engineering Society of
North America (RESNA) in 1996 but took a while to be accepted in the occupational therapy field.
There are two certifications: assistive technology practitioner (ATP) and assistive technology sup-
plier (ATS). To administer the programs, RESNA created a separate entity called the Professional
Standards Board (PSB).
306 Chapter 10

Table 10-6
LEGISLATION
2001 No Child Left Behind (NCLB) (P.L. 107-110). Schools were to test students in reading and math at
grades 3 and 8 and once in high school. All schools in the state education system were to meet a
certain proficiency level. (Bazyk & Case-Smith, 2010)
2003 Medicare Prescription Drug Improvement and Modernization Act (P.L. 108-173). Law to support
consumer-driven health care and lowering health care expenditures. Decision making is shifted from
the insurance company to the consumer. High-deductible health plans and consumer-directed
health plans are examples. These plans provide incentive not to spend health care dollars, so occu-
pational therapists need to educate people on the benefits of services. (Lohman, 2014)
2004 Individuals with Disabilities Education Improvement Act (IDEIA or IDEA) (P.L. 108-446). Reauthorized
and updated the 1997 IDEA Increased emphasis on accountability and outcomes. Supports response
to intervention (RtI) and early intervention services (EIS). (Bazyk & Case-Smith, 2010)
2006 The Deficit Reduction Act (P.L. 109-171). Allows for temporary exemption of the therapy cap for cer-
tain condition in hospital and nonhospital-based clinics. If continued interventions are reasonable
and medically necessary, exemptions can be granted. If client has qualifying condition or complex-
ity, an automatic exemption process exists. (Lohman, 2014)
2010 Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). Attempts to provide affordable
medical insurance to persons with no health insurance or who are uninsured. (Lohman, 2014)
References
Bazyk, S., & Case-Smith, J. (2010). School-based occupational therapy. In J. Case-Smith & J. C. O Brien (Eds.), Occupational
therapy for children (6th ed., pp. 713-743). St. Louis, MO: Mosby/Elsevier.
Lohman, H. (2014). Payment for services in the United States. In B. A. Boyt Schell, G. Gillen, & M. E. Scaffa (Eds.), Willard &
Spackman s occupational therapy (12th ed., pp. 1051-1067). Philadelphia, PA: Wolters Kluwer.

Research
In 2004, a joint task group from both the Association and the Foundation developed a set of
research priorities for the profession (Table 10-7).
The Evidence-Based Literature Review Project began in 1998 as “a feasibility study to assess the
use fullness of a standardized format to code selected occupational therapy outcome literature”
in the online search system (Lieberman & Scheer, 2002). As the project evolved through three
phases, a format was developed to separate levels of evidence regarding outcomes research. The
format included four levels: evidence for design, evidence for sample size, evidenced for internal
validity, and evidence for external validity. There were five levels of evidence for design: random-
ized control trial (I), non-randomized control trail—two groups (experimental and control) (II),
nonrandomized control trial—one group, one treatment (pretest and posttest) (III), single-subject
design (IV), and not applicable (NA), which included narratives, case studies, expert opinion, lit-
erature reviews, consensus statements, and other nonquantifiable designs. Sample size was divided
into two levels, internal validity into three levels, and external validity into three levels. In essence,
the research study was evaluated on design + sample size + internal validity + external validity.
Although the format was not formally adopted by AJOT, it provided a useful method for teaching
practitioners and students to evaluate research studies on a scale. Studies using randomized, con-
trolled trial design with a larger number of subjects (20 or more per cognition) and high internal
and external validity should be given greater weight or consideration in translating the informa-
tion from research to practice.
The Association has developed additional tools to help translate research into clinical prac-
tice called Critically Appraised Topics (CATs) or Critically Appraised Papers (CAPs). CATs are
designed to provide evidence-based information on a specific clinical situation and provide a
brief, easy-to-read summary of results of a systematic review of the literature (Arbesman, Scheer,
 Looking to the Future: 2000s to 2010s 307

Table 10-7
TEN RESEARCH PRIORITIES
1. Are occupational therapy interventions effective in achieving targeted activity and participation out-
comes and preventing/reducing secondary conditions?
2. To what extent does occupation-based intervention promote learning adaptation, self-organization,
adjustment to life situations, and self-determination across the life span?
3. Are environmental interventions that support occupation effective in preventing impairment and pro-
moting activity and participation in the individual, community, and societal levels?
4. When, when, how, and at what level (body structure/body function, activity, participation, and environ-
mental) should an occupational therapy intervention occur to maximize activity and participation, as
well as cost-effectiveness of services?
5. What measures/measurement systems reflect the domain of occupational therapy and identify factors
(body structure/body function, activity, participation, and environment) or document the impact of
occupational therapy on these factors?
6. How do activity patterns and choices (occupations), both in everyday life and across the lifespan, influ-
ence the health and participation of individuals?
7. What is the impact of activity patterns and choices (occupations), both in everyday life and across the
lifespan, on society?
8. What are the conceptual models that explain the relationship among body structure/body function,
activity, environment, and participation? What is the role of occupational therapy within these models?
9. What factors contribute to effective partnerships between customers and practitioners that foster and
enhance participation in individuals with or at risk for disabling conditions?
10. What factors support occupational therapy practitioners capacities to maximize the occupational per-
formance of the persons they serve?
AOTF/AOTA. (2004). Research priorities and the parameters of practice for occupational therapy. OT Practice, 9(4), 20-21.

& Lieberman, 2008). CAT authors develop a focused question to delineate the systematic review
of literature; identify studies on a topic under consideration using specific inclusion and exclusion
criteria; select a group of the highest quality and most relevant articles, ranked according to the
standardized criteria for study design as described in the previous paragraph; critically appraise
and evaluate the design and methods used in the study; present the findings in the articles; and
synthesize the findings. CAPs summarize individual studies using a standardized format. CAPs
may be grouped together to develop a CAT. The Association maintains both CAPs and CATs on
its website. Information from the CAPs and CATs has also been included in the Practice Guideline
series of topics developed over several years.

Association
Centennial Vision Project
The Board of Directors endorsed the development of a Centennial Vision project to act as road
map for the future of the profession. The goal was to:
… ensure that individuals, policy-makers, populations, and society value and promote
occupational therapy’s practice of enabling people to prevent and overcome obstacles
to participation in the activities they value, to prevent health-related issues, improve
their physical and mental health, secure well-being and enjoy a higher quality of life.
(Christiansen, 2004, p. 10)
308 Chapter 10

The eight elements developed were the following:

1. Expanded collaboration for success
2. Power to influence
3. Membership equals professional responsibility
4. Well-prepared, diverse workforce
5. Clear, compelling public image
6. Customers demand occupational therapy
7. Evidence-based decision making
8. Science-fostered innovation in occupational therapy practice
The Centennial Vision statement was as follows: “We envision that occupational therapy is a
powerful, widely recognized, science-driven, and evidence-based profession with a globally con-
nected and diverse workforce meeting society’s occupational needs.” The statement was adopted
by the Association Board of Directors in October 2003 and was posted to the Association website,
but was first published in 2007 (Corcoran, 2007, p. 267). The Centennial Vision project was envi-
sioned “to be a road map for the future of the profession to commemorate the Association’s 100th
anniversary in 2017” (AOTA, 2007c, p. 613). Charles Christiansen and Florence Clark were Vice
Presidents whose job was to track and record the developments toward the goals of the Centennial
Vision statement (Sidebar 10-1).
Corcoran (2007) states that the Centennial Vision project involved a “synchronized set of strate-
gies, imperatives, and priorities for advancing our profession” (p. 267). Four strategic directs were
identified at a retreat in 2006:
1. Build the capacity to fulfill the profession’s potential and mission
2. Demonstrate and articulate our value to individuals, organizations and communities
3. Build an inclusive community of members
4. Link education, research, and practice (AOTA, 2007c, pp. 613-614)

Branding Statement
“Occupational Therapy: Living Life to Its Fullest” was adopted as the new brand phrase in
April 2008 by the Representative Assembly at the meeting in Long Beach, California, and reported
to the membership by President Penelope Moyers Cleveland (2008). The new brand replaced
“Occupational Therapy: Skills for the Job of Living,” which had been used as an advertising mes-
sage for several years. In explaining the new brand, Cleveland (2008) gave several examples:
● When occupational therapy says the impossible is possible, we are helping people live life to
its fullest.
● When occupation therapy works with a person with mental illness to set meaningful occu-
pational goals thought to be beyond reach, we are helping that person live life to its fullest.
● When occupational therapy helps a wounded soldier learn to regain the balance and vision
and perception to ride a bike again, we are helping him or her live life to its fullest.
● When occupational therapy inspires people to reach for the summit, no matter what, we are
helping them live life to its fullest.
● When occupational therapy helps adults stay active in their own homes and communities, we
are helping them live life to its fullest.
● When occupational therapy helps a child control negative behaviors and engage in positive
socialization, we are helping him or her live life to its fullest (p. 742).
 Looking to the Future: 2000s to 2010s 309

SIDEBAR 10-1
AOTA Celebrates Century of Service

Prior to the adoption of the Centennial Vision, AOTA President Carolyn Baum developed a
plan to set a strategic vision for the future of the profession. She distributed this press release
envisioning AOTA celebrating the accomplishments at the end of a century of service.

FOR IMMEDIATE RELEASE CONTACT: John Q. Spokesperson

April 28, 2017 301-652-6611 [email protected]

AOTA CELEBRATES CENTURY OF SERVICE

(Washington, DC) ‒ Membership in the American Occupational Therapy Association has

reached record numbers as the profession of occupational therapy celebrates its centennial.
Since the profession s genesis one hundred years ago, practice, education, research and
society have changed and grown, said AOTA s President. Today occupational therapy is a
powerful, widely recognized, science-driven, and evidence-based profession that is globally
connected and employs a diverse workforce. We have come far in meeting the needs of
society. Occupational therapy practitioners have made much progress for:
Elderly Citizens
OT has been essential to the redesign of services and advocated for programs and fund-
ing̶changing Medicare as well as private services̶to enable our elderly to stay active and
safe in their own homes and communities.
Young Children
OTs have been elected to local school boards across the country and now OT is available
to any child in school to help them acquire the learning, coping, and developmental skills to
be successful in school and transition to adult life.
People With Mental Illness
OT research has guided successful strategies that have put OT into the mental health
mainstream, helping clinicians meet the needs of individuals with mental illness to enable
them to lead independent and productive lives.
The Workforce
OT has become integral to the development of safe and productive workplaces, provid-
ing interventions in manufacturing, service, sales and other industries so all workers can
avoid injury and older, disabled and all workers are valued and valuable.
People with Disabilities
OT has been the driving force behind a Second Wave ADA effort to finally and fully
remove barriers that limit the full participation of people with disabilities in society.
Education
Doctorally prepared faculty are educating record numbers of OT students to use their
knowledge to enhance the lives of people with chronic disease and disability. Occupational
Therapy is established as an academic discipline. Five faculty currently are Fulbright scholars
studying services in developing countries for people with disabilities.
Research
Record numbers of occupational therapy scientists have received funding from NIH and
NIDRR and are contributing knowledge to improve the lives of individuals with disabilities
and ways to prevent disease resulting in improved health and well-being.
The American Occupational Therapy Association, established in 1917, represents nearly
75,000 members. AOTA is an active advocate for the profession and for individuals who can
benefit from occupational therapy services.

Reprinted with permission from Baum, C. (2006). Presidential Address, 2006: Centennial challenges, millennium oppor-
tunities. American Journal of Occupational Therapy, 60(6), 609-616.
310 Chapter 10

Presidents, Executive Directors, and Association Priorities

Three people served as President of AOTA
from 2001 to 2010: Barbara L. Kornblau, 2001-
2004 (Figure 10-2); Carolyn M. Baum, 2004-2007
(Figure 10-3); and Penelope Moyers-Cleveland,
2007-2010 (Figure 10-4). Table 10-8 summarizes
their accomplishments. Biographical sketch-
es are included in Table 10-9. Joseph Isaacs
served as Executive Director from 2000 to 2003
(Johansson, 2000) (Figure 10-5), and Frederick
Somers began serving as Executive Director
in 2004 (Figure 10-6). Examples of goals and
objectives appear in Table 10-10, and documents
adopted by the Representative Assembly appear
in Table 10-11 (Figure 10-7). Figure 10-2. Barbara L. Kornblau, JD, OT/L, FAOTA,
President of AOTA, 2001-2004, (right) and her hus-
band Larry Sherry (left) meeting Princess Anne in July
Finances 2001 at the 25th Annual Conference of the College of
Occupational Therapists, held at the University of Wales,
In 2000, the Association faced a serious loss Swansea. (Reprinted with permission from Barbara L.
of income and had to revise Association pri- Kornblau.)
orities. All volunteer bodies were asked to make
do with less. Layoffs continued in the national
office. Departments were consolidated; such the Conferences and Meetings Departments were
merged to form a new Continuing Education and Events Department. Full-time staff were reduced
from 143 in 1998 to 94. Members were given the option to choose not to receive the a mailed copy
of AJOT to save postage. Some committees, such as the Recognitions Committee, were asked to
conduct business via technology, such as email and conference calls, rather than face-to-face meet-
ings (AOTA, 2000).
Primary sources of income in fiscal year 2001 were member fees, conference, books and pub-
lications, subscriptions, and building rental income. Major expenses were administration, peri-
odical publication, continuing edu-
cation, and building maintenance
(AOTA, 2001).

Continuing Competence
and Competency
In 2002, the Representative
Assembly voted, and the mem-
bership approved, to establish the
CCCPD to “address the growing
awareness of and need within the
profession for continuing compe-
tence” (AOTA, 2002b, p. 7). The
Figure 10-3. Carolyn M. Baum, PhD,
OTR/L, FAOTA, President of AOTA,
specific purposes were to promote
Figure 10-4. Penelope Moyers
2004-2007. (Printed with permission Cleveland, EdD, OTR/L, BCMH, high professional standards and
from the Archive of the American FAOTA, President of AOTA, continuing competence and to fos-
Occupational Therapy Association, 2007-2010. (Printed with per- ter success in both existing and
Inc.) mission from the Archive of emerging practice settings (AOTA,
the American Occupational
Therapy Association, Inc.) 2002b, p. 7). The CCCPD has no
 Looking to the Future: 2000s to 2010s 311

Table 10-8
PRESIDENTIAL ACCOMPLISHMENTS
Barbara L. Kornblau, 2001-2004
Reorganization of the Association stressing financial accountability and overseeing initiation of the centennial
vision
Carolyn Baum, 2004-2007
Development of the Model Education Curriculum
Penelope Moyers-Cleveland, 2007-2010
Overseeing creation of a new brand phrase

Table 10-9
BIOGRAPHICAL SKETCHES
BARBARA L. KORNBLAU
Born August 17, 1956
Born in Flushing, New York. She has a bachelor of science degree from the University of Wisconsin-Madison
and a doctorate in jurisprudence from the University of Miami. She holds certifications in case management,
disability management, and pain management and is credentialed in disability analysis and pain management.
She is member of the Florida Bar and the United States Supreme Court Bar. She became a Fellow in 1996,
received the Award of Merit in 2009, and served as President from 2001 to 2004. She had held positions as
Professor of Occupational Therapy and Public Health in the Colleges of Allied Health and Osteopathic Medicine
and Adjunct Professor in the Sheppard Board Law Centre at Nova Southeastern University. She has been a
Professor and Former Dean of the School of Health Professions and Studies at the University of Michigan-Flint.
She is Professor of Occupational Therapy, School of Allied Health Science, Florida A&M University, and Executive
Director of the Society for Participatory Medicine and Founder and CEO of the Coalition for Disability Health
Equity. Her research interests include health and disability policy, disability health, disparities, and health equity.
She is the co-author of the book Ethics in Rehabilitation: A Clinical Approach.
CAROLYN M. BAUM
(See Chapter 9)
PENELOPE A. MOYERS CLEVELAND
Born September 7, 1955
Lived in Indianapolis. Her bachelor s degree in occupational therapy is from the University of Missouri in 1977,
her master s degree in community development is from the University of Louisville, and her doctoral degree is
in adult education with a major in public administration from Ball State University. She served as President from
2007 to 2010. Her work career includes working at the Central State Hospital in Louisville, Kentucky and Plastic
Surgery Associates in Indianapolis, Indiana. She has served as Dean of the School of Occupational Therapy at
the University of Indianapolis, professor and Chair of the Occupational Therapy Department at the University of
Alabama-Birmingham, and Dean of the College of St. Catherine in Minneapolis. She is Board certified in mental
health from the Association. She received the Award of Merit in 2013 and was named a Fellow in 1997. She has
published on substance use disorders, continuing competence, and professional development. Prior to becom-
ing President, she was chair of the Commission on Continuing Competence and Professional Development.

regulatory authority to remove a practitioner’s license to practice; rather, the focus is on setting
model standards, tools, and guidelines to assist practitioners in their professional development.
An example is the Model of Continuing Competence Guidelines for the Occupational Therapist
and Occupational Therapy Assistant: A Resource for State Regulatory Boards approved by the
Representative Assembly in 2002 (AOTA, 2002d). The Association had originally approved
Standards for Continuing Competence in 1999, but revisions of the document would become the
responsibility of CCCPD, including the revision in 2006 (AOTA, 1999, 2005).
312 Chapter 10

According to Moyers,
competence refers to an indi-
vidual’s capacity to preform
job (profession) responsi-
bilities. “Capacity is most
clearly related to ongoing
professional develop or life-
long learning” (Moyers,
2002, p. 19). Competence,
in contrast, “focuses on an
individual’s actual perfor-
mance in a particular situ-
ation. Competency implies
a determination of whether
one is competent to per-
form a behavior or task as
measured against a specific Figure 10-6. Frederick Somers,
criterion” (Moyers, 2002, p. Figure 10-5. Joseph Isaacs, Executive Executive Director of AOTA,
19). Continuing competence Director of AOTA, 2000-2003. (Printed 2004-present. (Printed with per-
with permission from the Archive of
“is a process involving the the American Occupational Therapy mission from the Archive of the
American Occupational Therapy
examination of current com- Association, Inc.) Association, Inc.)
petence and the development
of capacity for the future
(AOTA, 2005, p. 661). The
role of competence, competency, and continued competence would become major issues as the
state regulatory boards reviewed the process of renewing licenses to practice.
The CCCPD also oversees the development and administration of the Board and specialty
certification. The Board for Advanced and Specialty Certification (BASC) is responsible for the
ongoing activities. These programs are voluntary but are designed to allow practitioners to dem-
onstrate expertise in a particular area of practice or a specific technique used as an intervention in
occupational therapy practice. There are four areas of Board Certification with recognized creden-
tials: Gerontology (BCG), Mental Health (BCMH), Pediatrics (BCP), and Physical Rehabilitation
(BCPR). There are five Specialty Certification programs available for either the occupational
therapist or the assistant: Driving and Community Mobility, Feeding, Eating and Swallowing,
Environmental Modification, Low Vision, and School Systems.

Fund to Promote
Table 10-10 Awareness of
STRATEGIC PLAN GOALS AND OBJECTIVES Occupational Therapy
2000-2004 The Fund was created in 2002
● To ensure a member-centered focus
in response to a membership sur-
vey that indicated that the number
● To advance excellence in practice, education and research
one priority was to raise awareness
● To represent and advocate for the profession about occupational therapy services
● To pursue strategic alliances and their potential contribution to
● To remain a viable and financially sound organization society both inside and outside the
profession. The Fund was created as
● To improve governance and management effectiveness
a 501(c)(3) charitable organization
Reference Manual 10th ed.
with the goal of building corporate
 Looking to the Future: 2000s to 2010s 313

Table 10-11
DOCUMENTS OF THE ASSOCIATION
2000 ● Occupational therapy Code of Ethics (2000). AJOT, 54(6), 614-616.
● Enforcement Procedure for Occupational Therapy Code of Ethics. AJOT, 54(6), 617-621.
● Occupational Therapy and the Americans with Disabilities Act (ADA). AJOT, 54(6), 622-625.
● Specialized Knowledge and Skills in Eating and Feeding for Occupational Therapy Practice.
AJOT, 54(6), 629-641.
● Specialized Knowledge and Skills for Occupational Therapy Practice in the NICU. AJOT, 54(6),
641-648.
● Statement: Occupational Therapy Services in Facilitating Work Performance. AJOT, 54(6), 626-628
2001 ● Occupational Therapy in the Promotion of Health and Prevention of Disease and Disability
(replaced 1989 document). AJOT, 55(6), 656-660
● Specialized Knowledge and Skills in Adult Vestibular Rehabilitation of Occupational Therapy
Practice. AJOT, 55(6), 661-665.
2002 ● Position Paper: Broadening the construct of Independence. AJOT, 56(6), 660
● Enforcement Procedure for Occupational Therapy Code of Ethics. AJOT, 56(6), 661-666
● Glossary: Standards for an Accredited Education Program for the Occupational Therapists and
Occupational Therapy Assistant. AJOT, 56(6), 667-668.
● Occupational Therapy Practice Framework: Domain and Process. AJOT, 56(6), 609-639
2003 ● Concept Paper: Scholarship and Occupational Therapy. AJOT, 57(6), 641-643
● Guidelines for Documentation of Occupational Therapy, AJOT, 57(6), 646-649.
● Position Paper: Physical Agent Modalities. AJOT, 57(6), 650-651.
● Statement: Applying Sensory Integration Framework in Educationally Related Occupational
Therapy Practice. AJOT, 57(6), 652-659. (replaces 1997 Sensory Integration Evaluation and
Intervention in School-Based Occupational Therapy)
● Statement: Philosophy of Professional Education (revised 2007). AJOT, 57(6), 640
● Statement: The Purpose and Value of Occupational Therapy Fieldwork Education (replaces
1996). AJOT, 57(6), 644
● Statement: The Viability of Occupational Therapy Assistant Education. AJOT, 67(6), 645
● Specialized Knowledge and Skills for Eating and feeding in Occupational Therapy Practice.
AJOT, 57(6), 660-678.
2004 ● Academic Terminal Degree. AJOT, 58(6), 648
● Assistive Technology within Occupational Therapy Practice. AJOT, 58(6), 678-680
● Enforcement Procedures for Occupational Therapy code of Ethics. AJOT, 58(6), 655-662/
● Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational
Therapy Services. AJOT, 58(6), 663-667.
● Occupational Therapy Services in Early Childhood and School-based Settings. AJOT, 58(6), 681-685
● Occupational therapy s Commitment to Nondiscrimination and Inclusion, AJOT, 58(6), 668.
● Psychosocial Aspects of Occupational Therapy. AJOT, 58(6), 669-672
● Role Competencies for an Academic Fieldwork Coordinator. AJOT, 58(6), 653-654
● Role Competencies for a Professional-Level Occupational Therapist Faculty Member in an
Academic Setting. AJOT, 58(6), 649-650.
● Role Competencies for a Professional-Level Program Director in an Academic Setting. AJOT,
58(6), 651-652.
● Scope of Practice. AJOT, 58(6), 673-677.
(continued)
314 Chapter 10

Table 10-11 (continued)

DOCUMENTS OF THE ASSOCIATION
2005 ● Occupational Therapy and Hospice. AJOT, 59(6), 671-675
● Occupational Therapy Code of Ethics. AJOT, 59(6), 739-642
● Enforcement Procedures for the Occupational Therapy Coe of Ethics. AJOT, 59(6), 643-652
● Occupational Therapy Services in Facilitating Work Performance. AJOT, 59(6), 676-679
● Position Paper: Complementary and Alternative Medicine (CAM) (replaces 2003 White paper).
● Role Competencies for a Faculty Member in an Occupational Therapy Assistant Academic
Setting. AJOT, 59(6), 635-636.
● Role Competencies for a Program Director in an Occupational Therapy Academic Setting. AJOT,
59(6), 637-638
● Standards for Continuing Competence (replaces 1999 document). AJOT, 59(6), 661-662
● Standards of Practice for Occupational Therapy (replaces 1998 document). AJOT, 59(6), 663-665
● Statement: Driving and Community Mobility. AJOT, 59(6), 666-670.
● The scope of occupational therapy service for individuals with autism spectrum disorders
across the life span. AJOT, 59(6), 6800683
● Telerehabilitation. AJOT, 59(6), 656-660
2006 ● AOTAs Statement on Health Disparities. AJOT, 60(6), 679
● AOTAs Statement on Obesity. AJOT, 60(6), 680
● Bylaws: The American Occupational Therapy Foundation, Inc. (Delaware)
● Guidelines to the Occupational Therapy Code of Ethics. AJOT, 60(6), 652-658.
● Role Competencies for a Fieldwork Educator. AJOT, 60(6), 650-651.
● Specialized Knowledge and Skills for Occupational Therapy Practice in the Neonatal Intensive
Care Unit (replaces 2000 document). AJOT, 60(6), 659-668.
● Specialized Knowledge and Skills in Adult Vestibular Rehabilitation for Occupational Therapy
Practice (replaces 2000 document). AJOT, 60(6), 669-678.
● The Role of Occupational Therapy in Disaster Preparedness, Response, and Recovery. AJOT,
60(6), 642-549.
2007 ● A descriptive review of occupational therapy education, AJOT, 61(6), 672-677.
● Accreditation Standards for a Doctoral-Degree-Level Educational Program for the Occupational
Therapist. AJOT, 61(6), 641-651
● Accreditation Standards for a Master s-Degree-Level Educational Program for the Occupational
Therapist. AJOT, 61(6), 652-661
● Accreditation Standards for tan Educational Program for the Occupational Therapy Assistant.
AJOT, 61(6), 662-671
● AOTAs Statement on Family Caregivers. AJOT, 61(6), 710
● AOTAs Statement on Stress and Stress Disorders. AJOT, 61(6), 711
● Enforcement Procedures for the Occupational Therapy Code of Ethics (edited 2007). AJOT, 61(6),
679-685.
● Occupational therapy services for individuals who have experienced domestic violence. AJOT,
61(6), 704-709
● Philosophy of Occupational Therapy Education. AJOT, 61(6), 678
● Position Paper: Obesity and Occupational Therapy. AJOT, 61(6), 701703.
● Specialized Knowledge and Skills in Feeding, Eating, and Swallowing for Occupational Therapy
Practice. AJOT, 61(6), 686-700
(continued)
 Looking to the Future: 2000s to 2010s 315

Table 10-11 (continued)

DOCUMENTS OF THE ASSOCIATION
2008 ● Academic Terminal Degree. AJOT, 62(6), 704
● AOTAs Societal Statement on Play. AJOT, 62(6), 707-708
● AOTAs Societal Statement on Youth Violence. AJOT, 62(6), 709
● Guidelines for Documentation of Occupational Therapy. AJOT, 62(6), 684-690.
● Occupational Therapy Practice Framework: Domain and Process. 2nd edition. (AJOT, 62(6), 625-683
● Occupational Therapy Services in the Promotion o Health and the Prevention of Disease and
Disability. AJOT, 62(6), 694-703
● Position Paper: Physical Agent Modalities. AJOT, 62(6), 691-693
● The Importance of Occupational Therapy Assistant Education to the Profession. AJOT, 62(6),
705-706
● White Paper: Wound management. OT Practive13(7), 17-18
2009 ● AOTAs Societal Statement on Autism Spectrum Disorders. AJOT, 63(6), 843-844
● AOTAs Societal Statement on Combat-Related Posttraumatic Stress. AJOT, 63(6), 845-846
● AOTAs Societal Statement on Livable Communities. AJOT, 63(6), 847-848
● Guidelines for Supervision, roles and responsibilities during the delivery of occupational therapy
services. AJOT, 63(6), 797-803
● Occupational Therapy Fieldwork Education: Value and Purpose. AJOT, 63(6), 821-822
● Occupational Therapy s Commitment to Nondiscrimination and Inclusion. AJOT, 63(6), 819-820
● Providing Occupational Therapy Using Sensory Integration Theory and Methods in School-
Based Practice. AJOT, 63(6), 823-842.
● Scholarship in Occupational Therapy. AJOT, 63(6), 790
● Specialized Knowledge and Skills of Occupational Therapy Educators of the Future. AJOT, 63(6),
804-818.

A B

Figure 10-7. (A) Polaroid photo of (left to right) Fred Sammons, Lori T. Andersen, and Larry Sherry. (B) Polaroid photo of
Kitty Reed (left) and Fred Sammons (right). Fred Sammons is one of AOTA’s treasured members and benefactors. Early
in his occupational therapy career, he started an adaptive equipment company. He is well known for taking Polaroid
photos with conference-goers at his exhibitor booth at AOTA conferences. Many occupational therapy practitioners
still have these photos in personal scrapbooks. This tradition continued until Polaroid film was no longer available.
(Reprinted with permission from Fred Sammons.)
316 Chapter 10

funding to support projects designed to promote recognition and visibility of occupational therapy
as a profession. The mission is to achieve greater understanding, availability, and use of occupa-
tional therapy and to promote the profession’s contribution to health, wellness, participation, pro-
ductivity, and quality of life in society (Fund to Promote Occupational Therapy, 2014). Its purposes
are to serve as the message hub and dissemination arm of the profession, help practitioners tell
their own stories more effectively, and focus on high-impact communication aimed at the general
public (Glomstand, 2003). One of the first projects was a commissioned survey conducted by the
Gallup Organization in March/April 2003 to assess the understanding of older adults as what
occupational therapy could do to meet their needs (Gallop Organization, 2003). Survey results
indicated that awareness of occupational therapy was low; only 32% of respondents considered
themselves to be very knowledgeable about occupational therapy, compared with 44% for physical
therapy and 58% for nurses. Home health aides and nursing assistants are perceived as similar in
function to occupational therapists. The Gallup Organization recommended that occupational
therapy needed to be defined based on training and professional knowledge to help distinguish
occupational therapy practitioners from home health aides and nursing assistants.
Another project underwritten by the Fund is National School Backpack Awareness Day, which
is an annual campaign to promote awareness of occupational therapy’s role in the health and
well-being of children. In addition, the Fund in involved in Occupational Therapy Month which
supports occupational therapy as a career choice and celebrates the work of practitioners in their
practice settings. The Fund has also partnered with Rebuilding Together, a national organization
that works to preserve and renew houses in communities.

Occupational Therapy Practice Framework

The Occupational Therapy Practice Framework was developed in response to current practice
needs to more clearly “affirm and articulate” the focus of occupational therapy on occupation,
activities of daily living, and the application of an intervention process that facilitates engage-
ment in occupation to support participation in life (AOTA, 2002c, p. 609). The purpose was to (1)
describe the domain that centers and grounds the profession’s focus and actions and (2) outline
the process of occupational therapy evaluation and intervention that is dynamic and linked to the
profession’s focus on and use of occupation (AOTA, 2002c, p. 609).
The Commission on Practice had begun reviewing the document entitled Uniform Terminology
for Occupational Therapy, Third Edition (Uniform Terminology III) in 1998 to potentially update
it (AOTA, 1994). During the review process, several problems became apparent, leading to a con-
clusion that another approach was needed. The problems identified were the following:
● Terms defined in the Uniform Terminology III document were unclear, inaccurate, or catego-
rized improperly.
● Terms that should have been in the Uniform Terminology III document were missing.
● Too much emphasis was placed on performance components.
● The concept of occupation was not included.
● Terms were used that were unfamiliar to external audiences (i.e., performance components,
performance areas).
● Consideration should be given to using terminology proposed in the International Classification
of Functioning Disability and Health (ICF) (WHO, 2001).
● The Uniform Terminology III document was being used inappropriately to design curricula.
● The role of theory application in clinical reasoning is being minimized by using the Uniform
Terminology III document as a recipe for practice.
● The practice environment had changed significantly since the last revision.
● The understanding had evolved within the profession of core constructs and service delivery
process. (AOTA, 2002c, p. 637)
 Looking to the Future: 2000s to 2010s 317

As a result of the review, changes were made to create a new document designed to replace
Uniform Terminology III. The new document was called the Occupational Therapy Practice
Framework: Domain & Practice (OTPF) and was adopted by the Representative Assembly in
2002 as Motion 29 (AOTA, 2002a). The document separated discussion of the domain of concern
from the process of service delivery. The domain of concern presented the “areas of human experi-
ence in which practitioners of the profession offer assistance to others” (Mosey, 1981, p. 51). The
domain was described as being concerned with “assisting people to engage in daily life activities
that they find meaningful and purposeful” that stemmed from the professional “interest in human
beings’ ability to engage in everyday life activities” called occupation (AOTA, 2002c, p. 610). The
domain included six major aspects: performance in areas of occupation, performance skills, per-
formance patterns, context, activity demands, and client factors.
The process of occupational therapy was descripted in three aspects focusing on occupation:
evaluation, intervention, and outcome. The process began by evaluating a client’s occupational
needs, problems, and concerns. Intervention focused on efforts to foster improved engagement in
occupation. Outcome focused on the success in reaching the targeted goals or objectives.
The glossary to the OTPF lists 109 terms, which is less than the number defined in the Uniform
Terminology III document (122 terms). However, additional terms appear in the document text
that are not listed in the glossary. Whether some changes in terminology are due to consolidation
of synonyms or elimination because they were not needed is not discussed. The discussion of
changes in terminology from the Uniform Terminology III to the OTPF only covers the six major
aspects but not the terms listed under the major headings (AOTA, 2002c).

2008 Revision of the Occupational Therapy Practice Framework

The OTPF was reviewed in 2007 as part of the 5-year review cycle established for all documents
of the Association to determine whether a document needs revision, can remain unchanged, or
should be rescinded because it is out of date or no longer useful. In general, the OTPF was found
to be useful, but some reorganization, additions, and clarification of definitions were needed
(AOTA, 2008b). For example, the concept of spirituality was moved from the section on Context
to the section on Client Factors because feedback from members suggested that individuals
considered spiritually to reside within the client rather than as part of a context. Context itself
was expanded to include the concept of environment to acknowledge that the two are different
ideas, but the term environment is used more often in the general literature. The concept of rest
and sleep was separated from the concept of activities of daily living because all people need rest
and/or sleep following occupation throughout their lifespan, as Adolf Meyer suggested in his
1921 lecture (Meyer, 1922). The concept of performance skills was broadened to include the con-
cepts of abilities and capacities. The category of outcomes was expanded to include occupational
justice and self-advocacy as legitimate outcomes of occupational therapy intervention. The term
client was expanded to include person, organization, and population as opposed to being restricted
to an individual only. The role of research in support of practice was emphasized by adding the
concept of evidence-based practice. In general, the changes did not alter the overall structure of the
OTPF but rather increased the consistency of the concept s with the current practice and delivery
of occupational therapy services. A summary of the changes appears in AJOT (2008, pp. 605-667).

Foundation
During the years 2000 to 2010, there were changes in personnel when three key people retired:
Martha Kirkland, who had served as Executive Director of the American Occupational Therapy
Foundation (AOTF) since 1986 (Figure 10-8); Nedra Gillette, who had been in charge of research
efforts; and Mary Binderman, librarian of the Wilma L. West Library. Charles Christiansen
318 Chapter 10

Figure 10-8. Martha Kirkland, OTR, Figure 10-9. Charles H. Christiansen, Figure 10-10. Ruth Ann Watkins,
FAOTA, Executive Director of the AOTF, EdD, OTR, FAOTA, Executive Director OTR, President of the AOTF, 2003-
2006-2015. (Printed with permission of the AOTF, 2006-2015. (Printed with 2007. (Printed with permission
from the Archive of the American permission from the Archive of the from the Archive of the American
Occupational Therapy Association, Inc.) American Occupational Therapy Occupational Therapy Association,
Association, Inc.) Inc.)

become Executive Director in 2006 (Figure 10-9). Ruth Ann Watkins (Figure 10-10) served as
President of the Foundation for 6 years, following Jane Davis Rourk.
In 2001, the Association and Foundation were involved in a serious dispute over the relation-
ship between the two entities. The Association was experiencing financial hardship due to loss of
membership revenue and was realigning priorities. Fiduciary responsibilities to the Association
to operate as a business were viewed as top priorities (AOTA, 2001; Rourk, 2001). The Executive
Board voted on three motions:
● Investigate the legal obligations to continue the 2% of each individual’s annual Association
membership feeds designated as a contribution to the AOTF in support of the Foundation’s
mission (approximately $120,000)
● Create a charitable 401(c)(3) organization to receive tax-deductible gifts separate from the
Foundation (Fund to Promote Awareness of Occupational Therapy)
● Formulate an agreement to eliminate and/or reduce significant subsides from AOTA to the
AOTF related to rented space, utilities, and other operating agreements which had totaled
approximately $100,000 annually
The result of the motions would have been to (1) end direct member support of the Foundation
and its educational, research, and public awareness activities; (2) establish a new charitable orga-
nization that would compete directly with the Foundation for private- and public-sector fund-
ing; and (3) alter the collaborative relationship between the Association and Foundation that
had jointly supported initiatives to broaden and strengthen the knowledge base of the profession
and its practitioners. On the other hand, the Foundation was fiscally sound and could pay the
going rate for office space rent. A more important point was that the relationship established in
1965 would be substantially changed. The Foundation was created to take advantage of the IRS tax
code that allowed certain activities, such as education, research, and public awareness, to be con-
sidered charity and thus not taxable or taxed at a reduced rate from activities considered business
related. The separation of functions between the Association and Foundation was never intended
to create two free-standing organizations with no interrelation except an agreement to cooperate
on projects of mutual interest. There were no federal laws or guidelines adopted between 1965 and
 Looking to the Future: 2000s to 2010s 319

2001 that required the Foundation to become a free-standing organization without any subsidy
from the Association.
In September 2002, an AOTA/AOTF Collaboration Task Force developed a set of principles
to guide collaboration between the Boards of three organizations (AOTA, AOTF, and National
Board for Certification in Occupational Therapy [NBCOT]). In essence, the guidelines allowed
each organization to seek charitable contributions but to communicate what each organization was
doing to the others (Rourk & Kirkland, 2003). In addition, the Association agreed to continue to
transfer the 2% of membership dues to the Foundation. Financial arrangements regarding rental
space and other operating expenses were to be reviewed annually. Budgeting for joint projects was
to be developed by the Association staff first, and then Foundation staff would be approached to
determine what assistance the Foundation could provide to avoid conflicts regarding who was
doing what with which money.

National Board for Certification

in Occupational Therapy
Continuing Certification Program
NBCOT began phasing in a continuing certification program on July 1, 2002, and com-
pleted the initial phase on January 1, 2005, as part of program of accountability to the public
(NBCOT, 2000a). Continuing certification must be renewed every 3 years and required obtaining
36 Professional Development Units (PDUs) during the 3-year period to continue using the terms
occupational therapy registered or certified occupational therapy assistant or the use of the initials
OTR or COTA after an individual’s name. PDUs could be acquired through any of 23 activities,
none which involved retaking the certification examination. Examples include attending work-
shops, making presentations, completing requirements for specialty certification, publishing an
article or chapter, mentoring a colleague, guest lecturing, writing a report about an peer-reviewed
article, supervising Level II students, participating in a study group, completing a self-assessment
and professional development plan, completing an independent study course, or taking a college
course. A chart of activities and their PDU values appeared in the spring issue of the newsletter
(NBCOT, 2002a). At least 50% (18) of the required PDUs must be directly related to the delivery of
occupational therapy services: “Directly related … included models, theorie,s or frameworks that
related to client/patient care in preventing or minimizing impairment, or enabling function within
the person/environment or community context” (NBCOT, 2002b). In general, activities accepted
as continuing education requirements for state licensure were accepted as PDUs for continuing
certification. Although practitioners do not have to maintain certification with NBCOT, many
choose to do so. States with the highest number of OTRs are California, New York, Pennsylvania,
Texas, and Florida. States with the highest number of COTAs are New York, Pennsylvania,
California, and Texas. Florida and Illinois are tied for fifth place (NBCOT, 2003, p. 5).

Practice Analysis Studies

NBCOT conducted its second practice analysis in 2003 (the first was in 1998) to obtain a
detailed description of practice or what an occupational therapy or assistant does. The results
were used to guide the development and content of the certification examination to ensure that
the examination reflects current roles and responsibilities of entry-level practitioners. Each level
of practice is divided into major performance domains. Each performance domain in turn is
delineated in terms of its major tasks. Each task was then divided into a series of knowledge and
skills statement (NBCOT, 2003). Table 10-12 shows the blueprint for the examinations, based on
320 Chapter 10

Table 10-12
BLUEPRINTS FOR 2005 INITIAL CERTIFICATION EXAMINATIONS
OTR COTA
Evaluate individual/group to identify needs/priorities 25% 12%
Develop intervention plan addressing occupational needs 21% 22%
Implement occupationally meaningful interventions 41% 50%
Provide occupational therapy services addressing needs of populations 06% 09%
Manage/organize/promote occupational therapy services 07% 07%

the results of the 2003 practice analysis. Survey results of practitioners renewing the certification
with NBCOT during the time period of 2003/2004 found that disorders most commonly seen by
both OTRs and COTAs were, in order, neurological, orthopedic, developmental, psychosocial,
musculoskeletal, cardiopulmonary, and systemic. The first three diagnostic groups accounted for
approximately 60% of clients seen (NBCOT, 2004).

Reflection
The development and implementation of activities to support the Centennial Vision took center
stage during this decade. Mid-decade, the profession began to recover from the effects of the BBA.
There was further distancing from the medical model and sponsorship by the medical profession.
The profession continued to develop new strategic partnerships. The profession also increased
advocacy efforts and initiated efforts to mentor/develop leaders. Not everything was serious busi-
ness. Figure 10-11 shows Florence Clark and Virgil Mathiowetz dancing in the aisle at the opening
session of the 2005 annual conference in Long Beach, California.

Figure 10-11. Dancing in the aisle: Florence Clark and Virgil Mathiowetz at the 2005
annual conference dancing in the aisle at the opening ceremony. (Printed with permission
from the Archive of the American Occupational Therapy Association, Inc.)
 Looking to the Future: 2000s to 2010s 321

References
American Occupational Therapy Association. (1924). Minimum standards for courses of training in occupational
therapy. Archives of Occupational Therapy, 3(4), 295-298.
American Occupational Therapy Association. (1958). Curriculum guide for occupational therapy. New York, NY:
Author.
American Occupational Therapy Association. (1994). Uniform terminology for occupational therapy, third edition.
American Journal of Occupational, 48(11), 1047-1054.
American Occupational Therapy Association. (1999). Standards for continuing competence. American Journal of
Occupational Therapy, 53(6), 559-560.
American Occupational Therapy Association. (2000). Summary of AOTA’s Executive Board actions: June 2000.
Retrieved from www.aota.org
American Occupational Therapy Association. (2001). AOTA Board of Directors October 2001 meeting summary.
Retrieved from www.aota.org
American Occupational Therapy Association. (2002a). 2002 Representative Assembly summary of minutes. American
Journal of Occupational Therapy, 56(6), 695-696.
American Occupational Therapy Association. (2002b). CCCPD background and purpose. OT Practice, 7(18), 7.
American Occupational Therapy Association. (2002c). Occupational therapy practice framework: Domain & process.
American Journal of Occupational Therapy, 56(6), 609-639.
American Occupational Therapy Association. (2002d). RA approves model continuing competence guidelines. State
Affairs Group News, 4(2), 1, 6.
American Occupational Therapy Association. (2004a). AOTA management report to the Representative Assembly.
Bethesda, MD: Author.
American Occupational Therapy Association. (2004b). Association policies: Definition of occupational therapy prac-
tice for state regulation (Policy 5.3.1). American Journal of Occupational Therapy, 58(6), 694-695.
American Occupational Therapy Association. (2005). Standards for continuing competence. American Journal of
Occupational Therapy, 59(6), 661-662.
American Occupational Therapy Association. (2006a). Athletic trainers aim to expand their scope. AOTA State
Affairs Group News, 8(2), 3.
American Occupational Therapy Association (2006b). Board of directors meeting minutes. Bethesda, MD: Author.
American Occupational Therapy Association (2006c). Workforce and Compensation Survey. Bethesda, MD: AOTA
Press.
American Occupational Therapy Association. (2007a). State scope of practice challenges. AOTA State Policy Update,
9(4), p. 3.
American Occupational Therapy Association. (2007b). AOTA’s APP recognized in state regulation. State Affairs
Group News, 9(4), p. 2.
American Occupational Therapy Association. (2007c). AOTA’s centennial vision and executive summary. American
Journal of Occupational Therapy, 61(6), 613-614.
American Occupational Therapy Association. (2007/2008). Annual data report. Bethesda, MD: Author.
American Occupational Therapy Association. (2008a). Listing of educational programs in occupational therapy.
American Journal of Occupational Therapy, 62(6), 721-732.
American Occupational Therapy Association. (2008b). Occupational therapy practice framework: Domain & process,
second edition. American Journal of Occupational Therapy, 62(6), 625-683.
American Occupational Therapy Association. (2008c). New OT brand “Living life to its fullest.” OT Practice, 13(6), 7.
American Occupational Therapy Association. (2008d). Occupational therapy practice framework: Domain &
Process, 2nd ed. American Journal of Occupational Therapy, 62(6), 625-668.
American Occupational Therapy Association (2008e). Occupational therapy model curriculum. Bethesda, MD:
Author.
American Occupational Therapy Association. (2008/2009). Annual data report. Bethesda, MD: Author.
American Occupational Therapy Association. (2009a). AOTA member participation survey: Overview report.
Bethesda, MD: Author.
American Occupational Therapy Association. (2009b). Number of licensed/regulated OTs and OTAs. State Policy
Update, 11(2), 4.
American Occupational Therapy Association. (2010a). Academic programs annual data report. Bethesda, MD: Author.
American Occupational Therapy Association. (2010b). Blueprint for entry-level education. American Journal of
Occupational Therapy, 64(1), 186-203.
American Occupational Therapy Association (2010c). The reference manual of the official documents of the American
Occupational Therapy Association, Inc., 15th ed. Bethesda, MD: AOTA Press.
322 Chapter 10

Arbesman, M., Scheer, J., & Lieberman, D. (2008). Using the AOTA’s critically appraised topic (CAT) and critically
appraised paper (CAP) series to link evidence to practice. OT Practice, 13(5), 18-22.
Boerkoel, D. (2004). Thriving with PPS. OT Practice, 9(20), 9-12.
Brachtesende, A. (2005, January). New markets emerge from society’s needs. OT Practice, 24, 5-6.
Christiansen, C. (2004). AOTA’s centennial vision: A map for the future. OT Practice, 9(17), 10.
Cleveland, P. M. (2008). Presidential address, 2008: Be unreasonable. Knock on the big doors. Knock loudly! American
Journal of Occupational Therapy, 62(6), 737-742.
Corcoran, M. (2007). From the desk of the editor: AJOT and the AOTA Centennial Vision. American Journal of
Occupational Therapy, 61(3), 267-268.
Fisher, G., & Cooksey, J. A. (2002). The occupational therapy workforce. Part two: Impact and action. Administration
& Management Special Interest Section Quarterly, 18(3), 1-3
Fund to Promote Occupational Therapy. (2014). About the Fund to Promote Occupational Therapy. Retrieved from
www.aota.org
Gallup Organization. (2003). Forging connections: A national public awareness survey of occupational therapy’s role
in helping independent-living older adults: Preliminary report. Retrieved from www.aota.org
Glomstad, J. (2003). The Fund to Promote Awareness of Occupational Therapy. Advance for Occupational Therapy
Practitioners, 19(19), 13.
Hasselkus, B. R. (1999). From the desk of the editor: Incentives for change. American Journal of Occupational Therapy,
53(1), 7-8.
Johansson, C. (2000). Meet Joe Isaacs, AOTA’s new captain. OT Practice, 5(16), 7-8.
LaGrossa, J. (2008). AOTA’s model curriculum. Advance for Occupational Therapy Practitioners, 24(18), 22.
LaGrossa, J. (2008). AOTA’s model curriculum: Raising the bar in education to meet 21st century health care needs.
Advance for Occupational Therapy Practitioners, 24(18), 232-235.
Law, M. (2000). Evidence-based practice: What can it mean for me? OT Practice, 5(17), 16-18.
Lenker, J. A. (2000). Certification in assistive technology. OT Practice, 5(16), 12-15.
Lieberman, D., & Sheer, J. (2002). AOTA’s evidence-based literature review project: An overview. American Journal of
Occupational Therapy, 56(3), 344-349.
Lieberman, D., Scheer, J., & Erby, K. (2003). In the clinic: AOTA offers evidence-based reviews. OT Practice, 8(3),
19-21.
Meyer, A. (1922). Philosophy of occupation therapy. Archives of Occupational Therapy, 1(1), 1-10.
Mosey, A. C. (1981). Definition of a model. In Occupational therapy: Configuration of a profession (pp. 49-57). New
York, NY: Raven Press.
Moyers, P. A. (2002). Continuing competence and competency: What you need to know. OT Practice, 7(17), 18-22.
National Board for Certification in Occupational Therapy. (2002a). Five easy steps to renewing your certification as
an OTR or COTA. Report to the Profession, Spring Newsletter, 4-5.
National Board for Certification in Occupational Therapy. (2002b). Frequently asked questions (FAWS) about the
New Guidelines for Certification Renewal. Report to the Profession, Spring Newsletter, 6.
National Board for Certification in Occupational Therapy. (2003). Practice analysis ensures valid examination. Report
to the Profession, Spring Newsletter, 3.
National Board for Certification in Occupational Therapy. (2004). Results from NBCOT practice metrics survey.
Report to the Profession, Fall Newsletter, 1.
Nemko, M. (2007). Career guide 2007: The best job for you. U.S. News & World Report, 142(10), 36-40.
Nemko, M. (2008). Career guide 2008: Best careers. U.S. News & World Report, 144(9), 60-61.
Olson, J. (2005). Call for comment on the ACOTE educational draft standards. OT Practice, 10(3), 23-24.
Peterson, E. W. (2003). Evidence-based practice: Case example: A matter of balance. OT Practice, 8(3), 12-14.
Rourk, J. D. (2001). Foundation’s perspective on the AOTA/AOTF relationship. Bethesda, MD: AOTF.
Rourk, J. D., & Kirkland, M. (2003). Report of the AOTF President to the Representative Assembly. Retrieved from
www.aota.org
Sackett, D. L., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (1997). Evidence-based medicine: How to practice and
teach EBM. London, UK: Churchill Livingstone.
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How
to practice and teach EBM (2nd ed.). London, UK: Churchill Livingstone.
Slater, D. Y., & Willmarth, C. (2006). Understanding and asserting the occupational therapy scope of practice. OT
Practice, 10(10), CE1-CE8.
Slater, E. Y. (2004). Legal and ethical practice: A professional responsibility. OT Practice, 9(16), 13-16.
Somers, F., Smith, K., & Willmarth, C. (2000). Key issues for the 2000 state legislative sessions. Bethesda, MD: AOTA.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva,
Switzerland: Author.
 Looking to the Future: 2000s to 2010s 323

Bibliography
American Occupational Therapy Association. (2002). Glossary: Standards for an accredited education program for
the occupational therapists and occupational therapy assistant. American Journal of Occupational Therapy, 56(6),
667-668.
American Occupational Therapy Association. (2007). 2006 AOTA workforce and compensation survey. AOTA State
Affairs Group News, 9(4), 4-6.
OT Model Curriculum Ad Hoc Committee. (2009). Occupational therapy model curriculum. Bethesda, MD: AOTA.
 On the Road to
11
the Centennial Vision
and Beyond

Key Points
● Licensure achieved in all 50 states and three jurisdictions (DC, Guam, and Puerto Rico)
● Value statement adopted in 2015
● Occupational Therapy Practice Framework, Third Edition (2014)
● Discussion of moving to doctorate-level entry
● Focus on increasing awareness of politicians of occupational therapy role in mental health and
behavioral management
● Communicating to all stakeholders that occupational therapy is a scientific-based profession
with research to support practice approaches
● Defining the role of occupational therapy as an autonomous profession concerned with
health, well-being, and participation.

Highlighted Personalities Key Places

● Florence Clark, AOTA President, 2010-2013 ● The national office remains in Bethesda,
● Virginia Stoffel, AOTA President, 2013-2016 Maryland.
● Amy Lamb, AOTA President, 2016-2019
● Diana Ramsey, AOTF President Key Times/Events
● Scott Campbell, AOTF Executive Director ● Centennial conference in Philadelphia

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 325-358).
- 325 - © 2017 SLACK Incorporated.
326 Chapter 11

Political Events/Issues Sociocultural Events/Issues*

● State licensure achieved in all 50 states in ● Changing health care problems caused by
2014 for therapists and in 2015 for assis- lifestyle factors (obesity, living conditions,
tants violence, stress, health literacy)
● 2010 Patient Protection and Affordable ● Occupational Therapy’s Perspective on
Care Act (ACA; P.L. 111-148) the Use of Environments and Contexts
● 2011 OT Mental Health Act (HR3752) to Facilitate Health, Well-Being, and
introduced at 112th Congress to include Participation in Occupations
occupational therapists as behavioral and ● Societal Statement on Health Literacy
mental health professionals in National ● Role of Occupational Therapy in Disaster
Health Service Corps (NHSC). Not Preparedness, Response, and Recovery: A
adopted. Concept Paper
● Complex Environmental Modifications
Economic Events/Issues ● Promotion of Health and Well-Being
● AOTA published Salary & Workforce ● Nondiscrimination and Inclusion.
Surveys
Practice Issues*
Educational Issues* ● Driving and Community Mobility
● Availability: Options for education such as ● Guidelines for Re-Entry Into the Field of
online courses, home study, downloading Occupational Therapy
● Affordability: Reducing costs and increas- ● Scope of Practice
ing funding through scholarships, grants, ● Standards for Continuing Competence
loans, sponsorships ● Documentation of Occupational Therapy
● Competency-based model curriculum Services
● Continuing education: measuring effec- ● Supervision, Roles, and Responsibilities
tiveness During Delivery of Occupational Therapy
● Interprofessional Education in Services
Occupational Therapy ● Mental Health Promotion, Prevention, and
● Education Standards and Guidelines Intervention
Revised, 2011 ● Role of Occupational Therapy in Wound
● Fieldwork Level II Management
● Philosophy of Occupational Therapy ● Cognition and Cognitive Rehabilitation
Education ● Occupational Therapy Services in Early
● Value of Occupational Therapy Assistant Childhood Education and School-Based
Education Practice
● Role of Occupational Therapy on End-of-
Technological Events/Issues Life Care
● Scope of Occupational Therapy Services
● Telehealth and telerehabilitation are
for Individuals With Autism Across the
viewed as methods to reduce costs and
Life Span
expand services.
● Role of Occupational Therapy in Primary
● Technology and Environmental
Care
Interventions in Occupational Therapy
Practice (AOTA document)

* Adapted from AOTA, 2010c.

 On the Road to the Centennial Vision and Beyond 327

Association Issues Foundation Issues

● Strategies and goals to keep the Association ● Celebrated 50th anniversary in 2015
a strong and viable membership organiza- ● Created the Leaders and Legacies Society
tion but has since become an independent
● Communication formats to keep members group
informed on relevant issues and opportu- ● Continue to increase support for scholar-
nities for leadership and participation ships and research grants
● Developing leaders ● Continue support and development of the
● Revision of the Occupational Therapy Wilma L. West Library
Code of Ethics and enforcement proce-
dures, 2015

National Board for Certification in Occupational Therapy

● Practice analysis of entry-level practice data and trends to keep certification examination
current
● Practice analysis to evaluate state of occupational therapy practice

Occupational therapy’s distinct value is to improve health and quality

of life through facilitating participation and engagement in occupa-
tions, the meaningful, necessary, and familiar activities of everyday
life. Occupational therapy is client-centered, achieves positive out-
comes, and is cost-effective. (AOTA, 2015b)

Occupational therapy maximizes health, well-being, and quality of

life for all people, populations, and communities through effective
solutions that facilitate participation in everyday living. (AOTA
Vision 2025)

Introduction

B
arack Obama was reelected President of the United States for a second term in
2012. The wars in Afghanistan and Iraq ended, but new crises arose in Syria and
throughout the Middle East. Immigration, both legal and illegal, became a hot topic of
discussion. Concern was expressed that immigrants were taking away jobs Americans needed and
were making use of social benefits such as welfare programs designed to help American citizens in
time of need. Mass shootings involving injury or death of four or more persons tended to domi-
nate the news, along with rhetoric about whether gun control would have any effect in reducing
the incidents. Most states responded by permitting more guns and permitting guns to be openly
displayed (open carry). Civil liberties were challenged by states demanding that voters present a
valid (defined as government issued) identification (ID) card with a photograph to prevent per-
ceived voter fraud. Those most likely not to have a photo ID were those who did not drive or have
a passport. The economy, although growing, was not improving everyone’s lives. Manufacturing
jobs requiring minimum skills or education continued to disappear or were replaced by jobs
328 Chapter 11

requiring more advanced skills, such as using a computerized control system to operate machin-
ery. Reflecting back on 100 years provides an opportunity to pose some issues, questions, and
comments regarding the profession that transcend the years.

Criteria for
Recognition as a Profession
Addressing a group of occupational therapists at a workshop on graduate education,
Brandenburg (1963) offered that he felt there were eight characteristics of a discipline that quali-
fied as a profession:
● A body of knowledge
● Education required
● Practical application (to society)
● Standardized qualification and admission to membership in the profession
● Widely recognized organization for the profession
● Ethical and altruistic behavior by its members
● Commonly recognized status
● Emphasis on the need for continuing education
The question is: Has occupational therapy fulfilled the requirements to be recognized as a
profession? The answer appears to be yes, although some characteristics may be demonstrated to
a greater degree than others. Occupational therapy has developed and will continue to develop its
own knowledge base. Models of practice and intervention approaches are published that address
the occupational nature of humans based on best available literature, current trends, values sys-
tems, and research. Research techniques will expand to better facilitate the heterogeneous practice
of occupational therapy as it interacts with humans and their many activities and tasks. Computer
programs, including apps, will facilitate the collecting and sharing of information, whereas safe-
guarding privacy is a challenge to assist data management and analysis.
Education is and has been required for many years. Originally, the national Association pub-
lished its own educational standards and conducted its own accreditation process. Beginning
in 1935, the process of developing standards was shared jointly with the American Medical
Association (AMA), and the first list of jointly accredited programs was published in 1938.
Beginning in 1992, the national Association again took over sole responsibility for setting educa-
tional standards and accrediting educational programs. Educational programs at the professional
and technical level are increasingly available in most, but not all, states. Since 2007, the require-
ment has been at the post-baccalaureate level.
Practical application has been documented for many years, but perhaps the recognition of
the discipline as a reimbursable therapy in the national Medicare program is the most public
acknowledgement of its practical application to society. Qualifications to become a registered
(now certified) practitioner initially required the person to submit proof that the individual had
work experience as an occupational therapist in a hospital or other specialized work setting, or
had graduated from a training school meeting AOTA minimum standards starting in 1932 but
the qualifications were changed in 1947 to require passing a written examination after graduat-
ing from an accredited educational program in occupational therapy. Licensure was obtained in
all 50 states and three other jurisdictions for occupational therapists in 2014 and for occupational
therapy assistants in 2015.
A formal organization has been available to occupational therapy personnel since 1917. The
national Association has functioned continuously since its founding, with only one change
 On the Road to the Centennial Vision and Beyond 329

of name in 1921, from the National Society of the Promotion of Occupational Therapy to the
American Occupational Therapy Association (AOTA). The location of the national office head-
quarters was originally in New York City but has been in the Washington, DC, area since 1973.
Ethical and altruistic behavior was originally integrated in the constitution and bylaws of the
national organization. A separate document formalizing the Code of Ethics was adopted in 1977.
The Code of Ethics and enforcement procedures have been revised and updated in an attempt to
keep the ethical standards for behavior current with changes in social points of view and legal
opinion.
Status may the most problematic characteristic. Although occupational therapy is well rec-
ognized within the rehabilitation field, it may be less recognized in other fields concerned with
health, well-being, and education. More consumers are familiar with the name but may be unable
to give a working definition or description of services. Status in the community continues to be
a work in progress. However, occupational therapy personnel are able to consult and work with a
variety of other professions, including educators, architects, politicians, engineers, computer pro-
grammers, dieticians, physical therapists, speech-language pathologists, psychologists, and others
and are beginning to be recognized as autonomous practitioners in their own right beyond the
concept of medical extenders.
Finally, continuing education and lifelong learning are accepted values within occupa-
tional therapy. Many state licensure laws require continuing education for license renewal. The
Association has offered an annual conference yearly, except during World War II, to present
information through presentations and opportunities to gain skills through workshops and dem-
onstrations. The Association also offers publications and online seminars to help therapists and
assistants gain new knowledge and skills or relearn existing knowledge and skills for those return-
ing to the field after an absence.
This chapter includes both current, past, and future ideas about occupational therapy as a
profession and discipline within society. Looking forward to plan ahead and looking back to see
whether useful knowledge and skills already exist are equally important. Planning ahead allows
strategies to be developed in advance to be implemented in a timely fashion. Using what is already
known and learned saves time and energy to deal with new situations for which current knowledge
and skill may be useful but not sufficient. Resources should always be used wisely to both conserve
and expend at the most appropriate time and situation.

Education
2011 Educational Standards
The Accreditation Council for Occupational Therapy Education (ACOTE) Educational
Standards documents for accreditation were revised for the eleventh time in 2011 for the profes-
sional level (original in 1923 and one revision by AOTA in 1930, seven revisions by AMA/AOTA,
and three revisions by ACOTE). For assistants, the 2011 revision was the ninth since the original
document in 1958 (six by AOTA and three by ACOTE). A major change in the 2011 revision
was the requirement for psychological factors, social factors, and psychosocial factors content
in fieldwork (practicum experience). Section C of the Educational Standards covers fieldwork.
Item C.1.7 states that the educational programs at all levels (assistant, master’s, doctorate) must
“ensure that at least one fieldwork experience (either Level I or Level II) has as its focus psycho-
logical and social factors that influence engagement in occupation” (ACOTE, 2011, p. 34). Item
C.1.12 states that “in all settings, psychosocial factors influencing engagement in occupation must
be understood and integrated for the development of client-centered, meaningful, occupation-
based outcomes” (ACOTE, 2011, p. 35). The requirement is the first since the Essentials of 1965 to
specify field work in a setting that focuses on “psychological and social factors” or psychosocial
330 Chapter 11

factors. Brown (2012a) quotes Neil Harvison, then Director of Accreditation and Academic Affairs
in the national office, as saying that “the basic rationale was that programs were not adequately
addressing psychosocial needs” and that employers were looking for people with psychosocial
skills (p. 13).

Doctoral-Level Single-Entry Education

As the knowledge base expands, the level of education for entry into the profession has
increased. A post-baccalaureate degree for initial entry was accepted in 1999 and implemented
in 2007. Post-baccalaureate can mean either a master’s or a doctoral degree. A doctoral degree at
the initial level of entry may be warranted, especially because other team members have chosen
to select the doctorate as the minimum entry point. In 2014, the Association Board of Directors
issued a position statement on doctoral-level single point of entry for occupational therapists
(AOTA, 2014). The Board members were responding to advisory committee reports recommend-
ing that the Board consider the issue of doctoral-level entry. In addition to aligning educational
requirements with other health care team members, the doctoral degree also supports the need to
more academic faculty and provides the training for research studies need by an autonomous pro-
fession. Although doctoral-level entry may be viewed as increasing cost of service, such increase
should be offset by improved quality of service in education of personnel, practice, and research.
A related question is the status of the assistant. If the entry level for the occupational therapist
is a doctoral degree, should the entry level for the assistant be a baccalaureate degree? These ques-
tions of entry level and the status they may provide continue to be discussed within the profes-
sional community of occupational therapy.
At the same time, educational institutions continue to be challenged to teach more content
in less time. As a result, students will need to take more responsibility for self-learning and peer
teaching away from traditional classrooms. Online and Internet content can facilitate learning
useful material, but the quality must be carefully measured and evaluated because it may be of
poor or questionable accuracy or simply wrong. Faculty need to evaluate content before directing
students to access the sites and/or develop criteria students can use to determine content quality
for themselves. Faculty can also continue to improve online content by adding useful material,
revising existing content, and recommending that poor-quality or inaccurate content be labeled
as such or removed.
Our knowledge base needs to continue to expand. For example, techniques in imaging the
body have continued to improve so that the techniques are less invasive and potentially harmful
while improving the quality of the image. As a result, imaging of fetuses and newborns is rapidly
expanding our knowledge of both fetal development and disorders occurring before birth. This
improved knowledge can help better direct practice to maximize therapy time. For example, if
imaging techniques determine that functional connections in the brain, such as the corticospinal
tract, did not develop and are not working, time spent on attempting remediation can be redirect-
ed to compensatory and adaptive techniques. The result may be better occupational performance
for the individual and less frustration practicing skills that have a low probability of becoming
effective in everyday life.

Practice
Sponsorship of Occupational Therapy
Sponsorship occurs between professions when one profession takes responsibility for sup-
porting and promoting activities of another or allowing its influence and prestige to be used by
 On the Road to the Centennial Vision and Beyond 331

another profession. As stated by Maxwell and Maxwell (1984), who studied the development of
occupational therapy in Canada:
… sponsorship has significance for the study of professionalization. An occupation
may create and sponsor another occupation in the status struggle within a differen-
tiating occupational structure. Such sponsorship will likely have a different effect on
the recipient group that if that group were to struggle on its own under conditions of
“pure” competition. It may also have certain benefits as well as costs for the sponsoring
occupation in the struggle for power. Like professionalization, sponsorship may occur
over historical periods and its temporal dimension should not be overlooked. (p. 331)
Sponsorship also occurs between professional organizations when a larger and more powerful
organization permits a small, less powerful organization to use the resources of the more powerful
organization to the advantage of the smaller one. Advantages may include publicity, recognition,
joint conferences, use of physical faculties, use of expertise and technical skills, use of manpower,
use of equipment and supplies, or any combination thereof.
Over the years, the profession of occupational therapy and its professional organization have
experienced sponsorship with several professions and professional organizations. The various
sponsorships may have occurred in part because of the diverse nature of the knowledge base in
occupational therapy or because of sociocultural events occurring as the health care system devel-
oped in the United States. Sometimes the sponsorship was by mutual agreement, but other times
the sponsorship happened without knowledge or consent. An example of the latter is the early
courses developed and sponsored by nursing in what was called invalid occupation beginning in
1906 (Tracy, n.d.). The sponsorship by nursing was not by agreement or consent of the profession
or professional organization because occupational therapy as a term did not exist until 1914, when
Barton formally used it, and the Association was not formed until 1917. Occupational therapy,
however, owes nurses and the nursing profession a debt of gratitude for developing the early
courses in the application of occupations for therapeutic purposes, although the initial intent was
largely for diversion of chronically ill patients.
On the other hand, the Association is totally responsible for agreeing to have its annual confer-
ence with the American Hospital Association (AHA) for several years during the early history of
the Association. The rationale was to use the AHA conference as an opportunity to increase the
visibility of occupational therapy to hospital administrators through exhibits of what occupational
therapy could do and to encourage them to support the development of an occupational therapy
service program in their hospitals and institutions. Although no record exists of how successful
the joint venture was in increasing the number of occupational therapy service programs, the
increased visibility appears to have been a good idea. The relationship with the AHA continued in
the 1950s and 1960s with the joint development of 10 institutes for occupational therapists between
1954 and 1965.
Another example with more substantial results was the decision by the early leaders to require
a medical prescription or referral by a physician to initiate services. The idea of a prescription was
likely influenced by Dr. Dunton, but it was clearly evident in the definition of occupational therapy
used by Dr. Pattison: “any activity, mental or physical, definitely prescribed….” (Pattison, 1922).
The medical prescription bound occupational therapy to the medical profession until 1969, when
the Statement on Referral (AOTA, 1969) allowed some referrals to be made by other professionals,
especially when medical diagnoses or conditions were not the primary problem, such as education-
al problems or physical access in the home and safety in the workplace were the identified prob-
lems. Using the physician and practice of medicine as a sponsor gave occupational therapy an aura
of scientific respectability that giving handicrafts to patients did not on the surface appear to have.
The professional organization further promoted sponsorship by the medical community
when, in 1931, members of the Board of Management agreed with Kidner’s suggestion to contact
the American Medical Association (AMA) to request assistance in inspecting and accrediting
332 Chapter 11

educational programs. From 1935 to 1992, AOTA and the AMA jointly developed seven editions of
the document entitled “Essentials of,” followed by various wording related to occupational therapy
or occupational therapists. Together, teams from the two organizations inspected and approved all
occupational therapy educational programs. The support of the AMA increased the recognition
and credibility of occupational therapy as a profession in a manner clearly visible for all to see.
Again, in contrast, the attempt by physical medicine in the late 1940s to sponsor occupational
therapy by becoming directors of the education programs and service programs was not welcomed
by the profession or professional organization. The idea that a physical medicine specialist would
be in charge of the educational program and that all occupational therapy service programs would
be administered under a physical medicine director was not acceptable to the profession. The idea
that physical medicine physicians should direct both physical therapy and occupational therapy
was outlined in Molander’s (1931) article. Prior to his article, many occupational therapy service
programs had functioned independently, often with the help of the Junior League and nurses
serving as sources of referral to identify patients who could benefit from occupational therapy
services. Physical medicine physicians, later physiatrists, went so far as to claim that occupational
therapy was a form of physical medicine or that occupational therapy was a special type of physical
therapy. Krusen (1934) stated that “the Council’s definition of physical therapy is sufficiently broad
so that it might include practically all occupational therapy” (p. 69). He was citing the Council
on Physical Therapy definition that physical therapy is the treatment of disease by means of the
“physical, chemical, and other properties of heat, light, water, electricity, massage, and exercise”
(AMA, 1932).
Sponsorship can also result in a mixed outcome that includes both positive and negative results.
Such is the case with allied health as an organizing strategy in institutions of higher education.
The term allied health is an organizational concept formally adopted in 1966 with the passage of
the Allied Health Professions Act (Maze, 1968) that included allied medical professions, associ-
ated health professions, allied health professions, and allied health sciences. All were designed to
reorganize traditional academic structure to gather together paramedical disciplines that served
the medical community and either required college-level course work or were being redesigned
to move toward college-level education. Examples in addition to occupational therapy include
medical technology, dieticians, radiological technology, cytotechnology, inhalation or respiratory
therapy, hospital or health care administration, and physical therapy. The purpose of the reorga-
nization was threefold: the lessening of course duplication, the implementation of an operational
health team format, and the development of autonomous schools of allied health professions that
could stand on par with schools of medicine, nursing, and dentistry (Meredith, 1971).
In the past, schools of occupational therapy had been integrated into the college and university
system in a variety of departments. Some occupational therapy programs were a part of schools
of art, home economics, education, nursing, or medicine. On the surface, location in a school of
allied health seemed attractive because the occupational therapy program would be grouped with
other similar health-focused programs as opposed to art, home economics, or education. The
allied health unit would be on par with other units (departments, schools, or colleges) within the
higher educational institution (college or university). The potential downside was the curriculum
reorganization, which attempted to reduce perceived duplication of basic science courses such as
anatomy, physiology, and other core courses. Content in the core courses may or may not address
the need for knowledge in occupational therapy education. Loss of control over curriculum con-
tent is a major drawback to participation in an allied health school.
The relationship with allied health is unusual in terms of sponsorship. Usually the sponsoring
group is older, more established, and more powerful than the group being sponsored. Such was not
the case with allied health. The first use of the concept occurred in 1950, when the University of
Pennsylvania established its School of Allied Medical Professions (Maze, 1968). The passage of the
Allied Health Professions Act provided funds for rapid expansion of college- and university-based
education for allied medical fields. However, occupational therapy was already well established as
 On the Road to the Centennial Vision and Beyond 333

a profession and had been educating therapists in colleges and universities since 1949, so from a
historical standpoint, it was the more established group. However, in the higher education system,
it did not have a unique identity and thus could be reorganized by more a powerful but younger
group with federal funds useful to both the allied health group and the occupational therapy edu-
cation program.
The professional Association began to decrease the emphasis on medicine and medical subjects
in the late 1950s and 1960s. The Board of Management discontinued inviting physicians to serve
as Fellows on the Board in 1959. The minutes state the Association had outgrown the need for this
kind of professional status (AOTA, 1959). Physicians had served on the Board as Fellows beginning
in 1946. However, the Association severed ties completely. Instead, a Medical Advisory Committee
was formed in 1954 and continued to meet and exist until at least 1968 (AOTA, 1968).
The 1965 Essentials of an Accredited Education Program for the Occupational Therapist
does not list fieldwork assignments by diagnostic categories such as orthopedics or tuberculosis
but instead use the general terms suggested by the recommendations from the Basic Approach
Study: psychosocial dysfunction and physical dysfunction (AOTA, 1965). The Essentials do not
specify medical lectures on certain diagnoses. In 1963, the new editor of the American Journal of
Occupational Therapy (AJOT) dispensed with the Advisory Committee to the journal, which had
been composed primarily of physicians representing areas of practice such as psychiatry, physical
medicine, pediatrics, tuberculosis, and general medicine. These areas presented the categories of
hospital affiliations under the Essentials adopted in 1949 (AMA, 1949; AOTA, 1950). Instead, the
new editor invited occupational therapists to service as division editors and reviewers without any
medical advisory oversight. The 1969 Statement on Referral does not require a prescription for
all referrals to occupational therapy services, recognizing that occupational therapy may provide
services in areas outside the purview of medical practice (AOTA, 1969).
In 1974, when the Delegate Assembly adopted the position to promote licensure, the Association
formally began the process of declaring occupational therapy to be an independent profession
(Johnson, 1975). If the profession wanted to be a subspecialty of medicine, it would have aligned
with the state medical practice acts that cover medical specialties. However, occupational therapy
personnel are educated as physicians, so they did not meet the qualifications. In addition, increas-
ing numbers of practitioners were working in areas that did not require medical management, such
as public schools, home medication, low vision, or health and wellness businesses. The time had
come to make the break from medical sponsorship.
In summary, sponsorship is a double-edged sword, and the benefits must be measured against
the drawbacks. Sponsorship always compromises the attainment of professional autonomy but
may help build the framework or infrastructure that ultimately facilitates such attainment.
Control over the standards for educational preparation (accreditation) and credentialing process
(registration, certification, or licensure) at the initial and continuing levels are key elements in
attaining professional autonomy. In addition, the profession must convince society that its services
are of value, worthy of financial payment, and needed by citizens for some identified purpose or
purposes. Occupational therapy has met the challenges over the years. Sponsorship, both solicited
and unsolicited, has been part of the process.

Definition of Occupational Therapy

Occupational therapy has roots and shoots from many fields, but major influences come from
social service (helping others), education (teaching and training), and maintenance of good health
(wellness). Dr. Licht (1952) stated that “occupational therapy was originally supervised by crafts-
men, then educators, still later by nurses, and now by occupational therapists” (p. 448). During the
formative years, occupational therapy was reported to be a branch of social service (Hall, 1923). At
the same time, an Association document stated that “treatment should be prescribed and admin-
istered under constant medical advice and supervision,” suggesting that occupational therapy was
334 Chapter 11

considered a subspecialty or adjunct within the medical field (AOTA, 1923). Dunton (1928) may
have been supporting the subspecialty status when he stated that “occupational therapy … is an
adjunct to other forms of treatment, supplementing them and increasing their value, so that from
the combined treatment the duration of care is decreased or a better end result obtained” (p. 5). At
the same time, he stated that “occupational therapy depends upon other branches, and especially
upon psychology, for its own advancement” (p. 5).
On the other hand, Robinson (1919) supported the social science aspects, stating that:
…occupational therapy must take into consideration social as well as physical prob-
lems, and must have constantly as its aim the teaching of persons to fit better into their
usual environment, as well as assisting them to return to their usual surroundings ….
Occupational therapy should, therefore, be an adjunct to those forces of the hospital
dealing with the social betterment as well as the physical betterment of the patient
…. It is generally recognized that an important function of occupational therapy is to
influence the mind as well as the body of those needing hospital care. (p. 524)
Rehfuss, Albrecht, and Price (1948) stated that:
…until modern psychology advances to the point where the physical and mental
effects of emotions upon the individual can be accurately determine, occupational
therapy must likewise lag as a science since it is believed that the creation of a pleasant
mental attitude or emotion and the stimulation of interest are the bases for the success-
ful employment of occupational therapy. (p. 766)
The profession of occupational therapy continues to develop as an autonomous profession
focused on promoting life to the fullest and participation in all aspects of living. Sponsorship by
medicine is no longer needed and tends to limit the scope of practice in a profession designed to
maximize the use of occupation by, and the occupational performance of, persons in educational
pursuits, living arrangements, vocational choices, qualify of life satisfaction, participation in activ-
ities of daily living, positive interpersonal relations, social inclusion, cultural diversity, community
interaction, lifestyle decision making, and political involvement.
As the model definition for legislature and value statement imply, professionals with occupa-
tional therapy view the profession as a discipline separate from the medical profession that focuses
on the use of occupation by humans to effect quality of life and participation. The study of occu-
pation is part of the social science. However, aspects of occupational dysfunction will always have
a relationship to body structure (anatomy) and function (physiology). Occupational therapy is a
hybrid discipline, using knowledge from social, biological, and physical sciences.
Occupational therapy seems to best fit as a life and living science based on achieving occupa-
tional performance that has goal direction, meaning, and purpose to individuals, organizations,
and communities and focuses on the structure and organization in time and space. Influencing
factors include age, sex, health or disability status, socioeconomic status, cultural customs, family
history and expectations, and past and present personal decision making. Many of these factors
are beyond the scope of medicine and the influence of drugs and surgery. Sponsorship made sense
when the profession was small and had few models of practice articulating its unique perspective
of occupation as a life force capable of helping people develop habits and routines in their everyday
life activities. In the past 100 years, occupational therapy has developed its own literature base and
created its own body of research. Use of resources in medicine is no longer needed as a support tool.
The process of delivering therapy continues to need improvement and revision. Currently, the
therapy process requires extensive clinical reasoning, which may be based largely on experience
rather than on logical progression from assessment to planning to implementation to reevalua-
tion. Too many assessments do not link to planning, implementation, and reevaluation. Too many
practice models do not have identified assessment instruments. The Model of Human Occupation
(MOHO) is an exception and is an example of what can be done in the occupational therapy
 On the Road to the Centennial Vision and Beyond 335

Table 11-1
OCCUPATIONAL THERAPY DEFINITIONS
2011 The practice of occupational therapy means the therapeutic use of occupations, including everyday
life activities, with individuals, groups, populations, or organizations to support participation, perfor-
mance, and function in roles and situations in home, school, workplace, community, and other set-
tings. Occupational therapy services are provided for habilitation, rehabilitation, and the promotion
of health and wellness to those who have or are at risk for developing an illness, injury, disease, dis-
orders, condition, impairment, disability, activity limitation, or participation restriction. Occupational
therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of
performance in a variety of contexts and environments, to support engagement in occupations that
affect physical and mental health, well-being, and quality of life (RA 4/14/11 [Agenda A13 Charge 18]
Policy 5.3.1.)
2013 Occupational therapy is a health, wellness, and rehabilitation profession that helps individuals maxi-
mize their performance and functioning throughout the lifespan (US, DHHS, Health Resources and
Services Administration)
2015 Occupational therapy (OT) is a profession that seeks to help individuals to achieve their optimal level
of independence and ultimately find satisfaction and meaning in their lives. The role of OT in health
care enables people to live fuller lives by preventing or learning how to live with illness, injury, or
disability. Through skilled activity analysis and purposeful activity, occupational therapists help indi-
viduals to achieve independence in performing activities of daily living, work, and leisure/play. (Lin,
Zhang & Dixon, PM&R, 7, 945.)

Table 11-2
EXAMPLES OF OCCUPATION OVER THE LIFESPAN
● The occupation of infants is learning basic functions such as eating and responding to the environment
around them
● The occupation of young children is mastering their developing bodies and performing the skills need-
ed for learning
● The occupation of adolescents is learning social interaction behaviors and exploring career opportunities
● The occupation of young adults is developing a career and establishing a healthy and satisfying lifestyle
of their own
● The occupation of adults is maintaining employment, fulfilling family responsibilities, and engaging in
community activities
● The occupation of older adults is to maintain a healthy lifestyle in retirement and engage in satisfying
activities
Adapted from the AOTA Calendar The World of Occupational Therapy 1990.

knowledge base. Linking assessment to planning, implementation, and reevaluation also facilitates
research and, more importantly, the application of research back to improving practice. Presently,
research studies often use a variety of assessment instruments in the methodology section and
different intervention techniques to study the same or similar disorders. Different assessment
instruments tend to measure different concepts and problems. Intervention techniques focus on
different problems when the research studies are compared. More confusion than clarity may
result within occupational therapy practice, making clear communication to other professionals
nearly impossible. Examples of current definitions are presented in Table 11-1, and examples of
occupation across the lifespan are listed in Table 11-2.
336 Chapter 11

Challenges to Practice
Helping to make communities more livable can be a goal of future practitioners. Working with
architects, engineers, and community planners, occupational therapists can evaluate how, when,
and where occupations are best performed to provide maximum effectiveness and efficiency, giv-
ing meaning and purpose to individuals, organizations, and community members.
Occupational therapy personnel have an opportunity to be product evaluators, especially in the
areas of safety and ease of use. Many products are recalled every year because of deficits and safety
flaws not detected during prototype tryout. Basic safety in product use and potential problems of
wear and tear could be observed by occupational therapy personnel, saving manufacturers money
and loss of reputation. Better design and usability could increase revenue and improve manufac-
turers’ reputations.
Occupational therapy personnel can increase their skills in working with people who have mul-
tisystem disorders. Multisystem disorders are often difficult to treat effectively because treatment
of one system, such as the nervous system, may result in decreased effectiveness of another, such as
the cognitive system. Examples of multisystem disorders are stroke, cancer, traumatic brain injury,
and polytrauma from vehicle crashes or explosive devices. Finding ways to create a balancing act of
effective treatment for one system while not seriously decreasing the effectiveness of another is the
kind of challenge occupational therapy personnel can meet. Changes in the way occupations are
performed and/or changes in the environmental demands may allow more aggressive treatment
of one system, such as the nervous system, while supporting another system, such as the cognitive
system, until the nervous system is better able to function with less therapy or adjustment to the
therapy has been achieved.

Legislation and Policy Making

Table 11-3 summarizes important legislation enacted from 2010 to 2015. The profession must
continue its advocacy for legislation and policies that promote the profession and the consumers
it services. Occupational therapy must be included in legislation that increases participation and
inclusion of all individuals, organizations, and communities. Occupational therapy must be active
in promoting and protecting civil rights. Occupational therapy personnel need to be included as
qualified providers in all legislation and policy making that affects the ability of practitioners to
provide services.

Table 11-3
LEGISLATION
2010 Patient Protection and Affordable Care Act (ACA) (P.L.111-148) was enacted which reforms health
care. All citizens are required to have or to purchase health insurance. Regulations for health insur-
ance companies require increase consumer protection against loss of insurance eligibility due to
pre-existing conditions or certain conditions previously considered uninsurable. To increase finan-
cial support for consumers, the ACA provide scholarships and loan repayments through National
Health Service Corps (NHSC). Occupational therapy is classified within the rehabilitation habilitation
required- benefit categories to cover services for a wide range of conditions (Brown, 2012)
2015 Every Student Succeeds Act (ESSA) (P.L. 114-95). Revises No Child Left Behind Act of 2001 . Preserves
federal mandate for standardized testing but eliminates punitive consequences for states and dis-
tricts that perform poorly.
2015 Medicare Access and CHIP Reauthorization Act (MACRA) (P.L. 114-10). Repeals the sustainable growth
rate formula designed to control the rate of increase for physician services. Requires a review of doc-
umentation for outpatient occupational therapy services that exceed a threshold amount of $3,700
in 2016 (Snadhu, 2015)
 On the Road to the Centennial Vision and Beyond 337

Educational programs should be available in all 50 states at both the professional and technical
levels in public and private institutions. Particular attention should be paid to the distribution of
practitioners per 100,000 population. Shortages of practitioners continue to exist in certain areas
of the country, whereas surpluses may exist in other areas. Research has shown that occupational
therapy assistants tend to not be as mobile as occupational therapists. Therefore, availability of
local education programs becomes more important. However, even at the professional level, the
existence of an educational program increases the opportunity for awareness and education of the
public sector about occupational therapy. The value of the physical location of the occupational
therapy education program continues to be a significant factor in providing a supply of educated
practitioners while also providing a physical presence of the profession in the sociocultural fabric
of society and the health care system.

Research
The Research Advisory Panel (RAP) is a joint group formed by AOTA and the American
Occupational Therapy Foundation (AOTF) to advise and inform on issues related to research
(Rogers, 2010). A document titled the Occupational Therapy Research Agenda was created with an
outline of activities considered relevant research topics for the profession. Five broad categories of
research are listed: assessment/measurement, intervention, basic research, translational research,

Figure 11-1. Occupational therapy research agenda. (Printed with permission from the Archive of the American
Occupational Therapy Association, Inc.)
338 Chapter 11

and health services research. The panel selected three of the five as most import to the Centennial
Vision: intervention research, translational research, and health services research. Goals and pri-
orities for each area of research are presented in Figure 11-1.

Association
State
State associations need to be strengthened so they can support members’ needs for up-to-date
information and can lobby on behalf of members and consumers for legislation to keep the occu-
pational therapy practice act up-to-date and services to consumers in line with needs for services
to which occupational therapy can contribute. In addition, state associations need to identify issues
that should be referred to the national organization for action at the national level. The national
association can address issues that are common to many states such as threats to scope of practice
and lobbying for federal legislation.

National
Presidents, Executive Director, Board of Directors, and Representative
Assembly
Three people have assumed the role of President of AOTA since 2010: Florence A. Clark, 2010-
2013 (Figure 11-2); Virginia C. Stoffel, 2013-2016 (Figure 11-3); and Amy Lamb, 2015-2019 (Figure
11-4). Biographical sketches appear in Table 11-4. Frederick Somers continues to serve as Executive
Director. The Association’s Board of Directors set the Strategic Goals and Objectives for 2014
through 2017 (Table 11-5). The Centennial Vision Priorities for Fiscal Year 2015 are listed in Table
11-6. The Representative Assembly adopted the documents listed in Table 11-7. A major focus of the
Association’s activity has been on driving, especially older drivers, as the cover of a 2011 issue of OT

Figure 11-2. Florence A. Clark, PhD, Figure 11-3. Virginia Stoffel, PhD, Figure 11-4. Amy Lamb, OTD,
OTR/L, FAOTA, President of AOTA, 2010- OT, BCMH, FAOTA, President of OTR/L, FAOTA, President of AOTA,
2013. (Printed with permission from the AOTA, 2013-2016. (Printed with 2016-2019. (Printed with per-
Archive of the American Occupational permission from the Archive of the mission from the Archive of the
Therapy Association, Inc.) American Occupational Therapy American Occupational Therapy
Association, Inc.) Association, Inc.)
 On the Road to the Centennial Vision and Beyond 339

Table 11-4
BIOGRAPHICAL SKETCHES
FLORENCE ARCURI CLARK
Born September 8, 1946
Born in Brooklyn, New York. She received her Bachelor of Arts in English (major) and speech drama (minor
from the State university of New York at Albany in 1968, her master of science in occupational therapy form
the State university of New York at Buffalo in 1970 ad her Ph.D. in education with a dual major in educational
psychology and special education from the University of Southern California in 1982. She was an instructor in
occupational therapy at Suffolk State School in Melville, NY, from 1966-67, and a Trainee in occupational Therapy
for the New York State Department of Mental Hygiene in Albany, NY, from 1968-70. She was the Coordinator
of Rehabilitation and Education, Adolescent Unit, Buffalo State Hospital from 1970-72 From 1970-1973 she held
positions as adjunction and clinical instructor in occupational therapy at the State University of New York at
Buffalo and Elizabethtown College. From 1973-1976 she was Director of Occupational Therapy at Pennhurst
State School and Hospital in Spring City, PA, and held an adjunct assistant professorship with the Department
of occupational Therapy at Temple University. From 1976-1984 she was a faculty member at the Center for
the Study of Sensory Integrative Dysfunction. She joined the faculty at the university of southern California in
1976, became professor and chair in 1989 and Associate Dean and professor of the Division of Occupational
Science Occupational Therapy at the Ostrow School of Dentistry in 2006 . She was president from 2010-13. She
received the Award of Merit in 1999, gave the Eleanor Clarke Slagle lectureship in 1993 and was named to roster
of Fellows in 1981. She is also a charter member of the American Occupational Therapy Foundation Academy
of Research She has authored and co-authored articles, chapters, and books.
VIRGINIA (GINNY) CARROLL STOFFEL
Born March 19, 1955
Born in Wisconsin. She has a bachelor s degree in occupational therapy from the College of St. Catherine in
1977, a master s of science in educational psychology from the University of Wisconsin-Milwaukee in 1983
and a doctorate in leadership for the advancement of learning and service from Cardinal Stritch University in
2007. She is board certified in mental health through the advanced certification program of the Association.
She is chair and associate profession at the University of Wisconsin-Milwaukee, College of Health Sciences,
Department of Occupational Therapy. Her research interests is on the strengths and needs of people with
serious mental illness living in the community, the occupational nature of people with substance use disor-
ders, and evidence based practice regarding behavior change. With Catana Brown, PhD, OTR, FAOTA, she has
published the text book titled Occupational Therapy in Mental Health: A Vision for Participation, Philadelphia,
F.A. Davis. She was named to Roster of Fellows in 1993.
AMY LAMB
Born December 16, 1975
She received her B.S. and OTD from Creighton University. She was chair of the Political Action Committee and
Vice President before becoming President. She received the Lindy Boggs Advocacy Award in 2011 and was
named to Roster of Fellows in 2012. She has worked as an occupational therapist at St. Joseph s Medical Center
in Omaha, Nebraska from 1998-2000, Fairview Medical Center in St. Paul, Minnesota, in 2000, Monroe-Meyer
Institute in Omaha from 2003-2005 and Brookdale Senior Living Center in Denver, Colorado from 2009-2010. She
has been a faculty member at the College of Saint Mary s in Omaha, from 2001-2004, Creighton University form
2004-2005 and at Eastern Michigan University in Ann Arbor, Michigan from 2010 to the present. She is also the
owner of AJLamb Consulting firm which she founded in 2000. In 2006 she was named Educator of the Year at
Creighton University. Her areas of specialty are health policy and advocacy, management and leadership, and
assessment and intervention with adults and older adults. She has published articles and chapters in textbooks.
She is married and has two children.

Practice shows (Figure 11-5). Another focus has been on the military and wounded warriors. The
2014 annual conference opened with a program featuring three wounded warriors (Figure 11-6).

Leadership
Leadership continues to be a crucial need in the profession. The profession has multiple needs
for leaders. Learning leadership skills is as important as learning practice skills. The format
continues to be the same: leadership skills involve mentoring. Mentoring is most effective at the
340 Chapter 11

Table 11-5
AOTA STRATEGIC GOALS AND OBJECTIVES 2014-2017
● Building the profession s capacity to fulfill its potential and mission
● Demonstrating and articulating our value to individuals, organizations, and communities
● Linking education, research, and practice
● Creating an inclusive community of members
● Securing the financial resources to invest in the profession s ability to respond to social needs
AOTA Board of Directors, Dated 3/1/2013

Table 11-6
CENTENNIAL VISION PRIORITIES FOR FISCAL YEAR 2015
● Boldly navigating a changing world
● Enhance AOTAs role as an essential resource to the occupational therapy community in a changing world
● Enhance the effectiveness of communications to members to help them message appropriately within
their settings and in their decision makers
● Engage in broad-based advocacy to ensure funding for occupational therapy in traditional and emerg-
ing areas
● Identify and articulate occupational therapy s distinct value to individuals, organizations and communities
● Promote occupational therapy s role in service delivery system redesign to assure fair payment and provi-
sion of quality care with particular emphasis on primary care, prevention and expansion of mental health
● Provide strategic support for educators, practitioners, and researchers to meet rapidly changing social
needs
● Explore relationships with other global national and regional occupational therapy associations with
similar levels of education/practice
● Foster member cultural competence to meet changing demographics an societal needs
● Define and promote quality occupational therapy
● Collaborate with AOTF in support of research activities that build the occupational therapy knowledge
base and support quality practice
● Promote member awareness of AOTA PERFORM & National Outcomes Database
● Promote evidence-based practice
Retrieved 8/21/2014 from www.aota.org/AboutAOTA/Get-InvolvedBOD/News/2014/FY14-CV-Iriorities.aspx

one-on-one level in which the mentor helps the mentee develop both skills and confidence to take
on more difficult tasks in the practice arena and professional associations.

Public Relations
Occupational therapy must articulate the unique value of occupational therapy services to
consumers in methods that reach target audiences. For many years, occupational therapy has
been associated with medical disciples and medical rehabilitation services. The value of occupa-
tional therapy is not limited to serving those consumers with an identified medically diagnosed
condition. Occupational therapy provides services to those who want to prevent or diminish the
impact of changes in ability and skills due to aging or change the focus of their occupations in
careers or from career to retirement. Occupational therapy in school systems promotes educa-
tional goals, not medical rehabilitation. The focus is on organizing the learning environment to
enhance the student’s learning potential, not on remediating dysfunction. Occupational therapy
 On the Road to the Centennial Vision and Beyond 341

Table 11-7
ASSOCIATION DOCUMENTS ADOPTED BY THE REPRESENTATIVE ASSEMBLY
2010 ● Driving and Community Mobility
● Enforcement Procedures for the Occupational Therapy Code of Ethics and Ethics Standards
● Occupational Therapy Code of Ethics and Ethics Standards
● Guidelines for Re-entry into the Field of Occupational Therapy
● Occupational Therapy Services in the Promotion of Psychological and Social Aspects of
Mental Health
● The Scope of Occupational Therapy Services for Individuals with an Autism Spectrum Disorder
Across the Life Course
● Specialized Knowledge and Skills in Mental Health Promotion, Prevention, and Intervention in
Occupational Therapy Practice
● Specialized Knowledge and Skills in Technology and Environmental Interventions for
Occupational Therapy Practice
● Standards for Continuing Competence
● Standards of Practice for Occupational Therapy
● Telerehabilitation
2011 ● Accreditation Council for Occupational Therapy Education Standards
● AOTAs Societal Statement on Health Literacy
● Complementary and Alternative Medicine
● Occupational Therapy Services for Individuals who have Experienced Domestic Violence
● Occupational Therapy Services in Early Childhood and School-based Settings
● Occupational Therapy Services in Facilitating Work Performance
● Philosophical Base of Occupational Therapy
● The Role of Occupational Therapy in Disaster Preparedness, Response and Recovery: A Concept
Paper
● The Role of Occupational Therapy in End-of-Life Care (replaces document on hospice)
2012 ● Fieldwork Level II and Occupational Therapy Students: Position Paper
● Physical Agent Modalities replaces previous papers
2013 ● AOTA Societal Statement on Health Disparities
● Cognition, Cognitive Rehabilitation and Occupational Performance
● Guidelines for Documentation of Occupational Therapy
● Obesity an Occupational Therapy
● Occupational Therapy in the Promotion of Health and Well-being
● The Role of Occupational Therapy in Wound Management
● Telehealth
2014 ● Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational
Therapy Services (edited)
● Occupational Therapy Practice Frame: Domain and Process, 3rd edition
● Occupational Therapy s Commitment to Nondiscrimination and Inclusion (edited)
● The Philosophical Base of Occupational Therapy Education
● Scope of Practice
● The Role of Occupational Therapy in Primary Care: Position Paper
2015 ● Complex Environmental Modifications: Position Paper
● Occupational Therapy for Children and Youth Using Sensory Integration Theory and Methods
in School-based Practice
● Occupational Therapy s Perspective on the Use of Environments and Contexts to Facilitate
Health, Well-Being an Participation in Occupations
November-December issues of the American Journal of Occupational Therapy for each year.
342 Chapter 11

in home modification promotes adapting space

and technology to facilitate the occupations peo-
ple want and/or need to perform in their daily
lives. Creative use of available media is needed
to promote the variety of occupational therapy
services that occupational therapists and assis-
tants can provide. Occupational therapy services
should be available to all citizens and custom-
ers regardless of whether they live in rural or
urban environments. As technology improves,
telehealth and telemedicine communication sys-
tems (i.e., tele-occupational therapy) may provide
answers to providing services to populations
where geographic distances limit access.
Occupational therapists and assistants need
to continue image building as a life science that
helps people better organize their occupations to
Figure 11-5. Driving project. (Printed with permis- increase enjoyment, management, performance,
sion from the Archive of the American Occupational and quality of life throughout the lifespan.
Therapy Association, Inc.) Occupational therapy has a unique perspective,
which is the ability to examine occupational
performance from a variety of perspectives in
time and space while taking into account personal likes and dislikes for doing occupations that
must be done (obligatory) as well as those that are pleasurable but not required to maintain health
and well-being but may enhance quality of life. The multidimensional perspective gives occupa-
tional therapy personnel an opportunity to help consumers make adjustments and adaptations
in the performance of occupations
that might not otherwise occur to the
person, organization, population, or
community.

Information Resources
The profession needs a worldwide
accessible database that includes
abstracts and access to all occupa-
tional therapy journals in all languag-
es, as well as all textbooks, teach-
ing manuals, and annual reports of Figure 11-6. Wounded warriors at the 2014 AOTA annual confer-
occupational therapy organizations. ence opening ceremony. (Printed with permission from the Archive
Occupational therapy information of the American Occupational Therapy Association, Inc.)
and literature need to be stored to
maximize distribution of knowledge
and promote resources for research activities to improve practice and promote the profession. A
site that translates articles into several languages would further augment sharing of information
and data.

Organizational Structure
The control of the professional Association has changed over the years. Some functions that the
Association spent personal and financial capital to develop are no longer within the Association’s
domain of control, such as accreditation of educational programs and credentialing of personnel.
 On the Road to the Centennial Vision and Beyond 343

Both are now conducted independently of the professional organization. Continuing credentials
or recertification is now primarily the responsibility of the state licensure boards. Even though the
Association’s financial management is now controlled largely by the requirements for incorpora-
tion under the District of Columbia code, members must maintain an active role in exercising their
rights to determine how the money is spent. Whereas Association members used to determine the
structure and organization of the Association, now the wishes of members are largely overshadowed
by governmental controls. Those controls are designed to keep organizations financially viable and
free of graft and corruption, but the same controls decrease the ability of members to determine
how to run the organization. Power to control the organization rests with a small number of elected
officers. Other members can advise but cannot override the elected officers and cannot change the
organization structure without violating the incorporation requirements specified in the District
of Columbia code. Membership in the professional organization may be voluntary, but the orga-
nization structure of the professional organization is not determined by the voluntary members.
Instead, the membership is once again given only an advisory role through their state representa-
tive; the same role they once had under the old House of Delegates which functioned in the 1940s
and 1950s before the 1964 bylaws gave the Delegate Assembly responsibility for policy making. The
real power is held by the elected members of the Board of Directors.

Occupational Therapy Practice Framework, Third Edition

The Third Edition of the OTPF incorporates addition changes in the content, although the basic
format of the document remains the same. Most of the changes were editorial or moving content
from one section to another to better explain the purpose and clarify the process. Changes include
removing the category “Therapeutic Use of Self” as an intervention technique because it is consid-
ered to be a general process. The category “Consultation Process” was removed as an intervention
and is now described as a method of intervention in the process. The subtitle “Therapeutic Use
of Occupations and Activities” was changed to “Occupations and Activities” because therapeu-
tic use is supposedly implied. Feedback had suggested there was confusion regarding the use of
interventions as hierarchical between occupation-based interventions and purposeful activities.
“Preparatory Methods and Tasks” became a subcategory apart from “Occupations and Activities.”
Preparatory methods are not activities, so they are no longer grouped in the category considered
with activities. Preparatory tasks are considered to be engagements (e.g., cones, clothespins) that
are not a part of occupation but do address underlying client factors. The term task is used to dis-
tinguish these engagements from activities and occupations. The “Advocacy” section was expand-
ed to include subsection “Self-Advocacy.” Advocacy is seen as the manner or intervention that
begins the process through which change occurs, as opposed to being the method. A “Preparatory
Methods” subcategory was “Assistive Technology and Wheeled Mobility.” “Education Process”
was changed to “Education Training” with two subheadings: “Education” and “Training.”

Foundation
In 2014, the Annual Report stated that the
Mission Statement was revised to read, “The mis-
sion of AOTF is to advance the science of occupa-
tional therapy to support people’s full participa-
tion in meaningful life activities” (AOTF, 2014,
p. 12). The Vision Statement reads, “We envision
a vibrant science that builds knowledge to support
Figure 11-7. AOTF 50th anniversary symbol celebrat-
effective evidence-based occupational therapy” ing the Foundation. (Printed with permission from
(AOTF, 2014, p. 12). A new group called the AOTF the Archive of the American Occupational Therapy
Leaders & Legacies Society was started to honor Association, Inc.)
344 Chapter 11

Figure 11-8. Scott Campbell, PhD, Chief Figure 11-9. Diana L. Ramsay, Chair,
Executive Officer, AOTF. (Printed with per- Board of Directors of the AOTF, 2010-2015.
mission from the Archive of the American (Printed with permission from the Archive
Occupational Therapy Association, Inc.) of the American Occupational Therapy
Association, Inc.)

occupational therapy professionals “who have demonstrate their leadership abilities and skills
through service in a variety of civic and professional organizations” (AOTF, 2014, p. 9). In 2016,
the Foundation celebrated its 50th year with a new logo (Figure 11-7). Scott Campbell (Figure 11-8)
became the new Chief Executive Officer of the AOTF. Diana Ramsey (Figure 11-9) was Chair of
the Board of Directors from 2000 to 2005. One of the fundraising activities was a “dancing with
the stars” contest featuring couples who were leaders in the Association. Figure 11-10 shows the
logo used for the contest. The Wilma L. West Library (Figure 11-11) has responded to requests for
over 3,370 books; 36,476 journal and newspaper articles; 1,172 doctoral dissertations and master’s
theses; 1,000 audiovisual resources, including photos and videos; and 1,096 proceedings and other
resources. The Annual Report also states that the Foundation had awarded 1,450 scholarships over
the years, amounting to $1,316,646. The year 2015 was a pivotal year for the Foundation. Its second
Executive Director, Charles H. Christiansen, retired, and its third Director, Scott Campbell, was
hired (Figure 11-12).

Looking Back and

Looking Forward
The Janus approach is one of looking forward and back-
ward at the same time—how we did it and what is next.

The Vision
How Has the Vision Barton Had When He
Created the Term Occupational Therapy
Figure 11-10. AOTF Event: “Dancing With
Changed Over the Years? the Stars” contest logo. (Printed with per-
mission from the Archive of the American
Barton stated in 1914, “If there is an occupational dis- Occupational Therapy Association, Inc.)
ease, why not an occupational therapy?” (Barton, 1914).
Barton further suggested that he believed that occupational
 On the Road to the Centennial Vision and Beyond 345

Figure 11-11. The Wilma L. West Library was formally dedicated in 1988. (Printed with
permission from the Archive of the American Occupational Therapy Association, Inc.)

Figure 11-12. Which Willard and Spackman did you have in school? This is an often-
asked question of occupational therapy practitioners. There have been 12 editions of
Willard and Spackman published—the first in 1947 and the 12th in 2014. The other
editions were published in 1954 (2nd), 1963 (3rd), 1970 (4th), 1978 (5th), 1983 (6th), 1988
(7th), 1993 (8th), 1998 (9th), 2003 (10th), and 2009 (11th). Pictured on the left from top
to bottom in order are the first through fourth editions. Pictured on the right from top
to bottom in order are the fifth through eighth editions. Pictured in the center from
left to right are the nineth through 12th editions. (Copyright © Dr. Lori T. Andersen.
Reprinted with permission.)

therapy could provide an occupation that would produce “a similar therapeutic effect to that of
every drug in material medico” (italics in original), the original name of the Physician’s Desk
Reference (PDR) (Barton, 1914, p. 139). In other words, he suggested that a doctor’s prescription
could be filled by the right occupation and dosage just as well as a pharmaceutical drug. He also
suggested that there is an occupation that will provide “exercise for each separate organ, joint, and
muscle of the human body” (Barton, 1914, p. 139). What is more, the occupation will be “a useful
346 Chapter 11

occupation” that will provide self-support. He mentions morphine for pain, a leucotoxin for leuke-
mia, strychnine, and digitalis. While there may not be specific occupation that produces equal (or
better) results than each drug listed in the PDR, Barton was on the right track in suggesting that
good health could be obtained through carefully selected and administered occupation. We have
been able to “use the hospital (and other settings) as a re-educational institution through which
to put the waste products of society (social dependents) back and into the right place” in society
(Barton, 1914, p. 140).

The Image
How Has the Image of Occupational Therapy Changed Over the Years
Since the Practice of Occupational Therapy Formally Began?
One early image is that of a basket lady carrying craft supplies in a basket hung over her arm.
Another is a room in a hospital or institution in which crafts activities are being performing such
as weaving, printing, or woodworking. Both are rather rare today. A clinic is more likely to have
items related to self-care for adults and selected sensorimotor play activities for children. The
image is more likely that of a therapist helping a person with dressing or performing kitchen and
work tasks from a wheelchair or evaluating a person’s fitness to drive. The focus is more on the
occupations of daily life in the 21st century. Handcrafts may still be seen as tasks to teach skills
such as hand manipulation and following directions but are rarely the main focus of intervention
which is focused on activities of daily living, instrumental activities of daily living, work, play,
leisure, rest and sleep, and social participation.

The Message
How Has the Public Message (Definitions and Descriptions) About
Occupational Therapy Changed Over the Years?
Originally, the definition and description of occupational therapy was quite broad: “any activ-
ity, mental or physical, definitely prescribed … to hasten recovery….” and return to roles and
activities previously pursued and enjoyed (Pattison, 1922). The focus was on reducing, curing, or
eliminating, if possible, the effects of illness and disease. At the time, the idea of “working one’s
way to health” was radial. The prevailing view was resting and avoiding active work. Preventing
health problems, maintaining function, and saying well and safe in the home and community
were rarely, if ever, mentioned. Today, the focus is on enabling participation in the home, at school,
at work, and in the community. However, occupation continues to be art of the process toward
achieving a goal, whether the goal is reduction of the effects of disease, increased community
participation, or both.

The Public “Face”

How Have We Changed Our Approach to Identifying and
Interacting With Other Stakeholders (Professional Organization,
Consumer Coalitions/Groups, Policy Makers, Service Recipients)?
Initially, interaction was primarily with physicians and hospital administrator groups such as
the AHA, AMA, American Psychiatric Association, and American Tuberculosis Association. In
the 1960s, the Association officers became more involved with other groups, such as the Coalition
of Independent Professions, Society of Allied Health Professions, and American Public Health
Association. Today, interaction with occupational therapy associations in other countries has been
useful, such as the joint annual conference with Canada in 1994. Establishing and maintaining
 On the Road to the Centennial Vision and Beyond 347

contact with legislators at both the state and national levels has become essential to provide an
“occupational therapy face” for legislation and policy making.

Education
How Has Our System of Education and Training Approach Changed in
Preparing Our Practitioners, Educators, and Researchers?
The original 6-week (or fewer) courses focused on how to perform craft activities, follow hos-
pital etiquette, and interact with patients. The length and content of the curriculum have both
increased. The course of study for occupational therapists has increased from 6 weeks to about
6 years of university- or college-level education. The content now includes biological and behav-
ioral sciences, training in multiple media and modalities, theory and application of occupational
therapy, management techniques, and supervised practice training. In addition, a certification
examination is required before a person is recognized as qualified to practice and become licensed.
Formal educational criteria and practice guidelines for occupational therapy assistant did not exist
in the early days of the profession and were not formalized until 1958; they have also expanded
from short courses of several weeks to several months of formal course work.

Standards and Standard Setting

How Has Our System of Quality Controls or Standards Setting
(Accreditation and Credentialing) Changed?
From 1917 to 1922, there was no generally accepted and published quality control. Starting in
1923, the Association developed and published minimum standards for educational programs in
the Archives of Occupational Therapy. In 1932, the first directory of recognized credentialing (reg-
istered occupational therapist) was published based on standards developed in 1928 and finalized
in 1931, including formal training in a recognized occupational therapy training school and/or
experience practicing in an occupational therapy service program. Formal recognition of accred-
ited education programs began in 1938 based on a set of essential factors first published in the
Journal of the American Medical Association in 1935. One examination for persons not previously
recognized in the National Register of qualified occupational therapists was administered in 1939.
Admission to the directory of registered occupational therapists by examination for new gradu-
ates began in 1944 based on essay and short-answer questions and by multiple-choice questions
beginning in 1947. Cooperation with the AMA in developing and implementing accreditation pro-
cedures occurred from 1933 to 1992. The ACOTE took over formal accreditation of occupational
therapy education programs at both the professional and assistant levels in 1992. Registration was
changed to certification in 1986 with the formation of the American Board for Certification of
Occupational Therapy (ABCOT) when membership in the Association was formally separated
from the process of certification. The name of the certifying organization was changed in 1996 to
the National Board for Certification of Occupational Therapy (NBCOT), and it became an inde-
pendent organization. The requirements to sit for an initial certification examination continue,
and the results are accepted by all 50 states and three jurisdictions (Guam, Puerto Rico, and the
District of Columbia). States started to require licenses to practice in 1975. All states and the three
jurisdictions required a license to practice as an occupational therapist as of 2014. Licensure for
occupational therapy assistants was achieved in 2015.
348 Chapter 11

Defense Against Encroachment

How Have We Changed Our Defense of Our Curriculum of Study
(Pedagogy) and Scope of Practice From Encroachment Over the Years?
In 1948/1949, we defended occupational therapy education and practice from a takeover bid by
the Council of Physical Medicine of the AMA through a series of meetings pointing out that the
practice of occupational therapy was broader than the content or service programs provided by
physical medicine alone. In 1979, the Association began a series of meetings with the American
Physical Therapy Association (APTA) regarding the broadening of scope of physical therapy to
include self-care in home, school, and community. The Association’s Government and Legislative
Affairs Department has reported threats to occupational therapy practice from physical therapists,
art therapists, music therapists, recreational specialists, optometrists, orthotics and prosthetics
practitioners, speech-language pathologists, naturopathic physicians, orientation and mobility
specialists, polysomnographic technologists (sleep specialists), exercise physiologists, and massage
therapists (2014 National Office report, p. 30). Others have included psychologists, physicians,
nurses, and kinesiotherapists. These threats most often occur today through attempts to revise,
update, or expand the scope of practice outlined in a licensure law. However, threats can also occur
from language written into a federal or state law.

Practice
How Have We Changed (Contracted and Expanded) Our Practice Arena
or Sphere of Influence (Illness to Wellness and Promotion, Rehabilitation
of Disability to Prevention of Disability)?
Two of the original areas of practice have decreased, and two others have increased. Tuberculosis
is no longer listed as a separate area of practice in occupational therapy data collection statistics
and mental illness, originally the largest area of practice, has decreased significantly in numbers
of practitioners over the years. In contrast, orthopedics was originally a minor area of practice but
is now a major area, along with physical disabilities and rehabilitation. The other major practice
area that has increased is pediatrics, which was a minor area in the 1930s and is now a major area
of practice in early intervention and school-based practice. Other diagnoses rarely seen today are
poliomyelitis, post-polio syndrome, and rheumatic fever as a cause of a person being labeled a
“cardiac cripple.” Increased diagnoses seen today include Alzheimer’s disease, spinal cord injury,
and head (traumatic brain) injury.

Legislation and Policy Making

How Have We Changed Our Approach to Achieving Legislation
Favorable to Occupational Therapy Education, Practice, and Research?
The Association had no lobbyist or department addressing legislation prior to the 1950s. The
Association was not involved in writing the original Medicare and Medicare legislation as physical
therapy was. Although occupational therapy was included in the 1943 Vocational Rehabilitation
Act, the inclusion was not a result of Association actions. Beginning in the 1970s, the Association
began increased involvement in federal legislation. In 1974, the Association formally agreed to
support state licensure. In 1980, efforts by the Association resulted in the inclusion of occupa-
tional therapy in Medicare Part B. The Association began publishing the Legislative Alert in 1973
(changed to the Federal Report in 1977) to inform members about the status of pending or adopted
federal legislation. In 1999, the Association began published the State Policy Department News to
cover state news regarding licensure law development, passage, and sunset review. The title was
 On the Road to the Centennial Vision and Beyond 349

changed to State Policy Update in 2007, and it was discontinued in 2011. The Government Affairs
Office of the Association publishes an occasional column in OT Practice regarding legislative
issues.
How Have We Changed Our Approach to Achieving Policy Regulations
Favorable to Occupational Therapy (Salary Schedules, Inclusion of
Occupational Therapy in Legislation for Evaluation and Intervention,
and Reimbursement for Services)?
The Association developed a Civil Service Committee to keep track of state salaries begin-
ning in the 1940s. Later, the Civil Service Committee became the Legislative and Civil Service
Committee. The Legislative Committee was formed under the Developmental Council in 1964.
In 1968, the Association hired its first lobbyist, Russell J. N. Dean, Director of the Washington
Consulting Service. Early interaction with Congress related to hearings on the amendments to the
Vocational Rehabilitation Act. Early interactions with federal agencies were with the Division of
Allied Health Manpower and Division of Medical Care Administration of the U.S. Public Health
Services, Department of Health Education and Welfare (HEW). One request was to explore grant
and contract possibilities for recruitment and refresher courses. A second was a recommendation
that independent occupational therapy practitioners be allowed direct payment under supplemen-
tary medical insurance part of the Medicare Program (Tiebel, 1968). The national office first listed
governmental affairs in 1973 under the Public Affairs Department. The Legislative Alert was pub-
lished from 1973 to 1975. The Federal Report was published by the Government and Legal Affairs
Department from 1977 to 1987 as a separate publication and was included in OT Week for 2 more
years. The Government and Legal Affairs Department was formed in 1976.

Research
How Have We Changed Our Approach to Facilitate Research on
the Effectiveness and Efficiency of Practice, Education, and Research
Methodology?
Research has been a focus since the founding of the Association. Dunton was the first chair
of the Research Committee. The primary focus was on collecting information about research
publications rather than supporting research through education of how to conduct research or
through grants or contracts. However, both Dunton and Louis Haas conducted studies related to
the practice of occupational therapy in psychiatry and mental illness. A series of studies appears in
Occupational Therapy and Rehabilitation on types of arts and crafts and their effect on mood or
emotion. Haas reported on the organization and administration of occupational therapy. Support
for education and research and financial grants became available with the formation of the AOTF
in 1965. Research activities has increased in the Association as more people have applied for and
received funding through the National Institutes of Health and other funding organizations.

Association Finances, Grants, and Outside Funding

How Has the Association Attracted Outside Funds (Non-Membership
Dues) Over the Years, Including Scholarships, Traineeships, Grants, and
Contracts?
Over the years, many source of outside funds have been sought by the Association. However,
as Executive Director Marjorie Fish pointed out, grants provide money and cost money (Annual
Report, 1961/1962). The financial hazards are that the more grants, the more personnel, the more
activities that cannot be suddenly cut off at termination (of grant funding) but require some
350 Chapter 11

Table 11-8
PARTIAL LIST OF EARLY ASSOCIATION GRANTS AND CONTRACTS
● Kellogg grants (scholarships, traineeships, grants, contracts), 1946-1969
● United Cerebral Palsy 1951-67 (undergraduate scholarships) Note: UCP took over awarding scholarships
after 1967. 1955-56, $10,000; 1950, $10,000; 1963, $1500
● National Institute of Mental health, NIH, PHS, DHEW 3M-9083 1955-59, Allenberry Conference held in
1956. Proceedings published in 1959.
● Office of Vocational Rehabilitation, DHEW, 1955 Institute held in New York, June 20-25, 1955. Proceedings
published
● National Foundation for Infantile Paralysis: recruitment 1955-56 $23,850, 1957-58, 1959-62
● Office of Vocational Rehabilitation, DHEW, 4 Regional Institutes, 1955-1956, $10,000. Proceedings published
● Office of Vocational Rehabilitation, Institute held October 2-25, 1957 Proceedings published
● Office of Vocational Rehabilitation, Grant 123-T-1957-61
● Office of Vocational Rehabilitation, Field Consultant, Rehabilitation of the Physically Disabled (Irene
Hollis), 1958-1962
● Office of Vocational Rehabilitation, Field Consultant in Psychiatry (Mary Alice Combs, 1961-1964; June
Mazer, 1964-69)
● National Foundation for Infantile Paralysis. Curriculum Study grant 1950-1958
● Office of Vocational Rehabilitation 1952. Traineeships for 1 person from each OT educational program to
attend WFOT conference in Philadelphia, PA
● OVR/VRA/SRA graduate education traineeships, 1960-1972
● Vocational Rehabilitation Administration 123-T-1962-1969 (Curriculum Study)
● Vocational Rehabilitation Administration (VRA 367-T-66 1966-69 Recruitment)
● National Institutes of Health (Training Institutes for OT educators), 1973-74
● Public Health Services (Educator Training workshops, 1974-76)

provision of an ongoing character (Fish, 1961-1962, p. 9). Major grant funds have been included
scholarships and traineeships, professional development, curriculum review, and student recruit-
ment (Table 11-8).

The National Office

How Has the Role of the National Office Changed Over the Years?
The first “offices” were in Consolation House (Barton’s home) and Mrs. Slagle’s kitchen. The
focus was on membership, educational standards, job placement, finances, and qualifications/reg-
istration. In the 1950s, grant development and administration and the publication of conference
proceedings and practice manuals was added. In the 1960s, legal consultation and lobbying at the
federal level was added. In the 1970s, legal consultation for states seeking licensure was added, and
the office was move from New York City to the Washington, DC, area. The Government and Legal
Affairs Department was added first to deal with federal legislation and then with state licensure.
Reimbursement demands and coding for insurance claims was also added to meet membership
demands. The office staff grew from one person and a secretary to multiple people occupying a
variety of positions as the needs and expectations of the Association grew to encompass accredita-
tion, registration, scholarships, continuing education and competency, recruitment, public infor-
mation, practice standards and guidelines, research, documentation and reimbursement, state
licensure, federal legislation, and legal affairs. Some of the activities would later become parts of
separate organizations, such as registration/certification (NBCOT), scholarships, and research
(AOTF). However, the initial organizing efforts were accomplished in the national office.
 On the Road to the Centennial Vision and Beyond 351

Workforce Demographics
How Has the Change in Location and Number of Practitioners Occurred
Over the Years?
The first membership list in 1917 was represented primarily by three states: Illinois,
Massachusetts, and New York, plus Canada. In the first National Registry of qualified practitio-
ners published in 1932, 80 of the 318 names are of therapists living in New York State. Membership
remains predominately from the North Central (12) and Northeast (9) states. California, Texas,
and Florida are the only states to be included in the top states reporting a significant number of
therapists that are not from the North Central or Northeast states. In 1997, the regional breakdown
of therapists showed that 53.9% of therapists responding to the survey lived in North Central or
Northeast areas of the country, comprising 21 states (AOTA, 1998a). In the 2010 Compensation
Survey, 52.4% of therapists responding to the survey lived in the North Central or Northeast areas.
Student enrollment from the two regions was 60.2% (AOTA, 2010, pp. 11, 62). In the 2015 Salary
and Workforce Survey, 51% of practitioners live in the North Central or Northeast states, and
56.4% of students attend occupational therapy educational programs located in the North Central
or Northeast states (AOTA, 2015a, pp. 12, 42). There is slight decreasing trend, but the influence of
the North Central and Northeast states will remain for many years to come.

Specialization Versus Generalist

What Is the Argument for and Against Specialization in Occupational
Therapy?
The argument has two aspects: one related to education and the other to practice. In educa-
tion, the argument concerns whether practitioners should be educated as generalists or should
select a field of specialization during their educational preparation. Over the years, the generalist
approach has dominated in educational preparation. The Essentials and Standards documents
have uniformly supported the generalist view. Not everyone agreed. In 1953, Dr. Dunton wrote an
editorial in support of permitting shorted periods of education “with more emphasis on special-
ties for which pupils seem best adapted” (Dunton, 1953, p. 215). His rationale was that allowing
specialization during educational preparation permitted students to finish their education quicker
and thus join the workforce sooner to alleviate the manpower shortage. Welles (1958) makes the
point that registration (certification) may imply that the person is qualified “for any type of posi-
tion on any level” in the practice of occupational therapy (p. 289). She states further that there is no
defined body of knowledge in occupational therapy that when mastered will automatically qualify
a person for a particular position. Nevertheless, she recommends that the concept of specialization
be accepted in the field of occupational therapy and that the profession should continue to define
function with greater precision. Hirama (1982) also supports specialization. She suggests that the
profession needs to define what advanced occupational therapy knowledge is and establish criteria
for the status of “specialist.” Dunn and Rask (1989) also support specialization and outline addi-
tional steps needed to develop specialty areas of practice. Later, the recommendations of all the
authors would be adopted in the specialty certification program as advanced practice concepts. In
the final analysis, both concepts have been accepted. Initial education and certification are at the
generalist level, but postgraduate education (degree or non-degree) is available to support special-
ization in many aspects and areas of practice.
352 Chapter 11

Definition of Core Concept

Is Occupation or Activity the Common Core of Occupational Therapy?
Barton chose the word occupation when he created the term occupational therapy in 1914.
However, Pattison used the word activity in the definition he created, which was widely used in
the profession for many years. The definition begins “any activity.” Thus, the profession has used
the two words interchangeably for many years. Dictionaries are of limited help because both words
have the additional meaning of an implied health benefit or therapeutic potential attached, which
dictionaries do not address. For many years, the term purposeful activity was suggested, but the
nature of purpose was likewise difficult to fully define or describe.

Looking Forward: Workforce Trends

The National Center for Health Workforce Analysis (NCHWA) under the Health Resources
and Services Administration of the U.S. Department of Health and Human Services conducted
an analysis of the projected workforce needs for occupational therapy and physical therapy using
the Health Workforce Simulation Model (HWSM) (NCHWA, 2013). The HWSM assumes that
demand equals supply in the base year. Major components include characteristics of the existing
workforce, newly trained workers entering the workforce, and workforce decisions such as retire-
ment and pattern of work hours. For demand modeling, the major components include population
demographics, health care use patterns, and demand for health care services. Based on the HWSM,
three statements were made that between 2012 and 2025:
● Supply is estimated to grow by 46% for occupational therapists and 33% for physical therapists.
● Demand is estimated to grow by 20% for occupational therapists and 23% for physical therapists.
● The projected supply of individuals in each occupation exceeds the projected growth in ser-
vice demand for occupational therapists and physical therapists.
According to these findings, there should be a more-than-sufficient supply of occupational
therapists and physical therapists to meet the project growth in demand for services by 2025. A
surplus of 22,300 occupational therapists and 19,100 physical therapists is projected. The calcula-
tions do not include numbers for occupational therapy or physical therapy assistants.
However, the estimated supply in 2012 is stated as 86,300. The source of the number is not
stated. According to the 2010 survey of state occupational therapy regulatory boards, the work-
force of occupational therapists was approximately 102,500 occupational therapists and 34,500
occupational therapy assistants (AOTA, 2010). The source of entrants (58,200) and projected sup-
ply (126,200) by 2025 is not provided.
On the other hand, a study by Lin, Zhang, and Dixon (2015) suggests that a shortage of occupa-
tional therapists exists now and will increase in the future. Their model included both a demand
and supply concept and is based on the difference between the national mean of available prac-
titioners for currently available positions as determined by the Bureau of Labor (given a grade of
C) and each state’s shortage (or overage) ratio using a fixed standard deviation. Grades A and F
were ±2.50, grades B and D grades were ±1.50, and grades C+ and C- were ±0.5 standard devia-
tions from the mean. Their findings suggest that a shortage is expected to increase in all 50 states
through the year 2030, the final year calculated. Using the grading system of A through F, they
report that the number of states with a grade of D or below will increase from three in 2010 to 18 in
2020 and 37 in 2030. The three states with the greatest shortage ratio are projected to be Arizona,
Hawaii, and Utah. The three states with the largest shortages (the number of practitioners available
for jobs) are projected to be California, Florida, and Texas. States in the Northeast region as a whole
are projected to have the smallest shortages of practitioners, whereas states in the South and West
regions are projected to have the largest shortages.
 On the Road to the Centennial Vision and Beyond 353

Projecting future needs is always risky. Events such as political and legislative changes can
quickly change the outlook for occupational therapy practitioners, as the Balanced Budget Act of
1997 showed. As of 2014, the Bureau of Labor projects an increased need for occupational thera-
pists of 29% and for occupational therapy assistants of 41% through to 2025. Throughout our his-
tory, shortages have been the rule. Time will tell if the trend continues.

Changing Work Settings

Where or in What Settings Will Occupational Therapy Personnel Be
Employed in the Future?
Changes in work settings appear to be occurring. In 2007, the primary work settings of new
graduates were rehabilitation (24%), schools (23%), skilled nursing facilities (21%), and acute care
facilities (14%) (NBCOT, 2008). In 2012, the primary work settings were skilled nursing facilities
(20%), rehabilitation (17%), acute care (13%), and school systems (13%). However, in the same
2012 survey, the percentage of practitioners working in pediatrics is listed at 19%, whereas the
number working in geriatrics is listed at 8% (NBCOT, 2012a). The primary work setting for new
occupational therapy assistants is also skilled nursing facilities, followed by rehabilitation and
school systems (NBCOT, 2012b). However, data from AOTA (2015a) show a different pattern for
occupational therapists, without regard for number of years in practice. Overall, hospitals are the
major employers (26.6%), followed by schools (19.9%), long-term care/skilled nursing facilities
(12.2%), and freestanding outpatient facilities (10.8%). The data for occupational therapy assistants
have remained consistent since 2000: long-term care/skilled nursing facilities followed by schools
and hospitals (AOTA, 2015a). If the trends hold, nursing homes will be the primary employers of
both occupational therapists and occupational therapy assistants, although hospitals will continue
to employ a substantial percentage of occupational therapists, along with schools.
What Kinds of Conditions or Diagnoses Will Be Seen by Occupational
Therapy Practitioners?
If past is prologue, the conditions or diagnoses seen by occupational therapy practitioners can
be organized into six major groups: neurological, developmental, musculoskeletal/orthopedic,
cardiopulmonary, psychosocial dysfunction disorders, and general medical/systemic disorders
(NBCOT, 2012a, 2012b. For occupational therapists, the top three disorders in each group are:
● Neurological: cerebral vascular accident, dementia, traumatic brain injury
● Developmental: developmental delay, sensory integrative disorder, intellectual disability
● Musculoskeletal/orthopedic: fractures, joint replacement, osteoarthritis
● Cardiopulmonary: chronic obstructive pulmonary disease, congestive heart failure, myocar-
dial infarction
● Psychosocial: anxiety disorders, autism spectrum disorders, behavior disorders
● General medical/systemic: general deconditioning/debilitation, cancer, diabetes
For occupational therapy assistants, the top three diagnoses in each category are:
● Neurological: dementia, cerebral vascular accident, Parkinson’s disease
● Development: developmental delay, sensory integrative disorder, visual processing deficit
● Musculoskeletal/orthopedic: fracture, joint replacement, osteoarthritis
● Cardiopulmonary: congestive heart failure, chronic obstructive pulmonary disease, myocar-
dial infarction
● Psychosocial dysfunction: anxiety disorders, behavior disorders, mood disorders
● General medical/systemic: diabetes, general deconditioning/debilitation, rheumatoid arthritis
354 Chapter 11

What Do We Really Know About the Process of Occupational Therapy

Practice?
There have been five analyses of practice conducted to develop rationale for questions on the
initial certification examinations. The first analysis of occupational therapy practice was con-
ducted in 1991 by the Educational Testing Service for the ABCOT and was based on a survey
from approximately 1,400 therapists and assistances practitioners and educators. The goal was to
establish the importance of knowledge of certain tasks for entry-level clinicians (Lang, 1994). The
results were organized into seven categories: assess occupational performance, develop treatment
plan, implement treatment plan, evaluate treatment plan, develop discharge plan, organization and
management of services, and promote professional practice.
The second practice analysis was completed in 1997 (Dunn & Cada, 1998; NBCOT, 1998). The
survey included 4,000 occupational therapists and 3,000 occupational therapy assistants. The
sample was designed to represent all geographical areas, experience levels, and practice areas. The
results were organized into four domains:
1. Provide occupational therapy services for person within the performance contexts of their
lives
2. Provide occupational therapy services that address the occupational needs of populations with
the context of their physical, social, temporal, and cultural environments
3. Manage the delivery of occupational therapy services
4. Advance the effectiveness of the occupational therapy profession
A third practice analysis was conducted in 2003 (Bent, Crist, Florey, & Strickland, 2005;
NBCOT, 2004a, 2004b). The format was similar to the 1991 study. Results were organized in five
domains:
1. Evaluate the individual/group to determine needs and priorities for occupation-based inter-
vention
2. Develop intervention plan that addresses the occupational needs of individuals/groups
3. Implement occupationally meaningful interventions with individuals/groups that support
participation in relevant environments
4. Provide occupational therapy services that address the occupational performance needs of
populations
5. Manage, organize, and promote occupational therapy services
The fourth practice analysis was conducted in 2008. A total of 1,282 occupational therapists
were requested to participate, and 1,156 completed the survey. Participations had to be working
36 months or less. Thus the study sample was different from the previous practice analysis stud-
ies, which included practitioners with a variety of years of work experience. Four domains were
created:
1. Gather information regarding factors that influence occupational performance
2. Formulate conclusions regarding the client’s needs and priorities to develop a client-centered
intervention plan
3. Select and implement evidence-based interventions to support participation in areas of occu-
pation (activities of daily living, education, work, play, leisure, social participation) through-
out the continuum of care
4. Uphold professional standards and responsibilities to promote quality in practice
The fifth practice analysis was conducted in 2012. The sample included 2,826 occupational
therapists who had been certified for less than 3 years. Response rate was 79% (2,235). Again, four
domains were established:
 On the Road to the Centennial Vision and Beyond 355

1. Acquire information regarding factors that influence occupational performance throughout

the occupational therapy process
2. Formulate conclusions regarding client needs and priorities to develop and monitor an inter-
vention plan throughout the occupational therapy process
3. Select interventions for managing a client-centered plan throughout the occupational therapy
process
4. Manage and direct occupational therapy services to promote quality in practice
An analysis of the five analyses shows the changing terminology in the occupational therapy
literature, such as meaningful intervention, performance contexts, areas of occupation, and
client-centered. However, the basic process is evident: gathering and evaluating information,
developing and implementing a plan of care, and managing and directing occupational therapy
services. What is missing from the 2012 domains (and was included in the 2008 domains) for the
occupational therapist is a domain concerned with upholding ethical and professional standards.
Why the domain was dropped is not clear. Such a domain is included for the occupational therapy
assistant in addition to assisting occupational therapists to acquire information that influences
occupational performance and implementing interventions in accordance with the intervention
plan and under the supervision of the occupational therapist (NBCOT, 2012b). In summary, the
process of delivering occupational therapy services remains consistent, although the descriptions
of the process change to reflect current terminology.
Will the Profession of Occupational Therapy Support Licensure Portability?
Now that licensure has been achieved in all states for both the occupational therapist and the
assistant, the next question concerns portability of the license across state lines. Initial certifica-
tion is uniform because all states use the examination results from the examinations administered
by the NBCOT. However, license renewal can vary depending on the frequency of renewal, the
cost, the number of continuing educational units required, and the type or category of continu-
ing education. Therapists and assistants who work in more than one state or jurisdiction or those
who move from one state or jurisdiction are most affected. The Association can help by provid-
ing model legislation, just as it did for licensure laws, but state associations will need to step in to
make the portability happen. State licensure laws, the rules and regulations, or both may need to
be modified to permit portability to occur. The result may save practitioners money and time in
renewing licensures, but the greater payoff may occur in facilitating movement of practitioners
across state lines, especially during times of natural or manmade disasters.
What Is the Continuing Role of the National Association?
In 1997, Steib wrote in OT Week that the role of the Association was to help practitioners create
and grow a strong, viable, and relevance profession; gain and maintain the respect and recognition
they deserved; and maintain acceptable salary and reimbursement levels (Steib, 1997). Professional
growth included “maintaining competency, gaining new skills, taking advantage of increased
educational opportunities, and accessing new technologies and research” and the Association was
actively involved in all of these (Steib, 1997, p. 19).

Reflection
This period of AOTA history includes the implementation of the Centennial Vision in AOTA
operations, beginning with intensified continual education of the public about the profession’s
progress and accomplishments. Initiatives toward the critical appraisal of existing related lit-
erature on specific areas of occupational therapy provide validation and documentation for
practitioners. Demand for evidence-based practice adds impetus for increased research. Revision
of ACOTE standards reflected realignment to current practice and graduate level of education.
356 Chapter 11

This period also revealed increased vigilance for protecting the profession’s scope of practice.
Consistent with the Centennial Vision of a global practice, there was increased recognition of the
value of international and interprofessional education in the curriculum. Conversations stemmed
from intensified awareness of the need for and a move toward higher degrees for entry into the
profession: doctoral degrees for occupational therapists and bachelor’s degrees for assistants, with
the number of applicant entry-level doctoral programs continuing to increase.

References
Accreditation Council for Occupational Therapy Education. (2011). Standards and interpretive guide. Bethesda, MD:
Author
Allied Health Professions Personnel Training Act (P.L. 89-751)
American Medical Association. (1932). Handbook of physical therapy. Chicago, IL: AMA Press.
American Medical Association. (1949). Essentials of an acceptable school of occupational therapy. Journal of the
American Medical Association, 141(16), 1167.
American Occupational Therapy Association. (1923). Bulletin No. 1. New York, NY: Author.
American Occupational Therapy Association. (1950). Essentials of an acceptable school of occupational therapy.
American Journal of Occupational Therapy, 4(3), 125-128.
American Occupational Therapy Association. (1959). Board of Management minutes. New York, NY: Author.
American Occupational Therapy Association. (1965). Guidebook for an accredited curriculum in occupational therapy.
New York, NY: Author.
American Occupational Therapy Association. (1968). Roster: Medical Advisory Committee. New York, NY: Author.
American Occupational Therapy Association. (1969). Statement on referral. American Journal of Occupational
Therapy, 23(6), 530-531.
American Occupational Therapy Association. (1998a). 1997 member compensation survey: Summary report and tables.
Bethesda, MD: Author.
American Occupational Therapy Association. (2010). 2010 occupational therapy compensation and workforce study.
Bethesda, MD: Author.
American Occupational Therapy Association. (2014). FAQs: AOTA Board of Directors position statement on doctoral
level single point of entry for occupational therapists. Retrieved from www.aota.org/AboutAOTA/Get-Involved/
BOD/OTD-FAQs.aspx
American Occupational Therapy Association. (2015a). 2015 AOTA salary & workforce survey. Bethesda, MD: Author.
American Occupational Therapy Association. (2015b). Statement on occupational therapy’s distinct value. OT
Practice, 20(11), 3.
American Occupational Therapy Association. (2016). Annual Meeting (Verbal Report with Slides). Bethesda, MD:
Author.
American Occupational Therapy Foundation. (2014). Celebrating 60 years of advancing the science of occupational
therapy. Bethesda, MD: Author.
Barton, G. Occupational therapy. Trained Nurse and Hospital Review, 54, 138-140.
Bent, M. A., Crist, P. A., Florey, L., & Strickland, L. R. (2005). A practice analysis of occupational therapy and impact
on certification examination. OTJR: Occupation, Participation and Health, 25(3), 105-118.
Brandenburg, E. (1963). Building toward professionalism. In Vocational Rehabilitation Administration/American
Occupational Therapy Association workshop on graduate education in occupational therapy (pp. 4-20). St. Louis,
MO: Washington University.
Brown, E. J. (2012a). Mapping out the new ACOTE standards. Advance for Occupational Therapy Practitioners, 28(17),
13-30.
Dunn, W., & Cada, E. (1998). The national occupational therapy practice analysis: findings and implications for com-
petence. American Journal of Occupational Therapy, 52(9), 721-728.
Dunn, W., & Rask, S. (1989). Entry level and specialized practice: A professional encounter. American Journal of
Occupational Therapy, 43(1), 709.
Dunton, W.R., Jr. (1928). Prescribing occupational therapy. Springfield, IL: Charles C Thomas.
Dunton, W. R., Jr. (1953). Specialization. American Journal of Occupational Therapy, 6(5), 214-216.
Evans, K. A. (1987). Nationally speaking: Definition of occupation as the core concept of occupational therapy.
American Journal of Occupational Therapy, 41(10), 637-628.
Fish, M. (1961/1962). Annual report of the executive director. New York, NY: American Occupational Therapy
Association.
 On the Road to the Centennial Vision and Beyond 357

Hall, H.J. (1923). OT – A new profession. Concord, NH: Rumford Press.

Hirama, H. (1982). Toward specialization. American Journal of Occupational Therapy, 36(9), 601-602.
Johnson, J. (1975). Nationally speaking: Licensure. American Journal of Occupational Therapy, 29(2), 73.
Krusen, F. H. (1934). The relationship of physical therapy and occupational therapy. Occupational Therapy and
Rehabilitation, 13(2), 69-77.
Lang, S. M. (Ed.). (1994). AOTCB study guide for the OTR certification examination. Rockville, MD: National Board
for Certification in Occupational Therapy.
Licht, S. (1952). Occupational therapy. In W. Bierman & S. Licht (Eds.), Physical medicine in general practice (3rd ed.,
pp. 448-471). New York, NY: Paul B. Hoeber.
Lin, V., Zhang, X., & Dixon, P. (2015). Occupational therapy workforce in the United States: Forecasting nationwide
shortages. Physical Medicine & Rehabilitation, 7, 946-954.
Maxwell, J. D., & Maxwell, M. P. (1984). Inner fraternity and outer sorority: Social structure and the professionaliza-
tion of occupational therapy. In A. Wipper (Ed.), The sociology of work: Papers in honour of Oswald Hall (pp.
330-357). Ottawa, Canada: Carleton University Press.
Maze, D. J. (1968). The growth and development of the allied health schools. Journal of the American Medical
Association, 206(7), 1548-1550.
Meredith, G. (1971). Schools of allied health professions. American Journal of Occupational Therapy, 25(1), 29-31.
Molander, C. O. (1931). An experiment in the combining of occupational therapy and physical therapy under single
management. Archives of Physical Therapy, X-Ray, and Radium, 12, 279-286.
National Board for Certification in Occupational Therapy. (1998). National study of occupational therapy practice:
final report. New York, NY: Professional Examination Service.
National Board for Certification in Occupational Therapy. (2004a). OTR certification examination blueprint.
Gaithersburg, MD: Author.
National Board for Certification in Occupational Therapy. (2004b). COTA certification examination blueprint.
Gaithersburg, MD: Author.
National Board for Certification in Occupational Therapy. (2008). NBCOT 2008 practice analysis: Executive summary
for the practice analysis study. Gaithersburg, MD: Author.
National Board for Certification in Occupational Therapy. (2012a). 2012 practice analysis of the occupational therapist
registered: Executive summary. Gaithersburg, MD: Author.
National Board for Certification in Occupational Therapy. (2012b). 2012 practice analysis of the certified occupational
therapy assistant: Executive summary. Gaithersburg, MD: Author.
National Center for Health Workforce Analysis. (2012). Health workforce projections: Occupational therapy and
physical therapy. Retrieved from bhw.hrsa.gov/healthworkforce/index.html
Pattison, H. A. (1922). The trend of occupational therapy for the tuberculous. Archives of Occupational Therapy, 1(1),
19-24.
Rehfuss, M. E., Albrecht, F. J. K., & Price, A. H. (1948). A course in practical therapeutics. Baltimore, MD: Williams
& Wilkins.
Robinson, C. (1919). Occupational therapy in the general hospital. Modern Hospital, 13, 524-527.
Rogers, J. C. (2010). AOTA and AOTF announce new research agenda. OT Practice, 15(1), 11-12.
Steib, P. A. (1997). AOTA: Shaping the future. OT Week, 11(15), 18-20.
Tiebel, H. (1968). Annual report to the membership of the executive director. New York, NY: American Occupational
Therapy Association.
Tracy, S. (n.d.). [Letter to Dr. Dunton]. Bethesda, MD: AOTA/AOTF Archives.
Welles, C. (1958). Da Vinci is dead: The case for specialization. American Journal of Occupational Therapy, 12(6),
289-290.
358 Chapter 11

Bibliography
American Occupational Therapy Association. (1998). 1997 member compensation survey: Final report. Bethesda, MD:
Author.
Brown, E. J. (2012). Health reform and occupational therapy. Advance for Occupational Therapy Practitioners, 28(15),
12-15.
Evans, K. A. (1987). Nationally speaking: Definition of occupation as the core concept of occupational therapy.
American Journal of Occupational Therapy, 41(10), 637-628.
Hanft, B. E. (1989). Early intervention: Issues in specialization. American Journal of Occupational Therapy, 43(7),
431-432.
Sandhu, S. (2015). Medicare Part B policy changes coming in 2016. OT Practice, 20(22), 7.
Appendix A
Presidents of NSPOT
and AOTA
TERM PRESIDENT
1917 (NSPOT) George Edward Barton
1918‒1919 (NSPOT) William Rush Dunton, MD (NSPOT)
1919‒1920 (NSPOT) Eleanor Clarke Slagle (NSPOT)
1920‒1923 (NSPOT/AOTA) Herbert J. Hall, MD (NSPOT/AOTA)
1923‒1928 (AOTA) Thomas B. Kidner
1928‒1930 (AOTA) C. Floyd Haviland, MD
1930‒1938 (AOTA) Joseph C. Doane, MD
1938‒1947 (AOTA) Everett D. Elwood
1947‒1952 (AOTA) Winifred Conrick Kahmann, OTR
1952‒1955 (AOTA) Henrietta W. McNary, OTR
1955‒1958 (AOTA) Colonel Ruth A. Robinson, OTR, FAOTA
1958‒1961 (AOTA) Helen S. Willard, OTR, FAOTA
1961‒1964 (AOTA) Wilma L. West, OTR, FAOTA
1964‒1967 (AOTA) Ruth W. Brunyate Wiemer, MEd, OTR, FAOTA
1967‒1973 (AOTA) Florence S. Cromwell, MA, OTR, FAOTA
1973‒1978 (AOTA) Jerry A. Johnson, EdD, MBA, OTR, FAOTA
1978‒1982 (AOTA) Mae D. Hightower-Vandamm, OTR, FAOTA
1982‒1983 (AOTA) Caroline M. Baum, PhD, OTR/C, FAOTA
1983‒1986 (AOTA) Robert Bing, EdD, OTR, FAOTA
1986‒1989 (AOTA) Elnora M. Gilfoyle, ScD (Hon), OTR, FAOTA
1989‒1992 (AOTA) Ann P. Grady, PhD, OTR, FAOTA
1992‒1995 (AOTA) Mary M. Evert, MBA, OTR, FAOTA
(continued)

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 359-360).
- 359 - © 2017 SLACK Incorporated.
360 Appendix A

TERM PRESIDENT
1995‒1998 (AOTA) Mary Foto, OTR, FAOTA
1998‒2001 (AOTA) Karen Jacobs, EdD, OTR/L, CPE, FAOTA
2001‒2004 (AOTA) Barbara L. Kornblau, JD, OT/L, FAOTA
2004‒2007 (AOTA) Carolyn Baum, PhD, OTR/L, FAOTA
2007‒2010 (AOTA) Penelope (Penny) Moyers-Cleveland, PhD,
OTR/L, BCMH, FAOTA
2010‒2013 (AOTA) Florence Clark, PhD, OTR, FAOTA
2013‒2016 (AOTA) Virginia (Ginny) Stoffel, PhD, OT, BCMH, FAOTA
2016‒2018 (AOTA) Amy Jo Lamb, OTD, OTR/L, FAOTA
Appendix B
Executive Officers of
NSPOT and AOTA
TERM OFFICER POSITION
1921‒1937 Eleanor Clarke Slagle Secretary-Treasurer
1937‒1938 Maud Plummer Executive Secretary
1938‒1947 Meta R. Cobb Executive Secretary
1948‒1951 Wilma L. West Executive Director
1951‒1963 Marjorie Fish Executive Director
1964‒1968 Frances Helmig Executive Director
1968‒1971 Harriet Tiebel Executive Director
1972‒1974 Leo Fanning Executive Director
1975‒1987 James J. Garibaldi Executive Director
1987‒1999 Jeanette Bair Executive Director
2000‒2003 Joseph Isaacs Executive Director
2004‒present Frederick P. Somers Executive Director

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (p. 361).
- 361 - © 2017 SLACK Incorporated.
 Appendix C
Locations of Headquarters for
NSPOT and AOTA
YEARS LOCATION
1917 Consolation House (Home of George Edward Barton)
A School Workshop and Vocational Bureau for Convalescents
16 Broad Street, Clifton Springs, NY
1921‒1922 Home of Mrs. Eleanor Clarke Slagle
541 Madison Avenue, New York, NY
1922‒1925 American Occupational Therapy Association, Inc.
370 Seventh Avenue, New York, NY
1925‒1945 American Occupational Therapy Association
Fuller Building (called Flatiron Building)
175 Fifth Avenue, New York, NY
1945‒1955 American Occupational Therapy Association
33 West 42nd Street (Aeolian Building), New York, NY
1955‒1967 American Occupational Therapy Association
250 West 57th Street (Fiske Building), New York, NY
1967‒1972 American Occupational Therapy Association
251 Park Avenue South, New York, NY
1972‒1980 American Occupational Therapy Association
6000 Executive Boulevard, Suite 200 (Wilco Building), Rockville, MD
1980‒1994 American Occupational Therapy Association, Inc.
1383 Piccard Drive, Rockville, MD
1994‒ American Occupational Therapy Association, Inc.
present 4720 Montgomery Lane, Bethesda, MD

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (p. 363).
- 363 - © 2017 SLACK Incorporated.
Appendix D
Official Organ/Journal of
NSPOT and AOTA
PUBLICATION ORGAN/JOURNAL
DATES
1911‒1921 Maryland Psychiatric Quarterly
1922‒1924 Archives of Occupational Therapy
1925‒1946 Occupational Therapy & Rehabilitation
1937 Journal of Occupational Therapy
(only one edition published)
1947‒present American Journal of Occupational Therapy

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (p. 365).
- 365 - © 2017 SLACK Incorporated.
Appendix E
Annual Meetings of
NSPOT and AOTA
DATE LOCATION
September 3, 1917 New York, New York
September 2-4, 1918 New York, New York
September 8-11, 1919 Chicago, Illinois
September 13-14, 1920 Philadelphia, Pennsylvania
October 20-22, 1921 Baltimore, Maryland
September 25-29, 1922 Atlantic City, New Jersey
October 30‒November 1, 1923 Milwaukee, Wisconsin
October 7-9, 1924 Buffalo, New York
October 19-22, 1925 Louisville, Kentucky
September 26-29, 1926 Atlantic City, New Jersey
October 10-13, 1927 Minneapolis, Minnesota
August 6-10, 1928 San Francisco, California
June 16-19, 1929 Atlantic City, New Jersey
October 20-24, 1930 New Orleans, Louisiana
September 28-30, 1931 Toronto, Canada
September 12-14, 1932 Detroit, Michigan
September 12-13, 1933 Milwaukee, Wisconsin
September 25-27, 1934 Philadelphia, Pennsylvania
September 30‒October 1, 1935 St. Louis, Missouri
September 28‒October 1, 1936 Cleveland, Ohio
September 14-17, 1937 Atlantic City, New Jersey
September 11-15, 1938 Chicago, Illinois
(continued)

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 367-370).
- 367 - © 2017 SLACK Incorporated.
368 Appendix E

DATE LOCATION
October 15-16, 1939* New York, New York
September 15-19, 1940 Boston, Massachusetts
August 31‒September 5, 1941 Washington, DC
October 8-9, 1942* New York, New York
October 12-15, 1943* Indianapolis, Indiana
November 12-15, 1944* New York, New York
June 26-27, 1945* Detroit, Michigan
August 10-15, 1946 Chicago, Illinois
November 2-7, 1947 Coronado, California
September 4-11, 1948 New York, New York
August 23-25, 1949 Detroit, Michigan
October 14-21, 1950 Glenwood Springs, Colorado
September 8-15, 1951 Portsmouth, New Hampshire
August 9-16, 1952 Milwaukee, Wisconsin
November 13-20, 1953 Houston, Texas
October 16-22, 1954 Washington, DC
October 21-28, 1955 San Francisco, California
September 29‒October 5, 1956 Minneapolis, Minnesota
October 17-25, 1957 Cleveland, Ohio
October 17-23, 1958 New York, New York
October 19-23, 1959 Chicago, Illinois
November 13-17, 1960 Los Angeles, California
November 6-8, 1961 Detroit, Michigan
October 22-25, 1962 Philadelphia, Pennsylvania
September 29‒October 3, 1963 St. Louis, Missouri
October 26-29, 1964 Denver, Colorado
October 31‒November 4, 1965 Miami Beach, Florida
October 11-14, 1966 Minneapolis, Minnesota
October 11-14, 1967 Boston, Massachusetts
October 20-26, 1968 Portland, Oregon
November 3-7, 1969 Dallas, Texas
November 20-24, 1970 New York, New York
October 31‒November 5, 1971 Cleveland, Ohio
October 23-27, 1972 Los Angeles, California
October 29‒November 2, 1973 Chicago, Illinois
October 21-25, 1974 Washington, DC
October 14-18, 1975 Milwaukee, Wisconsin
(continued)
 Annual Meetings of NSPOT and AOTA 369

DATE LOCATION
October 11-15, 1976 San Francisco, California
October 16-20, 1977 San Juan, Puerto Rico
May 7-13, 1978 San Diego, California
April 23-27, 1979 Detroit, Michigan
April 15-18, 1980 Denver, Colorado
March 9-13, 1981 San Antonio, Texas
May 10-14, 1982 Philadelphia, Pennsylvania
April 18-22, 1983 Portland, Oregon
May 7-11, 1984 Kansas City, Missouri
April 15-19, 1985 Atlanta, Georgia
April 20-23, 1986 Minneapolis, Minnesota
April 5-8, 1987 Indianapolis, Indiana
April 17-20, 1988 Phoenix, Arizona
April 15-19, 1989 Baltimore, Maryland
April 28‒May 2, 1990 New Orleans, Louisiana
June 1-5, 1991 Cincinnati, Ohio
March 28‒April 1, 1992 Houston, Texas
June 19-23, 1993 Seattle, Washington
July 9-13, 1994 Boston, Massachusetts
(Can-Am Conference)
April 8-12, 1995 Denver, Colorado
April 19-23, 1996 Chicago, Illinois
April 11-15, 1997 Orlando, Florida
April 3-7, 1998 Baltimore, Maryland
April 16-20, 1999 Indianapolis, Indiana
March 31‒April 4, 2000 Seattle, Washington
April 19-23, 2001 Philadelphia, Pennsylvania
May 2-5, 2002 Miami Beach, Florida
June 6-9, 2003 Washington, DC
May 20-23, 2004 Minneapolis, Minnesota
May 12-15, 2005 Long Beach, California
April 27-30, 2006 Charlotte, North Carolina
April 20-23, 2007 St. Louis, Missouri
April 9-13, 2008 Long Beach, California
April 23-26, 2009 Houston, Texas
April 29‒May 2, 2010 Orlando, Florida
April 14-17, 2011 Philadelphia, Pennsylvania
April 26-29, 2012 Indianapolis, Indiana
(continued)
370 Appendix E

DATE LOCATION
April 25-28, 2013 San Diego, California
April 2-6, 2014 Baltimore, Maryland
April 16-19, 2015 Nashville, Tennessee
April 7-10, 2016 Chicago, Illinois
March 30‒April 2, 2017 Philadelphia, Pennsylvania
*No National meeting held because of war emergency.
Annual Meetings from 1922 to 1937 were held in conjunction with the American
Hospital Association.
Adapted from:
AOTA. (1967). 50th Anniversary: Then...1917 and Now...1967. New York, NY: American
Occupational Therapy Association.
AOTA. (2014). Annual Meetings and Conferences of The National Society for the
Promotion of Occupational Therapy and The American Occupational Therapy
Association. Received from Mindy Hecker, May 21, 2014.
 Appendix F
Eleanor Clarke Slagle
Lecturers and Lectures
YEAR LECTURER TITLE OF LECTURE
1955 Florence M. Stattel Equipment Designed for Occupational Therapy
1956 June Sokolov Therapist Into Administrator: Ten Inspiring Years
1957 Ruth W. Brunyate Powerful Levers in Common Things
1958 Margaret S. Rood Every One Counts
1959 Lillian S. Wegg The Essentials of Work Evaluation
1960 Muriel E. Zimmerman Devices: Development and Direction
1961 Mary Reilly Occupational Therapy Can Be One of the Great Ideas of 20th Century
Medicine
1962 Naida Ackley The Challenge of the Sixties
1963 A. Jean Ayres The Development of Perceptual-Motor Abilities: A Theoretical Basis for
Treatment of Dysfunction
1965 Gail S. Fidler Learning as a Growth Process: A Conceptual Framework
1966 Elizabeth June Yerxa Authentic Occupational Therapy
1967 Wilma L. West Professional Responsibility in Times of Change
1969 Lela A. Lorens Facilitating Growth and Development: The Promise of Occupational
Therapy
1971 Geraldine L. Finn The Occupational Therapist in Prevention Programs
1972 Jerry A. Johnson Occupational Therapy: A Model for the Future
1973 Alice C. Jantzen Academic Occupational Therapy: A Career Specialty
1974 Mary R. Fiorentino Occupational Therapy: Realization to Activation
(continued)

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 371-373).
- 371 - © 2017 SLACK Incorporated.
372 Appendix F

YEAR LECTURER TITLE OF LECTURE

1975 Josephine C. Moore Behavior, Bias, and the Limbic System
1976 A. Joy Huss Touch with Care or Caring Touch?
1978 Lorna Jean King Toward a Science of Adaptive Responses
1979 L. Irene Hollis Remember?
1980 Carolyn Manville Baum Occupational Therapists Put Care in the Health System
1981 Robert K. Bing Occupational Therapy Revisited: A Paraphrastic Journey
1983 Joan C. Rogers Clinical Reasoning: The Ethics, Science, and Art
1984 Elnora M. Gilfoyle Transformation of a Profession
1985 Anne Cronin Mosey A Monistic or a Pluralistic Approach to Professional Identity?
1986 Kathlyn L. Reed Tools of Practice: Heritage or Baggage
1987 Claudia Kay Allen Activity: Occupational Therapy s Treatment Method
1988 Anne Henderson Occupational Therapy Knowledge: From Practice to Theory
1989 Shereen D. Farber Neuroscience and Occupational Therapy: Vital Connections
1990 Susan B. Fine Resilience and Human Adaptability: Who Rises Above Adversity?
1993 Florence Clark Occupation Embedded in Real Life: Interweaving Occupational
Science and Occupational Therapy
1994 Ann P. Grady Building Inclusive Community: A Challenge for Occupational Therapy
1995 Catherine A. Trombly Occupation: Purposefulness and Meaningfulness
1996 David L. Nelson Why the Profession of Occupational Therapy Will Flourish in the 21st
Century
1998 Anne G. Fisher Uniting Practice and Theory in an Occupational Framework
1999 Charles H. Christiansen Defining Lives: Occupation as Identity: An Essay on Competence,
Coherence, and the Creation of Meaning
2000 Margo B. Holm Our Mandate for the New Millennium: Evidence-based Practice
2001 Winnie Dunn The Sensation of Everyday Life: empirical, Theoretical, and Pragmatic
Considerations
2003 Charlotte Brasic Royeen Chaotic Occupational Therapy: Collective Wisdom for a Complex
Profession
2004 Ruth Zemke Time, Space, and the Kaleidoscopes of Occupation
2005 Suzanne M. Peloquin Embracing Our Ethos, Reclaiming Our Heart
2006 Betty Risteen Hasselkus The World of Everyday Occupation: Real People, Real Lives
2007 Jim Hinojosa Becoming Innovators in a Era of Hyperchange
2008 Wendy J. Coster Embracing Ambiguity: Facing the Challenge of Measurement
2009 Kathleen Barker Reclaiming Our Heritage: Connecting the Founding Vision to the
Schwartz Centennial Vision
(continued)
 Eleanor Clarke Slagle Lecturers and Lectures 373

YEAR LECTURER TITLE OF LECTURE

2010 Janice Posatery Burke What s Going on Here? Deconstructing the Interactive Encounter
2011 Beatriz C. Abreu Accentuate the Positive: Reflections on Empathetic Interpersonal
Interactions
2012 Karen Jacobs PromOTing Occupational Therapy: Words, Images, and Actions
2013 Glen Gillen A Fork in the Road
2014 Maralynne D. Mitcham Education as Engine
2015 Helen S. Cohen A Career in Inquiry
2016 Susan L. Garber The Prepared Mind
2017 Roger O. Smith Technology and Occupation: Past 100, Present and Next 100 Years
Note: Eleanor Clarke Slagle lectureship is not awarded every year.
Appendix G
AOTA Award of Merit
Recipients
YEAR RECIPIENT(S) YEAR RECIPIENT(S)
1950 Munzesheimer, Eva Otto 1968 McDaniel, Myra L.
Wiemer, Ruth Brunyate
1951 Greene, Marjorie B. 1971 Spelbring, Lyla M.
West, Wilma L.
1952 Kahmann, Winifred C. 1972 Crampton, Marion W.
1954 Taylor, Marjorie M. 1973 Hollis, L. Irene
Willard, Helen S.

1955 McNary, Henrietta 1974 Cromwell, Florence S.

1956 Rouse, Dorothy D. 1975 Welles, Carlotta

Spackmann, Clare S.

1957 Dunton, William Rush 1976 Hopkins, Helen L.

Kilburn, Virginia T.
Schwagmeyer, Mildred

1959 Robinson, Ruth A. 1977 Matthews, Martha E.

1960 Spear, Marion R. 1978 Moersch, Martha T.
1962 Wade, Beatrice D. 1979 Jantzen, Alice C.
Johnson, Jerry A.

1964 Fish, Marjorie 1980 Fidler, Gail S.

1965 Ayres, A. Jean 1982 Butz, Clyde W.

Jeffers, Lucie Spence
1967 Gleave, G. Margaret 1983 Hightower-VanDamm, May D.
Reed, Kathlyn L.
(continued)

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (pp. 375-376).
- 375 - © 2017 SLACK Incorporated.
376 Appendix G

YEAR RECIPIENT(S) YEAR RECIPIENT(S)

1984 Baum, Carolyn Manville 2000 Evert, Mary Margaret
Devereaux, Elizabeth B. Grady, Ann P.
Hamant, Celestine
Sammons, Fred
1985 Jaffe, Evelyn Grossman 2001 Anderson, Reba
Fine, Susan B.
Rourk, Jane Davis
1986 Llorens, Lela A. 2003 Jacobs, Karen
Slominski, Anita H. Ottenbacher, Kenneth J.
1987 Bing, Robert Kendall 2004 Miller, Lucy Jane
Yerxa, Elizabeth J.
1988 Tyndall, Dean R. 2006 Gillette, Nedra
1989 Hays, Carole Ann 2007 Clark, David D.
1990 Rogers, Joan C. 2008 Foto, Mary Elizabeth Smith
1991 Dunn, Winifred W. 2009 Kornblau, Barbara L.
Gilfoyle, Elnora M.
1992 Gilkeson, Grace E. 2010 Carrasco, Ricardo C.
Mitchell, Marlys
1993 Henderson, Anne 2011 Kielhofner, Gary (Posthumous)
1994 Hinojosa, Jim 2012 Kramer, Paula
1995 Prendergast, Nancy D. 2013 Moyers Cleveland, Penelope
1996 Hansen, Ruth 2014 Holm, Margo
Izutsu, Satoru
1997 Kolodner, Ellen L. 2015 Mitcham, Maralynne D.
(Posthumous)
1998 Stattel, Florence 2016 Fisher, Thomas F.
1999 Clark, Florence A. 2017 Christiansen, Charles
Note: Award of Merit is not given every year.
 Appendix H
AOTA Membership Summary

YEAR NO. OF YEAR NO. OF

MEMBERS MEMBERS
1917 40 1970 9,348
1920 190 1975 20,120
1925 749 1980 30,616
1930 883 1985 40,941
1935 831 1990 44,792
1940 1,207 1995 54, 884
1945 2,177 2000 46,093
1950 2,967 2005 34,368
1955 3,896 2010 49.226
1960 4,938 2015 53,203
1965 5,350
Notes: Based on unpublished membership numbers supplied
by the Association. Two external events slowed the growth of
the Association s membership. One was the Great Depression
of the 1930s and the other was the introduction of the man-
aged care payment system and therapy cap imposed by the
Balanced Budget Act of 1997.

Andersen, L. T., & Reed, K. L.

The History of Occupational Therapy: The First Century (p. 377).
- 377 - © 2017 SLACK Incorporated.