A History of the Occupational Therapy Profession
Era I - Pre Professional Age (1900s - 1920s)
Occupational Therapy (OT) stemmed from the arts and crafts movement and the moral treatment movement. Originally, there was no specific training for Occupational Therapists. However, the focus of OT practice was on the holistic point of view and looked beyond just medicine to find a sense of mental achievement and being productive.
The influence from the arts and crafts movement was to increase leisure and productivity through "hand and mind = health". The moral treatment movement helped facilitate the holistic point of view by actively involving the patients into the treatment.
In Canada, like in other parts of the world, occupational therapy had its early beginnings when doctors started to prescribe moral treatment for patients in the late 1800's in TB sanatoriums and mental hospitals. Later, in fear of exploiting patients, activity was moved away from realistic work to classes in occupational rooms led by occupational workers.
During World War I, 1914 - 1918, vast numbers of wounded men required activity to assist them to resume their daily living roles and at first volunteers assisted them. When the need for training was realized, the University of Toronto established first a 6 week, then a 3 month long course. From 1918 - 1919, 356 "suitable young ladies" graduated as occupational aides qualified to instruct in bedside occupation. These women worked in military hospitals.
Era II - Neo Professional Era (1920s-1930s)
When the war was over, the Ward Aids were demobilized and were moved into mental health facilities, tuberculosis sanatoriums, and workshops in the community settings.
Early occupational therapists recognized the need to establish an identity and some cohesion amongst themselves. They organized to promote occupational therapy to the medical profession and to the public. The Ontario Society of Occupational Therapy was inaugurated in October 1920. It was incorporated under Letters Patent in 1921 as the first professional association of occupational therapists in Canada. The head office of the Society was in Toronto, with branches in Hamilton, Kingston, London and Ottawa. His Honour the Lieutenant Governor of Ontario consented to act as the Honourary President. The Objects of the first Society were outlined at the first Drawing Room Meeting on October 4, 1921 at which there were 300 delegates. The objects were;
- To study occupations for various forms of handicaps
- To advance occupation as a therapeutic measure
- To disseminate knowledge on the subject
A second Drawing Room Meeting of the Ontario Society of Occupational Therapy was held in 1925. Two hundred and fifty occupational therapists and guests attended. An urgent need for more therapists was discussed and as a result the first university program at the University of Toronto was initiated in 1926.
In 1926, the Canadian Association of Occupational Therapy (CAOT) was founded and in 1932, CAOT launched the Canadian Journal of Occupational Therapy.
During the 1930s, Occupational Therapy progressed by including the vocational training, industrial therapy programs, and clinical workshops. These programs were set up to assist newly discharged patients to help them readjust and develop tolerance to work.
Specializations developed in the areas of tuberculosis, paediatrics, and psychiatry.
Era III - WWII - 1967
Occupational Therapists addressed orthopaedic, neurological, and psychiatric conditions with returning soldiers. Occupational Therapists also provided the opportunity for meaningful occupations for the Canadian and British POWs. The military saw how productive the wounded soldiers were after working with an Occupational Therapist and changed their policies to allow OTs on the front lines. On Nov. 6, 1943, the department of defense announced OTs could enlist in the Royal Canadian Army Medical Corps RCAMC) in the Nursing Corps.
In 1959, under the direction of Muriel Driver, the first "Special Courses" in OT were developed into an 18 month program at Queen's University.
Between 1950 and 1970, 20 OT programs were initiated and the length of the university programs increased to 4 years.
Era IV - Evidence based practice (1967-1990s)
Canadian Occupational Therapists played a major role in the establishment and ongoing development of the World Federation of Occupational Therapy
The Society continued to represent occupational therapists in the province and In October 1968 the name of the Society was changed to the Ontario Society of Occupational Therapists.
In the late sixties work began towards the goal of self regulation of the profession in Ontario. In 1968 the Society's first brief to government was submitted.
After two decades of combined training, the 1970s led to the separation of Occupational and Physical therapy programs and the replacement of the diploma with the baccalaureate degree.
The 1980s led to the development of Guidelines for the Client-Centred Practice of Occupational Therapy, Intervention Guidelines for Client-centred Practice of Occupational Therapy and Toward Outcome Measures in Occupational Therapy, all published by the Canadian Association of Occupational Therapists.
On May 17, 1983, the Canadian Occupational Therapy Foundation (COTF) was launched to provide the important step in providing funding for OT research and development projects.
In 1984, Ontario occupational therapists engaged a voluntary college, the College of Occupational Therapists of Ontario as a separate bylaw of the OSOT in an effort to demonstrate the profession's commitment to self regulation. Ontario's health professions regulation review commenced in the mid-80's and provided a policy environment in which OSOT could position the profession's merits for self regulation.
Development of the Master's program and PhD programs in OT. Canada's first MSc OT program was offered by University of Alberta in 1986.
In 1987, OT shifted from the focus of the medical model to community based practice and health promotion.
OSOT launched its membership newsletter, The LINK in April 1990, originally as a quarterly update and professional resource but quickly becoming a bi-monthly publication.
The profession was regulated in Ontario in 1991 under the Regulated Health Professions Act, 1991 which enacted a transitional council of the College of Occupational Therapists of Ontario which formally registered occupational therapists in 1994.
In 1991, CAOT's OT guidelines for Client-Centred Practice, led to the development of the Canadian Model of Occupational performance (CMOP), the Person, Environment, Occupation Model (PEO), and Occupational Performance Process Measure (OPPM) in the 1990s. These important documents demonstrated the profession's advance in theory and clinical practice.
During the 1990s, there was an increase in the number of self-employed OTs, a continuing shift away from departmental organization in hospitals to program management/matrix management models, hospital restructuring across the province and increasing privatization of health care services including the divestment of therapy services from Home Care Programs. Ontario's auto insurance sector saw 3 reforms over this decade and private occupational therapy services targeted for this sector saw tremendous growth.
Technology had a huge impact on the development of OT. CAOT launched their website in 1998 and offered web seminars, web workshops, online publications, practice resources, and discussion rooms. OSOT launched OSOT Online in 1999 and has continued to build web based practice resources, policy updates and monthly email updates as effective means to apprise members of information in a timely manner.
CAOT's practice-oriented magazine, Occupational Therapy Now, was developed in 1999.
Era V - 2000 and beyond
Technology is playing a huge impact on the development of OT. Speech recognition software, adaptive equipment, wheelchairs, computer software programs, and electronic environmental controls have assisted in the facilitation of clients into their daily activities.
The pace of OT has shifted and places a large component on communication and client centred practice. The demand for evidence to validate services and to meet the demands of payors is a driving force.
In 2002 the CAOT issued a position statement related to entry level educational preparation. Effective 2008, CAOT will only grant academic accreditation to those occupational therapy educational programs that lead to a professional Master's degree in occupational therapy as the entry credential.
Early in the new millennium Ontario occupational therapists participating in an OSOT visioning workshop identified the following 5 critical priorities to address to assure a vibrant future for the profession in Ontario:
- Assuring access to occupational therapy services - particularly accessing extended health coverage of OT services and defining a role for occupational therapy in primary care
- Supporting and assisting members to integrate evidence into practice - fostering knowledge transfer
- Transitioning to master level entry education
- Promoting and facilitating professional networking - a must
- Promoting the profession of occupational therapy - assuring a strong future
- Promoting a focus and recognition of OT in work practice.
McColl, M., Law, M., Stewart, D., Doubt, L., Pollock, N., and Krupa, T. (2003.) Theoretical Basis of Occupational Therapy Second Edition. Thorofore, NJ: Slack Incorporated.