How can the occupation base of occupational therapy be strengthened?
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Australian Occupational Therapy Journal (2003) 50, 1–2 Blackwell Science, Ltd Editorial Editorial How can the occupation base of occupational therapy be strengthened? Change is happening rapidly in occupational therapy today, driven by the internal maturation of the profession. Internationally the numbers of master’s and doctoral level occupational therapy programmes are increasing every year. More journals of general and specialised interest serve the field than ever before. More books are published. New areas of practice are emerging. Compared to 10 or 20 years ago, occupational therapy literature includes more research and it is of higher quality. Scholars in the field have become more critically insightful in regard to the multidisciplinary theories they import and the values that underlie different approaches to service and research. Occupational science, the study of human experiences and patterns of activity, has dramatically accelerated our con- tinued exploration of the primary mode and target of our interventions: occupation. Factors in the health-care environment are also pushing occupational therapy through rapid change. The call for evidence-based practice and outcomes research is shaping the work of many of our researchers. Occupational therapy’s long-held focus on function and skills for daily living has come into congruence with health care’s emphasis on functional outcomes. This has led to com- petition from other fields over areas of practice they have never before considered important and that have traditionally been the unquestioned domain of occupational therapy. An upswell of desire for stronger occupation-based practice is evident in the profession. As our practitioners, students, educators and researchers strive for ever-higher goals, they centre on the most powerful medium available, the therapeutic power of occupation. Accommodating to change, competition and growth, the profession reaches to its core for stability. Now that occupational science is yielding the harvest of scholarship on occupation that it promised (Clark et al., 1991), we cannot help but wonder how this new knowledge can best be applied in practice. How can the occupation base of occupational therapy be strengthened? Three bridges need to be built between occupational science and occupational therapy in order to put the discoveries of the discipline to work for the clients of the profession: a generative discourse, educational programmes, and demonstration programmes focused on occupation-based practice (Pierce, 2001, 2003). A generative discourse on occupation-based practice produces new concepts through a process of open discussion, research and debate on how occupation-based practice best occurs. By bringing these questions forward here, this editorial is a part of that generative discourse. From momentary conversations between therapists to published research projects, the vitality of this field-wide exchange of fresh ideas is a critical aspect of enhancing the occupation base of our practice. Without an active generative discourse, it is possible that the degree to which occupational science concepts would be brought to bear on practice would be limited. Thus far, some of the most potent ideas produced by the generative discourse on occupation-based practice include occupation as the means and ends of intervention (Gray, 1998), top-down assessment (Coster, 1998), and the appeal, intactness, and accuracy of intervention (Pierce, 2001, 2003). In my home country, the United States of America, there is an explosion of interest in educating practitioners for occupation-based practice. Driven by the accreditation mandate that entry into the field be at the post-baccalaureate level, many new curricula are being designed. The American Occupational Therapy Association has published the new Practice Framework, which details an occupation-based approach. This move by a national association to bring practice back to its core values parallels what occurred in Canada several years ago in creating a new focus on client- centred care in occupational therapy. Brought together in this way, these factors are combining to produce a rapid updating of educational programmes that are strongly occupation-based. As the students of these new programmes enter clinical settings, however, they encounter great variabil- ity in the practice approaches they find. This gap between newly trained and experienced clinicians calls for immediate attention. Demonstration programmes seek to use and model occupation-based practice to its best effect. To enhance
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Transcript of How can the occupation base of occupational therapy be strengthened?
Australian Occupational Therapy Journal (2003) 50, 1–2
Blackwell Science, Ltd
E d i t o r i a l
EditorialHow can the occupation base of occupational therapy be strengthened?
Change is happening rapidly in occupational therapytoday, driven by the internal maturation of the profession.Internationally the numbers of master’s and doctoral leveloccupational therapy programmes are increasing everyyear. More journals of general and specialised interestserve the field than ever before. More books are published.New areas of practice are emerging. Compared to 10 or20 years ago, occupational therapy literature includes moreresearch and it is of higher quality. Scholars in the fieldhave become more critically insightful in regard to themultidisciplinary theories they import and the values thatunderlie different approaches to service and research.Occupational science, the study of human experiences andpatterns of activity, has dramatically accelerated our con-tinued exploration of the primary mode and target of ourinterventions: occupation.
Factors in the health-care environment are also pushingoccupational therapy through rapid change. The callfor evidence-based practice and outcomes research isshaping the work of many of our researchers. Occupationaltherapy’s long-held focus on function and skills for dailyliving has come into congruence with health care’semphasis on functional outcomes. This has led to com-petition from other fields over areas of practice theyhave never before considered important and that havetraditionally been the unquestioned domain of occupationaltherapy.
An upswell of desire for stronger occupation-basedpractice is evident in the profession. As our practitioners,students, educators and researchers strive for ever-highergoals, they centre on the most powerful medium available,the therapeutic power of occupation. Accommodatingto change, competition and growth, the profession reachesto its core for stability. Now that occupational science isyielding the harvest of scholarship on occupation thatit promised (Clark et al., 1991), we cannot help butwonder how this new knowledge can best be applied inpractice. How can the occupation base of occupationaltherapy be strengthened? Three bridges need to be builtbetween occupational science and occupational therapyin order to put the discoveries of the discipline to
work for the clients of the profession: a generativediscourse, educational programmes, and demonstrationprogrammes focused on occupation-based practice (Pierce,2001, 2003).
A generative discourse on occupation-based practiceproduces new concepts through a process of open discussion,research and debate on how occupation-based practice bestoccurs. By bringing these questions forward here, this editorialis a part of that generative discourse. From momentaryconversations between therapists to published researchprojects, the vitality of this field-wide exchange of freshideas is a critical aspect of enhancing the occupation baseof our practice. Without an active generative discourse, it ispossible that the degree to which occupational scienceconcepts would be brought to bear on practice would belimited. Thus far, some of the most potent ideas producedby the generative discourse on occupation-based practiceinclude occupation as the means and ends of intervention(Gray, 1998), top-down assessment (Coster, 1998), and theappeal, intactness, and accuracy of intervention (Pierce,2001, 2003).
In my home country, the United States of America, thereis an explosion of interest in educating practitioners foroccupation-based practice. Driven by the accreditationmandate that entry into the field be at the post-baccalaureatelevel, many new curricula are being designed. The AmericanOccupational Therapy Association has published thenew Practice Framework, which details an occupation-basedapproach. This move by a national association to bringpractice back to its core values parallels what occurred inCanada several years ago in creating a new focus on client-centred care in occupational therapy. Brought together inthis way, these factors are combining to produce a rapidupdating of educational programmes that are stronglyoccupation-based. As the students of these new programmesenter clinical settings, however, they encounter great variabil-ity in the practice approaches they find. This gap betweennewly trained and experienced clinicians calls for immediateattention.
Demonstration programmes seek to use and modeloccupation-based practice to its best effect. To enhance
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occupation-based practice, we need occupation-basedprogrammes in every area. Publishing about how theseprogrammes work and are conceptualised will be criticalto the generative discourse. I have participated in reflec-tive research on the development of two such pro-grammes so far, one in an independent and assisted-living centre for elders (Goldstein-Lohman, Kratz &Pierce, unpubl. data, 2002) and one for at-risk youth inalternative educational settings (Cunningham, Dunn,Fehringer, Marshall & Pierce, unpubl. data, 2002). Inboth studies, the therapists discovered much, wereenergised by their efforts, and grew greatly in their cre-ativity and satisfaction with occupation-based practice. Ihope and expect that many such demonstration programsare currently being initiated by therapists around theworld, as they seek to apply the new discoveries of occu-pational science.
Can change move too fast? Perhaps. For us, it seemsstressful to be continually rethinking practice. For our clients,however, our strengthening of the therapeutic use ofoccupation to help them meet life goals can never cometoo fast.
Doris PierceEndowed Chair in Occupational Therapy,
Eastern Kentucky University,
Richmond, Kentucky, USA
Member, Editorial Advisory Board,
Australian Occupational Therapy Journal
REFERENCESClark, F. A., Parham, L. D., Carlson, M. E., Frank, G., Jackson, J.,
Pierce, D. et al. (1991). Occupational science: Academicinnovation in the service of occupational therapy’s future.American Journal of Occupational Therapy, 45, 300–310.
Coster, W. (1998). Occupation-centered assessment of children.American Journal of Occupational Therapy, 52, 337–344.
Gray, J. M. (1998). Putting occupation into practice: Occupationas ends, occupation as means. American Journal of Occupa-tional Therapy, 52, 354–364.
Pierce, D. (2001). Occupation by design: Dimensions, creativ-ity, and therapeutic power. American Journal of OccupationalTherapy, 55, 249–259.
Pierce, D. E. (2003). Occupation by design: Building therapeuticpower. Philadelphia: FA Davis.
EDITOR’S COMMENT
A special issue of the Australian Occupational TherapyJournal on Occupation will be published in June 2003.
