Celebrating AOTA’s Centennial: A Historical Look at 100 Years of Occupational Therapy

Shellshock. The signature injury of the first world war. Left soldiers in a panicked state of nervous and mental shock. Impairing the ability to reason, sleep. walk, or talk. In 1917, In 1917, the US War Dept. appointed reconstruction aides. Civilian women who served in military hospitals at home and abroad. These women provided treatments to help reconstruct disabled soldiers. Among the first occupational therapy reconstruction aids to arrive in France during the summer of 1918, was Lena Hitchcock “We landed at night. The next morning we were told by the very swank commanding officer that he had told Doctor Gold-plate, who was chief orthopedic man of the AEF, that he didn’t want us and he said, I assure you that you will be sent back on the next available boat. But in the meantime, make yourself useful. And Hillsy stood up with burning, puffing cheeks and stood up against him, “I would remind you general that the same government that placed you here, sent us. And we will probably remain as long as we behave ourselves.” “The called us the Blue Birds because of our uniforms being blue. They were hideous. They were designed by a man in the surgeon general office to be as unattractive as possible, because we’d be safer that way.” With backgrounds as teachers, secretaries, and artists, the occupational therapy reconstruction aides worked alongside nurses on handicrafts, as well as vocational skills, to distract the injured, increase physical activity, and improve morale. “I took tools into my ward everyday. After I told them to make their beds or helped them make their beds, I would do something that was fairly showy. They would gather around me. From that day on, I had 90 men working. It was thrilling!” Throughout the 19th century, the influence of moral treatment of the arts and crafts movements inspired physicians, nurses, and social workers to use occupation based activities to engage the mind and hands of patients. “Idleness too long continued, is as deadening to spirit as it is disabling to the body. Too often it means degeneration and increased suffering.” At his workshop for nervous invalids in Marblehead, Massachusetts, Dr. Herbert Hall prescribed occupation according to his “Work Cure” theory of using arts and crafts to promote self-esteem, employment potential, and better health. “Whatever the work, let it possess a certain dignity in the culminating sense of time well spent even though it be within the four walls of a sick room. Boston nurse, Susan Tracy began noticing the benefits of occupation for relieving nervous tension and making bed rest more tolerable for her patients. At the Adams and Irvine asylum she offered the first training courses for occupational nursing and at the Shepherd and Enoch Pratt hospital in Towson, Maryland, psychiatrist psychiatrist William Rush-Dutton became intrigued by the healing of his patients through purposeful activities. Embracing what was by Embracing what was by 1914 called “Occupational Therapy.” After spending more than a year in a sanitarium and knowing his health wouldn’t allow him to return to architecture, George Edward Barton opened Consolation House in Clifton Springs, NY to rehabilitate himself and others. “Occupational Therapy! If there is an occupational disease, why not occupational therapy?” It was here at the Consolation House on March 15, 1917 that the National Society for the Promotion of Occupational Therapy was founded Bringing together five additional distinguished founding members to round out this profession, Mr.Barton became the society’s first President. His Assistant and future wife, Isabel Newton, was appointed the first secretary. Dr. William Ruch-Dutton of the Shepard and Enoch Hospital also became a founding member. That occupation as necessary to life as food and drink, that every human being being should have both physical and mental occupation, so that sick minds, sick bodies, sick souls, sick souls maybe healed . through occupation Designer and arts and crafts teacher Susan Cox Johnson was known for her work at Blackwells Island Hospital in Manhattan Chapter of the Occupations Committee of the NY State Dept of Public Charities. She went on to teach occupational therapy at at Columbia Universit As the vocational secretary of the Canadian Military Hospitals Commission, Thomas B. Kidner developed a program to engage bedridden soldiers recovering from wartime injuries and tuberculosis in occupations with the eventual goal of returning to productive work His work gained the attention of Eleanor Clarke Slagle another of the founding members Eleanor Clarke Slagle was an important figure in the professional development of OT. She worked with the famous Hull House reformers directed Occupational Therapy Department at the Phipps psychiatric clinic at Johns Hopkins Hospital and from 1915-1920, she organized and directed the Henry B. Favill School of Occupations. The first professional school for Occupational Therapists. “She was handsome. She always dressed beautifully, yet she had a lot of charm and humor. and she could hold her own with anybody.” A natural born leader, not only was Miss Slagle the societies first Vice President, She eventually time than anyone else. “OT was her goal and her belief she could make other people see it A 1918 government bulletin stated That occupational therapy is science of healing by occupation This was the beginning of our tradition In that year, occupational therapy schools opened in Milwaukee, Boston, Philadelphia and St. Louis A first step from moving its women from handicrafts ladies to college educated therapists Dr. Adolph Meyer a Psychiatrist in Chief at Johns Hopkins Hospital who knew Eleanor Clarke Slagle from her time there incorporated community based activities and services to develop people’s every day living skills Our role consists of giving opportunities rather than prescriptions. There must be opportunities to do and to plan and to create and to learn to use material, not a question of specific prescriptions, but of opportunities. After the the Great War ended 1918, the sweeping popularity of the reconstruction aides secured a permanent spot for rehabilitation workers in American medicine Reconstruction Aide Ora Ruggles arrived at Fort McPherson at Atlanta Georgia where some 5,000 war amputees were hospitalized A captain growled at Ora, “How in God’s name can you help wrecks like these?” Ora replied, by finding and teaching them occupations that will take their mind’s off their misfortunes To make them aware of life again. And get them to respond to it. It is not enough to give a patient something to do with. his hands. It’s the heart that really does the healing. You must reach for the heart as well as the hands. The Roaring Twenties! The Jazz Age! An era energized with economic prosperity modern technology and political equality for women The prosperous twenties lead to a burst of milestones for the new organization. In 1920, the organization had 190 members and held its annual conference in historic Philadelphia A city it would return to right up to today. In 1922, Eleanor Clarke Slagle moved to the organization into its first official headquarters in a Manhattan office building. For the next 50 years, the headquarters moved in and out of various NYC offices including a stint in the landmark Flatiron Building. That same year, 1922, the organization published its first professional journal The Archives of Occupational Therapy Edited by Dr. Dunton, the new journal organized the professions growing body of literature in one publication. Later, the journal was renamed Occupational Therapy and Rehabilitation and was included as a member benefit. In 1923, the National Society for the Promotion of Occupational Therapy, finalized it’s new name and Eleanor Clarke Slagle was named its first Executive Director. The optimism and prosperity came to a dramatic end when the stock market crashed in 1929 sending the country into the Great Depression through the 1930’s. During this challenging era, AOTA continued to advance the profession’s status. In 1933, in order to accredit occupational therapy. A relationship that spanned the next 60 years. It was in 1935 that AOTA and The American Medical Association adopted the Essentials of an Acceptable School of Occupational Therapy, which have continuously evolved into the Educational Standards of today. And the annual conferences held in metropolitan cities were often in conjunction with the American Hospital Association, which increased the profession’s visibility and also closely linked it with physicians and hospital leaders. At the AOTA Conference in 1937 in Atlantic City, a special celebration dinner was held in honor of Eleanor Clarke Slagle who retired from professional life. Passing the torch to the second generation of occupational therapists after more than 2 decades of serving the association. First Lady Eleanor Roosevelt was not only in attendance, but also shared these fond memories: “I walked along the boardwalk in the sunshine to the auditorium. It was a very interesting exhibit, and as usual, the occupational therapy booths were particularly interesting to me. And a dinner in the evening in honor of Mrs. Eleanor Clarke Slagle was a very touching tribute. I have had much opportunity to observe her work, and to realize what it has meant to many unfortunates.” 1942. President Roosevelt calls on everyone to “do your part” as the United States enters World War II. Everything was conserved and redirected to the war effort, including the work of occupational therapists. “Good morning.” “Good morning, Miss.” “Now here in occupational therapy, we’ll give you various jobs to do, all requiring particular motions of your hand and help you regain the use of your hand.” “The next milestone is in conjunction with World War II, when the tremendous expansion of military hospitals to serve the war wounded opened up occupational therapy programs for a broad range of orthopedically disabling conditions. And we also practiced considerably in psychiatry during the World War II years.” As the need for Army OTs increased during World War II, so too did the need for quickly training them. Thus the 12-month-long war emergency courses were introduced at schools throughout the nation. “They needed considerable numbers of occupational therapists. And we went to school with a very heavy load for 4 months. And we were all college graduates.” Led by Winifred “Winnie” Kahmann, Chief of the Surgeon General’s Occupational Therapy branch, the Army agreed to raise occupational therapy to a professional classification. An important step toward wider recognition and respect. In 1944, the Women’s Army Corps implemented the occupational therapy assistants training course. OTAs were assigned to select Army hospitals, where they assumed much of the responsibility for recreation- and leisure-based programs. By the end of the war in 1945, 899 OTs and apprentices, and 278 OT assistants, were working in 76 Army hospitals across the country. In the peacetime of 1947, Winnie Kahmann became the first occupational therapist elected AOTA President. Under her leadership, AOTA launched the American Journal of Occupational Therapy. Charlotte Bone was the first editor. “I wanted to reach the practicing OT. I wanted to have the journal be something that would convey intent and purposes of AOTA to the membership. But I wanted it to convey the ideas back and forth on the therapy level.” In that same year, 1947, Helen Willard and Clare Spackman, instructors at the Philadelphia School, released their new textbook: Principles of Occupational Therapy. Now in its 12th edition, it is a foundational resource for students and clinicians. “I got so used to writing papers, that I decided we should have a book on OT. And I started to write a book on the treatment of physical disabilities. When out of the clear, blue sky, J. B. Lippincott, Mr. Lippincott himself, invited us to the Union League for lunch. And served us the best lunch possible, and proposed that we edit a book on OT, but he wanted representatives of all the schools and geographical distribution, and the covering of the whole field.” When asked to summarize the World War II generation of OT leaders, Alice Jantzen had this to say: “Women with minds of their own. And they would brook no nonsense. You knew what was expected of you, and if you wanted to take them on and challenge them you had to really have all your arguments in good order.” The 1950s and 60s were a time of economic expansion, new technologies, and widespread social reforms. Families settled into the suburbs, and turned on their tvs. [Archival narration] “Occupational therapy is interest- motivated activity with a therapeutic purpose. A controlled means for satisfying the physiological and psychological needs for activity. Such therapy is prescribed by the medical officer to the occupational therapist to fit the individual physical or mental need of the patient.” During this new rehabilitation era, occupational therapists were working in VA hospitals around the country. “Frankly, you may have to spend a considerable amount of time with him before you can even expect a response.” While still under the direction of a qualified physician, OT practice became more technical and more specialized. “We’ll see what we can work out.” In 1952, a record 57,000 cases of polio were reported in the United States. “Now I know you’ve heard of polio, because you’ve been given your polio shots. But these boys and girls didn’t get their polio shots in time, and now they need your help. To help address the polio crisis, occupational therapists entered pediatric practice, working with children with polio, as well as children with cerebral palsy. At the same time occupational therapy was aligning more closely with the world of medicine, science, and vocational rehabilitation, AOTA was working on new ways of advancing the profession and its members. Eva Otto Munzesheimer received AOTA’s first award of merit in 1950 for her distinguished service to the Association. An award still given today to members who have made an outstanding contribution to the profession. And Florence Stattel received AOTA’s first Eleanor Clarke Slagle award in 1955, the profession’s highest scholarly honor. Her lecture on Equipment Designed for Occupational Therapy, featured analysis on how the bilateral tilt table facilitated specific movement patterns and motivated the patient to achieve goals. AOTA also formed a new medical advisory committee to provide a medical perspective to the association. And the organization published its first formal outline of Administrative Practices and Personnel Policies. The Association was also working on global issues, becoming 1 of the 10 founding members of the World Federation of Occupational Therapists. WFOT. Willard and Spackman were instrumental to the Federation’s early years. Motivated to elevate their work, a small group within AOTA’s education committee, called the Curriculum Directors, embarked on raising the educational standards. As one Curriculum Director stated, “I’m just not going to let the American Medical Association take over my profession.” Almost 10 years after first recognizing the need for assistant-level practitioners, in 1958 AOTA adopted educational standards for Certified Occupational Therapy Assistants– COTAs. The first 12- week-long programs focused on COTAs practicing in psychiatric facilities. And in 1960, education expanded to COTAs working in general practice. Continuing to firmly establish the profession, in the 1960s, OT practice began to move away from the medical model to focus more on the psychological and social aspects of treatment and the need for quality health care services. While on staff of the amputee clinic at Northwestern University, occupational therapist Fred Sammons began to design and build devices to assist individuals with disabilities in their everyday activities. As demand for these devices grew, he founded the Fred Sammons company. “In 1959, I sold the exhibit space for the American Occupational Therapy Association conference in Chicago. And that was the very first time we exhibited the products for the Sammons Company. So it was my spare time. It was a hobby. I wanted to do something just for a hobby, just for fun. But it began to grow and grow and grow.” Renowned therapist Mary Reilly received the Eleanor Clarke Slagle lecture award in 1961. Her lecture, entitled “Occupational Therapy Can Be One of the Great Ideas of 20th Century Medicine, featured what has become the profession’s greatest quotation. “That man, through the use of his hands, as the are energized by mind and will can influence the state of his own health.” “She was a mind that drove a profession. She went to serve the Army during and after World War II. And so she had massive practice looking at the impact of chronic disease on people and how important it was for them to engage in occupations. And she also laid the groundwork for us to know we had to be advocates, and that we really, really had to put our focus on helping people live lives. The 1963 Community Mental Health Act, signed by John F. Kennedy, started a major transformation of the public care system, away from large institutions and towards community- based care. Leaders in psychiatric practice and research, such as Lorna Jean King, Gail Fidler, and Anne Cronin Mosey, forged a new path for what would become mental health occupational therapy. OT Wilma “Willie” West knew that occupational therapy needed to change with the times. In her 1967 Slagle lecture, she explained that occupational therapy is concerned not only with with the individual’s physical abilities, but also with his mental, emotional, social, and economic needs. “It was also the origin of the geriatric consumerism movement, which ultimately led to federal legislation we now know as Medicare and Medicaid. In 1965, Medicare and Medicaid established programs that have expanded for decades to cover occupational therapy. Also in the 60s, AOTA started a policy and advocacy mission to advance members’ interests in Washington, DC, and state capitals throughout the nation. And the American Occupational Therapy Foundation, AOTF, was chartered. A nonprofit charitable organization to advance the science of occupational therapy. Working primarily with children, Scientist and Occupational Therapist A. Jean Ayres, pioneered a theory she called sensory integration. “At that time no one really thought of the human being as being directed by his nervous system. And I could see that sensation had a tremendous amount to do with motor output.” “Jean Ayres really taught me how to be a scientist. I think of occupational science as a systematic study of occupation. What people do every day. And how that impacts their health and their well-being.” In 1969, Dr. Lela Llorens became the first person of color to be awarded the Slagle Lecture. And she recalled that while delivering her lecture in Dallas, Texas, the wait staff lined the balcony during her delivery because they had seldom seen a black person addressing a majority white audience. Dr. Llorens is nationally recognized for her contributions as a clinician, educator, scholar, researcher, and author. And for her leadership as an administrator in higher education. [Archival Narration] “In hospitals, in private practice, in community health centers–occupational therapists are using a wide variety of professional skills, meeting a person at his level of functioning, and helping him reach the highest level possible for him.” “Can you hold the pencil down a little lower?” During the 1970s through the 1990s, occupational therapy embraced its more holistic roots, moving from beyond the hospital and out into the community by focusing on clients’ quality of life and optimal function, new practice areas emerged. Prevention and Wellness. Ergonomic and Work Programs. Assistive Technology. And meeting the needs of an aging population. After 50 years in New York City, in 1972 AOTA President Florence Cromwell moved the headquarter offices to Rockville, Maryland, in order to be closer to Congress and the National Institutes of Health. And in 1994, AOTA moved 8 miles south to Bethesda, Maryland, where headquarters are still today. “My belief is that just as federal laws have been very influential in determining how and to where health care has grown up to now, they will be even more forceful in deciding on its shape and direction in the future.” Ms. Cromwell made significant contributions on the national stage in areas of political advocacy, research, and education. As Ms. Cromwell predicted, throughout the 1970s, 80s, and 90s, the United States Congress passed many legislative acts which increased demand and opportunities for OT services. With the 1975 Education for All Handicapped Children Act, practice expanded throughout school systems, as children with disabilities were assured equal access to public education and related services, such as occupational therapy. OT’s role expanded further in 1990 when the Individuals with Disabilities Education Act stipulated childrens’ rights to an individualized, appropriate education in the least restrictive environment. More recently, through their focus on occupation, school-based practitioners began to address bullying prevention, successful transitions, social and emotional skills, and mental health in general. In 1986, occupational therapy gained separate coverage as a distinct Medicare Part B benefit, further expanding services to skilled nursing facilities and rehab agencies. During this time, scholars and theorists were exploring new models for better understanding and guiding clinical practice. “We must ask ourselves if we are on dangerous ethical grounds. Has occupational therapy gone the royal route of technology in our values system? To answer, we have to closely examine how much we value analyzing, testing, manipulating, and splinting our patients, against how much we value the patients doing, acting, adapting, and growing. Kielhofner, Burke, and colleagues’ groundbreaking Model of Human Occupation proposed that humans’ daily activity choices are driven by their motivations, habits, capabilities, and environments. The Person-Environment-Occupation Model, by Mary Law and colleagues, recognized that people’s environments and occupations, not just their physical skills alone determine performance and participation across a lifetime. The Americans with Disabilities Act, passed in 1990, guaranteed and protected the civil rights of people with disabilities. By emphasizing community participation and accessibility, the ADA created opportunities for occupational therapy to facilitate full engagement and participation for all. The profession was making big changes, too. The 61-year relationship with the American Medical Association ended in 1994 as the Accreditation Council for Occupational Therapy Education took full responsibility for overseeing OT educational programs. Several years later, AOTA’s Representative Assembly voted to move entry-level education for occupational therapists to the post-baccalaureate level by the year 2007. In 1997, occupational therapy experienced a major setback with the passage of the federal balanced budget act, which made significant cuts to Medicare. The act changed the landscape for occupational therapy, with payment changes and strict caps on patient access to services. Practitioners faced job changes, salary cuts, and limited opportunities for several years. But recovery was swift, because of the profession’s dexterity, commitment, and advocacy. “In 2002, to unify the profession, we needed really a very strategic approach, that would yield concrete, unarguable, positive results. We needed a Centennial Vision. So we brought in stakeholders from around the world to help us.” With an aging American population needing specialized services, more children with disabilities being diagnosed earlier, and chronic diseases continuing to rise, occupational therapy was quickly back in demand, stronger than ever. “We built confidence in practitioners, we built confidence in students. They became the troops that went into the grassroots, and they also became advocates on the Hill. There were really radiating effects of the Vision throughout the health care environment. Occupational therapy continued to address societal need. Particularly with renewed focus on mental health. “I’m learning about money a little bit.” “How to count the money and everything.” And AOTA’s Occupational Therapy Practice Framework reaffirmed that clients belong at the very center of all occupational therapy services. “Everything that Rye did in the occupational therapy session made a huge difference in my life because I got myself back on the tennis court.” AOTA unveiled its Centennial Vision in 2006. “We envision that occupational therapy is a powerful, widely recognized, science driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs. “The Centennial Vision really became very widely disseminated, and enthusiastically embraced. We are a science-driven, evidence-based profession, with many of us funded by prestigious funding agencies like the National Institutes of Health.” Today, a license to practice is required in all 50 states and 3 jurisdictions. “I can get my washcloth, my long brush for my back.” “The thing that is clearly our domain is occupation. The impact of occupation on human beings, which was spelled out for us as our sole claim to professionalism, back in 1917.” It’s been 100 years. An entire century since the founding meeting of the American Occupational Therapy Association. And what began with 6 people in a small village in Upstate New York has grown into an association that today is 60,000 members strong. “We are two examples not only of the Boston Marathon bombing of which there were 17 amputees and many hundreds injured, but also of our wounded warrior brothers and sisters at Walter Reed and around the country. You all have given us and them a gift. You helped us to get our independence back. Our lives back. Our love back. And that is a truly beautiful gift that we will never forget and always be thankful for.” “Thank you for dedicating much of your lives to this unique profession of occupational therapy. Where science, creativity, and compassion collide.” “Occupational therapists love their profession. And this feeling of confidence, and of contributing to society stays with people and it’s passed on from generation to generation. There’s always going to be such a need for our services. The profession of occupational therapy will survive and flourish in the next 100 years.”

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  1. History of Occupational Therapy – A beautifully narrated description of –
    Origin of Occupational Therapy , a profession that heals the wounds Physical & Emotional – towards well being of suffering human beings ,

    To its evolution with changing times according to needs right from World War I-II years to present modern times

    The need for this science has never been more worthwhile than now .

    A perfect blend of Science – Technology – Compassion and ever evolving Human Mind – Occupational Therapy has risen to a stature from where there is no looking back.

    Celebrating AOTA`s Centennial with vision statement – ` We envision that Occupational Therapy is a powerful , widely recognized , science driven and evidence based profession with a globally
    connected and diverse workforce meeting society`s occupational needs `.

    ( The best and encouraging fact that comes across watching this narration is the dominance of women professionals in the field of Occupational Therapy and their pivotal role in bringing the
    profession to the level of standards anyone would feel proud of .)

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