Occupational Therapy in the Schools

Before one can understand the unique role that occupational therapists have in schools, one must understand what occupational therapy is, what occupational therapists believe and how their perspectives have changed over time.

The field of OT began as a response to the moral treatment movement of the early 19th century, which was concerned with rehabilitating and providing humane care to individuals with mental illness (Bryden & McColl, 2003). According to Kielhofner (2004), one of the key tenets of moral treatment was the notion that, ―participation in the various tasks and events of everyday life could restore persons to more healthy and satisfying function‖ (p. 30). The supporters of the movement believed that people with mental illness developed deficient habits that marginalized them in society and that it was society‘s obligation to help return individuals with mental illness to the mainstream. Early practitioners adjusted the individuals‘ physical, temporal, and social environments; helped them to develop and incorporate efficient and productive habits; and encouraged their participation in daily life, which included activities associated with education, self-care, work, and leisure.

At the beginning of the 20th century the principles of moral treatment began to be applied to individuals who were chronically ill or experienced physical or intellectual disabilities and the first meeting of the National Association for the Promotion of Occupational Therapy was convened. Early occupational therapists were physicians, nurses, architects, and artisans who shared a common vision that was guided by five constructs. These constructs included that: 1) humans need to be occupied; 2) an individual‘s health is dependent on and reflected in the habits that he or she uses to organize how time is spent on a daily basis; 3) the mind and body are connected; 4) disruption in an individual‘s participation in daily activities could be a result of poor health or could cause poor health; and 5) that participation in everyday activities (or occupations) could be applied therapeutically to enhance a person‘s physical or mental health (Kielhofner, 2004).

In the mid-20th century, the field of occupational therapy was criticized for lacking a rigorous and comprehensive theoretical grounding. As a result, the field‘s paradigm shifted to be aligned more closely with the traditional medical model and they adopted a reductionist view (Kielhofner, 2004). Reductionism, sometimes referred to as the mechanistic paradigm, is used by many medical professionals to explain illness or disability by seeking to identify causes for the apparent dysfunction and systematically introducing treatments to repair them. According to Kielhofner (2004), the adoption of this mechanistic or reductionist view resulted in the field of occupational therapy‘s collective focus on using psychology, neurology, and kinesiology to explain why individuals experienced occupational dysfunction, or a disturbance in the usual or typical patterns or pursuits of everyday activities.

While the shift in the mid-20th century brought about important changes related to the practice of occupational therapy, it also resulted in a divergence from the core constructs that guided pioneering occupational therapy practitioners during the moral treatment era. According to Kielhofner (2004), the face of occupational therapy practice changed during this time and, in many cases, therapists gave up the use of occupation (or engagement in meaningful activities) for exercise regimes and the use of physical agent modalities (e.g., the application of heat, cold or electrical stimulation to address musculoskeletal issues).

In the 1960‘s and 1970‘s leaders of the profession called occupational therapists to return occupation to the profession‘s core. This call resulted in another shift in occupational therapists‘ collective thinking. In 1962, Mary Reily said: The logic of occupational therapy rests upon the principle that man has a need to master his environment, to alter, and improve it. When this need is blocked by disease or injury, severe dysfunction and unhappiness result. Man must develop and exercise the powers of his central nervous system through open encounters with life around him. Failure to spend and to use what he has in the performance of the tasks that belong to his role in life makes him less human than he could be (Bryden & McColl, 2003, p. 35).

Current practice is based on the belief that humans have an occupational nature; that is, humans have a basic drive to be occupied and that participation in such occupations gives meaning to life (Hasselkus, 2002; Kielhofner, 2002; Kielhofner, 2008). Further, the meaning that individuals associate with participation in occupations (i.e., self-care, work, or play), depends on each individual‘s unique history and understanding of life‘s events (Helfrich, Kielhofner, & Mattingly, 1994; Mallinson, Kielhofner, & Mattingly, 1996).

The current paradigm has also resulted in the adoption of a focal viewpoint (Kielhofner, 2009, p. 44) for the profession. This viewpoint reflects the profession of occupational therapy‘s rededication to using occupations as both a means and an end to therapy. In addition, it calls OT practitioners to de-emphasize the mechanistic focus on an individual‘s impairments and consider how the environment and the larger context shape what is considered a disability.