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The Development of OT
The beginnings of Occupational Therapy in 10 countries.
By Fatimah Az-Zahraa binti Amir Farid, 1st Year, 2010 For INTRODUCTION TO OCCUPATIONAL THERAPY, Puan Siti Arbi binti Kamso

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Contents Introduction 3

United States of America ....................................................................................4 United Kingdom Canada Greece South Africa Bangladesh Hong Kong Iceland Japan Malaysia Conclusion References .. 5 .6 ...7 8 .9 10 .11 .12 . 13 ...14 14

3 Introduction 10 countries were selected for study, based on the availability of their datas. The histories of the founding of Occupational Therapy (OT) in these countries are summarized in this report, as to note the highlights in the developments. Among the countries chosen are those who pioneered the profession of OT, as well as those which had only begun their OT endeavor. It is interesting to note that most, if not all the pioneering countries had a common highlight in their historical timeline of OT development, i.e. enhancement of establishment of the profession after the World Wars. Also, most countries under study have had foreign OTs introduce Occupational Therapy in those respective countries, and the same people, along with the first batch of local OTs, established the first set of professional training programs (diplomas, advanced diplomas, bachelor degrees or post-graduate programs). The greatest point to note in this report; the highly dedicated OTs that had sacrificed much of their lives to ensure that this service would be available to all who needs it, regardless of geographic location nor it s demographical background. A sense of appreciation was sparked in the making of this report, fueling a motivation in the author to further contribute to the growth of the profession.

4 United States of America At the turn of the 20th century, many medical doctors became more interested in chronic diseases, which lead to the reform of the health care system. This included graded activities of therapeutic values to the system reformation. The therapy was mainly used as moral treatment (a reformed method of treatment after the inhuman form of treatment, chains were already outlawed by this time) in institutions for psychiatric cases that was widespread in America back in the day. A group from the medical and healthcare institutions came together, and by 1917, the Society for the Promotion of Occupational Therapy (now the American Occupational Therapy Association, Inc.) was formed, in line with Occupational Therapy s establishment as a profession. The aftermath of the first World War contributed greatly in the constructing the framework of OT (defining its purpose to the public), as well as stressing the demand on the service. During this time, many workshops, clinics and training schools were built in order to accommodate the injured soldiers. Another surge in employment of occupational therapists was seen after the enactment of the Education for All Handicapped Children Act in 1975. The OTs would give service to those children in preparation for regular schooling. Further developments on the part of education was seen in 1940, as the minimum requirement for certification (by the Association) as an Occupational Therapist is a bachelor s degree. In the 90 s, the bar was raised to a master s level as the requirement for the certification. In addition, most states require licensing to practice. During this period, PhD programs were introduced in OT schools and universities as well. Currently, a new discipline under the umbrella of Occupational Therapy is the Occupational Science, which is the academic discipline that generates knowledge about the impact of daily activities

on the health of individuals, communities, nations and the world (Occupational Science and Occupational Therapy Faculty, University of Southern California).

5 United Kingdom Prior to WWI, and dating back to the 19th century, graded activities were prescribed to patients (mostly suffering from TB) for rehabilitation after prolonged bed rest. One such doctor who condone the prescription was Scottish Dr. Philip. This regime has proven to be effective in helping patients get back to employment. The first Occupational Therapist to work in the UK was Peg Fulton, who graduated from the Philadelphia School, USA. She began her services at the Aberdeen Royal Hospital for mental patients until her retirement in 1963. She was also known for her extensive contribution towards the founding of both the Scottish Association of Occupational Therapy (SAOT) and the World Federation of Occupational Therapy (WFOT). When the number of casualties of the first World War became too great that it affected the amount of manpower required in the workforce, a rehabilitation program became the ultimate priority to address the issue, and hence, Occupational Therapy played the major role. Military hospitals sprouted, with departments and workshops facilitated for join and muscle exercises. This was the basis of the first OT department in Scotland in 1936 at the Astley Ainslie Institute in Edinburgh, as well as the founding of the Occupational Therapy Training Center in the same year. WWII also contributed largely to the growth of this service, as the number of wounded soldiers to be treated could not be ignored. The first Occupational Therapy school was founded by Dr. Elizabeth Casson in 1930, under the name of the Dorset House of Occupational Therapy, in Bristol. She was also involved in the forming of the Association of Occupational Therapy (AOT) in 1936. Today, a obtaining a bachelor s degree is the minimum requirement to practice as an OT, while the program itself must have accreditation by the College of Occupational Therapists (COT) and approved by the Health Professions Council (HPC). There are 31 institutions offering accredited OT programs.

6 Canada The use of activity as a therapeutic medium began in asylums just before the 1900s. This form of treatment then began to be used in rehabilitating soldiers after World War I. The OTs in those days were very active in organizing public events, that helped raised funds out of the products of the patients, which consisted of all the age-groups and backgrounds. The infamous Street Fairs were regularly featured in the media. The funds were then used to raise curative workshops all over the country, which existed between 1920-1950. These very workshops are also the place where function was restored in the former soldiers after the World War II s labour shortage. As training for new therapists was a major concern in meeting the increasing demand, the first academic program for Occupational Therapy was introduced in Montreal and Toronto in the 1910s. But the first OT school was only established in 1982, as the Dalhousie School of Occupational Therapy. The Canadian Association of Occupational Therapy was founded (1923) as the first professional body in the profession in Canada. Provincial bodies began establishment between 1950 s through the 70 s. Effective 2008, a professional master s degree in OT is the minimum requirement for professional practice.

7 Greece In Greece, the profession is known as Ergotherapia rather than Occupational Therapy. This is because in Greek, Ergotherapy has the more encompassing definition of the principles of the profession than the more commonly used term. Mrs. Billio O Caffrey pioneered Ergotherapy after the WWII. She had lived in the UK where her husband was a Royal Naval Officer. Mrs. O Caffrey discovered Occupational Therapy, and joined the British Red Cross in service. After returning to Greece, it was high time to introduce and organize the service as soldiers were coming back in great numbers, this was in 1946. The UN Relief and Rehabilitation Administration sent Belle Grieve (a physiotherapist from the US) to organize a rehabilitation program. The committee formed out of the initiatives had no trouble in funding, as they had extensive networks that included some of the elite of Athens. They particularly contributed a large sum of money in the sales of products of handicrafts by patients to support the workings of the hospitals. By the 1950 s, training courses were introduced, and nurses as well as those with a background in healthcare were to undergo. The Hellenic Occupational Therapy Association was created in 1962, consisting of medical doctors, physiotherapists and the ergotherapists. Unfortunately the association ceased to exist during the Junta occupation between 1967-74. But fortunately, the Association of Greek Ergotherapists managed to develop in 1982, and was accepted as a full member by the WFOT in 1985.

8 South Africa Unsurprisingly, the first Occupational Therapists arrived on South African soil after the 2nd World War, from Britain. They had planned to initiate an OT training program as well as departments in hospitals as to treat the large number of the injured. The first training course was in the University of Witwatersrand while the first department in Johannesburg General Hospital. These began in 1943. In 1945, only a couple of years after that, the pioneering OTs decided to form an organization, for better OT recognition and efficiency between the government. Hence, the South African Association of Occupational Therapy was formed. Beginning in 1955, more training centers and programs were created all through the 70 s and 80 s. This marked the rapid growth of number of locally trained therapists, but unfortunately, the prosperous growth had to stop just there. The Apartheid regime had set laws that restricted practice which thus hinders the development of the occupation. The 90 s saw a committee among a group of therapists formed specifically to handle the situation which OTs are currently in. The country s professional body was also one of the founder members of the World Federation of Occupational Therapy since 1952.

9 Bangladesh The scenario of the aftermath of war is repeated here again, only in this particular case, it is neither of the World Wars. In fact, it is actually the War of Liberation (1971) that had caused the wave of injured and wounded. This as well includes both fighters and civilians, therefore the numbers are relatively larger than those countries which established Occupational Therapy via the Wars. Professor R. J. Garst, an American Orthopaedic surgeon that specialized in rehabilitation, came down to Bangladesh soon after the war, and began his services. The Professor initiated an Occupational Therapy and Physiotherapy school on the basis of the high urgency of trained therapists to assist him. This was in 1973. But unfortunately, the school only ever had three students, all graduated however two migrated overseas for better prospects. Josene Ara, she who stayed behind, went on with her work and became the first Bangladeshi Occupational Therapy Association (BOTA) president. Professor Garst s school did not survive, and subsequently there was no other OT training programs developed, until 1995. The Center for Rehabilitation of the Paralyzed (CRP) started the Diploma in OT, to meet the needs of the disabled in Bangladesh. The Diploma program has already been accredited by the WFOT, and 70 students are currently undergoing it. Also currently, there are only 7 qualified OTs, in the country, unfortunately.

10 Hong Kong In the year 1950, physiotherapist Ms. Wallace Turner organzide a committee to address the OT issues in Hong Kong, which was Non-existent at that time. As a result of several initiatives but the committee, they managed to receive HK$900 of donations (mostly donated by the Hong Kong Jockey Club through connections with some individuals in on the committee). This amount was later used to support the foundations of the service (supporting the rents and equipments, preparing the training program, etc.). The professional trainings began in the physiotherapy department of the Queen Mary Hospital, and was used as a diversional therapy for TB and Orthopedic patients, in namely 3 hospitals; Queen Mary Hospitaol, Lai Chi Kok Hospital, and the mental hospital on High Street. Only in 1954 were two permanent posts were created out of the pleas of the OTs, but there was still no department set-up at that point time, only curative workshops. But by 1958, OT departments would have already existed in the 3 hospitals and the new Wanchai Polyclinic. The 60 s and 70 s saw many hospitals and rehabilitation centers opening, however the posts available were still filled by foreigners. The Hong Kong Association of Occupational Therapy was formed in 1978. Since then, many more posts created in the Occupational Therapy departments, and that the intake of OT students increases each year. At the moment, there are 250 OTs registered with the Association.

11 Iceland It is only known that the first Occupational Therapy graduates were Jane Kristofersdottir and Kristin Tomasdottir; in 1945 and 1963 respectively, and both graduated from Copenhagen. Ms. Tomasdottir worked as a trainer in several hospitals. Meanwhile, in 1970, foreign OTs begin to migrate to Iceland to provide their services from both Britain and the US. These OTs are also responsible for establishing the Icelandic Occupational Therapy Association in 1976. The Association gained full membership of the World Federation of Occupational Therapy in 1985. Progressing to the 90 s, professional programs begin to develop. The first Bachelor s in Occupational Therapy was at the University of Akureyni, so locals finally have a better chance at it. The first OT PhD student graduated in 2006, by the name of Thora Egilson.

12 Japan The first ever Japanese Occupational Therapy school was founded by the Ministry of Health and Welfare. They provide a Diploma program which lasts for 3 years. The lecturing staff was composed of American OTs. This was in 1963. In 1966, the first National Exam for the Licensure of Physiotherapists and Occupational Therapists was held, and as a result, the newly registered OTs began the Japanese Association Of Occupational Therapy. It later became a full member of the World Federation Of Occupational Therapy by 1972. 1979 marks the beginning of the first Occupational Therapy Degree. During the 80 s, the Japanese Association of Occupational Therapists was actively preparing and publishing texts for the start-up of the journal and books. By the 90 s, more professional programs were created; the bachelor s degree, masters and also post-graduate programs. There are 39 000 members under the association, a total of 179 Occupational Therapy schools established and most of the OTs these days see the growing ageing population.

13 Malaysia Occupational Therapy was introduced to Malaysians in 1958 by Mrs. Barbara, an expatriate. She first started out in the Sungai Buloh Leprosy Center, and later expanded to include the mentally ill in Tanjung Rambutan and Tampoi. OT continued to begin operations in several other hospitals in different states, but not all states yet at this point, all throughout the 70 s, by which there were already 20 occupational therapists in the country that were trained abroad. The Occupational Therapy Association of Malaysia was founded in 1978, with the help of Mrs. Barbara herself. The Association has been renamed recently to Malaysian Occupational Therapy Association (MOTA) and became a full member of the WFOT in 1990. In 1983, the Ministry of Health opened the first OT College, with its maiden intake of 20 students. In the late 80 s, OT departments were opened in all general hospitals, including those in West Malaysia; Sabah and Sarawak, along with some district hospitals and clinics. The Mara University of Technology (UiTM) became the first to facilitate an OT degree program, in collaboration with Teeside University via distance learning (2000), and the National University of Malaysia (UKM) became the first to provide a degree program in the country 4 years later. At the moment, a few private and local health colleges and universities are preparing to provide more OT degree programs. There are still no post-graduate programs in the country. To date, there is about 1100 practicing Occupational Therapists, and counting, both in the government and private sectors. Currently, no licensing is required to practice, however the bill requiring so is expected to be passed soon.

14 Conclusion Occupational Therapy is a relatively new profession, and has yet to gain popularity in the health sector in most countries. It s holistic, patient-centered approach as well as treatment in the form of occupational activities makes it unique from any other health profession, and thus the most rewarding of the lot. It has already been listed as one of the fastest growing, and among the most satisfying careers to pursue, so there is no doubt that OT will continue to flourish.

Fatimah Amir, Aspiring Occupational Therapist, Bachelor of OT, 1st Year, UKM.

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