Frames of reference utilized in the rehabilitation of individuals with eating disorders.

An occupational therapist's role with clients diagnosed with eating disorders, both anorexia nervosa and bulimia nervosa, has been described throughout the literature. However, the frames of reference and treatment approaches that occupational therapists implement have not been clearly established or validated. This paper outlines the symptomatology of anorexia nervosa and bulimia nervosa, and critically reviews the current literature concerning the frames of reference and treatment approaches used by occupational therapists when intervening with this population. The literature reviewed indicates that therapists are using a variety of frames of reference and treatment approaches. There appears to be an emphasis on the psychoanalytical and cognitive-behavioural frames of reference, although there is a lack of empirical evidence in regards to all frames of reference and treatment approaches. Reasons for the lack of current research with this population, and possible future areas of research are suggested.     

Opening feminist histories of occupational therapy.

This paper frames the history of occupational therapy in feminist terms. It focuses on gender segregation in occupational therapy, the influence of class and race in shaping opportunities for occupational therapists, and the place of feminism in the goals and achievements of the occupational therapy profession. Such issues have been addressed by feminist scholars in histories of women in medicine, nursing, and other helping professions. These sources help place the achievements of occupational therapy within the context of women's historic entry and advancement in the American work force.     

The use of crafts in occupational therapy for the physically disabled

In this article, the historical use of crafts in occupational therapy for the physically disabled patient is reviewed and the results of a survey aimed at describing current craft use is presented. A questionnaire was sent to a random sample of 250 occupational therapists throughout the United States who chose physical disabilities as their specialty section. Results demonstrated that, while most therapists use crafts to some degree in their therapy programs, other treatment modalities such as therapeutic exercise and activities of daily living were used a greater percentage of the time. Reasons for using crafts, problems with justification of craft use, and participation of certified occupational therapy assistants in craft programs are discussed. Questions are raised concerning the role of therapeutic crafts in the past and present practice of occupational therapy for the physically disabled. Recommendations are made for future research.     

Preparation of occupational therapists to work in early intervention programs.

This paper presents the results of a survey of 43 occupational therapy academic programs regarding their preparation of students to work with young children with special needs. The number of instructional hours devoted to topics related to services for infants or toddlers and their families varied greatly. Some programs plan an increase in hours but are limited by the total hours available within the curriculum. This paper also shares the recommendations of a panel of occupational therapists with expertise in early intervention and entry-level education. The panel was concerned with the quality of preparation of therapists entering early intervention programs and encouraged the profession to review the amount of course work within each curriculum that introduces students to basic knowledge and skills related to early intervention. Some knowledge, such as the consultant's role and working with families of persons who are physically or mentally challenged, are common to other practice areas. The panel stressed that students be taught strategies for obtaining the training necessary for postgraduate entry into a specialty area such as early intervention.     

A comparison of craft use and academic preparation in craft modalities

The purpose of this study was to compare the use of crafts in psychiatric occupational therapy practice with the actual craft-related training received by occupational therapy students. Two questionnaires were developed, one related to the crafts used in clinical practice, the other related to the amount and type of craft training received in educational programs. One thousand occupational therapists who work in psychiatry and 139 accredited and developing educational programs were asked to complete the questionnaire appropriate to their setting. The final analysis involved 121 educational programs (87% response rate) and 384 clinical programs (38% response rate). The results suggest that there may be substantial differences between craft-related training and actual clinical use of crafts. The findings imply that educational programs must reevaluate the types of crafts taught and the method by which they are integrated into the total curriculum. Implications for the profession include the need to clarify the role of crafts as a therapeutic modality and to reflect on the future direction of the profession.     

Special education and occupational therapy: making the relationship work

Working as an occupational therapist in publicly funded schools requires a variety of skills. These skills include assessing the needs of children, serving as a member of the multidisciplinary team, developing individualized education program (IEP) goals and objectives in conjunction with other team members, providing services, and coordinating efforts with parents, teachers, and administrators. To fulfill these responsibilities, occupational therapists must have a comprehensive understanding of the complex federal and state laws that mandate the provision of special education and related services. Therefore, the purposes of this article are (a) to describe the legal framework within which decisions are made to provide occupational therapy to students in publicly funded school programs and (b) to highlight the knowledge and skills occupational therapists need to work effectively in schools with teachers, administrators, and parents.     

Occupational therapy in the Department of Veterans Affairs: focus on health care of the elderly veteran

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the world (VA, 1989), with designated departments and programs designed to meet the long-term care needs of the aging veteran. Occupational therapy is an important intervention to maximize the quality of life of older persons. Because of the increasing number of aging veterans and the national shortage of occupational therapists, the VA has been devising programs to recruit and retain occupational therapists in VA medical centers. The combination of long-term care programs and the VA's commitment to ongoing research, education, and occupational therapy services points to a promising outlook for care of our aging veterans.     

Occupational therapy in long term psychiatry: what's new?

This paper summarizes the results of a survey of the role of occupational therapy in provincial psychiatric hospitals in Ontario. Occupational therapy was found to provide major programming in three areas: 1) functional skills assessment and training, 2) life skills assessment and training and, 3) self awareness and personal growth. Subjects used a variety of frames of reference, but models based upon Glasser's Reality Therapy predominated. A complementary relationship was found between occupational therapy and vocational and recreational services, with occupational therapy playing a clinical or therapeutic role, while vocational and recreational services provided normalizing experiences. A comparison of occupational therapy programming in the institutions surveyed, with programming reported in the recent occupational therapy literature indicated that techniques and media utilized paralleled those used in acute and community psychiatric programs.     

Reflections on ... the recovery paradigm: should occupational therapists be interested?

BACKGROUND The mental health literature attests to a paradigm shift from an emphasis on treatment towards a focus on fostering recovery. This paradigm emphasizes many constructs familiar to occupational therapists, including quality of life, empowerment, hope, meaningful activities and work. Occupational therapists are not only familiar with these terms, but have addressed recovery-related constructs in both research and practice. METHOD AND PURPOSE: Literature on the recovery paradigm, mental health and occupational therapy was reviewed to gain an understanding of this paradigm and its relationship to occupational therapy in mental health. RESULT: Core occupational therapy beliefs and assumptions are strikingly similar to those purported to be important to fostering recovery. IMPLICATIONS: Occupational therapists should consider taking a keen interest in the construct of recovery. By virtue of professional beliefs and assumptions, occupational therapists are uniquely positioned to assume a leadership role in the area of recovery-related research and practice.     

The value of psychosocial Level II fieldwork

The shortage of occupational therapists choosing to practice in mental health and the increase of therapists electing to specialize in other areas led to a pilot study designed to gather information regarding the value of psychosocial Level II fieldwork. A survey was mailed to 152 practicing occupational therapists who had graduated from Colorado State University in Fort Collins between 1983 and 1988; of the surveys returned, 116 were used in this study. The results indicate that the psychosocial Level II fieldwork experience provides therapists with valuable training and experience regardless of their current area of practice or specialization. The results also suggest that to preserve the holistic approach that occupational therapists offer their clients, psychosocial Level II fieldwork must remain a requirement of occupational therapy programs.     

Community care for the chronic mentally ill

The movement of chronic mentally ill patients from large mental hospitals into the community, seeks to liberate institutionalized clients and substitute a more humane environment. This article reviews the types of chronic mental patients now living in the community. The differences between a maintenance and a rehabilitation model for treating the chronic mental patient living in the community are discussed. Special treatment programs for the young adult chronic client are also considered. Three questions specific to occupational therapists working with chronic mentally ill patients in the community are then explored. These are: A. How can we increase the visibility of occupational therapy in community mental health?; B. Should occupational therapists be involved in programs which have a maintenance, rather than a rehabilitation focus?: and C. What has the occupational therapist to offer the young adult chronic client?     

Work hardening: occupational therapy in industrial rehabilitation

Work hardening, presented in this paper as a "new" service for the industrially injured, is actually well grounded in the traditional models and practices of occupational therapy. From the profession's early roots in industrial therapy to the development of a variety of programs for the industrially injured through the 1950s and 1960s, the historical and philosophical bases of occupational therapy support the use of work as an evaluative and therapeutic medium. What is actually new is the adoption of terminology, technology, and a program format that fits in with the needs of consumers in the 1980s. Recent developments that created the need for the specialized services that occupational therapists are uniquely qualified to provide include growth of private sector vocational rehabilitation, changes in workers' compensation laws, and increasing costs of vocational rehabilitation. This paper describes work hardening in its present form. A case example is given that demonstrates how work hardening can be a cost-effective and time-saving bridge which spans the gap between curative medicine and the return to work.     

Occupational therapy with patients with multiple personality disorder: personal reflections

Patients with multiple personality disorder are being admitted to acute care psychiatric units with increasing frequency. Occupational therapists have been confronted with setting treatment goals and designing interventions for this population with little information available in the occupational therapy literature. This paper describes how one therapist, the author, reviewed psychiatric and psychological literature on multiple personality disorder to delineate a role for occupational therapists who are working with this special population on an acute care psychiatric unit within the context of existing programs.     

A question of professional boundaries: implications for educational programs.

During recent on-site visits a curriculum fieldwork coordinator learned that occupational therapy students were expected to use physical therapy modalities in the treatment of patients. Since the students had no academic preparation in the use of these modalities, the curriculum committee of the academic program was advised of the situation. Two academic occupational therapy programs collaborated in sending out a 48-item questionnaire to the centers currently cooperating in their fieldwork programs with the purpose of determining the kinds of modalities being used in treatment. Results of the survey showed that there was self-reported use of physical therapy modalities by occupational therapists throughout the country with greater use in some regions. The survey also showed occupational therapy involvement in new treatment areas but diminished use of some traditional therapeutic media. Guidelines are suggested regarding student involvement in new treatment areas.     

The Effects of Exercise on the Elderly and Implication for Therapy

Physical and occupational therapy activity and exercise programs have historically been directed toward the restoration of function in the disabled elderly. These professions have not focused their attention on the well or mildly impaired elderly. The current research on exercise and the elderly described here documents the positive benefits of physical activity and exercise programs for the well or mildly impaired elderly. The potential for physical and occupational therapists to provide services to the non-disabled elderly population is explored and a model program is offered as an example of this expanded role for therapists.