Career As an Occupational Therapist

CAREER AS AN

OCCUPATIONAL THERAPIST

Research Number 102 ISBN 1-58511-102-3 DOT Number 076.121-010, 355.377-010, 076.364-010

CAREER AS AN

OCCUPATIONAL THERAPIST Healthcare Professional Helping People With Disabilities Regain Skills They Need To Live Full And Independent Lives You Can Make a Real Positive Difference in This Vitally Needed Service Profession A child born with cerebral palsy learns how to walk with crutches so that he can play with other kids. A teenager who suffers from a spinal cord injury caused by a car accident relearns the daily living skills that will help her return to school and graduate with her class. A woman with depression regains her ability to find meaning in daily activities. A factory worker injured on the job is able to return to work after adaptations are made at his plant. An elderly stroke victim relearns how to bathe, shave, and dress himself and, in the process, develops a new sense of independence. THESE ARE JUST A FEW OF THE scenarios made possible with the help

of a skilled and caring occupational therapist. In this sense, the word “occupational” doesn’t mean specifically relating to one’s work occupation, but to the tasks or activities with which the therapist “occupies” the time of a client. 2

Occupational therapists (OTs) work with people who have mental, emotional, and/or physical disabilities. OTs use goal-directed activities that are purposeful and meaningful to help their clients develop or regain the skills they need to live as independently as possible. For example, an occupational therapist might work with a premature infant using sensory stimulation to promote the development of the baby’s immature nervous system. Or a therapist may work with an adult who has had a spinal cord injury to adapt his home and workplace so he can resume daily activities, or provide an individual with emotional or psychiatric problems with coping strategies to deal with the stresses of daily life. Occupational therapists also help people with injuries or illnesses to make difficult life transitions, such as returning to school or work. And they assist employers in making adaptations in the workplace so that a disabled employee can return to his job. Occupational therapists have many roles. They often work directly with people who need their services, or they may evaluate clients, plan appropriate treatment and supervise someone else who works directly with the client. Additionally, they may act as consultants, managers, researchers, and educators. Occupational therapists work in many different settings and with persons of all ages. They may work in public and/or private schools with children who are learning disabled, physically challenged, and/or developmentally delayed. Medical settings (including hospitals, rehabilitation clinics, and nursing homes) are traditional sites where OTs work, usually with clients who have had their lives interrupted by acute and chronic illnesses and conditions such as head injuries, strokes, depression, or arthritis. Less traditional but increasingly common work settings are community environments and clients’ homes and workplaces.

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RELATED OCCUPATIONS OCCUPATIONAL THERAPISTS USE SPECIALIZED KNOWLEDGE TO HELP INDIVIDUALS

perform daily living skills and achieve maximum independence. Other healthcare specialists performing similar duties include orthotists, prosthetists, physical therapists, chiropractors, speech pathologists, audiologists, rehabilitation counselors, and recreational therapists.

Occupational Therapy and Physical Therapy Occupational therapists and physical therapists (PTs) often work as a team to help patients achieve as much recovery and independence as possible. In a geriatric setting, for example, a PT may evaluate how well clients use their lower extremities – their bed mobility, gait, and ability to transfer from a wheelchair to a bed. For the same clients and setting, an OT may evaluate how well clients use their upper extremities, looking for range of motion and the ability to complete tasks of daily living, such as washing their faces, and brushing their teeth and hair. Some PTs, however, may also address dysfunction of the upper extremities within the treatment session. An OT may evaluate cognitive function and perceptual skills. OTs and PTs may work collaboratively to address the clients’ balance and trunk control. In some settings, OTs address bed mobility; in other settings, bed mobility is the responsibility of the PT. Typically, PTs do not use purposeful activities, such as crafts and activities of daily living, to enhance recovery, nor do they work with clients diagnosed with mental illness, unless the client has a secondary physical limitation. PTs focus more on the use of exercises or mechanical devices, such as electrostimulation machines, to help recovery. OTs, on the other hand, use purposeful activities and crafts, which are considered to be the foundation of the profession. The most important point to remember, however, is that the two professions typically work together to address the clients’ deficits.

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TYPICAL JOB OPENINGS FOR OTs TO GIVE YOU AN IDEA OF THE JOB MARKET IN THIS FIELD, LOOK OVER THESE REAL

advertisements, placed by companies recruiting occupational therapists. They illustrate some of the skills and background employers seek. OUT-OF-CLINIC SETTINGS We are booming! Come join our family of high quality therapists. We offer tremendous flexibility for part-time or full-time positions, one to five days a week, working in early intervention, schools, or homes. PEDIATRIC OTs IN HOME SETTINGS Minimum baccalaureate level, license or certification, three years experience (two years in a rehabilitation or hospital unit). Adult orthopedic, neurological, and spinal cord background preferred. Strong interpersonal skills, computer skills. Independent worker. Overnight travel required. NEUROLOGICAL CLINIC Full-time position with benefits working in post-acute care rehabilitation in a new clinic to serve a progressive urban area. SCHOOL-BASED THERAPIST Seeking experienced and enthusiastic therapists to work with school-age children, utilizing an integrated model.

HISTORY OF THE CAREER AN OLD ADAGE TELLS US THAT KEEPING BUSY IS GOOD FOR WHAT AILS US. WITHIN

that simple concept lies the key to the occupational therapy profession. Using specific tasks or “occupations” to help someone who has been ill or injured is an idea as old as the concept of healthcare itself. The Egyptians used activities to speed the recovery of people suffering from melancholy, and Roman physicians spoke highly of treatment that involved activity or occupation. In the mental institutions of 18th century Europe, the seeds were sown for what was to become a profession based upon the concept of occupation. Physicians in an asylum in Spain observed that charity patients who were required to perform menial tasks recovered more quickly than their aristocratic counterparts who were inactive and idle during their treatment. Occupation as a form of treatment grew in mental healthcare and, during the 19th century, began to be employed in some asylums in the United States. By the early 1900s, a number of institutions were using 5

productive activities and daily living tasks – such as bathing, dressing, and eating – as an effective form of treatment for a variety of mental health problems. A group of supporters of the evolving profession gathered in Clifton Springs, New York in 1917 for a meeting of the Society for the Preservation of Occupational Therapy, later renamed the American Occupational Therapy Association. The new organization and its members quickly were challenged by the onset of World War I. Suddenly, a generation of servicemen, broken in mind and body, were in need of rehabilitation. Several thousand people were given a six-week course in occupational therapy practice, mainly in crafts skills, and were sent to Europe to serve as “reconstruction aides.” By the end of the war, thousands had received occupational therapy, and the experience gained by the reconstruction aides laid the foundation for the expansion of the profession into a variety of applications in both mental and physical rehabilitation. Following the Great War, occupational therapy training programs were established, and hundreds of practitioners graduated from them. By the start of World War II, occupational therapists were on hand to provide a wide variety of rehabilitation services to the wounded. They trained amputees to use artificial limbs and developed special programs to deal with dislocations, burns, arthritis, and nerve injuries. Programs were developed jointly with the armed services to train additional therapists. By the end of the war, almost a thousand occupational therapists were on duty in Army hospitals alone. By 1945, there were more than 3,000 occupational therapists in the United States, and 26 schools existed to train and accredit them. The profession had become a well-developed discipline which required a bachelor’s degree in order to be able to practice. As medicine moved into new specialties, such as geriatrics, occupational therapy followed. By 1960, professional specialization in occupational therapy had begun, with therapists concentrating on different areas, including prosthetics training, constructing splints, training in activities of daily living, and the rehabilitation of clients with spinal cord injuries and progressive neurological disorders. Today, occupational therapy is keeping pace with the changes in healthcare delivery. Occupational therapy personnel are actively involved in cardiac rehabilitation, stress reduction, working with the elderly, and promoting the healthy development of infants. In addition, occupational therapy practitioners are contributing to the development and use of 6

innovative technological advances in rehabilitation, such as bioelectric limbs and computerized communication systems. Entering the new century, there are more than 50,000 occupational therapists in the US, employed in a wide variety of healthcare facilities, schools, clinics, and businesses. Nearly 160 colleges and universities offer training to prepare individuals for a career in occupational therapy.

WHERE THEY WORK THE GREATEST NUMBER OF JOBS ARE IN HOSPITALS, INCLUDING ACUTE-CARE, GENERAL

or specialized rehabilitation units, pain management programs, neonatal intensive care units, outpatient rehabilitation, cardiac rehabilitation, and skilled nursing units. OTs also work at psychiatric hospitals and substance abuse centers, providing services for both inpatients and outpatients. Other employers include: Physicians’ offices Orthopedic and hand therapy clinics Public and private school systems Home healthcare services Nursing homes Community mental health centers Adult daycare programs Businesses Residential care facilities

A small number of occupational therapists are in private practice. Some are solo practitioners, while others are in group practices. They see clients referred by physicians or other health professionals, or provide contract or consulting services to nursing homes, schools, adult daycare programs, and home health agencies. The fastest growing areas of OT are home health, private practice, and gerontology.

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THE WORK DUTIES OCCUPATIONAL THERAPISTS WORK WITH PEOPLE OF ALL AGES – FROM INFANTS TO

the elderly – who have conditions that are mentally, physically, developmentally, or emotionally disabling. These conditions may include: Arthritis, cancer, or other debilitating illnesses Head or spinal cord injuries Orthopedic, work or sports-related injuries Amputation Burns Head trauma Stroke or other neurological conditions Mental illness Developmental disabilities. OTs help clients to develop, recover, or maintain daily living and work skills. They not only help clients improve basic motor functions and reasoning abilities but also compensate for permanent loss of function. Their goal is to help clients have independent, productive, and satisfying lives. Occupational therapists assist clients in performing activities of all types, ranging from using a computer to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while paper and pencil exercises may be chosen to improve visual acuity and the ability to discern patterns. A client with short-term memory loss, for instance, might be encouraged to make lists to aid recall. One with coordination problems might be assigned exercises to improve hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract reasoning, problem solving, and perceptual skills, as well as memory, sequencing, and coordination – all of which are important for independent living. For those with permanent functional disabilities, such as spinal cord injuries, cerebral palsy, or muscular dystrophy, therapists instruct in the use of adaptive equipment such as wheelchairs, braces, and aids for eating and dressing. They also design or make special equipment clients may need at home or at work. Therapists develop and teach clients with severe

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limitations to operate computer-aided adaptive equipment that helps them to communicate and control other aspects of their environment.

Industrial Therapists Some occupational therapists, called industrial therapists, treat individuals whose ability to function in a work environment has been impaired. They arrange employment, plan work activities and evaluate the client’s progress. School Therapists Occupational therapists may work exclusively with

individuals in a particular age group or with particular disabilities. In schools, for example, they evaluate children’s abilities, recommend and provide therapy, modify classroom equipment, and, in general, help children participate as fully as possible in school programs and activities.

Mental Health Cases Occupational therapists in mental health

settings treat individuals who are mentally ill, mentally retarded, or emotionally disturbed. They may also work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress related disorders. To treat these problems, therapists choose activities that help people learn to cope with daily life. Activities include time management skills, budgeting, shopping, homemaking, and use of public transportation. Recording a client’s activities and progress is an important part of an occupational therapist’s job. Accurate records are essential for evaluating clients, billing, and reporting to physicians and others. 9

PERSONAL EXPERIENCE OF OTS I Have a Lot of Variety – I Work With School Children and Seniors “When I was in

high school, I had average grades and I asked my guidance counselor what field I should go into. She suggested that I become a teacher. Because I always liked helping people, I got a degree in elementary education, with a specialization in special education. For seven years, I worked as a special ed teacher until I decided that I wanted to do something different. At that point, I was trying to decide between becoming a physical therapist or an occupational therapist. I decided on OT because I liked the functionality of it. What I mean is this: If a client (we don’t call them patients any more) needs to increase his bicep strength, a physical therapist will teach him exercises to do that. An occupational therapist uses skills from daily living to do the same thing. I like to apply real-life tasks in helping recovery. Occupational therapy also is what we call ‘womb to tomb’ as far as need. We help people at every age level. It’s a holistic field. In treatment, we look at the whole patient – their physical and emotional health, their family support and interaction, everything. We don’t just say, ‘Oh here comes the leg fracture today.’ We say that we’re going to treat Mrs. Jones, who has a leg fracture. And there’s so much flexibility in the field. Therapists can specialize in whatever area interests them. I enrolled in an OT program and got a master’s degree in OT. Because I already had a bachelor’s degree in a related field, I didn’t have to go back to square one and get a bachelor’s degree in occupational therapy. Soon after I graduated, I went into private practice, which is unusual for new OT graduates. Most work in a clinical setting first, gaining skills and learning from more experienced therapists, but I felt I was ready to be on my own. I was not interested in working with people with physical disabilities. I prefer to work with people with emotional and educational needs so, in my private practice, I worked at a 10

community-based residential center for adults with mental retardation. I taught them how to use public transportation, shop at the mall, pay for things. It was nice because they were able to meet their friends and relatives at the mall and get their hair done or have lunch together. Eventually, the facility closed because of an effort to integrate them more into the community. That’s when I moved East, and I got a job in a large suburban school system, where I still work today. I support the teachers in dealing with children with disabilities. For example, if a little kid comes to school using crutches, I help decide where the best place would be to locate the child’s storage cubby. When children are moving from elementary to middle school, I determine whether they are able to open a combination lock on a locker or carry a tray in the cafeteria. A lot of what I do is educating the teacher to see the child first and then the disability. In addition to working in the schools, I also do home healthcare for seniors. I teach them activities of daily living – how to shower and dress and brush their teeth and cut their food. I evaluate their environment to see how they might do things in a way that will expend less energy. The biggest drawback of the job for me is that an OT needs to be patient and flexible. That’s not always easy, especially if you’re working with other professionals who aren’t doing the best job to help the client. What I love most is the variety. I work with a three-year-old with autism and a 90-year-old man who has trouble bending down to tie his shoes. I’m never bored. I’m also able to make my own hours, and, while my job has structure, it also requires a lot of creativity. My advice to people considering occupational therapy as a profession is to plan on being a change agent. You’re there to help change people’s lives.”

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Karen Jacobs, a former president of the American Occupational Therapy Association, recently discussed with working therapists the present challenges of the profession. She talked about creative, unique ways different therapists around the country are using their skills. “Together, we are creating the future of our

profession. Figuratively speaking, we are writing a book together – one that could be titled, ‘The Future of Occupational Therapy.’ We probably all agree that, at present, our book is a real page-turner. Some might even be tempted to compare it to a work by Stephen King! Without a doubt, our profession faces greater challenges today than ever before. In the past year, many of us have seen some positions scaled back or eliminated. I believe that the future of our profession has never been brighter. I believe that the current challenges will force us to reexamine the value of occupational therapy, re-evaluate the direction of our profession, and identify and create new opportunities to apply our skills. I believe the difficulties we now face will make our profession stronger and each of us better occupational therapy practitioners. Henry Kaiser, an author and columnist who also happens to have a hearing impairment, put it another way. He said, ‘Problems are only opportunities in work clothes.’ Healthcare is changing. If occupational therapy is to remain relevant in this evolving climate, we must recreate ourselves. We can do this by becoming occupation F.A.N.A.T.I.C.s – in other words, Forecasters, Advocators, Negotiators, Adventurers, Teachers, Innovators, and Collaborators. Each of these words represents a quality that will help us ensure the future of our profession.

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Forecasters

As members of the healthcare field, we must anticipate and guide the change. As forecasters, we must take stock of the changes in healthcare and anticipate their direction, but we can’t stop there. We must also choose the future we desire for healthcare and our profession, and work to bring that future into reality. It is useful, for example, to recognize that because Americans are leading increasingly fragmented lives they will inevitably have greater mental healthcare needs. But it is much more useful to recognize that mental healthcare is an integral part of our profession. I believe we are all mental health occupational therapy practitioners. We have come to the conclusion that mental health represents one of our profession’s greatest opportunities for growth. The ‘Disease of Meaninglessness’ will reach epidemic proportions in the next decade. In my own opinion, it is already the greatest healthcare crisis of our time. You see the ravages of this disease in all walks of life. Increasing levels of depression and aggression among adults indicate that fewer people are finding meaning in their work. Teen suicides, substance abuse, eating disorders, shootings in schools – all give evidence to the rise of this disease among our country’s youth. Seniors, too, are particularly vulnerable to this disease. After devoting years to their families and professions, many seniors find themselves without meaningful occupation. As our population ages, this problem will become even more pronounced. The role of occupational therapy has never been more important. We offer an antidote to the disease of meaninglessness. By helping people find occupations that they love and by encouraging them to set and strive toward goals, we can help them achieve happiness. For example, Susan Stouffer, an assistant professor at the OT Program at Barry University in Miami Shores, Florida, has developed a food service training program in a mental health facility. 13

Susan says, ‘It has been enjoyable work, being in an environment where there is so much potential and the clients are usually hardworking and good hearted.’ Terrie McKamy, an OT in Deep East, Texas, has found an innovative approach to providing mental health services. Terrie and her colleagues use a 50-acre farm to provide therapeutic services for clients of all ages. Most of Terrie’s adolescent and adult clients have chemical dependencies. She is helping these individuals overcome dependencies by learning new life skills and appropriate social behaviors. As they tend gardens and care for animals, her clients gain a sense of achievement and discover new sources of enjoyment. Terrie remarked, ‘Many of these folks have never had fun without drugs and alcohol. We had a 60-year-old man catch his first fish ever, can you imagine?’ Terrie recognized a growing problem in our society – chemical dependence among teens and adults – and found a way to use her skills to address this problem. Advocators

But it is not enough to anticipate changes. We must also influence them. There are many ways in which we can influence change. We can influence potential clients and client groups. As OT practitioners, we have always viewed ourselves as advocates for our clients. That should not, indeed, must not, change. But we must also begin to see ourselves as advocates for our profession. As I see it, these two roles have a kind of symbiotic relationship: By strengthening our profession we will be better able to assist people who face challenges in their lives. And, with each individual we assist, we demonstrate anew, the importance and effectiveness of OT, making our profession stronger. Negotiators

Better fundamental business skills are a long-term goal toward which we must strive. In the meantime, however, we will each need to hone our own negotiating skills. As individual practitioners, these skills will aid us in our practices. As members of the OT profession, these skills will enable us to educate 14

potential partners and clients about the value of occupational therapy. Adventurers

It isn’t enough to forecast our future, to advocate for our profession, and to be willing to negotiate. We also have to be adventurers! We have to be willing to stretch our boundaries, to step outside our narrow sphere of comfort, and – yes – to take a few risks. One of our colleagues exemplifies the ability to make an adventure of one’s career. Jim is an OT who very modestly describes himself as having been in the ‘right place at the right time.’ I prefer to describe him as having had the right attitude at the right time. After serving in the army, Jim had the opportunity to work with the United Nations as a staff counselor for Peace Keeping Operations from 1993-1995. He helped people prepare to go into risky places. Recently, Jim left for The Hague, where he will work for the International Criminal Tribunal for the Former Yugoslavia (ICTY). He will be setting up an employee assistance program to help the 750 staff personnel of the ICTY, many of whom will be working in Kosovo, deal with stress and stress management and to assist them in resilience building. Jim will focus on prevention, but also on cure and rehabilitation. When I asked Jim to define his role, he explained, ‘I think if a person has a physical, psychosocial, educational, or social-skills problem, they can be a recipient of OT. We treat anyone who has a problem. We are enablers.’ Jim’s ability to think creatively about his career enabled him to seize a remarkable opportunity to help the people who are attempting to bring peace to one of our world’s most troubled regions. Jim’s definition of OT speaks to one of the fundamental precepts of our profession: As OT practitioners, we strive to heal the whole person. Another OT Jeanne Lewin, was also willing to stretch her ideas about what OT practitioners do. In 1983, Jeanne combined her OT skills with her entrepreneurial capabilities to found The Tramble 15

Co. Today, Tramble creates equipment for occupational therapy practitioners and offers continuing education opportunities to OTs. Her company now sells products throughout the world. You do not have to be an occupational therapy practitioner to be an adventurer, either. There are plenty of adventures for students. Elaine Leone of Richmond, Kentucky, accompanied by six OT students, went to Haiti to complete a fieldwork experience. The group went as guests of the Northwest Haiti Christian Mission, which established the mission in St. Louis du Nord, in 1978. The original program was a nutritional program. Since that time, the mission has built a small medical clinic, a 6-10 bed birthing center, a church, an orphanage (home to 45-50 children), a surgical unit, a school, a dental clinic. Elaine and her students were the first rehabilitation services of any kind to be offered on the northwest coast. Elaine said ‘originally the mission director did not believe that there would be any work for us to do; he had not seen people with disabilities. He was receptive to our coming but was fearful that we might be idle! We were on a radio program for about five minutes, describing occupational therapy. It was translated into Creole. People started arriving for OT services that very afternoon! During our stay there, we evaluated and provided consultation and treatment to infants, children, adults and the elderly.’ You don’t always have to change the direction of your career to embark on a professional adventure, however. We are surrounded by opportunities for adventure, if we just open our minds to them. A year ago, Angela Sallerson, took her background in pediatrics to open a pediatric clinic called Occupational Therapy of Rochester, NY. The clinic specializes in children of any age who are having problems with sensory processing disorders. Angela describes that ‘it was a dream of mine to open a clinic and after 27 years of practicing OT, I finally bit the bullet and did it!’

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Teachers

Most of us recognize that teaching is a very big part of what we do as OT practitioners: We teach our clients new behaviors and new skills. In addition to teaching individual clients, we need to teach client populations. We need to teach them to set new, higher goals for wellness and to adopt new, healthier behaviors that will help them achieve this goal. Before we can teach them anything else, however, we need to teach them to view OT practitioners as their allies in this effort. We need, for example, to teach seniors that OT practitioners can help them live more fulfilling lives and feel better, emotionally, and physically. Once senior organizations become convinced of the importance of OT, they will insist upon its inclusion in assisted living centers, homeless shelters, well senior centers, and senior affordable housing. We need to teach teens the meaning of self-worth and the value of contributing to a community. We need to teach them that OT practitioners can help them develop tools to counter feelings of isolation, confusion, and frustration. Before we can help the teens, though, we have to educate the administrators within the schools, families, detention facilities, and youth organizations about OT. We need to educate our nation’s workforce about the benefits of ergonomically correct work environments both at home and at the workplace. We must teach employees that OT practitioners can help them work without injury. We must teach employers that OT practitioners can help them drastically reduce workers’ compensation costs and absenteeism. Rannell Dahl, an OT who works for NorthBay Healthcare Systems on the West Coast, is leading the charge to educate corporate America. She has already helped several large corporations, as well as a major university, develop ergonomic programs. In addition, they have, as she puts it, ‘infiltrated’ every department within their own company.

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Innovators

We have to recreate occupational therapy to reflect all the changes in healthcare and in societal demographics that we have begun forecasting. In short, we have to become innovators. Who decreed that OT practitioners had to be employed by hospitals, schools, or skilled nursing facilities? We are trained to help anyone who is challenged or at risk. People have challenges in every walk of life and that is exactly where we belong. Donna Cunningham is an OT who has used innovation and virtual reality technologies to create a dynamic business called Virtual Rehabilitation Works. VR is already used in many healthcare arenas, such as surgical training, cognitive/perceptual retraining, and anatomy education. Donna believes that VR also can greatly enhance rehabilitation for clients recovering from a variety of illnesses including stroke, head injuries, arthritis, spinal cord injury, attention deficit disorder, Parkinson’s disease, multiple sclerosis, orthopedic disorders and Alzheimer’s. VR offers an opportunity for clients to engage in goal-directed movement. In a typical session, the client steps in front of a large screen television, where their life-size mirror image appears. Using video-gesture-controlled technology, the client can move about to ‘touch’ colored bouncing balls, ‘kick’ soccer balls or ‘play’ the drums. Auditory and visual cues make the simulated experience more real. Clients have so much fun, that they forget they are working on motion balance, eye/hand/body coordination and strengthening. Michele Ellis is an innovator. She created Accessible Vacations to meet the needs of travelers with disabilities. Michele says, ‘Although travel provides only supplemental income to my salary as an occupational therapist, it has provided the opportunity to create my own business and visualize a business plan into reality. Some of the interrelations between travel and occupational therapy have enabled an individual to complete a therapeutic goal of going to a play out of town; assisted a man with a brain tumor to visit his sisters; created the opportunity for children with disabilities to travel with their families; and aided a group of

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children with hearing impairments to attend a graduation ceremony that was completely signed. It is good to learn that some of the skills that we use every day in therapy such as active listening, decision making and problem solving make the difference in the business world. Collaborators

As healthcare providers, it is time for us to recognize the benefits of collaboration. First and foremost, by teaming up with others, we gain additional opportunities to assist people who can benefit from our services. That’s a very big positive. But it isn’t the only positive. We can also find new ways to apply our skills and new markets for our skills. When most of us think of collaboration, we think about working with other healthcare providers. However, we also have natural synergies with those who work in furniture or computer design, engineering, architecture, and the list is almost endless. Remember, we are innovators. We are not content merely to build upon existing relationships; we want to create relationships that haven’t existed in the past. Michelle Ziegmann is an OT who has entered into a highly productive and profitable collaboration effort. Michelle works for the Institute for Cognitive Prosthetics, where she works with computer programmers to develop and customize software programs for clients. By combining her OT skills with those of the programmers, the Institute is able to offer clients highly effective programs to meet their unique needs. Michelle is an innovator, as well. She and her colleagues also engage in tele-rehabilitation. They use video conferencing technology to work with clients around the country. Because they can observe the client working in his or her own environment, they are able to offer highly effective treatment at a reasonable cost.

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F.A.N.A.T.I.C.s

This is what it means to be Forecasters, Advocators, Negotiators, Adventurers, Teachers, Innovators, and Collaborators. Now I would like to consider what happens when we combine these traits. Taken together, they spell the word ‘fanatic.’ I have chosen this word advisedly, because it represents the kind of unflagging commitment and passion necessary to our great endeavor – the recreation of our profession. You may have noticed that I have used the word ‘passion’ repeatedly. Passion is a priceless commodity. With passion, we can recreate the face of the healthcare industry, giving occupational therapy the importance it deserves in the healing process. The future of occupational therapy is a bright one indeed!”

PERSONAL QUALIFICATIONS OCCUPATIONAL THERAPISTS NEED PATIENCE AND STRONG INTERPERSONAL SKILLS TO

inspire trust and respect in their clients.

OTs work with people from a wide variety of social, cultural, economic, and ethnic and religious backgrounds, so flexibility, open-mindedness, and the ability to communicate with a variety of clients are important. Ingenuity and imagination in adapting activities to individual needs also are assets. Those working in home healthcare must be able to adapt successfully to a variety of settings. Because OTs work long hours in a job that is both emotionally and physically demanding, a high energy level and an ability to handle stress are important.

ATTRACTIVE FEATURES THE MOST COMPELLING FEATURE OF THE CAREER IS THE ABILITY TO MAKE A POSITIVE

difference in the lives of many people. There is always a sense that you and your skills are needed and appreciated by the clients you serve. In addition, occupational therapy is adaptable to so many different types of settings, that OTs have their choice of working where they want 20

and with the types of clients they prefer. Some settings, such as home healthcare, allow a great deal of flexibility in scheduling. In addition, occupational therapy is a job that challenges its practitioners in a variety of ways – physically, emotionally, creatively, and spiritually – each and every day. That challenge and the variety of the job make it difficult to leave. When occupational therapy “gets into your blood,” it’s tough to walk away from.

UNATTRACTIVE FEATURES BEING AN OCCUPATIONAL THERAPIST IS NOT FOR THE FAINT OF HEART. IT IS A

physically and emotionally demanding career that can have a way of consuming other aspects of your life – a problem that eventually can lead to job burn-out. OTs work with patients who are recovering from an illness or injury and are at their most vulnerable. They can demand a great deal of patience and understanding. The therapist also must deal with family members who can be anxious and demanding. The job can be physically tiring because OTS may work long hours and are on their feet much of the time. Therapists also face potential injury, such as back strain from lifting and moving clients and equipment. Those providing home healthcare may spend several hours a day driving from appointment to appointment. In addition, OTs, like other healthcare professionals, must work in a climate where the kind of services clients need and how long they can be provided are being dictated by HMOs, insurance companies, and other third party payers, rather than the healthcare providers themselves. This can lead to frustration on the part of both the therapist and the client.

WORKING CONDITIONS OCCUPATIONAL THERAPISTS IN HOSPITALS AND OTHER HEALTHCARE AND COMMUNITY

settings generally work a 40-hour week. Those in schools may also participate in meetings and other activities, during and after the school day. Almost one-third of occupational therapists work part time.

In large rehabilitation centers, therapists may work in spacious rooms equipped with machines, tools, and other devices. 21

Therapists are increasingly taking on supervisory roles. Due to rising healthcare costs, third party payers are beginning to encourage occupational therapy assistants and aides to take more hands-on responsibility. By having assistants and aides work more closely with clients under the guidance of a therapist, the cost of therapy should be more modest.

EDUCATION AND TRAINING THE FIRST STEP IN BECOMING AN OCCUPATIONAL THERAPIST IS TO DO A CAREER

investigation and learn as much as possible about the field. A good place to start is with the career planning and placement offices of colleges and universities that offer occupational therapy programs. The staff there is trained to administer tests that determine individual preferences and needs relating to careers. Another important part of assessment is to gather information from a variety of sources. Many people think they know what occupational therapy involves, but they may never have observed an OT or received OT services. Search the World Wide Web for “occupational therapy” or occupational therapist.” Interested individuals may also want to contact state and national occupational therapy associations to receive printed materials. When you have learned more about the profession and your own professional preferences, you are ready to do a self assessment. Ask yourself how well you receive feedback, how well you relate to a variety of individuals from different backgrounds and cultures and what you feel are your strengths and weaknesses. Also, consider what your salary goals are, where you would like to live, and the kind of work schedule you would like to have. Try to be as objective as possible. Gain additional insights from teachers, friends, family members, current and past employers, and mentors. If possible, contact a local acute care hospital or rehabilitation center and ask to interview an occupational therapist to learn first-hand about the job. When you have done all of this and you are convinced that occupational therapy might be a good career fit for you, evaluate a variety of programs at colleges and universities. A bachelor’s degree in occupational therapy is the minimum requirement for entry into the field. You may enroll in an accredited 22

four-year college program leading to a degree in occupational therapy, or you may be able to transfer to an occupational therapy program after two years in a liberal arts program. Course work includes physical, biological, and behavioral sciences, and the application of occupational theory and skills. After the four-year program, students also must complete a supervised clinical internship of at least six months. Specific requirements for admission or transfer are set by the individual educational program. All states, as well as Puerto Rico and the District of Columbia, regulate occupational therapy. Although requirements vary from state to state, to obtain a license, all applicants must have graduated from an accredited educational program and pass a national certification examination. Those who pass the test are awarded the title of registered occupational therapist. College graduates who already hold a degree in another field may choose an entry level master’s degree program or a post-baccalaureate certificate program. A certificate program is one that, upon completion of academic course work and fieldwork, awards a certificate rather than a degree. The certificate enables the graduate to take the national certification exam. There are a few states that require a degree in the profession for licensing. Therefore, a certificate might not be as marketable or transportable to other jobs as a degree. Students who are considering entering the field should check with the regulatory board in the states where they intend to work. During their careers, occupational therapists are expected to regularly participate in continuing education programs. The American Occupational Therapy Association offers hundreds of workshops, courses, and other opportunities for new and experienced practitioners. The events also provide an opportunity for networking and sharing new practice strategies and techniques. The AOTA has established standards for the profession that have been adopted by many states in their laws and regulations. The association also has accredited the nation’s 300 programs and colleges throughout the United States. Leading undergraduate programs in this field are offered at these institutions:

New York University Boston University Wayne State University 23

Temple University University of Minnesota State University of New York College at Buffalo Colorado State University University of Florida University of Oklahoma University of Southern California University of Wisconsin - Madison

JOB OUTLOOK THE CAREER OUTLOOK FOR OCCUPATIONAL THERAPY APPEARS TO BE IN A STATE OF

transition. The shortage of OT practitioners that marked the 1980s and early 1990s seems now to have been replaced by a balance in the overall supply and demand. Shortages and vacancies are being reported in rural areas and in several practice settings, for example, in school systems needing pediatric practitioners. These shifts in demand for OT practitioners reflect some of the changes affecting healthcare delivery, with its increased reliance on managed care. But while payment and reimbursement for OT service are undergoing changes, the need for those services can only increase, given the demographic trends in the US. In general, the demand for OTs is expected to increase by over 50 percent by 2006 – more than for almost any other profession. The fastest growing segment of the population is the elderly, and their need for OT services is clear. Advances in medical care contribute to the growth of other populations who will need the special skills of the occupational therapy practitioner. For example, sophisticated neonatal intensive care assures the survival of premature infants, many of whom face developmental difficulties throughout their childhood. Advanced trauma services in emergency rooms means more lives saved. But survivors of spinal cord, traumatic brain, and severe orthopedic injuries require extensive occupational therapy. Finally, new ways in which occupational therapy practitioners may flourish are becoming evident. Most prominently, the prevalence of the 24

computer in all areas of today’s life – employment, leisure, and learning – means that the special skills of task analysis and ergonomics will be called upon. Preventing and treating the symptoms of repetitive strain injuries is a growing field into which OT practitioners are naturally qualified to move. Other practice areas with potential for occupational therapy relate to the American consumers’ embracing of a more holistic approach to health. Here, issues of lifestyle management and wellness are ones in which OT practitioners already have applicable skills.

EARNINGS ACCORDING TO RECENT SURVEYS, FULL-TIME SALARIED OCCUPATIONAL THERAPISTS

earn between $800 and $1000 a week. According to one survey of acute care hospitals, the median annual base salary of full-time OTs is about $45,000. Those at the top of the pay scale earn about $50,000. Salaries vary widely, of course, depending on location, the type of facility, and skill or experience level. Therapists who work in specific practice areas may be compensated for advanced skills or training. Therapists who work in private practice tend to earn more than those holding staff positions. When considering whether to accept a position, determine not only the base salary but benefits offered, including medical and dental insurance, malpractice insurance, continuing education, and travel benefits. Also consider the number of work hours, what time of day those hours will be and the conditions under which you will work.

GETTING STARTED-GAINING COMPETENCIES HIGH SCHOOL STUDENTS WHO ARE INTERESTED IN BECOMING OCCUPATIONAL

therapists should take college preparatory courses. The following courses in high school may be helpful to prepare you for your college career: Biology Chemistry and physics English and other writing courses History or social studies Foreign languages Mathematics 25

Computer science Psychology and/or sociology Choose course electives to compliment your career goals. These might include art, sewing, cooking, and other industrial arts courses. Many of the activities learned in these classes involve activities of daily living or activities that can be used in treating patients. Here are some other things you can do right now to help gain the skills and information you need to become an occupational therapist. Complete a co-op, intern, or volunteer experience in a healthcare or human-services setting. This will provide you with on-site experience and help you to learn good work habits early. Join art, music, and theater extracurricular activities to help expand your creativity. Conduct informational interviews with people in the occupational therapy field. Attend career and job fairs that feature job opportunities in OT and talk to recruiters about what they like to see in potential candidates. Attend relevant conferences and seminars about OT and the healthcare profession as a whole. Participate in a student exchange or study abroad program to learn about other cultures. Become familiar with work settings and job descriptions by visiting clinics, hospitals, schools, and businesses where OTs work. Join sports activities to help you maintain or improve your wellness and learn about your muscles and body. Practice making decisions by supervising a group of people. Act as a leader in a student or civic organization. Practice public speaking in classes or in organizations. Tutor students in various subjects. This will give you experience in instructing others. Develop a new campus organization. Join a professional organization such as the American Occupational Therapy Association. 26

COMPUTERS AND OTs COMPUTERS ARE BECOMING AN IMPORTANT TOOL IN OCCUPATIONAL THERAPY AND

will continue to play a growing role. Those considering a career in the field will want to gain proficiency in computer and Internet use as early as possible. “When I became an occupational therapist more than a decade ago, only a few clinicians had used a computer,” one OT says. “Now, just a generation later, few therapists have not used a computer. Increasingly, occupational therapists around the world are using computers to fill a variety of functions in and out of the clinic.” Computer users are generally quick to point out that, good as computers are, they do have their down side. Finding the right mix of hardware and software to meet the need and the budget is the first issue. Then, there are the extra hours spent learning to use the hardware and software. Finding the right connection to the Internet is not always easy or within budgetary constraints. Even after one finds and pays for the connection, time is required to learn how to connect to and function on the Internet. Several Internet users warn that surfing the net can take up quite a bit of time if one is not careful, especially at first when the software needs to be configured and the user needs to learn how to use it. Others caution about the possibility of becoming lost in an alluring, new, electronic world. Nevertheless, computer users identify many benefits. Many users of electronic, internationally-based discussion groups, comment on their broadened understanding across specialties, cultures, and geographical boundaries. Therapists who are geographically isolated delight in the sense of community and collegiality they have gained from their contact with other therapists on electronic discussion groups. Several therapists praise the efficiency in time, cost, and natural resources which e-mail has brought to communications – whether for a few team members in one’s clinical setting, or hundreds of colleagues on an electronic mailing list. Most therapists appreciate the educational and professional growth opportunities the Internet affords them. Occupational therapists who use computers as treatment tools with their patients are outspoken in their praise for the role of the computer as a playing field leveler for individuals with disabilities.

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How are occupational therapy practitioners using computers in the clinic? Computers are used by clinicians as

stand-alone tools for creating, processing, and displaying information, and they are used as links to other computers (linked computers are called a network). On another dimension, computer use can be seen as supporting the roles and functions of a therapist, including administering/managing, planning and documenting patient programs, communicating, conducting research, growing as a professional, and direct patient training. A manager of 20 pediatric OTs in a large hospital finds e-mail to be “a fantastic tool for increasing communication and making everything happen a little faster. I download and print-out a variety of messages from an electronic discussion group and distribute them to my staff. I also use the Internet for this purpose, by regularly checking out the OT related sites. I have templates I have created for my client-related reports, which have saved a lot of time.” Other therapists note that they use Lotus, Excel and invoicing programs and other spreadsheet or database programs for billing and for case management. Faxing reports directly from the computer is also a favorite efficiency of some managers. At a clinical site where most of the clients are preschoolers, computers are used to assess and treat the children, so the computer station at the clinic is part of introducing technology to children. Its use helps the family decide what software and hardware will work at home. At another site for children, the treatment teams use computers “for assessment and evaluation, with appropriate software, for physical access assessments, and for training and skill development in areas ranging from cause and effect to literary skill development.” Several therapists note their appreciation for on-line courses they have taken using their e-mail, while others appreciate the electronic newsletters and journals. Still others have exchanged articles with e-mail colleagues. One therapist put her experience this way: “I find that surfing the Internet is very interesting as it exposes me to areas I wouldn’t otherwise attend to. The discussions are a rich source of thought and interpretation. The spontaneity is energizing as are the unique perspectives that come through personal discussion as opposed to journal reading.” E-mail enhances professional communication. It fosters contact with other OTs even when geographical or other barriers prevent physical contact. E-mail affords therapists the opportunity to see themselves as healthcare professionals who are members of a global community and 28

who share concerns and responsibilities with other therapists around the world. Therapists whose specialties are narrowly focused and unusual are likely to find an international community of colleagues on the Internet. What most newcomers to e-mail and electronic discussion groups find remarkable is how easy and cost-effective e-mail can be. For someone who has good software, many contacts can be made with very little effort. One therapist said, “E-mail permits me to communicate with persons I would not necessarily telephone or write to, for example, with an author who wrote a book of interest and who greatly inspired me because of her research and her publications. I found her e-mail address, sent her a message in which I introduced myself and there began a wonderful professional relationship.” Another clinician says, “What I find fascinating about e-mail is the ability to interact with people of similar interests, and perhaps different opinions, from a whole variety of backgrounds. I find this interchange to be very broadening.” As good as communication by e-mail is, one respondent notes that it will get better as users learn new writing skills which are better suited to electronic communication, such as breaking up blocks of text, using meaningful subject lines in e-mail communication, keeping messages short, and selecting reply options more carefully when communicating via lists.

Some Examples of OTs Using Electronic Communication in Their Practices Consultant Gathers Data From the World Wide Web and E-mail “This year in my medical-legal consulting I was asked to comment on the likelihood of a musician having an occupationally related injury. I did the typical search on my university’s data bases and found a very small amount related to occupational injuries in this type of musician; it was quite general and therefore not too helpful. “I searched with two key words on the Internet to see what else I could find. I found an article by someone doing her PhD on the exact subject. It was quite an informative discussion and pointed out some of the issues. It was fascinating. I also found a bibliography, 198 pages long, listing occupational injuries of performing artists. I saved this and searched it by keywords to narrow it down to the particular type of musician I was concerned with. I was then able to select a few articles and have the library get them for me through regular inter-library loan. These articles were in a 29

journal that was not in the regular databases. They were specifically relevant to my question. “I e-mailed the person who maintained the bibliography and asked for names of relevant treatment centers and got a reply the next day. All this from my desk at home! “When I do go to the library I already know what I am looking for so it really saves me time. I can do the search at home in the comfort of my own office.” Obtaining Information About Surgical Intervention for My Client “I am an OT, living and working in a rural area. I have a young girl client who has Charcot-Marie-Tooth (CMT) Disease, and last fall I discovered what a powerful tool the computer was to help me connect with other persons who have this disorder. “I accompanied the girl to a hospital in another state. The doctor there suggested she have bilateral plantar fasciotomies. The family’s doctor at home was not positive about this surgery. That was a difficult position for me and the parents to be in – whose judgment do we listen to? “I learned that there is a CMT electronic discussion newsgroup. I wrote a message to the people on this list (at that time there were 40 people; there are now 85) asking if any of them had experience with this surgery and would they be willing to write to me. When I came home that night after work I found 18 messages! (from Norway, Holland and the US). Three of the respondents had experienced this surgery and shared with me their views on it. The other messages were very supportive messages. “I was very touched by these replies. Living in a very rural area as I do, there are no CMT support groups, and I didn’t know how to help the girl and her parents. “The end of the story is that my client had the surgery (she is 15) and is very glad she did so. She finds it easier to walk and can now wear shoes. Also, she can get her feet into ski boots and managed to ski at Christmas. I am now on the Internet all the time and have found various support newsgroups very helpful in obtaining information for my clients and their families.”

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Continuing Education on the Internet Many therapists

recognize the educational value of the Internet for entry-level, continuing, and specialty education. Of particular interest is the potential of the Internet to broaden access to learning opportunities in other parts of the world. One therapist who is currently teaching a course to two audiences at the same time using closed televideo believes this sort of teaching will increase in the future.

ASSOCIATIONS To learn even more about this career, you may want to contact industry trade associations and organizations and ask them to send information about careers in this field. Consult a directory of associations in your library for current addresses and phone numbers. n

American Occupational Therapy Association

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American Occupational Therapy Foundation

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National AMBUCS, Inc.

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State Occupational Therapy Associations

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Tri-Alliance

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World Federation of Occupational Therapists

PERIODICALS n

Advance Newsmagazines for Occupational Therapists

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American Journal of Occupational Therapy

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Journal of Occupational Therapy Students

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OT Practice

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OT Week

Copyright 2005 Institute For Career Research CHICAGO Careers Internet Database www.careers-internet.org

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