How can the occupation base of occupational therapy be strengthened?

Change is happening rapidly in occupational therapy today, driven by the internal maturation of the profession. Internationally the numbers of master's and doctoral level occupational therapy programmes are increasing every year. More journals of general and specialised interest serve the field than ever before. More books are published. New areas of practice are emerging. Compared to 10 or 20 years ago, occupational therapy literature includes more research and it is of higher quality. Scholars in the field have become more critically insightful in regard to the multidisciplinary theories they import and the values that underlie different approaches to service and research. Occupational science, the study of human experiences and patterns of activity, has dramatically accelerated our continued exploration of the primary mode and target of our interventions: occupation. Factors in the health-care environment are also pushing occupational therapy through rapid change. The call for evidence-based practice and outcomes research is shaping the work of many of our researchers. Occupational therapy's long-held focus on function and skills for daily living has come into congruence with health care's emphasis on functional outcomes. This has led to competition from other fields over areas of practice they have never before considered important and that have traditionally been the unquestioned domain of occupational therapy. An upswell of desire for stronger occupation-based practice is evident in the profession. As our practitioners, students, educators and researchers strive for ever-higher goals, they centre on the most powerful medium available, the therapeutic power of occupation. Accommodating to change, competition and growth, the profession reaches to its core for stability. Now that occupational science is yielding the harvest of scholarship on occupation that it promised (Clark et al., 1991), we cannot help but wonder how this new knowledge can best be applied in practice. How can the occupation base of occupational therapy be strengthened? Three bridges need to be built between occupational science and occupational therapy in order to put the discoveries of the discipline to work for the clients of the profession: a generative discourse, educational programmes, and demonstration programmes focused on occupation-based practice (Pierce, 2001, 2003). A generative discourse on occupation-based practice produces new concepts through a process of open discussion, research and debate on how occupation-based practice best occurs. By bringing these questions forward here, this editorial is a part of that generative discourse. From momentary conversations between therapists to published research projects, the vitality of this field-wide exchange of fresh ideas is a critical aspect of enhancing the occupation base of our practice. Without an active generative discourse, it is possible that the degree to which occupational science concepts would be brought to bear on practice would be limited. Thus far, some of the most potent ideas produced by the generative discourse on occupation-based practice include occupation as the means and ends of intervention (Gray, 1998), top-down assessment (Coster, 1998), and the appeal, intactness, and accuracy of intervention (Pierce, 2001, 2003). In my home country, the United States of America, there is an explosion of interest in educating practitioners for occupation-based practice. Driven by the accreditation mandate that entry into the field be at the post-baccalaureate level, many new curricula are being designed. The American Occupational Therapy Association has published the new Practice Framework, which details an occupation-based approach. This move by a national association to bring practice back to its core values parallels what occurred in Canada several years ago in creating a new focus on client-centred care in occupational therapy. Brought together in this way, these factors are combining to produce a rapid updating of educational programmes that are strongly occupation-based. As the students of these new programmes enter clinical settings, however, they encounter great variability in the practice approaches they find. This gap between newly trained and experienced clinicians calls for immediate attention. Demonstration programmes seek to use and model occupation-based practice to its best effect. To enhance occupation-based practice, we need occupation-based programmes in every area. Publishing about how these programmes work and are conceptualised will be critical to the generative discourse. I have participated in reflective research on the development of two such programmes so far, one in an independent and assisted-living centre for elders (Goldstein-Lohman, Kratz & Pierce, unpubl. data, 2002) and one for at-risk youth in alternative educational settings (Cunningham, Dunn, Fehringer, Marshall & Pierce, unpubl. data, 2002). In both studies, the therapists discovered much, were energised by their efforts, and grew greatly in their creativity and satisfaction with occupation-based practice. I hope and expect that many such demonstration programs are currently being initiated by therapists around the world, as they seek to apply the new discoveries of occupational science. Can change move too fast? Perhaps. For us, it seems stressful to be continually rethinking practice. For our clients, however, our strengthening of the therapeutic use of occupation to help them meet life goals can never come too fast. A special issue of the Australian Occupational Therapy Journal on Occupation will be published in June 2003.

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