Program Philosophy Statement
Health and Well-Being
The Master of Occupational Therapy Program at Cleveland State University embraces the World Health Organization’s definition of health. “Health is a state of complete physical, mental, and social well-being - not merely the absence of disease or infirmity” (Wilcock, 2006, p. 144). The Program strives to provide academic and practical experiences focusing on prevention and wellness. In addition health promotion is emphasized. Health promotion is the process of enabling people to increase control over and to improve their health through enabling, advocacy, and mediation. Empowerment is the guiding principle of health promotion. It facilitates the acquisition of choice and increases control over ways to improve health (World Health Organization’s Ottawa Charter for Health Promotion definition of health promotion as cited in Wilcock, 2006).
Evaluation of a client perceptions of their doing, being, and becoming should be a part of standard practice. These concepts are integral to health and well-being. A dynamic balance of doing and being is central to healthy living and becoming is dependent upon both. Doing provides the mechanism for social interaction, societal development and growth. There can be an imbalance in the experience of doing. For example time for leisure occupations has decreased in many societies. Being involves having time to contemplate, enjoy, reflect, and simply exist. Becoming holds the notion of potential and growth. People need to be enabled towards what they are best fitted and wishful to become. Occupational therapists are part of the process of becoming by enabling doing and being (Wilcock, 1998).
The practice of occupational therapy embraces and is centered on the value and meaning of purposeful occupations as performed by human beings across the lifespan. An understanding of the term occupation assists therapists in providing best practice, students who participate in occupational therapy education, and educators and researchers who implement occupational therapy curricula and develop new knowledge in the study of occupation and occupational therapy practice.
One may define occupation as that which takes hold of, or employs, one’s time or productivity Occupation may be organized into a view of the human as a multileveled, open system acting upon and responding to the environment over a developmental trajectory, from birth to death. At the cultural level occupation refers to the units of organized activity within the ongoing stream of human behavior that are named and classified by a society according to the purposes they serve; for example fishing or sewing or, at a more abstract level, playing or working. These everyday pursuits are self-initiated, goal directed (purposeful), and socially recognized. Occupations, constituted of adaptive skills, are organized to achieve human intentions. Engagement in occupations may be personally satisfying and my serve an extrinsic purpose. Occupation enables people to contribute to society and thereby find a place in their culture. Engagement in occupations influences health (Yerxa, 1998,pp. 366-367).
Occupations are viewed as activities having unique meaning and purpose in a person’s life. Occupations are central to a person’s identity and competence, and they influence how one spends time and makes decisions. (Occupational Therapy Practice Framework, 2002)
An occupation has a shape, a pace, a beginning and an ending, a shared or solitary aspect, a cultural meaning to the person, and an infinite number of other perceived contextual qualities. A person interprets his or her occupations before, during, and after they happen. Although an occupation can be observed, interpretation of the meaning or emotional content of an occupation by anyone other that the person experiencing it is necessarily inexact (Pierce, 2003, pp. 4-5).
In addition, engagement in occupation creates “by-products” such as temporal organization, social contact, identity, and goal setting and achievement, which further underlie a person’s abilities (Yerxa, as cited in Burke, 1998, p. 419). Engagement in meaningful occupations affects human development in areas such as self-knowledge (identity), self-efficacy (the experience of success and mastery), motivation (prolonged engagement in occupations that offer “pleasure, productivity, or restoration”[Pierce, 1998,p 490] that are relevant to one’s lifestyle, or that “nurture the human spirit to act” [Zemke & Clark, 1996, p. xiii]), and adaptation (the ability to create adaptive strategies to enhance opportunities to engage in occupation within their context.
Occupation as currently used in the field makes use of the term as both ‘means and end’ (Hasselkus, 2000, as cited in Royeen, 2002) or as a process as well as a product or outcome. Occupation as a process, or as a means, refers to occupation as a method of intervention (Rebeiro and Cook, 1999 as cited in Royeen, 2002), as a dynamic aspect of engagement in life and as an unfolding of interaction between a person and the world. Occupation as an end or product refers to the outcome of the process of engaging in occupation. In this use of the term, a state or condition such as being a mother or being a gardener is described. The use of term in this latter sense connotes a static condition.
Further, a person’s occupations must be understood within various contexts or environments. Cultural, physical, social, personal, spiritual, temporal and virtual contexts affect an individual’s engagement in activities and occupations. The person's actions have an effect on these larger systems, which in turn affect the individual in a continual, dynamic interaction that is highly complex. This interaction is often initiated and sustained by the individual out of an intrinsic need to explore and master the environment. The environment presses the individual to meet certain standards and affords the individual opportunities to engage in meaningful activity. Through this interaction the person influences his or her own development and adaptation and contributes to that of society (Kielhofner, 1995; Occupational Therapy Practice Framework, 2002).
Engagement in occupations is a natural and essential human function. A person’s health and well-being depend on it. This fundamental truth forms the basis for the discipline of occupational therapy.
Occupational therapy focuses on enabling people to do the activities of daily life. The very word "occupation" - means an activity which "occupies" our time. A child in grade school has the occupation of learning. An adult may need to learn how to write after a traumatic injury. A senior may want to continue driving safely in order to stay active in his/her community. All of these things are occupations and participating in them is vital to maintaining overall health and wellness (http://www.aota.org/Consumers.aspx).
The domain of occupational therapy is thoroughly defined in the OT Practice Framework (2002). The focus and targeted end objective of occupational therapy is “Engagement in occupation to support participation in context or contexts. … Engagement in occupation includes both the subjective (emotional or psychological) aspects of performance and objective (physically observable) aspects of performance” (Occupational Therapy Practice Framework, 2002, p. 611). The various aspects that occupational therapists attend to during the process of providing services include context, activity demands, client factors, performance skills, performance patterns, and areas of occupation. The CSU occupational therapy faculty has adopted this framework in its curriculum design.
The occupational therapy process includes (a) screening, evaluation and re-evaluation (analysis of an occupational profile and occupational performance), (b) intervention planning, implementation, and review, and (c) outcomes (engagement in occupation to support participation, selection of outcomes and outcome measures, documentation of changes, and preparation of a discontinuation or transitional plan ) The CSU Master of Occupational Therapy Program prepares students to practice as generalists using the Occupational Therapy Practice Framework, The AOTA Standards of Practice in Occupational Therapy, The Fieldwork Performance Evaluation and the Accreditation Council for Occupational Therapy Education (ACOTE) standards as guidelines for curriculum development and implementation (AOTA, 2005, AOTA, 2006, Occupational Therapy Practice Framework, 2002). These documents clearly and more specifically define the desired outcomes, skills, and practices of an entry level occupational therapist.
Occupational Therapy and Occupational Science
The CSU MOT Program recognizes the difference between the practice of occupational therapy and the study of occupation. “Although occupational science and occupational therapy both focus on occupation, they differ in that occupational therapy is a profession, and occupational science is an academic discipline. A profession is a form of paid employment distinguished by its service to the public through schooled application of a specialized knowledge base and skill… In contrast, an academic discipline is a branch of knowledge, learning, and scholarly inquiry legitimized by university communities that often supports the work of professions” (Larson, Wood, & Clark, 2003).
Occupational science focuses on the form, function, and meaning of human occupation… The form of occupation refers to the aspects of occupations that are directly observable. The function of occupation refers to ways occupation influences development, adaptation, health, and quality of life… Finally the meaning of occupation refers to the subjective experiences of engagement in occupation” (Larson, et al., 2003).
Occupations are defined in the science as chunks of daily activity that can be named in the lexicon of culture” (Zemke & Clark, 1996, p. vii.). Occupational science is distinct because it demands a fresh synthesis of interdisciplinary perspectives to provide a coherent corpus of knowledge about occupation… Its existence should be catalytic in spawning scholarly efforts that will provide creative synthesis of extant knowledge on occupation. Moreover, it should inspire new research that pointedly addresses occupation and its centrality within the framework of human lives” ((Zemke & Clark, 1996, pp. ix-x.).
Occupational therapy is therapeutic intervention that promotes health by enhancing the individual’s skills, competence, and satisfaction in daily occupations” (Johnson & Yerxa, 1989, p. 6). As a profession, occupational therapy applies the principles of occupational science in practice by helping individuals participate in meaningful occupations that contribute to health and well-being (Crepeau, et al., 2003). Although occupational science was originally conceived as a basic science that would focus on occupation without an immediate application to occupational therapy, there has been a natural tendency for occupational scientists to make inferences to practice (Zemke & Clark, 1996). According to Hoshmand and Polkinghorne (1992 as cited in Zemke & Clark, 1996), “the generation of knowledge that does not inform practice leaves practitioners without a knowledge base and creates obstacles to practitioners’ contributions to knowledge development” (p. x). Furthermore, by embracing a postmodernistic perspective, research and practice are not viewed as separate activities but as an integrated system of focused activity and action (Hoshmand & Polkinghorne, 1992 as cited in Zemke & Clark, 1996). Research in occupational science can and should be used to inform and shape occupational therapy theory and practice (Larson, et al., 2003; Primeau, et al., 1990).
The faculty of the CSU MOT Program embrace the study of occupation as part of our mission, as well as teaching our students about occupational science as a foundation for occupational therapy practice.
Occupational Therapy Education
Higher education should be locally relevant, of high quality, and drawing on and contributing to global knowledge production. Higher education should promote the public good (UNESCO, 1998). Graduates of health related programs need to be prepared to be facilitators of health and “agents of social change in the contexts where they work” (Duncan & Alsop, 2006, p. 11). For well-prepared graduates, there should be a good match between prevalent national and local health needs, emerging paradigms of practice and what students learn. (Duncan & Alsop, 2006).
Key threads or themes in the CSU Master of Occupational Therapy Program as seen in our mission statement include occupation based practice, innovative practice and teaching, research relevant to occupational therapy, collaboration with community and university partners, client centered care, the therapeutic use of self, and life long learning.