DITCH THE MEDICAL MODEL! (DISTANCING OURSELVES FROM MEDICAL MODEL...)


Mary provided that voice, calling out for OT to no longer be "passively dependent" on the medical field. (OT, it is proposed, can not be a unique service realistically committed to the reduction of incapacity until it constructs its own theoretical framework.”) She was one of the early proponents of moving beyond the medical model while simultaneously returning to the roots of the profession. ("It is the task of medicine to prevent and reduce illness; while the task of occupational therapy is to prevent and reduce the incapacities resulting from illness.”)

The Educational Process Mary Reilly 1969
The medical model should not be the single perspective of our practice. We should not turn our backs on the medical sciences however. We must recognize the difference between occupational therapy and medicine with regard to each discipline’s responsibilities. “It is the task of medicine to prevent and reduce illness, while the task of occupational therapy is to prevent and reduce the incapacities resulting from illness.” Traditionally, we conceptualized behavior in terms of deficits in body systems - pathologies. We have given less value to the technologies we developed to help a deficit person achieve satisfaction in social and work involvement. We must recognize these adaptations. The drug, surgery, and psychotherapy frame of reference of the medical science and their focus on acute conditions does not support Occupational Therapy’s focus on chronic illness and adaptations. A redirection in research of the Occupational Therapy version of man according to Anthropology, psychology, and sociology has led to a social psychology synthesis. This is a synthesis of psychology and sociology and their joint conceptualization of behavior. In this conceptualization of behavior, the individual (psychology) and his/her transaction with the environment (sociology) are considered.


A NEW THEORETICAL FRAME OF REFERENCE (our own OT framework that incorporates multiple disciplines


The theoretical framework that she put forth was the occupational behavior frame of reference. Essentially, Mary acknowledged that OT was not primarily concerned with "deficits to body systems," but rather, enabling "patient achievement" was the "direct responsibility" of occupational therapists. As Mary saw it, OT was geared toward the "reduction of incapacity" that resulted from disease, rather than a remedy for the disease itself. This idea persists today, although we may challenge that notion in light of emerging fields of practice in OT, such as ergonomics where the focus is often on preventing injury or illness altogether. It is important to note that Mary's occupational behavior frame of reference was not solely focused on "achievement" or "productivity."

UNDERSTANDING PLAY (Stagnitti, 2003) An important component of Mary Reilly's occupational behavior frame of reference was an emphasis and increased understanding of play. For years, occupational therapists viewed play as unscientific and inferior to other concerns, such as motor skills, which can be measured more easily. "The occupational behaviour frame of reference places childhood play as the primary vehicle for the development of skills needed for competence in adulthood (Parham & Primeau)." Mary understood play to be a complex behavior. She was influenced by arousal modulation theories of play, which hypothesize that play behavior must be sustained by the child's curiosity and exploration of objects, and that play prepares the child for adaptation to adulthood. In fact, Mary defined occupational behavior as a "continuum of play and work." Play for Mary was not only a necessary component of child development--a means of preparation for adult occupations later in life.... ("There is historical evidence that a child's ability to play, to explore his environment, to exercise his motor skills are the foundation for his later school experiences. The problem-solving processes and the creativity exercised in school work, craft and hobby experiences are the necessary preparations for the later demands of the work world.") But, very importantly, she also thought play or "social-recreation" occupations were necessary for adults too to support an his or her "work patterns." Mary's interest in play thus stimulated further research on play and laid the ground work for play and leisure to have their place as an area of occupation in our current OT practice framework.


The Educational Process Mary Reilly 1969
Creation of a consistent frame of reference will guide the occupational therapy process. Traditional values for biology + more recent values for social psychology = a patient service directed toward bio –psycho – social functioning of a disabled individual. This service does not distinguish us from any other health service though. OT cannot be a unique service committed to the reduction of capacity until it has its own theoretical framework. The professional frame of reference encompassed a variety of themes. First, occupational behavior was the core body of professional knowledge. Insert definition of occupational behavior. Second, Achievement influenced by Erik Erikson, Robert White, and David McClelland was a major frame of reference. Third, a development- achievement phenomenon was elicited. The process of growth elicits achievement drives that generate interests, abilities, skills, habits of competition, and cooperation. Play & work were believed to be on this developmental continuum. Play is a chronological area that is believed to prepare for and precede work. Fourth, roles were introduces as learned in the process of socialization. There was a focus on occupational roles I.e. student, housewife, preschooler, and retiree. Lastly, Levels of aspiration, the relationship between a level’s expectancy established in prior socialization and a current pattern of success and failure, was introduced.



Understanding Play (Stagnitti, 2003)

For years, occupational therapists viewed play as unscientific and inferior to other concerns, such as motor skills, which can be measured more easily.

Mary Reilly's contributions to the field of occupational therapy
  • Occupational behaviour frame of reference
  • "The occupational behaviour frame of reference places childhood play as the primary vehicle for the development of skills needed for competence in adulthood (Parham & Primeau)."

  • Understood that play is a complex behavior
  • Her influence stimulated research on play
  • Influenced by the arousal modulation theories of play, which hypothesize that play behaviour must be sustained by the child's curiosity and exploration of objects, and that play prepares the child for adaptation to adulthood.



SCIENTIFIC RIGOR (DETECTIVE) AND EVIDENCE-BASED PRACTICE


Even as Mary wanted to see OT move away from the medical model, she advocated strongly for OT to be science-driven. In her talk "Occupational Therapy Can Be One of the Great Ideas of the 20th Century," Mary envisioned a "laboratory setting for human productivity." Grounded in science, Mary envisioned OTs "modifying sensory-motor dysfunctions, perceptual difficulties and the difficulties inherent in coping with the world of play, work and school."
One of her students at USC, Linda Florey, described her professor's scholarly rigor when she told the story about the comments Mary gave her on a paper she had turned in for class: "Mary told me I had to 'stop treating my mind as if it were a playground.' I knew what she meant. I'd been creative but hadn't followed the rules of scholarship."

Elisabeth Yerxa of USC explained that Mary " referred to scholarly endeavors as ‘detective work’, "and as a result of her influence, Dr. Yerxa sees her role as an OT as "a person who sleuths out ideas, knowledge and wisdom wherever they might be found, finding clues and following trails." Though the profession as a whole would not begin moving toward evidence-based practice for several decades, Reilly laid the groundwork for this important transition.
[Authentic Occupational Therapy] 1966 Eleanor Clarke Slagle Lecture
"This body of knowledge must be based upon accepted research."
  • Occupational therapists are beginning to conduct their own research studies and developing tools of evaluation
  • No longer relying on the work of physicians and other professionals to determine what was important to our practice
  • Critical thinking, reasoning, and science CAN be combined with concern for the client as a human being
    • Began realizing the significance of collaborating with other professional

INFLUENCED DEVELOPMENT OF OT EDUCATION


While on faculty at USC, Mary Reilly developed a master's program (the first ever?) for OT. Her UCLA dissertation topic was "A theoretical basis for planned change in professional education" She proposed new ideas which we can see here at BU today...

[[#HISTORICAL BACKGROUND-INFLUENCED DEVELOPMENT OF OT EDUCATION---[Authentic Occupational Therapy] 1966 Eleanor Clark Slagle Lecture]][Authentic Occupational Therapy] 1966 Eleanor Clark Slagle Lecture
Since 1962, we began making numerous revisions on the curricula and educational objectives for occupational therapy
  • Began establishing programs by which students could earn their master's degrees while becoming registered occupational therapists
  • began developing and operating certified occupational therapy assistant training program
  • The union of theory and practice
  • Medicare bills and state legislation began recognizing the need for occupational therapy services in hospitals, home health, and extended care programs.

Redirection in the Educational Process – challenging old values and reconstructing new ones
1. Medical model should not be single perspective of practice
2. Exploration of the behavioral sciences
3. Creation of a consistent frame of reference will guide the occupational therapy process.

Mary Reilly made major changes in 2 master’s degree programs
1. Basic professional master’s program: Explanation of the treatment process to students
2. Advanced professional curriculum: Developing and applying theory to OTR’s.
Educational changes were made based on the philosophical rationale Reilly and others developed about Occupational Therapy.

Moved the point of balance toward sociology and use role theory as the academic bio-psycho-social synthesis. Role theory is a link between psychology and sociology. Role disruption is in the foreground of a person’s problem. Treatment of a housewife or an accountant v. a paraplegic.

Advanced Professional Curriculum & Basic Professional Curriculum: See article for specific details!


CLIENT VS. PATIENT DEBATE (SHOULD THIS BE A SKIT?)


A debate emerged within the profession of occupational therapy as to whether "patient" or "client" was more appropriate to describe persons seeking OT services. Consensus was reached in 1983, as Mary Reilly explained in her 1984 AJOT article "The Importance of the Client versus Patient Issue for Occupational Therapy," that the profession would move away from "patient" and use "client" instead. Surprisingly, given her history of advocating that occupational therapy distance itself from medicine and create its own theoretical framework, Mary Reilly staunchly supported keeping the term "patient." Her primary concern was that losing the term patient would undermine the ethical responsibilities and practices of occupational therapists. Her reasoning was that the term "client" denotes an economic-legal relationship between therapist and the person receiving care, the therapist's moral responsibilities would be compromised. She saw this transition as a reaction to the "self-interested" nature of the medical field, that routinely marginalized the services that occupational therapists provide; Reilly believed that the interest in using the word "client" was a VAIN attempt to distance OTs from medicine and assert their importance and independent value. Those in favor of switching to the term "client" argued that "patient" denoted a "passive recipient" of health care, while client indicated a person seeking out services, an active participant in their care. Suzanne R. Herzberg, when she was an OT student, boldly challenged Mary Reilly's position and argued in her 1989 paper Client or Patient: Which Term is More Appropriate for Use in Occupational Therapy? that The fear that moral actions will disappear with the use of the word client is irrational; moral actions are supported and reinforced by the existing legal code.
Herzberg also argued against the notion that transitioning from patient to client, or moving to an economic-legal relationship between therapist and person being served, would mean that occupational therapy would only be available to those who could afford it. Herzberg pointed out that this economics-related disparity in care already was the case while using "patient" to refer to people being served by OT.

Reilly argued that "For occupational therapy, it is doubtful that the golden parachute of a name change will work. The times do not require a name change as much as they require a systems change."

Reilly's passionate participation in the debate over the occupational therapy name may have been her last public contributions to the field. (She was retired from USC when the article was written and has since remained a recluse.)

Mary Reilly - Role Model

Confections of an Occupational Therapist who became a detective- Yerxa, Elizabeth J.

Occupational therapy could become an autonomous, self-defined profession only to the extent that we developed our own ideas, our own perceptions of service, and translated these into a curriculum (Yerxa 1995). I realized that Mary Reilly, the former director of occupational therapy graduate studies at SC, had been trying to do just that during her tenure. She served as one role model of a faculty member who was a brilliant scholar and who also created a community of scholars consisting of faculty, graduate students and clinicians. Together they developed the occupational behavior frame of reference (Reilly 1969) which served as the foundation for both a curriculum and new models of practice. Many of her former students have since become leaders, master clinicians, scholars and academics. It worked! Although I was never her student, Mary Reilly inspired me by her example, wisdom and life as a born academic. I can visualise her emerging from the womb exclaiming, ‘Forget the milk, bring me my literature!’ She referred to scholarly endeavors as ‘detective work’, an occupation I soon adopted. I am deeply inspired by the example of Mary Reilly who lives to learn.