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2. Transition from meaning of skit to Mary Reilly
4. Moving away from medical model
5. New theoretical framework
7. OT education
8. Scientific rigor/detective/evidence-based practice
9. (Practice) Client vs. patient
[Med] Medical model
Born Oct. 11, 1916, in Boston, MA
Planned to do medicine, but her family did not have enough money to send her.
attended Boston School of Occupational Therapy (In 1945, the Boston School of Occupational Therapy became affiliated with Tufts University. *)
Practiced in Detroit at Sigma Gamma Hospital School
OT in US Army following Pearl Harbor (BSOT asked Reilly to go to Ft. Devens, MA)
Mary Reilly would not return to school for almost 10 years, and in that time, she would carve out a distinguished career with the U.S. military as an army clinician. (She joined Army Medical Specialists Corps.)
BS degree at the University of Southern California
MS degree San Francisco State College
teaching at USC, developed master's program
getting doctorate at UCLA; dissertation: "A theoretical basis for planned change in professional education"
Retired from USC
DITCH THE MEDICAL MODEL! [BETHANY]
Mary thought that OT should move/distance itself from the medical model; She was one of the early proponents of moving beyond the medical model while simultaneously returning to the roots of the profession.
Mary called out for OT to no longer be "passively dependent" on the medical field; OT cannot be a unique service/profession until it constructs its own theoretical framework.
The Educational Process Mary Reilly 1969
The medical model should not be the single perspective of our practice; however, that does not mean we should turn our backs on the medical sciences either.
We just need to 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.”
This brings us to Mary Reilly's ...
NEW THEORETICAL FRAME OF REFERENCE [BETHANY]
our own OT framework that incorporates multiple disciplines--psychology, sociology, anthropology, etc.
She framework she put forth was the occupational behavior frame of reference
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.
Important to note that Mary's occupational behavior frame of reference was not solely focused on "achievement" or "productivity."
She saw OT as geared toward the "reduction of incapacity" that resulted from disease, rather than a remedy for the disease itself.
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
She was influenced byarousal 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.
"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.
Defined occupational behavior as a "
continuum of play and work.
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.
Her influence stimulated research on play
INFLUENCED DEVELOPMENT OF OT EDUCATION [CHRISTINE]
Redirection in the Educational Process – challenging old values and reconstructing new ones
Medical model should not be single perspective of practice
Exploration of the behavioral sciences
Creation of a consistent frame of reference will guide the occupational therapy process.
Mary Reilly made major changes in 2 master’s degree programs
Basic professional master’s program: Explanation of the treatment process to students
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.
Traditional values for biology + more recent values for social psychology = a patient service directed toward bio –psycho – social functioning of a disabled individual.
Roles were introduced as learned in the process of socialization. There was a focus on occupational roles I.e. student, housewife, preschooler, and retiree
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.
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.
SCIENTIFIC RIGOR (DETECTIVE) AND EVIDENCE-BASED PRACTICE [BETHANY]
Even as Mary wanted to see OT move away from the medical model, she advocated strongly for OT to be science-driven.
envisioned a "laboratory setting for human productivity."
envisioned OTs "modifying sensory-motor dysfunctions, perceptual difficulties and the difficulties inherent in coping with the world of play, work and school."
Elisabeth Yerxa of USC explained that Mary " referred to scholarly endeavors as ‘detective work’
See role as an OT as "a person who sleuths out ideas, knowledge and wisdom wherever they might be found, finding clues and following trails."
Reilly laid the groundwork for this important transition toward evidence-based practice for several decades
1966 Eleanor Clarke Slagle Lecture--Elizabeth Yerxa
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
Beginning realizing the significance of collaborating with other professional
CLIENT VS. PATIENT DEBATE
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.
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?
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.)
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