Examining the Underrecognition of Occupational Therapy

Nov 22 / Kimberly Breeden, MS, OTR/L Founding Partner

I think every OT practitioner is accustomed to answering the question “what is occupational therapy?” It is this question that causes most OTs and OTAs to feel that our profession is underrecognized.  I agree,  but I feel that the problem is not just a general lack of understanding of what occupational therapy is, but more concerning to me it is a lack of understanding regarding the value of our profession.  I see this in statements such as “physical therapy can do anything that occupational therapy can do”.  I see this when nurses and social workers make recommendations for adaptive equipment or durable medical equipment without consulting the occupational therapy staff involved in the individual’s care. Most of all I see it when other disciplines provide interventions that fall within the scope of occupational therapy.   

If you have attended one of Niccole and I’s courses or lectures, you know I always have a lot to say about the profession that I love.  I also have a lot to say about this topic. It is especially important to me and brings up a lot of different emotions for me; the strongest being frustration.  My guess is that most OT practitioners are frustrated with the perception that there is little understanding to exactly what we as OT practitioners do. I have blogged about this topic before but I feel that it deserves a deeper examination.  I think there are a lot of factors that should be discussed and even more importantly, a great deal that OT practitioners can do to change it.  I believe that this process can result in OT practitioners becoming more powerful in their practice.  Yes, I definitely meant to say powerful.  That word may make you feel uncomfortable, that is ok.  We will delve into that further in this blog series.  In my past blogs I have focused more on what we can do to promote OT, but I would like to start the discussion this time by further exploring just how underrecognized occupational therapy is.  

What does the public know about occupational therapy?As OT practitioners, we are aware that we frequently explain to our family, neighbors, friends, co-workers and clients what we do as OT practitioners.  Unfortunately there is not a lot of data specific to the public's knowledge of occupational therapy, but I was able to find a few studies to confirm what we already know.

 In 2018, a study of 3 media outlets found that although the profession of occupational therapy is over one hundred years old, it's presence in news and social media outlets needs to be stronger (Walsh, 2018).  

A study of older adults over the age of 65 in Australia found that only 10% of respondents could provide a good or advanced description of occupational therapy.  Over half of the respondents had some or limited knowledge of occupational therapy and 25% had no knowledge or did not answer the question.  (Rahja & Laver, 2019).   

While this information is no surprise, it's implications are troubling because a lack of awareness of the profession could actually result in a lack of access to occupational therapy services.  Trends demonstrate that healthcare consumers want more opportunities for choice in the services they receive. If consumers do not know how OT services could benefit them, they will not request or seek out our services.  For consumers who have co-pays, they may decline referrals to OT services because of limited financial resources and the lack of  understanding that OT can address more than bathing, toileting, and fine motor coordination.   

How much do other health care professionals know about occupational therapy? 

As OT practitioners, we are often uncertain as to how much other healthcare professionals understand about occupational therapy.  Again, it was not easy to find specific information.  I found the following studies interesting.  

In a 2009 study of 150 nurse practitioners, 49% reported not having adequate understanding of occupational therapy to make a referral to OT. (Patel and Shriner, 2009).  

A 2003 study of 55 physicians, found that only 62% felt they had sufficient knowledge for making referrals to occupational therapy (Metwali, 2003)

A recent study conducted by the University of Tennessee, Chattanooga found that 40% of physical therapy professionals did not feel strongly in their ability to know when to refer clients to occupational therapy services (York et al., 2020).  

The implications to this information is obvious, but also very disappointing. Again the concern is that individuals who need our services may not have access to occupational therapy if the healthcare professionals who make referrals do not have adequate knowledge to what areas can be addressed by occupational therapy.  

Do policymakers and payors recognize occupational therapy?The answer to this question is yes, no, and maybe?  This is a lot of information to unpack.  Let's just look at a few highlights and examples. 

There are instances in which occupational therapy may be recognized in regards to reimbursement such as the CMS outpatient thresholds in which occupational therapy has an individual threshold, while physical therapy and speech share a threshold.  This however does not seem to result in an increase in utilization of occupational therapy services as demonstrated by the most recent report from CMS for outpatient therapy utilization in 2010.  The report indicates the following number of individuals:  
4,156,895 Received Physical Therapy   
1,043,011 Received Occupational Therapy
526,628 Received Speech Therapy.   

In other instances, occupational therapy's value is underrecognized by payors such as CMS, which does not allow occupational therapy to open a home health episode of care unless another discipline is also ordered. This means that individuals who only require occupational therapy services do not qualify for the home health benefit.  

Although occupational therapy is grounded in the value of the mind-body-spirit connection and the biopsyschosocial model is the most widely accepted model for treating pain, the US Department of Human Services, Pain Management, Best Practices, Interagency Task Force Final Report mentions physical therapy 9 times and occupational therapy only 2 times. (DHS, 2019). 

Do occupational therapists, occupational therapy assistants and students recognize their own value?I could not find any specific studies to answer this question, so I am going to give my opinion based on my 28 years of practice as well as the summation of the literature I have read.  

No, overall we as OT practitioners do not recognize our own value.  There are a number of articles, lectures and even studies that address confidence within our profession.  If we lack confidence, we must not recognize our value.  I see discussions all over social media in which other disciplines seem much more willing to promote their value than we are to promote ours.  

I wish and hope that my assumptions are incorrect.  I truly hope that that my email and social media will be flooded by OT practitioners contacting me with information that will change my mind.    

So what do we do with this information?My goal for any OT, OTA or student reading this blog is to understand the significance of the problem and reflect on how it is impacting their own practice.  I am typically a very positive person who tries to present things in the most optimistic way I can, but for me personally that is not what I think I should do in this moment.  

Right now, I feel like I need to reflect and allow myself to experience my frustration.  I feel like I need to understand how this frustration affects my OT practice and most importantly my interactions and relationships with the rest of the interdisciplinary team.  I feel like I need to try to understand how it affects me as an OT practitioner.  

In my opinion, allowing myself to understand the significance of the problem and how it impacts my practice will help me to move forward.  Moving forward for me always involves the end goal of acting to solve the problem.  I am a problem solver, I know that.  I think a lot of OT practitioners identify themselves as problem solvers, so many of you can relate to this.  

Please don't misunderstand me, I do not think I can solve this problem on my own.  Our profession as well our professional organizations have been working to address this for as long as I can remember and have made a lot of progress.  For this I am grateful, but there is much still to be done.  It will take all of us, every OT, OTA and student to take action.  This journey for me will allow me to figure out what I am currently doing to address the situation and more importantly, it will help me identify what I need to change in the future to be a bigger part of the solution.  I hope you join me on your own journey.

The next step in my process, as well as this blog series, will be to look at all the factors that are contributing to the underrecognition of occupational therapy  The results may surprise us.  

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Written by: Kimberly Breeden, MS, OTR/L
Founding Partner of Aspire OT

Check out our upcoming webinar

Finding Your Voice: Addressing the Under-Recognition of Occupational Therapy

Wednesday, April 17,  7 pm CT/ 8 pm ET
$40, 2 Contact hour
AOTA Approved for CEs
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