The philosophy of the Department of Occupational Therapy reflects the mission statement and values of West Coast University (WCU), the values of the occupational therapy profession, and the mission and values of the faculty of the Master of Science in Occupational Therapy (MSOT) program. Some of the themes that these entities share are: Student-centricity; Commitment to the communities served; Innovation and creativity; and the efficient use of resources.
The program curriculum is shaped by the central beliefs about health and well-being, occupation, and teaching and learning:
Health and Well-being
The curricular philosophy of the MSOT Program at WCU provides a set of basic principles or concepts which determined the design of the curriculum.
The philosophy is based on one of the perspectives which underpin the nature of humankind: A “Holistic” approach as opposed to a “Reductionist” approach. The holistic approach is a foundational principle of the profession and integrates and maintains the person as a whole – “an interaction of biological, psychological, sociocultural and spiritual elements”. Thus, if any part of the system is affected by illness, disease, or disability, the entire system will be disturbed. In this “Systems” thinking, humans are viewed as active beings: Control resides within the individual, and the person is an active participant (client) in the services designed to aid in improvement, as opposed to a passive recipient (patient) receiving treatment to recover. The systems are interactive and adaptive and the subjective components – spirituality, thoughts, feeling and perceptions – are incorporated. Should the occupational therapist only focus on certain body parts/function during interventions, the client is denied the uniqueness of occupational therapy services: a holistic approach.
Because the client is an integral part of the therapeutic process, the occupational therapist must understand the full range of elements that constitute quality of life for the individual: "Health is not just the absence of disease. It is a feeling of total well-being on the Physical, Mental, Emotional & Spiritual levels of a person’s life" (World Health Organization [WHO], n.d.). This view of health supports a “top down” approach to therapeutic problem solving and it is in keeping with the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) (2001). It is an approach that aims to enable the individual to participate in his/her chosen life tasks. This top-down approach includes adapting tasks or activities and ensuring barriers to access posed by the environment (social and physical) are addressed as part of the intervention. The top-down approach is further congruent with a client-centered focus – another founding principle of the profession. The approach ensures information gathering, planning and interventions are grounded in life activities which are relevant and important to the client. By contrast a “bottom-up” approach, which focuses on particular deficits uncovered during a reductionist assessment process, tends to produce a fragmented and narrow definition of the client’s problems particularly from a body structure/function perspective (e.g., motor, sensory, perceptual, cognitive), and consequently leads to a narrow repertoire of possible interventions which are not client-centered. It focuses on the client’s deficits rather than acknowledging their interest, strengths, and enabling occupations.
To educate occupational therapy students to view their clients as a whole versus a composite of parts, the design of the curriculum will facilitate integrative versus fragmented thinking. A curriculum design characterized by creating fragmentation or silos of knowledge will be counterintuitive to this process. Courses should be designed and taught for students to focus on how the disease affects the occupational performance and quality of life of the person. In traditional curricula supporting the medical model, which is reductionist in nature, courses such as “pediatrics”, “orthopedics” or “neuro” prevent the student from viewing the client as multifaceted, incorporating all aspects of occupational therapy’s domain which will “transact to support engagement, participation and [ultimately] health” (AOTA, 2008).
The pedagogical solution to the issue of fragmentation of thought has led to the creation of three Occupational Performance courses covering the child and adolescent, the adult, and the older adult. Within these Occupational Performance courses, the student is presented with physical and mental health conditions most relevant to that particular life stage, as well as related evaluations and assessments, and interventions. The intent behind this pedagogical approach is to assist the student in viewing human beings from a biopsychosocial perspective, therefore integrating components of psychosocial interventions into physical health and vice versa.
Within the integrative shell of these three courses, conditions are presented as clusters through complex case studies, narratives, and principles of problem-based learning. The conditions incorporate both physical as well as psychosocial components, as in the following example: “Mr. Smith, who suffered a stroke one month ago, has signs of a depressed mood and social isolation.” This will enable the student to see their clients as multifaceted beings, thus integrating knowledge and skill to create client-centered interventions plans that are true to the nature of occupational therapy. The two assessment courses will be taught similarly; utilizing what the students already know and facilitating discovery of whatthey need to learn.
Furthermore, these courses focus on three life or developmental stages: The child and adolescent, the adult, and the older adult, placed in the curriculum in the 2nd, 3rd, and 4th trimesters. These courses are presented in the program in a life-course retrospective sequence starting with the older adult in the second trimester, followed by the adult, and ending in the child and adolescent in the fourth trimester. The curriculum also reflects the practice expectations of the immediate geographical area.
As mentioned, this holistic view of health focused on quality of life is achieved through the aspects of Occupational Therapy’s Domain as described in the Occupational Therapy Practice Framework: Domain and Process (American Occupational Therapy Association [AOTA], 2008).
All the aspects of the Domain transact to support engagement, participation, and health. The Domain encompasses four components: Areas of Human Occupation; Client factors; Performance skills; and Context and Environment. The program is committed to provide academic and practical experiences focused on health promotion, restoration of health, health maintenance, as well as compensation and adaptation.
The overarching statement of the Domain of Occupational Therapy is what connects the profession with health and wellbeing: “Supporting health and participation in life through engagement in occupation” (AOTA, 2008). The defining contribution of the profession is the application of knowledge, skills, professional attitude, and values to assist clients to engage in everyday meaningful activities or occupations, i.e., the things people need and want to do. The Occupational Therapy Program at West Coast University Texas will educate students to evaluate the aspects of the Occupational Therapy domain and apply this knowledge to the intervention process as the students support the health and participation of their clients. The program further highlights the profession’s “positive relationship between occupation and health and its view of people as occupational beings” (AOTA, 2008, p. 625). In operationalizing the curriculum, the core values of the profession will be made clear to the student:
- All people should be able to participate to their fullest in the occupations they want or need to do
- All people should be able to experience independence and interdependence
- All people have the right to be treated with equality
- All people have the right be well and have access to health care
Occupation is defined by Law et al. (1989) as activities people do every day to occupy themselves in order to look after themselves, enjoy their lives, and “contribute to the social and economic fabric of their communities”. The program thus centers its curriculum on the value and meaning of occupation as performed by human-beings through the stages of human development. Occupational therapists rely on a client-centered approach to provide occupation-based interventions. The value of this approach will be mirrored and reinforced through the university’s student-centered commitment to education. Occupational therapy education will require students to develop critical and clinical reasoning skills, problems solving, creativity abstract thinking, capacity for empathy, an understanding of diversity and the perspectives of all stakeholders. This focus on occupation-based practice will give the student the critical understanding of the uniqueness of the profession, inform the student of society’s view of the profession, and develop a strong professional identity within the student. Occupation-based occupational therapy can be seen as a major curricular thread in the course design, fieldwork, and students’ learning experiences.
Teaching and Learning
This entry-level program provides an organized curriculum, based on human development andoccupation that will assist students to develop the necessary knowledge, skills, professional attitudes, and values to be independent entry-level generalists. The curriculum is rooted in constructivism, incorporating problem-based learning principles. The faculty act as facilitators to extract the students preexisting knowledge and then transform the knowledge to a higher level of understanding of human occupational performance through the acquisition of new knowledge didactically and practically. Besides student-centeredness, this approach requires active learning: The active engagement and collaboration between students and faculty contributes to the education and transformation process. With faculty as partners, the students will become self-directed and lifelong learners through self- reflection and feedback, making learning an empowering experience. The Occupational Therapy Texas motto “Learning is Doing” reemphasizes we are not successful until we can demonstrate that the student has learned what was intended.