Developments in Occupational Therapy Education and Practice
The first school of occupational therapy in Europe opened in the UK in 1930 and since then, the profession has expanded rapidly throughout Europe. Education for occupational therapists was established in colleges, polytechnics and universities and at present, there are over 320 educational institutions in Europe offering occupational therapy education. In 1952, the World Federation of Occupational Therapists (WFOT) (www.wfot.org) was founded, and developed standards for the education of occupational therapists (1954), later published as the WFOT Minimum Standards for the Education of Occupational Therapists (1958), and last revised in 2002 (Hocking & Ness 2002). These minimum standards outline the fundamental philosophy and programme content of education programmes and have assisted in developing and maintaining a common understanding of the profession worldwide. In Europe, occupational therapy is regulated by the Council Directive on the Recognition of Professional Qualifications (Directive 2005/36/EC), which includes the directive on higher-education diplomas awarded on completion of professional education and training of at least three years’ duration, 89/48/EEC supplemented by Council Directive 92/51/EEC). In most European countries, national/professional regulations govern the profession and there are governmental/professional registration and professional profiles (www.cotec-europe.org). The profession of occupational therapy is typically governed by National Ministries responsible for Health, Social Welfare, Labour and Education. As already mentioned, the profession is guided by international standards for education and practice from the World Federation of Occupational Therapists, and also within Europe
by the Council of Occupational Therapists for the European Countries (COTEC) (www.cotec-europe.org)
and the European Network of Occupational Therapy in Higher Education (ENOTHE) (www.enothe.hva.nl).
These include guidelines and standards related to curriculum, ethics and quality enhancement.
Early education, in many cases, had a strong practical component, with many hours of education spent in both fi eldwork and in the learning of craft and practical skills. Gradually this balance has changed with a strong move towards the theoretical foundations of the profession and development of academic competences. However, there is still considerable con ict, especially in 3-year programmes, between the development of the required academic and practical competences. Currently, most programmes are aiming at corresponding to the minimum standard recommendations of 1000 hours of fieldwork suggested by WFOT.
Programmes have always, to some degree, reected the social and health policies and services of the society in which they are based. The revised WFOT Minimum Standards (Hocking & Ness 2002) stress the importance of developing occupational therapy programmes in a local context, taking into consideration local (national) health needs and challenges, priorities and traditions. This is also in line with the WHO regional strategy, which recognises the diversity of the political and health situations encountered in each country of Europe, leading to a need to «consider all
countries in their diversity» (WHO 2000, p.1). While earlier the profession was known as «a paramedical profession»
with practice based in hospitals, community services slowly started to develop with the move towards primary care in the community and community based practice. More recently, occupational therapy is moving towards a broader understanding of health and disability, in line with WHO definitions as presented in the ICF (WHO 2001). This has led occupational therapists to be concerned not only with those traditionally described as disabled, but also social groups at risk of occupational deprivation – those in prison, street children, refugees etc. Also, in some countries (Denmark, Norway), an increasing number of occupational therapists work within prevention and health promotion; in industry, ergonomics, and vocational rehabilitation or with planning and lifestyle changes. The degree to which the profession is orientating itself towards social or medical practice varies from country to country within Europe. This «re-alignment» has also brought an awareness of the need for graduate occupational therapists to be increasingly proactive towards the emerging needs of the society in which they practice. Traditionally occupational therapists only worked under the direction of the authorizing physician, which is certainly not the case today. Occupational therapists are expected to be able to work autonomously, think creatively, solve complex problems and be ready to work to develop new services that will best serve the occupational needs of clients. This has led many programmes to expect that the graduate of even 1 cycle studies are able to work with considerable autonomy. Since the enlargement of Europe and the European Year for Disabilities (2003), the Eastern European countries have been interested in the profession and education of occupational therapy. The establishment of the profession with the support of ENOTHE has contributed to social reform, enhancing the rights of persons
with disabilities, making the environments more accessible mainly through attitudinal change, and empowering and enhancing structures in society that sustain participation. The first cycle education for occupational therapy in Eastern and Central European countries has a particular focus on competences such as promoting the profession, developing and managing community based projects, developing networks consisting of disability organisations, occupational practice, education and local governments in order to establish inclusive communities. The first graduates have emerged as
real leaders of the profession. Diversity is evident not only in the wide range of services offered by the profession but also as a vital characteristic of European society today. Europe is a society rich in a wide range of backgrounds and cultures, and the mobility of European citizens means that a wealth of skills, talents,
perspectives and ideas are available for the benefit of all. Acknowledging and managing diversity in order to utilize the enormous benefits that it can bring to the workplace is essential for all organisations and professions. Occupational therapy programmes are working to develop in their graduates essential competences such as cultural knowledge, communication and interaction skills, together with the team skills necessary to work with a diverse team of professionals and with a wide range of service users and groups.In summarising the developments of the profession and of occupational therapy education in Europe, it may be said that while underlying core principles and philosophy are evident considerable variation exists. This is due to a wide range of factors including variations in the way higher education has developed and is governed in each country, local traditions of health care and social provisions and differences regarding the founding and development of the profession in each country. Development has also been affected by the availability of second and third cycle education in occupational therapy. For many years this was restricted to one or two countries (UK, Sweden), with students either travelling to study or completing post-graduate education in related fields in their home country. In some countries, this led to a reliance on English language professional literature and a limited degree of research and theory development in the local culture and language. In recent years, an increasing number of second and third cycle programmes are available throughout Europe. The European Union has also been in uential in promoting an increasingly mobile work force, and while there is not large-scale movement amongst occupational therapists, there is mobility towards the English speaking countries, and between neighboring countries, for example in Scandinavia and between Germany, Holland and Belgium.
The TUNING project has provided a methodology that acknowledges the diversity of higher education throughout Europe and provides a frame-work for maintaining differences, while offering the transparency and transferability essential for mobility amongst students and professionals. The methodology emphasises that educational programmes should identify competences to be developed based on local social needs. It has shifted the emphasis in education towards a student centred approach, in which students are enabled to chart their own progress and in some instances plot their own path towards competence using learning out-comes and competences. This approach requires that the key knowledge and skills that a students needs to achieve during the learning process determine the content of the study programme.