20Q: Interview with an OT Scholar and Historian

Kathlyn L. Reed, An Occupational Therapy Scholar and Historian

Kathlyn L. Reed is a distinguished occupational therapist who has been a clinical practitioner, a professor at Texas Women’s University, author of significant books in occupational therapy, historian and medical librarian, with a career extending over 50 years.

This interview of Kathlyn "Kitty" Reed describes her career and her contributions to occupational therapy. Professor Reed describes the process of reviewing the literature for a research study and the intricacies of historical research in occupational therapy.

 

 

 

Franklin Stein, PhD, OTR/L, FAOTA

Guest Editor

Salute to OT Leaders Series

20Q: Interview with an OT Scholar and Historian

PhD, OTR, FAOTA, MLIS

History

1. Where did you grow up and how did that affect your career?

I grew up in six different states as my father, a research chemist, changed jobs including Michigan (twice), Massachusetts, Kentucky, Ohio, Illinois, and Wisconsin. After I grew up, I added five more states: Missouri, Kansas, Washington, Oklahoma, and Texas, as I changed jobs and pursued advanced education. I learned to be flexible and adjust to different expectations in the classroom, to friends with different racial and ethnic backgrounds, and to a variety of community living situations including apartments and houses which we rented or owned. In Wisconsin, my parents owned and operated a paint and wallpaper store that included a hobby and art supply section which I ran during summers and holidays.

2. How did you become interested in occupational therapy?

My father overheard two therapists from Mary Freebed Hospital in Grand Rapids, MI “talking shop” as they eat lunch at a restaurant. He thought their conversation fit my interests and suggested I look into occupational therapy.I was 13 and never found a career that interested me more.

3. Where did you attend school?

I attended the University of Wisconsin at Madison for 3 years and the University of Kansas for 2 from which I graduated with a BS degree in Fine Arts. My first master’s degree is from Western Michigan University (Kalamazoo, MI) in occupational therapy administration. My PhD is from the University of Washington, Seattle, WA in special education. A second master’s degree is from the University of Oklahoma is in Library and Information Studies. I was registered (now certified) in January 1964. My undergraduate degree was paid for by my great-aunt, a teacher, who started my college fund when I was born and added to it each year through US savings bonds. I was a resident assistant at a dorm for my first masters which paid room and board. My doctorate degree was paid for through a Vocational Rehabilitation Administration grant to AOTA. In the last year, I had a no interest loan from my mother after the VRA grants were discontinued. My second master’s degree was paid for through my savings. I had no student debt when I finished my education except to repay my mother which I did.

Career

4. What was your first position in occupational therapy?

My first job was at the University of Kansas Medical Center Hospital in the psychiatric unit (40 beds on two floors) as a staff therapist. I worked for one year before starting my master’s degree at Western Michigan University.

6. What are your most important strengths as a leader in occupational therapy?

Curiosity, persistence and a willingness to try to write down “the stuff of occupational therapy”

7. What are your daily work habits?

I study and write in the morning for 4-5 hours every day unless I have an appointment or am at a conference. Occasionally, in the afternoon, I organize or reorganize materials in preparation for the next day. Most afternoons and evenings are devoted to shopping for essentials, cleaning house, attending to hobbies, and visiting with friends.

8. How would you describe your leadership style?

Mostly I lead by example and try to share with others information I have learned along the way. Mostly, my textbooks speak for themselves.

9. What motivated you to succeed in occupational therapy?

My work ethic was instilled by my parents to make my life worth something. I was also motivated to overcome my visual and learning disabilities that plagued my early education years and still cause problems as I work.

Achievements

10. When did you publish your first manuscript? What was the experience like?

I published an article in AJOT in 1972 on the Certification of Occupational Therapists in the Public Schools. The reviewers added a paragraph at the end but otherwise accepted the manuscript as submitted. Various difficulties with publishing would come later. My first textbook was published in 1980 at the suggestion of a book salesman from Williams and Wilkins.

11. What was one of your biggest challenges during your career as an occupational therapist?

One of my biggest challenges was getting occupational therapy service programs established in facilities in the state of Oklahoma during the 1970s. Many hospital administrators thought occupational therapists only made pottery from ceramic molds!

12. As an authority on literature research, describe how to initiate a research project examining occupational therapy’s role for example in treating individuals with autism applying sensory integrative techniques?

The outline below describes how to Search the literature successfully:

• Name and Frame
  • Example of a Research Question: Is occupational therapy intervention using sensory integration effective in treating children with autism in schools?
  • Name:  What are the names of major concepts and how are they defined?  Concepts are usually nouns or adjective-noun phrases. There are four (4) major concepts: autism, sensory integration, occupational therapy, and schools. 
  • Alternate names: Synonyms or closely related terms should be considered. 
    • Asperger’s or ASD or ASC (Autism spectrum conditions) for autism
    • Ayres (A.J.) or Dunn (W) sensory processing or sensory modulation or sensory filtering or sensory gating for sensory integration.
    • Sensory integrative (alternate spelling) for sensory integration
    • Classroom or education or academic or function or performance or participation for schools
  • Frame: The term effectiveness needs clarification.  Is effectiveness limited to academic performance or does effectiveness include behavioral adjustment and overall ability to function in a school environment?  Also important is the age of the children.  If elementary aged children are the focus the term “child” is appropriate in a search strategy but if teenagers are also to be included, then the term “adolescence” will need to be added.
• Resource Identification
  • There are a variety of types of reliable resources available on the Internet or in a physical library setting.  Many descriptions of autism and sensory integration are available online.  Some are correct and accurate but some are not.  Using recognized resources is usually the recommended course of action until the reviewer is thoroughly familiar with the subject matters and can make informed judgments for him- or herself.  Listed before are some useful resources.
  • Dictionaries: Medical, nursing, and occupational therapy dictionaries can help develop working definitions.
  • Thesauruses: Most databases have a list of terms used in organizing and classifying the publication indexed in the database.  The list usually includes working definitions of the terms as used in the database.
  • Handbooks: The Merck Manual or National Institutes of Health online or Quick Reference to Occupational Therapy can provide overviews of disorders or diseases
  • Reference Manuals: The Reference Manual of the Official Documents of the American Occupational Therapy Association contains statements of interest to occupational therapy personnel such as a statement on the use of sensory integration in school settings.
  • Textbooks:  The subjects of autism, sensory integration, occupational therapy intervention, and school-aged children may be discussed and summarized in occupational therapy textbooks
  • Manuals: Check AOTA Press for publications related to the subject of interest such as sensory integration
  • Review Systems: Most are online such as the Cochrane Library of databases or the Comparative Effectiveness Reviews published by the Agency for Healthcare Research and Quality.  The AOTA also has a review database.
• Initial Search Strategy
  • Use major databases for the initial search such as PubMed (Medline), Cumulative Index of Nursing and Allied Health Literature (CINAHL) or PsycInfo.  These databases index journals that are peer reviewed and have been cited frequently by other authors
  • Start by searching for review articles published in the past 5 to 10 years.
  • Often a slightly broader search strategy is useful to capture ideas that may not show up in a more limited search.
  • A useful search strategy might be as follows: autism AND sensory integration AND children AND review.  Note the term “occupational therapy” was left out to allow a broader search return including articles that might appear in education or psychology journals.
• Preliminary Analysis
  • Preliminary analysis should attempt to understand all potential issues related to the research question and to then determine which ones appear most relevant or have the greatest potential of answering the research question.
  • The focus of the sample research question is intervention effectiveness.  Therefore an analysis should examine issues related to intervention such as: What is the theory, rationale or explanation used to explain how sensory integration “works” or what it does to a person?  Is there more than one theoretical explanation related to sensory integration?  How have the theoretical explanations changed over the years?  What names or terms are currently being used to speak to the concepts of sensory integration? What assessment instruments are used to measure what aspects or elements of sensory integration?  Are the assessments attached to a particular theoretical explanation?  What examples of intervention strategies have been published in the literature?  Has the theory, assessment instruments, or intervention strategies changed over time?  Should the term sensory processing be included in the search strategy instead of sensory integration?
  • Other issues might include: Has the definition of autism changed over time and if so how?  Are there subcategories of autism that should be identified? Should Asperger’s be included in the in-depth search strategy?  How have school systems viewed the use of sensory integration in their classrooms?  Do certain author names appear in several reference lists indicating they may have a greater interest and knowledge of the subject area?  Which journal titles appear frequently suggesting a greater interest in the subject area?
• In-depth Search Strategies
  • Usually, the preliminary analysis identifies several issues to be searched which will require different search strategies to determine if relevant literature exists
  • Based on the preliminary analysis, certain aspects of the research question may be considered of greater importance than others.  For example, the searches may be limited to determining the effectiveness of selected techniques such as weighted vests, chair balls, yoga, or swinging.  Another approach may be to explore further the issues related to academic performance such as sensory over-responsivity or cognitive and learning dysfunction or visual-motor dysfunction.  Yet another approach may study the use of a specific assessment in measuring behaviors relevant to the school environment.
  • For the example, the research question will be restated to read “Is occupational therapy intervention using sensory integration equipment (weighted vests or garments, therapy balls or cushions) effective in treating children with autism in schools?
  • Additional databases or searches of online journals may be added to the search at this point. 
• In-depth Analysis
  • in-depth analysis is facilitated by obtaining full copies either in paper form or downloaded files.  Abstracts usually do not contain enough detailed information for in-depth analysis
  • Highlighting or underlining relative sections of the articles may be helpful
  • If articles are not published in an occupational therapy journal, noting whether one or more of the authors is an occupational therapist or assistant may help determine if occupational therapy services were actually delivered by qualified occupational therapists or assistants or if the authors simply read about sensory integration techniques and applied their best interpretation which may or may not follow the rationale identified in the occupational therapy literature or teachings.  Starting with the wrong rationale or a misunderstanding of how to apply a technique can change the results of the study without the researchers recognizing what has happened.
• Summary of Findings
  • There are several methods for summarizing the findings. One method is to organize the articles according to the levels of research starting with randomized clinical trials or systematic reviews and ending with such categories as personal accounts, case studies or expert opinion
  • Another method is to organize the findings by the amount of useful information identified starting with the article or articles that were most informative down to the least.
  • A third method is to select a number of articles such as 10 and report only the top 10 articles according to research levels, useful information, or other selected criteria.  Generally, older literature more than 10 to 20 years should NOT be included because the data or information may be out of date or be rendered inaccurate by more current scientific findings.
  • A fourth method is to organize the results according to the journal impact factor (JIF) number.  Higher JIF numbers indicate that a journal has been cited by other authors more frequently and may be viewed as having a better reputation for publishing high-quality research studies.  Note that journals with only a few published issues may be publishing quality studies but do not have a long enough record of publication to have obtained a high JIF number. Occupational therapy journals, except for the American Journal of Occupational Therapy, tend to have a low JIF because the occupational therapy literature in general, is not widely sighted.  The lower number of researchers publishing in the literature also decreases the score.
  • Within any of the approaches, articles may include both positive and negative findings. Such articles can be grouped together to present positive findings, then negative findings and finally a summary statement of the reviewer’s overall impression.  In the example, conclusions of studies for both weighted vests and therapy balls report at least as many negative findings as positive.  Use in any classroom should be accompanied by an understanding that possible outcomes may not occur based on the literature published to date.
  • Problems identified with the study methods or reporting of results should also be noted.  An example of reporting results is that studies of weighted vests may not state the amount of the weight in the vest or how the weight was calculated in relation to the weight of the child. The lack of a standardized method of calculating the weight in the vest may or may not change the results but without a standardized protocol, all results must be interpreted with caution.  In other words, the question is not answered as to whether more weight might produce a different result or if placement on different body parts such as the legs might produce different or the same results.  Another problem with the existing studies is that the severity of autism is often not identified or if certain characteristics have been identified such as over-reactivity or tactile defensiveness has been assessed or observed.  Such characteristics might change the response to a weighted vest or therapy ball but such information is not provided in studies to date.  In addition, the studies do not control for age.  Weighted vests or therapy balls might be more or less, effective depending on the chronological or developmental age of the child.  An astute reviewer might note other issues in the existing studies that should be addressed before a final decision is made of the value or lack of value of using such equipment in the classroom.
• Selective Application
  • Selective application is the translation of the information from the literature into the practice setting or settings in which the practitioner works.  The major focus is on what information can be translated into a format, program, or protocol that can be implemented in the work setting. 
  • Application usually depends on what issue prompted the original research question.  For example, did the research question come from a teacher who wanted to know if the occupational therapist thought sensory integration techniques such as the use of a weight vest might help a student with autism stay in his seat more of the time and attend to the lessons better?  Did school administrators question the use of sensory integration techniques or if buying weighted vests or therapy balls was worth the investment in school funds?  Did a parent request that her child is provided with a weighted vest because she heard that another child had benefited from wearing one but the school principal wanted more information on effectiveness before giving permission to allow the use of the vest in the classroom?
  • The search results should be written or reported in a format that addresses the question originally presented along with any additional information not found in the literature or parts of the question not answered.  As noted, the amount of weight in the vest has not been standardized.  Even if the parent wants to try the weighted vest and agrees to buy the vest with her own money, the amount of weight in relation to the child’s weight will have to be determined arbitrarily as well as other factors not satisfactorily addressed in existing studies.
  • Translational actions might be facilitated by suggesting an alternative approach.  For example, one successful study on sensory integration used goal attainment scaling (Schaaf, Benevides, Mailloux, et al, 2014).  Perhaps an approach based on setting attainable goals is a better idea to help children with autism succeed in the classroom than introducing equipment with questionable research results.

13. As a historian, what do you think are the Important Events/Facts in the History of Occupational Therapy?

The development of a philosophy of practice based on a focus on:

1. occupation, occupational adaptation, and occupational performance: The use of occupational performance (doing functional tasks) as a major focus designed to help people adapt to and succeed in accomplishing the tasks of everyday life
2. the belief that there is the potential for change and adaptation in three dimensions (person, occupation, and environment)  and/or any combination of the three in the performance of everyday living tasks
3. the belief that the practice of occupational therapy is unique and that the profession is autonomous from all other disciplines but may consult and cooperate in program development for a client or clients
4. time frames that support current and future occupational (functional) performance as opposed to a focus on the past
5. occupation as a means of organizing daily activity into habits and routines for  everyday life throughout the day, week, month  (24/7/365)
6. what the person can do, with or without external assistance, as opposed to what the person cannot do
7. the process, not the product.  In other words, the focus is on the process of  improving  occupational performance, not on achieving a perfect product or outcome with every effort
8. cultural sensitivity to the client in relation to independence, interdependence, or dependence status in the family, social, and community life in selecting and performing everyday living
9. sensitivity to changes in social, political, legal, and governmental trends, rules, and regulations that facilitate or hinder the performance of everyday living and its tasks
10. sensitivity to changes in mores, fashions, and technological advances that effect, positively or negatively, everyday living and its tasks

The establishment of a professional organization, in 1917, that facilitates the development of standards and organization of ideas into written statements for use by practitioners, clients, and legislators, while maintaining fiscal responsibility to maintain the organizational structure. The development, implementation, recognition, and enforcement of educational standards and the accreditation of educational programs beginning in 1923, that supports the education of persons to become practitioners in occupational therapy

The development, implementation, recognition, and enforcement of regulatory standards (registration, certification or licensure) beginning in 1932 that regulate entry into the profession at two levels of practitioner status (occupational therapist and occupational therapy assistant) at the state and/or national level.

The development of practice standards, beginning in 1950, designed to outline the parameters, descriptions, and scope of occupational therapy services

The development, implementation, recognition, and enforcement of a professional code of ethics beginning in 1977.

The commitment to continuing/life-long education and the provision of methods to facilitate continuing education

The commitment within the profession for developing and implementing ideas to change (modify, adapt) persons, occupations, and environments to encourage and support better occupational adaptation, performance, and participation in everyday life.

14. How do you motivate students or staff to do research and publish in occupational therapy?

I ask them to join a project I’m already working on and teach them what I’m doing and what they can do to help. Again motivating by example.

15. What is your major scholarly contribution to the profession of occupational therapy?

My textbooks were written to fill a perceived gap in the subject matter. My current projects reflect my strong interest in the history of occupational therapy.

Future of OT

16. How would you define occupational therapy?

Occupational therapy uses the occupations and activities of everyday life to promote health and wellness and decrease the impact of disorder and disability on peoples’ lives.

17. What do you see as the major issues in healthcare that is impacting on clinical practice in occupational therapy?

One, time pressure in everyday practice requiring therapists to practice efficiently and effectively, and two, the need to find better ways to help therapists keep up to date with new information and trends in practice.

18. What are some future trends to improve occupational therapy practice, education, and research?

Occupational therapy is a dynamic profession that must be sensitive to and accepting of changes in personal, occupational, and environmental factors while adhering to basic principles and philosophy of occupational therapy practice.

• Editors of journals publishing research articles need to include more content on the protocol(s) used by occupational therapy practitioners to deliver occupational therapy services.  While space in published journals may be limited, space online is available.  Replication of research depends in part on being able to duplicate the existing protocol or protocols used in the original study.  Lack of detailed protocols hinders follow-up studies.
• Educators in occupational therapy educational programs need to focus more on problem-solving and less on memorization of facts that can be looked up online or in a textbook.  A focus more on projects and case studies might help.  Problem-solving is an essential skill in occupational therapy practice.  Although protocols and manuals exist, they cannot address the variety of situations and problems encountered in the practice of occupational therapy.  Problem-solving is an essential skill to address new or unexpected problems.
• Practitioners need to focus less on skill building of isolated skills (the piecemeal practice of ADL skills) and more on integrating habits and routines into a pattern of everyday life.  Problems in living include both performance of certain skills AND the ability to organize the skills into habits and routines over time periods such as morning, day, week, month or year. 
• Researchers need to assist educators and practitioners to translate research results into teaching units and application into practice.  Research is important to the profession of occupational therapy but if the results are not translated into practice, little usefulness occurs.  If a tree falls in the forest we need to be sure we hear it, locate it, and understand why it fell so we can help other trees (our clients) to stay upright longer without injury.
• All occupational therapy personnel need to become better advocates and stewards of occupational therapy with stakeholders including legislators and other policymakers.  Occupational therapy has a valuable philosophy and approach to problem-solving which can be useful to society but we must make the message heard.  Others cannot be expected to talk for us; we must do the speaking and publishing.

19. How do you foresee the future of occupational therapy in your specialty area and on this topic?

We need to distill research findings into “useable” bites that students and practitioners (and researchers) can assimilate and implement into practice. Basic and applied research will continue to be needed to provide the “raw data” but without better methods of “bridging the gap” between research and practice, the effectiveness and efficiency is decreased or lost.20. How do you see the future of the international movements in occupational therapy?

20. Summarize your contributions to the profession of occupational therapy up to this point in your career?

One, a willingness to “dig” into the literature and try to synthesize and translate the valuable information into a format therapists can use in practice, and two, an interest in understanding how our “foreparents” (men and women) put together occupational therapy as a profession so we can preserve the  best ideas and continue to build upon it.