What is Occupational Therapy and How Does it Intersect with Applied Behavior Analysis?

Bathing, eating, using the bathroom, getting dressed…Many of us take for granted being able to perform these everyday activities that allow us to do what we need and want to do on any given day. It isn’t until we are unable to perform these activities that we realize how important they are to our quality of life.

The quality of life among those who are unable to accomplish basic life skills (called activities of daily living) can be greatly diminished, with their ability to live independently, attend school, or participate in social activities all being affected. But through occupational therapy, individuals across the lifespan can work to gain or regain the skills they need to care for themselves and perform everyday activities (called occupations).

Occupational therapists (OTs) are the heroes among those struggling to fully participate in life due to the inability to perform one or more activities of daily living. Their graduate-level education and training make them experts in the field of occupational therapy assessment and interventions and effective practitioners and collaborators in the continuum of care.

The synergistic relationship between occupational therapy and behavior analysis has led to the integration of ABA techniques into many OT practices. Both ABA and OT are widely used with children with autism and other developmental disabilities, and both are distinctly focused on sensory integration approaches, making both OT and ABA treatments quite compatible. And because of the near-constant evolution of ABA, the scope of occupational therapy has naturally broadened, with many OTs now frequently applying ABA therapies focused on the reinforcement of positive behaviors with a wide variety of patients with varying cognitive and physical abilities.

What Does an Occupational Therapist Do? – Understanding the Goals and Objectives of Occupational Therapy Practitioners

Occupational therapy can be best described as the use of therapeutic interventions to prevent disability, promote and maintain health, and increase independence. While occupational therapy may look quite different from one patient to the next, the goal is the same: to help patients improve upon the activities and tasks that they perform every day or that are important to them.

Occupational therapists are holistic providers, promoting the health of those with injuries, illnesses, or disabilities. Their focus is on helping their patients adapt to the environment or adapting the environment to them. The occupational therapist’s approach to treatment involves wellness promotion, rehabilitation, and habilitation.

Just some of the activities or tasks addressed in occupational therapy include:

  • Getting dressed
  • Using the toilet
  • Bathing
  • Combing hair/brushing teeth
  • Cooking or preparing a meal
  • Getting in/out of bed
  • Using public and private transportation
  • Utilizing a mobility device (wheelchair, scooter, walker, etc.)
  • Using a phone, television, computer, etc.
  • Grasping and properly holding items
  • Performing specific activities required for a job
  • Performing specific activities required for school

Occupational therapists work with patients across the lifespan, from the youngest of patients with developmental disabilities to adults recovering from physical trauma or surgery to seniors dealing with the effects of cognitive and physical decline.

The scope of their work, while broad, includes:

  • Providing an individualized evaluation that includes observing, interviewing, and discussing goals with the patient and patient’s family
  • Designing a customized intervention/therapy plan designed to improve the patient’s ability to perform activities/tasks and reach specific short- and long-term goals
  • Implementing specific therapeutic exercises and treatments using evidence-based interventions
  • Providing frequent assessments regarding patient progress to ensure goals are being met
  • Adjusting the intervention plan when necessary
  • Making recommendations for adaptive equipment (prosthetic devices, mobility devices, and adaptive devices) and providing training for its use
  • Educating family members and caregivers

Using ABA to Reach OT Goals

Both ABA and OT use concrete, measurable goals, and both are focused on reinforcing positive behaviors while allowing negative behaviors to extinguish themselves.

Sure, the practice of occupational therapy is about encouraging people to work through their physical limitations. However, at times, it may be as much about achieving a physical goal as it is about pushing past frustration, fear, and anxiety and finding the motivation to continue working toward a goal. This is where ABA comes in. Because behavioral training is at the heart of OT, incorporating ABA into your OT practice is a natural fit.

Consider a patient who has become sedentary after a recent fall. As an occupational therapist, your goal is to not just help the patient adapt to the use of a walker, but to also help him break the learned behaviors (habits) he has developed out of fear. By incorporating OT techniques, you’ll help the patient learn to use the walker. And by incorporating ABA techniques, you’ll help the patient push past those learned behaviors that are holding him back from enjoying a better quality of life.

Their Role in the Healthcare/Rehabilitation Team

It is important to recognize the important role these autonomous providers play as part of a comprehensive healthcare/rehabilitation team. Their coordination of care with other members of the healthcare/rehabilitation team, including behavior therapists, physical therapists, speech-language pathologists, social workers, physicians, occupational therapist assistants (OTAs), etc., is crucial for ensuring that all providers within a patient’s plan of care are focused on and working toward a common goal.

While the coordination of care with physical therapists has long been widely valued in both the OT and PT communities, their work with behavior analysts has been recently garnering the attention it deserves. This is because both occupational therapists and behavior therapists focus on encouraging and incentivizing patients to reach specific goals; both utilize evidence-based therapies to create a structured, personalized therapy plan; and both recognize the importance role the environment and positive reinforcement play in modifying learned behaviors. It’s a natural fit that lends well to better outcomes.

Where They Work

Occupational therapists work in a variety of settings, including:

  • Hospitals
  • Assisted care and skilled nursing facilities
  • Inpatient/outpatient rehabilitation centers
  • Homes
  • Outpatient clinics
  • Schools
  • ABA clinics

According to the American Occupational Therapy Association, occupational therapists worked in the following settings:

  • Hospitals: 26.6%
  • Schools: 19.9%
  • Long-term care/supervised nursing facilities: 19.2%
  • Freestanding outpatient facilities: 10.8%
  • Home health: 6.8%
  • Academia: 6.1%
  • Early intervention: 4.6%

How to Become an Occupational Therapist

A master’s degree in a program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) is the minimum educational requirement for becoming a licensed occupational therapist. The ACOTE accredits both master’s and doctoral degrees in occupational therapy.

Note: While a master’s degree is currently the minimum requirement for licensure, in August 2017, the ACOTE released an official mandate that the entry-level degree requirement will change to the doctoral level by July 1, 2027. Many schools have already made the switch to the Occupational Therapy Doctorate (OTD) and many others have submitted letters of intent to the ACOTE regarding their transition to the OTD. Currently, 38 programs have already transitioned to the OTD in anticipation of this impending regulatory change. While aspiring occupational therapists can still enter the profession with a master’s degree and won’t be required to earn a doctorate once licensed, many students are already making the switch and pursuing the OTD as to remain competitive in the field, both in the years leading up to the transition and after the transition takes place.

Degree Requirements

Master’s degrees in occupational therapy are designed as one of the following:

  • Entry-level degrees designed for students with an undergraduate degree in any field (consists of about 60-80 credits that take two years to complete)
  • Combined bachelor’s/master’s degrees (usually take between 5-6 years to complete)
  • Post-professional master’s degrees for bachelor’s-prepared licensed occupational therapists (consist of approximately 30 credits that take about one year to complete)

Both the combined bachelor’s/master’s degrees and the entry-level master’s degrees in occupational therapy are designed to prepare students for professional entry-level practice as an occupational therapist.

No fully online entry-level master’s degrees or combined bachelor’s/master’s degrees in occupational therapy exist. However, a number of programs offer some online or blended courses, along with weekend and evening classes.

Many post-professional master’s degrees in occupational therapy are available as fully online programs, with many taking as little as nine months to complete.

How to Earn State Licensure as an Occupational Therapist

Each state has its own licensing requirements for occupational therapists. In general, state licensure requires graduating from an ACOTE-accredited master’s or doctoral degree and passing the occupational therapist exam offered through the National Board for Certification in Occupational Therapy (NBCOT).

After passing the examination, candidates must then apply for state licensure through their state board of occupational therapy. Contact information for state licensing boards can be found here.

Doctoral Degree Options

You many also qualify for state licensure by completing an ACOTE-accredited doctoral degree. These degrees may be designed as entry-level degrees for candidates with a bachelor’s or master’s degree or as post-professional degrees for practicing OTs with a master’s degree. Both programs prepare students for advanced roles in occupational therapy, including leadership and scholarly roles.

Options for Career Advancement, Specialization

There are several ways occupational therapists can focus or specialize their careers on a specific area or population within occupational therapy.

AOTA Board and Specialty Certifications

Completing a post-graduate fellowship is a typical route to specialization, as is pursuing one of the board or specialty certifications through the American Occupational Therapy Association (AOTA). Board and specialty certifications through the AOTA are peer-reviewed designations that require the submission of reflective portfolio:

  • Gerontology (BCG)
  • Mental Health (BCMH)
  • Pediatrics (BCP)
  • Physical Rehabilitation (BCPR)
  • Driving and Community Mobility (SCDCM)
  • Environmental Modification (SCEM)
  • Feeding, Eating, and Swallowing (SCFES)
  • Low Vision (SCLV)
  • School Systems (SCSS)

ABA Coursework/BCBA Certification

Adding ABA credentials to your portfolio is a fantastic way to begin implementing ABA techniques into your practice and expanding the scope of your skills, both when working with behavior analysts and when working independently.

Currently, the Behavior Analysis Certification Board’s Board Certified Behavior Analysis (BCBA) credential requires candidates to complete either (1) a master’s degree in psychology, education, or behavior analysis that includes a verified course sequence (VCS) or (2) a VCS that’s completed either during or after the completion of a master’s degree in one of these three fields.

However, of January 2022, the scope of the BCBA will expand, allowing master’s-level practitioners in most human services fields to be able to qualify for this credential by completing the VCS. This has resulted in many schools removing the degree restrictions for the VCS, thereby opening up the esteemed BCBA credential to a variety of other professionals, including occupational therapists.

The VCS is offered by a number of schools as either a stand-alone course sequence or as a graduate certificate. Many schools now offer the VCS entirely online, thereby accommodating working professionals and those with geographic limitations. Pursue the VCS now to begin making a difference and then, in 2022, complete the experiential and exam requirements and earn the BCBA credential, if desired.

How Much Do Occupational Therapists Make?

According to the U.S. Bureau of Labor Statistics (BLS), occupational therapists earned the following salaries at the 25th, 50th, 75th, and 90th percentiles, as of May 2018:

  • 25th: $68,760
  • 50th: $84,270
  • 75th: $100,890
  • 90th: $120,750

The top-paying states for occupational therapists, according to mean salary, include:

  • Nevada: $100,970
  • New Jersey: $96,600
  • California: $95,160
  • Arizona: $94,800
  • Washington, D.C.: $94,360

The top-paying metropolitan areas for occupational therapists, according to mean salary, include:

  • Las Vegas-Henderson-Paradise, NV: $108,190
  • Vallejo-Fairfield, CA: $106,270
  • San Francisco-Oakland-Hayward, CA: $104,580
  • Hattiesburg, MS: $104,250
  • Santa Maria-Santa Barbara, CA: $103,120
  • Visalia-Porterville, CA: $102,540
  • Santa Cruz-Watsonville, CA: $102,480

 

Salary and employment data compiled by the United States Department of Labor’s Bureau of Labor Statistics in May of 2018 – (https://www.bls.gov/oes/current/oes_stru.htm). BLS salary data represents state and MSA (Metropolitan Statistical Area) average and median earnings for the occupations listed and includes workers at all levels of education and experience. This data does not represent starting salaries. Employment conditions in your area may vary.

Individual job listings with educational requirements and salary information accessed directly from internet job boards and directly from the sites of employing agencies and do not constitute offers of employment.

All salary and job growth data accessed in October 2019.