Occupational Therapist Education, Schools, and Career Overview

An occupational therapist (OT) helps people of all ages and with all different types of disabilities and challenges get back to the life activities that they need to resume following their disability. Patients could be children with autism struggling to stay seated at a desk; elderly individuals who could benefit from strengthening exercises to help with the aging process; or those recovering from a traumatic physical injury, to name a few.

OTs also work with those individuals who are at risk of developing disabilities. These professionals focus on intervention that will assist disabled people function independently in their homes and their communities. This may include helping these individuals learn how to take care of themselves independently, manage their own homes, and enter the community independently.

Occupational therapists use different intervention approaches to promote, establish, or maintain skills, as well as to help individuals use compensatory strategies or make adaptations to the environment so as to enable them to participate in meaningful activities.

Occupational Therapist Specializations

The majority of occupational therapists today work in hospitals and school systems, per the Bureau of Labor Statistics (BLS). However, they can also be employed in a wide variety of other settings including clinics, nursing homes, private practices, mental health hospitals, community-based settings, work settings, home health agencies, and travel companies.

Occupational therapists have a great deal of job opportunities in the military as well, working with veterans who have sustained combat related injuries and the families of these veterans. Occupational therapists who work in the military may be assigned military hospitals, rehab centers, or posts or bases where military families and schools are located to provide services to their children.

There are a wide variety of practice areas in which occupational therapists may specialize, such as hand therapy, early intervention, neonatal intensive care, feeding and swallowing, driver rehabilitation, mental health, and assistive technology. Special training and independent certification processes are available in some of these areas. In addition, occupational therapists may pursue certifications in specific assessment and/or intervention approaches such as lymph edema, neurodevelopmental treatment (NDT), sensory integration (SI), floortime, and therapeutic listening. 

There are also specialty certifications that can be obtained in different practice areas through the American Occupational Therapy Association such as driving and community mobility, environmental modification, feeding, and low vision. Board certification is also available in the follow areas: gerontology, mental health, pediatrics, and physical rehabilitation.

How to Become an Occupational Therapist

Becoming an occupation therapist requires hard work and a solid educational background and hands-on experience. Here’s a quick overview of what you should do to become an OT:

1. Job shadow a variety of licensed occupational therapists over an extended period of time. Learn the variety of settings OTs work in and which appeal to you.
2. Earn a bachelor’s degree in biology, psychology, or a health care related field.
3. Complete volunteer internship hours with an occupational therapist in a practice setting.
4. Apply to an occupational therapy master’s degree program.
5. Complete two 3-month long internships (level II fieldwork) with a licensed occupational therapist as part of the master’s degree requirement.
6. Sit for the certification exam administered by the National Board for Certification in Occupational Therapy to become registered and earn an OTR credential.
7. Apply to become licensed to practice in your state.
8. Search and apply for a job as an occupational therapist.
9. Maintain the necessary continuing education units.

OT degree programs

Typically, the entry-level minimum standard to practice as an occupational therapist is a master’s degree in occupational therapy, though some practices may accept those with a bachelor’s degree. There are a good number of occupational therapists with doctoral degrees or PhDs. The PhD has more of a research focus whereas the Occupational Therapy Doctorate is a clinical doctorate, based more on clinical practice, applied research, program development, and leadership.

To apply for a master’s program in occupational therapy a person must earn a bachelor’s degree, preferably in biology or a related physical science, even something like psychology. Expect courses in anatomy and physiology, biology, kinesiology, neurology, psychology, and anthropology, to name a few. Students are also required to complete a volunteer internship with an occupational therapist in a practice setting. The hours required for internship experiences vary from one program to the next. Students must also have a high grade point average, observation log, and strong letters of recommendation. Oftentimes occupational therapy degree programs involve an interview process as well.

Although all general occupational therapy bachelor’s programs prepare students for working with both children and the elderly, postgraduate programs can be designed specifically around more narrowly focused forms of therapy, such as pediatric or geriatric occupational therapy. Master’s level postgraduate occupational therapy programs that focus on mental health will involve some courses unique to this specialty. For instance, the medical community is astounded by the dramatic increase in the occurrence of autism among young Americans. This has become one of the major focuses of this profession in recent years, and this unfortunate trend is expected to continue. When pursuing a mental health specialty with a focus on autism, expect courses that delve more deeply into behavioral psychology and early childhood development.

Hands-on training for OTs

Upon completion of coursework, occupational therapy students must complete two three-month internships, which are considered level two fieldwork. A third internship is usually optional. The internships are typically unpaid, supervised by practicing licensed occupational therapists, and the student must meet particular standards in order to pass. Generally the internships occur in a variety of settings like hospitals, nursing homes, and school districts. The practice areas typically are in physical disabilities, mental health, geriatrics, and pediatrics. Once course work and the required level II fieldwork are completed, the student must take a certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT). Certification is required in order to apply for a license to practice. 

OT certification

Occupational therapists must apply to become licensed upon passing their national board exam. Some states require OTs to pass another licensure exam, and other states just require an application is completed and the necessary fees are submitted.

To become an OT, you must sit for the National Board for Certification in Occupational Therapy (NBCOT) exam, which is very rigorous with multiple-choice questions, many of which are clinical based. Some of these exam questions provides a scenario involving a particular client and describe the clinical picture for that client. The individual taking the exam must evaluate how they would intervene for this fictional client. 

The exam takes three to four hours to complete and the pass rate has historically been around 80%. To be eligible to sit for the exam, an individual must have graduated from a master’s degree program, including completing the necessary internships, and have a background check completed as well. Upon passing the exam, the individual earns the title “registered occupational therapist” and can put the initials “OTR” behind their name. 

Occupational therapists must maintain 36 continuing education credits every three years to maintain their national certification. Each state also requires continuing education credits in order to maintain licensure, however, the CE credits to satisfy national registration and state licensure can overlap. There are a variety of ways to earn continuing education credits such as clinical courses, conferences, writing an article, speaking on an occupational therapy topic, conducting or publishing research.

OT schools

Occupational therapy schools work to prepare graduates for an extraordinary career full of unique challenges and unmatched rewards. These educational programs are structured around the science and psychology of how environmental, emotional, and mental factors affect a limitedly able person’s ability to acclimate to performing daily tasks. Even more importantly, these programs are concerned with how to work within the confines of these factors when overcoming them is not an option so as to help give clients the dignity that comes form being able to function independently.

Communication is of paramount importance in this profession. This would be obvious in the context of a therapist-clientrelationship, but it is also imperative that those within the OT community speak the same language when describing a client’s degree of impairment, as well as their level of capability and functionality. A common language eliminates the potential for any subjective interpretation and allows for clear and unbiased descriptions of a client’s specific issues among occupational therapists, physical therapists, and physicians. 

The International Classification of Functioning, Disability and Health (ICF) was created as a universal language within the medical and therapeutic communities to resolve issues with subjectivity in diagnosis and treatment needs. The ICF is standard curriculum through all occupational therapy schools.

Because a great deal of the training an occupational therapist goes through is academic in nature, there is no longer a need to attend conventional brick and mortar campus based occupational therapy schools. Significant portions of the post-graduate Master’s-level occupational therapy training can be done as distance learning through online schools. Virtually all aspects of occupational therapy training not associated with the specific techniques of facilitating movement and general activity can be accommodated through online occupational therapy schools. These courses would include behavioral and environmental psychology, the physical sciences related to occupational therapy that do not have a lab based component, and the International Classification of Functioning, Disability and Health system of communication. 

Online schools are held to the same standard of accreditation as their campus based counterparts. In fact, most online programs are actually offered by institutions with one or many conventional campus locations across the country. These well-established accredited institutions have simply taken the inevitable step to make medical training widely available by offering options for pursing academia for those who may otherwise have very limited access.

Career advancement for OTs

Occupational therapy is deemed as a profession that is highly desirable because it has a high level of job satisfaction, jobs are plentiful, salaries are lucrative, and there is a lot of opportunity for growth.

There are a variety of opportunities available for career advancement such as promoting into management or leadership positions, or even director positions, which involve managing other occupational and sometimes physical therapists. Occupational therapy supervisors are responsible for performing evaluations and conducting annual reviews for other occupational therapists. An individual could also advance to the head of rehabilitation where they are managing occupational therapist, physical therapists, and speech pathologists in a practice setting.

Occupational Therapist Skills and Qualities

The job of an occupational therapist can be emotionally and physically taxing since these professionals work with people with special needs and disabilities. To be effective at this job one has to be emotionally strong. There can be some lifting of people in this profession, which can be hard on one's body, especially the back muscles.

Perhaps above all else it is important for an occupational therapist to be compassionate; having a love of people and wanting to see them succeed. Being creative is also important in this field because when one technique or method does not improve a person or get them closer to achieving his/her goal, the occupational therapist must have the ability to think outside the box and come up with another method. It is also important to be both flexible in this field since oftentimes goals are not met within the desired timeframe. As with most fields, communication skills are essential, both in written form for charting and documentation, and in oral form when communicating with clients and other staff.

Adaptive devices or equipment that occupational therapists regularly use or instruct other how to use can include the following:

• Sock grabber
• Long handled sponge
• Long handled shoe horn
• Elastic shoelaces for people who can’t tie their shoes
• Universal cuff that a spoon goes in for people who can’t hold their spoon to eat
• Weighted vest
• Pencil grip or adapted scissors
• Slant board, ruled paper with tactile and visual cues

Other devices can be used to help a client rebuild strength such as therapy putty or a hand gripper. Clients can also use a variety of things in their own home to work on fine motor skills such as shuffling a deck of cards or picking up uncooked elbow macaroni with tweezers. 

OT Salary and Career Outlook

Occupational therapy is deemed as a profession that is highly desirable because it has a high level of job satisfaction, jobs are plentiful, salaries are lucrative, and there is a lot of opportunity for growth. In this field an individual is able to work in a variety of settings and focus on a specialty or a specific population if they so desire. There are also both full and part time jobs available in this field.

As with any position, salary and job outlook for OTs can vary by region and experience. Some settings, such as hospitals and nursing homes, have historically paid more to their employees than others. Here’s the latest on what a typical OT's salary might look like:

Additionally, here’s data to show the latest occupational therapy job growth trends:

Academic Resources for Occupational Therapists

The American Occupational Therapy Association is the professional body that oversees standards and ensures the viability of the profession. The National Board for Certification in Occupational Therapy is primarily designed to protect the consumer and the public. This group administers the certification exam and monitors certified individuals to ensure continuing education credits are completed and that they haven’t committed a crime or had a complaint filed against them. 

Sources:

1.     Occupational Therapists, Bureau of Labor Statistics, Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/occupational-therapists.htm

2.     Occupational Therapists, Bureau of Labor Statistics, Occupational Employment Statistics. https://www.bls.gov/oes/current/oes291122.htm