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This article has been peer reviewed. It is the author’s final published version in The American Journal of Occupational Therapy, Volume 45, Issue 2, February 1991, Pages 173-176.

The published version is available at DOI: 10.5014/ajot.45.2.173. Copyright © American Occupational Therapy Association


In January 1990, clinicians, educators, and researchers met at the Directions for the Future Symposium in San Diego to delineate, discuss, and debate a wide range of economic, political, and social issues that are influencing the evolution of occupational therapy practice and education. By examining these factors in an open and thorough way, therapists believe they will be able to develop proactive positions that will ensure the continued well-being of the field. In this paper, we will consider two distinctly opposing forces that dramatically affect and present considerable obstacles to occupational therapists. On the one hand, occupational therapists are taught to embrace a fundamental, humanistically based philosophy of practice that emphasizes the importance of the individual On the other hand, they are expected to practice in an economically defined health care environment, where issues of reimbursement for service are highly valued and are among the key factors to be considered when making evaluation and treatment decisions.

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