Clarifying the Scope of Occupational Therapy

To the Editor: I was somewhat dismayed by the article by Kopelowicz and associates reporting a study in which patients were assigned to one of two groups: a community re-entry skills program, which was described in detail, and an occupational therapy group, which was described only as including "the full range of customary occupational therapy activities."

What are those "customary" activities? For the past eight years at the University of Western Ontario, I have taught occupational therapy students to incorporate skills training into predischarge rehabilitation programs, to provide psychoeducation about schizophrenia and its management, to ensure that clients receive in vivo preparation in order to set goals for future community living, and to explore the resources needed and wanted for successful and satisfactory transition to community tenure.

The authors' re-entry program is what I would consider expected "customary" occupational therapy practice with persons with severe and persistent mental illness. Such practice may owe more to the rehabilitation principles and techniques developed by the Center for Psychiatric Rehabilitation of Boston University than to Liberman's social skills training modules.

Dr. Cook is associate professor in the School of Occupational Therapy at the University of Western Ontario in London, Ontario.