Education: Facts and figures relating to occupational therapy in Europe

In these pages Chapter 3 of the booklet Occupational Therapy Education in Europe: An exploration is presented.

3.1 Facts and figures of occupational therapy practise and education in Europe (EU and EAA)

In this chapter data given by the COTEC delegates (appendix 12) are presenting the geographical distributions of all occupational therapy educational institutions of the EU and EEA, the total number of practising occupational therapists per country, the number of practising occupational therapists per 100.000 inhabitants, the number of occupational therapists qualifying annually per country and the factor of increase of Occupational therapists in 1999.

COTEC delegates annually up-date their national associations data, which are compiled in the document Occupational Therapy, Summary of the profession in the European Countries (COTEC, 2000). In order to complete this chapter this document was considered along with data from the extra questionnaire, which was sent out in spring 1999 to all COTEC delegates. While every effort has been made to establish accuracy of the information, it remains difficult to show the exact figures, as not all associations have the comparable registration methods.

Occupational therapy is still rapidly developing. Since 1996 there has been an increase of occupational therapists in Europe of 47.4 %. The total number of occupational therapists in Europe at present is about 73.700.

Figure A

As many countries have very few institutes/schools the above figure only shows the number of institutes per country up to 60. This enables the reader to clearly distinguish the small numbers. For Germany additional institutes (100) need to be added.

Figure B

This figure shows the number of practising (full time and part time) occupational therapists per country. To differentiate between 1000 and 1500, the numbers stop at 10.000. In reality we have to add for Germany and United Kingdom respective 12.000 and 10.482, that is about 2 times more than shown in the above figure.

It is clear that in Germany and UK the numbers of Occupational therapists are the highest, when however the numbers are compared per 100.000 inhabitants a different picture will appear.

Figure C

This table shows that despite the fact that Germany and UK have the biggest amount of practising occupational therapists, the Scandinavian countries with Denmark on top have the highest number of practising occupational therapists per 100.000 inhabitants (74 per 100.000 inhabitants).

While in most European countries occupational therapy started at the same time, after the second world war, it is clear from the difference in numbers of practising occupational therapists in 2000 that the profession developed in a different way in the respective European countries. The reasons behind these differences and the rights of the clients for this kind of service across Europe need more research.

Figure D

In order to make a proper differentiation between 50 and 100 qualifying occupational therapists, the numbers are going up to 2000. In reality in Germany 3800 occupational therapists are qualifying yearly, while the lowest amount is in Italy (0), where still no formal education in occupational therapy exists.

Figure E

As occupational therapy is a young profession and therefor not yet many occupational therapists retire, the amount of annually qualifying students causes an average increase of 10-12% of the total amount of occupational therapists in Europe.

Figure F

This table shows the relative increase of occupational therapists in percentages. In Spain, Malta, and the Netherlands the increase of occupational therapists in relation to the number of practising occupational therapists per 100.000 inhabitants is the highest, i.e. 20-22%. Indeed in the Netherlands the amount of jobs for occupational therapists are growing rapidly due to new legislation, however in Spain this is not the case and are occupational therapists un-employed. More research needs to be done in (un-) employment of occupational therapists in the different countries in relation to the number of qualifying occupational therapists.

3.2 Other facts about occupational therapy education and practise

Hereafter several elements of the occupational therapy education per country are shown in table forms. The type of education, academic level, responsible ministry and course duration (study load), the title of the occupational therapy diploma/degree awarded and the number of years of previous secondary education, and the title of the profession in the different countries are mentioned.

Tabel 3

The table shows an enormous diversity of occupational therapy education systems, from university to non- university higher education systems and to upper secondary vocational education. For the future it will be important to strive for one level (higher education) of occupational education in Europe or at least to provide students with pathways and programmes sufficiently interrelated to permit ready movement between the systems.

Tabel 4

In most European countries occupational therapy education is higher education (except in Germany), however only in half of the countries the diploma is officially (by law) recognised as Bachelor's degree. For the future credit systems as well as the articulation of programmes should be strengthened. The latter seems to be very important allowing fair assessment of a degree regardless of its origin from a university or a non- university institute. One of the major obstacles to recognition today is that nationally as well as internationally non-university degrees sometimes have difficulties in being recognised or getting credits if recognition is sought in relation to a university degree.

Tabel 5

Ten countries use the word 'ergotherapeut', six countries use the word occupational therapist, while three countries are using different terminology. Unity of terminology with respect for national and cultural differences is one of the future challenges.

3.3 Summary

The data described above give quantitative information about schools in Europe and qualifying students annually. When the total number of qualifying occupational therapy students (8095) is divided by the total number of schools (274), it shows an average number of 30 students per institute qualifying annually. That suggests that in general the institutes for occupational therapy education are relatively small. Often there is also a limited number of occupational therapy lecturers. This has been one of the reasons given, for occupational therapy institutes to co-operate within ENOTHE in order to share educational resources and to increase educational quality.

Secondly the above information shows differences in the level of education, duration of the programmes or study load and duration of fieldwork. In order to improve mutual recognition the curriculum guidelines for occupational therapy have been developed (ENOTHE2000,a). Occupational therapy educational institutes will be encouraged to describe their programmes following these guidelines, so that qualifying occupational students have fair access to master degree courses in occupational therapy. Finally the tables show a variety in educational systems and terminology, of which it is hoped that there will come more uniformity because of the Bologna declaration (appendix 7) and more uniformity in occupational education terminology could be one of the challenges for future activities within ENOTHE.

3.4 Occupational therapy in the Eastern and Central European region

In accordance with the Charter of ENOTHE one of the specific objectives is to focus on providing assistance to occupational therapy institutes. This objective is formulated as follows: "To provide assistance to institutes, who wish to start occupational therapy education programmes and to advise on potential resources". Since the Socrates/ Erasmus programme in 1998 is open to the so-called Associate Countries, ENOTHE decided to organise an extraordinary meeting in Prague in 1999 (appendix 8) in order to share ideas about developing occupational therapy education and practice in the Eastern and Central European region. A summary of the records of this meeting together with the outcomes of the questionnaires filled in by the representatives of this meeting give an impression of occupational therapy practice, projects and education in this region.

3.4.1 Belarus

In Belarus there are three major institutes. With money provided by UNESCO the German Church of Westphalia set up a workshop for 120 mentally handicapped people. This workshop has a needlework workshop and a printing- workshop. There is a Parents' Association of parents of mentally handicapped children, which runs support groups and publishes leaflets about its work. These leaflets are printed in the printing workshop. This Association runs a day school for 30 children employing therapists, teachers and doctors. Therapy is provided by Swedish occupational therapists sponsored by the Star of Hope. The third institution is NOVIC which runs a children's home and an adults' home. Support for this comes from England, Ireland and Germany. There has been very little input from occupational therapists. However under the auspices of a Tempus project a German occupational therapist has taught teachers and parents how to use various pieces of equipment and also how to use sensory stimulation with the children. Since the ENOTHE meeting contacts with two faculties in Minsk have been started in order to develop occupational therapy education formally.

3.4.2 Bosnia

Occupational therapists work in the War Victims Project and in community based rehabilitation. In 1997 physiotherapists had 6 months of practical occupational therapy, occupational therapy theory and some fieldwork education in Canada. A second group started in 1998. Legally occupational therapists do not exist and there is no association. Much work needs to be done with heads of institutes and in the promotion of occupational therapy.

3.4.3 Croatia

This section was presented by a physiotherapist who was about to qualify as an occupational therapist. In Croatia occupational therapy was first mentioned in 1915 in psychiatry. After World War II occupational therapy was used with people with war injuries. At present there is a Health School in Zagreb. Occupational therapy was set up there in 1986 and there are two teachers. Recently a new curriculum has been approved which has now been submitted to the National Council.

Little is known about occupational therapy in the country. Since 1986, 383 students have commenced the programme, 186 graduated but only 45 have found appropriate posts in Croatia. These therapists are paid a very low wage. There is an association of Occupational Therapists but it only has 20 members. The constitution is written. There appears to be a lack of logic in the system. Despite the lack of knowledge and employment of occupational therapists 60 are enrolled in the programme this year.

3.4.4 Czech Republic

The history of occupational therapy in the Czech Republic is as follows. Early in the 20th century the first occupational therapy department was set up in Barnice. After World War II, the first occupational therapy programmes were run by occupational therapists from the U.S.A. The process then stopped until the late 1950s. Beginning of the 60s occupational therapy restarted with the establishment of the study of rehabilitation assistant.

1970 - the occupational therapy profession started.
1978 - the Czech Rehabilitation Society was established.
1995 - the Czech Association of Occupational Therapy was established.
1998 - the Czech Association started the procedures to become WFOT associate member.

Practice
The working field for occupational therapists is still limited. Much occupational therapy is carried out by physiotherapists. There are very few occupational therapists in large hospitals. Where there are they work in the area of ADL, independence, compensatory aids, quality of life and advice to patients. Occupational therapy in psychiatry consists of work in hospitals, day centres, sheltered workshops with arts and crafts and aiming to give structure to the day. There is also occupational therapy in rehabilitation centres (20 centres) which includes work with amputees, CVA, spinal cord lesions and physically handicapped children. There is also occupational therapy with children which takes place in special institutes.

Education
There are three different routes of study - 4 diploma programmes at Ostrava, Teplice, Most and Plzen. There is one graduate programme at Charles University in Prague and a further education diploma programme run by the Ministry of Health in Brno. The occupational therapy programme in Prague has co-operated with the Hogeschool van Amsterdam, Glasgow Caledonian University and Lund University in a TEMPUS project.

3.4.5 Estonia

Estonia is divided into two regions for health care. Some basic programmes have been established at Tartu University, but a full occupational therapy programme is not yet developed. The occupational therapy programme is planned to be based at Tartu University. Developments in occupational therapy have taken place over the past ten years: 1992 was the Foundation of the Council of Disabled Persons (Government organisation). This resulted in two tiers of organisation of health. The first is run by local government organisation in each county including: special institutes for learning disabilities, special institutes for visually handicapped, departments of rehabilitation in hospitals, out patient rehabilitation and specialist rehabilitation centres in mental health. The second is non-governmental and private organisations including centres for technical aids, production of technical aids, rehabilitation centres in private hospitals, associations for disabled people, sanatoriums.

There are no professional occupational therapists in post as yet. The first seven occupational therapists have been studying in Oulu in Finland (1996-1999) (most of these students have a previous professional education e.g. medicine, social work, engineering, teaching). These students work in nursing homes, psychiatry, mental handicap and centres for physical disability.

3.4.6 Latvia

Latvia gained its independence in 1991. Occupational therapy is a new profession but there have been elements of it in speech therapy, physiotherapy etc. Occupational therapy is needed for social reasons, because the biggest number of disabled people are those who are of working age. Quality of life for disabled people is now important as well. The profession is recognised and termed Ergotherapy. A professional association was established in 1996 and is now an associate member of WFOT.

Education
A group of Latvian physiotherapists studied occupational therapy in Sweden and in 1995 10 Latvian physiotherapist graduated as occupational therapists and 9 started work in 1996. A four-year programme was established in 1996 with an intake of 22 students. There are now 58 students in the programme in years one to three. To be admitted applicants must be 18 and have completed secondary education. They must also have knowledge of what occupational therapy is. The programme is in accordance with the minimum standards. All students must learn English. On qualification they will gain a bachelors degree. The educational programme will soon seek WFOT recognition.

3.4.7 Lithuania

In 1991 a national health care concept was set up as a result of the law of Social Integration of the Disabled. In 1998 the education of occupational therapists at Kaunas University commenced. This is not an occupational therapy qualification, but a four-year bachelor's degree with a choice of six specialities one of which is occupational therapy. This speciality takes one-year (40 weeks) Swedish occupational therapists teach this part of the degree. There are 3 occupational therapists in Lithuania at present. Next autumn there will be 10. A major problem is the recruitment of teachers. Although there is no occupational therapy association there is an Association of Rehabilitation workers and occupational therapists will be members of this.

3.4.8 Poland

The Christian Association in Warsaw runs the School of Occupational Therapy and Occupational Psychotherapy. Occupational therapy in Poland is under the supervision of nurses and is very poorly paid. The Government does not appear interested although the school does have legal status. The programme is based on those of other European states and lasts for 3 years. It now gets a grant from the state. This programme has 350 graduates. The education is divided into four branches; consorting or arresting therapy (for the very ill), resting therapy, activity therapy and psychotherapy. The school has a link with the Karolinska occupational therapy institute in Stockholm. There is no occupational therapy association in Poland.

3.4.9 Slovakia

The first school of occupational therapy was set up in 1947 with the help of occupational therapists from the USA. The first department had commenced in 1945. In 1984 a National Rehabilitation centre was established and many organisations for disabled people were set up. In 1987 there were links established with the Charles University in Prague. There are now 40 occupational therapists in departments in hospitals, social institutes and physical and mental rehabilitation units. Mostly people who work in this field are not occupational therapists but are social workers or special teachers. At present there is a three-year programme in physiotherapy with an optional one and a half-year top up in occupational therapy. The education is not recognised by WFOT. There is no professional association in Slovakia.

3.4.10 Slovenia

Occupational therapy is based in Ljubljana University of Professional Education and is under the auspices of the Ministry of Education and Sport. The development of occupational therapy in Slovenia is as follows:

1964 occupational therapy education began - a 2 year programme with intake every second year, 20 students. Occupational therapists worked in psychiatric hospitals and rehabilitation units.

1982 a 2 year programme with intake every second year, 30 students. Occupational therapists work in the above plus special institutes and paediatrics

1985 as above plus occupational therapists also work in health resorts

1992 2 1 / 2 year programme with intake every year, 30 students

1996 3 year-programme, 40 students. Occupational therapists also work in community care and private practice.

1997 co-operation with York and Amsterdam started.

There are 387 qualified occupational therapists. An association of occupational therapists and physiotherapists was formed in 1970. Occupational therapy became an independent association in 1989. The profession was accepted in the law in 1969. The association started in 1998 the procedures to become associate WFOT member.

3.4.11 Romania

There have been rehabilitation centres in spas for many years. In 1974 rehabilitation became a clinical speciality and physiotherapy was recognised. Occupational therapy did not develop as a speciality on its own. Its tasks were carried out by doctors, physiotherapists, speech therapists etc. As yet there are still no occupational therapists. There is a tradition of the use of arts and crafts in psychiatry, which is carried out at a low level by physiotherapists. The importance of occupational therapy was discovered by a rehabilitation specialist on a visit to Amsterdam (NL).

Education
Education is for physiotherapy at present, although those doing a four-year physiotherapy programme can add one more year to gain a Masters degree in occupational therapy. There is now a willingness to set up occupational therapy programmes but a legal framework for the profession is needed.

3.4.12 Yugoslavia

The representatives from Yugoslavia were defectologists. They explained the range of rehabilitation and involvement of defectologists in Yugoslavia. They presented figures showing the numbers of people with disabilities and categories of disability in the country describing the health care system there in great detail. There are no occupational therapists at present.

3.4.13 Summary

The above stated data were mainly collected by the representatives of the Prague meeting and recorded in the report of this meeting (ENOTHE1999). This must be seen as a first attempt to describe some developments in occupational therapy in the Eastern and Central European region. It is clear that in most countries the profession of occupational therapist did not formally exist till recently, but there were rehabilitation workers or other kind of therapists involved in the care for the disabled. In the last few years different contacts between faculties of Eastern and Western European universities have been established to develop the education in occupational therapy.

Hereafter a summary of quantitative data will be given. Due to low professionalism and less registration in this area the data must be seen as provisional. Further research in this area is needed.