A call to action to make occupational therapy history matter Open Access

Occupational therapy history matters because it adds value to many aspects of the profession; it is a resource for values, identity and professional learning. The historical record demonstrates the existence, growth and resilience of occupational therapy in the 20th and 21st centuries. Historical evidence can be used to contest policy changes, connect with contemporary health initiatives, reveal hidden pioneers and challenge myths (Bradley and Scott, 2023; Frikha et al., 2025; Ilott et al., 2023; Marshall et al., 2022; Reed and Andersen, 2017). Early research can surprise and inspire, for example, Fransella’s (1960) experimental study shows that occupational therapy was at the forefront of mental health practice 65 years ago. History documents the profession’s responsiveness – or lack thereof – to societal forces such as racism and institutional inequities (Ahmed-Landeryou, 2024).

Accreditation bodies highlight this importance: the World Federation of Occupational Therapists (WFOT, 2016) and the Accreditation Council for Occupational Therapy Education (ACOTE^®, 2023) require that students understand the historical, philosophical and sociopolitical foundations of the profession. These education standards are premised on historical literacy: that students “can think historically and engage in discipline-based conceptual reasoning about the past” (Downey, 2015). This involves understanding the complexities, the contexts and choices made by individuals, institutions and systems when constructing our history.

Despite these mandates, occupational therapy history is the “most neglected aspect of our professional endeavours” (Bing, 1981p. 514). Recent evidence shows that little had changed since 1981 (Ilott and Edmans, 2020). Few museums contain OT collections, systematic archival efforts are rare, and historical research is underfunded and under-published compared with cognate professions such as nursing and medicine.

The COVID-19 pandemic exposed critical vulnerabilities in how institutions safeguard occupational therapy history. Both the American and British associations disposed of national collections of specialist knowledge held in their libraries. Hundreds of books and theses, irreplaceable assets that belonged to the whole profession, were dispersed or recycled. Rare theses, including Jean Ayresmasters thesis, were discarded rather than digitised for posterity (Alterio, 2022; Rutherford, 2023). Some decisions coincided with the easing of lockdown restrictions. In March 2021, senior managers at the British Associated approved the business case “to keep the physical library space closed” and replace a well-used library with “an entirely digital library service” (Rutherford, 2023, p. 597).

These examples of deaccessioning raise questions about the responsibility of institutions as custodians, entrusted with deciding the fate of unique historical assets. For example, should Mary Reilly’s books be preserved simply because of their provenance (Alterio, 2022)? Or should preservation be based on a transparent criteria? We believe so. This is why we developed a practical, conceptual framework to guide decisions about accession (preserving) and deaccession (removing) heritage assets.

The new, three-step decision-making framework integrates occupational therapy with archival and museum practice. It is intended to guide important decisions about tangible and intangible cultural assets. Tangible assets include documents, photographs and artifacts. Intangible cultural assets are vital for cultural diversity. They are the “traditions or living expressions inherited from our ancestors and passed on to our descendants” through storytelling, rituals, knowledge and practices concerning nature and the universe (UNESCO, n.d.).

The three steps are:

1. Apply the precautionary principle – Avoid harm in the face of uncertainty. In the absence of clear evidence, safeguard rather than discard. This principle, established in health and environmental policy, encourages careful consideration of long-term educational and societal benefits (Aronson, 2021).

2. Assess significance – Determine why an item or collection matters. Significance is widely used in museums and archives and considers provenance, historical and cultural value, rarity and emotional resonance (Historic England, 2019; Russell and Winkworth, 2009). Collaborative assessments involving occupational therapists, archivists, historians and community members can generate a statement of significance to inform decision-making.

3. Action planning – Translate significance into action. This step mirrors the occupational therapy process, moving from assessment to intervention. Depending on resources, assets may be accessioned, digitised or carefully deaccessioned. Action plans should be explicit, context-sensitive and sustainable.

This framework encourages intentional, respectful and accountable stewardship of occupational therapy’s heritage. It can be scaled to fit local, national or international organisations and systems.

Examples from around the world show how individuals, groups and institutions are preserving and sharing occupational therapy history in innovative ways:

• Storytelling and testimony – The story of Alice Mawerera Moyo, known as the “mother of occupational therapy in Zimbabwe” has been preserved through a digital video for WFOT Day, offering both tangible and intangible heritage and supporting decolonised curricula (mOTivate OTs, 2022).

• Community exhibits – At Sheppard Pratt Hospital in Maryland, tapestries depicting therapeutic occupation commemorate Dr. William Rush Dunton’s legacy and anchor the institution’s heritage (Sheppard Pratt, n.d.; Vastano Giannitti, 2024).

• Centennial celebrations – The Massachusetts Association for Occupational Therapy’s centennial video used museum exhibits and archival materials to showcase professional heritage (MAOT, 2022).

• Scholarship – Fleming-Castaldy (2018) demonstrated that studying historical literacy strengthens professional identity. The research programme at the University of Limerick is advancing critical understanding of occupational therapy history in Ireland (Cahill and Pettigrew, 2020; Dunne et al., 2018; Pettigrew and Robinson, 2024).

• Volunteer-led repositories – The OT Leaders & Legacies Society (n.d.) curates oral histories and digitised documents, providing sustainable, publicly accessible preservation by, and for, the profession. Wikipedia editing projects, like the Royal College of Nursing’s “Nurses in Red,” provides a model of high impact dissemination (Doherty and Rogers, 2024) that could be replicated by creating entries for notable pioneers in each country, such as “Ann Beckett” (2015), the first qualified occupational therapist in Ireland.

These examples illustrate the lasting impact of historical engagement.

The final call combines strategic and practical actions needed to reverse the systemic neglect and to make occupational therapy history matter. The decision-making framework and case examples offer practical starting points. These need to be augmented by strategic action and investment from the institutions, groups and individuals, ultimately responsible for the survival of our tangible and intangible heritage.

Action is required in many areas. We highlight just four to stimulate further discussion. The first is that institutions enact their responsibilities as stewards and custodians of occupational therapy history. Secondly, embed historical literacy and competence into curricula and practice as a foundation for professional identity. Next, invest in scholarship with critical, historical research as a priority for funding to build capacity and support research programmes. The final call encourages everyone to take ownership of, and pride in their personal, and professional history; to be curious, creative, and always challenge how our legacies are preserved, curated and interpreted.

We want this call to action to provoke change across the whole profession. Our history and heritage assets are fragile and powerful. Appreciating the relevance and richness of occupational therapy history is a pre-requisite to safeguard our heritage, inspire future generations and ensure that its distinctive evidence base and collective wisdom is not lost, but mobilised to benefit contemporary practice, policy and scholarship.

• An ambitious call to action, combining practical and strategic actions to reverse a century of neglecting occupational therapy history.

• To provoke change from a “history-lite” to a “history-proud” profession that understands history as a source of values, identity and evidence.

• COVID-19 pandemic-era dispersal of archival and library collections highlights the vulnerabilities of heritage assets entrusted to institutions.

• A new decision-making framework integrating occupational therapy, archival and museum knowledge, to guide accession and deaccession decisions.

• Creative examples from around the world of sustainable, engaging ways to safeguard and share history, to inspire action from individuals and groups.

• Strategic actions for institutions related to custodianship, historical literacy and scholarship to preserve our history before it is lost forever.