Alice Dean served as director until 1922 when Geraldine Lermit assumed the directorship of the Association and training school. Both women strove to enhance the School’s academic requirements and standardize professional procedures throughout the 1920s.
In 1923, the Missouri Association for Occupational Therapy established a home service department which provided visiting therapists for post-hospital cases and homebound persons. The Association promoted the establishment of occupational therapy departments in hospitals throughout the state of Missouri, often directly supervising these departments until the individual hospitals were able to assume responsibility.
By the 1922-23 academic year, the St. Louis School of Occupational Therapy lengthened its course of instruction to one year. Administrators lengthened the course of instruction in 1925 to cover a two-year period for high school graduates. Adjustments were made in the course length for those who entered with college credit. The curriculum included craft classes such as bead work, chair caning, leather work, rug making and woodwork. Lecture courses fell into two categories: general and medical-social. General lectures covered topics such as psychology, sociology and pedagogy; and medical-social lectures covered topics such as anatomy, physiology and neurology. Courses given by Washington University were also included in the curriculum. Students earned a diploma in occupational therapy at the end of the two-year period.
In 1929, the School was moved to 4567 Scott Avenue to a building purchased by Dr. Malvern E. Clopton and presented to Washington University. Clopton was president of the Missouri Association for Occupational Therapy at the time. The Great Depression began soon after the stock market crash of October 1929 and would set forth new challenges for the School and its graduates in the next decade.