The positive and negative consequences of four dimensions of change affecting higher education are examined to consider some strategies to ensure quality of the preparation and practice of future occupational therapists. Experts from several disciplines view the decades of the 1980s and 1990s as a period of intense political, social, and economic change. Forecasting the effects of change on occupational therapy education and practice could result in strengthening the profession since decisions made now will have a direct bearing on the nature of occupational therapy practice in the future. The four changes discussed are enrollment patterns, student characteristics, fiscal resources, and institutional issues.