Trust, but...

I have been seeing Xinren for several months, on and off, in a primary care fashion.  That is a frustrating interaction pattern from an occupational therapy perspective, and perhaps one that as a profession we are simply not acculturated to.  In traditional contexts occupational therapists see children on an ongoing and regular basis.  Xinren's family would call and then would be seen for a consult and recommendations were made and then they seemed to not follow up for some time.

The family initiated contact with me because they were concerned about their child's gross motor skills. The initial evaluation indicated that three year old Xinren had a lack of muscle tone and strength in both lower extremities, primarily in the ankles and feet.  Deep tendon reflexes were diminished and he had tightness in his heel cords and only trace strength in his ankles and toes that had a clear impact on his play skills.  I sent my report to the doctor who had no problem with writing a script…

Why do students in OTD programs respond so differently to survey questions about the OTD mandate?

Question: Why do students in OTD programs respond so differently to survey questions about the OTD mandate?

In May 2018, the American Occupational Therapy Association sent a survey to all AOTA members about the educational requirements put forth by ACOTE. More than 7,400 AOTA members completed the survey.  Students enrolled in OTD programs responded very differently than every other group.  That is a data point that requires some analysis.

This particular graph, with this breakdown of responses, represents an ethical question for the profession. That we have 60-65% of everyone except OTD students AGAINST the mandate, and 60-65% of OTD students FOR the mandate is a call for some real soul searching.

I personally believe that this response pattern may represent a sunk cost bias phenomenon.  The more important question is "How did that happen?" or "Why do students have such different ideas on the OTD mandate?"
AOTA members are bound by the AOTA Code of Ethics.  Th…

Use of a Case Study Method To Explore Sensory-Processing Characteristics of Children With Complex Regional Pain Syndrome

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coming soon!

A Pediatric OT's Screed on Trauma Informed Care (2015) - Three years later: Have we made progress?

Maybe some.

A couple years ago I wrote this 'screed' on trauma informed care (TIC) models.  My concerns at the time were related to the lack of direct intervention that was promoted as part of this model - and that it appeared that some OTs were adopting a social work approach to the issue.

Last night there was an #OTalk2Us twitter conversation about these models; I was not able to participate but I have been studying the conversation.  I think that this is a good opportunity to see if we are progressing ideas on TIC to be more occupational therapy directed and intervention-focused.

It was good to see more conversation around the areas of occupational therapy assessment and intervention.  I think that we still need some direct conversation about how this problem gets addressed from an intervention perspective.  In my local experience, most of the conversation around TIC models is still oriented toward 'awareness' and is being driven by systems-level consultants.  I als…

The AOTA reckless plan to open up all state occupational therapy practice acts

reckless. adjective (of a person or their actions) without thinking or caring about the consequences of an action.
"reckless driving"
On February 6-7, 2017, AOTA convened an ad hoc committee. This group was charged with the task to explore current experiential requirements for OTs and OTAs. As a result, the ad hoc group recommended a new model of experiential education that makes several disruptive changes including changes to the length of fieldwork and creation of a post-graduate first year practitioner resident program. Under this plan, graduates would complete the certification examination and practice under a limited license until the residency was completed. The group identified that this would involve the revision of many state's practice acts. They indicate that they were informed by staff and content experts on implications of these decisions. However, there were no state regulators listed in the ad hoc group. There were no representatives from the certification…

Annual NY early intervention post

Early intervention providers in New York State should be aware that when Governor Cuomo does not get what he wants he just tries to cram it down everyone's throat via legislation - repeatedly.

Blogging about the annual attacks on the early intervention program got boring around 3 years ago.  At that point in time the State Fiscal Agent (SFA) that is costing the taxpayers of NY millions of dollars in contract fees was only collecting 15% of monies billed for services.  In 2016 nearly 85% of claims submitted by the SFA to private insurers were denied.

Now in 2017, 82% of claims submitted by the SFA to private insurers are being denied.  That is just pathetic.  They have no idea what they are doing.  It is boring to repeat the same thing every year, but if anyone ran their practice with the inefficiency of the SFA they would not have a practice.

What is more pathetic is that we have been identifying how pathetic the SFA is for years - but no one listens to the provider community.


Analysis of occupational therapy leadership statements on student debt and the doctoral mandate


Selective use of statistics to support a flawed advocacy position on Medicare therapy cap repeal

This is a recurring theme - what should occupational therapists focus on when they are making decisions about services?  Should they focus on the people that need services, or should they focus on the amount of money being spent?

These ethical choices have been discussed in this blog before.

This question also applies to the latest situation with the repeal of the Medicare therapy cap and the resultant payment differential that has been applied to OTAs.

When attempting to develop an advocacy position - should the occupational therapy profession measure impact in terms of lives affected or in dollars spent?  Here is an analysis of how the professional association is cherry-picking statistics in order to suit their chosen advocacy position.

Perhaps we can call this analysis "A Tale of Two Table Fours"

Here is Table 4 from the Moran Company Report, commissioned by AOTA to look at the Medicare cap issue.

The RED information indicates the numbers of people (beneficiaries) who wer…