Tuesday, November 24, 2015

Analysis of the AOTA claim of a gender-based wage gap in occupational therapy

The American Occupational Therapy Association recently publicized a claim that although 90.9% of respondents in their workforce survey were women that male practitioners make 14.7% more than women, despite setting, years of education, or position.

 They added the following editorial comments: "Want to earn what you deserve and be more confident? You don’t have to join the boys’ club or be aggressive."

This is an interesting claim so I decided to research these statements and see if they could be validated.  Data on wage disparity was not previously collectible in OT because of low numbers of men responding to workforce or wage surveys.  There was a parallel problem in the nursing profession.  However, in a recent large scale study in the nursing profession (also dominated by women wage earners) male nurses made $5,100 more on average per year than female colleagues in similar positions (Muench, Sindelar, Busch, and Buerhaus, 2015).  However, the study reports that about half of that difference was accounted for by employment patterns and other measured characteristics like leaving the profession to raise children.  That leaves a small difference yet unexplained.  An economist for the American Nursing Association also reports that there is some volatility in the statistics based on the low numbers of men in the surveys. 

Peter McMenamin, a health economist and a spokesman for the ANA states “The folks who did the study are well qualified and they have lots of data,” he said. “But my main hesitance in terms of statistics is they have fewer men.” Only 7 to 10 percent of nurses are male, he acknowledged. But with a smaller sample, he said, “the reliability of the answers is less robust.” 

In sum, it seems fair and reasonable to state that some wage gap may exist but that small numbers of survey participants and the presence of unexplained confounding factors makes up for some of that difference.  It also seems fair and reasonable that there are likely to be similarities between female dominated health care professions, such as between nursing and occupational therapy.  Therefore, it seems in-bounds to look at data from other similar professions.

There is no real argument that there has been a historic gender-based wage gap but as gender roles have changed and evolved over the last several generations that wage gap has diminished.  Goldin (2014) provides an exhaustive review of the evolution of what she terms "gender convergence."  In simple terms, changes in gender roles and education and societal views have helped to drive wages closer and closer to equality.  The wage gap shrinks based on "explained" reasons related to role behavior but there is still a "residual" gap that requires analysis.  She explains that some people would attribute that residual gap to blatant gender discrimination or even due to women's alleged inability to bargain.  These attributions are in line with the AOTA statements.  These attributions are also not fact-centric.

 Through detailed mathematical and statistical analysis, Goldin identifies that the residual gap exists "because hours of work in many occupations are worth more when given at particular moments and when the hours are more continuous.  That is, many occupations earnings have a nonlinear relationship with respect to hours.  A flexible schedule often comes at a high price, particularly in the corporate, financial, and legal worlds."  Again, in simple terms, workers who require and/or take advantage of workplace flexibility do so at the peril of their own salaries.  It is a mathematically proven reality.

Therefore, evidence for the gap is not directly gender-related.  However, it is true that gender roles remain persistently traditional despite move towards convergence.  Everyone can apply their own anecdotes to this: my observations are that despite theoretical advancements in 'equality' it is still more likely for women to advantage workplace flexibility in order to meet other occupational demands.  If there are non-OTs reading this, I use the term 'occupational' in its broadest possible sense.

There is a difference between gender-based inequality and role-based inequality. It is unfortunate that people will conflate these concepts in order to suit a narrative. 

Goldin's research is corroborated by a U.S. Department of Labor study (2009) that reports that the gap can be brought down from 23% to between 4.8% and 7.1% once all of the "explained" reasons are controlled (human capital development, work experience, industry factors, and career interruptions).

What remains is the summary fact that economic analysis accounts for large amounts of any reported "gender-related" wage gaps.  The residual differential is unquestionably related to ways in which women tend to interact with their work environments, and whether or not that is reported as "gender discrimination" tends to vary with the political motivations of whoever is presenting the facts.  Again, there is a difference between gender inequality and role inequality.  You don't have choice over your biologic gender.  You have a lot of choice about the way you engage your roles.

Obviously there are some pockets of blatantly gender-discriminatory behavior in isolated workplace practices.  I don't feel the need to cite evidence to support that belief because after 35 years of employment I feel confident in the knowledge that discrimination can exist.  The question then is whether or not there is a culture of discrimination against women in the occupational therapy profession.

Perhaps the best way to test for this is to search for evidence related to the American Occupational Therapy Association's claims.  They reported that in order to get the salary you 'deserve' that "You don’t have to join the boys’ club or be aggressive."

After an exhaustive review I was unable to find any evidence that there is any kind of "boy's club" in the occupational therapy profession that is acting to suppress wages of women occupational therapists.  However, I did find documented evidence of what Peters (2011) described as an "old girl's club" and an "old girls' network" that used strategies like networking and mentoring to achieve their goals.  Peters explains that "In this connected system, community insiders watched over each other’s tutees who had ‘‘the right’’ occupational therapy pedigree."

Interestingly, the woman-dominated occupational therapy profession had an internal culture of 'taking care of each other' often to the detriment of anyone who was an 'outsider' to that network.  Peters describes several examples of gender, racial, and other forms of outsider bias that was perpetrated by the 'old girls network.' 

That is rather ironic.

In a more positive sense, Peters states that the network also openly identified the problems associated with conflicting home life vs. work life tensions.  Peters cites Jantzen (1972a, 1972b, Mathewson, 1975) that 34% of occupational therapists stopped working after ten years to raise families.  She explains that "One drawback to this pattern is that work discontinuation led women to be in a poor competitive position with men... typically, women continued to work around family needs first, placing them in a weaker economic position than working men... women experienced stress when balancing roles including wife, mother, homemaker, and worker with limited time..."  She also quotes Robert Bing

The real problem in the 50s was the fact that a typical OT practiced an average of 3 to 4 years, then disappeared, usually into marriage.  The schools could not turn out enough additional people to cover this loss.

It seems reasonable to believe that this pattern of concern persists into the present day.  These issues of discontinuous labor participation are faced by many women who choose to have children and who choose to take 'breaks' from their paid employment.

Peters' history goes on in rather extensive detail in describing and quoting a history of the occupational therapy profession that overtly promoted feminism and that overtly discriminated against men, rejected symbols of male dominance, and fought against any residual influence of a male-dominated medical system.  Her examples are not restricted to single anecdotes; she describes a culture that was pervasive and that was extraordinarily slow to change.  Peters concludes that

 Occupational therapy as a female dominated profession did not collapse or subsume to more dominant professions like physical medicine... rather than deferring, these women embraced gender inequities using their female networking strategies to overcome challenges... rather than becoming male-like or medicine-like, this female dominated profession strategically glorified its feminization as it became scientific, thus providing a unique template to gender specific professions.

There is no evidence of some 'old boy's club' that current therapists must avoid in order to 'get the wages that they deserve.'  That modern day OTs are subject to some specious narrative of victimization by social forces is not only historically incorrect but also in direct opposition to the economic analysis of respected scholars who have correctly described the nature of 'residual' wage gaps.  The actual historic evidence supports Goldin's research that describes the way women engage a career trajectory in context of a desire to also balance other life demands.  This is nothing new; female occupational therapists have been experiencing and documenting these challenges for many years.  These challenges are largely based on personal choices and not on gender-based discrimination.

The correct message for the predominantly female field of OT is to understand that they are not subject to a 'boy's club' mentality that is 'aggressive' and that suppresses the wages that they 'deserve.'  They also don't need to 'negotiate' better because that is not the problem.  These are all false narratives.

In the past occupational therapists have advantaged the reality of their own 'old girls' network' in order to support each other and to push forward.  I expect that there are residual forces within the profession that reflect that culture.  That old culture was never low on facts and high on finger pointing or excuse-making. 

I can't imagine that 'old girls' network' tossing down a blame card of discrimination and imagining a phantom network of gender-biased men who are protecting the club and holding down women's wages.  The narrative put forward on AOTA's social media is not supported by evidence.  Specifically, that narrative is not consistent with economic facts as explained by Goldin and as historically recognized by occupational therapists themselves.  It is also just not consistent with the cultural reality of this female dominated profession and the documented way it has framed its own challenges.

So is there a gap?  Probably not much of one if you adequately controlled for all the factors.  It is clear that any gaps that do exist are related to individual and personal choices people make about labor participation.  Evidence shows that OTs have known this and have documented this for years - and it has always been described in terms of occupational choices, not gender discrimination.

If a member association wants to raise the issue of the problematic nature of measuring and understanding salaries that is fine and actually should be encouraged.  Framing it in exaggerated terms without including an honest analysis of current economics and historical precedents is probably not helpful.


CONSAD Research Corporation (for USDOL) (2009).  An analysis of the reasons for the disparity in wages between men and women. Pittsburgh, PA: Author.  Downloaded from http://www.consad.com/content/reports/Gender%20Wage%20Gap%20Final%20Report.pdf

Goldin, C. (2014). A grand gender convergence: Its last chapter. American Economic Review, 104(4), 1091-1119.

 Muench, U., Sindelar, J., Busch, S.H., Buerhaus, P.I. (2015) Salary Differences Between Male and Female Registered Nurses in the United States. JAMA. 313(12), 1265-1267.   doi:10.1001/jama.2015.1487.

Peters, C.O. (2011) Powerful Occupational Therapists: A Community of Professionals, 1950–1980, Occupational Therapy in Mental Health, 27:3-4, 199-410, doi: 10.1080/0164212X.2011.597328

Tuesday, November 17, 2015

Sad days

"Today is my sad day," stated Lauren, in a matter of fact tone.

I work with many children who have superior language skills.  Often, those language skills outpace motor expression and emotional coping ability.  Sometimes doctors or psychologists call it a non-verbal learning problem or sometimes they will label it Asperger's Syndrome if the child has other behavioral quirks.  Either way, I am accustomed to hearing kids say things to me that would take the average listener off guard.

Lauren was a quick-witted and confident child with uneven red bangs from her own attempts at hair-styling.  Besides those bangs she had long tangled curls cascading down her back because she could not stand having her hair brushed.  Lauren had a habit of curling and twisting her hair in her hands, contributing to the tangles.  The mom intended to cut her hair to her shoulders but Lauren bargained herself a delay because she wanted long hair and also because she had the ability to perform verbal calisthenics and get things that she wanted.

I was seeing her because she had attention problems and some motor delays.  I know better than to respond too quickly, so I let her comment sink in a moment.  "What do you mean that 'Today is your sad day?" 

She reached into her backpack and pulled out a picture, directing it under my nose in a way that made me have to move my head back in order to focus.

"Today is the day that my dad died."

This was another one of those moments that you can never really be prepared for, because what do you say to a child that waves that information right under your nose?

It was an older picture with a deep fold down one side.  It was a picture of a baby, supported in her father’s arms, who seemed to be reflexively lifting her head to look at the other people surrounding her.  The baby had red hair; I imagine that it was probably as red as her father’s was when he was her age.  Now his hair was light brown.  As the baby looked at the strangers her dad teased the small curls in her hair with his fingers. 

"This is a picture of me and my Dad."  I knew that Lauren's dad died when she was a baby - her mom mentioned it to me during our first interview.  I started considering the pieces of the information that Lauren was giving me, and the implications of her statements started to fit together.

I stared at the picture and I thought how beautiful it was.  That dad loved his daughter.  Maybe his own parents held him the same way.  How else could he so effortlessly and perfectly hold his own daughter?  It was a perfect picture. 

"My mom told me that I used to be really fussy and all I had to do to calm down was let my dad hold me." 

I thought that was kind of funny, because little Lauren perceived her own intrinsic sense of control extending back to her infancy, as if she was letting her father hold her.  Her personality was so ingrained and she was only eight years old.  That made me smile.

"My mom told me that I would let my dad hold me on his chest and that would always make me close my eyes.  He would close his eyes, and I would close my eyes, and I would just listen to his heart beating and beating.  Sometimes I think I can still hear it, like when I am going to sleep and if I put my head on my pillow in a certain way.  Mom said that I am hearing my own heart, but I think I am hearing something else."

I stared at the picture that Lauren held in front of me as she talked and talked.  I imagined that it was his intention to remember this story himself twenty years after the picture was taken, and that she would not.  Instead she was developing a narrative of the event and she was doing the remembering. 

Death does that, I guess.  It takes the natural order of things and turns it all upside down.  Lauren now carried the memories that her father intended to have.

The story is now created and reinforced with the help of her mom.  It was originally supposed to be a love story that her dad had toward her.  What remains is a sense of love, but it is not the original love itself - because she only knows the story.  For Lauren that will have to be enough.

I thought about her uneven bangs, and her desire for long hair, and her ingrained habit of tangling it all together.  Then my perception shifted and I saw Lauren as a young woman, with long red hair that she would twirl wistfully with her own fingers.  I imagined her sitting and twirling her hair and dreaming about what it would be like to be loved.

She will understand that her father loved her, but she will know how that love was shown through a  shared and reconstructed story that will be as real as remembering the event herself.  Even on the sad days.

Friday, October 16, 2015

Thought exercise for occupational therapists

Thought exercise:
Take special note of the 'Service to society' section 
[my emphasis added].  Are we still providing this service? 
Or are we now chasing some other objectives that are out of 
sync with this original intent? 




Registrar, Boston School of Occupational Therapy 

Boston, 1920.
Description of occupation 

Occupational therapy is one of the new professions for 
young women. The necessity and importance of this work 
was firmly established in military hospitals during the late 
war and its future success is secure. The civilian hospitals 
are waiting for trained workers, and we believe that it is but 
a short time before every hospital and institution will employ 
at least one aide. 

The training is designed to develop not only artistic and 
mechanical skill and dexterity, but also ability to cooperate 
with every branch of the hospital service in order that there 
may result the highest standard of efficiency. This latter 
ability is quite as important as the former. 

Among the crafts used for their special therapeutic value 
are: Applied design, basketry, block printing, bookbinding, 
chair-seating, jewelry, leather work, modeling, rug-making, 
textiles, tin-can work, typewriting, weaving, wood-carving, 
woodwork and whittling. Also minor curative occupations; 
bead work, colonial mats, cord work, crocheting, knitting, 
netting. The work is carried on in hospital wards and shops 
and, when possible, with private cases. 

Preparation or training necessary 

General education, equivalent at least to high-school educa- 

Previous training in any of the following subjects with satis- 
factory credentials will be credited the student upon entrance 
to the schools of Occupational Therapy: nursing, social 
service, physical education, mechanical drawing, psychology, 
arts and crafts. 
Training may be secured at the following schools: 

Boston School of Occupational Therapy, 7 Harcourt Street, 

Teachers College, Occupational Therapy Department, New 
York City. 

Flavell School, Chicago, Illinois. 

Philadelphia School of Occupational Therapy, Philadel- 

Downing College, Milwaukee, Wisconsin. 

School of Occupational Therapy, St. Louis, Missouri. 
Qualifications necessary for success 

Strong physique, understanding of human nature, common 

sense, initiative and adaptability. 
Financial return 

Average, from $1200 to $1800 per year. 
Extent of occupation 

Occupational therapists are in demand in institutions such 
as State hospitals, private hospitals, Army and Navy hospi- 
tals, dispensaries. Government public health departments, 
work with private patients both in hospitals and at home. 
The demand for well-trained aides far exceeds the supply. 
Service to society 

To restore a patient's courage and his, or her, maximum men- 
tal, nervous, and physical ability is to add an asset to the 
community where there might have been a liability. To bring 
work out of idleness has economic value in time, morality, 
production, health, and happiness, and is elevating to the 
individual and to the entire world. 
Suggested reading 

"Ward Occupation in Hospitals," Bulletin No. 25. Issued by 
Federal Board of Vocational Training, Washington, D.C., 1918. 
"Handicrafts for the Handicapped" — Dr. Herbert J. Hall. 
"The Work of Our Hands" — Dr. Herbert J. Hall. 
"Teaching the Sick" — George Edward Barton. 
"Invalid Occupations" — Susan Tracy. 

Tuesday, October 06, 2015

A tale of two Mertons

In her famous Slagle lecture, Reilly describes the importance of criticism in professions in general and in occupational therapy in particular.  She stated that
"...a card-carrying critic must do more than merely engage in critical thinking. Judgments made by a critic must emerge from a discreet use of techniques which are difficult to master and dangerous to apply. Basically, the skill is dependent upon an ability to analyze, interpret and synthesize. A critic must have a sharply developed capacity to see deficiencies in data and fallacies in interpretation. The best stock in trade that any critic has is a discerning eye for trends and an ability to pattern and verbalize them. Whether a critic is worth listening to is usually decided by an ability to use language well, by a creativeness in synthesizing new relations and by courage to propose provocative hypotheses. Ultimately, however, a good critic rests his case upon how well he has been able to restructure the issue so that the necessary powers for its resolution can be freed."

Reilly understood that these were difficult standards because in her estimation criticism was not commonly employed or understood in professional affairs at the time she gave her lecture.

Unfortunately, not much has changed in this regard in 50 years.  The AOTA is proposing changes to the Bylaws that create an environment that will discourage member participation.  The current proposed revisions are posted online at http://www.aota.org/AboutAOTA/Get-Involved/BOD.aspx.

The new Bylaws create a process where any member can complain and call for the removal of another member based on the poorly defined concept of 'cause.'  Such complaints would be the type of complaints that would not rise to a full ethics violation.

There is an ugly history of people using association processes to air their personal disputes. Just ten years ago there were published allegations that the SEC (ethics commission) was becoming a place where "conflicts of interest or personality disputes [were] coming before the commission."  (Glomstad, 2005).  An AOTA member made a motion to eliminate the SEC because "The story behind the motion reveals that the SEC also has become an arena for airing personal conflicts among AOTA leaders and members." (Glomstad, 2005).

There was a lack of specificity in the new proposal.  After it was pointed out that there was no procedure for managing complaints, a document was created.  It does not appear that the brand new "Standard Operating Procedure for Investigation and Determination of Complaints to Terminate Membership" has even been reviewed by the BPPC or approved by the Board.  That leaves the impression that this is being made up on the fly.

After pointing out that there was no real definition of "cause" some clarification was given.  The FAQ was updated and now states that "This definition of “cause” is consistent with the longstanding description of “cause” used in AOTA policies for removing volunteer leaders from their positions."

It does not make sense to apply standards associated with volunteer leaders to members because the conditions do not apply to members.  The definition of 'cause' as stated in Policy 1.15 Removal and Appeal have no application to normal members.
That policy states:

1. All elected and appointed volunteer leaders may be removed for:
    a. Failure to accurately report or maintain qualifications for the office or position held, including maintaining the credentials and criteria for eligibility for the office, or
    b. Failure to perform official duties of the office or position held as defined in the governance documents, or
    c. Failure to declare a material conflict of interest in violation of the Association’s official policy or other action/omission of influence, or
    d. Misuse of proprietary or confidential information, or
    e. Violation of any fiduciary duty, or
    f. Proven unethical behavior in the conduct of the position held or proven conduct that reflects negatively on the reputation of the profession or Association.

None of this applies to regular members, except ethics concerns, which should be handled by the ethics commission.  Therefore, there is no compelling definition of 'cause' to apply to members and that reinforces the concern that this has the potential for serious misuse and abuse.

Additionally, the "Standard Operating Procedure for Petition to Challenge Association Action" places the Board in a position where it is essentially investigating itself and hearing appeals on its own actions.  That is not a functional process and any organization that hears appeals of its own decisions without some kind of external and independent arbitration is not offering any 'reasonable opportunity' for defense.

It is difficult to understand what the purpose of this new policy is.  It creates an environment where members can complain about each other and where there is  show trial conducted by a Board that has not really defined a due process procedure or opportunity for any reasonable defense.  The Board would be better off spending its time on governance.  Since there is already an Ethics Commission it is very difficult to know what kind of 'lesser' complaints and interpersonal grievances might be heard by this new process.

If this new policy goes into effect the AOTA will have a new mechanism for quelling member participation.  Who would want to speak out about anything or even participate in AOTA if that means that someone might complain about what you are saying and subject you to some whimsical Board process that can lead to membership revocation?

Considering this new proposed policy is what caused me to review Reilly's statements about criticism.  In her lecture she quoted Robert Merton who was a sociologist; he wrote about the role of professional associations and how they are supposed to foster exchange of ideas.  Merton (1960) wrote:
It is here that they can exchange ideas, experiences, and information that have not yet found there way to the printed page.  Some of this exchange is of the kind that seldom, if ever, gets into print.  That is why even the best of scientific journals is not a complete substitute for the give-and-take that, in the effective professional association, is provided by national meetings and all manner of other conferences.  That is why the professional society is the indispensable complement to schools and universities.  It provides for an interchange that would otherwise not take place.

Such profound words, and such a shame that interchange would be threatened by policies that allow members to complain about each other and attempt to have each other's membership revoked.  Criticism, debate, and information exchange is impossible in such a context.

In Reilly's Slagle lecture she invokes a very unusual term when talking about this topic.  She states that according to Merton (1960), "criticism stings a profession into a new and more demanding formulation of purpose and maintains a policy position of divine discontent with the state of affairs as they are."

"Divine discontent" is the unusual term that stands out, because it is an entirely DIFFERENT Merton that is commonly associated with that term.

Trappist monk and Catholic writer/social activist Thomas Merton (1948) was also a 'card carrying critic.'  He was chronically discontented with the way things were.  Although his path was tortured, his criticisms and questioning were always oriented toward growth.  His inherently critical nature did not make for an easy path because he constantly acted as a pebble in the shoe of nearly every authority figure that he met.  That led others to even take steps to silence him and to forbid him from writing or speaking on certain topics that would cause 'trouble' or 'embarrassment' for his superiors.

That reminds me a lot of this new proposal from AOTA.  It is a policy that threatens people who want to be card carrying critics and it is an oppressive action that will limit exchange of ideas.  Such policies have no legitimate place in a professional association that I want to participate in, so I ended my own membership.

I will just borrow a line from that other Merton (1948) that Reilly oddly and accidentally brings to mind:

Sit finis libri, non finis quaerendi.


Direct links, and...

Glomstad, J. (2005, April 4). A stormy transition.  Advance for occupational therapy practitioners, available at occupational-therapy.advanceweb.com/.../A-Stormy-Transition.aspx

Merton, T. (1948) The Seven Storey Mountain.  New York: Harcourt Brace.

Merton, R.K. (1960). The search for professional status.  American Journal of Nursing, 60, 662-664.

Reilly, M. (1985). The 1961 Eleanor Clarke Slagle Lecture: Occupational therapy can be one of the great ideas of 20th century medicine in AOTA (Ed.), A Professional Legacy: The Eleanor Clarke Slagle Lectures in Occupational Therapy, 1955-1984, (pp. 87-105). Rockville: AOTA.

Tuesday, September 22, 2015

Editing the American influence out of the history of occupational therapy

During the very long social justice debate that preceded the revised AOTA Code of Ethics there were repeated claims that social justice represented a Core Value of the occupational therapy profession.  Those claims have been thoroughly addressed here and here.  In these entries and several other previous entries information was presented to support the claim that American influences are germane to understanding the driving forces behind the formation of the profession.

In my ongoing readings related to this topic I was comparing textbooks and am developing some new questions.  I am very curious about information that was recently edited out of the new edition of the Occupational Perspective of Health, 3rd ed (Wilcock and Hocking, 2015).

In An Occupational Perspective of Health, 2nd ed., Wilcock (2006) discusses the driving forces leading up to the formation of the occupational therapy profession.  She explains that changes occurred as Ruskin and Morris' ideas (via the Arts and Crafts movement) were brought to the United States.  She writes

However, because the Puritan work ethic was so central to American culture, Ruskin's and Morris' conception of a preindustrial, creatively absorbed craftperson became reinterpreted so that eventually no distinction was made between modern and pre-industrial work habits.  American Arts and Crafts leaders, along with their progressive contemporaries, drew back from fundamental social change for social justice, favoring instead "a new kind of reform" aimed at "manipulating psychic well being" and fitting individuals into emerging hierarchies.  This notion of "mental and moral growth" was compatible with 19th century American ideas about individualism, which was central to capitalism, its liberal democracy ideology, and values focusing on human rights... Similarly at Hull House, where Ruskin's and Morris' photographs had pride of place, the Arts and Crafts ideology was reinterpreted from a socialist to an individualistic focus.

This analysis is in line with my previous essays on this topic and in my estimation this is an accurate representation that dismisses the fallacious 'Social Justice as Core Value' argument.  Unfortunately, this entire section has been edited out of the 3rd edition of the same text.  Instead, Wilcock and Hocking (2015) offers this:

Neither the antimodern socialist revolution focus, nor the capitalist, individualist growth focus, nor the establishment of occupational therapy was successful in creating global awareness of the need to consider people's inner being and occupational nature in future social or health planning, although all went some way in that direction.  Later, the dominance of reductionistic medicine led to public health practitioners being tied to a practice geared to civic sanitary conditions and control of epidemics of infectious diseases, and the diminution of broadly based, population-focused occupational approaches to health, delaying a collective consciousness of their importance.

So an accurate analysis of the American forces that shaped the unique focus of the profession is now removed and we are left with an accusation that those influences were detrimental to what I will label as Wilcock's and Hocking's Occupational Therapy New World Order, which is all based on a new justice paradigm.  This is consistent with other academic efforts to bend history in order to fit a social justice narrative.

I am wondering if Wilcock's original analysis is edited out of the 3rd edition discussion because its presence undercuts the arguments of social and occupational justice proponents. It is unfortunate that she did not EXPAND on this line of analysis and include information on the influence of the Transcendentalists, the Boston Society of Arts and Crafts, the Emmanuel Movement, and George Barton. This all becomes immensely important as it relates to our theory development because it helps us to answer questions about whether or not that American influence is important.  I argue that it is, and that is why I spend so much of my research time attempting to reconstruct the neglected Barton thread of the occupational therapy story.

These topics are important for uncovering the full truth about our historical roots and Core Values.  When we omit important historical facts and analysis we have incomplete information to form proper opinions.  This kind of cherry picking has led some scholars to misinterpret history and to oddly focus only on justice models or feminist interpretations of Hull House influences.  A proper historical analysis will balance all of these factors together and will not selectively edit anything out.

History should be history.  It should not be selectively edited and it should not be revised to suit current political and justice agendas.


Wilcock, A.A. (2006). An Occupational Perspective of Health, 2nd ed. Thorofare, NJ: Slack, Inc.

Wilcock, A.A. and Hocking, C.H. (2015). An Occupational Perspective of Health, 3rd ed.  Thorofare, NJ: Slack, Inc.

Monday, September 21, 2015

I vaant to TELL you zomething!

I want to share a message about authenticity in therapeutic relationships.

Jim was a 40 year old man who participated in  a day treatment program in a rural community.  The program itself was conceived and nurtured by Jim's parents along with other parents who were desperately trying to find non-institutional program options for their children.  Jim had cerebral palsy and an intellectual disability.  He attended that community program as a school child and eventually 'graduated' into the adult day treatment program.  The program grew from providing services to just a few children to several hundred people with developmental disabilities of all ages.  The program was an act of love, gifted by parents to their children.  That is the best way I can think to describe programs that developed this way.

I am not sure how aware Jim was of all that.  He was mostly focused on relationships with people and he had no disability in that social arena.

I had no special relationship with Jim, except that he treated all of the people that he interacted with in a special way.  Because of that I loved spending time with him.  Who doesn't love spending time with someone who treats them like they are special?

You could always hear Jim before you could see him; he had an uncanny ability to know where you were before he could see you.  Perhaps because his vision was poor and his motor abilities were limited he compensated with hearing or something else.  He would slowly wheel himself from around a corner, propelling his wheelchair mostly with small wrist movements, and you would hear a characteristic voice with his 'fake' accent that sounded like something out of a Dracula movie: "Chreeeeeestopherrrr.... I vaant to TELL you zomething!"

I have no idea where he got that 'voice' from.  Just remembering his voice cracks me up as I think about it.

Five years after I left that facility I was working in a children's hospital in a nearby city.  I was working in the orthopedic clinic and I heard that voice from behind one of the closed curtains in an evaluation room, just as if those five years had not even passed.  The voice said clearly, "Chreeeeeestopherrrr.... Eeez Zat YOU????  I vaant to TELL you zomething!"  Of course it was Jim - who despite his age was still being followed in the developmental disabilities clinics of that pediatric hospital.  I couldn't believe that he knew I was there even though he couldn't see me from the other side of that curtain!  It was a wonderful reunion, like seeing an old friend again.

There is a special authenticity about those kinds of interactions that is very difficult to explain in words in some blog post.

I got to thinking about this because I was recently reminded about this kind of authenticity in my work at the college.  The college has a transitional program for young adults who have developmental disabilities.  Those students attend educational classes, some of which are college courses.  They are not graded on their efforts but the idea is to promote inclusion and participation.  I was fortunate enough to have some of those students in a Freshman level 'Intro to OT' course, and even though I think that the program needs more OTs working in it in a general sense, the participation of those students in the class was positive in just about every way I might think to measure.

What struck me most though was that as the next semester began I would pass by some students from my Intro to OT course as I walked around campus.  The students were always polite and friendly, perhaps verbalizing a quick 'hi' or giving a quick head nod along with a fleeting moment of eye contact as they rushed around campus.

That is not how the 'Intro to OT' students from that transitional program acted though.  The first response that I got when I saw them was quite different.  They ran to greet me, excited to tell me about their summer experiences.  One asked for a hug.  And it wasn't just that first time, because now they stop by my office or stop me to talk when I am walking around the halls.  One of them still wanted to talk about the book I had them read last semester, Tuesdays with Morrie.  I think that even though the writing skills are imperfect, one of those students really understood the message in the book.  That student wrote:
Morrie said that “This  is  a  part  of  what  a  family  is  about,  not  just  love.  It’s  knowing  that  your family  will  be  there  watching  out  for  you.  Nothing  else  will  give  you  that.  Not  money.  Not  fame.  Not  work.”  So What  does  this  mean to me?  To  me,  it  means  that  yours  or  my family--mothers,  fathers,  brothers,  sisters,  aunts,  uncles,  cousins,  grandparents,  friends, teachers etc. will be  by  our  sides  no  matter  what.  It  doesn’t  mean  who’s  just  in  our  blood,  it  also  means who  our  friends  are  who  take  us  in  as  their  sister  or  brother.  You  could  be  famous  person  and  still  need  your  mom  or  dad  to  support  you.  You  could  have  a  job  that  has  a  bunch  of hours  and  pays  at  minimum  wage  while  still  being  happy  with  what  you  have. Families are  important  in  our  lives, no matter who we are calling family.  And we should probably dance with them if we love to dance.

So, I vaant to TELL zomething to OT students who I hope will also have the opportunity to work with people who have developmental disabilities during their careers.  It is pretty important that we learn to strip away and look beyond the labels that are placed on people.  Sometimes we find ourselves working within systems that apply those labels for what are supposed to be good reasons but sometimes they distract us from understanding that people of all abilities have some important observations to offer and some important contributions to make. 

I am not trolling for hugs next semester from my Freshmen students, but I think it is correct to observe that we have a lot to learn from each other, even when our abilities and skills are very different.  In particular, I think that we all have more to learn about how we are supposed to care about each other and how we can interact with each other in more authentic ways.

The whole idea of inclusion is that it opens us up to opportunities to interact.  It is never going to be enough to just interact though.  We have to open our hearts to each other and learn to listen closely to the messages that people have and that we can learn from.

Sometimes they come hidden in fake Transylvanian accents.  Sometimes it will come in an essay.  Sometimes it will come in the happiness that people experience when you stop long enough to treat them like they are important. 

You just never know, and that is why you always have to watch closely for those lessons when they come your way.

Tuesday, September 08, 2015

Narrative summary of the ACOTE Occupational Therapy Entry Level Survey

*This represents MY Summary and opinions on this report:

As part of the process of gathering data to inform decision making regarding the entry level degree required for occupational therapy practice, the Accreditation Council on Occupational Therapy Education conducted a survey.

In summarizing these statistics, categories of respondents were combined to simplify analysis.  Also, in summarizing agreement or disagreement, categories of 'strongly agree' and 'agree' were combined as were 'strongly disagree' and 'disagree.'

That survey was open between March 13, 2015 and closed May 15, 2015.  There were 2,829 respondents.  The generalized categories of respondents were OT practitioners (50%), OT students (19%), OT academicians (29%),and employers (3%).

The overwhelming majority of respondents (71%) agreed that the OT profession should embrace a single entry level.  This opinion was similar across all categories of respondents.

When asked if the body of OT evidence would benefit if the entry level degree moved to the doctorate, 61% of respondents disagreed.

When asked if if a doctoral entry level degree would allow for an increased impact on healthcare reform, 61% of respondents disagreed.  Practitioners in particular disagreed with this statement (70%).

When asked if moving to an entry level doctorate would positively impact practice on the respondent's particular region, 69% disagreed.  Practitioners in particular disagreed with this statement (78%).

When asked if such a change would positively impact students, 70% disagreed.

67% of respondents did not think that a doctoral entry level degree offered more opportunity for promotion.    Only 23% of practitioners thought it could offer such opportunity as opposed to 43% of educators who thought it could offer such opportunity.

 Securing fieldwork placements was a concern of the majority of respondents (66%).  Most respondents (57%) did not believe that academic institutions are positioned to meet the changing needs of OT programs.  70% of respondents believed that there was a lack of qualified faculty, 40% believed that there was a lack of State support, and 42% believed that there was a lack of institutional support.  72% believe that an entry level OTD will decrease the number of applicants to OT programs, and 64% believe that it will decrease the diversity of applicants.  Only 12% of respondents believed that no challenges were anticipated.

Cost was a significant concern; 74% of respondents believed that the cost of a higher entry level degree would not be worth any benefits that it might bring.

Employers responded in an overwhelming fashion (82%) that they are not more likely to hire OTs with a higher entry level degree.

Most respondents overwhelmingly felt that the current degree requirements were sufficient: 92% believed that basic tenets were sufficient,  90% believed that theoretical perspectives were sufficient, 87% believed education on evaluation was sufficient,  85% believed that education on intervention was sufficient, 89% felt that education on service delivery context was sufficient, and 94% believed that education on ethics and professional responsibilities was sufficient.   Beliefs on sufficiency of education on scholarship (79%) and management (82%) were lower, but still rather high.



The ACOTE decision to support dual entry into the profession is in opposition to the AOTA Board of Director's opinion on the doctoral degree as a single point of entry.  The recommendation is certainly not based on survey results alone.  However, the largest concern for the OT community should be the overwhelming and consistent difference of opinion between this survey and the responses and recommendations of the AOTA Ad Hoc Committee on the Future of Occupational Therapy Education and the AOTA Board of Directors.

The future of this doctoral issue remains uncertain, but the OT community should study the results of this survey and attempt to understand why the OT leadership would come to a conclusion that is so apparently out of step with its membership and other stakeholders.

Based on previous analysis, there was a concerning lack of diversity on the Ad Hoc committee.  That committee was composed almost entirely of academics.  I reported on the concern 18 months ago when the recommendation for the OTD was made:

The AOTA Board informed their decision on two workgroups: one an Ad Hoc Board Committee on the Future of OT Education chaired by Dr. Thomas Fisher and the other an internal subcommittee of the Board itself that reviewed the Ad Hoc Committee's findings.

The Ad Hoc Committee was comprised of occupational therapists who also served as Deans, Provosts, or other high ranking University officials as well as the AOTA Director of Accreditation and Academic Affairs.  Task groups were developed to address specific questions.  Specifically, one task group called the "Maturing of the Profession" task group made the specific recommendation for mandatory doctoral level education.  This group consisted of a physical therapy educator/Dean and four occupational therapy academics who all held high ranking University positions.

It is not known who comprised the sub group of the AOTA Board of Directors that looked at the Ad Hoc groups findings.  However, the AOTA Board of Directors is known to be heavily weighted with those who work in academic settings.  Among those who are not currently in academia, most either hold dual academic appointments, have held academic appointments in the past,  or are in senior administrative positions in their work settings.

The fundamental problem with the composition of these committees and task groups is that they are making recommendations that stretch outside the confines of academia.  The recommendation for mandatory doctoral level training is not an academic recommendation.  It is a practice recommendation.

The ACOTE survey provides a rich data set that reflects the position of a more diverse group of stakeholders.  Perhaps even more importantly, the survey represents an opportunity for the AOTA Board of Directors to reflect on how they constitute Ad Hoc committees and how they might promote more diverse engagement from the entire occupational therapy community in the future.