Monday, March 27, 2017

Governor Cuomo and the Early Intervention State Fiscal Agent boondoggle

Another update in the ongoing saga of the failing New York State Early Intervention program:

The Governor's 2018 budget proposal adds new requirements on insurance companies and providers.  Under other circumstances, a provider or fiscal intermediary would simply operate within the available rules that exist in the private marketplace, but since the State has designated a fiscal agent that is unable to compete in the free market, the Governor is forced to rewrite insurance laws in order to facilitate payment.

 In FY 2016, nearly 85% of claims submitted by the Early Intervention State Fiscal Agent to private insurers were denied.  The idea of cost sharing with private insurance has been a failure because the State botched the implementation and has contracted with an incompetent fiscal agent.  The breakdown of payment of Early Intervention costs has been as follows:

Private insurance: 2%
Medicaid: 41%
NY State: 27%
Counties: 30%

This is AFTER the State invested millions of dollars into a private contract for a State Fiscal Agent.  Providers went out of business in this transition and services to families have been compromised because of the ineptitude of the process - and now new laws are being proposed in order to address the obvious failure.

The following new proposals are included in the Governor's budget:

1. Placing new requirements on service coordinators and providers to obtain insurance information and signed IFSPs from referring doctors (attesting to medical necessity).

2.  Requiring providers to exhaust appeals before unpaid balances hit County books.

3. New mandates for payment on insurance companies.

Having a requirement for a doctor to certify that an IFSP is medically necessary is unrealistic.  Additionally, not all early intervention services will fall within the strict guidelines of 'medical necessity' because the program is not only a 'medical program.'  This issue hits at the heart of what happens when States get into the habit of using Medicaid funds for non-Medicaid activities.

These kinds of reforms also become unwieldy and complicated simply because of the existence of the failed State Fiscal Agent.  So as an example, a provider must now exhaust appeals which seems reasonable - but if an insurer is denying payment because the fiscal agent has improper coding procedures or if they are billing under a non-participating provider - it only serves to slow payments to providers even more.

As I have advocated from the beginning of all this, releasing providers to compete directly in the private market and having them bill insurance companies directly would immediately solve all problems with participating provider denials and it would solve issues of odd local coding anachronisms.  The State could be free to negotiate whatever cost-sharing agreement with the insurers, probably through the creation of regional service level caps, at which point the balances would be billed or waterfalled to a centralized New York State reserve fund.  That would remove the Counties and the designated fiscal agent from the equation altogether, saving millions of dollars in program costs and in shifted Medicaid responsibility.

As it now stands, the NYS Senate rejects the Governor's proposals, the Assembly partially accepts them, and the Counties support the proposals but want even more protections in place so that these costs never hit their balance sheets.

What does that mean?  The proposal will be worked out in backroom deals in Albany, and the provider community and families will not have much voice in the process.  The system will continue to fail.

As I have indicated in the past, savvy providers will learn to participate in insurance networks privately (including Medicaid) and will learn to bypass this failed system by seeing families on a private basis.

Read more at these links - and contact your representatives if you want, but the real solution of eliminating the failed State Fiscal Agent and adopting a modified model of privatization as outlined above is not even on the table.

Read the FY 2018 Article VII Bill Health and Mental Hygiene (HMH):

Read the FY 2018 Memoranda in Support, Health and Mental Hygiene (HMH) Memo:

Read the NYSAC Budget Comparison Fact Sheet on Early Intervention:

Saturday, March 25, 2017

Reasons to yawn: Wrap up analysis of two recent SCOTUS cases involving IDEA

On 11/8/16 I wrote

In both of these cases it is important to carefully analyze the details of what is actually being litigated.  So often the truth of what is being discussed gets lost in poor reporting about the topics.  For example, many news outlets focus on the 'evil school district vs. the child in the wheelchair with Wonder the GoldenDoodle' meme instead of focusing on the decidedly less appealing 'what is the importance of due process' angle.

As OTs become more savvy with policy analysis they will avoid the bias-trap of media reporting and try to approach a more 'rational comprehensive' method of considering the actual facts.  They will also become more savvy by dropping the naive notion that just because an issue might have the superficial appearance of something that should be supported, it is important to dive deeply into the actual policy to make sure we are promoting what is best for the people who seek our services.

Turns out that this analysis was essentially correct regarding the separate cases of Endrew and Fry.

In the Fry case the issue at hand turned out to hinge on the concept of 'administrative exhaustion' or whether or not a family had to satisfy IDEA due process rules before bringing an ADA lawsuit.  According to the decision, if the issue is not related to IDEA, there is no such requirement.  In this case the Fry family was not arguing about educational rights - they were arguing about wanting a monetary award for emotional distress.  Since the 'gravamen' of the concern was not IDEA the Court ruled that there was no need to exhaust IDEA due process.

This will have little to no impact on service delivery in school systems.  Over time we may see more lawsuits filed against schools earlier in the process, with savvy lawyers parsing out IDEA concerns and other non-IDEA concerns like 'emotional distress.'  Schools will have to respond differently to the possibility of dual-process complaints.

Bottom line: this was not an IDEA case.  It was a case that outlined rules for lawsuits under the ADA, wrapped in poor reporting and media obsession with the click-bait of little disabled children and their cute dogs.  The media got their clicks, the family got to sue under the ADA, lawyers have new strategies for making money, and the rest of us can go about our work.


The Endrew case was specifically related to IDEA as it wrestled with the central question of FAPE and what was considered 'appropriate.'  There have been a number of interpretations about FAPE criteria - most of the criteria discussed openly in courts but not openly in IEP meetings.  At issue was whether or not a de minimus standard could be considered 'appropriate' and the Court ruled that it was not.

That won't do many families much good because I don't  believe that most IEP teams sit around the table and design plans aimed at that low bar - and even if that is the end result of their efforts you would be hard pressed to ever find that recorded.  Schools will always believe that they are reaching for the stars.  An analysis of the mission statement of any school district shows the public proclamation that the goal is to create exemplary world citizens blah blah blah.

So even if the issue of FAPE came up in meetings before it was generally answered with 'We don't have to provide the BEST program; we have to provide a program they can BENEFIT from.'  In simple terms that is known as the Rowley standard, related to a previous SCOTUS decision.  Again, most school districts do not openly publicize that their definition of benefit is a de minimus standard.

The Endrew case is interesting in that it shuffles the words on FAPE, now indicating that a school has to provide an individualized education program that is reasonably calculated to enable a child to make progress appropriate in light of the child's circumstances.  That is a rejection of the de minimus standard - something that a word-parsing lawyer might argue in court but that I have never heard as a guiding policy around an IEP table.

Unfortunately, from the perspective of real world guidance, now you will hear schools say that their IEPs are designed in light of the child's circumstances and that they are reasonable.  The Court affirmed the role of schools acting in a good faith effort based upon local professional judgement - and specifically stated that they have no interest in developing a "bright-line" standard for schools to follow.  Deference is based on the expertise and judgement of the schools.  Plain and simple.

If you want to understand what the SCOTUS did with this case, look at this video, and imagine the bullets as 'the definition of FAPE'

As such, this decision also will not amount to much.  The definition of FAPE is no more clear today than it was under Rowley.  Perhaps the only thing that changed is that some lawyers will no longer make the de minimus argument.


Neither of these cases will have much lasting impact on everyday work in school systems.  They only clarify strategies to be used and avoided by lawyers when the rare case actually gets into a court.

Wednesday, March 15, 2017

You can't keep a good event down...

...but you might delay things just a little while because of winter weather!

Today a gathering was scheduled in Clifton Springs for a celebration of the occupational therapy founding.  The mayor was also scheduled to issue a proclamation but the celebration had to be postponed due to inclement weather.   

The event will be rescheduled.


The March 8. 1917 Clifton Springs Press had an announcement about the upcoming First Consolation House Conference, but it also had an interesting article about George Barton.  The subheadlines and text of the article are notable because they provide direct evidence of exactly how the Clifton Springs community felt about his efforts and also how influential he was.

The article quotes an unnamed folk source as saying, "You can't keep a good man down, especially when he runs an elevator for a living."  The newspaper editor goes on to state "and in no instance has the editor found opportunity to apply this witicism, where it was found more appropriate than in the introduction of George Edward Barton, A.I.A., a resident of this village, who is known by many, and who but few, really know."

Barton's disability is described in detail, as is his effort to overcome those difficulties and help other people. 

We all look forward to the rescheduled celebration of George Barton and his efforts in Clifton Springs that founded the occupational therapy profession.

 "You can't keep a good event down!" 

Thursday, March 02, 2017

A request for honesty about modern day practice in long term care facilities

Follow-up to Ethical occupational therapy practice in nursing home care

Studying historical phenomenon is helpful for framing modern problems - and so I would like to draw attention to an article that appeared in Modern Hospital in September 1922.

The author of the article, Christine Newman, was Head Aide of the Howell State Sanatorium for Tuberculosis in Howell, Michigan.  The facility is described as "a self-sufficient entity that aimed to meet the patients' and employees' every need with a working farm, apple orchard, convenience store, post office, water and heating plants and kitchen staff."

This model of 'self sufficiency' was common among asylums and sanitariums in the 19th century.  I would like to recommend Dr. Katherine Ziff's book Asylum on the Hill as well as her blog; these resources are invaluable to understanding a model of asylums during this time period and offer a counterpoint for understand modern institutions.

Ms. Newman's article, entitled "Defending my commercialism in occupational therapy," reminded me of the self-sufficiency model described in Ziff's book.  Ms. Newman's article describes the way that she views the occupational therapy service in 1922 and provides a justification for her perspectives and methods.

To start, she overtly states that the purpose of her occupational therapy work has both a "money and therapy aim."  She is decidedly pragmatic in her approach, believing that occupational therapy can serve both a therapeutic and financial benefit.  That is an unusual approach and occupational therapists today are not commonly heard discussing financial revenues so openly.

She outlines an interesting sequence of thinking to support her interest in both aspects.  Her core hypothesis can be represented in this sequence:

This would represent the therapeutic aspect of her thinking - but she layers on top of this the pragmatics of having the patient work on projects that she has need of.  Specifically, she expressed having a need of items that can "sell as fast as we can make them."  She is concerned that many aides were selling their items too cheaply and that this was a disservice to the people who were sick, whose labor should be recompensed as much as any well person.

Again, pragmatics are a guiding force in her approach, as she states
An occupational therapy aide particularly needs clever things [merchandise] because she is too poor to put her valuable labor on things that will not sell.  I know this sounds very commercial, but I still maintain there is just as much therapy in a number of salable things as in the same number of unsalable things, and I can do far more for my patients if my department is on a paying basis.

In ten months of work she incurred $1197.30 in expenses which included her salary and cash received by sale of goods produced was $818.35, leaving $378.95 that the sanitarium had to pay in order to maintain the OT department for the full year.  She was very hopeful that in the second year the OT department could pay for itself.

I was impressed with her argument and presentation, even if the underlying economic focus was troubling, because she at least had some core philosophy (see sequence above) that was  based on why she was doing certain activities.

That got me thinking about modern day occupational therapy in many long term care facilities, where the therapy is often reductionistic, biomechanically oriented, and not attendant to the patient's occupational needs.  There does not seem to be much of a theoretical focus on why a therapist chooses an upper extremity ergometer over repeated exercises with a cane or dowel with weights attached.  I also don't see anyone defending these methods.  Occupational therapists just do them.  And a lot of revenue is generated.

What is even more interesting is that there does not seem to be too much open conversation about the gross profiteering that goes on in those departments.  I am left wondering: what is the financial surplus of occupational therapy efforts in those facilities?  Are the departments self-sustaining?

Instead there are some general conversations about how therapists are supposed to be concerned about ethics in these environments and how different professional organizations get together and have concerns (AOTA/APTA/ASHA, n.d.). The purpose of this collaborative statement is to "emphasize clinician's responsibility to understand payers' policies and regulations, as well as their obligation to act ethically and to report inappropriate practices." (Brown & Hemm, 2015).

It is all very vague - and no one seems to be hitting the issue directly.

We all know that a lot of money is being generated by modern day occupational therapy, and that money is going somewhere.  So where is the modern day article from the clinicians in the field that is entitled "Defending my commercialism in occupational therapy?"

As I am interested in seeing such an article in the modern period, I implore one of my colleagues to write it.

Please incorporate a theoretical justification for the work being done in long term care facilities, even if the economic aspect will remain a primary focus.

I wonder if I will ever see such an article.  Perhaps people were just willing to be more honest about things in 1922?


embedded links, and...

AOTA/APTA/ASHA (n.d.) Consensus statement on clinical judgment in health care settings: AOTA, APTA, ASHA.  Downloaded 3/2/2017 from

Brown, J. & Hemm, M. (2015, May). ASHA, NASL address concerns in skilled nursing facilities.  The ASHA Leader, 20(5), 8. doi 10.1044/leader.NIB1.20052015.8

Newman, C. (1922). Defending my commercialism in occupational therapy. The Modern Hospital, 19(3), 250-252.

Ziff, K. (2012).  Asylum on the Hill. Athens, OH: Ohio University Press.

Tuesday, February 28, 2017

The Lenten message of Emmanuel practitioners that influenced the occupational therapy profession

I have previously documented (in presentation and in blog) the role of the Emmanuel Movement with regard to its overall impact on 'treatment' of mental health conditions at the turn of the century in general and its impact on George Barton in particular.  I have also documented some lingering impact of concerns with spirituality and how the topic has been reflected in some occupational therapy documents over time.  As we are on the eve of the Lenten season, and as we are properly situated in history to reflect on the crucible of values that contributed to the founding of the occupational therapy profession, this little sideways journey seems timely and appropriate.

Many occupational therapists enjoy using the term 'holistic' to describe their orientation and interest but few are adroitly capable of putting such diversity that includes spirituality into actual practice.  This has always been the case - even when turn of the 20th century 'providers' made the attempt.

Emmanuel methods centered around a merger between medicine and spirituality: a medical clinic with free weekly examinations, a weekly health class with multidisciplinary lectures on medical, psychological and spiritual health, and private psychotherapy/counseling sessions.  Reverend Elwood Worcester, founder of this movement, specifically recruited well known Boston physicians (Putnam, Cabot, Pratt, and Coriat) to lend medical credibility to his ministerial efforts (Caplan, 1998).

From the start, Elwood Worcester had difficulty distancing his methods from the controversial Christian Science movement and the work of Mary Baker Eddy.  The methods were not at all similar; in fact Eddy spoke out against what some termed the 'mind cure movement' and specifically stated her opposition to people like Worcester.  These differences were outlined extensively in Willa Cather's series that appeared in McClure magazine from January 1907-June 1908 (nom de plume Georgine Milmine).

Clarence Farrar was a prominent psychiatrist who leveled blistering attacks on the Emmanuelists (1909), stating that their "faddist faith cure movement" arose from Boston, "the land of witchcraft and transcendentalism."  This kind of criticism from prominent medical leaders led to the waning of support from the Boston doctors that Worcester recruited.  As explained by Caplan (1998), these criticisms may have been primarily motivated by a desire for 'control' over the growing psychological movement.  Worcester and his colleague Samuel McComb attempted to respond (1909) but at that point the opinions of most medical practitioners were settled: psychotherapeutics was to be the domain of doctors and not of the clergy. 

The criticism was so powerful and effective that concerns were echoed many years later by occupational therapy leaders.  In the Fifth Annual Meeting of the American Occupational Therapy Association there was discussion about the need to develop a research base to help doctors understand the role of the new profession.  Herbert Hall (1922) stated, "We must be careful not to go about making claims for occupational therapy as the Christian Scientists do for their methods."  The Emmanuel practitioners were never able to fully shake the incorrect association of their approach with the Eddyists, and it is clear that physicians like Hall were sensitive to the negative association.

One of the final formal defenses of the Emmanuel method was published as an article in Good Housekeeping entitled Lent: A friend to the nervous (McComb, 1910).  Given the current season I choose to highlight this article in particular.

The article is interesting not only for its chronology in the medicine vs. religion debate, but also for its clarity in describing the universality of a 'Lenten' experience.  McComb wrote
Now I would like to contradict this idea [Lent as an ecclesiastical custom] and to assert very emphatically that while Lent may and ought to be used for ends that are strictly religious, it is pre-eminently a human institution, with a vital bearing on our earthly life and happiness.  We all need, at times, a complete break with our accustomed habits, with our ordinary ways of thinking, with our usual food and drink and recreations; and we all need this because we are all accustomed to get into ruts and grooves, until we become, as it were, mental and physical automatons instead of living, progressing, moral beings.

McComb further argued that Wordsworth (notably, a Transcendentalist) was sadly correct:
The world is too much with us; late and soon,
Getting and spending, we lay waste our powers;-
Little we see in Nature that is ours

McComb believed that the Lenten season, applied across religious or non-religious convictions, could serve as a model for taking a pause in the busy-ness of life that was so culturally and socially unsettled at the time.  This is the precise message that was given to George Barton by Worcester - a directive to let go of his own suffering and to make sacrifices for 'the other fellow.'

The Lenten season, from religious definition, is all about hope and an Easter beginning.  The Lenten 'experience,' from a secular perspective, is an application of spiritual hope on a backdrop of confused and complicated modern living.

As a Christian man, Barton interpreted the Emmanuel Church message in directly Biblical terms, specifically related to Isaiah 61:3 when he used the term 'Beauty for Ashes' on his Consolation House logo (see picture above).    However, the Emmanuel Movement's message was more broad than simple and direct religious application, as summarized by McComb:
Lent is a reminder that two worlds are ours: the lower, with its miseries, its cares, its distractions, its worries; and the higher world within to which we can make our escape, with its faith and hope and love and peace.  As we lay hold of this higher, the lower world loses its grip upon us, ceases to paralyze us; and while we may not claim any mere stagnation or brute freedom from toil and care and responsibility, we may, nevertheless, have a secret that makes music in the heart and nerves us to rise triumphant over the strains and stresses of experience.

That was McComb's Lenten message, and it was the basis for an occupational therapy message that Barton put into action at his Consolation House project.


embedded links, and...

Archives of Occupational Therapy (1922).  The Fifth Annual Meeting of the American Occupational Therapy Association, Meeting of the Board and Members of the House of Delegates.

Caplan, Eric (1998). Mind Games: American Culture and the Birth of Psychotherapy. Berkeley, Calif:  University of California Press. Chapter 6: Embracing psychotherapy: The Emmanuel Movement and the American Medical Profession.  Available online at

Farrar, C.B. (1909). Psychotherapy and the Church, Journal of Nervous and Mental Diseases, 36, 11-24

McComb, S. (1910). Lent: A friend to the nervous. Good Housekeeping, 50(3), 327-329.

Worcester, E. & McComb, S. (1909). Christian Religion as a Healing Power. New York: Moffat, Yard.

Saturday, February 25, 2017

An unusual connection between American opera and George Edward Barton

There is a God whose laws unchanging
No one may hope to disobey.
Man's own desires forced upon the ordained way.
He for a moment triumphs,
He has his will,
He pays the penalty.
    (Barton, 1905)

The Pipe of Desire is a one act play published in 1905 by George Edward Barton, and set to operatic score by Frederick Converse.  It might be just a curious fact that architect George Barton attempted the role of librettist except for the historic implications of this effort.

We know that as a young man Barton was raised in a family "steeped in the arts and letters" (de Lancey, 1958).  From the same source we also know that he had a bicycle encounter in the English countryside with King Edward VII where they were both "whistling operatic arias."

So although Barton may have had early exposure to and enjoyed the operatic form there is not much known about the specifics of how the historic collaboration with Converse actually came about.  Coburn (1909) wrote, "Yet refreshing and spontaneous qualities of romanticism are distinguishing marks of Converse's output.  A brief analysis of the subject matter of "The Pipe of Desire" the words of which were written by Converse's personal friend, George Edward Barton, a Boston architect, will perhaps reveal the kind of work in which this composer delights."

Their collaboration may have been a simple function of an apparent friendship between Converse and Barton.

This was a daring collaboration because of longstanding controversy regarding the appropriateness of opera sung in English.  Coburn continues, "Popularization of American operatic music, such as Mr. Converse's, is peculiarly notable.  Serious opera has rarely emanated from an Anglo-Saxon source.  It is, indeed, something of a shock to listen to an opera that is not phrased in Italian, German, or French."

The world premier of The Pipe of Desire was on January 31, 1906 at Jordan Hall in Boston, and some reviews were unkind. Hale (1906) wrote,
"Mr. Barton, an architect in Boston, is a man of wide and curious reading.  Where did he find this legend?... Even if the symbolism were suggested consistently throughout the libretto, the book would not be well suited to operatic purposes, for it lacks both action and human interest."  Regarding Converse: "He has given dramatic interest to a libretto that is undramatic... All in all this opera music must be reckoned among the very first and few compositions of true importance that have as yet been produced in this country; it is music that would excite respect and admiration in any land."

Again, the theme of skepticism of American opera is notable, although the critic is more kind to Converse than Barton.

The Pipe of Desire was nonetheless accepted for performance at the Metropolitan Opera House on September 10, 1908 as reported in the Boston Evening Transcript despite the ongoing debates about validity of singing opera in English (Garofalo, 1994, p.37). 

After substantial preparation the work was finally presented on March 18, 1910, making the effort the first opera composed by an American and the first opera performed in English by the Metropolitan Opera.  A reviewer from The Sun (Henderson, 1910) wrote,

"Of course the symbolism is easy enough to read. But as a stage subject the story is not at all potent. The book certainly furnishes opportunity for picturesque groupings of nymphs and gnomes, for beautiful effects of light and shadow, for an exquisite woodland scene, admirably provided at the Metropolitan, and for moods not unsuited to the language of music. But there is nothing in the employment of details to clamor for musical utterance. In fact the text is seldom poetic in thought or melodious in technic. Many of the lines are hostile to lyric song and many are awkward in themselves even when considered merely as pieces of English... Mr. Converse was not inspired by it or, if he was, the gods did not make him operatic. His music is of a kind which suggests the respectable atmosphere of the oratorio concert. It lacks throughout the distinctness of theatrical utterance. The declamation in the recitatives is angular and void of spontaneity. The arioso passages are labored, and their attempts at expression are but moderately successful."

Perhaps, more simply, in the words of Isabel Barton, "The opera flopped." (de Lancey, 1958).  As she did not know George Barton at the time, the only basis of her report would have likely been what he shared with her.

And so it remains an unusual historic footnote that the first opera to be performed at the Met with score and libretto written by Americans and performed in English was a product of architect and occupational therapy founder George Edward Barton and his friend, Frederick Converse.

Score from The Pipe of Desire, signed by Frederick Converse to George Barton

Portrait of Frederick Converse, given to George Barton

Libretto from The Pipe of Desire, signed by George Edward Barton

Louise Homer, famous American contralto, as Naoia (reclined) in Pipe of Desire, performance at the Metropolitan Opera in 1910


Barton, George E. (1905). The Pipe of Desire and Other Plays. Boston: D.B.Updike, The Merrymount Press.

Coburn, Frederick W. (1909, January). Frederick S. Converse, Composer of Grand Opera.  The World To-Day. 16(1), 30-34.

de Lancey, B. (1958, May 9). George Edward Barton: Undaunted cripple's courage aided others. The Geneva Times, p. 2.

Garofalo, Robert J. (1994). Frederick Shepherd Converse (1871-1940): His Life and Music.  Metuchen, NJ: The Scarecrow Press.

Hale, P. (1906, March). Music in Boston. The New Music Review and Church Music Review, 52(5), 773-774.

Henderson,  W.J. (1910, March 18). The Pipe of Desire Well Received.  The Sun.  Downloaded from

Wednesday, February 15, 2017

Occupational therapy history: A lopsided tale told by the 'designated survivors'

Some overtly prejudicial information has been published about George Barton.  In an officially sanctioned history of the occupational therapy profession, Quiroga (1995) wrote that "Barton was undoubtedly an unusual if not eccentric character, who had difficulty knowing his own identity."  She also stated that "some of Barton's writings may have created more foes than allies to the cause" and that "George Edward Barton was an occupational therapy zealot" with a "near-crusade mentality" who "was undoubtedly a difficult person with whom to work in the organizational phase of the national association" who "did not possess the interpersonal skills that he needed" and "simply did not fit the profile of what his contemporaries considered to be a professional leader."

There is very little evidence to support this level of prejudice.  Quiroga misinterprets Barton's claim to being a 'sociologist' - forgetting to consider his training under William Morris.  She fails to understand and correctly interpret Barton's metaphorical style in his paper, "Inoculation of the bacillus of work."  There is no evidence at all that suggests Barton alienated the broad medical profession.  In fact, his minimal involvement in NSPOT following his resignation makes it nearly impossible to have had some negative impact on the developing profession.

As I have been documenting for the last several years, it is probably very fair to state that Barton was eccentric - but the extreme negativity is unwarranted.  Based on a study of correspondence between the Founders it is more accurate to state that the negative feelings towards Barton resulted from his withdrawal of his participation as an officer, the reluctance of and social mores preventing others to assume leadership roles at the time, and slow revisionism and selective 'remembering.'

Within 15 years of the founding meeting in Clifton Springs, five extremely influential individuals passed away: Barton, Herbert Hall, Susan Tracy, Susan Cox Johnson, and Thomas Kidner.  The truth is that Barton was not even alive long after the founding and could not have had much if any negative impact.  This series of deaths essentially left Slagle and Dunton to tell the occupational therapy story, and even though an attempt was made in 1967-8 at the 50th anniversary to obtain a more accurate picture of what happened around the founding, the effort clearly fell short.

Negative attributions of Barton were reinforced over  time.  In her farewell address to the profession, Slagle simultaneously respected and jabbed at George Barton's legacy:

 "In the words of the first President of this Association, Mr. George Barton, who retained the office six months and resigned because we were in debt $150 (lawyer's fee for legal services and organization papers) and because we saw no immediate way of raising the salary of a Secretary.  "I relinquish the honour of being your officer, proud to have been of any assistance to a cause so noble, and I lay down the office content in the knowledge that it can be more ably filled."

In fact, Barton did not relinquish his office because of the debt itself, but only because as President and Secretary he and Isabel could not take on the burden of fronting these fees by themselves.  Barton resigned his office in a letter to Dunton dated July 23, 1917 where he wrote

After very careful consideration, I have decided not to accept the possible renomination as President of the Society, but to withdraw in your favor.  This seems to me to be the eminently proper thing to do, and it will probably redound to the benefit of the Society.  I am not, of course, withdrawing my interest, and hope to be allowed still some word in its councils. 

In response on July 27, 1917 Dunton wrote to Barton, stating

I am extremely sorry that you should have reached the conclusion that you have, but I hope that you will reconsider it.  I am also sorry that you will not be presenting at the New York meeting.  I hope that you can make arrangements to be present as it seems to me that it would create a bad impression if you are not.  However, you are the best judge of your own conduct as I am not familiar with these circumstances which have brought about your decision.  I naturally feel like calling you and Miss Newton slackers, quitters, etc, but my natural politeness restrains me."

On the same day (July 27, 1917) Dunton also wrote to Slagle stating

I presume you have received Mr. Barton's notice.  I do not know what is the trouble, but am inclined to think that he has grown somewhat piqued.  I had written to him on Wednesday asking him to reconsider his decision of which he had written me, but evidently he had already made up his mind and my letter reached him too late to influence him.  He suggested that I be made President.  I do not want the job but at the same time I think it is very essential that our society be continued.

Barton responded to Dunton on August 8, 1917

I am sorry for the tone of your letter of August 6, and feel that your attitude is most unjust.  Also it seems a little strange to me that you are unable to understand that it is impossible for me to pay the salary of the Secretary of the Society.  When I undertook at your request to get things started and get together, I neither undertook to give up all my life to the Society nor to pay its expenses.

There is no record of the "August 6" letter in the AOTF archives that I could locate.  It may be a date error or there may have been an additional letter from Dunton that is not available.  Either way, Barton was quite clear on why he had to relinquish his office.  It is also quite clear that Dunton was irritated by the action and did not understand Barton's concern.

Slagle and Dunton carried their negative perceptions of Barton forward.  Barton's role in the founding was minimized and sometimes even left out of the history altogether.  Dr. Sidney Licht, a student of Dunton, wrote the following in 1948 even though he had no direct knowledge of Barton at all

This brief history comes to an end with the coining of the phrase Occupational Therapy.  Many non-medical persons have made considerable contributions to the field of medicine and it was left to a layman to coin this term.  George E. Barton, an architect by training, was greatly impressed by the type of work accomplished by Grohman and Hall and helped to organize at Clifton Springs, New York, an institution where by means of occupation, people could be retrained or readjusted to gainful living... Mr. Barton was an extremist and although he contributed much in the way of enthusiasm, he retarded the acceptance of occupational therapy by physicians as a result of his unbounded claims concerning the therapeutic value of work... It would be well to forget all but two of George Barton's words - occupational therapy.

Dr. Licht's comments are all the more curious in consideration of his admitted lack of information on Barton and the founding of NSPOT/AOTA.

George Barton published more early literature on occupational therapy than any of the other founders and was instrumental in coordinating and organizing the Consolation House meeting.  He understood the problem of disability from multiple perspectives, had knowledge of how to start and organize groups, and was motivated by his own spiritual and physical reformation.  Perhaps he was zealous and he was probably eccentric, but neither of those characteristics warrant the negative perceptions that have been published.

The evidence is clear and indicates that he is guilty of a simple thing: he could not afford to front the money by himself to support a fledgling Society.

I understand that some narrative approaches include a degree of sanitizing facts related to personal interactions of historical figures.  However, since so much prejudicial information has already been published about Barton it seems reasonable to delve into source documents and letters between the founders to correct the historical record.

The centennial anniversary of the occupational therapy profession offers a good opportunity to reappropriate Barton's contributions and cast them with a more even-handed perspective.

Since there is ample access to source historical documents, it is not correct to have the narrative dictated by the prejudices of the 'designated survivors.'


Correspondence retrieved from Wilma West library, AOTA Archives, and...

Barton, G.E. (1917). Inoculation of the bacillus of work. The Modern Hospital, 8(6), 399-403.

Licht, S. (1948). Occupational therapy source book. Williams & Wilkins: Baltimore.

Slagle, E.C. (1937). Editorial: From the heart. Occupational Therapy and Rehabilitation, 16, 343-345.