The day before Christmas eve is always busy, and yesterday was no exception. The office will be closed for several days and there were so many things that needed to be done. Payroll had to be audited and sent out, some schools had paperwork deadlines for the end of the second quarter, schedules needed to be coordinated for time off so we were sure to have coverage for those families that wanted services next week, some end of the year banking needed to be done... on and on.
It was busy, and the message was delivered this year on cue in the form of Tina. At the very end of the day we had three families jostling past each other between appointments and Tina burst through the front door on a mission. She made a bee-line straight toward me, absolutely disregarding all the social cues that might have otherwise indicated she needed to wait. It didn't matter that other parents were standing near me, that we were engaged in a conversation, or that her own mom was trying to corral her into the waiting room - her message HAD to be delivered.
As Tina jumped excitedly from toe to toe she reached as high as she could to show me a gift card to a local coffee shop and she could barely contain herself,"Here is a $5.00 gift card so that when you are done working today you can go to relax a little and get yourself a really nice cup of coffee or maybe a hot chocolate or WHATEVER YOU WANT!"
The 'WHATEVER YOU WANT" is what caught me on several levels, and I suspect it caught all the other people in the room too. The parents in the waiting room all understood the impulsivity, and the lack of attention to social convention, and the excited lack of emotional regulation in Tina's voice. They deal with those issues themselves every day.
But what demanded attention was the purity of the gift and the absolute joy of giving - which at the end of a day that was filled with attention to comparatively inane issues - was exactly the message that I needed to hear.
Thursday, December 24, 2009
Monday, December 14, 2009
Conversation with a future OT student
From: A future OT student
Sent: Sunday, December 13, 2009 7:07 PM
To: chris@abctherapeutics.com
Subject: from a future OT student: wanted to say thanks
Dear Dr. Alterio,
I just wanted to thank you for all of the great stories you posted on your blog... I am writing to you because I have been searching for stories by occupational therapists where they actually help people, where they make a real difference. After going through prerequisites, applications and finally being accepted into two of my top choice schools- I have found terrible posts on [a website] posted by ex occupational therapists and some physical therapists which all revolve around how occupational therapy is an ineffective, terrible profession to go into. They warn people to stay away from the profession. Many people have written in response to those posts saying that because of them, they have changed their mind. You helped me to not change my mind.
I started looking into occupational therapy after having worked with special needs children as an aide for several years. I particularly remember enjoying work with an occupational therapist as she treated a girl with cerebral palsy. I also enjoyed working with children with autism and Downs Syndrome. I have a back ground in the arts (thought I haven't been able to earn an income from it).
I'm just glad to hear your real stories that reveal that you really do help people, and that its not all about getting reimbursed (for something patients don't need) and [providing personal care].
I wanted to ask you what you thought of skilled nursing facilities (if you don't mind).
I also wanted to ask you if you think it would benefit my future to go to a better school like [University A] versus [University B] (which is good, but not as good in some areas). Do you think people who go to more reputable schools have a better shot at a job they want?
I hope you don't mind my questions. Initially, I just wanted this to be a note of appreciation for the work you do, and for documenting it.
Thanks a million,
A future OT student
+++++++++++++++++++++++++++++++++++++++++
Dear Future OT Student,
Thanks for your very kind note.
The Internet is a challenging place to get information because there is no guarantee that you are getting a balanced opinion and whatever you read may not always represent the true spectrum of opinion on any given topic. This even holds true for my own online writing. This does not invalidate anyone's opinions, but it is still important to remember!
As for skilled nursing facilities, I personally find them to be challenging places to work - but there is very important work to be done in those environments. I spent many hours in nursing homes early in my career, but this was before the so-called 'nursing home boom' of the 90s when the environment changed and became even more focused on reimbursement. My experience in nursing homes is that people in these facilities have incredible needs and that it is very challenging to meet those needs in that environment. The context is 'foreign' to most of the people placed there and in fact very few people choose to live in those facilities. In itself, this reality makes nursing home care tend toward tragic - at least when measured against the ruler of typical expectations of where people want to be in their lives.
There are exceptions, of course. Some skilled nursing facilities have re-engineered themselves into rehab facilities and people who reside there are only there on a short term basis for post-surgical or post-trauma recovery. Many skilled nursing facilities have sizable populations of people in this category. The problem happens when people who are elderly and experiencing declining health are determined to be 'eligible' for rehab beds or positions based upon someone else's formula. This causes unfortunate activity like rehab for someone who under other situations might not even choose it or might not even want it.
An exceptional skilled nursing facility situation I experienced was where the patients quite literally co-opted the occupational therapy room and created a 'culture' of work for themselves - they even went so far as to hang a sign on the door that said something to the effect of 'Let no one call another person's work inconsequential.' People who were long-term residents of that nursing facility came in and worked on things that they wanted to work on - some were functional activities and others were not! As a new graduate (at the time) I thought that it was my job to make sure all of their activity choices were respective of their occupational roles - any my naiveté almost prevented me from understanding that for many of these people the therapy was the environment and the culture - and not the activities! The people in this particular nursing home who created and participated in their occupational therapy routines were among the happiest residents of any skilled nursing facility I have ever seen in the twenty plus years since that time. These people, all with very broken physical bodies, represented a triumph of the human spirit that I have not again seen demonstrated - it was a rare and compelling experience.
My point is that even in desperate conditions there is hope, and hope is good when we can learn how to harness it for people who we are charged to care for.
Maybe the people who posted on those forums you refer to have lost some hope? I hope they can find it, somewhere - because spending your life doing something or being somewhere you don't want to be is not a way to spend a life.
Finally, regarding your question about schools - go to a place that feels like a match to you. Of course you should ask the school about their accreditation, graduation rate, and percentage passing the certification examination - but other than that your choice of a college has to match so many other factors in your life. Your future career as an occupational therapist will not be determined by the college that you go as much as what you choose to do with the college that you go to!
And I am very hopeful that you make all the best choices, for you!
Warm regards,
Chris
Sent: Sunday, December 13, 2009 7:07 PM
To: chris@abctherapeutics.com
Subject: from a future OT student: wanted to say thanks
Dear Dr. Alterio,
I just wanted to thank you for all of the great stories you posted on your blog... I am writing to you because I have been searching for stories by occupational therapists where they actually help people, where they make a real difference. After going through prerequisites, applications and finally being accepted into two of my top choice schools- I have found terrible posts on [a website] posted by ex occupational therapists and some physical therapists which all revolve around how occupational therapy is an ineffective, terrible profession to go into. They warn people to stay away from the profession. Many people have written in response to those posts saying that because of them, they have changed their mind. You helped me to not change my mind.
I started looking into occupational therapy after having worked with special needs children as an aide for several years. I particularly remember enjoying work with an occupational therapist as she treated a girl with cerebral palsy. I also enjoyed working with children with autism and Downs Syndrome. I have a back ground in the arts (thought I haven't been able to earn an income from it).
I'm just glad to hear your real stories that reveal that you really do help people, and that its not all about getting reimbursed (for something patients don't need) and [providing personal care].
I wanted to ask you what you thought of skilled nursing facilities (if you don't mind).
I also wanted to ask you if you think it would benefit my future to go to a better school like [University A] versus [University B] (which is good, but not as good in some areas). Do you think people who go to more reputable schools have a better shot at a job they want?
I hope you don't mind my questions. Initially, I just wanted this to be a note of appreciation for the work you do, and for documenting it.
Thanks a million,
A future OT student
+++++++++++++++++++++++++++++++++++++++++
Dear Future OT Student,
Thanks for your very kind note.
The Internet is a challenging place to get information because there is no guarantee that you are getting a balanced opinion and whatever you read may not always represent the true spectrum of opinion on any given topic. This even holds true for my own online writing. This does not invalidate anyone's opinions, but it is still important to remember!
As for skilled nursing facilities, I personally find them to be challenging places to work - but there is very important work to be done in those environments. I spent many hours in nursing homes early in my career, but this was before the so-called 'nursing home boom' of the 90s when the environment changed and became even more focused on reimbursement. My experience in nursing homes is that people in these facilities have incredible needs and that it is very challenging to meet those needs in that environment. The context is 'foreign' to most of the people placed there and in fact very few people choose to live in those facilities. In itself, this reality makes nursing home care tend toward tragic - at least when measured against the ruler of typical expectations of where people want to be in their lives.
There are exceptions, of course. Some skilled nursing facilities have re-engineered themselves into rehab facilities and people who reside there are only there on a short term basis for post-surgical or post-trauma recovery. Many skilled nursing facilities have sizable populations of people in this category. The problem happens when people who are elderly and experiencing declining health are determined to be 'eligible' for rehab beds or positions based upon someone else's formula. This causes unfortunate activity like rehab for someone who under other situations might not even choose it or might not even want it.
An exceptional skilled nursing facility situation I experienced was where the patients quite literally co-opted the occupational therapy room and created a 'culture' of work for themselves - they even went so far as to hang a sign on the door that said something to the effect of 'Let no one call another person's work inconsequential.' People who were long-term residents of that nursing facility came in and worked on things that they wanted to work on - some were functional activities and others were not! As a new graduate (at the time) I thought that it was my job to make sure all of their activity choices were respective of their occupational roles - any my naiveté almost prevented me from understanding that for many of these people the therapy was the environment and the culture - and not the activities! The people in this particular nursing home who created and participated in their occupational therapy routines were among the happiest residents of any skilled nursing facility I have ever seen in the twenty plus years since that time. These people, all with very broken physical bodies, represented a triumph of the human spirit that I have not again seen demonstrated - it was a rare and compelling experience.
My point is that even in desperate conditions there is hope, and hope is good when we can learn how to harness it for people who we are charged to care for.
Maybe the people who posted on those forums you refer to have lost some hope? I hope they can find it, somewhere - because spending your life doing something or being somewhere you don't want to be is not a way to spend a life.
Finally, regarding your question about schools - go to a place that feels like a match to you. Of course you should ask the school about their accreditation, graduation rate, and percentage passing the certification examination - but other than that your choice of a college has to match so many other factors in your life. Your future career as an occupational therapist will not be determined by the college that you go as much as what you choose to do with the college that you go to!
And I am very hopeful that you make all the best choices, for you!
Warm regards,
Chris
Monday, December 07, 2009
Questions about AOTA's response to the National Autism Center
The National Autism Center published a comprehensive National Standards report regarding evidence-based practice guidelines for children and young adults who have autism. The report is an excellent summary of research about intervention methods and effectiveness. It was particularly interesting to me that this report referenced and hoped to expand on the New York State Early Intervention Clinical Practice Guidelines for autism spectrum disorders which of course is a document that is familiar to many of the families in my geographic area. The NYS guidelines were published ten years ago so an update to include new research was needed.
The new report focuses on quantitative studies and in this sense some important occupational therapy literature may not have met the inclusion criteria. There have been some excellent qualitative studies completed that make important occupational therapy contributions to best-practice considerations so I am really looking forward to the next report that promises to include qualitative methodologies.
In reviewing the report I was intrigued by the treatment classification process. It is undoubtedly a daunting task to conglomerate such a large number of articles into discrete categories. It was particularly interesting to me that many articles that have 'sensory' issues in them were listed in 'behavioral' treatment packets - for example there was an excellent article on the use of a fading technique to improve tolerance for milk drinking. Now I suppose that you could describe this intervention as a behavioral fading but you could just as easily describe it in sensory terms because in this study they manipulated amount of chocolate syrup until the child was drinking plain milk. Either way, many OTs use similar techniques when addressing the feeding problems of people who have sensory intolerances associated with their autism.
There are many other important established and emerging interventions that are used by occupational therapists and supported in the NAC document including social stories, relation/interaction approaches, behavioral approaches, and functional skills training.
This brings us to the AOTA response to the report. The AOTA response stated "We believe it unfortunate that the National Standards Report of the National Autism Center did not include valuable research findings available regarding occupational therapy and sensory integration." I don't agree - I think that there was a lot of supportive evidence for occupational therapy interventions in general and also for sensory-based interventions in particular (depending, of course, on how you are choosing to 'label' and 'categorize' the studies)! Deep reading of the report validates this observation. The NAC report validated MANY important occupational therapy intervention approaches, including some sensory-based approaches that were just labeled in different categories.
Again, the underlying problem contributing to misconceptions about the report and about so-called "sensory integration" research is an absolute mish-mash of definitions and total lack of research and intervention fidelity. It is always disappointing to see summation reports or meta-analysis mislabel sensory interventions - but this time AOTA also contributes to the fuzzy definitions. The AOTA response letter references the Case-Smith & Arbeson (2008) study that lumps 'auditory integration' and 'massage' into the sensory-based category. I know a few respected OTs who might object to passive auditory and tactile sensory approaches being termed sensory integration.
So the bottom line here is this: what are sensory integration studies and can they be lumped together with sensory-based intervention studies? Are they classic sensory integration models in specially designed play environments? Are they deep pressure massage or weighted vests? Are they listening to music with headphones? Are they gustatory fading techniques to improve tolerance to milk????
My recommendation for practitioners is to read the report and be very happy that there is so much evidence for so many occupational therapy interventions. I encourage people to use those techniques that are established or those which are emerging. For those where there are less evidence - encourage families to use discretion and try those techniques AFTER other methods have not been effective. Resources are not unending and we need to first promote interventions that have the best likelihood of success.
My recommendation to AOTA is to re-think these response letters. I believe that there can be more harm than good accomplished with responses that don't celebrate the many OT interventions supported in the report - including those sensory-based and sensory-related studies that are listed in other categories! Finally, our profession really needs to get its definitions straight and we need to tackle this fidelity issue once and for all. Harm is being done by continually failing to appropriately define these interventions and have a robust professional debate on this topic.
References:
(please read the links as well!)
Case-Smith, J., & Arbesman, M. (2008). Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy. American Journal of Occupational Therapy, 62, 416-427.
Luiselli, J. K., Ricciardi, J. N., & Gilligan, K. (2005). Liquid fading to establish milk consumption by a child with autism. Behavioral Interventions, 20(2), 155-163.
The new report focuses on quantitative studies and in this sense some important occupational therapy literature may not have met the inclusion criteria. There have been some excellent qualitative studies completed that make important occupational therapy contributions to best-practice considerations so I am really looking forward to the next report that promises to include qualitative methodologies.
In reviewing the report I was intrigued by the treatment classification process. It is undoubtedly a daunting task to conglomerate such a large number of articles into discrete categories. It was particularly interesting to me that many articles that have 'sensory' issues in them were listed in 'behavioral' treatment packets - for example there was an excellent article on the use of a fading technique to improve tolerance for milk drinking. Now I suppose that you could describe this intervention as a behavioral fading but you could just as easily describe it in sensory terms because in this study they manipulated amount of chocolate syrup until the child was drinking plain milk. Either way, many OTs use similar techniques when addressing the feeding problems of people who have sensory intolerances associated with their autism.
There are many other important established and emerging interventions that are used by occupational therapists and supported in the NAC document including social stories, relation/interaction approaches, behavioral approaches, and functional skills training.
This brings us to the AOTA response to the report. The AOTA response stated "We believe it unfortunate that the National Standards Report of the National Autism Center did not include valuable research findings available regarding occupational therapy and sensory integration." I don't agree - I think that there was a lot of supportive evidence for occupational therapy interventions in general and also for sensory-based interventions in particular (depending, of course, on how you are choosing to 'label' and 'categorize' the studies)! Deep reading of the report validates this observation. The NAC report validated MANY important occupational therapy intervention approaches, including some sensory-based approaches that were just labeled in different categories.
Again, the underlying problem contributing to misconceptions about the report and about so-called "sensory integration" research is an absolute mish-mash of definitions and total lack of research and intervention fidelity. It is always disappointing to see summation reports or meta-analysis mislabel sensory interventions - but this time AOTA also contributes to the fuzzy definitions. The AOTA response letter references the Case-Smith & Arbeson (2008) study that lumps 'auditory integration' and 'massage' into the sensory-based category. I know a few respected OTs who might object to passive auditory and tactile sensory approaches being termed sensory integration.
So the bottom line here is this: what are sensory integration studies and can they be lumped together with sensory-based intervention studies? Are they classic sensory integration models in specially designed play environments? Are they deep pressure massage or weighted vests? Are they listening to music with headphones? Are they gustatory fading techniques to improve tolerance to milk????
My recommendation for practitioners is to read the report and be very happy that there is so much evidence for so many occupational therapy interventions. I encourage people to use those techniques that are established or those which are emerging. For those where there are less evidence - encourage families to use discretion and try those techniques AFTER other methods have not been effective. Resources are not unending and we need to first promote interventions that have the best likelihood of success.
My recommendation to AOTA is to re-think these response letters. I believe that there can be more harm than good accomplished with responses that don't celebrate the many OT interventions supported in the report - including those sensory-based and sensory-related studies that are listed in other categories! Finally, our profession really needs to get its definitions straight and we need to tackle this fidelity issue once and for all. Harm is being done by continually failing to appropriately define these interventions and have a robust professional debate on this topic.
References:
(please read the links as well!)
Case-Smith, J., & Arbesman, M. (2008). Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy. American Journal of Occupational Therapy, 62, 416-427.
Luiselli, J. K., Ricciardi, J. N., & Gilligan, K. (2005). Liquid fading to establish milk consumption by a child with autism. Behavioral Interventions, 20(2), 155-163.
Sustainable communities and disaster relief for people who have disabilities
In general, people are not inspired to continue monitoring post-disaster relief operations after most of the television cameras leave. So any commentary on this topic may seem to be johnny-come-lately except for those who sustain their interest and understand how big the problem really is.
This is an attempt to refocus a little bit of attention on an issue - and I am not as interested in getting preachy as I am in shining a flashlight on issues that are good fuel for action.
There is a great competition for students to examine the challenges that people who are elderly or disabled face during and after disasters in their own cultural and local contexts. I hope some students see this and become interested in the topic.
If you need some motivation for outrage, read this first.
This is an attempt to refocus a little bit of attention on an issue - and I am not as interested in getting preachy as I am in shining a flashlight on issues that are good fuel for action.
There is a great competition for students to examine the challenges that people who are elderly or disabled face during and after disasters in their own cultural and local contexts. I hope some students see this and become interested in the topic.
If you need some motivation for outrage, read this first.
Tuesday, November 17, 2009
Student survey: What education level is needed for COTAs?
Please consider helping an OT student by taking this non-scientific survey so she can gather opinions on what education level is needed for COTAs.
The survey is at http://freeonlinesurveys.com/rendersurvey.asp?sid=83x03dmh7libgux672024
Thanks!
The survey is at http://freeonlinesurveys.com/rendersurvey.asp?sid=83x03dmh7libgux672024
Thanks!
Distinctions between health care delivery problems and social policy problems regarding premature births
Today the March of Dimes released their 2009 premature birth report cards for each state. Premature births are an important issue to discuss for occupational therapists because so many of the children who require OT services have a history of prematurity. Even so-called 'late preterm births' where the children are 34 weeks gestation and older have a higher incidence of learning problems.
People will take advantage of the release of this report to politicize the findings as an indictment of the US health care system. This is only partially true because a multitude of social and cultural factors causes this problem, including:
The health care system CAN do more to improve access and quality of prenatal care delivery, particularly to vulnerable or at-risk populations who already have Medicaid coverage. Continued education and outreach to help control the impact of negative lifestyle factors is also critical. Still, the larger indictment is on our social policy and NOT on our health care system. Once preterm infants are born, the care they receive in the US is unparalleled in the world. The problem is in how the prematurity occurred - which is more about social policy than anything else. There seems to be a real confusion in separating out the CARE system from the SOCIAL POLICY. They are quite different from each other and each requires a very distinct approach for improvement.
People will take advantage of the release of this report to politicize the findings as an indictment of the US health care system. This is only partially true because a multitude of social and cultural factors causes this problem, including:
- MDs practicing defensive medicine and increasingly using 'late preterm' cesarean delivery.
- Couples opting for fertility treatments that inevitably lead to increased incidence of twin/triple/quad pregnancies (and sometimes more).
- Poor prenatal care among illegal immigrants and undocumented aliens who do not have health insurance.
- Poor prenatal health care among groups who DO have access to Medicaid.
- Smoking, obesity, teenage pregnancy, and other lifestyle factors.
The health care system CAN do more to improve access and quality of prenatal care delivery, particularly to vulnerable or at-risk populations who already have Medicaid coverage. Continued education and outreach to help control the impact of negative lifestyle factors is also critical. Still, the larger indictment is on our social policy and NOT on our health care system. Once preterm infants are born, the care they receive in the US is unparalleled in the world. The problem is in how the prematurity occurred - which is more about social policy than anything else. There seems to be a real confusion in separating out the CARE system from the SOCIAL POLICY. They are quite different from each other and each requires a very distinct approach for improvement.
Monday, November 16, 2009
Good question from a student
From: OT Student
Sent: Sunday, November 15, 2009 11:55 AM
To: info@abctherapeutics.com
Subject: OT student needs help
Hi,
I just visited your website and found your blog section very interesting. I am a current MOTS student from XXX that is working on a project looking at whether COTAs should be required to have a bachelors degree rather then just an associates.
I am wondering if you are able to post this question on your blog as I need feedback from OTRs and COTAs on how they feel about this issue.
I would be most grateful.
Thank you in advance,
OT Student
**************************************************************************
Dear OT Student,
If you create an online survey (there are several free survey tools available) I will be happy to put the link on my blog.
I am not aware of any evidence that supported graduate degrees for OTRs - and this is an important question that should be raised. If more schooling is required and this feeds competence that is fine - but I don't know that anyone is able to say that someone trained at the masters level is more proficient or competent than someone trained at a baccalaureate level.
If you apply degree inflation to COTAs then you will undoubtedly price many people right out of the job market. People sometimes participate in associates level degree programs because they can't afford more schooling.
This is a big human resources issue for the profession.
There is a corollary issue to also consider: How is the education and skill set of a COTA suited to meet the needs of people who receive occupational therapy? What level of education is needed to provide occupational therapy services? This is a thorny problem for the profession that most people aren't willing to seriously discuss.
Individual states place limits on COTA practice but the limitations vary widely. There is very little specific guidance from the professional association, presumably because of the way that the issue would alienate some of their potential association participants. In the vacuum of this lack of specificity you will find some rather varied opinions about what COTAs should be able to do. You will find no such vacuum of guidance from our physical therapy colleagues and how they delineate the professional and technical levels of their profession.
Good question though. Please don't stop asking because we need a lot more questioners in order to advance our profession.
Regards,
Chris
Sent: Sunday, November 15, 2009 11:55 AM
To: info@abctherapeutics.com
Subject: OT student needs help
Hi,
I just visited your website and found your blog section very interesting. I am a current MOTS student from XXX that is working on a project looking at whether COTAs should be required to have a bachelors degree rather then just an associates.
I am wondering if you are able to post this question on your blog as I need feedback from OTRs and COTAs on how they feel about this issue.
I would be most grateful.
Thank you in advance,
OT Student
**************************************************************************
Dear OT Student,
If you create an online survey (there are several free survey tools available) I will be happy to put the link on my blog.
I am not aware of any evidence that supported graduate degrees for OTRs - and this is an important question that should be raised. If more schooling is required and this feeds competence that is fine - but I don't know that anyone is able to say that someone trained at the masters level is more proficient or competent than someone trained at a baccalaureate level.
If you apply degree inflation to COTAs then you will undoubtedly price many people right out of the job market. People sometimes participate in associates level degree programs because they can't afford more schooling.
This is a big human resources issue for the profession.
There is a corollary issue to also consider: How is the education and skill set of a COTA suited to meet the needs of people who receive occupational therapy? What level of education is needed to provide occupational therapy services? This is a thorny problem for the profession that most people aren't willing to seriously discuss.
Individual states place limits on COTA practice but the limitations vary widely. There is very little specific guidance from the professional association, presumably because of the way that the issue would alienate some of their potential association participants. In the vacuum of this lack of specificity you will find some rather varied opinions about what COTAs should be able to do. You will find no such vacuum of guidance from our physical therapy colleagues and how they delineate the professional and technical levels of their profession.
Good question though. Please don't stop asking because we need a lot more questioners in order to advance our profession.
Regards,
Chris
Thursday, November 12, 2009
Feedback on alternatives to the therapy cap
Occupational therapy payment restrictions, typically referred to as 'therapy caps' on Medicare Part B, are daily concerns for all occupational therapists working in private practice, outpatient clinics, and nursing facilities. AOTA is participating in a long-term project aimed at finding an alternative to the current cap system. RTI International, the entity that was awarded the government contract to conduct this research, states that "CMS envisions a new method of paying for outpatient therapy services that is based on classifying individual beneficiary’s needs and the effectiveness of therapy services, e.g., diagnostic category, functional status, health status. Currently, CMS cannot evaluate or implement this type of approach because CMS does not currently collect the appropriate data elements."
RTI is proposing assessment tools to describe the characteristics of Medicare Part B clients. The proposed tool for outpatient settings collects demographic data and consists primarily of a patient report of how well they think they are able to participate in tasks. There is a more extensive assessment based on therapist opinion for cognitive, speech, and swallowing functions - no such therapist data is collected for other functional performance areas. It seems that the outpatient tool is potentially very limited - it is rather odd that something as important as determining therapy reimbursement would essentially be dependent on patient opinion of their functional status. The facility-based tool relies more on therapist or professional assessment. For this reason I have fundamental disagreement with the assessment proposal and I don't understand why such different assessment methodologies are in place for the two tools.
I also have some concerns with their data collection and sampling. To begin with, the data collection forms are very long and burdensome - I cannot imagine that many private practitioners will be able to afford to participate because therapists and office staff will not want to wade through so many pages. The outpatient based form is 17 pages long - and when I think about who the Medicare Part B participants are who come into my outpatient clinic I just can't imagine that they are going to want to fill out this long, confusing, small-font form.
The researchers are planning to use a weighting formula during data analysis because of expected frequency and distribution differences between PT (which is a more heavily utilized service) and OT/ST (which are not as heavily utilized). This causes some potential problems with whether or not the OT data will capture the breadth and scope of actual practice. Simple weighting adjustment can really skew data - and weighting only works correctly if you are relatively certain that you have adequately captured a representative sample to begin with. Further confounding this issue is the extreme disparity between the nature of a nursing home Part B population and an outpatient Part B population. I have very little faith that there will be 'enough' correct data in the sample to adequately represent the population of people who come to small private outpatient clinics.
I don't have faith in this data collection tool or the methodology that is proposed for interpreting the data. The outpatient tool is limited to patient perspective on function and is likely to under represent and misrepresent the nature of outpatient Part B OT participation.
I would like AOTA to advocate for a better tool that is based on therapist assessment of patient function (there are already many that already exist) and to advocate for distinct separation between nursing home and outpatient Part B data analysis.
Background reading:
AOTA - Alternatives to the therapy cap update: Need your feedback. Downloaded from http://www.aota.org/News/AdvocacyNews/Feedback.aspx?emc=lm&m=591948&l=44&v=2336991 on November 12, 2009.
RTI is proposing assessment tools to describe the characteristics of Medicare Part B clients. The proposed tool for outpatient settings collects demographic data and consists primarily of a patient report of how well they think they are able to participate in tasks. There is a more extensive assessment based on therapist opinion for cognitive, speech, and swallowing functions - no such therapist data is collected for other functional performance areas. It seems that the outpatient tool is potentially very limited - it is rather odd that something as important as determining therapy reimbursement would essentially be dependent on patient opinion of their functional status. The facility-based tool relies more on therapist or professional assessment. For this reason I have fundamental disagreement with the assessment proposal and I don't understand why such different assessment methodologies are in place for the two tools.
I also have some concerns with their data collection and sampling. To begin with, the data collection forms are very long and burdensome - I cannot imagine that many private practitioners will be able to afford to participate because therapists and office staff will not want to wade through so many pages. The outpatient based form is 17 pages long - and when I think about who the Medicare Part B participants are who come into my outpatient clinic I just can't imagine that they are going to want to fill out this long, confusing, small-font form.
The researchers are planning to use a weighting formula during data analysis because of expected frequency and distribution differences between PT (which is a more heavily utilized service) and OT/ST (which are not as heavily utilized). This causes some potential problems with whether or not the OT data will capture the breadth and scope of actual practice. Simple weighting adjustment can really skew data - and weighting only works correctly if you are relatively certain that you have adequately captured a representative sample to begin with. Further confounding this issue is the extreme disparity between the nature of a nursing home Part B population and an outpatient Part B population. I have very little faith that there will be 'enough' correct data in the sample to adequately represent the population of people who come to small private outpatient clinics.
I don't have faith in this data collection tool or the methodology that is proposed for interpreting the data. The outpatient tool is limited to patient perspective on function and is likely to under represent and misrepresent the nature of outpatient Part B OT participation.
I would like AOTA to advocate for a better tool that is based on therapist assessment of patient function (there are already many that already exist) and to advocate for distinct separation between nursing home and outpatient Part B data analysis.
Background reading:
AOTA - Alternatives to the therapy cap update: Need your feedback. Downloaded from http://www.aota.org/News/AdvocacyNews/Feedback.aspx?emc=lm&m=591948&l=44&v=2336991 on November 12, 2009.
Monday, October 19, 2009
New York toughens child abuse laws, some.
Earlier this year I wrote about Nixzmary Brown and I was happy to learn that Governor Paterson signed the bills into law that toughened possible sentencing for child murderers.
Under the new law, an adult who intentionally causes the death of a person under the age of fourteen years old can be found guilty of Aggravated Murder if they tortured the victim prior to death. [Penal Law §§ 125.26] The bill also authorizes a sentence of life imprisonment without the possibility of parole. [Penal Law §70.00(5)].
Tougher sentencing options are good - and if you want to feel good about this outcome then don't look into the history of the case. If you want to feel good about this outcome then don't research any details about the trial.
If you happen to do any research into this you will still feel an empty aching in the pit of your stomach. I suppose there should be no rest for the wicked - and we really have not yet done enough.
Under the new law, an adult who intentionally causes the death of a person under the age of fourteen years old can be found guilty of Aggravated Murder if they tortured the victim prior to death. [Penal Law §§ 125.26] The bill also authorizes a sentence of life imprisonment without the possibility of parole. [Penal Law §70.00(5)].
Tougher sentencing options are good - and if you want to feel good about this outcome then don't look into the history of the case. If you want to feel good about this outcome then don't research any details about the trial.
If you happen to do any research into this you will still feel an empty aching in the pit of your stomach. I suppose there should be no rest for the wicked - and we really have not yet done enough.
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