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Showing posts from June, 2006

New York State's Medicaid problem in the schools

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New York State decided this week to agree on some methods to address fraud as it relates to the $46 billion dollar Medicaid program. Don't for a moment think that the discussion was all high-minded and oriented toward saving the taxpayers money; one of the sticking points that the Dems finally had to let go was letting their trial lawyer buddies get a whack at the money pinata by allowing whistle-blower suits.

So now we have a more fully funded Medicaid Inspector General's office, which has been pinched by the feds to pony up on several billion dollars worth of payments. Of course this means that the state turns around and pinches the counties that administer the Medicaid program, asking for proof of all the services that were provided. Then counties turn around and pinch the municipalities and school service providers for their paperwork. The problem here is that municipalities and school providers probably didn't keep good enough records because they don't know how to…

Making sense out of child development

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There was a very nice article in Parenting magazine about children's sensory development but as is typical of such articles it could have said so much more. So, in the interest of broadening the dialogue, I submitted the following for them to consider publishing:

Making Sense out of Child Development

When we bring our six month old children to the pediatrician’s office we can usually expect the doctor to ask if they are rolling over or sitting up. When our children are one year old the doctor asks about what words our children are saying and if they started walking. Now with new research that helps doctors better understand child development, you may begin hearing different questions during your well-child visits.

In addition to understanding how children develop typical motor and speech skills, researchers are learning about other aspects of development that make a big difference in children’s lives. Sensory skills are not a totally new area of scientific study, but developmental sp…

On the nature of Truth and getting steamrolled by a CSE

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Today I had the opportunity to recall the 1980 presidential election. Perhaps this was the first election where I was politically cognizant. I recall watching debates and listening to candidates speak, but at that time I had no ability to understand how two different people could give two radically different perspectives on the same issue, both citing facts and figures during their explanations. At the time I assumed that certainly one of them had to be right, and the other had to be lying. Certainly one position was the 'Truth.'

I struggled through the entire campaign, not knowing what to think.

I don't have the same problems in trying to understand politics today. I understand now that people 'cherry pick' their facts, and that there are so many facts floating around nowadays that it is not difficult to find those that support your position. So, this picking of facts does not necessarily bring you any closer to Truth - and as soon as you realize this it is much eas…

Eye to eye

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Greg was pushed into my office, sitting in a wheelchair, and he didn’t make much eye contact. “Hi Greg,” I said, trying to find a way to elicit some response. He still didn’t look at me, but nodded his head in acknowledgement to my greeting.

Although Greg had limited eye contact he willingly shared the details of his story. Greg had hopes that he could make sense of things. Talking helped him, and he had hopes that things happened for reasons. He told me that he struggled with this on a daily basis. From my vantage point, at the time when we first met, I didn’t have many answers for him.

Greg joined the army when he was 18, hoping to find some structure and discipline in his life. He was a part of the wild crowd in a rural high school. In his opinion, the army was a form of escape - and an opportunity to change things. It was a blank slate, a do-over. Most importantly, he would earn money so that he could continue his education. It was never important to him in high school, superficiall…

Asperger's Syndrome: A primer for occupational therapists

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CLASSIFICATION/DIAGNOSIS RESEARCH

Asperger’s Syndrome was first described by Hans Asperger who identified a group of his patients who had difficulties with social skills but intact cognitive ability (Asperger, as cited in Klin & Volkmar, 1997, p.94). Asperger and Leo Kanner were reportedly unaware of each other’s work (p. 95) which respectively focused on similar clinical signs, although those signs were of different degrees of severity. Asperger’s description of autistic psychopathology was focused on higher-functioning, verbal, school-aged children while Kanner’s description was more focused on lower-functioning children (p. 95).

Wing’s (1981) accounting of Asperger’s Syndrome increased familiarity and interest in the diagnosis in the United States; since that time there has been a steady increase in the number of people identified as having the disorder. Actual prevalence is difficult to ascertain because of the constantly evolving nature of the diagnostic criteria. Several autho…

Very random notes from LA

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OK, I should have known that it was going to be a very random day. I saw Sigmund, tied to the back of a pickup truck, entering I-10 heading toward LA from Santa Monica. I am not lying.

If you have any idea who Sigmund is, then you truly are my compadre.

Anyway, because of a confluence of events I had the opportunity to do some random occupational therapy surfing, and found a few blog entries that were noteworthy and that I wanted to share.

The first was this story about a family who struggled with the cost of occupational therapy services. It seems like they had a reasonable outcome, but I wince when I hear that insurance has denied coverage. I don't know if I am particularly lucky in my geographic region, but I have virtually no denials for the OT services that we provide. However, we are also keenly aware that insurance companies avoid reimbursement for intervention that they deem 'experimental -' as is their policy with sensory integration. In practice, we don't exclus…

California's Proposition 82 and the slow creation of a caste society

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The decision on universal pre-kindergarten is coming to a head in California. Voters will decide on this controversial issue on June 6th.

Proposition 82 establishes a right to voluntary preschool for all four-year old children. The program is funded by a 1.7% tax on individual incomes above $400,000 or $800,000 for couples. More details on the proposal can be found here.

Supporters of the proposition state that Prop 82 gives a free, high quality preschool education to every four-year old in California. They claim that it will provide trained, credentialed teachers in every classroom, more parental involvement, and strict accountability and enforcement to ensure that every dollar is dedicated to preschool.

Opponents of the proposition state that Prop 82 will not appreciably increase preschool participation and that turning over control of preschool to the state will result in a less efficient and more expensive program. They state that the money would be better spent on improving current …

The ABC Therapeutics Road Show

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I am on a west coast road trip that will extend to 6/14. Since this trip has virtually nothing to do with my own choices I thought it was fitting to start off with this picture.

Actually I really am starting off here in San Francisco, where I will remain until Sunday - and then I am off to Santa Monica for next week.

I have mastered the art of long distance supervision so I will be able to keep things running through a combination of cell phone interactions and of course relying on the only employee who never complains no matter how much gets heaped on her plate.

I'll try to update here regularly to record my activities...