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Showing posts from 2010

Evidence of need for system change: Another CSE case study

I attended a CSE meeting for a child who has an autism diagnosis. This child previously received EI and CPSE services and was declassified upon entry to kindergarten. The parent called the meeting for CSE consideration because of the severe functional problems the child was having in the classroom. The school wanted to 'give him more time' despite the problems he was having because in their perspective many kindergarten children haven't been exposed to school environments and that is why it is reasonable to expect that there is a wide variation in skill levels of children that age. I suppose that is true, but I guess they forgot to remember that he received EI services and CPSE services and has autism.

The school-based occupational therapist presented a boilerplate evaluation that stated the child was normal in all areas with the exception of atypical scores on a Sensory Profile. In the entire four page evaluation there were three or four narrative statements that we…

One child's Christmas wish, as expressed to the OT

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Lisa is ten years old and currently lives in a residential treatment facility for children who have emotional and behavioral difficulties. Her biological mother was addicted to drugs and Lisa was removed from her custody when she was four years old. She lived for a few years in several foster home placements and the most recent foster family had her for two years and intended to adopt her but they backed out at the last minute. There was a corresponding increase in uncontrolled behavior so she was admitted from another temporary foster placement to her current residential placement.

Lisa's current behavior is very erratic. Her everyday speech is laced with profanity. She is claiming that she was pregnant and just had a baby, but this isn't true. She is physically aggressive, sexually precocious and inappropriate, and has attempted suicide twice.

Lisa was referred for occupational therapy in her residential program because the previous foster family took her for a sensory-b…

Liveblogging at the student conclave

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This weekend I am attending the AOTA/NBCOT Student Conclave and was excited to see hundreds of students in attendance! I offered some welcoming remarks to the attendees prior to Dr. Clarke's keynote presentation last night.

This morning Paul Grace, the CEO of NBCOT, offered an excellent presentation on 'Steps Toward Your Essential Credential.' Paul gave students many tips on how to prepare for taking the certification examination, including information on making sure that all college or university requirements are met, how to set up an account with NBCOT, review of examination security, and a call to participate in NBCOT examination development after students achieve their certification. He also encouraged all students to participate on the NBCOT Facebook page. Each week sample exam questions are posted and students engage in conversation using evidence-based practice on how to arrive at the best answer.

As I type, there are two separate sessions for OTR and COTA candida…

Book Review: Tuck Me In!

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I received an email from a children's author asking me to take a look at a book he recently co-authored. The book is Tuck Me In! by Dean Hacohen and Sherry Scharschmidt. Dean was hearing some feedback from parents that the book was nice for toddlers who were developing fine motor skills and he was interested in my feedback. He was kind enough to have his publisher forward me a review copy.

I was interested in Dean's book because I am interested in habits and rituals. I spend a lot of time thinking about algorithms that can be programmed to simulate dynamic adaptability in generating non-automated responses to unpredictable environmental stimuli. I think about this stuff a lot because of the typical behavior of toddlers and the clinical behavior of people with autistic spectrum disorders. I sometimes think someone might ask me to be a software consultant for unmanned Mars missions so that is always another reason to keep my thinking sharp. You never know.

Anyway, typically…

Occupational Therapy Assistants in NY State: A SUPER PROFESSION

Background fact:
occupational therapy assistant (OTA) means someone who has not passed a NBCOT certification examination or who has not renewed their certification. NY State allows these people to practice.

certified occupational therapy assistant (COTA) means someone who HAS passed a NBCOT certification examination and who HAS renewed their certification. NY State does not require this for occupational therapy assistants.

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The recent NYS Department of Health ruling on qualified professionals to provide OT in NYS schools originally stated that one qualification for practice was:

A certified occupational therapy assistant (COTA) “under the direction of” such a qualified licensed and registered occupational therapist, acting within his or her scope of practice under New York State Law.

This sent quite a few people into a panic because there are many OTAs in NY practicing without ever haven taken the NBCOT examination. After someone takes and passes the NBCOT…

Soap opera in NY: As the autism insurance bill turns...

I received an interesting mass emailing from Autism Speaks today, which is an advocacy group that is currently supporting passage of the autism insurance bill in NY State. I paused because the email contained the following:


"Please stay tuned over the coming hours. The health plans are still working hard to ensure a veto. We need to work together to let the Governor know that we expect him to provide principled leadership and sign S.7000B into law this week."

I found this a little confusing because every other autism advocacy group that I know of in NY is opposing this bill, as are the NYS OT Association and the NYS Speech and Language Therapy Association. The concerns are that no other conditions require such a high standard for 'evidence based practice' as this bill and that this may be used to actually decrease what insurance companies have to reimburse. I don't know anyone that is against the concept of evidence based interventions, but it would be unfair to…

Sensory integration: More evidence that OTs have lost control of the narrative

There are quite a few opinion pieces in this blog about the state of sensory integration as a model for occupational therapy - the reader is particularly referred here and here for quick background if needed.

Continued evidence that occupational therapists have lost control of the 'sensory integration' narrative can be found in the October 2010 Scientific American Article by Nancy Shute entitled "Desperation drives parents to dubious autism treatments."

Sensory integration therapy is described in the article as ranging from "wrapping children in blankets or placing them in a hug machine to having them play with scented clay..." They also note in the article that this intervention costs families up to $200 per hour or $6000 per year. Sensory integration is listed in a chart as Temptations: Dubious Therapies.

These kinds of articles always seem to generate responses from people who disagree from them, but before anyone responds I think this is a good opportuni…

A promise to Dolores

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I can only remember one time in my professional career that I cornered myself with a promise - and as terrified as the experience made me feel - I am so much richer for having made a promise to Dolores.

Dolores had mild learning disabilities and some motor clumsiness. She and her brother were being raised by their mom who was a single parent. Things I remember about this family focus a lot around their names: Dolores, Wally (brother), and Hazel (mom). All of these names are uncommon today, but as uncommon as the names were they fit this family well, because the names reflected precisely on the way that they did not exactly 'fit in' with most of the other people around them. The family was quite poor, and perhaps a little socially awkward, but at the same time the kindest people I have ever met.

Dolores wanted to learn how to ride a bike - she was clumsy and could not coordinate her balance with the motion of her legs. In therapy we worked on developing these skills so that she…

Annual update: Another massive hike in health insurance rates

Yawn.

Is anyone surprised?

We received our new rates for the cost of the health insurance that we offer to employees. The single rate increased 21% and the family rate increased a whopping 27%. I surveyed other WNY health insurance plans and they all have similar increases.

Click here for the ongoing documentation in this blog on the issue. If you can stomach it.

This is not a local New York phenomenon - you will begin hearing a lot of press on this issue now that the October and November rates that reflect mandates from the Patient Protection and Affordable Care Act ('so-called ObamaCare') are being implemented. Headlines out of a neighboring state are similar. Insurance companies claim that removal of lifetime limits, removal of pre-existing condition waiting periods, and assorted other mandates are responsible for driving up the costs.

What this will mean, of course, is that fewer families will be able to afford insurance - which will lead to the accelerated collapse of a m…

Somewhere that's green.

This entry is another study in parenting occupations, and in studying how children help to make meaning for their parents and in turn for themselves. So this is for Caleigh.

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To say that I wanted to tame the yard wouldn't be entirely accurate. That would place the yard in a subservient position to myself, and that isn't really how I felt about it. Rather, I wanted the children to be able to live in it and to play in it, and in its state at the time it just wasn't a habitat that was conducive to children's play and development.

One of the immediate problems was that in the back yard the ground that was ten feet closest to the sliding glass doors wasn't graded properly, so water would tend to puddle against the house. The previous owner was dog-sitting a large golden retriever that got left outside a lot - so that caused the space in front of the sliding glass doors to be a giant mudpit of dog prints. No grass grew there. I tried…

The Billy Williams Chair

I want to write a little bit about donations. I am prompted because a mom who I haven't heard from in a couple years stopped by my office recently and made a donation of equipment that her son used. He died a couple years ago, and the mom (in her words) was able to finally sift through some things in the basement and decided that the therapist would make good use of the items with other children and families.

I can't write about this particular situation yet because to be honest it is too raw and too recent.

Instead I want to write about The Billy Williams Chair. I can write about this chair now without crying, mostly.

Billy had a full 18 year old life before I ever met him for his final year or so. He was a high school student, a singer in the chorus, a big brother, and so much more. Unfortunately, when I met him he was stuck in a hospital bed in a pediatric intensive care unit for most of his time. Billy had transposition of the great arteries, which means that the import…

The erosion of special education services in New York State

Money is tight and the new method for getting budgets passed in the NY State capital is to cram everything into emergency budget extensions that the public never gets to see or comment on.

The other method for cost savings is to make rule and regulatory changes that have a public comment period - but it does not matter what the public says because the rules are going to be passed no matter what.

Early intervention providers saw this earlier in the year when they experienced a 10% rate reduction for most home and community based visits. This effectively limits the reimbursement to therapy providers and is driving a large number of professionals out of the delivery system. A mandatory 10% pay cut is significant, and although there were public hearings about changes to the rates and other delivery issues it really did not matter. Fewer providers means fewer services provided - which is precisely what the bureaucrats intended.

A new round of regulatory changes is on the horizon, this time…

Child health professionals need to do more to help parents

A sad story has been in the news recently about a parent who allegedly murdered her children who were diagnosed with autism. 911 tapes and other evidence indicate that the family was having difficulties coping with the diagnosis and care of these children.

Several years ago I put some thoughts together regarding efforts I wanted to make in my own private practice to support mental health of parents. I based my original ideas on Leading Health Indicators of the Healthy People 2010 project. Perhaps it is time to assess our progress and lack of progress on these indicators. I understand that Healthy People 2020 is due out this year - and we need to remember that it is not enough to just talk about how these issues are important. We need to actually DO THINGS that will help to improve the health of children and families.

Here were my thoughts on this subject five years ago. I am afraid that if this case in the news now is any indicator that we still have some work to do:

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Ongoing series: Unintended consequences of the Affordable Care Act

Government and bureaucracy, even when it is acting with purported good intention, tends to be a poor predictor of human behavior. This needs to be considered before we continue to hand over responsibility for our health care system to our politicians.

Why couldn't the bureaucrats see this headline happening:

Some insurers stop writing new coverage for kids
Ahead of requirement to cover kids with medical problems, some insurers drop out


Now that certain requirements have been put in place on insurance companies, a situation has been created where parents who are interested in saving money on premiums may opt for single coverage and then if some event occurs necessitating medical care for children they can purchase an insurance policy for their children without restriction.

Insurance companies see the potential abuse of parents not paying into the insurance pool and then only obtaining coverage 'on the way to the hospital' and so the insurance companies are now refusing to write…