I personally always fished with worms, or occasionally newts - but I am no fisherman and my knowledge of this occupation is restricted to the things a young boy would gain by spending summers casting into the Hudson River more for a way to commune with friends than for the sport. Back then it never really mattered what we caught or even if we caught because the occupation was directed toward the social experience. Besides, there is nothing worse than having to get a river eel off of your line. Gross.
Anyway, I was preparing a lecture and the concept of 'emerging practice area' ran across my radar screen. This is certainly nothing new in OT. The word 'emerging' seems to be an interesting buzzword in occupational therapy right now and it is applied across many contexts. There are 'emerging leaders' and there are 'emerging practice areas' and there are 'emerging fieldwork sites' just to name a few. It must be important because there are even ACOTE standards that demand that accredited educational programs promote 'emerging' practice areas.
Sometimes words are used so frequently that there is a risk of just accepting the word without really doing much diligent investigation into why we are using the word. I think that might be true with the concept of 'emerging' things.
'Emerging' sounds good, mostly, and generally evokes images of forward thinking or being innovative. In the OT literature the word is often accompanied by 'niche' which makes me think of ideas that are small but valid. So the concept of emerging niche actually seems kind of appealing, at least from the perspective that it might be kind of nice to find some things that are not easily noted but might be growing in significance. Being 'cutting edge' is generally a positive attribute, so these words evoke some connections to other words that might seem to be good things.
If you try to trace back the use of the word 'emerging' as it relates to OT I think it is mostly fair to state that the AOTA Centennial Vision process really kicked off the use in its present context. That is not to say that OT hasn't talked about future-thinking before - but just that the use of the word 'emerging' in so many contexts was spurred largely by that visioning process.
I have indicated previously that I am a pragmatist in my heart. I spend time looking at the 'emerging practice' information because I am always wondering how we wed the intention of future planning to the realities of what we are demanded to do on a daily basis in our work. It interests me that the Centennial Vision document specifically identifies misalignment between priorities and the external environment as a point of barrier.
As an example, under the Children and Youth heading of the AOTA website there is a tab for 'Emerging Niche.' That tab has topics under it like childhood obesity, use of RTI models, bullying, and other topics. All of these are interesting topics and they impact the occupational performance of children, but they really don't represent the efforts of what most practitioners are doing in their daily jobs.
So who determined that these areas were 'emerging' and others were not? Are we using evidence to determine what is emerging? Are we using evidence to determine if practicing OTs are really that involved in these areas?
I recall an interesting conversation on the OT Connections site where the notion of strategic planning and the Centennial Vision was being discussed. The issues discussed were whether or not it was correct to strategic plan on needs or to strategic plan solely on where you want to go. It is a legitimate debate, but I believe that the best strategic planning has an important element of pragmatism.
You see, without that element of pragmatism, we run headfirst into misalignment between priorities and the external environment. This creates a large problem, in my opinion. Specifically, while we cast our line out and fish around for issues related to obesity and bullying we are actually catching severe problems with reimbursements and service delivery structures. So the fishing is good but the catching is bad.
I have been trying for about two years to get the river eel of New York State's failed early intervention program off of my fishing line. It is slimy and gross. When I look over to my AOTA buddy's efforts all I see are 'emerging niches' of bullying prevention. Are some folks catching bullies and doing great work??? They sure are! But what are we doing about the slimy river eels on our lines?
It is not just AOTA though. For months I would look over to see what NYSOTA is doing about the early intervention problems I have documented for a couple years now and although there are some johnny-come-lately efforts you were more likely to see tons of pictures about some marketing effort of taking pictures of some branded multicolor hand thingie as you were to see even a single picture and a story of some sad therapist turning the sign on the front of her early intervention business to where it reads "CLOSED." That has changed recently, and that is good, but now it is too late.
This is misalignment between priorities and the external environment.
We all have responsibilities for this. Outcomes are not measured by the integrity of our intentions. Outcomes are measured by what actually happens. I am acutely aware that banging the drum on a blog is not solving the problem either, so I am taking other steps to try to solve problems. I have been meeting with my legislators myself. I am educating parents about these issues even more directly. I am trying to collaborate and team with others in my community that are facing the same issues. I am even changing my lecture topic content.
We can walk and chew gum at the same time. So, I can talk about 'emerging' practice but I can also talk straight about what is real and happening in the field now. If educators fail to talk about what is real then all we will accomplish is promoting a bunch of disconnected graduate and doctoral projects on childhood obesity or bullying that have no traction beyond the demonstration project level.
The point is to serve the needs of people, not to endlessly prop up our own good intentions with non-viable ideas. Honestly, how many AOTA poster sessions and student projects will we actually see about the role of OT with homelessness or domestic violence shelters before we realize that virtually no one is actually working in those areas?
Again, I want to point out that this kind of visioning about emerging areas is not bad in itself, but it really does increase the risk of distracting us from really important everyday concerns that are right in front of our faces.
I think there is great risk in this posting because I don't know if the notion of how fishing is good but catching is bad will resonate. I was thinking instead of writing this around the Aesop's parable of the milkmaid and her pail. She daydreamed endlessly and spilled her milk before she ever got to market - the moral being the same as my fishing analogy. It is a little simplistic so I hope the fishing analogy is more apt. You can legitimately think about it either way.
We just need to have some pragmatism. Or at least a little more than what we are currently employing.