tag:blogger.com,1999:blog-147729992024-03-15T04:58:54.969-04:00ABC Therapeutics Occupational Therapy WeblogChristopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.comBlogger572125tag:blogger.com,1999:blog-14772999.post-56125038034003603922024-02-08T14:10:00.006-05:002024-02-08T19:35:31.063-05:00Occupational therapy education: How to navigate in a Perfect Storm<p style="text-align: justify;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgX3_n9EJMHcmCfYBdUThzaCkxiqcIUs6N6ECIShfqYudpWBoJQ2p0_TCGG4TmDQ1_vLWfWCuq4cM_yS1OG3s6AW9dGGTACTTIJz4jEB2Sj8Jn9pk9vWa0fUY7gV6ECTsmx6ulUQpuQqIWeI-z2phf8zVTxlzr0uy1362DodT5ZfYtSVdlfJS3Mw/s1400/perfect%20storm.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="929" data-original-width="1400" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgX3_n9EJMHcmCfYBdUThzaCkxiqcIUs6N6ECIShfqYudpWBoJQ2p0_TCGG4TmDQ1_vLWfWCuq4cM_yS1OG3s6AW9dGGTACTTIJz4jEB2Sj8Jn9pk9vWa0fUY7gV6ECTsmx6ulUQpuQqIWeI-z2phf8zVTxlzr0uy1362DodT5ZfYtSVdlfJS3Mw/s320/perfect%20storm.jpg" width="320" /></a></div>Please click on and read all of the links - they include critical information that is required for this analysis. <p></p><p style="text-align: justify;"><span style="text-align: left;">A little over four years ago I stated that </span><a href="https://abctherapeutics.blogspot.com/2019/07/there-are-too-many-occupational-therapy.html" style="text-align: left;" target="_blank">there are too many occupational therapy educational programs in New York State</a><span style="text-align: left;">. At the NYSOTA conference legislative information session in 2023 I stood up and suggested that we should all stop taking jobs at these institutions that were seeking to develop new programs. I thought that if we did not take those jobs that the problem would be solved. <br /><br />That was not realistic or correct, even if the intention was good.</span></p><div class="separator" style="clear: both; text-align: left;"><div style="text-align: justify;">Well karma tends to strike when you make public pronouncements, so I thought I should expand on my perspectives on this topic.</div><br />At current count there are still ~22 occupational therapy programs and ~11 occupational therapy assistant programs in NY. Most of the programs are delivered at the master's level. There are a very small number of entry level doctoral programs, but some of the current master's programs are attempting to transition to the doctoral level.<br /><br />In the Upstate NY region in particular (the area I am most concerned with as it relates to my current geography!) there have been many new programs in the last ten years - leading up to my statement four years ago linked above. There are additional complicating factors that need to be added to the analysis: <a href="https://www.bls.gov/opub/mlr/2023/beyond-bls/increases-in-minimum-wage-decrease-community-college-enrollment.htm" target="_blank">the changing economy that places severe upward wage pressures for entry level health professionals (especially damaging the OTA level)</a>, <a href="https://13wham.com/news/local/local-new-york-state-lawmakers-lunsford-call-on-hochul-to-increase-rate-of-funding-for-early-intervention-services-for-children" target="_blank">flat reimbursements in early and primary education that constrict service provision</a>, <a href="https://www.pandemicoversight.gov/oversight/our-publications-reports/health-care-staffing-shortages" target="_blank">severe staffing problems in long term care following COVID</a>. There is also <a href="https://research.aota.org/ajot/article/77/3/7703345010/24117/Faculty-Preparation-for-Teaching-in-Occupational" target="_blank">the shortage of qualified faculty</a> - a severe problem in the context of an expanding number of schools offering occupational therapy programs. I suppose we should also add in <a href="https://www.cupahr.org/issue/feature/higher-ed-enrollment-cliff/" target="_blank">the long-predicted demographic enrollment cliff that higher education is experiencing</a>. There are so many problems.</div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;">Here we can see a chart from AOTA indicating a 31% increase in the available number of seats in occupational therapy programs along with a 36% drop in applications.</div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq7g1EY6izo28EOKfCKjM1XC77g5KGmykrlzvJRbGsFsH34u0-GpvgPFfC1b6wPabcKU5v6JT9JD5uITNnsO1wUk9kS33ILZ3vV_4B5iX85m0VwCXrp57pXDOIyblfZdh0-_NGci2WSM7iyd4d50xueMRJjm2850AHM-UYBIY1h1Y-RXUwal3ydQ/s1055/OT%20program%20trend%20data.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="505" data-original-width="1055" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq7g1EY6izo28EOKfCKjM1XC77g5KGmykrlzvJRbGsFsH34u0-GpvgPFfC1b6wPabcKU5v6JT9JD5uITNnsO1wUk9kS33ILZ3vV_4B5iX85m0VwCXrp57pXDOIyblfZdh0-_NGci2WSM7iyd4d50xueMRJjm2850AHM-UYBIY1h1Y-RXUwal3ydQ/w482-h230/OT%20program%20trend%20data.png" width="482" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">Here is another chart demonstrating the severe drop in number of applicants to occupational therapy programs.</div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEi01tFv18ygRxBYv2EU7mrHuZaUysH1dYKwTK_socJyDZdz57CobCjdTFPiHcTF_V_SAquQF_S5eREweLBAEGKHw7HG6ttnE8Sp9wTJ1_zCycEk-YKDq4ZlRvEJXwivzUD--MVeqmElZiJUbRr8YSZVbHQdqKYIr8lZQ6TdylU4Z98DSESrP2Ug4g" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="452" data-original-width="752" height="288" src="https://blogger.googleusercontent.com/img/a/AVvXsEi01tFv18ygRxBYv2EU7mrHuZaUysH1dYKwTK_socJyDZdz57CobCjdTFPiHcTF_V_SAquQF_S5eREweLBAEGKHw7HG6ttnE8Sp9wTJ1_zCycEk-YKDq4ZlRvEJXwivzUD--MVeqmElZiJUbRr8YSZVbHQdqKYIr8lZQ6TdylU4Z98DSESrP2Ug4g=w480-h288" width="480" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: left;">That is why I label this problem as the occupational therapy profession's version of 'The Perfect Storm.' The definition of such a situation is when many bad things are all happening at the same time. In this context I have previously<a href="https://abctherapeutics.blogspot.com/2019/03/degree-escalation-and-doctoral.html" target="_blank"> railed against occupational therapy doctoral mandates</a> and <a href="https://abctherapeutics.blogspot.com/2019/04/relying-on-student-subservience-in.html" target="_blank">mandatory degree escalation. </a> I have previously argued that the solution was for ACOTE/AOTA to do something to control the number of approvals granted to developing educational programs. The counter-argument to that has consistently been that an accreditor does not have the right to restrict program development (an antitrust argument) and that it was up to the market to dictate the number and quality of occupational therapy programs. <br /><br />That is a fine argument, and it actually comports with my free-market inclinations, except that the accreditor has a monopoly on collecting accreditation fees. There are also several other elements that must be present for a market to correct. For example, good information for consumers must be plentiful - and the AOTA decision to promote a mandatory doctorate introduced such confusion among consumers that it is still a regularly asked question at any enrollment event if a doctoral degree is required as of 2027. We have an endless barrage of external shock in the form of pandemics and inflationary pressures, and we also have very imperfect competition - the final topic I want to spend some time on.<br /><br />In the context of occupational therapy education, imperfect competition comes in the form of limited resources and inadequate faculty qualifications. A resultant death spiral can occur if we do not pay attention to it - in a scenario where too many schools compete for students but lack the sufficient resources to attract and retain adequate faculty, you get significant variability in quality of education and declining enrollments. As student numbers decrease, schools face financial strain due to decreased tuition revenue - a particularly vexing problem in the kinds of institutions that house many occupational therapy programs in New York State. That impacts the institutions' ability to invest in faculty, facilities, or to meet new ACOTE standards - leading to a downward spiral in quality and competitiveness.<br /><br />To address these challenges stakeholders may need to consider strategies to rationalize the market. Rationalizing the market could involve program consolidations or mergers to reduce duplication and ensure that resources are allocated more efficiently. We are already seeing that in higher education on the <a href="https://www.insidehighered.com/news/business/financial-health/2023/12/21/look-back-college-closures-and-mergers-2023" target="_blank">macro level</a>. The principle needs to be applied at the micro level as well. Some occupational therapy programs need to merge/close.<br /><br />Quality standards also need to improve. Perhaps the recent glut of programs who seem unable to pare down their credits to meet the credit requirements for a master's degree are a reflection of this need for improvement. This is dangerous territory though - for example, setting requirements for faculty qualifications is a double edged sword in the context of a known faculty shortage. Still, strict adherence to quality standards, whether that takes the form of student outcomes or program accreditation in general, is something that we all need to insist on.<br /><br />The profession also needs to align supply with demand. On the level of individual programs there needs to be an adjustment of program capacity as well as an analysis of offering specialist training in high demand areas. That is hard to do when programs are required to produce generalist practitioners - but what are the demands of the future? <a href="https://abctherapeutics.blogspot.com/2019/10/the-need-for-occupational-therapy.html" target="_blank">I have made this argument previously</a> - do we need an endless number of doctoral capstones directed at developing OT in areas that will never pragmatically actually hire an occupational therapist? Or do we orient our top-trained practitioners into the areas of future growth and future demand? What schools are equipped to do this best?<br /><br />Overall, rationalizing the occupational therapy education market involves balancing supply and demand dynamics, improving quality and efficiency, and promoting innovation to ensure that programs produce competent and well-prepared practitioners who can meet the needs of patients and healthcare systems.<br /><br />So I no longer leave this to competent 'others' to solve. I made those arguments in good faith but ACOTE won't fix this and I think it is more complicated than simply not supporting the 'new' programs. We all work in fine institutions and we all have the best intentions with our individual programs - but I think that educators need to develop new tactics to rationalize the market.<br /><br />That is what everyone will see out of me in my future efforts.</div>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-22809295777829079162023-08-09T22:57:00.004-04:002023-08-09T23:21:27.244-04:00Globalization and occupation therapy - a continued musing.<p><span style="background-color: white;"><br /></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwpp9kHWkARq2k0jH0OWqPogy6ZgJYqvdx_bLFdZU34zbgmz6pNtudH5xDCTrB-fkmKNCHysy7XFjZ2cIAoQyXy6KI9Dk46-MQnDQXeVlrqbT9IXXO8M7dpAa-pwgmSHvvz3FkndUjTMHIoKk1tYkGVFlCmUsVDtiQJr6_cxm6z9yyaFtTHf1GXQ/s687/W%20and%20S.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="687" data-original-width="526" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwpp9kHWkARq2k0jH0OWqPogy6ZgJYqvdx_bLFdZU34zbgmz6pNtudH5xDCTrB-fkmKNCHysy7XFjZ2cIAoQyXy6KI9Dk46-MQnDQXeVlrqbT9IXXO8M7dpAa-pwgmSHvvz3FkndUjTMHIoKk1tYkGVFlCmUsVDtiQJr6_cxm6z9yyaFtTHf1GXQ/s320/W%20and%20S.jpg" width="245" /></a></div>I have been talking about the implications of globalization on the occupational therapy profession for quite some time - it started off with <a href="http://abctherapeutics.blogspot.com/2013/07/a-fourth-of-july-message-for.html" target="_blank">blog posts here</a> and then a <a href="https://www.slideshare.net/ChristopherAlterio/occupational-justice-alterio-ot24-vx-final" target="_blank">presentation at OT24VX in 2015</a>. Then I gave the topic a whole chapter in <a href="https://www.amazon.com/Clinically-Oriented-Occupational-Therapy-Christopher-Alterio/dp/1496389530" target="_blank">my theory textbook in 2019</a>. Then there were more blog posts <a href="http://abctherapeutics.blogspot.com/2022/02/the-problems-with-polarity-frames-in.html" target="_blank">here </a>and <a href="http://abctherapeutics.blogspot.com/2022/04/the-new-fascism-in-occupational-therapy.html" target="_blank">here</a>.<br /><br />In sum, I am uncertain if occupational therapy is a unitary global profession, although I now add this caveat: <i style="font-weight: bold;">at least as understood in the publications of academics. </i>I add this caveat now because I am uncertain if the things that people in academia write about truly reflects actual practice in other countries. I know that in the United States there is some academic scholarship that is highly relevant to practice, and other scholarship that leaves me wondering if I am an occupational therapist according to the way some suggest that practice should be constructed.<br /><br />So for example I read the Canadian Journal and wonder if everyday practitioners are functioning in '<a href="https://journals.sagepub.com/doi/10.1177/00084174211022891" target="_blank">change agent roles</a>' as described or if I would be more likely to find someone providing traditional OT to a worker who injured their hand in the Alberta oil sands so they can resume their occupational roles. I am unsure. I know that in the US I am more likely to find practitioners doing very pragmatic and traditional things in traditional health and educational/community settings - and that social/occupational justice 'work' on a population level is actually quite rare (except for the seeming endless stream of doctoral capstone projects done in homeless shelters and soup kitchens - that rarely seem to translate into actual work settings).<br /><br />Anyway, the point is that there is some scholarship that seems to promote OT in these new roles and that seems to have very little traction in reality. A lot of the international scholarship is like this too - promoting OT as a political methodology or as a mechanism for understanding oppression (anti-Western, anti-Northern, anti-Capitalist, etc etc). I suspect that OTs around the world understand and respect social and cultural dynamics and treat people with high levels of respect and care. OTs in my opinion are a very accepting, kind, and sensitive lot of people. I don't know how many practitioners outside of academia make it their lifework to be systems change agents though.<br /><br />I suspect that more OTs help people put on their pants or learn how to write or do similar kinds of everyday tasks that they find meaningful. I am not a world-traveler though, so I can't be certain.<br /><br />Anyway, the disconnect between what some academics write about and what practitioners do is a problem in the United States. That is particularly true when ideas from other countries are floated as potential models for practice in the United States. I have tried to explain numerous times - colonial transfer of ideas is problematic in any direction. That seems to be a point of sensitivity for people who have been on the receiving end of Western ideas/dominance for a long time, but you don't fix the problem by reversing the data flow. You just create the same problem in the opposite direction.<br /><br />The methodology for treating a broken bone is rather plain on a biomedical level and could probably transfer easily from country to country. That is why we can state with greater surety that medicine and nursing and even physical therapy translates pretty easily around the globe. But when we take it to the level of occupations then all kinds of cultural elements start to interfere - is independence valuable around the globe, or is that a Western construct? <br /><br />The OT profession has really taken the conversation into far-flung places along the 'general systems theory' hierarchy - to the point that some academics seem to consider social OT as a Freirian political movement, or that we should just abandon the medical model, and so on. Is this the way that OTs are actually practicing, or is this just the philosophical musing of some academics? Reading the international journals is a journey into the unknown.<br /><br />Here in the US the problem is that the professional association is overpopulated with academics and underpopulated with clinicians. Policy papers, model practice acts, and many other forms of influential documents come flying out of the national office - and to be honest they have varying levels of applicability to what practicing OTs are doing. This is a problem. This is also why I always worry about what idea will come out of WFOT - because invariably some American OT academics who don't practice might think WFOT policy papers are the next great idea that we need to insert into our own Practice Framework. That Practice Framework now is so expansive and out of touch with what many American OTs do - and it just gets more disconnected with each new edition. Again, that is why globalization of ideas is a real problem in any direction when higher level social and cultural elements are in play.<br /><br />Maybe the solution is to have more members of our Academy practice. Is that how medicine remains grounded?<br /><br />This all comes top of mind again because I see that the new Willard and Spackman text is being released. I know the publisher; they published my text as well. I was asked to make my text relevant for an international audience and I told them that it was not possible to make a theory textbook internationally relevant if it was going to be clinically focused. I might not be asked to write another theory textbook because of that opinion, but it remains my position. That hurts book sales, I know. I get the objectives of the publisher that wants to have international sales - but how realistic is it to believe that we can create a global textbook? Let's just take one example - nearly a third of OTs in America provide services in pediatric contexts, and practice is driven around specific American laws that dictate how early intervention, preschool, and school-based services are delivered.<br /><br />How do we translate that and make it relevant in other countries that don't have those same systems and guidelines and restrictions?<br /><br />Now we can criticize the American systems all day. Goodness knows they are imperfect. But as an American academic I have to teach American students how to practice in America. And I have to hope they pass the American certification exam. And those students have to be competent within the laws about occupational therapy delivery in those service contexts.<br /><br />Do my American students need to be change agents to help move the American system into a Freirian political movement? Do they need to be concerned about theoretical colonialism and if MOHO applies in other countries? In American practice do those students have future roles in sustainability and climate change and social justice?<br /><br />This is the disconnect.<br /><br />I don't begrudge anyone's interest in these topics. Actually I think that these are interesting topics to think about. I am uncertain if they apply to American occupational therapy practice.<br /><br />So I will order the new W&S text, and I will read it thoroughly. <br /><br />Whether or not I decide to encourage my students to read it is another story - that will depend on whether or not the content is relevant to their future careers as American occupational therapists.<br /><br />I really wish more members of our Academy would think critically about this issue. We need more honest dialogue on these things.<p></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-79147044152832672652023-07-28T02:00:00.000-04:002023-07-28T02:00:02.933-04:00Environmental sustainability and occupational therapy practice, revisited.<p> <br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiNRsDRwIs_F88GA7ZMryXFrx62Cy4xOf5I9CgrLEeYsGBoxGMh9r_E-gJkm74UIbw9-3hlaWPDo-entrkXJlXESm-FpALRSWhvi-Rjs2iMIQyrBlfQzmxjc2zIx7iA5VqK2DlgY8NTsJzTW6kj99erbk7RUAqhj--Sd0ZR1Z5EmbuHRgrw03p8A/s1600/what-is-occupational-therapy-2023.webp" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="900" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiNRsDRwIs_F88GA7ZMryXFrx62Cy4xOf5I9CgrLEeYsGBoxGMh9r_E-gJkm74UIbw9-3hlaWPDo-entrkXJlXESm-FpALRSWhvi-Rjs2iMIQyrBlfQzmxjc2zIx7iA5VqK2DlgY8NTsJzTW6kj99erbk7RUAqhj--Sd0ZR1Z5EmbuHRgrw03p8A/s320/what-is-occupational-therapy-2023.webp" width="320" /></a></div>Please go here for <a href="http://abctherapeutics.blogspot.com/2012/12/environmental-sustainability-and.html" target="_blank">my first thoughts on sustainability in occupational therapy around ten years ago</a>.<br /><br />I received an email from a colleague who has been an advocate and published author on this topic asking me if I had the opportunity to revisit my thoughts on sustainability and occupational therapy. <br /><br />In fact I have continued to think about this, so I thought I would document my response here.
<br /><br /><br />Hi XXXXX- <br /><br /> Thanks for reaching out. I have previously and still believe that the study of climate change itself should remain within the purview of climate scientists. It seems to me that when it is co-opted by distal groups (including occupational therapy) that the issue tends to be used to promote a political social justice agenda. I continue to object to that because I don't know that occupational therapy can advance climate science itself and I find that the proposed actions advance very specific political ideologies and constricts the intellectual diversity within the profession.
<br /><br /> I disagree with the conflation of climate science with local political movements - such that in the AOTA policy it states that it is the role of occupational therapy practitioners "...to increase individual, organizational, and community awareness and action related to sustainable occupational choices which threaten human, animal, and environmental well being, and the importance of making occupational choices that preserve natural and built environmental/ecological resources in the United States." <br /><br />I am uncertain if it is the scope or role of occupational therapy practitioners to dictate lifestyle choices to others. Certainly that is not a core construct of the profession. What would stop any occupational therapist with any particular belief system from telling service recipients how they should be conducting themselves? From a practical perspective, the social contract of occupational therapy is to assist people with returning to independence or occupational role functioning in rather traditionally defined areas of personal care, productivity, and recreation or leisure skills. That is encoded into our licensing laws, our billing systems, and our identity. I understand that some individuals may wish that occupational therapy was not embedded within such a medical and Westernized model of care, but in fact it is in the United States. In short, Medicare won't pay for OTs to promote climate justice - and that makes these political white papers a little out of step with the realities of everyday practitioners. I don't say that with any disrespect toward anyone's interests or beliefs. It is simply factual.
<br /><br />From a scientific standpoint, it is also difficult to understand why any occupational therapists' actions should be limited to what is happening in the United States. There seems to be compelling evidence that negative environmental consequences are driven by the sum of planetary activity. If China produces more than twice the CO2 than the United States, why would we exclude action in that direction? If the US comprises 10-15% of the global total of carbon emissions, how effective will restricting action in the United States be? Do we advance or constrict quality of life by advising populations of individuals in the United States that they need to find alternatives to disposable consumerism - or do we spend our time instead helping them learn how to put on their pants after a stroke, or learn how to write legibly if they have fine motor delays? I have spent 35 years in practice, mostly in areas of significant rural and urban poverty. It has never crossed my mind to tell my patients that recycling will help them improve their lives - particularly when much more immediate concerns consume their thoughts and constrict their opportunities.
<br /><br />As a final point, I struggle with the idea that in order to achieve climate justice that it is important to prioritize the experiences of those who are labeled as marginalized groups. As an example, the position paper suggests that we are to "recognize the impact of climate change on marginalized and high-risk populations who are disproportionately affected, and in many cases unable to make sustainable occupational choices..." The proposed actions for occupational therapy practitioners are to promote sustainable lifestyle choices, to address social/economic/environmental/spiritual determinants of health, to advocate for sustainable health care, and to be advocates for legislation that promotes the climate justice agenda. It is unclear to me how any of these actions does anything other than promote a singular political approach to the concern. Co-opting a scientific construct into sociopolitical terms and identity-based activism seems counterintuitive to generating consensus around an action.
<br /><br />I really don't begrudge anyone's interest in this topic. I consider myself a conservationist although I don't agree with nearly any of the above methodologies for solving pollution problems. I still just don't see this as a function for the occupational therapy profession to be dabbling in - particularly when the profession is losing ground in so many practical areas to other health care professions. As we generate white papers on social justice and climate change and reproductive health, physical therapy is taking over our jobs in many settings. That does not mean that social justice or climate change or reproductive health are not important - in fact they are - but when a small profession like occupational therapy has constricted resources and a defined scope of practice it seems imprudent to be making forays into these other areas.
<br /><br /><br />Background reading:<br /><br />AOTA (2022). Professional Policy: Sustainability and climate change. <a href="https://www.aota.org/practice/practice-essentials/aota-official-documents">https://www.aota.org/practice/practice-essentials/aota-official-documents</a><br /><br />Dennis, Carol; Dorsey, Julie; and Gitlow, Lynn (2015). A call for sustainable practice in occupational therapy. Canadian Journal of Occupational Therapy, 82(3) 160-168. <span style="background-color: white; color: #333333; font-family: "Open Sans", sans-serif; font-size: 16px;">doi:</span><a href="https://doi.org/10.1177/0008417414566925" style="background-color: white; box-sizing: inherit; color: #006acc; cursor: pointer; font-family: "Open Sans", sans-serif; font-size: 16px; transition: background 0.15s ease-in-out 0s, color 0.15s ease-in-out 0s;">10.1177/0008417414566925</a><br /><br />Lieb, Lisa C. (2022). Occupational Therapy in an Ecological Context: Ethics and Practice. AJOT, 76(3), <a href="https://doi.org/10.5014/ajot.2022.049148">https://doi.org/10.5014/ajot.2022.049148</a><br /><br />Wood, Peter (2011). Critiquing sustainability. The Chronicle of Higher Education, <br /><a href="https://www.chronicle.com/blogs/innovations/critiquing-sustainability">https://www.chronicle.com/blogs/innovations/critiquing-sustainability</a><p></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-78886227899119479542022-08-09T16:54:00.000-04:002022-08-09T16:54:01.997-04:00On American Pickers and some homeless treasures of the occupational therapy profession<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtoa09Xugg6TkjmWC-4FwhgDNW5-f7pcTP_A203PEmvTca6Kj8ydgjs6Iexn3KcFHCbugrbyUoKeoWK66Pnv5xiA8jqVcUYCW_KwYazPt0d5dGrlvgLZ6k0zrOs_PuHT1tLblASuaCA24g4Vxc9DC-QGJ2AZzQbO1nI3JNdBu9iB0HoBDfNUY/s800/pickers.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="532" data-original-width="800" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtoa09Xugg6TkjmWC-4FwhgDNW5-f7pcTP_A203PEmvTca6Kj8ydgjs6Iexn3KcFHCbugrbyUoKeoWK66Pnv5xiA8jqVcUYCW_KwYazPt0d5dGrlvgLZ6k0zrOs_PuHT1tLblASuaCA24g4Vxc9DC-QGJ2AZzQbO1nI3JNdBu9iB0HoBDfNUY/s320/pickers.jpg" width="320" /></a></div>Many people accumulate stuff, and people ascribe varying levels of value to their stuff. Some people can't part with stuff because of sentimental feelings. Some people can't part with stuff because it represents a <a href="https://www.aetv.com/shows/hoarders" target="_blank">deeper psychological affliction</a>. We have <a href="https://konmari.com/how-to-konmari-sentimental-objects/" target="_blank">cultural movements</a> now that address the problematic relationships that people have with their stuff.<br /><br />I initiated an Ebay hobby recently. There is nothing like the death of parents and the associated task housecleaning that prompts assessment of the value of earthly goods. I have had quite a bit of fun selling things that I no longer wanted.<br /><br />I am a fan of the show '<a href="https://www.history.com/shows/american-pickers" target="_blank">American Pickers</a>' and am moved by Mike Wolfe's philosophy about finding things that people no longer wanted and 'putting them into their place' with someone who loved or appreciated them. That is the flip side of my Ebay hobby - I have also purchased a few things that other people no longer wanted - and in doing so that brings me 'joy.' So we all find joy in different ways - sometimes in the letting go and sometimes in the finding and keeping. I think there is space for all of these approaches.<br /><br />Over three years ago I asked the question, "<a href="http://abctherapeutics.blogspot.com/2019/03/what-will-happen-to-wilma-west-library.html" target="_blank">What will happen to the Wilma West Library and archives of the occupational therapy profession?</a>" As the AOTA offices were moving the library was being weeded. This is always a perilous task for any librarian, no matter how delicately they approach the process or how they <a href="https://www.tandfonline.com/doi/full/10.1080/07317131.2018.1422882" target="_blank">attempt to frame their methodology</a>. Whenever you throw away books you will incur the wrath of people who don't want certain things thrown away. What is a librarian to do - meet the needs for joy, differentially defined, by anyone who expresses an opinion on the value of a given library treasure?<br /><br />So what is important, and what is not, when it comes to the collection of materials in the libraries of a profession? Are Mary Reilly's books important, simply because they belonged to Mary Reilly? Who wants to be the person to throw THOSE books out? Does it matter that they are all outdated by at least 50 years?<br /><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUyhDF95zDCxKveK-D1Sei_BlbhGiayXpIGzrhUe2BWECH3OhwAEYDRfZcD9JqWGoTNkxz_mtIkbiX5AmxEAOIamjAwVskC8Rms5YOmGFc0Fl-krrs92qPwyQ_j3cnlHBVoOzGe17_zPZNWX1mzL6xaJWzwikFA3NYrlVdUEsBuJHjjNyzoHQ/s320/reillys%20books.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="240" data-original-width="320" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUyhDF95zDCxKveK-D1Sei_BlbhGiayXpIGzrhUe2BWECH3OhwAEYDRfZcD9JqWGoTNkxz_mtIkbiX5AmxEAOIamjAwVskC8Rms5YOmGFc0Fl-krrs92qPwyQ_j3cnlHBVoOzGe17_zPZNWX1mzL6xaJWzwikFA3NYrlVdUEsBuJHjjNyzoHQ/s1600/reillys%20books.JPG" width="320" /></a></div><br /><div>And then there is the issue of the occupational therapy master's theses. At some point AOTA sent out a notification that anyone who wanted their thesis that was donated to the library should claim them. Any thesis that was unclaimed was going to be disposed of. I felt panic and had images of <a href="https://www.cbc.ca/news/world/the-books-have-been-burning-1.887172" target="_blank">book burning</a> running through my head! I am one of those people that librarians want to avoid when it comes to 'curating' their collections.<br /><br />I immediately wrote a letter and laid claim to about 20 master's theses - asking if I could have them if no one else claimed them. AOTA was happy to oblige - and even though I offered to pay for them (and the shipping) they just went ahead and sent me every single one I asked for - I thought it was very generous that they did that!<br /><br />I was shocked - no one wanted or claimed Jean Ayres' master's thesis? No one wanted the collective work of all Mary Reilly's graduate students and the theoretical groundwork they documented for the occupational behavior model? Nope. No one claimed them. They had no home, or perhaps no one wanted them. So I somehow got them into my hands.<br /><br />What does one do with this kind of documented history? Of course I read them, and then I started thinking about where they belonged. The immediate answer I thought of was that they belonged in the archives of the professional occupational therapy association - but they were the ones who were throwing them away! Where else should they go?<br /><br />The<a href="https://www.otleaders.org/" target="_blank"> OT Leaders and Legacy Society</a> has a process of digitization and they were very interested in having them - but in the process of considering this transfer I learned that there are complex copyright laws for such materials. For most of the unpublished OT theses, they are covered by copyright for 70 years after the death of the individual who produced the work. That means that in order to digitize them, I would need to track down the next of kin or estates of these individuals - as many of them have passed away and can't provide a digitization release.<br /><br />What a mess. No wonder AOTA didn't want these any longer? Maybe giving them to me was not so generous after all!<br /><br />Who should be the correct steward of this information? Just because it is hard, should AOTA have abdicated their role in the preservation of their own archives? <a href="https://www.historians.org/publications-and-directories/perspectives-on-history/january-1998/from-chaos-to-archives-the-records-of-the-american-occupational-therapy-association" target="_blank">The American Historical Association has been critical of how the occupational therapy profession neglected archival materials in the past. </a> Has history simply repeated itself?<br /><br />So I am now sitting on some pretty interesting historical documents. One school learned that I had a copy of a specific thesis and apparently they have been unsuccessfully searching for it for a long time. They asked and so I sent them a print copy - I figured it was a fair use argument and will take the risk of sharing it there - but I asked that it not be reproduced and explained the copyright problem. Perhaps they will chase down permission - they have contact with the family who I understand is still connected to that institution. Maybe that one can be digitized, at least.<br /><br />But what about all the others? Do I make a personal project of chasing down copyright releases from the families of all these occupational therapists who have passed away? Is that my job now that I am caretaker of the documents? I don't suppose I 'own' them given the copyright issue.<br /><br />Do I find a way to put these treasures in their place and get them into the hands of people who will love them and appreciate them? What a tough project that will be. <br /><br />Or do I box them up and wait for some bibliophilic picker to find them in another half century - when all the copyrights will have expired and the material is in the public domain? Will there even be an occupational therapy profession then?<br /><br />Tough questions - and so far I just don't have solid answers. I am relatively certain that these things should not be in my hands and that this work belonged to the collective occupational therapy profession. And I only saved the ones that I thought were most historic.<br /><br />That is an important reflection point. <b><i><u>What has been lost</u></i></b> - it is such a sad thing to ponder. Hundreds and hundreds of books and theses were unclaimed and are now gone.<br /><br />And of the small amount that was salvaged - does it just remain homeless, or unwanted?<br /></div>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-10505581100308685882022-06-15T22:01:00.000-04:002022-06-15T22:01:23.248-04:00The stories we tell ourselves about the past<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgxhSjMiRn_X3mV8VPqQmQeWR9jXxRUqKQ2rcvfVKB0wNV-UzLY0zcqybKXP0qisQ6PKyUNNQY3CNlCiB8uriXROHQ9oV3UzdpSzsIC1GCoUuW9Y683YpMyelVmTqawfnqnMgsthiLxMkCht55GuyyeZWLnH_8Bv-Q0lmaRuuSvfmo0zAKBZLU" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="1200" data-original-width="798" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEgxhSjMiRn_X3mV8VPqQmQeWR9jXxRUqKQ2rcvfVKB0wNV-UzLY0zcqybKXP0qisQ6PKyUNNQY3CNlCiB8uriXROHQ9oV3UzdpSzsIC1GCoUuW9Y683YpMyelVmTqawfnqnMgsthiLxMkCht55GuyyeZWLnH_8Bv-Q0lmaRuuSvfmo0zAKBZLU" width="160" /></a></div>The concept of narrative captured my interest sometime around 1984 - ironically - because it may have been the Orwell novel with that year's title that prompted my thinking on the topic.<br /><br />I was interested in written narrative and how Winston Smith established his rebellion and then his freedom through a written form (even if it all eventually led to a horrible end). I was also fascinated by his attraction to the paperweight that he purchased - something that was old - and seemingly of unknowable utility.<br /><br />What was the purpose of knowledge, or of the past - except that it all did represent a freedom from the drudgery of the present. So the paperweight meant something to him, just like his writing meant something.<br /><br />Winston told himself a story about the past. He created a narrative.<br /><br />As I am on a precipice of decision regarding our private practice I find myself spinning narratives, perhaps to tell myself a story about the past. I started telling the stories to my wife - maybe to ease the separation from this present.<br /><br />If the past was negative, the separation would be easier. I figured that I could use a convenient narrative.<br /><br />So I focused on Heath, an impossibly cute six year old with severe learning disabilities that I saw in 1990. I helped him with writing and motor skills but I remember how much he struggled with reading. I remember long talks with his mom, who loved him and worried for him and did everything she could to help him. She drove long hours to make his therapy appointments, across state lines, as the clinic I worked in was the only therapy option for them. When he was discharged she gave me a picture of Heath, and I displayed it on my desk for many years - because of all the fond memories that it elicited.<br /><br />I was engaging my habit of reading the local papers of places where I have previously lived and I saw a shocking headline: "32 year old <CITY NAME> man arrested for attempted murder." The face was not recognizable, but the name was clear. It was Heath, no longer impossibly cute.<br /><br />I remember reading a book while I was seeing Heath - the book was entitled <a href="https://www.amazon.com/Learning-Disabilities-Psychosocial-Functioning-Neuropsychological/dp/0898627672" target="_blank">Learning Disabilities and Psychosocial Functioning</a>. The book was full of grim statistics, particularly related to the negative outcomes of children with severe learning disabilities - something that is now popularly referred to as 'special education to prison pipeline.' Many of the people who end up incarcerated also have some kind of disability - it is a very sad statistic and it is not a particularly good reflection on our system of intervention. The statistic didn't resonate with me at the time. How could Heath ever end up in prison? He was so cute - and his mom loved him so much - and certainly everything we were doing to help him would set him on a positive trajectory for the future. I cognitively understood what that book said, but I emotionally tuned out.<br /><br />Failure did not seem like a possibility.<br /><br />But here I was staring at my failure that was plastered as a front page headline. I wondered how his mom could have let that happen, and after googling around I found out that she died of breast cancer about ten years earlier right when he was on the cusp of adulthood. I was also able to trace his encounters with law enforcement from the time of his mom's death up to the present and it was quite a rap sheet. Larceny. Assault. Domestic violence. Resisting arrest. Drug offenses. <br /><br />How could that happen? Was it because his mom died? Did he ever finish school? WHY?<br /><br />'Well we were fighting and I got really mad so I grabbed a hammer and I just conked her on the head,' was the explanation that he gave to the arresting officers. Conked her on the head? A three year old would say that. My mind was just reeling at this horrible narrative.<p></p><p>I went to go sit back at my desk, and I started looking around. There was the lego sculpture from Kyle. There was the rock from Annette. There was the impossibly cute smiling photo of Heath. Conked on the head? I wondered how many other kids I 'helped' have been charged with attempted murder?<br /><br />Maybe that was the legacy of a mom's failed effort. And of a therapist's failed effort. Conked on the head. What a narrative THAT was.<br /><br />It wouldn't be hard to separate from a private practice if that was the narrative. So what in the world do I do with Heath's picture now?<br /><br />+++<br /><br />I stuck with that convenient narrative for a couple weeks. OT doesn't help children with learning disabilities - they are impossibly cute when we see them in elementary school and then they end up conking people on the head with a hammer. That narrative made decisions about the private practice easy.<br /><br />Then another mom dropped a different pink coral paperweight into my email. It was a counter-narrative - another child's story dredged up from the past and also completely unexpected.</p><blockquote><p><i>Dear Dr. Chris - I have been meaning to send you a note for a couple of years... my son was a patient with you years ago, I think probably 18 years ago. I just wanted to let you know how much you helped him and how he has since forged a very successful path in life thus far.</i></p></blockquote><blockquote><p><i><lengthy amazing narrative outlining this child's struggles and how he overcame them... with lots of identifying detail - he is a very successful young adult now!>... I wanted to give you an update so you knew what a difference you made in his life. Thank you so much for your expertise that enabled my son to thrive. He still can't throw a frisbee, but he has come a long way!!! I am forever grateful to ABC Therapeutics!!!</i></p></blockquote><p>Well that just blew my other narrative to smithereens. Why in the world was I sent THAT email at the same time I saw the headline about Heath?<br /><br />+++<br /><br />Two different stories about kids seen in the past and who had two very different outcomes. <br /><br />Two different narratives. <br /><br />Is the past important? Does it free us or imprison us? <br /><br />What narrative do we choose, when both are true?</p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-12638382550552472822022-04-25T20:46:00.003-04:002022-04-25T21:00:50.930-04:00The New Fascism in Occupational Therapy<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi02mRBKpAWmTVzT_x6NqkgfsE-9SR0ZESI9RKdxLvKz1zYDx_9tvd5esUQWdd48NxZF5gq3FHiGmafIyzIBzUNgOt3doYnO5e6hX68SHw-MVt_yrGucnDesDwFDfBXhvZCwFRI4b9oUeNHf6w3deSnpDsQObRGijfl0vFEUTxLply1DYp6DWA/s640/repent.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="625" data-original-width="640" height="313" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi02mRBKpAWmTVzT_x6NqkgfsE-9SR0ZESI9RKdxLvKz1zYDx_9tvd5esUQWdd48NxZF5gq3FHiGmafIyzIBzUNgOt3doYnO5e6hX68SHw-MVt_yrGucnDesDwFDfBXhvZCwFRI4b9oUeNHf6w3deSnpDsQObRGijfl0vFEUTxLply1DYp6DWA/s320/repent.jpg" width="320" /></a></div>I am sometimes hesitant to extend my commentary to the academic editorializing that happens in the occupational therapy literature of other countries, but I am unable to remain silent. Too often the ideas expressed elsewhere slither their way into the thinking of academics in the United States.<br /><br />And, of course, any objection to these ideas immediately causes one to be branded xenophobic, and usually worse, so I will simply gird myself for that criticism; I know it is coming. <br /><br />Over time I have raised the issue of international 'goodness of fit' of philosophical constructs - initially in OT24VX presentations. I talked about <a href="https://www.slideshare.net/ChristopherAlterio/occupational-justice-alterio-ot24-vx-final" target="_blank">the incompatibility of 'occupational justice' models</a> in societies that had health systems that had elements of free-market construction as opposed to those that are more fully socialized. For a while I tried to discuss reverse colonialism, thinking that if I spoke the language of those who perceived themselves to be oppressed by Western OT thinking that perhaps they might get the point. Of course, oppressors can never be oppressed or colonized in their model of thinking - so that was not an effective discussion tactic. I also tried to express these ideas in <a href="https://www.amazon.com/Clinically-Oriented-Occupational-Therapy-Christopher-Alterio/dp/1496389530/r" target="_blank">a theory textbook</a>, and I blog about the issue as well - <a href="http://abctherapeutics.blogspot.com/2022/02/the-problems-with-polarity-frames-in.html" target="_blank">even recently</a>. Still, concerns about the adoption of justice frameworks are largely ignored by the academic elite in occupational therapy. These ideas are not entertained in mainstream professional literature - and so are relegated to conferences or blogs. In short, intellectual diversity is not encouraged.<br /><br />Alternate viewpoints are generally not allowed. There is very little intellectual diversity expressed in occupational therapy, mostly because of the bullying tactics that are regularly used by those who seek to 'disrupt' and 'replace' the philosophical core of the profession. Most occupational therapists are simply too afraid to say what I am about to say, but I assure the intellectual elite of the profession that many people disagree with this new philosophical framing. Many people find it to be negative, divisive, and even a misrepresentation of Truth.<br /><br />But the new fascism in occupational therapy persists. The operational definition of <a href="https://www.merriam-webster.com/dictionary/fascism" target="_blank">fascism </a>that I am using is "a tendency toward or actual exercise of strong autocratic or dictatorial control." Accordingly, the First Premise of this movement is "All occupational therapists must hold the worldview and philosophy that they are directed to adopt by the academic elite." This is clear in the recently published agitprop in the Canadian Journal of Occupational Therapy entitled '<a href="https://journals.sagepub.com/doi/full/10.1177/00084174221089708" target="_blank">Unbecoming Change Agents</a>.'<br /><br />There are several assumptions and concepts expressed in this article that are particularly offensive to the New Fascists that in their view need to be eradicated in the field of occupational therapy. First is the abolition of the any interest in the individual - a particularly Western construct that is rooted in Emersonian values of self-reliance. Individualism formed the core philosophy of the occupational therapy profession since its inception and was celebrated and re-affirmed explicitly in the United States in <a href="https://journals.sagepub.com/doi/abs/10.1177/000841746303000102" target="_blank">Mary Reilly's Slagle lecture</a>. I intentionally link the reprint of the article in the Canadian Journal to demonstrate a core tactic of the New Fascists: they will make their sanctioned ideas open-access (like the article 'Unbecoming Change Agents,' but will paywall the ideas of people they oppose (Reilly's Slagle lecture). After all, exerting strong autocratic or dictatorial control must be accomplished in order to prevent the proles from looking up information that is counter to the preferred narratives of the New Fascists. <a href="http://www.telelib.com/authors/O/OrwellGeorge/prose/NineteenEightyFour/part2sec9.html" target="_blank">'Oceania has always been at war with Eastasia!'</a><br /><br />Another important assumption of the New Fascists is that any historical or current oppression or mistreatment of marginalized groups must form the center and core for all subsequent thinking and action - no matter how disconnected the concern may be to a 'therapeutic encounter' in an occupational therapy context. Here I will be criticized roundly for daring to believe that historic sins should not mandate a subsequent frame of 'centering' those that were previously oppressed - no matter how long ago or when it happened or who supported the oppression. We are all still guilty, according to the New Fascists.<br /><br />The required self-flagellation of thought is to recognize that as occupational therapists we all inherently wield power in oppressive ways - just as a function of our core being. To be an occupational therapist is to carry the Original Sin of Oppression. That we even dared to call ourselves 'Change Agents' was a particularly offensive expression of our power. The example given by the New Fascists is that in Canada there was apparently a group of people with the employment title of '<a href="https://www.thecanadianencyclopedia.ca/en/article/indian-agents-in-canada" target="_blank">Indian Agents</a>,' and that we would even use the term 'Agent' in any proximate (???) way is a shameful expression of of our colonial and genocidal tendencies as occupational therapists.<br /><br />Now I don't know about anyone else, but I guess I never thought that I had colonial or genocidal tendencies. I like to think I am a pretty sensitive person who understands a lot of sociocultural and interpersonal dynamics and complexity. But that I won't accept that I am colonially genocidal must be proof that I am not evolved enough, probably. <br /><br />Usually I like new ideas, and I am generally open to them, but this seems a little unhinged to me.<br /><br />Another assumption is that most occupational therapists apparently view themselves as 'saviours' which is reportedly a self-aggrandizing perspective that, of course, strips power away from other people. Reportedly, the 'Saviour Complex' is an integral part of being "Euro-centric, White-centric, ableist, and middle class.' Accordingly, the required self-flagellation is to recognize your evil nature and stop trying to save other people because really all that you are trying to do is reinforce your own power, control other people, and perpetuate injustice.<br /><br />Did you realize that when you were treating your patients that you were really just interested in your own White European Power Trip? I had no idea! To think that my driving focus for the last 35 years has been the oppression of other people and the perpetuation of my own power! <br /><br />The New Fascists are hesitant to introduce new terminology quite yet - we just have to stop being 'Change Agents.' We all need to accept our Original Sin of Oppression, we need to self-flagellate and be 'reflexive' - one of their favorite words - and find some way to 'liberate' those people that we have been 'oppressing' all of these years. And if you object to the language and framing of the New Fascists, that is because you are still on your White European Power Trip. Shame on you!<br /><br />Now rank and file occupational therapists, in my view, should always be sensitive to power differentials and should always advocate for the needs of the people they are serving. In the old days we used to call that Beneficence. That is no longer enough. Now we have replaced Beneficence with Social Justice Activism - and the only acceptable remedy is self-flagellation and reparation by adhering to the philosophy and framing of the New Fascists - who apparently have all found a way to transcend their Original Sin. Please pay your membership fees to their club so you can be fed a steady stream of propaganda about how the rest of us are miserable and oppressive human beings. Read about it in their sanctioned journals, swallow it whole in their updated Competencies or Practice Frameworks. Maybe one day you will be able to write a textbook and be as enlightened as they are!<br /><br />There will be no room for dissent! Disagree and be exiled - and labeled every negative term that the New Fascists can throw in your direction. 'Pick the target, freeze it, personalize it, and polarize it.' <br /><br />+++<br /><br />I entered this field 35 years ago and there was a classic student interview question that was asked of all of us: 'Why do you want to be an occupational therapist?' Most students had a rather de facto response that went something like 'Because I want to help people. Occupational therapy is a field where I can be creative, and caring, and responsive, and if good fortune abounds, maybe I can make a difference to someone else who needs help.'<br /><br />What a negative and oppressive White European Power Trip we have all been on, and we never realized it.<br /><br />Thank God for the New Fascists, who are liberating us all.<p></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-79867614840601313612022-02-28T13:22:00.001-05:002022-02-28T17:11:01.795-05:00The problems with polarity frames in occupational therapy theory<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEhuV77l22vhxuKELDSXMjPGpQv0MaQKSqmiU56IZBWmuES8frHnQ4ZAUufApz1yFPOkvzFtWY1C-gu1_K9LutlMuJXLBl2lKumQZm-PvVcxThESTowsnbKXo9yzaRmgQR4tNg1OfR0KBJw7j91o6Xq3QpxmHsrJPhkDex1_9mOr_gb9V_p7jGw=s1102" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1101" data-original-width="1102" height="320" src="https://blogger.googleusercontent.com/img/a/AVvXsEhuV77l22vhxuKELDSXMjPGpQv0MaQKSqmiU56IZBWmuES8frHnQ4ZAUufApz1yFPOkvzFtWY1C-gu1_K9LutlMuJXLBl2lKumQZm-PvVcxThESTowsnbKXo9yzaRmgQR4tNg1OfR0KBJw7j91o6Xq3QpxmHsrJPhkDex1_9mOr_gb9V_p7jGw=s320" width="320" /></a></div><br />There is nothing quite like starting off a Monday morning with a good theory article. I opened up my Twitter feed to find a link to Taff & Putnam's contribution entitled "Northern philosophies and professional neocolonialism in occupational therapy: A historical review and critique."<p></p><p>The authors "suggest with confidence that the current American philosophical landscape in 2021 is a mix of mostly analytic philosophy accompanied by a smaller measure of neopragmatism predisposed to a Continental mindset." (Taff & Putnam, 2022). I am uncertain if this is a view shared by all, and to any degree that it is true, this perspective does not respect an entire heritage of thinking that has been adopted into the American perspective generally and by occupational therapy practitioners specifically.<br /><br />The fact
that many occupational therapy practitioners in the United States continue to frame their practice around core American values is a topic that is important to explore. Claiming that a paradigm change is needed to address extra-contextual beliefs represents the logical fallacy of begging a question. Is it possible that there is no paradigm crisis, at least from the perspective of American occupational therapy practitioners? Change can be interpreted as problematic or evolutionary, depending on perspective. Paradigms change over time to reflect new theories. However, when new theories disrupt everything that is previously known or are
inconsistent with practice this represents a paradigm crisis. Therefore, the term 'colonial' has to be approached cautiously and it has to be appreciated in a contextual manner. What exactly is 'colonial' about a perspective that is being practiced in a 'home' context? And what would the possible interest be in de-constructing that perspective that was designed for that context? <br /><br />Perhaps the most important question - who is the audience for an article in a journal in an Internet/global context? I am responding as an American occupational therapy practitioner.</p><p>What constitutes the ordinary meaning of occupational therapy for practitioners in the United States? The answer to that question depends on whether or not the American context of the founding of the occupational therapy profession is primarily considered. To use an ‘older’ reference that reflects occupational therapy heritage, perhaps critiques about American paradigms have not always remembered to pass that entire weft of American history through the warp of our current model and theory development. This dynamic has implications for the practice of the profession in the United States. It is interesting to propose de-colonization, and that may be helpful for some contexts, but is it helpful for American practice where the concepts are being applied within those systems?</p><p>That occupational therapy in the United States adopted reductionistic models in its Second Paradigm is not being debated. However, it was Mary Reilly's work along with her graduate students in the 1960s and 1970s, leading to Kielhofner's Model of Human Occupation, that rejected monolithic pragmatism and instead encouraged what is commonly referred to as Reilly's 'Not Only, But Also' (NOBA) approach (Alterio, 2019, p.80). That approach was designed to respect the scientific advances of the 21st Century, but to also recognize the need to consider human agency (occupation) and its association with the values of the Arts and Crafts Movement (aesthetics, beauty, design, meaning, and purpose). Reilly proposed episteme and techne - and I am confused about why that is so frequently skipped over in these analyses. Truth and Knowledge should not be set in a zero-sum polarity - that is against American occupational therapy philosophy at its core - a philosophy that has always valued 'knowing that' as well as 'knowing how.' Ironically, occupational therapy practitioners often re-label that approach as 'pragmatic' or as 'making sense!' What would Heidegger say of this 'sense-making!'</p><p><o:p></o:p></p><p>Still, does a dominant model of traditional pragmatism persist in Northern/Western practice - of course. Reimbursement systems remain oriented around that perspective, and one can make an argument that this creates problems even for practice within the United States. However, there is ample space for other ways of knowing and they certainly do <i>flourish </i>(Clark, 1993). To any degree that they don't, one might point directly at the Academy that is more concerned about colonialism than others who are practicing the profession daily. After all, the members of the Academy are the ones who control the profession's Northern/Western literature and journals. So, if perspectives or approaches are not being promoted - I say 'cura te ipsum!' I don't see much of that in the high-impact-factor journals though, and so authors have to publish in Southern journals, or write blogs, I suppose.</p><p>I believe that the error in the authors' approach is twofold. First, by labeling the an American approach as 'colonial' implies an intent that I don't believe exists, for the most part. The criticism is not new - and it was started by Mocellin (1992, 1995, 1996) - but the problem with the criticism is that there is no acknowledgement that Northern/Western occupational therapy constructs were explicitly designed for the American context - so much so that Reilly even said that in her Slagle lecture (Reilly, 1962). The piling on over time (Iwama, 2006; Hammell, 2009, 2011; many others - and now Taff & Putnam, 2022) assumes colonial intent. I have argued that occupational therapy may not be a profession that easily bridges socio-political contexts (Alterio, 2019, p. 192). Reilly explicitly said that occupational therapy was an American hypothesis - why do so many theoreticians just gloss over that?<br /><br />Admittedly, there has been some intentional colonialism (described by Bowyer et al, 2008) and in general I think that was a bad idea. I am unaware of any existent pressure on international colleagues to adopt American textbooks, and if no other textbooks are available then they could be written - or even open-sourced. Then those international contexts could define practice in terms that are locally and contextually relevant - and if it turns out that the totality of occupational therapy practice does not appear unitary, or at least have enough common elements to be recognizable between localities, then I suppose we have an important conversation to engage.<br /><br />I understand the pressure on Northern and Western authors though. I was told by a publisher to make my textbook internationally contextual, so that people would buy it globally. Privately, I thought that was a ridiculous request - but that is because I happen to have a deep understanding of the problems of what is perceived as and called "colonialism." Accordingly, I wrote my book the way I wanted, and inserted a chapter on globalization that called out the problem. </p><p>The second error of the authors is that using terms like 'neoliberal' inserts a political motivation that I also don't believe exists and may be unnecessary and divisive. I am uncertain if the term is designed to be a slur or a descriptor based on the venom that often seems to accompany its use. Here we enter into a world of capitalistic-critique and get far afield of our purpose. I just don't see this as a productive conversation. Calling American practice neoliberal is like getting angry at the black cat for being black and a cat. Is all of medicine in the United States oriented around insurance systems that some love (to hate)? Of course, and if we deconstruct that system, or de-tangle from it, what are we expecting American students to do - practice in another country? There is nothing pragmatic in such an argument, but here I go using the 'P' word again.<br /><br />I don't know of any American students (medical, allied health, etc) or practitioners who are unable to understand determinants of health and that care systems need to be constructed in ways that meet the needs of all who seek care. Is the American system perfect - no - and I don't see any model systems in other contexts either. So what is the point of the argument?<br /><br />This is another opportunity to teach American students about our history - and the value of charity - and how that value informed the American founding. We do not all need to adopt social justice (redistributive) political models to function as care providers, and if the 'neoliberal' or 'capitalistic' health care system of the United States does not reflect the reality of how systems work in other contexts - then again, others should feel free to practice in accordance with their own context. I believe the common parlance among American students, who seem to understand that you should not force values down each other's throats, is 'You Do You.'<br /><br />The framing of 'colonial' and 'neoliberal' intent creates a false polarity for the occupational therapy profession that I don't believe is helpful and in fact I don't think it is particularly accurate. Emerson & Lewis (2019) wrote an interesting book about the abolition of 'either/or' thinking - and in this context I would call the assumption of 'Northern/Western neoliberal colonial intent' a shining example of what these authors suggest avoiding. Again, the core message of Reilly's Third Paradigm resolution was NOBA - not only but also. Techne and episteme. Knowing how and knowing that. On and on. Kielhofner provided roadmap with the contextual application of GST and heterarchical thinking so we wouldn't leave out important understandings. If we go back and review all of this we may find that creating false polarities is not really needed, or particularly helpful.<br /><br /></p><p class="MsoNormal">References/Additional Reading:<br /><br />Alterio, C.J. (2019). Clinically oriented theory for
occupational therapy, Wolters Kluwer.<br />
<br />
Bowyer, P., Belanger, R., Briand, C., de las Heras, C. G., Kinebanian, A.,
Launiainen, H., Marcoux, C., Mentrup, C., Morel-Bracq, M.C., Nakamura-Thomas,
H., Pan, A.W., Tigchelaar, E., Yamada, T., Ziv, N., & Kielhofner, G.
(2008). International efforts to disseminate and develop the Model of
Human Occupation. Occupational Therapy in Health Care, (22), 1-24. <br />
<br />Clark, F. (1993). Occupation embedded in real life: Interweaving occupational science and occupational therapy. American Journal of Occupational Therapy, 47, 1067-1078.<br /><br />Emerson, B. & Lewis, K. (2019). Navigating polarities. Paradoxical Press.</p><p class="MsoNormal">
Hammell, K.W. (2009). Sacred texts: A sceptical exploration of the assumptions
underpinning theories of occupation. Canadian Journal of Occupational Therapy,
76(1), 6-13. <o:p></o:p></p><p class="MsoNormal">Hammell, K.W. (2011). Resisting theoretical imperialism in
the disciplines of occupational science and occupational therapy. British
Journal of Occupational Therapy, 74(1), 27-33. <o:p></o:p></p><p class="MsoNormal">Iwama, M. (2013 June 18). Open Plenary Speech to the College
of Occupational Therapists Annual Conference 2013. [Video File] Retrieved
from https://www.youtube.com/watch?v=67PqinQ7qNM <br /><br />Kielhofner, G. (1978). General systems theory: Implications for theory and action in occupational therapy. American Journal of Occupational Therapy, 32, 637-645.<br />
<br />
Mocellin, G. (1992). An overview of occupational therapy in the context of the
American influence on the profession, Parts 1 &2, British Journal of
Occupational Therapy, 55(1), 7-12; 55(2), 55-60. <o:p></o:p></p><p class="MsoNormal">Mocellin, G. (1995). Occupational therapy: A critical
overview, Part 1. British Journal of Occupational Therapy, 58(12), 502-506. <o:p></o:p></p><p class="MsoNormal">Mocellin, G. (1996). Occupational therapy: A critical
overview, Part 2. British Journal of Occupational Therapy, 59(1), 11-16. <o:p></o:p></p><p class="MsoNormal">Reilly, M. (1962). Occupational therapy can be one of
the great ideas of 20th Century medicine. American Journal of Occupational
Therapy, 16, 2-9. <o:p></o:p></p><p class="MsoNormal">Taff, S.D. & Putnam, L. (2022). Northern philosophies
and professional neocolonialism in occupational therapy: A historical review
and critique. Brazilian Journal of Occupational Therapy, 30, e2986.<o:p></o:p></p><p>
<br /><br /></p><p>
</p><p class="MsoNormal"><o:p> </o:p></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-90218393437147569242021-11-13T10:30:00.000-05:002021-11-13T10:30:23.607-05:00When occupational therapy and public health collide<p> Presented at NYSOTA's Annual Conference. 11/13/21</p><p>Thanks for stopping by to look at my slides!<br /><br /><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg-KDp-q1l7nCm4e8_YnvRJ7w9nx3l4DB3IRk_Fd8zJReuYFMmUDRcV0NVuuapPl8eNJ6rRHN7fMObnRn9frcoi73P_TFqU0nsM965HsYUqXp6obuqbYFrrbk5lYWJPYvxe5y2ZA/s960/Title+slide.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgg-KDp-q1l7nCm4e8_YnvRJ7w9nx3l4DB3IRk_Fd8zJReuYFMmUDRcV0NVuuapPl8eNJ6rRHN7fMObnRn9frcoi73P_TFqU0nsM965HsYUqXp6obuqbYFrrbk5lYWJPYvxe5y2ZA/s320/Title+slide.jpg" width="320" /></a></div><br /><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><a href="https://drive.google.com/file/d/1zAH6fEFKtNQqL5hInGynOg_H6ybm-4Jf/view?usp=sharing" target="_blank">Click here for slides!</a></div>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-6789739548476566752021-06-24T16:07:00.000-04:002021-06-24T16:07:27.579-04:00Will the occupational therapy Academic Leadership Council stand up to the accreditation function of its own organization?<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0baat9MRGWzzaH57VMg2GBGXuMAa0hbQJelpd5stkARTRrmrqwM_ifo9KyGCi9SPFeFSWcILEfAJzXMrlNHDhQPi1dQUxGxdaUVHu1HkymOQRjQtrYJk2bSg0WC34YhHU6nagzw/s1280/chain-297842_1280.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0baat9MRGWzzaH57VMg2GBGXuMAa0hbQJelpd5stkARTRrmrqwM_ifo9KyGCi9SPFeFSWcILEfAJzXMrlNHDhQPi1dQUxGxdaUVHu1HkymOQRjQtrYJk2bSg0WC34YhHU6nagzw/s320/chain-297842_1280.png" width="320" /></a></div>The <a href="http://acapt.org/" target="_blank">American Council of Academic Physical Therapy (ACAPT)</a> recently published a paper entitled "Future of physical therapist education programs in higher education." This paper should be mandatory reading for anyone interested in the proliferation of some allied health programs, credential escalation, and the intersection of these issues with practice.<br /><br />For starters, it is important to disambiguate ACAPT from <a href="https://www.capteonline.org/" target="_blank">CAPTE (Commission on Accreditation in Physical Therapy Education)</a>. CAPTE grants accreditation to entry level programs for the physical therapy profession, and although 'independent' is also a part of the <a href="https://www.apta.org/" target="_blank">American Physical Therapy Association (APTA)</a>. ACAPT is a membership association of physical therapy educational programs and their educators. ACAPT is also an offshoot of the APTA. This complex relationship makes the ACAPT position statement rather interesting.<br /><br />The <a href="https://acapt.org/docs/default-source/public-docs/university-leadership-letter-2020.pdf?sfvrsn=cdd38fd8_2" target="_blank">ACAPT paper</a> identifies a few key points:<br /><br />1. There are more PT programs being developed and class sizes are increasing while reimbursements are decreasing<p></p><p>2. Actual PT employment is not likely to match BLS projections and continued expansion of programs is likely to be detrimental</p><p>3. Increased student debt has outpaced salary growth</p><p>4. There is a nationwide shortage of qualified PT faculty</p><p>5. There is increased competition for clinical education sites</p><p>And then the culminating statement, <b>"In light of these issues, we urge higher education institutions to consider this changing landscape before adding new physical therapist education programs, expanding current class sizes, or increasing tuition."</b><br /><br /><b>+++</b><br /><br />Readers here will undoubtedly see the parallels between the statement in this paper and the arguments presented in opposition to the mandatory entry level doctorate for occupational therapy. There is also direct relation to information I have presented over the past year as it relates to the state of strain in clinical fieldwork sites (also exacerbated by COVID-19) - see <a href="http://abctherapeutics.blogspot.com/2020/04/immediate-action-is-required-to-address.html" target="_blank">HERE </a>and <a href="http://abctherapeutics.blogspot.com/2021/06/in-search-of-evidence-based-approach-to.html" target="_blank">HERE</a>.<br /><br />What is interesting for the occupational therapy community is that apparently our colleagues at APTA are more willing to consider internal voices that represent viewpoint diversity. At any time that occupational therapy leadership is presented with the topic of possibly discussing the problems of over-proliferation of sites, or the problems with escalating credential requirements - the field is told that it is not allowed to 'meddle' in the free market and restrict the trade of developing programs. Alternate perspectives on this matter have been brought up many times, with little impact. There has been a call for <a href="http://abctherapeutics.blogspot.com/2020/02/on-so-called-civility-pledges-and.html" target="_blank">viewpoint diversity within the occupational therapy community</a> for many years, and it has largely been ignored.<br /><br />And yet here we have a similarly internally-conflicted APTA with its membership and educational constituencies at seeming odds with its accreditation function, and yet they feel free to write a paper expressing concern about the state of affairs.<br /><br />The only way that the occupational therapy field has had to influence the system is from grassroots effort OUTSIDE of the membership association - via the OTD Mandate - Uncertain Future Facebook group and its affiliated efforts. The motion that passed the Representative Assembly to promote dual levels of entry would never have happened without that grassroots effort.<br /><br />So what is different in APTA, that its academic members feel liberated enough to write such a position paper - and yet we don't see that in AOTA? Certainly the concerns are parallel, if not identical.<br /><br />I encourage the Academic Leadership Council of the AOTA to take this issue up, and consider drafting a similar letter to the OT community.</p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-80160259215925281442021-06-03T00:17:00.000-04:002021-06-03T00:17:36.347-04:00In search of an evidence-based approach to occupational therapy practice education that would include simulation experiences<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIhR4sqITy332VyqqPk4v4sFGyWJuuaqM8ScaEmKTLOOIFKnjDn-39X7xKg1COHOHTuUIzwbw98HyXOnYPXf4qApKNnre2rbFmJwaQShAycusICulr6-ZmYBbLhya9XNvu0ViGPA/s759/matrix-keanue-reeves-759.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="422" data-original-width="759" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIhR4sqITy332VyqqPk4v4sFGyWJuuaqM8ScaEmKTLOOIFKnjDn-39X7xKg1COHOHTuUIzwbw98HyXOnYPXf4qApKNnre2rbFmJwaQShAycusICulr6-ZmYBbLhya9XNvu0ViGPA/s320/matrix-keanue-reeves-759.jpg" width="320" /></a></div>Simulation is a methodology used to replicate real-world tasks. Simulation provides experiences that lead to direct learning or that can be used as an assessment of competence. Such tasks have been used as a primary tactic in occupational therapy and other rehabilitation services since their inception - although they were generally applied in a therapeutic context. For example, an individual would learn how to dress themselves out of context to develop skill, and then that skill would be transferred to contextual learning. Sometimes, more esoterically, a simulated activity broken down into components would be used to practice parts of tasks that would then be scaffolded in a total practice method. Either way, simulated experiences are a staple methodology used by occupational therapy professionals for many years.<p></p><p>Over time, preferences emerged for 'real-world' and 'contextually-relevant' experience - so much so that entire service delivery systems incorporated 'natural environments' as it was believed that this would help in the transfer of learning. To the degree that completely 'natural environments' were not always available or perhaps had barriers themselves, incorporating contextually meaningful elements into simulation experiences became a staple of rehabilitation and habilitation approaches.</p><p>It is interesting that rehabilitation fields like occupational therapy that employ simulated learning experiences as their primary therapeutic methods have been slow to fully explore applying those same methods to the clinical training of its own workforce. Simulation is heavily used as a pedagogy in the classroom. Regularly, occupational therapy students complete mock evaluations on their classmates, practicing goniometry or muscle testing or transfers or interviewing skills. Even complex skills like splinting are practiced on healthy peers in laboratory contexts - a full simulation of what that experience might be like in a natural clinical setting. Although now moderately controversial, 'simulated' disability experiences are still used regularly as an educational method. Those same methods of simulation are also employed in other empathy games - again somewhat controversially - but with widespread use.</p><p>Fieldwork education, or what I suggest should instead be called 'practice education,' remains mired in a very antiquated model that is more process-oriented than outcomes-oriented. As a result, it is common for accreditation functions and state licensing to require prescribed experiences that are not evidence based. For example, occupational therapy students must complete 24 weeks of on-site clinical training and there is no evidence that supports that such training has to be either 24 weeks long or completed on-site. Therefore the emphasis remains on the process and not on the outcomes. <br /><br />A more correctly designed approach would identify skills and tasks that require competence, and then measure students abilities to complete those tasks with the requisite skill and proficiency. Randomly designated timeframes in natural contexts does not guarantee competence with any skill - something that occupational therapists already know. Occupational therapy practitioners would never apply such a teaching strategy in their own therapy, yet they apply those teaching strategies on their own students.</p><p>So, simulation as applied therapeutically can also be applied in education for both skill development as well as assessment, but the occupational therapy field has been slow to apply this knowledge in education. In 2012 the National Board for Certification in Occupational Therapy began looking at simulation and 'serious gaming' as an assessment and competence-building methodology that could be applied to certification renewal (McNamara, Bent, & Grace, 2019). I participated on the Board at that time and I recall how radical an idea this was - but in listening to the gaming and simulation applications that were already well-developed in military contexts it became evident that there were application opportunities to occupational therapy. The Navigator product was launched in 2015 and included simulated learning and assessment activities that could be used for professional development and competency assessment. I spent eight years working on that project, developing simulation experiences and helping to create this unique suite of products for the occupational therapy profession. It remains a groundbreaking exemplar in professional development and competency assessment among health professions, winning several awards and now being accepted by over 43 states for occupational therapy licensing renewal (Bent, Carroll, & Grace, 2020; Myers, 2019).</p><p>Medicine and nursing fields have studied simulation education and studies consistently demonstrate the effectiveness of these methods (Alexander, et al., 2015; McGaghie, et al, 2011). There is reason to believe that these same findings will apply to other health care disciplines. Since the release of the Navigator product, occupational therapists have begun to explore and document the use of simulation experiences in their pedagogy. Shea (2015) described the intentional inclusion of high-fidelity simulation experiences in an occupational therapy curriculum, including aforementioned patient interviews, physical assessment techniques, and simulated case studies.</p><p>Imms, et al (2018) conducted an RCT comparing simulated clinical placement with traditional clinical placement and found that there were no significant differences between the groups related to learning outcomes. The authors identify that in Australia up to 20% of all clinical placement hours can be completed by simulation training. During the COVID-19 pandemic context the Accreditation Council for Occupational Therapy Education gave allowance for Level I fieldwork experiences to be completed with simulation methods. However, they also clarified that simulation could not be used for any part of Level II fieldwork. The primary reason for this, as identified above, is the process-oriented methodology that is hard-coded into both the accreditation standards and in many state licensing laws. (ACOTE, 2020).<br /><br /><a href="https://www.nysenate.gov/legislation/bills/2021/A7767" target="_blank">New York State is considering a bill</a> that would allow up to 30% of all clinical training to be completed in a simulation context - and this effort is supported by nursing, occupational therapy, physical therapy, and a number of other professions. The bill was drafted by a working group of educators who were concerned about the constriction of clinical training opportunities during the pandemic, and has been championed by the <a href="https://cicu.org/" target="_blank">Commision on Independent Colleges and Universities in New York</a>. It is unlikely to pass through the Higher Education committee as it is rather late in the legislative session, but it is something that all health care professionals in NY and elsewhere should be attending to. Accreditation and licensing requirements remain process-oriented, but this kind of bill would be an important first step in breaking away to a more modern and evidence-based approach to practice education.<br /><br /><br /></p><p><br /></p><p>References:<br /><br />ACOTE (2020, April 21). COVID Update 4-14-20. https://acoteonline.org/covid19-update-4-14-20/<br /><br />Alexander, M. et al (2015). NCBSN simulation guidelines for prelicensure nursing programs. Journal of Nursing Regulation, 6(3), 39-42.</p><p>Bent, M., Carroll, S., & Grace, P. (2020). One organization's journey to implement an innovative competency assessment platform: The NBCOT Navigator five years on. Clear Exam Review, 30(2), 24-34.<br /><br />Imms, et al (2018). Simulated versus traditional occupational therapy placements: A randomized controlled trial. Australian Journal of Occupational Therapy, 65(6), 556-564.<br /><br />McGaghie, W.C., et al (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706-711.<br /><br />McNamara, J. Bent, M., & Grace, P. (2019). Using applied game and simulation technologies to support continued practice competency: A case study. Journal of Applied Testing Technology, 20(S1), 69-77.<br /><br />Myers, C. (2019). Occupational therapists perceptions of online competence assessment and evidence-based resources. American Journal of Occupational Therapy, 73(2), 1-8.</p><p><br /></p><p><br /></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-55082365910200579862021-01-10T13:02:00.001-05:002021-01-10T13:02:10.128-05:00Best practices for successful OT/OTA partnerships in NYS<p> <span style="background-color: white; color: #757575; font-family: Roboto, sans-serif; font-size: 15px;">Presented at NYSOTA's Dessert & Dialogue Continuing Education Series, January 5, 2021. </span></p><span style="background-color: white; color: #757575; font-family: Roboto, sans-serif; font-size: 15px;">Thanks for stopping by to look at our slides!<br /><br /><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpEa88KweQHaYTxtifRSjuEfw-yAz5GqCl3rp1GGLchppa0_smx_PCs-MR6XhPXSLmMv7rjK8SSebr6IJu7qLlzQcGTm3tmRHJLgNzKHkIs6lpETCuB-TRr90HjkobZjx8IE5HVw/s960/ot+ota+title+slide.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpEa88KweQHaYTxtifRSjuEfw-yAz5GqCl3rp1GGLchppa0_smx_PCs-MR6XhPXSLmMv7rjK8SSebr6IJu7qLlzQcGTm3tmRHJLgNzKHkIs6lpETCuB-TRr90HjkobZjx8IE5HVw/w320-h240/ot+ota+title+slide.jpg" width="320" /></a></div><br /><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><a href="https://drive.google.com/file/d/1gHtJfW0IqeOSLc5_gr6gMJiFioxLmfYe/view" target="_blank">Click here for slides!</a></div>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-79952115674843830062021-01-04T17:45:00.001-05:002021-01-04T17:48:42.673-05:002020 Year in Review: nOT so bad!<p> <b><u><span style="font-size: medium;">2020 – An eventful year – pedagogy in a pandemic!</span></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>
<br />
Celebrating 33 years of certification as an occupational therapist!</u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN4NHXeXHTmrgvnDzfGZE9HloRDhqRXg7GGKumkyeXjz1GjJbfXJpkCCJI7TiUB5E0umdRh6XYQ_zibCHjwASWJQfLRaQ33L7FwOCuTJaDm-E76K2LFg-xTet9pS954Scw1vVkiw/s561/33+years.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="561" data-original-width="421" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN4NHXeXHTmrgvnDzfGZE9HloRDhqRXg7GGKumkyeXjz1GjJbfXJpkCCJI7TiUB5E0umdRh6XYQ_zibCHjwASWJQfLRaQ33L7FwOCuTJaDm-E76K2LFg-xTet9pS954Scw1vVkiw/s320/33+years.jpg" /></a></b></div><b><br /><u><br /></u></b><p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>A trip to Florida to present on ‘qualitative data sources for narrative
analysis’<o:p></o:p></u></b></p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_ijxi9XGmubV2DMnZAPQiB_4jeQCtJjHi_oQA1RlWCRSiNm9tnPJerVJuLDssKkAmjmrKrAxna6bhZZMOaQRU4JGVPgC_R1F_cpRJyvEeqg_llPoaYK_pK04Ojx-Jv931hJ4RyA/s640/IMG_0826.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_ijxi9XGmubV2DMnZAPQiB_4jeQCtJjHi_oQA1RlWCRSiNm9tnPJerVJuLDssKkAmjmrKrAxna6bhZZMOaQRU4JGVPgC_R1F_cpRJyvEeqg_llPoaYK_pK04Ojx-Jv931hJ4RyA/s320/IMG_0826.jpg" /></a></div><br /><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><br /></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><a href="https://nsuworks.nova.edu/tqrc/eleventh/day1/42/" target="_blank">https://nsuworks.nova.edu/tqrc/eleventh/day1/42/</a></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: left;">(last time I have traveled out of New York State)</p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>
Final photo of me as I left the college in the Spring 2020, optimistic for a
quick return!<o:p></o:p></u></b></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b></b></p><div class="separator" style="clear: both; text-align: center;"><b><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNaSUWUTMEs-KEgK8LoBvaJQYbRzxjMXKKxqoZIOims8jJZAhaO-FALVPkJ5Dfnw8_6C7lCrInzv9WOiJS4YiJMYePn4Cd-ef92JcGUrUBvHSsRivKslHFobo271EkEYuVKJQ2Mw/s640/IMG_0975+%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="188" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNaSUWUTMEs-KEgK8LoBvaJQYbRzxjMXKKxqoZIOims8jJZAhaO-FALVPkJ5Dfnw8_6C7lCrInzv9WOiJS4YiJMYePn4Cd-ef92JcGUrUBvHSsRivKslHFobo271EkEYuVKJQ2Mw/s320/IMG_0975+%25281%2529.jpg" width="320" /></a></b></div><b><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKXW0GNeMYXduUb0ZZ6KF57aZpypAFojGadLOg5N-4mYHmklbUaZAMp2sRVQPWeJqSlnlpalkZJYkcsxfVGNQgVrYWm9LHhbZbc3wJmUF8od_M1x5kCVELKuhivZccLODnZLyZLg/s640/IMG_1004+%25281%2529.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKXW0GNeMYXduUb0ZZ6KF57aZpypAFojGadLOg5N-4mYHmklbUaZAMp2sRVQPWeJqSlnlpalkZJYkcsxfVGNQgVrYWm9LHhbZbc3wJmUF8od_M1x5kCVELKuhivZccLODnZLyZLg/s320/IMG_1004+%25281%2529.jpg" /></a></div><br /><u><br /></u></b><br /><p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>Sample 2020 Blog posts</u></b>:</p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;">
<br />
Alterio, C.J. (2020, January 27). On so-called ‘Civility Pledges’ and the
abolition of free thought and free speech.<span style="mso-spacerun: yes;">
</span><i>ABC Therapeutics Blog</i>, <a href="http://abctherapeutics.blogspot.com/2020/02/on-so-called-civility-pledges-and.html" target="_blank">http://abctherapeutics.blogspot.com/2020/02/on-so-called-civility-pledges-and.html</a></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Alterio, C.J. (2020, March 17). Synchronous vs. asynchronous
content delivery in context of COVID-19.<span style="mso-spacerun: yes;">
</span><i>ABC Therapeutics Blog</i>, <a href="http://abctherapeutics.blogspot.com/2020/03/synchronous-vs-asynchronous-content.html" target="_blank">http://abctherapeutics.blogspot.com/2020/03/synchronous-vs-asynchronous-content.html</a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Alterio, C.J. (2020, April 12). Immediate action is required
to address the crisis in occupational therapy fieldwork education caused by the
COVID-19 pandemic.<span style="mso-spacerun: yes;"> </span><i>ABC Therapeutics
Blog</i>, <a href="http://abctherapeutics.blogspot.com/2020/04/immediate-action-is-required-to-address.html" target="_blank">http://abctherapeutics.blogspot.com/2020/04/immediate-action-is-required-to-address.html</a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;">Alterio, C.J. (2020, September 17). A critique of the concept of
‘occupational rights’ on Constitution Day 2020.<span style="mso-spacerun: yes;">
</span>ABC Therapeutics Blog,<a href="http://abctherapeutics.blogspot.com/2020/09/a-critique-of-concept-of-occupational.html" target="_blank">http://abctherapeutics.blogspot.com/2020/09/a-critique-of-concept-of-occupational.html</a></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p>
<p class="MsoNormal"><b><u>Initial invitation to present in an online context</u></b>: </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiATAPz198bq_FS8acXindQCbMgs-q1YB136hYK3A4jt1jYSSzI7S0uHlWFr1HR12225UxkmhqJPYDZGWnlp01gQLKEcZeQx8tj72tyzVXoAxUaEKdknsqFkpk3fyFwH_OsokQV2A/s2001/Otalk2us+OTMonth.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1125" data-original-width="2001" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiATAPz198bq_FS8acXindQCbMgs-q1YB136hYK3A4jt1jYSSzI7S0uHlWFr1HR12225UxkmhqJPYDZGWnlp01gQLKEcZeQx8tj72tyzVXoAxUaEKdknsqFkpk3fyFwH_OsokQV2A/s320/Otalk2us+OTMonth.jpg" width="320" /></a></div><br /><p></p>
<p class="MsoNormal"><b><u><br /></u></b></p><p class="MsoNormal"><b><u><br /></u></b></p><p class="MsoNormal"><b><u><br /></u></b></p><p class="MsoNormal"><b><u><br /></u></b></p><p class="MsoNormal"><b><u><br /></u></b></p><p class="MsoNormal"><b><u>Media recognition for Community Health and Wellness
degree</u></b>:</p><p class="MsoNormal"><o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;">Fingerlakes1.com (2020, April 23). Keuka College, FLCC join forces to
increase areas medical professionals.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><a href="https://fingerlakes1.com/2020/04/23/keuka-college-flcc-join-forces-to-increase-areas-medical-professionals/" target="_blank">https://fingerlakes1.com/2020/04/23/keuka-college-flcc-join-forces-to-increase-areas-medical-professionals/</a><o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>Media recognition for Reopening taskforce work</u></b>:</p><p class="MsoNormal">
<br />
Finger Lakes Times (2020, August 28). Keuka College celebrates ‘Community Day’ <a href="https://www.fltimes.com/news/keuka-college-celebrates-community-day/article_385dec42-3e9f-586e-9217-9467ffef8181.html" target="_blank">https://www.fltimes.com/news/keuka-college-celebrates-community-day/article_385dec42-3e9f-586e-9217-9467ffef8181.html</a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p> </p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>Keuka College recognition for Reopening taskforce work</u></b>:<o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKi1Yw9Io3iDmylE5Ta-r7NyOEp1Z_08-peWb_on6-t31kBrNToMnvllgGdsDKgDBhWTvdhCij8dfDdGDFAGAdEP-v5wr-o2LQey-Q92154so1nrRs7yYGtmgzfPXYyesZAbDRSg/s640/61955645368__A627CDC0-7CAF-49BD-8092-2A4DDAE75A0C.JPG" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="640" data-original-width="480" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKi1Yw9Io3iDmylE5Ta-r7NyOEp1Z_08-peWb_on6-t31kBrNToMnvllgGdsDKgDBhWTvdhCij8dfDdGDFAGAdEP-v5wr-o2LQey-Q92154so1nrRs7yYGtmgzfPXYyesZAbDRSg/s320/61955645368__A627CDC0-7CAF-49BD-8092-2A4DDAE75A0C.JPG" /></a></div><br /><p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>Press that I wish didn’t happen:</u></b></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;">The Chronicle Express (2020, October 15). Keuka College temporarily
closing campus operations. <a href="https://www.chronicle-express.com/story/news/2020/10/15/keuka-college-temporarily-closing-campus-operations/3667696001/" target="_blank">https://www.chronicle-express.com/story/news/2020/10/15/keuka-college-temporarily-closing-campus-operations/3667696001/</a><o:p></o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>More peer reviewed and invited presentations are delivered in a virtual
context…</u></b></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgoUCUMBNXBgSAxD7obPmxGxRS3WOyubIXK1ATuxDx8vXxqfU6bYelXCmZnDlxkPNVJ-HxzhMgVnUIJIsRaUaTWqj80DbRM6KX24Rk5MXO8k2JOJr8BzqjnZNqeegznM9yEti-xg/s793/OT+and+OTA+partnership.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="793" data-original-width="454" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgoUCUMBNXBgSAxD7obPmxGxRS3WOyubIXK1ATuxDx8vXxqfU6bYelXCmZnDlxkPNVJ-HxzhMgVnUIJIsRaUaTWqj80DbRM6KX24Rk5MXO8k2JOJr8BzqjnZNqeegznM9yEti-xg/s320/OT+and+OTA+partnership.jpg" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJVkMn721N-guoOvvqlAK4zHwuAm2Iaqn4qrZf2TJVJICfhqBHcYe-yQbEkxWjAHaXD_wzBdHhLlaJraQ2NYl1JnmJIomMmi0EuD6ni4j3XIg4f_GhD5H9FcEJ1kKuPitUCvUOmA/s1024/nysota+viewpoint.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="925" data-original-width="1024" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJVkMn721N-guoOvvqlAK4zHwuAm2Iaqn4qrZf2TJVJICfhqBHcYe-yQbEkxWjAHaXD_wzBdHhLlaJraQ2NYl1JnmJIomMmi0EuD6ni4j3XIg4f_GhD5H9FcEJ1kKuPitUCvUOmA/s320/nysota+viewpoint.jpg" width="320" /></a></div><br /><p></p>
<br />
<br />
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>Good news!<br style="mso-special-character: line-break;" />
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<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u><br /></u></b></p><p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>2020 silver lining – working from home all year with a toddler
and preschooler underfoot – <o:p></o:p></u></b></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><b><u>good excuse for getting to break up the day with so many walks with grandchildren!<o:p></o:p></u></b></p>
<p class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><o:p> </o:p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2IZ0eRn1H2_YtvMXCoxQwMj7iAOyndlL4368c6iHLLH7a6nND4MOOWhNOFUeO_3QuvPv_AZewVW4oJBAl8htGhqrK_wO0eTV2y7TTdfRrOT8utm1fLzd8u_r21UBvE-85Dv2g_g/s418/silver+lining.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="418" data-original-width="415" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2IZ0eRn1H2_YtvMXCoxQwMj7iAOyndlL4368c6iHLLH7a6nND4MOOWhNOFUeO_3QuvPv_AZewVW4oJBAl8htGhqrK_wO0eTV2y7TTdfRrOT8utm1fLzd8u_r21UBvE-85Dv2g_g/s320/silver+lining.jpg" /></a></div><br /><p></p>
<br /><br />Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-58661453182162726992020-09-17T14:17:00.000-04:002020-09-17T14:17:21.236-04:00A critique of the concept of 'occupational rights' on Constitution Day 2020<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiou2GhvVLREpSULKoYR0Vs914zxz-joNoBe4R0c7aFdWrhUCRgalJpw1F0jSBCNOnyjtb68FOiGpySvtWocOngbYaUXYd3i6K_GqVRdPzEckag6S4dNH6hKNp4Bz8p7_QxuDiHqQ/" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" data-original-height="474" data-original-width="876" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiou2GhvVLREpSULKoYR0Vs914zxz-joNoBe4R0c7aFdWrhUCRgalJpw1F0jSBCNOnyjtb68FOiGpySvtWocOngbYaUXYd3i6K_GqVRdPzEckag6S4dNH6hKNp4Bz8p7_QxuDiHqQ/" width="320" /></a></div>Today is Constitution Day - a good time to reflect on the nature of rights, particularly as this is an apparent topic of interest among some occupational scientists.<br /><br />Many people improperly believe that in an American context rights spring out of the Constitution. Actually, the so-called Bill of Rights is a list of governmental limitations - or actions that the government can not take against individuals related to their rights. One of my favorites is the ninth amendment - so limiting in its scope - it states that enumerating any rights in the Constitution shall not be construed to deny or disparage other rights retained by the people.<br /><br />So what is the actual source of these rights? The American Declaration of Independence states that they are endowed by a Creator - often interpreted as natural rights that are inalienable. <br /><br />Natural rights were previously identified by John Locke in context of England's Glorious Revolution - identified at the time as the rights to "life, liberty, and property." The purpose of government, then, is to establish the political authority to socially and morally create the context where people can live with those freedoms. As such, justice systems are created as an enforcement mechanism for those rights.<br /><br />The rights do not spring out of the government; rather, the government structure respects and preserves the natural order.<br /><br />Occupational scientists have been discussing new types of rights - sometimes referring to them as "occupational rights" (Townsend and Wilcock, 2004). Four types of "occupational rights were originally identified:<br /><br />1. to experience meaning and enrichment in one's occupations<p></p><p>2. to participate in a range of occupations for health and social inclusion</p><p>3. to make choices and share decision making power in daily life</p><p>4. to receive equal privileges for diverse participation in occupations</p><p>It is interesting that there has not been much conversation about these rights, that the authors seem to spring in reverse fashion out of an identification of injustices. Townsend and Wilcock state that these ideas were developed out of literature review and free-form conversations in workshops about a nebulously defined concept of "occupational justice."<br /><br />This fountainhead of rights-creation, reverse-engineered out of a created justice model, is an atypical methodology for understanding the complex issue of rights, at least in the well-established philosophy of notables like John Locke.<br /><br />Nevertheless, occupational scientists have since been advancing the notion that occupational rights exist. More recently, these 'occupational rights' have been elevated as a form of 'human rights' (Hammell, 2017, 2020). The intent of such a presentation was admittedly framed so that the future of the occupational therapy profession could be shaped to be more important than it currently is. That in itself is also a rather atypical methodology for discussing something as important as rights.<br /><br />The question that we might ask is, "Should occupational scientists or occupational therapists be proposing a new rights framework simply to help aggrandize the discipline and profession?" I think this is an important issue, since it seems that when rights are attempted to be comprehended it has historically been a part of rather important cultural and social revolution. I am uncertain if an allied health field that has historically associated itself with otherwise noble goals of rehabilitation and helping people is an expected springboard for a human rights framework. <br /><br />Crawford (2017) wondered if a rights-approach was beyond the scope of occupational therapy - and determined that it would be only if we held true to our philosophical grounding - which she identified as being represented in PEO models. Only by expanding the notion of 'environment' to include political and social structures of government could occupational therapists begin conversations about human rights being synonymous with occupational rights. She advances the argument that rights identified by the United Nations via the International Covenant on Economic, Social, and Cultural Rights are relevant to occupational engagement rights. Still, this does nothing to address the fact that these enumerated 'rights' came from the UN, a body that is routinely criticized for barely holding to its own standards on such matters.<br /><br />Still, Crawford's method requires occupational therapy to abandon its core philosophy to even enter the arena. That is a concerning requirement to advance a new direction for a profession.<br /><br />These types of fundamental concerns don't seem to be addressed by those who are interested in this new concept of occupational rights. There is no philosophical justification to support occupational therapy's foray into this space. Also, the rights discussed seem to be advanced from an assumption that governments and political bodies are the locations from which rights can spring. It does not seem to matter that this idea contravenes the notion of natural rights.<br /><br />It seems that the justification for occupational science and occupational therapy is that if you abandon your core philosophy and ignore the intellectual tradition of John Locke and ignore the fundamental underpinnings of Western philosophy then you can just create your own 'rights' system.<br /><br />This all takes the profession of occupational therapy into a strange place - for example by having the occupational therapist advocate for a toy lending library based on some perceived rights infringement as opposed to helping them in a way that most people still consider occupational therapy - by helping them improve their skills and abilities (Wolf, et.al., 2010).<br /><br />I understand that I may be considered regressive, but I would argue that the correct label would instead be conservative - at least as it pertains to the notion that an obscure health profession should be the germination point for a new rights framework.<br /><br />Fundamentally, this exploration of 'occupational rights' primarily remains the intellectual pursuit of those who are not affiliated with any kind of mainstream practice in the United States context. There is nothing inherently incorrect with these intellectual pursuits or for people to pursue philosophical constructs that make local sense. However, as I have argued in the past, this should be incredibly important for the American Occupational Therapy Association when it considers what kinds of concepts are allowed to infiltrate American practice documents like the new Practice Framework.<br /><br />For all the concerns about colonization that are expressed by non-Western intellectuals, there seems to be a gigantic blind spot among some American occupational scientists about whether or not ideas generated in other societies and cultures properly fit within the American context.<br /><br />Today is Constitution Day - an important day for Americans to reflect on the ideas of rights. It is also a correct time for American occupational therapists in particular to question ideas about 'occupational rights' that would have us abandon our core philosophy, contravene our understanding of where rights emanate, and that subvert our fundamental social compact to an international body that is arguably less consistent in respecting human rights than American society itself is able to imperfectly express.<br /><br /><br />References:</p><p class="MsoNormal"><span style="font-family: "Times New Roman", serif; font-size: 12pt;">Crawford, E. (2017). Continuing the dialogue: A
rights-approach in occupational therapy. Australian Occupational Therapy
Journal, 64(6), 505–509. https://doi.org/10.1111/1440-1630.12416</span></p><p class="MsoNormal"><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; line-height: 107%;">Hammell, K. W. (2017). Opportunities for well-being: The right to occupational
engagement. Canadian Journal of Occupational Therapy. Revue Canadienne
d’ergotherapie, 84(4–5), 209–222. https://doi.org/10.1177/0008417417734831<br />
<br />
Hammell, K.W. (2020). Action on the social determinants of health:
Advancing occupational equity and occupational rights. Cadernos
Brasileiros de Terapia Ocupacional, 28(1), 378-400. Epub March 27, 2020.<a href="https://doi.org/10.4322/2526-8910.ctoarf2052">https://doi.org/10.4322/2526-8910.ctoarf2052</a><br />
<br />
Townsend E, & Wilcock AA. (2004). Occupational justice and client-centered
practice: a dialogue in progress. Canadian Journal of Occupational Therapy, 71(2),
75–87.<br />
<br />
Wolf, L., Ripat, J., Davis, E., Becker, P., MacSwiggan, J. (2010). Applying
an occupational justice framework. Occupational Therapy Now, 12(1), 15–18. <o:p></o:p></span></p><p><br /></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-31424362968234288232020-09-03T09:42:00.002-04:002020-09-03T20:50:00.948-04:00Perspectives on motive <p> </p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggsds3lM9oi4WAM7gLw851jBQW8XFSsQWN5MTUyljikJXFsdajmu79fBD-ufvvhmrDJGH6lteYRaK0vHyhRue2ihlvOtRC_JNwYLAUDHbBCL3MkEKFmbgcs5UtCIq7-5PGntOPVw/s1861/motive.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1512" data-original-width="1861" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggsds3lM9oi4WAM7gLw851jBQW8XFSsQWN5MTUyljikJXFsdajmu79fBD-ufvvhmrDJGH6lteYRaK0vHyhRue2ihlvOtRC_JNwYLAUDHbBCL3MkEKFmbgcs5UtCIq7-5PGntOPVw/s320/motive.jpg" width="320" /></a></div>Because we are inherently social, we spend a lot of time trying to understand motive in the actions of others. Motive provides a context from which we can apply a category or frame - and as we are also inherently driven toward sense-making and meaning-making this idea of motive is a pragmatic tool that actually serves our own purpose.<br /><br />In occupational therapy, a practitioner will take motive out of this standard context and attempt to manipulate it as a tool for promoting a certain outcome. It is a presumptuous methodology, and probably something that we need to spend time discussing. Used incorrectly, the manipulation of motive can at best simply backfire, and at worst can actually be an assault on another person's autonomy and freedom. In either case, if you get it wrong, it ends up being rather unhelpful.<br /><br />+++<br /><br />We have many squirrels in the neighborhood of our home in the Finger Lakes. The grandchildren derive endless amusement at watching them - the front yard animals all have names assigned by the toddlers - any gray colored squirrel is 'Tam' and any black colored squirrel is called 'PeepPeep." The squirrels interact regularly with Dingle the bluejay, Corrine the robin, Peetle the cardinal, and a cast of many others. We have an ongoing practice of critter watching right out the front window, and the animals play out created dramas as dictated by the children - mostly oriented around 'good' and 'bad' behavior, who is chasing who from the bird feeder, who and who should not be allowed to be on the bird feeder, and so on. Motives are assigned, often dictated by the marginally intelligible logic of toddler brains. And from the apparently equally questionable thinking of their grandfather.<br /><br />The children are also aware that some trees have bugs in them (emerald ash borers is too much of a mouthful at 2 years of age) and that the woodpeckers are trying to eat the bugs to save the trees. We have decided that the loss of trees would be problematic since the trees hold up our hammocks, attract the birds, and provide nesting homes for Tam and PeepPeep. Therefore the bugs are being naughty and the woodpeckers are like the police force, trying to instill some sense of law and order in our little community.<br /><br />All assigned motives - perilous if you get it wrong.<br /><br />One day while we were stalking the yard and picking up branches from the Catalpa trees (the trees never pick up after themselves, so someone has to do it), we noticed something unexpected - an oak seedling. After some discussion we decided that some squirrel had planted it, but made an error in placing it too close to the foundation of the house. Since we try to avoid trees in our flowerbeds, I plucked out the seedling and it came out cleanly with the acorn still intact!<br /><br />Well now, this was an unexpected opportunity so we took it upon ourselves to re-plant the acorn and seedling in a separate pot, with what we thought was more fertile soil, and then gave it a pleasant and presumably protected location on the deck where it could grow. The objective was to eventually re-plant the seedling into a more suitable location so the squirrels could have a preferable home, since the ash trees were having difficulties on account of those naughty bugs.<br /><br />All motives assigned, and with good intention. I have trained for over 33 years for moments like this.<br /><br />The spring and summer moved on - and we continued to use our yard as a combined entertainment, learning, and leisure venue in this pandemic context, and we dutifully watered and nurtured our seedling and watched it sprout a couple of new leaves. Everything was going perfectly, or so we thought.<br /><br />I am uncertain if it was Tam or PeepPeep, but the squirrels came back and took actions that we did not anticipate - this can happen when you misidentify motive. They messily dug out their foodstore and had a very tasty breakfast out of what we thought was supposed to be their future home!<br /><br />When I first came upon the scene I screamed in my head, 'Murderers!' and wondered if it was toddlers who had dug out our positive intentions and made such a mess on the deck. Sometimes we can sabotage our own efforts this way. But then I saw the real evidence: the cleanly severed seedling, the acorn shell remnants, and I immediately knew that we made a grave error in understanding motive.<br /><br />This was no future home. This was future breakfast for Tam and PeepPeep.<br /><br />Understanding motive is hard, and perilous, and I guess that even after 33 years practice it is possible that grave errors can still be made. It is an important lesson, and probably useful for occupational therapists to think about.<br /><br /><br /><p></p>Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-22842659079954979432020-04-12T12:23:00.002-04:002020-04-12T13:04:33.218-04:00Immediate action is required to address the crisis in occupational therapy fieldwork education caused by the COVID-19 pandemic.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbaJMff6gN1JYIFXydRfIP2nBWrgD3-WQSIC0xUrOqsiXQjYJvoeGoGMM8b8DbDiSDY5L_NzWuhIY4CyW8JFEZH0Nfp5so0QdDeJnQMCHZa3NDd1Li3p6dUUYjvwDGqrRdH9KSow/s1600/Corona+OT.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1416" height="162" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbaJMff6gN1JYIFXydRfIP2nBWrgD3-WQSIC0xUrOqsiXQjYJvoeGoGMM8b8DbDiSDY5L_NzWuhIY4CyW8JFEZH0Nfp5so0QdDeJnQMCHZa3NDd1Li3p6dUUYjvwDGqrRdH9KSow/s320/Corona+OT.jpg" width="320" /></a></div>
<a href="https://www2.ed.gov/admins/finaid/accred/accreditation.html" target="_blank">Accreditation </a>is a function that ensures quality in higher education. Many accreditation functions in higher education are regional, and schools must engage those accreditation processes in order for students attending to be eligible for many forms of financial aid.<br />
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Many professional educational programs are also accredited <a href="https://www.aota.org/Education-Careers/Accreditation.aspx" target="_blank">by discipline specific organizations</a>, which are in turn themselves <a href="https://www.chea.org/about" target="_blank">monitored by national accreditors</a>. In sum, there are multiple layers to the educational accreditation process that all serve as a quasi-public protection to ensure quality.<br />
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The occupational therapy profession has a discipline specific accreditor, named the Accreditation Council for Occupational Therapy Education (ACOTE). <a href="https://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Policies/Policies/VIK%20Academic%20Quality.pdf" target="_blank">This group has a statement on educational quality that can be found here.</a> This policy states that<br />
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<blockquote class="tr_bq">
a profession is distinguished by a variety of factors. Among these are a set of recognized educational standards for professional preparation; a credentialing mechanism for certifying its members; and a degree of autonomy in making decisions which guide its future.</blockquote>
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As such, ACOTE establishes standards that all occupational therapy professional educational programs must follow. One key standard listed in ACOTE's statement on educational quality is to<br />
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Ensure the integration of fieldwork education into the educational program so that it is implemented and evaluated as a key component of the overall curriculum design.<br />
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In order to accomplish that requirement, the <a href="https://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/StandardsReview/2018-ACOTE-Standards-Interpretive-Guide.pdf" target="_blank">ACOTE occupational therapy education standards </a> include an entire section on Fieldwork Education (Section C). Additionally, entry level doctoral programs have an additional section on Capstone Experiences (Section D), that also dictate requirements for that experience that can also involve some aspects of supervised internship in the field.<br />
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Most notably, Standard C.1.5 states that occupational therapy educational programs must ensure that "fieldwork agreements are sufficient in scope and number to allow completion of graduation requirements in a timely manner; in accordance with the policy adopted by the program as required by Standard A.4.7."<br />
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Directly related, Standard A.4.7 states that "The program must have a documented and published policy to ensure that students complete all graduation and fieldwork requirements in a timely manner. This policy must include a statement that all Level II fieldwork [and Doctoral Capstone, as appropriate] must be completed within a time frame established by the program."<br />
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ACOTE places such a high value on the fieldwork function that <a href="https://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Policies/1stOverview/IIIA-Overview-Initial-Accreditation-Process.pdf" target="_blank">as of August 2020, all candidacy applications require that a qualified fieldwork coordinator must be hired full-time and on-site 6 months prior to the submission of the Candidacy Application.</a><br />
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In order to comply with standards set out in Section C, <a href="https://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Policies/1stOverview/IIIA1%20Step%20One%20%20The%20Application%20Review.pdf" target="_blank">ACOTE requires that candidacy programs provide evidence of signed letters of intent for two Level II fieldwork placements for each student in a variety of settings consistent with the curriculum design. </a> For example, if a program anticipates accepting 60 students, the program must provide letters of intent for 120 student placements in the Candidacy Application.<br />
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+++<br />
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Because of the COVID-19 pandemic, occupational therapy educational programs have experienced severe disruption with student fieldwork placements. This difficulty became evident starting approximately March 10th. A crowdsourced Google Sheets document that was populated with data from academic fieldwork coordinators across the country quickly filled up to over 400 placement cancellations. After that time schools around the country closed, our country began social distancing processes, and fieldwork placements became an even more distal likelihood. Primary schools are closed and teletherapy is only being provided to a fractional number of students, hospital systems sent students home because the training was not deemed 'essential' and there was a shortage of personal protective equipment. Clinical fieldwork placements are simply on 'hold' across the United States in many contexts. Efforts to collect data on that original sheet were suspended and ACOTE has started collecting the data in a more formal context. I understand that their data indicates the scope of this problem is tremendous.<br />
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The issue was not restricted to the occupational therapy profession, but has been <a href="https://www.insidehighered.com/news/2020/03/23/obstacles-completing-clinical-education-hours-risk-delaying-graduation-nurses" target="_blank">documented as heavily impacting the nursing profession</a> and even <a href="https://khn.org/news/in-face-of-coronavirus-many-hospitals-cancel-on-site-training-for-nursing-and-med-students/" target="_blank">medical students</a>.<br />
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Health care professions responded to this crisis with varying levels of flexibility, in accordance with corresponding flexibility in state licensing laws. According to the American Occupational Therapy Association, 2<a href="https://www.aota.org/Practice/Health-Wellness/COVID19/educators-students-faq.aspx" target="_blank">1 states have statutes dictating that occupational therapy fieldwork requirements must occur over a specific number of weeks</a>. This causes some challenge, because if some states offer flexibility to meet the needs of students who had their clinical fieldwork cancelled with only weeks to go in the experience, the students might not be eligible for licensing in another state with stringent time requirements. Accordingly, implementing a national solution is challenging in the absence of a centralized set of fieldwork requirements for licensing.<br />
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ACOTE has released a statement outlining the details of this challenge and at this time are pointing to their standards related to Fieldwork (Section C) and Capstones (Section D). There are no concrete 'solutions' to the problem of student fieldwork cancellation, and now programs are faced with a complex set of concerns:<br />
<br />
1. Some current students who were on the fieldwork have been sent home, they can't finish their fieldwork, and their graduations are delayed. This has a downstream impact of ineligibility to sit for the certification examination, obtain licensing, and enter the workforce. Many students are simply in limbo.<br />
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2. Students who had fieldwork scheduled for this Summer and Fall are now beginning to hear that their placements have also been cancelled. That will cause a similar threat to their graduation timeline, with all the same downstream impacts that existing students are experiencing.<br />
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At some point in time we will see clinical sites willing to take students again, but we don't know when that will be. That uncertainty adds significant stress into the educational and clinical placement system. We require solutions, and the following suggestions are offered for the interim period of time:<br />
<br />
<br />
<ul>
<li>ACOTE must immediately place a MORATORIUM and HOLD on all new applicant and developing occupational therapy educational programs. In accordance with ACOTE's own standards, educational programs must be able to demonstrate that there is adequate availability of student fieldwork experiences to meet the needs of the numbers of students who are planned for enrollment. It would be irresponsible to allow new programs to develop in this context when it is known that fieldwork placements are constricted. Furthermore, ACOTE has an affirmative obligation to its existing accredited programs to ensure that students currently enrolled have the best chance of being able to secure fieldwork experiences and complete their educational programs. Existing programs should not be forced to compete with developing programs for scarce fieldwork slots.</li>
</ul>
<div>
<br /></div>
<ul>
<li>ACOTE must immediately place a MORATORIUM and HOLD on all program transition of Masters level programs to the Doctoral level that would include Capstone Experiences that might compete with traditional fieldwork sites. Some doctoral Capstone Experiences might be in educational or non-traditional contexts that would not strain the fieldwork system. Those should be allowed to continue. However, some of those experiences might be clinical in nature. At this time, it would be irresponsible to allow new program development if those programs were going to create Capstone Experiences that would take away from the traditional fieldwork placement of existing Level II students.</li>
</ul>
<div>
<br /></div>
<ul>
<li>ACOTE should involve broad stakeholders in making decisions regarding flexibility in student fieldwork experiences. Flexibility and problem solving is desired by all stakeholders; however, we must be cautious that flexibility does not threaten the integrity of the certification and licensing process. Those stakeholders in particular need to be regularly consulted and involved in all decision making processes.</li>
</ul>
<div>
<br /></div>
<ul>
<li>AOTA and ACOTE should continue efforts to forge a national solution for the varying requirements that are present in the licensing laws of different states. This may take some time, and is probably not a solution that will bear fruit in the short term - absent federal intervention and dictum. However, this is such a unique and severe threat that appeal to federal level authorities should also be considered.</li>
</ul>
<div>
<br /></div>
<ul>
<li>Longer term reforms are required in the clinical training requirements for the occupational therapy profession. This pandemic event has strained the system and demonstrates inherent weaknesses that can be better planned for in the future. Specifically, fieldwork should be constructed around the demonstration of competence on specific learning objectives and outcomes. It should NOT be simply a function of a designated length of time. Furthermore, to better strengthen the pedagogic connection of these experiences to the occupational therapy curriculum, we should consider calling these experiences 'Practice Education' as opposed to 'Fieldwork.' This kind of name change can drive a new philosophy and approach so that this system can be re-imagined and strengthened for the future.</li>
</ul>
Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-9726134879719864592020-03-17T10:22:00.002-04:002020-03-17T13:09:05.518-04:00Synchronous vs. asynchronous content delivery in context of COVID-19<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUCYeTtBEOi5Su8nZ9s2V-zIMX1e4pXHEUEHGv9a1cODQP5XUktWLXfIxVqMXMrAR01hf6DGSRtdGf4CRX4-MOem2YwFyxWsQrbIKuUzyq8mdA7f-pRjLLNcvcozdja_H-d3c1LQ/s1600/boreas.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="720" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUCYeTtBEOi5Su8nZ9s2V-zIMX1e4pXHEUEHGv9a1cODQP5XUktWLXfIxVqMXMrAR01hf6DGSRtdGf4CRX4-MOem2YwFyxWsQrbIKuUzyq8mdA7f-pRjLLNcvcozdja_H-d3c1LQ/s320/boreas.jpg" width="320" /></a></div>
<br />
<br />
<blockquote class="tr_bq">
Time is but the stream I go a-fishing in. I drink at it; but while I drink I see the sandy bottom and detect how shallow it is. Its thin current slides away, but eternity remains. I would drink deeper; fish in the sky, whose bottom is pebbly with stars. (Thoreau).</blockquote>
<br />
Many educators are considering ways to deliver their courses in this unprecedented context of students being in their homes, away from the normal routines and location of the Academy. We no longer have control of the schedule - the students are not a captive audience in front of us at the times that we normally expect.<br />
<br />
What does this mean for our new context of online delivery?<br />
<br />
I have heard many educators talk about synchronous delivery - 'it will offer some structure to the student learning experience,' some say. 'By delivering our content synchronously we will provide a valuable service to students who suddenly have lost their anchor points.'<br />
<br />
I would like to encourage my educator colleagues to re-think their options. I think we have a lot to learn from Thoreau.<br />
<br />
Time, and even time disruption, is something that we are all experiencing right now. Time is the anchor for our occupations - the ways we occupy ourselves. We often complete our occupations in discrete increments of planned and organized temporal units. At 7:45am the students might sit in a specified lecture hall and attend a class. It is not surprising that instructors would seek to re-anchor the learning process within some structure of temporal organization, and to even believe that students want the same.<br />
<br />
Maybe some do want that structure, but now they are in home or other environments that are familiar but unfamiliar. Their parents may be home trying to access a virtual private network or understand how to use networking software for their work. Their younger nieces and nephews may be in the home, displaced out of daycare or school, crying because they no longer have their normal structure or routines. Perhaps the family is still trying to contact their Internet provider to see if they are eligible for having data caps lifted. Maybe there is not enough toilet paper. Multiply this complexity by 20, 50, or 100 students.<br />
<br />
Suddenly, expecting so many pieces to fall into place for a synchronous delivery method might seem a little complicated.<br />
<br />
We are all so interconnected - we would drink deeper; fish in the sky, whose bottom is pebbly with stars.<br />
<br />
Take some time to watch the stream, sliding away, so much more complex than our impulses would have us normally consider. There may be high value in considering asynchronous delivery and allowing students to access course content on their own new schedules. Perhaps we can help our students and their families and each other to find some new balance points. Some new harmony.<br />
<br />
Some new connection and interconnection to a very unusual context, for now.<br />
<br />
<br />
<br />
<br />Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-52378547869431449772020-02-27T18:05:00.005-05:002020-02-28T09:13:27.872-05:00On so-called 'Civility Pledges' and the abolition of free thought and free speechI have blogged previously about the glaring problem of lack of tolerance for viewpoint diversity in occupational therapy, and unsuccessful attempts to address the concern. <a href="http://abctherapeutics.blogspot.com/2014/12/time-to-update-aota-position-paper-on.html" target="_blank">See here for more details.</a> It is not a new problem in occupational therapy, and now the problem is being demonstrated again.<br />
<br />
<br />
An important agenda item has been added to the Spring Representative Assembly meeting of the American Occupational Therapy Association - to explore the creation of a 'Civility Pledge' as follows:<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0xS5loSSQ5zpjeQT6SEmQgXlA4JMhVfu3NqbxC42xNx39ua8Zsfc8seof6uws1qYfs-aK1i3YTTYx8Dc4HYhv5_LLT4zcX8VUV12UTTJ0jC_jBMD5DRU-BVZAwpvhv-rQxKYezQ/s1600/civility+pledge.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="584" data-original-width="1063" height="348" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0xS5loSSQ5zpjeQT6SEmQgXlA4JMhVfu3NqbxC42xNx39ua8Zsfc8seof6uws1qYfs-aK1i3YTTYx8Dc4HYhv5_LLT4zcX8VUV12UTTJ0jC_jBMD5DRU-BVZAwpvhv-rQxKYezQ/s640/civility+pledge.jpg" width="640" /></a></div>
<br />
<br />
On its surface, most people will agree that it is important to be kind and respectful when interacting with others. However, 'Civility Pledges' have been introduced before in our national government, on many college campuses - and they rarely succeed in gathering much interest or respect.<br />
<br />
Why is that?<br />
<br />
Most 'Civility Pledges' end up listing speech and behavior that goes far beyond apirational kindness - and wades into the murky territory of mandated 'guiding principles' that people must adhere to - and are then often used as a cudgel by those who would seek to restrict heterodoxical opinions.<br />
<br />
Promoting 'Civility Pledges' signals the constriction and death of both free speech and free thought - elements that are required in any intellectually thriving group.<br />
<br />
In 2011 there was a rather famous example of a mandatory 'Civility Pledge' at Harvard University - roundly criticized by some faculty there including the former Dean of the College who wrote, <a href="http://harry-lewis.blogspot.com/2011/08/freshman-pledge.html" target="_blank">"the right to be annoying is precious, as is the right to think unkind thoughts. Harvard should not condone the sacrifice of right to speech and thought simply because they can be inconvenient in a residential college."</a> He went on to quote the Supreme Court decision regarding compulsory flag salutes, "Struggles to coerce uniformity of sentiment in support of some end thought essential to their time and country have been waged by many good as well as by evil men. … As first and moderate methods to attain unity have failed, those bent on its accomplishment must resort to an ever-increasing severity. … Those who begin coercive elimination of dissent soon find themselves exterminating dissenters. Compulsory unification of opinion achieves only the unanimity of the graveyard."<br />
<br />
<a href="https://www.washingtontimes.com/news/2018/feb/12/harvard-berkeley-among-top-10-worst-schools-free-s/" target="_blank">This kind of action at Harvard has landed the school a consistent place on the list of "worst schools for free speech."</a> That is not an enviable place for an elite intellectual institution.<br />
<br />
Perhaps therapists would be encouraged to sign this new pledge - would there be a list of those who signed? Would there be public shaming (overtly or covertly) of those who did not sign? Would the list be aspirational - or would "guiding principles" lead to concrete actions against those who uttered some words or opinions that someone decided to label as "uncivil?"<br />
<br />
Who is the judge of civility? Is it civil to burn cars in the street and shout down opposing opinions, as long as you are on the "right" side of the issue? Who determines the "right" side of an issue?<br />
<br />
I understand the intent of such a motion, and I assume that it is offered with good spirit, but it is the absolutely incorrect way to go about the concern. Instead, true inclusion, respect, and diversity has to be modeled from the top of an organization and has to be reflected in values and policies and actions. You don't accomplish 'civility' or 'kindness' by creating a set of rules that people must pledge to - that is so incredibly oppressive and history is replete with examples of leaders who have taken their aspirational good intentions to drive dangerous orthodoxy.<br />
<br />
Instead, AOTA and its leadership should promote the kind of intellectual and viewpoint diversity that has been called for over many years. A thriving intellectual community requires viewpoint diversity and people should be free to speak up and challenge each other without the threat of being labeled 'unkind' or 'uncivil' simply for offering a heterodoxical perspective. Should people be kind - of course. But if we start labeling what the guiding principles are to operationalize 'kindness' you start down a very slippery slope - and actually we have seen this play out on college campus - where speakers are shouted down and not allowed to speak because their simple speech and opinions are considered 'hateful' or 'dangerous' or 'un-kind.'<br />
<br />
Such policies create the 'safe spaces' where intellectual progress is arrested - where there is never any chance for dialogue, or for mutual understanding, or even for constructive disagreement. These policies accomplish the abolition of free thought and free speech - something we should not be promoting.<br />
<br />
<a href="http://abctherapeutics.blogspot.com/2015/10/a-tale-of-two-mertons.html" target="_blank">This is not the first assault against viewpoint diversity in occupational therapy. </a> I encourage all occupational therapists to study this issue deeply - to understand that we can all agree on the need for kindness without promoting 'pledges' that have been criticized and that have failed in other contexts.<br />
<br />
We need to move toward embracing viewpoint diversity rather than trying to find ways to label it as 'uncivil.'<br />
<br />Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-19268798192616900322020-01-29T19:46:00.000-05:002020-01-29T19:46:41.220-05:00The 2020 motion to Update Policy E.6 Entry-Level Education of Occupational Therapists and Occupational Therapy Assistants<br />
Please see the following for background information:<br />
<br />
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<a href="http://abctherapeutics.blogspot.com/2018/08/aotas-claim-to-authority-over-entry.html" target="_blank"><span style="font-family: Times, Times New Roman, serif;">AOTA's claim to authority over entry level degree requirements</span></a></div>
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<span style="font-family: Times, Times New Roman, serif;"><a href="http://abctherapeutics.blogspot.com/2018/09/a-motion-to-update-policy-e6-entry.html" target="_blank">A Motion to Update Policy E.6 Entry-Level Education of Occupational Therapists and Occupational Therapy Assistants</a></span></div>
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<div style="background-color: white; color: #212121; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px 0px 8px; max-width: calc(100% - 48px);">
<span style="font-family: Times, Times New Roman, serif;"><a href="http://abctherapeutics.blogspot.com/2019/04/an-analysis-of-how-small-changes-can.html" target="_blank">An analysis of how small changes can potentially lead to unintended consequences in a motion</a></span></div>
<div class="BodyA" style="line-height: 32px;">
<span style="font-family: Times, Times New Roman, serif;"><br />+++</span><br />
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<span style="font-family: Times, Times New Roman, serif;">A new motion has been submitted to AOTA to update Policy E.6 regarding entry level education of occupational therapists and occupational therapy assistants. The originator of this motion believes that this update is necessary because in fact the intent of the first motion was changed through wording and that these changes introduced uncertainty in how the AOTA policy can be interpreted. Details are outlined in the motion below.</span><br />
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<span style="font-family: Times, Times New Roman, serif;">Additionally, since the RA voted on and decided the entry level education issue, supporters of the mandatory doctoral entry level have attempted to up-end that decision just six months after the decision was made. In fact, comments have been made on social media indicating that repeat motions would be filed until there was a mandatory doctoral policy.<br /><br />Because of a need for clarity in the language of the policy, and because of ongoing threats to offer repeated motions on this issue that has already been decided, the following motion has been submitted to AOTA for consideration at the Spring 2020 Representative Assembly meeting.</span><br />
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<div style="background-color: white;">
<span style="font-family: Times, Times New Roman, serif;">This motion might not be necessary if those who seek to alter the entry level to a mandatory doctoral level would cease and desist with their attempts to up-end this decision. If there is some other mechanism for promoting stability there would probably be broad interest in supporting such an effort. As stated in the motion, the intention is to promote stability, allow for important debate on this issue if there is a super-majority agreement that it would be important to do so, and to move us all off of this issue so that other important matters can be attended to.</span></div>
<div style="background-color: white;">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div style="background-color: white;">
<span style="font-family: Times, Times New Roman, serif;">Those of us in the field would much prefer association resources being dedicated to PDPM, PDGM, ACA reform, scope of practice infringement, and other important issues that threaten practice.</span></div>
<div style="background-color: white;">
<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
<div style="background-color: white;">
<span style="font-family: Times, Times New Roman, serif;">+++</span></div>
<span style="font-family: Times, Times New Roman, serif;"><br />I move that the Representative Assembly revise Policy E.6 to read as follows: </span></div>
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<span style="font-family: Times, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Times, Times New Roman, serif;"><b><u>IT SHALL BE THE POLICY OF THE ASSOCIATION THAT: </u></b></span></div>
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</span></w:sdt><br />
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<span style="border: none; font-size: 12.0pt; line-height: 200%;"><span style="border: none;"><span style="border: none;"><span style="border: none; font-family: Times, Times New Roman, serif;">1. <span style="border: none;">The Association requires
entry-level education at either the associate or bachelor degree levels for
occupational therapy assistants.<span style="mso-spacerun: yes;"> </span><span style="border: none;"><span style="mso-spacerun: yes;"> </span></span></span></span></span></span></span></div>
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<span style="border: none; font-size: 12.0pt; line-height: 200%;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none; font-family: Times, Times New Roman, serif;"><br /></span></span></span></span></span></span></span></div>
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<span style="border: none; font-size: 12.0pt; line-height: 200%;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none; font-family: Times, Times New Roman, serif;">2.The Association requires entry level education at either
the master or doctoral degree levels for occupational therapi<span style="border: none;">sts.<span style="mso-spacerun: yes;"> </span></span></span></span></span></span></span></span></span></div>
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<span style="border: none; font-size: 12.0pt; line-height: 200%;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none; font-family: Times, Times New Roman, serif;"><br /></span></span></span></span></span></span></span></span></div>
<div class="BodyA" style="line-height: 200%; margin-left: .5in;">
<span style="font-family: Times, Times New Roman, serif;"><span style="border: none; font-size: 12.0pt; line-height: 200%;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;"><span style="border: none;">3.<span style="border: none;"> <span style="border: none;">This policy requires a two
thirds majority vote of the Representative Assembly to be reconsidered,
separate from any other motion or debate <span style="border: none;">on the
contents and subject of this policy itself<span style="border: none;">.</span></span></span></span></span></span></span></span></span></span></span></span></span><span class="Hyperlink0"><span style="color: windowtext; font-size: 12.0pt; line-height: 200%; mso-fareast-font-family: "Arial Unicode MS";"><o:p></o:p></span></span><span style="border: none; font-size: 12.0pt; line-height: 200%;"><w:sdtpr></w:sdtpr></span></div>
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<b><span style="font-family: Times, Times New Roman, serif; line-height: 32px;"><u>RATIONALE:</u></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 32px; margin-bottom: 0.0001pt; text-indent: -0.25in;">
<ul>
<li><span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="line-height: 32px;">·<span style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span></span></span><span style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 200%; text-indent: -0.25in;">This motion is relevant in that it
clarifies Policy E.6 which establishes the entry level requirements for the
occupational therapy profession. Another
clarifying motion on this topic that was submitted in 2019 was
modified and adopted by the Representative Assembly with language changes to
the original motion that altered the originator’s intent. Additionally, a motion has already been
introduced to the Representative Assembly in Fall 2019 that attempted to
up-end the decision making process on this issue, causing instability to the
profession. This motion seeks to remedy
these challenges to the 2019 motion’s intent and to promote stability on the
issue of entry level degree requirements.
Accordingly, this directly impacts the practice of </span><span style="font-family: Times, Times New Roman, serif; font-size: 12pt; line-height: 200%; text-indent: -0.25in;">occupational
therapy.</span></li>
</ul>
<ul>
<li><span style="font-family: Times, Times New Roman, serif;"> This issue is of national
importance.<span style="font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-size: 12pt; text-indent: -0.25in;">Clarity</span></span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> in this policy is
critical as the current wording of Policy E.6 with the conjunctive ‘or’ establishes
that AOTA could support ‘one or the other’ degree levels.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">Adding the word ‘either’ further clarifies
that AOTA supports both of these levels, which is how the current wording is
being operationalized at this moment.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">
</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">This is critical in that this policy requires even more clarity and specificity
as members have been told that ACOTE will use the input of the Representative
Assembly as well as AOTA policy to inform their decision making about entry
level requirements.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">Additionally,
adding point 3 promotes stability for the educational community.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">The membership has been told by those who support an
entry level doctorate, including the authors of the failed motion on this
topic in Fall 2019, that there will be repeated motions to up-end the
Representative Assembly’s decision making on this issue. </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">The RA has already dealt with one such motion
submitted in the Fall 2019 meeting, just six months after the RA made their decision
on this issue.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">This motion does not
seek to change current policy as much as it seeks to provide clarity in the
policy’s language so that it matches current operational interpretation and to
promote stability so that the profession has some surety that the entry level
requirement will not be repeatedly debated unless there is a broad consensus
that it is important to do so.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">A
super-majority requirement for reconsideration is in line with standard
parliamentary procedure to change existing rules and to protect from such
whimsical repeated motions that do not serve the national interests of the
profession and that in fact threaten members and other stakeholders with unstable
entry level degree requirements.</span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-family: "times new roman" , serif; font-size: 12pt; text-indent: -0.25in;">Given
the constrictions on rules in the online context of meetings, having such a requirement
for super-majority within the policy itself will help to communicate the
stability that is required on this point and the need to prevent endless
debate on the topic.</span></li>
</ul>
<ul>
<li><span style="line-height: 200%; text-indent: -0.25in;"><span style="font-size: xx-small;"> </span></span><span style="font-family: "times new roman" , serif; font-size: 12pt; line-height: 200%; text-indent: -0.25in;">This motion relates to a broad range of
AOTA members – all are impacted by the entry level requirements into the
profession. In the prior RA meeting in
Fall 2019 a motion was defeated that intended to change the entry level
requirement; the motion failed by a 55-13 margin, which was significant. Based on the defeat of this
motion by a wide margin it is evident that a broad range of AOTA members want stability in decision making
around the entry level and do not want to see repeated motions seeking to
up-end the Spring 2019 decision on Policy E.6, absent a significant change
where the super-majority would deem it important to </span><span style="font-family: Times, Times New Roman, serif; font-size: 12pt; line-height: 200%; text-indent: -0.25in;">revisit this issue. </span></li>
</ul>
<ul>
<li><span style="text-indent: -0.25in;"><span style="font-family: Times, Times New Roman, serif;"> Setting the entry level requirements for
the profession of occupational therapy is a function of the Representative
Assembly and as such is appropriate for consideration by AOTA.</span></span></li>
</ul>
<ul>
<li><span style="font-family: Times, Times New Roman, serif;"> This motion will move the profession forward in a meaningful way with
stability in the entry level degree requirements, while still allowing for
changes to this policy should there be important external or environmental
changes, acknowledged by a super-majority, that can be considered by the
Representative Assembly.<span style="font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-size: 12pt; text-indent: -0.25in;">If any part of
this motion is determined to be procedural (for example a requirement for a
super-majority), it should not impact that other part of the motion that calls
for clarity around the conjunctive ‘or’ in the existing policy.</span><span style="font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-size: 12pt; text-indent: -0.25in;">This author’s intent is to promote stability,
encourage and allow debate on this issue when there is clear consensus that the
issue should be revisited, and to serve the best interests of the occupational
therapy profession.</span><span style="font-size: 12pt; text-indent: -0.25in;"> </span><span style="font-size: 12pt; text-indent: -0.25in;">If it is determined
that the Representative Assembly is not the appropriate place to address all or
part of this concern, the originator of this motion calls upon the AOTA Board
of Directors to find other appropriate mechanisms to address these relevant
issues.</span></span></li>
</ul>
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Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-3014588799039352712020-01-18T13:35:00.001-05:002020-01-18T13:35:42.392-05:00Online data sources for narrative analysis: An innovative use of technology in a graduate projectPresented at The Quality Report Annual Conference, Ft. Lauderdale, FL, 1/15/20<br />
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Thanks for stopping by to look at our slides!<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheWUQHP5UIQg1CvdyucuN4EH_VUjE6iZmd8sUqkDraQeJf0PwFSSq-sOom6iXM5PDaokneDW60194ooEo3t-0J0rUk6OWEW5yXhjx7B-C6nSVtRGBe29R1eqxsPtwmZxVp9hvUJg/s1600/TQR.conference.introslide.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheWUQHP5UIQg1CvdyucuN4EH_VUjE6iZmd8sUqkDraQeJf0PwFSSq-sOom6iXM5PDaokneDW60194ooEo3t-0J0rUk6OWEW5yXhjx7B-C6nSVtRGBe29R1eqxsPtwmZxVp9hvUJg/s320/TQR.conference.introslide.jpg" width="320" /></a></div>
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<a href="https://drive.google.com/file/d/1uWxIbBjxPbgHIqUZyPrr-RY7ZlmQc3_W/view?usp=sharing" target="_blank">Conference slides!</a><br />
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<br />Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-82223105113422806762019-10-30T13:59:00.000-04:002019-10-30T13:59:13.809-04:00The OTD Mandate and The Great Pumpkin<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisrcBVGBBEMnXB8_7aKo_JQLgBTz1oH5HSXMqEOSO-NexkWFFfdjN2hnaM2PFrVdchlkZ0WphGxiGddzeg7T1_VqYIaqldrChBGjCCo8YX7DPMHEKH3NS6KYS6j4mA4ahLYSanBA/s1600/pumpkin.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="360" data-original-width="640" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisrcBVGBBEMnXB8_7aKo_JQLgBTz1oH5HSXMqEOSO-NexkWFFfdjN2hnaM2PFrVdchlkZ0WphGxiGddzeg7T1_VqYIaqldrChBGjCCo8YX7DPMHEKH3NS6KYS6j4mA4ahLYSanBA/s320/pumpkin.jpg" width="320" /></a></div>
It is near Halloween, so a themed entry seems appropriate.<br />
<br />
We have another motion in front of the AOTA Representative Assembly to mandate an entry level doctoral degree - even though a decision point was reached just six months ago on this same issue. At that time, the decision was to support dual entry at both the master's and doctoral level.<br />
<br />
That did not satisfy a Small Group of individuals, and so we are at the debate again.<br />
<br />
People frequently ask me 'why' the profession is going through this again. That is where the Halloween story comes in.<br />
<br />
Each year, despite overwhelming evidence against his belief system, Linus would sit in the pumpkin patch and wait for the arrival of the Great Pumpkin - who he believed flies around and gives toys to sincere and believing children on Halloween eve. Each year the Great Pumpkin would fail to appear but that does not stop Linus from believing. Sometimes he even manages to convince his friends to sit in the pumpkin patch waiting with him. It always inevitably ends in disappointment.<br />
<br />
This is very similar to the OTD mandate. There has been overwhelming opposition to this but we have been told by some members of the Small Group that they will continue to submit motions to the Representative Assembly on this issue. Now we sit on Halloween eve and another motion on this issue that was already decided is in front of the Representative Assembly. The Small Group sits in the pumpkin patch, waiting for the Great Pumpkin to bestow gifts upon them since they hold these sincere beliefs.<br />
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Of course there is no Great Pumpkin. And if there was - no one wants it anyway - that has been proven repeatedly by survey after survey on the issue. Still the Small Group waits, hopeful that something will change that will fulfill their deep wishes.<br />
<br />
I can only write this parable because at the time of the writing there is no justifiable reason to believe that the Great Pumpkin will appear. There has been no change in survey results and there is no intervening change in facts. It would take an abberation or perversion of process for the Great Pumpkin to appear.<br />
<br />
It is lonely and cold in the pumpkin patch each year, particularly since so few of Linus' friends believe in what he is doing. His belief system might be ok on its own, but he keeps dragging friends in with him, ruining their Halloween. That is the unfortunate part. He is always unrepentant in the end, but I suppose we can at least acknowledge his faith, even if it is out of step with what everyone else believes.Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-4978312535584009632019-10-27T11:46:00.002-04:002019-10-27T11:46:41.886-04:00The need for occupational therapy educational standards reform: Addressing the real problem behind the push for a doctoral mandate<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWGTjFkhJxqE1kEwfpLGgnfAbFKUF2OIzO7CKLK3gTbuBW559QDp6Y4cPTi7ce_3tqTotAiuhZDP8WyrTR9fZ3ePf7zpB1SOgncCUCl3ism9EQLGkA-w3NcVZE34Z0uCcjhED47w/s1600/Problem+Solution.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1068" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWGTjFkhJxqE1kEwfpLGgnfAbFKUF2OIzO7CKLK3gTbuBW559QDp6Y4cPTi7ce_3tqTotAiuhZDP8WyrTR9fZ3ePf7zpB1SOgncCUCl3ism9EQLGkA-w3NcVZE34Z0uCcjhED47w/s320/Problem+Solution.jpeg" width="320" /></a></div>
As a profession, occupational therapists have been spending time talking about opposing the motion to mandate the doctorate – but we need to spend time trying to solve the problem that is bringing this issue to the table.<br />
<br />
I believe that we have a specific problem (too many credits in masters programs) and some of our colleagues are trying to justify the escalated degree solution by conflating the real problem with a
lot of side issues that may not be accurate (e.g. doctorates will give us a seat at the table, doctorates will make us more respected, doctorates will maintain parity with other professions, doctorates
will make people practice at the top of their license etc - all evidence-free platitudes).<br />
<br />
We should try to address the Credit Problem by reforming curriculum, reforming ACOTE standards, removing excess from those systems - and that will solve the REAL underlying problem.<br />
<br />
Here are some ideas that Caroline Alterio and I generated and that she posted on the AOTA forums the other day. Let’s contribute to a REAL solution by encouraging dialogue around the REAL problem:<br />
<br />
What can be trimmed from the standards? A lot.<br />
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1. Requirements for escalation in Bloom's taxonomy. Every time that we escalate the complexity of Bloom levels we add to the curriculum. Much can be trimmed on a standard by standard basis based on Bloom
complexity. We do not need frontline practitioners, our primary outcome objective, being able to analyze and evaluate for societal determinants of health on a public health level as much as we need them to
simply demonstrate knowledge of the issue. This is an example of how we over-require complexity in our Bloom levels in the curriculum.<br />
<br />
2. We have added population level care into many of our standards, and yet the primary outcome objective is to produce clinicians who treat patients. OTs can understand population level impacts, but we have
expanded the curriculum exponentially with turning us into a public health profession - which does not reflect how most OTs practice anyway. It is an imagined role that is not reflected in any practice
analysis that has ever been completed.<br />
<br />
3. We can constrict content based on other imagined roles that are very uncommon to our primary outcome objective. Case management is a good example - a fine role for someone who does not want to provide
direct care OT but hardly something that needs to be in an entry level curriculum. OTs in case management roles are very uncommon, and yet we include it in the curriculum now based on special interests.<br />
<br />
4. We can constrict requirements under other categories like management, education, and advocacy. These are all important functions but we continue to escalate the complexity of requirements far beyond
what most practicing clinicians will ever need to engage. Do we really need to have instructional/curricular design as a standard? Our primary outcome objective is not to produce occupational therapy
educators.<br />
<br />
5. The same is true for scholarship and obtaining grants. Our primary outcome objective is clinicians and not researchers. The point here is not to exclude this kind of content from the curriculum but
that we need to design the requirements/standards at a level that make sense for intended outcomes - consuming evidence and applying literature - not designing studies and obtaining grants.<br />
<br />
6. Do we really need to mandate that all students complete work in emerging areas where there are not OTs, or to even allow them to pursue fieldwork placements or capstones where non-OTs are supervising
them. It is so odd that an occupational therapy degree would include training supervised by people in places who are not occupational therapists and where occupational therapy does not happen. A
generation of training in non traditional settings has not moved the needle on non traditional practice. All we created is an endless stream of students doing demonstration projects in soup kitchens
and then graduating to go work in schools, hospitals, and nursing homes. It is a failed experiment.<br />
<br />
We have not spent enough time discussing the existing problem with our educational standards. The few times it has been raised it has led to straw man arguments like 'We can't exclude evidence based practice from the
standards.'<br />
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Standards reform is a nuanced process and should not result in polemic and polarized arguments that distract us from the important work of evaluating and reforming our current system. No one wants evidence
based practice out of the standards. However, that is different than teaching entry level students about obtaining grants and implementing research.<br />
<br />
Again, the point is to direct the curriculum toward the primary objective - and that is toward the production of practicing clinicians. It is not our primary objective to produce educators or toward creating imagined public health roles that don't reflect actual practice. We need those functions, but advanced content should be just that - advanced. It is over-education for our primary role and purpose and does not belong in an entry level curriculum.<br />
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Advocating for a pragmatic curriculum should not devolve into conversations about not being 'visionary.' I think we can be appropriately visionary without requiring all participants in an entry level program to engage in activities that they will never again do once they leave the academic setting, or that will only be engaged in by very small percentages of people who pursue highly specialized roles.<br />
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Let's address the REAL problem - and try to come to a REAL solution.Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-40580844225694653302019-10-09T11:56:00.000-04:002019-10-09T11:56:04.378-04:00Open letter to the Representative Assembly of the American Occupational Therapy Association<br />
Dear Representative Assembly Members,<br />
<br />
I am a program director of an occupational therapy program. I am shocked and concerned that the AOTA's Representative
Assembly has accepted a new motion to re-litigate the entry level
doctoral issue after it was just voted on and decided six months ago.<br />
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<div class="text_exposed_show">
In any democratic process, issues should never be considered 'closed.'
However, we also need to have some procedural safeguards to ensure
that there is not an abuse of processes in order to effect a Small
Group's will.<br />
<br />
The Representative Assembly has such a process. In the document 'Rubric for RA Motions' it clearly states:<br />
<br />
<blockquote class="tr_bq">
" Topic #4:<br />
Motion originators/Rep articulate how the intended outcome of the
motion is different from anything that other AOTA groups (ad hocs, COE,
COP, EC, etc.) is working on or has already been addressed."</blockquote>
<br />
It
is a mockery of the process to serially submit motions on the same
topic that has already been litigated and when there is no intervening
new context or information. The profession debated this issue for over
five years. A decision was reached.<br />
<br />
If time has passed, or if
there is new information, or if the context has changed - that is
another issue. However, none of that is the case.<br />
<br />
Instead we
have a Small Group attempting to hijack the Representative Assembly
process to enforce their own will in support of a mandatory doctorate
that the profession has already rejected.<br />
<br />
This is severely
disruptive to the educational community. We are attempting to move
forward with curriculum planning and strategic planning. This
uncertainty makes that impossible.<br />
<br />
As a Program Director I am
asking you to oppose this Representative Assembly motion and to engage
an investigation of your Agenda Chair's process that this motion would
come back up for debate. The community can't tolerate this uncertainty
and it is both damaging and embarrassing for the occupational therapy
profession.<br />
<br />
Thank you for your consideration.<br />
--<br />
<br /></div>
Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-47067169629658529612019-08-12T12:20:00.001-04:002019-08-12T12:20:43.862-04:00Can you have too many books?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qiEqwTnEFCW0WOlIyxaSVdeNatKZeKRb3q_etcvIfjOm3SFx28G71cUK8gWD5XAw2MnrY-_Od4GsV1zC7RXnphebiXvXNEsDvJFt4rzTiHVN6NEFYIDAo1mU0MsxqhmTUtEOwQ/s1600/books.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="187" data-original-width="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2qiEqwTnEFCW0WOlIyxaSVdeNatKZeKRb3q_etcvIfjOm3SFx28G71cUK8gWD5XAw2MnrY-_Od4GsV1zC7RXnphebiXvXNEsDvJFt4rzTiHVN6NEFYIDAo1mU0MsxqhmTUtEOwQ/s1600/books.jpg" /></a></div>
On the theme of having 'too many' of something...<br />
<br />
Can you have too many books?<br />
<br />
My choice to engage in private practice complicated my life plan to have dedicated spaces for work and play. Work became a lifestyle, and the Internet just made the whole problem that much more complicated - accessing email and any other point of information at any time. I am not sure why I didn't consider this back in 1981 when I first logged onto CompuServe. I might have planned all this differently, and maybe made different life choices about information access.<br />
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Anyway, I think that I have too many work-oriented books. Maybe. Or maybe I just have too many in locations that I don't want to have them in. I am working from one satellite office today and I looked at the books overflowing the bookshelf all over the floor. How does this happen? <br />
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I thought for a moment to just move them all down the street to my college office, but then I started looking at them and immediately recognized a problem. Some of the work-oriented books are just good books that I wouldn't mind in this space but I have turned them into work-oriented books. Jerome Bruner - Acts of Meaning - work book, or not? Yuval Noah Harari - Sapiens: A brief history of humankind - work book, or not?<br />
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I can easily categorize the Willard and Spackman's occupational therapy text - but what in the world am I supposed to do with the book about Ella Lyman Cabot and her contributions to American pragmatist philosophy? It was a good book - kind of related to OT - but not so directly.<br />
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I have some books that easily stay in the 'home' and 'non-work' category: my Flintstones and Marvel superheroes coffee table books, collected poems of Robert Frost and T.S. Eliot, my Lloyd Alexander books and other favorite children's literature. I think the point of this is that I want more of that in my living space, and perhaps a little less of this other 'could be work' stuff.<br />
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The work-oriented books are just starting to bother me in some living spaces. I don't know if it is a phase. Maybe I will try to move some of them out and see how it feels.<br />
<br />
Anyone else have this problem, and some solutions?Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-61040758680550341802019-07-11T14:11:00.000-04:002019-07-11T14:11:39.631-04:00There are too many occupational therapy educational programs in New York State<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJadOOT0en8WeeH4PZmf0wLK1iYBgdozXzdKoOZc8lDBrOm4lznkFtBD8NOh6tnytChuX5aNuNBQXEnZcpPGYHjHsN61HfSo0Iu9J3K6Nqjjvx6EEiH6OnejXUthk_gn4t0snlQA/s1600/maldistribution.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="328" data-original-width="656" height="159" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJadOOT0en8WeeH4PZmf0wLK1iYBgdozXzdKoOZc8lDBrOm4lznkFtBD8NOh6tnytChuX5aNuNBQXEnZcpPGYHjHsN61HfSo0Iu9J3K6Nqjjvx6EEiH6OnejXUthk_gn4t0snlQA/s320/maldistribution.jpg" width="320" /></a></div>
There is an alarming increase in the number of accepted applicant and developing occupational therapy programs in New York State. The current entity responsible for the accreditation of these programs is the Accrediting Council for Occupational Therapy Education (<a href="https://www.aota.org/Education-Careers/Accreditation.aspx" target="_blank">ACOTE</a>), a function of the American Occupational Therapy Association (<a href="https://www.aota.org/" target="_blank">AOTA</a>).<br />
<br />
<a href="https://www.aota.org/Education-Careers/Find-School.aspx" target="_blank">According to data provided by AOTA and ACOTE</a>, there are 22 accredited occupational therapy masters-level degree programs in NY State and 12 accredited associates-level occupational therapy assistant degree programs.<br />
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There are two additional developing masters-level degree programs, ten applicant doctoral-level programs, and one applicant masters-level program. Of the developing and applicant programs, approximately half are new and the other half are existing accredited programs that are seeking to add an additional degree level.<br />
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The question that is never asked is “How many occupational therapy educational programs can be reasonably supported in a single state?” California has 11 accredited occupational therapy programs and 6 accredited occupational therapy assistant programs. Florida has 12 accredited occupational therapy programs and 21 accredited occupational therapy assistant programs (half are from a single educational entity, an interesting issue unto itself). Pennsylvania has 18 accredited occupational therapy programs and 12 accredited occupational therapy assistant programs. Texas has 11 accredited occupational therapy programs and 19 accredited occupational therapy assistant programs.<br />
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New York currently has more occupational therapy educational programs than any other state. Even more are being developed.<br />
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In contrast, there are large swaths of the country where there is very little opportunity for students to pursue an occupational therapy degree locally. New Mexico has one occupational therapy program and two occupational therapy assistant programs. Nevada has one occupational therapy program and one occupational therapy assistant program. Montana has nothing.<br />
<br />
This issue is important on several levels. People living in low-access areas have decreased access to occupational therapy as a service. Additionally, these areas also represent some historically under-represented population groups. The occupational therapy profession already has a severe problem with diversity; the overwhelming majority of the profession is white and female. Maldistribution of educational programs contributes to this problem.<br />
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Education deserts are defined as geographic localities where college opportunities are few and far between. As reported, “Place still matters; in fact, the majority – 57.4 percent – of incoming freshmen attending public four year colleges enroll within 50 miles from their permanent home.” Also, distance education does not mitigate structural problems with access because of poor broadband availability in many of these rural areas (Hillman & Weichman, 2016). Clearly, there is a severe problem with occupational therapy education deserts - so what is AOTA and ACOTE doing to address this problem?<br />
<br />
Applicant programs are required by ACOTE to demonstrate that fieldwork agreements are sufficient in scope and number to allow completion of graduation requirements in a timely manner. It is commonly repeated that there are inadequate numbers of available fieldwork sites even for existing programs – so much so that in recent years three has been a ‘relaxing’ of standards with the allowance of ‘emerging’ fieldwork sites and doctoral capstone experiences where the onsite supervisor does not even need to be an occupational therapist. Also, new fieldwork supervision models have been proposed for part time ‘faculty-led’ supervision and even single supervisors overseeing multiple students. The occupational therapy literature is replete with studies that document concerns with fieldwork capacity (Evenson, et.al., 2015; Roberts & Simon, 2012; Stutz-Tanenbaum, Hanson, Koski, & Green, 2015).<br />
<br />
In such a context, it is difficult to understand how and why all of these new educational programs in saturated areas are being granted developing status. This is an area for AOTA and ACOTE to have some transparency over because the disconnect between the stated concerns in the literature and the unfettered approval of new programs in overly-saturated geographies is startling.<br />
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This is also disturbing given the propensity for occupational therapy academicians, a population responsible for all of this maldistribution, to lecture the profession about equity and justice (Hemphill, 2015). The occupational therapy profession needs to have a look in the mirror over this issue.<br />
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Additionally, ongoing concerns that have been expressed during the profession’s ‘doctoral debate’ led to a <a href="https://www.aota.org/AboutAOTA/Get-Involved/BOD/News/2019/Message-AOTA-ACOTE-Policy.aspx" target="_blank">newly developed memorandum of understanding</a> between AOTA and ACOTE. There are still concerns about the inherent conflicts of interest present when an educational accreditation function is housed within a membership organization. These also require transparent discussion in that accreditation decisions are not at full arms-length from a group that benefits from increased membership from students.<br />
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For all of these reasons, ACOTE and AOTA need to have more open conversations about these concerns with the broad community of stakeholders that are being impacted by the severe maldistribution of educational programs.<br />
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In particular, there needs to be immediate attention given to the problems that are being caused in places like New York State where the artificially inflated supply is far outstripping the actual demand.<br />
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References:
See embedded links, and…<br />
<br />
Evenson, M.E., Roberts, M., Kaldenberg, J. Barnes, M.A., & Ozelie, R. (2015). National Survey of Fieldwork Educators: Implications for Occupational Therapy Education. American Journal of Occupational Therapy; 69 (Supplement_2):6912350020p1-6912350020p5. doi: 10.5014/ajot.2015.019265.<br />
<br />
Hemphill, B. (2015) Social Justice as a Moral Imperative, The Open Journal of Occupational Therapy: Vol. 3: Iss. 2, Article 9.Available at:http://dx.doi.org/10.15453/2168-6408.1150<br />
<br />
Hillman, N. and Weichman, T. (2016). Education Deserts: The Continued Significance of “Place” in the Twenty-First Century. Viewpoints: Voices from the Field. Washington, DC: American Council on Education<br />
<br />
Roberts, M. E., & Simon, R. L. (2012). Fieldwork challenge 2012. OT Practice, 17(6), 20.<br />
<br />
Stutz-Tanenbaum, P., Hanson, D. J., Koski, J., & Greene, D. (2015). Exploring the complexity of the academic fieldwork coordinator role. Occupational Therapy in Health Care, 29, 139–152.
Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0tag:blogger.com,1999:blog-14772999.post-1848543322440054802019-05-31T17:11:00.001-04:002020-01-18T13:31:27.038-05:00The Barton Project: CAOT 2019 Conference slides<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiilSJsntDxyo-HGl4ZYUM5fW-MZY9dYEVRWQWWZERQd6OKwzlH9Hyoa4M9QbNokOwZGUiAyzZ99CX5ThpKPpMH10ge9ZIV_jJZUUHUCItwVhjziWyRjd4rPXoANsB1Evq2pi2KFg/s1600/CAOT+Title+Slide+Spirituality.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiilSJsntDxyo-HGl4ZYUM5fW-MZY9dYEVRWQWWZERQd6OKwzlH9Hyoa4M9QbNokOwZGUiAyzZ99CX5ThpKPpMH10ge9ZIV_jJZUUHUCItwVhjziWyRjd4rPXoANsB1Evq2pi2KFg/s320/CAOT+Title+Slide+Spirituality.jpg" width="320" /></a></div>
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<a href="https://drive.google.com/file/d/1_Awx-rSOK-mxsYsm-MT-Fj7_kwib5EkW/view?usp=sharing" target="_blank">Conference slides!</a><br />
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<br />
Hi and thank you for stopping here to look at the slides for my presentation at the 2019 CAOT conference!<br />
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<br />Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.com0