Saturday, January 07, 2017

Deconstructing the myth of clothing sensitivity as a 'sensory processing disorder'


Please note first that there is no formally recognized clinical designation of  'sensory processing disorder.'   It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community.

In our clinic we receive many referrals from local pediatricians when parents have concerns about children being overly sensitive to their clothing.  Most often the children referred are from four to seven years old and the families are severely disrupted by the children's behaviors and responses to clothing issues.  Commonly, children will have severely constricted tolerance for certain outfits, want to wear the same clothes repeatedly, complain that clothing is itchy/scratch/bumpy/wiggly/ouchie, and this all leads to disruption of daily dressing routines.  There is no doubt that the behavioral concerns are very real.

The pediatricians tend to be appropriately conservative and provide families with good behavioral management suggestions before making a referral.  Families are very challenged with managing the problem and often resort to online assistance before being referred to us.  Most parents have already completed sensory questionnaires online, tried seamless socks, and read books on sensory sensitivity in children long before they ever come in for an occupational therapy evaluation.

The pre-conditioning that parents receive online is unfortunate because one of our first objectives in assessment is to inform the parent that it is important that we don't want to fall into the trap of trying to identify the nature of the problem before we even complete any testing. 

For this reason we do not have the parent complete any sensory-based questionnaire in our office as we find that these assessments serve as a point of confirmation bias as soon as parents begin to answer the questions.  Instead, we complete these assessments last - after all other observations are completed and after we have already discussed results of other tests with the families.  We also have the parents complete these assessments remotely via computer administration to encourage as much neutrality into that line of questioning as possible.  Even when we get the results, we tend to give them very little weight given their tendency for confirmation bias.

It is critical to inform parents that most children who have sensitivity to clothing do not have any 'neurological-based sensory processing disorder.'  We carefully educate parents and help them to understand that the presence of a neurological condition would be supported if the child has accompanying deficits in motor skill, motor planning, attending, socialization, and learning.  So, for all children who are referred because of 'clothing sensitivity' we complete a thorough developmental assessment including motor, language, cognitive, social, and adaptive domains.

We are also very careful to educate parents that there are no unique sensory receptors that respond only to clothing, or that only respond to certain kinds of clothing, or that only respond to certain kinds of clothing in the morning when a child is getting ready to avoid missing the bus.  It is also important for occupational therapists to reflect on their training in anatomy and neuroanatomy so that they remember tactile processing pathways, affective limbic connections, and neural regulatory mechanisms.  It is difficult for a therapist to justify calling a clothing sensitivity a 'neurological tactile defensiveness' if they spend any amount of time reflecting on evidence associated with neuroanatomy and behavioral correlates.

There are thankfully only a very few children who, when tested, exhibit concerning delays in these other areas.  Such children sometimes go on to have diagnoses of autism or dyspraxia or attention deficit disorder.  In our experience these constitute an extreme minority of the total population of children who have clothing sensitivity.

The vast majority of children do not have any corresponding developmental delays.  They are sometimes 'slow to warm up,' have some mild socio-emotional delays (people often use the word 'immature' but I am not always happy with the negative connotations of that term), or have some mild degree of anxiety or obsessive tendencies.  Sometimes they have experienced varying degrees of normal developmental trauma that is not handled well - death of family member, divorce, birth of new siblings, family stressors, etc.  Often it is a combination of many different factors.  The fact that most of these children do not have serious developmental conditions is actually a good thing - and that is something that we reinforce to parents.  At the same time, we are always careful to remind parents that the absence of a serious developmental condition does not minimize the functional behavioral problem that they are experiencing at home.

The vast majority of these situations are easily managed with some parental coaching, some developmental support, and some cognitive-behavioral language re-framing for the children - e.g. "These socks are itching me a little, but that's ok!"  Sometimes for older children behavioral contracts and confidence building positive behavioral support models can be very effective.  Most often we need to de-condition the parents from reinforcing the children's behavioral responses.  All of this can be generally accomplished in a few sessions, at most.

The worst thing that occupational therapy professionals can do to families is to reinforce a mythology that the child has some 'sensory processing disorder.'  This is dangerous because it pathologizes a very common early childhood behavioral response pattern to stress.  It also externalizes the nature of the problem in such a way that the family becomes dependent on the occupational therapy 'expert' who alone 'understands' and can 'solve' the problem.  This commonly leads to over-utilization of therapy which is critical to avoid.

I would like to encourage my occupational therapy colleagues to reconsider the way that  they talk to families about these matters.  There are pages and pages of Google search results that point parents to a mythological sensory 'diagnosis' - and this far outstrips the actual incidence of significant developmental problems that may have sensory modulation difficulties as a feature (e.g. autism).  Again, most children who have these atypical behavioral responses do not have significant developmental delays.  The pages and pages of Google search results should reflect positive behavioral supports and cognitive-behavioral reframing and parent training.  Google search results should accurately reflect the actual nature of the problem - which is exaggerated behavioral response to contextual developmental stress.

This post is my effort to change the online narrative that unnecessarily pathologizes this issue as a 'sensory processing disorder.'   This too often unnecessarily sends families down the rabbit hole of a 'diagnosis' that is not accepted by other medical professionals.  Proper framing of the problem leads to appropriate conservative treatment approaches.  This should be the goal for all occupational therapists.

Thursday, December 22, 2016

Isabel Gladwin Barton: Wife, Helpmeet, and Collaborator

According to publicly available records and genealogy databases, Isabel Gladwin Newton was born on July 21, 1891, in Geneva, New York, to Mary Risley Gladwin, age 24, and Frank Ellsworth Newton, age 28.

Isabel Gladwin Newton met George Barton when she was twenty five years old and working as a bookeeper in a preserving and canning plant.  She responded to his contact and offer for work; she reported being particularly motivated by the salary of $15 per week, which was more than her $11 weekly salary at the plant. She began working for him on August 1, 1916. (Barton, 1968).

She reported being "drawn to him from the very first" and immediately began acting as his secretary and helping him with the publication of several articles and books.  She also provided significant material support to Barton in helping to manage his correspondence and organize materials for the First Consolation House Conference and founding of the National Society for the Promotion of Occupational Therapy in March 1917.

Prior to this she did not have experience with occupational therapy.  At the presentation before the Western New York Occupational Therapy Association at the Clifton Springs Sanitarium on May 16, 1947, she stated

To go back to the calling of the conference at Consolation House prior to the formation of the National Society, Mr. Barton had contacted four leaders in their various fields, and so it was that these five zealous workers in the subject, with a very young, most inexperienced though intensely interested sixth, the young secretary, came together at Consolation House in March 1917.

She served aptly as the first secretary of the National Society of the Promotion of Occupational Therapy.  Review of the correspondence between Barton and Dunton at the time indicates that Isabel Newton was able to effectively coordinate the development of mailing and membership lists, dues collection, and many other tasks that were critical for the new profession.  In fact, following her resignation, it is clear that the record keeping associated with the group was a significant challenge for her successors.

Isabel Newton married George Barton on May 6, 1918.  She continued serving as secretary to George Barton and Consolation House.  In Barton's book, Teaching the Sick: A Manual of Occupational Therapy and Re-Education, he dedicates the book to Isabel and writes:

To Isabel Gladwin Barton
My Wife, Helpmeet, and Collaborator

All of this evidence indicates that Isabel Gladwin Barton, although young and inexperienced and certainly not a luminary in any field such as nursing or medicine or social work or teaching or architecture, was still a critical point of support for George Barton.  George had ongoing challenges with disability and there is no doubt that his wife Isabel helped him to achieve the goals that he set out for himself.

The November 2013 AOTF Research Resources has a column entitled Occupational Therapy: History in Focus.  That article includes an inaccurate description of Isabel Barton.  The article states

Every dutiful occupational therapy student is led through the profession's "catechism" of history; typically memorizing the names of the OT founders pictured in the famous photo shown here. Of course, serious students know that some of the key players responsible for occupational therapy's emergence are not even pictured; and one who was pictured (Isabel Newton, secretary and paramour to Mr. Barton) was largely incidental. 

I believe that use of the term 'paramour' trivializes the important work that Isabel did for the National Society for the Promotion of Occupational Therapy in general and for George Barton in particular.  Following her husband's death she withdrew from active participation in occupational therapy, focusing on raising their young child.  She regularly followed the developments in the occupational therapy field and as noted above was called upon to present the history of the occupational therapy founding at several important events (30th anniversary, 50th anniversary).

Isabel was not just a secretary, as her husband George noted in his book dedication.  She was a dedicated parent, an accomplished seamstress, a faithful correspondent, and she loved her parents and other family members.  She was also fiercely independent and took care of Consolation House on her own for many years.  At the end of a long day after her son was asleep she would read books deep into the night and she would also indulge in going to the movies, which she loved.   She also remained deeply in love with George, and celebrated their wedding anniversaries long after his death.  These details were all made available to me as I have had the privilege of reading five years of her personal diaries.

Isabel Gladwin Barton was recently named to the AOTA 'Influential Persons List.'  Her support for George Barton and the skill that she brought to her role as Secretary of NSPOT was certainly not incidental.  Her appearance on this list is an honor that is deserved.


References:

American Occupational Therapy Foundation (2013, November). OT: History in Focus. Downloaded from http://www.aotf.org/Portals/0/documents/News/Research-Resources/November%202013%20Research%20Resources.pdf

Barton, G.E. (1919). Teaching the sick: A manual of occupational therapy and re-education. Philadelphia: WB Saunders, Co.

Barton, I.G. (1968). Consolation House, Fifty Years Ago.  American Journal of Occupational Therapy, 22(4), 340-345.

Newton, I. (1917). Consolation House. The Trained Nurse and Hospital Review, 59, 321-326.

Tuesday, November 29, 2016

Guest entry: Taking a stand for patient safety with the Hospital Readmissions Reduction Program

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information in the form of a narrative blog post is provided courtesy of a graduate student who is interested in promoting increased awareness of impacts of the Hospital Readmissions Reduction Program.  Because the author only has fieldwork experience and the facility or patient could be possibly identified, with the student's permission I have conducted my standard 'ABC Therapeutics mash-up' of details and narrative so that the intent of the experience could be expressed while maintaining confidentiality. 

In school occupational therapists learn all about diagnostic conditions.  They also learn about ways that people might have difficulties with their occupations.  Occupational therapists also learn how to assess and treat those people so that their conditions will not limit them in the future.

Occupational therapists also learn that some conditions are acute, that some are chronic, and that some are progressive.  None of that really matters though because the best thing about occupational therapy is that knowledge about disability can be matched to the patient’s need, no matter where they are in this process.

That is how it is supposed to work.

These skills that I learned in occupational therapy school did not prepare me well to respond to the needs of one of my patients on my Level II fieldwork.  I completed my fieldwork at a large hospital and I saw people with common diagnoses including heart and lung diseases, joint replacements, and similar acute conditions.  Unfortunately, I learned that a person's care is not always determined by what I think is most appropriate as a professional.

The pace of work at the hospital was fast and the evaluations were simple, but functional.  One aspect of my experience that I did not expect was my work in the hospital’s emergency department.  When a patient entered the ED, the doctor would write an order for an occupational therapy evaluation. The occupational therapist would ask the patient about their home setup and prior level of function as well as have the patient complete simple ADL tasks and transfers. Throughout the evaluation, the occupational therapist would assess the patient’s cognition and safety awareness as well.  Was the patient able to safely complete essential ADL tasks? If not, the occupational therapist is responsible to document that the patient is functionally unable or unsafe to return home and must document appropriate discharge recommendations.

I learned that in October 2012, Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act, which established the Hospital Readmissions Reduction Program. This program was established with the purpose to reduce hospital readmissions – which is defined as an admission to the same or another subsection hospital within thirty days of an initial hospitalization.

The purpose of the program is to improve quality of care and to  reduce Medicare spending. Under this program, Medicare payments to many hospitals across the United States are deducted three percent to hospitals with ‘excess’ readmissions.  The program specifically looks at the kinds of diagnostic categories that I saw on my Level II Fieldwork, namely heart failure, myocardial infarction, pneumonia, COPD, THA/TKA, and CABG.

During my Level II Fieldwork, I evaluated many people; however, there is one person who literally and figuratively 'stands' out.

Mary came to the emergency department with complaints of severe pain in her hip after a recent hospitalization for a total hip arthroplasty. Mary is an active and healthy 66-year-old woman who had a big personality and even bigger life responsibilities.  She is a caregiver for her disabled spouse, watches her grandchildren during the week, volunteers at the local library, and enjoys socializing with her friends. She had a small physique, but her personality was oversized! She was very friendly!

"I have to be independent," Mary told me during the evaluation.  "My husband had a stroke and he needs me - and what would my babies do if I didn't watch them?"   I loved how she called them her babies, even though she was the grandmother!

During the evaluation, she had difficulty with simple dressing tasks using adaptive equipment.  She was also unable to transfer to or from the toilet. In fact, when asked to demonstrate, she unsteadily stood facing the toilet with her hands on the wall as if she was getting arrested and her legs apart straddling the toilet as if she was aiming at a target.

My immediate thought was, "How is this safe?  And if she is this unsteady, how is she able to do all of these other tasks safely?"

In fact it was not safe. I became very anxious thinking of all the things that could go wrong in this situation. Does the walker fit over her toilet at home? If not, does she rely on the wall for support? Where is the toilet paper located? How does she reach the toilet paper if it’s behind her? How does she keep her pants from falling to her ankles? If her pants fall, how does she reach them without breaking her hip precautions or losing her balance?  How is she caring for her husband or her grandchildren when she could not even safely care for herself?

Because of this, I recommended that she receive skilled services at the hospital and then transfer to another facility (SNF) for additional skilled services to maximize functional return and safety.  I based my recommendation on other patients that I saw who were in in the rehab program.  I thought that perhaps Mary just wasn't ready to be home, especially if she was supposed to be the primary caregiver for other people.

However, the hospital disapproved of my recommendation and this caused a lot of tension between the rehabilitation director and my supervisor.  That is not generally a situation that you feel comfortable creating when you are a Level II student!

The rehabilitation director, my supervisor, and myself all met to discuss the issue. It was apparent that the rehabilitation director was using this meeting as a ‘teaching opportunity’ since I was a student, as she stated, “this is the part of healthcare you don’t learn in college.”

This made me feel discouraged and defeated.

Despite my attempts to defend my recommendations, the hospital discharged Mary with a script for more pain medications and outpatient therapy services.

I believe that the hospital's decision to avoid readmission was influenced by the threat of reduced Medicare payments. During the meeting with the rehabilitation director regarding this issue, I was told, “it is cheaper for the patient to receive outpatient services.” I left the conversation feeling frustrated.

Whose needs were met in this situation - the patient or the hospital?

Instead of focusing on the patient and her needs, which we are taught to do in school, the hospital is focused on financial incentives or penalties. This not only affects the patient as it puts her at a higher risk for falls at home or other serious injuries, but this also affects the occupational therapist who is held accountable for discharge recommendations.

Overall, I understand the importance of reducing excessive and preventable healthcare spending, which is the primary goal of the Hospital Readmissions Reduction Program.  However, I believe that hospitals should not solely focus on the financial penalties imposed by the Centers for Medicare and Medicaid Services (CMS) nor that occupational therapists decisions should be influenced by this policy.

Instead, both hospitals and occupational therapists should focus on providing appropriate, quality care to patients in need of skilled services.  Patients like Mary rely on our ability to make decisions and recommendations that are in their best interest, and not that are influenced by the bottom line of some hospital's balance sheet.

Monday, November 28, 2016

Guest entry: Advocating for FERPA rights

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Sarah Watson, a graduate student who is interested in promoting increased awareness of privacy concerns and FERPA in context of computerized record keeping and documentation.

Extra note: I was really happy to see one of my students tackle this topic - I have seen many privacy breaches because of improper permission settings in common software used by many school districts, most notably the IEP Direct product.  School support personnel need to be regularly inserviced on how to use permission settings so that providers do not have blanket access to a district's entire special education database.  This is a common problem.

Additionally, procedures need to be tightened so that notices about IEP meeting schedules that have protected information are not sent out in global emails to multiple agencies who are all providing services to school districts.


"I am an occupational therapy graduate student at Keuka college. I have created an infographic for my Global Advocacy class on Family Educational Rights and Privacy Act (FERPA).

The infographic has been a result of a semester long project on the policy process. I encourage everyone to read it and watch the video. I am very passionate on the topic of FERPA and the educational community that it impacts as a future occupational therapist.  Protecting student privacy is so important and can happen only when the right steps are taken. 

Please SHARE and feel free to comment and ask questions.

This assignment is for my final project and my goal is to have several people look it over! Thank you!"

Click here to open up the chart in your browser!

Wednesday, November 23, 2016

Guest entry: Advocating for a loan repayment bill that could impact occupational therapy


A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Nagella AL-Balushi, a graduate student who is interested in promoting a bill that improves health professional workforce distribution via a loan repayment program when practitioners work in underserved areas.

"Greetings fellow OT students and future colleagues,

I am a graduate OT student seeking opinions, feedback and thoughts about a legislative bill that would potentially have a great impact on the field of OT if passed​!

This act would have three main professional consequences including establishing a new​​​ ​federal loan repayment system​​​, ​increasing the overall distribution of our ​health care services, and ultimately making the role of OT more commonly understood across the nation.

The Access to Frontline Health Care Act is designed to provide a federal loan repayment system for health care professionals (including Occupational Therapy) in exchange for two years of service at a federally regulated agency, such as hospitals, clinics, nursing homes, and schools located in underserved areas.

The Access to Frontline Health Care Act was drafted in 2015 by Congressman David Loebsack of Iowa and ​thanks to his time and effort in creating this Act, the Access to Frontline Health Care Act would be able to save various working professionals in healthcare from the despair of endless student loan payments.

 The ​reasoning behind establishing the loan repayment system is to incentivize recent grads to work in remote areas to ​create a more balanced distribution of health care workers across the country. ​ Not only will you​, the professional,​ receive aid in paying back your student loans, but more importantly you will have the ability to help those who truly need it and don't have regular access to your services! ​

On the biggest scale, by providing services in areas where OT or other health professions are not commonly found, we are diversifying our profession and spreading awareness of what Occupational Therapy is to people who would not normally have reliable access to our services.

The infographic attached ​is provided to give you a visual explanation of the Access to Frontline Health Care Act, and the overall impact it would have the U.S. health care system. As mentioned before, I would love​ ​to hear your opinions about the Act and its potential effect on the OT profession. ​

Regardless if it is positive or negative, all feedback is beneficial!!

Thank you for your time and good luck in your future endeavors!
Nagella"

CLICK HERE to see the infographic in your browser.

Link to Bill: https://www.congress.gov/bill/114th-congress/house-bill/1707

Sunday, November 20, 2016

Guest entry: Advocating for canine training programs that benefit veterans

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Nina Fusco, a graduate student who is interested in increasing awareness to HR 3016, particularly those sections that support canine training programs that would benefit veterans who have PTSD and other conditions.


"The Veterans Employment, Education, and Healthcare Improvement Act is a federal bill currently in committee in the Senate. Upon meeting with a legislative aid from Senator Gillibrand's office, it was recommended to me that attaining statewide and nationwide support would be the best course of action. Support from both New York and the nation will help push to amend and reintroduce Veterans Employment, Education, and Healthcare Improvement Act. 
I have provided a link to a presentation I created on this bill, that I have posted on YouTube. 

I hope you will consider taking a few minutes out of your day to watch and listen, and getting back to me with some feedback.  Thank you."

Guest entry: Advocating for co-payment reform in New York State

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Tori Persons, a graduate student who is interested in legislation that would help alleviate the burden of out of pocket costs for people receiving occupational therapy services.  

"Existing laws in New York have stated that health plans must cover occupational therapy services.

However, the insurance companies have found loopholes and bypassed these laws. They did this by shifting the majority of the costs for OT services onto the patients by increasing the cost of copayments.
 
This increase in copayment cost has caused financial burdens on patients, changed access to occupational therapy services, and overall has defeated the purpose of insurance coverage for occupational therapy.
 
There is currently a bill in New York Assembly to expand health insurance coverage for occupational therapy services. The bill is in the very early stages and has not been put to a vote in either the state Assembly and Senate. 
 
Occupational therapy practitioners across New York State have the opportunity to advocate for our patients by encouraging legislators to vote for the passage of Bill A9384. 
 
Thanks!"


Friday, November 18, 2016

Guest entry: Advocating for people who have traumatic brain injuries

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Ashlee Lytle, a graduate student who is interested in advocating for people who have traumatic brain injuries.  Under a current plan, transitioning this population to a managed care system will impact the quality of their care.


"As I am soon entering the profession of occupational therapy this May, I have become increasingly interested in the individuals that I will soon be providing services for. 

After researching information regarding traumatic brain injury, which is my area of interest, I came across the transition plan proposed by the Medicaid Redesign Team to remove the Traumatic Brain Injury (TBI) & Nursing Home Transition and Diversion (NHTD) waivers that currently exist and transition these services into Medicaid Managed Care. 

Placing individuals who have experienced a traumatic brain injury into the managed care system will jeopardize their frequency as well as quality of services available to them in the community. 

There is currently a bill in the Assembly awaiting approval to prevent this transition known as Bill A09397.

I strongly encourage those who are interested in advocating for these individuals to take a look at the info-graphic, located below, that was created to give you knowledge and resources to refer to in order to educate yourselves and understand the importance surrounding this issue. 

Thank you for taking the time to read this. 

Just try and remember that you can only make a difference if you try.

To see the info-graphic in your browser in a larger format, click on this link!"



Guest entry: Advocating for occupational therapy wellness programs

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan  to increase awareness of their topics.  

This information is provided courtesy of Emily Scholl, a graduate student who is interested in promoting occupational therapy's involvement in wellness programs.  She found an interesting bill that promotes wellness in NY State and is advocating for occupational therapy to be added to the existing bill.

"Occupational Therapy should be added to the list of qualified wellness programs in NYS Assembly bill A4238.

The 2015-16, in-process, NYS Assembly bill A4238 authorizes NYS health insurers & HMOs to provide policyholders with reductions in healthcare premiums and potentially waiving related costs or co-payments, in exchange for active, voluntary participation in approved wellness programs. 
 
This policy would operate on a non-health contingency basis, which means that obtaining these financial rewards would NOT be based upon personal health details. Participation would be enough.

People want to live healthy, successful, meaningful lives. OT should be added to the list of wellness programs in this bill.
 
Why?  Lifestyle education and enacting personal change is hard. It requires moral support, goal-setting, guidance, enjoyable activities, collaboration, and a greater degree of involvement than just knowing what one “should” be doing. The features of wellness programs that are outlined in this bill would be greatly supported by the occupational therapy professional skillset. 
 
If we can get car insurance discounts for participating in related programs, why not get health insurance discounts for participating in occupational therapy wellness programs?  This would allow the citizens of NY to save on rising healthcare costs AND improve health!  
 
Check out the poster attached below or click on this link for a larger version in your browser.  Thank you!"


Guest entry: Advocating for a workload approach in school systems

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan  to increase awareness of their topics.  

This information is provided courtesy of Jenna Soldaczewski, a graduate student who is interested in promoting a workload approach in school systems.  She found out how a parallel profession in NY (speech therapy) promoted change by advocating for alterations to the Part 200 NYS regulations that govern special education:


Many occupational therapists in school settings have caseloads so large that it negatively impacts the way that they can help children.  Some therapists have proposed using a 'workload' approach for better managing productivity in the school systems.

After studying the caseload versus workload approach debate I created a quick presentation to encourage and inform OTs about what they can do to advocate for a 'workload' approach.

This presentation provides facts and information on the topic and also encourages OTs to speak with policy makers.  This information is specific to New York State but could be generally applied in other locations.  Please feel free to share the presentation with other professionals or on social media sites to spread the word regarding this topic.

My goal is to encourage as many people as possible to use this information to engage with policy makers.

Click here to see the presentation via your browser, or scroll below.  Thank you!