ABC Therapeutics Occupational Therapy Weblog

Like many others navigating the skies this week, I ran headlong into the perfect storm of weather delays, FAA flow restrictions, and cascading cancellations. By Wednesday it became clear I wasn’t getting to the AOTA Education Summit - at least not physically. I made the error of having too short a window for connecting flights... Rather than let the workshop vanish into the ether, I decided to take a different path and record the full presentation from home. In some ways this feels appropriate, because the talk itself is all about imagination, accessibility, and democratizing ethical inquiry . If people couldn’t gather in one room, then why not open the room to everyone? The presentation -  “Teaching Occupational Therapy Ethics Through Speculative Fiction” - explores how narrative forms can help students engage with complex moral problems in ways that feel emotionally safe and intellectually honest. Ethics education today often unfolds in a climate where students worry more abo...

In 2012 , I asked on this blog: “Is NY State taking steps toward a paraprofessional delivery model?” That was the year the state began inserting Level II HCPCS codes into the New York Early Intervention System (NYEIS). These were not therapy codes — they were catch-alls used for durable medical equipment and non-professional services. I warned at the time that commercial carriers would never reimburse them. These codes had no standing in pediatric therapy billing. The only plausible reason for inserting them into NYEIS was to create billing pathways for non-licensed, lower-cost providers. A few months later, I wrote again — “More Road Paving for Paraprofessional EI Services in New York State.” That post analyzed how New York was linking Early Intervention with OPWDD’s Home and Community-Based Services (HCBS) waivers . Services like Family Education & Training or Community Habilitation are commonly delivered by staff with 2- or 4-year human services degrees, not licensed therap...

In a recent article appearing on the CNN website, author Wayne Drash reviews the concept of 'wrongful birth' in context of Lesli, a person who has developmental disabilities.  Drash's profile states that he "specializes in stories off the radar" and that "his passion is to tell narratives about life and the unfolding drama of the world we live in." It would be more accurate to state that Drash cherry picked one person's perspective and advanced a fiction that serves one ideological perspective. His initial description of Lesli in his opening sentence tells us everything he believes about her person-hood.  He immediately goes to the 'fetal position' trope that promotes his message of Lesli's helplessness and haplessness. For just a moment the reader is led to believe that there may be another side of the story to be told as he describes Lesli's joy at having her mother hold her hand - but the author quickly reverts to reporting...

On 11/8/16 I wrote In both of these cases it is important to carefully analyze the details of what is actually being litigated.  So often the truth of what is being discussed gets lost in poor reporting about the topics.  For example, many news outlets focus on the 'evil school district vs. the child in the wheelchair with Wonder the GoldenDoodle' meme instead of focusing on the decidedly less appealing 'what is the importance of due process' angle. As OTs become more savvy with policy analysis they will avoid the bias-trap of media reporting and try to approach a more 'rational comprehensive' method of considering the actual facts.  They will also become more savvy by dropping the naive notion that just because an issue might have the superficial appearance of something that should be supported, it is important to dive deeply into the actual policy to make sure we are promoting what is best for the people who seek our services. Turns out th...

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 ne...

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 ...

The OT Capital Briefing in the November 7, 2016 OT Practice analyzes two Supreme Court cases that are summarized together as follows: If the Supreme Court finds in favor of the families in both cases, the expertise occupational therapy practitioners provide will be more important than ever to ensure students with disabilities receive a meaningful education, and that schools fully comply with the ADA and Section 504. This is a confusing summary because neither case has anything to do with OT specifically and in fact if the Supreme Court finds in favor of the families there may be unintended consequences that are damaging. In the first case, Endrew F. v. Douglas County School District , the issue of concern has to do with what constitutes FAPE, or a free appropriate public education.  In this case the parents removed their child from school because they believed that his progress was insufficient as it relates to his autism condition.  The enrolled him in a private schoo...

I live in a border region and local health care folk frequently talk about Canadian medical tourism.  A week or so ago Buffalo Business First published this article about the increasing trend for our northern neighbors to cross the border for elective surgeries, emergency room visits, and diagnostic procedures in order to avert the long wait times that are commonly associated with the Canadian care system. http://www.bizjournals.com/buffalo/news/2016/01/29/nearly-1-000-canadians-treated-at-wny-hospitals.html The article discusses the issue from the grim perspective of how this is all a revenue opportunity for Western NY hospitals.  That may be true but it is probably the most immoral spin that you could possibly put on this ethical morass.  +++ Cue article number two - a story that gives us a polarizing different perspective on the lack of access to care in a socialized system.  Laura Hillier was an 18 year old young girl who died from leukemia while on a wa...

I want to share a message about authenticity in therapeutic relationships. Jim was a 40 year old man who participated in  a day treatment program in a rural community.  The program itself was conceived and nurtured by Jim's parents along with other parents who were desperately trying to find non-institutional program options for their children.  Jim had cerebral palsy and an intellectual disability.  He attended that community program as a school child and eventually 'graduated' into the adult day treatment program.  The program grew from providing services to just a few children to several hundred people with developmental disabilities of all ages.  The program was an act of love, gifted by parents to their children.  That is the best way I can think to describe programs that developed this way. I am not sure how aware Jim was of all that.  He was mostly focused on relationships with people and he had no disability in that social arena. ...

I went to an IEP meeting with a parent the other day and was greeted with hesitance by the occupational therapist on the educational team. "Why are you here?" asked the therapist.  "Are you here because you are actually treating the child or are you here as an advocate?" Neither characterization seemed correct.  I paused and thought for a few seconds as I was not sure why it mattered.  I also was not sure if I was free to divulge the information.  I ran for the safest middle ground I could find and responded, "I know the child and I am helping the family."  Both were true. I know that the word "advocate" is often perceived negatively by school based practitioners.  I have been attending IEP meetings as an 'outside' therapist for over 20 years and I tend to avoid the term 'advocate' because it engenders a lot of negativity.  I see a lot of reactivity in educational teams when an 'advocate' is involved. Bruce and Ch...

Concern Troll: ( noun ) A person or persons who pretends to be 'concerned' about something and talks about it, all the while serving to actually disrupt the legitimate concerns and activities of people who are trying to address problems. Concern trolls are particularly skilled in derailing conversations, conflating issues, and leading people off track. ***** AOTA recently released a new document on use of restraints and seclusion related to school based practice.  I will not link that document because I believe that it is fundamentally flawed and does not represent the thinking of many people who actually practice in school settings.  There is no value in spreading that faulty document, but I will describe the problems with a hope that more conversation will be generated about the issue broadly. The paper has some positive aspects, including identification of the role of OT in helping teams understand and interpret personal and contextual factors that might lead to disru...

Last year I bumped face first into a gnawing problem.  I was discussing practice trends in a professional context with an impressive panel of colleagues who were subject matter experts.  I raised the topic of the role of OT in planning transition services for adults who have developmental disabilities, and the more general topic of services to adults who have developmental disabilities was bantered about. My own personal perspective is that OT has a critical role in providing services to this population, and in fact concerns about adults who have developmental disabilities have been discussed in this blog more    than    a    few    times .  The problem I ran into is that among the opinions of the subject matter experts who represented diverse geographies around the country, not all could confirm that occupational therapists were an important part of the care plan for this population.  In some contexts, subject matter exper...

The following Twitter conversation underscores the problems with use of a population health model in an occupational therapy context: Framing a conversation about the need for older drivers to consider their abilities underneath a context of population statistics is in direct conflict with the profession's Core Value of respect for patient autonomy and individuality. Although it may be true that there are descriptive statistics about driving safety, numbers of accidents, and other factors associated with elderly drivers, when we lead our conversations with talk about the broad population we are adopting a potentially ageist stance that restricts the freedom of many drivers who are not falling within those normative ranges. This is the problem with use of a population health model for meeting the needs of individuals.  To describe this problem within a general systems theory framework, consider the following chart: Within this traditional framework of intervention, the...