ABC Therapeutics Occupational Therapy Weblog

AOTA held its annual business meeting this week. There were the expected reports about advocacy wins, strategic priorities, publications, communities of practice, and the upcoming conference. There was also a rather substantial financial problem. AOTA finished fiscal year 2026 with an operating deficit of approximately $3.4 million . Investment income covered nearly all of that amount, leaving a comparatively small overall loss of about $100,000. That sounds reassuring until you separate investment performance from regular operations. AOTA did not come close to paying its operating expenses with the money it generated through membership, conferences, accreditation, continuing education, publications, and other routine activities. The investment portfolio rescued the income statement. That is fortunate, but it is not a business model. The budget was balanced with assumptions the Board already doubted The most remarkable disclosure came from Treasurer Bryant Edwards. He described the...

  I recently wrote that occupational therapy’s real AI problem is not ChatGPT itself, but us. More specifically, it is our profession’s vulnerability to confident, polished, automated explanations built on partial knowledge, private frameworks, and unexamined assumptions. I argued that the real risk is not that a machine will invent nonsense from nowhere, but that it will absorb and amplify the profession’s existing epistemic weaknesses. Now we have Part II of this discussion. I was reminded of this topic when I posed a straightforward question to AOTA’s new chatbot . I asked it "Has there ever been any tension around how to operationalize the ethical principle of social justice in occupational therapy, and what would a violation of that look like in practice?" The answer I received was plausible, polished, but very superficially informed - and thus, fully incorrect. It discussed system barriers, inequities in access, conflicting values, organizational constraints, and the ...

At the recent ALC meeting of the AOTA, there was a question about why we are seeing a drop in student interest in OT programs. There seemed to be a hesitancy to look internally and critically at the real reasons so I decided to do my best to answer that question. Label me as a reluctant futurist. +++++ Occupational therapy stands at a pivotal moment. For years, we’ve operated with an assumption that the future of the profession should be bigger, more academic, more credentialed, and more “doctorate-forward.” For a while, that vision aligned with workforce need and cultural momentum. But lately, the data tell a more complicated story and I believe that many of us in education and professional governance have been unwilling to confront directly. Here is the uncomfortable truth: The rapid proliferation of OT programs, especially entry-level doctorates, is no longer being driven by workforce demand, public need, or educational innovation. It’s being driven by institutional survival, tuit...

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...

A few months ago, I submitted a formal petition to AOTA expressing concern about the approval of the revised Code of Ethics through a consent agenda. I questioned whether it was appropriate to pass a foundational document that defines the ethical framework of the profession without open deliberation or engagement with members. I was invited to present my concerns to a Review Committee. The process was respectful. The committee listened attentively and expressed gratitude to me for my engagement. Today, I received word that the consent agenda vote to approve the Code would not be reconsidered and that there was no violation of AOTA bylaws. However, AOTA acknowledged that future governance and member education needed to be strengthened such that the governance team developed targeted educational strategies to support volunteer leaders in their understanding of how to use consent agendas. In sum, they affirmed the procedural decision while offering a commitment to improved the process mo...

  Lately, I’ve been reflecting on a new rhetoric within occupational therapy circles. Specifically, I am seeing messaging that serves as a call for action on social and political issues, and also insists that the occupational therapy  profession must become a vehicle for radical change. One recent example came from a group calling itself Diverse-OT National , which published a statement rejecting neutrality and explicitly accusing professional institutions of “collusion” in state violence. I have no objection to anyone advocating for a cause they believe in. I respect passion, and I understand the appeal of movements. But I believe we need to ask a critical question - i s the profession of occupational therapy the right vehicle for this kind of activism? In my view, it is not. And here’s why. 1. Occupational Therapy Is a Health Profession, Not a Political Movement Occupational therapy is built on the foundation of helping people live lives of meaning and participation. We se...

The House-passed Budget Reconciliation Bill—nicknamed the "One Big Beautiful Bill" by its sponsors—has generated swift opposition from AOTA. The association’s article focuses on the very real concern that shifting Medicaid funding to block grants or per-capita caps could jeopardize occupational therapy (OT) services for vulnerable populations. That is correct analysis. But the AOTA messaging on this issue lacks depth and strategy. A pre-written form letter to Congress isn’t a serious response to a structural overhaul of one of OT’s largest funding streams. It’s time for clinicians and educators to stop outsourcing our critical thinking and advocacy. Here’s a deeper, more balanced look at what’s in this bill—and what OTs   need to be doing. The Real Structural Threat: Medicaid Block Grants Let’s start with the most important thing the bill proposes: a fundamental shift in Medicaid funding . Instead of Medicaid functioning as an open-ended federal match for state spending, ...

In April 2025, the American Occupational Therapy Association Representative Assembly approved substantial revisions to the Occupational Therapy Code of Ethics as part of a bundled consent agenda — without open deliberation. Ethics are not routine administrative matters. They define the values, boundaries, and identity of a profession. This petition was submitted to respectfully challenge the process by which the new Code of Ethics was adopted, to call for greater transparency, and to reinforce the importance of meaningful member participation in shaping the standards that govern our work. Members deserve transparency, deliberation, and stewardship. I encourage all colleagues to remain engaged in the governance of our profession. Note: For purposes of this public posting, I have redacted personal information such as my address and AOTA member number, as well as removed the names of individual forum contributors cited in the original petition. These edits do not alter the substance of th...