Showing posts from 2005

An Analysis of Continuing Competence Regulation of Occupational Therapy in New York State

Goals of the policy

Regulation of continuing competence is an important current issue for the public consumers of occupational therapy services in New York State. Two bills were introduced by New York State legislators in 2005 to address this issue. Assembly bill A.5160 and Senate bill S.1388 are identical companion bills that establish requirements for occupational therapists and occupational therapy assistants to complete continuing education as part of their triennial license renewal. The proposals also mandate continuing competency fee be paid to help support the administration of this additional requirement.

This proposed policy is being decided in the New York State Legislature and has been referred to the Committee on Higher Education for their review and feedback. No legislative action was taken on either bill during 2005.

There is no uniform licensure or continuing competence requirement among the states. Forty-one jurisdictions currently have continuing competence requirements…

An Analysis of Foster Care Policy and its Impact on Occupational Therapy

Identifying Information

Foster care is defined by the United States Government Department of Health and Human Services as "24-hour substitute care for children outside their own homes… [and] includes all children who have or had been in foster care at least 24 hours. The foster care settings include, but are not limited to family foster homes, relative foster homes…, group homes, emergency shelters, residential facilities, childcare institutions, and pre-adoptive homes." (DHHS, 2003a). According to the most current governmental data, 523,000 children were in foster care on September 30, 2003 (DHHS, 2003b). Children are placed in temporary foster homes when their parents are unable to care for them. Foster care is generally designed as a temporary service for children and families who are experiencing a crisis. New York State outlines specific regulations for foster care (18 NYCRR 421).

History of the Policy

Children in foster care have historically been disenfranchised and unde…

up in flames

I have had several good reasons to write more this last week but my time has been consumed with so many tasks. That has been somewhat depressing. There is an interesting juxtaposition of living such a tremendously full life and wanting to document some of the more candid experiences here - and then deciding that life is too full to be spending any spare precious moments documenting it. That is interesting to me.

Anyway, today was just the pinnacle of insanity when we walked into the pediatric clinic and were surprised to find the computer turned off. That in itself is not such an unusual finding because power outages do occur and I figured that perhaps the recent ice storms caused some temporary 'brown-outs'. What was crazy was that I precognitively thought to myself "Well I will just fire up the computer here and get to work." So I flipped the power on and the computer literally started smoking.

It is a depressing thing to see a computer go up in flames like that, kn…

forensic occupation

Here is a question I had the opportunity to respond to recently: Should the justice system focus on punishment or rehabilitation? Why? How does this affect occupational therapy?

I don't intend to take both sides of this issue as a 'cop-out' but I believe that prisons should focus on both punishment and rehabilitation. I'll address punishment first, as that seems to be the easier topic.

Some people commit crimes that are so heinous that they simply deserve to be punished. In my opinion, the best way to do that is to keep people incarcerated and separate from society for the rest of their lives, without opportunity for parole. Their treatment should be humane, but they should not be afforded luxuries including education, work-release, halfway houses, or parole. I believe that some people are not capable of rehabilitation, and they should not be eligible for rehabilitation. I don't know that I have a set of criteria ready to list that would preclude rehabilitation but …

occupation and identity

I went to my daughter's Christmas concert this evening, and this event always evokes some thinking. I live in a smallish place, and there are some particular traditions associated with the school's Christmas concert. Each year one of the final songs is the Hallelujah Chorus and members of the audience are invited to go on stage and sing with the students. Now my son just graduated so of course it is much too un-cool for him to step onto that stage yet, but I expect that at some point in time he will fondly recall the regional tradition and he may even choose to go sing on that stage again. It is the stage that he was on when Emile de Becque kissed Nellie Forbush, the stage where someone handed him his diploma, and of course the stage where he sang the Hallelujah Chorus . It will be a return, because it is a part of him. Perhaps it is a part of his identity, and the occupations that he engaged in on that stage were all quite defining for him.

I hope I am not presuming too much. …

An Analysis of Head Start Policy and its Impact on Occupational Therapy

Identifying Information

The Head Start and Early Head Start programs are comprehensive child development programs that serve children from birth to age 5, pregnant women, and their families. The program provides services to low-income preschool children including children with disabilities. The program is designed for children to achieve social, emotional, physical, and mental development. Head Start is a federal program within the Administration on Children, Youth and Families in the Department of Health and Human Services (DHHS). It was most recently reauthorized through fiscal year 2003 by PL 105-285. The program was scheduled for reauthorization in 2003 but no agreement could be reached on proposed changes to the programs. Head Start reauthorization is being currently debated in the House and Senate.

History of the Policy

The Head Start programs were originally a part of the ‘Great Society’ ideas that became the domestic policy initiatives of President Lyndon Johnson (1964). Johnson …

Metablogging and interactivity

I apologize in advance for the rambling nature of this entry, but stream of consciousness is part of the process, and I hope helps to lead to an understanding of the issue.

As I see so many children who have attending and regulatory-type difficulties I spend a good deal of my time investigating strategies that will help them to improve their capabilities. In order to be successful those strategies have to be reinforced, and so logically this means that the rest of the world that interacts with kids has to 'believe' in the stragegy if they are going to help facilitate its use. This is a primary problem with many sensory-based interventions that lack the face validity needed that would support general acceptance. Throw in the issue of a total lack of evidence and mix in the intraprofessional dogma that clinicians are fed about sensory techniques and you essentially have the current evidence-less state of clinical pediatric practice today. That is rather grim now, isn't it?


prayer as occupation

I saw my first patient 20 years ago, and at that time the debate was raging over whether we should call the people who we work with 'patients' or 'clients.' I don't know that there was ever any 'official' decision made, but now we see patients, clients, students, workers, etc. I usually use the term patient, which is mostly out of habit. When you work in a single field for 20 years you can be accused of being 'old school' and old habits die hard.

But I didn't choose to write tonight about semantics.

I was thinking back to my first patient contact 20 years ago because that is when I learned about people who have cancer. When I am struck squarely between the eyes with a proverbial baseball bat I automatically start working from the beginning of my experience to remember what I have done before, seen before, experienced before. My experience is my crutch, like an old man's walking stick.

A former patient's mom emailed me today and told me tha…


All I do is write, but not here. This evening I cranked out about 18 pages worth of evaluations. That is single spaced technical reporting. My hands are numb.

I've been spending a little time thinking about what I am choosing to write lately and what I am not choosing to write. There is a story I needed to record - and I will only put the snippet here for memory-jogging purposes, but there was so much behind it.

I have been considering the nature of disability, particularly as it relates to children. It is hard to be disabled as a child because so many people do so many things for you ANYWAY. The standards are just not the same as with adults.

Example: if an adult has a stroke and can't dress themselves, they are considered disabled. If a child has a stroke and can't dress themselves, the parent provides care. Because children are children, and because parents do what they do, the concept of disability is different with kids.


Well a parent asked me an interesting question…

96 hours

I saw a posting on my discussion forums from a previous student; she was talking about her experiences working in pediatric critical care. I am sure that she does an excellent job; she was a very competent student.

I am still recovering from my pediatric critical care experience. Here's a story that is stuck in my mind, despite it happening nearly ten years ago.


Transference is an old Freudian term that refers to the unconscious redirection of feelings. I didn't know Mandy for very long, but I felt that I loved her the moment that I walked into her room. This little girl was just six years old, beautiful and blonde - she could have been my daughter. So when I saw her I felt love for her.

When I walked into Mandy's room I also felt an immediate sense of deep and profound sadness. She was lying still in the bed, eyes defocused toward the ceiling, and not responding to anything. In a corner of the room I saw a man who I imagined was her father. His eyes were just as distant …

On string theory and muddy paws

I mentioned a couple months ago that I would be an astrophysicist if I wasn't currently practicing as an OT. Actually, I lack the mathematical ability to do this kind of work seriously. Despite this, in my ongoing attempts to enlighten myself on the nature of the universe I went and listened to a Brian Greene lecture this evening.

This actually does have something to do with OT. This has to do with our choice of occupations and the impact that it has on our world-view.

I have a General Systems Theory Knowledge Map hanging on the wall of my office. I keep it there to remind me to think expansively, but the bottom end of the Knowledge Map is a little outdated - I think it lists atoms or perhaps just quarks. Tonight the lecture was about strings, of course. It was interesting, but perhaps not as technical as I was hoping to hear.

Actually the most important part of the evening to me was listening to the questions that people asked him. There were some very hostile questions, although th…


I watched the young boy approach the table at the farmer's market. He was only 8 I figured. Maybe 9. His hands reached immediately for a ball on the table. It was oddly shaped so that as it 'rolled' it would go in unpredictable directions.

The young boy looked at the 75 cent price tag and dug deep into his pocket. He smiled, excitedly: he had enough money. Still, he seemed to pause. I imagined that he was trying to decide. Is this what he would spend his money on?

"My son and I spent hours and hours playing with that ball," announced an adult voice from across the table. "We would play with that ball for hours. It was the most fun we ever had."

I don't know how to convey the true intent of this man's statements. I am sure that I heard something very different than the little boy. I heard a professional farmer's market pitch-man, trying to eke out another sale. The little boy's eyes lit up. This statement made his decision easy. He quickly h…

Reflections on the occupation of collecting

In an ongoing attempt to develop a (hopefully expanding) understanding of childhood occupations, I offer this self-reflective entry. In it I can find the dynamics of interpersonal interaction, the rule-making and gamesmanship that hopefully leads to participatory democratic thought and action, and of course meaning that transcends time. All interesting, when you consider it was just a childhood collection.


Young children enjoy collecting things. Bugs. Baseball cards. Comic books. Rocks. Lincoln pennies. My brother and I collected bottle caps.

I am thinking that Gary, one of my earliest school friends, was the first one to have a bottle cap collection. His Dad worked for the government (we weren't allowed to know what he did - and to this day I still don't know) and he went to odd and exotic places around the world. Their living room was decorated in a Japanese motif - and Gary's Dad brought back bottle caps from Japanese beer bottles. That got us all intrigued.

As ten year…