Showing posts from 2013

The architectural legacy of George Barton

n.b. ongoing series related to a study of George Barton, founder of the Occupational Therapy Profession.  George Barton was diagnosed with tuberculosis in 1901 (Reed and Sanderson, 1999) and he traveled to Colorado some time after that.  I could not confirm the exact dates of his travel but an educated guess would be sometime around 1907, because his architecture practice with Sturgis was listed as  being active up until that approximate time (AIA, 1914). It is difficult to know exactly what brought George Barton to Colorado - it could have been his own "chase" for a tuberculosis cure or it could have been that he had political connections with the Colorado governor, John Shafroth who was a member on the Committee on the Philippines in the 65th Congress and prior to that was a Colorado representative and frequently involved in US-Filipino relations. Reed and Sanderson document that the Governor commissioned Barton to investigate factors related to famine along t

On Pygmalion and sensory integration research

Occupational therapists have been attempting to improve research on sensory integration by adopting more strict fidelity standards and by using Goal Attainment Scaling as an outcome measure.  Three years ago I blogged about an SI effectiveness study and expressed some concerns on the research design - you can read about that at A new study has been published by Schaaf et al (2013) and can be accessed online in full text at  However, one major difference is that in the new study the researchers used an intervention and a 'usual care' group. Use of control groups in this manner can help to correct for potential Hawthorne effects - but only if the study is designed properly.  In the previous study there was an OT/SI group and a fine motor training group.  The fine motor group in the first study was probably not exactly a

On beehives, planetary motion, and reasons for not writing reports sooner.

Autumn clings tightly to these late November days like the last remaining leaves on the trees.  Looking out into my front yard I see that bee hives and abandoned birds nests also populate the branches of trees.  I know that the leaves fall and they fertilize the earth and feed the trees for the Spring.  I have been wondering if the bees re-populate their hives, or if the birds recycle their nests.  I have to look into that. Why is it that my immediate impulse was to remove these remnants of the Spring and Summer?  In my mind I was waiting for it to be cold enough so that the bees would be torpid.  I have been developing a plan for the last several weeks to knock the beehive out of the tree, recreating a childhood family tradition of smashing a pinata with a bat on New Years Day.  I didn't expect that candy would come out.  In fact, I was praying that angry bees would not possibly come out, which is why I was waiting until we were full into Winter. Being a professional beehiv

Reasons to pause when discussing a "sensory processing disorder" construct.

The Sensory Profile is an assessment tool that purports to measure sensory processing abilities (Pearson Education Inc., 2008); there are versions for infant/toddlers, school aged children, and adolescent/adult populations.  The tool has been used to document the incidence of a "sensory processing disorder" construct (Ahn, et. al., 2004; Ben-Sasson, et. al., 2009).  To date, although many scientists recognize that children can have difficulties with processing sensory information, this diagnostic construct has been rejected and is not considered as a distinct clinical entity (AAP, 2012).   For more in depth reading, please reference previous blog posts here . I was interested to see an article in a recent OT Practice magazine regarding sensory processing abilities of children involved in the justice system (Shea and Wu, 2013).  The article presents an interesting test case for use of the Sensory Profile to help understand the nature of some difficulties that these adolesce

Written testimony for public hearing on EI fiscal agent implementation

Although I was initially planning to present oral testimony for the upcoming public hearing on EI fiscal agent implementation I have decided to present written testimony.  My ideas on this differ a little from other providers who very understandably are stressed by the notion of billing because of how difficult this process has been.  I think that a correctly implemented plan as outlined here would be the best solution. Here is what I have submitted: +++++++++++++++++++++++++++++++ My name is Christopher Alterio and I am an occupational therapist and private practice (small business) owner in Western New York. Thank you for the opportunity to submit this written testimony. In my practice I see children through the early intervention program and I also see children whose families choose to be seen privately outside of that system. I have been involved with the early intervention system since its inception in the early 1990s and have been working as a pediatric occupational therap

Evidence update: Pediatric fecal incontinence and best practices for intervention

Almost seven years ago I wrote a blog entry on pediatric fecal incontinence which is archived here .  In that review I briefly discussed psychological and physiological and regulatory factors that might contribute to the problem.  The evidence at that time indicated that dietary, activity, and cognitive behavioral interventions were most likely to be successful in helping families. I also discussed a common occupational therapy mythology that sensory processing factors such as preference for deep pressure stimulation might contribute to fecal retention.  There has never been any evidence to indicate that this is a relevant factor. In the current issue of the American Journal of Occupational Therapy there is an article by Bellefeuille, Schaaf, and Polo (2013) that describes OT intervention for a child with retentive fecal incontinence.  The authors hypothesize that a 3 year old child's difficulty with passing stool is related to overresponsivity to sensory stimulation.  By repo

Are NYS Medicaid audits improperly destroying care systems?

Follow up to earlier post: ++++++ New York State Medicaid regulations are a dizzying and complex ruleset that most providers in good faith attempt to follow in their care of people who are Medicaid recipients. There is an appropriately strict set of rules that most people don't disagree with because naturally we want our State monies to be distributed appropriately and we certainly don't want people fraudulently gaming a reimbursement system. Undoubtedly, there are examples of fraud and abuse that require strong auditing response and hopefully even referral to the criminal justice system.  We have all heard of stories of providers submitting documentation for services that were never provided, or providers claiming all kinds of illegitimate program costs, and even providers creating no-show Medicaid funded administrative jobs for friends and relatives.  These are the kinds of cases that

The influence of William Morris and the Arts and Crafts Movement on Occupational Therapy

n.b. ongoing series related to a study of George Barton, founder of the Occupational Therapy Profession. By my reckoning, it is probably impossible to conduct a study of an event without studying the context in which that event occurred.  Here I suspect that occupational therapy colleagues reading this will understand the bias of the author as he attempts to become a historian.  As clinicians we have well established practice frameworks like the P-E-O model (Law, Cooper, Strong, Stewart, Rigby, & Letts, 1996) that explicitly state that the behavior can’t be separated from its contextual influences. Additionally, this model re-introduced the importance of history-taking for establishing personal contextual relevance for clinical reasoning. Similarly, the Lifestyle Performance Model (Velde & Fidler, 2002) takes a congruent approach by completely embracing phenomenology as being the only possible method for understanding the personal contextual relationships between an indiv

When the fishing is good but the catching is bad.

I personally always fished with worms, or occasionally newts - but I am no fisherman and my knowledge of this occupation is restricted to the things a young boy would gain by spending summers casting into the Hudson River more for a way to commune with friends than for the sport.  Back then it never really mattered what we caught or even if we caught because the occupation was directed toward the social experience.  Besides, there is nothing worse than having to get a river eel off of your line.  Gross. Anyway, I was preparing a lecture and the concept of 'emerging practice area' ran across my radar screen.  This is certainly nothing new in OT.  The word 'emerging' seems to be an interesting buzzword in occupational therapy right now and it is applied across many contexts.  There are 'emerging leaders' and there are 'emerging practice areas' and there are 'emerging fieldwork sites' just to name a few.  It must be important because there are ev

NYS Early Intervention Program makes up more rule changes as they trip along

Here is an illustration for providers in the NYS Early Intervention Program that clearly illustrates the selfish orientation of thinking that is driving decision making on a central level at the Bureau of Early Intervention. Exactly two months and two days ago, the Bureau of Early Intervention instructed providers to "accept claim amounts proposed by the insurer as payment in full from the insurer for the claim which are lower than the State-established EIP rate."  Although they explained that this would not impact payments from escrow in the short term, we explained that accepting these payments in this way would be problematic because of the long term intent of having providers accept payments directly from insurers. TODAY we received a DIFFERENT set of instructions from the Bureau of Early Intervention that states: Dear Colleague: The Department is aware that insurers or insurer clearinghouses (Multiplan, Omni Plan) have sent expedited agreeme

New York State Early Intervention: Roadmap through the end of 2013

My email box is flooded from colleagues asking about the NYS Early Intervention program - so I thought I would lay out the likely path toward the end of 2013 so people can plan appropriately for what lies ahead. I also have a roadmap through 2014 and 2015 which will be published as a part of this series.  Stay tuned. Fall, 2013: The already stressed EIP will continue to come apart at the seams.  Payments to providers will continue to be excruciatingly slow and complex.  Even more providers will leave the system creating even longer waiting lists for children and families. There will be no immediate 'fix' because the legislature is out of session until January. Governor Cuomo and his administrative team will continue to blame the insurance industry for the problem and will refuse to acknowledge their own roles in creating the mess.  This will lay the groundwork for insurance reforms that will be introduced next year in the Governor's Budget.  The State will stick to

Understanding Common Core Standards in two short videos.

Here is everything you need to know about Common Core standards in two short videos: Enjoy!

Early intervention providers: Look the 'Gift Horse' in the mouth please.

I received this in email today: Dear Colleague: The NYS Department of Health (Department) is offering a one-time State safety net payment to Early Intervention providers, and will not proceed to implement the Preliminary Escrow Payment (PEP) proposal due to insufficient county participation.   State safety net payments will be calculated as seventy-five percent of the value of claims submitted to insurers, with the exception of the medical assistance program, in the period April 1, 2013 through July 29, 2013 for which no known payment or denial has been received.  The State safety net payments will be reconciled commencing on October 1, 2013 by assigning to the Department twenty-five percent of each early intervention payment payable from the escrow account until such time as the State safety net payment is fully recovered.  The safety-net payment is a one-time payment made by the State.  All claims submitted by the provider, including those submitted to insurers i

Note to politicians: Grandstanding on important policy issues does not win votes.

All press is not good press.  Especially when people get distracted from what the primary issues are. In tonight's Capitol Confidential post there is a report that is headlined: "Therapists want to get paid, Tedisco sees 'War on Women.'" The headline I would like to see is: "Children go without important therapy as NYS decimates Early Intervention Program." A parallel example recently was the announced closure of O.D.Heck.  This announcement generated conversation about the plight of union jobs.  What got lost in the shuffle was the important human rights policy of de-institutionalization and the very real fact that there are problems with maintaining appropriate standards of care when we warehouse people who have disabilities. How do concerns with the early intervention program degrade into a headline about the 'war on women"  and grandstanding on some cause du jour???  The cheapening and coarsening of our policy discourse in this way m

George Barton: Birth and early influences.

George Edward Barton was born on March 7, 1871.  That is a rather dry fact about one of the important founders of the occupational therapy profession - so what can be done to help give it context? Context provides dimension - and if we want to learn a little about George Barton it might be helpful to know a little about his history.  His parents lived in Boston, Massachusetts.   His father was Edward H. Barton, the Secretary and Treasurer of the South Boston Savings Bank.  His mother was Rebecca Duncan (Boynton) Barton. It was difficult to find other information about George Barton's parents, but a rather unexpected pair of portrait photographs were contained in some of his possessions that led me through this investigation.  Here is the first picture: I recognized this photograph; it is an original portrait of Louisa May Alcott - but why would it be in the possession of George Barton?  Louisa May Alcott was born November 29, 1832 and she died on March 6, 1888.  That would