Showing posts from September, 2013

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