Showing posts from 2018

When leaders fail to lead.

Three years ago a controversial bylaws change was suggested for the American Occupational Therapy Association that granted the Board of Directors powers to revoke memberships based on complaint of other members and a finding of 'cause.'  This issue was fully discussed and documented in this blog at the time of the release of the proposal. As is the rule for all Bylaws changes, they need to be voted on by the membership, which happens at the subsequent Business Meeting.  That meeting happened in Chicago at the annual conference and is summarized in these minutes  with a synopsis of the specific issue at hand following: President Stoffel recognized Dawn Sonnier, Chairperson of the BPPC, to present a summary of the proposed Bylaws revisions. Chairperson Sonnier moved to adopt the revised Association Bylaws. President Stoffel opened the floor for discussion. The following members rose to speak to the motion: – Reggie Campbell (TX) spoke in opposition. Nicholas Hantzes,

How a motion to affirm dual levels of entry for occupational therapy was killed by the leaders of the AOTA.

CLICK ON PHOTOS TO ENLARGE It is important for the occupational therapy profession to understand that there was close collaboration between the RA leadership and the AOTA Board of Directors leading up to the Fall meeting.  As such, the Board of Directors may have been able to shape and form the agenda and the response to motions long before they ever were formally discussed by the RA members. The reason why Motion One on dual entry was killed was by what appears to be coordinated table setting engaged in by the AOTA Board of Directors, facilitated by the RA Leadership team, and then followed by those RA members who bothered to participate. Timeline:  8/14/18: AOTA signals to ACOTE that it still supports the doctoral single point of entry but just lacks the evidence to support the decision. 8/23/18: AOTA member contacts RA rep about dual entry motion. 8/24/18: Speaker Debi Hinerfeld indicates that AOTA staff are working "behind the scenes" to guide RA members in

A Motion to Update Policy E.6 Entry-Level Education of Occupational Therapists and Occupational Therapy Assistants

I am receiving email asking for assistance in drafting specific language for RA Motions related to the entry level educational mandates.  Here are my suggestions - please work with your RA representatives and each other to coordinate efforts. II. BODY OF MOTION: I move that the Representative Assembly revise Policy E.6 to read as follows:  PURPOSE: To state the education required for entry into occupational therapy.    IT SHALL BE THE POLICY OF THE ASSOCIATION THAT:   1. The Association recommends and supports entry-level education at the associate and bachelor degree level for occupational therapy assistants.   2. The Association recommends and supports entry level education at the master’s and doctoral degree levels for occupational therapists.    3. Consistent with the Association’s desire to improve practice, education, and research, the Association will take active steps to promote new programs and to assist existing programs to develop in ways that are c

When the shoe is on the other foot.

I am going to try to keep this simple, but the underlying message is critical for occupational therapists. The recent announcement from AOTA that places the entry level degree requirement decision of ACOTE in abeyance was a surprise to most people, whether they agreed with the decision or not. This post is not going to address the background of the issue, or the reasons for the AOTA reversal, or what some of the controversial elements are.   I want to focus on the response of some OTs who disagree with the decision, most notably program directors who lead academic programs that have to deliver the curricula. I agree with the fact that some academic programs who were set to follow through on the increase to entry level degrees are left in a difficult situation.  These are a couple of the legitimate complaints that I truly understand: 1. Financial resources have been expended in order to transition their programs. 2. Time and energy has been expended in order to transition their

AOTA's claim to authority over entry level degree requirements

ACOTE released their version of the timeline of their OTD accreditation decision and AOTA released their statement along with the MOU - and now the two sides sit in opposition with the fundamental question being "Who is responsible for setting the entry level educational standards for the occupational therapy profession?" The quick and easy answer, that apparently may be wrong, is ACOTE. The more probable answer, buried in documents available on the AOTA website, is the Representative Assembly of the AOTA. The policy of the AOTA, as determined by the Representative Assembly, sets the entry level educational requirements for the profession. The next logical question is: Does the Representative Assembly have this authority?  Yes, it does, and this authority is directly granted in the Bylaws: Does ACOTE have the authority to set AOTA association policy, specifically related to entry level educational requirements for the profession?  No, it does not, and this is

Analysis of the ACOTE/AOTA Memorandum of Understanding

On January 29, 2005, the Accreditation Council for Occupational Therapy Education and the American Occupational Therapy Association entered into an agreement that has been commonly referred to as their ' Memorandum of Understanding (MOU). ' As background for understanding this process it is important to consider the relationship between the national member association and its credentialing arm, which is technically a separate organization.  As I have stated for many years, in my opinion, AOTA and ACOTE are functionally indistinguishable.  ACOTE is an "Associated Advisory Council" of the AOTA Executive Board.  It is notable that intertwined relationships exist between the two groups since the creation of the credentialing group. ACOTE has its own Board of Directors, but ACOTE itself is staffed by AOTA employees who all answer to the AOTA Executive Director, who answers to the AOTA Board of Directors. Accreditation income generated by ACOTE amounted to ove

Trust, but...

I have been seeing Xinren for several months, on and off, in a primary care fashion.  That is a frustrating interaction pattern from an occupational therapy perspective, and perhaps one that as a profession we are simply not acculturated to.  In traditional contexts occupational therapists see children on an ongoing and regular basis.  Xinren's family would call and then would be seen for a consult and recommendations were made and then they seemed to not follow up for some time. The family initiated contact with me because they were concerned about their child's gross motor skills. The initial evaluation indicated that three year old Xinren had a lack of muscle tone and strength in both lower extremities, primarily in the ankles and feet.  Deep tendon reflexes were diminished and he had tightness in his heel cords and only trace strength in his ankles and toes that had a clear impact on his play skills.  I sent my report to the doctor who had no problem with writing a scri

Why do students in OTD programs respond so differently to survey questions about the OTD mandate?

Question : Why do students in OTD programs respond so differently to survey questions about the OTD mandate? In May 2018, the American Occupational Therapy Association sent a survey to all AOTA members about the educational requirements put forth by ACOTE. More than 7,400 AOTA members completed the survey.  Students enrolled in OTD programs responded very differently than every other group.  That is a data point that requires some analysis.   This particular graph, with this breakdown of responses, represents an ethical question for the profession. That we have 60-65% of everyone except OTD students AGAINST the mandate, and 60-65% of OTD students FOR the mandate is a call for some real soul searching. I personally believe that this response pattern may represent a sunk cost bias phenomenon.  The more important question is "How did that happen?" or "Why do students have such different ideas on the OTD mandate?" AOTA members are bound by the AOTA Co

Use of a Case Study Method To Explore Sensory-Processing Characteristics of Children With Complex Regional Pain Syndrome


A Pediatric OT's Screed on Trauma Informed Care (2015) - Three years later: Have we made progress?

Maybe some. A couple years ago I wrote this 'screed' on trauma informed care (TIC) models.  My concerns at the time were related to the lack of direct intervention that was promoted as part of this model - and that it appeared that some OTs were adopting a social work approach to the issue. Last night there was an #OTalk2Us twitter conversation about these models; I was not able to participate but I have been studying the conversation.  I think that this is a good opportunity to see if we are progressing ideas on TIC to be more occupational therapy directed and intervention-focused. It was good to see more conversation around the areas of occupational therapy assessment and intervention.  I think that we still need some direct conversation about how this problem gets addressed from an intervention perspective.  In my local experience, most of the conversation around TIC models is still oriented toward 'awareness' and is being driven by systems-level consultants. 

The AOTA reckless plan to open up all state occupational therapy practice acts

reckless. adjective (of a person or their actions) without thinking or caring about the consequences of an action. "reckless driving" On February 6-7, 2017, AOTA convened an ad hoc committee . This group was charged with the task to explore current experiential requirements for OTs and OTAs. As a result, the ad hoc group recommended a new model of experiential education that makes several disruptive changes including changes to the length of fieldwork and creation of a post-graduate first year practitioner resident program. Under this plan, graduates would complete the certification examination and practice under a limited license until the residency was completed. The group identified that this would involve the revision of many state's practice acts. They indicate that they were informed by staff and content experts on implications of these decisions. However, there were no state regulators listed in the ad hoc group. There were no representatives from t

Annual NY early intervention post

Early intervention providers in New York State should be aware that when Governor Cuomo does not get what he wants he just tries to cram it down everyone's throat via legislation - repeatedly. Blogging about the annual attacks on the early intervention program got boring around 3 years ago .  At that point in time the State Fiscal Agent (SFA) that is costing the taxpayers of NY millions of dollars in contract fees was only collecting 15% of monies billed for services.  In 2016 nearly 85% of claims submitted by the SFA to private insurers were denied. Now in 2017, 82% of claims submitted by the SFA to private insurers are being denied .  That is just pathetic.  They have no idea what they are doing.  It is boring to repeat the same thing every year, but if anyone ran their practice with the inefficiency of the SFA they would not have a practice. What is more pathetic is that we have been identifying how pathetic the SFA is for years - but no one listens to the provider commu

Analysis of occupational therapy leadership statements on student debt and the doctoral mandate

The occupational therapy profession is joining the credential inflation bandwagon through the mandate of its membership organization AOTA and its educational accrediting subgroup ACOTE.  Proposals are in place to advance the entry level for occupational therapists to the doctoral level .  A companion proposal to advance the entry level for occupational therapy assistants to the baccalaureate level has been made but is in temporary abeyance . It is important to analyze the statements of the leaders and future leaders of these groups in order to understand their positions on these topics.  Additionally, it is important to hold leaders accountable for their statements. 1. When queried about the impact of credential inflation in the occupational therapy profession to the doctoral entry level, AOTA President Elect Wendy Hildenbrand made several statements related to costs that require analysis.  She stated  I’m not a fan of the escalating cost of higher education generally,