Showing posts from 2019

The OTD Mandate and The Great Pumpkin

It is near Halloween, so a themed entry seems appropriate.

We have another motion in front of the AOTA Representative Assembly to mandate an entry level doctoral degree - even though a decision point was reached just six months ago on this same issue.  At that time, the decision was to support dual entry at both the master's and doctoral level.

That did not satisfy a Small Group of individuals, and so we are at the debate again.

People frequently ask me 'why' the profession is going through this again.  That is where the Halloween story comes in.

Each year, despite overwhelming evidence against his belief system, Linus would sit in the pumpkin patch and wait for the arrival of the Great Pumpkin - who he believed flies around and gives toys to sincere and believing children on Halloween eve.  Each year the Great Pumpkin would fail to appear but that does not stop Linus from believing.  Sometimes he even manages to convince his friends to sit in the pumpkin patch waiting wi…

The need for occupational therapy educational standards reform: Addressing the real problem behind the push for a doctoral mandate

As a profession, occupational therapists have been spending time talking about opposing the motion to mandate the doctorate – but we need to spend time trying to solve the problem that is bringing this issue to the table.

I believe that we have a specific problem (too many credits in masters programs) and some of our colleagues are trying to justify the escalated degree solution by conflating the real problem with a lot of side issues that may not be accurate (e.g. doctorates will give us a seat at the table, doctorates will make us more respected, doctorates will maintain parity with other professions, doctorates will make people practice at the top of their license etc - all evidence-free platitudes).

We should try to address the Credit Problem by reforming curriculum, reforming ACOTE standards, removing excess from those systems - and that will solve the REAL underlying problem.

Here are some ideas that Caroline Alterio and I generated and that she posted on the AOTA forums the …

Open letter to the Representative Assembly of the American Occupational Therapy Association

Dear Representative Assembly Members,

I am a program director of an occupational therapy program. I am shocked and concerned that the AOTA's Representative Assembly has accepted a new motion to re-litigate the entry level doctoral issue after it was just voted on and decided six months ago.

In any democratic process, issues should never be considered 'closed.' However, we also need to have some procedural safeguards to ensure that there is not an abuse of processes in order to effect a Small Group's will.

The Representative Assembly has such a process. In the document 'Rubric for RA Motions' it clearly states:

" Topic #4:
Motion originators/Rep articulate how the intended outcome of the motion is different from anything that other AOTA groups (ad hocs, COE, COP, EC, etc.) is working on or has already been addressed."
It is a mockery of the process to serially submit motions on the same topic that has already been liti…

Can you have too many books?

On the theme of having 'too many' of something...

Can you have too many books?

My choice to engage in private practice complicated my life plan to have dedicated spaces for work and play.  Work became a lifestyle, and the Internet just made the whole problem that much more complicated - accessing email and any other point of information at any time.  I am not sure why I didn't consider this back in 1981 when I first logged onto CompuServe.  I might have planned all this differently, and maybe made different life choices about information access.

Anyway, I think that I have too many work-oriented books.  Maybe.  Or maybe I just have too many in locations that I don't want to have them in.  I am working from one satellite office today and I looked at the books overflowing the bookshelf all over the floor.  How does this happen? 

I thought for a moment to just move them all down the street to my college office, but then I started looking at them and immediately recognize…

There are too many occupational therapy educational programs in New York State

There is an alarming increase in the number of accepted applicant and developing occupational therapy programs in New York State. The current entity responsible for the accreditation of these programs is the Accrediting Council for Occupational Therapy Education (ACOTE), a function of the American Occupational Therapy Association (AOTA).

According to data provided by AOTA and ACOTE, there are 22 accredited occupational therapy masters-level degree programs in NY State and 12 accredited associates-level occupational therapy assistant degree programs.

There are two additional developing masters-level degree programs, ten applicant doctoral-level programs, and one applicant masters-level program. Of the developing and applicant programs, approximately half are new and the other half are existing accredited programs that are seeking to add an additional degree level.

The question that is never asked is “How many occupational therapy educational programs can be reasonably supported in a …

The Barton Project: CAOT 2019 Conference slides

Conference slides!

Hi and thank you for stopping here to look at the slides for my presentation at the 2019 CAOT conference!

Relying on student subservience in the degree escalation competition game.

I was wondering today how many students were paying attention to the early presidential primary activities.  During Joe Biden's kickoff presidential rally in Pittsburgh yesterday he discussed the problems with over-credentialing and how it can serve to restrict competition in the marketplace.

He framed his basic presentation in context of lower wage earners and Union jobs, but does his argument apply to health care other middle income licensed occupations?

"They do the same thing with occupational licenses. Why should someone who braids hair have to get 600 hours of training? It makes no sense. It's designed to keep the competition down.

Look, folks, you can't just transfer your licenses across one state to another. They're making it harder and harder in a whole range of professions all to keep competition down."
He also talked about reclassification into exempt categories in order to prevent paying overtime.  That made me think of all my colleagues work…

Occupational therapy: The mouse that roared about degree escalation and credential inflation

It is easy for occupational therapy practitioners who have been embroiled in the intraprofessional debate about entry level credentials to lose sight of a larger perspective.  Sometimes the closer you are to a concern, the more challenging it is to understand the more broad ramifications of something that happened.

The grass roots effort that pushed against a mandated escalation of the entry level degrees in the occupational therapy profession made a very broad social and cultural statement.  It was a historic example of a professional group that argued against some of its own leadership in an effort that ultimately serves the more broad public interest.  It was an amazing testimonial to the nature of occupational therapy practitioners, their common sense and pragmatism, and their interest in fairness, diversity, and inclusion on many levels.  The effort highlighted the very best of the occupational therapy profession, even if it was a contentious and at times divisive argument.


An analysis of how small changes can potentially lead to unintended consequences in a motion

An analysis of the recent motion to update policy E.6 Entry Level Education is offered for consideration.

Please refer to the following for background information:

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

and also AOTA's claim to authority over entry level degree requirements


To understand the problems with the wording changes you need to read and understand the first policy as it is written in the policy manual.  Then you have to read and understand the motion that was submitted to update.  Then you have to read and understand what the RA actually passed.  All of this has to be considered in context of an unknown relationship between AOTA and ACOTE.  There is no way to dive into the weeds of this issue without reading all of the materials.  There is simply no way to condense it.


The original policy E.6 states

The motion that was submitted to update the policy use…

What will happen to the Wilma West Library and archives of the occupational therapy profession?

During the last year, minutes from the Board meetings of the American Occupational Therapy Association indicate that there has been discussion on two matters that have an important impact on the Wilma West Library, home of the collected resources that catalog the history of occupational therapy.

Around last year, discussion apparently started getting more specific related to sale of AOTA's current building.  In May 2018 the board authorized the (re)allocation of funds necessary to pay off the mortgage on the building and exploration of new sites for the organization's operations.  It is unclear if a new location has been identified, but in the recent February 2019 meeting a current board member will provide consultation regarding redesign and build out of the new space, indicating that the process is moving forward.

Also noted in the February 2019 minutes is that AOTA will take sole responsibility and ownership for the Wilma West Library, excluding graduate theses and dissert…

Degree escalation and doctoral education are sinking the occupational therapy profession

Occupational therapy started on a simple premise - that man, through the use of his hands as they are energized by mind and will, can influence the state of his own health.  That statement was provided to the profession by Mary Reilly, our greatest theoretician.

It is a simple concept, borne out of a core philosophy of pragmatism and infused with a dose of all the good intentions of the moral treatment movement.  If you carefully read that core philosophy of occupational therapy you will hear the Emersonian reverberations of self-reliance: 'Trust thyself: every heart vibrates to that iron string.'  That is what occupational therapy seeks to nurture in the spirit of people: Independence, harmony with the self, harmony with nature, and a satisfaction in authentic work and effort and purpose and meaning.

Occupational therapy is a concept that was designed to create solutions for the problems of living - and was field tested in the settlement house projects of Chicago and Bos…

The primary driver for degree escalation in occupational therapy is to solve poor curriculum design of master's level programs

Perhaps the greatest point of misinformation that is routinely spread when academicians discuss the 'need' for escalating the entry level degree to the doctoral level is that master's level OT programs can vary between 80 and 100 credit hours, depending on the school.  This is not a factual statement.

 There are some OT schools that are configured in a 4+1 or 3+2 model and the number of graduate credits is only around 30-40.  In these schools, the bulk of the occupational therapy curriculum is delivered at the undergraduate level.

Throughout the conversation, I have heard educators and practitioners both attempt to get AOTA and ACOTE to acknowledge that not all educational programs are experiencing the same kind of 'credit pressure.'  People use different terms to describe this concern; most explain it in terms that some programs are requiring more credits than are necessary or perhaps even typical for granting a masters degree.

It is true that some programs…

The ongoing occupational therapy identity crisis: 2019 edition

What does it say about a group of professionals that can't agree on what titles to use to describe themselves?

Several years ago I wrote a post entitled "Why students will be making elevator speeches to define occupational therapy for the next 100 years."  The issue behind this is that some occupational therapists believe that the public does not recognize what the profession does and that it is important to have a handy 1 minute description.  The post describes the fact that the profession serially re-defines occupational therapy and that the constant tinkering with definitions contributes to the confusion.

The problem that some people in the occupational therapy profession have with their self-identity now extends to the title that they want to use to represent themselves and whether or not they want to even use the national credentials that they have earned and that have given them the right to apply for state licensing.

One point of genesis of this problem is with s…

A sad prediction that is coming true for occupational therapy assistants

Last year I wrote several blog posts about the devastating advocacy position taken by AOTA to remove the Medicare therapy caps that caused a 'paygo' impact on services provided by occupational therapy assistants.

In short, the Bipartisan Budget Act of 2018 lifted the Medicare therapy caps and was 'paid for' by an agreement that OTA services under Medicare Part B would have to be paid at 85% of the standard rate whenever that therapy was delivered in whole or in part by an OTA.

Professional lobbyists and policy analysts at AOTA were surprised by this 'last minute' inclusion of a payment differential even though the House Rules Committee clearly included this language in the document summary that was sent to the CBO for scoring prior to the legislation being passed.  As a result of their inattention, no one was alerted to this dangerous language, no one could advocate against it, and OTA practice was severely damaged.  It was a colossal and inexcusable policy an…