ABC Therapeutics Occupational Therapy Weblog

Something unfortunate has been happening in occupational therapy, and I’ve been watching it develop for years. At first it was a little distant but now it is uncomfortably close. The profession has always had its share of plucky innovators and small-scale entrepreneurs, but the landscape has shifted. An increasing number of young therapists are building a “personal brand,” launching a subscription service, or producing downloadable content with a logo and a tagline. These are not just side hustles - for some, it is the work. None of this is inherently bad - and I understand why it happens. Salary-to-debt ratios look like a punchline and clinical autonomy is chipped away by policy and productivity expectations. It makes perfect sense that people look elsewhere to find meaning, income, or both at the same time. But something gets distorted when the gravitational pull of monetization starts to reshape what counts as knowledge in the field. The distortion becomes even more concerning wh...

Like many others navigating the skies this week, I ran headlong into the perfect storm of weather delays, FAA flow restrictions, and cascading cancellations. By Wednesday it became clear I wasn’t getting to the AOTA Education Summit - at least not physically. I made the error of having too short a window for connecting flights... Rather than let the workshop vanish into the ether, I decided to take a different path and record the full presentation from home. In some ways this feels appropriate, because the talk itself is all about imagination, accessibility, and democratizing ethical inquiry . If people couldn’t gather in one room, then why not open the room to everyone? The presentation -  “Teaching Occupational Therapy Ethics Through Speculative Fiction” - explores how narrative forms can help students engage with complex moral problems in ways that feel emotionally safe and intellectually honest. Ethics education today often unfolds in a climate where students worry more abo...

Also titled: How occupational therapy can stop arguing for inclusion and start designing itself into relevance Occupational therapy spends a lot of time talking about being ‘overlooked.’ But being overlooked isn’t a visibility problem—it’s a design problem. We’ve built a profession that is extraordinarily self-aware and socially conscious, but not always system-literate. We’re fluent in the language of empathy, occupation, and participation but often ill-equipped to translate that into the economic, technological, and policy structures that drive decision-making. How did that happen? When OTs ask, “Why don’t companies hire us for product design, UX, or consulting?"  the answer isn’t bias. It’s fit . The market doesn’t know what to do with occupational therapy rhetoric (jargon) because we rarely show up with the frameworks, data fluency, and deliverables those systems require. Talk to an engineer, and you hear systems. Talk to an OT, and you hear an apology and an elevator sp...

Also titled:  Why OT’s next evolution must move from consumption to creation I’ve been writing about occupational therapy’s educational evolution for nearly two decades, and this feels like the conversation we need to have next. For years, the justification for moving occupational therapy education to the doctoral level has centered on an oft-repeated promise: we will gain a seat at the table. The logic was simple enough - if we matched the credentials of our peers in other health professions, we’d gain equal standing, influence, and voice. I believe that assumption, though comforting, is wrong. A degree doesn’t grant influence. Credentials open doors, but they don’t dictate what happens once you step through them. A “seat at the table” means very little if the table itself was built by someone else, and if all we do is wait to be served. I’ve been a vocal critic of the mandatory entry-level OTD for exactly that reason. The last time we went through a similar transition - from ...

In 2012 , I asked on this blog: “Is NY State taking steps toward a paraprofessional delivery model?” That was the year the state began inserting Level II HCPCS codes into the New York Early Intervention System (NYEIS). These were not therapy codes — they were catch-alls used for durable medical equipment and non-professional services. I warned at the time that commercial carriers would never reimburse them. These codes had no standing in pediatric therapy billing. The only plausible reason for inserting them into NYEIS was to create billing pathways for non-licensed, lower-cost providers. A few months later, I wrote again — “More Road Paving for Paraprofessional EI Services in New York State.” That post analyzed how New York was linking Early Intervention with OPWDD’s Home and Community-Based Services (HCBS) waivers . Services like Family Education & Training or Community Habilitation are commonly delivered by staff with 2- or 4-year human services degrees, not licensed therap...

  Language my lawyer told me to insert: “The following is a satirical commentary intended to critique scope creep in occupational therapy scholarship.” I recently saw an article on the role of occupational therapy in global nuclear disarmament. Inspired by this expansion of our scope into the realm of geopolitics, I thought I would make my own contribution to these kinds of important and clinically relevant proclamations. Abstract The looming challenge of interplanetary colonization poses an existential opportunity for humanity and directly impacts the ability of individuals and communities to engage in meaningful occupation beyond Earth. This article argues that occupational therapists and occupational therapy assistants have a critical role to play in preparing for Mars colonization, and that such efforts align with both our ethical responsibilities and scope of practice. By anticipating the profound occupational disruptions of space travel and Martian settlement, occupational ...

Several years ago, I wrote about the confusion that arises when occupational therapy conflates charity with social justice  and about the subtle but important shift from the Social Gospel tradition toward a politicized discourse of redistribution and equity   At the time, some dismissed these concerns as overly semantic. But the receipts are there: once you build “social justice” into the profession's  Code of Ethics , you’re no longer talking about voluntary altruism. You’re talking about mandatory redistribution. And now, as discussion emerges on academic listservs about the decline of student volunteerism , some are discovering that not all students are enthusiastic about forced redistribution. So, what’s the next move? You start mandating volunteerism. Think about that for a moment. Mandatory volunteerism. That phrase itself is a contradiction so sharp it should stop us in our tracks. If the goal is charity , it cannot be compelled because coerced charity is ...

For twenty years, I have used this blog to document occupational therapy as it unfolded: its controversies, contradictions, policy shifts, and unfinished arguments. This archive records my evolving perspective as well as the broader struggles of the profession to define itself. It is not tidy, and it was never meant to be. Sometimes sharp, sometimes uncomfortable, occasionally at odds with what the field preferred to hear, but always honest. The blog has received more than 1.7 million pageviews since 2006, with an estimated 200,000 to 250,000 of those representing real human engagements. That is a remarkable footprint in a small profession where many peer-reviewed articles are read only a few hundred times. Spikes in readership came during inflection points such as the doctoral mandate debate, showing that the blog became a gathering point when the profession was most unsettled. Even in quieter years, thousands still returned, treating the archive as a touchstone for reflection and cr...