ABC Therapeutics Occupational Therapy Weblog

Concern Troll: ( noun ) A person or persons who pretends to be 'concerned' about something and talks about it, all the while serving to actually disrupt the legitimate concerns and activities of people who are trying to address problems. Concern trolls are particularly skilled in derailing conversations, conflating issues, and leading people off track. ***** AOTA recently released a new document on use of restraints and seclusion related to school based practice.  I will not link that document because I believe that it is fundamentally flawed and does not represent the thinking of many people who actually practice in school settings.  There is no value in spreading that faulty document, but I will describe the problems with a hope that more conversation will be generated about the issue broadly. The paper has some positive aspects, including identification of the role of OT in helping teams understand and interpret personal and contextual factors that might lead to disru...

There is ongoing debate on the AOTA forums about move to an entry level doctorate.  Within that debate there is repeated discussion about the 'future.'  I am very interested in the concept that occupational therapists should attempt to 'focus more on what COULD and SHOULD be different for practitioners graduating in the future.' Prognostication is an interesting endeavor, and I am wondering if this is something that most occupational therapists really have the skill set to accomplish.  I don't believe that there is evidence to support OTs having these skills. R. Buckmister Fuller, who in my opinion was a tremendously gifted anticipatory design scientist, felt that he had an ability to prognosticate based on his model of integrative systems thinking and on his naval training in navigation and ballistics.   In his book 'Operating Manual for Spaceship Earth' he explained how some people felt that he was 1000 years ahead of his time, which puzzled h...

Can use of an occupational justice model in an American context result in accusations of professional misconduct? Conceptual practice models are interrelated bodies of theory, research, and practice resources that are used by OTs to guide practice (Kielhofner, 2009). One such conceptual practice model is the Occupational Justice Model (Townsend, 1993; Townsend and Nillson, 2010).  According to these sources, the Occupational Justice Model is framed around the concept that injustice occurs due to inherent governance and social structures that allegedly restrict the occupational performance of some populations and individuals. Concepts associated with occupational justice models have filtered into some official documents of the American Occupational Therapy Association.  For example, the AOTA 2010 Code of Ethics included a new principle of 'Social Justice' (AOTA, 2011).  That new principle required occupational therapy personnel "to provide services in a fair and equita...

I was interested to see some comments from Dr. Elizabeth Townsend (2015) in an online forum asking "How are we building leadership for key posts at universities in support an [sic] occupation focus - both in the science and therapy of occupation?"  She asked this question in context of an open position at Dalhousie's School of Occupational Therapy in Halifax, Nova Scotia but was interested in a more general sense of how to build leadership outside of large metropolitan areas.  This interested me because I have been studying recruitment and spread of occupation workers at the time of the founding of the occupational therapy profession.  I began to wonder if a study of this history could provide context for interpreting the current recruitment call. An important early supporter of proto-occupational therapy was a man that is not often cited in American textbooks.  Sir Wilfred Thomason Grenfell is described as a "physician, medical missionary, social reformer, and ...

Follow up to PTE Speech in 2012: Ways you will be paid . I said in that speech that "The people who need you the most might not be able to pay you the most."  I thought about that this morning, because several things that I did are not 'reimbursable.' The idea of my talk to those students was to tell them that over the longer course of their careers that it is likely that they will make enough money to repay their student debt, but that it would be short-sighted to measure success in monetary terms because sometimes the ways you are paid can't be identified as a quantifiable amount in your Account Receivables, or it might not be noticed by the widget counters that reside in the Halls of Productivity, Outcomes, and Cost-Control. This morning a mom called to cancel their appointment, and then asked sheepishly, "I have a question, and I hope that you don't think it is silly.  My son deleted his Minecraft world and do you have any idea how we might be a...

When I get home from work I have things to do, like everyone else, and sometimes those things make my hands dirty.  Sometimes it is some minor maintenance on my car, or repairing something in the house, or doing a little gardening.  I know that I have to scrub my hands clean after these activities so that there is no evidence of dirt or paint or grease.  I keep my fingernails very short for precisely this reason. What would I tell a parent the next day - that I have the residual stain of grease on my hands because I was elbow deep into my engine compartment the night before?  I suspect that most parents would understand, but it would not feel comfortable.  If you work on cars or paint a room you know how difficult it is to remove all traces of those occupations from your hands. Cultural stereotypes abound surrounding the nature of a person's hands.  We even have idiomatic language about 'getting your hands dirty.'  This is a positive concept that m...

I was interested to read the comments of Dr. Moses Ikiugu who is a candidate for AOTA delegate to WFOT.  His full post addressing the AOTA's future priorities in context of the Centennial Vision can be found here . First of all, I would like to thank Dr. Ikiugu for sharing this thoughts because this is an important topic and not all candidates take the time to document their positions. One of his more interesting comments was a call for WFOT to develop and support  theory-based clinical decision-making.  He states: The hallmark of professionalism is the ability to explain how what we do in the process of providing our services works to address the problems that are within our domain of practice. This explanation usually comes from the theoretical base of the profession. That is why we should develop a strategy to ensure that theories that guide occupational therapy practice are clear and every occupational therapy practitioner in the world can use such theorie...

The occupational therapy profession is unique because it is positioned as a stepping point to help people escape the despair of a liminal disability state and move toward the function that people wish to achieve, for themselves or for their children. I have written previously on the occupation of writing and the notion of interactivity through written text.   I have come to understand over time that parents are Manifesto-writers, often taking pen to page to attempt to make sense of their parenting occupations.  I frequently evaluate children and in that context am handed Manifestos of parents who have so much to say and want to be sure that their message is adequately conveyed during what they perceive as an all-critical evaluation process. The evaluation is a moment in time that is pulled outside of the stream of other normal interactions and it is often elevated in contextual importance.  The parent may have expectations that the evaluator is expert and many hopes ...

Last year I bumped face first into a gnawing problem.  I was discussing practice trends in a professional context with an impressive panel of colleagues who were subject matter experts.  I raised the topic of the role of OT in planning transition services for adults who have developmental disabilities, and the more general topic of services to adults who have developmental disabilities was bantered about. My own personal perspective is that OT has a critical role in providing services to this population, and in fact concerns about adults who have developmental disabilities have been discussed in this blog more    than    a    few    times .  The problem I ran into is that among the opinions of the subject matter experts who represented diverse geographies around the country, not all could confirm that occupational therapists were an important part of the care plan for this population.  In some contexts, subject matter exper...

I was interested to read Dr. Braveman's blog post yesterday on Triple Aim.  In that post he stated "What did surprise me was the call for volunteer leaders to stop sharing their opinions and perspectives on such issues with the rationale that the issues can be interpreted by some as political and partisan."  You can read the whole post at http://otconnections.aota.org/community_blogs/b/brentbraveman/archive/2015/01/08/why-we-should-hear-more-about-health-policy-issues-such-as-the-triple-aim-of-healthcare.aspx He doesn't reference what 'call' he was referring to, but I would like respond to that statement because of the statements I have made on that topic.  I am not aware of any other statements on this topic, but if there was some other 'call' I would like to read it. In any event, related to my postings, I am not aware of any statements I made that could be reasonably interpreted as a call to stop sharing perspectives on issues - what I have ...

A recent article published in the American Journal of Occupational Therapy furthers the politicization of the professional association by issuing another full-throated endorsement of the Institute for Healthcare Improvement's 'Triple Aim.'  Leland et.al. (2015) state that "Failure of the profession to clearly demarcate what constitutes high-quality occupational therapy and demonstrate its contribution to the broader patient outcomes that value-based care will measure may marginalize occupational therapy in the rapidly changing health care environment." Unfortunately, the authors align the concept of 'value' with the IHI 'Triple Aim' that includes "improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations." (Berwick, Nolan, and Whittington, 2008).  These objectives sound quite noble, but they break the primary social contract that health care providers ha...

Politically controversial conversations continue to spew from the social media accounts of AOTA leaders.  These conversations represent perspectives that are not reflective of the broad membership and are highly partisan.  The steady stream of ideological thinking is concerning because it represents a pattern where some leaders don't know how to separate their personal political inclinations from the mission of a diverse professional association. We often associate topics of diversity and nondiscrimination and inclusion in racial or ethnic or religious perspectives.  However, in what is supposed to be a politically neutral environment like a professional association, we can also consider the negative impact that is caused when leadership adopts a partisan and biased political agenda. This is not a new problem with the American Occupational Therapy Association.  The inclusion of Social Justice in the Code of Ethics was the first major foray of leaders into politic...

I got an interesting question in email today so I decided I would answer it publicly.  The email asked: You used to write a lot about early intervention, but there hasn't been much on that topic lately.  Providers are still struggling, there are provider shortages in some areas, lots of people lost their businesses and either went into agencies or gave up on early intervention.  Are you still working in this area and will you still be writing about how we are struggling with early intervention? Here is my answer: The reason why I don't write about early intervention as much anymore is because everything that I predicted about the municipal takeover of the system has come to fruition.  There just isn't anything left to say about it, and now the program will limp along in a reduced capacity just as planned.  The transition to the State Fiscal Agent system was intended to destroy the program as it was previously designed and that objective has been met....

The following Twitter conversation underscores the problems with use of a population health model in an occupational therapy context: Framing a conversation about the need for older drivers to consider their abilities underneath a context of population statistics is in direct conflict with the profession's Core Value of respect for patient autonomy and individuality. Although it may be true that there are descriptive statistics about driving safety, numbers of accidents, and other factors associated with elderly drivers, when we lead our conversations with talk about the broad population we are adopting a potentially ageist stance that restricts the freedom of many drivers who are not falling within those normative ranges. This is the problem with use of a population health model for meeting the needs of individuals.  To describe this problem within a general systems theory framework, consider the following chart: Within this traditional framework of intervention, the...