Wednesday, July 26, 2006

occupational therapy runs in the family

We had a family function recently and my Great Uncle Joe brought his artwork for everyone to look at. It was such a treat to be able to see his work, and now it has surfaced again on the web.

Please indulge my family photos here - this is my sister Stephanie admiring his artwork. I am so glad that I had this picture - now I don't have to risk copyright infringment by using the one in the paper...

Here is link to a very nice article in the Albany Times-Union about my Great Uncle Joe. Under most circumstances I wouldn't use this forum to link to news articles about relatives, but I admire my Uncle Joe so much that I want to spread this around. I figure he wouldn't mind since it is already out in the public domain.

I don't know if my Uncle knows about occupational therapy and I don't think I have ever discussed it with him. However, this story illustrates the bi-directional power of occupation - in this case both for him as a teacher and for the people who sign up for his art class. A sharp staff member at his residence understands how to engage people and keep them involved in occupations that are important and meaningful. That makes me happy.

I find it very validating to hear about these kinds of stories, especially as they are expressed through non-occupational therapists.

I hope you all enjoy this as much as I do.

Wednesday, July 19, 2006

Join our team!

We are growing again! We have openings in the Fall for the following positions - please spread the word to anyone you know who may be interested in employment:

COTAs
OTRs
PTAs
PTs

The positions are pediatric - preschool and school based in Erie County, New York.

Thanks for spreading the word! If anyone is interested in applying for a position they can call (716) 759-8634, or stop by and visit at ABC Therapeutics, or email at chris@abctherapeutics.com

We would love to hear from you...

Thursday, July 13, 2006

More notes from the carceral archipelago

Advance warning: this is not for the faint of heart. If you are easily offended, please move on.

I don’t want to discuss too many details because this is a sensitive situation, so I will try to focus my discussion on the issues of sociobiology, sensory processing and behavioral analysis, disability rights, and of course the carceral archipelago.

I get the most interesting referrals. A recent one was for a young adult who has mild to moderate developmental disabilities who was removed from his community vocational placement because of inappropriate sexual behavior. A psychologist had the idea that perhaps some of the behaviors were generated from a ‘sensory seeking’ type of profile so I was asked to assess this area and provide some input for the team to consider.

I would like to offer an analogy for purposes of beginning this discussion. I am not equating human and animal behavior by giving this example, but rather trying to find a means of opening a discussion on instinctive sexual activity. So, my poor dog Hunter will serve as the focus of the conversation (and I label him as such because his ‘personal’ information is about to be posted for the world to see).

Hunter has been physically castrated but he still has some instinctive sexual urges. I suppose that his adrenal glands can still produce some androgens, so the castration couldn’t have totally eliminated testosterone from his body. This could represent some hormonal contribution to his behaviors, although this would presumably be small.

Sexual activity has a social component, so it is important to consider this angle as well. We were careful to establish that humans are the alphas in the family. So although it kind of grossed out the kids, I wasn’t really surprised when one of them came running up the stairs screaming “Help! Help! Hunter is humping my stuffed panda bear!” He had to find something to dominate, I guess.

Hunter is a sensory seeking dog – just like most golden retrievers. But I don’t know that my dog has a sensory processing disorder. I also don’t know that if I put him on a sensory diet that I would be able to materially change his episodic humping of the stuffed panda bear. I stand firm in my reasoning that makes me believe that poor Hunter does not have a sensory disorder.

So how can this relate to the referral I received?

Here is where the disability rights issues enter into the equation. My jaw dropped when I read it, but the fellow I assessed receives Depo-Provera shots. It just grates at my sense of morality – this fellow can read at a 3rd or 4th grade level, communicates well, and lives in a community setting. I understand that there has to be some concern for the safety of others but is chemical castration ethical in people who have developmental disabilities? Anyway, right or wrong, hormones obviously can’t totally explain his behaviors because he has been essentially castrated but the behaviors persist.

From a sensory perspective, I don’t know that I will focus my recommendations on any kind of sensory program. I gave the Adolescent/Adult Sensory Profile but didn’t score it yet – although I wouldn’t be surprised if he has some sensory seeking tendencies. I just don’t know if there is a lot of face-validity to the notion that sensory seeking tendencies would lead to paraphilias in whatever forms. Certainly sensory stimulation is part and parcel of sexual activity but it is another leap entirely to state that people who demonstrate ‘alternate’ sexual activities are primarily driven by sensory seeking tendencies. So I am willing to consider the hypothesis, but not willing to entirely focus my recommendations that way.

If we eliminate hormones and don’t want to accept sensory explanations, we are left with the social contributions. This is where we have to discuss the carceral archipelago.

Sexuality is instinctive, and unfettered or unrepressed sexuality can be interpreted to represent a range of behaviors. Instinctive sexuality might represent a lack of inhibition such as could happen with a person who has cognitive deficits. Instinctive sexuality might also represent a total lack of a moral compass such as with a pedophile. I imagine that forensic psychologists have to cope with this issue frequently, even though there is some debate about the DSM-IV-TR diagnosis of Paraphilia. To label something as deviant is to pass a moral judgment on the activity, and it seems that a lot of psychologists are interested in avoiding a repeat of the homosexuality debate.

The System (whatever that is) decided that castration was an answer to the problem – because the System Administrators have to dance around the issues of what constitutes appropriate vs. inappropriate sexual behavior. This is an error of magnificent proportions on so many fronts. I challenge whoever provides a paraphilia diagnosis to hang out for a weekend in the dorms of a bunch of college aged men. You will see all kinds of sexual obsession and even paraphilia in a college dorm. The difference is that college aged men generally have superegos that prevent them from acting on these obsessions (please let’s not talk about lacrosse players at Duke).

It seems to me that what this fellow is missing is a filter so that he will keep his proclivities to himself. His behaviors are inappropriate but I know that his thoughts are relatively common. He just needs to unplug thought from action. Or at least be a little more discriminatory about where and how he expresses himself. He is mentally retarded and he has some other developmental disabilities. Is it a surprise that a few social filters could be missing?

So how do missing filters contribute to non-criminal sexual ‘deviance.’

Prison Systems support and reinforce homosexuality – simply because sexuality becomes an issue of opportunity and availability (and perhaps power). Group homes for people who have developmental disabilities can do the same thing. Group homes can socialize a young man who lacks filters into an environment that is primarily male. Then consider that there are limited opportunities for socializing with women. Then consider that there is a failure in providing normative opportunities for psychosexual and social development. These factors are at the root of ‘situational homosexuality’ or ‘behavioral bisexuality.’

When the target of a sexual advance is non-consensual, people don’t stop to think about the roots of the problem. Instead, the System apparently moves with lightning speed toward Depo-Provera, behavioral intervention plans, and wacky ideas like sensory diets to solve hypersexuality. We have to know better than this.

If we had a humanizing environment and system of care for people who have developmental disabilities we would not create or contribute to these problems. You can not take a young person who is developmentally disabled, place them in an institutional environment, and then expect that they will develop normally. So even though we all went along with deinstitutionalization and thought it was the best thing to do, we are finding out that the creation of mini-institutions in our communities has not solved the problem. Everyone knows it too – which is why you will see people screaming “Not in my back yard!’ at zoning board meetings across the country whenever someone tries to open up a community residence.

So a sensory diet won’t solve this problem. Neither will chemical castration. Neither will placement far away from society. The real answer lies in providing opportunities for normal development, including normal education, normal occupation, and normal socialization. Nothing could be so simple, and yet so hard for the System to provide.

Wednesday, July 05, 2006

Road trip?

I can't seem to add pictures - and don't know why. Oh well.

I recently received an email announcing AOTA's Annual Capitol Hill Day Kick-Off. I went to this event last year and am now deciding if I will participate again this year.

The primary issue I discussed last year was the legislation to repeal the Part B cap on therapy services. My senator's aide agreed that this was an important issue to residents of New York State but asked us if we had approached CMS with this issue. As a group we explained that this was an issue that had to be addressed legislatively, and I am not entirely convinced that the aide had a full understanding of this issue. She expressed that Part D Medicare legislation was on the forefront of all health care legislation for the upcoming session and she expressed sincere doubt that any other Medicare legislation would come to the floor for a vote prior to the Part D legislation being addressed. Now we see that there is a cap exception process - and from an end-user perspective I haven't seen any people really harmed by the way the whole issue turned out. Part D really did overshadow everything else at the end of last year, which made it hard to find any remaining oxygen in the room for the cap issue.

Last year we also discussed HR 3022 about OT as a qualifying home health service - this bill needed a Senate companion bill. The aide appeared interested to hear that this is a cost-saving measure which could eliminate unnecessary referrals for other services when occupational therapy is the only service required. She stated that she would review the information that we provided to her. I don't know that this issue has gone anywhere in the last year.

The aide seemed very aware of the 75% rule legislation, which my senator was already co-sponsoring. We took the opportunity to thank her for supporting this Act.

The aide seemed aware of occupational therapy because she met with another contingent of occupational therapists from New York State in the week prior to our visit. I believe that our visit was a positive opportunity for the aide to hear these issues for a second time. So although our visit was not well coordinated with other occupational therapy groups, at least we sent them a consistent message over a couple different visits.

I strongly encourage all occupational therapists to become more involved in the political process and to communicate regarding important issues to their representatives.

Constructive criticism can be useful, so I offer some freely to AOTA. Last year I was sorely disappointed in the lack of overall coordination and promotion of this event. After the event it was very difficult to even find any information about our lobbying efforts on the AOTA website. Also, I don't recall seeing anything published about the event. However, AOTA did publicize the visit that the AOTA President made after the actual event. The ‘One Minute Update’ that I received in email on 10/24/05 described the AOTA President’s meetings and included some quotes on how important it is for occupational therapists to participate in the process. I believe it would have been more accurate to report that the actual Capitol Hill Kick-Off Day was poorly coordinated and that it was not attended by either the AOTA President or a representative of AOTPAC. Sadly, the efforts of several dozen occupational therapists during the planned lobbying event did not merit much acknowledgement or publicity by AOTA. I hope that they change that this year - it will help to get more people involved.

This negative aspect is far outweighed by the positive experience I had in participating in this process. Although I only met with one representative, I appreciated the opportunity to learn the process of setting up appointments and presenting information to a representative’s office. I also appreciated the opportunity to drop off important educational materials to the representatives that were not able to meet.

I look forward to continuing my participation now that I experienced this and gained important perspectives on how to effectively deliver information to my representative’s offices. Anyone care to join me in a trip this year?