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Showing posts from September, 2008

Erie County Executive Collins: Right and wrong at the same time

The issues are just too fast and furious lately - but this one had me falling out of my chair. Check out Collins comments on the burden of unfunded mandates from the State in this Buffalo News article.

Collins statement as it relates to preschool services is excruciatingly correct - although I am not sure if his solution really solves the problem. The article states:

"Besides Medicaid — the local costs for which eat up all the $200 million in revenues raised by property taxes in Erie County— Collins cited as among the unfair mandates a program that provides special services for children younger than 5 who need help to get ready for going to school.

He said the county pays the costs of the program — $23 million a year — but has no authority in running a program administered by local school districts. When children turn 5 and schools have to then pick up the costs, Collins said, pupils are “miraculously cured” and no longer offered the services."

This is oh so true, but the presch…

NYSOTA response re: continuing competency regulations

I received an excellent response from Jeff Tomlinson about the recent continuing competency issues. I didn't want his response to get lost in comments, so I am posting it as an entry. There is a lot of good information here. I would really like to hear more about the direct access issue and problems in securing scripts for school aged children - sounds like something that could benefit from roundtable conversation.

Anyway, here is Jeff's response:

I have also been encouraged by another occupational therapist to check out this discussion.
We were certainly surprised by the speed with which the physical therapists were able to pass their mandatory continuing education bill. It was quite an accomplishment in a legislative session that passed very few bills that regulated the professions. I will be talking to the lobbyist and the leadership at NYPTA about how they got this done.

At the same time, it should also be noted that the PTs continuing education law is not like the NYSOTA&#…

Time for more name changing?

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Juliet:
"What's in a name? That which we call a rose
By any other name would smell as sweet."



There is a history of name changes in describing sensory integration problems. People have probably heard:
SI disorderSID (sensory integration dysfunction)DSI (Disorder of sensory integration)SPD (Sensory processing disorder)You can check here for someone's blog entry on the issue. The SPD Foundation (formerly KID Foundation) has mostly scrubbed references on its website to the words that are no longer in vogue. That is helpful, particularly since they are seeking DSM-V recognition of SID/DSI/SPD.

Have I used enough initialisms and acronyms in this entry yet?

Now we have a companion problem in that there are multiple meanings for the concept of a 'sensory profile.' I was googling some information on the Sensory Profile assessment and I came across these references:

Sensory profile of mandarin chilled juices and consumers' acceptability

Mexican Mennonite-style cheese:…

Occupational therapy and habit re-training for idiopathic toe walking

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I don't know that I have ever seen any occupational therapy literature on idiopathic toe walking.
For an excellent overview and references on this condition please check this article from the Journal of Family Practice.

As the reference states, it is important to avoid 'over medicalizing' the problem especially since there are not many toe-walking adults that are presenting themselves for intervention. It is possible that toe walking is a self limiting problem in many children. However, there is a reasonable concern when toe walking begins to contribute to pes cavus deformities which of course can have longer term implications. In our clinic we see a few children each year with toe walking that is beginning to cause functional foot deformity.

Idiopathic toe walking is a relatively common condition that is often seen by occupational therapists - but not generally as a primary reason for referral. Some professionals view toe walking as a marker of other developmental immatu…

Professional competence: How do you weed the weeds?

We are making strides in promoting continuing competence and ongoing professional development in the occupational therapy profession but there is still work to be done. The current theme running through my head has to do with quacksalvers and quality in continuing education offerings.

As far as I can tell, there are few if any standards for the quality in continuing education courses as it relates to the CONTENT of the offering. I read the IACET standards and was disappointed that Standard 7 didn't really delve deeply into the issue of regulation of the QUALITY and CONTENT of continuing education courses. So if the primary standard-setter of quality in continuing education does not address quality of CONTENT, what should be done?

As an aside, I don't know that I blame IACET - how could they possibly address quality across so many diverse topic areas? Does this leave the professional associations to make statements about quality of content? Or is this left to certification b…

Silence from NYSOTA on OT Continuing Competency

I recently posted on the status of continuing competency requirements for occupational therapists in NY State. In summary, my concern is that the bill for these requirements has been stalled in senate committees but a very similar requirement for physical therapists just passed. I wrote to NYSOTA asking about an update on this issue and have not received any response.

Of course this is an issue that I have all kinds of historical interest in - and it is no secret to anyone that I am a long-term volunteer for the National Board for Certification in Occupational Therapy. This is where my passion over the issues of competence and competency was born and bred.

Still, my feelings on this matter also have a lot to do with the perceived legitimacy of occupational therapy as a profession and broad protection of the public. Regulation is sometimes unnecessary and stifling - I am not a believer in the nanny-state. However, health professions are historically unable to police themselves appro…

The power of words

There is more opportunity to follow the conversation in the Advance for Occupational Therapy magazine about early intervention service delivery. I read the magazine today and still felt uncomfortable as I kept stumbling over what Dr. Jane Sorenson wrote:

“At the end of the year, all of them were performing at maximum potential… I explained, as I do with all parents whose permanently disabled child is performing at his maximum potential within the reality of the disability, that more treatment won't mean more function right now… I believe it is our responsibility to the children to discharge them from direct service when they have reached realistic goals within the reality of their diagnoses.”

I wanted to do some self-checking to be sure that I wasn’t applying any bias to reading her based on my disappointment over her previous comments. After a lot of consideration, I think I understand the nature of my concern and discomfort.

It is the words.

As an amateur anthropologist I have so…