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Showing posts from March, 2012

Field report: Fidelity problems persist with 'sensory integration'

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Consider this as Part II of Sensory integration: More evidence that OTs have lost control of the narrative. A major HMO in my region just published a clinical practice guideline update on sensory integration, which I will re-publish in full below. However, if you want to understand the fidelity problem, I think the graphic to the left says it all.

Sensory Integration Therapy

Implemented By: Chief Medical Officer, Health Care Services

Policy No.: M110207082

Effective Date: May 1, 2011

Location/Type: MRM/EXT

Revised Date: May 1, 2012

Signature: (Signed copy on file)

Reviewed Date:

Purpose:
To provide clinical coverage guidelines for sensory integration therapy for Independent Health plan members.

Responsible Departments: Medical Resource Management

Applicable Vendor: N/A


Definitions:
Sensory integration therapy: sensory integrative techniques are performed to enhance sensory processing and promote adaptive responses to environmental demands. These treatments are performed when a deficit in processi…

More regulatory changes to impact NYS occupational therapists very soon.

This is a follow-up to my entry on 2/16/12: In NYS a single OT can still supervise a million OTAs, for a while at least.

Something will happen on June 13th...

Unless there are some unanticipated changes, new regulations regarding supervision of OTAs will go into effect in NY. Perhaps the largest issue that will impact jobs is the new restriction that reads as follows:

In no event shall the occupational therapist or licensed physician supervise more than five occupational therapy assistants, or its full time equivalent, provided that the total number of occupational therapy assistants being supervised by a single occupational therapist or licensed physician shall not exceed ten.
That means that a couple things might happen on 6/13/12:
A bunch of OTAs will get their walking papers and agencies/schools will hire OTRs instead to avoid being out of compliance with the regs.A bunch of job postings will appear for OTRs so that agencies around the state will be in compliance with the new regs and…

Going the extra mile.

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I recall being a newbie occupational therapist and having a keen sense of "having to put my time in." It is probably a broad cultural value passed to me first from my family. My Dad was a hard working person who I saw go to work every day and sometimes even every night when he was assigned an evening shift.

When I graduated from college I gravitated toward home care and consultative occupational therapy; the freedom and responsibility of these settings matched my interests and work style. Since I was a newbie and trying to work for home care agencies all of the preferred geographic areas were taken by more seasoned occupational therapists. That left me with assignments in far-flung areas where I had to drive up to an hour to get the the patient's home. I figured that I would accept these cases and then after some time I would be offered cases that were not as far away.

So, during this time in my career when I was driving from Buffalo to Farnham and North Collins, dre…

Will my child be eligible for services this year?

This is a common question that parents ask this time of year - many children are having their annual reviews and determinations are being made for eligibility. In an interest of making sure that all families are aware of their rights, New York State does things like releasing the new translation of revised procedural safeguards into multiple languages.

Families might want to look elsewhere for information about how eligibility determinations will be influenced in the future in NY State. In addition to focusing on translation of procedural safeguards maybe the Department of Education and Department of Health and the Governor's office should be more clear about new funding methodologies that are being considered.

I will attempt to demystify what is going on because I don't see that they are informing the public in a particularly clear way.

Last year Governor Cuomo held meetings around the state discussing plans for redesigning Medicaid. I was really hoping we would see some opp…

Why I support DSM-V criteria to make autism diagnosis more difficult.

Be patient as you read, please - and in advance I ask forbearance from autism advocates for use of this issue to make a point.

The Diagnostic and Statistical Manual is undergoing another revision and there are changes suggested that would effectively make the diagnosis of autism a little more specific. There has been a lot of popular reporting about the unintended consequences of 'tightening up' the diagnostic criteria. Specifically, many people are legitimately concerned that it will make fewer people who really need help eligible to receive services because they no longer meet the criteria for the diagnosis.

I have had concerns about this problem because I know people who would probably be negatively impacted by no longer meeting diagnostic criteria. However, after some additional thought, I decided that this was the correct time to take a different stand and support the DSM-V changes.

What prompted my change of heart? Let me walk you through the process.

Kent Tigges was my …