Tuesday, September 23, 2014

When your legacy is OT education and the Sarbanes-Oxley Act

I support free market capitalism, and respect ownership rights people have in the money they have earned through voluntary trade.  Since the money belongs to them they should be able to spend it or give it away at their own discretion.

This week we all learned that the University of Southern California Division of Occupational Science and Occupational Therapy received a $20 million gift from the Chan family.  The gift creates the first named and endowed occupational therapy program in the nation, according to the school's website.

The article states that USC is a pioneer in occupational science and occupational therapy.  An interesting feature of occupational science is that it purports to be an interdisciplinary field that is intended to inform the occupational therapy profession by providing basic research knowledge about the occupational nature of human behavior.

Since the inception of this 'new science,' several scholars have pursued studies relating to the social and political nature of occupations (Wilcock, 1998; Townsend and Wilcock, 2004; Pollard, Sakellariou, and Kronenberg, 2008).  These authors have all been proponents of a concept of occupational justice, which is loosely equivalent to the political concept of social justice, except focusing on the occupational nature of the issue.  Embedded within these beliefs are concepts including occupational apartheid, occupational deprivation, and occupational alienation.  The solutions to these perceived problems is proposed as the political activation of the occupational therapy profession.

These initiatives have not gone unchallenged.  The social justice debates within the profession have focused on whether or not ethical requirements to follow specified political initiatives is a proper scope for a professional health care field.  Some people, myself included, don't believe that politics is the proper field for a health care profession.  Others disagree.

The social justice thread has also been evident through the profession's literature including  a special issue of the American Journal of Occupational Therapy (Braveman and Bass-Haugen, 2009) and it has been infused into the AOTA Code of Ethics and Occupational Therapy Practice Framework.

This heavy interest in social justice that was birthed at USC is what makes the $20 million gift all the more interesting.

 The gift was made by Ronnie C. Chan, who is also a USC TrusteeMr. Chan is a Chairman of a major Hong Kong real estate firm, and was also a Director of Enron Corporation and a member of its audit committee when it filed for bankruptcy as a result of fraud.  Enron became infamous in the early 2000s for its well publicized bankruptcy that was necessitated because of accounting fraud.  Deceptive accounting practices caused average people to lose billions of dollars while Enron insiders, including some of its senior management and Board, sold their shares before the bankruptcy filing.  According to the Washington Post, many of the Directors of Enron remained largely unscathed by the bankruptcy, but they did collectively have to pay a combined $13 million to settle a shareholder lawsuit alleging insider trading.  Mr. Chang was one of the Directors in that group.

 Chan also resigned from the Motorola Board after the Enron collapse. The AFL-CIO, which represented the interests of many Motorola shareholders, called on Procter and Gamble to reject Chan's re-nomination to the Motorola Board.  As reported in Bloomberg Businessweek, the AFL-CIO was motivated to block former Enron Directors from other public boards because its members lost more than $1 billion on their 3.1 million Enron shares.

The occupational science scholars have been concerned with social forces that contribute to limitations on people's ability to engage in occupations, including oppressive political forces, oppressive economies, oppressive banking systems, oppressive sociocultural practices, and so on.  This is what makes the USC/Chan alliance so unexpected.  The Enron scandal epitomizes the kinds of structures that many occupational scientists point to as constituting primary sources of oppression in society.

In the week prior to the announcement of the USC gift, the Chan family announced an even larger gift of $350 million to Harvard University's school of public health.  Commenters and bloggers were quick to note that Ronnie Chan was not mentioned in many of the Harvard news releases.  Some commenters wondered why money allegedly made off of the backs of poor renters in Hong Kong should go to support elite private colleges in the United States.  Others reflected on "Ronnie’s Teflon status [that] also allowed him to emerge unscathed from the SARS epidemic in Hong Kong when Amoy Gardens, a middle class housing development, became the epicenter of infection with 321 cases and several deaths. The high number of cases in this one location was attributed to poor maintenance of water pipes. Hang Lung was the developer of Amoy and managed the buildings."


Hang Lung Properties is Mr. Chan's company.  That is quite a notorious historical record in consideration of a hefty donation in the interest of public health.

The acceptance by USC of this gift, however, tells me quite clearly that I should no longer accept the proselytizing of do-gooder occupational therapists who claim to be concerned about structures that contribute to problems with social or occupational justice.  If they are going to hold out their hands and accept money like this while promoting an opposing agenda, then their message cannot be taken seriously.

I am not a social/occupational justice proponent, but point out these facts so they can be considered for intellectual and ethical consistency.

References:

Articles linked above.

Braveman, B. and Bass-Haugen, J.D. (2009). Social justice and health disparities: An evolving discourse in occupational therapy research and intervention. American Journal of Occupational Therapy, 63, 7-12.

Pollard, N., Sakellariou, D., & Kronenberg, F. (2008). A political practice of occupational therapy, Edinburgh: Elsevier.


Townsend, E. & Wilcock, A. (2004). Occupational justice and client-centred practice: A dialogue in progress, Canadian Journal of Occupational Therapy, 71(2), 75-87.

Wilcock, A. (1998). An Occupational Perspective of Health, Thorofare, NJ: Slack, Inc.

Tuesday, September 09, 2014

Basic vs. applied science: The ongoing OT and OS debate


 Over the course of the last several years an important professional debate about social justice has been occurring in the occupational therapy profession.

That actual debate started innocently by a student who posted a question in the Public Forums on OT Connections who was interested in conversation about an RA motion to remove Social Justice from the AOTA Code of Ethics.  That student disagreed, stating that she did not think that Social Justice represented a single political philosophy and that it should not be removed.

Some leaders in the occupational therapy community voiced their support of the student's position, stating that social justice is not reflective of a singular political ideology and should not be re-framed as such.  There was near immediate disagreement, with other AOTA members expressing that it does represent a single political ideology.

The basis of the eventual RA vote that supported inclusion of Social Justice was made on the questionable premise that Social Justice does not represent a single political ideology.  In the ensuing years of debate a lot of evidence has been provided to counter that premise.  The new draft of the AOTA Code of Ethics removes the term 'social justice' but many of the constructs remain embedded within the document.  That document remains in revision and feedback is still being collected.

I am prompted to write this reflective summary because I believe that a new level of evidence about the nature of Social Justice has been revealed, although it is unfortunate that this evidence is not in the public OT Connections forum where the debate has continued for several years.  The evidence about the political nature of Social Justice as it relates to occupational therapy is evident in a discussion thread of the International Society of Occupational Science.

The ISOS group is an essentially open membership organization that is virtually organized and focused on enabling international communication between people who are interested in occupational science.  Many of the members and leaders within the ISOS organization are occupational therapists, but certainly not all of them are.  Many of the members and leaders of the ISOS organization are also members of the Society for the Study of Occupation: USA.  As such, many of the ISOS participants are leading academics for American-based occupational therapy.

Unfortunately, while the debate about Social Justice occurred on the open OT Connections forum, there was not broad participation by the OT Academic community or the membership itself, for that matter.  Underlying the OT Connections debate there have been several themes.  Some who opposed Social Justice did so more from a basis of political opposition to the concept.  Some did so more from a basis of concern about applicability of the Social Justice and other occupational science concepts to the applied field.   Some had a combination of concerns.

The challenge in the debate has been a lack of participation and most certainly not a lack of substance.

In August 2014, the ISOS group started a discussion thread entitled "Developing occupational science as a critical and socially responsive discipline: challenges and opportunities." The following information is available on their website and is quoted directly:



"Occupational science appears in a crucial moment of its development, characterized by an increasing awareness of issues of inequity and injustice, and calls to further embrace diversity, situatedness and critical reflexivity. Overall, there appears to be a call for occupational science to become a more critical and socially responsive discipline, and increased attention has been focused on topics such as: how certain occupations are promoted by social policy discourses that reinforce structures of domination, how ideologies underlying certain occupations create and perpetuate occupational injustices, and whether occupational science has a responsibility to address social justice, humanitarism and human rights."


Certainly, occupational science is NOT occupational therapy, but one of the expressed purposes of the science was to inform the occupational therapy profession.   However, we now have a basic science that is interested in "expand[ing] the understanding of occupation and enhance the social relevance of the discipline, particularly as issues of occupational inequity and injustice are increasingly fore- fronted in local to global socio- political contexts."

The content of the discussion is based on the a priori assumption of "how can occupational science move forward in its development as a socially and politically engaged discipline?"  Responses from forum participants in the ISOS context are entirely political, including open embrace of Marxism, promotion of Nussbaum's Capabilities Approach, and a strong interest in interpretation of occupation through the lens of socialistic political interpretations of economies and power distribution.  In short, the ISOS discussions represent a unidimensional political agenda.

It is unfortunate that the proponents of occupational science were not willing to commit to a public and open conversation about this on the OT Connections website.  A lot of discussion about the political aims of Social Justice could have been avoided if we had more participation from those Academics who were proponents of this politicization.

So the facts are very clear, and those facts are that Social Justice does reflect a particular political ideology and represents a unidimensional world view on the political nature of occupations.

This leaves some members who stated that Social Justice is apolitical in a position where they need to explain their statements.  It may be very possible that some of those members were simply unaware of the political nature of the Social Justice construct.  Even a cursory review of the ISOS discussion will provide evidence to refute those claims.

As a final point, the occupational therapy profession needs to move forward.  There are several important issues that are on the table:

1. Will we re-affirm our Core Values or will we follow a handful of international Academics into a New Model of justice-based and rights-based ethics?

2. Will we take steps to revise our Code of Ethics to reflect pragmatic concerns of practice?

3. Will we expend occupational therapy resources on a basic occupational science that is not responsive to actual practice concerns and seems focused on promoting a political philosophy?

4. Will we create, nurture, and promote conversations where we have HONEST DIALOGUE about the very nature of these concerns?

The OT Connections forum and the ISOS forum should serve as a reflection point for those who wish to identify as 'occupational scientists' and those who wish to identify as 'occupational therapists.'  It is evident in these conversations that the concern about basic vs. applied science is far from over.

I would like to close this with a quote from Dr. Gary Kielhofner, who I believe presciently identified our current problem and explained his concerns when discussing the purpose of some of his final work:


This current volume was inspired by my increasing concern  that the pendulum has swung too far in the opposite direction.  It was greatly influenced by a concern that the field, in its eagerness to develop a science of occupation, may be leaving behind or forgetting the "therapy" in occupational therapy.



References:

(direct links above)

Kielhofner, G. (2009). Conceptual Foundations of Occupational Therapy Practice, 4th ed.  F.A. Davis: Philadephia.



Background reading:

 The 2011 Social Justice Debates in Occupational Therapy
Social Justice Follow Up: Brass Tacks for the Occupational Therapy Profession
Social Justice: What Would Dr. Kielhofner Say?
Emmanuelism Provided the Core Values to the Developing Occupational Therapy Profession
Patient vs. Client - What Could Go Wrong?  Look Around and See...