Tuesday, September 22, 2015

Editing the American influence out of the history of occupational therapy

During the very long social justice debate that preceded the revised AOTA Code of Ethics there were repeated claims that social justice represented a Core Value of the occupational therapy profession.  Those claims have been thoroughly addressed here and here.  In these entries and several other previous entries information was presented to support the claim that American influences are germane to understanding the driving forces behind the formation of the profession.

In my ongoing readings related to this topic I was comparing textbooks and am developing some new questions.  I am very curious about information that was recently edited out of the new edition of the Occupational Perspective of Health, 3rd ed (Wilcock and Hocking, 2015).

In An Occupational Perspective of Health, 2nd ed., Wilcock (2006) discusses the driving forces leading up to the formation of the occupational therapy profession.  She explains that changes occurred as Ruskin and Morris' ideas (via the Arts and Crafts movement) were brought to the United States.  She writes

However, because the Puritan work ethic was so central to American culture, Ruskin's and Morris' conception of a preindustrial, creatively absorbed craftperson became reinterpreted so that eventually no distinction was made between modern and pre-industrial work habits.  American Arts and Crafts leaders, along with their progressive contemporaries, drew back from fundamental social change for social justice, favoring instead "a new kind of reform" aimed at "manipulating psychic well being" and fitting individuals into emerging hierarchies.  This notion of "mental and moral growth" was compatible with 19th century American ideas about individualism, which was central to capitalism, its liberal democracy ideology, and values focusing on human rights... Similarly at Hull House, where Ruskin's and Morris' photographs had pride of place, the Arts and Crafts ideology was reinterpreted from a socialist to an individualistic focus.

This analysis is in line with my previous essays on this topic and in my estimation this is an accurate representation that dismisses the fallacious 'Social Justice as Core Value' argument.  Unfortunately, this entire section has been edited out of the 3rd edition of the same text.  Instead, Wilcock and Hocking (2015) offers this:

Neither the antimodern socialist revolution focus, nor the capitalist, individualist growth focus, nor the establishment of occupational therapy was successful in creating global awareness of the need to consider people's inner being and occupational nature in future social or health planning, although all went some way in that direction.  Later, the dominance of reductionistic medicine led to public health practitioners being tied to a practice geared to civic sanitary conditions and control of epidemics of infectious diseases, and the diminution of broadly based, population-focused occupational approaches to health, delaying a collective consciousness of their importance.

So an accurate analysis of the American forces that shaped the unique focus of the profession is now removed and we are left with an accusation that those influences were detrimental to what I will label as Wilcock's and Hocking's Occupational Therapy New World Order, which is all based on a new justice paradigm.  This is consistent with other academic efforts to bend history in order to fit a social justice narrative.

I am wondering if Wilcock's original analysis is edited out of the 3rd edition discussion because its presence undercuts the arguments of social and occupational justice proponents. It is unfortunate that she did not EXPAND on this line of analysis and include information on the influence of the Transcendentalists, the Boston Society of Arts and Crafts, the Emmanuel Movement, and George Barton. This all becomes immensely important as it relates to our theory development because it helps us to answer questions about whether or not that American influence is important.  I argue that it is, and that is why I spend so much of my research time attempting to reconstruct the neglected Barton thread of the occupational therapy story.

These topics are important for uncovering the full truth about our historical roots and Core Values.  When we omit important historical facts and analysis we have incomplete information to form proper opinions.  This kind of cherry picking has led some scholars to misinterpret history and to oddly focus only on justice models or feminist interpretations of Hull House influences.  A proper historical analysis will balance all of these factors together and will not selectively edit anything out.

History should be history.  It should not be selectively edited and it should not be revised to suit current political and justice agendas.


Wilcock, A.A. (2006). An Occupational Perspective of Health, 2nd ed. Thorofare, NJ: Slack, Inc.

Wilcock, A.A. and Hocking, C.H. (2015). An Occupational Perspective of Health, 3rd ed.  Thorofare, NJ: Slack, Inc.

Monday, September 21, 2015

I vaant to TELL you zomething!

I want to share a message about authenticity in therapeutic relationships.

Jim was a 40 year old man who participated in  a day treatment program in a rural community.  The program itself was conceived and nurtured by Jim's parents along with other parents who were desperately trying to find non-institutional program options for their children.  Jim had cerebral palsy and an intellectual disability.  He attended that community program as a school child and eventually 'graduated' into the adult day treatment program.  The program grew from providing services to just a few children to several hundred people with developmental disabilities of all ages.  The program was an act of love, gifted by parents to their children.  That is the best way I can think to describe programs that developed this way.

I am not sure how aware Jim was of all that.  He was mostly focused on relationships with people and he had no disability in that social arena.

I had no special relationship with Jim, except that he treated all of the people that he interacted with in a special way.  Because of that I loved spending time with him.  Who doesn't love spending time with someone who treats them like they are special?

You could always hear Jim before you could see him; he had an uncanny ability to know where you were before he could see you.  Perhaps because his vision was poor and his motor abilities were limited he compensated with hearing or something else.  He would slowly wheel himself from around a corner, propelling his wheelchair mostly with small wrist movements, and you would hear a characteristic voice with his 'fake' accent that sounded like something out of a Dracula movie: "Chreeeeeestopherrrr.... I vaant to TELL you zomething!"

I have no idea where he got that 'voice' from.  Just remembering his voice cracks me up as I think about it.

Five years after I left that facility I was working in a children's hospital in a nearby city.  I was working in the orthopedic clinic and I heard that voice from behind one of the closed curtains in an evaluation room, just as if those five years had not even passed.  The voice said clearly, "Chreeeeeestopherrrr.... Eeez Zat YOU????  I vaant to TELL you zomething!"  Of course it was Jim - who despite his age was still being followed in the developmental disabilities clinics of that pediatric hospital.  I couldn't believe that he knew I was there even though he couldn't see me from the other side of that curtain!  It was a wonderful reunion, like seeing an old friend again.

There is a special authenticity about those kinds of interactions that is very difficult to explain in words in some blog post.

I got to thinking about this because I was recently reminded about this kind of authenticity in my work at the college.  The college has a transitional program for young adults who have developmental disabilities.  Those students attend educational classes, some of which are college courses.  They are not graded on their efforts but the idea is to promote inclusion and participation.  I was fortunate enough to have some of those students in a Freshman level 'Intro to OT' course, and even though I think that the program needs more OTs working in it in a general sense, the participation of those students in the class was positive in just about every way I might think to measure.

What struck me most though was that as the next semester began I would pass by some students from my Intro to OT course as I walked around campus.  The students were always polite and friendly, perhaps verbalizing a quick 'hi' or giving a quick head nod along with a fleeting moment of eye contact as they rushed around campus.

That is not how the 'Intro to OT' students from that transitional program acted though.  The first response that I got when I saw them was quite different.  They ran to greet me, excited to tell me about their summer experiences.  One asked for a hug.  And it wasn't just that first time, because now they stop by my office or stop me to talk when I am walking around the halls.  One of them still wanted to talk about the book I had them read last semester, Tuesdays with Morrie.  I think that even though the writing skills are imperfect, one of those students really understood the message in the book.  That student wrote:
Morrie said that “This  is  a  part  of  what  a  family  is  about,  not  just  love.  It’s  knowing  that  your family  will  be  there  watching  out  for  you.  Nothing  else  will  give  you  that.  Not  money.  Not  fame.  Not  work.”  So What  does  this  mean to me?  To  me,  it  means  that  yours  or  my family--mothers,  fathers,  brothers,  sisters,  aunts,  uncles,  cousins,  grandparents,  friends, teachers etc. will be  by  our  sides  no  matter  what.  It  doesn’t  mean  who’s  just  in  our  blood,  it  also  means who  our  friends  are  who  take  us  in  as  their  sister  or  brother.  You  could  be  famous  person  and  still  need  your  mom  or  dad  to  support  you.  You  could  have  a  job  that  has  a  bunch  of hours  and  pays  at  minimum  wage  while  still  being  happy  with  what  you  have. Families are  important  in  our  lives, no matter who we are calling family.  And we should probably dance with them if we love to dance.

So, I vaant to TELL zomething to OT students who I hope will also have the opportunity to work with people who have developmental disabilities during their careers.  It is pretty important that we learn to strip away and look beyond the labels that are placed on people.  Sometimes we find ourselves working within systems that apply those labels for what are supposed to be good reasons but sometimes they distract us from understanding that people of all abilities have some important observations to offer and some important contributions to make. 

I am not trolling for hugs next semester from my Freshmen students, but I think it is correct to observe that we have a lot to learn from each other, even when our abilities and skills are very different.  In particular, I think that we all have more to learn about how we are supposed to care about each other and how we can interact with each other in more authentic ways.

The whole idea of inclusion is that it opens us up to opportunities to interact.  It is never going to be enough to just interact though.  We have to open our hearts to each other and learn to listen closely to the messages that people have and that we can learn from.

Sometimes they come hidden in fake Transylvanian accents.  Sometimes it will come in an essay.  Sometimes it will come in the happiness that people experience when you stop long enough to treat them like they are important. 

You just never know, and that is why you always have to watch closely for those lessons when they come your way.

Tuesday, September 08, 2015

Narrative summary of the ACOTE Occupational Therapy Entry Level Survey

*This represents MY Summary and opinions on this report:

As part of the process of gathering data to inform decision making regarding the entry level degree required for occupational therapy practice, the Accreditation Council on Occupational Therapy Education conducted a survey.

In summarizing these statistics, categories of respondents were combined to simplify analysis.  Also, in summarizing agreement or disagreement, categories of 'strongly agree' and 'agree' were combined as were 'strongly disagree' and 'disagree.'

That survey was open between March 13, 2015 and closed May 15, 2015.  There were 2,829 respondents.  The generalized categories of respondents were OT practitioners (50%), OT students (19%), OT academicians (29%),and employers (3%).

The overwhelming majority of respondents (71%) agreed that the OT profession should embrace a single entry level.  This opinion was similar across all categories of respondents.

When asked if the body of OT evidence would benefit if the entry level degree moved to the doctorate, 61% of respondents disagreed.

When asked if if a doctoral entry level degree would allow for an increased impact on healthcare reform, 61% of respondents disagreed.  Practitioners in particular disagreed with this statement (70%).

When asked if moving to an entry level doctorate would positively impact practice on the respondent's particular region, 69% disagreed.  Practitioners in particular disagreed with this statement (78%).

When asked if such a change would positively impact students, 70% disagreed.

67% of respondents did not think that a doctoral entry level degree offered more opportunity for promotion.    Only 23% of practitioners thought it could offer such opportunity as opposed to 43% of educators who thought it could offer such opportunity.

 Securing fieldwork placements was a concern of the majority of respondents (66%).  Most respondents (57%) did not believe that academic institutions are positioned to meet the changing needs of OT programs.  70% of respondents believed that there was a lack of qualified faculty, 40% believed that there was a lack of State support, and 42% believed that there was a lack of institutional support.  72% believe that an entry level OTD will decrease the number of applicants to OT programs, and 64% believe that it will decrease the diversity of applicants.  Only 12% of respondents believed that no challenges were anticipated.

Cost was a significant concern; 74% of respondents believed that the cost of a higher entry level degree would not be worth any benefits that it might bring.

Employers responded in an overwhelming fashion (82%) that they are not more likely to hire OTs with a higher entry level degree.

Most respondents overwhelmingly felt that the current degree requirements were sufficient: 92% believed that basic tenets were sufficient,  90% believed that theoretical perspectives were sufficient, 87% believed education on evaluation was sufficient,  85% believed that education on intervention was sufficient, 89% felt that education on service delivery context was sufficient, and 94% believed that education on ethics and professional responsibilities was sufficient.   Beliefs on sufficiency of education on scholarship (79%) and management (82%) were lower, but still rather high.



The ACOTE decision to support dual entry into the profession is in opposition to the AOTA Board of Director's opinion on the doctoral degree as a single point of entry.  The recommendation is certainly not based on survey results alone.  However, the largest concern for the OT community should be the overwhelming and consistent difference of opinion between this survey and the responses and recommendations of the AOTA Ad Hoc Committee on the Future of Occupational Therapy Education and the AOTA Board of Directors.

The future of this doctoral issue remains uncertain, but the OT community should study the results of this survey and attempt to understand why the OT leadership would come to a conclusion that is so apparently out of step with its membership and other stakeholders.

Based on previous analysis, there was a concerning lack of diversity on the Ad Hoc committee.  That committee was composed almost entirely of academics.  I reported on the concern 18 months ago when the recommendation for the OTD was made:

The AOTA Board informed their decision on two workgroups: one an Ad Hoc Board Committee on the Future of OT Education chaired by Dr. Thomas Fisher and the other an internal subcommittee of the Board itself that reviewed the Ad Hoc Committee's findings.

The Ad Hoc Committee was comprised of occupational therapists who also served as Deans, Provosts, or other high ranking University officials as well as the AOTA Director of Accreditation and Academic Affairs.  Task groups were developed to address specific questions.  Specifically, one task group called the "Maturing of the Profession" task group made the specific recommendation for mandatory doctoral level education.  This group consisted of a physical therapy educator/Dean and four occupational therapy academics who all held high ranking University positions.

It is not known who comprised the sub group of the AOTA Board of Directors that looked at the Ad Hoc groups findings.  However, the AOTA Board of Directors is known to be heavily weighted with those who work in academic settings.  Among those who are not currently in academia, most either hold dual academic appointments, have held academic appointments in the past,  or are in senior administrative positions in their work settings.

The fundamental problem with the composition of these committees and task groups is that they are making recommendations that stretch outside the confines of academia.  The recommendation for mandatory doctoral level training is not an academic recommendation.  It is a practice recommendation.

The ACOTE survey provides a rich data set that reflects the position of a more diverse group of stakeholders.  Perhaps even more importantly, the survey represents an opportunity for the AOTA Board of Directors to reflect on how they constitute Ad Hoc committees and how they might promote more diverse engagement from the entire occupational therapy community in the future.