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Showing posts from 2016

Isabel Gladwin Barton: Wife, Helpmeet, and Collaborator

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According to publicly available records and genealogy databases, Isabel Gladwin Newton was born on July 21, 1891, in Geneva, New York, to Mary Risley Gladwin, age 24, and Frank Ellsworth Newton, age 28.

Isabel Gladwin Newton met George Barton when she was twenty five years old and working as a bookeeper in a preserving and canning plant.  She responded to his contact and offer for work; she reported being particularly motivated by the salary of $15 per week, which was more than her $11 weekly salary at the plant. She began working for him on August 1, 1916. (Barton, 1968).

She reported being "drawn to him from the very first" and immediately began acting as his secretary and helping him with the publication of several articles and books.  She also provided significant material support to Barton in helping to manage his correspondence and organize materials for the First Consolation House Conference and founding of the National Society for the Promotion of Occupational T…

Guest entry: Taking a stand for patient safety with the Hospital Readmissions Reduction Program

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information in the form of a narrative blog post is provided courtesy of a graduate student who is interested in promoting increased awareness of impacts of the Hospital Readmissions Reduction Program.  Because the author only has fieldwork experience and the facility or patient could be possibly identified, with the student's permission I have conducted my standard 'ABC Therapeutics mash-up' of details and narrative so that the intent of the experience could be expressed while maintaining confidentiality. 

In school occupational therapists learn all about diagnostic conditions.  They also learn about ways that people might have difficulties with their occupations.  Occupational therapists also lear…

Guest entry: Advocating for FERPA rights

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Sarah Watson, a graduate student who is interested in promoting increased awareness of privacy concerns and FERPA in context of computerized record keeping and documentation.

Extra note: I was really happy to see one of my students tackle this topic - I have seen many privacy breaches because of improper permission settings in common software used by many school districts, most notably the IEP Direct product.  School support personnel need to be regularly inserviced on how to use permission settings so that providers do not have blanket access to a district's entire special education database.  This is a common problem.

Additionally, procedures need to be tightened so that n…

Guest entry: Advocating for a loan repayment bill that could impact occupational therapy

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Nagella AL-Balushi, a graduate student who is interested in promoting a bill that improves health professional workforce distribution via a loan repayment program when practitioners work in underserved areas.

"Greetings fellow OT students and future colleagues,

I am a graduate OT student seeking opinions, feedback and thoughts about a legislative bill that would potentially have a great impact on the field of OT if passed​!

This act would have three main professional consequences including establishing a new​​​ ​federal loan repayment system​​​, ​increasing the overall distribution of our ​health care services, and ultimately making the role of OT more commonly under…

Guest entry: Advocating for canine training programs that benefit veterans

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A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Nina Fusco, a graduate student who is interested in increasing awareness to HR 3016, particularly those sections that support canine training programs that would benefit veterans who have PTSD and other conditions.


"The Veterans Employment, Education, and Healthcare Improvement Act is a federal bill currently in committee in the Senate. Upon meeting with a legislative aid from Senator Gillibrand's office, it was recommended to me that attaining statewide and nationwide support would be the best course of action. Support from both New York and the nation will help push to amend and reintroduce Veterans Employment, Education, and Healthcare Improvement Act.  I hav…

Guest entry: Advocating for co-payment reform in New York State

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A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Tori Persons, a graduate student who is interested in legislation that would help alleviate the burden of out of pocket costs for people receiving occupational therapy services.  

"Existing laws in New York have stated that health plans must cover occupational therapy services.

However, the insurance companies have found loopholes and bypassed these laws. They did this by shifting the majority of the costs for OT services onto the patients by increasing the cost of copayments.
This increase in copayment cost has caused financial burdens on patients, changed access to occupational therapy services, and overall has defeated the purpose of insurance coverage for occupat…

Guest entry: Advocating for people who have traumatic brain injuries

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan to increase awareness of their topics.  

This information is provided courtesy of Ashlee Lytle, a graduate student who is interested in advocating for people who have traumatic brain injuries.  Under a current plan, transitioning this population to a managed care system will impact the quality of their care.


"As I am soon entering the profession of occupational therapy this May, I have become increasingly interested in the individuals that I will soon be providing services for. 
After researching information regarding traumatic brain injury, which is my area of interest, I came across the transition plan proposed by the Medicaid Redesign Team to remove the Traumatic Brain Injury (TBI) & Nursing Home Transition and Diversion (NHTD) waivers that…

Guest entry: Advocating for occupational therapy wellness programs

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A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan  to increase awareness of their topics.  

This information is provided courtesy of Emily Scholl, a graduate student who is interested in promoting occupational therapy's involvement in wellness programs.  She found an interesting bill that promotes wellness in NY State and is advocating for occupational therapy to be added to the existing bill.

"Occupational Therapy should be added to the list of qualified wellness programs in NYS Assembly bill A4238.

The 2015-16, in-process, NYS Assembly bill A4238 authorizes NYS health insurers & HMOs to provide policyholders with reductions in healthcare premiums and potentially waiving related costs or co-payments, in exchange for active, voluntary participation in approved wellness programs.  This poli…

Guest entry: Advocating for a workload approach in school systems

A number of my students at Keuka College have been working on policy and advocacy projects that I wanted to share.  The students researched a topic of their interest, met with their legislators, and developed a broad action plan  to increase awareness of their topics.  

This information is provided courtesy of Jenna Soldaczewski, a graduate student who is interested in promoting a workload approach in school systems.  She found out how a parallel profession in NY (speech therapy) promoted change by advocating for alterations to the Part 200 NYS regulations that govern special education:


Many occupational therapists in school settings have caseloads so large that it negatively impacts the way that they can help children.  Some therapists have proposed using a 'workload' approach for better managing productivity in the school systems.

After studying the caseload versus workload approach debate I created a quick presentation to encourage and inform OTs about what they can do to ad…

Support for ESSA - not as simple as you think

This week has been identified as the #OTWeekOfAction by the American Occupational Therapy Association.  They are encouraging member actions on a number of policy initiatives; however, as noted in the previous blog post, it is important for occupational therapists to independently assess the nature of these proposals before blindly writing letters of support to Congress.

Individuals may learn that they agree with the positions of the professional association or they may learn that they disagree. 

Today's topic is the Every Student Succeeds Act (ESSA) which is an important law for pediatric practitioners to be aware of.  The act was signed into law in December 2015 and its purpose is to replace the No Child Left Behind Act.  ESSA has new requirements for accountability and transparency in school operations and includes mandates for low performing schools.  It continues the NCLB testing regime and mandates 95% participation in testing for grades 3-8.  However, only 1% of all student…

The importance of rational policy analysis for occupational therapists

The OT Capital Briefing in the November 7, 2016 OT Practice analyzes two Supreme Court cases that are summarized together as follows:

If the Supreme Court finds in favor of the families in both cases, the expertise occupational therapy practitioners provide will be more important than ever to ensure students with disabilities receive a meaningful education, and that schools fully comply with the ADA and Section 504.
This is a confusing summary because neither case has anything to do with OT specifically and in fact if the Supreme Court finds in favor of the families there may be unintended consequences that are damaging.

In the first case, Endrew F. v. Douglas County School District, the issue of concern has to do with what constitutes FAPE, or a free appropriate public education.  In this case the parents removed their child from school because they believed that his progress was insufficient as it relates to his autism condition.  The enrolled him in a private school instead and ar…

The Case of Lena, Part III: George Barton's promise to help others who were in pain

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The original book "The Counterpane Fairy" was written and illustrated by Katharine Pyle in 1898.  It is a fanciful story of a fairy who visits children in their beds as long as they do not cry.  The fairy brings some comfort to these children and has the ability to magically transport them away from their circumstances if they focus on one of the squares of their counterpanes (bedspreads).

Occupational therapists may not be aware of how this story is relevant to the profession's history.  This post will conclude the exploration of 'The Case of Lena' and explain how Pyle's story influenced George Barton.

Barton did not write much about children but as previously noted he was struck by the 'Case of Lena' and that prompted him to write to his newspaper's editor in January of 1920.  It is hazardous to guess a person's motivation from such a distal historical vantage point, but we do know that Barton referred to Lena as "a very real and dear…

Correcting the record: The relationship between Barton and Dunton

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The 1992 article "Point of Departure: A Play About Founding the Profession" written by Robert Bing, has some notable inaccuracies that require correction.  The article has incorrect dates, incorrect attributions, and factual errors.  The article was written in a somewhat whimsical fashion in the form of a play.  However, it is important for such a telling to correctly reflect the historical record.  It is possible that poetic license, used in context of history, does a disservice to our proper understanding of events as they actually occurred.

Contrary to what commonly occurs, I believe that it is important for us to make sure that legends do not become facts.

In an article relating to historical documentary methods, Dunne, Pettigrew, and Robinson (2016) state that researchers must be cautious about facts and that simple linear accounting may be helpful to establish basic narratives.  Bing's article does not meet this criteria in that some reported events in his 'p…

The Case of Lena, Part II: Barton's response to 'A Common Man'

Continued from Part I - Read here.

This exploration of some of Barton's writing outside of professional journals is offered for additional context to assist readers in understanding his concerns and passions that related to the occupational therapy profession.

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The story of Lena got one reader of the Geneva Daily Times "all choked up."  This reader called himself "A Common Man" and wrote a letter to the editor on January 19, 1920 asking more about Lena's story:

Now what I don't understand is this.  It was too bad that Lena couldn't take that elegant job in the 5&10 and I guess the manager was sorry too because they say it's hard to get good girls like Lena and her father would be glad of her help I'll say so.

Well what I want to know is this.  Why couldn't Lena learn something at Oak Mount so that when she got well again she could get a better job... that would help her father more and the extra pay she's get would sort of ma…

Occupational Therapy Can Be One of the Great Ideas of Myopic 21st Century Health Policy Experts

(with deep apologies to the memory of Mary Reilly)

Social media has been one long party this week in the occupational therapy world with therapists and membership associations popping champagne corks over the recent article that appeared in Medical Care Research and Review entitled "Higher hospital spending on occupational therapy is associated with lower readmission rates."  Click here for the abstract, but please go read the whole thing.

Once you get beyond the abstract you get straight to the nut of the problem where the authors admit right in the introduction that "the relationship between hospital spending and quality...is poorly understood in the literature..."

For background reading on this precise issue and concerns about how people are defining 'quality' in health care outcomes click here and here .

There is unquestionably some 'value' (however one may choose to define that term) in decreasing hospital readmission rates.  People who are NOT…

The Case of Lena

History provides context for understanding.  We are so far removed from the daily life struggles of 100 years ago and our own experiences are so very different that it is difficult for us to develop a clear understanding of  why events unfolded the way that they did.

Occupational therapy is a health related profession that was born from the crucible of American society and culture at the turn of the 20th century.  As such, events from those times greatly influenced the thinking of our primary founders.

George Edward Barton lived in Clifton Springs in Ontario County on the street behind the Clifton Springs Sanitarium (private) which had a capacity of 400 patients.  The Ontario County Sanitorium for Consumptives (Oak Mount) was the public facility, previously known as the County 'Poor House' in nearby East Bloomfield and had a capacity of around 40 patients.

Barton was motivated by realities of the public health crisis of tuberculosis.  He was motivated because of living in the …

Time to throw in the towel on sensory processing assessment

Today's Wall Street Journal includes the standard article in its Life/Health section on Sensory Processing Disorder that we are all accustomed to seeing published every six months or so.

The general idea of these journalistic offerings includes the standard trope of expert occupational therapists who can identify a disorder that the medical community can't quite agree on.  It also includes the standard ethical bombshell that occupational therapists can't bill insurance for this therapy and that the costs are $175 per session and are needed for 18 or 30 sessions, depending on who you ask.  Maybe it depends on credit card limits in different geographic localities, I am not sure.  The fact that the cost for this therapy can range from $3000 to $5000 is in itself a red flag that should make most parents squeeze their wallets shut and run for the hills.  The fact is that there is no consensus on frequency of these interventions and there is also no consensus if this 'intens…

How to damage OTA practice and diminish the OT profession in three easy steps.

1. Promote mission and scope creep of community colleges without thoughtful vetting of the consequences.

2. Purposely ignore the impact of minimum wage increases on the nonprofit human services sector.

3. Ignore the feedback of a professional membership that strongly opposes increasing OTA education to the bachelor's level.


It is very important to click the embedded links (above) to fully understand the scope of this issue.

What is left to do?  Get involved and demand more thoughtful decision making from the OT leadership.

Or watch it crumble.

Your choice.

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Occupational therapists want the general systems funk

Specialization is an unfortunate by-product of expansive knowledge.  It is challenging to remain abreast of developments in multiple fields and in the busy lives of modern day humans people come to rely on the comprehensive thinking of 'others' while they busy themselves with their specialized thinking.

Few stop to consider whether or not those 'others' to whom great power is ceded for their comprehensive thinking are actually up to the task.  Or, if they are up to the task, who is doing the checking to make sure that the use of said power is being delegated for the broader good?

In particular, occupational therapy is a broad field with multiple areas of specialization.  As such, practitioners working in geriatric long term care facilities may not be paying much attention to the goings-on for their pediatric school-based colleagues, and vice versa.  In a complicated world where specialists struggle to function within their own constricted spheres of operation it is ha…