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Case study: Demise of a professional membership organization

Unless there are dramatic changes in statistical trends, the New York State Occupational Therapy Association may face insolvency and may be forced into dissolution in the very near future.

Two years ago I reported that the NY State OT Association was at a critical juncture. At that time, only 4.4% of all NY practitioners were members of the group.  During the period of time from 2006 through 2014 NYSOTA OT/OTA membership declined 24%.   The decreasing trend of participation is continuing.

According to statistics published by NYSOTA, now there are only 379 OT members and 120 OTA members.  In consideration of the total of OT practitioners in NY State (17,318 total) that is a membership participation rate of 2.9%.  This is decreased from the rate two years ago of 4.4%

According to publicly available financial information (Form 990), NYSOTA's net assets are in free fall.


YEAR      NET ASSETS
----------------------------------
2012        $180,045
2013        $135,154
2014        $107,…

OT History in Clifton Springs!

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A group of people made OT History today - pulling off an amazing day of celebration in Clifton Springs that was enjoyed by so many attendees.

Eighteen months ago I started corresponding with Steve Egidi, an occupational therapist and Vice President of the Clifton Springs Chamber of Commerce.  He invited me to join a working group that was forming to help make plans for  the 100th OT Anniversary Celebration in Clifton Springs.  Steve was a steady organizing force for the group and it was a real pleasure getting to work with him.

Also from the Chamber was Jeff Criblear, President of the Clifton Springs Chamber of Commerce.  Jeff did amazing work with restoring the 50th anniversary plaque and also helping to coordinate so many of the Centennial celebration activities with the Clifton Springs community.

The glue behind the entire project was undoubtedly Jamie Noga, Coordinator from the Clifton Springs Chamber of Commerce.  Jamie did it all - she kept us all organized and on track, manag…

Re-post: The Passion from a kid's perspective

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A story worth re-posting:

A fairly standard component of my pediatric occupational therapy evaluations is to ask the child to draw a picture of themselves. This assessment technique provides an opportunity to evaluate the child's skill with writing and also is a functional assessment of their cognitive and perceptual ability.

Sometimes kids draw things that just beg to be probed and questioned - as was the case recently. I watched intently as 6 year old Patrick drew a representation of himself, but then he began adding odd details to his picture. First he colored dark spots on his figure's hands and feet, and then added a row of X's across the forehead.

I leaned forward and quizzically asked, "Patrick, what are these marks here?"

He looked at me for a moment and then responded: "Jesus died for you, you know. He got nailed to a cross, in his hands and his feet. My Dad said that he had to wear prickers on his head and it made him bleed."

"…

The meaning of a word cloud

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This image caught my attention when I attended the Presidential Address at the AOTA national conference in Philadelphia last week, and it has been tweeted around in occupational therapy circles since that time.


The question is - what does it mean?

The AOTA president discussed population health as a concept that she believes will be integral to occupational therapy's future vision.  Unfortunately, this vision has more to do with a misguided alignment with payment models (Triple Aim) than anything to do with patient care.

This unusual vision has been promoted by other occupational therapists and also discussed extensively in this blog here and here and here and here, to link a few.

What exactly is the meaning of this word cloud?  The initial intent of word clouds was to provide a base narrative analysis of content within written text.  Even at their best they are crude, because the words are presented in a decontextualized format.

In this example the word cloud is a manipulative mes…

The danger of assuming universal and singular narrative explanations of disability

In a recent article appearing on the CNN website, author Wayne Drash reviews the concept of 'wrongful birth' in context of Lesli, a person who has developmental disabilities.  Drash's profile states that he "specializes in stories off the radar" and that "his passion is to tell narratives about life and the unfolding drama of the world we live in."

It would be more accurate to state that Drash cherry picked one person's perspective and advanced a fiction that serves one ideological perspective.

His initial description of Lesli in his opening sentence tells us everything he believes about her person-hood.  He immediately goes to the 'fetal position' trope that promotes his message of Lesli's helplessness and haplessness.

For just a moment the reader is led to believe that there may be another side of the story to be told as he describes Lesli's joy at having her mother hold her hand - but the author quickly reverts to reporting the p…

The Barton Project: AOTA 2017 Conference Handouts

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Hi and thank you for stopping here to look at the poster handouts that are being distributed at the 2017 AOTA conference!

If you were unable to get a copy of the handout of the poster presentation, the files below are hi-res JPG scans that you can download and view in a larger format.

This version of the timeline is one small step of a multi-year project attempting to document George Barton's life.  I was always struck by the fact that his life story was documented in such a limited way as compared to other occupational therapy founders.  The lack of previously published information on Barton motivated my effort.

Having personal geographic proximity to Clifton Springs made the project interesting from that perspective as well.

This effort started by happenstance and with a meeting my wife Caroline had with George Barton Jr.'s wife Barbara.  She was kind enough to supply materials to us that started this inquiry.  A visit to Consolation House also yielded results with the owner…

Governor Cuomo and the Early Intervention State Fiscal Agent boondoggle

Another update in the ongoing saga of the failing New York State Early Intervention program:

The Governor's 2018 budget proposal adds new requirements on insurance companies and providers.  Under other circumstances, a provider or fiscal intermediary would simply operate within the available rules that exist in the private marketplace, but since the State has designated a fiscal agent that is unable to compete in the free market, the Governor is forced to rewrite insurance laws in order to facilitate payment.

 In FY 2016, nearly 85% of claims submitted by the Early Intervention State Fiscal Agent to private insurers were denied.  The idea of cost sharing with private insurance has been a failure because the State botched the implementation and has contracted with an incompetent fiscal agent.  The breakdown of payment of Early Intervention costs has been as follows:

Private insurance: 2%
Medicaid: 41%
NY State: 27%
Counties: 30%

This is AFTER the State invested millions of dollars …

Reasons to yawn: Wrap up analysis of two recent SCOTUS cases involving IDEA

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On 11/8/16 I wrote

In both of these cases it is important to carefully analyze the details of what is actually being litigated.  So often the truth of what is being discussed gets lost in poor reporting about the topics.  For example, many news outlets focus on the 'evil school district vs. the child in the wheelchair with Wonder the GoldenDoodle' meme instead of focusing on the decidedly less appealing 'what is the importance of due process' angle.

As OTs become more savvy with policy analysis they will avoid the bias-trap of media reporting and try to approach a more 'rational comprehensive' method of considering the actual facts.  They will also become more savvy by dropping the naive notion that just because an issue might have the superficial appearance of something that should be supported, it is important to dive deeply into the actual policy to make sure we are promoting what is best for the people who seek our services.
Turns out that this …

You can't keep a good event down...

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...but you might delay things just a little while because of winter weather!

Today a gathering was scheduled in Clifton Springs for a celebration of the occupational therapy founding.  The mayor was also scheduled to issue a proclamation but the celebration had to be postponed due to inclement weather. 

The event will be rescheduled.

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The March 8. 1917 Clifton Springs Press had an announcement about the upcoming First Consolation House Conference, but it also had an interesting article about George Barton.  The subheadlines and text of the article are notable because they provide direct evidence of exactly how the Clifton Springs community felt about his efforts and also how influential he was.


The article quotes an unnamed folk source as saying, "You can't keep a good man down, especially when he runs an elevator for a living."  The newspaper editor goes on to state "and in no instance has the editor found opportunity to apply this witicism, where it was found mo…

A request for honesty about modern day practice in long term care facilities

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Follow-up to Ethical occupational therapy practice in nursing home care


Studying historical phenomenon is helpful for framing modern problems - and so I would like to draw attention to an article that appeared in Modern Hospital in September 1922.

The author of the article, Christine Newman, was Head Aide of the Howell State Sanatorium for Tuberculosis in Howell, Michigan.  The facility is described as "a self-sufficient entity that aimed to meet the patients' and employees' every need with a working farm, apple orchard, convenience store, post office, water and heating plants and kitchen staff."

This model of 'self sufficiency' was common among asylums and sanitariums in the 19th century.  I would like to recommend Dr. Katherine Ziff's book Asylum on the Hill as well as her blog; these resources are invaluable to understanding a model of asylums during this time period and offer a counterpoint for understand modern institutions.

Ms. Newman's articl…

The Lenten message of Emmanuel practitioners that influenced the occupational therapy profession

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I have previously documented (in presentation and in blog) the role of the Emmanuel Movement with regard to its overall impact on 'treatment' of mental health conditions at the turn of the century in general and its impact on George Barton in particular.  I have also documented some lingering impact of concerns with spirituality and how the topic has been reflected in some occupational therapy documents over time.  As we are on the eve of the Lenten season, and as we are properly situated in history to reflect on the crucible of values that contributed to the founding of the occupational therapy profession, this little sideways journey seems timely and appropriate.

Many occupational therapists enjoy using the term 'holistic' to describe their orientation and interest but few are adroitly capable of putting such diversity that includes spirituality into actual practice.  This has always been the case - even when turn of the 20th century 'providers' made the att…

An unusual connection between American opera and George Edward Barton

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There is a God whose laws unchanging
No one may hope to disobey.
Man's own desires forced upon the ordained way.
He for a moment triumphs,
He has his will,
He pays the penalty.
    (Barton, 1905)

The Pipe of Desire is a one act play published in 1905 by George Edward Barton, and set to operatic score by Frederick Converse.  It might be just a curious fact that architect George Barton attempted the role of librettist except for the historic implications of this effort.

We know that as a young man Barton was raised in a family "steeped in the arts and letters" (de Lancey, 1958).  From the same source we also know that he had a bicycle encounter in the English countryside with King Edward VII where they were both "whistling operatic arias."

So although Barton may have had early exposure to and enjoyed the operatic form there is not much known about the specifics of how the historic collaboration with Converse actually came about.  Coburn (1909) wrote, "Yet refresh…

Occupational therapy history: A lopsided tale told by the 'designated survivors'

Some overtly prejudicial information has been published about George Barton.  In an officially sanctioned history of the occupational therapy profession, Quiroga (1995) wrote that "Barton was undoubtedly an unusual if not eccentric character, who had difficulty knowing his own identity."  She also stated that "some of Barton's writings may have created more foes than allies to the cause" and that "George Edward Barton was an occupational therapy zealot" with a "near-crusade mentality" who "was undoubtedly a difficult person with whom to work in the organizational phase of the national association" who "did not possess the interpersonal skills that he needed" and "simply did not fit the profile of what his contemporaries considered to be a professional leader."

There is very little evidence to support this level of prejudice.  Quiroga misinterprets Barton's claim to being a 'sociologist' - forgetting…

The use of online journaling as a qualitative methods datasource