About Debora Davidson, PhD, OTR/L

Debora Davidson, PhD, OTR/L, has practiced OT since 1979. Her clinical career initially centered on children and adolescents with behavioral and emotional problems. For 20 years she served as an OT faculty member at several nationally ranked universities. In 2011 Debora left academia to initiate Bright Futures in Focus, a private practice serving young adults with disabilities who want to achieve a satisfying transition to adulthood. From 2011-2015 she was the OT Clinical Editor for OnCourse Learning. She is a clinical occupational therapy blogger for TodayinOT.com. Debora initiated Authentic Occupational Therapy to inspire OTs who want to regain their clinical mojo. Join the conversation at www.facebook.com/AuthenticOT.

Laura Hershey:  An American Hero

As an OT, I have many professional heroes:  A. Jean Ayres, Lela Llorens, Gary Kielhofner, Wendy Coster, Suzanne Peloquin, Chuck Christiansen. My list goes on and on. These scholars and master clinicians are well represented in our professional texts and lauded at conferences. They have contributed hugely to our profession and the lives of people with disabilities.

Here’s an interesting question: how many celebrity heroes can you name from the ranks of those we serve?  I must admit that I can barely come up with even a few!  The activists for disability rights are not well represented in our texts and OT stories.  In fact, they are rarely mentioned in any media, I think.

I would like to start to correct this imbalance by sharing a bit about heroes in the struggle to gain civil rights for Americans with disabilities, starting with  Laura Hershey. Laura was a tireless advocate for the rights of people who are disadvantaged, including those with disabilities. She wrote many poems and articles focusing on the challenges faced by people with disabilities in a society that treats them with pity or disregard.  She protested the muscular dystrophy telethons for their negative portrayal of people such as herself and twice participated in United Nations conventions of women’s rights. She received an honorary doctorate from Colorado College, where she had previously earned her undergraduate degree. She was a petite woman in a power chair, with a strong, clear voice and a lot of energy!  Laura died at the age of 48, having improved the lives and awareness of many.  Her most famous poem is  “You Get Proud By Practicing”.

Below is a bit of her poem, the stanzas that speak to me as an OT.  […]

Therapeutic compassion

I live in St. Louis, a community that, unfortunately, recently has made international news because of violent events. Just so you know, most of us live here in the river city in peace. However, that does not mean that we go untouched by anger, or even aggression. In fact, all of us working in healthcare spend our days doing one of the more dangerous jobs out there. Even if you generally avoid physical assault, chances are you will experience clients’ frustration or even rage as they come up against the realities of loss.

I work with young adults with disabilities who need help to reach their goals for careers, independent lives and a sense of belonging. I strive to engage my empathy, to keep the balance of power weighted on my client’s side and to avoid saying or doing things that could be coercive. When things are going well, this is easy. It’s not unusual, though, for our trajectory of progress to be unexpectedly thrown off by events, moods or changes of heart.

This occurred when a young guy I work with went from acting enthusiastic about his chosen career path one week, to unexpectedly refusing to discuss his plans or much of anything else the next. His face was wooden and his legs jiggled under the table as I attempted to engage him in conversation about next steps for education, training or volunteer work in video game development, his career of choice. He reacted by saying, “You don’t know anything about video games or software development, and my mom is just wasting her money on these dumb sessions.”

My face grew immediately hot as my mind began to race. Wasting their money? I had already brought […]

Harness the power of flow

Are you aware of the positive psychology concept called flow?  It is a powerful force that we OTs can use to help clients to heal and gain strength from. Here’s a quick definition:

Flow is a psychological state that occurs when an individual is engaged in a task that is so engaging that they become extremely focused, to the exclusion of distractions, discomfort and time.

In his 2004 Ted Talk, Mihali Csíkszentmihályi relates flow to a state of ecstasy or joy that adds greatly to one’s quality of life.  Flow is different from some other types of ecstasy, as it is a state of that is connected with occupation.  I love the feeling of flow, and I am lucky to have accessed it during a range of activities that are easily available to me. Writing, lecturing and working with my clients have all resulted in flow at various times.

I know that many others derive flow very differently. Sewing, making music, creating a splint, or playing a sport might result in flow for others. These are not easy or mindless occupations; rather they are complex and challenging activities that challenge me at the “just right” level that A. Jean Ayres also wrote about. Here is what I know from having experienced flow: it is therapeutic and rejuvenating in a unique and important way, and OTs should try to help clients to achieve it as often as possible.

I have had my experience validated by watching my clients’ and students’ experiences of flow. When they achieve flow states, their eyes shine. They are oblivious to distractions. They are focused and engaged and “lose themselves” in the moment. They sustain their attention and persist through difficulties. When the session must […]

Interprofessional teamwork: Let’s go there

Are you aware of all of the attention that interprofessional teamwork in healthcare is getting these days? It started in the 1970s and 80s in Canada and Great Britain, and today it’s a full-blown worldwide phenomenon.

In 2010, the World Health Organization published the “Framework for Action on Interprofessional Education and Collaborative Practice,” which describes the “culture shift in healthcare delivery” that is occurring and ways to promote it in healthcare settings and practitioner education. A literature search of databases of medical and allied health journals reflects an explosion of publication about interprofessional teamwork: what it is, how to establish and grow it, and its many positive outcomes. Foundations have established competitive grants to fund scholars and service providers who want to promote clinical programs that demonstrate and live up to high standards of interprofessionalism. University programs have formed curricula to reflect interprofessional values and skills. A shift to interprofessionalism is definitely happening, and Today in OT is helping to move it forward.

As practitioners who almost always function as members of a mixed team of professionals, one may rightly wonder what all of the fuss is about. Is interprofessionalism really something new, or just old news that has been rediscovered and repackaged? Having given the issue quite a bit of study and thought over the past several years, I can say that the today’s interprofessional team model is a souped-up, more defined and demanding approach to teamwork than was seen in the past. It moves us away from the multi-disciplinary approaches that most settings have used and toward a more truly integrated, informed, and efficient approach.

In today’s paradigm, a team is functioning interprofessionally when expert professionals of two or more disciplines :

Understand and respect one […]

Time to get disruptive

When I was at the AOTA Conference in Baltimore, I had the great pleasure of meeting up with a number of my former students who are practicing OT all across the country. It was, as always, delightful to see them and to know that they are out there helping so many people whose lives have been limited by illness or disability. I felt very proud to have them as my colleagues and satisfied because I had participated in the effort to prepare them for this great career. This year, though, I also came away with a nagging worry, based on two former students’ comments about their work.

Upon walking into the Baltimore Convention Center, I ran into the two students in quick succession. The first had graduated two years ago; the other had been practicing for about 15 years. They worked in two distinct regions of the country in adult rehabilitation settings. Each of them spontaneously shared with me that they were frustrated in their work because they had been significantly limited in their scope of practice. Both were prevented from assisting patients with transferring and were told to ask physical therapists to perform this function. They were actively limited by their supervisors and administrators to training patients in basic ADLs or upper-limb strength and endurance and discouraged from working on more complex goals. Their OT peers were acquiescent to these restrictions and seemed complacent. My former students described a reduced level of satisfaction with their work and decreased self-confidence.

I was dismayed. I recalled how idealistic and capable both women were upon graduation, and it was sad to see them feeling dissatisfied and unsure. This was not the kind of OT that we taught in […]

Manners and assertiveness in professional exchange

“Manners are the happy way of doing things.” — Ralph Waldo Emerson

For my 11th birthday, my mother gave me a book called “White Gloves and Party Manners,” by Mariabelle Young and Ann Buchwald, undoubtedly hoping it would assist in my transformation from an ugly duckling into a graceful swan. I recall being singularly unimpressed with its instructions about making formal introductions and using fingerbowls. (Fingerbowls were in short supply in our tiny Illinois town, situated in the middle of corn and bean fields.) It was a book written in the 1960s — for the 1950s — and I was much too modern for most of it. Still, since that time, I have acquired a great fondness for manners and etiquette. Manners actually have nothing to do with white gloves.

“Manners are a sensitive awareness of the feelings of others. If you have that awareness, you have good manners, no matter what fork you use.” — Emily Post

Knowing how to interact with others in ways that communicate respect for their intelligence and caring for their feelings is a skill that opens minds and doors. Manners are especially important when you strongly disagree with someone, feel threatened by them or you suspect they do not know the facts of an issue. Listen fully and with an open mind, and ask questions before sharing your perspective. Try to find something about the other person’s views that you can support, or at least understand, and reference this before sharing your ideas.

Generating excitement and sharing thoughts and reactions to new ideas are all key goals of Today in OT on Facebook. Recently we had an exchange of ideas in response to a small research article about issues related to the […]

It’s back in style: 10 reasons to use crafts in your therapy

Remember your History of Occupational Therapy course in which you learned about how your future profession was rooted in the moral treatment and arts and crafts movements? Well, guess what, crafts are back in style and they still pack a therapeutic punch. It’s time to give them a try or to take them out of storage. Here’s why:

1) Crafts are cool and contemporary. People of all ages and backgrounds are crafting at home, in classes, at parties and in bars. They spend time sharing craft ideas via Internet sites such as Pinterest and Etsy.

2) Crafting can improve motivation and outcomes. Research shows patients who are working to increase their strength and functional performance will work harder and longer if there is a meaningful outcome attached to their efforts.

3) Producing a valued object can completely revise a person’s view of himself or herself. One of my favorite experiences is enjoying the expression of wonder crossing my clients’ faces as they realize they have made a fabulous product, whether it is a wooden tool box, a mosaic plant stand or a leather comb case. You know the look: it’s priceless.

4) Others’ views of a person with disability change when they see tangible evidence of competence. What is sweeter than the compliments of family and friends when a client emerges from OT with a well-made item that he or she has created? The question, “Did you make that?” always results in huge smiles of pride. “Will you make one for me?” just adds to the joy.

5) Crafts facilitate a patient’s motor skills. In fact, it’s difficult to imagine any crafting process that does not involve an array of bilateral fine motor skills, not to mention that just […]

Work as a gold standard OT outcome

Occupational therapists love to multitask, when it comes to designing therapeutic interventions. My sessions sometimes look simple, and I am sure that others have looked upon me at work and thought, “Why does it take a professional to do that?”

But just ask me, and I will be delighted to list all of the ways that making a sandwich or playing a board game can change my client’s life: fine motor skills, bilateral coordination, visual perception, impulse control, sequencing, problem solving, the list goes on.

And then there’s the occupational result: she has a sandwich to enjoy or now he can play this game with his siblings — abilities that most of us can take for granted, but that can mean the world to someone who has been unable to do them. OTs also like to achieve outcome goals that place our clients into the swim of things in their families and communities and that allow them to assume valued roles. We call this “participation in context.” Well, there’s an outcome goal can do all of the above:  facilitate ongoing therapeutic improvement, while placing adult clients into developmentally typical roles. It’s having a career.

A career, in this instance, does not refer only to jobs requiring a college degree or specialized training. Rather, it means any productive work that a person pursues for a significant period of time, with opportunities for growth and development. So, a person whose job at a restaurant progresses from bussing tables to washing dishes, and then to preparing the salads can be said to have a career. A career should be something that the worker cares about and wants to learn more about. There should be a sense of pride in identifying […]

By |February 21st, 2014|Categories: From the Editor||0 Comments

Model reaches 30-year milestone

Did you know that the Canadian Model of Occupational Performance has reached its 30th birthday? You may not realize it, but this approach revolutionized OT in the U.S. and has been influential in the development of contemporary professional language and philosophy, as articulated in the Occupational Therapy Practice Framework. This blog is my tribute and thanks to the brilliant minds who have formed and developed such an elegant, practical and durable model for OT practice.

The Canadian Model, or “P-E-O” (Performance, Environment, Occupation) as many call it, is the culmination of efforts by a small group of Canadian scholar-therapists who were called upon to help develop their national healthcare system. They drew from ideals and concepts that had been described in the literature of various professions, and articulated ways to translate these ideas into practice.

As an OT practitioner, I love the way the following model structures my thinking about key aspects of each client’s situation and helps me to be both holistically and occupationally focused:

• Person: Who they are, what they care about, how they see their strengths and problems, what they most want help with, what is their diagnosis and prognosis, what they believe will help.

• Environment: Where they live and work, the important people in their lives, their financial and social resources, how accessible and safe their communities are.

• Occupation: Their life roles, how they spend their time, what they want to be doing, what they dislike doing, what may be impeding their occupational performance.

As an OT educator, I have seen how analyzing clinical scenarios through a P-E-O lens facilitates students’ rapid development of clinical reasoning. It is easy to learn and gives them a solid basis for reasoning ways to evaluate and […]

By |February 12th, 2014|Categories: From the Editor||3 Comments

The ACA: A revolution in the making

The Affordable Care Act was among the most discussed news stories of 2013. Much of the reporting centered on the many frustrations and problems caused by its halting implementation. Merging health insurance with federal law is bound to result in complicated text, and the ACA is all that one would expect in this regard. Amid all the noise and confusion lie some gems that we can celebrate, such as the inclusion of habilitation services as part of the newly required package of health insurance benefits.

Habilitation is the provision of services that help individuals with developmental disabilities improve, maintain and prevent deterioration of functioning. In the past, most health insurance policies did not include these kinds of services and defined them as educational rather than health-related issues. Through the diligent efforts of consumer advocate groups and professional groups, such as the American Occupational Therapy Association, habilitation services have been added as a basic, covered health service.

According to the American Academy of Physical Medicine and Rehabilitation’s position paper “Defining ‘Rehabilitative and Habilitative Services and Devices,’” the ACA requires insurance to routinely cover:

• Therapies that improve, maintain and prevent deterioration of function, including pain management.

• Therapies or treatments that enable people with developmental disabilities to attain functional abilities or reduce the deterioration of function over time.

• Outpatient rehabilitation services without an arbitrary cap on benefits that is unrelated to medical necessity, and maintenance services (to prevent deterioration), cognitive retraining, adaptive skills training and other services as determined by a physician to be reasonable and necessary.

• Durable medical equipment, prosthetics, orthotics, mobility equipment, supplies, and assistive and adaptive devices that improve or maintain function and do not include arbitrary limits on access to these devices and related services.

These […]