From the Editor

Feeling stressed in your SNF? You’re in good company

Bosses sometimes ask therapists to treat patients who refuse care, don’t need it or are in advanced stages of illness, therapists say. Recent interactions with OT colleagues in distress have left me wondering just how widespread the extreme pressure for productivity is. An Aug. 16 article in the Wall Street Journal provides some answers. The article said the rate of classifying Medicare patients as recipients of ultra-high therapy (at least 720 minutes per week) has increased from just 7% in 2002 to a whopping 54% in 2013. The article stated many of these older adult patients are too frail to tolerate intense intervention, as their therapists are well aware. I have been communicating with OTs across the country who are anxious because they are pushed to take actions they know are inappropriate and try to compress too much work into too little time. I know I’m preaching to the choir here, but I am compelled to state the obvious when things are going off the tracks for so many of us. The Wall Street Journal story highlights a tragic case in which a frail 96-year-old man with dementia was the recipient of ultra-high therapy. If the report is accurate, the patient went into medical crisis and died weeks after being hospitalized for dehydration. I was mortified to read excerpts from the OT and SLP records that reflected how ill and disabled this gentleman was. My heart goes out to those therapists. Although I don’t really know their side of the situation, I imagine they are like so many others across the U.S. who must follow rigid protocols and productivity demands. The article references interviews with healthcare providers and administrators across 17 states who indicated they [...]

Tell me a story: The oral tradition of OT

By Debora A. Davidson, PhD, OTR/L I have always been fortunate to practice OT among an amazing community of clinical role models with whom I have shared stories about our ways of practicing. I recognize the enormous effect these stories have had on my development as a therapist. I was and am part of a wonderful community. The oral tradition has taught me there are many ways to influence people’s occupational lives. I’ve learned that OTs can develop their own best strategies and avoid mistakes based on stories shared by peers. Here is one of my best stories. I am sharing it to illustrate the power of clinical story-telling. I have left out or changed critical details to protect my patient’s confidentiality, but it’s quite true. I’ve used this story in my classes to springboard discussion among my OT students about safety in the workplace. I’ve also relayed it to experienced OT pals to generate a laugh. It was 31 years ago. I was a young OT, newly hired onto the child psych unit of a large teaching hospital. I had worked with lots of kids in community settings. I felt quite confident in my skills and was eager to prove myself. My patient, a young adolescent boy who was about my size, seemed fatigued and depressed. Those traits were not uncommon for kids in our unit. I decided that what he needed was mildly aerobic activity. I decided we’d play badminton in the gym. My colleagues raised their eyebrows when I announced my plan, but I was not worried. I knew this kid, and we had a solid therapeutic alliance. Off we went. I was well aware that what brought this patient into our [...]

OTs on the same page in response to last column

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor After I poured out my feelings about the way that occupational therapists are often forced to reduce their practices to meet employer’s productivity standards in my last column, Seeking Your Advice: Ideas for OT’s Future, I felt nervous.  I was worried readers might get angry or feel I was criticizing them or their areas of practice.  I am not afraid of spicy discussions or controversy, but I know that exchanges online can become very emotional, especially when they center on a topic as near to our hearts as OT is to most of us. I held my breath. Nothing prepared me for the flood of responses to my column … not just the number of comments, but the uniformity of the responses.  Although each person had a unique perspective, there were no outright dissenters. Certain themes sang out among the responses: A disconnect between values and demands  “Days I am actually able to do client-centered meaningful tasks, such as cooking, with patients are productivity killers. Who has time for that? Here have this peg board instead! Sigh!” –A. J. “…most OT practitioners did not go into the profession to do conveyor belt therapy.  We chose this profession because we care deeply about our clients and their wishes and desires.”–A. B. “The last clinic I worked in had exercise equipment … period. There was no kitchen area at all. When I became the rehab manager, I really got to see the money game. I did not last long in that role. It’s shameful!”–A. B. Empathy and worry for the next generation of OTs “It’s sad that so many new grads will never know the pleasure of [...]

By |August 14th, 2015|Categories: From the Editor|22 Comments

Seeking your advice, ideas for OT’s future

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor I recently served as a CI for a Level II OT student, and it was an eye opening experience for both of us.  She split her week between Bright Futures, my private practice that serves adults who need help with transitional goals, and a local inpatient rehabilitation center serving older adults. Our OTS spent two days per week with Bright Futures and the other three days at the rehab center. Just before midterm I noticed that our OTS was looking a bit stressed and was perhaps not having as much fun as I was.  When I asked her how things were going overall with her fieldwork, she surprised me. I was worried that the sometimes slow, uneven pace of our clinical days at Bright Futures was not as stimulating as she had hoped or that perhaps the sessions were not as technically oriented as she had expected. (Perhaps making a casserole with our client with Down syndrome was not doing it for her? Or spending time culling through job ads with one of our fellows with Aspergers syndrome was kind of tedious?)  I was prepared to hear this and to try and find ways to amp things up a bit more, somehow. To my surprise, our student’s universe did not revolve around Bright Futures! Yes, she was in some distress, but it was more related to realizing that her other placement was disappointing in some key ways. This OTS loves working and being with older adults. She went into the rehab center ready to fall in love with the job and to serve the patients with her whole heart. What she experienced was the [...]

By |July 15th, 2015|Categories: From the Editor|64 Comments

Opportunity knocks for OT in behavioral health

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor I whooped with joy upon reading the news release that OTs have been listed as “suggested staff” for newly created certified behavioral health clinics.  From the nearly 2,000 views and many responses on Facebook, many of you feel the same way. I am enjoying this moment, made sweeter by the hard work that we put into advocating for it. Now what? The door has opened a crack, and it will be up to us to make the most of the opportunity. We finally have a chance to show our stuff in a small group of two-year Planning Grants for Certified Community Behavioral Health Clinics. Listen to the language of this legislation, which mandates that the grant winners will: Facilitate cultural, procedural, and organizational changes to CCBHCs that will result in the delivery of high quality, comprehensive, person-centered, and evidence-based services that are accessible to the target population. Doesn’t this sound like a perfect fit for OT? There will be up to 25 demonstration programs that will, hopefully, light the way for future community mental health programs across the country. OTs can be invited to join teams that would include some combination of: psychiatrists, social workers, psychologists, psychiatric nurse specialists, marriage and family counselors, substance abuse counselors, peer specialists/recovery coaches, case managers, and community health specialists. Team members will participate in training and development. Goodness knows we need these programs. The vast majority of Americans with severe and chronic mental illnesses receive no or inadequate care at this time. The outcome of such negligence is crime, homelessness, child abuse and neglect, and lost lives. Occupational therapists know that we have unique skills and knowledge to [...]

By |June 5th, 2015|Categories: From the Editor|3 Comments

OT faculty: Multi-tasking superheroes

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor I am writing this entry in tribute to my friends and colleagues who educate the next generations of OT practitioners.  Having served as a full-time faculty member from 1991 to 2011, I feel confident in saying that I know what the work entails and that most people who have not been in your shoes have no idea of all that you do. This is a note of recognition for the contributions and extreme-sports multi-tasking that being full-time faculty entails. It is also my hope that non-academic OTs will read it and better understand the work-lives of OTs who teach. The month of May is, for most college educators, a time to celebrate the commencement of another batch of graduating students.  There is a mixed sense of achievement, poignancy, exhaustion, and amazement that you have (once again) done more in less time than seemed possible.  Facilitating students’ progression into our beloved profession means helping them to gain admission to fulfilling professional lives, and to know that, as OTs, their efforts will, radically improve the lives of many. Your power to help others in need is exponentially increased with each competent OT you graduate. Most people who have never managed a college course do not realize all that you do in your role as a classroom educator. I recall friends expressing surprise when they realized that I was not lecturing all day, every day. What they did not consider is that the time spent lecturing is the smallest unit of effort expended. If a course were a Broadway production, the professor would be the writer, producer, director, stage hands, set designer and, finally, actor. This does [...]

In celebration of OT month

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor If you have ever read my writings, sat in my classrooms, worked alongside me or just hung out with me for any time at all, you probably know that I am in love with occupational therapy.  My husband teases me that "OT stands for Only Topic,"  a line that he picked up from a friend whose wife is also an OT evangelist. So, for me, OT month offers another happy reason to pause and count the ways that I love this unique and powerful profession, starting with our beautiful roots. I love that OT was created with thought and intention by an eclectic group of professionals who saw first-hand the power of meaningful activity as they worked with patients and individuals with severe social and economic disadvantages.  OT was imagined, discussed and deliberately outlined by this group of thinkers and doers that included a social welfare reformer, a teacher, a psychiatrist, a physician, a nurse, and two architects, one of whom had personally experienced chronic illness, and the impact of meaningful occupation on healing.  While all of the many health and helping professions have evolved from diverse roots, OT alone was proactively planned and named, including curricula for training people to practice it.  Read more here in the inspiring Eleanor Clark Slagle Lecture by Kathleen Barker Schwartz: OT continues to embody the knowledge and effort of compassionate people with a diversity of talents and interests, and dedication to these basic truths about human needs and rights: That occupation is as nec­essary to life as food and drink That every human being should have both physical and mental occupation That all should have occu­pations [...]

By |April 7th, 2015|Categories: From the Editor|1 Comment

David Gray: An American hero

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor In October, I initiated writing about people with disabilities who have made a significant impact on society and the lives of others. My first subject was Laura Hershey, a civil rights activist, poet, and writer. Today, I am writing about David Gray, PhD, who I met when he joined the OT faculty at Washington University in 1995. He joined the faculty as a full professor, and I was a lowly instructor. I recall David interacting with each of us as peers with no regard or concern for the usual academic hierarchy. In fact, I think he was especially warm toward the more junior faculty members and students, just because we had so little status. I am inspired to write about David because his scholarship and mentorship have changed the lives of so many people with disabilities, OT students and colleagues. I am writing about him at this particular time because he recently died. I hate this. The world will definitely be a tamer, less interesting place for our loss. On the other hand, I am not sorry that I didn’t write this sooner because David probably would have laughed and seriously teased me about the very idea of writing homage to him. This is because David was the real deal, someone who did the work for its own sake and because he loved it and he knew that it was important. David’s scholarship was always directed toward the study of the impacts of disability. He initially focused on the needs of people with developmental disabilities. Then, in 1976 at 32 years of age and very soon after completing his PhD in psychology and genetics [...]

By |March 2nd, 2015|Categories: From the Editor|4 Comments

Speak up and be heard: A call to action in February

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor “The most dangerous ideas are not those that challenge the status quo. The most dangerous ideas are those so embedded in the status quo, so wrapped in a cloud of inevitability, that we forget they are ideas at all.” ― Jacob M. Appel, Phoning Home: Essays The American Occupational Therapy Association Ethics Committee is inviting all occupational therapists to complete a quick and easy online survey on “Ethical Challenges and Moral Distress in the Workplace” through February 28th. You can take the survey at I took the survey in less than 15 minutes. It asks very targeted questions about our experiences as therapists, and there is the opportunity to add specifically- themed narrative responses, in addition to the checkbox responses.  Questions include issues of scope of practice (a particular favorite of mine), productivity demands, and interpersonal stressors on the job. In 1998, OT Practice published results of a survey showing that most OT practitioners dealt with ethical challenges on a daily or weekly basis.  Top conditions of concern were: Cost containment versus quality of care Inadequate or inappropriate documentation Improper or inadequate supervision Pressure to perform inappropriate intervention Breaches of confidentiality in the workplace Does any of this sound familiar? Our workplaces have certainly not become less challenging and hurried since then. These are such important and pressing concerns for everyone in health care and educational settings. Please add your voice and complete this important survey today! Share your thoughts:

By |February 17th, 2015|Categories: From the Editor|0 Comments

The revolution continues

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor Back in May 2014, I wrote a blog in response to having encountered young colleagues who were burning out because they had been systematically prevented from providing essential, scope of practice OT functions at their jobs. They had been forced to narrow their services in order to meet ever-increasing productivity standards. I exhorted readers to “rock the boat and save your own life” by taking real steps to practice authentic, occupationally relevant OT, despite bureaucratic and cultural pressures to provide cookie-cutter, reduced services.  The response to my call to action was strongly positive, and I was pleased to know that my concern for our clients’ and our collective wellbeing was not unique. Last fall, I was made aware of a larger movement afoot, or at least a growing awareness that we need to provide practitioners with support and means to push back. In October 2014, AOTA, in coordination with the American Physical Therapy Association (APTA) and the American Speech-Language-Hearing Association (ASHA) published a “Consensus Statement on Clinical Judgment in Health Care Settings.” This official document reflects awareness at the upper levels that practitioners often work in contexts that stifle them professionally, and may even strive to force unethical practice. “Decisions regarding patient/client care should be made by clinicians in accordance with their clinical judgment.” “Respect for the therapist’s clinical judgment and expertise is critical to achieving optimum patient/client care. Overriding or ignoring clinical judgment through administrative mandates, employer pressure to meet quotas, or inappropriate productivity standards may be a violation of payer rules, may be in conflict with state licensure laws, and may even constitute fraud.” The document also outlines practitioners’ responsibility to know [...]

By |December 12th, 2014|Categories: From the Editor|5 Comments