The cover story for ADVANCE's June 22 issue will examine how occupational therapy in the U.S. is different from occupational therapy in other countries, such as Australia, Great Britain and Canada. I am looking for an OT who has practiced both in Canada and the states willing to discuss his/her experiences and the differences noted.

 If you're interested in setting up a phone interview at some point during the next week, contact me at scoyle@advanceweb.com.

 I look forward to hearing from you.

Recently, the American Occupational Therapy Association endorsed Boston University's Activity Measure for Post Acute Care (AM-PAC), a tool to measure client outcomes in three categories of function-mobility, daily activities and cognition. The assessment will play a critical role in the development of AOTA's outcomes database, a project identified by the AOTA Board of Directors as a high priority in achieving the Centennial Vision, which foresees occupational therapy as a "science-driven and evidence-based profession."

For more information on the AM-PAC and the recent AOTA endorsement, check out this Q & A with AOTA's program director of evidence-based practice Deborah Lieberman, and Chuck Willmarth, AOTA's director of state affairs, and reimbursement and regulatory policy: http://www.aota.org/News/AOTANews/QA.aspx

The May 25 cover story of ADVANCE will take an in-depth look at the development of AOTA's outcomes database and the role that the AM-PAC will play in that endeavor.

The shrinking economy began hitting the association hard last year, and it continues to challenge AOTA's financial resources unrelentingly, according to Treasurer Saburi Imara, whose annual report at the national conference in Houston last week was sobering. Nevertheless, quick action in the past six months has helped to keep the wolf away from the doorstep.

"There is no doubt that we face one of the most difficult economic times in the history of AOTA," Imara told members attending the annual business meeting April 25 at the George R. Brown Convention Center in Houston. AOTA had lost $540,000 in investment income as of January, and revenue for FY 2008, which ended last June 30, showed a loss of almost $785,000 in net assets. The year before, the association had seen an increase of almost $200,000.

Higher taxes, a $345,000 payment to the defined-benefit pension plan to adjust the required minimum liability, and empty rental units in the national office building accounted for most of the expense-sheet woes. The pension fund has been frozen since 1998 and will be discontinued next year.

Meanwhile a slow but steady increase in membership has been keeping the ship afloat and continuing education revenue is also going up. According to executive director Fred Somers, membership is now over 39,000, up 15 percent in the past four years. AOTA continues to push for greater membership; there are some 140,000 certified practitioners in the United States, according to the National Board for Certification in Occupational Therapy (NBCOT).

The 2008 conference in Long Beach, CA, swelled the coffers by $2 million, with 5,665 people in attendance. This year in Houston, registration was 5,100. Those numbers include exhibitors.

In an effort to stem its rising tide of expenses, association leaders began last fall to reduce the fiscal '09 budget by $537,000 by cutting training and travel. In December, the national office laid off employees and reduced its senior staff salaries.

For the first time, the association held its spring Representative Assembly meeting online instead of face to face, saving up to $75,000 in travel expenses it would have had to pay for delegates from across the country. The jury is still out on whether the virtual meeting, which was considered very successful, will continue. Most leaders believe it is likely, at least in the short run.

Funding for key Vision projects has remained in the budget, Imara said, and new tenants may be moving into the headquarters building. AOTA had wanted to sell the space as condominiums, but scrapped the idea in such a down market.

Questions from members dealt with the association's formal and financial ties to for-profit industry and how far along AOTA has come in bringing the national office building into ADA compliance.

Somers said that as far as he knows now, AOTA's continuing alliance with General Motors, which has funded research regarding occupational therapy's involvement in driver re-education, is still intact despite GM's pending bankruptcy. The national association also has a longstanding partnership with Genesis Healthcare. One member questioned whether AOTA is willing to hold its for-profit partners up to the light when it comes to treatment and employment policies. Somers said that AOTA would take any such matters into consideration if they came up.

As to ADA compliance, the building is about one-third of the way there, he said, and the plan is to continue; but in light of the current financial crisis, it cannot happen right now.

Two new officers and one board member were sworn in at the meeting. Vice-president Florence Clark stepped into the post of president-elect, which she will hold for one year under President Penny Moyers Cleveland. Virginia Stoffel took the oath of office as AOTA's new vice-president, and Thomas Fisher will take a seat on the board of directors.

I have been studying the history and concept of occupational therapy for the past 21 years, mentored mostly by people like the late Helen Hopkins, the late Gail Fidler, ADVANCE columnist Jane Sorensen, and Texas educator Kitty Reed. The founders' names, the places, are inscribed on my brain. Their philosophies are by this time in my blood.

Yet I never understood the way it really was for the founders of the profession - the fact that they had to fight almost from the beginning the same way we do today - against colleagues in medicine and science who didn't take them seriously. This sleeve-tugging issue we have didn't begin in the 1970s; it started in the 1920s.

In her 2009 Slagle Lecture, historian Kathleen Barker Schwartz, EdD, OTR, FAOTA, brought the day and age of OT's birth and "childhood" a little closer, so we could look at it more clearly. Her goal was to show how the original mission of William Rush Dunton, George E. Barton, Eleanor Clarke Slagle, Adolf Meyer, Herbert Hall, Thomas Kidner, Susan Tracy and others meshes with our Centennial Vision today.

All of these people were unusual in some way. They determined what they believed and lived by it, despite the opinions of friends and sometimes even family. It was a time of war, steady immigration, industrialization, poor schools and inadequate medical care. "The founders believed that society's problems could be solved with progressive reform," Schwartz said. Their work was founded on social science, their treatment principles guided by compassion, and their tools enmeshed with the arts and crafts movement led by Englishman William Morris.

I will mention two men here whose particular philosophies demonstrate the thread between yesterday and today in OT. Barton, an architect, was introduced to OT when he suffered from TB; later, in 1912, he lost a foot to gangrene. Inspired by his pastor to help others, he bought a home in Clifton Springs, NY, with a barn and a lot of ground and turned it into "a place to rest, get well, gain enjoyment and learn a new profession." Consolation House was probably the first true "rehab center" of its time. Here Barton created opportunities for carpentry and gardening. As an architect, he was interested in methods of measurement and preciseness.

Dunton, on the other hand, was a physician who strongly believed in the value of therapeutic occupation. He believed that mind/body medicine was coming back. He explained occupational therapy in terms of medical diagnoses (and it was taught that way well into the 1960s). Dunton was a lifelong believer in crafts, but he had a hard time convincing his 20th Century colleagues, who were leaning toward science rather than art, that occupational therapy was really medicine. He wrote and published voraciously throughout his life, and tirelessly advocated for research. "He understood that it was necessary to conduct research, and that research needed to be published," Schwartz said. "It was necessary to articulate the occupational process in a way that could be scientifically understood."

Today, in the World Health Organization (WHO), the medical branch of the United Nations, occupation is a strong principle in its international classification of functioning, disability and health(ICF) for countries around the world. (I believe that occupation is much better understood as medicine outside the United States than it is here. Even in the early 20th Century, physicians began to lump OT with physical therapy, seeing occupational treatment as an end-stage of recovery rather than a means to it.)

In the 21st Century, occupational therapy will concentrate heavily on prevention of chronic illness through lifestyle modification. The Occupational Therapy Framework best articulates the methodology and scope of the profession.

"The Vision links the profession to the global community," Schwartz explained. She added that to do that, occupational therapists must retain their founders' vision, blending science and humanism, and become risk-takers and pioneers. "It takes courage, optimism and imagination to implement a vision," she said.

On April 25, the World Health Organization (WHO) declared swine flu a "public health emergency of international concern." On April 26, the U.S. followed suit, declaring a national public health emergency, according to the New York Times.

Thus far, the CDC has documented 20 cases of swine flu in the U.S. -- in New York, Texas, California, Kansas and Ohio. Worldwide, cases have been reported in Mexico and Canada, with suspected incidences in France.

Health officials said it is too soon to predict how quickly and how much the flu will spread. It could be contained within weeks or it could be the pandemic flu officials have warned of.

Until it is under control, it is vital that all healthcare practitioners take particular care while working and during every-day activities.

For the CDC's guidelines, as well as symptoms of swine flu, visit www.cdc.gov/swineflu/. For continued international updates, including reported cases, visit www.who.int/en/.

No AOTA Conference is complete without its annual night to celebrate the best, brightest and most dedicated. Last night's awards ceremony honored dozens of OTs who have helped advance the profession through research, practice, education, scholarship, advocacy and more.

AOTA and the American Occupational Therapy Foundation handed out some of their highest awards. The AOTA Award of Merit went to former AOTA President Barbara Kornblau, JD, OT/L, FAOTA, DAAPM, CCM, CDMS for "leading, mentoring and inspiring our profession's future."

Janice Burke, PhD, OTR/L, FAOTA, of Thomas Jefferson University in Philadelphia, received the Eleanor Clarke Slagle Lectureship Award. Dr. Burke will present her lecture at next year's conference in Orlando.

M. Carolyn Baum, PhD, OTR/L, FAOTA, received a high and prestigious honor, the AOTA/AOTF Presidents' Commendation Award. Dr. Baum served two separate terms as AOTA President, and also served as President of the National Board for Certification in Occupational Therapy.

Thomas Fisher, PhD, OTR, CCM, FAOTA, received the Lindy Boggs Award for his efforts in political advocacy. Dr. Fisher was integral to Indiana's successful efforts to attain occupational therapy licensure, and is now helping craft the regulations for licensure. Twenty years ago, he spearheaded a similar successful attempt at licensure in Kentucky.

Other honorees of the night included:

Academy of Research
Leeanne Carey, BAppSc(OT), PhD
Nancy A. Baker, ScD, OTR/L

A. Jean Ayres Award
Shelly Lane, PhD, OTR/L
Susanne Smith Roley, MS, OTR/L, FAOTA

Virginia Scardina Award of Excellence
Teresa May-Benson, ScD, OTR/L

AOTF Meritorious Service Award
Phyllis Bauer Madachy

Cordelia Myers Writer's Award
Marian Arbesman, PhD, OTR/L

Jeanette Bair Writer's Award
Jean McKinley-Vargas, MS, OTR/L
Katherine Thomas, MS, OTR/L

Recognition of Achievement Award
Sarah Burton, MS, OTR/L
Margaret Kaplan, PhD, OTR
Jane Painter, EdD, OTR/L

AOTA Roster of Fellows
Sue Berger, MS, OTR/L, BCG
Shirley A. Blanchard, PhD, OTR/L
Patrick J. Bloom, MA, OTR/L
Patricia L. Bowyer, EdD, MS, OTR/L
Kathleen Hampton Conyers, MEd, OTR/L
Carol A. Doehler, MS, OTR/L
Sandra M. Dunbar, DPA, OTR/L
Sharon A. Gutman, PhD, OTR
Carol H. Gwin, OT/L
Claudia List Hilton, PhD, OTR/L, SROT
Linda A. Hunt, PhD, OTR/L
Leslie L. Jackson, MEd, OT
Kristie Patten Koenig, PhD, OTR/L
Jaclyn Faglie Low, PhD, LOT
Ann H. Nolen, PsyD, OTR
Jane Painter, EdD, OTR/L
Monica L. Robinson, MS, OTR/L
Diane L. Smith, PhD, OTR/L
Wendy B. Stav, PhD, OTR/L, SCDCM
Scott David Tomchek, PhD, OTR/L

Additionally, over 200 professionals received 2009 Service Commendations from AOTA.

That was AOTA President Penelope Moyers-Cleveland's question for her audience at the Presidential Address this year. Attendees received spider rings as they entered the hall to hear her speech, and Cleveland took the stage with a red cape that resembled interconnected spider webs.

"We need each other to implement the Centennial Vision," she told the audience. "We are all interconnected as we strive to meet the occupational needs of our society."

There are only 8 years left until 2017, the 100th anniversary of the profession. By then, AOTA would like to see its Centennial Vision become reality: "We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society's occupational needs."

Using the spider analogy, Cleveland explained that OTs can weave their webs in three realms: personally, organizationally (at one's facility) and professionally. "If you are a spider, you will spin a web beyond yourself," she said, by working with others to extend your reach.

Cleveland detailed many ways the association is weaving its webs to make the Vision a reality: through the association's new OT Connections social networking site; through its state and federal advocacy, especially on bills to repeal the therapy cap and to make OT a qualifying service in Medicare home health; through focus groups to incorporate member input into Vision activities; through its endorsement of the Boston University Activity Measure-Post Acute Care, an assessment selected by CMS as a recommended outcome measure for applying for outpatient therapy cap exceptions; and through its push for increased membership, which resulted in gaining more than 1,000 new members of AOTA last year.

However, AOTA cannot make the Vision on its own; it needs the help of the 140,000 OT practitioners out there to bring occupational therapy to the forefront. Cleveland exhorted the audience members to not only participate in Vision activities themselves, but to encourage their colleagues to become involved as well. "Web creation never stops," she said. "Each and every one of you has to embrace your role as a spider."

So are you a spider? Have you contributed toward the Vision? If you've working on an initiative, program, research project or other effort to help make the Vision a reality, we want to hear about it! Contact me here at ADVANCE at jglomstad@advanceweb.com and tell me about how you are helping to make the Vision happen.

It's sunny and in the 80s this week in Houston, but its occupational therapists who are really heating up the city as thousands have come from far and wide for AOTA's 89^th annual conference.

If you've ever attended an AOTA conference, you know the opening ceremonies are always something to look forward to. This year was no exception, as OTs were up in the aisles dancing to the live band, doing the Electric Slide or weaving a conga line throughout the hall.

AOTA President Penelope Moyers-Cleveland welcomed all to the conference, reminding why "Energy" is the theme of this year's conference. "Right now occupational therapy is at an important juncture on the road to the Centennial Vision," she told the thousands of therapists in attendance. "We have many shovel-ready construction projects but we have hit some potholes, but we can't let them stand in the way. We need to buckle our seatbelts, step on the accelerator and get those sparkplugs firing!" she exclaimed to cheers and applause.

Moyers-Cleveland also took a few minutes to recognize some special groups in the audience, including those occupational therapists who serve in the Armed Forces, the many OT students in attendance, and occupational therapy assistants, who celebrate 50 years of their own history this year.

Shirley Wells and Roxie Black, co-authors of the new book Culture Occupation, introduced this year's keynote speaker, Freeman Hrabowski III, president of the University of Maryland Baltimore County. Hrabowski conveyed to attendees the importance of knowing one's own story. We each are products of our experiences, he told the crowd, and to understand someone else's culture and situation, we must first know our own stories.

"You must look in the mirror and know that you make a difference," he said. "It is important to feel the energy of what you do and the difference that you make."

There are two kinds of people in the world, he continued: those who suck the energy out of you, and those who inspire you and energize you. "Each of us every day has the opportunity to be in one of those two categories."

Knowing who you are and why you do what you do empowers you to bring the very best to your clients and their families.

Hrabowski left by encouraging OTs to ask themselves, "Why do you do what you do?" What's your answer? What brought you to this field and what keeps you going everyday?

It's widely known within the profession that occupational therapy has an education "problem."  The issue isn't in the quality of its academics, nor in a lack of program levels or foci. The difficulty that is arising lies in how far and wide the scope of topics and skill sets can go in entry-level training.  That is, what should the basic OT curriculum teach in the 21st Century? What should it let go of? What should it add?

 This morning here in Houston, educators, clinicians and students filled a whole ballroom to talk about where OT education should be going in light of the Centennial Vision's goals for 2017. A panel of people who are researching the issue and have created AOTA's Blueprint for the Future of Entry-level Education in Occupational Therapy were presenting the preliminary results of four Zoomerang surveys of practitioners and educators on what should be taught and how. The results are eye-opening because they show just how much divergence of opinion there is within the profession as to what really matters most in OT practice. It reinforced evidence of the growing gap between education and practice that has arisen over the past 10 years as OT educators try to return practice to its roots. Many educators want to make occupation-based practice the standard, reimbursable methodology in the profession. But quite a few do not.

This is not a problem that appears in most other disciplines, who of course must maintain competence in their sciences but whose scopes of practice are well defined and all practitioners accept them. Nurses know exactly what it means to be nurses. Physical therapists know exactly what it means to be PTs. But OT is like the proverbial elephant that several blind men were asked to  describe. Touching different parts of the pachyderm, their descriptions ranged from a wall to a tree trunk to a snake to a spear to a rope. Just so, occupational therapists will describe and value therapy according to what they themselves do with it.

Just what is OT? The fact that no one seems able to define it has led to the idea that there is an identiity crisis going on in our industry. But I have come to believe that's not the problem. There are just too many ways to do it. AOTA has moved from formal definitions to sound bytes that try to capture OT's impact on people, such as "Skills for the Job of Living" or, currently, "Live Life to Its Fullest." But currently up on its Web site at www.aota.org is the association's latest attempt to define the profession. It reads: "By taking the full picture into account—a person’s psychological, physical, emotional, and social makeup—occupational therapy enables people to achieve their goals, function at the highest possible level, concentrate on what matters most to them, maintain or rebuild their independence, and participate in everyday activities that bring meaning to their lives."

For other health care professionals, even one such outcome would be what they hoped to contribute to through their own small part in the mission. For OTs, all of those outcomes actually are practice!  OTs and OTAs feel as though they're supposed to get them all done for every patient. But of course, that's impossible, and practice reflects that fact. Inevitably, clinicians focus on which goals are most important to the patient and to the third-party payer.

 The other issue is that OTs and OTAs can conceivably use the knowledge bases of medicine, psychology, cultural anthropology, technology, and/or arts and humanities as part of their interventional repertoire. They're not stealing. The broad brush of OT practice today reflects its founders' own association with different fields of health care. William Rush Dunton was a physician. In his day, well before the advent of antibiotics, holistic practice was part of medicine. Adolph Meyer, who advocated the balanced-life theory that still under girds OT, was a psychiatrist. Eleanor Clarke Slagle was a social worker at Chicago's famous Hull House. She worked with people in similar circumstances who were being trained to enter American society. Slagle made habilitation through habit training a significant part of occupational therapy. But as insurers and government increasingly set forth their own rigid parameters for reimbursing various health care providers, a discipline so broad-based is at risk. Competing professions want it carved down. They challenge occupational therapists to prove they have a curricular connection to all that they say they can do; yet the entry-level curriculum, even at a master's level, cannot possibly include all the foreseeable skills a practitioner might need.

Securing reimbursement for today's practitioners and tomorrow's is what AOTA's board of directors is currently prioritizing in its Vision goals. You can read them at www.aota.org on the home page. The Blueprint committee will press on. You can see the Blueprint there under educator resources. ADVANCE will report more fully on the preliminary results of the surveys after conference.

The ADVANCE team is packed and ready to head to Houston for the 89th Annual AOTA National Conference! Well, some of us still need to pack, but we are definitely ready for the warm Texas weather and to see all of the friendly, familiar OT faces that we have come to know over the years.

To read a little about the behind-the-scenes preparation for conference and to learn more about Houston be sure to read our conference prviews "The Many Sides of Houston."

Be sure to visit this blog over the next few days for up-to-the-minute posts live from the conference floor!

Visit our photo galleries to see the conference through our eyes...Houston sites, conference happenings, the exhibit hall, fellow therapists, etc.

And if you are attending the conference be sure to look for us in the exhibit hall at booth 800!

Are you one of the 200 million?

ADVANCE is, and we'd love for you to join us. Visit http://www.facebook.com/ to become a member; then become a fan of ADVANCE for OT (www.facebook.com/home.php?#/pages/ADVANCE-for-Occupational-Therapy-Practitioners/17248586841).

We'll see you there!

Voting will begin at noon on a substitute motion from Task Group 1 on the definition of OT/OTA roles; on Motion 3, a title change for occupational therapy assistants; and on Motion 2, a skills paper on OT in oncology (a substitute Motion from TG 3).

Voting continues on Motion 6 - Building diversity in occupational  therapy.

The Representative Assembly is in full swing this week, having already voted on several measures and in discussion of several more.

The assembly passed the items on Consent Agenda Y, and also voted unanimously to have the Commission on Continuing Competence and Professional Development (CCCPD) develop guidelines that state licensure boards can use to create standards for people returning to practice. (Motion 4) The RA also gave a unanimous nod to having the Commission on Education refine and post to the AOTA Web site documents drafted in preparation for an International Fieldwork Collaboration Program to use as resources for students who would like to do fieldwork outside the United States.

The guidelines will be available to state associations and regulatory boards seeking to establish or amend re-entry competency. The language also will be added to AOTA's Model Practice Act that many states are in the process of adopting, to make it easier to incorporate re-entry standards into future state practice act updates.The State Affairs division of AOTA has been working with individual states as these issues come up, and would welcome more uniform standards for re-entry across the country. Particularly because the profession is still more than 90 percent female, some OTs and OTAs let their licenses lapse during their child-rearing years and return when their children are older. Others return after working outside OT. CCCPD will present a final report on this effort at the fall 2009 online assembly meeting.

  Representatives were enthusiastic about encouraging what is becoming a small but more popular trend as time goes on - fieldwork outside the United States. Up to this point schools and students have had little help in finding the resources they needed to do this. The documents  may include an ethics document, an international planning guide and a guide for students seeking these posts as well as timelines for academic programs and fieldwork sites and a sample memorandum of understanding. Reps felt that connecting with OT programs abroad is one of the things that should be happening in support of the Centennial Vision, to make occupational therapy a more recognized and powerful profession by 2017.

Voting also closed today on 2 other motions, for which results have not yet been posted:

1) a charge by the Special Interest Section Council (SISC) to have RA leadership develop "an equal and consistent system for soliciting member feedback on proposed RA motions for both spring and fall RA meetings";

2) Motion 5: a charge led by President-elect Florence Clark to reorganize the AOTA Board of Directors in a way that ensures that "a broad range of occupational therapy practice areas are consistently represented on the board."; and

Meanwhile, discussion on a substitute motion from Task Group 3 to have AOTA look into the timeline and costs of developing evidence-based practice products on OT in oncology is being held open until tomorrow morning as the Speaker awaits information delegates requested about it. .

 The task groups are recommending defeat of the first two motions without any substitute motions, and adoption of the substitute motion (3) for oncology. 

The rationale for creating a better member feedback system is rooted in the desire of RA reps to know as much as possible about how their constituents want them to vote on upcoming issues. This motion argues that since the development of the fall online meeting almost a decade ago, there has been less effort to collect information from members as to what they think about the fall topics, as  on what is on the agenda; the topics are not published in OT Practice. Task Group 2, however, felt that it is expected that elected delegates will communicate with their constituents in preparation for the meetings, but the main reason is money. The AOTA Web site is now being used as an "official publication" to get information out without having to spent money on printing and distribution.

Task Group 2 is also recommending defeat of Motion 5 (changing the representation on the AOTA board) without a substitute motion. Clark's contention is that the board is overly weighted right now with educators rather than practitioners, who often are elected because they have better name recognition among AOTA members. At one time elections rules did ensure that one group of people could not monopolize the board; however, almost a decade ago the RA voted to have the board stop representing practice areas and instead seek corporate expertise in the form of elected directors rather than the heads of the various AOTA commissions. That structure still exists. The task group discussing this rejected the argument. Statistics, it said, show that clinician participation has actually increased since the board adopted the director model. Also, most members are both practitioners and educators. The BOD is not meant to create and enact policy, but to guide the corporation. The Speaker of the RA is a member of the board.

 As to the oncology issue, representatives were concerned about having AOTA national office staff spend time and money researching something that might not come to fruition. They sought clarification on how action on the issue would be taken. Voting will begin on this matter tomorrow at noon.

Voting has recently opened on Motion 6, a member-driven motion to build diversity within the profession to meet the goals of the Centennial Vision by "establishing a method for collecting, reporting, and maintaining statistics related to clinical and academic workforce diversity."  Task Group 3 is recommending defeat of the motion based on the fact that AOTA already keeps such statistics.

Discussion is continuing on two motions:

1) a substitute motion asking the RA Coordinating Council (RACC) to determine just what is OT "practice" ? Can people in education, research, etc. be considered practitioners in terms of regulatory language?  This issue is coming up in state regulation cases.

2) probably the most controversial motion this assembly, Motion 3, asking for a name change for OT assistants to OT associates. Task Group one is recommending defeat of this motion, which we will cover more fully in our April 27 OTA edition of the print magazine.

On day 4 of the 2009 Representative Assembly, the body is still awaiting passage of Consent Agenda Y, which recommends defeat of three orginal motions with which task groups (TGs) have replaced some substitute motions. They are:

 The Consent Agenda also recommends adoption of AOTA's latest Societal Statement on Autism Spectrum disorders and amendments to the 2007 Bylaws that will help "clarify the differences between state affiliates and election areas, put into effect the changes the RA passed regarding WFOT delegates, and creates a way for the RA to make changes to the Bylaws more often if the Assembly feels it is necessary.

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Under discussion on Agenda A today was Motion 4, to have the Commission on Continuing Competence and Professional Development (CCCPD) develop guidelines for return-to-practice (re-entry) that could be incorporated into AOTA's Model Practice Act and/or into state practice acts. To date there are no national standards regarding this, which leaves licensing boards out in the cold when it comes to making sure people returning to practice have the skills they need today. Posts on this were also highly favorable. The State Affairs division of AOTA has also been working on this effort.

The country's largest tobacco tax increase went into effect this morning, raising the tax on cigarettes from 39 cents a pack to $1.01, according to USA Today.

The money from the tax reportedly will be used to fund the State Children's Health Insurance Program, which provides coverage to uninsured children throughout the country. But that's not the only health benefit stemming from the increase.

Tobacco companies raised the price of their products in preparation of the tax, USA Today states, sending the cost of a pack soaring well above the previous average of $5. Officials from tobacco companies told USA Today the hike will likely lead to a decline in smoking. And Matthew McKenna, director of the Office of Smoking and Health at the CDC, said he anticipated at least 1 million of the nation's 45 million smokers to quit.

Whether or not this happens remains to be seen, but if it does, it looks like one tax has made 2 huge problems a little bit smaller.