Are you on Twitter? ADVANCE for OTs is! Our Twitter updates can keep you current on the newest features on our website, the latest news and stories about occupational therapy in the popular media, and issues in health care that affect you and your colleagues. Find us here: http://twitter.com/advanceforot

Each week, we'll blog our most popular tweets -- the ones our Twitter followers are clicking on the most -- to keep you up to date on what your colleagues are reading and what you might be missing if you're not following us on Twitter too!

Check out the newest blog posts on the OT Advance site: Halloween and autism, re-connecting, OT in mental health and more! http://ow.ly/wROP

How is the economy is affecting health care? Find out in our latest top story at OT ADVANCE online, w/ video and webcast! http://ow.ly/wRf6

Bringing Evidence into Everyday Practice by Winnie Dunn: our newest book review at OT Advance online http://ow.ly/xklX

Fired for the Flu? The debate over mandatory vaccines for health care workers - new web feature on OT Advance online http://ow.ly/wRjV

We've overhauled our Vision Watch center -- keep up to date on OT's progress toward 2017 at http://ow.ly/wX1z

Just head to http://twitter.com/advanceforot to follow us on Twitter!

There's a ton of great content on our website -- so where do you start? Each week, we'll blog the five most popular content items on OT Advance online. See what your fellow OTs are reading on www.advanceweb.com/OT!

Tops this week is our webcast on Sensory Processing Disorder: http://occupational-therapy.advanceweb.com/article/understanding-sensory-processing-disorder.aspx
ADVANCE was very lucky to have Dr. Lucy Jane Miller, a prominent OT and one of the nation's leading researchers on SPD, record a webcast for us on understanding this complex condition. Check it out and share it with families and non-OT colleagues as well!

ADVANCE's 2009 Salary Survey -- popular every week!: http://occupational-therapy.advanceweb.com/article/advances-2009-salary-survey.aspx

Our Patient Education Handouts: http://occupational-therapy.advanceweb.com/editorial/content/editorial.aspx?ctiid=886
We've got lots of handouts, from strengthening exercises and arthritis to stroke and energy conservation.

The OT POV Forum, an online message board to talk to your fellow OTs: http://community.advanceweb.com/forums/28/ShowForum.aspx
Check out new discussions on whether PTs can employ OTs, starting a job in a new hospital and much much more!

Our Continuing Education Calendar: http://occupational-therapy.advanceweb.com/General/Calendar/Main.aspx
Need CEs? Search for what you're looking for in our handy online calendar.

Are you on Twitter? ADVANCE for OTs is! Our Twitter updates can keep you current on the newest features on our website, the latest news and stories about occupational therapy in the popular media, and issues in health care that affect you and your colleagues. Find us here: http://twitter.com/advanceforot

Each week, we'll blog our most popular tweets -- the ones our Twitter followers are clicking on the most -- to keep you up to date on what your colleagues are reading and what you might be missing if you're not following us on Twitter too!

Our current print cover story on the quest to get Sensory processing disorder into the DSM http://ow.ly/ucOZ

Sensory processing disorder webcast with Lucy Miller, PhD, OTR, leading SPD researcher, new on OT Advance online!! http://ow.ly/ucII

Senate Finance Committee passes bill with victories for AOTA lobbying efforts http://ow.ly/uPS3

2 yrs ago we profiled Winter, a dolphin with a prosthetic tail http://ow.ly/uAOU Now kids can enter a contest to meet her http://ow.ly/uAPp

New Jersey OT who works with kids with special needs profiled in local newspaper http://ow.ly/sKyW

Just head to http://twitter.com/advanceforot to follow us on Twitter!

There's a ton of great content on our website -- so where do you start? Each week, we'll blog the five most popular content items on OT Advance online. See what your fellow OTs are reading on www.advanceweb.com/OT!

Our new blog, From Inside the Puzzle: Raising a Child with Autism: http://community.advanceweb.com/blogs/ot_9/default.aspx
Devon Asdell is the mother of Aisling, a young girl with autism. She talks first-hand about the issues parents confront when raising a child with this complex disorder. In her latest post she talks about the experience of taking Aisling to a corn maze.

ADVANCE's 2009 Salary Survey: http://occupational-therapy.advanceweb.com/article/advances-2009-salary-survey.aspx

How Not to Network: http://occupational-therapy.advanceweb.com/editorial/content/editorial.aspx?cc=208143
A web feature discussing what to do -- and what NOT to do -- when you are making professional connections.

The OT POV Forum, an online message board to talk to your fellow OTs: http://community.advanceweb.com/forums/28/ShowForum.aspx
Check out new discussions on whether PTs can employ OTs, starting a job in a new hospital and much much more!

A Pediatric Perspective blog: http://community.advanceweb.com/blogs/ot_4/default.aspx
Check out the newest post by blogger Wendy Spoor Hof, COTA/L, on the versatility of bubbles as a tool in therapy.

Are you on Twitter? ADVANCE for OTs is! Our Twitter updates can keep you current on the newest features on our website, the latest news and stories about occupational therapy in the popular media, and issues in health care that affect you and your colleagues. Find us here: http://twitter.com/advanceforot

Each week, we'll blog our most popular tweets -- the ones our Twitter followers are clicking on the most -- to keep you up to date on what your colleagues are reading and what you might be missing if you're not following us on Twitter too!

OT is 14th on CNNMoney.com's list of the 50 best jobs in America! http://ow.ly/txHI   

Choosing toys for children with disabilities this holiday season (with USP OT professor Paula Kramer) http://ow.ly/txVr    

New Jersey OT who works with kids with special needs profiled in local newspaper http://ow.ly/sKyW

NJ launches electronic autism (and other special needs) registry to help connect families with services http://ow.ly/txWF

News alert: Federal court says EEOC guidelines may prevent OTs & PTs from administering functional capacity evals http://ow.ly/tryB 

Just head to http://twitter.com/advanceforot to follow us on Twitter!

A hitherto inert definition embedded in the enforcement policy manual of the Equal Employment Opportunity Commission (EEOC) has me wondering what in the world the commissioners were thinking when they created the rule.  

The EEOC enforces the Americans with Disabilities Act (ADA), and in order to enforce it, the commission often has to clarify parts of the law. Last week a federal court gave an Oregon woman the right to sue her employer for violation of the ADA because the employer's contracted occupational therapist had given the woman a "medical" exam along with her functional capacity evaluation.

In other words, the OT had tested the physiological responses (blood pressure, heart rate, etc.) to the lifting task the woman was attempting to do, as well as the degree of muscle and joint stiffness she felt the next day. Based on the 2-day exam, the therapist recommended that the woman not return to that particular job.

The company used this as a legal reason to fire the employee. She had been out of work beyond the period of time their policy allowed.

You can read the whole story of the court ruling at www.advanceweb.com/ot. But it's not the case particulars that bother me. It's how the EEOC defined who the OT was and what she should or should not be doing.

The OT definitely overstepped the bounds of what such testing is to cover, if she did what they describe. The law is clear that functional capacity tests must relate specifically to the job requirements and cannot extend to the individual's physical or psychological response to the effort. And that rule is recited in the EEOC's document Enforcement Guidance: Disability-related Inquiries and Medical Examinations of Employees Under the Americans with Disabilities Act (ADA).

But even if she hadn't done those things - even if she had tested only what she should have - the OT could still have been considered guilty of giving a "medical exam" just because she's an OT. EEOC "guidance" says that if the test is administered by a "health care professional," it should be considered a medical test.

Now, maybe there is in the law somewhere a list of practitioners who qualify as "health care professionals," but I can't find one. Even the EEOC does not define the term. But the court did. And OTs and PTs were part of it.   

Well, yeah. They are health care professionals. But they are precisely the health care professionals trained to administer FCEs! Who does the court want to perform them - people off the street?

And among the examinations that are considered "medical" are "range-of-motion tests that measure muscle strength and motor function..."

That seems to indicate that whoever tests these things is to watch, only, and just nod or shake their heads.

Yep, right. Anyone off the street could do that. And what would it prove? That the employee performed that task, perhaps staggering and huffing, but hey, he did it. 

The controverted principle here is that employers are not to look for indicators that might or might not have any real impact on job performance. People with high blood pressure are working right now at just about every workplace in America. The risk it represents is considered their risk, not the employers'.

But as the cost of health care rises, employers are going to consider it their risk. And many of them will want to know these things in advance. That is distinctly against the law - now.

This is reportedly the first ADA case in which the courts have used the EEOC guidelines to determine their definitions. If I were a judge, I'd have questioned whether the guidelines made sense before hanging my hat on them. One dissenting judge did just that and warned his colleagues that the precedent they set in the Kris Indergard-Georgia Pacific case could leave employers with no real way to control their quality or their costs.

Or ours. People do have the right to work, but only to the satisfaction of the person who signs the paycheck.

You can see the EEOC guidelines at http://www.eeoc.gov/policy/docs/guidance-inquiries.html#4. They were adopted July 27, 2000.  

We'll see what happens when the case goes to court.

There's a ton of great content on www.advanceweb.com/ot -- so where do you start? Each week, we'll blog the five most popular content items on OT Advance online. See what your fellow OTs are reading!

ADVANCE's 2009 Salary Survey: http://occupational-therapy.advanceweb.com/article/advances-2009-salary-survey.aspx

A Pediatric Perspective blog: http://community.advanceweb.com/blogs/ot_4/default.aspx
Check out the newest post by blogger Wendy Spoor Hof, COTA/L, on the need for support for children with special needs and their families

The OT POV Forum, an online message board to talk to your fellow OTs: http://community.advanceweb.com/forums/28/ShowForum.aspx
Check out new discussions on PRN status, pediatric evals, aquatic therapy, returning to the profession after a hiatus, COTAs in the schools and much much more!

Weak in the Knees: http://occupational-therapy.advanceweb.com/editorial/content/editorial.aspx?cc=207207
A web feature on an ACL-injury prevention program in Pittsburgh

H1N1 Vaccine is a Go: http://occupational-therapy.advanceweb.com/editorial/content/editorial.aspx?cc=207209
A web feature on the readiness of the new swine flu vaccine

Are you on Twitter? ADVANCE for OTs is! Our Twitter updates can keep you current on the newest features on our website, the latest news and stories about occupational therapy in the popular media, and issues in health care that affect you and your colleagues. Find us here: http://twitter.com/advanceforot

Each week, we'll blog our most popular tweets -- the ones our Twitter followers are clicking on the most -- to keep you up to date on what your colleagues are reading and what you might be missing if you're not following us on Twitter too!

Our latest print cover story profiles Walgreens efforts to employ 100s of people w/ disabilities. Story and video links: http://ow.ly/rEjn   

Update on the H1N1 vaccine - new web feature on OT Advance online http://ow.ly/rDI3    

Art Is Ageless: exhibit of Philadelphia youth and senior artists, w/photos and video! New Top Story on OT ADVANCE online http://ow.ly/rDBj

New Fall Prevention site from CDC offers fact sheets, brochures, podcasts and more for both practitioners and patients http://ow.ly/r2ES

Florida man with post-polio syndrome gets home modifications to help him age in place with the help of his OT http://ow.ly/qWV5 

Just head to http://twitter.com/advanceforot to follow us on Twitter!

ADVANCE is pleased to introduce our new Specialty Spotlights on our Web site!
On Sept. 1 we unveiled 9 new specialty sites which highlight many of the most popular practice areas and interests in occupational therapy. Each specialty site contains information tailored exclusively to therapists working in that practice area, including targeted articles, columns, blogs and forums, as well as the latest jobs and more. To access our new specialty sites, choose the specialty that suits you best from the list below. (You'll need to login or sign up for a free online account.)

Pediatrics: http://occupational-therapy.advanceweb.com/Pediatrics/default.aspx

Geriatrics: http://occupational-therapy.advanceweb.com/Geriatrics/default.aspx

Home Health: http://occupational-therapy.advanceweb.com/Geriatrics/default.aspx

School-Based Therapy: http://occupational-therapy.advanceweb.com/School-based/default.aspx

Mental Health/Cognitive Rehab: http://occupational-therapy.advanceweb.com/Mental-Health-Cognitive-Rehab/default.aspx

Early Intervention: http://occupational-therapy.advanceweb.com/Early-Intervention/default.aspx

Physical Rehab: http://occupational-therapy.advanceweb.com/Physical-Rehab/default.aspx

Industrial Rehab: http://occupational-therapy.advanceweb.com/Industrial-Rehab/default.aspx

Hand Therapy: http://occupational-therapy.advanceweb.com/Hand-Therapy/default.aspx

Once you choose your specialty, you can:

• Keep a step ahead of your colleagues through top stories and feature articles focused on your specialization;
• Search for the latest jobs in your specialty;
• Read focused columns and interact with the authors; and
• Discuss topics with your colleagues through our community of blogs and forums.

To access your specialty site from our homepage, login (or sign up for a free online account) and then look for the Your Specialty Spotlight graphic on the left side of the page. And you'll still be able to access all nine specialty sites from our home page at any time through the Specialty drop-down menu along the horizontal navigation bar at the top of every page.

Our specialty sites are brand new, but we plan to add many more features over the next few months, including specialty-specific patient handouts, salary information, CE offerings and more.

As we move forward, we'd love feedback from readers on our specialty sites and how they are meeting your needs as practitioners. Have an idea you'd like to see us make available? Or maybe a question on how the sites work and what they have to offer? Just leave your comments and questions here!

Are you frustrated and a little scared wondering who is going to be paying your doctor and hospital bills this time next year? I am. And most people I talk to these days don't even want to think about it. That’s because they can’t see where Congress is headed with health care reform. The current bills are so full of unknown factors that no one can predict with any credibility the consequences of enacting any of the proposals. 

Meanwhile, any pending legislation has the potential to make or break occupational therapy's vision of empowered practice by 2017. The seeds of both opportunity and setback are in the mix. Which ones will take root? And how much power do we have to influence that?

Right now, the big push simply is to get everyone insured without breaking the bank. While the plans are being laid, it’s time to make a move. OTs work in all kinds of settings with all kind of programs. If you are doing something unusual that is working well and saving money with good patient outcomes, meet with your representatives and senators to show them how it can help insure quality care. Occupational therapy can not only fit into, but lead, the future of preventive care in both physical and mental health, and OT operating in the community can reduce hospitalization.

Lawmakers have historically acted on perceptions of who are "good guys" and who are "bad guys" in the health care environment. The good guys save them money and make them look good at election time. The bad guys cost them money and put them at risk of public displeasure. A case in point: Large rehab companies in the 1990s manipulated reimbursement rules and regulations to their own ends. A government investigation into the actual costs of rehab led to a public outcry. The ensuing crackdown created policy changes that turned rehab into a financial liability and sparked a two-year recession in the industry. Many therapists, most of whom didn’t even know how much their employers were charging for their services, lost their jobs.

The end result was that lawmakers saw occupational therapy as too expensive. Some of them still have that taste in their mouths. And OT is expensive. That’s why we’re seeing paraprofessionals come out of schools with degrees in certain skill sets that OTs also have, but who charge far less for their services. In response, thoughtful leaders of the profession are pushing consultative practice, in which OTs train others to do parts of their work. These issues will be of paramount importance as OT moves ahead, no matter in what environment it finds itself. Let your lawmakers know that you share their concerns about cost, and how your program or approach to care can help them reach that goal and still provide quality care.

Bradley Cooper, one of the stars of The Hangover, recently told Entertainment Weekly that Breaking Bad was his "must watch" television show. Coincidentally, the ADVANCE editorial team added Breaking Bad to our "must watch" list when it first came out and haven't taken it off since.

Still not convinced you should watch it?  

Check out ADVANCE's article "Breaking Big" here and discover what the buzz is all about.

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.