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A Voice in the OT Wilderness

Splitting More Hairs

Published May 11, 2009 2:13 PM by OTCM
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Thank you, Ed Kaine, for introducing me* to the organization ALOFT, and its trademarked titles "Registered Functional Therapist" (RFT) and "Registered Functional Therapy Associate" (RFTA). I'd like to start a discussion about this initiative. Please visit ALOFT, then use the comments section of this blog to express your opinions.

I admire the entrepreneurial spirit of the ALOFT team and the time and energy they're devoting to their beliefs. I also give them credit for using the word "associate" instead of "assistant" in the RFTA designation, thus addressing the long-standing controversy in the OTA community about the term "assistant".

Nevertheless, I don't think creating an "expert in function" title does Occupational Therapy any favors, and in fact, might undermine us in any number of ways. For example:

  • A separate title specific to "function" implies that OT practitioners who don't have it lack the skills to address functional challenges. If you think the general public has difficulty understanding what we mean by "occupation", how much more confused do you think they'll be about OT practitioners who don't have a "function" title? "RFT/RFTA" is not equivalent to specialty certifications denoting advanced practices or additional academic degrees; but most of the general public interprets professional acronyms as such. To ALOFT's credit, the RFT or RFTA is not currently available to OT practitioners who aren't also registered with NBCOT. This requirement provides some mechanisms for consumer protection and speaks to the professionalism of ALOFT's founders. However, there are some OT practitioners who choose not to maintain the right to use NBCOT's trademarked "OTR" or "COTA", and rely instead solely on their states' licensing. Where does their "RFT(A)-ineligibilty" leave these OT practitioners in the struggle for recognition of Occupational Therapy?

  • As I suggested in "The F-word: Function(al)", I believe OT practitioners waste time and energy trying to "own function." As much as I respect the allied professionals for their skills and knowledge, I don't care to be "lumped in" with them on the basis of "function". Not only that: I'd just as soon leave the "functional" groundwork to the other disciplines. That frees me up to focus on occupation without the distractions of "component remediation."

  • ALOFT and its trademarks were created in response to OT practitioners' fatigue from endlessly trying to explain what OT is and isn't. There are actually groups on Facebook called "I'm tired of explaining what Occupational Therapy is!"and "Yes, I am a Occupational Therapist and no we don't wipe bums [backsides]!!" The "I'm tired..." group has more than 10,000 members! But I don't think creating a function-specific title will clarify anything. I can't say I'm any better at "summarizing" OT than anyone else, but I don't agree with Tim's 4/23/08 comment to the F-word post that "we are stuck with the fact that occupational means work to the public at large." We're "stuck" only if we give up.

  • Ed has told me that he considers creating RFT/RFTA exclusively for OT practitioners as preventing other disciplines from defining OT. I see it as accomplishing just the opposite. I also consider the assumption that OT is only about work and jobs to be a conversation starter about what an AOTA motto calls the "job of living." Maybe having spent more than 20 years in the work. comp system makes it easier for me to see the conversational potential. But I've also chosen to look at the difficulty as a result of the broad application of our profession to the nearly endless variety in human life. I celebrate being in a profession that doesn't "fence me in" with easy definitions or descriptions the way the "component" disciplines do.

  • Is there a danger of RFT/RFTA making it harder for OT practitioners to focus on occupation? That is, if a "function" title makes people stop asking us what we do, will it be harder to keep occupation at the forefront of our thinking and service delivery? You've already heard me complain about the "occupation-less" interventions I've seen from my so-called OT colleagues. If they can't find their way out of the "performance components" woods now, how will a title like RFT(A) help them avoid further erosion of their occupational focus?

Now it's your turn: please use the comments section below to voice your opinions. If you're worried about what people who know you might think of you, notice that you can choose to reveal only your first name to the public. So come out of "lurker" mode and speak up!

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*by way of his 4/30/09 comment on the blog entry "The F-word: Function(al)"

posted by OTCM

4 comments
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Hi Allie;

Thank you so much for your article. I think it brings up the other side very well.

Please check out http://www.RegisteredFunctionalTherapist.blogspot.com for several articles which are trying to build an opposite case.

One article is entitled "An argument from the visual Thesaurus." In the 89 years of the AOTA having active annual conferences there has been little movement to share our definition of Occupation. Unfortunately, our definition is not in the dictionary. I think that it is possible to petition Webster and Roget and the rest and try to get a definition of Occupation in there. I think that when looking at the 10,000 people who lament our anonymity we might forgive them the feeling of frustration given the poor ability to overcome the actual existing definitions of Occupation (jobs and related to occupancy and military occupation.)

Another asks "Should we stop using the O-word?" This article starts with a quote "All words are pegs to hang ideas on.” (Henry Ward Beecher). It is useful for us to have a great word like occupation. It helps us to convey a broader concept to the concept of function. What we should also recognize is that we are in a competitive healthcare environment and our name is not recognized. If you can go to your doctor and ask for Lipitor but can't remember the type of therapist who got you grandmother back home we have a problem.

There are so many reasons why we might benefit the community of healthcare consumers by becoming more accessible. I recognize that it's hard to change, it's uncomfortable and its difficult. I just learned that there are at least 10,000 of us who have found that the burden of having an ambiguous name has its own share of difficulties.

This movement is not meant to take anything away from the great progress Occupational Therapy has made. I think it has made this progress largely because of the successes that the many therapy practitioners have achieved... and not due to it's name. The option to become a Registered Functional Therapist (RFT) or a Registered Functional Therapy Associate (RFTA) is just that, an option. It is only trying to add meaning to a complex field.

In University we worked hard to learn all that Occupation means. We should not expect our customers, clients, patients to understand all we understand about it. We bring that philosophy to our treatments naturally. We should ask ourselves how hard do we want to make it for people to find our care?

We know other professions address aspects of function. We see that PT has added the functional goal and has tried to incorporate many more functional principles to their treatments. This is wonderful, it is the right way for them to go, it is best for their patients. That said, Occupational Therapy brings so much to the service of "Function" that it is hard to deny that we have a right to own the title. The holistic view of a person, living in the context of their lives, and doing the things they do is what "Function" is all about. By narrowing the term to "physical functions" as your article might suggest you might be cutting off the realms of "Functional Mobility", "Functional Cognition" and the general pursuit of independent function.

The nuances between the profession's definition of "Occupation" and the world's definition of "Function" are subtle. We can still work to broaden the definition of "Function". We should continue to introduce people to the concepts contained in "Occupation" after we get them to seek our help.

I think we should consider, with humility, that our name may be a barrier to customers seeking our help. The view that the customer is always (at least) entitled to their view (and possible "always right" about what they think). We have so much to offer, I don't think that Functional Therapy has to detract from that.

I invite you to look into what we are attempting. It represents a possible opportunity to increase the understanding of the services we can provide.

Thank you so much for all you do.

Sincerely,

Ed Kaine

President of the American League of Functional Therapists

http://www.FunctionalTherapist.org

Functional Therapy... the Next Generation fo Occupational Therapy

Please feel free to contact me at: RFT@FunctionalTherapist.org
Ed Kaine, American League of Functional Therapists - President May 28, 2009 5:58 PM
CT

I am a new grad embarking on a career in school-based contract OT & private practice in an emerging area of women's health promotion and disease prevention. I respect the desire for change, but disagree about the approach. I truly believe that the only one we can change is ourselves. We can change our frustration and convert the energy to relating our unique perspective to potential client's at any given moment we are engaged in conversation. If family and friends have difficulty understanding what we do: look for ways to relate how they can personally benefit from the help of OT. If somehow you have a perfectly healthy family with no potential need for OT and no possibility of disease or future accidents; then tell them how fortunate they are to never need an OT. I am wholeheartedly opposed to the change and hope that all reading and monitoring these comments take this as a vote against. I look forward to a lifetime of opportunity to promote the profession throughout endless conversations. If all else fails, tell them it's "MAGIC !"
Beth, Occupational Therapy - OTR/L, School-based & private practice in emerging area o May 26, 2009 9:34 PM
Phoenix area AZ

I am an OT and dont know a whole lot about RFT's but can say that I do not think it helps the profession of OT one bit. Function without motivation is not occupation and occupation is what sets us apart from other related services. There is no function in fulfilling roles and no meaning behind function. I understand that the whole world does not know what OT is, BUT... couldnt a solution to that be ADVOCATING for our current profession as AOTA is always encouraging us to do, rather than renaming what is already perfect. Practice defining OT, its not that hard...

Alison Smith, OT - MS OTR/L May 19, 2009 6:56 AM
New Smyrna Beach FL

Well said, Allie. %0d%0aThere is no way that I can think of to demonstrate that any rehab practitioner OT, PT, SLP or indeed any therapist - music, art, massage cannot contribute to a client's improvement in function. In the same sense there is no way to demonstrate that only an OT can contribute to a person's occupational performance. OTs are needed when specific expertise in occupation is indicated. %0d%0aPerhaps if we give up trying to be all things to all people with hugely inclusive definitions and start thinking about what our specific expertise is we'll get closer to tne mark.%0d%0a
Joan , Geriatrics - OT(C), Alberta Health Services May 14, 2009 3:49 PM
High River, Alberta

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