Thanks for Nine Great Months!

You are currently reading the very last entry that will be posted on OT Advocacy. Creating this blog was a wonderful experience- I learned so much, met some amazing people, and hopefully shared some info and passion with others.  I hope to continue learning about and practicing advocacy to help further the good works of occupational therapy, and I hope all of you will as well.

Thanks to everyone who read, commented, and contributed!

~Alece

Apology From Optometry (Advocacy Works!)

Yesterday, a public hearing occurred in Tumwater, WA to discuss the Optometric Physicians of Washington’s (OPW)proposal to amend the scope of practice of optometry through Draft House Bill H-0931.2. The proposal was developed to update legislation concerning the practice of optometry in Washington State. While the Optometric Physician’s bill addressed numerous areas of practice, one amendment to current legislation appeared to be an attempt to ensure that low vision rehabilitation services were designated as solely within the scope of practice of optometry (and not, as was mentioned more than once in the proposal, services to be undertaken by occupational therapists).

Upon learning of the optometry bill, the WOTA Legislative Committee immediately sprung into action, contacting OT practitioners with expertise in low vision rehabilitation and drafting a letter to the Department of Health to voice concerns about the Optometric Physicians of Washington’s proposal. On August 3rd, a comprehensive letter was sent to the Department of Health Sunrise Review Secretary detailing WOTA’s concerns about the proposed amendments to legislation defining the scope of practice of optometry, providing clarification and education about the role of occupational therapy in low vision rehabilitation, and offering suggestions for revised language to HB H-0931.2.

Three days after the aforementioned letter was sent, WOTA received a letter from the Optometric Physicians of Washington stating that the organization decided to withdraw the portion of their proposed bill that deals with low vision rehab. The OPW states that it was never their intention to prevent licensed occupational therapy practitioners from providing low vision therapy or rehabilitation services, nor to limit patients with vision challenges’ access to skilled services. Rather, the OPW sought to ensure that individuals with low vision needs receive an eye examination to determine the need for medical or surgical treatment prior to undergoing low vision therapy with a professional other than an optometrist. Sounds reasonable to me. The letter concluded with an apology for misconceptions created by the original proposal, and a statement of respect for professionals who work with and provide valuable services to individuals with low vision

Yesterday, WOTA Lobbyist Mark Gjurasic attended the Department of Health Sunrise Review Public Hearing, and reports that the OPW did in fact remove the portion of their bill that deals with the regulation of low vision services. Way to go WOTA!

Proposed Optometry Bill Impacts OT

On July 1st, 2009, the Optometric Physicians of Washington submitted an Application for WA Statement Dept. of Health Sunrise Review and Approval of Draft House Bill H-0931.2 to amend the scope of practice of optometry in RCW 18.52.010.

In short, the draft bill is designed to update legislation concerning the practice of optometry in Washington. The bill addresses numerous aspects of the optometric scope of practice, the majority of which do not impact occupational therapy in any shape or form. HOWEVER, one contentious issue that this bill seeks to address is the fact that, “current low vision rehabilitation can include services from sources other than an optometric physician or ophthalmologist, meaning the services can be delivered to a patient without the oversight of a regulatory board”.  The proposed amendments to current legislation would “define low vision rehabilitation services as the practice of optometry”. To further clarify the matter in question, my favorite line of the draft bill states, “the definition of low vision rehabilitation services…as the practice of optometry will aid in enforcement against unlicensed practice that is carried out by hairdressers, flea markets, opticians, physical therapists, or occupational therapists”. Hairdressers?? Flea markets?? What??

The bill doesn’t seek to completely disallow OTs from addressing clients’ low vision needs, but rather insists that, “If patients receive low vision services from other sources such as occupational therapists, low vision rehabilitation instructors, and others, an eye doctor should be involved to make sure the services are appropriate. That involvement could take place through making a referral, writing of a prescription or protocol, or periodic monitoring of the patient’s progress”.

An OT’s responsibility to refer clients with a medical condition affecting their vision to a physician is already in keeping with the WA OT licensure law. However, considering that occupational therapy is mentioned by name not once but twice in this peice of legislation, the optometry  bill may indicate the Optometric Physicians of Washington’s desire to carefully monitor and restrict occupational therapy practitioners from working closely with clients with low vision. Speaking as an MOT student, I received valuable education regarding visual impairment, and the many ways that occupational therapy can help  address subsequent performance limitations. Additionally, there are  occupational therapists who specialize in low vision, and have obtained extensive continuing education and training in this area.

To prevent the Optometric Physicians of Washington from imposing unnecessary restrictions on occupational therapists working with clients with low vision it is important that OT practitioner-advocates provide expert testimony regarding occupational therapy’s role in low vision rehabilitation. On August 10th there will be a public hearing to discuss the proposal to change the optometrist scope of practice. The hearing will occur in Tumwater, WA at 9:00 AM. If you are interested in attending this meeting please read the hearing announcement found on this page. Alternatively, you can submit written comments on the proposal to sunrise@doh.wa.gov.

Bust Out The Meds!

Attention occupational therapy practitioners in Washington State: get ready to administer some medication! (Within the legal confines of a new law authorizing the purchase, storage, and administration of medications by occupational therapists, of course).

The little bill that could, HB 1041: pre-filed for introduction on December 11, 2008 by WOTA lobbyistMark Gjurasic, steadfastly lobbied for over the course of four long months, and signed into law by Governor Gregoire on April 13, 2009, will officially go into effect this Sunday, July 26th.

I am pleased to report that earlier this month the Washington State OT Practice Board decided that they are not going to write separate rules for the law (at least at present time). This means that the statute will stand exactly as it was passed by the legislature. Facilities are free to address the details of implementing the legislation at their specific practice site, as long as facility rules conform to the State law. As time goes by, the Practice Board may decide additional rules must be set in place to further regulate the administration of medication. In this vein, facilities where OTs plan to administer medication on a frequent basis may consider preemptively developing express protocol regarding the administration of medication.

As it stands, the new law reads as follows:

“An occupational therapist licensed under this chapter may purchase, store, and administer topical and transdermal medications such as hydrocortisone, dexamethasone, fluocinonide, topical anesthetics, lidocaine, magnesium sulfate, and other similar medications for the practice of occupational therapy as prescribed by a health care provider with prescribing authority as authorized in RCW 18.59.100. Administration of medication must be documented in the patient’s medical record. Some medications may be applied by the use of iontophoresis and phonophoresis. An occupational therapist may not purchase, store, or administer controlled substances. A pharmacist who dispenses such drugs to a licensed occupational therapist is not liable for any adverse reactions caused by any method of use by the occupational therapist. Application of a prescribed medication to a wound as authorized in this statute does not constitute wound care management.”

Thanks to everyone whose hard work and dedication made this law possible!

In Their Own Words: Clients Write About OT

In this entry I am going to compare/contrast two blog entries written by clients regarding their experience receiving occupational therapy. Here we go!

Entry # 1: “I Love Occupational Therapists”

In her blog, “After Cancer, Now What?”, Kate Burton, a breast cancer survivor, writes about her experience receiving OT to treat bilateral De Quervains tenosynovitis. The De Quervains was caused by Femara, an adjuvant therapy drug for breast cancer. As a result of the condition, “it was absolutely awful holding a fork, pulling up a zipper, writing with a pen or typing was excruciatingly painful”.

In an effort to treat her De Quervains, poor misguided Kate saw an orthopedist, then a chiropractor. After undergoing unsuccessful treatments at the hands of the aforementioned professionals, Kate writes that one day she “was at a conference one day wearing the terrible sexy wrist braces when someone asked me if I had seen an occupational therapist”.

Luckily, Kate took this wise individual’s advice and sought the services of an occupational therapy. Kate’s OT treatment consisted of six months of electrophoresis, therapeutic exercises, “some pain and more patience”.  The end result of treatment is reported as functional use of her hands. Kate writes,  “I am crocheting a baby blanket for a colleague, who happens to be an occupational therapist as well. A year ago I never thought I would be able to crochet again and thanks to some great OT’s here’s part of my work” (picture of Kate’s work to right).

Things I Like About This Blog Entry:
1. Kate doesn’t claim that OT “cured” her– rather she highlights the functional gains she made in activities of daily living and meaningful leisure pursuits.

2. The title of the blog entry says it all

Areas For Growth:
1. Kate ends her blog post with a link for all those who “want more information about Occupational Therapy”. The link connects readers to the AOTA homepage BUT the hyperlink in the blog entry is cited as the American Orthopedic Therapy Association. Tsk tsk….

2. A brief definition of OT would make the entry more educational and meaningful for readers who, like Kate, would never think to ask their doctor for a referral to an occupational therapist.

Blog Entry’s Relationship to Advocacy:
1. The entry highlights the lack of public knowledge concerning the myriad conditions and performance limitations that OT can skillfully address. Kate was lucky- she happened to run into someone who knew about OT. Without advocating for OT – through public events, political advocacy efforts, healthcare workplace education, etc – people like Kate will continue to seek the services of other healthcare professionals for problems that can be best addressed by occupational therapy.

Entry #2: “I’ve never liked sandwich holders. And you can tell my OT I said that”

This blog entry describes the frustrations that Tiffiny, a woman with C6 incomplete quadriplegia, encountered while receiving occupational therapy as a teenager.

While it is implied that Tiffiny has many points of contention with occupational therapy (“It’s probably the most annoying type of therapy I had to go though”), the post uses a specific piece of adaptive equipment – the Quad-Quip Sandwich Holder – as an example of the inadequacies of such equipment… and OT in general.

Tiffiny describes the Sandwich Holder’s technical flaws and the stigma that can accompany use of adaptive equipment: “It drove me crazy. I felt like a weirdo using it in public and yes, it’s as awkward as it looks. And don’t put a heavy sandwich in there because if you do, it’ll topple out”. These are very valid points, and ones that should have been addressed by the occupational therapist who issued Tiffiny the Sandwich Holder.

Tiffiny writes that despite her frustrations with the Sandwich Holder,  “I was even told (and obediently did) to carry my Quad-Quip around in my backpack (which I also don’t have anymore), just in case a sandwich presented itself to my mouth sometime in my daily activities.”. Tiffiny’s statement exemplifies a (true? false?) cliche that I was specifically told in my Physical Disabilities class to avoid: all OTs LOVE adaptive equipment and have a tendency to push equipment on all of their clients, regardless of whether the individual client has expressed the interest or buy-in necessary to actually use the equipment in daily life.

Tiffiny believes that adaptive equipment is actually a hindrance to independence, and she eventually revealed her true feelings about the Sandwich Holder to her OT. The blog entry concludes: “You’re probably wondering the solution I came up with. It’s easy. I just don’t eat sandwiches anymore.”

Things I Like About This Blog Entry:
1. If I was an individual receiving OT, or any therapy for that matter, this article would inspire me to advocate for myself by letting my therapists know what therapeutic activities/equipment/techniques are and are not working for me.

2. The entry provides OT practitioners with a good reminder of the importance of client-centered therapy, and the need to spend time really delving into clients’ inner thoughts and feelings about their individualized plan of care.

3. The entry provides a link to the Wikipedia article on OT. Personally, I have issues with the OT Wikipedia article, but it’s a good start.

Areas For Growth:
1. When reviewing Kate Burton’s blog post I mentioned the benefits of including a definition of occupational therapy in a blog post about OT…..perhaps I should have qualified that statement with the caveat, an ACCURATE definition of OT. Here’s Tiffiny’s definition: “OT is physical therapy for the arms and hands (dexterity), and therapists in this field are perhaps best-known for helping people with paralysis (from stroke victims to people with quadriplegia, like myself) re-learn how to do a myriad of things, from feeding themselves to buttoning buttons.” While I appreciate the definition’s emphasis on meaningful occupations, the comparison to PT is just terrible (can you imagine someone saying, “PT is like OT for the legs”???), and the scope of clientele presented is very limited.

2. The article leaves me with many questions: What other assistive technology did Tiffiny’s OT suggest, and how did that pan out? What else did Tiffiny do in OT that made it “the most annoying type of therapy” she had to go through? What, if anything, did Tiffiny actually gain from OT? Etc etc etc. Tell me more, Tiffiny!

Blog Entry’s Relationship to Advocacy:
1. When describing OT to clients, avoid comparing OT to PT unless absolutely necessary!

2. Encourage your clients to advocate for themselves during therapy sessions, and take an active role in their plan of care.

3. In today’s world you never know when you will treat a client in possession of a personal blog who plans to record their experience with OT for all the world to see. Give every client a reason to brag about OT!

Diversity (or lack thereof) Among Allied Health Care Workers: Part 2 of 2

To pick up where we left off…..

It’s clear that cultural diversity is a valuable characteristic of an effective health care team. Consequently, many health care disciplines actively strive to increase the diversity of their practitioner base. Occupational therapy, a profession staffed primarily by white women, is one such discipline.

AOTA’s Centennial Vision for Occupational Therapy mentions workforce diversity: “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.” This is a good start; the Powers That Be have recognized an important need and have made it a priority. Or have they? When the AOTA Board met in February to determine which Centennial Vision objectives would be given priority for fiscal year 2010 (which began July 1, 2009), increasing diversity among the OT workforce did not make the cut.

As disappointing as this is, AOTA makes sure to point out that just because an aspect of the Centennial Vision was not selected as a FY 2010 priority does not mean that it will fall by the wayside. AOTA states that efforts to enhance ethnic, economic, and gender diversity in the OT workforce are ongoing. AOTA claims that one efforts toward enhancing diversity is the AOTA E.K. Wise Scholarship. A $5,000 scholarship is given to three female (so much for gender diversity) post-baccalaureate (so much for economic diversity) students every year. Award recipients are able to “meet E.K. Wise’s and the Association’s objectives of developing a workforce to meet society’s diverse occupational needs in underserved areas or communities”.  I could write an entire blog post about the E.K. Wise Scholarship, but for now I’ll just say that this is a pretty indirect way to address diversity in the workforce…

Another way that AOTA seeks to enhance diversity is through marketing OT practitioners of minority status. At first I wasn’t sure how I felt about this- the people highlighted on this web page are unique individuals who owe their accomplishments to hard work and dedication… should they really be marketed? However, thinking it over, I see the merit in this approach. Through these personal profiles, AOTA demonstrates that the career of occupational therapy has wide appeal, and practitioners of many different backgrounds can advocate for and represent the field.

In addition to efforts undertaken by AOTA as an organization, individual groups have formed to address cultural issues in occupational therapy. There are numerous state-level cultural organizations, as well as national organizations. While these groups may partner with AOTA on occasion, they are independent organizations; individuals do not need to be a member of AOTA in order to join a cultural group. Below are links to National cultural groups that I am currently aware of:

The Black Occupational Therapy Caucus

The Association of Asian/Pacific Occupational Therapists in America

Network for Lesbian, Gay, Bisexual and Transgender Concerns in Occupational Therapy

TODOS Network of Hispanic Practitioners

Orthodox Jewish Occupational Therapy Chavrusa

As an oft-quoted adage states, “The first step is admitting that you have a problem”. By including diversity in the Centennial Vision, AOTA has publicly recognized the need to improve diversity among occupational therapy practitioners. I look forward to seeing how this aspect of the Centennial Vision is addressed in coming years. Maybe it will even make the cut for a FY 2011 priority!

As I wrote in Part 1, improving diversity in any health care profession requires targeting the higher education system for some much needed change. A focused partnership between AOTA and educational programs around the country may be the profession’s best bet for increasing diversity among the ranks. National education initiatives, such as an OT student loan repayment program are also in order.

Until next time, here’s to diversity!

Diversity (or lack thereof) Among Allied Health Care Workers: Part 1 of 2

This morning I happened upon an article entitled Where’s the Diversity? on minoritynurse.com, an online supplement to Minority Nurse Magazine. Although the article was written in 2003, the topic is still incredibly relevant today.

The article starts with the quip, “What do Martha Stewart house paint and the allied health workforce have in common? Give up? Both come in any shade of white you can imagine”. From here the article takes a more somber tone, relating disheartening statistics regarding the under representation of minorities in the United States’ allied health care workforce. The author is quick to point out that “the lack of diversity certainly is not due to a lack of available positions”. This very true! I found a pdf document created by the Department of Labor which lists the 30 fastest-growing professions between 2004-2014. Approximately half of these professions were in the field of allied health care. Examples include: home health aides, medical assistants, physician assistants, physical therapists, physical therapy assistants, physical therapy aides, dental assistants, dental hygienists, and (of course) occupational therapists, and occupational therapy assistants. Many of these ever-growing job openings will remain vacant, as the demand simply outweighs the supply of allied health care workers.

Many people, including the author of “Where’s the Diversity?”, believe that “the problem of poor diversity in health care professions has its roots in the higher education system. For many reasons, minorities are not enrolling in allied health programs”. One of the primary reasons for the paltry enrollment rate is likely more an issue of socioeconomics than of race. Many minorities attend disadvantaged high schools that are not targeted for college recruitment or financial aid. Furthermore, if students from these schools do seek post secondary education of their own volition, unlike students from more affluent school districts, they are often unable to meet the prerequisite and standardized testing requirements of many health care programs.  Finally, “even for college-bound minorities, the allied health professions may not appear glamorous or financially rewarding enough to be worth the cost in sweat and dollars”.

Obviously, the disparities that plague America’s educational system lead to the under representation of minorities in many job sectors, not just that of allied health care. It seems obvious that, in general, a homogeneous workforce is far from ideal. In the field of allied health care, this may be especially true. “It has become painfully obvious that in this culturally rich country, minorities do not receive the same level of health care as their white counterparts.” These disparities negatively impact millions of Americans every year. Differences in treatment and outcomes result from a number of factors, including a patient’s socioeconomic status, health behaviors, language barriers, education and literacy levels, and health care coverage. Other disparities result from “the lack of multicultural tools and sensitivity in part of the health care provider, outright discrimination and stereotyping by health care practitioners, and the lack of diversity in the health care workforce”.

A more diverse population of allied health care professionals could help circumvent the root of much unfortunate and avoidable health care disparity among individuals of different racial and cultural backgrounds. Practitioners from diverse backgrounds may be able to provide patients with more culturally sensitive/competent care than practitioners hailing from America’s mainstream, majority culture. Also, it may likely be the case that patients from minority or disenfranchised backgrounds feel more comfortable discussing their health care concerns with practitioners of similar backgrounds- i.e. practitioners who understand the unique health-related challenges that minorities face on a day-to-day basis. It is also very plausible that by employing a diverse health care team, a health care facility provides non-minority employees with valuable experiences that will help them become more mindful of cultural issues in their own interactions with patients.

At this point you may be asking yourself important questions, including: “what does the lack of diversity amongst occupational therapy practitioners mean for our patients, and for the field in general?”, and “what can/should/is being done to remedy our profession’s unfortant similitude to Martha Stewart housepaint?”……..well reader, stay tuned-these questions addressed (not answered) in Diversity (or lack thereof) Among Allied Health Care Workers Part 2 of 2…….coming soon!

Join the Club: Districts and Committees

Today I was thinking that one of the cool things about being a member of the Washington Occupational Therapy Association (WOTA) is the opportunity to participate in a committee or district composed of dedicated practitioners striving to promote and safeguard occupational therapy in Washington State.

Districts are created to serve the needs of WOTA members in specific geographical areas of Washington. Districts consist of 10 or more WOTA members located within a geographical area who have joined together and formed a group such as the Inland Northwest Occupational Therapy (INWOT) District. INWOT supports OTs and OTAs in the Inland Northwest region by providing therapists with networking and employment resources, offering local continuing education opportunities, and serving as a bridge between therapists and WOTA.

Committees on the other hand, form to address specific issues such as public relations, recruitment, the WOTA newsletter, membership, continuing education, etc. An example of an important standing committee of WOTA is OT in Schools (OTIS). The mission of OTIS is to support occupational therapy services in school-based settings, facilitate school-based therapist networking, promote evidence-based practice, and increase public awareness of the role of occupational therapy in school based environments.

So join WOTA and then join a District or Committee already! All the cool kids are doin’ it!

Roll Up Your Sleeves

Saturday, June 27th is the first National Health Care Day of Service. This nation-wide event was developed by Organizing for America, a project of the Democratic National Committee. On June 27th volunteers around America will engage in local community service activities designed to expose participants to the reality of America’s health care system and the millions of people who the system is currently failing. The day of service is one aspect of the Obama Administration’s overall campaign to ensure health care reform in 2009.

While it is probably too late to organize and host an event, simply entering your zip code will provide you with a list of open events in your community. The map to the right shows the numerous events in my immediate area. Examples of diverse opportunities to get involved include food drives, blood drives, distributing information about children’s health care to low-income families, free QiGong classes, group discussions about health care reform, health care information booths at farmer’s markets, health care documentary viewings, volunteering at assisted living facilities, health screenings at skilled nursing facilities, etc etc etc.

The Obama administration claims that, “volunteers who participate in the National Health Care Day of Service will be stronger advocates for health care reform”. I agree- the simple act of joining together with others from our community to learn and start a conversation about our current health care system and the way it is failing millions of Americans has the power to open our eyes to all that needs to be done…. and the ways that we as individuals and groups can make an impact.

I’ve heard time and time again that in 2009 President Obama and Democratic Party is committed to supporting health care reform legislation that “protects what works about health care and fixes what’s broken”. While I am guardedly optimistic about the results we will see in the next six months, I fully support the efforts of the President to engage individuals and communities in the fight for long-term, systemic health care reform.

As occupational therapy practitioners, we have a lot to offer the conversation and efforts undertaken on National Health Care Day of Service, and everyday. Our understanding of the ins-and-outs of the health care system, experience with the challenges clients face navigating this system, emphasis on viewing people holistically, rather than as diagnoses or disabilities, and willingness to advocate for the wellfare of those we serve are qualities that directly lend themselves to community service. If you would like to learn more about the National Health Care Day of Service, and/or participate in an event near you, click here.

OT Student Loan Forgiveness

Earlier this month, HR 2891: Legislation to establish a Frontline Providers Loan Repayment Program was introduced by Representatives Bruce Braley (D-IA) and Zack Space (D-OH).

The bill seeks to provide student loan assistance/forgiveness to designated “Frontline Health Care Professionals” working in medically underserved areas. A similar program, the National Health Services Corps currently exists and provides loan forgiveness to Allopathic and Osteopathic Physicians, Primary Care Nurse Practitioners, Certified Nurse-Midwife, Primary Care Physician Assistants, Dentists and Dental Hygienists, Health Service Psychologists, Social Workers, Psychiatric Nurse Specialists, Marriage and Family Therapists, and Licensed Professional Counselors. HR 2891 would extend student loan forgiveness eligibility to additional health care professions, including occupational therapy.

In order to obtain student loan forgiveness under the proposed program, OTs would be required to work in a medically underserved area for a minimum of two years. “Medically underserved areas” are determined by the Health Resources and Services Administration Shortage Designation Branch of the US Department of Health and Human Services, or by the State itself.

In addition to occupational therapy, the bill extends Frontline Health Care Provider status to the following professions: physical therapy, speech language pathology, general surgery, chiropractic, optometry, ophthalmology, audiology, pharmacy, public health, podiatric medicine, dietetics, general pediatrics, respiratory therapy, medical technology, and radiologic technology.

This bill is designed to increase the public’s access to quality, affordable health care services. It is anticipated (hoped?) that the student loan repayment program will provide students in health care scarcity areas with an incentive to enter the field of health care, and will provide current health care professionals with an incentive to work in underserved areas. The inclusion of occupational therapy in this bill demonstrates recognition of the unique value and importance of our profession.

To read more about HR 2891:
Medical News Today
Channel 7 KKWL News

To send an email to Congress asking them to support HR 2891:
AOTA Legislative Action Center email template