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AOTA T H E

A MERIC A N

OC C UPAT IONAL

T HE RAPY

ASSOCIAT ION

®

SEPTEMBER 24, 2012

Battling Workplace Burnout

PLUS

Working With Children Who Are Deaf or Hard of Hearing n Developing a Job Shadow Program n Tech Talk: Electronic Portfolios n Social Media Spotlight
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CE ARTICLE

Assessment of and Intervention for Adults With Sensory Processing Disorders

Chief Operating Officer: Christopher Bluhm Director of Communications: Laura Collins Director of Marketing: Beth Ledford Editor: Ted McKenna Associate Editor: Andrew Waite CE Articles Editor: Maria Elena E. Louch Art Director: Carol Strauch Production Manager: Sarah Ely Director of Sales & Corporate Relations: Jeffrey A. Casper Sales Manager: Tracy Hammond Advertising Assistant: Clark Collins

AOTA • THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION
VOLUME 17 • ISSUE 17 • SEPTEMBER 24, 2012

FEATURES
Battling Workplace Burnout

Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org
OT Practice External Advisory Board

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Donna Costa: Chairperson, Education Special Interest Section Michael J. Gerg: Chairperson, Work & Industry Special Interest Section Dottie Handley-More: Chairperson, Early Intervention & School Special Interest Section Kim Hartmann: Chairperson, Special Interest Sections Council Gavin Jenkins: Chairperson, Technology Special Interest Section Tracy Lynn Jirikowic: Chairperson, Developmental Disabilities Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Linda M. Olson: Chairperson, Mental Health Special Interest Section Regula Robnett: Chairperson, Gerontology Special Interest Section Tracy Van Oss: Chairperson, Home & Community Health Special Interest Section Jane Richardson Yousey: Chairperson, Administration & Management Special Interest Section
AOTA President: Florence Clark Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge Chief Professional Affairs Officer: Maureen Peterson
© 2012 by The American Occupational Therapy Association, Inc. OT Practice (ISSN 1084-4902) is published 22 times a year, semimonthly except only once in January and December, by The American Occupational Therapy Association, Inc., 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offices. U.S. Postmaster: Send address changes to OT Practice, AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449. Canadian Publications Mail Agreement No. 41071009. Return Undeliverable Canadian Addresses to PO Box 503, RPO West Beaver Creek, Richmond Hill ON L4B 4R6. Mission statement: The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public. Annual membership dues are $225 for OTs, $131 for OTAs, and $75 for student members, of which $14 is allocated to the subscription to this publication. Subscriptions in the U.S. are $142.50 for individuals and $216.50 for institutions. Subscriptions in Canada are $205.25 for individuals and $262.50 for institutions. Subscriptions outside the U.S. and Canada are $310 for individuals and $365 for institutions. Allow 4 to 6 weeks for delivery of the first issue. Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from the Copyright Clearance Center to reproduce or photocopy material appearing in this magazine. Direct all requests and inquiries regarding reprinting or photocopying material from OT Practice to www.copyright.com.
COVER PHOTOGRAPH © JAMES BREY / ISTOCKPHOTO

Practitioners Discuss Keys to Job Satisfaction and Lower Turnover
Andrew Waite reports on opportunities for education, social participation, managerial input, and other factors that contribute to workplace satisfaction and reduce turnover.

DEPARTMENTS
News Capital Briefing
AOTA, State Associations Collaborate on Health Reform Advocacy

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Beyond Communications
Team Efforts to Serve Children Who Are Deaf or Hard of Hearing

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In the Clinic

Watch and Learn: Developing a Job Shadow Program Within Your State Association

Practice Perks

Adapting Assessments in School-Based Settings

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Social Media Spotlight

Updates From Facebook, Twitter, YouTube, and OT Connections

Tech Talk

Meredith Gronski describes how occupational therapy helps children who are deaf or hard of hearing with their intellectual, social, and emotional development at school.

Electronic Portfolios: Universally Designed Tools for Self-Advocacy

Calendar

Continuing Education Opportunities

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Employment Opportunities Reflections

An Approach to Assessment of and Intervention for Adults With Sensory Processing Disorders
Earn .1 AOTA CEU (1 contact hour or 1.25 NBCOT professional development units) with this creative approach to independent learning.

CE Article

The Occupational Therapy Aide Bar: A Historical Milestone of the Girl Scout Centennial

• Discuss OT Practice articles at www.OTConnections.org in the OT Practice Magazine Public Forum. • Send e-mail regarding editorial content to otpractice@aota.org. • Go to www.aota.org/otpractice to read OT Practice online. • Visit our Web site at www.aota.org for contributor guidelines, and additional news and information.
OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practice’s editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to members@aota.org, or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.

OT PRACTICE • SEPTEMBER 24, 2012

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AOTA News

Association updates...profession and industry news
AOTA Responds to AAP’s SI Therapy Statement
OTA President Florence Clark recently submitted a letter on behalf of AOTA to the American Academy of Pediatrics’ policy statement on sensory integration therapy, in which they discussed occupational therapy’s role. Read the letter in full, in addition to AOTA’s comments to the American Psychiatric Association on the DSM-5 revision, AOTA’s response to a systematic review of sensory integration therapy for autism spectrum disorders in the journal Research in Autism Spectrum Disorders, and AOTA’s response to the National Autism Center’s National Standards Report, at http://www. aota.org/practitioners-section/ children-and-youth/browse/si. Association of Occupational Therapists, and the Canadian Association of Occupational Therapists, members of each association can now access the other countries’ journals. AOTA members can reach the British and Canadian journals by logging in to view the American Journal of Occupational Therapy (www.aota.org/highwire/ajot-online) and clicking on the links listed there.

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Attend AOTA’s Stroke Specialty Conference

f you work with older adults, be sure to attend the AOTA Adults With Stroke Specialty Conference, to be held from November 30 to December 1 in Baltimore, Maryland. An estimated 5.4 million people in America live with the disabling effects of stroke, and that number is predicted to increase as the population ages. Occupational therapy helps those recovering from a stroke resume valued activities through a holistic approach to intervention. Join keynote speaker Carolyn Baum, PhD, OTR/L, FAOTA, and other renowned experts offering comprehensive sessions, while earning up to 13 contact hours (1.3 CEUs/13 NBCOT PDUs). Register now at www.aota.org/ confandevents/stroke.

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Public Disciplinary Action

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Recognize a Colleague for an AOTA Award

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Register Now for the Student Conclave
ccupational therapy students and soon-to-be new practitioners can get a head start on a successful career by attending the 2012 AOTA/NBCOT National Student Conclave, to be held from November 9 to 10 in Columbus, Ohio. For more information, or to register, go to www.aota.org/ confandevents/conclave. The Conclave will provide attendees with evidence-based knowledge about current issues and emerging practice areas, exclusive opportunities to speak with leaders and experts, opportunities to meet with job recruiters and have résumés critiqued, and much more.
OT PRACTICE • SEPTEMBER 24, 2012

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Prospective Student Chats Ahead
now someone interested in joining the occupational therapy profession? Direct him or her to AOTA’s prospective student chats this fall, to be held on October 17 and November 15 at 7 p.m. EST. To participate or view archived chats, head to www.aota.org/ students.

he AOTA Recognitions Committee encourages you to recognize colleagues who have made significant contributions to the profession by nominating them for one of the awards offered by the Association each year. Description of the awards, nominations forms, FAQs, and the general point system can be found on the AOTA Web site at www. aota.org/practitioners/profdev/ awards. Questions can be directed to awards@aota.org.

he Representative Assembly Investigating Committee recently took the following disciplinary action. As per AOTA Policy 1.14.1, “all elected and appointed volunteer leaders may be censured for: a. Misconduct: This term is defined as a violation of the AOTA Occupational Therapy Code of Ethics and Ethics Standards (2010) (Code and Ethics Standards). Any behavior, public or private, that reflects negatively on one’s professional role, the profession, and/or the Association is a violation of the Code and Ethics Standards.” Name: Delvin Champagne, MSHE, COTA/L, CHES Sanction: Censure based on violation of Policy 1.14.1. Please contact Deborah Slater, AOTA liaison, at dslater@ aota.org if there are questions concerning this information.

Industry News

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OT Practice Thanks Reviewers
he staff members of OT Practice thank the following persons for sharing their expertise by providing content reviews of manuscripts and articles from July 2 through September 24: Felicia Chew, Jennifer DeRosa, Paul Fontana, Michael Gerg, Leslie Jackson, Gavin Jenkins, Kim Hartmann, Deborah Lieberman, Susan Lin, Maria Elena Louch, Maureen Peterson, Laurel Radley, Sandy Schefkind, Deb Slater, Karen Smith, Judy Thomas, T racy Van Oss, and Elizabeth Wall.

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HHS Announces New ICD-10 Deadline
he Department of Health and Human Services recently announced the final rule that delays the International Classification of Diseases, 10th revision, Clinical Modification (ICD–10–CM) from October 1, 2013, to October 1, 2014. The rule means diagnosis coding, including the Official ICD–10– CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD–10–PCS) for inpatient hospital procedure coding, including the Official ICD–10–
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American, British, and Canadian OT Associations Now Sharing Journals
nterested in research emerging abroad? Thanks to a recent reciprocity agreement between AOTA, the British

a o ta B u l l e t i n B o a r d
OUTSTANDING RESOURCES FROM

PCS Guidelines for Coding and Reporting, will not change until October 2014.

WFOT Anniversary Poster Posted
ant a way to commemorate the World Federation of Occupational Therapists’ 60th anniversary? Download the anniversary poster at www.wfot.org/resourcecentre. aspx. For more on the “diamond” year, visit www.wfot.org/ newsletter/201203/wfot60th anniversary.aspx.

Early Childhood: Occupational Therapy Services for Children Birth to Five
(SPCC) B. Chandler Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). ocuses on communitybased programs, examines the impact of federal legislation on occupational therapy practice, and explores ways to articulate and demonstrate the expertise of occupational therapy in transitioning early childhood development into occupational engagement in natural environments. $259 for members, $359 for nonmembers. Order #3026. http:// store.aota.org/view/?SKU=3026

The Occupational Therapy Manager, 5th Edition
K. Jacobs & G. L. McCormack ncludes 37 new and updated chapters, discussing aspects of creating evidencebased practices; effectively leading and motivating staff; ensuring ethical service delivery; and handling day-to-day items such as budgeting, documentation, and reimbursement. A fundamental classic for all occupational therapy students, clinicians, and managers. $79 for members, $112 for nonmembers. Order #1390C. http:// store.aota.org/view/?SKU=1390C

A World of Opportunity for OT
orld Occupational Therapy Day 2012, on October 27, is an opportunity to promote and celebrate the global profile of the profession. For ideas on ways to take part, check out www. wfot.org/resourcecentre.aspx. A related initiative, the OT Global Day of Service (OTGDS), calls for occupational therapy practitioners and students to volunteer a small amount of time to promote the profession. The World Federation of Occupational Therapists is partnering with www.promotingot.org to support OTGDS. In addition, OT4OT (www.ot4ot. com) is hosting an OT 24-Hour Virtual Exchange from October 29 to October 31 (depending on participants’ locations). The virtual exchange is a way for occupational therapy practitioners around the globe to share ideas about occupational therapy practice, education, and research.

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Interagency Autism Coordinating Committee Meets
full committee meeting of the Interagency Autism Coordinating Committee (IACC) of the U.S. Department of Health and Human Services was recently held. Researchrelated resources highlighted by the IACC that could be helpful to occupational therapy practitioners include a summary of 20 research studies, at https://iacc.hhs.gov/summaryadvances/2011/index.shtml; and an analysis of public and privately funded research, at https://iacc.hhs.gov/portfolioanalysis/2010/index.shtml. An archived recording of the meeting is available at http://webcast. nccsite.com/nih/0007/index.htm.

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OT Manager Topics
(CEonCD™) D. Chisholm, P. Moyers Cleveland, S. Eyler, J. Hinojosa, K. Kapusta, S. Phipps, & P. Precin Earn .7 AOTA CEU (8.75 NBCOT PDUs/7 contact hours). resents supplementary content from chapters in The Occupational Therapy Manager, 5th Edition, and provides additional applications that are relevant to selected issues on management. Topics include occupation-based practice in management, evidence-based occupational therapy management, continuing competency, conflict resolution, and employee motivation. $194 for members, $277 for nonmembers. Order #4880. http://store. aota.org/view/?SKU=4880

Occupational Therapy Practice Guidelines for Children and Adolescents With Challenges in Sensory Processing and Sensory Integration
R. Watling, K. Patten Koenig, P. Davies, & R. C. Schaaf iscusses the occupational therapy process for children and adolescents with sensory challenges, including the foundations of occupational therapy services, evaluation, and intervention. Extensive evidence tables summarize current, relevant research by analyzing and rating the validity of studies and organizing research according to the client’s age and challenges. $69 for members, $98 for nonmembers. Order #2218. http://store. aota.org/view/?SKU=2218

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NY OT Continuing Competence Bill Signed
he governor of New York recently signed a bill that brings New York in line with 42 other states and the District of Columbia in requiring occupational therapists and occupational therapy assistants to complete continuing competence requirements. The New York State Occupational Therapy Association had lobbied for this requirement since legislation to mandate continuing competence requirements was introduced in 2004. AOTA also helped support passage of the bill. For more, visit www.aota.org/news/ advocacynews/ny-ot-cc-bill.

Resources

Older Drivers, Falls Prevention
OTA has released a new tip sheet, Driving Safely as You Age, available at www.aota. org/fact-sheets/driving-tip-sheet. Another tip sheet on older drivers, Keeping Older Drivers Safe, is available at www.aota.org/ consumers/consumers/adults/ olderdrivers/35123. Practitioners interested in this topic might also be interested in AOTA’s driving resource center at www. aota.org/older-driver. AOTA has also released a new tip sheet on falls prevention,
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

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Practitioners in the News
n Nancy Yang Her, Alanna Moire Holmgren, and Michelle York are the recipients of the $5,000 2012–2013 AOTA EK Wise Scholarship. The scholarship supports female students pursuing a postbaccalaureate entry-level degree program in occupational therapy. For more information, visit www.aota. org/students/aid/scholarships/ ekwise_1.aspx. n Scott Matthews, OT, MS, owner and executive director of Intensive Therapeutics, was honored by the Senate and General Assembly of New Jersey for his work with children with special needs. The assembly specifically highlighted his intensive programming for children diagnosed with cerebral palsy and autism. n Patricia J. Scott, PhD, MPH, OT, FAOTA, associate professor at the Indiana University (IU) Department of Occupational Therapy and adjunct associate professor at the IU School of Medicine, recently spoke on public radio about his two liver transplants, the transplant process, and the related role that occupational therapists can play. To listen, visit http://soundmedicine.iu.edu/segment/3358/ what-does-the-transplant-recovery-process-involve-.

In Memoriam
Jerome Kevin Burik, MHS, OTR/L, of Mount Pleasant, South Carolina, died August 12, 2012. He was born on August 13, 1959, in McKees Rock, Pennsylvania. He attended West Virginia University in Morgantown, then transferred to the Medical University of South Carolina (MUSC) in Charleston, graduating in 1982 with a bachelor’s degree in occupational therapy
OT PRACTICE • SEPTEMBER 24, 2012

and in 1991 with a master of health science degree. As a licensed occupational therapist, Burik had been an independent contractor, a consultant, an adjunct instructor, and an entrepreneur. He co-founded Therapy Resources, the first private practice of occupational therapy in Charleston, South Carolina, prior to joining the faculty at MUSC. In 1999, Burik was appointed assistant professor and the academic fieldwork coordinator at the MUSC College of Health Professions’ Division of Occupational Therapy, where he served at the time of his death. Burik was an active member of AOTA and the South Carolina Occupational Therapy Association and served on a number of advisory boards. He was a great collaborator with his faculty colleagues, which led to his participation in many grant-funded activities and publications. He also held a leadership role in the MUSC Leadership Initiative, C-3, Creating Collaborative Care, which promotes interprofessional education strategies that build teamwork for bridging the classroom and the clinic. In 2002, Burik was awarded the MUSC Health Science Foundation Teaching Excellence Award, in the Developing Teacher category. When interviewed about this award, Burik said he loved his profession and wanted to educate his students, not only train them. He was an inspiring and dedicated faculty member and an excellent fieldwork coordinator. Many phone calls occupied his nights and weekends as he advised and encouraged students on fieldwork. A gifted teacher, Burik spent his life passing his love of occupational therapy on to his colleagues, students, and clients. —Nancy E. Carson, PhD, OTR/L
Andrew Waite is the associate editor of OT Practice. He can be reached at awaite@aota.org.

Going beyond the traditional one-to-one model of mentoring, this reader-friendly text provides in-depth discussion on various ways and forms mentoring can take place, including group and offsite mentoring. A workbook offers readers many stories reflecting the core concepts as well as questions for selfreflection. HigHligHts and topics Part I: Mentoring Leaders • Leadership and communication • Nature of mentoring • Power of stories Part II: The Workbook • Self-reflection and growth • Community building • Leading for the future
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AOTA, State Associations Collaborate on Health Reform Advocacy
Dan Brown
(AOTA) and state occupational therapy associations have been partnering to advocate for occupational therapy as states select EHB benchmark plans and define coverage for habilitative services. The following examples show how this process is playing out in select states. In Washington state, the benchmark plan was established through legislation; however, the process did not end there. The Washington insurance commissioner was required to establish rules related to EHBs. In doing so, the commissioner scheduled public meetings and is in the process of establishing a habilitative services workgroup. AOTA has strategized with the Washington Occupational Therapy Association (WOTA) about advocacy efforts. In addition, AOTA collaborated with WOTA on a comment letter, and WOTA is working with its lobbyist to get a seat on the habilitative services workgroup. In Utah, legislation was passed that delegated EHB decision making to the insurance commissioner, but only after an existing health reform task force made a recommendation. That task force first formed a workgroup to study the issue. The workgroup held public meetings, and members of the Utah Occupational Therapy Association testified at one of those meetings about the importance of occupational therapy. AOTA supported their efforts by providing information on EHBs and the process taking place in Utah. Kentucky’s process has been less formal. Its Insurance Department held forums around the state to discuss health care reform implementation. It also posted information on EHB benchmark plan options on its Web site and requested comments from stakeholders. The Kentucky Occupational Therapy Association, with the help of its lobbyist, scheduled a meeting with key decision makers to advocate for occupational therapy coverage in the benchmark plan. AOTA provided support and assisted with drafting a comment letter. California will have identified its benchmark plan and defined habilitative services through the legislative process, assuming Governor Brown signs the related bills that the state’s legislature has already passed. The Occupational Therapy Association of California (OTAC), its lobbyist, and AOTA worked together to influence the legislative process, particularly the definition of habilitative services. The health insurance industry was a formidable opponent in these efforts, significantly altering the definition that OTAC and AOTA proposed. However, the final product retains the fingerprints of occupational therapy advocates, who helped foster a better outcome than would otherwise have likely occurred. Similar to Utah, Maryland passed legislation delegating selection of the EHB benchmark plan to a health reform council, which itself established an advisory committee to evaluate options. The Maryland Occupational Therapy Association, in coordination with AOTA, attended public hearings and provided written and oral testimony that supported a strong habilitative services benefit. AOTA will continue to work with state occupational therapy associations on health care reform implementation activities. Your support makes these efforts possible. n
Dan Brown is AOTA’s senior state policy analyst.
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

his summer has been abuzz with health care reform implementation activities. One activity with significant implications for occupational therapy is the adoption of essential health benefit (EHB) benchmark plans. The federal government has empowered each state to choose an EHB benchmark plan, which would serve as a model for the services covered in its small group and individual health insurance markets. Should a state fail to select a plan by September 30, 2012, the federal government’s default option takes effect. For roughly half of the states, that deadline has provided sufficient incentive to choose a benchmark plan. Yet few states have actually finalized their decisions. Which plan each state chooses is important to the profession of occupational therapy for several reasons. Most obviously, the plans will influence the scope and limitations of covered services for millions of people, determining the extent of occupational therapy coverage in EHB categories such as rehabilitative and habilitative services and devices. Additionally, habilitative services, an EHB category under which occupational therapy should be included, is rarely provided as a benefit in commercial health plans and has therefore not yet been defined for the purpose of the EHBs. To a greater extent than the other EHB categories, that lack of a definition creates an opportunity for occupational therapy advocates to influence how habilitative services are covered in benchmark plans. Although the requirements of the EHBs do not take effect until 2014, decisions regarding the EHBs are being made now. The American Occupational Therapy Association

in the clinic

Watch and Learn

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ILLUSTRATIONS © A-DISC / ISTOCKPHOTO

Developing a Job Shadow Program Within Your State Association
Kari Cruanes-Buck
Placed in charge of developing the program, which began in November 2011, were our then three members at large. (Currently, the executive board is within a transition period, with only one member at large.) With the assistance of Judy Sheehan, vice president of ConnOTA, an initial program outline was created to better clarify the responsibilities of the member(s) at large, the duties of the job shadow host, and other aspects of the program, including creating a survey for anyone participating in the program to evaluate their experience. Next, we built a base of practitioners who are readily available to host job shadows, a job that we touted as a perfect way for them to support ConnOTA without the commitment required in other positions. Building this bank of hosts proved to be a somewhat difficult task for a multitude of reasons. We knew it was important to represent all practice settings and geographical areas of the state, but it was evident that some practice settings are more conducive to job shadows than others. For instance, certain mental health settings, depending on the level of acuteness, are limited in their ability to allow observation. Also, facilities often have individualized regulations and guidelines surrounding observation that ConnOTA must honor. Regardless, with some effort, we succeeded in creating a pool of practitioners who represent most practice areas, including skilled nursing and geriatrics, home care, pediatric clinics, school systems, acute care, rehabilitation hospitals, outpatient facilities, and a certified hand therapy clinic. Through word of mouth, e-mails to all practicing members, and announcements during semiannual conferences, the members at large recruited these practitioners. A job shadow experience can be a few hours, one day, or even several days. That is ultimately decided upon by the job shadow host and shadower, and it often depends on the availability and schedule of both parties. As with any organizational program, consistent maintenance is necessary in order to guarantee smooth operations. For example, four times yearly the member(s) at large send an e-mail to all job shadow hosts, currently 15 hosts, to ensure that they are still able to honor job shadow requests. This is also a way to be certain that contact information has not changed and that hosts respond in a timely way. It has been an arduous task to collect job shadow satisfaction surveys from shadowers once a job shadow has been completed. Often, after
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job shadow program was at one time simply a future goal for the Connecticut Occupational Therapy Association (ConnOTA). However, as proud practitioners, our executive board members felt it important to represent our profession and share our specialty with others. Because of our strong focus on fostering student involvement as an organization, ConnOTA last year determined that the time had come to add the program to our repertoire of resources available to the population we serve. Just as a therapist may skillfully observe a client, students and others who are intrigued by occupational therapy need the opportunity to observe our profession first hand. We serve such a variety of settings, that only by observation can one truly understand the profession and its impact.

Just as a therapist may skillfully observe a client, students and others who are intrigued by occupational therapy need the opportunity to observe our profession first hand. We serve such a variety of settings, that only by observation can one truly understand the profession and its impact.

OT PRACTICE • SEPTEMBER 24, 2012

Battling Workplace Burnout

practitioners discuss keys to JoB satisfaction and loWer turnover
ANDREW WAITE

Opportunities for education, participation in company social activities, input on management decisions, and other factors that contribute to practitioner satisfaction and reduce turnover.

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PHOTOGRAPH © JAMES BREY / ISTOCKPHOTO

uring her first week on the job, Allison Kelleher, COTA/L, noticed a trend among her new co-workers. “Almost everybody that spoke about the company finished their introduction with, ‘And I have been here for 30 years; I have been here for 25 years, 10 years.’ You name it, the longevity was there, so I thought, ‘Wow, this must be a great place to be where people want to stay and grow with their careers.’” That turned out to be right. “The agency as a whole almost seems to have an OT’s brain. It’s very client centered and really focuses on client choice and partnering with the people that we serve,” Allison says of her new firm. “This position definitely allows for a lot of flexibility and creativity that really benefits the clients.” Compare Allison’s situation with Cassandra’s. Cassandra recently left her job after about a year. And in that
OT PRACTICE • SEPTEMBER 24, 2012

year, she watched a handful of other therapists quit as well. “The opportunity to learn and grow and be encouraged to learn and grow hasn’t really been put on the table,” Cassandra says. Cassandra has an interest in sensory integration and was hoping to be able to learn more specialized skills. But that hasn’t panned out. She was hoping to get SIPT (Sensory Integration and Praxis Test) certified, but her company never allowed her to take the training. “There is so much other stuff to do that they don’t care about their employees really growing as professionals.” Right down the list, Allison and Cassandra have opposite answers when it comes to satisfaction with their employers. For example, Allison was encouraged that she received kudos from upper management for helping to lead a fundraising walk, while Cassandra was disheartened when her idea for

a movie night never received serious consideration. “Why are you going to ask me to go through the motions of planning an event if you aren’t going to follow through?” Cassandra says. Allison and Cassandra’s dichotomy represents a perhaps unsurprising theme that emerged as OT Practice interviewed practitioners about job satisfaction: Employees want to be treated like individuals with needs to learn and grow, and not be seen as cogs in a machine whose sole purpose is to fill out forms to fulfill productivity standards. And when employees are not treated as people, it can lead to burnout, which is bad for everyone in the profession.

WHAT IS BURNOUT?
David Boman, OT/L, MBA, therapy manager acute/outpatient therapy services at Hillcrest Baptist Medical Center/Scott & White Healthcare in
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Texas, has been studying burnout for several years. The idea interests him because he knows that happy employees are better equipped to care for clients. He is also concerned that as the health care industry changes, more might be required of employees, thus increasing the challenge to keep them satisfied. Boman shared his research with OT Practice. The term burnout dates back to the 1970s when Freudenberger defined it while studying health care workers.1 In 1998, Maslach and Goldberg further defined it as a “psychological syndrome of emotional exhaustion, depersonalization, and reduced accomplishment” (p. 64).2 Burnout is especially common in health care because the jobs center on sickness and death and often require that critical decisions be made quickly, Boman says. In one sample of physical therapists, 53% reported having burnout.3 Boman says classic signs of burnout include feeling depersonalized, experiencing emotional exhaustion, feeling as though you are not accomplishing anything while at work, and experiencing a loss of motivation. “I have gone to staff (if they are willing and open) and said, ‘I perceive that you’re possibly burned out or approaching it.’ I say, ‘I notice you have been cynical about organizational constructs and a little bit on edge with some of the staff. And it seems like maybe you are getting a little bit burned out,’” Boman says. “And then on an individual basis I have asked them, ‘Are you exercising at all to keep your body in shape? Are you doing anything to replenish your soul? Are you a musician? A poet? What are you doing to replenish yourself when you are not at work? And what is going on at home right now? Are there additional stresses?’ Generally I have found my staff have really appreciated that and say, ‘Yeah, I have a lot going on at my house right now, a lot of stress’ and so then it opens up a dialogue.”

can normalize their feelings and put their situations in perspective rather than becoming overwhelmed. “Managers have an opportunity with staff to say, ‘This is a problem; it’s common regardless of setting,’” he explains. “Then you have set the stage for people to come to you and say, ‘You know, I am really on edge. I have a lot of anxiety at work, and I am really tired. I have no emotional capacity when I get home.”

CLASSIC SIGNS OF BURNOUT
Feeling depersonalized Experiencing emotional exhaustion Feeling as though you are not accomplishing anything while at work Experiencing a loss of motivation

ADDRESSING BURNOUT
Boman believes it is a manager’s responsibility to address burnout in employees. He says it starts with managers letting workers know that burnout is a common problem so they
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Boman says he regularly sits down with staff to stay on top of any potential issues. “I try to meet with them about twice a week just to check in and have them tell me something about their days. And I ask them to tell me some things that were very hard and frustrating. So we try to walk through those together to provide some decompression opportunities.” When an employee is demonstrating signs of burnout, Boman encourages him or her to take it easy. He reminds them that paid time off is part of their benefits package, and he wants them to use it. This is, of course, the best case scenario, as some work places might not be so flexible. If burnout seems to be a problem among most employees, then it is up to the manager to relay

the concern to senior administrators, Boman says. Michael Gerg, MS, OTR/L, CHT, CEES, CWCE, program director of Harcum College’s Occupational Therapy Assistant Program in Pennsylvania and chairperson of AOTA’s Work & Industry Special Interest Section, knows firsthand and from his conversations with practitioners as the SIS chairperson that unrealistic productivity demands are almost certain to lead to tired employees and burnout. Like Boman, Gerg believes leisure time is undervalued. “Working in medicine is stressful and you should have a sufficient amount of time off to be able to unwind,” Gerg says. “I worked for a modern client health system in Virginia and they just really did everything right. I knew that they always had the interests of the patients first and then the interest of the employees was not far behind that.” Obviously, time off is not always an option. In such instances, Boman reminds employees to reserve time for their other passions in life. Be it swimming, painting, meditating, or whatever, Boman says it’s important to continue doing what makes you happy in the face of stress. Another strategy to satisfy practitioners is to encourage them to consider additional training and education to gain expertise. When clinicians have additional skills, they can share those skills with cohorts, which boosts self-confidence and collaboration at the workplace. That’s why Boman reminds his staff that funding for continuing education (CE) courses as well as time off to attend classes are also part of their benefits package. Jamie Morris recently earned her occupational therapy degree from Loma Linda University in California and at presstime was looking for a job. Although there are many opportunities available, she is seeking the right one. Ideally, she will find herself in a well-established university hospital system and develop her career there as an occupational therapist working in neurological rehabilitation. When considering job opportunities, she wants to ensure that they will include access
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

STAYING COOL UNDER PRESSURE
“It’s important for me to know if an employer supports [continuing education], recognizes that we have that requirement as OTs, and is committed to the quality of the professionals they hire.”

“With large caseloads and high productivity expectations, it’s really easy to get burned out. It’s good when the leadership acknowledges that and shows appreciation for the work you’re doing.”

“I have also encouraged people to think back to what it was that really caught their heart when they decidedthey wanted to be an occupational therapist. Can we re-visit it a little bit?”
to continued training so she can garner more specialized skills. “[Continuing education] is really important to me because you have that requirement in order to keep your licensure. It’s important for me to know if an employer supports CE, recognizes that we have that requirement as OTs, and is committed to the quality of the professionals they hire,” she says. Providing positive feedback is another means of keeping employees happy and feeling like their work is valued, Boman says. His organization has a system in place in which employees can recognize each other for a job well done, and then laudatory notes are passed through the company’s hierarchy. “It provides another opportunity to recognize people so they don’t feel depersonalized or dehumanized or minimized and placed in a corner and essentially just told to complete all their widgets for the day,” he says. Abby Brayton-Chung, MS, OTR/L, who currently works as an independent contractor primarily in early intervention settings after working in a hospital, says appropriate kudos make her feel like her employer is willing to support her. “With large caseloads and high productivity expectations, it’s really easy to get burned out. It’s good when the leadership acknowledges that and shows appreciation for the work you’re doing.”
OT PRACTICE • SEPTEMBER 24, 2012

Employees who don’t feel valued will start to question why they are even in the profession, leading to expensive staff turnover and interrupted client care, Boman says. “I have also encouraged people to think back to what it was that really caught their heart when they decided they wanted to be an occupational therapist. Can we re-visit it a little bit? Because there are probably elements that are still occurring, but because they are feeling burned out they may not be able to see it.” This can help practitioners refocus their mindset even if they aren’t getting everything they would like from their employer. One of the best ways to re-visit the joys of the profession is to think about your past clients. Most occupational therapy practitioners are in the business because they enjoy helping people, and remembering the time when they helped Mrs. Smith get back to cooking can be re-inspiring, Boman says.

A WORD ABOUT BALANCE
A recurring concern of practitioners interviewed for this article was that unrealistic productivity standards would lead to them becoming dissatisfied with their jobs. Productivity is a part of the current health care system and will likely be part of the future. “Productivity has become a very negative term, but if productivity is

determined in an appropriate way, it should not harm patient care,” notes AOTA Chief Public Affairs Officer Christina Metzler. “Productivity should be about using time wisely, and following appropriate practice guidelines as well as reimbursement guidelines.” Metzler says that Medicare is looking at including productivity elements in some payment systems: “What Medicare wants is to assure beneficiaries get good care efficiently and effectively.” Although this is what positive productivity can mean, Sara Androyna, COTA, says unrealistic productivity standards too often dehumanize people. “It is a turnoff in a job. I am not thinking about how productive I’m being today when treating a client. No, I am trying to figure out how I can help this person, and I am trying to be client centered.” Changes to reimbursement standards as a result of budget cuts and legislation could require health care companies to do more with less. But Metzler notes this may not be what happens. “As practice evolves and research supports new techniques, professionals and systems may find better ways of meeting individual needs that can also be less expensive,” she says. Boman says of health care that “the writing is on the wall that, unless some things change down the road to maintain the current financial state, more is going to need to be done by fewer people.” That means burnout could grow even more rampant as employees start to feel more robotic because they are dealing with bigger caseloads. Metzler observes that while this may be true, technological advances, thanks to the development of tablet computers and mobile apps, can help practitioners accomplish as much with less stress. She thinks that might temper the risks of burnout that come from time pressures, productivity demands, and caseload growth. Experts note that when considering whether you might be burning out, you must also consider your obligations in relation to the quality of care you are able to provide. It can sometimes be an ethical dilemma.
11

CONNECTIONS
Discuss this and other articles on the OT Practice Magazine public forum at http://www.OTConnections.org.

for More inforMation
AOTA CEonCD™ Ethics Topic—Moral Distress: Surviving Clinical Chaos By L. C. Brandt, 2009. Bethesda, MD: American Occupational Therapy Association. (Earn .1 AOTA CEU [1.25 NBCOT PDUs, 1 contact hour]. $45 for members, $65 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store. aota.org/view/?SKU=4840. Order #4840. Promo code MI) AOTA CEonCD™ Ethics Topic—Organizational Ethics: Occupational Therapy Practice in a Complex Health Environment By L. C. Brandt, 2009. Bethesda, MD: American Occupational Therapy Association. (Earn .1 AOTA CEU [1.25 NBCOT PDUs, 1 contact hour]. $45 for members, $65 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store. aota.org/view/?SKU=4841. Order #4841. Promo code MI) AOTA CEonCD™ Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition By AOTA Ethics Commission, 2011. Bethesda, MD: American Occupational Therapy Association. (Earn .3 AOTA CEU [3.75 NBCOT PDUs, 3 contact hours]. $105 for members, $150 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=4846. Order #4846. Promo code MI) Life Balance: Multidisciplinary Theories and Research Edited by K. Matsuka & C. Christiansen, 2009. Bethesda, MD: AOTA Press. ($55 for members/ nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=1243. Order #1243. Promo code MI) The Occupational Therapy Manager, 5th Edition By K. Jacobs & G. McCormack, 2011. Bethesda, MD: AOTA Press. ($79 for members, $112 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=1390C. Order #1390C. Promo code MI) AOTA CEonCD™ OT Manager Topics By D. Chisholm, P. Moyers Cleveland, S. Eyler, J. Hinojosa, K. Kapusta, S. Phipps, & P. Precin, 2011. Bethesda, MD: American Occupational Therapy Association. (Earn .7 AOTA CEU [8.75 NBCOT PDUs, 7 contact hours]. $194 for members, $277 for nonmembers. To order, call toll free 877404-AOTA or shop online at http://store.aota.org/ view/?SKU=4880. Order #4880. Promo code MI) Reference Guide to the Occupational Therapy Code of Ethics and Ethics Standards, 2010 Edition By D. Slater, 2011. Bethesda, MD: AOTA Press. ($44 for members, $62 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1139F. Order #1139F. Promo code MI)

AOTA frequently receives member questions about care as it relates to productivity standards, according to Deborah Slater, MS, OT/L, FAOTA, staff liaison to AOTA’s Ethics Commission and the Bylaws, Policies, and Procedures Committee. Productivity requirements are part of every workplace. Practitioners must remember to evaluate administrative mandates to ensure that ethics principles related to client care are not violated. Slater notes that what she discussed a 2006 OT Practice article4 about the ethical issues related to productivity requirements remains as true today as in 2006. In that article, Slater wrote, “A challenging reimbursement environment has the potential to give rise to unrealistic productivity requirements that are potentially illegal or unethical. Occupational therapy practitioners should remember that they have an obligation to exercise their professional judgment in making clinical decisions and to be in compliance with the Standards of Practice,5 Code of Ethics6 and applicable bylaws, regardless of organizational, supervisory, or peer pressure” (p. 30).4 The point of ethics standards for occupational therapy is to ensure clients receive care that is appropriate to their condition, beneficial to them, and does not cause harm. And Boman says that concept is an opportunity for practitioners to lobby on their own behalf, because even though companies are concerned with their financial bottom line, they also have to worry about the quality of the service they provide. That starts with satisfied and valued employees. “Patient satisfaction is becoming increasingly important to bottom line numbers. So that would be one thing as a manager that’s really important to pass along the leadership hierarchy— we really have to find ways to take care of our staff because they are the bread and butter of who we are,” Boman says. “If we don’t have staff to provide the services, then we are nothing.”
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BURNOUT EFFECTS
Companies that don’t take care of their staff end up with the kind of revolving door situation that Cassandra recently escaped. Burnout leads to reduced performance, high turnover, and poor patient care.7 Some estimates put employee turnover-related expenses at as much as 5% of a hospital’s annual budget,8 so it behooves companies to retain their employees, from both a bottom line and a quality of care perspective. As Cassandra looked for a new job, she sought a place that understood who its employees are and allowed them to pursue their professional interests and career goals. That’s why she settled on a clinic that has been in practice for more than 20 years. “It’s much more established, more streamlined, and my supervisors are interested in research and evidencebased practice,” Cassandra says. She is hoping that she won’t have to look for a new job anytime soon. “I want at be at one of the best clinics that is doing something important, doing something unique, doing something that is going to impact the profes-

sion—that’s my ultimate goal,” she says. “So if I can get involved in a place, if I can get my foot in the door, those are the places I want to work and where I want to be, and where I want to stay.” n References
1. Wood, B., & Killion, J. (2007). Burnout among healthcare professionals. Radiology Management, 29(6), 30–34. 2. Maslach, C. & Goldberg, J. (1998). Prevention of burnout: New perspectives. Applied & Preventive Psychology, 7, 63–74. 3. Schuster, N., Nelson, D., & Quisling, C. (1984). Burnout among physical therapists. Physical Therapy Journal, 64, 299–303. 4. Slater, D. (2006). The ethics of productivity. OT Practice, 19(11), 17–20. 5. American Occupational Therapy Association. (2005). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 59, 663–665. doi:10.5014/ajot.59.6.634a 6. American Occupational Therapy Association. (2005). Occupational therapy code of ethics (2005). American Journal of Occupational Therapy, 59, 639–642. doi:10.5014/ajot.59.6.639 7. Taris, T. (2006). Is there a relationship between burnout and objective performance? Work and Stress, 20, 316–334. doi:10.1080/02678370601065893 8. Waldman, J., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in healthcare. Health Care Management Review, 29(1), 2–7. Andrew Waite is the associate editor of OT Practice. He can be reached at awaite@aota.org.
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

Team Efforts to Serve Children Who Are Deaf or Hard of Hearing

Beyond Communications

MEREDITH GRONSKI

L
PHOTOGRAPH COURTESY Of ROBERT BOSTON PHOTOGRAPHY, WASHINGTON UNIVERSITY SCHOOL Of MEDICINE

ast spring, three preschoolers at a school for the deaf went out to the schoolyard for an experiential learning activity. The goal of the activity was to use the targeted vocabulary for that week’s “Garden and Flowers” theme while planting petunias. In this auditory-oral deaf education program, students learn to use their amplification devices to listen and use spoken language. As I joined the group in the garden, one boy did not have the upperextremity strength to grasp and scoop the packed dirt in the large planter pots, another little boy was resisting because he did not want to grasp the shovel handle that had potting soil on it, and a little girl was having such difficulty visually focusing on the task and sustaining attention that she was rarely in the vicinity of the work area. Each child was responding to the teacher’s verbal prompts and questions, but they were not working together to accomplish the task, engaging in conversational exchanges, or successfully performing the motor demands of the gardening activity.
OT PRACTICE • SEPTEMBER 24, 2012

How occupational therapy can help children who are deaf or hard of hearing with their intellectual, social, and emotional development, before, during, and after school.
CHILDREN WHO ARE DEAF OR HARD OF HEARING
In the United States, 2 to 3 of every 1,000 children are born with a congenital hearing loss.1 Not detecting hearing loss at an early stage in life can result in a decrease in educational performance and functional status; specifically, delays in developing receptive and expressive communication skills, learning problems, and social isolation and/or low self-esteem. As children develop physically and emotionally, their participation in academic activities sparks interests that will develop into meaningful postcurricular occupations. Occupational roles, both academic and nonacademic, are essential to intellectual, social, and emotional development. Conversely, lack of participation in educational activities can have a negative impact on overall academic success2 and thus, ultimately, the development of nonschool occupations. Research at the elementary school level has shown that children who are deaf or hard of hearing (D/HH) engage in fewer interactions with hearing peers.2–3 Without this interaction, children who are D/HH are not experiencing the same levels of social or academic group participation as their hearing peers, nor are they receiving the social and scholastic benefits that such participation provides. But occupational therapy can help. First, practitioners can educate teachers, families, and health professionals that the behaviors, academic delays, and social struggles of children who are D/HH are not “just because they are deaf,” but, rather, because they are deaf, they have more barriers to social
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participation. In addition, occupational therapists are qualified to screen for, evaluate, and ameliorate through remediation or compensation approaches for these deficits.This article will look at how occupational therapy practitioners can broaden their viewpoints to capture the distinct concerns of children who are D/HH, by first moving beyond individual intrinsic factors and measuring how children are building on their strengths to play and learn, and second broadening their sense of professional relatedness to build a new team of collaborators to best provide services for these children.

to poorer educational performance, restricted participation, and most importantly, diminished occupational performance compared with peers. Teachers of the Deaf and School Psychologists: Executive Function and Behavior Regulation The cognitive construct of executive functioning (EF), including problem solving, planning and organizing, time management, and the ability to shift and inhibit during the thought process, typically develops later in childhood and is integral to the student role.11 The very structure of a typical school

effective working memory processes, which negatively affect academic performance relative to their hearing peers.12–15 Occupational therapy practitioners have essential skills to teach these students cognitive and organizational strategies that not only can be used for academic work in the classroom but can also extend to support memory and everyday life skills. Furthermore, children who are D/HH have been reported to have behavioral problems related to impulsivity and an inability to focus attention. Although hearing individuals’ attention is at its peak in the center of the visual field, individuals who are D/HH show greater

A NEW TEAM
Audiologists and ENTs: Visual, Vestibular, and Balance Vestibular audiologists, who measure the pure functioning of the inner ear, and otolaryngologists (ear, nose, and throat (ENT) physicians) are important members on the team for a child who is D/HH. They provide access to essential information about auditory structures and function. Occupational therapists working with children who are D/HH should not overlook the need to gather more information about the child’s vestibular system. The vestibular system is responsible for stabilizing the position of the eyes, head, and body in space, and it helps one to maintain an upright stance.4 People who are D/HH frequently have vestibular dysfunction because the auditory and vestibular anatomical structures are continuous and linked in structure and organization. As a result, dysfunction or injury to the inner ear that leads to sensorineural hearing loss (SNHL) may also disrupt peripheral vestibular function.5 Delays in the area of vestibular control and motor development have been widely reported in children with congenital and acquired SNHL.6–9 Children with hearing loss start walking an average of 2 1/2 months later than their typical peers,10 a sign that may trigger a referral for an occupational therapy evaluation. A child who has delayed vestibular development can also have sensory integration dysfunction, slow visual processing, and reading disability.10 Hearing loss and delays in vestibular development can make the child susceptible
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day involves EF skills to move from subject to subject, both mentally and physically. Figueras, Edwards, and Langdon confirmed that there is a link between language and executive function skills.12 EF and language were positively correlated for both D/ HH groups and normal hearing groups. Children who use memory strategies such as sub-vocal rehearsal, or mentally talking themselves through tasks, have a greater memory capacity than those who do not use such aids. Although children with normal hearing and those who are D/HH both use memory strategies, the implementation of rehearsal methods were found to be delayed in the latter group, and, therefore, may put those in that group at risk for decreased memory spans and less

attention at peripheral locations.16 This greater peripheral processing has often been interpreted as greater distractibility in individuals who are D/HH. In terms of adapting to the environment, the attentional difference observed in students who are D/HH makes intuitive sense—a redistribution of visual attention to the periphery can compensate for the lack of peripheral auditory cues provided by the environment, such as the sound of an approaching vehicle or the creak of an opening door.17 This is an essential perspective that schoolbased occupational therapy practitioners can integrate into their classroom consultations. A child who is D/HH may have differences in the way he or she processes and responds to sensory information
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

PHOTOGRAPH COURTESY Of ROBERT BOSTON PHOTOGRAPHY, WASHINGTON UNIVERSITY SCHOOL Of MEDICINE

social media spotlight

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Backpack Day a Success for Polk State Students
http://otconnections.aota.org/blogs/media_relations/ archive/2012/08/30/backpack-day-a-success-for-polk-statestudents.aspx
Published Thu, Aug 30 2012 4:00 PM

Century Rehab @CenturyRehab

How can OTs help stroke patients? How can
you help? http://bit.ly/RnTMlQ
30 Aug

By Katie Riley Occupational therapy assistant students and instructors at Polk State College in Winter Haven, Florida, got an early start to celebrating Backpack Safety Awareness Day. “School starts in August in Florida, so we had to act a little ahead of Backpack Awareness Day,” said Craig Bowen, OTA/S, adding that he hopes sharing his group’s experience will encourage other OTs to participate in raising awareness. This year’s National School Backpack Awareness Day was September 19. Bowen said that the idea to get involved was sparked by Professor Robin Richmond, OTR/L, and the process to get involved was surprisingly simple. Knowing that they did not want to take on their own standalone event, Bowen and his classmates started by investigating already planned events in their area where they could showcase backpack safety. He contacted the director of Family Fundamentals of Polk County, a division of the United Way that hosts an annual Back to School Bash, and was welcomed with open arms to set up a booth at the event. More than 5,000 area students and their parents attended the August 4 event to receive free school supplies, many of which visited Polk State’s booth featuring Backpack Safety tips, stickers, and other information. “We weighed each child in order to educate them and their parents about the maximum weight that could be placed in their backpacks,” Bowen said. “We properly fitted each child in their backpack and each parent left with a copy of AOTA’s ‘Backpack Strategies for Parents and Students.’” For more from the Media Relations blog, visit http://otconnec

AOTA @AOTAInc RT@rhonda_conner: Great explanation of OT’s role w/ helping the development in important areas of Autistic child http://fb.me/P6iibEsN 20 Aug

Find us on Facebook www.aota.org/facebook
American Occupational Therapy Association shared a link. August 30 AOTA President, USC assoc. dean Florence Clark’s recent invite to get inside look at nation’s defense http://news.usc.edu/#!/article/40749/ trojan-gets-firsthand-look-at-nationsdefense-systems/ American Occupational Therapy Association shared a link. August 10 Olympic athletes inspiring you to get moving? Read this for motivation & to find your Olympic body match http://ow.ly/cRvvF 28 people like this
Fanny Marzanh I really admire how hard athletes push themselves and many times they accomplish what they put their mind into. Never give up keep going so easy to say it.
August 11 at 1:51 am via mobile

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On September 24, occupational therapy practitioners and students from across the country will come together in Washington, http://www.youtube.com/watc DC to meet with their elected officials to discuss key legislative h?v=BcVD44M06WM&list=PL issues affecting occupational therapy practice. They will come E022F2F3AAD16E93&index= intent on making a difference, in the lives of their clients and for 1&feature=plpp_video the profession of occupational therapy.

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SEPTEMBER 24, 2012 • WWW.AOTA.ORG

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AOTA Capitol Hill Day 2012

Published on Aug 30, 2012, by AOTAInc

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PHOTOGRAPH COURTESLY Of POLK STATE COLLEGE

Rehab Management @RehabMgmt Research May Hold Promise For New Technology To Verbalize Unspoken Words Of Paralysis Patients:... http://bit.ly/P9be25 #physicaltherapy 24 Aug

T E C H TA L K

Electronic Portfolios

s
n n n

Universally Designed Tools for Self-Advocacy
Karen Majeski
yearly progress as well as document their participation in work and life skills programs. The role of occupational therapists in developing e-portfolios is to identify the software and equipment available to develop them; identify the students’ technology skills; and develop a plan of action of portfolio development, including organizing, creating, and sharing the information. Teaching and troubleshooting certain technology concepts may be necessary for students to create their e-portfolios as independently as possible using upto-date technology. This transition program, which is for students ages 19 to 21 years, focuses on developing functional skills necessary for obtaining employment, living in the community, engaging in lifelong learning experiences, and socializing with people outside of the high school peer group. Technology skills are a main area of focus. Each student has his or her own electronic tablet or iTouch-type device that they use to take pictures throughout the school year of themselves and other students participating in various activities, including job training, life skill and leisure activities, and actual on-the-job duties. Using these photos, students create PowerPoint presentations for their e-portfolios. This is a dynamic and ongoing process that students in this program work on intermittently throughout the school year, with photographing activities, storing, and organizing these photos part of a monthly routine.

tudent portfolios have been in use in higher education and K–12 education for several years as a means to demonstrate student growth and abilities. Todd Bergman, an independent consultant and teacher at Mt. Edgecombe High School in Sitka, Alaska, defines a portfolio as “a purposeful collection of student work demonstrating the student’s achievement or growth characterized by a strong vision of content ” (p. 1).1 One variation is an electronic portfolio, or e-portfolio, which uses electronic multimedia to demonstrate one’s growth and abilities. E-portfolios accommodate different technology platforms and solutions, including those readily available in many classrooms, and they are not limited to a specific type of software program. E-portfolios let students engage in dynamic self-reflection and selfexpression using a highly visual format while still offering assistive technology supports and accommodations to students with special abilities.

AREA OF OCCUPATION
E-portfolios tap into several areas of occupation for our students. The photographs help students recall the activities they have participated in throughout their school year and offer a basis of discussion for describing the details of a certain task or activity. Adding these photographs to a PowerPoint presentation gives students a new method of self-expression and creativity through the use of different slide layouts and designs. Students show self-determination by creating slides depicting their favorite and least favorite jobs. Some students are able to type bulleted comments and phrases describing these activities. Others can narrate their presentation through voiceovers, favorite songs, and custom animations. Students with greater writing abilities can use additional assistive technology tools such as word prediction or voice activation software to enhance the writing in their e-portfolio. Students in the Cheshire Transition Program present their e-portfolios at their annual planning and placement team (PPT) meeting or exit PPT meeting with their prospective adult agencies, which provides them with a real-life opportunity to practice interview skills, self-advocacy, and public speaking. These e-portfolios tell a story about each student’s special abilities and successful engagement in occupations in a manner that can be more powerful and descriptive than the stu19

CONTExT AND ENVIRONMENT
At the Cheshire Public Schools Transition Program in Cheshire, Connecticut, e-portfolios demonstrate students’

Apps That Can Be Used as Electronic Portfolios
Three Ring (free). Students can use this app to create a “notebook” of their work, including handwritten work, artwork, digitally created work, and photographs. Coolibah (free). This app has a layout built in that allows users to share the electronic portfolio online, through e-mail, or via text. It is a basic scrapbooking app with layouts that can be modified by inserting photos and text. Minimal Folio ($2.99). Photos, PDFs, and video can be organized into a folio system. This system also allows for the use of the same materials to create multiple portfolios.

Note: These apps are available on iTunes.

OT PRACTICE • SEPTEMBER 24, 2012

CALENDAR
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA endorsement of content, unless otherwise specified. Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course has met the APP requirements and has been awarded AOTA CEUs. October Introduction to Driver Rehabilitation. Course designed for individuals new to the field of driver rehabilitation. Topics include program development, driver training, adaptive driving equipment, and program documentation. Course will also emphasize collaboration with mobility dealers and consumers and families. Contact ADED at 866-672-9466 or visit our Web site at www.aded.net.
practice of manual lymphatic treatment and bandaging skills; and one third to exercise, skin care, patient evaluation/assessment, pneumatic pumps, compression garments, patient self- management, and clinic set-up topics such as insurance, marketing, support groups, and equipment. Program includes hands-on opportunities to work directly with patients. Also offered in March and June. for additional courses, information, and registration, visit our Web site at www.chs-ce.uwm.edu or call 414-227-3123.

Continuing Education Sensory Integration Certification Program by USC/WPS Richmond, VA: Course 4: November 2–6 London, ON, Canada: Course 3: November 9–13 Philadelphia, PA: Course 4: December 7–11 For additional sites and dates, or to register, visit www.wpspublish.com or call 800-648-8857
D-6152

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Oct. 5-6

Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition, by AOTA Ethics Commission and presented by Deborah Yarett Slater. foundation in basic

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tion of Part I course, this intense practicum provides hands-on experience in administering, interpreting, and using evaluation results to develop intervention for visual processing deficits including eye movement disorders, hemianopsia, reduced visual acuity, and visual neglect. Offered only once a year. faculty: Mary Warren PhD, OTR/L, SCLV, fAOTA. Also Boston, MA, November 8–10, 2013. Contact visABILITIES Rehab Services: www.visabilities.com or (888) 752-4364, fax: (205) 823-6657.

Eval & Intervention for Visual Processing Deficits in Adult Acquired Brain Injury Part II. Continua-

Oct. 12–14

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The Power of Affect: Developing Human Potential Through DIRFloortime, Self-Determination and Mindsight. At Montclair State University,

Nov. 16–18

ethics information that gives context and assistance with application to daily practice and rationale for changes in the Occupational Therapy Code of Ethics and Ethics Standards 2010. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4846, AOTA Members: $105, Nonmembers: $150. http:// store.aota.org/view/?SKU=4846

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Montclair, NJ. Register at registration@icdl.com or www.floortime.org. AOTA CEUs Available!

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Chattanooga, TN

Nov. 3–13

Lymphedema Management. Certification courses in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and advanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certification for compression-garment fitting included. Certification course meets LANA requirements. Also in Dallas, TX, November 3–13. AOTA Approved Provider. for more information and additional class dates/locations or to order a free brochure, please call 800-863-5935 or log on to www. acols.com. Lymphedema: The Next Level (3 Day). This course is designed for certified lymphedema therapists who want to acquire more in-depth knowledge in specific treatment areas, increase “hands on skills” in these areas, and learn additional treatment skills through group discussions. Topics include Into the Tissue: A Deeper Look at Lymphedema Treatment; Treatment of the Bariatric Patient Population; MfR and Kinesio Taping for Lymphedema; Edema and Wound Management: Assessment, Treatment and Case Studies; and Treatment Techniques That Will Enhance CDT Delivery to Our Patients. for additional courses, information, and registration, visit our Web site at www.chs-ce.uwm.edu or call 414-227-3123.

Internet & 2-Day On-Site Training

Shoshana Shamberg, OTR/L, MS, fAOTA. Over 22 years specializing in design/build services, technologies, injury prevention, and ADA/504 consulting for homes/jobsites. Start a private practice or add to existing services. Extensive manual. AOTA APP+NBCOT CE Registry. Contact: Abilities OT Services, Inc. 410-358-7269 or info@aotss.com. Group, COMBO, personal mentoring, and 2 for 1 discounts. Calendar/info at www.AOTSS.com. Seminar sponsorships available nationally.

Become an Accessibility, Home Modifications & Ergonomic Jobsite Consultant. Instructor:

influence ethical decision making and strategies for addressing pressure from administration on services in conflict with code of ethics. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4841, AOTA Members: $45, Nonmembers: $65. http://store .aota.org/view/?SKU=4841

CEonCD™

Ethics Topics—Moral Distress: Surviving Clinical Chaos, by Lea Cheyney Brandt. Complex nature

Self-Paced Clinical Course

of today’s health care environment and results in increased moral distress for occupational therapy practitioners. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4840, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4840

Milwaukee, WI

Nov. 8–11

community mobility issues are complex and changes in independence are life-altering. This comprehensive SPCC gathers researchers and clinicians in a team effort to offer expert guidance in this developing practice area. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3031, AOTA Members: $259, Nonmembers: $359. http://store. aota.org/view/?SKU=3031

NEW! Driving and Community Mobility: Occupational Therapy Strategies Across the Lifespan, edited by Mary Jo McGuire, MS, OTR/L, FAOTA, and Elin Schold Davis, OTR/L, CDRS. Driving and

CEonCD™

Let’s Think Big About Wellness, by Winnie Dunn.

Official documents and materials that support OT concept of wellness, interdisciplinary literature, and models from other disciplines. Earn .25 CEU (3.13 NBCOT PDUs/2.5 contact hours). Order #4879, AOTA Members: $68, Nonmembers: $97. http://store .aota.org/view/?SKU=4879

CEonCD™

CEonCD™

West Bend, WI

Comprehensive Lymphedema and Venous Edema Management (6-Day Certification Course). One
third of the course is devoted to lymphatic system anatomy and physiology; one third to theory and
OT PRACTICE • SEPTEMBER 24, 2012

Nov. 12–17

The Occupational Therapy Manager, 5th Edition with additional applications relevant to selected issues on management. Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota. org/view/?SKU=4880

OT Manager Topics, by Denise Chisholm, Penelope Moyers Cleveland, Steven Eyler, Jim Hinojosa, Kristie Kapusta, Shawn Phipps, and Pat Precin. Supplementary content from chapters in

Framework supports practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4829, AOTA Members: $73, Nonmembers: $103.50. http:// store.aota.org/view/?SKU=4829

Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition, by Susanne Smith Roley and Janet V. DeLany. Ways in which

Online Course

Occupational Therapy in Action: Using the Lens of the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition, by 21

CALENDAR
PDUs/6 contact hours). Order #OL33, AOTA Members: $180, Nonmembers: $255. http://store.aota. org/view/?SKU=OL33

aota SPecialty coNFereNce

adults With Stroke
November 30–December 1, 2012 baltimore, marylaND earn Up to 13 contact Hours (1.3 aota ceUs/13 Nbcot PDUs)

REhABIlITATION, DISABIlITY, & PARTICIPATION

Self-Paced Clinical Course

Dysphagia Care and Related Feeding Concerns for Adults, 2nd Edition, edited by Wendy Avery.

Up-to-date resource in dysphagia care written from an occupational therapy perspective for OTs at entry and intermediate skill levels. Earn 1.5 AOTA CEUs (18.75 NBCOT PDUs/15 contact hours. Order #3028. AOTA Members: $199, Nonmembers: $299. http://store.aota.org/view/?SKU=3028

Self-Paced Clinical Course

tive, computer-based learning to present the anatomical basis and clinical presentation of problems in the hand and forearm and preparation for Hand Therapy Certification Exam. Earn 1.6 CEUs (20 NBCOT PDUs/16 contact hours). Order #3017, AOTA Members: $182, Nonmembers: $252. http://store. aota.org/view/?SKU=3017

The Hand: An Interactive Study for Therapists, by Judy C. Colditz. Written coursework with interac-

register now at www.aota.org/confandevents/stroke A stroke can take meaning out of life, but occupational therapy can restore it.
An estimated 5.4 million people in America live with the disabling effects of stroke and that number is bound to increase in the years to come. Occupational therapy must take the lead in stroke rehabilitation for survivors, families and caregivers, so join us this fall at Adults With Stroke and take advantage of top-level continuing education!

CEonCD™

Occupation-Focused Intervention Strategies for Clients With Fibromyalgia and Fatiguing Conditions, by Rénee R. Taylor. Evidence-based strate-

gies for managing fibromyalgia and other fatiguing conditions, such as chronic fatigue syndrome, with interdisciplinary treatment approaches and collaboration with other professionals. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4839, AOTA Members: $68, Nonmembers: $97. http:// store.aota.org/view/?SKU=4839

CEonCD™

Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations, by Reneé R. Taylor. Examines strategies

for managing client pain, fear, and avoidance in OT practice with six distinct modes of interacting based on the author’s conceptual practice model. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4836, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4836

CEonCD™

Hand Rehabilitation: A Client-Centered and Occupation-Based Approach, by Debbie Amini.

Occupation-based intervention to enhance hand rehabilitation protocols without sacrificing productivity or detracting from the concurrent client factor focus. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4832, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4832

ASHT Test Preparation. Comprehensive overview of all topics related to upper extremity rehabilitation with 25 PowerPoint™ chapters and more than 2,000 slides and sample multiple-choice test questions. Earn 30 AOTA approved contact hours (3 AOTA CEUs/30 NBCOT PDUs). Order #4850, AOTA Members: $300, Nonmembers: $450. http://store.aota. org/view/?SKU=4850

Available From AOTA

Join us on the road to the Centennial Vision at
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SEPTEMBER 24, 2012 • WWW.AOTA.ORG

e ploy ent opportunities EMPLOYMENT OPPORTUNITIES
Midwest Faculty

Occupational Therapist
Long-term sub needed 2 days/week for 2012–2013 school year. Provide specialized eval/instruct/ consult services to meet unique education needs of students with fine motor & related impairments. BA degree required, MA preferred. Current IA OT license & NBCOT required. Open until filled. Start on or after Sept 18. HR Manager 1520 Morningside Avenue Sioux City, IA 51106 Application/instructions: www.nwaea.org 712-222-6114
M-6156

EOE/AA

henandoah University’s Division of Occupational Therapy (SUDOT) invites applications for Program Director. This position provides opportunities to lead our cutting edge of curricular hybrid design for entry level occupational therapy and develop multiple programming initiatives including our entry level program in Jerusalem (launch date expected August, 2013) and an OTD. We are seeking dynamic and innovative leaders who will continue to build on a strong program foundation involving use of technology in practice and education, integration of research and practice, community-based experiential learning opportunities, and studentfaculty mentored research. Duties include but are not limited to program development and curricular design, engagement in interdepartmental and university-wide collaboration, engagement in teaching responsibilities in the applicant’s area of expertise, development and enhancement of current relationships with area agencies and community partners, and participation in scholarly activity in collaboration with students. Additional requirements include providing general oversight of all division activities including human resources, budget, curriculum, facilities, admissions, and accreditation. Pre-employment background check is required. Qualifications: Candidates must have an earned doctorate, 6 years of clinical experience, a minimum of 4 years of teaching experience, a background in management/administration, and evidence of scholarly work. Experience with Web-based learning platforms (i.e., Blackboard) is strongly recommended. Application Procedure: Send a letter of interest including a statement of your philosophy of education and teaching, current C.V., and contact information for three professional references to Shenandoah University-OT, Office of Human Resources, 1460 University Drive, Winchester, VA 22601 or e-mail all of the above to HR4U@su.edu and indicate “Program Director OT” in the subject line.
We encourage and support diversity in the workplace. EOE. Faculty
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Program Director, Division of Occupational Therapy

DEPARTMENT OF OCCUPATIONAL THERAPY
Assistant/Associate Professor, Tenure-Track Beginning September 1, 2013
New York University, founded in 1831, is located in the Greenwich Village area of New York City, a world class city famous not only for its size, but also for its cultural health and financial leadership. Ranked 10th in the nation, the Department of Occupational Therapy is one of the oldest, largest occupational therapy departments in the United States. The combined resources of the city, the university and the department incorporate an incomparable learning environment for professional and personal growth. Responsibilities: An active agenda of research and publication; graduate teaching and the ability to advise doctoral dissertation research. Participation in faculty meetings, committees and other service appropriate to a university faculty member is expected. Qualifications: An earned research doctorate and a record of high level competency in scholarship and teaching experience for occupational therapy. Applicant must be eligible for the New York State license in Occupational Therapy upon hire. NYU’s dynamic Global Network University includes NYU Abu Dhabi and international programs and academic centers around the world. NYU Steinhardt faculty may be afforded the opportunity for variable term work at these global study and research sites. NYU is committed to building a culturally diverse educational environment and strongly encourages applications from historically underrepresented groups. To Apply: Please apply online with a two-page letter of interest highlighting qualifications, curriculum vitae, three letters of reference, and at least two samples of peer reviewed publications. The three letters of reference should be submitted online directly to the committee by the referees. www.nyuopsearch.com/applicants/Central?quickFind=51043 Further information about the position can be obtained from: Kristie P. Koenig, Ph.D., OTR, FAOTA, Chair of the Search Committee, New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, 35 West 4th Street, Room 1103 New York, NY 10012-1172, email: occupational.therapy@nyu.edu. Ph: 212-998-5825

New York University is an Equal Opportunity/Affirmative Action Employer.
OT PRACTICE • SEPTEMBER 24, 2012

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Advance Your Practice with Young Children and Their Families!

Early Childhood:

Occupational Therapy Services for Children Birth to Five
Self-Paced Clinical Course
Edited by Barbara E. Chandler, PhD, OTR/L, FAOTA Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours) Experiences in early childhood resonate throughout a child’s life and affect all aspects of development, both positively and negatively. Occupational therapy can bring broad-based, holistic, strengths-based, and functional perspectives and practices to children at the earliest stage of their lives. This new Early Childhood SPCC is a journey of occupational therapy in early childhood. It aims to develop perspectives, knowledge, and skills to improve the ability of occupational therapy professionals to have a positive impact on the lives of the recipients of their services, including children and families, teachers, and child care providers. Each chapter provides cases to illustrate important concepts.

Course Highlights Include
• Service Provision Systems • Infant, Toddler, and Young Child Development • Family-Centered Practice • Models and Process of Service Provision • Evaluation, Assessment, and Outcomes • Promoting and Using Rhythms of Daily Life • Play in Early Childhood • Assistive Technology

Order #3026 AOTA Members: $259 Nonmembers: $359

CE-171

Linking Research, Education, & Practice

Continuing Education

To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/?SKU=3026

Living Life To Its Fullest
OT Reflections From the Heart

The Occupational Therapy Aide Bar

t
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A Historical Milestone of the Girl Scout Centennial
Naomi Schubin Greenberg
ments) we would stand at the curb and wave to Frank Sinatra, whose parents were customers of our parents, as he waved to us from the float at the end of the parade. I was a lot younger when I enjoyed the primitive conditions of outdoor row sinks at Girl Scout camp. The memories were awakened and proved useful as I accompanied occupational therapy and occupational therapy assistant students on a mission to Nicaragua. We had the same kind of outdoor sinks, but in Nicaragua, the water went straight to the ground. There was no plumbing to carry it to a sewer for waste disposal. In that outdoor sink at the conference center in Jinotepe, I washed my clothes with a washboard, perhaps something I had also learned at Girl Scout camp or at home in Hoboken, New Jersey. It was at camp that we sat around the brick fireplace in the Girl Scout courtyard. It was there that we learned to line up for inspection, which included our uniforms and our nails. It was there that we sang with strong voices and learned to play group games. The friendships bonded and reinforced group identities. Girl Scouts meant more than good times. As my colleague Carole Lazorisak, who created the Sign Language merit badge, remarked, “Through my experience with Girl Scouts, I developed various skills, such as personal, marketing, and leadership skills; also character and value building!” We salute the Girl Scouts on the centennial and for early recognition of occupational therapy as a career to explore. n
Naomi Schubin Greenberg, OTR, MPH, PhD, is a professor of occupational therapy at LaGuardia Community College in Long Island City, New York.
SEPTEMBER 24, 2012 • WWW.AOTA.ORG

he year 2012 marks the centennial celebration of the Girl Scouts, whose founder, Juliette Gordon Low, organized the first troop on March 12, 1912, in Savannah, Georgia. In 1953, Girl Scouts introduced the Occupational Therapy Aide Bar, which lasted until 1962. That purple metal bar, one of the first Senior Aide Bars, was the catalyst that led to my career of more than 50 years. Were you also one of those few individuals able to earn an Occupational Therapy Aide Bar in the few years it existed? To earn an aide bar required volunteer work in the designated field. What a terrific way to promote the field of occupational therapy! Each of the merit badges I earned as a girl scout focused on a particular occupational performance area. Among those I earned while exploring and learning new skills were housekeeping, cooking, sewing, orienteering, playing games, hiking, and even good grooming and citizenship. Each merit badge was an adventure in pursuing something new, setting goals toward the requirements, and demonstrating that they had been met. Without my being aware of it at the time, each merit badge laid the groundwork for another step toward my occupational therapy career and the variety of occupations that I could consider for my future clients. The specific craft skills also proved helpful for my teaching position in an occupational therapy crafts lab. La Guardia Community College, where I work today, continues to expect its students to learn and teach woodworking, leather crafts, finger painting, water painting, mosaics, ceramics, macramé, and a form of weaving.

The author as a Brownie and in her college office wearing her badge sash.

Girl Scouts also meant events and experiences that went beyond the specific awards earned. It was on a Girl Scout trip that I first went to Washington, DC. Perhaps that’s what triggered my travel to almost 100 countries, many in conjunction with occupational therapy. Pictures from the Girl Scouts trip show our senior scout troop posing together at one monument after another in our nation’s capital. When I saw the white flowers emerge this spring, I immediately began singing the words to myself, “White coral bells upon a slender stalk, lilies of the valley deck our garden walk.” Yes, another occupation I experienced in Girl Scouts—group singing. It was an accepted part of my life that after school I would go straight to my parents’ store to wait on customers, and as I took their cash to the register I would try to entice them to consider adding a box of Girl Scout cookies to their purchase. How we loved to march with the Brownies and Girl Scouts in the parades that passed in front of our parents’ store. After I finished playing the fife (another Girl Scout occupation—musical instru-

PHOTOGRAPHS COURTESY Of THE AUTHOR

AOTA
 in 

93rd annual conference & expo

San diego cAlifOrniA
april 25–28, 2013
plAn TOdAy fOr 2013!
Bring your family and visit ocean life at Sea World, stroll the beautiful Pacific Coast, and see pandas at the zoo. Shopping and dining are all within walking distance from the convention center and hotels.

Education Article

(one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Earn .1 AOTA CEU

An Approach to Assessment of and Intervention for Adults With Sensory Processing Disorders
TERESA A. MAY-BENSON, SCD, OTR/L, FAOTA
Director of Research and Education The Spiral Foundation, Newton, MA

MOYA KINNEALEY, PHD, OTR, FAOTA
Faculty Emeritus, Temple University, Philadelphia, PA

home-based intervention. However, this model does not address the full range of sensory and motor dysfunction seen in SPDs such as sensory discrimination, postural-ocular skills, or praxis needs. Thus, a more comprehensive framework of practice that encompasses all aspects of OT-SI practice is needed for adults with SPD.

ABSTRACT
Occupational therapists using a sensory integrative frame of reference routinely assess and treat children with sensory processing disorders (SPDs). However, similar services for adults with SPDs are less available, perhaps in part because therapists feel unqualified or unprepared to work with this population. This article presents a conceptual framework for guiding occupational therapists in assessing, intervening with, and setting priorities for adults with an SPD, whether the focus is on specific body function difficulties, activities of daily living, or full participation in daily life.

UNDERLYING ASSUMPTIONS REGARDING INTERVENTION WITH ADULTS
Occupational therapy practitioners must first understand and appreciate several important facts when working with adults with SPDs. First, recent studies suggest that sensory modulation problems, especially for tactile and auditory defensiveness, are partly hereditary (Van Hulle, Lemery-Chalfant, & Goldsmith, 2007), supporting SPD as a unique diagnosis and not just an aspect of some other disorder, such as anxiety. Further, adolescents and young adults do not “grow out” of their sensory and motor difficulties. Research on motor skills demonstrates that children with motor problems do not grow out of their clumsiness (Cermak, Trimble, Coryell, & Drake, 1991; Cousins & Smyth, 2003) but continue to demonstrate difficulties in these areas into adulthood. Similarly, May-Benson and Patane (2010) found adults seeking OT-SI services for the first time reported remarkably little change in their signs and symptoms of sensory and motor dysfunctions from childhood to adulthood. Kinnealey, Oliver, and Wilbarger (1995) found that although adults reported they developed coping mechanisms to manage their sensory problems, thus making symptoms appear less severe over time, the problems persisted, resulting in deleterious effects on emotional and mental health, daily life functioning, and participation in desired daily life activities. In addition, adults with SPDs frequently are not aware that their perceptions differ from others. Their sensory and motor problems are lifelong difficulties that are their lived experience and the only reality they know. For example, when discussing with an adult that the evaluation finding of double vision was a sign of oculomotor difficulty, she remarked, “You mean everyone does not see double?” Thus, occupational therapy practitioners must appreciate the lifelong nature of sensory integration and processing problems for adults with SPDs and the profound impact these difficulties have on these individuals. Further, the effect of managing these lifelong sensory difficulties on quality of life is well documented. Kinnealey et al. (1995) and Kinnealey, Koenig, and Smith (2011) reported adults with sensory modulation problems may manage their sensory symptoms to the detriment of their quality of life. Heufner, Cohn, and Koomar (in press) found mothers of
CE-1

LEARNING OBJECTIVES
After reading this article, you should be able to: 1. Identify four areas of assessment important for comprehensively evaluating adults with SPDs. 2. Identify the two major areas of intervention for adults with SPDs. 3. List the subcomponents of each area of intervention for adults with SPDs. 4. Recognize four coping strategies used by adults with SPDs.

INTRODUCTION
Occupational therapy practitioners using a sensory integration frame of reference have become increasingly aware in recent years of the need to address the sensory concerns of adults as well as children. Adults with sensory processing disorder (SPD) are increasingly seeking sensory integration– based occupational therapy (OT-SI) services and frequently report they are not able to locate occupational therapy practitioners who are willing or able to treat them. This is particularly true for adults with co-morbid mental health issues and adults with developmental disabilities, such as autism. Occupational therapy practitioners are often educated in using a sensory integration frame of reference with children; however, formal education on applying sensory integration principles with adults is lacking. Thus, therapists may not be sure how to approach assessment and intervention of older clients. For adults with sensory modulation difficulties, Kinnealey (2012) and Pfeiffer (2012) articulated a model of intervention focused on self-advocacy, sensory diets, and
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AOTA Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

children with SPDs who had sensory problems themselves reported that their own sensory issues negatively affected their ability to mother and actively engage with their children, especially if a child’s sensory needs were different than their own. In addition, Koomar (2012) interviewed adults with SPDs and found sensory processing issues negatively affected their quality of life. They felt constantly overwhelmed or exhausted from managing and coping with sensory experiences, under constant stress and anxiety from sensory experiences, and unable to do or enjoy many daily life activities. Thus adults with SPDs experience a lifetime of living with adverse sensory and motor functioning, which shapes their perceptions of the world and forms a foundation for possible problems with their emotional and mental health. Recent publications have described the sensory and motor needs and patterns of function and dysfunction of adults with SPDs and highlighted the high frequency of co-morbid mental health diagnoses, especially trauma, anxiety, and depression (Kinnealey et al., 1995; May-Benson, 2011; Pfeiffer, 2012). Problems in mental health are one reason adults seek OT-SI services. May-Benson and Patane (2010) examined the clinical records of adults seeking OT-SI therapy services and identified three major reasons for referral: (1) socialemotional and interpersonal difficulties, especially with significant others; (2) anxiety, over-arousal, and a desire to be calm and relaxed; and (3) functional motor and organization problems interfering with participation in desired daily life and leisure activities. Many adults, because they had never heard of OT-SI or did not think it applied to them, indicated that OT-SI services were their last resort after seeking other medical or mental health services with no relief. An approach for assessment and intervention that addresses the unique complexity of needs of adults with SPD is needed to assist occupational therapists in navigating the assessment and intervention process for this particular population. Based upon the World Health Organization’s International Classification of Function, the framework presented in this article articulates specific areas of assessment and intervention to be addressed, and it provides a roadmap to guide therapists through the assessment and intervention process for adults with SPD, including effective intervention tools and activities.

EVALUATION
Assessment of adults with SPD should be as comprehensive as possible, although adults often want to spend their resources on intervention and not on an extensive, potentially costly evaluation. Comprehensive OT-SI assessments encompass physical, cognitive, and social-emotional functions in order to determine factors that both facilitate and inhibit clients’ participation in occupations and quality of life. These areas later guide prioritization and selection of intervention activities.
CE-2

Performance skills that should be addressed in a comprehensive assessment include sensory perceptual, motor and praxis, emotional regulation, cognitive, and social skills. Specific areas may include sensory processing of both modulation and discrimination of inputs, postural control, ocular motor and functional vision skills, motor control and praxis, and cognitive functions such as memory and attention. To directly evaluate these areas, May-Benson (2009) described a process and materials that may be used in conjunction with structured self-report sensory histories such as the Adult Sensory Profile (Brown, Tollefson, Dunn, Cromwell, & Filion, 2001) or therapist-directed sensory interviews such as the ADULT-SI (Kinnealey & Oliver, 1999). Further, Champagne and Koomar (2012) and Champagne, Koomar, and Olson (2010) described sensory integration–based assessment processes and tools specifically for adults with mental health concerns. Additional assessments of body-level functions that may be useful for adults with and without mental health concerns include the Quick Neurological Screening-3 (Mutti, Martin, Sterling, & Spalding, 1999), the Motor-Free Visual Perceptual Test (Colarusso & Hammill, 2003), the Dynamic Loewenstein Occupational Therapy Cognitive Assessment (Katz, Livni, Bar-Haim Erez, & Averbuch, 2011), and the Allen Cognitive Scale (Allen, 1990). Social-emotional concerns, including clients’ beliefs, desires, self-esteem, and emotional state, are best assessed through a comprehensive semi-structured interview such as the ADULT-SI (Kinnealey & Oliver, 1999). Goal-setting tools such as Goal Attainment Scaling (Kiresuk, Smith, & Cardillo, 1994) or the Canadian Occupational Performance Measure (Law et al., 2005) are recommended to gather relevant information and establish intervention goals. Occupational therapists may wish to use tools such as Beck’s Anxiety Scale (Beck & Steer, 1990) or Beck’s Depression Scale (Beck, Steer, & Brown, 1996) to screen for mental health issues such as anxiety or depression and identify areas of emotional health that they may need to support during intervention. In addition, re-assessment using both of the Beck scales after a period of intervention may help therapists and clients identify whether these emotional issues are improved by the sensory integration intervention or whether more direct mental health intervention is needed. Adults with SPDs may have difficulties with eating, sleeping, working, and participating in leisure and social activities. This information may be obtained during the interview process and from sensory histories such as the Adult Sensory History (Koomar, Hurwitz, Kahler-Reis, & Szklut, 1996). The Kohlman Evaluation of Living Skills (Thomson, 1992) or the Adaptive Behavior Assessment System (Harrison & Oakland, 2003) may help identify difficulties in specific areas of occupational performance. During assessment, therapists should identify what affects occupational performance the most. For instance, if a client does not dress appropriately for work, is
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