Vol. 24 Issue 2 Page 12
Vision Watch
By E.J. Brown
Welcome to the new ADVANCE Vision Watch page! In this space once a month we plan to keep you up to date on how the march toward occupational therapy's centennial anniversary in 2017 is progressing.
The Centennial Vision is a multifaceted roadmap AOTA created in 2003 to move the profession into higher worldwide standing medically, professionally and publicly by its 100th birthday. The goal is to make OT a sought-after service-one that is based on scientifically driven treatment protocols that meet society's occupational needs.
That means OT needs to become tighter-with more specific and unified educational standards, evidence-based protocols in all six practice areas, qualified status as mental health practitioners and recognized status in wellness and community health.
In order to reach these goals, the national association is building the foundations for upgrades in all these areas (see "Envisioning the Road to 2017," June 25, 2007).
ADVANCE has identified related goals in each of the six practice areas that we believe are essential for achieving the vision. We will track one in this department each month, and advocate for all of them at the state and national levels. Most of them have already been on the drawing board for many years.
Children and Youth
Although pediatric OTs and OTAs have worked on sensory processing disorders with children for more than 40 years, the condition still has no defined standing in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the book that codifies mental diagnoses, so insurers will not pay to treat it. Getting a new diagnosis into the book is very difficult, but sources say it is possible that SPD could be added to the DSM V in 2012 in a footnote, as a condition that qualifies to be more keenly studied.
In school-based OT, response to intervention (RtI) is now allowing therapists to come in and evaluate typical children having specific difficulties in school as they occur. It's important to encourage this kind of approach, to allow occupational therapists to use their skills when and where they are most necessary.
Productive Aging
OT must become a qualifying primary Medicare provider in home care. Currently, a PT or SLP must open a home care case before an OT can go in. The face of home care is already changing, however, and by 2017, many patients may be monitoring aspects of their own medical care at home. The potential for OTs working with patients in their homes in the future is huge.
Mental Health
During the 1990s, the number of OTs working in mental health dwindled far enough to disqualify them in many states from remaining on the list of recognized mental health providers. It's important that state OT associations examine their states' mental health provider requirements and work with AOTA to get practitioners back on the lists.
Health and Wellness
Health and wellness includes an array of services that contribute in many different ways to people's general health or perception of well being. OTs who undertake practice in this area as private practitioners working with undiagnosed private-pay clients on general wellness goals should now look for various certifications for health and wellness professionals, such as certified health education specialist (CHES) or others. Clinicians also might look for referrals from physicians whose patients need to make lifestyle changes in order to get chronic illnesses under control.
Work and Industry
Getting states to establish OT-friendly protocols for rehabilitation under Workers' Compensation will be necessary to maximize OT participation in this area of practice. Some states are beginning to organize around function-based protocols-that is, actual job-related tasks as treatment rather than just strengthening. As OTs strive to put evidential foundations under their treatment approaches, they should look to tools that will enhance this approach.
Rehabilitation, Disability and Participation
When the U.S. government introduced "Ticket to Work" in 1999, many rehab specialists hoped it would take off to bring their clients with disabilities new opportunities to undertake paid employment. The program operates through employment "networks" that offer people with disabilities help getting around some of the barriers that prevent them from going to work. Getting qualified as a provider under the plan had its complications, but the real problem has been that many clients are not using Ticket to Work because they have been unable to find jobs that paid them more than what they were being given in Social Security Disability Insurance payments.
The program needs to be revamped to avoid that pitfall. New work-at-home options may be available to some with current technology. It is also vital that OTs bring their psychosocial skills back into physical disabilities to aid their clients in overcoming their fears of change as they take on new responsibilities.
E.J. Brown is editor of ADVANCE.
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