OT Practice November 26 Issue

AOTA T H E
A MERIC A N
OC CUPAT IONAL
T HE RAPY
ASSOCIAT ION
NOVEMBER 26, 2012
The Gaps paThways projecT

PLUS
and
Meeting the Driving and Community Mobility Needs of OT Clients
Emerging OT Practice in Developing Nations Motor Vehicle Accident Prevention Revising the Practice Framework News, Capital Briefing, & More
CE ARTICLE
Collaborative Intraprofessional Education With Occupational Therapy and Occupational Therapy Assistant Students
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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 21 NOVEMBER 26, 2012, 2012
FEATURES
The Gaps and Pathways Project
Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org

OT Practice External Advisory Board
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 Sharon Kurfuerst: Chairperson, Administration & Management 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
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 ILLUSTRATIONS TOTLAND & WOODCOCK / ISTOCKPHOTO
Meeting the Driving and Community Needs of Our Occupational Therapy Clients
Elin Schold Davis and Anne Dickerson describe new efforts to provide occupational therapy practitioners with expanded guidance for helping clients with driving.
DEPARTMENTS
News Capital Briefing
Medicare CY2013 Fee Schedule Final Rule: New Requirements for Outpatient Therapy
2 5
Going Global in Guatemala
14
Practice Perks
Revising the Occupational Therapy Practice Framework
6 7 20
Supporting Emerging Occupational Therapy Practice in Developing Nations

Steve Taff and Catherine Hoyt discuss Washington Universitys Occupational Therapy Program work with universities, clinics, and other health care facilities in Guatemala.
In the Clinic
Reaching Beyond Clinic Walls: Motor Vehicle Accident Prevention
Tech Talk
Tech Support for the Emotional Regulation Needs of Children and Adolescents With Autism
Social Media Spotlight
Updates From OT Connections, Instagram, Facebook, and Twitter,
22 23 28 32
Calendar
Continuing Education Opportunities
Collaborative Intraprofessional Education With Occupational Therapy and Occupational Therapy Assistant Students. Earn .1 AOTA CEU (1 contact
hour or 1.25 NBCOT professional development units) with this creative approach to independent learning.
CE Article
Employment Opportunities Questions and Answers

Elaine Adams
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 Practices 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 Practices 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 AOTAs Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.
OT PRACTICE NOVEMBER 26, 2012
News
Association updates...profession and industry news
AOTA News
confidence that transportation will not be a barrier to independence. Throughout the week, AOTA will bring attention to a different aspect of older driver safety. Go to www.aota.org/old er-driver/awareness for more. outpatient therapy. Information provided on these calls (including therapy documentation guidelines and clarifying supervision requirements) can be found on CMSs Web site (www.cms.gov) by searching open door forums. On the October 22 call, CMS leadership and contractor representatives addressed some of the ongoing problems with the pre-approval process, but not all of the issues that providers and associationsincluding AOTAhave reported. For more, check out the article on manual medical review in the Advocacy News section of AOTAs Web site. The Master of Occupational Therapy program will receive a 1-year allocation of $604,925 from the U.S. Department of Health and Human Services HRSA Scholarships for Disadvantaged Students program.
Call for Spring RA Motions

ant to become an active participant in your Congress, the Representative Assembly (RA)? Give thought to the professional issues you encounter, and draft motions that you would like to be considered by the RA at its spring meeting in San Diego. Specific instructions on how to write motions are found at www.aota.org/governance/ra. Contact any of the RA officials or your representative(s) for advice on whether your idea should be a motion and to discuss appropriate topics and issues for policy changes. For the names(s) of the officials or your representative(s), go to the Members section of AOTAs Web site and click on Get Involved/Governance, then Representative Assembly for the RA Roster. Alternatively, you can call AOTA at 800-SAYAOTA (729-2682), ext. 2103, or contact Laurel Radley at lradley@aota.org for assistance. The deadline for submitting motions to be considered at the RA Spring Meeting is January 1, 2013.
Upcoming Chat
OTA will host a pediatric virtual chat on Common Core Standards: Role for Occupational Therapy on December 10 at 11:00 a.m. EST. To participate and view chat archives, visit www.talkshoe. com/tc/73733.
OT4OT Archives Posted
Call for Papers Issued for AOTAs Education Summit

OTA invites educators, scholars, postprofessional graduate students, and clinicians who share the common vision of enhanced understanding of teaching and learning in occupational therapy and occupational therapy assistant degree programs to submit a proposal for presentation at the upcoming Education Summit, to be held in Atlanta from October 4 to 5, 2013. Submissions are due January 15, 2013. For additional information, e-mail specialtyconference@aota.org or visit www.aota.org/confandevents/ education-summit.
issed out on the Online Technology for Occupational Therapy (OT4OT) webinars? Thats OK. The content is still accessible at http:// ot4ot.com/ot24vx2012. Topics range from cultural balance to sensory integration and crafts occupations.
Pictures Worth $1,000
Resources
he World Federation of Occupational Therapists (WFOT) has announced its inaugural online photograph competition. WFOT is asking practitioners to capture images of their work around the world. The competition will run until May 15, 2013, with prizes totaling $1,000 available for 1st, 2nd, and 3rd place winners. For more on the competition, including access to a downloadable promotional poster, visit www.wfotphotos.com.
Research Webinars
nterested in research and/ or education? Check out the free webinar on Career Explorations: OT Professor or Researcher, led by Susan Lin, ScD, OTR/L, AOTAs director of Research, and available at http://vimeo.com/49859468. Those interested in this webinar might also appreciate a free webinar developed by the Center for Rehabilitation Outcomes Research, with the support of the Retirement Research Foundation, that discusses issues related to using outcome measures in geriatric rehabilitation. The webinar can be found at www.rehabmeasures.org/ rehabweb/resources.aspx.
Older Driver Safety Awareness Week Just Ahead

OTAs upcoming Older Driver Safety Awareness Week, from December 3 to 7, promotes the importance of safe mobility and transportation for ensuring that older adults remain active in the communityshopping, working, or volunteeringwith the
2
Industry News
Manual Medical Review
Grant Supports UTEP Graduate Students
he Centers for Medicare & Medicaid Services (CMS) recently held open door forums for providers related to manual medical review for
he University of Texas at El Pasos College of Health Sciences has been awarded a Health Resources and Services Administration (HRSA) grant that will be used to provide financial support to the schools occupational therapy graduate students.
ADRC Grants Available

ealth and Human Services (HHS) Secretary Kathleen Sebelius recently announced $12.5 million in
NOVEMBER 26, 2012 WWW.AOTA.ORG
awards to Aging and Disability Resource Centers (ADRCs) to help older Americans and people with disabilities stay independent and receive long-term services and supports. Occupational therapy practitioners may be interested in taking an active role in their local ADRCs, which are designed to make it easier for state and local governments to manage resources and monitor program quality through coordinated data collection and evaluation efforts. For more information about the grants, recipients, and the ADRC initiative, see www.hhs.gov/ news/press/2012pres/09/2012 0911c.html.
Childhood Neuromuscular Disorders Web Site

OTA partnered with the Centers for Disease Control and Preventions National Task Force for Early identification of Childhood Neuromuscular Disorders to create a new Web site, www. childmuscleweakness.org. The Web site is meant to increase clinicians awareness of peripheral neuromuscular disease as a cause of developmental delay in young children. AOTA contributed a range of information of interest to occupational therapy clinicians and educators, including videos of normal motor development as well as red and yellow signs of muscle weakness by age, why early diagnosis makes a difference, and suggestions for effective communication with families.
Intersections
n Chris Davis, director of AOTA Press, recently attended the Center for Association Leaderships 2012 Healthcare Associations Conference in Chicago. n Kathleen Klein, MS, OTR, BCP, AOTAs director of ConOT PRACTICE NOVEMBER 26, 2012
tinuing Education, attended the National Academies of Practice conference on Patient-Centered Care: Working Together in an Interprofessional World in Cleveland. The conference included sessions that discussed practice and policy issues related to interprofessional collaboration in health care environments. Conference sessions explored best practices that promote collaboration between health care team members to ensure quality outcomes for clients. Interprofessional collaboration is a topic under discussion by AOTAs Future of Education ad hoc committee and was also an important topic at the 2012 AOTA Program Directors/Academic Fieldwork Coordinators Meeting. n Sandra Schefkind, MS, OTR/L, AOTAs Pediatric coordinator, presented at the Annual Conference on Advancing School Mental Health in Salt Lake City, Utah. n Susan Lin, ScD, OTR/L, AOTAs director of Research, recently attended the Patient-Centered Outcomes Research Institute (PCORI) workshop in Washington, DC, on patient engagement. PCORIs goal is to increase patient involvement in research by awarding nearly $50 million in grants to research projects that are not only patient-driven but also mandate patient participation as part of the process. Occupational therapy practitioners and their clients are encouraged to submit research questions to PCORI by visiting www.pcori. org. PCORI is also looking for stakeholders (i.e., patients, clinicians) to serve on review panels and evaluate grant applications. For more, visit www.pcori.org/ get-involved/reviewers. n Deborah Yarett Slater, MS, OT/L, FAOTA, AOTAs staff liaison to the Ethics Commission and the Bylaws, Policies, and Procedures Committee, represented AOTA at the
a o Ta B u l l e T I N B o a r d
OUTSTANDING RESOURCES FROM
Linking Research, Education, & Practice
Continuing Education
OT-DORA: Occupational Therapy Driver Off-Road Assessment Battery
OT
C. A. Unsworth, J. F. Pallant, K. J. Russell, & M. Odell -DORA Battery is a unique, user-friendly, and convenient collection of assessments that allows efficient evaluation of an individuals cognitive, perceptual, behavioral, physical, and sensory skills and abilities that are related to driving, prior to an on-road assessment. $99 for members, $140 for nonmembers. Order #1261. http://store. aota.org/view/?SKU=1261
Driving and Community Mobility for Older Adults: Occupational Therapy Roles, Revision
(ADED-APPROVED ONLINE COURSE) S. L. Pierce & E. S. Davis Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). his updated course will advance your knowledge about driving and community mobility. Content will enable occupational therapists at both the generalist and specialist levels to determine older driver risks, recommend that driving cease or resume, help provide transportation options and alternative forms of community mobility, and build a network of services from multiple disciplines. $180 for members, $255 for nonmembers. Order #OL33. http:// store.aota.org/view/?SKU=OL33
Culture and Occupation: A Model of Empowerment in Occupational Therapy
R. M. Black & S. A. Wells his book emphasizes the role that culture and cultural competence play in occupational therapy. The Cultural Competency Model introduced in this book helps clinicians, educators, researchers, and students develop self-awareness and the concept of power, attain cultural knowledge, and improve cross-cultural skills. $55 for members, $79 for nonmembers. Order #1241. http://store. aota.org/view/?SKU=1241
Ethics Topic Organizational Ethics: Occupational Therapy Practice in a Complex Health Environment
(CEonCD) L. C. Brandt & AOTA Ethics Commission Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). his course material explores ethical conflicts that may arise between practitioners who are organizational employees and autonomous health care providers. Participants will learn strategies to assist in addressing situations in which occupational therapy practitioners may be pressured by an organizations administration to provide services that conflict with their personal or professional code of ethics. $45 for members, $65 for nonmembers. Order #4841. http://store. aota.org/view/?SKU=4841
Questions? Phone: 800-SAY-AOTA (members) 301-652-AOTA (nonmembers and local callers) TDD: 800-377-8555 Ready to order? By Phone: 877-404-AOTA Online: http://store.aota.org Enter Promo Code BB
Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.
American Academy of Family of Physicians Scientific Assembly in Philadelphia. Jeffrey Casper, AOTAs director of Sales, and Jean E. Polichino, OTR, MS, FAOTA, senior director of the Therapy Services Division and ECI Keep Pace, represented AOTA at the American Academy of Pediatrics Annual Conference and Exhibition in New Orleans. Carol Siebert, MS, OTR/L, FAOTA, represented AOTA at the National Association of Homecare and Hospices Annual Meeting and Exposition in Orlando, Florida. Karen Smith, OT, CAPS, attended the Rebuilding Together National Conference in Orlando and was invited to the Business-to-Business symposium as part of the conference. AOTA had a booth at each of these conferences, to help educate these particular audiences on the value of our profession.
Practitioners in the News

n Cynthia S. Bell, PhD, OTR/L, associate professor, and Megan Edwards, PhD, OTR/L, assistant professor, recently completed the Winston-Salem State University Center for Excellence in Teaching and Learning Master Teacher program and were awarded certificates designating them as master teachers. This was the inaugural year of the program, which focuses on attending numerous educational sessions centered on teaching and pedagogy. n Danielle Butin, MPH, OTR/L, appeared on Katie, Katie Courics TV show, and discussed leaving a corporate career for a more rewarding life as an occupational therapist. Butin works to provide medical equipment to developing countries.
n Sarah Nielsen, PhD, OTR/L, assistant professor in the Department of Occupational Therapy at the University of North Dakota School of Medicine and Health Sciences, was honored as the 2012 Occupational Therapist of the Year by the North Dakota Occupational Therapy Association (NDOTA). Rebecca Polansky, a University of North Dakota graduate student in occupational therapy, was named 2012 Occupational Therapy Student of the Year by the NDOTA. n Judith Rothenstein-Putzer, MS, OTR/L, was recently spotlighted in the Jewish News of Greater Phoenix (www.jewishaz.com/issues/ story.mv?120831+medium) for her transition from being an occupational therapist to an artist and incorporating art as a treatment modality.
n Carolyn F. Sithong, MS, OTR/L, SCEM, CAPS, founded the Central Florida Aging in Place Chapter, which recently hosted its 5th annual Aging in Place Educational Summit, in Maitland, Florida. The chapter is meant to bridge communication gaps between local builders, senior service providers, and health care professionals. This years summit highlighted the importance of collaboration to concretely change the way homes and communities are designed as well as how to develop strategic plans within the aging-in-place service areas so that services are readily available for seniors who choose to remain in their homes. More than 100 people attended the summit, including 25 occupational therapists. Andrew Waite is the associate editor of OT Practice magazine. He can be reached at awaite@aota.org.
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
Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours)
NEW SelfPaced Clinical Course!
The range of issues for driving and community mobility is vast and can extend across the lifespan. This course provides strategies to address community and driving across occupational therapy practice areas and settings, including administration and management,
ISBN: 978-1-56900-335-0
rehabilitation centers, skilled nursing facilities, and outpatient clinics.
schools, acute care hospitals,
It also provides techniques to work with clients with various disabilities or difficulties, including developmental, physical, sensory processing, vision, and mental health.
Order #3031. AOTA Membes: $259, Nonmembers: $359
To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/?SKU=3031

CE-254
c a p I Ta l B r I e f I N G
Medicare CY2013 Fee Schedule Final Rule

New Requirements for Outpatient Therapy
Jennifer hitchon
Figure 1. G-Code Categories Other SLP Mobility: Changing &
Walking & Moving Around More detailed information about data collection requirements may be found on the AOTA Web site, in forthcoming guidance from CMS and its contractors, and in the final rule itself. We encourage providers to be as well-versed in these codes as possible before the start of 2013.
he Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) made a number of changes to the Medicare Part B outpatient therapy landscape. Changes for next calendar year are reflected in the Centers for Medicare & Medicaid Services (CMS) CY 2013 Medicare Physician Fee Schedule Final Rule, which was released November 1, 2012. The Outpatient Therapy Cap. The Medicare Economic Index is used to determine the outpatient therapy cap amount for every calendar year. As announced in the final rule, the therapy cap amount for CY 2013 is $1,900 for occupational therapy and $1,900 for physical therapy and speech-language pathology combined (an increase from the 2012 level of $1,880). The exceptions process to the therapy cap expires December 31, 2012, but AOTA is working hard to extend the process through next year. Functional Data Collection. CMS first proposed its plan to comply with MCTRJCA language by instituting a claims-based functional data collection process in July 2012. Under the final rule, practitioners furnishing outpatient therapy services are required to include new, nonpayable G-codes and modifiers on claim forms for therapy services beginning in 2013. The G-codes would be used by the provider to identify the primary issue being addressed by therapy (see Figure 1). A scale of seven modifiers would indicate the complexity of the patient (i.e., their impairment/ limitation/restriction) and would be used to track functional change over time (see Table 1). This final scale is reduced and simplified, as per AOTA request, from the original 12 proposed modifiers.
Maintaining Body Position Carrying, Moving, & Handling Objects Self-Care Other PT/OT Functional Limitation
Functional Limitation Swallowing Motor Speech Spoken Language Comprehension Spoken Language Expression Attention Memory Voice
OThER ELEMENTS OF ThE FINAL RULE

MPPR: Medicares multiple procedure payment reduction (MPPR) policy for outpatient therapy pays in full for the CPT code/unit billed with the highest value, and then applies a 20% to 25% cut to the practice expense of any second and subsequent codes/units. The policy applies to all always therapy service codes billed by a single Part B provider or institution for a single patient in a single day. CMS confirmed in the final rule that these harmful cuts, instituted in 2011 over objections from AOTA and our coalition partners, will continue. PQRS: Occupational therapists in private practice have been eligible to participate and receive Medicare incentive payments for meeting quality measure reporting requirements under the Physician Quality Reporting System (PQRS). The incentive phase of the system is nearing an end, and in order to avoid Medicare payment cuts beginning in 2015, occupational therapists in private practice should begin reporting on quality measures in 2013.
Table 1. Severity/Complexity Modifiers

Modifier CH CI CJ CK CL CM CN Impairment/ Limitation/ Restriction 0% 1%19% 20%39% 40%59% 60%79% 80%99% 100%
Although reporting will begin on January 1, 2013, in accordance with the authorizing statute, the first 6 months of the year will be a testing period during which providers can acclimate to the change. After July 1, 2013, CMS will reject claims that do not include the required G-codes and modifiers. The professionals required to report these data on the claim form include occupational therapists; physical therapists; speech-language pathologists; physicians; and certain nonphysician professionals, such as physician assistants, nurse practitioners, and clinical nurse specialists.
AOTA will continue its active engagement in decision-making and rulemaking processes in order to protect and promote the practice of occupational therapy and the pathways to care for beneficiaries. n
Jennifer hitchon, JD, MHA, is counsel and director of Regulatory Affairs for AOTA. You may contact her directly at jhitchon@aota.org.
IN The clINIc
Reaching Beyond Clinic Walls
Motor Vehicle Accident Prevention

Claire M. Mulry
ont do what I did; be careful. You do not want to end up lying in a hospital bed, in pain, unable to walk, wearing a diaper, eating pureed slop, drinking thickened liquids, and wondering if your friends enjoyed graduation. This is how Jack ends his talk to the drivers education class at the high school he attended a year earlier. Jack tells the students how a year plus after his accident, he is still in pain and needs another surgery. His eventual goal of getting a job and living alone seems like a remote dream. Mike shares how his parents heard about his accident on television, before the police had a chance to call them to say what hospital he had been taken to. He likes to show the video clip of the news story and pictures of his demolished car. Adele shares, The choices you make nowto text, talk on the phone, change the CD, speed, drink before drivingmay affect the rest of your life. I had a million friends; now I dont have one. Their lives go on without you; they end up in a different place. I now live on Medicaid; they pay for me to stay in a nursing home, and I get $35 a month for spending money. That is it; it is all I have for birthday presents, movies, cigarettes. Their audience sits in stunned silence, some are even crying, and then inevitably the questions begin rolling in and the discussion starts. This discussion happens in the drivers education classes three times a year at a high school close to the JFK Johnson Rehabilitation Institute in Edison, New Jersey. The therapists at the Center for Head Injuries use a consultation and education model. Inpatient and outpatient clients participate in an occupation-based
Does occupational therapy have a professional and moral responsibility to help prevent [motor vehicle injuries]? The clients who tell their stories, the therapists who treat them, and students who hear their presentations offer a resounding yes!
intervention as they commute to and present their stories at the school. The participants change each quarter; sadly, there are always clients who have a story to tell. If my story can help one kid, this nightmare will be worth it, Mike states. This project allows therapists and clients to collaborate and extend occupational therapys therapeutic reach beyond a single client within the clinic walls, to the clients of the high school and community. Is there a potential to expand this program to a population level? What do the numbers tell us? In 2005, 4,544 teens ages 16 to 19 died from motor vehicle crashes and an additional 400,000 sustained injuries that required treatment in emergency rooms. Young people ages 15 to 24 represent 21% of the U.S. population.1 However, they account for 30% ($19 billion) of the total costs of motor vehicle injuries among males and 28% ($7 billion) of the total costs of motor vehicle injuries among females.2 It is unclear if these numbers include the costs of rehabilitation and subsequent lifelong health care costs.
The numbers do tell us the societal need for education exists. Healthy People 2020 identifies motor vehicle injury prevention as a national health objective.3 Does occupational therapy have a professional and moral responsibility to help prevent this extensive and costly social problem? The clients who tell their stories, the therapists who treat them, and the students who hear their presentations offer a resounding yes! That was real, Their stories are so painful; how do they recover? and Thank you, thank you, thank youI will never forget you all and I will try to make smart choices is just some of the student feedback received. In an effort to make a contribution to promoting health and participation of people, organizations, and populations (teenage drivers), the occupational therapists created this education program in collaboration with an interdisciplinary team. In the 9 years since its inception, the program has grown from one to three quarterly dates each year, with the clients telling their stories to nine different driv7
PHOTOGRAPH UPPERCUT IMAGES / FOTOSEARCH
The Gaps paThways projecT

and
Meeting the Driving and Community Mobility Needs of OT Clients
ELIN SChOLD DAVIS ANNE DICKERSON
J
COVER ILLUSTRATIONS TOTLAND & WOODCOCK / ISTOCKPHOTO
ennifer Jones guided her 80-year-old mother into the occupational therapy clinic. As a busy bank manager, she was grateful this was the last occupational therapy visit. It was difficult to take time off, but when her mother fell and broke her right wrist, Jennifer made it a priority to get her the best care. Because her mother lives alone, Jennifer watched as the occupational therapist asked her mother to prepare coffee and toast in the therapy kitchen. Although the objective was to ensure mom was able to use both hands functionally, Jennifer noticed that she forgot to turn off the stove and prepared the toast with jelly instead of the butter as planned. Thus, when the occupational therapist sat with Jennifer and her mother to report that her physical recovery was good but the therapist had concerns about her moms safety in the kitchen, Jennifer could only agree. I am also concerned about her driving, the occupational therapist told Jennifer. Driving is a complex task just like cooking. We may be seeing beginning safety issues with planning and scanning the environment, which may increase risk for unsafe driving. Jennifers mother immediately protested, pointing out that she has never gotten a ticket and was a very safe driver. Jennifer could not remember the last time she had driven with her mother and felt the weight of her care become overwhelming. Understanding the impact that not driving would have on Jennifer and her mother, the
Funded through a cooperative agreement with the National highway Traffic Safety Administration, the Gaps and Pathways Project will provide expanded guidance for occupational therapy practitioners helping clients with the instrumental activity of daily living of driving and community mobility.
occupational therapist was prepared to describe the services offered by a driver rehabilitation specialist, offer helpful resources for exploring alternative means of community mobility, and reassure them both that regardless of the driving evaluation, there would be assistance in meeting Mrs. Smiths mobility needs. Project is to provide applicable support to all occupational therapy settings specifically, providing expanded guidance for addressing the essential IADL of drivingwith every client in a helpful, effective, and efficient manner. With the success of the Gaps and Pathways Project, launched in 2011, we hope that all occupational therapy practitioners will answer yes! when a client, family member, or physician asks, Can you help me with my questions about driving? By understanding the current pathways of driving and community mobility servicesparticularly the gaps in servicesthe objective of the Gaps and Pathways Project is to build and expand programs. Through direct service or referral pathways, all practitioners will be empowered to address driving and community mobility with their clients. For the medically-at-risk driver, safe community mobility requires an individualized plan, not just a check sheet with bus schedules or a list of volunteer driver numbers. NHTSAs Older Driver Program 5-year Strategic Plan (2012 to 2017) prioritizes projects that build communication, develop partnerships, and
9
PERSONAL AND PUBLIC SAFETY

Driving and community mobility is an instrumental activity of daily living (IADL) included in the scope of practice for occupational therapy.1 Just as illustrated with Jennifer and her mother, occupational therapy practitioners always need to extrapolate beyond the walls of the clinic to consider how clients will function in their home and community. As practitioners working with older adults who intend to continue driving, it is our ethical obligation to consider their safety with all ADLs and IADLs, as well as public safety when it comes to the IADL of driving. Funded through a cooperative agreement with the National Highway Traffic Safety Administration (NHSTA), the intention of the Gaps and Pathways
Figure 1. Examples of Developed Consensus Statements in Select Topics Client Groups

n
Navigating Toward a Consensus
Self-report regarding driving capability is often inaccurate; therefore, observation of occupational performance is necessary. Regardless of diagnosis, evaluation and recommendations for optimal and safest community mobility should be provided. Co-piloting, in which a passenger is assisting the driver with tactical maneuvers (e.g., prompts for scanning, obeying rules of the road) or operational aspects of driving (e.g., prompts for braking, turn signaling) lacks sufficient evidence to recommend it as a strategy to improve fitness to drive. This type of co-piloting is an indication that the client should stop active driving, as verbal instructions are insufficient in a driving situation where a rapid response is required to prevent a crash. Navigational assistance (e.g., verbal prompts about upcoming turns, assistance with directions) may be helpful to all drivers and is not an indication of being unfit to drive. An individual with a nonfunctional lower limb, lower extremity prosthesis, or orthotic on a lower limb used for operating a vehicle should be referred for a driving evaluation.
By Andrew Waite opics at the Gaps and Pathways Project meeting held in March 2012 at AOTA headquarters in Bethesda, Maryland, included everything from terminology (e.g., at-risk drivers is now preferred over older drivers) to the need for better developed driving simulations. The result is a concise document meant to build an encyclopedia on driving rehabilitation. Elin Schold Davis, OTR/L, CDRS, said the idea of the meeting was to craft statements that can guide current practice and determine the research questions that can lead to future evidence-based practice. This panel was about identifying the low-hanging fruit, meaning those clients with compelling clinical evidence that indicates they are unsafe to drive, Schold Davis said. These consensus statements are a combination, tapping the expertise of scientists who know the research and clinician experts who know what they see working in practice, to form guidance statements allowing practice to move forward as the evidence is published. With this guidance, therapists can apply results from their regular assessments to the IADL of driving and community mobility, through direct intervention or referral to a specialist, with confidence and competence. To arrive at consensus, the panel used an anonymous electronic voting system that displayed results on a projector screen. Schold Davis and Anne Dickerson, PhD, OTR/L, FAOTA, would pose a question and all 20 panel members voted simultaneously. Those who disagreed with the majority would explain their opinions, sparking a dialogue that could lead to compromise. When all agreed, that fact was captured and the discussion moved forward. Panel participant Johnell Brooks, PhD, a human factors professor at Clemson University in South Carolina, works on creating driving simulator scenarios. She plans to use the consensus statements devised at the March meeting to direct her future studies. We are trying to get everything These consensus statements [and more uniform, so if someone needs a identified research priorities] will serve driver evaluation it means one thing, as research guidelines for me, she says. not 15 different things. Especially when we work with students, they are always asking, What in the world should I be studying? What should I do for a dissertation? Because this is the state of the art of driver rehabilitation today, I plan to pull out the document of consensus statements and say, These are the questions that the therapists need answered right now. Is there a way through engineering or psychology or medicine that we can help provide more evidence? Anne Hegberg, OTR/L, CDRS, is a full-time driver rehabilitation specialist who served on the panel. Shes been involved with AOTA, the Association for Driver Rehabilitation Specialists, and the National Mobility Equipment Dealers Association for almost her entire career. She found the collaboration facilitated by expert panel useful because it will lead to more clarity in this practice area. I think its real important to see us coming together and try to get everybody on the same page so there is not duplication of effort, Hegberg says. We are trying to get everything more uniform, so if someone needs a driver evaluation it means one thing, not 15 different things. n
Ethical
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Driving is a high-volume, high-risk activity, and the changing demographics will result in increasing demand and opportunity for occupational therapy evaluation and recommendations. Occupational therapy practitioners are obligated to follow the ethical principles as applicable to practice.
Screening and Assessment

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A decision about continued, restricted, or cessation of driving should never be made based on the results of one tool in isolation, as there is not enough evidence from any one tool to make a decision. Measurement tools that are developed specifically for a diagnostic group should be interpreted carefully when used with other diagnostic groups, unless there is sufficient evidence supporting the use of the tool with this other group.
Andrew Waite is the associate editor of OT Practice and can be reached at awaite@aota.org.
serve the driving and safety needs of older drivers and caregivers in their communities.2 Occupational therapy is ideally positioned to address driving and community mobility as an IADL. NHTSAs support, through cooperative agreement funding and conference participation, demonstrates a strong
affirmation of occupational therapys opportunity and duty to address older driver safety through pathways to direct service and referral to specialized programs. This federal funding supports resource development at little or no cost to programs and practitioners. However, the benefit to seniors depends
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Global IN Guatemala
Supporting Emerging Occupational Therapy Practice in Developing Nations
GOING
STEVE TAFF CAThERINE hOYT
Student Ashley housten helps to position a child in his wheelchair.
OTAs Centennial Vision directs us to consider ways in which we can be globally connected within the varied aspects of the profession of occupational therapy. These connections can be cultivated in many ways, including service trips, fieldwork experiences, and a host of other collaborative efforts. Of all the possibilities under the umbrella of global connections, perhaps the most critical is to support growing practices of occupational therapy. Best practice from the commonly accepted Eurocentric perspective, however, may not be relevant to meeting the occupational realities of clients in developing nations.1 Therefore, the challenge is not simply to grow occupational therapy in developing nations, but also to find culturally specific and appropriate ways to help implement client-centered practice while realizing that results may not resemble the Western or American version of the profession. In some developing nations, for example, quality of life can be more associated with providing (or securing) basic needs such as safety, shelter, food, and clean water. But for most people in developed nations, the phrase holds an entirely different meaning. Collaborating with people in developing countries can help define the varying perspectives of what a good life means. In some cultures, occupational therapy strives to make individuals independent, whereas in others, the goal is to be autonomous. These words, while similar, have
WAShINGTON UNIVERSITY AND SERVICE FOR PEACE

In March 2010, 2011, and 2012, students and faculty from the Program in Occupational Therapy at Washington University in St. Louis School of Medicine (WUOT) joined forces with Service for Peace. Service for Peace is an organization that aims to provide intensive service learning opportunities through community development programs around the world. Service trips were
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PHOTOGRAPH COURTESY OF THE AUTHORS. FLAG SPEEDFIGHTER / BIGSTOCK. MAP COURTESY OF MICROSOFT IMAGES.
distinct meanings with very different implications for the direction of therapy. It is critical that connections be made to help establish relationships to create, promote, and expand the profession of occupational therapy worldwide in a manner that is valuable and culturally relevant to all populations.
planned and sponsored through the student group, International Assistance Committee, supported by WUOT and guided by Service for Peace. Service for Peace coordinators were vital in making connections with local agencies and authorities to provide transportation, safety, lodging, and translation. Over the past few years, the following organizations in Guatemala have participated in the learning collaborative: n A local orphanage, ANINI n A Mayan special education school in St. Martin n Two hospitals: Roosevelt Hospital and the Hospital Infantil de Infectologia y Rehabilitacion n Two universities: Universidad Mariano Galvez and the University of San Carlos
Therapy room (not currently in use) at ANINI.
An employee at Transitions (see page 16) works on making a wheelchair wheel.
Students and faculty at Washington Universitys Occupational Therapy Program find that the power of occupation to enhance performance, participation, and well-being is an international truth.
Transitions, a Guatemala-based organization that makes wheelchairs and teaches employment skills n Hermano Pedro, a facility for people with disabilities Each year, approximately 15 students are selected to go on the trip, along with two licensed occupational therapists. The following sections describe some of the experiences and observations by participants and faculty at these various locations. Students observed and assisted at each location for 1 to 2 days each.
n
ANINI
ANINI is an orphanage that houses approximately 60 children with conditions as varied as hydrocephalus, autism spectrum disorders, cerebral palsy, developmental delays, and intellectual disability. These conditions are often associated with comorbidities such as stunted growth, severe contractures, learned nonuse, and respiratory complications. This orphanage is sustained purely through private funding and, when we visited, contained facilities that were relatively modern, including separate offices for individual therapies and services (e.g., dental room, hydrotherapy room). Occupational therapists and physical therapists were conspicuously absent due to decreased funding, despite available therapy resources. The caregivers at ANINI were anxious
to have an occupational therapist to assist them with positioning, range of motion, splinting, and activities of daily living. Washington University students and faculty provided orphanage staff with ideas in all of these areas. We also supplied the staff with ideas on how to incorporate occupation into daily routines. Significant changes were noticed on the groups third annual visit to the orphanage. After 2 years, relationships between the orphanage and local occupational therapy educational programs had flourished as a result of partnerships facilitated by WUOT. Local occupational therapy and physical therapy students were volunteering and completing fieldwork rotations on a regular basis at ANINI. Observable changes included: n Soft splints being used as restraints rather than having children be tied to a chair to prevent self-injurious behavior n Childrens music being played during free times n Caregivers engaging in sensory play and providing stretches and tactile experiences for more involved children n Increased conversation and interaction between the caregivers and the studentsfor example, with the suggestion of a homemade mobile to encourage visual tracking for an infant, a caretaker immediately
engaged with the occupational therapy student and they worked together to create a functional mobile with available materials. On the third visit, visiting therapists provided a manual translated into Spanish that included many pictures to assist caregivers with ideas for activities and stretches throughout the year.
ST. MARTIN
We visited a specialized school for children with disabilities in the rural Mayan town of St. Martin. There, we observed how each teacher had essentially taken over the roles of occupational therapist, physical therapist, and speech-language pathologist. Students and faculty from Washington University were able to answer questions and make suggestions for treatment ideas for specific student issues that teachers identified. We were also able to work with special education teachers in their classrooms. At this location, we heard overwhelmingly that teachers feel overtaxed and desperately want occupational therapists to assist them. But again, funding is scarce and there are few therapists available. The visiting students saw firsthand how environment, culture, and resources can strongly influence occupation. This location would benefit from future visits and assistance from occupational therapy students and other volunteers.
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PHOTOGRAPHS COURTESY OF THE AUTHORS
meet with WUOT students and faculty to discuss our curriculum, and a draft curriculum was designed by faculty and administrators from Mariano Galvez and first author Steve Taff PhD, OTR/L, from WUOT. This curriculum outline emphasized occupational therapy theory and culturally relevant evaluation and intervention approaches regarding person, environment, occupation, and performance factors. Also included was coursework that focused on return to work, work environments, and including family members as therapeutic partners.
UNIVERSITY OF SAN CARLOS

Left: Author Catherine hoyt learns how to navigate a wheelchair up a hill on a cobblestone street. Right: Student Ashley housten helps to engage a child in social interaction and developmentally appropriate games such as peek a boo.
ROOSEVELT hOSPITAL
Service for Peace set up a tour at a public hospital in Guatemala City. This is the type of medical care that the majority of citizens in Guatemala utilize. These hospitals are mostly located in the city, and appointments are not given. One goes to the hospital and waits to be seen. We were able to observe in the acute setting, intensive care unit, and occupational therapy department. Patients were waiting outside the therapy room just to get 15 minutes of time with the therapist. Therapists reported that there is just not enough time or resources to address all of the areas of occupation, and the majority of patients are focused on returning to work. Documentation was limited to hand-written notes in notebooks and some forms for the physician. These therapists were eager for treatment ideas using the resources they had available. One therapist asked in Spanish, Do you struggle to explain why your job is important in the U.S., too? That indicated to us that in Guatemala, the majority do not recognize occupational therapy and few physicians are aware of its purpose and advantages.
a pediatric hospital and observed an occupational therapy treatment session. In Guatemala, no consent is needed to talk about personal health information. Again, we overwhelmingly heard the desire for more information. The therapist asked us for new treatment ideas, and for guidance in improving her practice. The students demonstrated some additional treatment techniques (e.g., positioning, weight bearing, upper-extremity extension) to help facilitate the interaction. We were able to participate in a question-and-answer session with staff occupational therapists and music therapists. The therapists here were eager to learn more but expressed that access to research or even other therapists was rare, as occupational therapy is not a well-developed profession in this country.
We determined that there is one existing occupational therapy program in Guatemala. The University of San Carlos is training occupational therapists but has not yet been recognized by WFOT. We exchanged presentations about our curriculums and practices and engaged in discussions to continue our partnership. Students from WUOT learned about emerging areas of practice and how curricula can reflect cultural and societal priorities. WUOT students also were able to share resources to enable the Guatemalan students to learn more about research and standards of practice in countries with more developed occupational therapy programs.
TRANSITIONS
Transitions is located in Antigua, Guatemala, and is a producer of wheelchairs. This organization teaches work skills to those living with physical disabilities, supports a classroom for children with disabilities in a rural town outside of Antigua, trains many athletes on the national wheelchair basketball team, and creates and fits prostheses. Employees were very knowledgeable about the needs of people living with disabilities in Guatemala and were collaborating with several programs to design more functional wheelchairs for the physical environments of rural communities. One of the major concerns was the difficulty for those with mobility impairments to navigate Guatemala because of the many cobblestone roads and uneven or nonexistent sidewalks. Additionally, wheelchairs and prostheses are difficult and expensive to obtain.
UNIVERSIDAD MARIANO GALVEz

Universidad Mariano Galvez currently has a physical therapy program and is anxious to begin an occupational therapy program. In our visits there, we exchanged presentations with their physical therapy students and learned that physical therapists are often required to meet the demands of both occupational therapy and physical therapy services in a small amount of time, and consequently feel their patients do not receive adequate therapy. Representatives of this school were eager to
hOSPITAL INFANTIL DE INFECTOLOGIA Y REhABILITACION

Additionally, the group visited an occupational therapy department at
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Transitions is working to decrease this barrier by making wheelchairs and prostheses using local materials that are more affordable. Transitions demonstrated that they are working hard to help decrease the stigma associated with disability by teaching job skills and helping people adjust to living successfully with mobility impairments.
hERMANO PEDRO
Hermano Pedro is a facility for people with disabilities who require assistance with activities of daily living. It has a specialized clinic for infants born with cleft palates and provides therapy and care for a wide range of diagnoses. Hermano Pedro has occupational therapists and accepts therapy volunteers for a minimum of 1 week. Challenges observed at this facility included feeding, positioning, and communication.
Left: Occupational therapy students work on positioning and trying to engage a client in reciprocal interactions. Right: Student Rachel Baum assists with positioning for a small child to enable him to participate in developmentally appropriate play.
It is critical that connections be made to help establish relationships to create, promote, and expand the profession of occupational therapy worldwide in a manner that is valuable and culturally relevant to all populations.
At the time of our visit, staff provided adults with many meals and liquids including coffeein baby bottles, and people were fed with very large bites to hasten the meal. Adults were sometimes fed while lying down. Students suggested raising the adults upper bodies to assist with eating and swallowing. Staff encouraged students to assist with meal times and were quick to respond to requests to adjust positioning. ture, it is perfectly acceptable (and in most cases, expected) for family members to act as caregivers for someone who has been injured or has a disability. Occupation in terms of daily living, leisure, or self-care is not recognized by the populace as an explicit area of attention needing skilled services. Return to work is the highest priority in a nation where not working often means going hungry; however, occupational therapy is not recognized as a necessary therapy to help patients return to work. Most are not aware of the purpose of occupational therapy, and occupational therapists are not available in most treatment and therapy settings. health Care System. Insurance is a benefit enjoyed by only a minority of Guatemalansgenerally the wealthy and those in valued professions such as medicine, business, and politics. There is no national program or community outreach structure to provide a coordinated system of health care in a nation where well over half of the population is below the poverty line. Those with insurance or the money to pay up front
ChALLENGES FOR ThE EMERGING PROFESSION

Culture. Cultural competence and cultural sensitivity are vital to successful interactions and successful client outcomes. Cultural competence is a multistep process that begins with awareness and knowledge building regarding the beliefs and values of others.2 Our group remains in the beginning stages of becoming competent in Guatemalan culture, but several facets have become clear. In Guatemala, independence may not be as valued as it is in the United States, and therefore is not viewed as a primary client outcome. Within this culOT PRACTICE NOVEMBER 26, 2012
for services can go to private hospitals when injury or illness occur. The vast majority of working citizens must seek out public hospitals, which are overcrowded and may involve extremely long waiting periods. Although public hospital services are state funded, primary medical care is the priority and occupational therapy is not present in the acute setting. The Guatemalan health care system concentrates on reacting to the immediate medical needs of the population and gives little attention to prevention or follow-up care. Resources. Resources for the few occupational therapists practicing in Guatemala are scarce. Even relatively standard (in the United States, at least) occupational therapy tools such as goniometers, reachers, and transfer boards are rare. We did observe therapists working with clients in the clinic using cones and simple crafts aimed squarely at the fine-motor and upper-extremity function necessary for the workforce. The vast majority of textbooks and assessments are written in English, and Spanish translations were not available to the therapists we observed. Evaluation is mainly accomplished via interview with clients and family members, in combination with informal range-ofmotion and strength evaluations. Education/Training. To our knowledge, there is only one occupational therapy
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for More INforMaTIoN

International Interests: AOTA Resources www.aota.org/practioners/resources/intl International Fieldwork: AOTA Resources www.aota.org/educate/edres/international Multicultural Resources www.aota.org/practioners/resources/multicultural Culture and Occupation: A Model of Empowerment in Occupational Therapy By R. M. Black & S. A. Wells, 2007. Bethesda, MD: AOTA Press. ($55 for members, $79 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=1241. Order #1241. Promo code MI) Common Phrase Translation: Spanish for English Speakers for Occupational Therapy, Physical Therapy, and Speech Therapy By J. Thrash, 2006. Burbank, CA: Author. ($40 for members, $56.50 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1420. Order #1420. Promo code MI) Occupational Therapy Fieldwork Survival Guide: A Student Planner, 2nd Edition By B. Napier, 2010. Bethesda, MD: AOTA Press. ($34 for members, $49 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1253. Order #1253. Promo code MI) AOTA CEonCD Ethics TopicOrganizational Ethics: Occupational Therapy Practice in a Complex Health Environment Presented 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 (2682) or shop online at http://store.aota.org/view/?SKU=4841. Order #4841. Promo code MI)
CONNECTIONS
Discuss this and other articles on the OT Practice Magazine public forum at http://www.OTConnections.org.
program in Guatemala (at San Carlos). One program (Mariano Galvez) is working toward developing a program in its university. Curricula and training methods display a strong similarity to the academic preparation required of physical therapy students, and the level of training is comparable roughly to the bachelors degree for both occupational and physical therapy. One therapist at Roosevelt stated that there were no opportunities for continuing education to keep skills current after graduating. Guatemalan occupational therapy students told us that fieldwork opportunities are rare and job placement is limited to the hospital setting. Students do not have much opportunity to observe current occupational therapy practice and learn from experienced therapists. Licensing and national exams are not yet standard, and there is no guidance as to what needs to be included in occupational therapy curricula. Professional Obscurity. Occupational therapy is not well known in Guatemala. There is minimal public awareness of what the profession is or does. There are few practicing professionals, only one established educational program, and strong competition from physical therapy, which has a firmer foundation in the public sphere. Therapists and students alike sensed that there is a distinct lack of identity, even within the
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occupational therapy community. Students stated that there is competition between professions, and they feel that other professions dont understand the purpose of occupational therapy. Nearly all occupational therapists work in the hospital setting, rotating between acute care and rehabilitation assignments. They are not represented in community settings such as schools or outpatient clinics, and therefore have less public exposure.
CONCLUSION
To meet the goals of the Centennial Vision, we must support growing practices of occupational therapy around the globe. We believe that the goal of global connection is crucial, as this is the foundation for expanding occupational therapys power, visibility, and diversity on an international scale. In this article, we have highlighted Guatemala based on our experiences and observations. However, with obvious modifications for culture and language, comparable scenarios exist in many developing nations that wish to build or expand the profession of occupational therapy. The current practice models in the United States are based on theoretical and cultural assumptions that are not entirely appropriate in Central America, South America, Africa, or Asia.1 To be able to expand occupational therapy to developing nations,
and to successfully meet their citizens occupational needs, alternative perspectives of the profession, its purpose, and potential roles are necessary. Part of the goal of the Centennial Vision is to support the professions growth in ways that are participatory and truly meaningful to the health and well-being of local populations, not simply to transpose a Western or American version of occupational therapy to other regions. To this end, we have outlined a series of general strategies to facilitate a diverse framing for occupational therapy in developing nations. The key to creating such a socioprofessional development plan is a collaborative approach based on an ongoing needs assessment from local citizens, clinicians, educators, and agency representatives. Teams of educators and clinicians from nations where occupational therapy is flourishing could then partner with local representatives or agencies to: n Collaboratively develop academic training programs (including curricular and instructional approaches and continuing education models) that are viable within an environment of limited resources and low public visibility n Reframe values about occupation, performance, participation, and well-being that are culturally competent n Problem solve to create niches for occupational therapy within the realities of local health care systems n Create culturally specific and appropriate definitions of occupational therapy and scope of practice that resonate with local citizens and government agencies n Support translation of occupational therapy literature, textbooks, and assessments n Establish sister schools or satellite university locations with frequent student exchanges, partnered educational activities (e.g., via distance-learning technologies), and collaborative research opportunities n Increase awareness of available resources, such as those available from www.wfot.org We found the students and practitioners in Guatemala to be eager learners who displayed a passion for the develNOVEMBER 26, 2012 WWW.AOTA.ORG
opment of occupation therapy and a motivation to see it expand in presence and prominence. We also believe that Guatemala is not alone in this interest and desire to promote the occupational therapy profession. The power of occupation to enhance performance, participation, and well-being is an international truth. Its time to go global. n References
1. Molke, D., & Rudman, D. (2009). Governing the majority world? Critical reflections on the role of occupation technology in international contexts. Australian Occupational Therapy Journal, 56, 239248. 2. Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13, 181184.
Survey Says: Practitioners Think Globally

n a recent 1-Minute Update poll, more than 80% of nearly 1,400 respondents said they would like to practice occupational therapy overseas, either through fieldwork, volunteer work, or living and working overseas:
Are you interested in practicing occupational therapy in other countries? Yes, Id like to live and work overseas ................................................................ 36% Yes, Id like to do volunteer work ........................................................................ 27% Yes, Id like to do fieldwork ................................................................................. 27% Maybe. I have considered it ................................................................................ 13% No, I am not interested ......................................................................................... 5% Respondents noted a wide range of places they have either worked or would like to work, including London, Paraguay, Ireland, Scotland, China, India, Budapest, Honduras, Mexico, Ukraine, and Thailand. As one respondent said, It would be amazing to do OT in another country! Not only could one take new ideas there, but one could bring new ideas home! View the original results and related comments at http://polldaddy.com/poll/6586404/.
Steve Taff, PhD, OTR/L, is associate director of professional programs for the Program in Occupational Therapy at Washington University School of Medicine in St. Louis, Missouri. Catherine hoyt, OTD, OTR/L, is an occupational therapist for the Program in Occupational Therapy at Washington University School of Medicine.
GAPS AND PAThWAYS PROJECT

Continued from page 13 Specialists will work with AOTA to flesh out core concepts and common terminology. This issue is critically important, as many terms have different meanings depending on the stakeholder. For example, consider the term driving evaluation. The same term may be used to describe a 10-minute drive with a Department of Motor Vehicles examiner, a 4-hour clinical and on-road evaluation with a driving rehabilitation specialist, and a self-administered driving inventory completed on a computer screen. This ambiguity is confusing to clients, professionals, and payers, and it places tremendous risk on the accurate interpretation and communication of research evidence. Following the meeting, expert members helped clarify and consolidate the descriptions of research and project ideas. Nine research agenda ideas were forwarded to the NHTSA research
department and eight were developed into mini projects. Figure 2 on p. 12 lists the projects to be completed; Figure 3 on p. 12 lists the identified research needs, which the NHSTA will consider over the next few years. For more, see the posting of project descriptions and applications, awardees, and updates on the progression of work at www.aota.org/ older-driver.
ers and available as downloads from the Older Driver section of AOTAs Web site. n References
1. American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed). American Journal of Occupational Therapy, 62, 625683. doi:10.5014/ajot.62.6.625 2. National Highway Traffic Safety Administration. (2010). Older driver program five-year strategic plan 20122017. Retrieved from http://www. nhtsa.gov/staticfiles/nti/pdf/811432.pdf 3. Reitan, R. M. (1958). Validity of the Trail Making test as an indicator of organic brain damage. Perception and Motor Skills, 8, 271276. 4. Folstein, M. F., Folstein, S. E., White, T., & Messer, M. A. (2010). Mini-Mental State Exam2Users Guide (2nd ed.). Lutz, Florida: PAR. 5. Ball, K. K., Owsley, C., Sloane, M. E., Roenker, D. L., & Bruni, J. R. (1993). Visual attention problems as a predictor of vehicle crashes in older drivers. Investigative Ophthalmology and Visual Science, 34, 31103123. 6. Fisher, A. G. (2006). Assessment of Motor and Process Skills: Users manual (Vol. 2). Fort Collins, CO: Three Star Press. 7. DriveABLE Assessment Centres. (1998). DriveABLE Competence Screen and Road Test. Edmonton, Alberta, Canada: Author. Elin Schold Davis, OTR/L, CDRS, is the coordinator of AOTAs Older Driver Initiative. Anne Dickerson, PhD, OTR, FAOTA, is a professor at East Carolina University, in Greenville, North Carolina.
SUMMARY
The Gaps and Pathways Project is an exciting opportunity for all occupational therapy practitioners and programs. Although initially directed toward older adults, the tools and resources developed will have the potential to stimulate thought and prompt further work to translate the evidence for practitioners who work with teenagers or young adults, identifying driving as a goal while facing conditions that may place them medically at risk as drivers (e.g., autism spectrum disorder, traumatic brain injury, spinal cord injury). The resources from this federally funded project will be free to practition-
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ILLUSTRATION PAVLEN / ISTOCKPHOTO
T E C H TA L K
w
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Tech Support for the Emotional Regulation Needs of Children and Adolescents With Autism
Melissa R. Olson
and caregivers can use the following tools to support a regulated state: n To-do lists (can be on notepad of a smartphone for those able to read or created using a traditional or digital photo album) n Calendars (can be a paper calendar or the calendar feature of a smartphone outlining the day/week/month for an individual) n Schedules (can be symbol/text based and either low tech or digital, use photos to depict the schedule for the day, or customized using applications) First Then Visual Schedule (available for Apple and Android devices) iPrompts (available for Apple and Android devices, Nook Tablet, and Kindle Fire) n Timers (can be useful in providing a clear beginning and end to a task for easier transition or to assist in persisting in a task) Built into most smartphone clock features Time Timer and Kiddie Timer Activity Countdown apps (available for Android and Apple devices) on their smartphones. In addition to the timer, Rays family is able to use photographs to show him where they will be going during the day to further prepare him and support him during transitions. These tools help decrease Rays frustration, control his emotions, and persist with tasks rather than becoming overly focused on the transitions of his day.
ith 1 in 88 children now diagnosed with an autism spectrum disorder (ASD),1 occupational therapy practitioners are treating more and more individuals on the spectrum. Working primarily within the pediatric population, the majority of the children and adolescents on my caseload have an ASD diagnosis. The vast majority of those clients demonstrate moderate to severe difficulties with managing their emotions and arousal levels. Emotional regulation skills as defined in the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition are the actions or behaviors a client uses to identify, manage, and express feelings while engaging in activities or interacting with others (p. 640).2 Engaging a client in therapeutic activities and occupations can be extremely difficult if the client is unable to maintain a regulated state or manage his or her emotions. Technology tools ranging from low tech to high tech can offer support to individuals who experience difficulties with emotional regulation skills. The accessibility of high technology tools (such as smartphones and tablets) makes supporting emotional regulation needs across environments easier for individuals and caregivers. Structure, organization, and predictability are important in maintaining a regulated state for many individuals. With built-in features and accessibility of applications on todays phones and tablets, the use of schedules, lists, and timers can be implemented with ease. Using such tools can decrease anxiety and prevent dysregulation. Clinicians
RECOVERING FROM DYSREGULATION

Oftentimes, simply being able to express an emotion can help an individual maintain control or recover from an extreme reaction. With a number of individuals on the spectrum experiencing language and communication deficits, expressing emotion can be a difficult and frustrating task. Providing tools to support the communication of emotions is necessary not only for nonverbal clients, but also for those who struggle with word finding or who become so overwhelmed with an emotion that they are unable to access language. I have had success not only providing a means of communication but also helping clients better understand their emotions using the following tools. A simple low-tech tool that I use frequently in my practice and have named the emotional regulation board (see photo, p. 21) is made with picture symbols for a variety of emotions (customized for each child) that can be pulled off and placed next to the words or symbol (e.g., I feel). The bottom of the board offers a number of options to assist the individual in then controlling his or her emotion with or without the support of another person. This board has been successful for a number of children who use maladaptive approaches to expressing and recovering from an emotion. Some children are
CASE ExAMPLE: RAY

Ray is a 5-year-old boy recently diagnosed with an ASD. He struggles greatly with transitions and managing his emotions after he becomes upset. Ray is verbal but unable to express his emotions accurately and is often unable to control and recover from dysregulation. Ray is better able to transition from one task to another with the use of a visual and/or auditory timer. Having the timer available to Ray is easy for his family and caregiver, regardless of the environment or context, because it is
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American Occupational Therapy Association Shared a link Oct 24. University of Buffalo has the most students attending Conclave! Shawnee State University is a close second. Check out the other schools with the highest representation and JOIN US! www.aota.org/ConferenceDocs/ Conclave.aspx (click on the link to the infographic) 2012 AOTA/NBCOT National Student Conclave Register today! www.aota.org/conclave
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Sensory Strategies for Classrooms

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mollyschaffer Posted: Thu, Sep 13 2012 2:32 AM

I have a 1st grader who is very active in his classroom. We are looking for some calming strategies to use with him. We cant use anything like vests, chewies, or fidget toys because mom wont allow it. Right now he comes out of the classroom for movement/sensory breaks in the morning and in the afternoon but we need some more strategies for the classroom. Id appreciate any suggestions!
Debi Hinerfeld replied on Thu, Sep 13 2012 4:15 PM

You can tie a piece of Thera-Band around the front of his chair that he can use to push against when sitting and listening.
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kelseyturcotte replied on Fri, Oct 5 2012 7:34 PM

I think that its important to provide structure and make sure that the room isnt full of distractions. Also, adding breaks or having sensory integration before he needs to be in a sit-down classroom. This may help release some of his excess energy. Maybe think about incorporating exercise balls for the child to sit on during class or a squishy chair cover. Have the child wear a weighted vest, carry a weighted stuffed animal, or use weighted blankets. Make sure that the child is able to do some hands-on activities, such as being able to write on the board. The teacher might want to incorporate some brain gym exercises or more musical sessions for her class. The opportunities are endless.
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eMployMeNT opporTuNITIes
Faculty Faculty
Assistant/Associate Professor
Tenure-Track Faculty Position in Rehabilitation Science

Nominations and applications are invited for a tenure-track faculty position in Boston Universitys College of Health and Rehabilitation Sciences: Sargent College. We are especially interested in candidates with expertise in interdisciplinary collaboration whose research is connected to areas of strength in the college and who will help us expand our research doctoral programs in rehabilitation science. We invite applicants who have a clear vision of their research direction; who can relate the relevance of their work to the fields of occupational therapy, physical therapy, or speech, language, and hearing sciences; and whose research program is supported, or has strong potential for support, by external funding sources. Qualifications include an earned doctoral degree and peer-reviewed publications. Postdoctoral experience is preferred. This is a full-time, tenure-track faculty position at the Assistant Professor level, with a primary appointment in the most applicable department. The successful candidate will conduct an independent line of research, participate in service, and teach at the undergraduate and/or graduate level. The College of Health and Rehabilitation Sciences: Sargent College is part of a vibrant academic and research community that includes 16 schools and colleges across Boston Universitys Charles River and Medical campuses, as well as many highly regarded medical and educational institutions in the Boston area that allow for collaborative and interdisciplinary activities. The College offers a wide range of undergraduate, professional, and research programs in the health and rehabilitation sciences. The Colleges three ranked graduate professional programs (physical therapy, occupational therapy, and speech-language pathology) all place in the top 8% nationally, and Sargent is among the national leaders in funded research. The environment is highly collaborative, and many faculty have intersecting research interests. Active research areas include speech, language, and hearing development and disorders; motor adaptation and the dynamics of walking; perception of complex signals; brain/computer interface development; development and assessment of the efficacy of rehabilitation technologies; effectiveness of interventions for serious mental illness; measurement of function in children and youth with disabilities; neurorehabilitation; and the influence of environmental factors on home and community participation. The College houses a wide range of research and clinical facilities, as well as two NIDRR Rehabilitation Research and Training Centersone in the area of psychiatric rehabilitation and one in the area of rheumatological rehabilitation. Join our interdisciplinary faculty and become involved with our network of collaborations within Boston University and the greater Boston community. For more information about BU Sargent College and our programs, visit our web site at http://www.bu.edu/sargent. Review of applications will begin immediately and continue until the position is filled. Applications (letter of intent, including statement of research interests; curriculum vitae; and three references) should be directed to Gael Orsmond, PhD (gorsmond@bu.edu), Rehabilitation Science Junior Faculty Position Search Committee Chair, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA 02215.
Boston University is an Equal Opportunity/Affirmative Action Employer
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F-6206
Assistant/Associate Professor/ Academic Fieldwork Coordinator (AFWC)

The University of Tennessee at Chattanoogas Occupational Therapy Department is seeking qualified doctoral applicants for two positions: Assistant/Associate Professor and Assistant/Associate Professor/Academic Fieldwork Coordinator (AFWC). For more information, visit our website at http://www.utc.edu/Administration/ AcademicAffairs/FacultyOpenings/.
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Faculty
Assistant/Associate Professor of Occupational Therapy

Tenure-track faculty position in the Department of Occupational Therapy for our entry level Master's and post-professional Doctorate programs. Qualifications: Post-professional doctorate in Occupational Therapy or related field; Identified practice expertise in one or more areas of Occupational Therapy practice; College or university teaching experience at the graduate level; Eligible for Occupational Therapy licensure in Illinois. For more information about the position and requirements and to apply, go to: employment.govst.edu. Governors State University, an affirmative action/equal opportunity employer, is committed to achieving excellence through diversity.
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AD REGION COLOR KEY

Faculty opportunities in education Northeast Connecticut, Washington, D.C., Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont South Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, S. Carolina, Tennessee, Texas, Virginia, West Virginia Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin West Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming National Multiple locations within the U.S. International All countries outside the United States
EMPLOYMENT OPPORTUNITIES
west Faculty
Occupational Therapists
Multidisciplinary pediatric practice seeking occupational therapists on a full-time and part-time basis in Los Angeles and San Fernando Valley. Competitive pay based on experience. Generous benefit package for full time employees. Independent contracting available. Job Description: Provide OT services to clients in clinic, home and schools. Participate as a member of the interdisciplinary team of speech pathologists, occupational therapists, BCBAs, behaviorists, educational therapists, early interventionists and child development specialists. Graduates from an accredited Occupational Therapy program, current certification by AOTA/National Board for Certification of Occupational Therapy. California State Licensure. Must have 2+ years experience. Strong assessment, treatment planning, communication/organizational skills, knowledge of and interest in working with children and adults. Speech, Language & Educational Associates 16500 Ventura Boulevard, Suite 414 Encino, CA 91436 818-788-1003 FX 818-788-1135 west
Search For
(occupational Therapy Fulltime Tenure Track Faculty) (assistant or associate Professor) DeParTMeNT oF occUPaTIoNaL TheraPY SchooL oF heaLTh ScIeNceS
Winston-Salem State University, one of the 17 constituent institutions of the University of North Carolina system, occupies a picturesque 110-acre campus overlooking the woodlands of Salem Lake in the heart of WinstonSalem. This Masters Level I university enrolls approximately 6,000 diverse students and offers more than 40 bachelors programs, ten masters programs through the universitys School of Graduate Studies and Research, and one certificate program in computer science. The School of Health Sciences at Winston-Salem State University produces clinically and culturally competent undergraduate and graduate health care students, with a framework of altruistic values, who are dedicated to serving the best health interest of society. The schools focus is to also produce pragmatic field-relevant research that advances both health care practice and knowledge, in improving the availability, accessibility, acceptability, and quality of health services, particularly for the medically underserved experiencing health care disparities.
W-6239
Pediatric Occupational TherapistsPeninsula and South Bay Areas Associated Learning and Language Specialists, Inc. (ALLS, Inc.) www.allsinc.com
Full-time/part-time experienced occupational therapists interested in working with pediatrics. Clinic- and school-based positions. Experience in sensory integration and early intervention is preferred. Please send cover letter and resume to: Keiko Ikeda, SLP kikeda@allsinc.com or Fax: 650-631-9988, Attn: Keiko Ikeda W-6226
west
General responsibilities: assist in occupational therapy program/curriculum development and evaluations at graduate level teach 18 semester hours annually maintain office hours consistent with faculty guidelines advise students and guide student research supervise students in Level I Fieldwork develop research agenda and maintain research skills and interest consistent with OT department and university policies assist in departmental administrative tasks serve on university, School of Health Sciences, and departmental committees serve in community or civic organizations or activities as specified by university guidelines maintain active membership in state and national associations education: Ph.D. or Ed.D, from a regionally accredited college or university and eligibility for North Carolina licensure as a practicing occupational therapist required. Preference given to candidates who possess experience in occupational therapy education, including mental health, physical rehabilitation, and/or research. experience: Two years or more fulltime or part-time teaching experience in a college or university. Five years or more clinical experience. Two years supervising students. Scholarly Production: Should have record of scholarship at state, national, or international level. Salary: Commensurate with education and experience. Position open until filled. For immediate consideration, please visit https://jobs.wssu.edu. applicants will be asked to attach a letter of interest, curriculum vita, names of three references, and unofficial transcripts. official transcripts will be required for the successful candidate. No applications will be accepted by mail. Serious applicants must complete their application by January 15, 2013. For Inquiry about program contact: Dr. Dorothy P. Bethea Chair & Professor Occupational Therapy Department 432 F.L. Atkins Building Winston-Salem, NC 27110 Phone: 336-750-3170 betheadp@wssu.edu
Phoenix, Tucson, & Burbs 602-478-5850/480-221-2573 Schools, 16 wks off, 100% Paid: Health, Dental, Lic, Dues, CEU-$1,000,401K, Hawaii/Spanish I trips Jobs@StudentTherapy.com
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Q &A
uestions and Answers

Elaine Adams, OTR, manager of Regulatory Compliance at Genesis Rehab Services, is one of
AOTAs go-to persons for regulatory issues. Because of this, Adams recently accompanied Jennifer Bogenrief, AOTAs manager of Reimbursement and Regulatory Policy, to a Centers for Medicare & Medicaid Services (CMS) meeting in Baltimore regarding Quality Assurance and Performance Improvement (QAPI) initiatives in nursing homes. The meeting brought together a number of health care professionals to discuss the quality of care at skilled nursing facilities in relation to the implementation of the Affordable Care Act. (For more on QAPI, see the Capital Briefing in the November 12, 2012, issue of OT Practice.) Adams discussed her meeting experience with OT Practice associate editor Andrew Waite.
grams, restraint reduction, reducing falls, etc., there are tools that OT can provide and a perspective that OT can bring to nursing homes to resolve problems. The fact that CMS is asking us for resources that they can use is really important, and practitioners need to take advantage of it. I think it will be very easy for practitioners to say, Oh, my administrator is taking care of it, so I dont need to be involved. But I think it is important for pracLook at issues in your workplace titioners working in skilled nursing facilities and figure out what needs to be done to recognize that they may very well have an to fix them, how you can help, and important role in helping how those improvements can be sustained. to resolve issues in their facility. Its a matter of continuing to communicate within their nursing homes and ing in nursing facilities to ensure the know whats going on and what the safety of the clients and to ensure the nursing homes are working on. quality of care for the clients. therapys role at this meeting? Adams: There is already a quality assurance program in place, but CMS is really looking to refine it to promote best practice. In a skilled nursing facility it requires interdisciplinary involvement, and that is where practitioners need to be involved. They are part of the interdisciplinary team and help to resolve the issues that are happen-
Waite: What was occupational
We evaluate, we figure out what the problem is, we come up with the plan, and then we assess the effectiveness of that plan and modify the program. So it very much is parallel to how we operate as clinicians.
Waite: What advice do you have for

practitioners who are interested in becoming a sort of AOTA point person like you are on regulatory issues? Adams: Join your state and national associations. And dont just join but get actively involved and read the information that is released by both associations to keep up on current issues.
Waite: Why is being connected so

important?
Adams: I have been an OT now for

over 30 years. I have seen real changes in health care. When I first became a therapist, I went and I saw my clients, and I didnt worry about all the regulations and all the reimbursement rules that were out there. It was a lot less complicated back then, but the whole industry has become much more regulated now. And in looking at making sure that those we serve get the services they need and have access to those services, its really important to know the rules and to be an advocate for our clients. The only way you can do that is by staying informed. n
Waite: How specifically can occupational therapy help ensure that quality of care? Adams: CMS came to us and said one of the things the pilot program for the quality assurance initiative has shown is that having the resources and tools available in skilled nursing facilities can help them with particular problems they may be encountering. So CMS is looking to occupational therapy to see if there are tools that we have that can help facilities resolve issues. Whether those issues have to do with positioning, dining pro32
Waite: What lessons can occupational

therapy practitioners not working in skilled nursing facilities take from this meeting? Adams: Quality improvement and quality assurance are really important no matter where you are working. So thats something for all practitioners to be thinking about: Look at issues in your workplace and figure out what needs to be done to fix them, how you can help, and how those improvements can be sustained. Its very much like when we do evaluations in treatment. Thats exactly what we do:
PHOTOGRAPH COURTESY OF ELAINE ADAMS
93rd Annual Conference & Expo

April 2428, 2013 ~ SAn DiEgO, CAlifOrniA
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The American Occupational Therapy Associations
Registration opens December 10.
experiencing great opportunity as we expand in evidencebased research and practice. But we also face serious challenges in health care legislation and public awareness. As we take our place as leaders in the profession and as skilled providers of excellent practice, research, and education, the more opportunities will arise and the more challenges will be met. The AOTA Annual Conference & Expo is the most dynamic gathering for occupational therapy professionals each year. Stimulating Presidential and keynote addresses, hundreds of focused educational sessions, exceptional speakers, valuable connections, and an Expo brimming with state of the art products and opportunities are all under one roof in San Diego. This is your chance to
flourish!
AC-116
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Education Article
(one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.
Earn .1 AOTA CEU
Collaborative Intraprofessional Education With Occupational Therapy and Occupational Therapy Assistant Students
DONNA COSTA, DhS, OTR/L, FAOTA
University of Utah, Salt Lake City, UT
RIVKA MOLINSKY, OTR/L

Touro College, New York, NY
CAMILLE SAUERWALD, EDM, OTR/L

The Richard Stockton College of New Jersey, Galloway, NJ This CE Article was developed in collaboration with
AOTAs Education Special Interest Section.
ABSTRACT
Graduates of occupational therapy and occupational therapy assistant programs are expected to work collaboratively as practitioners. Preparing competent practitioners is the goal and outcome of all professional programs. Developing opportunities for students to work together during their fieldwork experience enhances their skills for that collaboration in their future as practitioners. Academic and fieldwork (clinical) educators are encouraged to create opportunities for occupational therapy and occupational therapy assistant students to learn together, both in the classroom and during fieldwork experiences.
LEARNING OBJECTIVES
1. Recognize the main components of the collaborative learning model. 2. Identify a supervision strategy with multiple fieldwork students from different levels and schools. 3. Identify learning experiences for occupational therapy and occupational therapy assistant students that lead to increased collaboration.
INTRODUCTION
It is important to start with some common definitions currently used in academic and fieldwork education. A term that needs definition is intraprofessional education, which is defined as an educational activity that occurs between two or more professionals within the same discipline, with a focus on the participants to work together, act jointly, and cooperate (Jung, Solomon, & Martin, 2010, p. 235). This concept has received considerable attention in the fields of nursing, physical therapy, and occupational therapy, in which there is more than one professional level. In nursing, there is the licensed
NOVEMBER 2012
n
practical nurse and registered nurse; in physical therapy, there is the physical therapist (PT) and physical therapy assistant (PTA); and in occupational therapy, there is the occupational therapist (OT) and occupational therapy assistant (OTA). In intraprofessional education, students and practitioners within the same profession are engaged in learning together and subsequently collaborating in the workplace. The second concept that warrants defining is the collaborative learning model, a method used in both interprofessional and intraprofessional education. Collaborative learning refers to pairs or small groups engaging in reciprocal learning experiences whereby knowledge and ideas are exchanged (Rozsa & Lincoln, 2005, p. 229). The collaborative learning model is based on work by Russian educational psychologist Lev Vygotsky (Costa, 2007). He theorized that learning has a social component and that people learn best through interaction. The collaborative learning model, which is an expansion of constructivist learning theory, is the opposite of the traditional 1:1 model, in which the fieldwork educator is the expert. Instead, students help each other learn, and the educator guides the learning process. Collaborative learning is based on four principles: 1. Knowledge is constructed, discovered, transformed, and extended by the students. The educator creates a setting where students, when given a subject, can explore, question, research, interpret, and solidify the knowledge they feel is important. 2. Students actively construct their own knowledge. Students guided by the instructor actively seek out knowledge. 3. Education is a personal transaction among students and between educators as they work together. 4. All of the above can only take place within a cooperative context. There is no competition among students to strive to be better than the other. Students take responsibility for each others learning. (Cohn, Dooley, & Simmons, 2001, p. 71)
BACKGROUND LITERATURE
Thomas Dillon (2001), in interviewing OT/OTA teams in Pennsylvania, Ohio, and West Virginia, found that both OTRs and COTAs expressed that effective intraprofessional relationships enhance the quality of OT services provided, and strengthen their desire to practice in the field (Dillon, 2001, p. 1). Dillon said that the essence of the relationship between OTs and OTAs cannot be learned by reading articles on professional role delineation and supervisory guidelines. Supervision
CE-1
OT PRACTICE, 17(21)
ARTICLE CODE CEA1112
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).
of an OTA by an OT is an ongoing process that should mutually enhance the professional growth of each individual; both parties have their own set of responsibilities. Themes that emerged in this study included the necessity of effective two-way communication, the need for mutual respect, and the importance of professionalism. Carol Scheerer (2001) described a partnering model used in Ohio between an OT and OTA program in the classroom. Partnering between the OT/OTA team needs to become a habit so that future practitioners can use it as part of their daily occupation. To develop this partnership, practice needs to be embedded in the educational curriculum of future occupational therapy practitioners. Scheerer paired students from OT and OTA programs in a series of classroom learning activities. The first sessions involved learning about each others curriculum and role delineation, and then the pairs applied the American Occupational Therapy Associations (AOTAs) Standards of Practice for Occupational Therapy (AOTA, 2010c) to a hypothetical case. The second set of sessions focused on working on cases in OT/OTA pairs, then using a Scattergories game format to identify one-word descriptors of an ideal OT/OTA relationship. In the third and final set of sessions, OT and OTA students were assigned to work as teams to complete joint assignments related to a group process course. Later, they worked as collaborative research teams, with the OTA students serving as research assistants to the OT students. All students reported benefitting from the hands-on learning. Practicing interaction, teamwork, and collaboration as students should provide a lifetime habit of partnering as practitioners (Scheerer, 2001, p. 204). Jung, Salvatori, and Martin (2008) described a fieldwork study in which seven pairs of OT and OTA students in Canada were jointly assigned to fieldwork placements. Student participants all agreed that working together in a clinical setting not only enhanced their understanding of each others roles, including similarities and differences, but also fostered the development of competence and confidence in ones own skills and abilities as well as ones partner (Jung et al., 2008, p. 48). They further wrote, pairing OT and OTA students in collaborative fieldwork placementshas not been common practice. Nevertheless, there is increasing evidence that such collaborative learning experiences can generate positive learning outcomes that include learning about the roles of OTs and OTAs, emulating real world practice by pairing student OTs and student OTAs to provide client care, and expanding opportunities for collaboration and teamwork (Jung et al., 2008, p. 43). The students in this study reported that they learned the importance of developing a working relationship through shared learning, effective communication, and mutual trust and respect. Through understanding each others roles and effective communication, there emerged a sense of teamwork and genuine interest in collaborating on a comprehensive client plan that ultimately
CE-2
complemented the delivery of occupational therapy services (Jung et al., 2008, p. 46). Another study from Canada by Jung, Sainsbury, Grum, Wilkins, and Tryssenar (2002) reported on a joint clinical learning experience between OT and OTA students. The strength of this collaborative model included allowing students to learn about the roles of OTs and OTAs, emulating real world practice by pairing the student OTs and student OTAs to work together to provide client care (Jung et al., 2002, p. 96). The importance of collaborative learning, which included ideas about partnership and teamwork, was evident. Learning together led to feelings of respect and trust about the different knowledge and skills each brought to the client as well as the different responsibilities each had in the care of the client (Jung et al., 2002, p. 99). Higgins (1998) described her experience with supervising OT and OTA students in Massachusetts. Although collaboration among practitioners is an everyday occurrence, collaboration among students is not. The OT/OTA collaborative model of student education provides opportunities that parallel those in the working environment while promoting positive fieldwork experiences, enhanced clinical reasoning development, and continued personal and professional educational opportunities (Higgins, 1998, p. 41). The physical therapy literature yields articles focusing on intraprofessional education between PT and PTA students. Matthews, Smith, Hussey, and Plack (2010) reported on a 4week joint placement between PTs and PTAs in North Carolina and South Carolina that employed a 2:1 supervision model. The placements were designed to provide an authentic experience that enhanced the students knowledge of, skills for, and attitudes about working together. Students kept reflective journals, and 14 jurors reviewed these for themes. The researchers noted ongoing misperceptions regarding the roles among both PTs and PTAs that may have impeded a preferred PTPTA relationship (p. 50). The authors concluded with recommendations: Establish clear expectations of collaboration, not competition; provide structured feedback; develop clear learning contracts; clarify individual student roles; establish ground rules to facilitate collaborative learning; and pair students in the later phases of their educational preparation so that PT students will feel better prepared to delegate patient care to the PTA. In the same article, the authors cited Robinson, McCall, and DePalma (1995), who reported that more than 50% of PTs surveyed in 1992 said they received no information during their professional education on the role of the PTA. Subsequently, other studies done in the 1990s indicated that both PTs and PTAs had erroneous perceptions of their respective roles (Robinson et al., 1994; Robinson et al., 1995). PTs were noted to be either overly restrictive or permissive in working with PTAs. Similarly, PTAs also varied between being overly restrictive or permissive when interpreting their job roles
NOVEMBER 2012
n
ARTICLE CODE CEA1112
OT PRACTICE, 17(21)

OT Practice November 26 Issue

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AOTA T H E

NOVEMBER 26, 2012

The Gaps paThways projecT

Meeting the Driving and Community Mobility Needs of OT Clients

Outstanding solutions that fit your style.

AOTA THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION

Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org

Going Global in Guatemala

Revising the Occupational Therapy Practice Framework

Supporting Emerging Occupational Therapy Practice in Developing Nations

Reaching Beyond Clinic Walls: Motor Vehicle Accident Prevention

Social Media Spotlight

Updates From OT Connections, Instagram, Facebook, and Twitter,

Continuing Education Opportunities

Employment Opportunities Questions and Answers

OT PRACTICE NOVEMBER 26, 2012

Call for Spring RA Motions

OT4OT Archives Posted

Call for Papers Issued for AOTAs Education Summit

Pictures Worth $1,000

Older Driver Safety Awareness Week Just Ahead

Manual Medical Review

Grant Supports UTEP Graduate Students

ADRC Grants Available

Childhood Neuromuscular Disorders Web Site

Linking Research, Education, & Practice

OT-DORA: Occupational Therapy Driver Off-Road Assessment Battery

Culture and Occupation: A Model of Empowerment in Occupational Therapy

Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.

Practitioners in the News

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NOVEMBER 26, 2012 WWW.AOTA.ORG

Medicare CY2013 Fee Schedule Final Rule

OThER ELEMENTS OF ThE FINAL RULE

Table 1. Severity/Complexity Modifiers

OT PRACTICE NOVEMBER 26, 2012

Reaching Beyond Clinic Walls

Motor Vehicle Accident Prevention

PHOTOGRAPH UPPERCUT IMAGES / FOTOSEARCH

OT PRACTICE NOVEMBER 26, 2012

The Gaps paThways projecT

Meeting the Driving and Community Mobility Needs of OT Clients

ELIN SChOLD DAVIS ANNE DICKERSON

PERSONAL AND PUBLIC SAFETY

Figure 1. Examples of Developed Consensus Statements in Select Topics Client Groups

Navigating Toward a Consensus

Screening and Assessment

STEVE TAFF CAThERINE hOYT

Student Ashley housten helps to position a child in his wheelchair.

WAShINGTON UNIVERSITY AND SERVICE FOR PEACE

NOVEMBER 26, 2012 WWW.AOTA.ORG

Therapy room (not currently in use) at ANINI.

An employee at Transitions (see page 16) works on making a wheelchair wheel.

PHOTOGRAPHS COURTESY OF THE AUTHORS

UNIVERSITY OF SAN CARLOS

UNIVERSIDAD MARIANO GALVEz

hOSPITAL INFANTIL DE INFECTOLOGIA Y REhABILITACION

PHOTOGRAPHS COURTESY OF THE AUTHORS

ChALLENGES FOR ThE EMERGING PROFESSION

STARS StudentTherapy.com W-6037