Here is the third installment of blogs on my exploration of changes in the Articles of Incorporation and the Bylaws and how they may provide insight into our current situation with AOTA, ACOTE and the mandate for single point of entry at the doctoral level for the occupational therapist.
 
I realize that I have mistakenly been implying that our most recent Bylaws changes (2015) were instrumental in articulating the responsibilities related to “professional standards” and “educational standards.” These changes were actually introduced in the 2013 revisions to the Bylaws. That I can tell there were no significant changes from 2013 to 2015 related to the Representative Assembly (RA) or ACOTE. If I have missed something, please point it out to me.
 
However, there were changes from the 2007 Bylaws to 2013 in
 

1. The Sixth Article of Incorporation
2. The section on ACOTE (the addition of a sentence stating that ACOTE has complete autonomy) and,
3. The section on the Representative Assembly which changes from describing it simply as the legislative body responsible for policies to a designated body of the Board responsible for the establishment of professional standards and policies

 
I also have been reviewing various RA documents since 2004 searching for motions related to ACOTE. I am a little bit of an electronic pack rat and have saved most documents sent to me including a list of final charges related to motions passed or defeated. I continue to notice the language of motions/charges which are almost always phrased as “requesting” ACOTE to do something rather than “directing.”
 
I am limited before 2004 because I first joined the RA as the Special Interest Sections Council Chairperson.
 
An important date/time period may be 2003ish to 2004ish and developments resulting in a Memorandum of Understanding between AOTA and ACOTE. Actions in the RA in the next few years seem to treat ACOTE with deference for its role in making decisions independent of more than suggestions and recommendations from the RA.
 
I have pasted relevant sections of the documents below. If anyone notices any mistakes, do not hesitate to call it to my attention!
 
The nerd fest continues!
 
2007 Articles of Incorporation and Bylaws
 
SIXTH Article of Incorporation
SIXTH: The number of trustees, directors, or managers of the corporation shall be not less than five (5) nor more than fifty (50), and shall be known as the Board of Directors. The manner of election or appointment of such directors shall be provided in the bylaws.
 
Article V Section 9. Associated Body of the Board 
ACOTE®
Purpose: To accredit occupational therapy educational programs and occupational
therapy assistant educational programs. ACOTE® establishes, approves, and administers
educational standards to evaluate occupational therapy and occupational therapy assistant
educational programs. ACOTE® shall establish its own policies and procedures.
 
ARTICLE VII.
Representative Assembly
Section 1. Purpose
The Representative Assembly, herein called the Assembly, shall be the legislative body
directly responsible for the policies affecting the direction of the profession.
 
2013 Articles of Incorporation and Bylaws

The 2013 amendments add by name the Representative Assembly as a designated body of the board, responsible for the establishment of professional standards and policies. This change was made to incorporate AOTA’s then existing organizational structure into the framework of the 2012 changes in the DC nonprofit corporate law. 

SIXTH Article of Incorporation
SIXTH: All corporate powers shall be exercised by and under the authority of the board of directors except as provided in this Sixth Article. The number of trustees, directors, or managers of the corporation shall be not less than five (5) or more than fifty (50), and shall be known as the Board of Directors. The manner of election or appointment of such directors shall be provided in the Bylaws. There shall be a designated body of the board known as the Representative Assembly which shall be directly responsible for the establishment of professional standards and policies. 

Article V Section 10. Associated Advisory Council of the Board
ACOTE® 
Purpose: To accredit occupational therapy educational programs and occupational therapy assistant educational programs. ACOTE® establishes, approves, and administers educational standards to evaluate occupational therapy and occupational therapy assistant educational programs. ACOTE® shall have complete autonomy in establishing standards for educational programs; developing and implementing policies, rules, and procedures for conducting accreditation reviews; and making accreditation decisions.
​
ARTICLE VII. 
Representative Assembly 
Section 1. Purpose 
The Representative Assembly, herein called the Assembly, shall be a designated body of the Board directly responsible for the establishment of professional standards and policies. With respect to matters within the scope of its purpose, each member of the Assembly shall have a fiduciary duty when discharging responsibilities as a member of the Assembly to act in good faith and in a manner reasonably believed to be in the best interest of the Association and otherwise in accordance with standards of conduct under the D.C. law for fiduciaries in non-profit associations. 
 
2015 Articles of Incorporation and Bylaws
 
Sixth Article of Incorporation:
SIXTH: All corporate powers shall be exercised by and under the authority of the board of directors except as provided in this Sixth Article. The number of trustees, directors, or managers of the corporation shall be not less than five (5) or more than fifty (50), and shall be known as the Board of Directors. The manner of election or appointment of such directors shall be provided in the Bylaws. There shall be a designated body of the board known as the Representative Assembly which shall be directly responsible for the establishment of professional standards and policies.
 
Article V Section 10. Associated Advisory Council of the Board
ACOTE® 
Purpose: To accredit occupational therapy educational programs and occupational therapy assistant educational programs. ACOTE® establishes, approves, and administers educational standards to evaluate occupational therapy and occupational therapy assistant educational programs. ACOTE® shall have complete autonomy in establishing standards for educational programs; developing and implementing policies, rules, and procedures for conducting accreditation reviews; and making accreditation decisions.
 
ARTICLE VII.
Representative Assembly
Section 1. Purpose
The Representative Assembly, herein called the Assembly, shall be a designated body of the Board directly responsible for the establishment of professional standards and policies. With respect to matters within the scope of its purpose, each member of the Assembly shall have a fiduciary duty when discharging responsibilities as a member of the Assembly to act in good faith and in a manner reasonably believed to be in the best interest of the Association and otherwise in accordance with standards of conduct under the D.C. law for fiduciaries in non-profit associations.
 
 

There were some interesting reactions and observations to my blog post yesterday on our current situation with AOTA, ACOTE and the educational mandates. I am glad that most (not all, but most) of the responses were dispassionate. I was surprised to see that I had 522 unique visitors to my Blog! Cool! My aim is to stimulate thoughtful and respectful dialogue.
 
Thanks to my colleague Carol Seibert for introducing me to the word "dispassionate." I so often speak about the importance of passion, but need to think seriously about the incredible value of being dispassionate at times and the skill of choosing when to act in what way!
 
I continue to be most interested by the issue of who has authority for establishing entry-level educational requirements and what is the basis for what seems to be a clear shift in the position of the AOTA Board of Directors. I am pretty convinced the answer must rest in the Articles of Incorporation and the Bylaws. While there seems to be disagreement in interpretation, others have also pointed to this document as likely holding our answers. A challenge is that it seems apparent that interpretation of some long-standing content may have changed. 
 
Searching the document there are three sections that address 1) Professional Standards, or 2) Educational Standards. The fact that both terms are used may be important. Does determining entry-level requirements fall under professional standards or educational standards? Is the use of these two terms intentional or accidental?
 
In the Sixth Article in the Articles of Incorporation and in Article VII of the Bylaws the term “professional standards and policies” is used in regards to the Representative Assembly. In Article V Section 10 of the Bylaws the term “educational standards” is used. 
 
AOTA Policy E6 was also referenced but this document does not hold any clear answer as the words “recommends and supports” are used rather than definitive words such as “establishes” or “directs.” This is consistent with the soft and fuzzy wording of the 1999 Resolution J.
 
While these sections of the official documents of AOTA may hold part of the key to understanding interpretations our current stand off I think they are far from clear evidence of one stance or another. 
 
There has to be more and I hope that both AOTA members and other stakeholders can come to learn the specifics of rationales behind actions soon and that this will help to lower tensions and bring us to common understanding.
 
I have included the relevant sections of the documents below. If I missed something important, please call it to my attention.
 
Sixth Article of Incorporation:
SIXTH: All corporate powers shall be exercised by and under the authority of the board of directors except as provided in this Sixth Article. The number of trustees, directors, or managers of the corporation shall be not less than five (5) or more than fifty (50), and shall be known as the Board of Directors. The manner of election or appointment of such directors shall be provided in the Bylaws. There shall be a designated body of the board known as the Representative Assembly which shall be directly responsible for the establishment of professional standards and policies.
 
Article V Section 10. Associated Advisory Council of the Board
ACOTE® 
Purpose: To accredit occupational therapy educational programs and occupational therapy assistant educational programs. ACOTE® establishes, approves, and administers educational standards to evaluate occupational therapy and occupational therapy assistant educational programs. ACOTE® shall have complete autonomy in establishing standards for educational programs; developing and implementing policies, rules, and procedures for conducting accreditation reviews; and making accreditation decisions.
 
ARTICLE VII.
Representative Assembly
Section 1. Purpose
The Representative Assembly, herein called the Assembly, shall be a designated body of the Board directly responsible for the establishment of professional standards and policies. With respect to matters within the scope of its purpose, each member of the Assembly shall have a fiduciary duty when discharging responsibilities as a member of the Assembly to act in good faith and in a manner reasonably believed to be in the best interest of the Association and otherwise in accordance with standards of conduct under the D.C. law for fiduciaries in non-profit associations.
 
POLICY E.6 
Entry-Level Education of Occupational Therapists and Occupational Therapy Assistants 
RA Motion 4/83, 4/87, 4/89, 2003M54, 2003M56, 2011AprC5 
To state the education required for entry into occupational therapy. 
The American Occupational Therapy Association, Inc. 
IT SHALL BE THE POLICY OF ASSOCIATION THAT: 

1. The Association recommends and supports entry-level education at the associate degree level for occupational therapy assistants.
2. The Association recommends and supports entry-level education at the master’s and doctoral degree levels for occupational therapists. 
3. Consistent with the Association’s desire to improve practice, education, and research, the Association will take active steps to promote new programs at the graduate level and to assist existing programs to develop in ways that are congruent with the preparation of graduates who have the ability to frame, analyze, and solve complex practice problems. 

 
The Articles of Incorporation and Bylaws can be found at: https://www.aota.org/~/media/Corporate/Files/AboutAOTA/OfficialDocs/Approved-Bylaws-2017.pdf
 
The AOTA Policy and Procedures can be found at: https://www.aota.org/~/media/Corporate/Files/AboutAOTA/Governance/2017-Policy-Manual.pdf

​Like many occupational therapy practitioners I am greatly concerned over the turn of events related to the mandate by the Accreditation Council on Occupational Therapy (ACOTE) to move to a single point of entry at the doctoral level by 2025. I am concerned about the future of our profession and I am concerned about the future of a strong professional association. 
 
Much of the situation including pros and cons for the move to doctoral entry have been debated in great detail in multiple forums including social media. I am not sure that many minds were changed as a result. It seems that most who favored the move to the doctoral level still favor it and most who opposed it still oppose it. I witnessed a little bit of true exchange of information and believe that here and there, there was learning on both sides. Unfortunately I believe I witnessed a good amount of accusations, misinformation and mistrust. It is hugely disappointing to me. As a result I have simply stopped participating in the pro-con debate any longer. I don’t see an upside. 
 
There are a couple of issues that I am “stuck” on, meaning that I have do not yet fully understand and still want to know more. I am interested in respectful and professional discussion of these issues. 
 
One issue is one that seemed to be at the forefront of the debate early on, but that I don’t hear much about anymore. At first I heard many strong calls for an “independent accrediting body.” I read opinions about the structure of AOTA and ACOTE and how ACOTE could not possibly be functioning as an independent decision making body. The rationale as I understand it is that because ACOTE is staffed by employees who ultimately report to the AOTA Executive Director they must influence ACOTE decision making in some way (either intentionally or unintentionally), and I guess in some undesirable way. I read suggestions that AOTA staff “whisper” in the ear of ACOTE. 
 
I don’t hear many calls for ACOTE to be an independent decision making body any longer. I have asked if the more important thing to practitioners is to have an independent accrediting body making independent decisions or to have decisions made with the result they want. I haven’t gotten much of an answer from many to this. However, it does seem that now that the AOTA Board has adopted a position counter to moving forward with the mandate, it does not seem as important to many that ACOTE is fully independent.
 
Another issue I am still trying to understand is the appropriate role of the Representative Assembly (RA) in the decision making process related to entry level. From my perspective it seems that something significant has changed. AOTA leadership has shared that after obtaining new legal counsel and new advice; they were changing their tact. I am likely okay with that, but I need to understand more about the basis for such a change.
 
I have recently read assertions that the AOTA Board had not been following its own Bylaws and the suggestion that some or all of the should resign. This is an absurd suggestion to me, based on my experience on the Board, as Speaker of the Representative Assembly and as someone close to leadership of the Association for a period spanning almost two decades. 
 
For as long as I was involved in the RA or the AOTA Board, it seemed clear to me that multiple groups of AOTA leaders (under several different Presidents) believed that the decision about entry level fell to ACOTE. Some have pointed back to Resolution J as evidence that the RA was “circumvented” in the most recent events. I do not think that is true or that Resolution J provides such evidence. When you read Resolution J it does not seem apparent that the RA believed that their decision was the final step in moving from Baccalaureate entry to graduate entry. The RA in 1999 made recommendations to ACOTE, they did not charge or direct ACOTE.
 
The full text of Resolution J follows the end of this blog post. I would love to hear first hand accounts from those actively involved in debate of Resolution J in the RA. 
 
Now, one answer to my questions may rest with the AOTA Bylaws changes approved in 2017. These changes were made primarily in response to changes in the nonprofit incorporation laws in the District of Columbia where AOTA is incorporated. The emphasis of some of the changes (as I understand them) is that nonprofit Boards cannot delegate certain areas of authority to other bodies and Bylaws must reflect the clear responsibility of the Board in many areas. This shifted some levels of power from the RA to the Board. It could well be, in fact it is my hunch, that the review by new legal counsel in light of the very recent Bylaws changes is what is driving the current thinking and position of the AOTA Board. 
 
If my hunch is true, it is significant to understanding how we got to where we sit today and possibly how to resolve issues. If true, it is also a clear explanation of why prior Boards of Directors made the decisions they made, and why the current Board is deciding differently. If true, it is also a clear indication to me that both prior Boards of Directors and the current Board have acted in full and good faith and do not deserve the destructive and in my opinion the unreasonable criticism levied against them.
 
There are probably other things I don’t fully understand, but for now I am good to wonder about these issues:
 

1. As practitioners is it most important to us that we have an independent accrediting body or is it most important that we achieve the outcomes we desire?  
2. What specifically was the underlying logic of new legal counsel that convinced the current AOTA Board of Directors that it IS the role of the RA to make decisions about entry level for the profession? 

 
Here is the text of Resolution J approved by the RA in 1999.
 
RESOLUTION J
Movement to Required Post baccalaureate Level of Education
 
WHEREAS, contemporary practice arenas require occupational therapists, including new graduates, to demonstrate an unprecedented level of advanced clinical reasoning; and
 
WHEREAS, new graduates, now more than ever, need to define, demonstrate and articulate the uniqueness and value of occupational therapy; and
 
WHEREAS, new graduates need to be capable of functioning as autonomous professionals and must be encouraged to see themselves in this role; and
 
WHEREAS, practice arenas are shifting and therapists are challenged to establish programs in areas where occupational therapy services have not previously been offered; and
 
WHEREAS, new graduates enter settings and are challenged to make decisions and engage in a level of clinical decision-making previously reserved for experienced clinicians; and
 
WHEREAS, the move to the post baccalaureate level is apt to clarify the delineation between professional and technical education; and
 
WHEREAS, movement to post baccalaureate entry is consistent with current trends in other related professions; and
 
WHEREAS, analyses conducted by the COE Entry-Level Task Force confirm that the environment reinforces current readiness to move to this level; and
 
WHEREAS, currently, many graduates of entry-level programs have essentially been conferred the baccalaureate degree for the equivalent of masters level education; and
 
WHEREAS, preparation of more therapists at the post baccalaureate degree level is likely to meet the current and future needs for qualified faculty in our education programs; and 
 
WHEREAS, preparation at the post baccalaureate degree level would position occupational therapy to better meet personnel needs in emerging practice arenas including effective and cost efficient staffing patterns; and
 
WHEREAS, movement to post baccalaureate degree entry reflects and acknowledges the complexity of our knowledge base and the high degree of professional judgment required for practice; and
 
WHEREAS, the preparation of occupational therapists at the post baccalaureate level would address the needs for more outcomes research supporting the tenets of occupational therapy practice, efficacy interventions and staffing models; 
 
THEREFORE BE IT RESOLVED, that the official position of AOTA is one that supports a post baccalaureate degree in occupational therapy as the required level of professional entry into the field of occupational therapy; and
 
BE IT FURTHER RESOLVED, that the AOTA recommend that ACOTE consider the implications of a required post baccalaureate degree in occupational therapy and, if feasible, move the Standards for an Accredited Educational Program for the Occupational Therapists to the post baccalaureate degree level; and
 
BE IT FURTHER RESOLVED, that the AOTA recommend that ACOTE establish timelines whereby established programs must be at the post baccalaureate degree level in order to be re-accreditation; and
BE IT FURTHER RESOLVED, that the AOTA recommend that ACOTE establish timelines whereby new programs must be at the post baccalaureate degree level in order to receive initial accreditation; and
 
BE IT FURTHER RESOLVED, that AOTA insure the membership that all rights and privileges of occupational therapists who have graduated from baccalaureate degree programs prior to the implementation of this change will be continued; and
 
               BE IT FURTHER RESOLVED, that the Executive Board identify and charge appropriate groups within the AOTA to make support available to baccalaureate professional level occupational therapists for addressing their concerns and their professional development activities; and
 
BE IT FURTHER RESOLVED, that the Executive Board identify and charge appropriate groups within the AOTA to develop and make support available to professional level occupational therapy educational programs to facilitate their transition to the post baccalaureate degree level.
 
BE IT FURTHER RESOLVED, that information regarding this transition be communicated in AOTA publications
 
Motion:I move adoption of Resolution J.
 
The Speaker recognized Leader of Task Group 2, Dan Lipka, for a report. Task Group 2 recommends adoption of Resolution J as amended.
 
Rationale:
1.  ACOTE has already adopted higher professional entry level standards which will take effect in July, 2000.  ACOTE reports that bachelor's level occupational therapy educational programs will have great difficulty meeting these new accreditation standards.
 
2.  ACOTE reported that over 60% of the accredited and developing programs have already decided on their own to move to a post baccalaureate level.
 
3.  ACOTE also reported that only about 12 of the 62 existing or developing programs may be affected by this change because they are only in a bachelor's level educational institution. ACOTE/COE have explored numerous options for these programs to help them address this change.
 
4.  Some constituents expressed concern regarding how the role and responsibilities of the OTA's might be influenced by this resolution. This resolution only addresses professional level degree education and does not address the OTA degree level.   
 
5.  There was constituent concern that culturally diverse groups may not be targeted for recruitment, admission and graduation from post baccalaureate programs. COE reported that when Physical Therapy (PT) moved to master's level entry, there was in fact an increase among applicants from culturally diverse groups.   
 
6.  Financial concerns of students were identified and discussed. These included:
A.

1. Students may have a greater debt from which to recover as a new clinician,
2. Increased cost of graduate education may adversely affect culturally diverse applicants more than majority populations.
3. Cost of graduate education may deter applicants from lower income brackets.

 
The Task Group felt that although these concerns may cause some challenges, the benefits to the profession as a whole far outweigh these individual issues.
 
The Speaker recognized the Representative from Oregon, Karen Foley who moved to amend Resolution J, by addition of “Therefore, be it further resolved that the RA supports ACOTE's timeline to be as responsive and timely as possible.”
                             
THE RESOLUTION WAS AMENDED
 
The Speaker recognized the Representative from Mississippi, Peter Giroux who made a motion for a substitution to the amendment of the word “recommends” for “supports”.
THE RESOLUTION WAS AMENDED A SECOND TIME
THE RESOLUTION WAS ADOPTED AS AMENDED TWICE
Charge1999R9