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Like the vast majority of the approximate 14,000 attendees, I had a wonderful experience at AOTA’s 2017 Annual Conference & Exposition in Philadelphia celebrating the 100th anniversary of occupational therapy. It was joyful to catch up with colleagues, network, make new professional connections, learn and share my experience in three presentations I was involved in delivering. One of those presentations was a Pre-Conference Institute titled, “Supporting Occupational needs Through Population and Organizational OT: Gain Knowledge and Skill to Expand Your Practice.” This institute was organized by Roger Ideishi, JD, OT/L, FAOTA who is an Associate Professor of Instruction in Rehabilitation Sciences & Program Director at Temple University. Roger led 13 faculty including myself in delivering this six hour learning experience with an enthusiastic audience of occupational therapy practitioners who are either interested in, or currently providing population-based occupational therapy interventions.
Population health is a key component of the American Occupational Therapy Association’s (AOTA) Vision 2025 which reads: “Occupational therapy maximizes health, well-being, and quality of life for all people, populations and communities through effective solutions that facilitate participation in everyday living (AOTA, 2106).” The genesis of Vision 2025 can be found here: https://www.aota.org/AboutAOTA/vision-2025.aspx. It is important to note that the new vision statement was developed over an extended period of time through a process that offered tens of thousands of occupational therapy practitioners and other stakeholders the opportunity to provide input and feedback. The draft of the statement was sent to 58,000 practitioners and students and met with a 78% overall approval rating. This of course means that there is not universal approval and that some members of AOTA and non-members of the association object to part or the whole of the statement. Nonetheless, population based intervention has been endorsed as an appropriate area of intervention for occupational therapy practitioners by the official bodies of the association including the Representative Assembly. For example, AOTA’s (2013) official statement on Occupational Therapy in the Promotion of Health and Well-Being includes a section on a population health approach and states, “In addition to providing occupational therapy interventions for individuals, occupational therapy practitioners can develop and implement occupation-based population health approaches to enhance occupational performance and participation, quality of life, and occupational justice” (AOTA, 2013, p. S49). The 3rd Edition of the Occupational Therapy Practice Framework: Domain and Practice clearly establishes communities and clients as populations and establishes the appropriateness of population-based interventions to address the occupational needs of populations (AOTA, 2014). At the end of our Institute the faculty and the attendees discussed strategies for keeping participants in touch with each other and for finding a structural home in AOTA. I volunteered to explore options and one simple step that has already been accomplished was to create a permanent discussion thread in the AOTA Member Forums area on “Population Health.” If you are a member of AOTA you can find the discussion here: https://otconnections.aota.org/sis_forums/f/7926.aspx. If you are an AOTA member and are not yet a participant on OTConnections all you have to do is create a free account. We are interested in having a thought provoking and respectful interchange about the development of effective population-based occupational therapy interventions around the globe. While there are already occupational therapy practitioners providing creative, innovative and effective population-based interventions in a variety of areas we have much to do to move our way forward in this area of intervention. Some of these needs include:
I’m already on the road to 2025. I hope you join me and others and help to shape the journey! References: American Occupational Therapy Association. (2014).Occupational therapy practice framework: Domain and process (3rd ed.).American Journal of Occupational Therapy, 68(Suppl.1), S1–S48, http://dx.doi.org/10.5014/ajot.2014.682006. American Occupational Therapy Association. (2013). Occupational therapy in the promotion of health and well-being. American Journal of Occupational Therapy, 67(6, Suppl.), S47–S59, http://dx.doi.org/10. 5014/ajot.2013.67S47.
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I have spent most of the weekend working on my workshop for AOTA’s Annual Conference & Exposition coming up in Philadelphia on Saturday April 1st at 8:00 a.m. (Session 302, Convention Center rooms 104AB). The title of the session is “Health Disparities, Social Justice and Occupational Therapy Intervention: Exploration and Application of Key Concepts.” I submitted the conference abstract on a whim one afternoon. It took me less than an hour to write it as I have submitted abstracts many times and reviewed abstracts for the conference for over 20 years so I know what a good abstract includes, and it is a topic that I am passionate about. I was excited to have the abstract accepted, despite the only comment from a reviewer that read “Boring. How many of these presentations can one conference support?” Gladly, I guess the answer was “At least one more.” I don’t remember exactly why I decided to write and submit this abstract; but sitting here at my computer keyboard today I vaguely remember reading something that I read on social media and finding it objectionable. I remember thinking “Grrrr.” which is the expression I use to convey general disapproval and annoyance. I also remember thinking, “Okay, its about time.” This meant I decided it was about time to publicly reclaim my passion about the topics of health disparities, social justice and occupational therapy. That last thought deserves explanation for two of the six regular followers of my blog (smile, appropriate self-deprecating humor) who don’t understand. In February of 2011 a discussion started on OTConnections regarding a motion to remove social justice from the AOTA Code of Ethics. What followed was a discussion lasting several years that was interesting, disappointing, enlightening, scary, thought provoking, challenging, exasperating, sometimes insightful, and confusing. The experience had a significant impact on me; so much so that I finally had to post to that I would no longer participate because I felt it (the context of the discussion thread) was unproductive and unsafe. That experience changed me; it caused me to learn and to grow. Overall, I don’t regret it. I am glad I had that experience. Since that time I’ve spent less time promoting social justice ideas publicly within a professional context. I haven’t avoided public debates on ideas I feel strongly about (see anything on the AOTA Board of Director Position Statement on a single point of entry) and so still I can take a public whipping for a cause (grin); but I just had less energy to revisit social justice. Until now. Much of the debate about the Code of Ethics included discussion of social justice as politics and forcing members to accept a philosophical ideal in their code of ethics that was counter to their personal beliefs. Today I am steering clear of that argument. One of the first things I did in outlining my workshop was to include information on objections to social justice to acknowledge that my world viewpoint is not the only valid one. However, it is the one I am focusing on in my workshop. I am also trying to quickly put to rest the question of “Is that occupational therapy?” by expanding on comments I made in 2015 in the American Journal of Occupational Therapy that read, “As a profession, occupational therapy has moved beyond the question “Is that occupational therapy?” to the equally important questions of “Is that something that occupational therapy practitioners can do?” “Can occupational therapy make an important contribution in this area?” and “How can we demonstrate our distinct value through contributions to population health?” (Braveman, 2015, pg. 4)?. I am including this simple framework to acknowledge that we can address health disparities and social justice in therapy, and within our general practice as occupational therapy practitioners, or as a societal action informed by our position as an occupational therapy practitioner.  I feel energized to be thinking about social justice as an occupational therapy practitioner again. I am excited to be putting my name on a presentation at our annual conference, especially the conference celebrating our Centennial Anniversary as a profession in the United States. I am equally energized by writing and talking about global perspectives on health disparities and social justice as a clear nod to the fact that American occupational therapy practitioners are not the center of the world on justice issues and that despite the greatness of American society and of American occupational therapy practice we can learn much from our colleagues around the globe.
Yes, with all the things going on in American society today, it is definitely about time to revisit social justice and occupational therapy. I look forward to sharing my passion and my thinking with colleagues on April 1st. Even better, I look forward to leaving the workshop knowing more than when I went in. Happy 100th birthday U.S. colleagues! Hope to see you in Philly! On January 27th & 28th the first Specialty Conference on the Distinct Value of Occupational Therapy in Oncology Rehabilitation co-sponsored by AOTA and the MD Anderson Cancer Center Department of Rehabilitation Services was held at MD Anderson Cancer Center's Onstead Auditorium. 140 occupational therapy practitioners from 32 states were in attendance to network, learn and share on the distinct role of occupational therapy with adult cancer survivors. In addition to our Keynote presentation by Dr. Ki Shin titled "Cancer Rehabilitation, Our Experience at MD Anderson" we had 15 concurrent sessions presented by expert occupational therapy practitioners in oncology rehabilitation. Unfortunately because some of the sessions ran concurrently I could not be in all the rooms but I heard nothing but positive comments from the 140 attendees! Dr. Shin's keynote was inspiring and is a major advocate for occupational therapy. He serves as the Medical Director for the Department of Rehabilitation Services and I am proud to work with him to meet the needs of patients with cancer as Director of the Department of Rehabilitation. Thanks to the following outstanding occupational therapy practitioners who gave high quality presentations:
It was an honor to have President Amy Lamb onsite to meet attendees, participate in the discussions and to share perspectives from our professional association. We are beginning to make great strides in moving occupational therapy forward as key players in the rehabilitation of cancer survivors. The two presentations that I gave are attached. Thank you AOTA! 
A short off the top of my thoughts blog for this Sunday morning on the unfolding circumstances of the Presidential election.
A perspective that may not be very popular. Yes it looks like HRC won the popular vote with a large margin but lost the electoral college. This means the country is widely divided which we knew before the election. It also means that she lost fair and square. HRC, her campaign and her supporters understood the rules before the election began. Hindsight is 20/20 and perhaps some different messages and time spent in different places may have made a difference. The DNC can spend time looking backwards to understand, I don't need to spend energy there. The unpopular perspective I want to share is that Bernie Sanders also knew the rules of the contest and that contest included super delegates. When the primary was close to over, I suggested that Sanders' supporters complaining about super delegates get over it, the rules were the rules. We can change rules for future contests, but the rules of this election relied on the results of the electoral college and no matter how disappointed or scared we are about the results of the election, there is nothing unfair about wining the EC but losing the popular vote. Rules are rules and we need to accept the outcome. I am not a fan of the "not my President" messages I am seeing. I will hold President Trump accountable at every turn and work as hard as I can to elect a progressive candidate that reflects my values in 2020, but starting January 20, President Trump is my President. Keynote Presentation from the 2016 Indiana Occupational Therapy Association Annual Conference11/9/2016 On Saturday I had the pleasure of presenting the keynote Address to the 2016 Indiana Occupational Therapy Association Annual Conference. It was a great experience and gave me the chance to share my thoughts about some of my favorite issues all rolled into the presentation titled, "You have a seat at the table. Now what?" I think it was well received and I am sharing it here with anyone who has an interest in topics such as health disparities, population health, the Triple Aim and the Distinct Value of Occupational Therapy.
I don't think the new Hillary Clinton email revelations will make a bit of difference in the outcomes we see a week from Tuesday. At this point so much is baked into the formula already.
Hardcore Hillary detractors will immediately believe any suggestion of impropriety as fact and hardcore Hillary supporters will react as just another GOP attempt to smear her image and reputation. The real challenge is that on November 9th we will have a horribly fractured electorate. There will be no sense of a fair fought election and little chance of bipartisan efforts. Depending on your personal values and hopes you will either be breathing a sigh of relief that things won't be as bad as you feared or have lump in your throat and a sick feeling that things may be worse than you feared. We can blame it on Washington but it is not establishment politicians who chant "lock her up" or post caricatures of his hair. At some point we have to accept responsibility about what we say as individuals. Mindless memes and exclamation points say much about us and not much about the candidates. Personally I have cause for optimism because I believe that the outcome that I expect is the one that is most likely to lead to the support of equal rights for women, persons of color, immigrants and the LGBT community. It is the outcome that I think has the best chance of moving to universal health care as a basic human right afforded to U.S. citizens and the outcome that will the best for our economy, our education and our future. I took the 9th off so because I LOVE election nights, and will stay up until the last Senate race is decided and we know how controls the House. I will have champagne and lots of goodies to enjoy. Why aren't I more excited? I was honored to be an invited participant at a National Cancer Institute (NCI) Roundtable on August 11th and 12th titled, “Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors.”
The NCI invited 25 oncologists, scholars from various disciplines (rehabilitation, epidemiology, economics etc.) from Harvard, Boston University and Case Western Reserve University and representatives from organizations such as the American Cancer Society, the National Business Group on Health, the U.S. Department of Labor, and the National Center for Medical Rehabilitation Research. There were two occupational therapists invited to attend, myself and Robin Newman, Clinical Assistant Professor of OT at Boston University: Sargent College of Health and Rehabilitation Sciences. This transdisciplinary group was convened to assist the NCI staff to outline a research agenda for improving work outcomes among cancer patients and survivors. We were provided a few meta-analyses on cancer and work prior to attending as well as key statistics and figures on employment in persons with cancer. Over the two days we spent time in small and large group discussion focused on the following questions:
The discussions were spirited, productive, honest and incredibly respectful and collegial even when we disagreed. I could not have been more pleased with the progress made and how committed every participant was to hearing from others, learning and bringing our disparate knowledge together. The NCI will produce a formal summary and when it is available I will post a link or information about accessing the report. In the meantime here are some key facts and my key takeaways from the meeting (I sought permission to share my observations before posting):
There is just SO much opportunity for occupational therapy scientists to answer critical questions to decrease health disparities and improve the lives of cancer survivors it makes my head spin! Watch for more updates on the NCI initiative! There just are not enough resources to meet all of our health care needs. Despite the success of the Patient Protection and Affordable Care Act (ACA) in decreasing the numbers of uninsured Americans from a high of 18% in 2013 for the 18–65 demographic to 11.4% by the second quarter of 2015, millions of Americans remain without insurance (Obmacarefacts.com, 2016).
“The cost of health care continues to rise. U.S. health care spending grew 5.3% in 2014, reaching $3.0 trillion or $9,523 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.5% (Centers for Medicare and Medicaid, 2015). According to the Centers for Medicare and Medicaid (CMS), “Health spending is projected to grow at an average rate of 5.8% from 2012-2022, 1.0 percentage point faster than expected average annual growth in the Gross Domestic Product (GDP)” (Centers for Medicare and Medicaid, 2015b). According to the Kaiser Family Fund, “In 2015, spending on Medicare accounted for 15% of the federal budget. Medicare plays a major role in the health care system, accounting for 20% of total national health spending in 2014, 29% of spending on retail sales of prescription drugs, 26% of spending on hospital care, and 23% of spending on physician services.” The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States. Nearly 90 million Americans rely on health care benefits through Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) (CMS, 2016b). Regardless of our personal political affiliation we must all agree that our current path is unsustainable. Value-based payment (VBP) strategies are approaches to paying for health care services based on value rather than volume. To understand “value” we must consider both quality and cost. To focus only on one is a dead end. VBP strategies enlist providers of care as partners in accepting the financial risks for care provision. These strategies are also intended to address systematic problems such as large variations in care and costs from one geographic area of the U.S. to another. For example, Dartmouth-Hitchcock (a non-profit academic health center in New England) notes that, “One result of this payment based on volume model is enormous variation in rates of procedures and tests such as imaging and screening. As documented by The Dartmouth Atlas of Health Care, there is a 2.5-fold variation in Medicare spending nationally, even after adjusting for differences in local prices, age, race and underlying health of the population. This geographic variation in spending is unwarranted; patients who live in areas where Medicare spends more per capita are neither sicker than those who live in regions where Medicare spends less, nor do they prefer more care. Perhaps most surprising, they show no evidence of better health outcomes” (Darthmouth-Hitchcock, 2016). The hospital VBP program is a CMS initiative that awards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries (Centers for Medicare and Medicaid, 2015c). CMS rewards hospitals based on: “The quality of care provided to Medicare patients;
Occupational therapy practitioners have a responsibility, as do all health care professionals, to provide patients the best care possible (i.e. patient centered and occupation-based). We also share responsibility for reasonably controlling costs for our patients, for the organizations for which we work and for society at large. For example, we demonstrate responsible practice when we avoid wasted materials when making a splint. We demonstrate responsible practice by providing the right amount of care to meet a patient’s goals and charge patients in an ethical manner following guidelines and regulations of payers and our organizations. We demonstrate responsible practice when we design occupational therapy programs to prevent unintended negative events such as falls, proactively plan to assure smooth care transitions under bundled-payments or in accountable care organizations (ACOs), and help our patients, our organizations and the system when we take an active role in care management and help to prevent readmissions. The department of Health and Human Services announced that, “it would seek to make 30% of Medicare payments for hospitals and physicians through alternative payment models such as ACOs and bundled payments by the end of 2016, and to make 50% of Medicare payments through APMs by the end of 2018 (Advisory.com, 2016). Recently it was announced that the 30% goal was met ahead of schedule. HHS, CMS and private payers are moving full-steam ahead with the implementation of alternative payment models and value-based purchasing such as bundled-payments. There is a statement that I am quite fond of regarding getting a “seat at the table.” At a fundraising event for Senator Tammy Baldwin of Wisconsin that was held in Houston, the Senator used a version of this statement and noted, “If you don’t have a seat at the table talking with them, they are talking about you.” An attendee politely interrupted Senator Baldwin and noted that, “In Texas we say that if you don’t have a seat at the table, you are on the menu!” Most recently I have learned the importance of a related thought which is, “If you want to keep your seat at the table, you have to understand the conversation!” I am an optimist by nature. No matter how frustrated I become, I almost always rally and think, “What can I do to change course and to direct my future?” I hope that I bring this attitude and optimism to my leadership at MD Anderson Cancer Center and in the profession of occupational therapy. Given the financial challenges faced by the U.S. government including CMS and the challenges that face our health care providers we have to think about what we can do as occupational therapy practitioners to have an impact by understanding the conversation, taking our seat at the table, and making a contribution. What can we do? Here are some initial suggestions that I will edit over time as I think of others or I hear suggestions from others:
There are many tables in health care organizations and in communities all around the United States and with over 200,000 occupational therapy practitioners and students there are many opportunities for us to demonstrate our understanding of value and the distinct value that we contribute. References: Advisory.com. (2016). HHS just hit a big value-based payment milestone. Here’s what happens next. Online at: https://www.advisory.com/daily-briefing/2016/03/04/obama-administration-reaches-2016-value-based-payments-goal. Centers for Medicare and Medicaid. (2015). National health expenditure data. Online at: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html Centers for Medicare and Medicaid. (2015b). https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/proj2012.pdf. Centers for Medicare and Medicaid. (2015c). Hospital value-based purchasing. Online at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf). Obamacarefacts.com. (2016). Obamacare enrollment numbers. Online at: http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/. Centers for Medicare and Medicaid. (2016b). CMS Roadmaps Overview. Online at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/downloads/RoadmapOverview_OEA_1-16.pdf. Dartmouth-Hitchcock.(2016).Online at: http://www.dartmouth-hitchcock.org/about_dh/what_is_value_based_care.html. I received a message from a colleague asking me to reconsider this blog post and to "reconsider categorizing conversations about occupational therapy the same way that you are categorizing conversations about race relations and gender issues." I like to think that I am always open to feedback and to making an effort to being more clear if there is the potential that I have been misunderstood (or if I have just NOT been clear) so I have edited the post (8/5/16).
More and more often these days I hear a type of response to sharing an opinion (particularly in social media exchanges) that is a total deflection of any issue being put forward for consideration. It is a type of response that ignores the speaker and their message and sends the tacit or sometimes the blunt message that “What you have to say does not matter, because here is what is truly important to me.” If you follow me on Facebook, Twitter, my blog or OTConnections to some extent (I am not cross posting everything on OTConnections) there is no surprise that in social issues and health care policy I have liberal leanings. I am a strong supporter of social justice issues, global health care and equal rights. For this reason I immediately tuned in to one social example of the “what about me” political response when the “Black Lives Matter” movement was met with a retort of “All Lives Matter.” To me it is a tone-deaf, racially insensitive retort that responds to an imagined “only” that is not said (i.e. “only Black Lives Matter). I wrote on the day after the murder of Dallas Policemen, “It is possible to be equally incensed by the systemic racism present in our society, our justice system and our system of law enforcement AND the senseless murder of police officers. We don't have to choose.” Recently posts on Twitter celebrating June as GLBT Pride month and a #GayPrideDay were met with a retort of “heterosexualprideday.” The posters of the hash tag vehemently advocating that if Gays, Lesbians and Transgendered persons could have a day to celebrate their pride than what was wrong with heterosexual persons having a pride day? Of course this tone-deaf, insensitive response ignores the reason that GLBT Pride Celebrations exist; which is a long history of discrimination, hate and violence targeted against the GLBT community. The retort of #heterosexualprideday ignores the fact that most heterosexuals have never had to experience the discrimination, violence and hate targeted to the GLBT community and therefore might be sensitive enough to realize they do not need a “heterosexual pride day.” I am going to totally skip over the idea of things like responding to Black Pride Month with a White Pride Month. In the occupational therapy world the “what about me” response can take a couple of variations. These interchanges are different than the examples above that concern racism and homophobia and related more to the interaction of colleagues. Just yesterday my comments on the value and need for occupational therapy practitioners to advocate for a “seat at the table” to promote OT as part of a response to bundled payments by CMS as one value-based strategy was met with (and I am paraphrasing) “but valued-based payments are partisan schemes and we need to advocate to kick over the table and defend against the status quo!” This response is tone-deaf and falls into the “but what about me” category because there was no recognition that bundled payments are a value-based strategy going into effect RIGHT NOW AS WE SPEAK and that whether you believe they are a partisan scheme or not, advocacy against them as a strategy is unlikely to change the impact on occupational therapy practice in the short-term. Now to be fully transparent, I support the trial of value-based payment strategies and especially bundled-payments as a means of achieving the Triple Aim of improving health, improving healthcare and decreasing costs. There just are not enough resources to go around. Still, I have never discouraged someone from advocating against value-based payment and would never respond to a post from a colleague suggesting that we should advocate against value-based payments by saying, “but no, I want you to talk about this instead!” Another common form of the “what about me” retort in occupational therapy is anytime that someone writes about a new practice idea, “emerging practice” or a new role that an occupational therapy practitioner can adopt and the immediate retort is “But is THAT occupational therapy?” More and more often I am saying in reply, “I’m not sure I care; sometimes “Is that occupational therapy?” is an important question but often it is not.” So this blog post falls a little in the “rant” category so I hope that readers will not parse my words one by one and focus on the big picture. Can we care about multiple things at the same time and isn’t it a little more helpful to respond by acknowledging that a friend or colleague cares about or is excited about an idea before you rush in and say, “Yeah, but this is what I really want to talk about?” PLEASE! During this tense time of political debate, care for our most abused and maligned friends!7/6/2016 Dear Friends,
During this tense time leading up to the fall elections emotions will run high. We will learn that our personal values are in conflict with friends and family alike. We’ll read comments on Facebook and Twitter by our “friends” and twittermates that make our eyes twitch, will shock us, make us audibly gasp and stir us to pour a second glass of wine or scotch before we sit down and write a response that will change that mind, put that person in place, or at least give us the glib satisfaction of thinking, “I bet they wish they thought of that!” for a moment or two. It is a dangerous time for friendships. Just this weekend I stuck near the shallow-end of the pool during one of Houston’s famous pool parties because I knew (from late night Facebook reading) that the pool was diverse in more ways than one (except Gender, because none of our Lesbian friends came). Yes, there WERE Gay conservatives in the pool! Luckily decorum was maintained and we avoided all controversial topics other than whether the hotter movie of the weekend was The Legend of Tarzan or Finding Dory. So I feel the need to bring your attention and your caution to the care of the most abused, the most malingned, the most frustratingly overused of our friends during this political minefield. Who you ask? (I know you just did!). Who? Our capital letters and exclamation points! YES THAT STAR WAS A STAR OF DAVID AND A DOG WHISTLE CALL TO ANTI-SEMITES!!!!!!!!!!!!!!!!!!! YES, HILLARY SHOWED CRAP JUDGEMENT IN USING A PRIVATE SERVER AND BILL HASN’T SHOWN WORSE JUDGMENT ABOUT HOW TO SPEND 30 MINUTES SINCE THE WHITE HOUSE!!!!!!!!!!!!!!!!! While both true, neither of those were more convincingly stated by typing in all capital letters or using multiple exclamation points. So please. Share your political views carefully this season, because neither Hillary nor The Donald are a perfect catch and 2020 is too far way for bumper stickers. Think carefully about those you love who are seriously misguided in their understanding of foreign policy, who haven’t read about trade other than ad on Craigslist, and whose primary source of news is either Fox & Friends or the Huffington Post. However MORE IMPORTANTLY, no one takes you more seriously or gives your thinking more social media cred if YOU TYPE IN ALL CAPS AND USE MORE THAN ONE (1) EXCLAMATION POINT! These tools are grammatical dessert, savor them, and use them sparingly for times when it really matters. Thank you! |
The opinions expressed in my blog are personal and neither represent the views of my employer nor any organization.
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