I have been in one of my quiet times on my blog. It’s been almost 3 months since my last post.
 
Today is the anniversary of my Mom’s death and the boomerang of losing two parents in less than a year took a bigger toll than I had imagined, or have been willing to admit at times. The toxic tone of the echo chamber that many of the OTD entry-level discussions have become has left me discouraged and not at all sure how to constructively contribute. It is my nature is to spend time, considerable time thinking about what “we” can do to solve problems and move our profession forward and I am stymied. 
 
For the last couple of weeks, I am back to thinking about an idea that has been both friend and foe over the last few years: social justice. I do not use the term occupational justice because I have not yet been convinced the construct has been sufficiently developed to be different than social justice. This time, the issue is justice and student debt.
 
There has been a fair amount of comment in the social media world about whether increased student debt that is likely to occur with movement towards the entry-level OTD is unjust. Many practitioners from around the world have joined the chorus of voices expressing exasperation about the impact of student debt on the profession of occupational therapy. Some are asking how professionals who value social justice can also support moving to a single point of entry at the OTD with its increased tuition costs. Others are more pointedly accusatory of those who hold differing views. 
 
Personally, I have become convinced that student debt is moving toward a crisis point in our country. Therefore, I would be disingenuous, if I did not acknowledge that it was not as much of a concern for me in 2014 when I served on the AOTA Board of Directors. Today, I am paying much more attention to those who speak in rational and respectful ways about the student debt issue and OT. I am not yet convinced that it is a reason for programs moving to the OTD to back off; however, it may be the tipping point to convince me that dual entry, at least for the foreseeable future is our most prudent course of action. 
 
Now to justice. Is student debt a matter of (social) justice? I am not yet convinced, but my resolve to the contrary is shaken. It is not a simple issue and I am reading, asking questions and listening to answers. 
 
For example, here is one question: 
 
If two prospective students are interested in occupational therapy but one has the resources to complete their education debt free and the other must finance all of their graduate education and bear the burden of that debt, is this unjust? We have some colleagues who believe so. 
 
A different but related question is: If there are prospective students who wish to pursue a career as an occupational therapist but cannot afford to assume the debt incurred and therefore cannot pursue this occupational choice, it is a social injustice?
 
This is a complex issue; one that will not be sorted out on Facebook or Twitter given the limitations of those platforms to having a balanced and thoughtful discussion focused on learning.
 
Currently I have more questions than answers and here are just a few. I’ve tried to alternate perspectives to represent the cognitive whiplash I feel sometimes when sorting through this maze.
 

• What about individual responsibility? On one hand it is not surprising that a 22-year-old would make some less than fully informed financial decisions. I certainly made my share of early financial mistakes.  But should a profession be expected to make a decision about what is best for its future to head this off at the pass, or choose a less than optimal path to protect these young adults from themselves? Shouldn’t even a 22-year-old be expected to assume responsibility for their own decisions?
• What about the social injustice of long-standing economic discrimination? Student debt does not affect all groups equally. As Amy Brown (2014) notes, “People of color are much more likely to have education debt: 34 percent of African Americans and 28 percent of Latinos have student debt, compared with 16 percent for whites. Shouldn’t we recognize this disparity and factor it into our decision making?
• Is it a reasonable argument that students have choices and that even at the OTD level, there are affordable (assign your own definition of affordable) options at state universities and teaching universities. Students don’t have to choose programs located in the most expensive private institutions and if they do, don’t they bear responsibility? 
• Do we know the average debt for OT students and what the average difference would be of moving to the OTD? It is not helpful to focus on either end of the range. Countering a story about a graduate with $200,000 of debt with a story about one with $10,000 gets us nowhere. 
• What about the difference between equitable versus equal access. Does social justice demand that all individuals can afford to pursue any opportunity for higher education (e.g. occupational therapy education) or just that they have the same opportunity for access if they can garner the resources?
• Does society have a responsibility to assure all people, regardless of the economic situation they are born into, have the option to pursue the occupation of their choice if they have the aptitude and interest in order to be a just society? 
• What are the roles and responsibilities of AOTA as of our professional association to address the issue of student debt? There is little consensus that student debt IS an issue of justice, but does it matter. Crushing student debt is undoubtedly negatively affecting current (and future) graduates and the potential for it to have wider effects such as our ability to recruit a diverse workforce is real. What can AOTA do and what should it do if anything to address student debt?

 
I don’t have answers to all, or even most of these questions; yet.
 
More than anything I hope this post does not present at all as “preachy.” My logic on these matters is far from solidified. It has and continues to evolve as I open myself to more information and more ways of thinking. I hope that leaders and influencers of the profession and of our professional communities remain open to new perspectives as well. I hope we all continue to ask questions and listen to answers. 
 
Here are some interesting reads on the issue of justice and student debt:
 
Student Debt and Social Justice: Tess Carter. National Association of Justice
 
https://www.nas.org/articles/student_debt_and_social_justice
 
Student Debt and Social Justice: Five Things You should Know. Amy Brown. www.FordFoundation.com
 
https://www.fordfoundation.org/ideas/equals-change-blog/posts/student-debt-and-social-justice-five-things-you-should-know/
 
Why Student Loan Forgiveness is a Social Justice Issue. Aaron Taylor
 
http://www.nationaljurist.com/national-jurist-magazine/why-student-loan-forgiveness-social-justice-issue
 

Last evening, I had the opportunity and honor to do one of my favorite things! I spent the evening with students, faculty, alumni and guests of the Touro University Department of Occupational Therapy in Henderson, Nevada, exploring the future of the occupational therapy profession and AOTA’s Vision 2025. I could not be more grateful for their invitation, and their request that we focus our discussion on leadership and Vision 2025.
 
I had the pleasure of serving on the AOTA Board of Directors (BOD) as Secretary during the development of the Vision 2025 Statement. It was particularly rewarding as I was also in a leadership position and invited to the retreats that gave birth to the Centennial Vision. I have been an ardent proponent since its release and welcome any opportunity to promote its value! And, I think we need all hands on deck promoting the Vision. Unfortunately, when I asked the audience of about 90, who had heard of or who had read the Vision Statement before, less than a third of them raised their hands! 2025 is seven short years away and it is time for us all to kick things into high gear! I say all because AOTA's vision belongs to all of us. We all share responsibility for promoting it and for making it a reality.
 
As such, I am thrilled to see that the current AOTA BOD is actively working to educate members and other stakeholders on our new vision. I commend the BOD for listening to member concerns and revising the vision statement to address concerns over diversity and adding a new phrase and a new pillar. 
 
The revised Vision 2025 Statement reads:
 
“As an inclusive profession, 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, 2018).”
 
I was also very happy to listen to an excellent Webinar given by AOTA Vice-President Debra Young as part of 2018 member appreciation events titled, “AOTA’s New Vision 2025 for the OT Profession” (AOTA, 2018a). She did a wonderful job of explaining the vision and exploring challenges and opportunities for occupational therapy practitioners to demonstrate the vision in action in their practice. The Webinar provides a CE credit and is available free of charge on the AOTA Website. If you are an AOTA member I encourage you to listen to it. If you are not an AOTA member, join now!
 
Preparing for this evening and participating in the discussion gave me an opportunity to reflect some more and think about the road in front of us. Here are some observations: 
 
As occupational therapy practitioners we face many challenges and have a lot to accomplish if we are going to achieve Vision 2025; and we can do it!
 
We must convince practitioners that we will continue to support their work in traditional practice areas while expanding our horizons, and we can do it!
 
We need to listen to concerns such as the need to adequately articulate a model of ethics for practitioners focusing on communities, populations or organizations as clients, and we can do it!
 
We need to develop models for intervention in population health that are replicable and that promote evidence-based and occupation-based occupational therapy practice, and we can do it!
 
We need to create high profile exemplars of practitioners including OTAs who are “living” the Vision and share them widely on social media, Websites and in publications and we can do it!
 
We need to explicitly reach out to occupational therapy students, promote the Vision and help them understand what it looks like in ‘everyday practice,’ and we can do it!
 
We need to recruit leaders nationally, regionally, locally and at all levels of the profession to become vocal advocates for Vision 2025,  and we can do it!
 
We need to be open to alternative opinions and resist the urge to reject voices that don’t completely fall in line with mainstream talking points, and we can do it!
 
We need to translate the vision in ways that articulate how occupational therapy practitioners can implement the Vision in their everyday practice, and we can do it!
 
2025 is just seven years away and there is much to accomplish. We need all hands on deck!
 
What can you do to help us on our road to Vision 2025?
 
AOTA. (2018). AOTA Board Expands Vision 2025. Online at: https://www.aota.org/Publications-News/AOTANews/2018/AOTA-Board-Expands-Vision-2025.aspx?promo_name=diversity-update&promo_creative=About-AOTA&promo_position=hero.
 
AOTA. AOTA’s New Vision 2025 for the OT Profession.(2018a). Online at: https://www.aota.org/Conference-Events/member-appreciation/week.aspx.

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
 
 

It has been a while since I have blogged. I am not completely sure why. I have started a post several times and lacked the motivation or inspiration to continue. It certainly is not due to a lack of material. All one has to do is read the “news,” or scan Facebook and there are dozens of topics that are worthy of comment.
 
I’ll admit that intellectually I have felt a little “blah.” I have grown frustrated and weary of the click bait consciousness that seems far too pervasive today. That along with the growing tribalism that seems to have invaded our politics, our social worlds and even our professional dialogues in occupational therapy has resulted in a bit of writer’s block or at least avoidance. 
 
One of my favorite quotes that I attribute to my mentor, Gary Kielhofner on the struggle of writing is “You aren’t writing unless you are writing. Even bad writing is better than no writing.” 
So today I am just tossing something up on the site (even if it is bad writing) to let you know that I am still here. This is not my best work by far, but I am sure that in no time I will be back to frequently sharing my brilliant insights into the profession of occupational therapy and the world in general…….
 
I have been thinking a lot about tribalism lately. 
 
Lalia Lalami (2018), writing in the New York Times Magazine, explained the evolution of the concept of tribalism. “In its first sense, tribalism refers to the organization of people along lines of common ancestry or joint identity for the purpose of exercising political power — as the indigenous people of many parts of the world, including the Americas, have long done. But over time, as new forms of governance appeared — city-states, kingdoms and especially empires, which controlled vast colonies with different races, cultures and languages — tribalism came to be seen as crude and antiquated, a political structure that could never hope to address the challenges of large states. And now, in the modern era, the word is used almost exclusively in its second, derogatory sense, to suggest an irrational loyalty to your people.”
 
David Ropiek (no date) wrote on BigThink, “Tribalism is pervasive, and it controls a lot of our behavior, readily overriding reason.” Just as bad, or worst, I think that tribalism can cause us to skip over any effort at rational thought. How many times do we see a photo or Meme shared without a moment’s hesitation to consider, “Am I sharing the truth?” I don’t mean to be judgmental, I have been guilty of this in the past, and even though I am much more careful, I still fail sometimes in this and other ways. 
 
I have been watching a Netflix series called the 100. It is a post-apocalyptic story of humans who return to earth a century after it was destroyed by a nuclear apocalypse. It is all about tribalism. The “Sky People” have to face the “Grounders” and are soon spearing each other, shooting each other with arrows and blowing each other up. It is a lengthy parable for what is happening right here on earth today (Wilken, 2017). 
 
Yesterday I blocked a woman on Facebook. She is an occupational therapy colleague who continually voices extreme conservative views. Yesterday I just could not take reading her words anymore and blocked her. It was a momentary lapse….today I unblocked her. If I can give her tribe a second chance, maybe there is hope for the Sky People and the Grounders.
  
Lalami, L. (2018). Does American “Tribalism” End in a Compromise or a Fight? Online at: https://www.nytimes.com/2018/06/26/magazine/does-american-tribalism-end-in-a-compromise-or-a-fight.html
 
Ropiek, D. (No Date). Online at: https://bigthink.com/risk-reason-and-reality/how-tribalism-overrules-reason-and-makes-risky-times-more-dangerous
 
Wilken, S. (2017). We’re all grounders now. Humanity, tribalism and the pursuit of humanity on CW’s ‘The 100’ Online at https://www.hypable.com/the-100-season-5-unity-endgame/

My attention was called to the principle of Beneficence this weekend in one of the discussions on the Accreditation Council for Occupational Therapy Education (ACOTE) mandate to move to a single point of entry at the doctoral level for the occupational therapist by 2027. A simple definition of beneficence is the act of doing good, active goodness, kindness or charity (http://www.dictionary.com/browse/beneficenceretrieved April 14, 2018). 

The principle was cited in response to a discussion I started on whether eliminating two points of entry for the OT in the US is an issue of justice. Despite thinking myself a strong social justice advocate proponent (I would proudly wear the badge of “social justice warrior!”) I don’t think that moving to a single point of entry is an issue of social injustice. I use the term social justice because I do not think that the term occupational justice has sufficiently been defined as a unique construct distinct from social justice.

I care about the justice issue because I have been dismayed by some of the comments I have read and heard. I appreciate that the OTD discussion has raised strong feelings and emotions but expressions that those who support the move to a single point of entry have abandoned principles of social (occupational) justice and the implication that they must not “care” as much as others bothers me. I am concerned over the creation of animus that will be counterproductive and destructive to our profession’s future.

After reading some thoughtful and instructive posts yesterday morning I spent some of my thinking time (which I do during grocery shopping and my 5 mile walk around our nearby park) considering what is means to “do good” and to “want good” in the context of the ACOTE mandate debate. 

It struck me that part of our challenge may be that people on both sides of the issue are acting out of a true sense of beneficence. People on both sides of the issue are concerned about doing good for our consumers, our current and future students, our practitioners and our other stakeholders. A problem arises when there are different carts and different horses and we disagree about which course of action will be most effective in achieving “good” for the most stakeholders while limiting negative consequences to the fullest extent possible.
 
There are likely many types of good that most of us would support although some are at odds with others. A non-exhaustive list might these include: 

• It is good for our profession and our consumers that we have a more diverse work force.
• It is good for our profession and our consumers to gradate students with the ability to evaluate and apply evidence at sophisticated levels in existing and emerging practice areas. 
• It is good for our profession and our consumers to support economically disadvantaged students to enter the profession.
• It is good for our profession and our consumers to assure a strong future for our profession by graduating students with sophisticated skills to succeed and lead in complex environments.
• It is good for our profession and our consumers to encourage practitioners educated abroad to move to the US to practice.
• It is good to limit student debt.
• It is good for our profession and our consumers to graduate students prepared to be independent practitioners who can problem solve and design interventions with limited supervision in environments with decreasing reimbursement and increased demands for productivity.
• It is good for our profession and our consumers for practitioners to understand the payoffs of value-based care for consumers, for organizations and for health care systems and to design and deliver highly effective and efficient intervention. 
• It is good for potential students, consumers, payers, state licensing boards and employers to understand what entry-level means and how new practitioners are educated and deemed competent.
• It is good to prepare competent entry-level practitioners, some of who will continue with training as research scientists to continue to develop our body of knowledge.

The principle of Beneficence is articulated in the AOTA Code of Ethics along with related Standards of Conduct. It is interesting to note that I do not think any of the Standards of Conduct apply to the discussion of entry-level requirements for our profession.

“BENEFICENCE 
Principle 1. Occupational therapy personnel shall demonstrate a concern for the well-being and safety of the recipients of their services. 
Beneficence includes all forms of action intended to benefit other persons. The term beneficence connotes acts of mercy, kindness, and charity (Beauchamp & Childress, 2013). Beneficence requires taking action by helping others, in other words, by promoting good, by preventing harm, and by removing harm. Examples of beneficence include protecting and defending the rights of others, preventing harm from occurring to others, removing conditions that will cause harm to others, helping persons with disabilities, and rescuing persons in danger (Beauchamp & Childress, 2013).

RELATED STANDARDS OF CONDUCT 
Occupational therapy personnel shall 

1. Provide appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs. 
2. Reevaluate and reassess recipients of service in a timely manner to determine whether goals are being achieved and whether intervention plans should be revised. 
3. Use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current, and within the recognized scope of 
4. Ensure that all duties delegated to other occupational therapy personnel are congruent with credentials, qualifications, experience, competency, and scope of practice with respect to service delivery, supervision, fieldwork education, and research. 
5. Provide occupational therapy services, including education and training, that are within each practitioner’s level of competence and scope of practice. 
6. Take steps (e.g., continuing education, research, supervision, training) to ensure proficiency, use careful judgment, and weigh potential for harm when generally recognized standards do not exist in emerging technology or areas of practice. 
7. Maintain competency by ongoing participation in education relevant to one’s practice area. 
8. Terminate occupational therapy services in collaboration with the service recipient or responsible party when the services are no longer beneficial. 
9. Refer to other providers when indicated by the needs of the client. 
10. Conduct and disseminate research in accordance with currently accepted ethical guidelines and standards for the protection of research participants, including determination of potential risks and benefits (AOTA, 2015.”

In many of my blogs I seek to play with ideas as I go about trying to understand them and to apply them to daily life. There may be great flaws in my thinking here. I do not suggest it is fully developed, and hope that others, perhaps greater thinkers than I will help to develop this line of thought to lower the level of negative emotions in our community and to move toward productive and constructive action. 

Occupational Therapy Association. (2015). Occupational therapy code of ethics (2015). American Journal of Occupational Therapy, 69(Suppl. 3), 6913410030. http://dx.doi.org/10.5014/ajot.2015.696S03

Social media is having a sometimes profound impact on our lives. The advantages of being able to stay in touch with friends and family who may live great distances away are clear. Likewise, the frequent opportunity to offend people you know and those you have never met, to be misunderstood or to misstep are likely familiar to us all.

Add the complexity of attempting dialogue about professional issues and the dynamics immediately become not only complex, but perhaps mind-boggling. Moreover, the new challenges to being a leader in the age of social media may seem like the difference between hiking up a hill and climbing Mount Kilimanjaro. Whether you hold a formal leadership role as a paid employee, are a volunteer leader, or simply are seeking to be influential in your profession, leading in the age of social media has become a whole lot more complex.

My personal experience has been varied. Participation in various forums have provided me with a range of new opportunities. I’ve been able to connect with colleagues within occupational therapy and other professions that I might never encountered in a “pre-Facebook” age. Formats like OTConnections have facilitated thoughtful communication and the sharing of information, perspectives, strategies and resources in ways that have been invaluable. However, experiences in some of these same formats have left some scars and have led me to become increasingly intentional about my participation.

One particular dynamic of social media participation is that you can have individuals with widely different expectations about the norms of communication. What is simply ‘rough edges,’ humor or well-intended sarcasm to some can be perceived as highly aggressive, offensive and unprofessional to others. Add the aspects of some level of anonymity and the perils of any form of electronic communication (e.g. not being able to read body cues or paralinguistic elements of communication) and you have a potential powder keg.

I was pleased that a Google search for “Leadership in the Age of Social Media” yielded immediate results. I am starting to read and will share resources and learning as they come across my plate. If anyone reading has resources to share, I would be most grateful.
Here is a link to one article I found and read with interest from Army University Press related to “Leadership in the Social Media Age” in the military.

http://www.armyupress.army.mil/Journals/NCO-Journal/Archives/2018/January/Social-Media/www.armyupress.army.mil/Journals/NCO-Journal/Archives/2018/January/Social-Media/

First, a quick thank you to everyone who supported the AOTA elections by giving your opinions, your feedback and suggestions and voicing your concerns.

Second, congratulations to Wendy Churchill-Hildenbrand and Debra Young who were elected as President-Elect and Vice-President. AOTA will be in the hands of committed and skilled leaders.

Third, thanks to everyone who supported me by voting for me, by engaging with me during the election and for all the nice messages I received after. Your words and the caring and appreciation demonstrated in them via Email, Texts and Facebook messages helped to soften my disappointment. I gave it my all and I am proud of that with no regrets!

Now, on to the future! During the campaign there were many expressions of concern over 1) the lack of diversity in the profession, in AOTA and in AOTA leadership, 2) the lack of OTA engagement in AOTA and in AOTA leadership, and 3) the need to mentor a group of young and diverse leaders so that we had fresh faces stepping forward!

Okay, time to step up! AOTA’s Volunteer Leadership and Development Committee (VLDC) has put out the call for applications for quite a number of positions. Several of these in the SIS’s are specific to newer practitioners, and most could be filled by an OTA.

I am walking the talk by reaching out specifically to several young practitioners who I “met” through the campaign and to staff who work at MD Anderson Cancer Center. I am forwarding the link to the AOTA Website and offering my assistance with anything I can do to help with the application process.

I challenge all of you, but especially anyone who voiced concern since November about the lack of diversity in AOTA leadership, the lack of OTA involvement OR the fact that many of the same people step forward again and again to make sure you contact no less than 1 person and ask them to submit their application. Offer to help if they need it, provide them encouragement, ask them to share the link, and refer them to me or any other seasoned AOTA volunteer if they have questions.

We can determine our own future and if we want a group of future diverse leaders we can create that cohort now!

https://www.aota.org/Publications-News/AOTANews/2018/VLDC-Seeks-Candidates-for-Appointed-Volunteer-Positions.aspxwww.aota.org/Publications-News/AOTANews/2018/VLDC-Seeks-Candidates-for-Appointed-Volunteer-Positions.aspx

​The last two months of campaigning to be the next AOTA Vice-President has been an invigorating, inspirational and illuminating adventure! What a ride! When I decided to run for VP I decided that I was leaning in hard and going all out! I truly believe that I am the right leader for the right time at AOTA and I want to have zero regrets about anything I should have done to get my message out to AOTA members.
 
So over the last two months I have:

• Skyped with 10 classrooms of OT or OTA students (and have 3 more scheduled)!
• Mailed postcards (20,000!) to every OT and OTA educational program in the country!
• Held two “Candidate Listening Sessions” for OTAs and OTA students on increasing OTA engagement in the profession and AOTA leadership!
• Participated in an hour-long Facebook Live interview with Alexis Joelle (https://www.facebook.com/8alexisjoelle/videos/1377655329046666/)!
• Held individual phone conversations with 8 AOTA members who wanted to speak with me directly in a 1:1 discussion!
• Held numerous Email conversations with member and non-member stakeholders.
• Vigorously participated in social media to get my message out including Facebook, OTConnections, Twitter and my personal webpage www.brentbraveman.com.
• Answered member questions in the OTConnections Elections 2018 Forum (https://otconnections.aota.org/sis_forums/f/7928.aspx)
• Posted “just a few” videos on serious subjects such as Vision 2025, leadership, diversity and the future of occupational therapy

(https://www.facebook.com/brent.braveman/videos/10212962611638001/  https://www.facebook.com/brent.braveman/videos/10212946146266377/  https://www.facebook.com/brent.braveman/videos/10212864225698414/) 

and a couple just to show my FUN side (https://www.facebook.com/brent.braveman/videos/10213094218608093/ and https://www.facebook.com/brent.braveman/videos/10213014488774897/) and https://www.facebook.com/brent.braveman/videos/10213004301720227/)  

So what I have I learned? Here are some of the key points:

• There is great optimism and enthusiasm among occupational therapy practitioners about the future of our profession! AOTA leadership and AOTA staff deserve high praise for the progress made under pursuit of the Centennial Vision.
• Member and non-member stakeholders have deep interest in AOTA’s Vision 2025 but need to develop a deep understanding.
• Diversity matters and is still a primary concern for our members! We’ve made some progress but not nearly enough in making occupational therapy a diverse workforce. We need to take a step back, reassess, recommit and re-engage to increase diversity in terms of race, ethnicity, participation of practitioners with disabilities, gender and other characteristics.
• We need to GO BIG in selling the value of our occupational therapy assistants! Here also we need to take a step back, reassess, recommit and re-engage with our OTA members and develop new strategies to increase the participation and engagement of OTAs in the profession and in AOTA leadership. We need to examine our habits, our language, and our messaging about the contribution of OTAs as part of effective and cost-effective, science-driven, evidence-based and occupation-based care.
• We have a burnout problem. Practitioners in multiple areas but especially our practitioners in SNFs are struggling to maintain their enthusiasm in the face of unreasonable expectations for productivity and questions about the level of support they receive from their profession and their professional association. There are significant concerns about the potential impact of the proposed Resident Classification System (Version1) (RCS-1) on the practice of occupational therapy in SNFs.
• Member and non-member stakeholders are concerned and some are angry about the possible implications of the ACOTE mandates for OT and OTA education. Some have grave concerns over how decisions are made and how they are communicated. Transparency in decision-making and communication is critically important.
• We have to look forward to Vision 2025 AND pay close attention to the challenges that practitioners face in SNFs, in medical model settings, in schools, in private practice and in the home, workplaces and the community. We MUST and we CAN do both. We cannot accept a false, forced choice.
• We need AOTA leaders who are accessible, engaged and open to feedback from both AOTA member and non-members.

 
I am excited that we have a slate of highly qualified, committed and skilled candidates running for AOTA offices this year. I am pleased that the level of engagement of the candidates has been raised to a meet a new bar; and I hope that I have been instrumental in making that happen.
 
I have 33 years of experience as a direct care clinician, manager, educator, researcher, scholar, and a consultant to community-based agencies. My experience as a State Association President, in SIS leadership, as Speaker of the Representative Assembly and as Secretary of AOTA have provided me with broad knowledge, skills and experience to be a highly engaged and effective Vice-President. I am passionate and committed to service to AOTA as a servant leader.
 
If you have not voted and have questions please reach out to me on Facebook or at bbraveman@gmail.com.
 
If you have not voted, please vote at www.aota.org.

If you have voted, THANK YOU for participating!