Practice

CE Article: Reducing Hospital Readmissions
The American Occupational Therapy Association
Practice
August 22, 2016
®
Familiar Pathways
Learning From the Story of Marty
Also in This Issue
Planning a State OT on the Hill Day
A Magical Teacher

AOTA Specialty Conference
September 23–24, 2016 · Cleveland, Ohio
Preconference Workshops: September 22, 2016 (separate registration required)
Presented by Lucy Jane Miller, PhD, OTR/L and Susan Bazyk, PhD, OTR/L, FAOTA
Register by August 24, and SAVE!
www.aota.org/autismconference
Autism diagnoses continue to rise, along with the greater necessity to
understand life transition challenges. It is urgent for the occupational
therapy profession to be fully prepared to meet the needs of children,
adolescents, and young adults on the autism spectrum.
A must-attend
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practitioners
working with kids or
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Occupational therapists play a key role in working with individuals on the autism spectrum to
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Conference, featuring national experts in occupational therapy, will give practitioners an
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SP-122

side
The American Occupational Therapy Association (AOTA)
Volume 21 • Issue 15 • August 22, 2016
2 Editor’s Note
3 News
5 Capital Briefing
New Occupational Therapy
Evaluation Codes Released
19 Evidence Perks
New AOTA Practice Guidelines
on Autism Spectrum
Disorder and Traumatic
Brain Injury
21 Perspectives
A Magical Teacher
23 Around the World
Making Global
Connections in Galway,
Ireland: 1st Joint Congress
of COTEC-ENOTHE
26 Continuing
Education
Opportunities
29 Employment
Opportunities
31 AOTA for You
32 Social Media
Spotlight
Cover Story
6 Familiar Pathways
Learning From the Story of Marty
The story of a skilled nursing facility client reveals the value of
occupational therapy in helping individuals find comfort and meaning.
By Carolyn Pluta
Also in This Issue
12 Planning a Successful
State OT on the Hill Day
Lessons Learned From Legislative Experiences
in Missouri
By Jacquelyn M. Sample
12
OT PRACTICE • AUGUST 22, 2016
21
CE Article
The Role of Occupational Therapy
in Reducing Hospital Readmissions
Earn .1 AOTA CEU (1 contact hour or 1.25 NBCOT professional development
units) with this creative approach to independent learning.
1

Chief Operating Officer: Christopher Bluhm
Director of Communications: Laura Collins
Director of Marketing: Rebecca Rutberg
Editor: Ted McKenna
CE Articles Editor: Debbie Amini
Art Director: Carol Strauch
Production Manager: Gary Furton
Director of Sales & Corporate Relations: Jeffrey A. Casper
Sales Manager: Tracy Hammond
Advertising Assistant: Clark Collins
Ad inquiries: 800-877-1383, ext. 2715,
or e-mail sales@aota.org
OT Practice External Advisory Board
Donna Costa: Chairperson,
Special Interest Sections Council
Julie Dorsey: Chairperson,
Work & Industry Special Interest Section
Elena Espiritu: Chairperson,
Physical Disabilities Special Interest Section
Lenin Grajo: Chairperson,
Education Special Interest Section
Ellen Hudgins: Chairperson,
Administration & Management Special Interest Section
William E. Janes: Chairperson,
Technology Special Interest Section
Patricia Laverdure: Chairperson,
Early Intervention & School Special Interest Section
Wanda Jean Mahoney: Chairperson,
Developmental Disabilities Special Interest Section
Jenny Martinez: Chairperson,
Gerontology Special Interest Section
Annie Baltazar Mori: Chairperson,
Sensory Integration Special Interest Section
Susan Noyes: Chairperson,
Mental Health Special Interest Section
Marnie Renda: Chairperson,
Home & Community Health Special Interest Section
AOTA President: Amy Lamb
Executive Director: Frederick P. Somers
Chief Academic & Scientific Affairs Officer: Neil Harvison
Chief Public Affairs Officer: Christina Metzler
Chief Financial Officer: Chuck Partridge
Chief Professional Affairs Officer: Maureen Peterson
© 2016 by The American Occupational Therapy Association, Inc.
OT Practice (ISSN 1084-4902) is published 22 times a year,
semimonthly except only once in January and December, by
The American Occupational Therapy Association, Inc., 4720
Montgomery Lane, Suite #200, Bethesda, MD 20814-3449;
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support of occupational therapy through standard-setting,
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Annual membership dues are $225 for OTs, $131 for OTAs,
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Editor’s Note
Life’s Pathways
T
his issue’s cover story (p. 6) conveys, I think, the full spectrum of care
and compassion that occupational therapy practitioners provide for
clients, however far along they are on their paths through life. In the
case of older adults, the desire for meaningful occupations may well
entail activities they engaged in when very young, a kind of circling
back to what were the most profound events of their lives. This path through
life, wherever it may take clients over their lifespan, is also described through a
first-person account (p. 21) from a young adult with autism about the lessons he
learned from his occupational therapist, from when he was very young to his days
in high school.
Turning to political matters, which have dominated the news of late, this issue
also provides extensive lessons learned about planning a successful state OT on
the Hill Day (p. 12). So much of occupational therapy practice is affected by state
legislation, and as author Jacquelyn M. Sample notes, practitioners must not
assume that someone else will do their advocating for them—they themselves
can be among their profession’s own best boosters. On the federal level as well,
lawmakers are returning to office following their August recess, and with national
elections in full swing, they may be especially alert to advocacy efforts. Much
more on Congressional, federal regulatory, and state policy affairs as they affect
occupational therapy can also always be found at www.aota.org/advocacy-policy.
As we here at AOTA build toward a celebration at the next Annual Conference
of the profession’s 100th anniversary, we aim to share more such stories about the
benefits of occupational therapy, past and present. Any lessons learned from your
work with clients that you would share? Send us a note to let us know.
Best regards,
Ted McKenna, Editor, OT Practice, tmckenna@aota.org
• Discuss OT Practice articles at www.OTConnections.org.
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OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants
to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions
and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA.
Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor
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(U.S. and Canada) while supplies last.
2 AUGUST 22, 2016 • WWW.AOTA.ORG

News
Evidence Highlights
Surviving Cancer
A
recent systematic review reveals moderate to
strong evidence that addressing psychosocial
components of cancer survivorship is beneficial
for survivors, regardless of age or the type or stage
of cancer. To learn more and find out about key findings in
other areas such as complementary and alternative medicine,
exercise rehabilitation, symptom management, and
multidisciplinary rehabilitation, check out the new Critically
Appraised Topics on cancer at http://goo.gl/21XkUM.
2016–2017 Emerging Leaders
Development Program
Participants Named
A
OTA
announced the participants chosen for the
2016–2017 Emerging Leaders Development Program
(ELDP):
Jesse Ausec, MS, OTR/L, (C)SI
Moira Bushell, OTD, MEd, OTR/L
Gabrielle Heckman
Sabrina Hilton, OTR/L
Lauren Jones, MSOT
Bridgette LeCompte, MS, OTR/L
Rebecca Masterjohn, MSOT
Miranda Miller, MS, OTR/L
Erin O’Donnell, OTD, OTR/L
Hanna Paul
Niccole Rowe, COTA/L
Gail Stephens, MS
Abigail Swidergal, COTA/L
Kirsty Vannoy, MS, OTR/L
Jarrett Wolske
The ELDP, created for students and practitioners at the start
of their careers who have demonstrated dedication and commitment
through service to the profession, provides selected
candidates with leadership training and ongoing mentorship
while addressing volunteer service needs within AOTA. Participants
receive formal face-to-face (2-day) training focusing on
leadership development and other components of the program.
Prior to the training, candidates are paired with a mentor who
currently holds a leadership position within AOTA, and they
participate in service learning activities over a 1-year period that
directly support AOTA’s Strategic Priorities. For more on the
ELDP, visit http://goo.gl/rcs8hb
PHOTOGRAPHS © ISTOCK AND GETTY IMAGES
Apply for Student
Membership Circle
A
OTA’s
Student Membership
Circle is a three-tier plan that
supports academic program
student membership initiatives—
Gold Level, Silver Level, and
Bronze Level. Student Membership
Circle recipients are determined based
on the percentage of enrolled students
who are also current active members of
AOTA. AOTA is now accepting applications
for the 2016–2017 academic year.
To apply to Student Membership Circle,
fill out the online form at www.aota.org/
studentcircle no later than October 31.
OT PRACTICE • AUGUST 22, 2016
3

News
Practitioners in the News
University of North Carolina–
Wilmington occupational therapy
student Oyoana Allende was
profiled in the News & Observer
(http://goo.gl/3UMsIG) and
other news outlets for her drive
to become an occupational
therapist after surviving a
suicide-bomber attack in Iraq
while serving in the U.S. Marine
Corps.
Karen Dobyns, OTD, MOT,
OTR/L, an occupational therapist
based in the San Diego
AOTA for You
Nancy Baker, SCD, MPH, OTR/L,
an associate professor at the
University of Pittsburgh, is quoted
in an article in Everyday Health on
tips for people with arthritis who
are hosting outdoor parties.
area, is quoted in an article
in Everyday Health on tips
for making life with multiple
sclerosis easier.
MarketWatch highlighted a
study led by Yael Goverover,
PhD, OT, an associate professor
of occupational therapy
at New York University, on
the difficulties people with
multiple sclerosis may face in
managing their finances as a
result of cognitive impairment
(http://goo.gl/hOQuR9).
Laura Vogtle, PhD, OTR/L,
FAOTA, and Sarah C. Tucker,
MS, OTR/L, faculty members at
the University of Birmingham,
in Alabama, are profiled in the
Birmingham Times (http://goo.gl/
dXlPev) for teaching occupational
therapy students about
working with kids to gain the
myriad social, gross motor, and
other benefits of playing.
Janet Weisberg, MS, OTR/L,
executive director of the
nonprofit Hold Your Horses, is
quoted in the Minneapolis Star-
Tribune on her organization’s
work providing equine-assisted
therapy.
Missouri Health Professions
Consortium Occupational
Therapy Assistant Program
student Jaclyn Weydert was
quoted in an article in the
News-Express (http://goo.gl/
cR2cS6) on helping to organize
the third-annual Adaptive
Anglers Fishing Derby, held
near Plattsburg, Missouri.
Get the latest updates
at www.aota.org/alerts
AOTA Awards: Nominate a
colleague who has made
significant contributions to the
profession for an AOTA award.
The deadline is September 13.
New CMS Demonstration
Project: Illinois, Florida, Texas,
Michigan, and Massachusetts
will be part of a 3-year, preclaims
review of home health
agency services to avoid
Medicare fraud and improper
payments.
Participate in Capitol Hill Day:
Participate in the first joint
Capitol Hill Day of AOTA and
the American Society of Hand
Therapists (ASHT), in person
or virtually, on September
19. Registration to attend
the Washington, DC, events
is limited this year, and will
close on September 4, or
when full capacity is reached.
Reviewers Needed: The
Evidence Exchange, a central
repository of quality evidence,
is looking for individuals to
review critically appraised
summaries (CAPs) of research
articles for the exchange.
Applications for this round
close on September 16.
The Texture of Life,
4th Edition
J. Hinojosa & M. Blount
This text presents a theoretical
foundation for the
idea of occupation, framed
within historical and current
practice and developed
from within the occupational
therapy profession.
$89 for members,
$126 for nonmembers.
Order #900352.
Ways of Living
C.H. Christiansen
& K.M. Matuska
This text reflects the
terminology of the Occupational
Therapy Practice
Framework and content in
light of the new realities
of health care, including
interventions strategies
beyond adaptation to ADL
and IADL challenges.
$89 for members,
$126 for nonmembers.
Order #1970B.
A Mindful Path to Leadership
Series Module 1: Exploring
Your Leadership Journey
(Online Course)
N. Blair & V. Stoffel
Earn 1 AOTA CEU (1 NBCOT
PDUs/1 contact hours).
This course supports the
exploration of leadership
from the inside out through
the identification of core values,
purpose, and personal
mission, leading to authentic
and trusting relationships
with others. $39.95 for
members, $49.95
for nonmembers.
Order #OL4791.
TO Order: http://store.aota.org (enter order # preferred) or call 877-404-AOTA
Questions?: 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555.
2015 Conference Presidential
Address by Dr. Stoffel:
Engagement, Exploration,
Empowerment (Webcast)
V. Stoffel
Earn .75 contact hours.
The course illuminates how
engagement, exploration,
and empowerment strategies
not only enhance our
effectiveness as practitioners,
educators, managers,
and researchers, but also
meets society’s occupational
needs. Free for members,
$24.99 for
nonmembers.
Order #WA0215.
PHOTOGRAPH © ALEX RATHS / GETTY IMAGES
4 AUGUST 22, 2016 • WWW.AOTA.ORG

Capital Briefing
New Occupational Therapy
Evaluation Codes Released
PHOTOGRAPH © MILOSDUCATI / GETTY IMAGES
Although the new
re-evaluation code presents
a similar coding concept,
the new evaluation codes
introduce a coding paradigm
for evaluations based on
patient complexity.
Bryan Hull
O
n July 7, 2016, the Centers
for Medicare & Medicaid
Services (CMS) issued a
proposed rule that updates
payment policies, payment
rates, and quality provisions for services
furnished under the Medicare Physician
Fee Schedule (PFS), effective January 1,
2017. After a multi-year collaborative effort
involving AOTA, the American Medical
Association (AMA), and CMS, the release
of the proposed rule provided a first look
at the long-awaited new evaluation and
re-evaluation codes for occupational therapy.
Although the new re-evaluation code, replacing
CPT© code 97004, presents a similar
coding concept (single, untimed code, billed
once per day, per patient), the new evaluation
codes, replacing CPT® code 97003,
introduce a coding paradigm for evaluations
based on patient complexity (low, moderate,
or high). AOTA introduced complexity levels
to reflect the complex clinical decision making
of the occupational therapist during the
evaluation process and address the needs of a
significantly different health care population
than that which existed when
these codes were originally
developed almost two decades
ago.
AOTA proposed and advocated
for this tiered coding
system, which was ultimately
accepted by AMA and later
presented to CMS. Although
CMS accepted the new
evaluation and reevaluation
code descriptors, it opted for a
work relative value unit (RVU)
of 1.20 for each of the occupational
therapy evaluation
codes, rather than differentiating
values per code, as AOTA
advocated. CMS expressed
concerns with potential abuses
of the levels—for example,
upcoding a moderate level evaluation to a
high level. The agency proposed to maintain
each level at the same value, meaning
that reimbursement will be the same
regardless of the complexity of the patient,
as defined by the code descriptor.
Same Values … So What Now?
Even though the codes have been given the
same values, AOTA will be working to educate
occupational therapy practitioners on
the importance of accurately differentiating
and documenting for the levels contained in
the three evaluation codes. In the proposed
rule, CMS also encourages education on the
factors embedded within each code descriptor
to better equip therapists to correctly
choose the appropriate level. AOTA is devoting
significant effort to member education to
define key terms, such as performance deficits,
as well as the process therapists should use to
identify the number of performance deficits
that result in activity limitations and/or
participation restrictions, and the relevance
of the number of comorbidities and treatment
options. Therapists have a professional
responsibility to code and document accurately.
In addition, CMS has indicated that
it will analyze the utilization of the different
levels and will make value determinations
based on that data. Therefore, correct level
selection and documentation will provide
AOTA and CMS with accurate utilization
data so we can advocate for stratified values
in the future. Stay tuned to AOTA publications
and the website for upcoming CE
articles, webinars, in-depth coding and
documentation guidelines, and AOTA presentations
to state associations and specialty
conferences to highlight these new codes.
For more details, including a table listing the
new codes and descriptors, see www.aota.
org/advocacy-policy/federal-reg-affairs.
Bryan Hull, JD, MPH, is AOTA’s manager of coding and payment
policy.
OT PRACTICE • AUGUST 22, 2016
5

The story of a skilled nursing facility client
reveals the value of occupational therapy in
helping individuals find comfort and meaning.
6 AUGUST 22, 2016 • WWW.AOTA.ORG

Familiar Pathways
Learning From the Story of Marty
Carolyn Pluta
“ Good luck getting anything out of him;
he plays possum,”
the med tech told me as I curiously
approached a long-term resident I was
meeting for the first time. “Oh, and he
has dialysis every Monday, Wednesday,
and Friday.”
I found him sleeping in his wheelchair,
the same way he always looked,
according to the nursing staff. I was told
that they recently discovered he had
sustained a pelvic fracture, from which
the cause was unknown, thus warranting
a therapy evaluation. He used to walk
but had been wheelchair bound for quite
some time, and they thought that the
fracture was simply pathological.
I ran my typical evaluation protocol.
“How is he with his daily activities?
Does he get himself dressed? How about
showers?”
“Total assist; he doesn’t do anything
himself. Sometimes he’ll try to fight you.”
“What about transfers?” “He can’t
stand on his own. We need two people to
use the sit-to-stand lift for him.”
Wow. What am I going to work on
with this guy, who won’t even open his
eyes for me? I left the ward feeling unaccomplished
and nervous. Not knowing
what this guy could do, or what I could
do for him, I hesitantly brought my finger
to the buttons on the phone and slowly
dialed the number for his power of attorney,
his father.
Wait—his father? I work in a skilled
nursing facility/long-term-care center.
Almost all of my clients for short-term
rehab, in addition to our long-term
residents, have received a diagnosis of
dementia. Some are in the early stages
and simply have trouble remembering
the date or what they had for breakfast.
Others have reached the tail end, where
they are entirely dependent on their caregivers
to get out of bed, get dressed, sit
upright in their chair, and even to chew
their food. Marty was only in his 60s.
His parents were still alive. And he lived
here, with the other long-term residents.
And he was now my responsibility.
“Hello??”
“Oh, hi, this is Carolyn from occupational
therapy. I am calling to tell
you that we received an order to evaluate
your ... er ... son ... after his pelvic
fracture.”
“You might want to speak to the
physician about that. He’s in a lot of pain.
I don’t want your therapy to hurt him any
more than he already is hurting.”
What do I even say? I don’t want him
hurting either, nor do I want to put this
poor father through any more trouble
than he already is experiencing, given
his son’s current circumstance. I thought
about it.
“Well, you know, we think the fracture
may actually be due to prolonged sitting
in that wheelchair. I understand that the
nursing staff hasn’t really been encouraging
him to actively stand up or participate
in daily tasks. It might be good for
him to off-load that weight. And I saw
him today and noticed he tends to close
his eyes when he wants nothing to do
with someone. If he does that, I will not
OT PRACTICE • AUGUST 22, 2016
7

Something in
Marty’s facial
expression told me
that he understood
more than he was
letting on.
Marty slowly raised
his hand and
pinched the gel
with his index finger
and thumb.
Marty smiled.
He really smiled.
push for therapy that day and take it as a
sign that he is hurting. And nursing and I
will work closely together to manage his
pain.”
“Well, Carolyn, you’re the expert.”
Shoot, am I really, though?
“I trust your judgment. You can try,
but I don’t know what all he will do for
you.”
Feeling a combination of relief that
the man didn’t tell me to go to hell, yet
apprehension toward my clinical abilities,
I hung up the phone. The next day,
Marty was due for a shower. I jumped
at the opportunity to use that as a time
to incorporate occupational therapy. I
saw how Marty grew agitated with the
certified nursing assistant (CNA) as he
was wheeled in his shower chair and his
clothing was removed. Most of the residents
who live in my facility rely on nursing
staff to do these once-simple tasks for
them, but I wondered about something.
Something in Marty’s facial expression
told me that he understood more than he
was letting on.
The CNA began threading Marty’s
right hand through his sleeve, and he
swatted at her. I had an idea. I took Marty’s
shirt and placed it on his lap. Marty
put his own shirt on.
“I didn’t know he could do that,” the
CNA muttered.
I gave Marty his pants. Marty crossed
one leg over the other and pulled a pant
leg over his foot. Marty, I realized, closes
his eyes because he is in pain. Because he
doesn’t want to be bothered. Because he
wants to avoid his reality. Not because he
doesn’t understand.
Creature Comforts
The following sessions were frustrating.
Marty would occasionally participate for
a good 5 consecutive minutes, be it in the
form of lacing up his shoes or pedaling
his arms on an exercise machine, and
in the drop of a hat he would close his
eyes again. I felt like I was just an added
nuisance in his life.
Later one day, I was working with
another resident in the dining room of
Marty’s ward. The same CNA who had
helped Marty shower saw me and flagged
me over.
“Please, go talk to Marty! He keeps
standing up! He’s going to fall!”
Talk to Marty? Dementia is an
interesting condition. Some people can
still have a conversation with you, but in
addition to reminiscing about how they
met their husband or where they grew
up, they also acquire unsafe and inappropriate
behaviors without much rationality
involved. A lot of residents try to stand
up from their wheelchairs just for the
heck of it, and this is when falls occur.
Once this impulsive behavior happens,
the best bet is to distract the resident
rather than try to talk things through.
But Marty seemed different. I found
Marty supporting himself with his hands
on the table and leaning over with his
head down. He didn’t look like he was
causing trouble. He looked like he was
hurting.
“Marty, are you in pain?” Marty
nodded. “Marty, let’s sit down. Please. It’s
not safe. I’ll ask the nurse to get you some
pain meds. Please sit down.”
Marty slowly lowered down.
“Please don’t stand up like that again.”
“Yes, dear.”
Dear? Marty still talks. Marty can
rationalize.
The next day I took a look at Marty’s
wheelchair cushion. The foam was so
worn out that the area his tailbone rested
on was essentially a piece of paper. Marty’s
fractured pelvis was not being cushioned.
No wonder he was hurting. I ran
down to the equipment room and was
ecstatic to find a cushion with gel around
the tailbone region and foam surrounding
it. It was the perfect size for Marty’s
chair. I found Marty seated on the couch,
with his eyes closed. Playing possum.
“Marty, look at this cushion I got for
you. I think it will hurt less when you sit
in your wheelchair.”
Marty blinked his eyes open.
“Feel it! Do you like it?”
Marty slowly raised his hand and
pinched the gel with his index finger and
8 AUGUST 22, 2016 • WWW.AOTA.ORG

thumb. Marty smiled. He really smiled. I
have seen Marty smile twice in the short
couple of months I’ve known him. And
that’s two more times than some staff
members who have been working here
with Marty for years have seen. From his
brief smile, I can tell you that Marty has
some teeth missing. He has crystal blue
eyes that squint and create lines at the
corners.
“Thank you,” he said.
I changed out his old cushion for the
new one and left him in peace.
The social worker in Marty’s ward
sent me an email requesting that I attend
a care conference with Marty’s parents
to discuss his plan of care in regards to
nursing, therapy, and his overall prognosis.
My heart dropped. Marty’s father, the
man who questioned my intentions over
the phone, who so dearly loved his son,
who didn’t want him to feel any more
pain, would now see me in person.
I gently knocked on the office door
and entered to find the social worker
seated with two individuals who had
canes propped against their chairs. They
looked elderly certainly, but alert and
strong. Marty’s parents are in their 90s
and have no diagnoses of dementia,
unlike their son. I tried to muster up my
most professional voice and shook each
of their hands.
“HI. NICE TO MEET YOU.
I’M CAROLYN.”
With a good 80% of my client
population being hard of hearing, the
over-exaggerated mouthing of my speech
just came out automatically. I instantly
regretted not suppressing that reflex.
I learned quickly that Marty’s parents,
though almost a century old, were still
extremely coherent. The care conference
began rather unpleasantly, with the social
worker reviewing the documentation that
Marty’s father had submitted as power
of attorney, including Marty’s “Do not
resuscitate “ status and the progression of
Alzheimer’s disease, from the early stages
to the inevitable death of the individual.
In the short time I have been at this
facility, I have already participated in a
large number of these care conferences.
For a while, I feared that I had already
lost my sensitivity, my compassion, my
empathy for this population because I
could leave these conferences unscathed
by the impact this condition clearly has
on the families.
But here is the thing. The familiar
pattern of life typically entails children
outliving their parents. Parents grow old
and lose their strength, their memory
fades, and they become more dependent
on their caregivers. Losing a parent or
grandparent is not easy, by any means,
but it is more or less a natural experience.
Attending Marty’s care conference
just hurt. It was my turn to talk. I tried
to keep my composure as I recapped my
experience with Marty in therapy thus
far. I told his parents how I switched
out his cushion, how I learned just how
much he can actually still do on his own,
how he was standing and walking with
physical therapy. How we have been
respectful of his pain.
“We really appreciate everything
you’re doing. Marty has always been very
independent, and we know this is hard
for him. Oh, and we love the new cushion.
We took turns sitting in it.”
Whoa, they appreciate me? Just a few
weeks ago I felt like I had to muster up all
I had learned in grad school about advocating
for my profession while on the
phone with Marty’s father, and now they
were seeing the value in the therapy sessions?
From that point forward, we were
a team. I gave his parents a gentle touch
on the shoulder as they left smiling,
walking hand in hand, each with a cane
supporting their other side. Relying on an
assistive device to keep their balance yet
possessing more emotional strength than
I could ever imagine.
Client Priorities
Weeks went by, and Marty’s participation
in therapy continued to be spotty,
depending on his pain and overall motivation.
Marty’s parents popped in and out
of the facility, and they always greeted me
with a smile and appreciation. I began
Just a few weeks ago
I felt like I had to muster
up all I had learned in
grad school about
advocating for my
profession while on
the phone with
Marty’s father,
and now [his parents]
were seeing the value
in the therapy sessions?
From that point forward,
we were a team.
OT PRACTICE • AUGUST 22, 2016
9

to learn that Marty was funny. I would
occasionally pass by to find him wearing
a straw hat.
“Marty, is that your hat?”
“I guess it is now.”
“Marty, what are you doing waiting by
the elevator?”
“Trying to catch a lift!”
That was the second time I saw
Marty smile. I learned Marty liked rock
’n roll and dogs. I learned his legs were
beginning to hurt more than his pelvis. I
learned he sometimes transferred himself
to bed from his wheelchair on his own,
an occurrence so unfathomable that the
nursing staff simply assumed it was one
of the CNAs who assisted him.
I learned that Marty didn’t want dialysis
anymore. I learned Marty now had
weeks left to live.
I began seeing Marty’s parents more
frequently, and my guarded aura of
professionalism began to dissipate. I had
to discharge Marty from therapy because
he was now transitioning to hospice
care, but I told his parents that I would
continue to look out for him.
I kept that promise. While sitting in
the dining room helping other residents
eat, I would periodically glance out into
the courtyard. I will never erase from
my mind one particular image painted
before me. For there in the courtyard was
Marty, the same Marty who spent the
majority of his days in his wheelchair,
with one leg crossed over the other in
a figure four, with his head bowed and
his eyes closed. But now the Marty who
played possum was walking with his dad.
His dad had one hand on Marty’s belt
loop and another grasping a cane, with
Marty pushing his front-wheeled walker,
and Marty’s mother trailing after them
with Marty’s wheelchair. If Marty fell, his
father would not be able to recover him,
and his father would be in serious condition
as well. But at the same time, Marty
was walking with his parents for the last
weeks of his life. What is to be prioritized
at a time like this?
Later that afternoon, my boss and I
walked outside to talk to Marty’s parents.
We told them of our safety concerns, and
offered to provide a nursing aid to accompany
them. They told us the problem was
not that they didn’t want to be safe, but
rather than Marty would spontaneously
start walking out of nowhere, whether
they had prepared for it or not. They
expressed their gratitude toward receiving
assistance whenever possible. As my
boss and I walked back into the building,
out of the corner of my eye I could
already see Marty beginning to stand
again. Marty knew he was dying. Marty
just wanted to walk with his parents.
Safety concerns were no longer of value
to him.
Getting glimpses of Marty walking in
the courtyard with his father became a
daily ritual, and there was something so
beautiful and so tragic about this scene.
It was mesmerizing. Then one day it
stopped. I found Marty on a recliner in
the TV room of his ward, playing possum,
with a tray of food in front of him. Marty
hadn’t eaten that day, much less opened
his eyes.
I asked about Marty every day. Suddenly
I stopped seeing him out in the TV
room. The door in his room was closed,
and the nurses told me he wasn’t doing
well. At the end of the week I found two
chairs seated outside Marty’s room. The
door was left ajar and inside the room I
could see a table with a water pitcher and
dinner for two. We were accommodating
for his parents. It was only a matter of
days. I punched out at the time clock,
then went back up to Marty’s room. I
crossed paths with Marty’s mom. She
smiled, but I was too distracted by the
redness in her eyes. I gave her a hug.
Marty had been sleeping all day, she told
me. She wasn’t sure whether he would
last through the night. I walked into
Marty’s room and was greeted by his
father. There were two chairs set up at
the foot of his bed. All the lights were off.
I helped Marty’s parents prop their canes
against the wall as they took a seat next
to their sleeping son.
“We should just stay here forever; look
at this free food we get!”
10 AUGUST 22, 2016 • WWW.AOTA.ORG

While I am forced to face the sadness of this world,
I am equally exposed to its beauty.
They gestured to the dinner for two
I had seen through the door. Humor. A
preferred defense mechanism in times
of turmoil. I let out a supportive laugh,
then asked whether I could hug their
son. I knelt down next to Marty’s bed,
announced my presence, and gave him a
one-sided hug as he continued to sleep.
On the other side of him I saw a stuffed
dog with the tag still on it.
“Did you just get this for him? It’s
adorable.”
They nodded. Marty’s mom stood up.
“Do you want to see his childhood
dog?”
She reached into a drawer and pulled
out the remnants of a small stuffed animal,
with matted fur and a faded coat.
“Did he name it?” I asked as I choked
back the tears.
“Poochie.”
“How original,” I joked.
Good old humor, saving the world
from raw emotions. I tucked Poochie
under Marty’s chin and stood up. I asked
his parents if they needed anything and
they politely declined.
“You drive home safe, young lady.”
I can’t remember what additional
words were exchanged at that moment,
only the emotions that were felt. I will
forever hold in my heart the cool dimness
that flooded that room. The loving wear
and tear of Marty’s beloved toy. The
unique combination of sadness and peace
I gathered from Marty’s parents. The
tears that left my eyes as I drove home
that evening.
I didn’t work the next day, so I texted
my boss to notify me of Marty’s status. She
told me she hadn’t heard anything yet.
The morning after that I received the
text.
“I’m so sorry Carolyn. Just find peace
in that it was what he wanted ... and that
you helped him live out his last months
with dignity and a sense of purpose …
you made him smile.”
Marty had told me he was waiting for
the elevator to “catch a lift.” That day, his
wait was over. No more pain, no more
playing possum to block out the triweekly
dialysis appointments, no more
loss of independence. Marty was free.
Marty was lifted from the confines of his
wheelchair.
Daily Reflections
This job is not easy. I stare at death in
some form on a daily basis. It is through
Marty I am reminded why I work with
this population. While I am forced to face
the sadness of this world, I am equally
exposed to its beauty. I hear tales of traveling
the world, of previous careers. I witness
the silliness of a food fight instigated
by a confused resident. I watch the power
of human connection and the emotional
resilience of two parents. Marty temporarily
avoided his daily woes by closing
his eyes, but he also faced the hardships.
He knew the control he had of his own
life and made the conscious decision to
cease his dialysis appointments. And on
his final weeks, when he no longer had
control of the situation and his timeline
was unpredictable, he held onto those he
loved and just kept walking. And that’s all
any of us can do. We work with what we
have, making informed decisions when
we can. After that, we can either live in
fear, or we can walk and enjoy the breeze
of a courtyard in the afternoon while we
wait for the unpredictable to happen.
Rest in peace, Marty. And may Marty’s
parents find peace now and for the
remainder of their beautiful lives.
Carolyn Pluta, MS, OTR/L, is an occupational therapist at a
skilled nursing facility/long-term-care center.
For More Information
www
Fact Sheet
Occupational Therapy’s
Role in Skilled Nursing
Facilities
http://goo.gl/Q5wg6O
Living Life To Its Fullest:
Stories of Occupational
Therapy
By A. Hofmann & M. Strzelecki,
2010. Bethesda, MD: AOTA
Press. ($19 for members, $27 for nonmembers.
To order, call toll free 877-404-
AOTA [2682] or shop online at http://store.
aota.org, and enter order #1254).
Ways of Living: Intervention
Strategies to Enable
Participation, 4th Edition
By C. H. Christiansen & K. M.
Matuska, 2011. Bethesda,
MD: AOTA Press. ($89 for members, $126
for nonmembers. To order, call toll free
877-404-AOTA [2682] or shop online
at http://store.aota.org, and enter order
#1970B).
OT PRACTICE • AUGUST 22, 2016
11

Planning a Successful
State
Lessons Learned From
Legislative Experiences
in Missouri
I
was born with an advocate’s heart…
or maybe I am just stubborn. Either way, I spend most days trying to
follow my dad’s and grandfather’s advice: “Be part of the solution,
not part of the problem.” My family instilled a value of offering and
working toward solutions instead of adding to the list of complaints.
Complaints, however, are usually a required first step in determining how we
can impact change and where we need to start. Complaints, although a negative
connotation, result in clientele for the practice of occupational therapy.
Clients complain to their doctor about an illness, an injury, pain, or concerns
for a loved one. The occupational therapy profession would be difficult to
maintain if we did not first recognize and attend to complaints. The beauty of
being an occupational therapy practitioner is that we are part of the solution.
We are solution practitioners, problem solvers, and advocates for productive
living.
The Occupational Therapy Practice
Framework: Domain and Process,
3rd Edition (Framework; American
Occupational Therapy Association
[AOTA], 2014) defines advocacy as
“efforts directed toward promoting
occupational justice and empowering
clients to seek and obtain resources
to fully participate in daily life occupations.
The outcomes of advocacy
and self-advocacy support health,
well-being, and occupational participation
at the individual or systems
level” (p. S30).
The Framework definition of
advocacy suggests the importance of
advocating for clients and teaching
clients skills in self-advocacy, but we
must also advocate for our profession,
and that includes being aware
of relevant legislation at the state and
federal levels. Legislation directly
affects the reimbursement rates
for occupational therapy services
as well as what services are available
to vulnerable populations. We
must advocate for our profession, to
protect our scope of practice and the
independent occupational functioning
of our clients.
What steps do we take to protect
our clients and the profession? This
article will provide some steps to
follow based on the successes of
the Missouri Occupational Therapy
Association (MOTA) On the Hill Day
event, held over the past 3 years at
the Missouri State Capitol Building,
in Jefferson City.
PHOTOGRAPH © GETTY IMAGES
12 AUGUST 22, 2016 • WWW.AOTA.ORG

OT on the Hill Day
Jacquelyn M. Sample
Action Plan
Know your audience.
Know who you are dealing with. Take a
quick look at the structure of your state’s
legislative branch. Determine:
l How many members are in the state
House of Representatives? How many
senators are in the Senate? Knowing
these numbers will allow you to
adequately plan and request meetings.
You will need multiple practitioners
and students to cover all of the offices.
l What are the term limits? Constituents
can be weary of this question,
especially in an election year. But
turnover does occur. To effectively
advocate, you need to know who has
extended experience in the legislature,
perhaps leading to more political
influence. Missouri state representatives
have a term limit of four 2-year
terms. These term limits can result
in large turnover rates in the House.
Continuing education of and familiarity
with new representatives as they
take office is necessary and imperative
to supporting occupational therapy
practice and education.
l What committees has each legislator
been assigned to? No, you do not need
to know every committee every legislator
sits on. However, if your state
association has an active bill, it will be
assigned to committee(s) for hearings.
As an advocate for legislation that supports
occupational therapy practice,
you will need to identify the assigned
committee members and committee
chair, specifically communicating
with the committee members regarding
the actual bill that has been filed.
OT PRACTICE • AUGUST 22, 2016
l What is the political party representation
in the House and Senate, compared
with the governor’s office? Is
bipartisan cooperation more than just
a buzzword for election platforms and
promises? Again … election years can
be a bit tense. Political parties view
and vote for health care and funding
in different ways. It is important to
know which party has the majority in
the House and the Senate. That information
may influence whom your
state association chooses as a sponsor
of an occupational therapy bill. If the
governor’s party is not the majority
party, actually getting the bill signed
could be difficult.
l Identify the leaders in the House and
Senate. Have your state association
officers visit with them personally
during Hill Day.
Know your advocates.
Your advocates include every occupational
therapy practitioner and student in your
state. Keep them involved and up to date.
l Increase involvement and membership
numbers in your state occupational
therapy association. The goal is
to have state association members in
every district. If that goal is met, every
state representative and senator will
have a constituent active regarding
occupational therapy legislation.
l Have occupational therapy district
meetings. Invite the elected officials
of each area to the meetings to discuss
their views on health care and occupational
therapy.
l Provide information to all state association
members year round regarding
legislative issues that can impact the
practice of occupational therapy in
your state.
l Reach out to non–state association
members. If your state has one, collaborate
with the state board of occupational
therapy to determine where the
licensed practitioners are.
l Invite each and every occupational
therapy program faculty person and
student in your state to attend your
Hill Day. Attending and participating
in the state Hill Day activities
is a great assignment for students
at all levels of occupational therapy
education.
Know your reasons.
As private citizens, we may have many
reasons why we would like to talk with an
elected official. As a profession, the most
effective Hill Day has one main message.
It could be support of a particular bill,
opposition to a bill, or information on
legislation affecting occupational therapy.
Have a clear and concise message, and
train all Hill Day attendees to communicate
that message.
13

Plan Hill Day
The basics.
We all have to start somewhere.
Your state’s Hill Day can be as
large or as small as your state
organization wants it to be. Missouri’s
goal is to have as many
occupational therapy practitioners
and students as possible in
the capitol building on the same
day. Two hundred bodies in one
hearing room or rally space is
very powerful. The following
steps have proven the most successful
for us.
Hawaii became the 50th and final state to fully
license occupational therapists and one of
the last remaining states to license occupational
therapy assistants when then Governor
Neil Abercrombie signed the practice act. (2014)
Successful
Advocacy
1Pick your team. The Hill Day planning
team will be made of volunteers. Team
members do not necessarily need to
be legislative experts. However, they
do need to be organized and willing to
dedicate the time to planning and follow
through. I suggest the following four
main team positions:
l Appointment Master. This person is
in charge of requesting and scheduling
all appointments with legislators.
This requires lots of emailing, phone
calling, and reminding. This person
will coordinate the schedule of events
for the day and assist with finding
rally speakers. On the actual Hill Day,
this person is responsible for keeping
attendees on schedule and making
sure all legislators are visited.
Maryland Governor Larry Hogan signed a law
that strengthens the state law regarding habilitative
services and brings it in line with a new
federal rule. (2016)
l Logistical Planner and Visual Marketer.
This person is responsible for
reserving space and tables, determining
visual displays promoting occupational
therapy, and coordinating Hill
Day marketing, including invitations
to all licensed occupational therapy
practitioners and invitations to hand
out to the legislators and legislative
assistants during the Hill Day event.
This person(s) will need to be creative
and organized to ensure visual
appeal of the displays and marketing
material. Working with a marketing
and/or mailing agency is highly
recommended.
l Legislative Summarizer. This team
member writes the information
regarding current legislation, or creates
the “message” of OT on the Hill
Day. This information should be provided
prior to the event, as well as on
the day of the event. This will ensure
all attendees are giving a consistent
message.
l OT Power Player. This is everyone
else. Hill Day events are not successful
because of one or two people. Hill
Day events are successful because of
all the practitioners and students who
support the event. Hill Day is a lot
of fun, but it is also a lot of work. It
takes a lot of people to reinforce positive
messages, educate, and contact
legislators.
PHOTOGRAPHS: HAWAII GOVERNOR’S OFFICE (LEFT) AND
© EXECUTIVE OFFICE OF THE GOVERNOR OF MARYLAND (RIGHT)
PHOTOGRAPHS OF STATE CAPITOLS © GETTY IMAGES
14 AUGUST 22, 2016 • WWW.AOTA.ORG

Missouri OT advocates meet with Representative Todd Richardson, Speaker of the House (back
row, center).
Missouri OT advocates meet with Representative Bart
Korman (third from right).
PHOTOGRAPHS: TOP: COURTESY OF THE AUTHOR.
BOTTOM/: COURTESY OF ANDREA STAYZER AND NNAZARETH COLLEGE
PHOTOGRAPHS OF STATE CAPITOLS © GETTY IMAGES
2
Schedule. Pick and reserve
a date. Make sure it is
during the time legislators
are in session. End
of session is very busy, so you may
want to avoid that time frame, as you
will be granted fewer meetings. Try
to choose the same date each year.
For example, in Missouri, we have
Hill Day on the 4th Wednesday in
February every year. Keeping the date
consistent will keep it on everyone’s
calendar.
3
Invite. Send an invitation
to Hill Day to all licensed
occupational therapy
practitioners throughout
your state. Work with your state’s
occupational therapy licensure board
to obtain their mailing addresses.
Offer contact hours. Email or call
all legislators and legislative assistants
inviting them to meet with the
occupational therapy experts on Hill
Day. Provide personal invitations the
morning of the event to each office.
4
Educate. Once your Hill
Day message is determined,
educate all attendees on
that message. Provide brief,
written information or have information
available for mobile devices.
Assist your attendees in identifying
their elected officials. Make this a
requirement for registration.
5
Organize. Match constituents
with their legislators
for meetings. If a practitioner
or student has a
personal relationship or connection
with a legislator, schedule a meeting!
6
Hold the meetings. Meetings
will usually be brief;
usually around 5 minutes.
Meetings with legislators
should always have more than
one occupational therapy practitioner
and/or student present. Pair
students with practitioners and
educators for role modeling and
creation of future occupational
therapy advocates.
7
Say “thank you.” Make sure
you recognize all occupational
therapy attendees
at least verbally and thank
them for their participation. In
addition, have volunteers write thank
you notes after their meetings with
legislators. During Missouri OT on
the Hill Day, a “thank you” note table
is set up for easy and timely completion.
All thank you notes are hand
delivered by occupational therapy
volunteers by the end of the day.
OT students from Nazareth College and Bryant and
Stratton College in Rochester, New York, meet with
Senator Joseph Robach.
OT PRACTICE • AUGUST 22, 2016
15

Plan Hill Day
Hill Day events in each state in support of occupational therapy legislation are feasible,
realistic, and imperative to occupational therapy practice.
candy to your message. For example,
when lobbying for a co-pay parity bill,
MOTA had “100 Grand” candy bars on
the tables. We added stickers with the
bill information to the candy. Regardless
of the kind, though, be sure to have
good-quality candy on your tables.
Create signs and banners that you
can use year after year. Avoid including
a specific date or bill number.
Provide a registration packet to the
attendees online.
Have them print the packet for their
use prior to Hill Day. This will cut down
on printing costs.
Additional Tips
Several extra tasks can personalize
the day, assist in helping legislators
remember occupational therapy, and
serve occupational therapy practitioner
attendees.
Social media.
Create a Twitter hashtag (e.g., #MOTA-
OnTheHill2016). Encourage all
attendees to take pictures and post to
social media outlets. All pictures with
legislators should be tagged and sent to
the legislators’ social media profiles and
emailed to them.
Consider special needs, such as accessible
entrances and dietary needs if you
serve lunch or snacks, as well as space
for attendees to breast feed and/or pump.
Have a rally!
Having 200 occupational therapy practitioners
and students in one place at
one time sends a big message and will
be remembered by all involved.
Serve lunch or snacks to attendees.
Have candy (chocolate!) on your display
tables. If at all possible, “theme” the
Check WiFi connections.
Make sure you are aware of the availability
of the wireless connection in
the state building. Let attendees know
ahead of time if the WiFi is poor.
Give prizes.
Have a drawing in which attendees
can win a free membership in the
state association. Also consider having
occupational therapy–themed gift
baskets available for a raffle for capitol
employees. MOTA has had baskets for
pediatrics, stress management and wellness,
adaptive gardening, and kitchen
adaptations. Each basket includes an
information sheet on how occupational
therapy supports occupational performance
in each area.
PHOTOGRAPH © GETTY IMAGES
Don’t get discouraged, and stay persistent!
For us, Hill Day has been a success, with the Missouri governor recently signing a bill into law that included an occupational
therapy–related amendment for co-pay parity. Impacting legislation is not a quick process. Hill Day events in each state in support
of occupational therapy legislation are feasible, realistic, and imperative to occupational therapy practice. As a profession and
individual practitioners, it is important for us to not believe that “someone else” will take care of occupational therapy legislative
efforts. That “someone else” could be someone whom we do not want speaking for us and guiding the decision-making regarding
occupational therapy policy. The tired question of, “What is OT?” is best answered by us! Have an excellent Hill Day!
16 AUGUST 22, 2016 • WWW.AOTA.ORG

Reference
American Occupational Therapy Association. (2014).
Occupational therapy practice Framework: Domain
and process (3rd ed.). American Journal of Occupational
Therapy, 68, S1–S48. http://dx.doi.org/10.5014/
ajot.2014.682005
Jacquelyn M. Sample, MEd, OTR/L, is completing a Doctorate
of Occupational Therapy through Nova Southeastern University in
Fort Lauderdale, Florida. Sample’s clinical specialty is pediatrics.
She is currently an instructor in the Missouri Health Professions
Consortium Occupational Therapy Assistant (OTA) program. For
the Missouri OT Association, Sample serves as director of practice
and chair of the Mid-Missouri District, and has served as co-developer
of the MOTA Hill Day for the past 3 years.
For More Information
www
www
AOTA’s Guide to Advocacy &
Promotion: A Special Issue
of OT Practice
http://goo.gl/dOs6Jh
State Policy News and
Resources
www.aota.org/advocacy-policy/state-policy
Webcast
2015 Conference Presidential
Address by Dr. Stoffel:
Engagement, Exploration,
Empowerment
By V. Stoffel, 2015. Bethesda,
MD: American Occupational Therapy Association.
(Earn .75 contact hour. Free for members,
$24.99 for nonmembers. To order, call toll free
877-404-AOTA [2682] or shop online at http://
store.aota.org, and enter order #WA0215).
Jacquelyn M. Sample (left) and MOTA Legislative
Representative Diana Baldwin at MOTA on the
Hill Day
PHOTOGRAPH COURTESY OF THE AUTHOR.
Joint Capitol Hill Day of
AOTA and the American
Society of Hand Therapists,
on September 19,
in Washington, DC—
Join with more than 500
practitioners and students from around the
country to advocate for issues important
to both professions, www.aota.org/Conference-Events/Hill-Day
Mentoring Leaders: The
Power of Storytelling for
Building Leadership in Health
Care and Education
By E. Gilfoyle, A. Grady, & C.
Nielson, 2011. Bethesda, MD:
AOTA Press. ($44 for members, $62.50 for
nonmembers. To order, call toll free 877-404-
AOTA [2682] or shop online at http://store.
aota.org, and enter order #1255).
NEW EDITION FROM AOTA PRESS!
OT PRACTICE • AUGUST 22, 2016
The Reference Manual of
the Official Documents o
the American Occupational
Therapy Association, Inc.,
21st Edition
Since 1980, the American Occupational
Therapy Association has
collected its official documents
must-have information for occupational
therapy students and practitioners—into one handy,
frequently updated reference work. The 21st edition continues
that tradition and includes concept papers, guidelines,
position papers, roles papers, specialized knowledge and
skills papers, standards, statements, and information on the
American Occupational Therapy Foundation.
In addition to the 3rd edition of the Occupational Therapy
Practice Framework: Domain and Process, this volume
contains many valuable and timely documents
Order #900395
AOTA Members: $79
Nonmembers: $259
SKU: 900395
ISBN: 9781569003954
Est. 700 pages
To order, call 877-404-AOTA, or shop online at
http://store.aota.org
BK-439
DOCTOR OF OCCUPATIONAL
THERAPY (OTD)
A post-professional degree plan
offering Bachelor’s-to-OTD and
Master’s-to-OTD options
The program enables practicing OTs to complete a course
of study that will prepare them to assume leadership roles,
management positions, and/or to serve as clinical faculty.
The program is primarily online with two visits to the Galveston,
Texas, campus for on-site learning; it can be completed in six to
seven semesters while maintaining active clinical practice.
For more information please contact: Sharon McEachern,
PPOTD.admissions@utmb.edu or (409) 772-3062.
shp.utmb.edu/OccupationalTherapy
P-7824
17

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You’ve invested time, energy, and money into your continuing
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With AOTA’s new digital badging program, you can now easily share your learning achievements with
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badge’s requirements prior to claiming.)
How to Earn a Badge
• Ensure your AOTA membership is up to date.
You can renew or join if you need to.
• Take and pass designated AOTA CE courses
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PR-297

Evidence Perks
New AOTA Practice Guidelines
on Autism Spectrum Disorder
and Traumatic Brain Injury
OT PRACTICE • AUGUST 22, 2016
Marian Arbesman
Melissa Stutzbach
Deborah Lieberman
Through outlining key
evidence-based findings
on the effectiveness of
occupational therapy
interventions in these topic
areas, the guidelines are a
useful tool for improving
the quality of health care
and education,
enhancing consumer and
family satisfaction,
promoting appropriate use
of services, and reducing
health care costs.
In conjunction with the American
Occupational Therapy Association
(AOTA) Evidence-Based Practice
Initiative, AOTA Press recently published
two new Practice Guidelines:
Occupational Therapy Practice Guidelines for
Individuals With Autism Spectrum Disorder
(Tomchek & Koenig, 2016) and Occupational
Therapy Practice Guidelines for Adults
With Traumatic Brain Injury (Wheeler &
Acord-Vira, 2016). Both guidelines combine
an evidence-based perspective with
key concepts from the Occupational Therapy
Framework: Domain and Process, 3rd
Edition (AOTA, 2014) to provide an overview
of the occupational therapy domain,
process, and interventions for individuals
with autism spectrum disorder (ASD) as
well as adults with traumatic brain injury
(TBI), respectively. Through outlining key
evidence-based findings on the effectiveness
of occupational therapy interventions
in these topic areas, the guidelines are a
useful tool for improving the quality of
health care and education, enhancing consumer
and family satisfaction, promoting
appropriate use of services, and reducing
health care costs.
Current evidence for the Practice
Guidelines is based on findings from
systematic reviews that cover key concepts
of interventions within the scope
of occupational therapy practice. The
systematic reviews were conducted by content
experts with experience in critically
appraising, synthesizing, and summarizing
the research literature. For the guidelines
on individuals with ASD, four systematic
reviews were completed. The systematic
reviews focused on the effectiveness
of interventions in the areas of social
participation, play, leisure, and social and
restricted behaviors; work, activities of
daily living, education, and sleep; improving
family outcomes in areas such as stress
and coping; and the effectiveness of Ayres
Sensory Integration ® and sensory-based
interventions. Six systematic reviews were
completed for the Practice Guidelines on
Adults With Traumatic Brain Injury. Five
systematic reviews were on interventions
to address motor impairments; cognitive
impairments; arousal and alertness; vision
and visual-perceptual impairments; and
psychosocial, behavioral, or emotional
impairments. The sixth systematic review
examined the evidence for interventions
that address everyday activities and areas
of occupation and social participation.
Understanding
the Evidence Base
Providing quality services to individuals
with ASD or TBI requires a comprehensive
understanding of evidence-based best
practices. Coauthor Stephen Wheeler of
the Practice Guidelines for Adults With
Traumatic Brain Injury notes that although
“the complexity and unique presentation
of impairments that may result from
traumatic brain injury can challenge
the skills of even the most experienced
occupational therapy practitioner,” there
is strong evidence to support occupational
therapy services in TBI recovery, including
“the impact of aerobic activity and exercise
on psychosocial well-being, the value of
client-centered goal setting and goal-directed
interventions to facilitate participation,
and the value of cognitive behavioral
approaches at the later stages of recovery.”
The Practice Guidelines can help
occupational therapy practitioners better
understand and apply these findings to
practice.
“Through its coverage of motor, cognitive,
psychosocial, behavioral, and visual
interventions, the Practice Guidelines put
evidence-based decisions at the clinician’s
fingertips. The assessment tables are an
important bonus that facilitates the collection
of baseline information and outcomes
19

Learn More About What You Read in OT Practice!
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By American Occupational Therapy Association
With over 13,000 valid responses collected, the largest sample of any AOTA Salary
and Workforce Survey, this report provides valuable information on workforce
compensation trends to allow you to compare to your peers across the United
States. The information in this report can also serve as a reference for further
research on workforce issues and efforts to advocate for the distinct value of the
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Occupational Therapy Practice Guidelines Series
Using an evidence-based perspective developed by the AOTA Evidence-Based
Practice Project and key concepts from the Occupational
Therapy Practice Framework, these guidelines provide an overview
of the occupational therapy process for each respective topic. They
define the process and the nature, frequency, and duration of the
intervention that occurs within the boundaries of the illness or
physical disability being addressed.
Visit www.aota.org/pg for a complete list of Practice Guidelines.
To order, call 877-404-AOTA, or visit store.aota.org
BK-424
data to support client progress at all
stages of the rehabilitation process,”
according to Wheeler.
Each Practice Guideline also includes
an Executive Summary—a brief, digestible
synopsis of key findings as well as
recommendations and implications for
occupational therapy practice. The summaries
can be used as a quick reference
for occupational therapy practitioners to
provide quality, evidence-based services.
Appendices, provided on a flash drive for
ease of use, include searchable evidence
and risk-of-bias tables.
Supporting Decision Making
AOTA is committed to developing new
Practice Guidelines and revising those
already published on a regular basis to
ensure that occupational therapy practitioners
and external audiences have the
best available scientific evidence and recommendations
to support decision making
that promotes a high-quality health
care and education system. All Practice
Guidelines are available at AOTA’s store.
To learn more, visit www.aota.org/
practice/researchers/practice-guidelines.
References
American Occupational Therapy Association.
(2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American
Journal of Occupational Therapy, 68, S1–S48.
http://dx.doi.org/10.5014/ajot.2014.682006
Tomchek, S. D., & Koenig, K. P. (2016). Occupational
therapy practice guidelines for individuals
with autism spectrum disorder. Bethesda, MD:
AOTA Press.
Wheeler, S., & Acord-Vira, A. (2016). Occupational
therapy practice guidelines for adults with traumatic
brain injury. Bethesda, MD: AOTA Press.
Marian Arbesman, PhD, OTR/L, FAOTA, is president of
ArbesIdeas, Inc., and an adjunct assistant professor in the
Department of Rehabilitation Science at the State University
of New York at Buffalo. She has served as a consultant with
AOTA’s Evidence-Based Practice Project since 1999.
Melissa Stutzbach, MS, OTR, is the project coordinator
for AOTA’s Business Operations Division, staff liaison to the
Assembly of Student Delegates, and a contributor to the
Evidence-Based Practice Project.
Deborah Lieberman, MHSA, OTR/L, FAOTA, is the program
director of AOTA’s Evidence-Based Practice Project and staff
liaison to the Commission on Practice. She can be reached at
dlieberman@aota.org.
Write for
OT Practice!
See author
guidelines at
otpractice.org
20 AUGUST 22, 2016 • WWW.AOTA.ORG

Perspectives
A Magical Teacher
Kirby Scott
Kirby Scott is a 19-year-old man who
was diagnosed with autism spectrum
disorder (ASD) at age 3 years. Scott is
a currently a student at Northern Oklahoma
College, pursuing an associate
of science degree in engineering. He
graduated from Enid High School in
2014 and completed a 2-year program
in drafting and design at Autry
Technology Center in 2016. Scott is
the third of four sons born to Jon and
Sue Scott. His younger brother, Luke,
also has high-functioning ASD (the
type previously identified as Asperger’s
syndrome). Scott’s future plans are to
pursue a bachelor’s degree in animation
and filmmaking. This essay, about his
occupational therapist Diane Fosmire,
was part of an assignment for a college
composition course identifying someone
who made a difference in his life. Fosmire
was Scott’s school-based therapist
at Enid High School and is now in
private practice, as owner and operator
of Acres of Joy, in Enid.
A
teacher is someone who
instructs, but a teacher takes
many different forms. Not all
kids grow up knowing what
occupational therapy means.
For some, they might think it’s about
getting a job, because of the root word
occupation. For me, I learned quickly that
an occupational therapist was my friend,
my teacher, my mentor; Diane Fosmire was
just that. I was King Arthur, and she was
my Merlin.
When I first met Diane Fosmire, I was 3
years old and I kept mostly to myself. Diane
was a sweet lady. She had short, straight
blonde hair with subtle hints of grey. Her
smile was as beautiful as her voice. She
always spoke calmly and firmly. She always
dressed in business casual, comfortable
clothing that suited her personality perfectly.
Diane had a great sense of humor
along with a heartwarming laugh. She
was physically fit, which was most likely a
result of her daily work.
During my toddler years, I didn’t speak
to many people, but Diane was different.
Diane had many tools and games that
sparked my interest. She helped me learn
how to get my needs and wants met. The
first step she taught me was to say, “I
want.” Then, she had all kinds of activities
for me to choose from. I listened as the
computer spoke the words for my choices,
and soon I was speaking along with the
computer voice. She taught me the power
of communication. She made my life less
complicated and confusing because I could
speak to the people who I cared about and
understand the world around me. I was
finally able to make choices instead of
melting down because nobody understood
what I wanted.
Diane had a keen understanding of kids
with disabilities. There are many people
who choose a job based on the amount of
money they might earn. However, there
are others, like Diane, who choose a career
because it lets them help people and not
because of what it pays. Diane knew me
so well, and she pushed me very hard to
do things that I wouldn’t do on my own.
She always had a reward for me when I
PHOTOGRAPHS COURTESY OF THE SCOTT FAMILY
OT PRACTICE • AUGUST 22, 2016
21

Because of [Diane’s] teaching, wisdom and guidance,
I was able to pull the “sword from the stone”
and become the ruler of my world.
NEW AOTA
ONLINE COURSE!
completed those tough tasks. She knew
how to use all the activities I enjoyed
as part of my therapy. I remember
bringing my stuffed toys—Woody from
Toy Story, a dog named Blue from the
show Blue’s Clues, and the Road Runner
and Wile E. Coyote from the Looney
Tunes cartoons—to my sessions with
Diane. Everything I did, my toys did
as well. When I chose the ball bath
and I jumped in, I did it with toys in
hand. Diane could make a game out
of almost anything. In the beginning, I
was hesitant to leave my mom and go to
occupational therapy, but it wasn’t long
before my mom had to “make” me leave
my sessions with Diane.
Diane taught me lifelong skills.
She showed me tricks for tying my
own shoelaces, such as the bunny ears
technique. She showed me a handwriting
system called Handwriting Without
Tears, through which I learned to write
in cursive. My classroom teachers
throughout the years were always
impressed with my handwriting. Diane
helped me to better understand the
facial expressions of the people around
me. We worked on making eye contact
with the people I was talking to, and
she taught me how to introduce myself
to new people. One very important
skill she taught me was correct hand
positioning on a keyboard. I learned to
avoid the “hunt-and-peck” trend.
As a result, I am a very skilled typist.
A vitally important strategy I learned
from Diane was how to identify when
I was becoming stressed out or overwhelmed.
She showed me how to use
a color-coded chart with an “engine
speed meter” on it. It helped me realize
how important pacing is to my daily
life. I could successfully identify when I
was becoming too worked up, and then
I would use some of the procedures
we worked on in therapy: Breathing
through the nose and out of the mouth,
removing myself and taking a walk, or
spending some time on the swing or
rocking chair. All of these things helped
calm me down and kept me focused.
During therapy, we worked on
my fine and gross motor skills. Diane
showed me how I could feel better so I
fit into the world by wearing a weighted
vest, crawling through a tunnel, being
squashed by a “big cheese” (a large
triangular foam/sponge pillow), and
rolling on a walrus (a large, rounded,
inflated pillow-shaped mattress). She
helped me develop my fine motor
skills by hiding objects in Play-Doh.
Oftentimes, I would search through the
dough and find coins. Diane taught me
the value of the coins, and I learned to
count money. But the most memorable
of these comforting activities was the
cocoon swing. This swing was made
from a nylon Spandex type material,
and it shaped to my body. Diane would
swing me while she sang a song, “Caterpillar,
caterpillar in a cocoon, I want to
be a butterfly soon.” I loved that song.
Diane Fosmire was more than
a teacher to me. She helped me to
develop so many valuable attributes.
I will never forget her sweet personality,
the songs she sang, the games we
played, the techniques she introduced,
or the many important life lessons she
taught me. Because of her teaching,
wisdom, and guidance, I was able to
pull the “sword from the stone” and
become the ruler of my world.
PHOTOGRAPH COURTESY OF THE SCOTT FAMILY
Organizational Ethics:
Occupational Therapy
Practice in a Complex Health
Environment, 2nd Edition
Presented by
Lea Cheyney Brandt, OTD, MA, OTR/L
Earn .1 AOTA CEU (1.25 NBCOT
PDU/1 contact hour)
This newly updated course will explore
organizational ethics issues that may
influen e the ethical decision making
of occupational therapy practitioners.
Course material will explore ethical
confli ts that may arise between
the practitioner as an organizational
employee and as an autonomous
health care provider.
Participants will be introduced to
strategies that will assist in addressing
situations in which occupational
therapy practitioners may be pressured
by an organization’s administration
to provide services that are in confli t
with their personal or professional
code of ethics.
Order #OL4950
AOTA Members: $24.99
Nonmembers: $39.99
To order, call 877-404-AOTA,
or visit http://store.aota.org
CE-366
22 AUGUST 22, 2016 • WWW.AOTA.ORG

Around the World
Making Global Connections in Galway, Ireland
1st Joint Congress of COTEC-ENOTHE
Thomas Hawksworth
Susan Burwash
Shannon Brawley
Center: Author Thomas Hawksworth
makes a presentation.
Right: Boston University’s Karen
Jacobs (left) meets up with Eastern
Washington University’s Diane Norell
T
he 1st Joint Congress of the
Council of Occupational
Therapists for European
Countries (COTEC) and
the European Network of
Occupational Therapy in Higher Education
(ENOTHE) provided a recent opportunity
for making global connections. The Congress
took place in Galway, Ireland, from
June 15 to 19. For occupational therapy
practitioners unfamiliar with COTEC and
ENOTHE, here is a bit of background.
COTEC was founded in 1986 with the
intent of bringing European national occupational
therapy associations together to
address issues of education, practice standards,
and advancing occupational therapy
theory to serve the social and health
needs of European citizens. It represents
30 occupational therapy associations and
more than 120,000 therapists. ENOTHE,
founded in 1995, focuses on helping to set
educational standards for occupational
therapy, supporting new programs, and
working with COTEC to promote education.
It was initially funded through the
European Council’s Erasmus/Socrates
program, which was established as a means
of enabling students to complete a portion
of their studies as exchange students
outside their home country. ENOTHE has
both institutional and individual members.
The headquarters has been in the Netherlands
and Denmark, and is currently in
the United Kingdom. In addition to the
joint Congress, COTEC-ENOTHE worked
together recently to launch a joint website,
at www.oteurope.eu.
The Congress had more than 900
attendees from 50 countries, including
all of the European Union countries, the
United States, Canada, Australia, and
Japan. It took place at the National University
of Ireland Galway, located along the
banks of the River Corrib. The Congress
theme was, “Connecting: Education/Practice/Research/Policy.”
Keynote speakers
came from England, Spain, Belgium, the
PHOTOGRAPH ©
OT PRACTICE • AUGUST 22, 2016
23

University of Scranton
graduate students
Kathleen Phelan
and Courtney Ruch
(pictured left to right)
and faculty mentors
Verna Eschenfelder,
and Marlene Morgan,
EdD, OTRL presented
a poster on A Relational
Content Analysis
of Current and
Future Pedagogical
Instruction of Motor
Control Approaches.
Being a global profession means continuously developing the
means by which expertise and knowledge are shared to address
challenges that our clients face, taking into account the many
varying regions, countries, conditions, and settings. It is both our
diversity as a profession and our ability to draw on the pool
of our diversity that makes us effective.
United States, Canada, and Ireland, and
attendees presented 404 oral papers, 303
posters, 13 symposia, and 87 workshops.
Highlights included an opening ceremony
featuring harp, whistle, and fiddle
music as well as a greeting in Gaelic from
the president of the university.
Although this was a European
Congress, there were many attendees
from the United States. Some of the
presenters included Karen Jacobs, EdD,
CPE, OTR/L, FAOTA, from Boston
University; George Tomlin, PhD, OTR/L,
from the University of Puget Sound;
Nancy Krusen, PhD, OTR/L, from Pacific
University; Katherine Phelan, Courtney
Ruch, Verna Eschenfelder, PhD, OTR/L,
Marlene Morgan, EdD, OTRL, and Rita
Fleming-Castaldy, PhD, OTR/L, FAOTA,
from the University of Scranton; Kristine
Haertl, PhD, ACE, OTR/L, FAOTA, from
St. Catherine University; Donna Costa,
DHS, OTR/L, FAOTA, from Touro University;
Peggy Martin, PhD, OTR/L (OT),
from the University of Minnesota; Susan
Burwash, PhD, OTR/L, and Diane Norell,
MSW, OTR/L, CPRP, from Eastern Washington
University; and Pollie Price, PhD,
OTR/L, from the University of Utah. Bill
Wong, OTD, OTR/L, both presented and
contributed to the Twitter feed from the
Congress. Shannon Brawley, a new OTR
from Wenatchee, Washington, presented
narrative inquiry research into homeless
women’s experiences at a drop-in center.
Also attending were then AOTA President
Virginia Stoffel, PhD, OT, BCMH,
FAOTA, and then AOTA President-Elect
Amy Lamb, OTD, OT/L, FAOTA, AOTA.
One of the aims of the joint Congress
was to launch the public face of occupational
therapy in Europe through the shared
visual identity of the website, but also as a
shared voice, demonstrating the collaborative
power of both COTEC and ENOTHE.
As such, the executives of the Congress
identified eight areas of significant interest
for the profession to be considered and
addressed at a European level and created
workshops for delegates to contribute to
the discussions and direction of the conversation.
Congress delegates were asked to
choose one of the following workshops in
which to consider these key topics:
l The importance of evidence-based
practice
l The accessibility of occupational therapists
in primary care across Europe
l The increasing number of occupational
therapists working with
refugees
l The struggle in many countries to provide
sufficient fieldwork opportunities
l The successes and challenges of curriculum
development for occupational
therapy in emerging areas
l The role of practitioners in social and
political changes
l E-health as a developing area in medical
practice
l Creating and developing a self-sustaining
research branch of ENOTHE
The Brexit vote, which followed hard
on the heels of the COTEC-ENOTHE
Congress, highlights recent European
sociopolitical discourse in which the
specters of disunity, separation, and
nationalism reared their heads. This
discourse is, of course, not limited to
the Eurozone. The conference theme of
connecting seems especially relevant in
this context. It remains more important
than ever that the profession is outward
looking, collaborative, and “without
borders.” Being a global profession means
continuously developing the means
by which expertise and knowledge are
shared to address challenges that our
clients face, taking into account the many
varying regions, countries, conditions,
and settings. It is both our diversity as
a profession and our ability to draw on
the pool of our diversity that makes us
effective.
The next COTEC-ENOTHE joint Congress
is scheduled for Prague in 2020.
Perhaps we’ll see you there? In the meanwhile,
slán go fóill (goodbye for now).
Thomas Hawksworth is recent graduate of the bachelor
of science Occupational Therapy Program at the University
of Derby, United Kingdom, and is now working for the U.K.
National Health Service’s Priory Group with Eating Disorders
in Child and Adolescent Mental Health Services.
Susan Burwash, PhD, MSc(OT), OTR/L, OT(C), is an associate
professor at Eastern Washington University.
Shannon Brawley, MOT, OTR/L, is a recent graduate of
the Occupational Therapy Program at Eastern Washington
University.
24 AUGUST 22, 2016 • WWW.AOTA.ORG

Save the dates!
AOTA Specialty Conferences and Student Conclave
www.aota.org/conferences
Autism
September 23–24, 2016
Cleveland, Ohio
Registration
Now Open!
AOTA/NBCOT National
Student Conclave
November 18–19, 2016
Dearborn, Michigan
Registration
Opens
August 24!
Chronic Conditions
December 2–3, 2016
Orlando, Florida
Registration
Opens
September 7!
Oncology
January 20–21, 2017
Houston, Texas
Registration
Opens
October 25!
SP-119

Continuing Education Opportunities
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per
insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA
endorsement of content, unless otherwise specified
Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization
has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course
has met the APP requirements and has been awarded AOTA CEUs.
SEPTEMBER
Cleveland, OH Sept 23-24
AOTA Specialty Conference: Autism. Learn evidencebased
practices that will prepare you to meet the needs of
children, adolescent, and young adults on the autism spectrum.
Earn up to 20 contact hours, including Pre-Conference
seminars. AOTA Member: $325, after August 24: $370,
Nonmember $490, after August 24: $550. www.aota.org/
autismconference
Columbus, OH Sept 30–Oct 1
WEIGHT LOSS: The Next Therapy Frontier (15 live hrs).
BE PART OF THE SOLUTION! Learn skills to treat your
clients for weight loss/inflammation/chronic diseases. Gain
knowledge to grow your business in this much needed area
of practice with a structured, reimbursable, evidence-based
treatment system focused on intensive lifestyle interventions.
Flash drive of manual and client education guidebook
included. To register: www.healthehabitsforliving.com or call
337-261-9188. Like us on Facebook!
OCTOBER
Sioux Falls, SD Oct. 1–2
Eval & Intervention for Visual Processing Deficits in
Adult Acquired Brain Injury Part I Faculty: Mary Warren
PhD, OTR/L, SCLV, FAOTA. This updated course has
the latest evidence based research. Participants learn a
practical, functional reimbursable approach to evaluation,
intervention and documentation of visual processing
deficits in adult with acquired brain injury from CVA
and TBI. Topics include hemianopsia, visual neglect, eye
movement disorders, and reduced acuity. Also in Kansas
City, Mo, November 5–6 and Wilmington, NC, March
11–12, 2017. Contact: www.visabilities.com or (888)
752-4364.
Dobbs Ferry, NY OCT. 14–15
Optimizing Executive Function: Strategy Based Intervention
in Children and Adults. This course will provide
in-depth information on treatment of cognitive dysfunction
across the lifespan, with a focus on executive function
impairments. Case applications of intervention principles
across different ages and populations will be discussed.
Instructors: Joan Toglia and Izel Obermeyer; Contact: Mercy
College, 914-674-7837 for questions, SHNS@mercy.edu
AOTA CE PRACTICE AREAS
ASSESSMENT & EVALUATION
BRAIN & COGNITION
CHILDREN & YOUTH
GENERAL FOCUS
MENTAL HEALTH
PRODUCTIVE AGING
REHABILITATION, DISABILITY, &
PARTICIPATION
WORK AND INDUSTRY
VISIT WWW.AOTA.ORG/CE FOR A COMPLETE
LISTING OF ALL AOTA CE COURSES.
for details and registration. Pre-registration $375 (7/1-8/1);
Reg. Registration $425(8/2-9/16). AOTA CEU Application
Pending (12 contact hours / 1.2 CEU’s)
Baltimore, MD Oct 22–30
Lymphedema Management. Certification courses in
Complete Decongestive Therapy (135 hours), Lymphedema
Management Seminars (31 hours). Coursework includes
anatomy, physiology, and pathology of the lymphatic system,
basic and advanced techniques of MLD, and bandaging for
primary/secondary UE and LE lymphedema (incl. pediatric
care) and other conditions. Insurance and billing issues,
certification for compression-garment fitting included.
Certification course meets LANA requirements. Also in
Palm Beach Gardens, FL. AOTA Approved Provider. For
more information and additional class dates/locations or to
order a free brochure, please call 800-863-5935 or visit
www.acols.com.
NOVEMBER
Boca Raton FL Nov. 7–8
The Impact of Disabilities, Vision & Aging and Their
Relationship to Driving. Course designed for driver
education and allied health professionals who wish to
apply their knowledge of the different types and levels of
disabilities to the driving task. 15 ADED/1.5 AOTA hours
offered. Contact ADED 866-672-9466. Register online:
www.aded.net
ONGOING
Internet Ongoing & 2-Day Onsite Trainings
Become an Accessibility, Home Modifications,
& ADA Consultant. Instructor: Shoshana Shamberg,
OTR/L, MS, FAOTA. 25+ years specializing in design/
build services, technologies, injury prevention, and
ADA/504 consulting for homes/jobsites. Start a private
practice or add to existing services. Extensive
man-ual. AOTA APP+NBCOT CE Registry. Also in Baltimore,
MD, August 28–29, 2016. Contact: Abilities
OT Services, Inc. 410-358-7269 or info@aotss.com.
Group, COMBO, personal mentoring, and 2 for 1
discounts. Calendar/info at www.AOTSS.com.
Seminar sponsorships available nationally.
Online Course
Clinician’s View ® offers unlimited CEUs for one low
price. Three great options. 7 months for $177, 1 full year
for $199, and Super Saver 2 full years for $299. More
than 640 contact hours, more than 780 PDUs, and more
than 100 courses of clinical video continuing education
approved for CEUs by AOTA and accepted by NBCOT for
PDUs. Approved by BOC for athletic trainers. Take as many
courses as you want for the duration of your unlimited coupon.
Go to https://www.clinicians-view.com for previews
of all courses and details. Click on Unlimited CEU Offer.
Phone: 575-526-0012.
NEW COURSES FROM AOTA CE
AOTA Digital Badges now available
for select AOTA continuing education
courses.
Learn more! Visit www.aota.org/digitalbadging
Online Course
A Contemporary Occupational Performance Approach
to Pediatric Self-Regulation Part I: Theoretical
Framework and Evaluation Considerations by
Meredith Gronski, OTD, OTR/L and Theresa Henry, MSOT,
OTR/L. This course will present an evidence-based theoretical
foundation for authentic practice with children and
youth who struggle with emotional and behavioral regulation.
This course will offer a comprehensive framework
for evaluation from an occupational performance perspective,
focusing on assessment tool selection and developing
a comprehensive, yet targeted measurement model.
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).
Order #OL4930. AOTA Members: $24.99, Nonmembers:
$34.99. http://store.aota.org 0716
Online Course
A Contemporary Occupational Performance Approach
to Pediatric Self-Regulation Part II: Self-
Regulation Intervention Framework and Strategies
by Meredith Gronski, OTD, OTR/L and Theresa Henry, MSOT,
OTR/L. This coursewill present the most effective treatment
strategies from a comprehensive foundation of evidencebased
practices, all within the context of the PEOP (Person/
Environment/Occupational Performance) framework, from
Part 1 of this 2- part course. The primary focus of this
course will be on client-centered, environmentally-relevant
interventions that lead to productive occupational performance
across the developmental continuum from early
childhood to adolescence. Earn .1 AOTA CEU (1.25 NBCOT
PDU/1 contact hour). Order #OL4931. AOTA Members:
$24.99, Nonmembers: $34.99. http://store.aota.org 0716
Online Course
Applying the OT Practice Guidelines for Adults With
Neurodegenerative Diseases by Katharine Preissner,
EdD, OTR/L. Evidence-based practice is integral to successful
client outcomes. This course is intended to assist
occupational therapy practitioners in providing evidencebased
assessment and interventions to adults with neurodegenerative
diseases (NDDs). The course facilitates
the use of the practice guidelines by presenting the information
in a multimedia format and walking the learner
through case studies that illustrate important concepts in
the guidelines. Four interactive case studies are presented
that address the following NDDs: Multiple Sclerosis (MS),
Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis
(ALS), and Transverse Myelitis (TM). Earn .15 CEU (NBCOT
1.88 PDUs/1.5 contact hours). Order # OL4896. AOTA
Members: $34.95, Nonmembers: $49.95. http://store.
aota.org 0216
Online Courses
Occupational Therapy: Across the Parkinson’s Disease
Continuum Series - designed and created in collaboration
with the Parkinson’s Disease Foundation. These
online courses are designed by expert occupational therapy
practitioners in the field of Parkinson’s to help their colleagues
to ensure best practice care for people living with
the disease. These courses will provide practical, evidencebased
knowledge across the continuum of Parkinson’s care
to help occupational therapists evaluate and treat individuals
in all settings — including in home care, community rehabilitation
and long-term care practice settings. Earn .2 AOTA
CEUs (2.5 NBCOT PDUs, 2.0 contact hours). Members/
Nonmembers: $19.95. Module 1: Overview of Parkinson’s
Disease (Order #OL4960); Module 2: Assessment in Parkinson’s
Disease Intervention (Order #OL4961); Module 3:
26 AUGUST 22, 2016 • WWW.AOTA.ORG

Continuing Education Opportunities
Occupational Therapy Intervention for Parkinson’s Disease
(Order #OL4962); Module 4: Parkinson’s Disease: Emerging
Research, Resources, & Beyond (Order #OL4963).
http://store.aota.org 0216
Online Course
Using the Occupational Therapy Practice Guidelines
for Home Modifications by: Carol Siebert, MS, OTR/L,
FAOTA and Stacy Smallfield, DrOT, OTR/L, FAOTA. This course
addresses the home modification process, strategies, and assessments;
types of home modification interventions; he importance
of integrating home modifications into daily life; and
examines the procedures for reviewing, selecting, and organizing
evidence in the guidelines. Earn .15 CEU (NBCOT 1.88
PDUs/1.5 contact hours). Order #OL4895, AOTA Members:
$34.95, Nonmembers: $49.95, http://store.aota.org 1115
Online Course
Social Skills for Children with Autism Spectrum
Disorder (ASD) by Sharon A. Gutman, PhD, OTR,
FAOTA & Emily I. Raphael-Greenfield, EdD, OTR. The
course presents the theoretical basis and guidelines for
the SIMPLE Intervention and illustrates its use through
written and video demonstrations. Instructions for 11
warm-up and 10 role-play activities are embedded in the
course. Video clips are provided to demonstrate many
of the activities. The SIMPLE Intervention can be used
in the school system or in private practice. Earn .2 CEU
(NBCOT 2.5 PDUs/2 contact hours). Order #OL4897,
AOTA Members $49.95, Nonmembers $64.95, http://
store.aota.org 1115
Self-Paced Clinical Course
Traumatic Brain Injury (TBI): Interventions to Support
Occupational Performance, Neurorehabilitation
in Occupational Therapy Series, Volume III, edited by
Kathleen M. Golisz, OTD, OTR, and Mary Vining Radomski,
PhD, MA, OTR/L, FAOTA; series senior editor, Gordon
Muir Giles, PhD, OTR/L, FAOTA. This course provides the
core concepts and theoretical foundations that inform occupational
therapy across the continuum of care for people
with TBI as well as detailed discussions of occupational
therapy assessment and intervention at each phase of
the recovery, rehabilitation, and community and social
reintegration continuum. Earn 2 AOTA CEUs (25 NBCOT
PDUs/20 contact hours). Order #3034, AOTA Members:
$259, Nonmembers: $359. http://store.aota.org 1115
Organizational Ethics: Occupational Therapy Practice
in a Complex Health Environment 2nd Edition presented
by Lea Cheyney Brandt, OTD, MA, OTR/L. This newly
updated course will explore organizational ethics issues that
may influence the ethical decision making of occupational
therapy practitioners. Course material will explore ethical
conflicts that may arise between the practitioner as an organizational
employee and as an autonomous health care
provider. Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact
hour). Order #OL4950, AOTA Members: $24.99, Nonmembers:
$39.99. http://store.aota.org 0716
Online Course
Health Literacy: Effective Client Communication and
Education by Cheryl Miller, DrOT, OTR/L. This clinically
relevant interactive course is designed for occupational
therapy practitioners who desire effective, meaningful, collaborative,
and profes sional interactions with clients and
caregivers in any practice setting. Effective communication
is required to help clients achieve desired outcomes and
goals. Earn .2 CEU (2.5 NBCOT PDUs/2 contact hours).
Order #OL362SC. AOTA Members: $65, Nonmembers:
$89. http://store.aota.org
Online Course
Cancer Series - Module 1: Impact of Psychosocial
Aspects of Cancer on Occupational Engagement by
Kathleen Lyons, ScD, OTR, Author; and Claudine Campbell,
MOT, OTR, CLT and Lauro Munoz, MOT, OTR, CHC, Series
Editors. This module, the first in AOTA’s Cancer Series, addresses
three psychosocial challenges (distress, depression,
and anxiety) and three psychosocial opportunities (lifestyle
changes, spiritual growth, and life completion) that may occur
within the context of cancer. Earn .15 CEU (NBCOT 1.88
PDUs/1.5 contact hours). Order # OL50, AOTA Members:
$49.95; Nonmembers: $64.95. http://store.aota.org
Online Course
Cancer Series - Module 2: Lymphedema and Breast
Cancer for OT Practitioners by Claudine Campbell,
MOT, OTR, CLT and Series Editors: Claudine Campbell,
MOT, OTR, CLT & Lauro Munoz, MOT, OTR, CHC. This module,
the second one in the AOTA Cancer Series, explores
the differences between primary and secondary lymphedema,
and the 5 stages of lymphedema. The module
examines the causes and symptoms of secondary lymphedema,
specifically breast cancer related lymphedema.
Methods for measuring the severity of lymphedema are
addressed, together with OT intervention strategies for
meeting the physiological, psychological, and emotional
challenges associated with breast cancer related lymphedema.
Finally, a case example walks the learner through
an OT evaluation and recommended interventions for a
client with breast cancer related lymphedema. Earn .15
CEU (NBCOT 1.88 PDUs/1.5 contact hours). Order #OL51.
AOTA Members: $49.95, Nonmembers: $64.95. http://
store.aota.org 0216
Online Course
Preparing for ICD-10 Implementation Webcast, Second
Edition by Sharmila Sandhu, JD & Elaine Craddy
Adams, OTR/L. The long awaited transition from ICD-9 to
ICD-10 occured on October 1, 2015.This webcast presentation
provides legislative and regulatory background
information about transition, and reviews basic information
about ICD-10 as well as additional coding basics. Considerations
in preparing your workplace for the transition as
well as how to choose and document ICD-10 codes are
Master real-world expertise
Online Post-Professional Master of
Occupational Therapy
Raise your level of hands-on excellence while boosting
your career with this unique, practice-based curriculum,
delivered with the flexibility and convenience of
leading-edge online learning. Incorporating extensive
interdisciplinary support and feedback through an
on-going community of mentors and peers, it’s an
exceptional opportunity to advance and excel.
Get real about mastering practice-based expertise.
www.atsu.edu/AMOT
A post-professional Doctorate of Occupational
Therapy is also offered online.
FIRST IN WHOLE
PERSON HEALTHCARE
D-7811
OT PRACTICE • AUGUST 22, 2016
27

Continuing Education Opportunities
Assessment & Intervention Training
Two Days of Hands-On Learning (1.6 CEU)
Upcoming Locations & Dates:
2016
Freehold, NJ Sept. 23–24
Columbus, OH Sept. 30–Oct. 1
San Antonio, TX Oct. 20–21
Leesburg, VA Nov. 4–5
2017
Livonia, MI Jan. 6–7
Gainesville, FL Jan. 13–14
Irvine, CA Jan. 20–21
Greeley, CO Feb. 9–10
San Leandro, CA March 2–3
Atlanta, GA March 17–18
Houston, TX May 19–20
Birmingham, AL June 30–July 1
For complete training schedule & information visit
www.beckmanoralmotor.com
Host a Beckman Oral Motor Seminar!
Host info (407) 590-4852, or
info@beckmanoralmotor.com D-7829
Faculty
also discussed. Earn: .1CEUs, 1 Contact Hour and 1.25
PDUs. Order #OL4894. AOTA Members: $24.99, Nonmembers:
$34.99. http://store.aota.org
SPECIAL INTEREST TOPICS
Continuing education courses based on Special Interest
Quarterly articles that are published 4 times per year by
each of the AOTA Special Interest Sections. Each Special
Interest Topic is comprised of 2 thematically connected
quarterly articles selected for their insight and immediate
applicability to practice. AOTA CEUs, contact hours, and
NBCOT PDUs are earned after successful completion of
the accompanying exam.
Special Interest Topic #1: Models of Practice for
Increasing Self-Awareness by Caitlin Synovec, OTR/L;
Courtney Dauwalder, OTD, OTR/L, MFA; and Christine
Berg, PhD, OTR/L, FAOTA. Earn .1 AOTA CEU (1.25 NB-
COT PDU/1 contact hour). Order #CESIT01 AOTA Members:
$24.99, Nonmembers: $29.99. http://store.aota.org
Special Interest Topic #2: Intervention Models
for School Age Youth by Sarah A. Schoen, PhD, OTR;
Lucy Jane Miller, PhD, OTR; Shannon Hampton; Meira L.
Orentlicher, PhD, OTR/L; Dottie Handley-More, MS, OTR/L;
Rachel Ehrenberg; Malka Frenkel; and Leah Markowitz.
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).
Order #CESIT02 AOTA Members: $24.99, Nonmembers:
$29.99. http://store.aota.org
Special Interest Topic #3: Enhancing Quality of Life
for Older Adults by Cristina Michetti, OTR/L; Joanne Gallagher
Worthley, EdD, OTR/L, CAPS; Laura Caron-Parker,
OTR/L; and Sharon Nichols, CTRS/L. Order #CESIT03
AOTA Members: $24.99, Nonmembers: $29.99. http://
store.aota.org
Find your way. The South Way.
Earn your Doctor of Occupational
Therapy or AAS or AS in Occupational
Therapy Assistant degree the South Way,
with hands-on training and one-on-one
mentoring. Choose from online,
on-campus, or a hybrid class schedule.
800.504.5278 | SouthUniversity.edu
Programs, credential levels, technology, and scheduling options vary by school and are subject
to change. Not all online programs are available to residents of all U.S. states. Administrative
office: South University, 709 Mall Boulevard, Savannah, GA 31406-4805. ©2016 South University.
All rights reserved. Our email address is materialsreview@southuniversity.edu.
See SUprograms.info for program duration, tuition, fees and other costs, median debt,
salary data, alumni success, and other important info.
D-7801
Visit store.aota.org for additional special interest topics.hours).
Order #OL4886. AOTA Members: $65, Nonmembers:
$89. http://store.aota.org
Webcast
From Volume- to Value-based Productivity: What it
Means for the Future of OT Practice by presenter Gerben
DeJong, PhD, FACRM. Learn how upcoming changes in
post-acute policy will change the value proposition of occupational
therapy from one of maximizing reimbursement to
creating value for all stakeholders—patients, family, payers,
and providers. Earn 1 contact hour (1 NBCOT PDU). Order
#WA1219. AOTA Members: FREE!, Nonmembers: $9.99.
http://store.aota.org 0416
Webcast
Home Modification Webcast Series. Learn how upcoming
changes in post-acute policy will change the value proposition
of occupational therapy from one of maximizing reimbursement
to creating value for all stakeholders—patients, family,
payers, and providers. Earn 1 to 1.5 AOTA CEUs (1.25–1.88
NBCOT PDUs/1–1.5 contact hours) per completed webcast.
AOTA Members: $24.95, Nonmembers: $34.95. Enabling
Design: A Person-Centered Approach (Order #WA1226); Occupational
Therapy’s Role in Assisting a Patient Transition from
Hospital to Home (Order #WA1225); Fundamentals of Pediatric
Home Modifications (Order #WA1224); Setting up a Home
Modifications Business (Order #WA1223); From Inspiration
to Installation: The Search for Creative Ideas to Solve Home
Mod Challenges (Order #WA1221); Meeting the Psychosocial
Needs of Clients (Order #WA1220). http://store.aota.org 0416
Webcast
Lifestyle Redesign Webcast Series. The award-winning
Lifestyle Redesign® manual is now a continuing education
course. This six-unit course provides practical guidance in this
preventative occupational therapy program for independentliving
older adults. The 12 text modules, including those on
longevity, stress, home safety, and navigating health care, are
incorporated into 6 webcast units to illustrate how to incorporate
the program into practice. Earn 1 to 1.5 AOTA CEUs
THE (1.25–1.88 RICHARDS NBCOT PDUs/1–1.5 contact hours) per completed
webcast. AOTA Members: $24.95, Nonmembers: $34.95.
GROUP
TRG Unit JOB 1 (Order #: #WA1231); Unit 2 (Order #WA1232); Unit 3
STH-16-0026
(Order #WA1233); Unit 4 (Order #WA1234); Unit 5 (Order
CLIENT: #WA1235); Unit 6 (Order #WA1236). http://store.aota.org 0416
South University
TITLE:
Distinct Value
OT
Demonstrating the Distinct Value of Occupational
PUBS:
Therapy—Module 1: An Overview by Amy Lamb, OTD,
OT Practice
OTR/L, FAOTA. Join Dr. Amy Lamb as she provides an overview
of the Distinct Value priority of AOTA. You will learn how
INSERTION DATE:
7/11/2016
this priority and the Distinct Value statement were informed
TRIM: by historical and current leaders within the profession. You
4.687" x 4.375"
will also learn how health care changes in America due to
LIVE:
the Affordable Care Act are creating opportunities for the
na
profession as well as calling us to action to more accurately
BLEED:
naarticulate our distinct contribution to the health and wellbeing
of those we serve. Earn .1 AOTA CEU (1.25 NBCOT
COLOR: CMYK
SWOP PDU/1 contact hour). Order #OL4891. AOTA Members:
CONTACT: $24.95, Nonmembers: $35.95. http://store.aota.org
Kathleen
Pendergast Distinct Value
214-891-2918 Demonstrating the Distinct Value of Occupational
Therapy - Module 2: Infusing the Distinct Value
into Occupational Therapy Practice and Documentation
by Amy Lamb, OTD, OTR/L, FAOTA. In this module
you will learn how to articulate the distinct value statement
as well as how the priority will help the profession
in achieving the centennial vision. In addition, Dr. Lamb
will offer strategies for communicating the distinct value
of OT through daily documentation and explain why this
is so critical in an era of changing healthcare systems.
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).
Order #OL4892. AOTA Members: $24.95, Nonmembers:
$35.95. http://store.aota.org
28 AUGUST 22, 2016 • WWW.AOTA.ORG

Employment Opportunities
Faculty
Faculty
Assistant Professor, Midwestern University
The Midwestern University Occupational Therapy
Program in Downers Grove, IL has immediate
opportunities to join an established occupational therapy
master’s degree program. The program is currently in
the Pre-Candidacy phase of the transition process from
a M.O.T. to an O.T.D. Program.
Applications are invited for full time tenure track faculty positions as an
Assistant Professor. Successful applicants must possess:
1) an earned doctorate in occupational therapy or a related field
2) licensure as an occupational therapist in Illinois
3) at least 5 years of clinical experience; and
4) instructional experience in a college or university academic program.
Experience in pediatrics, adult rehabilitation or program development/
administration is preferred.
Rank and salary are commensurate with qualifications and experience.
Interested applicants should apply online at www.midwestern.edu. Application
packets should include a letter of interest, CV, and the names and contact
information of 3 professional references. Additional questions may be directed
to Mark Kovic, OTD, OTR/L. FAOTA, Chair, OT Program Search Committee,
Occupational Therapy Program at mkovic@midwestern.edu.
Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate
against an employee or applicant based upon race, color, religion, gender, national origin, disability,
or veterans status, in accord with 41 C.F.R. 60-1.4(a), 250.5(a), 300.5(a) and 741.5(a).
F-7826
OT PRACTICE • AUGUST 22, 2016
Faculty
Salem State University requires the addition of
a full-time, tenure-track occupational therapy
faculty member to teach in a growing program.
The ideal candidate will possess knowledge of
accreditation standards, experience in program
development, and have a strong background in
research and grant writing and MS direct-entry programs. Additionally, we are seeking
a full-time, temporary, one-year faculty member with some knowledge of accreditation
standards, curriculum development, research and grant writing. Teaching assignments
for both positions may include courses in part-time evening combined BS/MS OTA bridge
and MS direct-entry programs.
The Occupational Therapy program at Salem State seeks to engage the student in a journey
of transition from OTA to OT. The creation of a professionally enhanced, culturally competent
and critically thinking practitioner is a major objective of this academic program.
An important outcome of the program is to instill the value and importance of life-long
learning for a profession that is continuously changing and growing in its complexity and
scholastic advancements. Students learn to embrace their commitment to the profession
and work toward setting and attaining both personal and professional goals. The acquisition
of leadership skills, appreciation of alternative treatment directions taking place in the
profession and the formation of solid foundation skills in the area of research is critical in
the development of entry-level clinicians graduating from Salem State. The attainment of
such goals leads to an individual who appreciates values and is committed to the future
prosperity of occupational therapy.
Salem State is a teaching university, committed to our students’ learning and growth, many
of whom are the first in their family to go to college. Collegiality, student success, collaboration,
initiative, continuous improvement and accountability are highly valued in our
organizational culture and we seek a colleague who shares those values and wants to be
part of our community.
Salem State University is an equal opportunity/affirmative action employer. Persons of
color, women and persons with disabilities are strongly urged to apply.
To view the entire postings and apply, please visit salemstate.edu/jobs
F-7822
OCCUPATIONAL THERAPY
Faculty Position
New faculty will join a department
with a 74-year history of excellence.
NON-TENURE TRACK POSITION
Assistant Professor
(position# F39910)
REQUIRED QUALIFICATIONS
• Earned doctorate (e.g., OTD) or
doctoral candidacy
• Ability to complement and
expand existing Departmental
expertise
• Strong written and interpersonal
communication skills
• Commitment to working with
diverse faculty, staff and students
PREFERRED QUALIFICATIONS:
• OT licensure or eligibility for
licensure in Virginia
• At least 3 years of experience in
practice and/or academic
settings
• Teaching experience in OT or
related disciplines
RESPONSIBILITIES:
• Teach and advise OTD students
• Coordinate student OTD leadership/capstone
projects
• Contribute to Department service
and research
APPLICATION:
Please visit VCU’s e-jobs site at
https://www.vcujobs.com
CONTACT: Dr. Jodi Teitelman, Search Committee
Chair at jlteitel@vcu.edu for position
information or http://sahp.vcu.edu/occu
for more information about VCU’s OT
Department
Virginia Commonwealth University is an equal opportunity,
affirmative action university providing access to education and
employment without regard to age, race, color, national origin,
gender, religion, sexual orientation, veteran’s status, political
affiliation or disability.
F-7832
29

Employment Opportunities
National
Program Manager for Board & Specialty Certification
Come to AOTA and help us build the profession for the 21st century and grow our advanced
specialty credentialing programs
This national level position will be responsible for the
oversight and growth of AOTA’s Board & Specialty
Certification program. This includes exciting collaborative
work with academic institutions, further developing
& refining the user experience for all certification applicants
and continuing to build the value of this program for
our members. The position will be responsible for staying
abreast of the external continuing competence environment,
as well as assessing our members’ needs in this area.
Additionally, the program manager will have staff liaison
responsibilities for the Commission on Continued Competence
& Professional Development (CCCPD), the Board for
Advanced & BOS053149B Specialty Certification 1 (BASC) and the Special
Interest Sections Council (SISC).
AKWAN
PY ASSOC 2016
The successful candidate will have demonstrated expertise
and knowledge in areas of professional development & continued
clinical competence. The candidate should have very
strong leadership, management and communication skills, as
well as the ability to manage projects effectively. The candidate
should also have a proven track record of working well with
teams and keeping an open mind to innovative ideas. This
position requires a Master’s Degree at a minimum with an
OTD or PhD preferred. Ideal candidate will have 8-10 years of
experience or a combination of formal education and experience.
Experience should demonstrate progressive leadership
responsibilities. The candidate must be technologically proficient
in a Windows environment. On-site status is highly preferred,
but long distance tele-commuting may be considered.
KINTHE0388
AOTA offers a comprehensive benefits package OT that Practice includes Magazine 401(k) employer match, health insurance, transportation/
parking subsidy, plus much more! Please send letter of interest, an up-to-date resume and salary history to: jobs@aota.org or
send to: AOTA, HRJob/PM-BSC, 4720 Montgomery Lane, Bethesda, MD 20814 or Fax: 240-762-5147. EOE
U-7815
Midwest
Kindred Rehab Services, Inc. d/b/a RehabCare
is seeking an Occupational Therapist to work
full-time in our Streamwood, IL facility. Must
possess or be eligible for a State of Illinois
occupational therapy license. Please e-mail
your resume to: Nichole Brewer at:
Nichole.Brewer@rehabcare.com.
M-7831
West
ARIZONA OTs—$65,000
Phoenix, Tucson, & Burbs
602-478-5850/480-221-2573 Schools,
16 wks off, 100% Paid: Health, Dental, Lic,
Dues, CEU-$1,000,401K, Hawaii/Spanish I
trips… Jobs@StudentTherapy.com
*STARS* StudentTherapy.com
W-6037
FIND AOTA ON
Stand apart from
the ordinary.
www.OTJobLink.org
PR-283
30 AUGUST 22, 2016 • WWW.AOTA.ORG

AOTA for You • Evidence in Practice
TBI
Children
and Youth
Interested in increasing
your evidence-based
practice (EBP) knowledge-base
and skills in a
school setting? Cahill, Egan,
Wallingford, Huber-Lee, and
Dess-McGuire’s (2015) article
featured in the March/
April 2015 issue of the
American Journal of Occupational
Therapy demonstrates
the effectiveness of
a 17-month EBP initiative
to significantly improve
EBP knowledge and skills
for school-based occupational
therapy practitioners.
To learn more about the
initiative and how it can be
used to build your own EBP
skills, visit www.ajot.aota.
org. For more school-based
practice EBP resources,
visit www.aota.org/
practice/children-youth/
evidence-based.
Work
& Industry
Learn how a structured
intervention program can
reduce pain and improve
body posture in health care
professionals in the Critically
Appraised Paper (CAP)
at http://goo.gl/iOxo25.
Based on a peer-reviewed
article, the CAP provides an
at-a-glance summary of the
effectiveness of an ergonomic
program that offers
education and skill training
to address work-related
body posture and lower-back
pain. The program
can be used as in-service
or continuing education
opportunity to prevent or
restore function for health
care professionals. For other
CAPs and information on
opportunities to submit
or serve as a reviewer for
a CAP, visit www.aota.
org/practice/researchers/
evidence-exchange.
Mental Health
Learn how a life review
writing workshop can
reduce depressive symptoms
and increase social support
in older adults in the
Critically Appraised Paper
(CAP) available at http://
goo.gl/ygVZUw. Based on
a peer-reviewed article, the
CAP provides an at-a-glance
summary and methods of
a randomized control trial,
8-week writing workshop
held in senior residencies.
Occupational therapy
practitioners can use the
program as an intervention
to address the psychosocial
needs of older adults. For
other CAPs and information
on opportunities to submit
or serve as a reviewer for
a CAP, visit www.aota.
org/practice/researchers/
evidence-exchange.
Rehab
& Disability
A recent AOTA systematic
review reported moderate
evidence that activity-based
interventions focused on client-centered
goals delivered
in a relevant environment
by an occupational therapist
can improve occupational
performance for individuals
with TBI. To find out more
and learn about other key
evidence recommendations
in areas such as cognition,
vision, behavior, motor
function, social participation
for individuals with
TBI, check out the Critically
Appraised Topics (CATs) at
www.aota.org/practice/
rehabilitation-disability/
evidence-based.
For more, check out http://www.aota.org/Practice/
Researchers/EBP-Resources.aspx
GRAPHICS © GETTY IMAGES
Education
I
ncorporating
evidence-based practice (EBP) into the
classroom is essential to help students understand the
value of EBP and to prepare them to apply EBP as
fieldwork students and new practitioners. AOTA has
numerous EBP resources and tools that can be seamlessly
incorporated into curricula to provide students with a
strong, comprehensive background of EBP in many practice
areas. To learn more about how to incorporate the resources
into curricula, visit www.aota.org/education-careers/
educators/evidence.
Productive Aging
What is the distinct value of occupational therapy
to address driving and community mobility? In the latest
AOTA Everyday Evidence Podcast, Wendy Stav, PhD, OTR/L,
SCDCM, FAOTA, explains how occupational therapy services
help older adults stay safe on the road and access the community
despite age-related changes. To listen to the podcast and
learn more about the evidence for driving and community
mobility, visit http://goo.gl/v5h4D0.
OT PRACTICE • AUGUST 22, 2016
31

Social Media Spotlight
How do you infuse
OCCUPATION
into your daily practice?
We asked our friends on social media to
share practice-based examples.
Send yours to promotions@aota.org.
Advocating for OT
Last month, AOTA staff and members advocated for OT at the
national conventions. It’s an opportunity to interact with policymakers
outside the traditional D.C. setting. Check out what they
were up to:
1
2
Working in public
schools, I work with students
doing community
integration during the
school day. We grocery
shop, practice community
navigation, bowling,
Zumba—whatever is
meaningful to my students.—Erin
Villanueva
Some of the cabinet
doors in our ADL apartment
were getting loose.
What better activity for
our retired contractor
patient than to grab a
screwdriver and tighten
them for us!
—Kara Vautour
3 4
Today we had a patient
who used to be a hairdresser
French Braid two
therapists’ hair.
—Kainaan Nelson
I had a 99-year-old vet
reach up to the top shelf
in his closet to retrieve
his WWII hats so he
could show them to me.
—Ruth Blameuser
5
OT Connections
— A prospective student asks whether she is too old
at age 35 to become an OT. See the inspirational
reactions. www.aota.org/otc/nontraditional-student
— Have you seen the new OT evaluation CPT codes?
Your colleagues are discussing how the codes might
affect OT practice. www.aota.org/otc/new-codes
— An AOTA member is starting a private practice and
has questions about billing Medicare and private
insurance. Can you help them out? www.aota.org/
otc/private-billing
11. AOTA President Amy Lamb
met with Senate Majority
Leader Mitch McConnell (KY)
at the Republican National
Convention in Cleveland.
2. Chris Metzler, AOTA’s chief
public affairs officer, spoke
about the Americans with
Disabilities Act at the Democratic
National Convention in
Philadelphia.
3. Heather Parsons, AOTA’s
director of Federal Affairs,
met with OT champions
Representative Paul Tonko
(NY) and Senators Ben Cardin
(MD) and Brian Schatz (HI) at
the DNC.
4. 4 AOTA members Wendy
Fox and Paula Kramer and
AOTAPAC Chair Yvonne Randall
attend a lunch in support
of the Achieving a Better Life
Experience (ABLE) act.
5. 5 Barbara Glauser, AOTA
member, John Ray, AOTA’s
legislative representative, and
Amy Lamb met with Representative
Glenn Thompson
(PA) at the RNC.
PHOTOGRAPHS COURTESY OF CHRISTINA METZLER (1, 4),
HEATHER PARSONS (2, 3), PENNY AMMERMAN-THOMPSON/AMY LAMB (5).
32 AUGUST 22, 2016 • WWW.AOTA.ORG

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SC-134

The Role of Occupational Therapy in
Reducing Hospital Readmissions
Earn .1 AOTA CEU
(one contact hour and
1.25 NBCOT PDU).
See page CE-7 for details.
Marnie Renda, MEd, OTR/L, CAPS, ECHM
Occupational Therapists and Founder/Owner, Rebuild Independence
LLC, Cincinnati, OH, and Adjunct Faculty Member, Xavier University,
Norwood, OH
Susan Lee, MS, OTR/L
Occupational Therapist and Research Scientist, Center for Assistive
Technology and Environmental Access, Atlanta, GA
Marian Keglovits, OTD, MSCI, OTR/L
Occupational Therapist, Washington University in St. Louis, School of
Medicine, Program in Occupational Therapy
Emily Somerville, MS, OTR/L
Occupational Therapist, Washington University in St. Louis, School of
Medicine, Program in Occupational Therapy
This CE Article was developed in collaboration with
AOTA’s Home & Community Health Special Interest Section.
ABSTRACT
The implementation of the Affordable Care Act led to the Centers
for Medicare & Medicaid Services mandate to reduce costly
unplanned hospital readmissions. As a result, hospitals are
actively seeking solutions to reduce readmissions, which now
have financial penalties. This provides occupational therapy
professionals the opportunity to demonstrate their expertise
and knowledge in contributing to a reduction in readmissions.
The role of occupational therapy in reduction can include care
coordination, fall prevention, medication management, assistive
technology acquisition, and community re-integration.
LEARNING OBJECTIVES
After reading this article, you should be able to:
1. Describe the impact of the Affordable Care Act on hospital
readmissions
2. Identify known risk factors for hospital readmissions
3. Name the current conditions considered in the ratios for
calculating hospital readmission rates
4. Identify three practice areas in which occupational therapy
practitioners participate during the discharge planning process
INTRODUCTION
The rapid change in the health care system toward value-based
purchasing, propelled by the Affordable Care Act of 2010 (ACA),
provides an opportunity for occupational therapy practitioners to
expand their traditional roles and showcase their distinct skills.
Reducing hospital readmissions is one such area where occupational
therapy can demonstrate the value of its services, improving
the health and wellness of clients while reducing health care costs.
The ACA was designed to facilitate changes in our health care
system by linking quality of care to reimbursement. In doing so,
health care providers are encouraged to discover and use best
practices to create optimal outcomes while reducing cost. The
Medicare Payment Advisory Commission (n.d.) in June 2011
identified hospital readmissions as a critical area to be addressed.
Hospital readmission is defined as a repeated hospitalization
within a defined period of time. CMS defines a readmission as a
hospitalization occurring within 30 days of discharge. This includes
readmissions to any hospital, not just the hospital at which the
patient was originally hospitalized (Boccuti & Casillas, 2015).
CMS spends an estimated $26 billion annually on hospital
readmissions for Medicare recipients (Rau, 2014). Of those
readmissions costs, about $17 billion has been identified as
preventable, stemming largely from substandard care, including
poor resolution of the cause for hospitalization and inadequate
post-discharge care (Benbassat, 2000).
CMS began measuring and reporting the incidence of hospital
readmissions for particular medical conditions in 2007. In an
effort to create transparency, this information is available on the
Hospital Compare website (www.medicare.gov/hospitalcompare).
CMS reports each hospital readmission rate compared with
hospitals nationally to determine each hospital’s Excess Readmissions
Ratios for specific medical conditions. Hospitals with
readmission ratios above the national average are issued financial
penalties of between 0.01% and 3% of total revenue (CMS,
2014a). Currently, CMS measures readmission rates related to
the following medical conditions: acute myocardial infarction,
chronic obstructive pulmonary disease, heart failure, pneumonia,
total hip arthroplasty, and total knee arthropasty, with coronary
artery bypass graft surgery to be added to this list next year (CMS,
2014b). Because CMS reimburses hospitals using 3-year performance
periods, Excess Readmission Ratios have a long-lasting
financial effect on the organization. This has resulted in hospitals
becoming highly focused on reducing these ratios by ensuring
discharges are effective in returning patients home and keeping
them there. Although measuring readmission rates is new, it has
already shown to have had a significant impact. The hospital
readmission rate dropped from 19.6% to 18.4% within 30 days of
discharge in 2012 after the penalties started (Dharmarajan et al.,
2013), translating to significant cost reductions.
Although limited, available research provides strong evidence
to support several methods to reduce admission rates. These
include conducting patient needs assessments, performing
AUGUST 2016 l OT PRACTICE, 21(15)
ARTICLE CODE CEA0816
CE-1

Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).
medication reconciliation, providing patient education, arranging
timely outpatient appointments, and providing telephone
follow-up (Kripalani, Theobald, Anctil, & Vasilevskis, 2014).
No single intervention alone reduced hospital readmissions
within 30 days of discharge (Hansen, Young, Hinami, Leung,
& Williams, 2011). Hoyer et al. (2014) found that patients with
higher functional status at the time of hospital discharge have
lower readmission rates than patients with more functional
impairments. Thus, improving functional status during hospitalizations
is thought to be an important strategy for lowering
readmission rates. It is expected that our knowledge of the
factors contributing to unplanned hospital readmissions will
continue to expand rapidly in the coming years.
It is essential that occupational therapy practitioners understand
the impact occupational therapy services can have on
hospital readmissions and be prepared to provide these needed
services. Occupational therapy practitioners need to be a vital
part of the discharge planning team, at all phases of a client’s
hospital stay and transition back into the community. They
have an opportunity to add value in discharge planning, fall
prevention, home modifications, medication management, and
assistive technology (AT) to reduce hospital readmissions.
ROLE OF OT IN CARE COORDINATION AND DISCHARGE PLANNING
Discharge planning is a process in which patients’ needs are
identified and a plan is formed for a smooth transfer from one
environment to another (CMS, 2014a). Occupational therapy
practitioners provide a unique perspective on their clients’
functional abilities, which, in conjunction with medical considerations,
influences the determination of the appropriate
living arrangement after discharge. In addition, occupational
therapy practitioners possess a broad skillset that is beneficial
in identifying and coordinating individuals’ needs to ensure full
participation in desired activities and roles.
Having worked with the individual throughout his or her
stay to increase functional abilities needed for day-to-day living,
occupational therapy practitioners offer the most comprehensive
insight about the individual’s functional abilities relative to
his or her baseline level of function. When there is a change in
functional status from baseline, occupational therapists are able
to provide recommendations regarding how activities should be
modified to eliminate activity barriers, and what level and type of
assistance their clients need to complete daily activities safely.
Occupational therapy practitioners collaborate closely with
other health care team professionals, such as case managers,
nurses, physical therapists, speech-language pathologists, and
physicians, to create an interdisciplinary plan of care and a coordinated
and appropriate discharge plan. The American Occupational
Therapy Association (AOTA) has consistently shown
support for increased involvement of occupational therapy in
the discharge planning process. In November 2015, CMS proposed
revisions to requirements for discharge planning in acute
care hospitals, long-term care hospitals, inpatient rehabilitation
facilities, critical access hospitals, and home health agencies.
The intention of the proposed revisions was to allow patients
and their families’ access to information that helps them make
informed decisions about their post-acute care. In January 2016,
AOTA submitted comments to the proposed revisions requesting
that an occupational therapist be listed as part of the discharge
planning team needed to perform discharge assessment
and planning (Bogenrief, 2016). This was on the grounds that
occupational therapists assess, treat, and consider discharge and
transitions as part of the evaluation of a client’s functional and
cognitive status on an ongoing basis. AOTA strongly supports
the involvement of patients in determining their goals of care
and discharge planning, as well as taking into account realistic
caregiver support after discharge.
Recent research points to the need for greater emphasis
on functional and environmental factors during the discharge
planning process. Changes in functional abilities place increased
demands on the patient’s ability to participate in pre-hospitalization
roles, and are cited as a factor contributing to preventable
rehospitalization. For example, Tao, Ellenbecker, Chen,
Zhan, and Dalton (2012) reported that the extent of self-care
deficit was positively associated with risk of rehospitalization,
and others have identified caregiver burden as a predictor of
hospital readmission (Bonin-Guillaume et al., 2015; DePalma
et al., 2012). DePalma et al. (2012) also reported that returning
to the community from a recent hospitalization with unmet
activities of daily living (ADLs) was associated with a higher
probability of readmission. These findings suggest that an early
identification of individuals in need of additional support, and
coordination of necessary services, may prevent unnecessary
re-hospitalization. Occupational therapy practitioners are well
positioned to be an asset in this realm through offering their
professional expertise in (1) analyzing pre-hospitalization roles
and their clients’ likelihood of resuming them; (2) identifying
the need for adaptive equipment and caregiver assistance; and
(3) identifying and coordinating community needs in mobility,
activity participation, and more. After the needs are delineated,
occupational therapists can coordinate training sessions with
family caregivers to ensure that the needs will be adequately
met. In collaboration with social workers and case managers,
occupational therapy practitioners can identify community
resources, such as additional funds for home modifications
and AT, transportation services, and support groups, to extend
support services available.
ROLE OF OT IN FALL PREVENTION
Fall prevention is an important aspect of the discharge planning
process, as it can reduce hospital readmission and increased
disability. The rate of falls following discharge from a medical
hospitalization are as high as 40%, and up to 15% of those who
fall require re-admission to a hospital (Hill, 2011; Mahoney,
2000). In addition, 20% of older adults presenting to the emergency
room for a fall have had one or more hospitalizations in
CE-2 ARTICLE CODE CEA0816
AUGUST 2016 l OT PRACTICE, 21(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.
the previous year (Close et al., 2012). Falls can have a range of
negative effects on older adults including injury, activity restriction,
institutionalization, and death. Because of the increased
risk of falls after hospitalization and the potential for a fall to
cause readmissions, fall prevention is an important area for
occupational therapy to address in discharge planning.
Falls are often preventable, with proven strategies to reduce
older adult fall risk. Effective fall prevention programs include
evidence-based practice of occupational therapy, durable medical
equipment (e.g., home modifications), and referral to community
programs (AOTA, 2010). Occupational therapists are distinctly
skilled to assess the person and environment. Occupational
therapists should identify personal limitations and environmental
hazards that have the potential to cause falls and make subsequent
recommendations for a combination of fall prevention
interventions. Fall risk factors that occupational therapists may
assess include lower-extremity weakness, impaired balance,
cognitive impairment, incontinence, sensory impairment, fear
of falling, medication adherence, and environmental hazards
(AOTA, 2012). In addition to risk factors that put all older adults
at risk for a fall, identifiable risk factors that are present in older
adults at high risk for a fall post discharge include dependence
in one or more ADLs before hospitalization, a history of falls,
preexisting mobility impairments, and prior hospitalizations
(Mahoney, 2000). Occupational therapy is well positioned to
identify patients with fall risk factors and implement or assist
with care coordination for recommended interventions.
A recent systematic review conducted in conjunction with
AOTA’s Evidence-Based Practice Project found home modification
interventions are effective for high-risk older adults when
high-quality interventions are implemented by an occupational
therapist (Clemson, Mackenzie, Ballinger, Close, & Cumming,
2008). High-quality interventions include evaluating person
and environment factors, using a valid fall hazard assessment
tool, evaluating functional capacity within the home environment,
and following up for modifications/adaptations. Interventions
must include at least three of the four criteria to be
considered high quality (Clemson et al., 2008). When implementing
home modification programs for fall prevention, it is
important for occupational therapy practitioners to ensure that
they provide effective, high-quality, evidenced-based interventions.
Home assessments pre-discharge from a rehabilitation
hospital reduced falls within the first month post discharge for
cardiac, spinal, deconditioned, and orthopedic trauma patients,
indicating that these may be target populations to reduce fall
readmissions (Johnston, Barras, & Grimmer-Somers, 2010).
Another review found strong evidence for multifactorial programs,
including home evaluations, physical activity or exercise,
education, vision and medication checks, and AT (Chase, Mann,
Wasek, & Arbesman, 2012). The most successful fall prevention
interventions use a multifaceted approach. Recommended exercise
programs include Tai Chi, for better balance (Wolf et al.,
1996); Matter of Balance (Tennstedt et al., 1998); Otago Exercise
Program (Robertson, Campbell, Gardner, & Devlin, 2002);
and Stepping On (Clemson et al., 2004). Occupational therapy
practitioners may also work with nonprofit organizations or
government agencies to implement fall prevention initiatives
within the community (AOTA, 2012).
ROLE OF OT IN MEDICATION MANAGEMENT
Medication management has been identified as one way to help
reduce hospital readmissions. Research indicates that as many
as 50% of patients do not adhere to medication routines (Lee,
Grace, & Taylor, 2006) and 30% of patients failed to fill new
prescriptions (Fischer et al., 2010). Medication non-adherence
is primarily the result of patients forgetting to take their medication
or choosing not to because of unpleasant adverse effects
or their view that the medication is not necessary (Hughes,
2004). Between 23% and 40% of persons in a nursing home are
admitted due to medication non-adherence (Pan, Chernew, &
Fendrick, 2008; Strandberg, 1984).
Factors in medication management include the patient’s or
caregiver’s knowledge of the medications needed, the reason(s)
for medication, the medication’s side effects, access to medication,
and ability to administer it. Many different health care
practitioners can provide education to increase adherence to
medication routines; however, occupational therapists have the
ability to identify the problems that individuals have in correctly
adhering to their medication routine. In addition, occupational
therapists and occupational therapy assistants have the skills
and knowledge to help clients integrate medication administration
into their daily routine effectively, thus increasing medication
administration accuracy and compliance. Occupational
therapist and occupational therapy assistants have the skills to
help clients learn to manage taking medications and the impact
of side effects on their daily activities to increase performance
and safety.
Often, patients are prescribed new medications or medication
instructions change when they are hospitalized. Occupational
therapists are able to review medication information
sheets with their clients and evaluate their ability to understand
and use this information. Practitioners can then help clients
understand medication instructions and incorporate them into
their daily routines and habits. For example, diuretics prescribed
to manage congestive heart failure can cause patients to need
to use the bathroom more frequently. The occupational therapy
practitioner can discuss timed voiding, simplified clothing
fasteners, and mobility issues related to accessing the bathroom,
especially away from home, and other strategies to manage or
avoid incontinence, and this in turn should increase the client’s
compliance with taking the medication as directed (AOTA Legislative
Affairs and State Regulatory Affairs, 2016).
“The OT role in medication management can include:
• Recording medication dosages and routes per agency policy
when required as part of an assessment
AUGUST 2016 l OT PRACTICE, 21(15)
ARTICLE CODE CEA0816
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Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).
• [Referring clients] back to their pharmacy/doctor or
referral to nursing if the patient needs to be taught specific
information about a medication that is not provided on
written instructions
• [Ensuring] that patients know how to take their medications
and are in fact taking them as directed. If not, the OT
can explore reasons why they are not being taken or are
taken incorrectly.
• [Identifying], through the assessment process, when the
patient takes medications within their daily routine and
when there have been disruptions to that routine that
interfere.
• Identifying habits and routines that have worked to support
appropriate medication management for the patient in the
past. How can we work with them vs. changing them?
• [Assessing] medication management as part of the patient’s
overall ADLs so tasks can be accomplished timely, allowing
for medications to be taken within the prescribed time
frame relative to food, blood sugar, etc.
• [Considering] how OT skills and knowledge around energy
conservation techniques can assist with managing all
ADLs.”
(AOTA Legislative Affairs and State Regulatory Affairs, 2016)
Given that medication non-adherence is a significant risk
factor for hospital readmissions, it is essential that practitioners
understand their potential role and initiate providing these
needed and valued services.
ROLE OF OT IN ACQUISITION OF AT
AT is frequently part of an effective discharge plan, as it
facilitates functional performance and minimizes barriers to
function. However, for provision of AT to be an effective part
of reducing hospital readmissions, individuals must be receptive
to and actually benefit from the AT.
“Despite their utility, a high proportion of assistive technology
users abandon their device for reasons relating to
unmet expectations of the device, difficulty of use, lack
of social support or inappropriate instruction. Adopting
an assistive technology device that meets the needs of the
individual requires collaboration between the assessors,
the client and their family/caregiver, and the service provider.”
(Harris, Rosenwax, Hunter, & Andrews, 2014)
Therefore, it is crucial that recommendations for AT are
based on a skilled assessment of fit between the individual’s
needs and features offered by the equipment (Stark, Somerville,
Keglovits, Smason, & Bigham, 2015). Occupational therapy
practitioners’ understanding of occupational needs and performance,
coupled with their skills in activity analysis and focus
on achieving client goals, are indispensable to the AT provision
process (AOTA, 2015a). Occupational therapy practitioners can
provide a broad range of services in the process of AT provision,
including evaluation, recommendation, justification of need,
advocacy, awareness of funding resources, fabrication, customization,
training, and follow up (AOTA, 2015b).
Occupational therapy practitioners also recognize that
recommendation is only the first step of the extensive AT
provision process. Recommendations of AT must be followed
by identifying sources of funding, as well as providing support
to acquire the equipment and training for correct use. Often,
the individuals’ needs and desires for AT and durable medical
equipment are not sufficiently met with federal and private
insurance alone. Thus, community resources, such as diseaseand/or
injury-focused nonprofit organizations, area agencies
on aging, and Medicaid Waiver Programs, may serve as critical
sources of support for obtaining a needed piece of equipment.
Practitioners may also collaborate with individuals to leverage
their existing relationships with local organizations to obtain
additional sources of support.
ROLE OF OT HOME ASSESSMENT AND MODIFICATION
Home assessment and modification are essential to the discharge
planning process, as they can directly impact individuals’
ability to participate safely in ADLs and instrumental ADLs
(IADLs) in their home and enable older adults to age in place.
The role of the occupational therapist is to assess occupational
performance in an individual’s home to gain a better understanding
of his or her to complete desired activities there.
Through the assessment process, the occupational therapist can
identify environmental barriers that prevent the individual from
engaging in activities. This is especially important prior to discharge,
because an individual’s abilities may have changed and
he or she may need additional supports at home to live independently.
This assessment process provides the occupational
therapist with the opportunity to identify and address any safety
issues in the home prior to discharge that could lead to a fall
and result in readmission, and help determine whether a person
should be discharged home.
In addition to an in-home assessment, the occupational
therapist can make recommendations for home modifications,
such as adding grab bars, ramps, lifts, railings, shower
chairs, and other adaptive equipment, as well as removing
environmental barriers, such as clutter, throw rugs, or cords
across pathways, which could contribute to a fall and hospital
readmission. An occupational therapy practitioner can also
assist the individual in obtaining the equipment, through a
local durable medical equipment vendor or a health equipment
lending program; coordinate with local contractors to
install architectural modifications as needed; and follow up
to provide necessary training to ensure that the recommendations
meet the needs of the individual. Home assessment and
modification help ensure that an individual’s home is safe and
provides appropriate support for the individual to engage in
activities after they are discharged, while reducing their risk
of readmission.
CE-4 ARTICLE CODE CEA0816
AUGUST 2016 l OT PRACTICE, 21(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.
ROLE OF OT IN COMMUNITY RE-INTEGRATION
Reintegration into previous roles and activities in the community
is another important part of a successful discharge after an
inpatient stay. Participation, or involvement in a life situation,
can often look different and potentially be more challenging
after an injury or illness. Additionally, after an inpatient stay,
individuals often wait to continue to make gains in rehabilitation
and return to their baseline functioning before feeling like
they can assume previous roles in the community. As a result,
many individuals never become fully reintegrated back into
their community. However, because of occupational therapy’s
focus on participation, we are well suited to address community
reintegration. This begins with using performance-based
assessments with occupational histories, instead of relying
solely on assessments that measure only basic ADLs (Wolf,
Baum, & Connor, 2009). Occupational therapy practitioners in
inpatient settings need to take all of these factors into consideration
to make appropriate recommendations for additional
therapy after discharge. Community reintegration is likely to
occur in free-standing community reintegration programs (e.g.,
vocational rehabilitation), home health, outpatient therapy, or
private practice. Thus, occupational therapy practitioners have
the ability and the responsibility to advocate for appropriate services
for their clients on discharge to receive the services they
need, beyond basic ADLs.
Occupational therapy practitioners are qualified to play a
vital role in connecting patients to needed community resources
necessary for both community re-integration and discharge
planning to reduce hospital readmissions. The role of the occupational
therapist is to identify and access the needed community-based
resources, which can include AT, medical equipment
covered and not covered under insurance, services (including
homemaking or personal care attendants), home modifications,
and support groups. Completing a detailed occupational profile
can aid occupational therapists in identifying potential community
supports and resources available to client, or simply to
encourage them to use the resources available. For example, a
therapist could help a client with Parkinson’s disease access a
local chapter of the American Parkinson Disease Association’s
adaptive equipment loaner closet to get a portable ramp or adaptive
utensils. In addition, the occupational therapy practitioner
can recommend that a client pursue a local grant for home
modifications to get needed grab bars for the shower. Perhaps
the individual just had a life-altering injury and now needs to
be connected to a support group, or the spouse needs to be
connected with respite care to allow for optimal occupational
performance. By accessing these needed resources, occupational
therapy practitioners can help ensure that clients get what they
need in a timely manner to help reduce readmissions. Therefore,
it is important that practitioners, in all care settings, are
aware of the resources available to the clients they serve outside
of the basic medical equipment provided by Medicare or other
medical insurance providers.
CASE EXAMPLE
Mr. Xavier was a 68-year-old male who was readmitted to City
Hospital 20 days after his initial hospital admission because
of complications of stroke. Mr. Xavier was initially discharged
home with orders for a home health care agency to provide
nurse visits for medication preparation once a week, and a
home health aide to visit twice day for ADL and IADL assistance.
However, Mr. Xavier was readmitted to the hospital after
sustaining a left humerus fracture after falling when attempting
a toilet transfer by himself.
City Hospital, following the lead of top-performing institutions
recognized for their clinical performance and dedication
to patient-focused care, wished to consider areas in which the
initial plan of care could have addressed to avoid Mr. Xavier’s
return to the hospital. During Mr. Xavier’s second stay, the
leadership team performed an in-depth analysis of their performance,
and sought to address these points in their plan of care.
On evaluation and conversation with Mr. Xavier, the team
found out:
• Home health RN prepared medications, but Mr. Xavier
was responsible for taking them correctly and on time. The
team learned that Mr. Xavier could not independently open
his pill bottles after his stroke because of weakness and
impairment in coordination in his affected hand. He had
not received any further therapy to address this decreased
ability to use his hand or to address his difficulty taking his
medication correctly on a daily basis.
• Mr. Xavier did not receive any rehabilitation after discharge,
as he was able to complete his basic ADLs independently
in the hospital. In addition, he did not have
reliable transportation and had not attempted to drive after
his stroke, so even when outpatient therapy was initially
discussed, he was hesitant to agree as he did not think he
had a reliable way to get to therapy.
• Side effects of Mr. Xavier’s new medication post stroke
included drowsiness and increased need to urinate.
Although Mr. Xavier had been verbally educated on these
side effects, he did not remember, as he received numerous
instructions on discharges. The connection between the
side effects and Mr. Xavier’s decreased independence with
toilet transfer at home was not addressed in the home, as
he did not receive any occupational therapy in the home
post discharge. Mr. Xavier tried to wait to use the toilet
only when the aide was present to help with transfers, but
that proved to not be very feasible. Instead, he chose to
limit his water intake, which created a risk of dehydration.
• As a result of the physical changes he experienced from his
stroke, his fear of falling during daily activities increased
significantly. Thus, he severely restricted his activities in
the home, including limiting his meal preparation, getting
dressed on his own, grooming, and getting his mail. He was
too embarrassed to let his daughter know about his significant
decrease in change in activity.
AUGUST 2016 l OT PRACTICE, 21(15)
ARTICLE CODE CEA0816
CE-5

Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).
• Mr. Xavier needed grab bars installed and a railing on his
steps going to his upstairs. He also had other needs outside
of Medicare-reimbursed AT, which was not adequately
addressing his needs. Mr. Xavier had not been educated on
alternative sources.
As a result, the plan of care for Mr. Xavier’s second stay
included the following:
• Intensive fall prevention education/training from his
inpatient occupational therapist. He was also referred to a
community-based exercise program, which provided transportation
to and from the exercise class.
• An in-home assessment completed with Mr. Xavier before
he was discharged from the hospital. During this visit, the
occupational therapist identified environmental barriers
to performance in the home and also noted fall hazards.
The therapist made recommendations for appropriate
home modifications (e.g., she marked the correct installation
location for grab bars) and was able to organize the
completion of the home modifications through volunteers
at Mr. Xavier’s church.
• Based on the in-home evaluation, the occupational therapist
also made recommendations for appropriate adaptive
equipment and was able to obtain the equipment for Mr.
Xavier through a local health equipment reutilization
program.
• While on the home visit, the occupational therapist and
Mr. Xavier discussed the basics of his medication management
routine and identified potential barriers to the routine.
During the remainder of Mr. Xavier’s inpatient stay,
the therapist worked with nursing to help Mr. Xavier incorporate
his new medication schedule into his daily routine.
Additionally, the occupational therapist recommended that
Mr. Xavier’s medications be provided in packages he could
open with one hand.
• Mr. Xavier was educated on his increased need for social
support. Afterward, he agreed to contact a family member
to ask for help, as well as establish a local contact to
provide help. A conference was organized with the family
member and local friend, for which a registered nurse,
social worker, occupational therapist, and physical therapist
were present.
• The recommendation for increased level of rehabilitation
on discharge included outpatient occupational and physical
therapy.
CONCLUSION
The implementation of the Affordable Care Act led to the
CMS mandate to reduce costly unplanned hospital readmissions.
As a result, hospitals are actively seeking solutions to
reduce readmissions, which now have financial penalties. This
provides occupational therapy professionals the opportunity to
demonstrate their expertise and knowledge in helping reduce
readmissions. The role of occupational therapy in reduction
can include care coordination, fall prevention, medication
management, assistive technology acquisition, and community
re-integration.
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CE-6 ARTICLE CODE CEA0816
AUGUST 2016 l OT PRACTICE, 21(15)

Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See below for details.
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How to Apply for
Continuing Education Credit
A. To get pricing information and to register to take the exam online
for the article The Role of Occupational Therapy in Reducing
Hospital Readmissions, go to www.aota.org/cea, or call toll-free
877- 404-2682.
B. Once registration is paid, you will receive instant email confirmation
with password and access information to take the exam
online immediately or at a later time.
C. Answer the questions to the final exam found on page CE-8 by
August 31, 2018.
D. On successful completion of the exam (a score of 75% or more),
you will immediately receive your printable certificate.
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org/10.1097/ANS.0b013e318271d2ad
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(1998). A randomized, controlled trial of a group intervention to reduce
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(1996). Reducing frailty and falls in older persons: an investigation of Tai Chi
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Therapy, 63, 621–625. http://dx.doi.org/10.5014/ajot.63.5.621
AUGUST 2016 l OT PRACTICE, 21(15)
ARTICLE CODE CEA0816
CE-7

Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).
Final Exam
Article Code CEA0816
The Role of Occupational Therapy in Reducing Hospital
Readmissions • August 22, 2016
To receive CE credit, exam must be completed by
August 31, 2018.
Learning Level: Entry
Target Audience: Occupational Therapists and Occupational Therapy
Assistants
Content Focus: Category 2: OT Process; Category 3: Professional Issues
1. Which of the following medical conditions is not currently
being measured by the Centers for Medicare &
Medicaid Services and used in the Excess Readmission
Ratios?
A. Pneumonia
B. Total hip arthroplasty
C. Myocardial infarction
D. Spinal cord injury
2. Hospital readmissions began to decline in the first
several months after mandated measuring went into
effect in 2012.
A. True
B. False.
3. The following strategy is within the scope of occupational
therapy services.
A. Recommending changing the timing of when a drug is
taken
B. Recommending different dosage amounts to clients
C. Encouraging a client to increase dosage of pain
medication
D. Reviewing medication information sheets
4. Evidence-based risk factors for hospital readmission
includes which one of the following:
A. Increased functional impairment
B. Low social support
C. Racial minority
D. Low socioeconomic status
5. Evidence-based fall prevention strategies does not
include which of the following:
A. Home assessment to identify fall hazard
B. Home modifications and/or adaptive equipment
C. Review of medication by pharmacist for interactions
D. Home exercise program
6. High quality fall prevention treatment does not include
one of the following:
A. In-home assessment
B. Recommendation of adaptive equipment
C. Home hazard checklist
D. Training on home modifications
7. When making recommendations for assistive technology
(AT), occupational therapy practitioners should include
one which of the following:
A. Personal factors and environmental factors
B. Standardized recommendations
C. Environmental factors
D. Referral to durable medical equipment provider for
recommendations
8. Occupational therapy has unique expertise to address the
following areas in the discharge planning process except:
A. Community mobility needs
B. Identification of pre hospitalization roles
C. In-home care coordination
D. Training and/or modifications to address unmet activities
of daily living needs
9. Environmental barriers can be identified correctly
through the following process:
A. Interview the client while he or she is inpatient
B. Conduct an in-home assessment with the client present
prior to discharge
C. Ask family members about how the home is set up
D. Have the family member conduct a home hazard
checklist
10. All of the following practice areas are common settings
during which community reintegration can be emphasized
except:
A. Home health
B. Outpatient therapy
C. Private practice
D. School-based settings
11. All the following are common reasons for non-use of
assistive technology except
A. Realistic expectations of the AT
B. Difficulty using the AT
C. Lack of social support
D. Inappropriate AT instruction
12. The role for occupational therapy practitioners is expected
to expand over the next decade?
A. True
B. False
CE-8 ARTICLE CODE CEA0816
AUGUST 2016 l OT PRACTICE, 21(15)