cswilhite - Tumblr blog

[cswilhite]

Technology revolution in the history of occupational therapy: Past, present, future

An invited convocation address to the University of New Mexico graduating class of 2019:

Welcome family, friends, graduates, faculty & staff of the Occupational Therapy Graduate Program Class of 2019. Families and loved ones: Thank you for entrusting the education of these brilliant young minds to the University of New Mexico where we are Lobos for Life.

Note to the audience: The graduates have requested a talk that makes them laugh and cry, is sobering, and also inspires them. I will endeavor to deliver!

First, let’s get the crying part over with. Many of our graduates will be making their new car payments to the federal government student loan repayment system for many, many years. So that is something to cry about.

Class of 2019, thank you for asking this speaker to address those assembled at your convocation. I don’t think it is a secret how much I admire you and am inspired by you to be a better teacher and occupational therapist. We caught lightning in a bottle.

Your group made learning together fun, even when tackling difficult concepts in neuro-rehabilitation. Your care and consideration about the topics, peer to peer teaching, generous sharing of resources, and willingness to explore and take risks was inspiring. You are very likely among the few in our profession at this moment who have learned about 3-D scanning and printing, virtual reality rehabilitation, engaged in prototyping and designing mobile apps, participating in Hackathons, and more. Let’s dig deeper.

You are entering the field of occupational therapy at a time like no other, influenced by a revolution in technology. I am talking specifically about the technology of information, communication, and the age of making things. All of these contemporary influences on technology are ripe for delivering occupational therapy in new and unprecedented ways. You are exactly the right group to harness this potent and powerful wave. I want to assure you that the manner in which you will use technology will not create the alienation and de-personalization that often accompanies technology tsunamis.

In fact, it is interesting to note our profession was born in such a turbulent period: the period known as industrialization: the industrial age enabled the rapid deployment of mechanical machines to perform work and resulted in the displacement of millions of master craftspeople from owning the products of their labor, the quality of their work, the knowledge of building an artful product from start to finish, and it especially severed them from the direct profit of their labor.

Industrialization herded craftspeople along with countless numbers of workers: immigrants, men, women, and children- into factories and piecework production on assembly lines. Their labor transformed continents, commerce, and politics. But the conditions of labor were quite intolerable and dehumanizing. Suddenly, Captains of industry had to deal with the collectivity of Union Labor. Strife and stress were headlines of the age. We fought two world wars with ever immense catacombs of weapons, chemicals, and the resulting millions of graves of combatants and innocent alike.

Occupational therapy was created as an antidote to the anonymizing effect industrialization had on people. We were born of a maker movement well before the current maker age happening now. We encouraged meaning and purposeful activity, occupation, as a means for health and wellness through the usefulness of one’s hands. During the time of war, our knowledge of activity and occupation became instrumental in rehabilitating injured and disabled soldiers and returning them to useful life in the community, while others were sent back to the theater of war.

Our professional ambition led us to practice within the medical model where we became experts in using adaptations and assistive devices to compensate for lost function; and we were experts in rehabilitative techniques to promote physical recovery. With legislative and policy successes we branched into outpatient, schools, long term care, and home care…and we were fortunate to lobby successfully to be an insurance reimbursable service. Our current policy asks involve increasing our direct access to home care patients, creating specific occupation-based reimbursement codes that are distinct from physical therapy codes, and gaining provider status in mental health care settings.

But will these hoped for victories be enough to secure our future as a profession? I think not. In this country, healthcare is a business. Business is competitive. Business is an evolutionary zero sum game where there are winners and losers. Prey and predator. Them and us. Collaborations and alliances evolve and others dissipate depending on the forces at play in the marketplace. But because we belong in healthcare systems, because this where the majority of people currently receive the value of our services, some of us must compete and be adept at the game. To be sure, we need occupational therapy professionals who are able to savvy the vagaries of the market sphere in pursuit of our goal of ensuring people undergoing episodes of medical care receive the benefit of occupational therapy services; the services that are proven to restore participation in life activities. We especially need people in the system who are able to hold the core of our ethos, our philosophy, and our practice…and not dumb it or dilute it down into a meaningless set of rote procedures.

Unfortunately, the business scenario is not a sustainable one. Resources for health care as usual are evaporating. While the business of health care remains lucrative, the cost of healthcare to society is overwhelming, taking up the largest percentage of our gross domestic product. We can’t afford the current model. Something’s got to give.

The delivery system of care must be rebuilt and redesigned: a sustainable system designed for high quality of care and where all people have equitable access to health care, quality of life, and quality of community life. It is a HUGE ask, and it is at the center of every health profession’s concern. We need to be at that drawing board where high level policy decisions are being made. We need to deliver best evidence, best bang for the buck. Some of you will be well suited to get to that workspace.

And as archaic as it may seem, it is time to become a master craftsperson, maker of things.  For example, the modalities of the near future involve revolutionary technologies in 3-D printing, robotics, and virtual reality. Occupational therapists working with people to recover from strokes, burns, and amputations will need advanced knowledge of rehabilitation strategies for working with people embedded with 3-D printed living tissue and who are recipients of 3-D printed organs. We also will be called upon for assisting our clients navigate occupations, with concurrent physical and emotional challenges, of using and accepting alterations to their bodies from implanted devices, robotic limbs, and brain transplants; and we will have to exercise good judgment in determining when to use virtuality to bring context to the bedside when pushing the principles of brain plasticity at human scale.

The entire human interface with technology is growing nearer, in real proximity to our “selves” and we must wonder if it will fundamentally change who we think we are as occupational beings. And so, the occupational therapist…the master craftsperson of occupation, must inform those who design and fabricate this new world. We must be on the top teams in healthcare, but also architecture, urban and regional planning, and engineering. We should, we must, deeply understand the technology AND the user experience of those depending on technology to perform occupations. There will also be ethical conundrums that are sure to follow in the wake of so much change. This age we are entering is both exciting and sobering. After all, we are fundamentally the same, albeit a tad more sophisticated version of our cave dweller selves.

So, understandably, you are probably feeling a bit overwhelmed by my forecast. I get it. You have been trained and educated in a 20th century model for the current systems in which you find your services reimbursed. We haven’t prepared you for this raucous new age. YOU must be at the forefront of inventing the 21st century model through trial and error, bootstrapping your way, and navigating through uncertainty until you reap your 21st century education.

Fortunately, there are a growing number of leaders in the profession of occupational therapy who have already foreseen the need to innovate a 21st century profession. In her 2018 Presidential Address, AOTA President Amy Lamb said “Occupational therapy practitioners are in the perfect position to [innovate] because we touch people in real time”.

I dig that. The need for healthful occupation is universal and the need is growing across our complex world. That will not change as long as our species exists. What is new is the use of occupation as a means for preventing occupational deprivation and for ensuring occupational justice. It’s like working without a net, but we have the tools.

Dr. Lamb goes on to provide the rubric for 21st century practice. The rubric of why, what, and how? She says: “From the inception of our profession, we have been grappling with and indeed mastering the why, what, and how. We have seen practitioners transform empty spaces into centers for healing, and we have used common materials to create adaptations that foster independence and enhance quality of life”.

The why occurs when you encounter untenable problems of occupational deprivation that harm people. You ask, why is this situation occurring? You set off, often with other disciplines on board, as well as the people affected by the problem, and together you circumnavigate the complexity of the problem until you see it in high definition.

Then you ask, what if? You work with your team to begin a brainstorming process, and then a winnowing, until you achieve a set of possible solutions.

Finally, you are ready to say how? What are the action steps that can be taken in implementing the solutions?

It is likely some actions taken will be at the level of law and policy, while others happen at the grassroots and in the contexts where the occupations are performed.

And you will be adept at implementing useful technologies, have a hand in their design and fabrication, and work to ensure technology is beneficial and distributed equitably and ethically.

In conclusion, hopefully, what we have given you as a Faculty, are lessons in persevering through challenge, the love of lifetime learning, and the limitlessness of your imagination. That you have the belief that you can create structure where there is none.

Honestly, speaking for the Faculty, we NEVER could have taught you enough. So you will benefit if you adopt responsibility for your 21st century education early. In turn, the world will benefit from your wisdom, your solutions, and your innovations.

Thankfully, there are many professions and health professions in the same boat as you find yourselves, and they too will need to pursue readiness for the challenges and opportunities ahead. Encourage them to join you in the work.

I know you are the right people, at the right time, in the right place. I have seen the results of your work, your tenacity, and your imaginations whether in the classroom or the pop up labs. I see what you can accomplish, and I know you are ready to move into the world.

And lastly I promise this: if you hold occupation as your core belief, as both the means and ends of the therapy process, and hold it dearly, you cannot help but create authentic solutions for future occupational concerns.  

[cswilhite]

Where are the occupational therapy philosophers?

I’m concerned. Very concerned. Where are the occupational therapy philosophers? Where is Wood? Hooper? Peloquin? Reilly? Adolf Meyer? Where are the critical theorists, feminists, neo-pragmatists, instrumentalists, post-modernists, and meta-modernists? 

When did our signature journal become ONLY about science-driven empiricism? Where is the lyrical? Where is the ethos? Where is the art? Where is the philosophical? 

In this new age, in our contemporary reality, aren’t we hungry for meaning in our profession? Isn’t it time we evolved? But is the old way capable of leading us in a new day?

I believe in order for our beloved profession to survive we must become adaptive, creative, and entrepreneurial...and yes, philosophical. Or maybe we leave this work to the occupational scientists? No, I think,  that isn’t workforce enough. And I refuse to abandon occupational therapy to the domination of medicine. That isn’t what our founders intended.

And our philosophy is in need of an update...its emphasis on man-centered heroism and utility is overdue for an overhaul. What should the ethos and philosophy of our profession be? Will it recognize the sentience and cognition of animal beings and our inter-connected living planet (a la Fritoj Capra and the dynamical system we call the web of life)? Will it fundamentally assert the right of all people to have occupational justice and ameliorate occupational deprivation (A.A. Wilcock & C. Hocking)? Or will it just keep riffing on an occupational therapy practice framework as if this were enough to satisfy our understanding of what it is to be an occupational therapist? 

But wait, there’s more....this confusing complex stressed world needs what the new occupational therapist can give....

One example of a new kind of occupational therapy: Karen Jacobs #lifestylebydesign is leading the pack in designing a new frontier for occupational therapy. I take comfort in her beautiful photographs, quotes, and emphasis on a more meaningful way of living. Oh, you say...you can’t get paid just posting stuff on Facebook and Linked In (always the emphasis on filling and billing)? But I know I would pay to spend a weekend in retreat with her to learn how to design my beautiful occupation-filled life. 

In our past philosophy we have largely listened to privileged voices. However, we need more than ever, to have the contributions of new powerful authentic voices who can describe and amplify what occupation means when you are a community of color, indigenous, LGBTQ, disabled, or third world. In this ravaged, altered, climate crisis world....let us re-invent this profession to be the skillful tool it can be in healing our world through occupation. 

[cswilhite]

The Design Mind in Occupational Therapy

We envision that occupational therapy is a powerful, widely recognized, science-driven, evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs. (AOTA Centennial Vision)

One of the strategic initiatives from the American Occupational Therapy Association seeks to "Increase educators’ understanding of the need to accelerate content development in curricula for changing workforce opportunities in areas such as wellness, prevention, primary care, wounded warriors, mental health, and work and industry. [And]Support the preparation of existing occupational therapy practitioners for traditional and changing roles, environments, and patient demographics through continuing education, conference sessions, books, and their preferred communication vehicles."

As an educator, I see this as a complex challenge. Stuffing more content into the brains of learners does not necessarily lead to filling all the practice niches and opportunities that will evolve now and in the future. Rather, we must evolve as a profession to recognize occupation where it is occurring in native contexts of work, home, community, or school and be able to nimbly respond when we see individuals, families, and groups challenged from performing desired and healthful occupations. This requires a design mind.

What is a design mind? Certainly it is a habit of mind for thinking creatively, flexibly, and moving adaptively to changing phenomena. According to the blog at Design Mind, designers must be: 

1. Systems thinkers: designing for the inter-relationship of ideas, not just a single aspect of a problem.

An example of teaching occupational therapy design mind might incorporate having students examine how facilitating an individual's use of a dressing stick leads not only to the independence of dressing oneself, but also to the relationships and connections dressing has to a person's identity through fashion and participation in work and community; and how inclusion of all people into the fullness of society expands our social and cultural competence in the world (occupational justice).

2. Unifying design with technology: Today's designers must be facile not only with creative materials and methods, but also be capable in the realm of technology.

There are examples of occupational therapy students in many colleges and universities tinkering with designing apps and using iPads to enable activities of daily living. So why not have a new "shop" course in OT education programs replete with 3-D printers, small robotics, and creative software like Google Sketch? Students could become engaged in creating the products, services, and designs that nurture people occupying spaces that permit maximum inclusion and use of space for all.

3. Entrepreneurial: According to Design Mind, people burgeoning with ideas go to the front of the pack.

Occupational therapists, educators, and occupational therapy students brimming with ideas and solutions for addressing society's occupational problems will be reimbursed FIRST and recruited into positions of leadership and policy making at the highest levels of creative thinking and doing. 

4. Think with our hands: Creating things help bring design skills to life.

In occupational therapy education this looks like giving students the tools of time to incubate and marinate in ideas, learning to shape those, turn them over, visualize them inside/out, and practice performing them in contexts where occupation needs to unfold. Such a learning culture allows (even perpetuates) failure, pushing the envelope, risk-taking, and reaping reward when proto-typical ideas can be launched robustly into places of practice.

5. Emphasizes experiences, not things: Good design is about relationships.

This bullet is so rich for occupational metaphor I cannot even contain myself! Design creates change, as does the use of therapeutic self! Students must be taught how to use "self" beyond "selfie".

6. Connect by sharing: 21st century is about open-source, sharing, and collaboration.

In occupational therapy education, this is the encouragement of the community of scholars to "steal" and appropriate like artists do. Reserving and meting out intellectual effort within the academy does little to ensure our profession is widely recognized and globally connected. Educators with design mind will push to share in open journals, on blogs, and other connecting sources. It's about publishing to flourish versus publishing "to not perish".

So sure, this is my take on design mind for occupational therapy education and practice. I guess I'm not finished hoping for occupational utopia yet!