Occupational Therapy is Better Together

Last evening, I attended a virtual occupational therapy “town hall” webinar. The conversation revolved around advocating for the utilization of occupational therapy services in school transition contexts. Numerous attendees expressed their frustrations and challenges around convincing administrators of the value that occupational therapy offers within transition services.  One significant barrier mentioned was the costs associated with employing occupational therapists to provide valued services that, in many cases, are provided by lower-cost “non-professional” workers.

I did post a comment regarding my concern that the entire discussion failed to acknowledge, even once, the role of occupational therapy assistants in contributing to cost-effective quality occupational therapy services. And one person did reply in the comment box with an apology (that you, sir). Yet, the conversation continued unchanged. Throughout the entire conversation every single person used the term “occupational therapist” when discussing OT workforce.  

Have you ever sat at a dinner table and were ignored, “talked around”, and not acknowledged even once?  Well, sitting at a professional “table” and not being acknowledged by other professionals at that table is profoundly hurtful, disrespectful, and highly offensive. As an occupational therapy assistant for over 36 years, and as an OTA program director and academician for over 25 years, I felt so disheartened!

In this era of “Affordable Care”, doesn't it behoove ALL occupational therapy practitioners (and our professional associations) to recognize and promote the distinct value that occupational therapy assistants bring to quality, cost-effective occupational therapy? Sitting right under our noses is one of the greatest assets of our profession – our INTRAprofessional Workforce Model! Occupational therapy assistants are not a threat or burden. We are a solution!  Our profession can innovate the most amazing and effective solutions to address society’s occupational needs. BUT, if we can’t offer those solutions at a price point that matches what the market is willing to pay, our great ideas are not sustainable.  

INTRAprofessional practice is an essential key to occupational therapy’s emergence (or reemergence) in those “emerging practice” areas we often talk about: mental health, population health, transition services, community-based practice settings (all sectors where cost is always a barrier to overcome). Why is this not discussed more? Why do colleagues, publications, and professional associations convey language, beliefs, and attitudes that exclude our OTA sisters and brothers? We are all OCCUPATIONAL THERAPY PRACTITIONERS! Occupational therapy delivers its greatest value through INTRAproffesional practice. Occupational Therapy Practice is Better Together! To move beyond just grumbling, I thought of several suggestions to encourage us all to advocate for INTRAprofessional Occupational Therapy:

• Researchers: When researching occupational therapy practice, be sure to include both occupational therapists occupational therapy assistants in your studies and surveys. Be sure to use the term “occupational therapy practitioner” (the appropriate term that is inclusive of both occupational therapy assistants and occupational therapists) in your communications and publications. Consider inviting an occupational therapy assistant to partner with you in your research. And when developing and studying your innovative demonstration projects and pilots that are often designed around the use of free student labor, consider how your awesome program ideas could be financially sustainable based on an INTRAprofessional workforce model of service delivery.  An innovative OT idea proven through a university project or pilot is worthless if it cannot be sustainably replicated in the "real world".  
• Educators: Incorporate INTRAprofessional learning in your classes, learning activities assignments, and readings. Check out the AOTA document "Importance of Collaborative OT/OTA Intraprofessional Education in Occupational Therapy Curricula” for more ideas and evidence to support the value of INTRAprofessional learning. Our ACOTE Standards for OT and OTA programs are beautifully designed in parallel, to prepare future OT and OTA practitioners to collaborate in providing occupational therapy services. Teach your students to think and speak inclusively and collaboratively.     
• Entrepreneurs: Consider how you can lower your operating costs, expand your reach, and deliver high quality products and services through effective use of an INTRAprofessional workforce model. Promote your INTRAprofessional model as a business strength. Present on your INTRAprofessional models at conferences and in publications. And remember, occupational therapy assistants are entrepreneurs and inventors too! Here's just a few who have created amazing solutions to meet society's occupational needs:
  • Holly Masters, COTA and Ali Izzo-Linton, COTA of Purpose
  • Kelli Casto, COTA of Saving our Seniors 
  • Tara Simmons, COTA of All Abilities Fitness Center 
• Directors and Administrators: Evaluate ways you can expand services, lower costs, increase productivity, through effective use of occupational therapy assistants on your team. Consider how you could expand services beyond treatment of conditions by utilizing occupational therapy assistants to provide prevention and wellness services to broader markets.  Also, recognize that occupational therapy assistants can be (and are) directors and administrators too.   
• Practitioners: Use the term “occupational therapy practitioner” whenever talking about role and scope that is inclusive of both occupational therapy assistants. It the ethical responsibility of both occupational therapists and occupational therapy assistants to accurately understand and function within our scopes of practice, scopes of role (OT and OTA), and scopes of competence. Know all that occupational therapy assistants can do. For example, recognize that occupational therapy assistants CAN perform assessments for which they have service competency. Occupational Therapy Assistants CAN contribute to intervention planning. Celebrate your INTRAprofessional team! 
• State and National OT Associations: Are occupational therapy assistants included in your governance, membership, participation, communication, events, in ways that are purposeful, meaningful, and reflective of your populations? Does your OTA membership and engagement mirror the demographics of the occupational therapy workforce? If not, then something is wrong, and it is YOUR responsibility as an association to fix it. Be sure to advocate for the interests of both occupational therapy assistants and occupational therapists when lobbying for legislation and regulations. To overlook or exclude occupational therapy assistants hurts our entire profession. Our OT associations must deliver value to ALL occupational therapy practitioners. Make sure everyone feels welcome and valued (OTs, OTAs, students) We must stand together as one! Nothing about us without us! 
  
• Everyone: Occupational therapy assistants evolved over 60 years ago as an innovative solution to address society’s need for occupational therapy services. We are still here and passionate as ever about OT. We are collaborators. Value us. Respect us. Include us. We are better together!  
  

I bet there are other ideas out there. Share your suggestions of how we all can strengthen, expand, and promote one of our OT profession's greatest assets - our INTRAprofessional Workforce Model.

David M. Merlo, MS, COTA/L, CPRP, ROH

I've been an occupational therapy assistant for over 36 years. Best career decision ever!