The New Look of Competition

Posted on: November 21, 2011

I applaud AOTA President Florence Clark’s 2011 Presidential address (see in which she discussed competition as it related to the practice of occupational therapy. Clark stressed that it is to our credit that we are compassionate, kind, and honest, but added that these values do not have to preclude competition. “Competition is not mean. But we can’t continue to let others define occupational therapy. That’s not playing nice-it’s playing dead,” she said.

Clark compared OTs to sleeping giants who must stop letting others muscle in. We need to be worthy collaborators rather than support personnel. As she noted, “victories are sometimes won through teamwork but always through competition.” Clark pointed out that in its best form, we compete with, not against others; the stronger the occupational therapy team members are, the better the outcomes.

Competition vs. Service Substitution

An old adage is “to compare is to despair.” That does not have to hold true. Good can come out of looking around at other practitioners. Heidi Grant Halvorson, author of Succeed: How We Can Reach Our Goals, writes that upward comparison can be punishing and make you feel terrible . but also states that you can look upward to learn.

Downward comparison may make you feel superior, may remind you of your good fortune, but could also help you avoid the challenge to do better. To be competitive in today’s environment, you first have to have a good handle on who your competition is and what it has to offer.

I have found from consulting with therapists that they may not realize how competition in health care has changed over the years, most notably in the last five. Traditional, or direct, competition is typically what we are used to. A pediatric OT practice is in competition with another one in town, a physical therapy practice specializing in ortho competes head to head with another. But that condition is not very stable. For many years, Pepsi and Coke were direct competitors for the cola market, and they loved it! Why? Because they each had a 50-percent share of the cola market, they knew and understood each other, and had made peace (and profits) with each having half the market. Then something happened to rock their world. Along came water. The consumer began drinking water instead of soda, and act that we would call service substitution. Pepsi and Coke were blindsided; they knew how to compete with each other, but not with another product. Sound familiar?

Therapists need to realize the extent to which there is service substitution encroaching in health care. Many consumers are looking to other services much like the consumer turned to water. There are personal trainers, athletic trainers, life and wellness coaches, behavioral therapists, even posture coaches to name a few.

Clark shared her confidence that this is OT’s time, based on the rising incidence of polytrauma and TBI; and I would add that the fact that baby boomers now survive and live with many diseases, including cancer, can give our field momentum to be acknowledged and embraced by consumers. She suggested promoting areas where OT is already well recognized, including hand therapy, autism and “wounded warriors.” We can take a competitive edge by sharing published studies emphasizing OT’s effectiveness, increasing grant proposals to NIH, using our experience in home health for falls prevention and energy conservation, and “owning” the appropriate words in documentation to reflect OT intervention.

As holistic as our frame of reference is, we need to look at the whole picture. Make sure you know with whom you are competing so you can better strategically position yourself for long term success and recognition in this increasingly crowded market place.

Pepsi and Coke found a way – they started bottling water. I know we can do better than that!





Starting Fresh without Starting Over- Refreshing Your Career to Gain New Opportunities

Reprinted from the NYTimes  April 2018 By Kerry Hannon
Two years ago I hosted a webinar for therapists over 50. Since that time I have been looking for different ways to support my over 50 colleagues ( myself included). One  easy way is to share information, and here for starters is a great article.

For Susan Golden, now 64, flinging on a backpack filled with books and rambling around the Stanford University campus in Palo Alto, Calif., for a year in 2016 was “like drinking from a fire hose,” she said. “There was so much to learn, so many classes and lectures I could attend.”

She graduated that year from the Stanford Distinguished Careers Institute, operated in partnership with the Stanford Center on Longevity. Each academic year 25 fellows, who have had two or three decades of a successful career, are selected to attend the program and to enroll in classes across the university.
Harvard’s Advanced Leadership Initiative, a yearlong program for corporate executives and professionals interested in applying their skills to social problems, operates with a similar concept. The program’s fellows (for 2018, 48 were selected from more than 550 applicants) get to audit courses at the university and its graduate schools and develop independent projects with professors and fellow students.

Rosabeth Moss Kanter, a Harvard Business School professor who is director of the leadership initiative, said the program was started “to deploy a new leadership force of people transitioning from their main career to their next years of service.”

Todd Fisher, 52, a fellow in Harvard’s program, was ready for a new challenge. He was a global chief administrative officer and partner of the private equity firm Kohlberg Kravis Roberts & Company and, he said, “I wanted to fundamentally shift my career.”

When Mr. Fisher turned 50, he heard about the program and started to make his plan. “I was nervous about finding my new career,” he said. “I’m the type of guy who wants to go get things done. I felt it would be valuable for me to be in a stimulating environment, where I had to develop different routines and to detox, or reprogram.”

This semester, Mr. Fisher is enrolled in a course on community colleges and another on leaders and leadership in history at the Harvard Kennedy School. His aim is to figure out his “next direction, to have a little bit of fun, make some new friends and to broaden my perspective and life,” he said. “I did not retire in the classic sense of the word. I do want to throw myself into something else: a true second career.”

In addition to the Stanford and Harvard programs, there are a handful of other educational programs for Gen Xers and baby boomers eyeing a second act.

Later this year, for example, the University of Notre Dame will start the Inspired Leadership Initiative, a one-year program for “accomplished leaders at the end of their careers.”

The University of Texas at Austin will also welcome later this year its first cadre for its nine-month Tower Fellows Program for those who “have built a career of major accomplishments (20 to 30 years) and who now seek to deepen their knowledge and/or embrace new fields.”



Don’t Use Infant Walkers

Reprinted from the NYTimes  – September 2018  N. Bakalar

More than 230,000 children younger than 15 months were treated in emergency rooms for injuries incurred while using infant walkers from 1990 to 2014.

An analysis published in Pediatrics has found that 6,539 of them had skull fractures, 91 percent of them from falling down stairs. The devices are banned in Canada, and the American Academy of Pediatrics recommends that they be banned in the United States as well.

The number of injuries went down in 1994 with the introduction of stationary activity centers — devices similar to walkers, but without wheels. Injuries declined again in the four years following the adoption of federal mandatory safety standards in 2010. Other factors may have been involved in the decrease as well, including declining infant walker sales, the number of them still in use, and product recalls.

“There are no advantages to using walkers,” said the senior author, Dr. Gary A. Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. “They continue to have the potential for serious injury. Parents should be told not to use them.”

NYTPA is now an Approved ABA Provider in the Greater NY Area

Families living within 5 Boroughs of New York City, Long Island and Westchester can benefit from our team of Licensed Behavior Analysts (BCBA) and Behavior Therapists. We are ready to structure a program to address behavior goals, communication training and life skills essential for independence. Parents benefit from guidance and experience in the form of parent training and participation in the therapy. This program comes to you from an agency with 30 years of experience providing therapeutic and educational services across multiple modalities.

We make the process simple:
1.  Speak with our team and provide some basic information about your child.
2.  Once we verify insurance benefits, parents will need to provide proof of diagnosis and prescription for services.
3.  We will obtain authorization from the insurance carrier to assess, develop treatment plan and begin treatment.

We accept most major insurance plans including GHI, UHC, Fidelis Care, NYSHIP,  and Oxford. Our team is ready to help verify your benefits, eligibility and check whether you are covered. For some insurance carriers, the service can be provided at no cost.

If you’re a provider and know of a family or families who can benefit from this service, please feel free to pass along this information.  Please call our main office and inquire about ABA Therapy.

Don’t Count this NYC OT OuT- A New York Story with a Happy Ending!

When last we left veteran NYC Occupational Therapist Debra Fisher back in 2014, she had been suspended for 30 days without pay by the NYC Department of Education. Debra and others in the school where she worked had set up a Kickstarter fundraising drive aimed at helping a student on her caseload, Aaron Philip, put together a book and film to help other disabled kids — a project the school enthusiastically approved and supported.  In fact, the school participated in the campaign by sending out ongoing emails to the entire school community of both parents and staff.  Debra was none the less accused of “theft of services”, and the story was picked up by the major NY newspapers, including the NY Times and the Daily News.

By August 2015, NYC’s Special Commissioner of Investigation found  that an Education Department investigator made inaccurate statements and drew the wrong conclusions in his probe. In short, Debra’s “punishment” was rescinded by the DOE’s School Chancellor Carmen Farina.  Shortly there after, the publicity surrounding this story attracted the attention of the publishing house, Harper Collins, and this past February  This Kid Can Fly: It’s about Ability (NOT Disability) by Arron Philip was published. Written with award-winning author Tonya Bolden, This Kid Can Fly chronicles Aaron’s extraordinary journey from happy baby in Antigua to confident teen artist in New York City.

Aaron has since graduated  from PS 333, where Debra still works, but the two will be reunited on May 20, 2016.  Aaron, who currently attends the school at Blythdale Children’s Hospital following hip surgery returns to PS 333 for a special Town Hall Meeting where he will read from his book and sign copies. This great accomplishment will finally overshadow and put to rest the initial circumstances that brought this story into the public domain.

There could be no better validation for Debra. Along with others, she founded This Ability Not Disability (TAND), a non-profit organization that  works to find ways to support children, teens and young adults with significant physical disabilities develop the self-determination, self-advocacy and leadership skills to foster their own and everyone else’s belief that they can have a dream for their lives and work towards it like other youth. Its inaugural activity was supporting Aaron’s Kickstarter that allowed Aaron to work with artists and animators at the Children’s Museum of the Arts to create his first children’s book and video, TANDA.

This is why we do what we do.  Congratulations to Debra for her longstanding service to the children of New York, and her fortitude and spirit in demonstrating all that is great in Occupational Therapy. There is no doubt that she and Aaron will continue to inspire many of us for years to come.

Check out this fantastic video about the book and its author 


“As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination.”

Reprinted from the NYTimes – 4.12.2016 Written by on a Friday night. Dhruv Khullar, M.D., M.P.P. is a resident physician at Massachusetts General Hospital and Harvard Medical School.

Too good and spot on not to share – this gentle and beautifully written reminder for everyone in the healthcare field!

Friday night in the emergency department is about what you’d think. It starts off slow: a middle-aged man with a middling pneumonia; an older nursing home resident with a urinary tract infection that is making her delirious. Then come two heart attacks at the same time, followed by a drunken driver with a head bleed and half his rib cage fractured. At midnight, in roll the inebriated members of a bachelorette party that has not gone, one assumes, according to plan.

Amid the chaos, I break off to greet a thin, older man, quietly bundled up on a hallway stretcher. I look over his chart and prior scans. His prostate cancer has grown through several chemotherapy regimens. His spine is full of tumor and he’s been vomiting everything he eats or drinks for weeks. He can’t move the left side of his body after a recent stroke.

He smiles a charming, crooked smile. “It hasn’t been the best month of my life.”

“I’m sorry to hear that.”

I ask him about his symptoms, when they started, how bad they’ve gotten. He asks me where I went to medical school and if I have a girlfriend. I ask him if he’s dizzy and whether there’s blood in his stool. He tells me he emigrated from Greece 50 years ago, almost to the day. He won a scholarship to M.I.T. and studied electrical engineering. There he met his wife — “a fantastic cook” — and started his first company.

Now, decades later, he’s alone — in a crowded emergency room, on a Friday night, his wife dead, his two sons overseas, a nurse visiting him once a week at home to help him with some medicines and make sure the various tubes coming out of his body aren’t infected.

I ask him when he last moved his bowels. “Son, I’m dying. I’m alone. One day you’ll learn there’s more to a good death than how often I move my bowels.” I pause.

I am better at many things than I was when I started my journey to become a physician more than a decade ago. But I am not sure that understanding patients as people — and placing them in the context of their long, messy, beautiful lives — is one of them.

Doctors are trained first to diagnose, treat and fix — and second, to comfort, palliate and soothe. The result is a slow loss of vision, an inability to see who and what people are outside the patient we see in the hospital.

As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination. We see patients dressed in hospital gowns and non-skid socks — not jeans and baseball caps — and train our eyes to see asymmetries, rashes and blood vessels, while un-training them to see insecurities, joys and frustrations. As big data, consensus statements and treatment algorithms pervade medicine, small gestures of kindness and spontaneity — the caregiving equivalents of holding open doors and pulling out chairs — fall by the wayside.

But all care is ultimately delivered at the level of an individual. And while we might learn more about a particular patient’s preferences or tolerance for risk while explaining the pros and cons of a specific procedure or test, a more robust, more holistic understanding requires a deeper appreciation of “Who is this person I’m speaking with?”

In Britain, a small but growing body of research has found that allowing patients to tell their life stories has benefits for both patients and caregivers. Research — focused mostly on older patients and other residents of long-term care facilities — suggests that providing a biographical account of one’s past can help patients gain insight into their current needs and priorities, and allow doctors to develop closer relationships with patients by more clearly seeing “the person behind the patient.”

In the United States, Medicare recently began paying doctors to talk with their patients about end-of-life planning. These conversations allow patients to discuss and explore their preferences about a slew of complex medical interventions, including clinical trials, transfers to the intensive care unit, use of mechanical ventilation or feeding tubes, and the desire to die at home or in the hospital. These discussions, too, may benefit from a biographical approach, in which patients are able to elaborate on what is and has been most important in their lives. To better serve patients, we need to see not only who they are, but also who they were, and ultimately, who they hope to become even at the end of life.

How much more effective would we be as diagnosticians, prognosticators and healers if we had a more longitudinal understanding of the patient in front of us? If we saw not just the shrunken, elderly Greek man on the emergency room stretcher in front of us, but also the proud teenager flying across the Atlantic to start a new life half a century ago?

The emergency room is, by its nature, an arena designed for quick thinking and swift action. There are certainly other places, times and circumstances more conducive to probing goals-of-care discussions and lengthy forays into the internal lives of patients.

Still, there is always some moment of grace and meaning we can help patients find in the time they have left, a moment that recalls a time when they felt most alive — even if it’s just a fleeting conversation about gyros and electrical circuits in a busy emergency room, late on a Friday night.

An Occupational Therapist to Admirer – 91 y.o Barbara Knickerbocker- Beskind

“When I got married at the age of 52 my private practice flourished, because we built a separate building that housed my then-husband’s practice of psychotherapy on one side and my OT practice on the other. In 1984 we moved from New Jersey to Vermont and I was a consultant for the school system there.I tried to retire five times – as an OT, as a private practitioner, as an author – but it never works. I went back to school to become an artist in 1997 and that has been helpful in drawing my inventions.

In 2013, I saw David Kelley – the founder of the design firm IDEO – on the TV programme 60 minutes. When I realised he accepted, and really respected, people from a varied background, I thought, “I have a unique kind of life experience and designing skills – I could be of value to their firm.” I was 89.I typed a letter, which might have caught their attention because they don’t get many communications by “snail mail”- I have macular degeneration so my eyesight prevents me from using computers.”

Read more at:



New Legislation Passed in NYS on Telehealth and OTAs!!!

(1) NYS has become the latest and last state to require licensure for OTAs!

(2) The OT/PT telehealth parity bill was also signed into law. The law states that deductibles, co-insurance or other conditions for coverage of telemedicine cannot differ from those for in-person visits. It also differentiates between telemedicine and telehealth. Telemedicine, it says, refers to real time, two-way electronic audiovisual communications, while telehealth can include telephones calls, remote patient monitoring devices or other electronic means of diagnosis, consultation, education and treatment.

Table of Contents for Policy and Procedure Manual


1.  Initial Intake Form – Generic for Adults and Specific to Pediatrics
2.  Generic Evaluation Forms  (Pediatric and Adult Practices)
3.  Generic Progress Re-evaluation Note
4.  Generic Discharge Form
5.  Assignment of Benefits Form/Patient Notification of Billing/Cancellation/Discontinuance of Services Policy/Financial Policy Form
6.  Medicare Beneficiary Form
7.  Authorization for Release of Confidential Information
8.  Notice of Patient Privacy Practice/ Patient Information Consent Form
9.  Patient Satisfaction Survey
10.  Referral Source Satisfaction Survey
11.  Photo/Video Release Form / Waiver Form for Onsite Classes/Permission Slip for Caregivers
1.  Incident Reporting and Form
2.  Child Abuse
3.  Confidentiality, Release and Handling of Information including HIV Information
4.  Confidentiality for Emails/Faxes
5.  Emergency Preparedness Plan
6.  Health and Safety Issues Including Universal Precautions, Infection Control/   Handwashing Procedures
7.  HIPAA Policy and Procedures –
8.  Rehabilitation Update/Documentation for Medicare Patients
9.  Clinical Chart Review Form

1.  Application Form, Orientation and Minimum Requirements of Therapists
2.  Reference Forms
3.  Clinical Competency Review Form
4.  Employee Health Assessment
5.  Hepatitis B Consent/Decline Form
6.  Freedom from Impairment Form
7.  On Site Clinical Competency Form
8.  Sample Employee Handbook
9.   Code of Ethics  – OT, PT ST
1o. Job Descriptions – clinical and non clinical –

1. Sample Temporary Personnel Services Agreement
2. Sample Home Care Personnel Services Agreement
3.  Sample Contract for School District Service Provision
4.  Sample Independent Contractor Agreement
5.  Sample Employee Contract

PLUS – New for 2018 – forms for pre payment and prompt payment discounts, medical hardshipconsent for treatment

Purchase now:  $160 for downloadable, editable word document you can edit and customize with your practice name etc.

The Art of Communication – Easier Said Than Done ( no pun intended)

Good communication is at the heart of patient safety, cultural sensitivity, and the pillar of quality care.  Most of the time we focus on the message we are communicating, and how best to choose  words that adequately communicate the message we are trying to convey, while using language that the patient and family fully understand.  Yet, as pointed out in a great NY Times Op Ed Piece this week  (Doctor Shut up and Listen by Nitmal Joshi ), we need to focus equally on the other side of the communication equation, listening.

The core skill of good communication is listening. Listening requires that we put aside any thoughts of what we want to say next and just attend to the person talking. It requires that we be curious enough and interested enough in the other person to make sure we are clear about what they are saying, asking for clarification and reflecting back to make sure we have heard correctly. It is about taking seriously that the conversation is not about us but about the other.

Good listening is about understanding that good listening is often enough. Do patients want an answer to a question or do they just want me  — as the therapist — to listen to them? They want to be heard and, through that hearing, respected. Do they want my words or do they want my attention and presence? Even when the patient is looking for an answer, listening and creating a space for the patient to reflect may be all they need to come to the answer themselves rather than having me impose it on them.

 Don’t minimize listening by saying we “just” listened. This so simple but so powerful that often it is one of the best interventions we can make with our patients and their families.