The following concerns are a representation of anecdotal feedback that has been compiled by occupational therapy stakeholders (educators, students, and practitioners) on social media platforms and within closed discussion circles throughout the United States for approximately 3 years through social media posts, e-mails, and direct messages. 

This body of supporters (those signing this document) acknowledge and support the current and ongoing efforts made by educators, program directors, and leaders of ACOTE, AOTA, and NBCOT to develop the occupational therapy profession and its role in continuing efforts to spread the hope that is offered by our core beliefs. 

This petition is seen as a formal vehicle to address concerns that may be perceived barriers for OT educators, practitioners, and students to experience the full potential that we have as those who can be equally employed in both the medical and social models of the healthcare system (as well as every other sector of commerce). 

This petition is seen as a formal vehicle to address concerns that may be barriers for OT educators, practitioners, and students to experience the full potential that we have as those who can be equally employed in both the medical and social models of the healthcare system (as well as every other sector of commerce).The following concerns do not negate the respect and understanding we have of the work that is being done within our organizations to support occupational therapy and the sacrifice educators make to do the best they can do each and every day for the future of the profession. 

We would desire to obtain perceptual data regarding the voice of practitioners and become another advocate for the profession we all love. We believe that if we can find a way to create a formal action plan together addressing these reported concerns (regardless of their anecdotal nature), the occupational therapy profession can further adapt to the ever-changing landscape of health, medicine, and occupation.

Curriculum and Academic Standards

1) Trends appearing in OT Programs throughout the country seem to indicate an over-emphasis on the social model (occupational science, meaningful activities, adaptive equipment, compensation/modification, psychosocial factors) at the expense of the medical model (anatomy, kinesiology, functional anatomy, functional neuroscience, pathology).  

One possible solution: Creating an ACOTE standard that requires occupational therapy programs to equally represent the medical and social models of healthcare as full scope occupational therapy requires an equal combination of this training to be applied for each client, regardless of setting. 

2) Preparatory methods and the biomechanical framework have often been promoted as less desirable than occupation-specific approaches (per student and clinician response in social media). Per their report, these approaches are conceived as better suited for, and used more, in physical therapy 

One possible solution: To further support the full scope of occuational therapy, both social and medical  frames of reference and models of practice should be given equal support. Examples of using a combination of biomechanic and holistic frames of reference should be given to support clinicians who use them all equally within every setting.  

3) Occupation-specific interventions appear to be  promoted as the most valuable and efficacious type of intervention in academic programs vs. equally representing the many forms of occupational therapy intervention that are represented within the OTPF-4. These interventions include virtual interventions, group interventions, advocacy, education and training, self-regulation, wheeled mobility, assistive technology, orthotics and prosthetics, PAMS and mechanical modalities, activities, and occupation-specific interventions (AOTA, 2020, pgs. 59-62).

One possible solution:  To prevent the appearance of bias toward occupation-specific intervention and continue using current evidence which indicates best practice far exceeds this type of isolated intervention, it may be beneficial to have an ACOTE standard that requires intervention-based competencies based on every available OT intervention outlined in the OTPF-4.

4) Currently, a standard does not exist to require current/ongoing clinical practice for educators that may result in OT programs utilizing outdated information/techniques and antiquated teaching methods. 

One possible solution:  ACOTE standards may include a requirement for current clinical practice experience or ongoing clinical continuing education. Local communities and underserved populations may benefit from OT programs creating pro bono clinics with faculty members offering core supervision and students being given opportunities to put into practice what they are learning. Current healthcare infrastructure is limiting access to outpatient and community-based support, and this could be a great direction that will allow teachers to remain current in practice, students to get experience, and communities to thrive from the OT point of view. 

5) Hard sciences (gross anatomy, kinesiology, pathology, neuroanatomy, functional application of anatomy) and graduate-level occupational courses (theory, meaning, occupation, group processing) seem to be siloed within curriculums. Many school designs (data currently being compiled) have required pre-requisite courses for hard sciences such as Anatomy, Physics, Kinesiology, etc., and appear to not provide adequate graduate level courses that integrate this content into occupational therapy application. 

One possible solution:  To prevent the wrongful appearance that occupation is not science-based, ACOTE standards could include the requirement of graduate level knowledge translation and integration courses that combine pre-requisite understanding and the vantage point of an occupational therapy practitioner. This will allow greater opportunity to learn how to integrate these components and prevent the incorrect understanding that hard sciences don’t directly apply to the application of full scope occupational therapy. 

6) Based on a poll conducted via a social media account of February 24, 2023 involving 1,972 pollers, 64% of them stated they felt they did not have entry-level competence for their full scope of practice. 

One possible solution: In order to ensure there are not gaps in knowledge upon graduation, ACOTE could create an objectively clear, higher standard related to the education, curriculum design, training and implementation of course content that represents hard science and social sciences equally and consistently across occupational therapy programs. 

7) AOTA has not made freely available updated clinical practice guidelines for common diagnoses as it relates to the remediation of body functions, structures, and skills across human development for common diagnoses within the nine occupation categories. 

(https://myaota.aota.org/shop_aota/search.aspx#q=%22practice%20guidelines%22&sort=relevancy&f:@producttype=[Multiple%20Formats,Ebook] 

One possible solution: Possible increased collaboration with other OT associations to develop the most up to date clinical practice guidelines nationally and internationally.  An example could be found on the ANPT website under clinical practice guidelines.  We would also recommend that these guidelines be made freely available to the public as to increase the evidence based practice among clinicians and further equip them with information to advocate for this profession we love.  

As reference, this is a great resource and something that would be a great addition to the resources housed within AOTA archives: https://www.neuropt.org/practice-resources/anpt-clinical-practice-guidelines

8) Many programs require or promote students to be AOTA members.

One possible solution: In order to eliminate concerns or contentions that we have heard from social media, schools could eliminate the mandatory requirement for students to be AOTA members. Instead, schools can work with AOTA to create incentive by establishing incentives for joining. For example, students who have maintained membership throughout the time of their program receive unique cords; students receive a special pin each year they are a member; or if students are a member and complete specific guideposts throughout their academia, they receive specifical honors from AOTA in order to build their curriculum vitae. 

Fieldwork 

1) Many OT programs are experiencing challenges in establishing clinical fieldwork placements for their students within a reasonable geographic distance from their college community. 

Possible solutions: 

• ACOTE/AOTA can establish a paid position or paid work group to help establish more placements to support the rapid proliferation of OT programs in the United states between 2018-2023. (Data will be available on website)
• If a program can mostly offer “out-of-town” placements, this can be a required piece of information to be made prior to admitting a student. Program fees can be allocated to financially supporting a student who must relocate or travel to meet this requirement.

2) In 2020, there was a group of petitioners who petitioned ACOTE to accept Modified Fieldwork Placements during COVID-19. With 13,000 signatures, ACOTE accepted this for consideration. Although this may have been appropriate to some during unprecedented times, it is important to re-establish strict requirements and standards for fieldwork placements. Anecdotally, “alternative fieldwork placements” also labeled as “placements in emerging practice areas” have risen while clinical fieldwork placements have decreased. As a result, they graduate without sufficient clinical experience in traditional settings and struggle to secure employment as practitioners because of the lack of exposure to crucial concepts and practices.

Possible solutions: 

• Because there is real value in using the fieldwork experience to gain exposure in areas that occupational therapy practitioners are and should be, schools should ensure the fieldwork placement category is likely to give the practitioner employable skills. We are unsure of what this entails.  Further discussion and collaboration is necessary to meet this barrier.
  ACOTE should require each school to have a specific percentage of clinical placements vs. emergent practice placements in order to ensure all practitioners are equipped with hands on clinical experience and skills prior to leaving their institution. 
  ACOTE should design and implement standards for emerging practice placements and each “emerging practice area placement” or “non-traditional placement” should be documented and filed, overseen by the governing institution. 

3) Fewer practitioners are volunteering to be fieldwork educators, and current clinicians are often overworked, underpaid and undersupported. There is a perceived lack of support for fieldwork educators.

One possible solution: Although a potentially contentious suggestion, fieldwork educators may deserve financial compensation for their time. Much clinical training of the student is trusted to the clinician who must support the student’s learning process while managing their caseload, designing support tools for their student, mentally and emotionally supporting their student through the vulnerable components of become a clinician and working with clients for the first time, and ensuring they are meeting standards for entry-level competency. AOTA may consider making all fieldwork support resources free to fieldwork instructors as they are sacrificing to further support the profession.  

4) The current standards for fieldwork may lead to disruptive learning experiences for students and clinical sites offering fieldwork opportunities. 

Some universities are requiring students to split their level two fieldwork experiences across years of education, and in some cases students are returning for an entire year of education after their fieldwork experience impacting the development and growth of their clinical experience and reasoning skills they had just begun to put into practice.

Places of employment often attempt to hire their fieldwork students, but students returning back to school for an extended timeframe limits this from taking place. This impedes good outcomes for the student and the clinical site that has invested time, energy, effort and in many cases money to train and educate the student. This is more pronounced for some programs noted above that train students with an abundance of theory and depend excessively on fieldwork educators to help students achieve entry-level competence.
Some universities have designed their curriculums to require students to take courses during their clinical rotations that may not support their simultaneous fieldwork experiences. This level of distraction is not supportive of the active learning taking place during fieldwork. 

One possible solution: It is understood that there is a saturation of programs in specific geographical areas that require schools to coordinate their fieldworks so that there are enough placements for their students. With the current proliferation of programs, this is going to be a strategy that will fall short. We must plan for this. We worry about the future of occupational therapy and would like to request the support of ACOTE to help use best meet the needs of this potential barrier. Because the need for coordination is so strong, the possible solution is increased support services from ACOTE and AOTA to help fieldwork coordinators secure placements. This is a very difficult job for educators and places a lot of pressure on them. Fieldwork coordinators could benefit from more advocacy support to establish placements surrounding each program ACOTE accredits. 

Advocacy for the Full Scope of Occupational Therapy 

Per clinician reports over social media and individual conversations, occupational therapy has struggled to be  fully accepted in the medical model. At national and local levels healthcare professionals, clinicians, administration and entire companies are unable to understand the the value of occupational therapy and the full scope of the skills occupational therapy practitioners possess. Advocacy is not the sole responsibility of AOTA. The supporters of this petition recognize that OT students and practitioners should be responsible for this as well.

In order for all parties to be capable of this, we recommend that consistent and higher standards be set as part of ACOTE standards so all graduates are capable of defining, practicing, and advocating for the full scope of occupational therapy within multiple contexts. Advocacy efforts should be taught as it relates to the general public, other allied health professionals, schools, primary care physicians/medical professionals, local government, state government, and national government. Occupational therapy practitioners must learn how to boldly stand for their full scope of practice and be empowered to voice their relevance. As former AOTA president, Wendy Hildebrand stated, “Yes, as a profession, we are experiencing change, and yes, some of the changes ahead might be hard, but we’ve done hard before, and we will come to the other side of change again as a strong, relevant profession. We must recognize that maintaining or establishing relevance takes work. Relevance is not doled out like a participation trophy, and it is not up to others (not even AOTA) to make us relevant. Being relevant is up to each one of us (2019).

Experienced OTs and new graduates alike are often unable to clearly and confidently define what occupational therapy is. Although we fully believe and acknowledge that the individual is responsible for this knowledge, this phenomenon is happening at such a large scale that it should be a high priority for AOTA. At this time, urgency should be used in addressing the underutilzation in traditional and non-traditional settings. Each area of leadership within the profession can work together, leverage their individual strengths, and help to make more immediate gians in this area of concern. 

Without an adequate advocacy program and strategy at federal, state, and local levels, the future of occupational therapy in many settings is in jeopardy. It is of the utmost importance that AOTA, NBCOT and all partners increase efforts to increase awareness, understanding and acceptance of the full scope of occupational therapy and help to promote it at every level. 

Possible solutions: 

• Work with local stakeholders to do this work through a paid position(s) for those who are adequately vetted to represent the full scope of occupational therapy.
• AOTA provides reimbursement for those who advocate for the full scope of occupational therapy at medical conferences and other specialty conferences Form a paid AOTA position of individuals who travel to local communities and meet with primary care physicians and specialists to explain how the profession can meet their new needs associated with MIPS. This requires time and money to present in this way. Following a similar model of business that pharmaceutical companies and equipment companies follow, AOTA should begin marketing occupational therapy at the ground floor. 

We believe the occupational therapy profession has limitless potential and can help people across the globe. We believe that occupational therapy can be just as represented as physical therapy in United States employment figures instead of the least represented. We humbly express these concerns and desire mutual respect in finding a solution to build the best profession possible so that the most people can be helped and healed.