Beyond High Definition: Attitude and Evidence Bringing OT in HD–3D
Florence A. Clark · American Journal of Occupational Therapy · 2012
Two years ago when we met in Orlando, I introduced the concept of occupational therapy in high definition—OT in HD (Clark, 2010).Compared with a standard-resolution screen, HD upgrades a blurry, narrow, unsaturated picture into a crisp, widescreen, vibrant one. In the same way, the metaphor of occupational therapy in HD upgrades the picture of our profession to the 21st century. OT in HD communicates what occupational therapy is with clarity and confidence. It knows that occupational therapy’s wide-ranging work settings and patient populations show the fundamental essence of everyday activity. It celebrates the ways people’s lives are truly transformed as a result of occupational therapy.Do you remember me telling you about the research I did while developing the HD analogy? I brought home electronics magazines and sales circulars to learn all the features and jargon. And just when I got up to speed, what happened? The technology changed! Now many televisions offer HD in 3D—high definition in three dimensions! With the right programming and wearing the special glasses, the picture jumps off the screen and into your lap!Today’s 3D craze is another example of what’s old becoming new again. I vividly remember going to see the horror movie House of Wax in 3D in 1953 (Foy & De Toth, 1953). I was 7 years old! House of Wax generated buzz as the first 3D release from a major motion picture studio. One of the legends of horror, Vincent Price, was the lead actor. He played a serial killer who encases his victims in wax and displays them in his wax museum, unbeknownst to the museum patrons. To say the least, it was a pretty gruesome movie. I’m not sure what my parents were thinking, taking a 7-year-old to see the film. But the characters and the story felt all the more real coming right at me off the screen in 3D. It scared me half to death, and the experience still lingers in my mind today!While the technology is not necessarily new, this latest generation of 3D looks more real than ever, thanks to HD technology. Last year alone, there were more than three dozen theatrical releases in 3D. This summer, moviegoers will see The Avengers (Feige & Whedon, 2012), Men in Black 3 (Parkes, MacDonald, & Sonnenfeld, 2012), Prometheus (Giler, Hill, Scott, & Scott, 2011), and the Amazing Spider-Man (Ziskin, Arad, Tolmach, & Webb, 2012) coming off their local megaplex screen. I’m probably most excited for the adaptation of F. Scott Fitzgerald’s classic The Great Gatsby (Fisher et al., 2012), coming in 3-D at the end of this year. But eye-popping effects alone don’t make a quality film. Great movies are appealing primarily because their themes, stories, and characters resonate within us.In his book The Hero With a Thousand Faces, Joseph Campbell (2008) examined classical myths from across world cultures and historical periods. Campbell was an expert on the role of mythology in societies, and he studied the Greek and Roman mythologies, folklore from antiquity, and stories at the heart of world religions.The word myth is sometimes used to mean “fabrication” or “exaggeration,” but that’s a modern usage—I’m talking about myth in the sense of culturally rich stories that teach larger, philosophical or spiritual lessons. Think of Homer’s Iliad and Odyssey, for example.Campbell (2008) showed that many myths, even across cultures and throughout history, share a common storyline—the hero’s journey. In fact, this storyline is so pervasive Campbell believed it to be central to all human social experience. He called it the monomyth, translated literally as “the one story” shared by all humankind. The monomyth—the hero’s journey—goes something like this: First, the departure—An unsuspecting everyman is called to depart the known world, leaving behind the comfort and familiarity of normal life; second, the tests—The protagonist enters an alternate reality, encounters sequentially greater tests, grows in strength and character, and ultimately conquers a supreme challenge; last, the return—Our victorious hero returns home transformed by the experience, and life will never be the same again. How many versions of this basic storyline exist in pop culture? Think of your favorite movie, and I guarantee you can identify elements of the hero’s journey. In fact, the medley of soundtracks that was playing when you entered this room draws from movies based heavily on the monomyth.When we adopted the Centennial Vision 7 years ago (American Occupational Therapy Association [AOTA], 2007), occupational therapy set sail on its own hero’s journey. Of course, the Centennial Vision envisions that by 2017, occupational therapy will be a “powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (p. 613).In 2003, AOTA President Barbara Kornblau first called us to leave behind life as we knew it by pursuing a Centennial Vision (Kornblau, 2004). In 2005, when Carolyn Baum was president of AOTA, we began the first phase of our journey by officially adopting the Centennial Vision (Baum, 2006). Dr. Baum scouted the trail ahead, asking us to harness opportunities to control our future and achieve our potential. She is especially credited for leading the effort for our career scientists to access the National Institutes of Health (NIH) funding mechanisms.In the second phase of our journey, AOTA President Penny Moyers Cleveland asked us to push beyond our comfort zones to expand our influence, visibility, and power (Moyers Cleveland, 2008). In 2008, she told us to be unreasonable, to knock on big doors, and to knock loudly! No doubt we have faced trials and tribulations along the way—encroachment by licensed and nonlicensed professions; cuts to publicly financed programs and reimbursement payments; adapting to the uncertainties of health care reform. But as with Odysseus in Homer’s Odyssey or, as I discussed at last year’s conference in Philadelphia, Rocky Balboa in Rocky (Chartoff, Winkler, & Avildsen, 1976), Indiana Jones in Raiders of the Lost Ark (Marshall & Spielberg, 1981), or Dorothy in The Wizard of Oz (LeRoy & Fleming, 1939), we emerge from each challenge stronger, wiser, and better prepared for what lies ahead.In 2010, we entered the third phase of our Centennial Vision journey when I stated that broadcasting occupational therapy in HD would be the overarching goal of my term as AOTA president (Clark, 2010). OT in HD sprang from my desire to challenge the fuzzy definitions of our profession held by clients, coworkers, and consumers.I wanted all of us to speak what we have always known but may have been reluctant to say out loud: that occupational therapy is an invaluable profession with unparalleled vibrancy, distinction, and detail. I wanted us to be proud of our diversity, breadth, and complexity, knowing that it mirrors that of everyday human experience. I wanted the entire world to recognize that occupational therapy professionals, more than those in any other discipline today, have the singular expertise to ensure people can live life to its fullest.Two years into this third phase, we are well on our way to accomplishing these objectives. Consider a few of our recent victories: Occupational therapist Tim Kennedy challenged a 28-year incumbent in the New York State Senate and was elected by a nearly 40-point margin! Senator Kennedy is the occupational therapist holding the highest public office in the entire country! Occupational therapy practitioners and academic programs made it into the pages of the Boston Globe, Time, Inc., cnn.com, atlanticmonthly.com, and the Huffington Post. In 2003, AOTA had 5,600 student members, but thanks to your personal recruitment efforts, last year we crossed the 17,000 student member mark—that’s more than 300% growth in less than a decade! Speaking of membership, 2011 was AOTA’s 7th consecutive year of membership growth, and today we number over 43,000 members strong!At the 2011 AOTA–National Board for Certification in Occupational Therapy Student Conclave in Providence, Rhode Island, more than 400 students took the Centennial Commitment Pledge, which challenges students to stay with AOTA through 2017. If all of today’s student members maintained their AOTA membership through 2017, the size and therefore the resources of AOTA would literally double—let me say that again, literally double! Let’s hear it for the thousands of students who have since taken the Centennial Commitment Pledge, and I ask that by the end of this week another thousand join them!Thanks to our grassroots advocacy, we successfully extended the Medicare therapy cap exceptions process, reversing a 27% scheduled payment reduction! In true David-and-Goliath fashion, occupational therapy educator Samia Rafeedie approached the Intercollegiate Bureau of Academic Costume, and for the first time, occupational therapy now has its very own academic regalia color, slate blue, which our students can wear with pride at commencement exercises.And Ken Ottenbacher was the first occupational therapist to lead an Infrastructure Grant from the NIH National Center for Medical Rehabilitation Research, receiving more than $4 million in federal research funding. Let’s hear it for these gladiators in the ring, successfully fighting for occupational therapy! The significance of the hero’s journey lies not in the victory, but in the personal, spiritual, and moral transformation that happens along the way. In Philosophy of Freedom, Rudolf Steiner (1894/1964) asserted, “There is given to the human being the possibility of transforming himself just as within the seed there lies the possibility to become a whole plant” (p. 142). There is no doubt that with each year we come closer to meeting the Centennial Vision—and 2012 will be no different; OT in HD is accelerating our own transformation. It’s triggering a change in our own self-concept and identity; in the ways we are competing in the wider arena of health care; in the ways we are redefining what it means to be a complete occupational therapy practitioner, educator, advocate, scholar, or scientist. In so many respects, we, too, have been transformed during this journey, and our professional life will never be the same. Take comfort in the fact that transformation is fundamentally a process of refinement, not replacement. The soul of occupational therapy remains steady.Our everyday pursuits are more than worthy. We still work to ease human suffering and optimize participation in the activities that make life worth living. We conduct scientific research to develop effective interventions and discover new knowledge. We mentor students who will grow into the next generation of leaders. Students, you hone your personal excellence through dedication to your studies. What valuable and admirable tasks! Diligence, compassion, and integrity are essential to the soul of our profession and to the spirit of all who make occupational therapy their career.This is a brave new world, and for occupational therapy to not simply survive but thrive, we must continue to evolve. The information revolution is changing the whole world—what are the implications for how decisions are made in a world overwhelmed by raw data? Is it any surprise when policymakers demand data—also known as evidence—for occupational therapy’s effectiveness?Information is also more portable, accessible, and interactive than ever before. How will we use mobile devices and applications to enhance occupational therapy practice? How will we ensure that electronic medical records capture our full scope and effectiveness? Care and reimbursement systems are riddled with complexity, and politics will continue to carve the landscape of health care. How will we maintain and expand occupational therapy’s political clout? Today’s most prevalent long-term health threats are chronic conditions—obesity, heart disease, diabetes—hastened by contemporary lifestyles. How will we strategically position occupational therapy at the forefront of health promotion and chronic care management?Ironically, the nature of modern warfare combined with advances in trauma medicine have rendered once-fatal combat injuries survivable. How will occupational therapy continue to develop innovative interventions that best serve America’s wounded warriors? How will we position occupational therapy as a cutting-edge profession not only for disease or care or educational management, but for life management—making a difference for real people in their real-world circumstances, to ensure they can live life to its fullest? By seeing ourselves as heroes on a journey to 2017, we capture the attitude of occupational therapy in high definition.At its core, that’s what OT in HD has emphasized—attitude—or maybe more accurately, an attitude adjustment. 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