A Soufflé Vision

Penelope Moyers Cleveland

doi:10.5014/ajot.2010.64603

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Editorial | November 2010

A Soufflé Vision

Penelope Moyers Cleveland

Author Affiliations

Article Information

American Journal of Occupational Therapy, November/December 2010, Vol. 64, 841-847. doi:10.5014/ajot.2010.64603

Abstract

This article was taken from Dr. Moyers Cleveland’s address given at the AOTA Annual Conference & Expo, held in Orlando, Florida, April 29–May 2, 2010.

In Orlando, I was introduced to the AOTA audience as American chef, author, and television personality Julia Child, who introduced French cuisine and cooking techniques to the American mainstream through her cookbooks and television programs. To underscore the metaphor of a soufflé representing the occupational therapy profession, I appeared onstage in an apron and holding a mixing bowl, pretending to be the great Julia Child.

Bonjour! A soufflé is artful in its distinctive look. A chocolate soufflé is even more beautiful and tantalizing. The enticing creation must have staying power to retain its elemental character, or it collapses under the slightest change in its surroundings. I imagine that occupational therapy practitioners know a thing or two about managing alterations in their environment with health care reform and the economic challenges going on.

Penelope Moyers Cleveland, EdD, OTR/L, BCMH, FAOTA

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Speaking of staying power, I’ll bet you want to know how I met Penny. We met many years ago in the Chicago O’Hare airport when she was on her way to see her father who was hospitalized as a result of a massive heart attack. She was flying on free passes, but paying passengers kept bumping her off flights throughout the day.

It was the last flight out, and it looked grim for her getting on the plane. She did not have any money to spare for a hotel room. So, when I came upon her, she was crying a little. I sat down beside her and inquired if I could be of help. She didn’t recognize me, and I gathered she knew very little about cooking. I sent her off to fix her face, and while she was gone, I convinced the ticket agent to make sure she got on the plane. Okay, I gave up my seat, but she never knew that until much later.

Oops, back to the soufflé! The paradox is that while a soufflé is light, chocolate is heavy. So the question is, how do you tackle this challenge to achieve resiliency for handling the heavy weight of the world while preserving the exquisite character of the soufflé? Obviously, your soufflé is the profession: occupational therapy.

The answer to the chocolate soufflé dilemma is that competence in technique is as important as the quality of the ingredients and the tools used. Even with the right ingredients, tools, and technique, the soufflé won’t come together without an inspired recipe. Do you believe Penny has learned this lesson first-hand through her service as AOTA President? Let’s find out how she did it. Welcome, Penny Moyers Cleveland.

[At this point in the Farewell Presidential Address, I began speaking as myself.]

Thanks, Julia! That story of how we met at O’Hare is true! What do you think it means that many of my amazing experiences have occurred when I was traveling? These travels have been both literal—like when I told you during my 2007 inaugural address about meeting Little Richard and now Julia Child—and figurative as I have traversed along this Centennial Vision (AOTA, 2007) journey. Julia, I assure you that I have learned, with the help of many members, the Board of Directors, and our AOTA staff, how to concoct the chocolate soufflé of our Centennial Vision.

Family has been very important for grounding my work on your behalf. You’ll remember that I got married at the end of the first year of my presidency. I have to give tribute to my husband for his loving support and understanding of all the time I was away from home. He has become a valued and regularly engaged participant at our Annual Conferences. Thank you so much, Frank.

Let’s take a quick look back over these past 3 years to show that we not only have the right ingredients, the special tools, and the competence in technique but also have developed a brilliant recipe necessary to keep going toward 2017.

Our Vision Is the Epitome of What Nanus Articulated About Transformative Visions.

Burt Nanus is a well-known expert on leadership and the author of many books on the subject, including Visionary Leadership (1995). Our Centennial Vision is the right vision because it has mobilized people into action, thereby jump-starting our future. The motivational value of our vision comes from its ability to inspire even during tumultuous change and disruption, such as what we have been experiencing in these turbulent economic and political times.

Our vision has kept us future oriented and has helped us to be bold regardless of the distractions in the external environment. The implementation of the Centennial Vision has been a vigorous experience in that we are discovering “who we are in the present is shaped by where we want to go, who we want to become, and what we want to do in the future” (Freiberg & Freiberg, 2007, p. 117).

In creating the recipe for the Centennial Vision, we turned to a logic model methodology for program evaluation, which was developed because of the tendency for organizations to carry out seemingly worthy activities and then to report, often with fanfare, that the activities were completed. Consequently, one was left wondering, So what? What was the effect of what we did? Does it matter? Think of the logic model as akin to what happens when the soufflé is served.

The chef attends to the responses of others to the soufflé’s presentation, its smell, and its taste. There are data to judge the quality of the culinary skill in selecting the best ingredients, using the right tools, and being competent in technique. In the case of the Centennial Vision, we will determine our success through the impact on the profession and, ultimately, society.

If we have chosen not only the finest ingredients but also the right sequence of combining ingredients for our recipe, then occupational therapy will be powerful, widely recognized, science driven, and evidence based with a globally connected and diverse work force. The recipe we have used thus far involves a sense of immediacy.

We are increasingly aware of the speed with which our external environment changes. As a result, we have continuously pursued flexibility in anticipating and seizing possibilities as they come our way, knowing we may otherwise lose an important opportunity.

We are winners when spotting big opportunities and inventing the next best association practices. Breakthrough opportunities unfortunately often are, according to management theorist, Peter Drucker, “visible, but not seen” (as cited in Edersheim, 2007, p. xii). We could choose to focus on what other organizations are doing and perform our work accordingly. It appears to be logical to ask, What are other health care organizations, such as the American Physical Therapy Association, American Speech–Language–Hearing Association, or the American Medical Association, doing to prepare for health care reform? Shouldn’t we benchmark ourselves in relation to organizations of similar types? I answer with another question: Why play catch-up?

We should invent solutions that others want to copy. Invention means that every leadership group and our members ask questions about whether our Association is positioned to

Recognize problems in society germane to occupational therapy,
Determine how the problem impacts the health of a variety of populations, and
Tackle this societal problem and thereby design a big opportunity for the profession and our clients.

To achieve flexibility, the Board of Directors has been using fluid structures in which we quickly brought together, through ad hoc committees, the right people at the right time to manage significant projects. The paradox, however, is that underneath this flexibility, we layered a focused commitment to strategy where we stuck to the core work plan and persisted in pursuit of our goals.

Then we topped all this off with a generous dash of humor. We have fun with our Vision even though the work is very serious. In Julia Child’s realm, we could learn about the importance of choosing the right chicken for roasting and laugh while we do it, just like when Julia Child playfully introduced one of her television shows by referring to all the different kinds of chickens as the chicken sisters!

To achieve the outcomes of being powerful, widely recognized, science driven, evidence based, and diverse, we must turn to the activities or major ingredients of the Centennial Vision. One of the major ingredients in the recipe includes engaging in broad-based advocacy to ensure funding for occupational therapy in traditional and emerging areas.

Advocacy depends, first of all, on increasing the number of members. Our AOTA membership has grown each of the past 3 years from about 36,000 members in June of 2007 to almost 41,000 members at the end of January 2010. Over the same period, member retention has improved from 75% to 81%, which is the highest it has been in 15 yr. However, although impressive, our current numbers are decidedly less than the 60,000 members I called for in my inaugural address. We have the opportunity to harness the energy of the 133,000 occupational therapy practitioners in the United States by letting nonmembers know that AOTA is a valuable partner in their careers.

It is important for all of us to be members of both AOTA and our state associations. Joining both provides us with career protection, gives us a voice, and safeguards what we value most—the authenticity of occupational therapy and its ability to meet society’s needs. When we collaborate and lead, we achieve success.

The California Board of Occupational Therapy, the California Occupational Therapy Association, and AOTA worked together to support the board’s legislation to extend licensure to occupational therapy assistants as of January 1 of this year. What a great achievement this team accomplished! These victories would not have happened if occupational therapy practitioners had chosen not to join. Our work would have been undone, the challenges unmet, and the profession disadvantaged.

Let’s Recognize All of Our State Presidents Here Today. These Are Our Unsung Heroes of Occupational Therapy.

Everyone knows that there are two types of people in this world: talkers and doers. But what is it that makes someone turn rhetoric into action, thus changing from a talker into a doer?

Typically, people become doers because they have a direct investment in their future. Their actions become imperative, because they know that talk alone will not get the job done, and their future will be affected.

Occupational therapy practitioners are in a similar position in which we must ensure that we remain doers. What is at stake is our career and our ability to help others. In this time when state budgets are being significantly cut, when federal and state governments must figure out how to deter rising health care costs, when many other professions are willing to say they do what occupational therapy does, none of us can afford to be bystanders. None of us can accept our occupational therapy colleagues sitting on the sidelines.

We have invested an extensive amount of money, time, and energy in developing ourselves as occupational therapy practitioners who have the ability to change the lives of others, enacting our brand so that our clients will “live life to its fullest.” Why should we sit back and let others outside of our profession take control of our investment? Why should we not do everything possible to ensure our career choice is less of a gamble and more of a sure thing? Why should we not lead?

Since I have been AOTA president, and as promised in my inaugural address, AOTA board members have regularly lobbied Congress every time they came to Washington for a board meeting. In the spirit of this promise, advocacy has spread throughout the organization as a powerful citizenry process in which all members can and should be involved. During the past year, we conducted a number of Capitol Hill days in which more than 450 students, practitioners, program directors, and the AOTA Board of Directors participated.

At the Student Conclave held in Baltimore, more than 120 attendees traveled to Washington, DC, to talk with their Congressional delegations. As a result, members of Congress knew both our practitioners and our issues better.

Whether you welcome or have concerns about the historic health care reform legislation recently signed into law by President Barack Obama, AOTA worked hard to protect the profession and our clients as well as to create new opportunities.

For example, we obtained a 1-year extension for the Medicare therapy cap exceptions process, and we ensured the health care reform bill had specific inclusion of “rehabilitation and habilitation” services, which is a significant gain over current insurance language that usually denies habilitation to children with disabilities.

We also made sure that occupational therapists were included in the definitions of health care work force, making our therapists eligible for state work force grants, among other types of programs. Remember, this health care reform law will not go into effect all at once. Many decisions remain about its implementation. Your continued support is necessary to ensure that AOTA keeps working on the inclusion of occupational therapy for our clients in legislative decisions about health care. We have much to do in the coming years. We can’t let up!

Our American Occupational Therapy Political Action Committee (AOTPAC) shattered its 2009 fundraising goal of $200,000 as together we collectively raised almost $231,000! Our ability to raise significant funds gives us great momentum for the 2010 midterm U.S. congressional elections! During the 2009 calendar year, 100% of the AOTA members on the Board of Directors contributed to AOTPAC for the third consecutive year. This past year, the board surpassed its dollar goal of $7,000 by almost $500. The Board of Directors has again set these goals for the fourth consecutive year. The program directors raised substantial monies of $10,000. The Assembly of Student Delegates contributed approximately $8,000, as 100% of its members donated. It is illustrative to all of us how student leaders are taking control of their future so they can continue to serve others.

This year, our goal is to raise $250,000 for AOTPAC, which is crucial when so many incumbents in Congress who have been our friends have retired or are facing tough battles. We must have friends in Congress, regardless of party affiliation. It is important for us to support candidates who will embrace and fight for our issues regarding health care, prevention and wellness, and veterans’ and primary care as well as for education practices, work force development, funding of our science, and support of higher education. Please contribute what you can… our conference goal is to raise $40,000 to exercise our power in ensuring clients have access to our services.

Another core ingredient of the Centennial Vision is our major image-building campaign to result in a widely recognized profession. During the past 3 years, we have developed the brand “Living Life To Its Fullest™” and have made available a brand toolkit on the AOTA Web site consisting of a poster, a wallet guide, and a brochure. We’ve also released a Living Life To Its Fullest podcast series on a broad range of consumer topics, such as disaster response, diabetes, breast cancer, and home modification.

We are making a concerted effort to show our pride in the profession. We want everyone to become a champion for occupational therapy! Many of you have already helped. You can still help us educate the public about occupational therapy by spreading brand awareness as described on our Web site.

I want to share with you about occupational therapy champions who are working on an exciting project by partnering with Rebuilding Together Greater Milwaukee.On Rebuilding Day, to be held on May 15, the occupational therapy teams will bring their home assessment recommendations gathered earlier in the project to life with the help of corporate-sponsored teams.

As a part of demonstrating our value to the community, we have to speak to the contemporary experience of the public. For example, to address the unemployment issues in this country, I asked Drs. Karen Jacobs and Lynn Shaw to develop a consumer tip sheet, “Work Transition—for the Newly Unemployed” (AOTA, 2009). In this tip sheet, these occupational therapists explain,

Loss of work has a cascading effect, disrupting daily routines, causing financial instability, weakening social connections, and diminishing self-worth by erasing a person’s work identity. Becoming unemployed begins a time period of uncertainty and change. It affects both men and women of all races, cultures, and socioeconomic backgrounds. Increased stress, anxiety, and worrying about the ability to manage present difficulties and cope with the future unknowns can be overwhelming. But there are answers. Occupational therapy practitioners can provide support during this transition for workers and families and promote the process of regaining employment.

It is important to understand that an image-building campaign is magnified when we combine our efforts with other organizations and cultivate strong partnerships.

AOTA, along with 10 other endorsing organizations, such as AAA and AARP, implemented Older Driver Safety Awareness Week during December 2009. Additionally, as a product of joint research among The Hartford, MIT Age Lab, and AOTA, a publication titled Your Road Ahead: A Guide to Comprehensive Driving Evaluations (The Hartford, 2010) has been made available free of charge on The Hartford’s Web site. We also received ongoing funding from the National Highway Traffic Safety Administration of $109,000, enabling AOTA to award mini-grants for practitioners interested in starting or enhancing driving programs.

We are building relationships with the Substance Abuse and Mental Health Services Administration (SAMHSA) and are supporting Children’s Mental Health Awareness Day on May 6. This year, the Awareness Day national event focuses on mental health awareness and positive growth in early childhood for infants and toddlers as well as for older children and youth. The key message for 2010 is that “positive mental health is essential to a child’s healthy development from birth” (SAMHSA, 2010).

Promoting Dissemination of Evidence-Based Knowledge Is Another Ingredient or Activity of the Centennial Vision.

We continue to publish evidence-based guidelines, the latest being Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease and Related Disorders (Schaber, 2010). Seven of our published practice guidelines have been accepted for inclusion in the Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse (NGC), as follows:

Occupational Therapy Practice Guidelines for Adults With Neurodegenerative Diseases (Forwell, 2006)
Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury (Golisz, 2009)
Occupational Therapy Practice Guidelines for Children With Behavioral and Psychosocial Needs (Jackson & Arbesman, 2005)
Occupational Therapy Practice Guidelines for Individuals With Work-Related Injuries and Illnesses (Kaskutas & Snodgrass, 2009)
Occupational Therapy Practice Guidelines for Adults With Stroke (Sabari, 2008)
Occupational Therapy Practice Guidelines for Driving and Community Mobility for Older Adults (Stav, Hunt, & Arbesman, 2006)
Occupational Therapy Practice Guidelines for Children and Adolescents With Autism (Tomchek & Case-Smith, 2009).

For AHRQ to accept a clinical practice guideline, [the guideline] must systematically develop recommendations to assist health care decision making in specific clinical circumstances, and it must have been developed through a verifiable, systematic literature search and review of existing evidence published in peer-reviewed journals. The NGC of AHRQ will expose our guidelines to physicians and other clinicians, health care organizations, medical specialty and professional societies, employers, educational institutions, and state and local governments.

In becoming more science driven, the AOTA/American Occupational Therapy Foundation (AOTF; 2009) Research Advisory Panel’s Occupational Therapy Research Agenda was completed and approved by both boards of directors. This important Centennial Vision activity highlighted the need to focus the profession’s research on intervention, translational, and health services research for determining the efficacy and effectiveness; optimal dose, frequency, duration, and location; and the active ingredients of occupational therapy interventions. Currently, the Research Advisory Panel is developing a research database enabling AOTA and AOTF to track the research being conducted in occupational therapy.

We’ve talked about the recipe and the major ingredients of the Centennial Vision. Let’s turn our attention to the tools for implementing it. AOTA is working to provide members the resources and information they need to inform and shape their practice. This past fall, OT Practice went “live,” so you can read it anywhere there is Internet access. The user-friendly format allows for a quick scan of the table of contents. You can jump directly to any article or area of interest in the magazine. Feature articles in the online version also link to relevant resources and information on our Web site and to discussions on our social networking community, OT Connections. Thousands of members have taken advantage of this new feature.

Here at Conference, we are rolling out our new online version of the American Journal of Occupational Therapy (AJOT). AOTA has partnered with Stanford University Press, using its HighWire 2.0 platform to bring you a state-of-the-art research journal. HighWire is used by a multitude of other prominent journals, such as JAMA. HighWire will greatly enhance the “discoverability” of AJOT articles, thereby increasing our impact factor over time, which is a measure of the importance of the journal.

HighWire will be launching a major marketing campaign to U.S. and international librarians already in the HighWire family about the availability of the journal, again expanding our exposure to the research community. Another positive feature of the online version involves opportunities to publish more research material and publish prepress and special compilation additions to support specific topic areas.

Another recently developed tool is our autism microsite (www.aota.org/autism), in which we have compiled a comprehensive guide to all the resources available from AOTA on autism, as well as links to other resources on autism. Although a work in progress, the site consolidates in one place the latest news; continuing education; various articles and books; and practice, research, policy, and consumer information. We are planning an AOTA Specialty Conference on Autism, December 3–4, 2010, in Baltimore, Maryland.

We’ve talked about the recipe, the ingredients, and the tools needed to create this chocolate soufflé we call the Centennial Vision. How do we ensure that we have, and continue to have, the competence it takes to prepare the soufflé and move forward toward 2017?

Baking the soufflé is really about building and rebuilding the profession’s capacity by making sure education, research, and practice remain aligned and that our Association has the resources it needs to accomplish its activities. I would like to recognize not only the competence but also the excellence of our AOTA staff and staff leadership. It has been a distinct pleasure to work with staff who passionately serve the profession and who are skilled collaborators in making sure our Association and the profession advance to 2017 and beyond.

Fred Somers, our Executive Director, and his leadership team have truly been supportive in enacting decisions of the Board, problem solving how to create efficient and effective operations, keeping the needs of members “front and center,” and ultimately ensuring my presidency kept its focus on the Centennial Vision.

Focusing on emerging leaders is another aspect of competence outlined within the Centennial Vision. The Emerging Leaders program addresses capacity by ensuring that we have an ongoing pipeline of leaders who are encouraged through a positive experience with AOTA to lead early in their careers. There were 84 applicants to the program launched this past January. In fact, I have a mentee from the program who is working with me on ways to increase membership in her state association and to improve the role of occupational therapy in the practice of mental health. You can see that we wisely included a service-learning component, in which the emerging leaders, with guidance from their mentor and others, fulfill a real need within AOTA or a state association.

We have completed several capacity-enhancing activities that also address competence, such as the Fieldwork Educator Certificate Program. The second Train-the-Trainer Institute was conducted at AOTA headquarters in November 2009. There are now 24 training teams nationally offering the regional workshops, and more than 265 practitioners have participated in the training thus far. We also have the Blueprint for Entry-Level Education (AOTA, 2010) in place to help educational programs identify the content knowledge needed to prepare future practitioners, educators, scientists, and entrepreneurs in the occupational therapy profession for the 21st century.

AOTA has consistently demonstrated competence in coping with financial uncertainty, recurring costs, and impediments that could have prevented us from moving forward on the Centennial Vision. There are many financial examples I could discuss, but my main goal here is to show how stewardship of membership dollars is of high importance.

Well before many other firms and professional organizations fully appreciated the severity of the economic crisis beginning in 2008, AOTA realigned staffing, volunteer, and other operating costs, thereby saving approximately $1.2 million per year. Not only did we cut costs, but we implemented many strategies to boost revenue, such as effective member recruitment and retention efforts. Now, as I leave office, the Association has the strongest financial position it has had in the recent past, which allows us to take advantage of opportunities and meet the challenges that lie ahead.

We have the competence to implement the Centennial Vision recipe. We have the right tools and the best ingredients. We can create the resiliency of the soufflé to lift the heavy but rich chocolate. As you can see, I love to use storytelling, in this case Julia Child’s soufflé au chocolat, as a tool in teaching, influencing attitudes and behaviors, and promoting understanding.

The real value of storytelling is that it becomes a mutual creation involving interaction and understanding between teller and listener. Metaphorical language suspends our habitual mindsets or belief systems for brief moments.

As a result, storytelling helps listeners consider new possibilities. Remember my stories over these past 3 years of presidential speeches, where I sang with Little Richard, was late to my AOTA presidential speech and arrived by hot-air balloon, and wore a spider cape like a Las Vegas showgirl? These were my attempts to tell our Vision story as an exciting travel experience, as an uplifting ride through the sky, or as linking all aspects of our profession together like a strong web.

And this year, we made a chocolate soufflé that lifted up our complex traditions for examination in the hopes of lightening the layers to ensure greater participation and involvement of all members. My goal was to show us our future in such detail that when you listened there would be a type of virtual experience, an intuitive feel, and a visceral understanding of our desired future.

I leave my presidency challenging all of us to continue to use our Vision to ask the following questions:

Even though we are well into implementation, what key messages does the Centennial Vision continue to convey to you?
What still needs further clarification, explanation, or elaboration to keep successfully moving ahead?
What, if anything, is missing from our implementation plan that you believe is important to include?
What do we need to do that we have not already done to translate this Vision into action and make it a reality for you?

Although Julia Child sought perfection in cooking, she made it feasible for the everyday cook to prepare delicious gourmet meals. Our Centennial Vision makes it possible for all of us to lead, to create impact. We can be remarkable leaders. Julia Child was not afraid of mistakes, and because she wasn’t, others could be self-accepting of the set-backs or glitches associated with risk taking. In fact, some credit her for the invention of the “5-second rule” because of a famous segment from one of her cooking shows in which she dropped part of a potato pancake when trying to flip it over. It did not faze her—she simply picked up the ingredients off the stove, put it back into the pan, and started over, exclaiming, “Who’s to see?”

You can see that Julia lived life to its fullest. Julia opened up French cooking to the world, transforming American cuisine. We also seek to improve our profession, thereby contributing greatly to society. Together we accomplish this feat of changing for the better the world in which we live. It is feasible. Our action on the Centennial Vision will get us there. And, to ease our fears, we always have the 5-second rule. Bon appétit!

References

American Occupational Therapy Association. (2007). AOTA’s Centennial Vision and executive summary. American Journal of Occupational Therapy, 61, 613–614. [Article]

American Occupational Therapy Association. (2009). Work transition—for the newly unemployed. Retrieved July 13, 2010, from www.aota.org/practitioners/practiceareas/mentalhealth/tips/unemployed/pdf.aspx

American Occupational Therapy Association. (2010). Blueprint for entry-level education. American Journal of Occupational Therapy, 64, 186–203. doi: 10.5014/ajot.64.1.186 [Article] [PubMed]

American Occupational Therapy Association & American Occupational Therapy Foundation. (2009). Occupational therapy research agenda. Retrieved July 13, 2010, from www.aota.org/documentvault/research/45008.aspx

Edersheim, E. H. (2007). The definitive Drucker: Challenges for tomorrow’s executives—Final advice from the father of modern management. New York: McGraw-Hill.

Forwell, S. J. (2006). Occupational therapy practice guidelines for adults with neurodegenerative diseases. Bethesda, MD: AOTA Press.

Freiberg, K., & Freiberg, J. (2007). Boom! 7 choices for blowing the doors off business as usual. Nashville, TN: Thomas Nelson.

Golisz, K. (2009). Occupational therapy practice guidelines for adults with traumatic brain injury. Bethesda, MD: AOTA Press.

The Hartford. (2010). Your road ahead: A guide to comprehensive driving evaluations. Retrieved July 13, 2010, from http://hartfordauto.thehartford.com/UI/Downloads/Your_Road_Ahead.pdf

Jackson, L., & Arbesman, M. (2005). Occupational therapy practice guidelines for children with behavioral and psychosocial needs. Bethesda, MD: AOTA Press.

Kaskutas, V., & Snodgrass, J. (2009). Occupational therapy practice guidelines for individuals with work-related injuries and illnesses. Bethesda, MD: AOTA Press.

Nanus, B. (1995). Visionary leadership. San Francisco: Jossey-Bass.

Sabari, J. S. (2008). Occupational therapy practice guidelines for adults with stroke. Bethesda, MD: AOTA Press.

Schaber, P. (2010). Occupational therapy practice guidelines for adults with Alzheimer’s disease and related disorders. Bethesda, MD: AOTA Press.

Stav, W. B., Hunt, L. A., & Arbesman, M. (2006). Occupational therapy practice guidelines for driving and community mobility for older adults. Bethesda, MD: AOTA Press.

Substance Abuse and Mental Health Services Administration. (2010). National Children’s Mental Health Awareness Day. Retrieved July 13, 2010, from www.samhsa.gov/children/

Tomchek, S. D., & Case-Smith, J. (2009). Occupational therapy practice guidelines for children and adolescents with autism. Bethesda, MD: AOTA Press.