Attitude,Authenticity,and Action: Building Capacity

Attitude

Let me begin by focusing on the first concept: attitude. Depending on your vocal inflection, the term attitude conjures up different pictures. Imagine a long line at a grocery store, where a frail elderly woman is patiently waiting for her turn to check out. A young man, headphones on and blissfully ignorant to his surroundings, attempts to cut in front of her. Using a larger-than-life deep voice, she confronts him and sends him rapidly to the end of the line. Not expecting such an assertive response, you smile and think, “She’s got attitude.”

Two of my friends show attitude à la Harley Davidson owners (otherwise known as HOGs, short for Harley Owners Group)! Because I live in Milwaukee, Wisconsin, home to the Harley Davidson Company, I get to see the Harley owners as they descend on Milwaukee each summer, with their joy of the open road, shiny chrome, and leather. When you see thousands of HOGs, there is no question about the power of attitude.

As occupational therapy practitioners, we work with people who may have just discovered that they have a life-changing condition that has totally altered their primary vision of themselves, their families, and their future. For some, it might rock them back to a time they thought they had left behind—when they were dependent on others, were less than able to do for themselves, and faced an unknown future. Attitude creates the just-right emotional context from which to pursue health, well-being, and participation.

With the distinct value of occupational therapy’s focus on everyday life, we might help clients adopt the attitude that, just for today, they will focus on how they handle what life has handed them. As we work to help people build on their strengths, they become clear about what is most important to them in life. Our focus is on helping people be fully engaged in their meaningful occupational roles, such as parent, aunt, friend, employee, or biker, on their road to recovery. In doing so, we become the health profession that facilitates reflection on what makes a life worth living and focuses on getting to the work of helping people live their life to its fullest.

Attitudes have a strong link to emotional states. I’d like to share some recent discoveries in neuroscience that inform our approach to using emotional skills as therapeutic agents of change and to tapping into the emotional lives of the people we serve.

Richard Davidson and other scientists from the University of Wisconsin–Madison’s Center for Investigating Healthy Minds have contributed to the science of health and well-being. Davidson cowrote a book with Sharon Begley, a science writer who makes reading an absolute pleasure, titled The Emotional Life of Your Brain: How Its Unique Patterns Affect the Way You Think, Feel, and Live—and How You Can Change Them (Davidson, 2012). This book describes six basic emotional styles: Resilience, Outlook, Social Intuition, Self-Awareness, Sensitivity to Context, and Attention. Through a series of questionnaires, the book can help you identify your own emotional styles to gain awareness of your strengths and of the ways they might guide your effectiveness as a practitioner. I dare say that many of you might find that these emotional styles capture what you believe to be characteristics of a good occupational therapy practitioner.

Let me review the emotional styles with you. Resilience measures how quickly someone recovers from adversity, with fast to recover on one end of the continuum and slow to recover on the other end. Outlook reflects the capacity to remain upbeat and to sustain positive emotion over time on a continuum from negative outlook to positive outlook. Social Intuition addresses the ability to consider the subtle nonverbal cues of others, with puzzled at one end of the continuum and socially intuitive at the other. The Self-Awareness dimension indicates the degree to which one is conscious of one’s thoughts, feelings, and bodily sensations, a dimension crucial to empathy because self-understanding allows enhanced understanding of others; self-opaque is at one end of this continuum and self-aware at the other. Sensitivity to Context involves being aware of rules and expectations and in tune with the social environment on a continuum from tuned in at one end to tuned out at the other. Finally, Attention involves the ability to screen out emotional distractions and stay focused; focused is at one end of the continuum and unfocused at the other.

Davidson’s (2012) work explicates how these emotional dimensions reflect specific brain activity, and he has mapped the brain circuitry associated with each dimension. He found that many of the circuits fall outside what are considered the brain’s emotion regions (the limbic system and the hypothalamus). For example, the prefrontal cortex controls how resilient people are, at the same site where executive functions such as problem solving and judgment are controlled. In the occupational therapy literature, Susan Fine’s (1991) Eleanor Clarke Slagle Lecture offers deep insights into resilience and its applicability to occupational therapy.

Davidson (2012) claims that emotional styles develop across one’s lifetime, have a genetic base, and change in response to environmental factors. Hence, a child with a genetic predisposition to shyness can develop into a sociable young person when parented in a manner that encourages her to interact with others and doesn’t indulge her instinct to remain sheltered from others.

So let me apply this knowledge to how attitude affects everyday life and ultimately our work as occupational therapy practitioners. Attitude colors what people do and how they approach everyday life situations. I’ll use travel as an example, an occupation I engage in far more than ever before as your AOTA president. If I have a positive attitude when traveling, I experience each step of the process differently than if I adopt a negative perspective. If the flight is delayed 20 minutes, I think, “Extra time to make a few more calls” or “Now I can walk another 15-minute mile before we board.” My social intuition might sense who may benefit from a smile or nod as we react to the announcement. I might decide to send a text message to the colleague who is picking me up at the next airport and make a conscious effort to remain calm and focused. Davidson (2012) suggests that the way we handle little challenges in life are often predictive of how we handle bigger challenges and life events.

During the past 15 months, two people close to me have been diagnosed with and treated for cancer. I have learned much from their willingness to share their lived experiences of adjusting to this roller coaster ride. In each case, attitude guided them to involve others close to them who could offer emotional and social support and to ask for assistance with tasks such as making treatment decisions and getting rides to and from radiation or chemotherapy. Attitude moved them to focus on the things they wanted to be able to do despite having to work around treatment, such as taking a planned, meaningful trip or having a group of friends over for a meal. Attitude guided their choice of dress, hairstyle (with a wig or without), diet, and exercise. No one would have questioned if they had canceled events or taken time to feel down and depressed, but instead their positive attitude had them looking so well that people wanted to know who their new hairdresser was and how they could be counting their blessings, not hardships.

As occupational therapy practitioners, we can carefully examine our own attitudes, shaped by our emotional styles. We can consider our own resilience, our own outlook, our own social intuitiveness, our own self-awareness, our own sensitivity to context, and our own ability to focus and attend. Each of these factors may influence our effectiveness in responding to the affective experience that is often a powerful agent of change in the therapeutic relationship. Our attitudinal awareness allows us to work in tandem with our clients and their families. We start by offering unconditional acceptance of each person. And over time, we tap into the strengths each person has, knowing that his or her attitude builds self-determination toward goals that have meaning to that person.

Much of my clinical practice and research have involved working with people with the lived experience of mental health and substance use disorders. Sometimes the road to recovery starts with treatment imposed externally, such as a court-ordered program that must be completed to get a driver’s license back after several drunk driving violations. When I sense resistance to intervention, I might say, “You get to decide how to make use of this treatment. You could choose to use it as an opportunity to take an honest look at yourself.” In short, I ask each person to be aware of their own attitude toward dealing with an unwanted condition, whether it be alcohol addiction, anxiety and depression, or coping with past trauma.

Another example was shared with me by Nick, a member of a psychosocial clubhouse, as he reflected on what it was like to live with a mental illness in a photovoice workshop I ran (see Stoffel, 2011):

Accompanied by a picture of the crucifix on his wall in his apartment, Nick wrote this narrative in an effort for others to understand the ups and downs of his lived experience, how he came to be grateful for this gift, and its impact on his life and his journey of recovery. His attitude of gratitude helped him take charge of his own recovery process. Davidson’s (2012) work would suggest that Nick’s attitude could be tracked by brain circuits that in turn influenced his experiencing a greater state of health and well-being. By exploring his attitude using photovoice, Nick came to know himself more deeply and found himself able to make better decisions about how to approach recovery.

Authenticity

Authenticity is the second concept I want to explore with you. You might remember that last year, when I talked about heartfelt leadership, I suggested that authenticity was an important aspect of leading with character and compassion. Authenticity affects our effectiveness not only as leaders but also as occupational therapy practitioners. When we are authentic with the people we serve, we offer them our professional perspectives and the lived experiences we have had that might relate to the everyday life challenges they want to overcome. When our clients’ occupational profiles are different from our own, we don’t pretend that we know what their life is like; rather, we ask them to show us or tell us a story so we can better understand how to help them return to those meaningful desired roles.

I also chose the word authenticity because it suggests that something or someone is real and down to earth. Occupational therapy addresses real, down-to-earth, everyday life issues. Being true to oneself despite external pressures is another way that authenticity might be characterized. We have a nearly 100-year history of authentic occupational therapy that is informed by this overarching statement of occupational therapy’s domain in the third edition of the Occupational Therapy Practice Framework: Domain and Process: “achieving health, well-being, and participation in life through engagement in occupation” (AOTA, 2014a, p. S2). We are true to our profession when our practice results in helping people reengage in everyday life activities that hold meaning, purpose, and value for them.

What are the essential elements of authentic occupational therapy? We know from our own literature that when older adults are involved in meaningful occupations such as work, volunteering, leisure, and social participation, they have better health and quality of life. The Well Elderly study (Clark et al., 1997, 2012; Jackson, Carlson, Mandel, Zemke, & Clark, 1998) and studies of home modifications have shown that client-centered occupational therapy provided to older adults results in better outcomes than interventions provided by others who have not been professionally trained in occupational therapy (Szanton et al., 2011).

Many of the essential elements of authentic occupational therapy are part of the foundation of our practice and involve a complex combination of factors, such as being person centered and recognizing the important occupations and environments that are part of a person’s everyday life. Essential elements of occupational therapy also include understanding the person, the occupations they want and need to engage in, the values that underlie their occupational roles, and the strengths and challenges found in their unique person–environment–occupation interface. The final phrase of AOTA’s (2007, p. 613) Centennial Vision, “meeting society’s occupational needs,” indicates a way to identify authentic occupational therapy. As our profession builds its body of knowledge, we will continue to uncover the authentic agents of change that underlie the distinct value of occupational therapy.

Action

And the final concept: action. Occupational therapy is a health profession that is action oriented: We enable people to participate in roles, habits, and routines in everyday life where they live and learn and work and play. Think of all of the ways we talk about action. And from an occupational therapy perspective, think about the ways we enable actions and participation. Each of the sayings and vignettes in this section helps us think broadly about actions.

Building Capacity at the Individual and Group Levels

Attitude, authenticity, and action—These are the tools we work with, and these are the areas in which we enable others. Our attitudes are reflected in the attitudes of our clients and help define the kind of practitioner we are. Being authentic and genuine begets real-life change and genuine working relationships. Actively using our skills enables action and participation with the individuals, organizations, and populations we serve. These skills are part of our heritage, and as we look to the future, they will allow us to grow as a profession, but only if we consciously build our capacity.

As you know from my presentation last year, one of the ways I learned about being a leader was by studying leadership, and I have been influenced by the work of Robert Greenleaf, who coined the term servant leadership in 1977. Building capacity is a core concept of servant leadership. Dickmann and Stanford-Blair (2009) expanded on the concept of servant leadership when they described mindful leadership as “the process of engaging and nurturing the capacity of others, the system and themselves to achieve a shared purpose of value” (p. x). Building capacity involves engaging and nurturing others, whether you are an occupational therapy practitioner, fieldwork educator, manager, entrepreneur, faculty member, or researcher. To build capacity to enhance our professional attitudes, our profession’s authenticity, and our action skills, our shared purpose of value will be to meet society’s occupational needs while realizing the goals set forward in our Centennial Vision (AOTA, 2007).

Let’s look at the Centennial Vision and selected priorities identified by the Board of Directors in AOTA’s (2013) annual report, titled 2017 and Beyond: Mile Markers on the Road to the Centennial Vision. These documents help us examine ways we might build capacity in our attitudes, our authenticity, and our action. As I highlight some of the accomplishments of the past year, let me encourage each of you to think about your own accomplishments and about opportunities that might help you plan your capacity-building journey. You will be able to clearly align your own goals with each strategic vision goal and to consider how you can be actively engaged in contributing to these goals, thereby building your individual capacity, the capacity of those around you, and AOTA’s organizational capacity.

“Occupational therapy is a powerful, widely recognized … profession”: This is the first statement of our Centennial Vision (AOTA, 2007, p. 613). Building attitudinal capacity means becoming comfortable with our power and voice. Over the past 4 years, we have engaged in leadership development training for emerging leaders and middle managers that has involved more than 100 occupational therapist and occupational therapy assistant students and practitioners. Each emerging leader was linked with an established AOTA leader in a year-long mentoring relationship, enabling further capacity development in both mentor and mentee. Participants from the leadership program are already serving as members of the Representative Assembly; as leaders of groups addressing multicultural, diversity, and inclusion issues and of the Volunteer Leadership Development Committee; and on the AOTA Board of Directors.

Despite being an active and engaged member of AOTA for almost 40 years, I have never had such a close look at how we build personal, professional, and organizational capacity as I have during these past 9 months. One event I participated in was Hill Day, an annual event at which AOTA members prepare for meetings and then meet with members of Congress. In September 2013, we topped the previous record of 500 participants at more than 750 participants from 34 states. Members visited their states’ congressional offices, and virtual participants sent 1,315 letters that day. With 360 tweets and 165 photos posted, we had nearly 56,000 hits on the AOTA Facebook page. Think about how, in this 1-day event, we built capacity around our attitudes, authenticity, and action. The attitude shared that day was that “what I have to share is important,” not only in advocating for access to occupational therapy but also, given the importance of mental health legislation, in promoting the contribution of occupational therapy to authentic mental health recovery.

For many, Hill Day was truly a capacity-building experience involving the action skill of advocacy, in person and in writing. We put our strong social and communication skills into action to build relationships with our legislators and their staffs so that they could see that occupational therapy is a profession whose practitioners are ready to roll up our sleeves and figure out how to provide occupational therapy in the new and emerging arenas of the changing health care system. Andrew Waite (2013), an AOTA writer, interviewed Alyssa Concha, a 2nd-year occupational therapy student at the University of Southern California. Alyssa spoke of how she

Do you see how events like AOTA Hill Day contribute to building capacity across attitudes, authenticity, and action?

In July 2013, I was able to participate in the AOTA specialty conference on Advancing School-Based Practice. For an audience of more than 200 occupational therapy practitioners, a panel of experts, many of whom were pioneers of school-based occupational therapy practice, described the knowledge, evidence, and skills needed in contemporary school-based practice. I was particularly impressed by the work being done in Ohio, where Susan Bazyk has a Department of Public Instruction grant to build school-based occupational therapy practitioners’ capacity to better address the needs of students with trauma and mental health issues that interfere with their ability to gain from the educational experience. Susan shared stories and examples of how practitioners address students’ needs not only in the classroom but also on the bus, in the school, down the halls, on the playgrounds, and in the lunchrooms. Wouldn’t it be great if we were to replicate her work in all states and territories? Reclaiming our authentic grounding in mental health and integrating it with all of our practice areas is yet another area in which capacity building is ripe for your engagement.

No longer are occupational therapy practitioners willing to sit back and complacently allow other professions to lead health care, community, and education teams. The voices of our middle managers who participated in a leadership development institute called “Cultivating Your Power and Influence: The AOTA Leadership Development Program for Managers” carry this message loud and clear. In January 2014, I joined a talented faculty and spent 3 days in Washington, DC, with a group of occupational therapy managers who immersed themselves in finding the inner values that form the core of their leadership. This dynamic event combined reflection, planning, sharing, and building and synthesizing knowledge to apply to complex real-world challenges that the participants brought to the table.

New to the faculty this year was Rebecca Durham Reder, senior clinical director of the Division of Occupational Therapy and Physical Therapy at Cincinnati Children’s Hospital. Rebecca emphasized the importance of emotional intelligence (attitude) to effective leadership. Emotional intelligence enhances how a leader develops others, provides inspiration and guidance, acts as a change catalyst, manages conflict, and promotes teamwork and collaboration. As one who oversees the work of 229 occupational therapy and physical therapy practitioners, recreational therapists, biomedical engineers, and support staff, Rebecca shared her leadership development story, which included her journey back to school to get her doctor of occupational therapy degree so she could lead the evidence-based practice (EBP) culture shift in her organization. In 2014, Cincinnati Children’s celebrated its 9th year of hosting an EBP lecture series and established an EBP interprofessional leadership team and 9 EBP groups. By the end of 2014, Rebecca's colleagues will have published 40 evidence-based care recommendations, available at http://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/recommendations/specialty-discipline/. Talk about attitude, authenticity, and action! Rebecca has created a culture embracing these concepts as she builds capacity at all three levels: self, others, and organizations.

One institute participant, Becky Piazza (2014), wrote about her experience after meeting Rebecca and participating in the program in an article, “Poised for Empowerment,” for the Florida Occupational Therapy Association newsletter:

Becky ended her article by quoting AOTA Vice President Amy Lamb: “To create change we must take our belief, connect it to our vision, and act now!” (Piazza, 2014, p. 7). This is a great example of how transformation occurs when AOTA promotes capacity-building programs focusing on attitude, authenticity, and action. Becky is just one of many members who have joined our AOTA leadership community. Remember, my vision is “every member a leader,” so join us!

Building Capacity at the Organizational Level

Let me move toward closure by citing two more examples of AOTA working in partnership with others to build capacity at the individual, group, and organizational levels. The first is promotion of occupational therapy’s contribution to primary care, and the second is our partnership with the American Occupational Therapy Foundation (AOTF) to build our professional body of knowledge and increase our research capacity.

We are in an era that will likely be reviewed closely in decades to come to determine how the changing health care system fared in creating new models of delivery focused on health care to replace past models that were focused on sickness care. AOTA is building organizational capacity by promoting the value occupational therapy brings to primary care. This process has been carefully orchestrated, from a 2-day interprofessional forum on primary care in June 2013 to responding to the establishment of closer links with other professions, such as the lifestyle medicine physicians who have pioneered this branch of preventive medicine since 2008. Dr. Donna Mann reached out to me in an email earlier this year, and we hope to meet the new executive director of the American College of Lifestyle Medicine and find ways to jointly promote occupational therapy practitioners’ background and training in facilitating lifestyle habits that promote health, well-being, and participation. Just last week, the AOTA Representative Assembly passed a new position paper from the Commission on Practice on primary care (AOTA, 2014b). Soon, the Commission on Education will work on a corollary document highlighting educational strategies to ensure a workforce that is prepared to address primary care needs as they affect everyday life. Our association is in the business of building capacity, and I encourage you to join me in taking advantage of all the ways we can benefit from these activities.

At last year’s AOTA Annual Conference & Expo in San Diego, Past President Florence Clark, AOTF President Diana Ramsay, and I jointly announced a new program, the AOTA–AOTF Research Grant program. During the past year, 39 researchers responded to the call for proposals, and just a few weeks ago, 5 researchers were announced as the recipients of $50,000 grants to support the gathering of pilot data that will allow them to seek greater funding for future major clinical studies. In addition to providing direct support for research, these funds build capacity in researchers and, in some cases, their research teams. This first call for proposals was directed at two conditions, aging and autism spectrum disorders, areas jointly defined as high priority by both AOTA and AOTF.

The first AOTA–AOTF Research Grant program was carried out with the highest level of integrity and care, and I applaud all those involved, from staff to the expert panel who conducted the grant reviews. The success of this first round has led to exciting strategic planning at both AOTA and AOTF. Based on leadership from the AOTA Board of Directors, the 2% of membership fees we direct to AOTF will now go directly to support this research grant program. We will also work with AOTF to seek additional sources of funding to expand the research conducted and scientist capacity building needed to bring our profession’s knowledge base to the next level. We will need your support to do this, so know that you can all play a role in making this a successful, long-term commitment. Did you know that our partnership with AOTF is nearly 50 years long? I suggest that healthy long-term partnerships require constant doses of positive attitudes toward valuing the relationship, regular communication to keep our focus authentically on what the profession needs, and coordinated action to create synergies so that we can be sure to do together what neither of us would be able to do alone. Thanks to both the AOTA and the AOTF Boards of Directors for contributing to our joint organizational capacity building, especially in the past 3 years.

Conclusion

Let me close by sharing my deep appreciation to all of you who have helped me grow these past 9 months as your AOTA president. I have had the pleasure, for almost 10 months now, of having another new occupational role, that of grandmother. Lucy reminds me that we have much to do as a profession to be sure that we are ready to meet the needs of Lucy and young people all around the world, whose world is so different than the one I grew up in. According to futurists, Lucy and all those born after 1997 are part of the digital native generation, never having lived in a world in which technology was not an important part of everyday life. Lucy has clocked more airplane travel in her first 10 months of life than I did in my first 25 years. Next year at this time, I fully expect she will speak Spanish as fluently as she will English. So let me thank Lucy Stoffel-Brown and her parents, Brian Stoffel and Alison Brown; our youngest son, Adam Stoffel, who joined my husband to attend Conference this year; and my book club friends Carol and Martha. I also thank my University of Wisconsin–Milwaukee students and faculty for continuing to celebrate and support all that happens on my day job to allow me to serve you and our profession. Let me also thank my sister-in-law, Cindy Jones, and Carol White, who generously allowed me to use their beautiful photos in today’s presentation.

Attitude, authenticity, action … may each term serve to remind you that our collective ability to meet society’s occupational needs expands when each of us takes time to build our own capacity, when we support others in building their capacity, and when we further our organization’s capacity. With 3 years remaining until we reach our centennial, there has never been a better time to act!