"If the Pelvic Floor Is Not Healthy, There Is No Occupation We Can Perform" with Alyson Stover, AOTA President

• Learn more about the first ever Trauma-Informed Pelvic Health Certification
• The 3rd Annual OTs in Pelvic Health Summit happens Aug 17-18, 2024!

In this episode, AOTA President Alyson Stover and I talk about:

1. Her 6 priorities as President of the AOTA.
2. Why does she think that OTP's are well suited for pelvic health
3. How does pelvic health remind her of other emerging practice areas and what has worked to gain traction for those areas?
4. How is the AOTA working towards expanding occupational therapy's role in pelvic health within the broader healthcare system? 
5.  How does she navigate the balance between business and healthcare aspects in occupational therapy? 
6. She shares her process in making difficult decisions and share some lessons learned since becoming president.
7. She shares a book that has deeply influenced your philosophy towards occupational therapy
8. What would she tell the OTP listening to this episode who is struggling with feeling misunderstood or burnt out in their field?

A little bit more about Alyson Stover:
A childhood family trauma introduced Alyson Stover, MOT, JD, OTR/L, BCP to the power of occupational therapy. A subsequent lifetime of study and practice convinced her that patient advocacy was every bit as essential as her technical practice of occupational therapy.

That would be a pretty full slate for most OTs, but it doesn't begin to describe all of Stover's accomplishments. Stover founded and owns Capable Kids, a private outpatient pediatric practice north of Pittsburgh that provides physical and speech and language therapy services in addition to occupational therapy. She's also an associate professor in the Department of Occupational Therapy at the University of Pittsburgh School of Health and Rehabilitation Sciences. In July 2021, she will begin a four-year term as president-elect/president of the American Occupational Therapy Association (AOTA), representing over 100,000 OT practitioners. Stover is the first Pitt faculty member to hold this national leadership position.

Stover earned a bachelor's degree in rehabilitation science and her master's degree (MOT) from Pitt. Like all licensed OTs, she passed the National Board for Certification in Occupational Therapy (NBCOT) certification exam and met other Pennsylvania commonwealth l

____________________________________________________________________________________________
Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

• Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
  ​
• Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!

Transcript

Lindsey Vestal (00:02:39):

Allison, I am beyond honored that you have joined me on today's OTs and Pelvic Health podcast. It is so incredibly refreshing to be able to have this conversation with you, and I'm, I'm so grateful for your time.

Alyson Stover (00:02:54):

Thank you. I'm, I'm honored to be here. This is really exciting.

Lindsey Vestal (00:02:58):

I've had the pleasure of you several times. We met at the Arizona Local Conference, which just blew me away that, that the president of our national organization was sitting in the audience just talking with us in this just incredibly relatable way, and it has just continued in that fashion. I met you at the national conference, and I really am probably the most invigorated that I've ever been in the state of being an A O T A member. And I am thrilled to be having this conversation with you. And I wanna just jump right into it. My first question for you is, can you share with us what your top six priorities are, uh, as a new president of the A O T A?

Speaker 3 (00:03:41):

Yes. So I'm, I'm really excited about this. Um, and, and we've, we've been able to formally move it into the vote and see it going forward in, in this upcoming fiscal year. So our priorities, um, for this upcoming fiscal year and, and, and will largely be priorities throughout, um, my tenure as president include behavioral and mental health. Um, we know that this is a place we started. We know this is a place that we have never, um, stopped, including in all of our interventions and evaluations and work that we do. So I'm excited to reestablish that as a priority, um, not just for our profession, but for all around us external stakeholders, consumers, to begin to recognize that that role in our profession. Um, then we also have the, the priority of the, what we are calling women's health, but then specifically outlining, um, also pelvic floor because we do recognize that, um, really every single person has a pelvic floor.

(00:04:50):

Um, there's, there's noth, there's nothing, uh, that requires you to have really any other category than being human. Um, and so we wanted to make sure that it was not forgotten about. Um, although we really want to especially embrace women's health as we see some of the challenges that have really emerged, particularly related to reproductive, uh, rights, um, access to reproductive care. And, um, so in recognizing that our second priority is, is women's health, with also that, that special announcement to paying attention to pelvic floor for all humans. Um, we also have then the, the, um, priority of, of the OT entrepreneur. We have long been entrepreneurs. Um, I often think that in order to practice occupational therapy, you actually have to be an entrepreneur. Most of the time we're selling our own services, uh, convincing people, uh, why they need us, how we can really improve their participation.

(00:05:52):

And so I think at heart, we're all entrepreneurs, but we're also the last place that's able to give really meaningful, um, resources, advice, uh, support opportunities to expand in that entrepreneur world. We then also have our initiative of what, um, our D E I committee has, has really, I think eloquently called and named Deja. So diversity, equity, inclusion, justice, and, um, acceptability. And, uh, with Deja, we know that this is something that is a priority and has been a priority for a number of years, but we really want to see what actualizing deja looks like. So, um, we're really thinking about ways that this year we can actualize deja in a meaningful but also replicable manner. So this is how A O T A was able to create a more inclusive or accepting environment, or here's where we were able to elevate the experiences of, uh, inclusion and justice and equity.

(00:07:02):

Um, here's ways that we were able to really hear the voices with, of those with diverse representation. And so how do we make it actionable within the National Association, but then can be replicable for all of us that are trying that in other spaces. Um, then we also have a overarching, uh, very large priority for, um, this idea of how do we really get the world to recognize what is occupational therapy? We see a trend, um, in many healthcare professions where individuals just aren't, they're not going to those healthcare professions anymore. Um, but we do find that even though we experience burnout in the occupational therapy profession, we are not losing our professionals at the same rate as say nursing is. And so we are a rewarding, meaningful profession once you enter, we're just not having enough people enter. So, um, how do we really unite with some of our incredible partners, uh, like N B C O T, uh, even the World Federation of Occupational Therapy.

(00:08:14):

How do we really get together and, and reestablish create a meaningful current relevant, um, what is occupational therapy? Either you, you, maybe you wanna be a consumer of it, maybe you wanna be a practitioner of it. Maybe you wanna be an educator or a scientist in it, um, or maybe you want to dabble in a little bit of all of it. Um, doesn't matter. How do you, how do you know what it is first and foremost? And so these are the places that we're really elevating, um, this year. So that, that, what does that mean then, for, for members and, and individuals listening? That means that every single budget line item in the A O T A budget must relate back to at least one priority. And so those are, that's what we'll be doing in June, is ensuring that all the things that we have in place in the association relate to one of those areas.

Lindsey Vestal (00:09:08):

Oh my goodness. I am blown away. So I, I could just jump out of my chair right now. Of all of those priorities you just mentioned, you know, entrepreneurship, near and dear to my heart, you're absolutely spot on. To be an ot, to practice an ot, we have to have that inventive, creative spirit. Uh, you know, the behavioral mental wellness, the diversity, everything you said, I could literally <laugh> start and have such a, an, an, an equally enthusiastic conversation with you about, this is the OTs for Pelvic Health podcast. So I'm gonna reign it in and I'm gonna focus on the women's health and the pelvic health aspect. But thank you so much for, for really addressing those issues that I really feel grounded and anchored to as an ot, every single one of those things. So I'm so excited to see where those things go. So regarding pelvic health though, Alison, why do you think occupational therapy practitioners are well suited for this practice area?

Speaker 3 (00:10:09):

Yes, that's a great question. And, and actually a question that not that long ago, I was investigating myself. Um, so I didn't have much knowledge, experience, exposure to pelvic health, um, as a consumer or as a student or as a clinician. Um, and so, uh, about, so it'll be almost a year ago, we had, um, put out a statement, uh, related to the Dobbs decision. And in that statement, what we were really looking for was where are the areas that may be profoundly impacted by such a, a national piece of legislation? And, um, we had a follow up to that, that, uh, statement in which we had individuals coming in and we were just doing a listening session, really hearing, um, what is it? What are, what are our clinicians experiencing, um, that might be impacted? Um, what are our clinicians feeling in response to this?

(00:11:10):

And I, I have to admit, um, this is where I really started to learn about pelvic health and occupational therapy's role in pelvic health. And, uh, there is a brilliant pelvic health therapist, Rocky, that I'm sure many listening to this podcast know. And I really thank her. Um, she gave me a list of Facebook groups to start to follow some podcasts to start to listen to. And she said, I can tell you a lot, but I can't tell you everything follow up. And so Lindsay, yours was one of the first that I had the great opportunity to follow up with. And I just found myself reading through the posts, listening to the information and thinking, this to me is OT in so many levels, in the levels of, you really can't perform any activity, whether it's an adl, whether it's an i, adl, whether it's leisure or work.

(00:12:07):

Our pelvic floor is always with us. And if our pelvic floor is not in the state of wellness, there's really nothing, there's no occupation we can participate in. Um, it as to our best ability. Uh, if we are being impacted by some kind of, uh, difficulty dysregulation, dysfunction in our pelvic floor, then how do we maintain our sitting posture and seated balance for being able to work for six hours to be a writer, right? There's, there's nothing. How do I walk around an amusement park with my child on a hot summer day if, uh, I have some pelvic floor dysfunction and dysregulation? And so I started to see that it's actually really a foundational component to participation. And then I started to think of the very specific ADLs related to the pelvic floor. Um, things like toileting, right? And listening to the conversations of just friends and family members.

(00:13:13):

And, um, I can't tell you, we were having a conversation at a family picnic, and my two cousins were saying, oh my goodness, you know, it's, it's getting terrible. I can't even laugh. I don't even wanna laugh without there being some leakage. Or, you know, heaven forbid I sneeze and there's leakage. And I'm like, wow, I don't, we're all the same age and I don't feel that. And they're like, well, yeah, cuz you had a C-section and we pushed our babies out. Like they're totally, your pelvic floor didn't have much involvement in, uh, your delivery process. Ours did. And I started to think about all the ways that, that we really do have to, to have a really healthy pelvic floor. And, and by having a healthy pelvic floor, I don't just mean physiologically, I mean psychologically being okay with saying, um, maybe there's something going on because sex hurts.

(00:14:07):

But, but without it, I can't be intimate with my partner and so I, I need to, um, I want to, but how do I get to a place where is there that clinician that I can say this hurts and I need something to help me through it? And then I thought about all my own clients and how many times I've heard the statement, you're the only clinician I feel comfortable telling this to. And I thought, my goodness, we are, we are doing a disservice to so many consumers by not elevating that we can help support and develop your health and wellness here. Um, and it became one those aha moments that you think 20 years in you'll never have again. But it was, aha, this is critical. This is crucial to human participation, performance and wellness. And we are the only ones who can address that in a meaningful way.

Lindsey Vestal (00:15:08):

You, you are so spot on. And also, Allison, you're not alone with not knowing the role of the pelvic floor. You know, I think a big part of our entrepreneurship as OT, specifically in pelvic health is helping people understand the ripple effect. And really, you know, how it is a fundamental part of what we do regardless across all of our occupations. And the most interesting thing about it is often you don't know about it until it impacts you. Then you're not sure who to talk to about it. And y you know, you, there's a lot of shame and so much disregard that happens both internally and in as an identity as well as in our social ramifications. And so I think that what you're highlighting is that therapeutic rapport, that true bio psychosocial approach that as OTs we are uniquely suited to bring to the table.

(00:15:59):

And that's exactly how, how I found it, right? That ability to be able to, to affect both the physical aspect of a person, but also to be able to hold space for that mental wellness is truly how the pelvic health is, is healed. And so I completely agree with you. Uh, and if you don't mind me quickly sharing, cuz I have so many questions for you, so I wanna make sure we have time. It's actually a also a very big, um, misunderstanding that if we've had a c-section, our pelvic floor hasn't been impacted because where the C-section happens, the incision happens, it's right through the transverse of dominance, which shares connections to the pelvic floor. So regardless of how the baby enters the world, the weight of the growing uterus and the baby on the pelvic floor still impact the tone and coordination, but also the incision does actually directly impact the pelvic floor cuz it's part of that core canister. So I I I, you're very fortunate that you didn't have those effects, but I can't tell you how many clients I have had in my New York City practice that came in and said, I had a c-section. I don't understand why I'm leaking. I didn't push out the baby. And so we're already in this conversation revealing all of the layers that we can still learn from with our, within our own bodies about how our pelvic floor affects all of the, all of our coincidence.

Speaker 3 (00:17:21):

Yes. Yes. That is, that is interesting. See, I, I learn every time I'm with you.

Lindsey Vestal (00:17:27):

Same <laugh>. I learn every, this is why I, I am, I, this is the highlight of my, of my month, so I'm so glad we're having this conversation. So Alison, through your course of being an ot, you know, there has been so many emerging practice areas that you have seen rise up. I'm curious because as pelvic floor practitioners, we're still really working hard to get the word out about what we do specifically in ot. Are there other emerging practice areas that you can think of that have, that you have seen grain gain traction that perhaps the pelvic floor field could model some approaches off of?

Speaker 3 (00:18:05):

Yeah, that's a, that's a great question. And I really think about some of the very, um, sort of

(00:18:13):

Almost niche parts of our behavioral and mental health practice. So our relevance in our space, in, in trauma care and not trauma-informed trauma care. Um, and, and the use of sensory integration beyond just the developmental child or, um, an individual with autism spectrum disorder. You know, I think about those places and they're very highly recognized and almost sought out regularly now, and I, I see this as, as relatable, um, in that for a long time. You know, I, I've actually heard stories where physicians have asked the question, um, uh, a consumer's gone in and said, you know, I'd really like a, a prescription for occupational therapy, uh, to assist with my trauma counseling. And, and physicians have said, what? Like, why would you go to an occupational therapist for trauma? You know? And, and so I see that same space, I see pelvic health being in that same space now.

(00:19:15):

And I think that there's two really important lessons that our profession has learned through that, um, through, through the trauma and sensory integration expansion that I think are really important for pelvic, uh, health and, and pelvic floor interventions. One is we must find those champions, um, those external stakeholder champions who are willing to just, um, speak about it loudly to their shared communities. So I remember early on, um, in, when I was working and first starting with this emerging practice in trauma, um, trauma intervention for occupational therapy about 15 years ago, um, I met a psychiatrist who said, you know, I don't ever see, um, I don't ever see an individual who has experienced, um, some type of mental health disruption or, or a mental health diagnosis that wouldn't obviously need occupational therapy services. Because one of my diagnostic criteria is they can't participate in ADLs or IADLs.

(00:20:22):

Well, if I'm saying they can't, they need to go see you all. You're the ones that know how to get them to participate in ADLs and IADLs, right? So it's, it is finding those champions, and I believe that there are strong members in, um, our ob gyn communities, our GYN communities that can really be the initial champions of that to say, um, Hey, a minute, regardless, you are going to do things differently. Once you begin menstruation, things are going to be done differently that might be impacting some of your pelvic floor experience. The idea, I I think about this often with my own 14 year old, the idea of her being aware and us having conversations about her pelvic floor now has been so rewarding for me to know that she is truly understanding her health. She is truly understanding that experience of as she goes through adolescences, and that I feel comfortable that as she becomes an adult, she's gonna recognize the difference between, um, perhaps a pelvic floor issue or a pelvic health issue versus just calling it cramps because that's what everybody says that she should be having at that time, right?

(00:21:45):

And so I think we can really find our champions that can say, uh, not those champions who say, oh, yeah, I've, I've seen an individual with a C-section who, um, had great outcomes. And so everyone with a c-section, no, I want to, to find those champions who say, oh my goodness, you know, every individual who starts menstruation should have, you know, a, a, a session or two with an occupational therapy professional who knows about the pelvic floor because things are gonna feel different and they should know what that is. Um, every individual who is going through menopause, every, um, I think about, um, finding champions in the school system. Uh, both of my children have gone through, um, you know, sexual education at school. My goodness, you know, they have an expert come in to talk about, uh, red flags for, um, you know, uh, date rape and how to remain safe and, and abuse in a, in an intimate relationship.

(00:22:48):

Why shouldn't, uh, our, our students in high school, all students in high school, of all genders be learning about the pelvic floor in that sexual ed class, who's our champion that can bring that in? So I, I think about that. Find the champions, the ones that you're not necessarily, um, thinking about and, and think about it in a way of every single person should have access to this. The other part I think about is, um, well, there is a part, I I should say on the other side of that, that, um, my, my science colleagues would be remiss if I did not mention we need to publish about it. Um, and I'm huge on the idea that we don't need to publish, um, just randomized control trials, right? Those of you working in this space have incredible consumer stories. Those, those case studies, they go into not just OT practice, but oh goodness, what a great story for like, just a, a newspaper article or, um, you know, some of those places outside of what our OT colleagues are reading.

(00:23:56):

You know, um, are we reaching out to some of those other, uh, just journals or, or, um, pieces of literature that are going out to our colleagues that can be our champions? So do the research, but not just the research, do the implementation science and then write about it and talk about it constantly. But then my final piece is really a charge to every single member of our community. And that is, I recently, um, and, and Lindsay, I must, I give this to you, this credit to you and Rocky, but I recently have, um, a, an individual that I've been working with, she's 15. We have been off and on together since, um, her first experience of sexual assault at four years old. Um, most recently she had a, um, multi-person sexual assault. And we've been really going through trauma, um, and, and navigating just participation in, in how do I get up and wanna brush my teeth and hair again, right?

(00:24:58):

And because of you and Rocky, I said to her caregivers, have you seen an occupational therapy professional who specializes in pelvic floor health? And they were like, what? No. And I said, I don't, but I have colleagues that do, and she needs this. She needs that. There is no way that she's experiencing pelvic floor wellness, pelvic health wellness after these lived experiences. And so my, my charge to every one of the members of our community is there is likely consumers that you are working with that absolutely need this. And just because you are not specialized or it's not the area that you can practice, you have an obligation to uphold and elevate our community members who do, and you have an obligation to your consumers who need it. And so look for those individuals that you are working with that are on your caseload, that, um, maybe you've just had even a neighbor talk to you about something that, oh, my, you know, I've got a five year old that, or an eight year old who still doesn't have control over urination at night.

(00:26:12):

I just don't know what to do with them. Oh, please, please help them to link them to our, our community, our occupational therapy community doing this work. And I do believe through those three pieces, we can, um, I don't wanna say elevate the practice, because I think the practice is exceptional already elevate the visibility, um, of the practice so that it is not an emerging area, but it is really just like that psychiatrist said to me 12 years ago about, about OT having to be a part of, of psychiatry. OT has to be a part of every space where the pelvic floor could be experiencing dysfunction.

Lindsey Vestal (00:26:54):

Oh, yes, yes, yes, yes. That is so incredibly spot on, and thank you so much for sharing those observations that you've had throughout your experiences of emerging practice areas. I will say the two examples that you shared with us, both trauma and then the sensory integration as as models, you know, those are all areas that we actually incorporate into pelvic health. And so I think that's like this with OT in general, right? There's just so much overlap and so much continuity, but there is so much roots there that we, we really reach into in order to care for our, our practitioner, for our clients. And I will say that I truly believe that trauma informed care is the foundation of pelvic health, and we're starting to see trauma informed courses come up, but it's, it's not the foundation. And so I'm actually debuting the first pelvic health trauma informed certification next year because, and I'm, I'm hoping that all of our colleagues take it, not just OT practitioners, because the statistics are so high for, you know, the general population, I think, what is it, one in three women experience some sort of sexual assault, but for people coming into our office with pelvic floor dysfunction, the numbers are much higher.

(00:28:08):

So, um, thank you so much for, for sharing that and really helping us to see all of the ways that we as practitioners and as consumers have an obligation here, uh, an ethical obligation to really help out. So, Alison, I read an article in the American Journal of Occupational Therapy where you said reinvention means not having to explain what OT is to anyone who is not in the OT community. This hit home with me in such a strong way, as I'm sure it does to most of the people listening to this podcast. And it goes well beyond being an O T P in pelvic health. I think most of us feel misunderstood. How do you see this evolving throughout the course of your presidency as that being one of your main priorities?

Speaker 3 (00:28:59):

Yeah, so that's another great question. And so one of the spaces and, and why I believe that, um, a really national and, and essentially a potentially global campaign of what is ot, um, can really support this goal of reinvention. You know, I think about, and, and many, I think, uh, members of the occupational therapy community can, can certainly relate to this. I think about how many consumers have walked through my doors sat in front of me, right? Thinking, I don't really know what this is. I don't know what you do, but my doctor sent me here, so I'm here. Right? And then after like visit two, they're referring their grandmother to you, their, uh, next door neighbor's brother to you, right? They're like, oh my goodness, you don't, like, I never knew. It's always this aha for them I never knew, right? And so I think about that and how I've never encountered a situation where occupational therapy was experienced by someone, and they didn't have that aha moment where I didn't have to explain every element anymore, right?

(00:30:08):

They, they like, got it, it clicked. There was something about it that said to them like, no, this is, this is so much more than than healthcare. This is like human care, right? And, and they got it to an extent that when they refer others to you, it's not even for the same reason that they're coming to you, right? They're like, oh my goodness, I need to refer my grandfather because, um, he's experiencing some, some early cognitive decline. But, oh my goodness, I also have to refer my sister because she has no idea what to do with these children. And she really needs some help developing the role of a parent. Um, you know, and, and oh, by the way, my, my brother's been experiencing substance misuse for a long time and is having a difficult ability to get to that state of recovery for long periods, right?

(00:30:55):

Like, they get it, our consumers get it when they have direct access to us. I need to find a way that we can have everybody have that aha experience without necessarily having to get to us first. Um, and so I really see this national campaign, um, being an opportunity to spread the, getting to an occupational therapy practitioner or professional, um, without actually having to sit in front of one or be referred to one or have that experience. I see it really as a place where we, um, elevate the, uh, ways that there is this overlap, like you just discussed, Lindsay. Like, so I, sure, I would say some of my n niche practice is in the area of trauma, um, and, and, um, and, and substance misuse. But like you said, I've seen individuals that could very much benefit from pelvic, pelvic floor health, and you also have this underlying great expertise in trauma too, right?

(00:32:04):

And so I think about those places where we can really align the idea that we are so much more than one professional when you walk through the door and walk with us, that we are really, um, we are really a culmination of every potential, uh, expertise that you need, um, in order to help you discover your own path to wellness. And that part of that's really inclusive of our, um, uncanny un um, unparalleled ability to listen in a way that we practice narrative medicine, so individualized. So how do I see this playing out over the next few years? I see this playing out as when you, um, see a billboard, uh, in New York City when you drive in that there is this complete picture and depiction of occupational therapy in a way that everybody can relate to, and it means minimal words. It just has one of those, those issues that everybody feels they can relate to.

(00:33:17):

And then it just says the words occupational therapy is, right? I see this as finding ways, um, to elevate the representation of occupational therapy in TV shows, in movies, um, in, uh, stories, books, novels, uh, in a way that it's not just us coming in and saying, oh, yes, so I'm, I'm your occupational therapist, right? No, no. When we have a hospital show and five different people walk in and just say who they are, but don't get to show what they do, you don't know the difference between me and the nurse that walked in even, right? But show me walking into that hospital room saying who I am, and then working with that individual on something that they've been talking about for the past three episodes that they can't wait to get back to doing. Show us, you know, leading that, that that individual from their hospital bed out to the waiting room and being able to engage and stand and hug their loved one again, right? And then have them introduce themselves as the occupational therapy professional. Um, so I see us really having to go into those places where we haven't been before, um, or we're not as comfortable being and boldly say, I don't just want the line. Oh, hi, I'm your occupational therapist today. I want that line, and I want, um, at least a ten second representation of why that's a powerful statement.

Lindsey Vestal (00:34:56):

Okay? So that's a charge every single one of us listening can do. I want everyone listening to write their ten second answer in reply to what it is, and, and take a moment to reflect on what gives you goosebumps, whether you felt that yesterday or maybe five years ago, tap back into that feeling state and, and take this charge that Allison has given every single one of us as to how we would answer that question. I have to say that when you bring up things about OTs being in places that we're not comfortable being, I think about a quote that I actually read, uh, from your father, Alison, who was a Vietnam veteran. And, um, I actually have it written, written here next to my desk, and it says, um, trial only seems large as you enter, if you can remember that, you can push through with motivation and endurance. Yes,

Speaker 3 (00:35:51):

It's one of my favorite. Um, so, so my father is a Vietnam veteran with post-traumatic stress disorder. Um, and he has, uh, some early cognitive impairment right now, um, and some Parkinsonism. Um, and my mom is still, they've been together since they were 16. She is his primary caretaker, but they're aging together, and it's, it's not often that my father can, um, participate in long or meaningful conversations anymore. And so, uh, it's one of my favorite, favorite times that I say, my father, uh, otd me. I was, um, pregnant and it was, I was in law school and, um, and the, uh, biological father of my child was my first husband. And, and when I was pregnant and in, in law school and, and working at Children's Hospital as an occupational therapist, um, and feeling all the, the terribleness of, of just stress and exhaustion and my body changing in ways I couldn't even understand.

(00:36:51):

Um, my husband at that time said that he felt no connection to the child growing inside of me or me, and he left to be with his girlfriend who could drink with him regularly. Um, and, and I, I looked at my dad and I said, I'm never gonna make it. Like, I'm not like this isn't, I got, I got five more months of this pregnancy, and then I gotta raise this child, um, and, and I gotta show up for my consumers every day, and I gotta go to class, and I, I can't. And he said to me, you know, when they dropped me off in Vietnam, I thought, this is never gonna end. I'm, I'm never getting outta here. And when they picked me up 14 months later, it's like, I was never there. And so he really gave me this idea that we just have to recognize that when we step into the storm, it feels like it's never gonna end.

(00:37:51):

But through it, we become stronger, more united, more aware of ourself, and we walk out and we say, wow, it was only that long. That's all right. I survived it. And I feel this way about occupational therapy all the time, not just in how we can work with our consumers, right? Because when they come to us, they are saying, I don't know how to get to that place of wellness on my own. And so guess what? It feels like I'm never gonna get to that place of wellness. Or, oh my goodness, I've lost something so meaningful to me. And, and I'm, I'm walking in and I'm thinking not getting out. And then together you form this beautiful, intimate relationship with this human that becomes as much a part of you as a clinician, as you hope that you become to them as a consumer. And when you walk out and they walk out, you are both changed, saying, wow, it only took that long.

(00:38:59):

I can't believe we're saying goodbye already. But I also think about it as us as a, as a profession for over a hundred years, we have been at a place where we have to be both collaborator as well as assertive in our value and representing all that we can do and should be reimbursed for. And that's a really stressful place to be, to be both assertive and collaborative. Feels like we are constantly in a place of, of contradiction. How do I tell you that I am a great teammate with the same voice of telling you that only I can do this thing, right? How do I say that I am a puzzle peace, but that I am the puzzle piece? That without it, you can never see the picture, right? How do I, how do I do that? And it's become so overwhelming that I think the only place that we feel comfortable to express that stress is in our own community, right?

(00:40:07):

And, and I think then that sometimes that becomes an even bigger burden to us, because the people that we go to, to understand us most are also the people that we seem to be the most comfortable having conflict with, which is very natural, right? It's, it's the very reason why we ourselves are more comfortable oftentimes, um, arguing with our, our significant other, or our parent than we are with, you know, um, our boss or, or, um, you know, a member of the community, a neighbor, right? It's, it's where you're most comfortable is where you are able to be most yourself and release your conflict and your stress, but at the same time, it's wearing us down. And so I wanna find that space. I want to remember my father's quote. I want to empower his, his wisdom within the whole community to find the way that, um, we all recognize that we are actually in a shared storm.

(00:41:09):

The experiences are different for each and every one of us, but it's a shared storm, and that storm is about elevating occupational therapy to where it needs to be at a national and global level. And each one of us experiences that storm a little bit differently. Um, and some of us, it's a very profound storm. Some of us, it's just trickling rain right now, but it is there for all of us, and we need to find a way to unite and elevate one another, um, so that we recognize that we're gonna get through this storm and we're gonna walk out and just like now, um, we see the representation of occupational therapy in some incredible spaces like trauma care and, um, like administrative levels in school districts. We're going to see that with, um, occupational therapy and pelvic health. We're going to see that occupational therapy and entrepreneurs we're gonna come through to this other side of the storm. And so, um, I, I love, I I came through on the other side of the storm, um, my daughter, uh, she is, you know, either gonna run the world for good or bad. I'm not sure yet, but, but at least she's gonna run the world, right? And I, I met her father when she was five months old. We got married when she was two, and he adopted her thereafter. And, and I got through my storm and occupational therapy. We are gonna get through our storm.

Lindsey Vestal (00:42:50):

Yes, we are <laugh>. Thank you Allison, for sharing so much of your own journey with us and for helping us see that it is woven through every aspect of what we do as occupational therapist. One of the things you said in your address during the, our Inspire Conference was that it's not just a job, it's a calling. And I can really feel that in our, in our shared conversation today. So thank you for helping us to feel seen and heard.

Speaker 3 (00:43:19):

Yes.

Lindsey Vestal (00:43:20):

Speaking of entrepreneurship, you know, you mentioned that one of your priorities this year is, is being the occupational therapy entrepreneur, and you, yourself are one, you own a private practice in Pennsylvania called Capable Kids. I would love to know, how do you navigate the balance between business and healthcare aspects and occupational therapy?

Speaker 3 (00:43:42):

Oh, yeah. Right. So does anybody really navigate it? Well, if so, please come to A O T A and be part of the resource development. We need to hear your voice. Um, I think that's a great question. And I think part of it is the idea of never losing, never losing that aha moment that brought you into the profession. So when you are in those phases of consistently finding walls or barriers to, um, whether having, um, the, the external stakeholders recognize that you are exactly what needs to be involved, um, whether it's finding the space where you need to be, or the continuous reimbursement challenges that you face over and over again, the things that bring me through when I feel like, ugh, is this even worth it anymore? Is, is my aha moments. Those, those times when I thought, this is why I came to this calling.

(00:44:41):

The, the other thing that I think is really important about it is, as, as that entrepreneur, never forget, an entrepreneur succeeds because an entrepreneur is an innovator who has a fire of passion inside of them. And often the world of healthcare, particularly healthcare as it is in this country right now, can be an overwhelming space of just frustration, right? Don't forget about that passion, and don't ever stop talking about that innovation. Keep trying, um, keep pushing. And, and you'll find that it doesn't become as, as burdensome as, as burnout esque when you're always centralizing it to the passion and the innovation that you started with. The second you try to fit into what somebody else wants your entrepreneur model to be is the second that you will come closer to feeling burnout, potential failure, um, and, and just a, uh, a disconnection to your, to your entrepreneur space.

(00:45:46):

Um, and you know, I think about the idea of really going to those places that we are uncomfortable, right? Having those conversations that we are uncomfortable being really, um, assertive with. This is, uh, what we are. This is what I do, and this is why you really actually cannot, uh, participate or function as a community, a population, an individual, a school district, um, at your full potential without us. And, you know, I think about the idea, um, also being, one of the things that being an entrepreneur has really taught me, and, and I've spoken about this a lot, is we, as occupational therapy professionals, we come into this, right? Because we have a, a giving heart, we have a calling for it. We have a love for what the profession can do and how it does it. And, um, at times it feels almost unethical to be paid for that, right?

(00:46:47):

Um, or it feels unethical to deprive someone of access to, uh, such a meaningful life altering resource that, that we neglect to recognize that the more we give our gift away for free, the less people will think that there is a value to it that it needs to be paid for. And so sometimes that really means getting into that uncomfortable space of really pushing forward why we have value and why that value must be paid for. Um, and there are many opportunities for us to look at unique ways to minimize barriers to access. There's great opportunities to look at ways to influence, um, individuals that can't access our care through other avenues than our traditional healthcare system or a traditional business model. But in those models, we still have to, we have to find a way that we are asserting the financial benefit of occupational therapy and why it must be considered in budgeting and reimbursement services. And, and, and I, I would say that's probably in the entrepreneur space, one of the first, um, first resources that we need to really put out there. How do you get paid for what you do? And how do you feel comfortable getting paid for what you do? Because that's how you are showing that we have value.

Lindsey Vestal (00:48:31):

Thank you, Alison. That was, that was incredible. I'd love to ask you something a little bit more personal now, if you don't mind, which is, can you talk about the process you have in making difficult decisions and perhaps some of the lessons that you've learned since becoming president?

Speaker 3 (00:48:50):

Yeah. Um, so this is a great question, and I think about this a lot. Um, I would say first and foremost, this is a place where I have been challenged to go to being uncomfortable. Um, and, and, and going outside of my box, one of the first lessons I had to learn as president is I, I came from a, I come from a very matriarchal family of very loud Pittsburgh women. Um, and they have incredible, um, partners and family members and and friends, um, of all genders who support their, their assertiveness and their loudness. Um, and so I've never been in a place where, um, I had to recognize that representing Allison, uh, is very different than representing a national association or an incredible profession. And so, one of the things that I have learned, one of the lessons I have learned is when I am asked to make a decision, a a very critical or difficult decision, I actually pause and I write out my immediate reaction.

(00:50:05):

Um, and then I highlight what is Alison and what is just Alison? And then what is actually representation of the National Association's core values, um, ethical principles, and, and how does it really represent every member of the profession? Um, sometimes that's more challenging than others. And so I will actually seek out individuals who I know may carry a different view or perspective, and ask them, if I read this to you, do you feel represented in this statement? Do you feel represented in this decision? Um, and so that's a, that's one of the lessons I've learned. Um, I, I also know that, um, as, as occupational therapy professionals, we are, we are all familiar with spirituality being a component of, of people's, um, people's occupational profiles. And, and my spirituality happens to be incredibly meaningful to me. I was raised a Christian, um, I was raised, uh, um, what I guess would be considered now, uh, maybe a progressive or liberal Christian.

(00:51:10):

Um, so I very much was, uh, uh, raised under a home. Uh, so we were a, a safe house. My, my mother was a, uh, um, a special education teacher, and my father was a drug and alcohol counselor. And, um, like you could come to our hou, we never locked our doors. So, um, you were in an abusive situation. There was a couch for you to sleep at, at our house. Um, you were, um, in a situation where you were using, and there was no safe place for you to use. You could just come use safely so that, and, and someone would be there to monitor you, to make sure that you were okay. And so, I, I think about, I was raised with this idea that, um, this great Bible verse that says, uh, you know, when, when did I clothe you? When did I feed you?

(00:52:03):

When did I care for you? When you were sick? And, and Jesus says, well, when you've done this for anyone, you've done this for me because I live in everyone. And so, so I believe this, that, that, that good lives in everyone. And it is, it is my obligation to serve any chance I get. And so I believe that every difficult decision is an opportunity to serve people. And so I stop and I pray, um, I have a clinging cross in which, um, I have two clinging crosses, um, both made by an aunt who is a potter, who took, um, my, my, they, you, they, they clinging in your hand, you hold them. Uh, I do all conversations with them too. But, um, it's one is one was made by my mother's hand. So when I hold my clinging cross, it is both, um, my spirituality and my mother.

(00:52:57):

And then one was made, um, holding my father in la father-in-law's hand as he was passing. And so I hold his hand, um, and my spirituality. And so I, I, I honestly pause and I, I pray for a really long time, uh, and I hope to hear, uh, which way to go. And then the other piece is, is that, um, I recognize that I have to be comfortable that probably 80% of the time I'm gonna get it wrong are not quite right. And, uh, and, and that's a hard space to be sometimes too. But, um, I, I think I've really gotten there over the past year of knowing that I'm not getting it right. Um, I'm trying, um, and, and finding new ways to, not new ways necessarily to get it right, new ways to, um, hold myself accountable when I get it wrong, apologize when it's not right. And then hear from the, the stakeholders and the people that I need to hear from so that I can do it better.

Lindsey Vestal (00:54:09):

So much there to reflect on. First things that really resonate with me with what you said, Allison, was your, I would call it like a four step approach. You first check in with yourself asking what is Allison's response here? You then are thinking about that community that you're part of. In this case, it's part of our national organization. You lean to people that you really respect and that offer a different opinion that could help you think about this in all of the ways. And then you have that sense of deep spirituality. And then what I heard that I want every OT practitioner listening is that Allison has said that sometimes 80% of the time she gets things wrong. And I think this is the human condition, and to give ourselves all more grace in the decisions that we make, knowing that this is that opportunity to grow and that growth happens when we're uncomfortable and when we make mistakes and we lift ourselves back up through whatever one of those four beautiful models that Allison just shared with us, or all of them to recognize that now we've got that inner resilience to take that next step to then, you know, improve that next life, improve that be next sense of self.

(00:55:21):

So thank you so much. So I'd love to know, uh, I know that you're a big reader. Uh, you shared with us a book, uh, during your presidential address that deeply influenced, uh, sort of a journey that you had around the country going to various state, um, state occupational therapy, uh, events. And so I'd love to ask you now, if this is a question you can answer, it's a challenging one, but what's a book that has deeply influenced your philosophy towards occupational therapy? If, if you could answer that, there may be many.

Speaker 3 (00:55:52):

Yeah. Yeah. I, there are so many. Um, but there is one that comes to mind very, very early on, and that is a book called No Pity by Josh Shapiro. Um, and, and Josh Shapiro was, um, instrumental in leading some of the movement towards, um, towards the ada. And, um, there was, and I'll tell you one of the reasons this has really influenced me. Um, so I entered in, uh, to occupational therapy because I had had a cousin who'd experienced, uh, traumatic brain injury, um, and, and has global brain damage. And so I, I grew up in a time, um, where the, the word retarded was still used and was often used and directed at my cousin, and was, was actually very painful because, um, in my young age and my understanding of what people use that word for, I didn't think that was my cousin.

(00:56:54):

Um, and Josh Shapiro interviews, um, a a number of individuals who are members of, uh, various developmental and intellectual disability communities. And, um, they talk about this idea of, um, well, well, even if you think that I'm retarded, right? That doesn't change that I still know what I want and need. Uh, it might not be, um, uh, mature enough for what you think is best for me, but I still know what it is. And so the day you neglect to ask me about me is the day you're no longer helping and walking alongside in my advocacy. You're walking in your own. And it was very powerful to me because there are many times, um, and, and the book is filled with so much incredible, um, just incredible insight into, um, what I, I would say, uh, Dr. Lisa Mahaffy, um, who I had the privilege of serving on the board with is inspirational as well.

(00:58:11):

Um, what, what she has really guided us to is the idea of elevating, um, the, the consumer is a consumer. Um, and so I don't, I don't ever want, like I, when I'm a consumer, I don't go into the grocery store and say, Hey, what do you think I should eat for dinner tonight? Uh, tell me what to buy for, for food for a snack. I go in and look for what I want, and then I'm, I'm given, I'm facilitated a way to purchase that. That's how we need to approach our profession. And it, there are many times when I've sat back and, and thought there are things that the consumer has wanted of me that I don't necessarily, I think, oh, I'm not sure that's the right way to go. But because of no pity in that book, I've stopped and I've said, doesn't matter.

(00:59:02):

I'm walking alongside their advocacy wellness journey, not my own. Um, and so that would be one of the most influential books, uh, in all of my philosophy. There's a number of books that I read. I, I'm always throwing, throwing books out there and, and quotes from books. Um, you know, there's, um, there's the book Accidental Saints by Nadia Boltz Weber, uh, that I absolutely love. And it's this idea of like, uh, how do you, how do you find that, that there's actually greatness and goodness in all people? And that sometimes when you think you're the teacher, you're actually the one learning the lesson, right? And so, um, how do I look for the lesson of my own growth in every single interaction? And I, and, and so I love that book, um, and, and reminding me that we're humans and to laugh at myself. Um, there's, there's a book called, uh, Sojourner's Truth, A Sojourner's Truth, um, and it's written by a woman with whose last name is Robinson.

(01:00:02):

And she, she does a great job in informing, um, just my journey in, um, how to, how to understand, um, and, and approach advocacy, particularly advocacy related to diversity and equity and inclusivity, um, from a space of, of, of authenticity. And sometimes authenticity means being mad. So in Sojourner's Truth, she taught me how to not be angry at myself or guilt feel guilty because I'm mad about, um, an injustice that I see. Uh, and so, so those are three. And then, then I would say interestingly, um, uh, a number of years ago I was, uh, had the great privilege of, of being exposed to Wgar Mathai who, um, is the woman who started the Green Belt movement, uh, in Kenya, Africa. And, um, she started this movement, uh, really because she wanted to empower women in her country. But she knew that that would, so would be perceived so poorly by the culture in the community, in her country, that she, she needed to find a way to empower women, but also, um, have the culture that was in that was essentially benefiting from being oppressive to them, embrace it.

(01:01:25):

And she said, you know, everybody is really, um, supportive of, of ensuring that our, our environment is safe and protected, because in Kenya, we live off of our environment. And so she built the Green Belt movement, which has the initial or, or the, um, the, the forward statement of how this helps the environment. But really every step of enacting her work empowers women in her country. And I, it it shows me that, um, that there is, i, there is no consumer, there is no barrier, there is no, um, societal injustice that can be too large for us to overcome. If we can think, like Wgar Mathai, who I say was probably an occupational therapy professional at heart by her, her Green Belt movement. But I think about like, we know how to do that, right? We know how to see the injustice, we know how to see the barrier. We know how to see the deficit, the disruption, the dysregulation, but we also know that we're living in a culture and society that doesn't want us to eliminate those. So who better to find that space where culture, society is comfortable being supportive, but then also is actually having the benefit of elevating and eliminating the injustices and barriers that we're seeing.

Lindsey Vestal (01:03:01):

Thank you, Allison. I'm gonna put all of those in our show notes, all three books so that people can check those out, because those sounds like indispensable must haves <laugh>. Yes. So my last question for you is, what would you tell the OT practitioner listening to this episode who is struggling with feeling misunderstood or burnt out in their field?

Speaker 3 (01:03:25):

The first thing I wanna say is, I hear you. Um, I am a part of you, um, many people. I, I have, um, I do have an appointment at the University of Pittsburgh that I love. Sometimes I say, I bleed blue and gold. I went there. I, I lo I feel like it's, it's home. Um, and I love the opportunities that I have to, to educate, uh, future clinicians through, um, my faculty appointment. But, but I, what I want, um, them all to recognize is that I do still have a private practice, a private practice that just last year, um, opened a second loca, or just the beginning of this year, opened our second location. Um, thank you, uh, that, that has a nonprofit type into it. I still see clients and Consumers weekly. Um, I'm still making decisions about how to run the business.

(01:04:19):

I'm, I'm still there. And so if you feel like, does my national association even know what it's like? I do. I do. I know what it's like and I hear you. Um, and I wanna hear more from you. Um, please, please reach out. Tell me about where that struggle is. Tell me about that reimbursement issue that you can't seem to get around that administrator who doesn't understand that they're, they're prohibiting growth of their students by putting boundaries on your work in the school district. Right. Reach out. I know it. And, and I'm probably facing it too, and I wanna work with you to find that. And, and that's my response to the burnout. Um, the burnout is that it's two-sided OT yourself. Give yourself balance. Um, it's hard to do. It's so hard. Um, there's times when I, I literally look and think, ah, I have eight other things to do, um, but I have my accountability partners.

(01:05:23):

And they say, yeah, but it's Friday at five and Friday at five, you shut the computer off and you don't look at emails. Um, and, and so create that balance, but also know that we are a community. You're, you're never doing this alone. You don't have to figure it out alone. Um, and you, one of the things if every member of our community could walk away knowing is, do I believe that occupational therapy can be all things for all people, communities, societies, and environments? Absolutely. Do I believe that me, as an individual occupational therapist, can I be all things to all people, communities, population, societies? No. My, my incredible profession can, and I, I'm willing to say, Hey, I, I can work with you on this trauma, and I know there's other elements of your, your daily routine that I need to help you to walk alongside with and discover. But I also know that in my profession, there's incredible individuals who know how to make you feel healthier in your pelvic floor. And so I don't have to be that, that other part of occupational therapy. I just have to know that occupational therapy has that other part, and then find that partner to refer my, my consumers to. So, so don't feel the pressure to be all the things. Just have the recognition that our profession is and amongst us all, we can be all things, but by ourselves we never will.

Lindsey Vestal (01:07:07):

Thank you so much, Allison, for your time and for sharing so much of your incredibly refreshing perspective with us. I know that there are great things coming for our field and for our profession and every step along the way, we are feeling seen and heard. So thank you so much for the work that you're doing. And, uh, I'm gonna go order those books that you recommended, <laugh>.

Speaker 3 (01:07:34):

Thank you. And thank everybody that's listening, everyone doing the work. We, we are occupational therapy.

Alyson Stover (01:07:42):

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and post it to ig, Facebook, wherever you post your stuff. And be sure to tag me and let me know why you like this episode. This will help me to create in the future what you wanna hear more of. Thanks again for listening to the OTs and PE Health podcast.