Symbolic play language during sensory integration treatment.

OBJECTIVE: Clinical writings on sensory integration treatment and theory have long professed that play serves as an important means of implementing treatment goals. However, to date, there has been little research that examines this aspect of the intervention. With the use of play language as an indicator for the occurrence of play, this study examined the frequency and characteristics associated with symbolic play language that therapists and children use during sensory integration therapy. This study is part of an ongoing research program designed to examine therapist-child interactions. METHOD: The frequency of symbolic play language observed in 41 videotaped treatment sessions of therapist-child dyads (21 children, 12 therapists) was recorded with the Challenge Coding System. The presence of symbolic play language was recorded if the child or therapist used language that incorporated the child, therapist, equipment, or activity into a symbolic or pretend play theme. The frequency of symbolic play language and percentage of time spent using play language were calculated. Associations among frequency of play language, child age, and behavior during the session (e.g., seeking assistance, cooperation) were also examined. RESULTS: Symbolic play language proved to be a major feature of sensory integration treatment sessions. It also correlated with child age and with some features associated with therapeutic interactions (i.e., child tries hard, child seeks assistance, therapist assists child, therapist modifies activity, therapist structures activity). CONCLUSION: The results suggest that these therapists used play language frequently and that this usage may support children in sensory integrative therapy to successfully accomplish activities.

Value-based leadership. A prescription for reforming the American health care system.

Many reforms have been suggested for health care in the last 30 years yet they are mainly treating symptoms rather than getting at the root cause of the problems. The underlying problem is a lack of vision for the health care system. There is no comprehensive, uniform vision of American medicine rooted in the needs of our society. This vision should be based on the values that significantly challenge physicians: patient satisfaction, patient empowerment, cost effectiveness and the appropriate use of resources, patent access, and continuous quality improvement based on appropriate data techniques.

Pressure on the emergency department: the expanding right to medical care.

Lack of a comprehensive health care system in the United States has resulted in a series of legal cases that have expanded the common-law right to care in the hospital emergency department, thereby bringing increased pressure on hospitals to provide care under an ever-widening variety of nonemergency conditions. Health care legislation at the state and federal level during the 1980s expanded the concept of physician duty to include women in labor as well as any condition that could reasonably be expected to lead to serious impairment to bodily functions or serious dysfunction of any bodily organ or part. Presently, any patient presenting to a hospital ED must be examined to determine whether an emergency exists. The expanding definition of an emergency and mandated patient examination requirements have hit urban hospitals particularly hard, as the uninsured and disenfranchised increasingly find the ED their only source of medical care. The United States needs a national health care solution that does not rely on the ED as the locus of care for general medical practice. Failure to act will jeopardize the ability of hospital EDs to provide the highly specialized care that only they can provide and will put more hospitals at financial risk as they struggle to comply with state and federal law while serving a growing population of uninsured and underinsured patients.

Managing in the new paradigm.

The 1990s represent a profoundly exciting time to be in health care. The following paper asserts that it is time for physicians and management to relinquish old baggage, to dream about what is best, and help create a new medical culture. Guiding the choices about what is best for the future of health care are three broad issues: cost and value, patient satisfaction, and standards of care.