20Q: Leadership Reflections From a College Dean

Charlotte Royeen, Leadership Reflections

Charlotte Brasic Royeen, PhD, OTR/L, FAOTA, FASAHP, FNAP, is the Dean of the College of Health Sciences and the Inaugural Chair of the Endowed A. Watson Armour III Presidential Professorship at Rush University Medical Center, which was just recently rated the #1 hospital in the U.S. for quality.  Dr. Royeen has served as an occupational therapy clinician, occupational therapy and research consultant, federal research analyst with the Office of Special Education within the U.S. Department of Education, and as a faculty member and academic administrator in five different universities with increasing levels of responsibility. She is nationally and internationally recognized in occupational therapy, neuroscience, and physical therapy and has 76 peer-reviewed manuscripts, 25 popular press or web-based publications, over 22 edited or authored books, and 27 book chapters, and just recently had four op-ed pieces published in the popular press. She was recognized as one of the top 100 most influential occupational therapists past and present by the American Occupational Therapy Association. 

Franklin Stein, PhD, OTR/L, FAOTA

Contributing Editor

Salute to OT Leaders Series

20Q: Leadership Reflections From a College Dean

Charlotte Royeen, OTR/L, FAOTA, FASAHP, FNAP

Reflections on Leadership

1. You have been an educator, researcher, and administrator in occupational therapy for many years.  What was your most satisfying position and why?

This may seem like a convenient answer, but I would say each job that I have had, while I have had it, has been my favorite.  Thus, my current position is my favorite since I am still at it, and in my 6th year.  I truly appreciate being at Rush University as the Dean of the College of Health Sciences. It is part of Rush University Medical Center and we are very integrated. I work with the hospital personnel as much as I work with university personnel – and that makes the job most interesting!  Note that as a Dean at Rush University, I also serve as Vice President at Rush University Medical Center. The complexity of what I do (we have 15 departments in the college) combined with learning about hospital operations has been truly an educational experience.  I have learned more about the health care business since being here than in all of my previous years of experience combined!

2. In 2003, you published a book on pediatrics issues in OT.  Now in 2020, what would you identify as the current issues facing pediatrics OTs?

I was not certain how I was going to answer this question until this morning after reading the "Wall Street Journal."  Dr. Jerry Johnson was Chairperson of the Occupational Therapy Education Program at Washington University School of Medicine while I served as a graduate fellow there. She said you had to read the "Wall Street Journal" every day to keep up on health care news, and I have carried on her tradition. Anyway, today’s "Wall Street Journal" (WSJ, “With Remote Learning, Disabled Children Face Extra Hurdles, 9-2-20) included an article on the challenges for students with special needs getting their OT, PT, and SLP services while educational instruction was being provided online during the Covid-19 pandemic. This past spring, many schools simply did not provide OT, OT, and SLP services while on-site instruction was shut down due to the Covid-19 virus. And, the article points out this action is not in compliance with federal funding expectations. Hence, I would identify the provision of therapy services in an online format (a form of telemedicine) is the single largest challenge for pediatric therapy services right now – since parents also do not want to bring their children into medical settings for services for fear of Covid-19 exposure. 

Additionally, I fear for pediatric practice being overly focused upon techniques and prescribed evidence-based research without a concomitant focus upon theory.  My colleagues Dr. Hinojosa (deceased), Kramer, and Howe (2020) have a fourth edition of a pediatric theory book that is available and expands practice beyond techniques and interventions and grounds all action in theory.

3. Leadership has been an important part of your career.  What are the significant characteristics of a successful leader in occupational therapy?

Long ago I remember reading an editorial in a medical journal that stated in order to be a good physician, one had to be a “good” person.  Unfortunately, I no longer remember who the author was. However, I think the same standards apply to leaders or at least the leaders whom I greatly respect. Each of them has been a “good” person illustrating high levels of virtue ethics, and that is what makes a person good, and in part, can allow them to be a great leader. Such virtues are compassion and understanding, action-orientation, intelligence, good problem-solving skills, and curiosity!

Specifically in occupational therapy, the characteristics of a good leader follow: 

(a)Being organized and anticipating the unexpected, or at least not getting too upset with the unexpected. A recent example of this was when an “adjunct” faculty member had a family emergency and could not teach the scheduled course (I was informed on the same day that the course first met). The first reaction of all involved was panic, but by the next day, the respective chairperson had successfully worked with all departmental faculty to design a “plan b” and immediately moved a spring course into the fall semester, with the fall course teaching being carried out by a faculty member who could absorb the load. The canceled class was rescheduled for spring when a new adjunct faculty member could be contracted.

(b)Working across staff and or faculty to solicit input and make timely decisions. To illustrate, in many of the academic institutions where occupational therapy exists, occupational therapy as a profession is often associated with undue “processing” without timely decisions being made. For example, one can discuss and solicit input about recommendations for action that affect a department, but at some point, the leader must bring an end to discussion and make a decision about how to move forward.

(c)Using business communication that is concise, targeted to the audience, and to the point. An example of this can occur with communication from legal support services. I have seen cases wherein the documents are written not for administration and faculty as consumers, but are written as communication to other lawyers. In fact, I have heard faculty complain that they feel like they need to hire a lawyer just to understand what is being put forth in legal communication. The value of plain and simple English to convey concepts is essential. A good example of this is the overuse of the word “utilize” instead of “use.” I suspect people think this sounds more erudite, but to me, it is a bit silly.

(d)Operating from a values or principles model and not from a model of what is politically expedient or self-enhancing. This may be seen when, for example, a pediatric therapist is working to meet the needs of the student and not responding to illegal policy or service limitations put forth by an administrative directive. The guiding question, in this case, is, “Whose need is being met?”

Research

4. Can you describe your research in sensory integration and how it has improved clinical practice?

My particular area of interest in sensory integration related to two sensory systems – the vestibular system and the tactile system. To the average person, both of these systems are less obvious than hearing or sight. In some small way, I contributed to the validation of constructs around testing or treating these sensory systems as pertaining to theory and practice. I always found tactile defensiveness to be of unique interest in that it is commonly seen not just in cases of sensory integration dysfunction but also is very prevalent when mammalian neurological systems were stressed or damaged.  Hence, there is a pervasiveness to tactile defensiveness that includes many, many patients with neurological dysfunction distinct from sensory integration dysfunction. That is a line of inquiry, however, that we have not really followed, and yet, we have a profound understanding of how the condition, i.e., tactile defensiveness, influences the quality of life and occupational engagement in cases of tactile defensiveness with a comorbid neurological condition. That is something for the next generation to pick up and explore!

I, with colleagues, developed the following instruments for the assessment of tactile defensiveness: the Tactile Inventory for Elementary School Aged Children (TIE) (Royeen and Fortune, 1990), test-retest reliability of the TIE (Royeen, 1987), and the Tactile Inventory for Preschoolers (TIP) (Royeen, 1987).  Tactile defensives can limit participation in ADL due to the fact that habituation to tactile cues does not occur. Consequently, many pieces of clothing with tags or rough textures annoy or upset someone with tactile defensiveness. I also suspect that many food preferences and children’s refusal to eat certain types of foods that are deemed "aversive" are due to their inherent texture. Also, children’s sense of self-esteem was negatively correlated with the degree of tactile defensiveness (Stephens and Royeen, 1998).  Additionally, a mother's view of the degree of tactile defensiveness is minimized as compared to that perceived by the child (Hotz and Royeen, 1988).

5. In 2012, you participated in a workshop on A Vision for the Future of OT in 2050.  Can you update your views on the future of occupational therapy?

I value and think occupation and occupational therapy are the essences of quality of life and the good life. That is, we are as much a health care service based upon evidence and theory as we are a philosophy of life or how to achieve "the good life." But, we have remained “invisible” to most of the public while physical therapy has moved forward politically and strategically. I was just informed that a new partnership with rehabilitation centers will be called “physical therapy” and not “rehabilitation” since leadership decided that “physical therapy” was better known to potential clients. Further, the requirement of the doctorate for entry-level practice has been pervasive and required in physical therapy while OT has been following the nursing model of multiple levels of entry for practice. Nurses can get away with this approach since there are so many of them. We are too small of a field for that, and for OT, lack of doctoral-level entry requirements has hampered the field in terms of qualifying as a “real” profession, having recognition as a field in the world of DC politics, and as worthy for new program development in academic medical centers. Case in point: I was consulting with an academic medical center in Florida for the implementation of a doctoral-level program in occupational therapy. While visiting on-site at the institution, the AOTA accreditation decision to allow multiple levels of entry for occupational therapy was announced. Upon hearing this news, the academic medical center immediately canceled plans for developing the OT program since a non-doctoral program really did not fit in at the academic medical center. Currently, most of the new OT programs are being started at the master’s level at smaller universities trying to sustain or grow their undergraduate enrollment, lacking a real partnership with clinical practice.

Thus, my vision of the future of occupational therapy requires that we self-correct and change occupational therapy entry-level requirements to the doctoral level. And, I truly believe the complexity of practice in the future will more than require a doctoral level of education.  By doctoral-level, I am referring to the Occupational Therapy Doctorate (OTD) as the entry-level degree for practice. The OTD is a professional degree that denotes that the degree holder is qualified to apply for certification and/or licensure to enter the practice of occupational therapy: It does not denote that the holder of the degree is qualified to carry out independent research endeavors. This is a distinctly different degree from what is required for long-range success in the academic setting and that is the research-based Doctorate of Philosophy degree (PhD) in areas relevant for occupational therapy. The PhD degree connotes that the holder of the degree has had strong research-based training and is capable of carrying out independent research endeavors. One degree does not substitute for the other. Further, an occupational therapist does not need a PhD to practice. However, in order to be a long term academic reaching for the ultimate level of Full Professor, a PhD is typically required at the current time and into the future for an occupational therapist in the academic setting.

Background

6. Where did you grow up? Describe your family background and education.

I grew up right outside of Chicago, Illinois in Gary, Indiana. Gary was a capital of steel production at the time.  Before entering sixth grade, my mother remarried (my father was deceased), and my new stepfather was transferred within Cities Service (now Citgo) outside of Princeton, NJ.  Moving to a small town outside of Princeton, NJ was my first cross-cultural experience.  Rather than deter me, I found I thrived in cross-cultural settings and loved the complexity of it. Thus, the rest of my life has afforded considerable cross-cultural experiences both within the US and abroad. Best of all, it set the stage for my cross-cultural marriage to a man from Afghanistan. Due to the life span process of aging, forty-one years later we are still figuring out new cross-cultural situations that are occurring. For example, he has bought burial plots for our bodies near family in Virginia, and I just want to be cremated. That issue (burial or cremation after death) never emerged when we were young but is currently a point of contention.

Further, my father had been an orphan and was one of the lucky ones to be placed in an orphanage. The catholic run orphanage in which he was placed emphasized education, and that spurred my father to get a degree in civil engineering from the University of Illinois at Champagne-Urbana. My mother was from a German community in the Ozarks of Missouri, wherein the boys were expected to attend college, but the girls only completed high school. My mother, due to not having a college education, was very determined that we three children would have one! Both of my parents, therefore, had an educational focus for their children.

Finally, when I look at my extended family, I realize that going into the academy was a natural path for me. My uncle (my mother’s brother) was a university professor. My cousin was a university professor. A distant uncle was the first soil sciences professor at the University of Missouri, and cantankerous enough to go up for tenure without a PhD. And, my cousin from the other side of the family is a university professor. I only realized this as an adult. I can clearly remember my undergraduate professor (Professor Harvey) from an Ohio University honors history course telling me, “You can do this type of research. You can be a scholar and an investigator.” And, I recall the public and financial support that AOTF provided for doctoral study in OT.  Thus, it was a) “family background”, b) a professor who invited me into research at the undergraduate level, and c) the AOTF that really oriented me to the academic life in terms of scholarship and research.

7. How did you become interested in OT?

After moving to New Jersey and completing sixth grade, my mother served on the Board of Directors for New Jersey Neuropsychiatric Institute in Skillman, NJ. She thought it would be good for me so I volunteered that first summer in the occupational therapy department. Every summer after that I returned as a paid employee and eventually was running a summer day camp for patients during summers in high school. I had a wonderful time studying my first two years of undergraduate studies as a painting major until deciding I wanted to study occupational therapy. And, since I knew I would not be a traditional sort of occupational therapist, I went to the most traditional program I could find at the time – Tufts University.

8. What university did you attend in completing your first degree?

As previously stated, I went to Tufts University. But, please know this was when the occupational therapy program was in the medical center in downtown Boston, specifically in Chinatown. I remember coming off the public transportation for my first evening class and seeing someone knifed in the street. This was a big change from rural Ohio and colonial New Jersey! However, I loved Boston and especially Cambridge where I lived, since while doing laundry at a laundromat one was almost as likely to meet a Nobel Laureate as someone from the local communist headquarters.

9. Where did you go for graduate study?

I had the good fortune of receiving a graduate fellowship from Washington University School of Medicine in St. Louis for my master of science degree in occupational therapy and attended from 1978-1980. I will never forget that one of my master’s advisors was also chair of physiology in the medical school. This early interdisciplinary experience led me to have a passion for interprofessional education. After completing the master’s degree (archaically known as an advanced masters at the time), my husband and I moved to Alexandria, VA where I started my career as an instructor and then Assistant Professor at Howard University in Washington, DC. My main course to teach was Neuroscience, which I co-taught with a member of the Department of Physical Therapy. For one year due to a shortage of faculty, I administered the academic fieldwork program, and believe that every faculty should do this at least once in a lifetime to understand the value of fieldwork to academic education.

Career

10. Who were mentors during your career?

I have already mentioned two of them. Other famous names in occupational therapy who served as mentors were Virginia Scardina, A. Jean Ayres, Margaret Rood, Gail Hills Maguire, Pat Wilbarger, and many others who touched me with sage advice at some point in life, but with so many moves and relocations (endemic to an academic vagabond), I have lost track.  Here is a snippet of what I learned from each of these mentors:

• Virginia Scardina taught me how to play with children and how to revel in their joy of doing! If it had not been for Virginia Scardina, I doubt that I would have stayed in occupational therapy. In fact, when interning with “Ginny,” I was thrilled to be a part of an evidence-based practiced clinic in sensory integration wherein practice changed on a regular basis as a result of publications devoted to sensory integrative occupational therapy practice. I had not seen a systematic evidence-based practice in occupational therapy until working with Ginny.  Her work represented an “Island of Excellence” of practice.
• Jean Ayres recommended me for a lecture in Munich, Germany and to this day, I am still friends with the person who organized the lecture over 30 years ago. 
• Margaret Rood taught me so much about how to think about movement and postural patterns. I have done at least one half-hour of prone extension each and every day due to what I learned from “Roodie” as she was called. And, I think this is partly why no one realizes I have had bilateral hip replacements because I move so well – in part by paying attention to the balance of postural patterns such as flexion and extension.
• Gail Hills Maguire introduced me to the world of federal funding, as she was one of the early scholars in occupational therapy to receive federal funding and specialize in geriatrics.
• Patricia Wilbarger mentored me in advanced sensory integrative interventions such as her brushing protocol, which I used for the first two years of my daughter’s life.

11. What was your first position in OT?

I graduated from occupational therapy school after nine months of internships (remember this was the old days when we went five years for a baccalaureate degree). I was desperate for work and absolutely nothing was available. People of the current time do not have an appreciation for how hard it was to get a job back then. I would call Ginny Scardina in a panic about not having a job, and she would tell me to be patient.

After about six months of waiting, an occupational therapist became pregnant and every vein around her stomach was damaged by the pregnancy so she had to take a leave of absence. And, I got to start my very first OT job as a substitute for this occupational therapist! (She did go on and have a healthy baby). I walked 4 miles each way to the Condon School for the Multiplied Handicapped in Hamilton, Ohio (right outside of Cincinnati, Ohio where Ginny Scardina was located), and this was when we had segregated schools for those with physical disabilities. I was in great shape from walking 8 miles a day and had summers off for travel. I loved that job. Sometimes, I wish I was back as a full professor with a nine-month contract having summers off in order to again travel and work more with students. I worked with students who were severely physically handicapped but most were functioning at grade level intellectually. We employed a sensory integrative based frame of reference for intervention.  At that time, scooter boards, swinging equipment, tactile experiences, and quiet time of drawing or coloring at the end of sessions were dominant treatments.

Upon completion of the substitute position, I obtained my next job in a segregated school for behaviorally disordered children. These children with serious behavioral disorders were sent to this special school from all over the state. If their behavioral issues could not be remediated within this site, the next placement was incarceration. I learned how important team consistency is to address behaviorally disordered children, and we (the staff) met for 10 minutes every morning to make certain we were all using the same approach regarding inappropriate behavior on the part of the students. Further, I got to work intensively with many of the students who also had serious sensory integration disorders, and it was thrilling to see their improvement.

During this time, I also participated in providing private practice services to clients in the sensory integrative practice Ginny founded in Cincinnati. In fact, after completing my PhD in the 1980s, I returned to full-time school based practice in Loudoun County, VA public schools for a period of time to reaffirm my clinical skills.

Pat Wilbarger always said that I thought like a clinician, even if I was educated as an academic. I owe that type of clinical reasoning to Pat, Ginny, and Jean.

12. When did you become interested in working in academia?

I started serving as a faculty member at Howard University in 1981 as an Instructor and then as Assistant Professor of Occupational Therapy until being awarded an AOTF doctoral fellowship in 1983, which allowed me to quit Howard and pursue my doctoral studies full time. Then, I had a five-year stint as a research analyst in the US Department of Education, Office of Special Education. After I had my first baby, and after maternity leave, I worked as an independent contractor designing and producing the AOTA Self Study Series (an early form distance continuing education prior to the internet being pervasive). One day I was in the AOTA office and Barbara Chandler, who at the time was the pediatric practice specialist at AOTA, came over and told me that someone was in the OT conference room talking with the AOTA education department about starting a program in occupational therapy at Shenandoah University. I knew I wanted to return to the academy since both my husband and I were independent contractors or freelancers and at that time. It was time for one of us to get a “real job” with benefits and retirement planning. Fortunately, I did get the job as Founding Chairperson of the Shenandoah University Program in Occupational Therapy, and Barbara Chandler joined me there as did many others like Joy Hammel and Gretchen Stone. It was an exciting time, and we got to put in the first fully, problem-based learning curriculum in the US in OT!

13. What advice would you give to OTs interested in teaching OT at a university?

I think working in the academy is the best job in the world, but the nicety of a collegial and social lifestyle around the university no longer exists in the manner of past culture. However, there is no better job when trying to raise a family due to the flexibility and autonomy afforded faculty. And for those of us with an academic bent, there is no better way to live one’s life. I am trying to get my daughter to consider academic life now that she has many years of practice under her belt and a PhD. There is no better way to spend one’s time and energy. In fact, she just called me today and said that she is ready to apply for academic occupational therapy faculty positions! Synchronicity!

The opportunities of the academic life are very rich – lifelong learning in a multitude of ways, opportunity to continually interact with the best and the brightest colleagues and students, the ongoing opportunities to do individual and collaborative research, and opportunity to travel nationally and internationally as one develops a national and international reputation.

14. As a Dean of a large institution what are your challenges and obstacles?

The challenges and obstacles of serving as a dean at an academic medical center have become far more pronounced and precarious since Covid-19 exploded in our world. It is now very similar to clinical practice in that you may have a plan, but that plan may change on a dime depending upon the state of the patient. Similarly, as a dean one may have plans, but you have to be ready to adapt and change on a dime as students and faculty change or present specific issues or challenges. In occupational therapy, as in almost all fields in allied health, we have a chronic shortage of well-qualified faculty that is far worse than nursing and medicine, and their potential human resources are not considered good. Thus, I have now started to invite new students who think they might have an academic bent to please think about getting their PhDs. And, any student who excels academically, I invite them to consider getting a PhD. That is, I repeat what Professor Harvey did for me – asking me to consider the academic life and that I had “the right stuff” for it. I am merely carrying on this work by identifying good candidates for PhD development and eventual academic careers in allied health fields and especially occupational therapy.

Enrollment trends, increasing part-time students versus full-time students, the need for more marketing, improvement of the student and faculty experience, the need to diversify faculty and students, and the effects of the Covid-19 pandemic are current challenges in administration.

Future of OT

15. How has OT changed during your career?

I am not too certain how to answer this one. OT has been my calling and my career. I always thought I would end up in psychiatric occupational therapy. And, in fact, in my service as a dean, I use all of my skills learned for psychiatric occupational therapy in my daily work with others at the university. So, I really am a psychiatric occupational therapist – only using my skill set in administration and not in a formal mental health setting.

Occupational therapy education no longer really focuses on doing occupations in our educational programs. I remember taking weaving and woodworking from a master craftsman. I still have the weavings and the turtle I made in woodworking. And, I and a big believer in the doing of things (occupations) that I fear we no longer really look at doing in our current curricula.

Occupational therapy remains an incredibly robust field of study rich in theory. Everyone’s current focus is upon evidence-based practice, but practice also emanates from theory. Theoretical foundations of occupational therapy are one of the field’s very strong suits, but we do not proclaim or acclaim it sufficiently. The emphasis on theory has not waned, and I hope to see it become even more robust in the future.  Paula Kramer and I (Hinojosa, Kramer, and Royeen, 2017) are now beginning the third edition of what we consider the main theory book in occupational therapy, "Perspectives in Human Occupation: Theories Underlying Practice."

16. How would you define OT to incoming graduate students?

Very simply as “doing with meaning,” (Royeen, Stein, Murtha, and Stambaugh, 2017). In this paper, we explain aspects of eudemonic care as a future path for occupational therapy. We have to be able to communicate about the complexity of what we do, and further explain how we assure the quality of life (eudemonia). That is why I love the phrase “doing with meaning.” 

We are the only field of study concerned with how humans do within the context of their environment. Psychologists, using talk therapy, explore how people think about their feelings. Occupational therapists explore how we do things, while also exploring how we feel about this doing (metaemotion of occupation - Royeen (2019; 2020).

17. What are the significant issues in 2020 in healthcare that are changing the practice of OT?

The Covid-19 crisis has changed everything. Given the financial pressures of caring for patients with Covid-19, it is likely that many hospitals will close as a result of this crisis. The cost of caring for Covid-19 patients is very high, and hospitals are not reimbursed for all costs. The loss of the usual “business” of outpatients during the Covid-19 crisis has wreaked havoc on every health care system’s budget. 

A big change resulting from the Covid-19 pandemic is telehealth care. Occupational therapy is currently a player in telehealth services for consumers needing occupational therapy services, and this is a focus each educational program needs to incorporate and also provide as continuing education for practicing therapists. This is likely to be a big part of health care services in the future. One of the faculty here at Rush University Department of Occupational Therapy Educational program, Dr. Lauren Little, has received institutional funding to research the delivery of telehealth by occupational therapists and additional grant support to train occupational therapists in certain states how to do so! This is a time of great opportunity for occupational therapy in this area.

18. How has international developments in OT affected the profession?

It has made it much richer, more complex, and multidimensional from cross-cultural perspectives. I remember wanting to go and practice in New Zealand after graduating from OT and all of my professors said, “No, go and practice in the US first.” Forget that. Things are different now. And, as a new graduate, if you want to go practice abroad, I say go do it. The world needs OT in many shapes and forms, and you will learn so much…

19. What are the important areas of research in OT?

Basically, there are four levels of research and scholarship in a field of study. The first is descriptive. The second is correlational (still related to descriptive). The third is interventional (what works). And the fourth is interventional using random selection and assignment (clinical trials). With the pervasive onset of evidence-based practice, the bandwagon is to conduct clinical trial research. The problem is that we as a field have about another 100 years of description research to do before we can really design good interventional studies. We must name, frame, study, and claim our variables of interest (descriptive research) prior to attempting to do interventional work on a grand scale. You just cannot skip steps and get to the end goal without foundational work. Consequently, I would say that OT needs volumes of descriptive research, but there is minimal funding and little interest in that during the current trends around the evidence-based focus of interventional research.

In addition to this, we need to further proclaim our theoretical base of practice and become known for our emphasis and use of theory. The current emphasis on evidence-based practice is grounded in aggregate data from the many, with very little application to an individual person in a particular environment. That is why theory remains so important. We cannot have evidence for how to proceed with every individual in each situation and must rely on theory to guide us where aggregate data fails to provide direction. 

An immediate area to investigate that will be essential for our future is telehealth and incorporating it into occupational therapy practice with related outcomes research. And, we need to quickly be investigating how OT services can improve the quality of life for post-COVID-19 survivors who may have residual functional issues.

Summary

20. How would you summarize your contributions to the profession of OT?

Again, this is a difficult question to answer as we all tend to be a bit self-blind. I can state that when deciding whether to pursue a publication or not, I always ask myself – will the world be a bit better off with this information? Not, will I change the world, but will it contribute? As long as I believe I have made some degree of contribution to the field and to those wanting to study in the field, I will be happy. And, each day on the tenth floor of my building I see a quote from Florence Nightingale with which I harmonize, "I attribute my success to this – I never gave or took any excuse." I would like my contributions to be remembered as having made some degree of improvement in occupational therapy as a profession and occupational science as a science. That is, I would like to think I have made a difference for the better.

Finally, one of my most recent contributions is a book by Dr. Laura Lee “Dolly” Swisher and myself that was the culmination of about five years’ worth of work but based upon the preceding twenty years of scholarly interactions with a group committed to ethics in occupational therapy and physical therapy, i.e., the “Dreamcatchers.” Dr. Swisher and I published the first edited book on rehabilitation ethics for interprofessional practice (Swisher and Royeen, 2020). I sincerely hope that this book further ignites interest in ethics in general and rehabilitation ethics specifically.

References

Hotz, S.D. & Royeen, C.B. (1998). Perception of behaviors associated with tactile defensiveness: An exploration of the differences between mothers and their children. Occupational Therapy International, 5(4), 281-291.

Kramer, P., Hinojosa, J., and Howe, H. (2020). Frames of reference for pediatric occupational therapy, 4th Ed., Philadelphia, PA.  Lippincott, Williams and Wilkins.

Hinojosa, J., Kramer, P., and Royeen, C.B. (2017). Perspectives in human occupation: Theories underlying practice. Philadelphia, PA:  F.A. Davis.

Royeen, C.B.  (1987). Test‑retest reliability of touch inventory for elementary school aged children. Physical and Occupational Therapy in Pediatrics, 7(3), 45-52.

Royeen, C.B. (1987).  TIP: Touch inventory for preschoolers. Physical and Occupational Therapy in Pediatrics, 7(1), 29-40.

Royeen, C.B.  (1989). Commentary on tactile functions in learning disabled and normal children: Reliability and validity considerations. Occupational Therapy Journal of Research, (9)1:16-23.

Royeen, C.B., Fortune, J.C. (1990). TIE: Tactile inventory for school aged children. American Journal of Occupational Therapy, 44(2), 155-160

Stephens, C. & Royeen, C.B. (1998). Investigation and tactile defensiveness and self esteem in typically developing in children. Occupational Therapy International, 5(4), 273-280.  

Royeen, C.B., & Stohs, S. (1999). Should the clinical doctoral degree be the standard of entry into the practice of occupational therapy? Innovations in Occupational Therapy Education, 1(1):171-177.

Royeen, C.B., Stein, F., Murtha, A., & Stambaugh, J. (2017) Eudemonic care: A future path for occupational therapy? Open Journal in Occupational Therapy, Vol. 5, Issue 2, Spring, D01:10.15453./2168-6408.1301.

Royeen, C.B., (2019). The Meta-emotion of Occupation: Feeling about feeling while doing. Annual Ruth Zemke Lecture in Occupational Science presented for the Study of Occupation: USA (SSO: USA) Annual conference, Scottsdale, AZ, October 2019) 

Royeen, C.B. (2020). Metaemotion of Occupation with Wissen (MeOW): Feeling about feeling while doing with meaning. Journal of Occupational Science.  DOI: 10.1080/14427591.2020.1742196.

Stephens, C. & Royeen, C.B. (1998). Investigation and tactile defensiveness and self esteem in typically developing in children. Occupational Therapy International, 5(4), 273-280.  

Swisher, L.L., and Royeen, C.B. (Eds.) (2020). Rehabilitation ethics for Interprofessional Practice.  Burlington, MA: Jones and Bartlett, Publishers.

Threlkeld, A.J., Jensen, G. & Royeen, C.B. (1999). The clinical doctorate: A framework for analysis in physical therapist education. Physical Therapy, 79(6):567-581.