Tag Archives: legislation

Breaking the Cycle: Occupational Therapy’s Inclusion in SAMHSA Mental Health Legislation

Back in November, I wrote about occupational therapy’s role in mental health, specifically the profession’s advocacy for occupational therapy’s inclusion in the Substance Abuse and Mental Health Services Administration (SAMHSA) legislation that will create Certified Community Behavioral Health Clinics (CCBHC).

On February 2nd, SAMHSA released their draft criteria (which you can read here) and occupational therapy is one of the professions that have been identified as potential CBHC providers! Although the document is just a draft, which means that we aren’t officially in the door, it’s still an important stride being made for the profession and for the clients who OTs have the potential to help in the future.

Occupational therapy actually has its origins in mental health, beginning with the moral treatment movement in the early 1800s and continuing throughout World War I, when “reconstruction aides” used crafts, functional activities, and their understanding of the human desire to live a productive, meaningful life to help returning soldiers cope with their physical and psychological injuries (AJOT, 2011). Unfortunately, in recent years occupational therapy has lost its footing in the realm of mental health due to political and legislative actions, professional identity shifts, poor professional advocacy, and other factors. This has led to a sort of vicious cycle of OT’s exclusion from the arena of mental health, which I’ve illustrated in the graphic below:

OT in Mental Health Cycle Graphic

Negative outcomes of this cycle include:

  • Decreased access to qualified mental health service providers by those who need services
  • Healthcare teams that are missing a valuable occupational therapist perspective on client treatment and recovery
  • Fewer opportunities for assessing or developing intervention and treatment methods that may be effective with clients with mental health concerns

However, with occupational therapy’s inclusion in SAMHSA’s CBHC draft comes a chance to break the cycle and make it known that occupational therapists bring valuable tools, insight, and clinical expertise to the field of mental health. In the same article I cited previously (available in full to AOTA members), the author offers several practical solutions to help remedy the current shortage of occupational therapists practicing in mental health, including increased professional advocacy at the state and local levels for the effectiveness of OT in mental health and high-quality research to support this conclusion.

I think that occupational therapy has a bright future in mental health, and I am hopeful that the next generation of therapists will be better-prepared, more confident, and capable of taking on the many challenges presented by working with people living with mental health concerns. We’re now one step closer to breaking the cycle, and I’m excited to see what happens when we reestablish our role as qualified mental health professionals!


Links

If you’re interested in learning more about occupational therapy’s role in mental health, check out these articles describing how the unique skills of OTs have made a difference in the lives of people with mental health concerns, including children, veterans, and families.

Military Service Members and Veterans: Occupational therapy interventions help veterans living with PTSD re-establish routines, learn how to cope with their symptoms, and successfully rejoin their communities.

Children & Adolescents: The community-based OT that the high school student in this article is seeing is helping him learn independent living skills that will help him become less dependent on his family members and likely ease the caregiver burden his mom reports experiencing.

Professional Opportunities for OT in Mental Health: AOTA President Ginny Stoffel authored a useful article that reviews the multiple opportunities for occupational therapy in mental health, including having OTs be members of primary care and “integrated treatment” teams and the important role OTs can play in the recovery of clients with mental health concerns.

References:
Special Issue: Effectiveness of Occupational Therapy Services in Mental Health Practice. Am J Occup Ther 2011;65(3):235-237. doi: 10.5014/ajot.2011.001339.

Occupational Therapy in Mental Health: SAMHSA Listening Session and Comments (November 12-26, 2014)

AOTA and SAMHSA

In case you didn’t know, occupational therapists currently play an important role in helping people with mental health problems and psychiatric disabilities. They work in community-based, outpatient, inpatient, and other settings to help people living with mental health concerns learn how to best complete the activities they need and want to do.

Although there are some occupational therapists helping some people with mental health issues, there is not nearly enough supply to meet the demand. In the past, OT has not really been recognized as a profession that is equipped to meet the needs of clients with mental health problems, but this could all change in the very near future!

On November 12, 2014, there is going to be a listening session to Support Occupational Therapy’s Inclusion in New Community Mental Health Services. It is vital that as many occupational therapy students, practitioners, assistants and supporters as possible get involved and comment on the session in order to show their support and advocate for occupational therapy services that could be of great benefit to people who access mental health services in the United States. Part of being a successful therapist is being an advocate for the profession, and what better way to promote OT than participating in this crucial political event!

Here is the background on the event, straight from AOTA’s website:

In April, Congress passed the Protecting Access to Medicare Act (H.R. 4302), which established a “Demonstration Program to Improve Community Mental Health Services.” This demonstration program will expand access to quality mental and behavioral health services by establishing federally certified community behavioral health clinics (CBHCs). The demonstration will initially establish CBHCs in eight states through a competitive process, but could eventually CBHCs could be in all 50 states.

This fall, the Department of Health and Human Services (HHS) and the Substance Abuse Mental Health Services Administration (SAMHSA) will be writing the rules that define what mental health services and supports will be provided by these federally supported CBHCs. SAMHSA will be holding a listening session to help them establish the criteria for staffing, services, payment and coordination of care at the CBHCs.

For those not able to attend and comment in person, there is also the opportunity to provide comments in writing. Written comments will be considered just as important as verbal comments during the listening session.

We have been told by SAMHSA that it is important to have a strong demonstration of support for the inclusion of occupational therapy through comments and at this listening session. The development of these criteria is a watershed moment for occupational therapy’s inclusion in quality, community-based mental health services.

And according to SAMHSA:

By September 1, 2015, criteria will be published for state certification of participating clinics and guidance issued for participating states’ establishment of a demonstration Prospective Payment System for services. SAMHSA has the overall lead for the program and is responsible for the establishment of the criteria for the behavioral health clinics.

It is currently too late to register to attend or provide verbal commentary, but listeners and contributors will have until November 26 to submit written commentary, which will be considered just as important as the spoken comments listeners make. Unfortunately, I will be working for half of the day during the session, but I plan to wake up early and catch as much of it as I can before I have to leave!

 

At this point in history, occupational therapy has a chance to be included in landmark federal legislation that will have a great impact on American people living with mental health problems. It is absolutely crucial that we make our voices heard and take the time to support AOTA and the future of the profession in this endeavor, and I want to be sure I do my part!

AOTA has links to several resources that will prepare you to leave a well-written, OT-endorsing comment that will be reviewed by the SAMHSA team. Although the main (and most important) comment-writing document is for “members only,” there are still other helpful links here.

In case you don’t have time to click around and want to get straight to writing, I have compiled a brief list of tips and information from the AOTA and SAMHSA websites in order to streamline the process and hopefully make it that much easier for you to participate! (No excuses!)

Writing Comments

If you are an AOTA member, you can login and view their page of comment-writing tips here: http://www.aota.org/advocacy-policy/congressional-affairs/legislative-issues-update/2014/guidance-samhsa-comments.aspx.

In case you are not an AOTA member, I have included several of their most relevant and important points here to help you write commentary for the SAMHSA session. All information below is from the AOTA.

  • SAMHSA has provided “guiding questions” in a worksheet format to help structure your comments. Consider using the SAMHSA-provided worksheet, or write a letter using the worksheet as your guide.
  • Consider submitting comments on behalf of a larger group of occupational therapy practitioners. One letter could be sent from a facility, state association, or simply have a list of signatures from interested practitioners. The comments will count as if submitted by each individual, and this will make less work for SAMHSA. If submitting on behalf of a facility or association, be sure to mention how many practitioners or clients it represents. Get signatures from non-occupational therapy practitioners if relevant and possible.
  • Comment on as many of the guiding questions that you think are relevant, or on those of which you have expertise.
  • Instead of synthesizing your overall thoughts, comment on each question individually, even if this means repeating something you have already written. Comments will be collated separately for each section.

If you do write a comment, according to AOTA the most important thing to include is the following: Skilled occupational therapy should be a service available to clients on-site in CBHCs and occupational therapy practitioners (with their unique skill set that you will describe in your letter) should be a part of the staffing requirements.

Sending Comments

Each submission must include the Agency name (SAMHSA) and the docket number (2014-25822) for this notice.

Comments are due by 5 PM Eastern Time on Wednesday, November 26, 2014.

  • Email is probably easiest. Send your comments to section223feedback@samhsa.hhs.gov
  • If you would like to send comments by mail, hand delivery or fax, here’s how:
    • Mail: The Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, Room 6-1019. Attn: Certified Community Behavioral Health Clinic Comments
    • Hand Delivery or Courier: 1 Choke Cherry Road, Rockville, MD 20857, Room 6-1019 between 9 a.m. and 5 p.m., ET, Monday through Friday, except federal holidays.
    • Fax: 1-240-276-1930 Attn: Certified Community Behavioral Health Clinic Comments

Please help make a positive difference in the future of Americans living with mental health concerns and write a comment for SAMHSA by November 26! And please comment and let me know if you do!

AOTA Hill Day 2014: Part II

For more information about planning for Hill Day, including information and advice about travel, lodgings, discounts, and things to do, check out my first post here.

This picture of the first and second year students from my program was featured on AOTA's Facebook page when they achieved their advocacy goal after Hill Day!

This picture of the first and second year students from my program was featured on AOTA’s Facebook page when they achieved their advocacy goal after Hill Day!

I had a great time last week at AOTA’s 2014 Hill Day, and I’ve finally found a moment to write up the second half of my blog post about the weekend we spent on Capitol Hill! Here are the rest of the conclusions I came to after actually attending Hill Day, for the reference of all future attendees!

  • Dress like you mean it. While it’s not necessary to buy a brand new business suit for the occasion, Hill Day is all about making an impression. And you want it to be a great impression! So no flip-flops, short skirts, cleavage-baring tops, exposed midriffs, etc. It seems like this should go without saying, but not all of the (mostly students, but some others as well!) attendees seemed to have gotten that memo. Dress in business casual clothing, at least.
  • For real, wear comfortable shoes. Riding the metro, walking across the Hill and traveling around town is super tiring! For your sake and the sake of those who will be dragging you and your bloodied feet back home if you decide to wear your brand new loafers or unbroken-in Louboutins, definitely wear shoes you can walk in.
  • Be prepared, but also be flexible. I went into the office with our representative’s assistant all ready to direct the conversation and deliver my super amazing elevator speech, but when I asked if she knew what occupational therapy was, the woman said, “Oh yes! I spoke with you guys last year!” and proceeded to speak candidly and knowledgeably on all the topics we planned to address. Womp womp. Still, I had to go with the flow, even if it meant not using my speech and taking my turn.
  • Develop and practice your “What is OT” elevator speech, even if you don’t plan to use it. While I was hanging out with my classmates on the Sunday before Hill Day, I called up a friend who lives in D.C. and asked her to hang out with us since I don’t get to the capital very often! When we finally got together, I had to explain what we were doing. After my spiel about the important of political advocacy and AOTA Hill Day, my friend says, “So…if, hypothetically…I didn’t know what occupational therapy was…” and looks to me to provide a definition of our my profession. Little did I know that I would be using my elevator speech to describe my profession to a good friend, but there I was!The moral of the story is, be prepared to speak briefly, clearly and purposefully about occupational therapy to anybody you might encounter while you’re on the Hill – you never know who you’ll see and you’ll want to be prepared! Hill Day is great practice for advocating to the “big dogs,” but it’s important – maybe more so – to be able to inform “laymen” as well.
  • Present what you learned. When you return from all of the exhausting Hill Day activities, make it a point to inform your classmates and other students in the program about what you did! The rush my classmates and I got from going to D.C. was amazing, but not everybody in a program will be able to go. So take good notes, make a brief presentation or prepare a short speech, and spread the word about why advocacy matters and what Hill Day is doing for the profession and the people we serve!
  • Participate in the AOTA Virtual Hill Day if you can’t make it to D.C. Although meeting with representatives in person is important, so is the difference you can make by sending in a letter outlining your support for the legislation and changes AOTA is advocating for! Please take a moment out of your busy life to support the profession and make your voice heard. Use the links and information at the AOTA’s Legislative Action Center to find out who your representatives are, what their policies are and send a letter to them making important issues like the therapy cap and occupational therapy’s inclusion in mental health legislation known. http://capwiz.com/aota/home/
    If this link is no longer working, just Google “AOTA Virtual Hill Day” to find everything you need to advocate from the comfort of your own home!

Hill Day was an amazing, empowering experience that helped me bond with my classmates, learn more about the political process and ultimately deepen my understanding of the many ways in which occupational therapists work to serve the public and the greater good. Ultimately, AOTA achieved their goal for sponsors of the bill, and you can read about this great success here! I definitely hope to attend again next year, and I hope anybody who went this year learned as much and had as great a time as I did!

Have you ever been to D.C. for Hill Day? Do you have any advice for veteran or new Hill Day attendees?

AOTA Hill Day 2014: Part I

Monument Jumping Pic

My classmates and me jumping for joy at the Washington Monument for AOTA Hill Day 2014! (Photo Credit: Hanna L.)

It’s Sunday night in DC, and I’m sitting here in my hotel room anxiously awaiting Monday morning. Why, you ask? Because tomorrow morning I’ll be sitting in my senator’s office, giving my one-minute elevator speech about OT and asking for his support for legislation that will benefit occupational therapy practitioners and clients!

In essence, OT Hill Day is very important day for political action, education and advocacy and it involves hundreds of OT students, supporters and practitioners from across the country. On one day, we all descend upon the capital and attend meetings with state representatives to encourage their support of various bills, amendments and laws that are related to occupational therapy practice. Two of this year’s major issues are the Medicare therapy cap and occupational therapy’s inclusion in the recent Excellence in Mental Health Act, both of which my classmates, colleagues and I will be addressing during our meetings.

In this post, I’ve written several tips that anyone interested in attending Hill Day in the future might find helpful. Most of my tips are geared toward students, but perhaps seasoned practitioners or others who have never attended a Hill Day event will find them useful as well.

Cutting Costs

  • Riding up with my classmates was not only a great way to cut the cost of gas, but to get to know everybody! We do spend a lot of time in class together, but I have certainly gotten to know my classmates on a much more personal level after spending 4-6 hours in a car with them.
    • Some schools may also let you rent a van to drive groups to various events. If this is something you might need to do, start the process EARLY and carefully consider whether or not you will actually save.
  • Ask your department for help. Our department is very generously providing $600 for our group of students to stay and eat in D.C. There are 11 of us altogether, so this doesn’t cover the cost of everything, but it definitely helps! Talk with your department director, graduate funding office, or other resources to see if money is available for students traveling to conferences, events, etc. Additionally, try searching your school’s website for travel funding or grants that you can apply to the cost of your trip.
  • Check Groupon or LivingSocial for savings on hotels, meals, travel and attractions. Before your trip, take a while to peruse these websites for deals. We booked our hotel through Groupon and got free parking and wifi included when it would have cost us extra to access these services with a regular reservation.
    • Staying outside the city (in places like Arlington or Alexandria, for example) is MUCH cheaper than staying in hotels in D.C. Book these places first!
  • Consider staying with local friends and family. Instead of getting a hotel room for several nights, ask if you can stay with friends and family who live close to D.C. If you do stay, they might also appreciate a small thank you card or gift when you leave.
  • Take advantage of free things! Why pay to go to a show or attraction when D.C. has plenty of amazing free museums, events and things to do? Just look up a city guide or check out the website to find hundreds of free things to occupy your time.
  • Plan ahead for meals. My classmates packed a large cooler and bags full of portable, filling snacks like nuts, granola bars, rice cakes and fruit that they could eat during the day so they weren’t constantly spending money on food. They even packed pre-made sandwiches and snack baggies for lunch during our daily outings! Not purchasing lunch at expensive food carts, attraction restaurants or chain restaurants saved us a great deal during the 3 days we were in D.C.

Before Arriving

  • Do your homework. Make sure you take some time as a group or on your own to research your representatives and learn about their stances on the issues you’ll be discussing with them. Being prepared means that you can be less nervous!
  • Check, re-check and DOUBLE CHECK your itinerary! We received multiple emails from AOTA and the Hill Day organizers detailing our daily schedules and when our meetings with our representatives would take place. But just three days before Hill Day happened, we got a revision of our meeting schedule that added another visit to our list. Check your email frequently, and be sure you know what to expect for your day on the Hill.
  • Ask your department leaders if you can briefly present about your experiences upon your return. As a Hill Day participant, you have a lot of valuable information that your classmates who were unable to attend may not be able to get from anywhere else. For example, you can describe what it was like in the meetings, what you would do differently in the future and things you enjoyed about your day spent advocating for OT in D.C.! If you can, take notes during your day to keep your commentary fresh in your mind.
  • Designate a trip photographer or two. Virtually everybody has a smart phone nowadays, so elect one or two people from your group to be the official photographers. Taking pictures of your group for posterity can be a great way to advertise your program, advocate for occupational therapy and remember the great time you had!

I hope these tips are useful and that you can save a few dollars and have a better time in D.C. as a result of my advice.

I’m currently off to bed to get ready for a long day tomorrow, but I’ll be back soon with a post-Hill Day post chronicling my grand adventure on the Hill!

Have you ever participated in AOTA Hill Day or other political advocacy efforts? Do you have any advice for talking to legislators?