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#154 OT as Mental Health Providers with Halley Read · OT Potential Podcast | Occupational Therapy CEUs

0:00
SPEAKER_00: For as long as I've been an OT, I've been hearing about occupational therapy's advocacy to be recognized as behavioral health providers.
0:09
SPEAKER_00: This is frankly a little confusing since OT has deep roots in mental health care, and many of us became OTs because of the unique way the profession holistically considers mental health and physical health together.
0:24
SPEAKER_00: But things become even more confusing when you start to dig into what exactly it means to be recognized as a mental health provider.
0:32
SPEAKER_00: What doors does this open to us?
0:34
SPEAKER_00: What is the current patchwork of states ruling on this?
0:38
SPEAKER_00: And what is our desired future here?
0:40
SPEAKER_00: There is no better person to speak to these questions than Hallie Reid.
0:45
SPEAKER_00: Hallie is the lead author on occupational therapy, a potential solution to the behavioral health workforce shortage.
0:52
SPEAKER_00: Her paper gets at exactly the right question.
0:55
SPEAKER_00: Why are we limiting the mental health workforce when mental health workers are so desperately needed?
1:02
SPEAKER_00: This course is intended for occupational therapy professionals to help us understand the situation, but also for our fellow members of the healthcare team to understand what OT can contribute and what policy changes would let us work in our full scope.
1:19
SPEAKER_00: We have a lot to cover today, so let's dive in.
1:25
SPEAKER_00: Welcome to the OT Potential Podcast.
1:28
SPEAKER_00: I'm your host, Sarah Lyon, OTRL, and I wanted to let you know that this podcast may qualify as continuing education for you.
1:36
SPEAKER_00: You are probably listening to this podcast on a free podcast platform, but to gain CEU credit, you will need to be a member of the OT Potential Club, our OT Continuing Education platform.
1:48
SPEAKER_00: You can go to OTpotential.com to learn more.
1:52
SPEAKER_00: Okay, here we go.
1:55
SPEAKER_00: As I mentioned at the top, joining us today is Hallie Reid, PhD O T R L F A O T A.
2:03
SPEAKER_00: Hallie is a mental wellness occupational therapist, servant leader, and social change agent based in Portland, Oregon.
2:10
SPEAKER_00: As a mental health occupational therapist, Hallie has worked with people across the lifespan living with serious mental health challenges.
2:18
SPEAKER_00: Now, as a passionate educator and researcher in full-time academia, her research and capstone coordination are driven by a commitment to equality, recovery, human rights, and advocacy.
2:31
SPEAKER_00: Mental health is a community and public health imperative.
2:35
SPEAKER_00: With a PhD in translational health sciences, Halley uses knowledge translation, implementation science, and the OT scope to help understand how we bridge the gaps between recovery and the care we deliver in mental health care in sustainable and cost-conscious ways.
2:52
SPEAKER_00: So without further ado, we will patch Hallie into our live studio.
2:56
SPEAKER_00: Welcome, Hallie.
2:57
SPEAKER_00: It's so great to have you today.
2:59
SPEAKER_00: Hi, thanks for having me.
3:01
SPEAKER_00: I am thankful you are here to talk about this really complex topic.
3:07
SPEAKER_00: Usually I'm really excited for the topic.
3:10
SPEAKER_00: I'm excited for this one, but I'm also a little annoyed because I love having podcasts about best practices, about new evidence.
3:20
SPEAKER_00: But the topic we're talking about today is unique because in mental health, we have this long history in mental health.
3:28
SPEAKER_00: We have done the hard work of it, it's in our scope of practice at the state level.
3:33
SPEAKER_00: We are trained in mental health and we have all this awesome evidence that we could be talking about.
3:40
SPEAKER_00: But the reason it's not getting into practice is at our policy level and it's at our reimbursement level.
3:48
SPEAKER_00: So unfortunately, that is what we have to spend our time in on today, even though it's going to be a great uh discussion.
3:55
SPEAKER_00: I'm excited for us to make progress in this area.
3:59
SPEAKER_00: Before we get to these like details, we just all need to understand and be talking about.
4:06
SPEAKER_00: I just want to hear about your story.
4:08
SPEAKER_00: Like, you are a mental health OT.
4:11
SPEAKER_00: Only 3% of us get to that status here in the United States.
4:16
SPEAKER_00: Tell me about your journey into OT and mental health.
4:20
SPEAKER_01: Sure.
4:20
SPEAKER_01: Well, thanks again for having me.
4:22
SPEAKER_01: And hello, everyone.
4:23
SPEAKER_01: You know, I first learned about occupational therapy, uh, working as an in-home behavior therapist for autistic children and their families post-getting my bachelor's degree.
4:32
SPEAKER_01: And what I saw was an early venture, early intervention occupational therapist come in and meet a child where they were at, down on the floor playing.
4:40
SPEAKER_01: And it felt so natural and seemed so um focused on meeting them where they're at and coming alongside.
4:46
SPEAKER_01: And so I wanted to know more about that and be in that professional place.
4:51
SPEAKER_01: And so I started studying what is OT and trying to understand.
4:55
SPEAKER_01: Um, and upon entering an OT program, my first class was OT for mental health, and I knew I had found where I was supposed to be.
5:04
SPEAKER_01: I had always been interested in working with people's mental illness.
5:07
SPEAKER_01: I thought about psychology, psychiatry, counseling, all those things.
5:12
SPEAKER_01: The thing that made OT unique in learning about it was that we helped people do the living, regardless of why living is hard.
5:19
SPEAKER_01: And the folks that in my personal life or that I knew that had mental illness often felt cast aside.
5:26
SPEAKER_01: So it was great to be in a place finding a professional home where I could work with people, you know, who had mental health and mental illness challenges.
5:36
SPEAKER_01: So I think it was really just meant to be in serendipitous.
5:39
SPEAKER_01: And I think ultimately working in mental health practice at a community level has made me the advocate that I am.
5:47
SPEAKER_01: So much of mental health care, along with all health care, is determined by policy.
5:51
SPEAKER_01: And that's a long marathon of a fight.
5:54
SPEAKER_01: And so knowing the systems that we work in, regardless of practice setting, will make you a better practitioner because then you'll know how to change it.
6:05
SPEAKER_00: I'm like you.
6:06
SPEAKER_00: I entered OT with an interest in mental health.
6:10
SPEAKER_00: I remember looking at two programs I was looking at, one in Chicago and one in New York.
6:14
SPEAKER_00: And the Chicago one was very orthopaedic focus.
6:17
SPEAKER_00: And I remember reading about like the community mental health offerings at the New York program, and I'm like, that's where I'm going.
6:24
SPEAKER_00: And then it took me a couple of years of practice, but I finally got to my ideal setting, which was in an acute psychiatric hospital where honestly, I was under this like bundled payment, and it was by far the easiest uh like reimbursement landscape to navigate.
6:41
SPEAKER_00: Like once there are jobs in the space where you get in there, and the reimbursement landscape is frankly more easy than some of our other settings.
6:52
SPEAKER_00: I have so many questions to ask you.
6:56
SPEAKER_00: As I'm saying, I've only experienced like a tiny sliver myself of OT and mental health.
7:02
SPEAKER_00: There's so many ways that OT and mental health can show up across the country.
7:06
SPEAKER_00: Um, you wrote this amazing paper that came out, I think, in 2024, called Occupational Therapy: A Potential Solution to the Behavioral Health Workforce Shortage.
7:21
SPEAKER_00: This is a really great paper that anyone can go read.
7:25
SPEAKER_00: It outlines our status across the United States, where the challenges are, where we're limited.
7:32
SPEAKER_00: How did this paper come to be?
7:34
SPEAKER_00: How did you go from working as a mental health OT to writing this uh really needed paper?
7:42
SPEAKER_01: I think it really started with finding a community of folks and a network across the country of OT practitioners facing the same challenges.
7:50
SPEAKER_01: Um, so other OTs and OTAs who worked in community mental health or other levels of mental health care in this country who had the same passion of whether or not the story continues that we shouldn't be at these tables.
8:02
SPEAKER_01: We want to carve out that space for us.
8:05
SPEAKER_01: And so um, some years ago, I started partnering with occupational therapists around the country who specialized in early intervention for psychosis care, just like myself.
8:17
SPEAKER_01: And out of that came a research collaborative, people who really wanted to build the evidence base and argue the case for occupational therapy to be included on early intervention for psychosis programs.
8:30
SPEAKER_01: And so what came out of that was a community of, you know, advocates and and fighters like myself to make space for us.
8:38
SPEAKER_01: And an opportunity arose to write that policy forum in psychiatric services.
8:44
SPEAKER_01: And so often, what I have heard is that there's a shortage of behavioral health workers, we need to train more, we need more.
8:52
SPEAKER_01: And I was sitting here saying, Well, we're available, why aren't you using us?
8:57
SPEAKER_01: And so also honestly, it was a way to use the platforms and the journals and spaces academically to say we could help and we're not being asked or seen as the part of the solution.
9:12
SPEAKER_01: And so that paper really came out of kind of that why and that motivation to say, here's how we can support you, and here's how we're trained, and here's how we have been advocating for change and the need to change policy to make it more available to us, using states like the one I live in as an example, or Illinois as another example.
9:32
SPEAKER_01: Um, there are unique cases around the country of how having certain billing statuses has have helped, but also that truly, Sarah, was a call to action for those who are not in our profession to see us as a value add and not uh a competitor.
9:51
SPEAKER_00: I've read this paper maybe 10 times over the years.
9:54
SPEAKER_00: It's one that I just go back to.
9:57
SPEAKER_00: Um, I think every OT should read it.
9:59
SPEAKER_00: It's a pretty easy read in terms of uh, or the length isn't too long, it's very achievable.
10:06
SPEAKER_00: I will have this paper in our show notes for people at OT Potential.
10:10
SPEAKER_00: We are also working on a blog post that um will come out by the time this uh comes out as a podcast by the end of the week.
10:18
SPEAKER_00: So for our live audience, you should see it by Friday.
10:21
SPEAKER_00: And it will kind of it will also outline like state by state where we're at in being recognized as this qualified mental health uh provider.
10:33
SPEAKER_00: I want to drill a little just into the phrase qualified mental health provider, because it's kind of it's a nuanced phrase, um, even though I say it all the time, like I'm still learning what it means because it means something different in each state.
10:50
SPEAKER_00: I want to bring in a question or a comment from um our comment section to kind of help us get at what it means.
10:59
SPEAKER_00: Someone is in our comments saying that they have worked in OT and mental health for over 30 years, but they cannot bill OT if the diagnosis is a mental health diagnosis.
11:13
SPEAKER_00: They can only bill if it's an IDD, if it's um an intellectual disability diagnosis.
11:20
SPEAKER_00: So they end up giving away just a lot of services for free.
11:24
SPEAKER_00: Tell me about what it means to be a qualified mental health practitioner, as well as you can state by state, um, and how it might help this person in the comments if we could achieve this status.
11:38
SPEAKER_01: Yeah, that's an excellent question.
11:40
SPEAKER_01: And uh thank you for 30 years of service to this part of the profession.
11:43
SPEAKER_01: It means a lot.
11:44
SPEAKER_01: I don't take lightly that I stand on the shoulders of some giants that have been doing a lot of work.
11:50
SPEAKER_01: It will vary state by state.
11:51
SPEAKER_01: And the main reason is that qualified mental health professional status or practitioner status is typically tied to Medicaid.
11:59
SPEAKER_01: And Medicaid is that public health insurance uh that was originally designed for children and for those, you know, under the poverty line.
12:06
SPEAKER_01: And so in states like Oregon, where I live, that status in the law has made it so that certain licensed professionals can bill as qualified mental health professionals in the fee-for-service system that is Medicaid.
12:23
SPEAKER_01: Now that varies state to state because not every state sees an OT or an OTA as a qualified mental health provider.
12:31
SPEAKER_01: And in some states, they may be limited by other things related to how much Medicaid expansion they have, how much Medicaid dollars they get from the federal government, those kinds of things.
12:43
SPEAKER_01: But overall, kind of generally, that qualified mental health professional status in states where it is tied to mental health care, which it sounds like for our guests, that's not the case.
12:55
SPEAKER_01: It allows me as an OT to bill for codes that are related to psychological services, group therapy, um, independent skills training, those kinds of things.
13:05
SPEAKER_01: And it puts me in the same arena as those that are counselors, social workers, psychiatrists, those kinds of things, and allows me to provide services for an agency to the clients that have mental health and be reimbursed for that time.
13:23
SPEAKER_01: But, Sarah, I am not at the same time billing those typical rehabilitation occupational therapy codes that many of us are so familiar with.
13:31
SPEAKER_01: And that again is because we we have a true divide between our physical health system and our mental health system.
13:37
SPEAKER_01: And that is even more true for those who are below the poverty line, have high social determinants of health, and require Medicaid coverage, right?
13:46
SPEAKER_01: Kind of those indigent populations that much of the state dollars go to covering their services, not private insurance, not Medicare.
13:55
SPEAKER_01: So yeah, I'm I'm also capped at not being able to bill for physical rehabilitation codes if I'm working with an adult in the community with schizophrenia who also has an upper extremity injury or has, you know, a foot injury.
14:08
SPEAKER_01: There's only so much that I can do as well.
14:13
SPEAKER_00: Oh, I have so much to say about that.
14:15
SPEAKER_00: First, I just need to say out loud the division is absolutely ridiculous.
14:21
SPEAKER_00: I think that when I was on um a mental health team, I felt like one of my big strengths was having a background in physical rehab.
14:29
SPEAKER_00: And I was like, how are these mental health teams functioning without someone with my background?
14:34
SPEAKER_00: Because no one has one set of problems typically.
14:38
SPEAKER_00: Usually they're uh a physical uh rehab thing and a mental health component in one person.
14:46
SPEAKER_00: So that just that division is so ridiculous.
14:50
SPEAKER_00: I do want to repeat back what you said as clearly as I can because I'm still working on understanding it.
14:58
SPEAKER_00: When we are looking to be recognized as uh mental health providers, we are saying we still want to build or we are still providing occupational therapy.
15:10
SPEAKER_00: We aren't becoming social workers, we aren't becoming um counselors, we're looking to provide occupational therapy in certain state programs, though, being recognized allows us.
15:24
SPEAKER_00: This status allows us to use a code set related to mental health conditions through which we can build occupational.
15:32
SPEAKER_00: We're still doing occupational therapy, but we're using a different code set.
15:37
SPEAKER_00: There's okay, so that's one yes.
15:39
SPEAKER_00: And then there's a whole other side of it where I've also heard of just like outpatient OTs who um say they want to provide OT related to a sleep condition, but the main diagnosis is a psychiatric one.
15:55
SPEAKER_00: And even though like there's great evidence behind that kind of OT intervention, insurance just says, no, you're an OT and physical rehab, you can't bill with a psychiatric condition.
16:10
SPEAKER_00: Yes.
16:11
SPEAKER_00: Yeah, okay.
16:13
SPEAKER_00: So they're kind of the two buckets, and getting the status would one just like help us bill really clearly under these Medicaid programs, and then would help our advocacy to commercial insurances that for some reason would sometimes say no to us uh based on diagnosis alone.
16:32
SPEAKER_01: I think that yes to some degree.
16:34
SPEAKER_01: I think what the QMHP status has allowed for those states that have had it for a long time, for example, Oregon, Illinois, is you see a higher concentration of OT practitioners working in community mental health and then taking that experience and doing things like private practice or building larger teams of OTs and OTAs to do this work.
16:58
SPEAKER_01: I in no way would say that becoming a QMHP solves all of our problems.
17:04
SPEAKER_01: But sometimes you know, you got to get in the arena and play the game that's happening.
17:09
SPEAKER_01: And I think if that opens up a door, that leads to more potential doors that we could open.
17:16
SPEAKER_01: Versus some of the states where, for example, they did not take the Affordable Care Act expansion, they have very limited mental health services, let alone access to occupational therapy as a service in rural parts of their state or anywhere.
17:31
SPEAKER_01: And so, you know, it's just a way to get in the arena and help those that we want to help.
17:38
SPEAKER_01: So I'll say that.
17:39
SPEAKER_01: The other thing I'll say is that the lack of parity is a real challenge because we have hundreds upon thousands of papers that say, for example, sleep and lack of sleep will impact your mental health.
17:55
SPEAKER_01: But we don't have a healthcare system that reimburses for the integrated needs that people have.
18:02
SPEAKER_01: And so we are forced to pick a side.
18:06
SPEAKER_01: Now that's not true in every state.
18:07
SPEAKER_01: I realize that, but in some in more cases than not, you are going to have to work extra hard in our profession to be able to provide care for something like the area of occupation of sleep because it's due to a psychiatric condition, because for so long the psychiatric space has been owned by diagnoses and codes related to those.
18:33
SPEAKER_01: Right.
18:33
SPEAKER_01: So there it's just it's it's a mess and it's gonna take a long time to change.
18:38
SPEAKER_01: But I think what I want the listeners to hear is that I didn't stop being an occupational therapist because I was a QMHP.
18:49
SPEAKER_01: If anything, it gave me the ability to use occupational therapy in places where it wouldn't have been available otherwise and operate at the top of my license and the top of our scope because we are mental health professionals by training.
19:07
SPEAKER_00: I'm going to say this list out loud a little earlier than I was expecting because um I'm seeing a lot of questions related to it in the comments.
19:16
SPEAKER_00: Um, and I think it will segue us next night or nicely into my next question.
19:22
SPEAKER_00: I have this list of 12 states that do recognize OT as mental health providers.
19:28
SPEAKER_00: They all have different names for that, but the 12 states are Illinois, Maine, Michigan, Missouri, Montana, North Dakota, Oregon, Pennsylvania, Tennessee, Virginia, Washington, and Wisconsin.
19:50
SPEAKER_00: Does that sound right to you?
19:52
SPEAKER_01: Yes.
19:53
SPEAKER_01: It's also grown in the time I've been doing this profession, so that's exciting.
19:57
SPEAKER_00: Yes, yes.
19:58
SPEAKER_00: Um, so we have those 12 states where we are recognized.
20:02
SPEAKER_00: There's three more gray states where we're like, kind uh there's some level of recognition, but not fully.
20:10
SPEAKER_00: And those are California, Indiana, and Minnesota.
20:15
SPEAKER_00: That's kind of the status of where we are.
20:17
SPEAKER_00: My question for you is what has changed since you wrote this paper in 2024?
20:24
SPEAKER_00: It feels like every year something's changing.
20:26
SPEAKER_00: How, what logistically has changed, and are you thinking about anything differently?
20:30
SPEAKER_00: Or are you just like, we're fighting the same fight?
20:33
SPEAKER_01: I think we're fighting the same fight with maybe some nuanced differences.
20:37
SPEAKER_01: I think at the time that that paper was written by myself and my colleagues, we didn't have states like Washington or even the opportunity to have that kind of status in California.
20:49
SPEAKER_01: Those major advocacy wins were happening at that time or came after in terms of being documented.
20:55
SPEAKER_01: And I know the fight in California was decades long to get into that status that they do have.
21:04
SPEAKER_01: Um, and Washington was also, you know, a challenge and a fight too.
21:08
SPEAKER_01: And so I think what I'll say is that there have been more discussions, you know, at a national level, and I think more recognition that that is an opportunity we could have.
21:20
SPEAKER_01: But also, you know, at the same time that myself and others have been pushing this argument or taking this fight on, we have a changing and rapidly changing healthcare system.
21:32
SPEAKER_01: And so that changes the conversation or how you might advocate for things.
21:38
SPEAKER_01: Um, I'm seeing more and more folks go different routes to make their services reimbursed, which I think are innovative, creative, and uh take opportunity, take a chance to make an opportunity out of a very chaotic situation and make our services available to people.
21:56
SPEAKER_01: You know, partnering with organizations through grant dollars.
21:59
SPEAKER_01: Uh start.
22:00
SPEAKER_01: Starting a private practice where you do fee for service or private pay, you know, those kinds of things, which still fills a gap.
22:07
SPEAKER_01: And so I think there have been changes, but I think one of the biggest things that still needs to change is a full recognition by ourselves, us as individual OTs and OTAs, that we are mental health clinicians to some degree, regardless of where we practice.
22:25
SPEAKER_01: And I realize that that's a big ask and that practice settings dictate a lot of what we do.
22:31
SPEAKER_01: But at the end of the day, you said it so beautifully, Sarah.
22:36
SPEAKER_01: I wanted to be able to operate both in the physical health and mental health space on my mental health care team in that job.
22:43
SPEAKER_01: And there was, there was a distinct line in the sand.
22:46
SPEAKER_01: But if someone is in your emergency room who maybe is houseless and has long-term chronic mental illness, but the reason they're there is because they have an infection in their foot.
22:57
SPEAKER_01: What other profession is better trained to live in those gray areas and span all those areas of occupation to help that person not come back in the hospital, not have infection cause delirium, all of those things.
23:09
SPEAKER_01: And so I think one of the reasons this paper was so important too was that it was a call to action for us as a profession to also see like, even if I cannot bill for that service that I did that was psychosocial in nature, because I did that service, it makes the physical rehab code I did bill for more likely to have a long-term impact on this person's life.
23:34
SPEAKER_00: That's so well said and so helpful.
23:40
SPEAKER_00: I wonder, sorry, I have to keep recapping because this is so complex.
23:46
SPEAKER_00: So we have the status of qualified mental health provider, practitioner.
23:53
SPEAKER_00: It's literally different in each state.
23:55
SPEAKER_00: Again, I'll have the blog post where the precise name is with each date.
24:00
SPEAKER_00: This status uh typically opens the door to um community-based services covered by Medicaid.
24:09
SPEAKER_00: Even if your state was not on the list of states that I read where we have that status, to your point, that doesn't mean there aren't OTs working specifically in mental health.
24:19
SPEAKER_00: They might be grant-funded, they might be at a hospital with bundled payment, they might have an innovative private practice.
24:27
SPEAKER_00: I think in all 50 states, mental health is clearly in our scope of practice.
24:32
SPEAKER_00: So there are OTs doing it.
24:34
SPEAKER_00: And to your other point, um, there are acute care therapists, there are school school therapists, there are outpatient therapists that are drawing on this mental health training all the time, but they may not be fully able to capture it in our code set because um, again, the world is so divided into physical rehab and mental health.
24:56
SPEAKER_00: So we're doing it everywhere, the degree to which it's explicitly recognized and then reimbursed for specifically by Medicaid, are kind of the nuances that we're talking through.
25:08
SPEAKER_00: Is that all accurate?
25:10
SPEAKER_01: Yeah, I think you did a great job.
25:12
SPEAKER_01: One other thing I want to say too, to that is that true to kind of, I think, the nature of politics in this country, the more there's a momentum at a state level, the more you can see a change and a tipping point at the federal level.
25:24
SPEAKER_01: If we have more and more states who open that door for us, we are more likely to see occupational therapy listed as a behavioral health profession at a national level so that this conversation can stop, right?
25:36
SPEAKER_01: Because CMS is often setting the trends and setting the rules that all private insurers follow.
25:43
SPEAKER_01: So if we could get to a world in which we are written into a national health core definition of what a behavioral health provider is, we could the landscape of mental health care in this country could change.
25:57
SPEAKER_00: There are a couple things related to this topic that I want to be sure to say out loud, and I want to hear how you say them.
26:07
SPEAKER_00: What is the unique value that OTs bring to these mental health teams?
26:13
SPEAKER_00: Like, say you're talking to someone at a state or federal level, and they're like, we already have these different behavioral health care workers, we have social work, we have counselors.
26:24
SPEAKER_00: Why OT?
26:26
SPEAKER_00: Why should we be recognized on these teams?
26:29
SPEAKER_01: Yeah, that's a great, great question.
26:32
SPEAKER_01: I think one way is that we think in a systems approach.
26:38
SPEAKER_01: And I realize that's true of a lot of professionals, whether they're social workers, counselors, psychiatrists, but we also think about systems within systems.
26:46
SPEAKER_01: And what I mean by that is the human in front of us is a system that is constantly changing and it exists within an environmental system that dictates more about its performance and its livelihood and its fulfillment than the illness itself.
27:01
SPEAKER_01: So we're not reductionist in nature.
27:04
SPEAKER_01: And so if we can see the whole person as a system that's impacted by the factors of the various environments it lives in every day, we naturally and automatically become stigma busting as a profession.
27:18
SPEAKER_01: And what I mean by that is we're not going to diagnose you with an illness.
27:22
SPEAKER_01: We may say your performance is not what it could be, but performance can change if things can adapt in the person, if things can adapt in the task, activity, or occupation itself, and more importantly, in the mental health space, if the system can change.
27:41
SPEAKER_01: Your whole life can change.
27:43
SPEAKER_01: And I think there's three major uh ways we do that sensory processing and sensory health.
27:50
SPEAKER_01: I don't know of any other professionals steeped in it like us.
27:54
SPEAKER_01: They may stake a claim and they may study it, but we make sensory health functional for people and help them self-advocate for systems and environments to change so that they can get their sensory processing needs met.
28:10
SPEAKER_01: So that's one.
28:11
SPEAKER_01: I think the other one is cognition and functional cognition.
28:15
SPEAKER_01: Yes, uh, there are people who do cognition, speech and language pathologists, you know, functional cognition, psychiatrists, whatever those terms may be.
28:24
SPEAKER_01: We take the cognition and see if it actually helps someone live in the community, engage in their life, and problem solve ways to engage fully, even if their cognition is a problem.
28:38
SPEAKER_01: And with things like bipolar disorder, schizophrenia, it is a processing challenge for many of them.
28:44
SPEAKER_01: And so, how can we teach them to adapt their environment, the way they approach their occupations, and how they think of themselves so that their cognition is the most functional it can be?
28:57
SPEAKER_01: And I think last but never least, and I think undervalued the most, is our cross-practice setting training in human development.
29:07
SPEAKER_01: I understand that there are professionals in neurodevelopment and professionals who are developmental psychiatrists, but I was trained in IDEA.
29:16
SPEAKER_01: While I never worked in a school, I could support a client who may have had an IEP or a 504 plan because I understood that practice setting.
29:25
SPEAKER_01: I can take what's happening at home and in the community and bring it to an IEP team in a way no other provider on their mental health care team can really do.
29:35
SPEAKER_01: And so I think those three special things add a value that maybe we don't talk about enough or that we don't see um highlighted enough, but we really can fill in those gaps that exist between these systems.
29:51
SPEAKER_01: You know, I used to tell a lot of the referring clinicians in my days in mental health-based practice all the things you're doing in that clinical office, I'll make sure they happen where they work, where they live, where they sleep, where they engage in public transportation.
30:08
SPEAKER_01: You know, if you want them to not need you anymore, I can help with that because I'll translate it out into the real world and they will feel better and live happy lives.
30:20
SPEAKER_00: I've been working on this um language in my own mind of uh like dividing talk therapy with doing therapies.
30:30
SPEAKER_00: Like that's the simplest way I can think of like thinking of the sessions my patients used to go to.
30:36
SPEAKER_00: Most of them were talk-based, and they would love to get to OT because we were going to do something typically and practice the skill.
30:44
SPEAKER_00: Like we're going to practice what you just learned in the talk therapy and reinforce, reinforce it.
30:50
SPEAKER_00: And it really does work so well when we get to team up like that.
30:56
SPEAKER_00: Yeah, it just works.
30:58
SPEAKER_00: It's awesome.
30:59
SPEAKER_01: What we can do because we are trained as in occupational therapy is going to be so much more powerful because we can do talk therapy while engaging in the doing of life.
31:11
SPEAKER_01: Problem solving becomes reality for people when they can practice it while facing a real world problem that in their life, not because they talked about it for 30 minutes in a therapy session.
31:23
SPEAKER_01: I mean, in even in my own life, it was better when there was not just learning, but there was applying and debriefing and then revisiting it when I tried it at home by myself.
31:36
SPEAKER_00: Thinking in a slightly different direction, again, of something that I think is important to just say out loud, and I want to hear how you say it.
31:46
SPEAKER_00: Back when I was young and naive and just in OT school, and we talked about evidence-based practice all the time.
31:55
SPEAKER_00: I thought that is what dictates what happens in the world.
31:59
SPEAKER_00: Like we look at, I thought we looked at where the evidence was, and then that's what got done.
32:05
SPEAKER_00: Are OTs not in mental health because we don't have the evidence base?
32:12
SPEAKER_01: I would say no.
32:14
SPEAKER_01: I don't think it's that simple of an answer.
32:16
SPEAKER_01: In my career as an occupational therapist who's very passionate about mental health practice, I have seen firsthand in the world of early intervention for psychosis in this country an exponential growth in the availability of these programs.
32:33
SPEAKER_01: And it was because of where money went, not necessarily evidence.
32:37
SPEAKER_01: So Congress funded mental health block grants, right?
32:41
SPEAKER_01: At the time that we had that large NIMH study about the RAISE project about how to combat early on in someone's journey with schizophrenia, the conversion rate to long-term challenges, right?
32:56
SPEAKER_01: What that means is that where the money flowed, programs were created because the opportunity provide was available.
33:04
SPEAKER_01: I don't think the argument can stand anymore that we don't have the evidence base because we also have the evidence to show that we need a workforce.
33:17
SPEAKER_01: And that evidence is that we don't have enough.
33:20
SPEAKER_01: And we have ample evidence to show that our profession impacts recidivism rates in hospitals, whether that's physical health related or not.
33:29
SPEAKER_01: But I have to imagine that if the people discharged from inpatient stays don't go back to the hospital, it's because they feel better about themselves, they have wellness and they can handle their everyday life.
33:38
SPEAKER_01: And that's all mental health related.
33:40
SPEAKER_01: May not be documented that way, but that is what's happening.
33:44
SPEAKER_01: So I think it's time for the argument that we don't have evidence to not kind of dictate everything we do, and for us to demonstrate what we can provide mental health care and those teams and those clients using what we know.
33:59
SPEAKER_01: Our evidence base is what we have been trained in doing.
34:03
SPEAKER_01: Therapeutic use of self, areas of occupation.
34:06
SPEAKER_01: That that is enough for you to claim stake.
34:10
SPEAKER_01: And I think, yes, research is very, very important, but the amount of time and money it takes to get research out into the world is one of the challenges we face.
34:20
SPEAKER_01: And you know, we we will see and have seen rapid change, not only because of a seminal article on some research project, but because money went somewhere and opportunity was capitalized on.
34:50
SPEAKER_00: I have early psychosis coming up, like so many interesting papers for us to draw on.
34:57
SPEAKER_00: And just in general, just therapeutic alliance alone, we know is a main driver of outcomes for multiple kinds of therapists.
35:08
SPEAKER_00: Like we just know that that is one of the things that works, and we know we're going to bring that to these relationships.
35:13
SPEAKER_00: So all kinds of interesting evidence to uh draw from.
35:17
SPEAKER_00: I totally agree that is not the thing holding us back here.
35:23
SPEAKER_00: We have been talking about policy, kind of high-level about evidence and our place on the team.
35:33
SPEAKER_00: Can you just tell me some stories of where this is working or interesting stories you know?
35:41
SPEAKER_00: Um, I feel like all the OT and mental health stories I know are in hospital settings because of that nice bundled payment reality.
35:48
SPEAKER_00: What stories do you know?
35:50
SPEAKER_01: Yeah, that's a great, great question.
35:52
SPEAKER_01: Um, I think this question and its answer may get back to your prior question about what's changed since that paper.
36:00
SPEAKER_01: Um, I speaking of the early intervention for psychosis paper, that that guest that you have coming onto your podcast, Sarah is a really good friend and colleague of mine.
36:08
SPEAKER_01: And she I think she is a living example and testament to the power of occupational therapy providers in leadership roles in mental health services.
36:19
SPEAKER_01: She works for an early intervention psychosis program based out of Stanford, and her team has done incredible work.
36:26
SPEAKER_01: Um, so I think one thing I would say to answer your question is that we are natural-born leaders and do well with program development and program evaluation.
36:35
SPEAKER_01: So we should step into those roles more often.
36:37
SPEAKER_01: And where you see that being successful is quite often in private practice, you know, mental health-oriented services where people have a unique and interesting idea and they want to bring it to life.
36:48
SPEAKER_01: Another example are all of the early intervention for psychosis occupational therapy practitioners I know well in the state of Oregon.
36:57
SPEAKER_01: They are caring for young people at one of the most scary times of their life, and they are going on to do some of the things we all wanted to be able to do as young adults, go to college, graduate high school, get a job, while also dealing with something like a psychotic disorder.
37:14
SPEAKER_01: And that's really, really, really powerful, speaking of evidence-based, because one of the largest economic drains on a country's GDP is long-term serious mental illness.
37:27
SPEAKER_01: And they're stopping it in its tracks as best they can.
37:30
SPEAKER_01: And I think that's pretty powerful stuff.
37:33
SPEAKER_01: Um, another example is a really good colleague and friend of mine based out of St.
37:38
SPEAKER_01: Louis, Missouri, who started her own private practice called Qualified Therapy Solutions.
37:42
SPEAKER_01: Quinn Teminski worked for years with people who are homeless and houseless, trying to break those vicious cycles.
37:48
SPEAKER_01: And she had a unique and brilliant idea of how to build her own business by coming alongside agencies and demonstrating the value of OT and offering them, you know, a bundled package.
37:58
SPEAKER_01: And it's changed the landscape there.
38:01
SPEAKER_01: And I think it's a really innovative model.
38:04
SPEAKER_01: And I think the other example I'll give is, you know, recently in the last few years, we have seen legislative and policy change allowing for school-based clinicians to bill Medicaid dollars.
38:14
SPEAKER_01: Well, occupational therapists and occupational therapy assistants are trained in the things that would help kids, you know, avert some of the trauma that's in their lives and overcome some of those ACE scores and really benefit from the learning and engaging in school.
38:32
SPEAKER_01: And if, you know, we have so many school-based practitioners that make up our profession, I think that's a huge opportunity.
38:39
SPEAKER_01: And I know in some states that's happening, which takes me to the last thing I'll say, and it's been around for a very long time is Dr.
38:46
SPEAKER_01: Susan Basic's work of every moment counts.
38:49
SPEAKER_01: That after-school program model has exploded and changed a lot of lives.
38:54
SPEAKER_01: And I think that's another thing that we provide is we are prevention and promotion experts too, without really knowing it.
39:01
SPEAKER_01: And so if you can work with a child or a group of children and they become empowered and more resilient to navigate, you know, their tricky lives, they're more likely to go on and have fulfilled lives.
39:13
SPEAKER_01: And so I think those are the examples I think of when you ask that question.
39:18
SPEAKER_00: I love hearing about all those.
39:20
SPEAKER_00: I can't wait to go Google them for listeners too.
39:24
SPEAKER_00: We also just talked about in neurodiversity affirming care for adults, uh, Spectrum Psych, which is a private pay option, uh, which kind of shows you what that option can look like that's based in California.
39:38
SPEAKER_00: I'm really having to use my imagination here for what these making progress in these areas would look like.
39:49
SPEAKER_00: And I feel like I, even though we've been talking for almost 40 minutes, I still need you to help help me paint the picture.
39:58
SPEAKER_00: I'm currently in Nebraska.
40:01
SPEAKER_00: We're not on that list of 14 uh recognized states.
40:05
SPEAKER_00: So all the OTs that I know in Nebraska work at hospitals, they work in these bundled payment settings.
40:13
SPEAKER_00: If by some miracle Nebraska was like, oh, OTs are recognized as these qualified, I know we have our own term, but this bucket of qualified mental health practitioners, what kind of work might I see an OT doing in the community?
40:29
SPEAKER_00: Uh, just paint me the picture of how that might change.
40:32
SPEAKER_00: Um, that's a great question.
40:35
SPEAKER_01: Um, I think you could see uh community mental health agencies that are, you know, run at a county level or um a nonprofit organization that has community mental health services.
40:47
SPEAKER_01: Let's say, for example, permanent supportive housing.
40:50
SPEAKER_01: It's a very common practice at a community level.
40:53
SPEAKER_01: You could see an occupational therapy professional providing groups on a daily basis to people on things like managing their own apartment, conflict resolution, paying their bills on time, shopping for healthy food on a fixed income, you know, how to navigate the world that they find themselves in in a way that they still feel purpose, meaning, and fulfillment.
41:16
SPEAKER_01: Um, I think you could see uh OT professionals doing a consult model where they perform the evaluations, they write up the results and they inform the team of how they interact with folks, you know, or they hire OTAs and the OTAs provide that ongoing treatment and the OT provides the evaluation and consultation.
41:37
SPEAKER_01: I think you could see more engagement of OT professionals because they had that status in the policy world.
41:44
SPEAKER_01: I really meant what I said about mental health practice making me an advocate.
41:49
SPEAKER_01: You learn the system because there's so many needs that aren't getting met, and you have a knack or desire to fill in those gaps.
41:57
SPEAKER_01: And I think working down at the community level with people, you'd see more OT professionals engaged in legislative policy work or engaged in advocacy, um, those kinds of things.
42:09
SPEAKER_01: I think you also would see more of that everyday word of mouth of how OT helped someone's child who was dealing with really hard, tough symptoms with ADHD or was struggling with um substance use disorder.
42:26
SPEAKER_01: And now OT is more sought after because it helps somebody they know in their in their community.
42:32
SPEAKER_01: Because that's what's happened here in Oregon.
42:34
SPEAKER_01: You know, it's more and more people are asking how do I get OT services for my 18-year-old who doesn't really have this or doesn't really have that, but really would benefit from those services.
42:44
SPEAKER_00: I love hearing all those examples.
42:47
SPEAKER_00: I can see those needs, I can see how helpful it would be to have a more clear person to call to help meet them.
42:56
SPEAKER_00: I'm going to link this to a question, but I would I remember working at skilled, a skilled nursing facility where you're working with both Medicare and Medicaid.
43:04
SPEAKER_00: People are leaving.
43:05
SPEAKER_00: And I just remember being like, oh, I wish there was an OT I could call, either during a transition, but just to run by some of the mental health components of what I'm seeing.
43:17
SPEAKER_00: Um, I think that person would be busy all day if they were open to getting these calls from skilled nursing facilities.
43:24
SPEAKER_00: One of the questions in the comments is Are these services able to be provided virtually?
43:31
SPEAKER_00: I know that's a really nuanced, I know off the top of my head, I know a lot of mental health OTs in the private pay area that provide virtual services.
43:39
SPEAKER_00: What's your answer to that question?
43:42
SPEAKER_01: Yeah, that's a great question.
43:43
SPEAKER_01: You know, I'm not as familiar with telehealth as a practice setting just because I did so much in person and really pre the COVID pandemic, when in person was kind of the only option.
43:55
SPEAKER_01: I really think that pandemic changed the way we think about delivering care.
44:00
SPEAKER_01: I will say I think the best place for therapeutic use of self from our profession is in community in real time with people.
44:10
SPEAKER_01: But not to say that there aren't successful models, particularly like a consultant model, where our way of thinking, our scope of practice really could inform a whole organization's approach, a whole nonprofit's approach, or, you know, um a consult model where you've performed an evaluation in real time and you're going over the results.
44:32
SPEAKER_01: Um, I think telehealth is one of those things that it needs to be an informed decision between the client and their provider team of what works best for them.
44:42
SPEAKER_01: And it doesn't always necessarily have to be in the way we think of telehealth, like you and I right now on this live webinar.
44:48
SPEAKER_01: Maybe there's more of a digital health approach that should be taken, especially with young adults.
44:53
SPEAKER_01: I worked with them a lot.
44:55
SPEAKER_01: And, you know, we would sign releases that would give us permission and they would allow us to text them because that's just the way they live their lives, is through digital things.
45:05
SPEAKER_01: And so I think that's something to be tapped into.
45:09
SPEAKER_01: Um, and I think that telehealth is something right now in this country that's probably providing our professional services to more people than we would be able to without it because of the lack of presence in rural health, for example.
45:24
SPEAKER_01: I mean, it it's something that's like vital.
45:29
SPEAKER_00: We've been talking a lot about this complete patchwork of 50 different states, literally with different language.
45:39
SPEAKER_00: Like this feels like the most patchwork of all of our state by state issues.
45:44
SPEAKER_00: Talk to me for just a couple of minutes about the federal level.
45:50
SPEAKER_00: I know you alluded to it, but I wanted to say it like together out loud.
45:54
SPEAKER_00: We have this Mental Health Parity Act.
45:56
SPEAKER_00: Would that solve our problems?
45:59
SPEAKER_00: What's when you think federal level advocacy, what do we need there?
46:06
SPEAKER_01: That's something that I have been thinking about probably since 2015.
46:10
SPEAKER_01: I um was in the Emerging Leaders Development Program for the American OT Association, and I was very fortunate enough to have Heather Parsons as a mentor in that program, and she is the current legislative affairs uh director for AOTA.
46:24
SPEAKER_01: And something that I know has been a long fight that changes every Congress is recognition of occupational therapy in kind of those national healthcare definitions that are used broadly with, you know, HERSA, SAMHSA, um, AHRQ, all of those kind of national think takes and funders and organizations that do this kind of funding and work.
46:52
SPEAKER_01: And that we just don't have it yet.
46:54
SPEAKER_01: We have it in places, but we don't have it fully.
46:57
SPEAKER_01: And I think the other reality is that we, as the clinicians and providers, once we do have to have that kind of designation, have to hold people accountable and say, like, you're not using us the way you could in this state.
47:12
SPEAKER_01: Um, because it once it's in law, that doesn't mean that that becomes everyday life.
47:16
SPEAKER_01: Yes, right.
47:18
SPEAKER_01: And and I I think something that could really change that is just an ought not giving up this fight.
47:26
SPEAKER_01: You know, I know I realize it's hard and I know burnout is so real.
47:30
SPEAKER_01: Um, but a world in which we could practice in anywhere we want, regardless of reimbursement structure at the top of our scope, like that's a dream.
47:41
SPEAKER_01: And so that's what keeps me fighting this on.
47:45
SPEAKER_01: And, you know, more and more I think to be in healthcare as a provider is also to be an advocate and a leader in some way, shape, or form.
47:53
SPEAKER_01: And there's a lot you can do with that, even if it's not big roles and big, you know, statuses that you have, but the everyday care you provide and the questions you ask your leadership, you know, those are the things.
48:05
SPEAKER_01: But a federal definition would change the funding landscape in a way that I don't think we've quite seen yet, because we could have providers get loan forgiveness, right?
48:18
SPEAKER_01: We could have workforce training grants more available.
48:21
SPEAKER_01: Um, we could get the seed funding we need to start a program in our communities where we see a need.
48:28
SPEAKER_01: And um, I think just like a state movement trickles up, a federal movement trickles down.
48:38
SPEAKER_00: Our mental health parity act, which is uh I just hear about on the regular, that is about recognizing OT.
48:48
SPEAKER_00: It's not about adding new billing codes, or it's mostly like an educational act almost.
48:57
SPEAKER_00: Like is that.
48:58
SPEAKER_01: Yeah, honestly, I'm not I'm not as versed in that either.
49:01
SPEAKER_01: What I know to be true is that there is the mental health parity act that occurred in the last decade.
49:06
SPEAKER_01: And that was like at a federal level, you need to see mental health and physical health care service delivery and reimbursement the same.
49:15
SPEAKER_01: But true to all federal law, it rolls out differently state by state.
49:19
SPEAKER_01: Yep.
49:20
SPEAKER_01: And that's just the way our country is set up.
49:23
SPEAKER_01: And I'm not really sure we have time to get into how that could be different or better, right?
49:27
SPEAKER_01: Yep, yep.
49:28
SPEAKER_01: Um, the OT Mental Health Parity Act, and I may not be saying that right, is something that I know has been lobbied for by AOTA, and there have been some key players at a con congressional level that have signed on to that.
49:41
SPEAKER_01: But again, you know, pulling from my schoolhouse rock knowledge, what becomes a bill and then makes it into committee and then comes out of committee to be then voted on as a law.
49:52
SPEAKER_01: So many things happen in that lifeline of something that it may never ever become real.
49:58
SPEAKER_01: But it doesn't mean it gets forgotten.
50:00
SPEAKER_01: It can be brought back up.
50:02
SPEAKER_01: There can be new sponsors of something.
50:04
SPEAKER_01: So yeah, I think you know, tracking that is also a full-time job, and I understand that.
50:09
SPEAKER_01: But yeah, um, yeah being aware of those things can help you understand the opportunities in front of you, I think.
50:17
SPEAKER_00: Yep.
50:18
SPEAKER_00: Yep.
50:18
SPEAKER_00: Yeah, we have this mental health parity bill before Congress.
50:22
SPEAKER_00: And then what you were saying earlier, when there is a behavioral health definition with CMS, with different programs, the more we can advocate to be included in those definitions.
50:34
SPEAKER_00: Uh, that would be a huge win.
50:36
SPEAKER_00: And the two levels of win might inform the other.
50:38
SPEAKER_00: Like if we could get the Mental Health Parity Act, that might help us get um our names in these definitions, or vice versa.
50:45
SPEAKER_00: And then that all hypothetically helps us at our state advocacy and commercial insurance advocacy.
50:53
SPEAKER_01: Yeah.
50:53
SPEAKER_01: Yeah.
50:55
SPEAKER_00: We have spent all this time talking about OT in the US.
51:00
SPEAKER_00: I just want to spend, I didn't leave enough time for this, but let's just spend two minutes saying just your high-level takeaways of where we're at globally.
51:11
SPEAKER_00: I'm just I'm particularly interested in are we laggards or are we leaders in mental health?
51:18
SPEAKER_00: Like, where do you see us as an OT profession here in the United States?
51:24
SPEAKER_01: You know, I think at any moment we're probably both of those things.
51:27
SPEAKER_01: You know, I think as leaders, it's in the way that we have a national professional association that really is supporting our profession and fighting for us at various tables, whether it's mental health or something else.
51:40
SPEAKER_01: I've heard that from my international colleagues a lot, just about kind of the power that exists in this country because of things like AOTA, NBCOT, those kinds of things.
51:51
SPEAKER_01: And there's a large educational pipeline.
51:53
SPEAKER_01: You know, my colleagues in Canada, there's like seven or eight, and that's it.
51:57
SPEAKER_01: But where we're maybe a laggard is in the OT profession as researchers in mental health.
52:06
SPEAKER_01: There aren't a lot of people like me.
52:09
SPEAKER_01: And I think that that is also just because we have a different healthcare system and we have a different funding structure.
52:17
SPEAKER_01: The two names I go to a lot are Canadian-based, and that's Dr.
52:20
SPEAKER_01: Sky Barbock and Dr.
52:21
SPEAKER_01: Carrie Ann Marshall.
52:23
SPEAKER_01: Um, Sky Barbock is an occupational therapist, but she's also the head scientist for Foundry BC, and that's a youth wellness hub-oriented program that is all over that province and was funded by the Canadian government.
52:35
SPEAKER_01: And it's youth-built, youth-centered, youth-designed, and it's all about helping youths avoid substance use and mental health and get their needs met because they are a unique part of our population.
52:47
SPEAKER_01: And that's really an international movement all over.
52:50
SPEAKER_01: There's Headspace and Australia and Origin.
52:52
SPEAKER_01: Um, and then Kirrianne Marshall is a big, big name in um homelessness and research on houselessness and how it impacts people and their occupations.
53:03
SPEAKER_01: And so those are two people that I've worked with a lot and learned from a lot.
53:07
SPEAKER_01: But, you know, in other countries like Australia, the UK, Ireland, New Zealand, people know what OT is by age six.
53:16
SPEAKER_01: I mean, I'll never forget Neil Harvison, the interim CEO of AOTA, saying at a conference once, like, I knew what an occupational therapy professional was by age six.
53:24
SPEAKER_01: I have a five-year-old daughter, she doesn't know what that is.
53:28
SPEAKER_01: And so, you know, it's a household name in some places, which means it's more present.
53:32
SPEAKER_01: And occupational therapy is used in different ways.
53:34
SPEAKER_01: There's a lot more of OTs and those professionals doing case management in other countries.
53:39
SPEAKER_01: So I think it's just we're leaders and we're laggers, and that's true of other countries too.
53:44
SPEAKER_01: It's a both and, unfortunately.
53:46
SPEAKER_01: Mm-hmm.
53:48
SPEAKER_00: Yeah, there's a lot of inspiration when you look around the globe at what's going on.
53:53
SPEAKER_00: But to your point, we can't underappreciate some of the things that we do have in the United States that are big assets for us.
54:00
SPEAKER_00: I feel like we've done a pretty good job talking about how kind of scattered this front is and what that we're looking at, these state by state uh, I want to say battles, state by state advocacy efforts.
54:15
SPEAKER_00: Um, and there's a couple different federal ones.
54:18
SPEAKER_00: But as I'm listening, I think it's good we've covered how scattered it is.
54:24
SPEAKER_00: I want to hear what's the one thing I can do?
54:27
SPEAKER_00: Like if you could simplify it for me as a professional, wanting to get this movement moving forward.
54:33
SPEAKER_00: What do you say to the people listening?
54:36
SPEAKER_01: I would say that it's important to remember that you are an occupational therapy professional first and foremost, and that qualifies you to work for and support the mental health outcomes of your clients, regardless of practice setting and regardless of reimbursement.
54:52
SPEAKER_01: That would be the one thing I would say.
54:54
SPEAKER_01: And that you should talk about yourself and demonstrate that as such to your friends, family members, students, if you're an educator, your research colleagues.
55:05
SPEAKER_01: You know, it is who we are.
55:07
SPEAKER_01: And I want to see the practice setting not dictate what OT is more and more in the future.
55:17
SPEAKER_00: And I will have this blog post for people.
55:21
SPEAKER_00: Like, to me, this is a hard area to get educated, or I've thought of it as a hard area, but it's also achievable.
55:29
SPEAKER_00: Like you can learn about your state, you can learn about your setting.
55:33
SPEAKER_00: Like, you don't need to learn about the other 49 states.
55:36
SPEAKER_00: Like, learn about yours, yes, um, your state and your setting and what you can do and can't do, and tell those stories and write to decision makers at your state and at the federal level.
55:48
SPEAKER_00: Yeah.
55:48
SPEAKER_01: We've touched that.
55:50
SPEAKER_01: Oh, yeah, go ahead.
55:51
SPEAKER_01: I was gonna say, Sarah, call on people like you and me.
55:53
SPEAKER_01: Like, I didn't get here overnight, and I'm always a resource and more than willing to answer an email or take a Zoom call or respond to a text.
56:00
SPEAKER_01: It's not, no one does this by themselves.
56:03
SPEAKER_01: And so reach out to those who maybe have that bandwidth or have that professional place where they can do those things because you don't need to do it all.
56:16
SPEAKER_00: We've covered so many things today.
56:18
SPEAKER_00: You've been so generous with your time and walking us through this.
56:22
SPEAKER_00: Um, again, I just keep calling it a scattered landscape.
56:25
SPEAKER_00: But what's the final thought you want to leave us on today?
56:29
SPEAKER_01: I just want to say thank you to you and your podcast team and also the folks that signed on for the live webinar.
56:36
SPEAKER_01: I think it means that you care about this and you want to see it change just like me.
56:39
SPEAKER_01: And so remember you're not alone and you know, don't be afraid to take an opportunity to innovate, even if it feels chaotic.
56:48
SPEAKER_00: Well, Holly, thank you so much for being here today, for sharing with us, for breaking down this complex topic.
56:57
SPEAKER_00: Uh, I hope there's so much more to come in this conversation, and we're just kind of dropping in in the middle of this long ongoing conversation.
57:05
SPEAKER_00: And I know there's more to come, but yeah, thank you for being here and for just sharing what you've learned with us.
57:11
SPEAKER_01: Yeah.
57:12
SPEAKER_01: Thank you so much for having me.
57:13
SPEAKER_01: It's been a lot of fun.
57:17
SPEAKER_00: Thank you for joining us on the OT Potential podcast.
57:21
SPEAKER_00: To earn one hour of AOTA approved continuing education for your time today, you will need to sign in or sign up at otpotential.com.
57:30
SPEAKER_00: Once you're in the OT Potential Club, you will find a five-question post-course quiz connected to this episode.
57:37
SPEAKER_00: When you pass the quiz with a score of 75% or higher, you will be able to download a PDF certificate that certifies your completion of this course.
57:46
SPEAKER_00: Okay, I want to thank you for joining us today, and we'll see you next time.