03-02-04 - Statement on Suicide Prevention and Youth
Statement for the Record
Before the Subcommittee on Substance Abuse and Mental Health Services, U.S. Senate Committee on Health, Education, Labor and Pensions Hearing on Suicide Prevention and Youth: Saving Lives
March 2, 2004
The American Occupational Therapy Association (AOTA) submits this statement for the record of the March 2, 2004, hearing. We appreciate the opportunity to provide this information regarding the relationship of occupational therapy services to meeting the needs of children and youth with mental health needs and who are at risk for suicide. It is critical for Congress to be aware of issues regarding America's public health needs so that it can develop appropriate national policies to meet society's needs. The topic of this hearing is critical to the development of a better, clearer picture of how to address the growing problem of youth suicide.
Issues related to mental health needs in this country have been clearly articulated in numerous sources, including the 1999 Surgeon General's report on mental health and the 2003 report of the President's New Freedom Commission on Mental Health. These include problems in the service delivery system, shortages of service providers, negative public attitudes about mental illness, and barriers to early identification, screening, and access to services and appropriate treatment. Data from the Centers for Disease Control and Prevention (2000) indicates that suicide is the third leading cause of death among youth, 10-24 years of age. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMSHA) reports that 36% of youth who are at risk for suicide (out of nearly 3 million) receive any mental health treatment. Many of these mental services are provided in schools. This fact speaks to the need for schools to effectively utilize and train all school personnel to appropriately recognize and address children's mental health needs. Occupational therapy services can play an important role in this effort.
How Occupational Therapy Helps Address Children's Mental Health Needs
Occupational therapy is concerned about an individual's ability to perform everyday activities, or occupations, so that they can participate in school, at home, at work, and in the community. Occupational therapists and occupational therapy assistants provide critical services to and for children and youth in a variety of educational and community settings, who have a variety of educational, learning, and behavioral needs, including children that may be at risk for suicide. Occupational therapy practitioners use purposeful activities to help children and youth bridge the gap between their capacity to learn and full, successful participation in education, work, play, and leisure activities.
Occupational therapists look at the individual's strengths and needs with respect to daily life performance in school, home and community life, focusing on the relationship between the client and their performance abilities, the demands of the activity, and the physical and social contexts within which the activity is performed. In addition, each individual's occupational performance is viewed through a psychological-social-emotional lens. This perspective helps the occupational therapist to understand what is important and meaningful to the child as well as how their past roles, experiences, strengths, and patterns of coping work together to shed light on current issues and problems.
Occupational therapy intervention for children and youth emphasizes functional and readiness skills and behaviors, and includes consultation with parents and families, teachers, and other professionals. Services are directed toward achieving desired outcomes that were developed in collaboration with the family and other professionals.
In education settings, occupational therapists identify the underlying performance skills, including motor, process, communication, and interaction skills that impede the student's ability to participate in learning and other school-related activities. Intervention strategies and service models are designed to support desired educational outcomes, and may be provided individually or in small groups. The therapist also works with classroom teachers and the student's family to determine how to modify the home or classroom settings, routines, and schedules to provide structured learning opportunities and experiences to support the student's emerging skills.
Why Occupational Therapy?
Children and youth are being challenged by many societal factors and increasingly higher standards of educational performance and achievement. They may feel pressure from parents, peers, and others to behave in certain ways or to conform to certain expectations that may be in conflict with one another. Occupational therapy intervention for these students can emphasize new skills, behaviors and more effective ways to cope with these challenges. With its roots in mental health, occupational therapy practitioners can recognize a child's social and emotional skills and assess how well they match the demands of the environment.
Occupational therapy for children/youth at risk for suicide utilizes activity-based interventions that serve as the vehicle for enhanced self-understanding, provide a reality-based structure, and supports skill acquisition or enhancement. Services focus on mobilizing both internal and external resources that support the individual's self-understanding within the context of a safe, caring relationship. Intervention strategies address interpersonal communication and other social behaviors. Strategies include helping the child learn to manage and organize their behavior and classroom work space and environment, and to complete assigned tasks. Intervention may also address underlying sensory-motor concerns that affect the student's active participation in school activities.
AOTA believes that occupational therapy is an underutilized service that can meet and address the mental health needs of children and youth in schools and the community. Services for school-aged children are intended to help them succeed in school. Intervention strategies may focus on improving the child's information-processing ability, academic skill development, and ability to function in the school environment. For adolescents, occupational therapy focuses on preparation for work life choices, improvement of social and work skills, and learning how to create or adapt the environment to maximize productivity.
AOTA believes that many children and youth who could benefit from occupational therapy do not receive services, particularly those with mental health needs. This limited access affects both students receiving special education under the Individuals With Disabilities Education Act (IDEA) as well as students in general education. Often this limitation is due to a lack of understanding about how occupational therapy can help or because of perceptions that therapists only address "motor" issues. Occupational therapy training is comprehensive and covers physical, psychological, social, and pedagogical aspects of human occupation. Occupational therapy's understanding of human performance, or "do-ing," can be invaluable in helping parents and school staff to understand the relationship between the physical and psychosocial and how these factors support or impede children's progress.
What Is Occupational Therapy?
Occupational therapy is a vital health care service, designed to help individuals participate in important everyday activities, or occupations. Occupational therapy services address underlying performance skills, including motor, process, communication, and interaction skills to assist in the correction and prevention of conditions that limit an individual from fully participating in life. For children with disabling conditions and other educational needs, occupational therapy can help them to develop needed skills within the context of important learning experiences and to perform necessary daily activities such as feeding or dressing themselves and help them get along with their peers at school. Occupational therapy services can help identify strategies for teachers and families to use to facilitate appropriate reading and writing development.
Occupational therapy practitioners have the unique training to assist individuals to engage in daily life activities throughout the lifespan and across home, school, work, and play environments. Services may be provided during only one period of the child's life or at several different points when the child is having difficulties engaging in his or her daily school occupations, such as when they are faced with more complex demands in the classroom resulting from increased emphasis and reliance on written output. Occupational therapy services may be provided in the family's home, at school, and in the community, such as day care and preschool programs, private clinics, and vocational programs.
Occupational therapy evaluation determines whether an individual would benefit from intervention. The evaluation looks at the individual's strengths and needs with respect to daily life function in school, home, and community life, focusing on the relationship between the client and their performance abilities, the demands of the activity, and the physical and social contexts within which the activity is performed. The findings of the occupational therapy evaluation inform the team of the need for intervention. Occupational therapy practitioners use purposeful activities to help individuals bridge the gap between capacity to learn and full and successful engagement in work, play, and leisure activities.
For example, occupational therapy for infants and young children may include remediation of problem areas, development of compensatory strategies, enhancement of strengths, and creation of environments that provide opportunities for developmentally appropriate play and learning experiences. Services for the school-aged child are intended to help them be successful in school. Intervention strategies may focus on improving the child's information-processing ability, academic skill development such as handwriting, and ability to function in the school environment. For adolescents, the occupational therapy intervention focus is on preparation for occupational choice, improving social and work skills, and learning how to create or alter the environment to maximize their productivity.
Occupational therapy is a health and rehabilitation service covered by private health insurance, Medicare, Medicaid, workers' compensation, vocational programs, behavioral health programs, early intervention programs, and education programs. AOTA represents 30,000 occupational therapists, occupational therapy assistants, and students. We thank you, once again, for the opportunity to submit our comments for the record.
9/2/04