Becoming an Advocate
By Catherine Nettles, Occupational Therapy Student, Brenau University, Georgia, State and Federal Affairs Intern
The author (right) with Senator Johnny Isakson (R-GA).
What is advocacy and how can occupational therapy practitioners promote the well-being of the profession, clients, and themselves?
This was one of the many questions I had when I started my 2006 summer internship at the American Occupational Therapy Association (AOTA). Interning at AOTA allowed me to search for and find the answer to this question as well as many others. I gained valuable knowledge that I will use as I complete OT school and develop my professional occupational therapy career. Splitting my time between the State and Federal Affairs units provided me with an opportunity to witness and be a part of advocacy at both the state and national levels.
Advocacy at the State Level
The AOTA State Affairs Group works closely with state occupational therapy affiliates and state OT regulatory boards to monitor state laws and regulations that affect the profession and advocate for appropriate language-consistent with AOTA standards and policies-that will allow occupational therapists and occupational therapy assistants to exercise the full and appropriate scope of occupational therapy practice.
Every state regulates occupational therapy through a state regulatory agency or board. Some regulatory boards are combined with other professions and/or function under a medical board. Board members are occupational therapy practitioners and public or consumer members. There is usually an executive director who oversees the board from an administrative standpoint, lawyers who advise the board, and other staff who assist with administrative functions.
The board is responsible for licensing (or otherwise regulating) occupational therapists and occupational therapy assistants, and implementing the regulations. The focus of the board is consumer protection, not protection of the profession.
In many states, the regulatory board and the state association work closely together because the state association brings members' concerns to the board regarding regulation of the profession, and may provide information and expertise in specific areas of practice. They may also work collaboratively on legislative proposals.
I attended four state regulatory board meetings with Karen Smith, AOTA State Affairs Regulatory Associate, in Virginia, Maryland, Pennsylvania, and Washington, DC. We attended the meetings as representatives of AOTA and provided input on specific agenda topics such as continuing competence, supervision, or other laws or regulations governing the practice of OT. We often provided the board members with resources such as charts of state statutes and regulations related to a specific topic or issue.
While working in State Affairs, I learned ways that occupational therapy practitioners can affect the state regulatory system. Occupational therapists and assistants can get involved with their state association as a legislative chairperson or committee member who monitors proposed revisions to state statutes and regulations. Also, the governor usually asks the state occupational therapy association to provide a list of occupational therapists (and in most cases occupational therapy assistants) who would be assets to the regulatory board and, from those names, the governor appoints OT practitioners to the board.
At the state level, occupational therapy practitioners can use grassroots efforts, including writing letters to state congressional members, making in-person visits to state offices, and helping political action committees make donations to congressional members who support occupational therapy as avenues to advocate.
Advocacy at the Federal Level
As for advocacy from the federal perspective, AOTA is also working to ensure that occupational therapy is included in health and education legislation aimed at a variety of populations. The goal of the Federal Affairs group is to protect occupational therapy's current scope of practice while, at the same time, pursuing emerging areas in which occupational therapists can provide their unique services.
My personal federal advocacy experience started the second day I was at AOTA. I attended a fund-raiser sponsored by the American Speech-Language-Hearing Association (ASHA) for California Congressman George Miller, the senior Democrat on the House Committee on Education and the Workforce. Miller is a strong supporter of the No Child Left Behind Act (NCLB), which sets high expectations for student learning and holds schools accountable for teaching students. Children with disabilities are ensured the opportunity of a public education that supports their needs in order for them to develop knowledge and skills. This law is up for reauthorization in 2007; therefore, amendments can be made.
I accompanied former AOTA Federal Affairs Representative Leslie Jackson to this fund-raiser where she was the lucky one who sat next to the congressman. This meant that she had the chance to discuss the importance of occupational therapy services in the school system. Because this was my first experience on "the Hill," I was amazed at the process of lobbying-there were multiple organizations at the fund-raiser explaining why their specific group was of value.
My next visits to Capitol Hill involved attending coalition meetings with Leslie. Coalitions are important at the national level because there is power in numbers. I represented AOTA at the National Alliance of Pupil Services Organizations (NAPSO), the Consortium for Citizens with Disabilities (CCD), and the Council for Exceptional Children (CEC) meetings. The topics of discussion included the Individuals with Disabilities Education Act (IDEA) and Medicaid.
In each of these meetings, I learned of the collaboration that goes on at the federal level. Organizations come together to lobby on broad common issues, while simultaneously focusing to promote their particular group's unique role and specific needs for legislative lobbying.
These advocacy experiences helped prepare me for my ultimate advocacy experience while at AOTA-meeting with the staff of my three legislative members, to discuss occupational therapy in my home state of Georgia. This was a great experience, but it took preparation.
AOTA lobbyists Tim Nanof and Daniel Jones helped me get ready for the meetings by giving me talking points on legislation regarding the Therapy Cap Exceptions Process and Medicaid funding. The goal of my meetings with Don Greene, the Health Legislative Assistant for Congressman John Linder; Hagan Sanders, the Health Legislative Assistant for Senator Johnny Isakson; and Monty Philpot, the Health Legislative Assistant for Senator Saxby Chambliss was to thank them for supporting an extension of the exceptions process for the therapy caps until 2007. I also asked my representatives to not support any more cuts in Medicaid funding because of concerns about the effect on community-based occupational therapy services.
In addition, I talked to them about the number of people who suffer from abuse, homelessness, addiction, and mental health disorders in the state of Georgia and how occupational therapists are helping them. I explained the need to expand occupational services for these populations in order to have an effect at the systems level by reducing the number of unemployed, homeless, welfare, and incarcerated persons. I spent between 30 and 45 minutes with each staff person talking about the importance of occupational therapy and the profound effect it could potentially have at the community level.
My experience at AOTA confirmed for me the importance of being a passionate advocate for occupational therapy. Although it can be a slow and time-consuming process, it is critical that occupational therapists, occupational therapy assistants, and students learn to advocate for the profession. If you don't do it, no one will.
At AOTA, I learned what it truly means to be an occupational therapist. An occupational therapist is not just a clinician, but also a researcher who uses evidence-based knowledge; a critical thinker who always incorporates meaningful occupation into the therapy process; and an advocate for clients, the occupational therapy profession, and himself or herself. I am excited that I can take my AOTA experience back to school and share it with others.
I encourage all occupational therapy students to consider spending time at AOTA!