Alison M. Cogan; Supporting Our Military Families: A Case for a Larger Role for Occupational Therapy in Prevention and Mental Health Care. Am J Occup Ther 2014;68(4):478-483. doi: 10.5014/ajot.2014.009712.
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More than 2 million U.S. military servicemembers have deployed to Afghanistan or Iraq since September 11, 2001. Unlike during prior conflicts, many servicemembers leave spouses and children behind. Long, multiple deployments cause strain on family at home, with new challenges arising when servicemembers return from combat and reintegrate into family and civilian life. In World Wars I and II, occupational therapy practitioners played a significant role in supporting servicemember reintegration. However, their presence in program delivery in this practice area is limited. Occupational therapy researchers and practitioners can make a valuable contribution by helping families tailor daily activities and routines to address challenges and optimize health and wellness. However, barriers such as reimbursement for services, workforce availability, and access to military families have limited the profession’s full engagement. Advocacy is needed to help establish occupational therapy as a key component of the mental and preventive health care teams serving military servicemembers.
Develop and test the efficacy of occupational therapy programs for military-connected families. The development of an evidence base for preventive and mental health practice with military families is critical to the profession’s ability to have an impact in this area. A lifestyle-based preventive program, similar to the complex, manualized intervention developed by Clark et al. (1997), could serve as a model for a family-centered program aimed at improving health outcomes and community reintegration. Alternatively, the process developed by Davidson and Radomski (2012) for helping individuals and families develop new habits and routines that align with their goals and vision for the future could be further researched and, eventually, widely disseminated. These intervention approaches provide a useful starting point for outcome studies. Such investigations may target military-connected personnel either with or without disabilities. Designated funding from the American Occupational Therapy Foundation (AOTF) to support such studies could help to promote this action.
Ensure that the identification of military status is standard in all occupational therapy evaluations. Efforts are underway in many school districts across the nation to identify children who are part of a military family. However, occupational therapy practitioners are likely to encounter military family members or veterans in almost any community practice setting who may not self-identify as being connected to the military. Practitioners should consistently inquire and subsequently document whether a person is military connected, adjust treatment accordingly, and be knowledgeable about what pertinent services are available locally.
Advocate for a larger role for occupational therapy in mental health. Coverage for occupational therapy interventions for mental health and preventive care, although negotiable, remains unclear under TRICARE insurance plans. This complication stems from the larger issue of diminished occupational therapy presence in mental health care over the past several decades. Because of the profession’s emphasis on everyday activity and work adjustment, occupational therapy services are unique and complement interventions offered by other mental health specialists. Acceleration of relevant research, expansion of student fieldwork opportunities in mental health, and growth of the workforce with expertise in provision of occupational therapy mental health services will enhance the effectiveness of advocacy efforts. Lobbying efforts by the American Occupational Therapy Association (AOTA) and the American Occupational Therapy Political Action Committee (AOTPAC) should continue to emphasize the profession’s role in mental health, such as the current initiative to build support for the Occupational Therapy in Mental Health Act (H.R. 1037).
Build understanding of the profession’s diverse scope of practice. Occupational therapy is well established in the military context as a rehabilitation provider for people with physical injuries and disability. This familiar perception of occupational therapy as unrelated to mental health can paradoxically be helpful for reducing stigma when services are accessed for a family-centered, occupation-based intervention aimed at promoting a family’s well-being through the reintegration process. However, the profession must first reach out to the military community and create widespread understanding of the breadth of occupational therapy services. Coordinated lobbying efforts to educate military and political leaders about the occupational therapy scope of practice would be effective strategy.
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