The Public Policy Environment

Why Public Policy Matters: Health Care Access

Insurance policies determine whihc services, medications, and providers are covered

Why Public Policy Matters: Occupational Participation

Policies influence employment, housing, transportation, and community engagement

Why Public Policy Matters: OT Advocacy

Practitioners work to address policy barriers affecting meaningful occupations

Understanding Policy Foundations: Public Policy

Government decisions that guide action

Understanding Policy Foundations: Laws

Legal frameworks that require or prohibit certain behaviors

Understanding Policy Foundations: Regulations

Detailed rules for enforcing laws

Understanding Policy Foundations: Politics

Activities and competing interests that shape government policy

Disability Rights and Access (ADA): Before ADA

Discrimination and inaccessible environments limited employment, transportation, education, and community participation for people with disabilities

Disability Rights and Access (ADA): After ADA

ADA established civil rights protections and requirements for reasonable accommodations and accessibility

Understanding Public Benefit Programs: Social Security Disability Insurance (SSDI)

Social insurance benefits based on work history and social security taxes paid

Understanding Public Benefit Programs: Supplemental Security Income (SSI)

Means-tested income assistance for eligible older adults and individuals with disabilities

Understanding Public Benefit Programs: Medicare

Federal health insurance for adults age 65 and older and individuals with qualifying disabilities

Understanding Public Benefit Programs: Medicaid

Means-tested health coverage funded jointly by federal and state governments

Mental Health Insurance Protections: Mental Health Parity

The MHPAEA addresses differences in out-of-pocket costs and treatment access between mental health, substance use, and physical health services

Mental Health Insurance Protections: Affordable Care Act

The ACA expanded coverage protections, including preexisting conditions, dependent coverage through age 26,and medicaid expansion options

Disability Civil Rights Legislation: Rehabilitation Act

Section 504 prohibits disability discrimination in federally assisted programs and activities

Disability Civil Rights Legislation: ADA

Prohibits disability discrimination across employment, government services, commercial facilities, telecommunications, and transportation

Disability Civil Rights Legislation: Olmstead Decisions

Affirms the right to live and receive services in the community instead of remaining unnecessarily institutionalized

Community-Based Mental Health Supports: Permanent Supportive Housing

Combining Stable housing with services that support independent living and community participation

Community-Based Mental Health Supports: Home- & - Health Community-Based Services

Provide individualized assistance with daily activities, routines, and community integration

Community-Based Mental Health Supports: Crisis Alternatives

Peer respite programs offer voluntary, short-term, community-based support during mental health crisis.

Addressing Policy Barriers via OT Intervention: Identify Occupational Barriers

Assess how insurance, transportation, or benefits
restrictions interfere with meaningful daily occupations.

Addressing Policy Barriers via OT Intervention: Support Functional Navigation

Practice completing forms, organizing documents, scheduling appointments, and communicating with service agencies

Addressing Policy Barriers via OT Intervention: Facilitate Community Access

Practice transportation planning, finding accessible resources, and requesting accommodations

Addressing Policy Barriers via OT Intervention: Use Compensatory Strategies

Introduce checklist, calendars, reminders, and simplified instructions for follow-through

Addressing Policy Barriers via OT Intervention: Collaborate and Advocate

Coordinate with SW, Case mangers, and community partners to address systemic barriers.

Translating Policy Knowledge into Occupational Practice:

• Identify policies affecting clients access to meaningful occupations

• Consider insurance, income, housing, and transportation during evaluations

• Help clients navigate benefits and community resources

• Advocate for accessible services and recognition of OTPs as qualified mental health and/or behavioral health providers

• Partner with clients to address systemic barriers to participations