PTSD Cases Flood into the US... New Policy Needed!

Issue: PTSD Cases Flood into the US... New Policy Needed!

            According to the U.S. Department of Veterans Affairs, PTSD affects almost 31% of Vietnam veterans, 10% Gulf War veteran, and 11% Afghanistan veterans. These statistics were from 2009, however, there was an extensive scientific review done. This review revealed that there has been a dramatic growth in mental illness after 13 years of war. There was an increased by ten fold of the soldiers returning from war with PTSD in 2012 compared to 2004. In 2003, slightly more than 200,000 veterans from Iraq and Afghanistan were found to have service connected PTSD. In the last year, this number surpassed 650,000. Furthermore, many of these individuals with PTSD are said to not be receiving treatment. As occupational therapists we must advocate for these individuals so that they can be both diagnosed and treated.

You can find the article here: http://www.usatoday.com/story/news/nation/2014/06/20/ptsd-va-pentagon-scientists-institute-medicine/10764991/

Service Delivery:

The service delivery to address this issue involves both the health care system as well as the educational system. Educating different branches of the military about the risk factors and symptoms of PTSD can help to identify individuals who may be suffering and in need of assistance.

The health care system is clearly involved as the policy requires a change in the care received upon arriving home after war. In addition, the health care system needs to ensure that they have adequate staffing to account for the growing number of veterans they could potentially be seeing. Statistics say that patients wait an average of eight weeks to see a VA counselor for PTSD and 2 ½ before they are enrolled in treatment programs. Hopefully the health care system (VA in particular) can work on this to cut down the time veterans are waiting to receive treatment. The health care system has the potential to change the lives of the people who have put their lives on the line for our country.

The financial and funding systems will also be involved in delivering this policy. The Pentagon’s expenditures on PTSD grew from 30 million in 2004 to 300 million in 2012 and will need to continue to rise along side the increase in PTSD prevalence. All of these systems are involved in the service delivery of this proposed policy and cannot be possible without the other. In order for the health care system to improve, they will need to receive adequate funding.

Policy:

Policies exist that enable veterans with PTSD to receive disability benefits for treatment. However, a lot of veterans delay treatment for PTSD after retuning from war. When PTSD goes untreated, the ability to succeed in relationships and in performance at work or school can be affected. PTSD can also create stress related problems such as alcohol or drug abuse, gambling, or eating disorders.  With all of this in mind, action must be taken to create a new policy to help identify PTSD as early as possible so that veterans are able to seek treatment immediately.

The new proposed policy would require all veterans to be screened for PTSD upon return from war overseas. In addition, this policy would also require all veterans to be subsequently screened for PTSD annually. This would help to identify and diagnose PTSD as soon as they arrive back from deployment. In addition, the annual checkups would ensure to screen for any new PTSD symptoms.

In order to make this policy possible for all, these PTSD screenings should be free for all veterans as well as active military members.

Data:

The data that would be needed to support this policy is that the number of veterans coming back from war with PTSD has increased. In addition, it may be helpful to know how many veterans have PTSD but have delayed treatment due to not being diagnosed until long after their return. If we are able to show that individuals are coming back from war with PTSD and not being treated, we will demonstrate the need for this policy of mandated PTSD screenings. There would also need to be data that the high-quality care needed for these individuals would be accessible to them. If this policy is able to identify more veterans with PTSD, there must be a plan in place to treat all of these individuals. Without the ability to provide care for these individuals, this proposed policy will not have any impact on the treatment of PTSD in veterans.

Implications for OT:

Occupational therapy will be affected, as it is predicted that we will begin to see more individuals coming back from the ware with PTSD than ever before. As more individuals with PTSD seek treatment, there may be a higher demand for occupational therapists in the VA and areas that have a high population of veterans. PTSD symptoms can severely impact social and occupational performance. As occupational therapists, our aim is to assist these individuals who are experiencing barriers to engage in meaningful roles and occupations. In addition, we work on increasing their participation, health, and wellness. As our caseloads involving PTSD increase, we need to ensure that we are treating our patients to the best of our ability. These veterans have served our country and this policy would give us a greater opportunity to honor these individuals by helping them receive the care that they need.

Additional Resources:

https://www.nlm.nih.gov/medlineplus/magazine/issues/winter09/articles/winter09pg10-14.html

http://www.disabilityadvisor.com/va-disability-claims/

https://www.aota.org/-/media/corporate/files/aboutot/professionals/whatisot/mh/facts/ptsd%20fact%20sheet.pdf

Mental Health Care vs. Medical Care, OT Can Help Bridge The Gap!

Issue: Mental Health Care vs. Medical Care, OT Can Help Bridge The Gap!

It is imperative that individuals are viewed holistically, which makes this policy so important. A person’s physical health and mental health are often related. For example, there is a significant correlation between chronic illness and depression. Individuals are seeking health care for certain issues, while ignoring other issues that they may also be having simultaneously. Often people push mental health issues to the side and focus more on their physical health issues. The stigma of mental health being uncomfortable and something that should be hidden can often exacerbate the situation. Something must be done to ensure that individuals are receiving the care that they need in order to live their best life possible. Occupational therapists help individuals do just that and therefore are interested in bridging the gap between mental and physical health.

You can find the article here:

http://californiahealthline.org/news/bridging-the-gap-between-medical-and-mental-health-care/?utm_campaign=KFF-2016-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=26607055&_hsenc=p2ANqtz-_keWriX2qvetCP9DYOr5IkrnADIJjn1odPAUii35R53527_8SXZ44px_V2pwFYHI4lLCgUhHXuu2w52GaA2Bdo42DfTg&_hsmi=26607056

Service Delivery:

            The service delivery to address this issue will involve both the health care and educational systems. Educating the public on warning signs, risk factors and treatment options for mental health issues is very important! In addition, reducing the stigma of mental health and educating the public that mental health issues should not be looked at differently than physical health issues.

            The health care system is also involved in the service delivery of the proposed policy because we would want physicians to be performing in depth annual checkups. The health care and education systems would collide because it would be paramount that the physicians performing the check-ups are educated on the signs, symptoms, and risk factors of a variety of mental health issues. According to the National Institute of Mental Health, Anxiety is the most prevalent mental illness in the United States affecting 40 million adults in the country. The physicians should be aware of all mental illnesses, but it is clear than anxiety is one that should be on the forefront of their minds.

Policy:

            There should be a policy made so that all individuals are required to get a annual check-up that includes a mental health screening. Although this may not be a catch all fix, it will help to bring mental health to the forefront while bridging the gap between the mental health and physical health sectors. In addition, there should be a policy made that facilitates and encourages communication between mental health practitioners and primary care physicians. This collaboration would help to bridge the gap between mental health and primary care practitioners. In order to make this policy nationwide, all insurance would be required to pay for an annual check up that includes the mental health screening. This screening would be helpful in identifying individuals who may be at risk for mental health issues and get a jump start on referring them to a mental health practitioner. In addition, when a physician identifies an individual as having a mental illness or that they are at risk, they should provide them with information on mental health. This education with the individuals may help them to seek help sooner or may even help them realize someone in their life that may need help. Incorporating the mental health screening into the annual checkup could help to reduce the stigma of mental health. If each physician educates their patients on these mental health signs and symptoms, people will become more aware and hopefully less judgmental.

Integration of physical health care and behavioral health care

Data:

            The data that would be needed to support this policy would be statistics showing that mental health issues are on the rise and that many people have delayed diagnoses. The delayed diagnoses would help to demonstrate the need for annual check-ups that incorporate mental health screenings. Data showing that mental health screenings are effective in identifying mental illness and warning signs would also be important.  Adding the mental health-screening component will not be affective unless it is accurate in assessing for mental illness. The physicians performing this screening must be educated on the signs and symptoms in order to start the process of addressing the issues.

Implications for OT:

            Occupational therapy would be affected, as we would begin to see more individuals referred to OT services for mental health issues than we currently do. Occupational therapists have a holistic view of their patients and are always thinking about one's physical and mental health. However, this would be a great opportunity for our profession to return to our roots in mental health. We would need to advocate to physicians our importance in the role of mental health. Physicians should be aware of what mental health services occupational therapy can provide so that when it is appropriate for a patient, the physician can refer them to OT. Furthermore, we would hopefully be seeing patients with newer mental health diagnoses and will be able to provide intervention much sooner than we currently are able to. As occupational therapists, it will be important that we are aware of a variety of resources that we can give to our patients. Providing information on organizations such as NAMI (National Alliance on Mental Health).

Resources

http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml

https://www.nami.org/stigmafree

Strokes on the rise among younger adults. OT can help!

Issue: Strokes on the rise among younger adults. OT can help!

The majority of strokes are occurring in older adults over the age of 50, but the number of people under 50 having strokes is increasing. The article states that about 10% of all strokes occur in people between 18 and 50 years old. This article describes the experience of a 41-year-old man who suffered from a intracerebral hemorrhage.

Articles like this help to educate the public on what it is really like to have a stroke. The individual in the article states, “You don’t think of things you do until you cant do them. You basically have to start all over again. I mean, you retrain your brain to use your limbs. You retrain your brain to remember. You retrain everything. It’s pretty devastating.”

You can find the article and podcast here:

http://www.npr.org/sections/health-shots/2016/02/18/467222400/strokes-on-the-rise-among-younger-adults

Service Delivery:

The service delivery to address this issue involves both the health care and educational systems. Educating the public on the risk factors that they can control would be a very important piece in reducing the number of strokes in young adults under 50. There are some risk factors that are uncontrollable such as age, gender, and ethnicity. However, the other factors can all be controlled. If we are able to educate the public on the importance of living a healthy lifestyle, we may be able to reduce the prevalence of strokes in younger adults under the age of 50.

            The health care system is also involved in the service delivery of the proposed policy because we would have to ensure that physicians and other health professionals would be willing to adopt these policies and actually assess for risk factors and educate their patients on how to reduce these risks. The health care system has the potential to change the lives of their patients! Providing free physicals to assess risk factors for stroke would be a great way to ensure that everyone is able to learn their risk for developing a stroke despite their financial situation.

The most common type of stroke occurring in adults under 50 is ischemic strokes. Ischemic strokes are caused by a blockage in the blood vessel. The article quotes a vascular neurologist who believes that the most likely underlying cause for the increasing incidence and prevalence in young adults under 50 is obesity. This also goes back to the healthcare system that parents should be educated by their children’s pediatricians on how to reduce risks for obesity. As childhood obesity has increased, these children grow up to be adults who if still obese, are at a great risk for stroke. As health professionals, we need to do what we can from the beginning to help prevent childhood obesity.

Policy:

There should be a policy made so that all individuals are required to get a physical at least once per year. This physical should screen for stroke risk factors such as high blood pressure, diabetes, obesity and lipid disorders. When a person has any of these risk factors, they should be educated on lifestyle factors that can be changed such as eating habits, physical activity, limiting or quitting smoking and drinking as well as medical risk factors that can be addresses such as high blood pressure, high cholesterol, diabetes, and poor circulation. To make this policy even better and more universal, the physicals should be free to all individuals. By offering free physicals, people will be more willing to get them and will not have to choose between a physical and something else they feel is more important to purchase. This policy could also incorporate an education component. If an individual is found to have any of these risk factors, they and their family should be educated on the signs of a stroke so that 9-1-1 can be called sooner. If this policy were put into place, I would hope that the number of strokes amongst young adults under the age of 50 would stop increasing and actually start to decline.

Data:

The data that would be needed to support this policy is the statistic that the number of young adults under 50 experiencing strokes is rising. In addition, the statistic that 80% of strokes can be prevented with lifestyle changes to reduce risk factors needs to be brought to the table. If a study was done in order to prove that education on prevention and signs of a stroke could help to decrease the amount of strokes and decrease the amount of time before 9-1-1 is called after witnessing a loved one’s stroke, this policy would be more supported. In order to educate the public on risk factors, there will need to be data to support the claims that these medical and lifestyle factors are indeed risk factors for having a stroke.  

Implications for OT:

Occupational therapy will be affected as we will begin to see more young adults suffering from strokes than ever before. Even though the majority of strokes occur in the older adult population, this will still have an impact on occupational therapy. Occupational therapists can work on advocating for the importance of education of the young adult population.

While some may think that because these individuals are young, they will be resilient and recovery quickly, this may not always be the case. Recovery will be difficult for anyone and these young adults are more likely to be raising children and have other responsibilities that are no longer possible to fulfill.  A stroke changes a person’s life completely. This drastic change in independence and function has the potential to lead to depression and other mental health issues.

As OTs, we have the power to make changes in peoples lives. Lifestyle redesign is “a treatment approach that has been shows to improve health and wellness by preventing and managing chronic conditions through building healthier lifestyles.” OTs can work with patients to redesign their lives so that they can acquire health-promoting habits and routines in their every day lives.

In addition, we can be training our clients and their families about FAST. FAST can help people to remember the warning signs of a stroke and recognize that their loved one is having a stroke and call 9-1-1 sooner. It has been shown that the faster an individual arrives to the hospital after a stroke the more likely they are to have a better recovery.

F= FACE. Ask the person to smile. Does one side of the face droop?

A= ARMS. Ask the person to raise both arms. Does one arm drift downward?

S= SPEECH. Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T=TIME. If you observe any of these signs, call 9-1-1 immediately.  Note the time of the first symptom.

Additional Resources

http://www.stroke.org/understand-stroke/preventing-stroke

http://chan.usc.edu/patient-care/faculty-practice/about

http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast

Policy Update

Policy Update

Issue:

Bill to Rewrite No Child Left Behind Act

http://www.aota.org/advocacy-policy/congressional-affairs/legislative-issues-update/2015/no-child-left-behind-signed-law-every-student-succeeds-act.aspx

Service Delivery:

The service delivery involved with this issue involves both the educational and political systems. The new bill had to be put into place by the political and governmental systems but largely affects the educational system. Without the political systems putting this bill into place, it would be difficult to assess the progress that students are making each year in the educational system. These systems are very distinct yet are both involved and necessary for educational bills to be signed into law.

Policy:

I reviewed an article that describes a new policy, “Every Student Succeeds Act” (ESSA) that has replaced “No Child Left Behind” (NCLB). NCLB was created based on the original “Elementary and Secondary Education Act” (ESEA) that was signed into law in 1965. The president signed the newest bill (ESSA) into law on December 10, 2015. This policy is supported by Nancy Pelosi, Harry Reid, Barack Obama, and 37 liberal civil rights and education groups.

I am excited for the potential of this new law but I believe that as the new law is implemented, they will find aspects that work better and things that still need improvement. Issues with NCLB were brought out in discussions early on, but it took from 2001 when it was signed into law until the end of 2015 when the new bill, ESSA was signed into law to replace NCLB. It is evident that changes in the political system will take time so it is important to advocate for our profession during the rewriting of such bills. When first beginning my masters program, I did not see the importance of having a policy and advocacy course in the curriculum. However, after only 3 short weeks of the course, I see the value and importance in this course.

Data:

The new bill, ESSA, passed both chambers of congress with strong bipartisan support. ESSA repeals the requirement that schools achieve annual progress in their student testing. One of the main issues with NCLB was that teachers began only teaching for the test in fear that if their students did not pass these tests, they would be fired. The test consists of multiple-choice reading and math questions, but as occupational therapists we understand the importance of a well-rounded curriculum as well as providing children with freedom for creativity. With the pressure of having a high pass rate, teachers focused most of their time on reading and math, limiting the time spent on other important subjects such as art, science, and physical education. Furthermore, students learn in a variety of ways and teachers should have the autonomy to teach in a way that best matches their students’ learning styles and preferences. Another issue was that all students were held to the same achievement standard (with the exception of students who had severe mental of physical disabilities) despite their varying SES, ability level, and native language.

Implications:

AOTA had two main priorities during the rewriting of this bill. Their goals were to improve the recognition that occupational therapists should be more involved in school-wide initiatives and classroom supports and maintaining accountability for students with disabilities. The new bill introduces a new term “specialized instruction support personnel” (SISP), which includes occupational therapists, and any related services under IDEA. It is required that schools, local education agencies, and states include SISPs in their planning of new programs and provision of testing accommodations. The new bill provides states with a lot of flexibility in how they implement their programs and standards for each school. This poses a challenge for occupational therapists as each school has the potential to have different accountability systems. This could be beneficial as the students in each school may have different needs, but difficult for the occupational therapists to stay up to date on each school’s programs and systems. As previously mentioned, it is important that occupational therapists advocate for the profession as well as our clients. This course is teaching us the different ways in which we can accomplish that.

Resources

http://drrichswier.com/2015/12/16/every-student-succeeds-act-common-core-by-a-new-name-and-on-steriods/

http://www.carleton.edu/departments/educ/vote/pages/Pros_and-Cons.html

http://www.ed.gov/essa