Occupational Therapy in Mental Health: Identifying Opportunities to Modernize AHCCCS Policy to Reflect Occupational Therapy Scope of Practice and Promote Cost-Effective Behavioral Health Care

Speaker:

• Susan Engel, OTD/S, MS, OTR/L

Learner Outcomes:

1. At the conclusion of this session, participants will be able to:
   Describe the differences between the OT scope of practice and the current definition of OT within the AHCCCS OT policy.
2. Identify opportunities to clarify AHCCCS policy language so that it more accurately reflects occupational therapy's evidence-based role in mental health.
3. Identify cost-effective interventions of occupational therapy services in behavioral health.
4. Implement advocacy strategies that support policy revisions recognizing occupation-based mentalhealth interventions within occupational therapy's existing scope of practice.

Abstract:

Background: Occupational therapy (OT) is a holistic, evidence-based profession that addresses the physical, cognitive, psychosocial, emotional, and behavioral factors influencing participation in meaningful occupations (American Occupational Therapy Association [AOTA], 2020). Arizona occupational therapists (OTs) are licensed to evaluate and provide interventions that promote health, well-being, recovery, and participation across the lifespan. Although the Arizona Health Care Cost Containment System (AHCCCS) recognizes OT as a covered rehabilitation service, current policy language primarily emphasizes restoration of physical function and activities of daily living. AHCCCS behavioral health benefits include services such as cognitive rehabilitation, health promotion, medication education, stress management, supported employment, and independent living skills, yet OT's role in providing these occupation-based interventions is not consistently reflected within reimbursement policy.

Purpose: This Call to Action presentation examines whether the current AHCCCS definition of occupational therapy adequately reflects the full scope of OT practice in mental health. The project evaluates existing AHCCCS policy language, compares it with occupational therapy scope of practice and practice standards, and develops recommendations to expand the operational definition of occupational
therapy within AHCCCS policy to better represent evidence-based behavioral health practice. It also evaluates the evidence supporting the cost-effectiveness of occupational therapy services in behavioral health and explores how these findings may inform eimbursement policy and healthcare decision-making among AHCCCS and other stakeholders (Johanson et al., 2023; Noyes et al., 2018).

Methods: This presentation will examine AHCCCS OT policies, Occupational Therapy Practice Framework: Domain and Process (4th ed.), Occupational Therapy Code of Ethics, Arizona occupational therapy statutes and legislation, and peer-reviewed literature supporting occupational therapy interventions in behavioral health (AOTA, 2020; AOTA, 2025; Read et al., 2024). Areas of agreement and policy gaps will be identified, with recommendations focused on clarifying or expanding AHCCCS's existing scope of
occupational therapy practice.

Expected Outcomes: The presentation will produce evidence-informed recommendations describing how AHCCCS policy language can more accurately define occupational therapy within its established scope of practice. Deliverables will include a policy crosswalk, recommendations for revised terminology, an evidence summary supporting occupation-based mental health interventions, and advocacy resources for both OTs and ArizOTA.

Implications for Occupational Therapy Practice: Updating the definition of occupational therapy within the AHCCCS policy has the potential to improve recognition of occupation-based behavioral/mental health interventions, promote more consistent reimbursement, and improve access to necessary mental health services that support participation, recovery, and community integration (García-Gestal et al., 2024; Adelle et al., 2025).

 

 

Biography of Speaker(s):

Susan Shifra Engel, OTR/L, OTD student
Susan Shifra Engel, OTR/L, is an occupational therapist with 18 years of clinical experience, primarily in skilled nursing and post-acute rehabilitation, where she has developed a special passion for serving older adults, particularly individuals living with dementia and co-occurring mental health conditions. Throughout her career, she has been committed to educating healthcare professionals and caregivers about the psychosocial needs of individuals with cognitive impairment and advocating for person-centered, occupation-based care.

Originally from Manchester, England, Susan's journey into occupational therapy was inspired by a deeply personal experience. After the birth of her premature daughter, she witnessed firsthand the profound impact that occupational therapy and early intervention services had on her child's development. That experience motivated her to return to school and pursue a career dedicated to helping others achieve meaningful participation in daily life.

Susan and her family relocated to Arizona ten years ago and proudly call it home. In 2024, she began pursuing her Doctor of Occupational Therapy degree at the University of St. Augustine for Health Sciences. Her doctoral capstone examines the evidence supporting occupational therapy's role in behavioral health and explores whether current Arizona Health Care Cost Containment System (AHCCCS) reimbursement policy language reflects contemporary occupational therapy practice. Susan is passionate about advancing awareness of occupational therapy's contributions to behavioral health and promoting policies that support access to occupation-based mental health services for Arizona residents. She is also passionate about reducing the stigma associated with mental illness and promoting a greater understanding of the psychosocial needs of individuals living with cognitive and behavioral health conditions.

 

References to Support Evidence-Based Practice:

Adelle, A., Bedford, K., McMahon, S., Dun, C., Starbuck, R., & Doroud, N. (2025). The role of occupational therapists in acute mental health inpatient settings: A systematic scoping review. Australian Occupational Therapy Journal, 72(3), 1–17. https://doi.org/10.1111/1440-1630.70032

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/AJOT.2020.74S2001

American Occupational Therapy Association (AOTA). (2025). AOTA 2025 occupational therapy code of ethics. American Journal of Occupational Therapy, 79(Suppl. 3), 7913060400. https://doi.org/10.5014/AJOT.2025.79S302

García-Gestal, U., Talavera-Valverde, M.-Á., & Souto-Gómez, A.-I. (2024). Occupational therapy in psychiatric short-term hospitalization units: Scoping review. Community Mental Health Journal, 60(7), 1283–1307. https://doi.org/10.1007/s10597-024-01286-3

Johanson, S., Oestergaard, L. G., Bejerholm, U., Nygren, C., van Tulder, M., & Zingmark, M. (2023). Costeffectiveness of occupational therapy return-to-work interventions for people with mental health disorders: A systematic review. Scandinavian Journal of Occupational Therapy, 30(8), 1339–1356. https://doi.org/10.1080/11038128.2023.2200576

Noyes, S., Sokolow, H., & Arbesman, M. (2018). Evidence for occupational therapy intervention with employment and education for adults with serious mental illness: A systematic review. American Journal of Occupational Therapy, 72(5), 1–10. https://doi.org/10.5014/ajot.2018.033068

Read, H., Zagorac, S., Neumann, N., Kramer, I., Walker, L., & Thomas, E. (2024). Occupational therapy: A potential solution to the behavioral health workforce shortage. Psychiatric Services, 75(7), 703–705. https://doi.org/10.1176/appi.ps.20230227