I hopped on live this week after a rich conversation in the Practical OT Facebook group (hi Chris! 🙌).Chris shared The Intentional Relationship Model — Renee Taylor’s seminal text on therapeutic use of self and the relational core of practice (and yes, the IRM lineage connects to Gary Kielhofner and MOHO). That post opened a door I care deeply about: Why do so many of us still feel hesitant—or “naughty”—bringing the psychosocial domain into “traditional” OT settings? Short answer: our systems trained us to separate what OT was never meant to split. 🧠 Our Roots Were Never Split: OT = Psychobiological Integration Early psychiatrist Adolf Meyer, who co-founded the American Occupational Therapy Association alongside Eleanor Clarke Slagle, coined the term psychobiology — a framework for understanding human beings as integrated systems of mind, body, and environment (Meyer, 1922). He argued that disturbances in this balance—not isolated mental or physical “defects”—were the source of illness. The therapeutic goal was to restore rhythm and meaning in daily life through occupation. “It is the proper rhythm and balance of activity and rest, of work and play, of day and night, that constitute the very basis of health.” — Adolf Meyer, 1922 This psychobiological lens is the taproot of occupational therapy’s foundations in the moral treatment and arts and crafts movements — where engagement in creative, purposeful occupation supported emotional regulation, identity reconstruction, and social participation. Our profession was born as a psychosocial intervention, long before it became entrenched in the biomechanical model. That continuity remains explicit in the Occupational Therapy Practice Framework: Domain & Process, 4th Edition (AOTA, 2020): occupation is not just biomechanical task performance. It is meaning- and purpose-laden activity shaped by volition, identity, roles, and context. If we leave out the psychosocial domain, we’re not fully addressing or assessing occupation — our primary protected and skilled domain across all U.S. practice settings. 📌 Fun fact: The 2020 revision of the OTPF-4 intentionally removed preparatory activities and exercise-centered approaches as stand-alone interventions to reaffirm that occupational therapy is grounded in occupation itself—not in isolated physical techniques. Even physical therapy is now shifting toward functional outcomes-based reimbursement per CMS guidance. 🩺 The Policy Playbook (So You Can Feel Confident) You don’t need permission to practice holistically — you already have it. Here’s language you can cite and stand on: “Occupational therapy services are... medically prescribed treatment concerned with improving or restoring functions... or, where function has been permanently lost or reduced... to improve the individual’s ability to perform those tasks required for independent functioning.”— Centers for Medicare & Medicaid Services, §230.2A Notice: this doesn’t say only when function is lost due to a physiologic cause. CMS explicitly recognizes psychosocially oriented activity as skilled occupational therapy. “The planning, implementing, and supervising of individualized therapeutic activity programs as part of an overall active treatment program for a patient with a diagnosed psychiatric illness; e.g., the use of sewing activities which require following a pattern to reduce confusion and restore reality orientation in a schizophrenic patient.”— (CMS, 2014, §230.2A) That’s not fringe OT — it’s federal definition of practice. 📎 Take-away: Skilled OT that restores or compensates for ADL/IADL performance — including interventions addressing motivation, affect, cognition, behavior, and role disruption — is squarely within coverage expectations. Psychosocial isn’t “extra”; it’s how independence is achieved — and how readmissions are prevented. 🖇️ Direct link to CMS formal guidelines for covered OT services ⚖️ Mental Health Parity and OT’s Expanding Role Since the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, federal law has required that insurance coverage for mental health and substance-use services be comparable to coverage for physical health conditions. This means psychosocial dysfunction cannot be treated as less legitimate than biomechanical dysfunction. However, implementation remains uneven. Many payers still reimburse only for “physical” goals — despite federal parity law and the CMS definition of OT practice. Parity isn’t optional—it’s our ethical mandate.It ensures that the mental, emotional, and social determinants of participation receive the same respect as physical rehabilitation. 🎥 Seeing It in Action Watch this short video:🎬 How Behavioral Health OT Can Be Integrated into Post-Acute Settings to Reduce Hospital Readmissions It shows how embedding occupational therapy into post-acute care reduces readmissions, enhances safety, and improves long-term outcomes. When OT is practiced through a psychobiological and psychosocial lens, it bridges the gap between physical and mental health care — just as our founders intended. This Bill to cover community behavioral health OT passed unanimously by the way! 💠 Integrating Trauma-Informed Care Principles Trauma-informed care (TIC) isn’t a specialty — it’s a lens for every setting. It re-centers safety, collaboration, and empowerment as therapeutic outcomes themselves. Core Principles (SAMHSA, 2014; AOTA, 2022): 1️⃣ Safety: Prioritize emotional and physical safety.2️⃣ Trustworthiness & Transparency: Explain procedures and expectations in plain language.3️⃣ Peer Support & Collaboration: Center co-regulation and shared decision-making.4️⃣ Empowerment, Voice, & Choice: Build agency and autonomy into every session.5️⃣ Cultural, Historical, & Gender Awareness: Acknowledge systemic trauma and intersectionality.6️⃣ Resilience & Recovery Orientation: Focus on strengths, regulation, and rhythm—not deficits. 📊 Tip: Download SAMHSA’s full framework and integrate it into your onboarding or staff education packets. Image placeholder suggestion:🖼️ “Trauma-Informed Care Principles in OT Practice” infographic 🔧 How to Integrate Psychosocial—Anywhere You Practice * Begin with the Occupational Profile → Roles, routines, values, supports, identity, grief, neurodivergence, social determinants. * Use Quick Screens → GDS, anxiety scales, cognitive/attention checks. * Build Relational Skill → IRM, ACT-informed OT, trauma-informed micro-skills. * Document What Only OT Does → Connect psychosocial factors to function, safety, and GG outcomes. * Advocate Like a Clinician → Cite parity, CMS, and OTPF. 📄 Chart Example: “Psychosocial factors (grief, role loss, low activity drive, attentional dysregulation) are limiting safe, consistent engagement in ADL/IADL tasks. Skilled OT will address motivation, pacing, environmental fit, and compensatory routines to restore participation and reduce risk of decline/readmission.” 🪞 Why Many Clinicians Still Hesitate (and How We Move) A lot of OTPs graduated before our frameworks were widely taught—during times of mass systemic divestment from mental health supports in the U.S. Add decades of underfunded infrastructure, and it’s no wonder psychosocial practice gets sidelined. But we must also name the intersectional discrimination that continues to marginalize clients with mental-health diagnoses within physical-health systems. People with psychiatric disabilities often experience sanism — discrimination that pathologizes, dismisses, or silences those perceived as “mentally ill” — leading to diagnostic overshadowing, reduced access to care, and poorer health outcomes (Poole et al., 2012; Faissner et al., 2024). Sanism compounds when layered with racism, ableism, sexism, classism, and ageism — shaping who receives empathy, time, and quality care.For example, Black, Indigenous, and LGBTQ+ clients with co-occurring mental-health and physical-health needs are still less likely to be referred for rehabilitation or receive equitable discharge planning (Faissner et al., 2024). The fix isn’t shame—it’s shared literacy and everyday translation. ✅ Talk OTPF-4 in plain language with your team.✅ Bring CMS §230.2A into in-services and appeals.✅ Connect psychosocial barriers → ADL/IADL limitations → utilization risk.✅ Track and report outcomes that matter: falls, LOS, GG codes, readmissions. 🌱 Keep Learning (and Un-Gatekeep) 📘 The Intentional Relationship Model (Taylor)📘 Model of Human Occupation (Kielhofner)📘 ACT-informed OT (Carlyn Neek)🎨 Trauma-informed Creative Practices (A Window Between Worlds)📜 CMS Pub. 100-02, Ch. 15, §230.2A – our shared evidence base 🌿 Final Word It doesn’t make us “better” clinicians to ignore neurodivergence, mood, trauma, identity, or role loss — it makes our work less effective. OT’s power is helping people rebuild lives that work, not just bodies that move. Let’s practice like the profession we are: psychobiological, trauma-informed, relational, creative, and policy-literate. 📚 References * American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.) * Centers for Medicare & Medicaid Services. (2014). Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, §230.2A – Occupational Therapy Services * Faissner, M., Stahmeyer, J. T., & Hoffmann, F. (2024). Intersectional discrimination and its health consequences: A systematic review. Frontiers in Public Health, 12, 1350670. * Poole, J., Greaves, L., & Riach, L. (2012). Sanism, “mental health,” and social work education: A review of the literature. Intersectionalities, 1(1), 20–36. * Substance Abuse and Mental H
