To: Nevada Senator and Assemblyperson
From: Dedicated OT and OTA Students
Advocacy Toolkit
University of Nevada, Las Vegas
Created by:
Mary Angela M. Terencio, OTD/S
A beginner's guide to support state system changes
Acknowledgements
The creation of this toolkit is only possible with your help and dedication to the occupational therapy profession.
I thank the following people and organizations:
- Dr. Paula Cook, Dr. Sheama Krishnagiri, Dr. Barbara Kornblau, and Executive Director Loretta Ponton for their expert guidance
- UNLV, Touro, and PIMA students, staff, and faculty for their support
- Nevada Occupational Therapy Association board members, members, and the legislative team and the American Occupational Therapy Association State Affairs and leaders for their contributions and hard work
- Thank you to the following OT state associations for allowing me to learn from you
- AZ, CA, CO, CT, FL, GA, ID, IA, MA, ME, MD, MI, MT, MN, NH, OH, SC, TX, VA
- My family, Kuya TJ, Ate Aiko, Mom Lea, Dad Manny, Mama Laura, and better half David, for their love and patience in helping me create this resource
About the Toolkit
The Advocacy Toolkit serves as a foundational resource to develop and support your advocacy knowledge and skills, especially at a state-systems level.
It is created with students in mind, ensuring the information is accessible and digestible. However, all are welcome to use this!
This resource will teach you about the current state legislative and regulatory processes that affect our profession, how to advocate effectively for occupational therapy, and what resources you can use to advocate for issues that affect OT/OTA practice.
Happy learning!
How to Use the Toolkit
As the user, you have total control over how you want to use this toolkit (We love autonomy!).
Navigate through the toolkit by scrolling down or clicking the links on the navigation menu to explore topics you want to learn more about or review.
The navigation menu can look like these:
You can click interactive links to learn more or practice your skills! They will be in this blue color and underlined.
*This toolkit is compatible with mobile devices but best viewed on a computer/laptop.
Disclaimer
The toolkit contains information specific to Nevada, though you may find some similarities to other states.
It focuses on state-level issues versus federal ones. However, note that federal issues can also impact state laws and regulations.
Though the student author is not an expert in advocacy, this resource is informed by a team of advocacy experts, OT association leaders, research, and experience. If you would like to add information or provide feedback, please email nevadaota@gmail.com.
*Note: References will be numbered and found in the QR code at the end of the toolkit in order
Definitions
Advocacy
1
Intentional actions to support a cause or make a positive change with and for others, and yourself.
This includes education and research to stay informed and aware of relevant issues and trends.
Systems-Level Advocacy
2
Contacting, interacting, and engaging with decision-makers, such as legislators, regulators, and others, to build a professional relationship or influence public policies, laws, or regulations.
This includes educating oneself on policies and systemic issues that affect your clients, your practice, and the profession.
Decision-Makers
Legislators
- State senators
- Assemblypersons
Regulators
- Executive director
- Board members
Advocacy can look like...
3
to ensure your client gets the services and equipment they need
to address a community need
on best practices in therapy and education
for others to learn about what we do and who we are
Systems-level Advocacy
can look like...
to your state and federal representatives
for or against a proposed regulation
with NOTA and/or AOTA
related to your practice
What are other ways you can advocate? Share your thoughts here!
Why Does
Systems-level Advocacy Matter?
4
It can lead to meaningful change.
5
See examples here.
Laws and regulations affect us all
When we amplify our voice on issues we care about to state decision-makers, we protect, promote, and progress our profession.
- Protect
- clients' access to OT services and our scope of practice
- Promote
- our role as practitioners and client participation in everyday living
- Progress
- our profession through more efficient and effective, long-term solutions in practice and education, such as:
- increasing access to quality services
- fair and appropriate reimbursement
- improving educational standards and experiences
Hear why 2023 NOTA President Dr. Paula Cook, Legislative Chair Matt Olivier,
and Capstone Student Angela Terencio advocate!
We have
STRENGTH IN NUMBERS
The more participation we have, the likelier we are to see change.
Everyone has a role!
We can make a more significant impact when we have a strong, coordinated effort at all levels.
There are many different levels of advocacy, including:
Federal (AOTA Federal and Regulatory Affairs)
6
- Focuses on national issues that affect all states
- Assists states in all government affairs
State (NOTA and AOTA State Affairs)
7
- Focuses on state and local issues specifically affecting Nevada practice
- More accessible to us!
Individual (You)
- Share your experiences and concerns to address any unmet needs
- Take the initiative and action to see change
- Don't worry! You will likely have guidance along the way
8
Hear how AOTA advocates at the federal level!
Did you know?
NOTA is run completely by volunteers!
Current board members are either practitioners, educators, and/or students. Your involvement is welcome!
Learn more about them here.
9
Advocacy is a
marathon, not a sprint
The First Step
10
Before you begin advocating, know you are worthy
Remember that your representatives work for you and want to connect with you. It's a win-win to have a mutually beneficial relationship (They want your vote after all)!
Share your love for OT shamelessly and work on changing the mindset that many don't know what we do.
Change doesn't happen over night. Sometimes advocacy efforts can lead to unfavorable outcomes and can discourage future actions.
It is important to remember our "why," and regroup. There are many resources available that can support our goals. Maybe, just maybe, the next time we try, we make a positive influence.
What comes next?
You will learn:
General Information
- Strong foundational knowledge on the legislative and regulatory processes helps you know when and how to best advocate
Advocacy Strategies
- Common tools identified to support the cause you are advocating for
Other Resources
- Organizations and other educational materials to enhance your learning
Making laws
Legislation
Nevada Legislature
11
Bicameral
- Has two chambers: Senate and Assembly
Citizen's Legislature
Nevadans work as part-time legislators
- (though they put in a lot more than part-time hours!)
Legislative/Regular Sessions
- Legislators meet at Carson City every odd-numbered year (also called biennial) for 120 days to discuss and pass laws
- Each session starts on the first Monday of February
Special Sessions
- Occur when the governor or 2/3 of each chamber issues an official proclamation
- Only bills in the proclamation can be worked on
- A special session was called during the beginning of the pandemic to work on the state budget
Between Sessions
- 12 members of the Legislative Commission meet to support the Legislative Counsel Bureau and address issues as they come up
- Legislators form committees to investigate certain issues to prepare for the next session through public hearings and research
Who Represents You?
11
Who's My Legislator/What's My District
Click to find out who your legislators are and write them down!
12
State Senate
- 21 members
- 4-year term
- Limited to 12 years in office
State Assembly
- 42 members
- 2-year term
- Limited to 12 years in office
Relevant committees that both chambers have:
- Health and Human Services
- Education
Look out for what committee your legislator serves in! There may be a bill of interest in their committee. If so, you have an advantage since they have more influence in the decision-making process.
How Does a Bill Become a Law?
13
Bill
- A draft of proposed legislation
Law
- Passed legislation that must be followed
Check out this less than 4 minute video made by the Nevada Independent!
Can you spot our Regulatory Board Executive Director Loretta Ponton?
(hint: she's testifying!)
Click here for a visual
Want to see this in action? Check out the Nevada State Legislature's YouTube channel!
Legislative
SpOTlight
Example of legislation that impacted us
Bill as introduced:
- Eliminate OT services for adults under Medicaid
- 6% cut for provider reimbursement, including those working in pediatrics
Action taken:
- NOTA sent a call-to-action to oppose the bill
- Many of the 600+ letter submissions were from OT practitioners and students
- Other practitioners called in during the hearing and testified against it
- Physicians and a judge also supported us!
Outcome - Bill amended:
- OT services were NOT eliminated for adults under Medicaid though the 6% cut remained
(Passed July 19, 2020)
We CAN make a change!
Imagine what would have happened if no OT practitioner or student had written and called in. Legislators would assume that we accepted these changes and kept the bill as written. Many people would have lost OT services and suffered the consequences. Though we may not get all that we hope for, it is essential that we speak up to protect our community and practice.
Implementing laws
Regulation
State of Nevada
Board of Occupational Therapy
15
Mission: Protect the public by ensuring licenses are given only to competent OT practitioners
Responsibilities
competent OT and OTA practitioners
through investigation and deliberation on complaints
OT practice by creating, enacting, and implementing regulations
administered every 5 years to review state practice act
- Attend Regulatory Board meetings and keep up to date here. All are welcome to attend!
- OT regulations address the following:
- General provisions
- Licensing
- Standards of practice
- Disciplinary action
- Proceedings before the board
Who's on the Board?
16
Executive Director
- Decides how the Board will operate to achieve the mission and initiatives
- Your first point of contact!
- Enforces laws and regulations in OT practice
Regulatory Board Members
- Decide the Board's purpose and outcomes
- Consists of five Nevada residents
- 3 occupational therapists
- 1 occupational therapy assistant or occupational therapist
- 1 public member
- Appointed by the Governor
- Practitioners must have 5 years of experience in teaching, practicing, or research
- Serve 3-year terms, with a maximum of two terms
Who are My Regulators?
Click to find out who your regulators are and write them down!
17
At times, the Board proposes changes to the regulations
18
This may be due to:
- Staff and Board member feedback
- Disciplinary actions requiring clarification
- Petitions by individuals or the State Association
When this happens, they hold a Public Hearing
You can provide feedback or propose additional changes through:
- Written submissions (email or hard copy) or,
- Virtual attendance
19
See an example of feedback here.
20
Click on the picture to read the entire notice.
Regulation intends to clarify the law.
Petition for Adoption, Amendment,
or Repeal of Regulation
21
This is if you want to see a new regulation or change or remove an existing one!
File an original and two legible copies
Address it to the Board Chair
Your full name and mailing address
To: Board Chair
Submit a petition to the Board in writing
If proposing a new regulation, include:
- the substance of the proposed regulation and supporting facts and arguments
If amending or repealing an existing regulation, include:
- the NAC citation and supporting facts and arguments
Your signature
Regulatory
SpOTlight
Example of regulation that impacted us
Proposal: Change the amount of Continuing Education credits for Level I and II fieldwork supervision
- Regulatory Hearing (November 23, 2019)
- Current Regulation
- Level I Fieldwork Educator (FWE) receives 2 hours
- Level II FWE receives 12 hours
- Board Proposal
- Level I increase to 4 hours
- Level II increase to 15 hours
- Public Comment
- One practitioner expressed approval for 4-hour proposal
- Another practitioner recommended 18 hours for Level II FWE
- Approved Regulation (Filed April 11, 2022)
- Updated regulation
- Level I FWE CE credit increased to 4 hours
- Level II FWE CE credit increased to 18 hours
Did you know?
23
The Board has a lobbyist! This means they have a professional who tracks legislative bills that affect the profession. The lobbyist also establishes relationships with legislators and staffers in Carson City to advance the Board's initiatives.
This is unique to Nevada, as many regulatory boards do not have lobbyists (NOTA does not currently have one).
In the 2023 Legislative Session, the Board will push for a bill related to the reciprocity of licensing (different from the OT compact) and administrative citations. You can learn more about this in their upcoming meetings or past meeting minutes.
State Association vs. Regulatory Board
24
- Advocates for OT
- Provides CEUs
- Offers networking and community
- Supports OT
- Board members include OTPs
- Licenses OTPs
- Protect public health, safety, and welfare
- Disciplinary action
- Regulates CEUs
Putting it All Together!
25
Legislation
Making laws
Regulation
Implementing laws
Note: Legislation must come before regulation
The law has to pass before we can do anything about it!
Example: Occupational Therapy Licensure Compact (Simplified)
Nevada is not currently part of the compact!
OT Practitioners voiced the need for an easier process to practice in other states to AOTA
AOTA does extensive research to determine and confirm its feasibility
Legislation
A bill is written for states to introduce to their legislature
Legislation
The OT compact has passed in 22 states as of February 2023
Legislation
Meetings with legislators were held to support passage of the law
Legislation
Individual states find sponsors for the bill
Regulation
The Compact Commission formed to discuss implementation to address finance, disciplinary action, etc.
The OT Compact privilege is expected to roll out at the beginning of 2024
Nevada anticipates revisiting joining the compact in 2025
23
Hear another reason why an OT practitioner advocates!
Former 2016-2021
OT Regulatory Board Member
Dr. Maria Soledad Magpantay
Building
Relationships
Connecting with Decision-Makers
Your presence is a present!
Legislators and regulators welcome your feedback and rely on you for your experiences and expertise.
In-person meeting
- Can be with an individual or a group
- Typically 15-30 minutes
26
Virtual meeting
Think about the purpose of the meeting:
- Are you asking for anything?
- They also appreciate "thank-yous!"
27
Mail-in Letter
- A hand-written letter shows how dedicated you are
- More personable!
Email
- Many templates make it easier
- Add your personal touch to make it more compelling
- Helpful for time-sensitive matters
28
Testify/Share Public Comment
Phone Call
- You can testify or make public comment in person or through a phone call
- Typically 3 minutes for Legislative sessions
- See an example here
Tips
- Be concise
- Speak to how it affects you and them and how it can save them costs
29
Social Media
- A lot of reps are on social media, especially Twitter!
- May share town hall opportunities or office/coffee hours
30
Host networking
events
- May be more casual
- Could be an event with an occupation they enjoy (ex. happy hour)!
31
Stronger Together
32
Advocacy efforts are even more impactful when more advocates voice the same message.
Find people who are passionate about the same things as you!
Check out CommunOT or use social media to connect with others!
Show Up and Show Out!
33
Any time you speak up, it counts on the record.
Remember, legislators' job is to represent you, and you can help regulators protect public health and safety.
- Identify who your state leaders are
- What do they care about or focus on?
- If at a public meeting, review their agenda
Know your Audience
34
Legislators
Love hearing personal stories
Regulators
Prefer facts, data, and research
Insurers and Payers
(ex. Medicaid)
Wants to save costs and increase access to beneficiaries
Think back to your unique experiences in fieldwork and practice...
- Make it personable
- Talk about your time with a client
- Give them a name, age, and their situation
- Comply with HIPAA
- Make it relevant
- How does your story relate to the regulation/legislation?
- Suggest a solution
- What change do you want to see?
- How can you work together to achieve it?
Combine storytelling and research findings
Refer to relevant research studies to strengthen your case
How do I set up a meeting with a Legislator?
Simply email them
requesting one!
37
Either the legislator or their staffer will reply through email or a call to confirm your meeting.
Here's a template to help set up your next meeting.
Find your legislators' email here.
What can make advocacy easier?
- Schedule time - routines help!
- Find a buddy
- write a letter together
- grab coffee and call a legislator
38
Tips
23
The best way to provide feedback to the Regulatory Board
- Email the Executive Director first!
- Allows for clarification and follow-up
- Can lead to a recommendation to appear before the board
- Participation in public meetings always welcomed during the public comment
- The Board will listen but not take action
- If you want action taken, you can request for it to be placed on the agenda
- Effective
- Be concise
- Provide a short background
- Identify the issue and the proposed solution
- Ineffective
- Rambling
- Not being specific with questions or issues that you're trying to address
Hill Day
Also known as Legislative Day
About Hill Day
39
What?
A day for OT practitioners and students to talk to legislators and staffers about our profession and practice
- can be in person or virtual
Why?
Connect with legislators and advocate your "ask"
- Do you want them to support/oppose a bill?
- Consider OT mental health or pain management bills
Where & When?
The Legislative Building at Carson City, Nevada
Currently, there is no designated date for Nevada. Find out during NOTA meetings!
How can I prepare?
Who's My Legislator/What's My District
Click to
find out!
priorities are
Know your legislators first,
then learn about what their
34
Refine your Elevator Speech
40
- Name
- District
- Brief introduction of who you are
- Issue - Name the Bill if possible! (Ex. AB 3)
- Impact on you and them
- Position - How should they vote?
- Contact you for more info
- Thank them
Dress code:
Business
41
If you're a beginner on Hill Day, you will be paired with a practitioner or someone who's more experienced!
What can I expect once I register for Hill Day?
42
- Make travel and accommodations
- Attend a NOTA orientation to prepare
- Learn who your legislators are
- Review legislative priorities and talking points
Before
- Attend briefing to prepare for the day and obtain materials
- Meet with legislators (if scheduled)
- Give your elevator speech
- You may talk to staffers instead of the legislators
During
- Follow up with thank you notes/emails to legislators and send them talking points
- Share your experience
- Stay involved by going to townhall meetings and inviting reps to events
After
Sharing your personal story is one of the most powerful actions you can take.
43
44
DO
- Know your rep
- Connect with their occupations!
- What are their legislative priorities?
- Respect their time
- Share talking points concisely and effectively
- Be patient with yourself and the day
- Leave information (handouts and contact information) with them
- Follow-up and be available for further contact
- Thank them
DON'T
- Assume they know what you're talking about
- You can ask "How familiar are you with...?"
- Guess if you don't know the answers
- False information can decrease your credibility
- Overload with information or use jargon
- View a meeting with a staffer as less than a meeting with a legislator
- The staffer is their eyes and ears for issues
AOTPAC
American Occupational Therapy Political Action Committee
What is the AOTPAC?
45
A non-partisan committee (supported by AOTA members and volunteers) that financially supports candidates for federal office who support and understand the policies important to our profession.
Invests in candidates with an interest in advancing OT services, education, research, and funding regardless of their views on other issues
AOTA membership dues are NOT ​used to make donations. Instead, the ​AOTPAC is permitted to solicit AOTA ​members f​or contributions
Aids any AOTA OT, OTA, and student member seeking public office
AOTPAC Chair Dawn Sonnier
46
Hear AOTPAC Chair Dawn Sonnier get pumped for the 2023 AOTA Inspire Conference and discuss how AOTPAC supports advocacy at all levels!
Wait a minute! What does AOTPAC have to do with state advocacy?
Federal affairs affect state affairs, so any changes at the national level can impact us, too. Because Nevada doesn't have an OT PAC, this offers another option to advocate.
After all, money talks.
When you don't have the time and energy to focus on advocacy and regulatory issues, you can invest in someone or an organization that does!
47
Know that your NOTA and AOTA memberships are valuable!
Federal and state leaders do their best to meet you and your clients' needs, and they do better with your support.
Did you know?
48
Students can get involved with AOTPAC by joining the AOTPAC Student Challenge, a fundraising event Student Occupational Therapy Associations can do!
More members in the state association can lead to more involvement and education about advocacy efforts.
You don't have to be someone with advocacy experience or a specific skillset.
Decision makers want to hear the voices of their constituents.
A personal story goes a long way!
Know your state practice act!
"What do you wish people knew about advocating or the regulatory process?"
49
It can feel intimidating to start, but it gets easier every single time.
I wish people knew how easy it is and how many resources AOTA has.
Responses from various state association leaders
It takes time. You can't make changes overnight.
The regulatory process is time-consuming and can take 3 months to a year before a regulation is approved.
How easy, effective, and important it is.
If we didn't have the advocacy at the state-level, OT wouldn't be involved with anything.
What can I do now?
Get Involved
- Start with NOTA & AOTA and connect with practitioners
- Find local community organizations with the same interests
Track Bills
- Explore legislation in your areas of interest
Show Up & Speak Up
- What you say can change minds and conversations
- Attend events and meetings
How to Track Bills
50
Interested in what's happening in OT now?
Track bills using the Nevada Electronic Legislative Information System (NELIS)
Register an account for FREE!
Explore different Assembly and Senate bills
Note: Bills that start with AB means it originated from the Assembly, SB means it started in the Senate
Type a topic you are interested in
Review and click on relevant bills
When you find a bill of interest, you can track it (located on the right-hand side)
When you start tracking a bill, you get email notifications on how the bill is progressing
In the overview of the bill, you can submit your opinion!
For more details, check out the NELIS manual.
You are a part of a Community!
51
Organizations you can go to when you have concerns.
Click below to learn more.
State issues
Additional Resources
52
Can't get enough? Here's more for you to explore!
Websites
Good luck! Thank you for your time and energy.
References
