Introduction

Introduction

Pediatric primary care is the first level of care and the entry point into the health care system for children and adolescents. Well-child care refers to the routine preventive health services that occur from birth until a child reaches age 21. Healthy People 2030 is a 10-year national plan set by the U.S Department of Health and Human Services in which goals and objectives are set to be achieved nationwide by the year 2030. Improving the quality and delivery of pediatric primary care is essential for meeting Healthy People 2030’s goals for improving health and well-being of children and adolescents. Six objectives related to promoting healthy development for children and adolescents and improving healthcare include:

The Affordable Care Act (2010) defines primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” (Patient Protection and Affordable Care Act of 2010, p. 515). The ACA emphasized prevention, health promotion, and healthcare delivery models such as the Patient Centered Medical Home (PCMH) in order to provide primary care that is accessible, family centered, continuous, comprehensive, coordinated, and team-based. The ACA identifies primary care practitioners as physicians, nurse practitioners, and physician assistants. This narrow view of who is qualified to provide primary care services contradicts the comprehensive and coordinated nature of the medical home model, and subsequently limits our health care system’s ability to achieve the Triple Aim: 1) Improving the Patient Experience of Care, 2) Improving the Health of Populations, 3) Reducing the Per Capita Cost of Health Care (Institute for Healthcare Improvement, 2022). The literature suggests that primary care patients are best served by a multidisciplinary, integrated team within the context of a medical home (AAFP, 2021; AOTA, 2012).

Occupational Therapy in Primary Care 

Health behaviors and decisions are embedded within people’s everyday activities, also known as occupations. Occupational therapy (OT) is a health profession that helps individuals across the lifespan achieve health, well-being, and participation in life through engagement in occupation (AOTA, 2017). Occupational therapy practitioners are well-suited to serve individuals as a member of an interprofessional primary care team because of the profession’s distinct knowledge of how habits, routines, and environmental factors affect health and participation in everyday activities (Dahl-Popolizio, Smith, Day, Muir, & Manard, 2023). Occupational therapy practitioners consider social determinants of health by examining the many contexts that individuals live in and offering strategies to enhance their health and well-being through everyday activities. 

Occupational therapy’s role in primary care has been discussed and demonstrated in the literature, but most studies  specifically focus on occupational therapy interventions for adult primary care patients (Mirza et al., 2020; Trembath et al., 2019; Pyatak, et al., 2019; Garvey, et al., 2015; Richardson et al., 2010; Jackson et al., 1998). The literature suggests that occupational therapy can contribute to pediatric primary care in the areas of developmental screening, identifying early intervention needs, parental education on child development, health promotion and prevention of disease and disability, and linking families with support services, resources, and community-based care (Dahl-Popolizio et al., 2023; Riley & Lazaro, 2021; AOTA, 2020; Brenner et al., 2020; Foxhoven, 2020; Zachry & Flick, 2018). Enhancing growth and development through parental education and establishment of healthy habits and routines in the context of the family unit are at the core of pediatric occupational therapy (AOTA, 2016). 

The limited understanding of occupational therapy’s full scope of practice is one of the most significant barriers to integrating occupational therapy into primary care (Andreae et al., 2021; Halle et al., 2018; Dahl-Popolizio et al., 2017a; Donnelly et al., 2013). Occupational therapy’s role in health promotion and prevention is supported by the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2020a), which is an official document that delineates occupational therapy practitioner’s domain of knowledge and services provided in practice. Occupational therapy’s unique lens of using occupation as the means for health promotion and prevention is what distinguishes it from other health care professions that provide services at the primary care level.  

Integrating occupational therapy in pediatric primary care would complement the medical services already provided with a holistic and occupation-based perspective of childhood health. However, before this integration can occur, the occupational therapy profession must gain support from interprofessional colleagues who currently work in the primary care setting. In order for interprofessional collaboration to occur between occupational therapy practitioners and PCPs within the pediatric primary care setting, there must be an understanding of each other’s roles, qualifications, and unique contributions to the care of each client (Halle et al., 2018; Dahl-Popolizio et al., 2017; Green & Johnson, 2015). Several studies and case reports support the claim that primary care provider knowledge of OT and the development of proper referral procedures are crucial to the integration of OT services in primary care (Garvey et al., 2015; Mirza et al., 2020; Murphy et al., 2017; Synovec, Merryman, & Brusca, 2020). Therefore, the purpose of this capstone project is to educate pediatric PCPs on OT’s scope of practice and role in primary care.