blogBlog: If I Ran the Nevada Health Authority, We’d Put OT in the Community Care Driver’s Seat ♿️
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Blog: If I Ran the Nevada Health Authority, We’d Put OT in the Community Care Driver’s Seat ♿️

By: Matt Brandenburg, OTD, OTR/L

You ever notice… how every big, shiny community health initiative in Nevada is bursting with buzzwords like “whole person care,” “care coordination,” and “population health”? Yet somehow, occupational therapy (despite rolling out whole-person care frameworks like they’re Bravo spin-offs since the 1940s) gets left out of the conversation.

Take Comagine Health’s Southern Nevada Pathways Community Hub. They run a Pathways Community HUB Institute (PCHI) certified care-coordination network that trains and supports community health workers (CHWs) across contracted agencies to tackle health-related social needs with 21 standardized “Pathways.” In English: they connect high-risk residents to the right help and make sure the loop gets closed. They’ve published early maternal-health pilot outcomes and, as of July 23, 2025, earned full national certification from the PCHI. Sounds pretty great right? Whole-person care? ✅ Community-based delivery? ✅ Track record improving maternal health, care coordination, and addressing social determinants of health? ✅✅✅

And yet… not a single OT involved.

If I Ran the Nevada Health Authority, we’d finally hand occupational therapy community health’s lead role. Because babe, whole-person, community-based care without OT? That’s like Vanderpump Rules without messy brunch fights. Sure, it might look and sound pretty, but it’s missing the guiding light (aka evidenced backed theory like PEO, MOHO, EHP, etc.) that makes it work. When OT steps in, it’s not about pouring another round of buzzwords, it’s about turning “community health” into safer homes, fewer falls, empowered caregivers, and real independence for Nevadans.

Exhibit A: AOTA Already Handed Us the Playbook…Kind of

The American Occupational Therapy Association offers community-based service resources including toolkits, a special interest section, and a link to their selection as a Healthy People 2030 Champion (how helpful…). The problem? It feels like they left these resources sitting on a coffee table next to a scented candle where Comagine, PCHI, and community health movements across the nation will never see them. Toolkits and badges don’t move policy, boots-on-the-ground OT practitioners (OTP) do. We need systems level influence that ensures the essential community services we provide are not ignored by policy makers and are reimbursed appropriately.

It’s time to move from “resource library” to “real-world leverage.” That means showing Comagine, the Nevada Health Authority, Nevada Medicaid, and anyone else who will listen (looking at you Nevada Center for Excellence in Disabilities, and Nevada State Office for Rural Health) exactly how OTPs improve community health by:

These aren’t just nice-to-have services, they’re essential infrastructure for a healthier Nevada. And it’s time we claim our role as the profession that delivers them best.

Exhibit B: The Center of Excellence Is begging for OT, they just don’t know it

The Center of Excellence to Align Health and Social Care lays out clear standards for what a Community Care Hub should be (standards that occupational therapy has been living and breathing for centuries btw):

  • Addressing health-related social needs and behavioral health alongside clinical care
  • Coordinating services across sectors and providers
  • Measuring impact in terms of function, participation, and independence (our bread and butter)
  • Delivering services in the community, not just in clinics or hospitals

Honestly, if the Center had called us first, they could’ve saved themselves a few white papers and a couple thousand lattes at their stakeholder meetings. If I Ran the Nevada Health Authority, I’d position NOTA as the roadmapfor integrating OTPs into these hubs statewide. That starts with drafting an OT-specific approach to care aligned to the Center’s standards, then inviting OTPs across Nevada to sharpen it with their expertise and frontline experience.

The end goal? A ready-to-launch, evidence-backed, OT-led model for community health. A model that funders, policymakers, and care hubs can plug into without reinventing the wheel.

Exhibit C: Partnering with the Pros Who Are Already Changing the Game

Comagine Health’s Southern Nevada Pathways Community Hub is already redefining how healthcare and social services work together. They’ve built the infrastructure and partnerships to support cross-sector care. But it’s occupational therapy practitioners who bring the real life trust, earned in homes, clinics, and communities across Nevada, that can amplify the Hub’s reach and impact.

Instead of reinventing the wheel, NOTA should position itself as Comagine’s go-to partner for expanding whole-person care into daily life. That means:

  • Embedding OTPs in care coordination, case management, and consultation teams to address functional and environmental needs
  • Using OTP’s expertise to close gaps in chronic disease management, fall prevention, behavioral health, and return-to-work programs
  • Bringing data on OT-led outcomes that strengthen Comagine’s case for continued and expanded funding
  • Co-developing pilot programs that showcase how OT interventions can improve hub performance metrics and community impact
  • Leveraging university partnerships for capstones, outcome research, and student fieldwork

With Comagine running the operations and OT running the day-to-day magic, Nevada’s community care hubs could pop up faster than Lisa Vanderpump can open another pink-velvet cocktail lounge.

Nevada could set the national standard for integrating functional health into community care models.

My Proposal: From Resources to Real-World Impact

If I were running the Nevada Health Authority’s OT strategy, I’d role out the following policy plan like a glow-up montage:

🔥 Launch the “OT in Every Hub” Campaign – Advocate for every statewide care coordination network (Comagine’s Southern Nevada Pathways Community Hub is the only one so far) to have OTPs in leadership and service delivery roles. If Nevada can put a slot machine in every gas station, why not put an OT in every care hub?

🔥 Roll Out the AOTA Resource Roadshow – Take AOTA’s community-based services toolkits, Healthy People 2030 Champion status, and case examples on the road. Encourage (and entice) OTPs across Nevada to spread the word about how AMAZING their clinical approach to care is and to use it to grow caseloads, prove outcomes, and influence policy.

🔥 Partner with Comagine on High-Impact Pilot studies – Embed OTPs into existing hub programs for chronic disease self-management, fall prevention, home modification, and caregiver training, then collect and publish the data to prove value and scalability.

🔥 Build the “Nevada Model” Playbook – Document our approach so other states can follow it, positioning Nevada as the national example for integrating OT into community health infrastructure.

🔥 Create a Feedback Loop with Nevada OTPs – Develop and circulate a draft OT approach to care aligned with the Center of Excellence to Align Health and Social Care, then invite every OTP in the state to help refine it before rolling it out.

In Closing:

OT isn’t just another line item in the care plan and we’re not just the glue that holds “whole person care” together. We’re the glitter glue. Flashy, functional, and impossible to ignore once you’ve seen it.

We’re the profession that turns hospital discharge summaries into sustainable Tuesday morning routines, that makes sure a “safe home” is actually livable, and that translates big policy ideas into the real-life moments where health happens.

Nevada’s community health future won’t be built by whoever drops the flashiest buzzword PowerPoint. It’ll be built by the folks who can translate ‘whole person care’ into effective and sustainable community health practices. Instead of buzzwords, it’s someone actually remembering to take their meds, or not breaking a hip in the middle of the night. That’s OT. We don’t need to audition for the part, we’re already the main character. Time to act like it.

So let’s stop waiting to be discovered and embrace our opportunity as the new bombshell entering the Nevada community health villa. Let’s walk in with our elevator pitch memorized, our outcomes data polished, and our sleeves rolled up. Are you ready to build the healthiest, most function-focused state in the nation?

Because here’s the truth:
We’ve been doing “whole person care” since before it had a name.
We’ve been solving the problems policymakers are just now learning to talk about.
We’re not here for a cameo. We’re here to star in Nevada’s health story.

Because “Babe, we were born cool.” And don’t you forget it.


Sincerely,

Your Vice President of Making Occupational Therapy Cool Again (VPOMOTCA) in waiting

Matt Brandenburg OTD, OTR/L

This Is Not About “Hating ABA.” It’s About Power.

This is not an attack on individual clinicians trying to do their best within a constrained system. It is not a condemnation of families seeking support. And it is certainly not an indictment of autistic children receiving services.

This is about power.

Specifically, who holds the power to decide: 

  • how much therapy a child is said to “need,” 
  • which outcomes count as success, 
  • when treatment continues or ends, 
  • and who benefits financially from those decisions.

Right now, too often, those decisions are not being driven by children or families. They are being shaped: 

  • by corporations with fiduciary duties to investors, 
  • through a therapy model that rewards volume and endurance, 
  • within a system that offers limited transparency about long-term outcomes.

That’s not healthcare.

That’s extraction.

And yes, this pattern is familiar to my fellow Mob Museum friends. Systems of extraction tend to follow the same playbook: 

  • enter spaces where people are desperate for help, 
  • control access to scarce resources, 
  • normalize overuse as “necessary care,” 
  • make themselves indispensable, 
  • and quietly collect while everyone else absorbs the cost.

Which brings us back to Nevada.

Nevada’s children should not be revenue streams.

Autistic kids should not be growth markets.

Disability services should not be acquisition opportunities.

Public insurance should not be a private equity playground.

What Nevada needs are autism care models that are: 

  • developmentally informed, 
  • evidence-informed and outcome-driven, 
  • trauma-aware,
  • neurodiversity-affirming, 
  • interdisciplinary by design, 
  • shaped and evaluated with meaningful input from the autistic community,
  • and led by licensed professionals with deep clinical training.

That means elevating occupational therapy, not as an add-on, but as a core component of care.

Occupational therapy providers are trained to ask different questions:

  • What is this child communicating through their behavior?
  • What is this child’s nervous system telling us?
  • What sensory, emotional, or environmental factors are shaping participation?
  • What supports create regulation rather than suppression?
  • How do we build capacity without erasing identity?
  • How does this family function in real life, not just in a clinic room?

We don’t sell stillness.

We support participation.

We don’t demand compliance.

We build capacity.

 

A Broader Coalition Is Raising the Same Concerns

These concerns are not mine alone.

The Nevada Therapy Alliance, a statewide coalition representing licensed occupational, physical, and speech-language therapy providers, penned a formal letter to the U.S. Department of Health and Human Services calling for a federal reassessment of Applied Behavior Analysis (ABA) funding and a redirection of autism care toward evidence-informed, developmentally grounded interventions.

The Alliance’s letter outlines:

  • the escalating financial burden of ABA on Medicaid and public systems,
  • concerns about limited oversight and minimal training requirements,
  • the expansion of ABA into complex medical and developmental conditions beyond its scope,
  • and the downstream consequences for children, families, schools, and long-term independence when skilled therapies are underfunded or delayed.

The letter advocates for better care. Care delivered by licensed clinicians with medical training in development, communication, motor systems, sensory regulation, and functional participation.

It echoes the same conclusion reached throughout this piece: when reimbursement incentives prioritize volume and compliance over outcomes and development, children and taxpayers lose.

Read the full Nevada Therapy Alliance letter here

 

If I Ran the NVHA…

I wouldn’t wait ten years for outcome studies while children are over-treated and mis-treated today.

I would restore accountability, realign incentives, and center children over capital:

 

1. Restore Oversight and Public Accountability

  • Pause approval of new private equity acquisitions in pediatric therapy and review acquisitions from the past decade.
  • Require full ownership and financial transparency for all pediatric therapy providers receiving public funds.
  • Establish a Citizens with Disabilities Advisory Council with formal representation in NVHA leadership and governance.
  • Set statewide interdisciplinary standards of care and supervision in pediatric therapy.

 

2. Realign Funding With Evidence and Outcomes

  • End preferential reimbursement and automatic authorization of high-intensity ABA services without interdisciplinary justification.
  • Conduct a formal, transparent review of ABA outcomes, costs, and long-term impact, including autistic lived experience.
  • Redirect cost savings toward licensed, evidence-informed therapies such as occupational, physical, and speech therapy.
  • Increase reimbursement rates and reduce network exclusions for therapies that demonstrate functional, developmental impact.

 

3. Redefine What “Success” Means in Autism Care

If I ran the Nevada Health Authority, we would stop measuring autism therapy success by quiet compliance and start measuring it by meaningful participation, emotional regulation, and engagement in daily life.

We would shift the question from “How do we control this child?” to “How do we support this nervous system?”

And we would finally align the care model with what children and families actually need:

  • ✅Occupational therapy integrated under physician oversight
  • ✅Behavior technicians appropriately supervised within interdisciplinary teams
  • ✅People over protocols
  • ✅Function over obedience
  • ✅Clinical decision-making insulated from corporate and investor pressure
  • ✅Autistic lived experience guiding every level of care

Because the truth is this: not all “therapies” are created equal. And not all “evidence” is ethically neutral.

Our shared objective should be clear: to ensure that children with autism receive interventions that respect their dignity, support their developmental needs, and demonstrate measurable, meaningful progress in daily life.

Nevada has been here before.
We know how rackets operate.
We know who gets hurt when oversight disappears.

If we can spot exploitation on the Strip, we can recognize it in healthcare.

And if I ran the Nevada Health Authority, I wouldn’t stand for it.

Neither should you.