Advocacy In Pelvic Health - How Far We've Come + Where We're Going

This is a special episode that was recorded originally by Sarah Lyon of OT Potential. It is groundbreaking and I had to share it here! To learn more about OT Potential, please go here. 

• Get $100 the recordings from the 3rd annual OTs in Pelvic Health Summit here. It comes with 16 CEUs!
• We'd love to welcome you to Pelvic OTPs United - Lindsey's off social media community ($39 a month with no obligation!)
• Grab Your FREE AOTA approved CEU pelvic health course here.

____________________________________________________________________________________________
Pelvic OTPs United - Lindsey's off-line interactive community for $39 a month!
Inside Pelvic OTPs United you'll find:​

• Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
  ​
• Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!

Transcript

Carlin Reaume As the health care policy landscape grows increasingly complex, we as occupational therapy professionals need collective mobilization like never before. But it often feels like our advocacy systems are difficult to navigate and our lobbying efforts are underfunded. Against this backdrop, which can seem quite discouraging. I think it's critical to shine a light on what I consider one of the greatest OT triumphs of the past decade our breakthrough into Pelvic health. This is a story of grassroots organization, individual thought, leadership. Facebook groups, podcasts, phone calls and coordinate of collaboration at the individual, state and national levels. We are thrilled to be joined by two leaders from this movement, Alyson Stover and Lindsey Vestal. Both have played a unique role in this effort and we are here to share what they have learned from the wins and setbacks along the way. Ultimately, we hope this story and our conversation will help you reflect on your own role as an occupational therapy advocate in this new era. Welcome to the OT Potential podcast, where we review new and influential O.T. Journal articles and then invite a guest to help us pull out actionable takeaways you can implement in your practice starting today. Welcome to the podcast. I'm your host, Carlin Reaume OTD OTRL. Before we dive into our topic of advocacy and pelvic health, I wanted to let you know that this podcast may qualify as continuing education for you. You are probably listening to this podcast on a free podcast platform, but to gain CEU credit, you will need to be a member of the O.T. Potential Club, our OT continuing education platform. Bearing in mind that this could count as a CEU course, I want to explicitly state our two learning objectives so you can be thinking about them throughout the podcast today. You'll be able to identify simple steps you can take to advance advocacy for O.T. in Pelvic health, and you will be able to recognize the importance of state and national level position statements around pelvic health. Now to help us wrap our minds around what a concrete advocacy win can look like and to orient us to the Pelvic health practice area, I want to give a brief overview of the position statement that was just adopted by the O.T. Association of California. Then we'll bring on Lindsey and Alyson to talk through the implications of advocacy like this for your own practice. The Association of California adopted their Pelvic health position statement in March of 2024. The two page document can be read on their website. But to summarize, it answers the following. Why should the greater health care community support the role of O.T. professionals and pelvic health? What is Pelvic health? Why is Pelvic health important? Why are O.T. professionals uniquely qualified to provide Pelvic health care? What does O.T. Pelvic health assessment and intervention entail, and how does OT integrity and competence support our role in providing pelvic floor therapy? The statement ends by asserting that it is firmly within O.T. professional scope of practice to address pelvic floor dysfunction, to promote independence and enhance quality of life, and optimize occupational participation and performance across diverse segments of the population. We'll get into what state level wins like this mean for our profession in just a little bit. We will also talk about what is current effort to create a pelvic health position statement. This new position statement will eventually join the 39 other aotea position statements. To illustrate why position papers like this are important, we'll discuss the learnings from a recent advocacy disappointment where OT was not included and proposed legislation that would boost the role of Pelvic health physical therapy for Medicaid beneficiaries. There's clearly so much to talk about, and we promise to bring these high level, sweeping topics down to a more personal context, down to you and how you can use this information to advocate for your career and your clients. And like I mentioned, we have the perfect two people to help us do just that. Lindsey Vestal OTRL Lindsey has been a trailblazer in advocating for OTs role and Pelvic health. She was the founder of the Functional pelvis, the first in-home pelvic health practice in New York City run by an occupational therapist. Lindsey has helped thousands of people overcome chronic pelvic health challenges like incontinence and pelvic pain. Her goal is to empower women and men to listen to the wisdom of their own bodies without resorting to invasive surgeries or prescription drugs so they can heal and get back to enjoying life again. Lindsey also teaches AOTA CEU approved OT courses on how to specialize in Pelvic health and how to start their own private pay business. Whether or not you are an O.T. in Pelvic health, she has a thriving Facebook group called O for Pelvic health, where she hosts Free Weekly Facebook Lives chockfull with case studies, business topics and more. As a financial disclosure, Lindsay does mention an upcoming certification course. During this episode, which Lindsay is affiliated with, O.T. Potential has no financial stake in her course. And Alyson Stover Alyson is humbled and honored to serve as the president of the American Occupational Therapy Association. She has made uplifting public health a key focus of her presidency. A childhood family trauma introduced Alyson to the power of occupational therapy. A subsequent lifetime of study and practice convinced her that consumer advocacy was every bit as essential as her technical practice of occupational therapy. Now, Alyson and her husband own a private outpatient pediatric practice in a rural county in Pennsylvania and cofounded a nonprofit organization that uses occupation to address community, societal and population needs. She currently serves as the director of clinical services and continues to practice as an occupational therapist at Capable Kids and lead clinical consultant for capable families. Additionally, Alyson is an associate professor in the Department of Occupational Therapy at the University of Pittsburgh, where she also obtained her juris doctorate in law with a postgraduate certificate in health law. Without further ado, let's patch Lindsay and Alyson into this podcast. I am so excited to be here with both of you today to have this conversation around something that's so near and dear to my heart. And they know to both of you are as well. So and Carlyn Ram, I'll be your host for today and moderating this conversation between our two very special guests. We have Alyson Stover and Lindsey Vestal. So, Alyson, if you could introduce yourself to our our listeners, that would be great. 

Alyson Stover Sure. So hello, everyone. I'm Alyson Stover. I am the president of the American Occupational Therapy Association, and I hold hats as a professor at the University of Pittsburgh and the owner of a private practice in Pennsylvania called Capable Kid. 

Carlin Reaume Right. Thank you for being here, Alyson and Lindsay, tell us a little bit about you. 

Lindsey Vestal I am so jazzed up to be here. I'm Lindsey Vestal and the owner of the Functional pelvis and I help OTs find their way into Pelvic health, which is undeniably the best specialty we can ever be in. And we'll talk more about that today. But I'm really, really excited to have this conversation. So thank you for having me. 

Carlin Reaume Yes, very happy to to explore this topic. Alyson, as you kick us off, just what are your thoughts? 

Alyson Stover Yeah, thank you. So I am I am likewise very thrilled and honored to be here. As I had mentioned before. Sometimes I pinch myself and think it's hard to believe who I get to have the privilege of sitting in the room with. And I have learned a tremendous amount from both Lindsey and Carlin and continue to. But I was thinking a lot over the past few weeks about this conversation and our topics, and a very different conversation came to my mind. And so I'm going to take us on a little journey, as I often do. So so bear with me. But it does come back for us to understand. And it starts with my daughter, right? So my daughter had come home from school one day and she said, Hey, the principal's going to call you, probably. And she didn't. And kind of gone through a process where she had known some children who were having trouble with the way that a process worked at school. So children who were in the special education room were not given any the necessary accommodations to do some test practice. In fact, not only were they not given the necessary accommodations, but they were actually given consequences for not finishing on time with peers who were not in a special education classroom or had any identified additional accommodations necessary. And she said she went into the principal's office to share that. That was not that actually wasn't how this worked, in her words, and proceeded to to talk about how the meaning of special education and accommodations is really the idea that we don't fit the individual into the process, but instead we fit the process to the individual. And and they had gone back and forth a few times. And finally the principal said to my daughter, you know, Avery, how many detentions did you end up getting? I'll wipe them clean for a great argument. And my daughter looked at him and said, I don't have any. I finish in the first day of retirement. I'm talking about the process. And, you know, he was quite shocked by that, that she would go in and advocate for this this issue, this idea that it didn't really it didn't really have any day to day impact or influence on her life. And so she and I were chatting about that and I said, you know, I think this is incredible that you've done this. And. And when we drove in deeper about it, she said, Mom, it's really about the importance of language. The language without consistent and understood meaning has nothing. It has no power. And so as we talk about how we are challenged by many heroes and sheroes across many decades, one of the things that we often talk about is what they've said or what they've shared or how language and voice is the power. But but she really opened my idea to this thought process of. Well, language is only powerful if it has a shared, known, consistent meaning. Which brings me here. See, I see from where I have the opportunity to sit daily that our health care system is going to change drastically. We continuously and consistently see poor outcomes. We continuously and consistently see lack of access, minimal preventative care. We see higher expenses burdens related to the effects on a caregiver. We see individuals often having to choose between working or taking care of someone that they love. We see individuals that aren't able to age gracefully in their own homes. We have a health care system that is crumbling under our feet. But with that, we have this opportunity where in the next 5 to 10 years we're going to be redefining health, wellness and health care. And at that stage, occupational therapy can be written in to what it is, or it can be written out. And we need to start to understand and use the language that everybody uses. Which brings me to today. Doesn't matter what type of occupational therapy you practice or you want to practice or where your interests lie, the pelvic floor is going to be involved, whether it's functional mobility for an individual who recently experienced a stroke. Or it's toileting for an older adult who's aging in place with cognitive impairment. Or it's the ability to manage and navigate bowel movements for a child who wants to be able to go to school all day and not have an accident or it's related to are difficulty in being able to impact our breathing activities for anti-anxiety measures because our diaphragm doesn't know how to be activated. See, there's actually no place where we can practice occupational therapy, that the pelvic floor is not involved. But if we don't take this opportunity now to jump together and advocate for the name occupational therapy, to walk along side pelvic health in any capacity in every capacity, will be speaking a language that only we understand and half the community will be offended and not want to ever say it. And half the community will embrace it. And then we won't really see occupational therapist presence in that new set of language we're defining. So I hope, if anything, as we talk through all of this, that we kind of embrace a little bit of Avery Rose Stover and say. I am going to walk away and I am going to advocate so that in my state there is something that recognizes pelvic floor pelvic health and occupational therapy together so that in five years, in ten years, we have a thriving profession in a language that everybody understands. So thank you again. And I I'll kick it back to either of you as we jump in to what I think is going to be so exciting to talk about. 

Carlin Reaume Thank you so much for that, Alyson. I mean, that's the perfect way to to start this conversation. You touched upon so many pieces and nonstory and, you know, having this space where we can talk about, you know, the commonalities that we share, the language that we use, the ways in which we move our profession forward. It's relevant to all of us in whatever setting we're practicing in, whatever. If you know you are a student, whatever setting you're thinking about practicing in in the future, this matters. So I'm curious, you know, why do you both think that this has this area has taken hold in a way that some other emerging practice areas haven't? I think, Alyson, you spoke to that a bit. You know, everyone has a public floor. Is there anything else, Lindsay, that you would add? 

Lindsey Vestal I mean, I honestly think we can end the podcast right now because I think that Alyson has said it also, I'm going to I'm going to make an attempt to add something to this. I it's interesting, you know, in preparing for this amazing conversation today, I was reflecting on something that Alyson actually said on my podcast, which was, If your pelvic floor is not healthy, there is no occupation you can perform. And hearing it reinvented. And yet new language that reflects a very deep sentiment that, you know is the same just continues to to light me up and to hear it to hear it. The impact that the pelvic floor has on everyday occupations, regardless of the situation and OTs, are no strangers to intimate situations, right? Regardless of your setting and the population you serve, at some point in your career, you helped a client with toileting and hygiene and dressing and bathing. All of these things involve the pelvic floor. So if we're already addressing these things, why not get to the root of what they need to function the pelvic floor? So I think it's taken hold because it's about coming back to our roots and the root of what it means to be a human being. And this often involves vulnerability. Intimacy and all of the important occupations that we do behind closed doors, which are the jobs of the pelvic floor. 

Carlin Reaume It's. Yeah, beautifully stated. And I see, you know, I have one hat in academia and it's really exciting to see the students that the more that we have these conversations, we talk about these vulnerable, intimate issues and we normalize this as our role as practitioners to create safe spaces for our clients, to feel comfortable to explore all of these. I'm really seeing students that are excited to begin their careers and unafraid to address, you know, and feeling equipped to address all these important topics. Lindsay you really are a trailblazer in advocating for Ot's role and pelvic health you have been for a long time. Why do you feel like that mission was so important to you and how do you think it's been a match for your your skill set? 

Lindsey Vestal So many of us come to public health through very personal experiences. That was definitely how I found my way through my very outgoing and gregarious dad's experiences. My dad had both bladder and prostate cancer and experienced urinary urgency and frequency, and it caused him to withdraw from nearly every activity that brought him joy and fulfillment. Pelvic therapy drew me in because after my dad's experience with it, I not only got my dad back, but the community got back an incredible leader, and my dad stepped back in to what brought him true joy. He felt led up again by life. But in those experiences, I realized that Pelvic health wasn't just a right for my dad. It's a right for every single person. For the child who experiences sensory challenges in a public restroom due to the unpredictable, loud flashing noises to the pregnant person who's leaking urine with every cough, to the post-menopausal person who isn't able to be intimate with her partner anymore due to painful sex. So it's literally something that has or will affect either you or someone you deeply care about. And due to the very taboo nature of the topic, people don't often know there is hope. They don't. Often they think they just have to put up with it. And there aren't enough trained professionals in this area of practice. So once I discovered O.T. and learned about our background in mental wellness and our buyer's psychosocial framework, I, I was absolutely compelled to be in O.T. in order to be a pelvic health therapist. I knew that Pelvic health was so much more than clamshells and leg slides. And in its very best it takes into account all of the innate abilities and training that we have as OTs, such as therapeutic use of self function centered care, approaching treatment sessions from a facilitator versus a fixer mindset and our behavioral and cognitive strategies and of course our desire for collaboration and advocacy. You see, OTs are natural leaders in this space and our O.T. practice framework includes toileting, hygiene and intimacy. So what's more pelvic health centric than that? And then in terms of my skill set, well, first, it absolutely takes a community for this type of movement to happen. And I'm actually on a podcast right now with three of the most incredible community leaders I know. Alyson, you have single handedly energized the Pelvic health community in ways I have never seen before, from site visits to public health clinics, including our own Carlyn Ryan's clinic and learning as much as you can about it and making it one of your strategic priorities throughout your term. Carlyn Your advocacy to make the Otak Pelvic health position paper a reality was no small feat to jumping on a call with anyone and everyone in our community to help answer any state or national policy and advocacy question. And our own Sarah Lyon, who you know is the OTP, is the brain behind O.T. potential? Don't even get me started with her leadership. She recently got the 2024 Jim Hinojosa Award this year for advocacy, generosity and mentorship. So let's just say that I'm in a really good company, and where I fit in a little bit to this is that I'm kind of a rebel. I usually don't ask for permission on things I believe in. I usually just ask for forgiveness if it's needed. And after my dad's experience, I wholeheartedly believed in pelvic health specifically for occupational therapy practitioners. So right then and there, I decided there was nothing that was going to stop me. And that's how I found myself with a Facebook group of I think we're up to 6500 OTPs and Pelvic health to training over a thousand OTPs since 2018 with my course Oti Pioneers two to now finding myself in a place where I have a podcast that is rated as one of the top 25% of all podcasts internationally. So I think it's about surrounding yourself with people that lift you up, which I've had the distinct privilege to do, as well as finding in you that that call, that mission, that that takes you there. And in terms of what I brought up, Carlyn, about your advocacy, I have seen this in you and I love I'd love to ask you, why was that mission so important to you? 

Carlin Reaume Thank you so much, Lindsay. I. You know, the state. I've been involved with our state's professional association for a really long time as a member, as a grad student, and started taking on different leadership roles, you know, beginning with annual conference and kind of dabbling. And it's it's evolved over its years where I've taken on more and more responsibilities. And I have been serving as an advocacy chair for our state association. And in that way, I have access to a lot of conversations. I am able to do a lot of networking and just getting to meet practitioners throughout our state and around the country. And I that all things advocacy initially actually felt a little bit intimidating to me. Like I'm not somebody who I naturally would have seen myself in this role at all ever. But as I have gotten into it, I realize that it doesn't have to be scary. And a lot of it is about having conversations, just simple conversations, providing education for people and so and relationships, relationship building. And so as I've been doing this over the last couple of years, I started seeing, okay, there are small ways where I can begin to make changes and I felt well-positioned within our state as I was thinking about what was going on the throughout the country and the legislative landscape and just seeing this momentum that has been building around Pelvic health, I thought, well, what can we do at a state level that I'm well positioned to have an impact in? And I thought, you know what, I we need to have a position statement at towards the tail end of last year to the end of 2023. The voters representative Assembly, they passed a motion to create a pelvic health position statement, which was really exciting and exciting, some exciting movement forward. And so that was passed and the end of 2023. And I advocated I was one of the voices that advocated for them to speed up that timeline a little bit. Originally, it had been proposed to be launched in 2025. And knowing, you know, the groundswell, the things that were happening, I said, you know, can we please consider launching that and fall of 2024 that, you know, was like the soonest that it seemed like it could be possible. And so I'm really grateful that that was passed. And they adopted that revised timeline of fall of 2024. And that felt like a win. But simultaneously, I thought, my goodness, that is so far away. That's like a year away. Is there anything else that we can be doing in the meantime to help move all of this forward? And I thought, you know what, we're going to take it to the state level. I know that we we meet more frequently. We have a group of motivated people. I feel like there's the momentum, the power to shift at forward. And I also knew the process to do it, you know, So I was, well, well-positioned and persistent in advocating to make it happen. And I'm so pleased that we were able to it was a it was a team effort and we were able to publish that last month in March of 2024. So ahead of the AOC position statement. Yeah, really big win and I feel really pleased with how how it turned out. So. So thank you for that. And to my my many colleagues across the public health community that were that were involved in kind of brainstorming ideas and how we can move it forward, it really is a collective group effort around all of this. So, Alyson, I have to ask you, you know, you really have made pelvic health a focus and one of your priorities during your presidency at the national level. And can you can you share with us like, why has this mission been so important to you? 

Alyson Stover Yeah. Yeah. So, I mean, first I just have to say thank you. I mean, Carlene, this work that you did in California, it needs to be replicated in all of our state, the District of Columbia. Like, we all need to do this. Move this forward. Thank you for starting the outstanding work that has to happen. And and, you know, I would say just on top of that, too, like this is this is one of the reasons that I have long been an admirer of Sarah Lyon. She she has this unbelievable ability to bring these necessary movements to a very just accessible place for all of the community. And so I just I love that movement can happen with that. The work that you all put into this. But, you know, it's funny. Why was this mission important to me? I the president prior to me, Wendy Hildebrand, taught me many things. But I remember as she was exiting, one of the things that she had said many times was she felt this sense of urgency so often. And I think that's what made this mission so important to me was urgency. You're right. This is something that we are seeing moving tremendously rapidly through out to many different legislative spaces. This is something that we're seeing recognized as a priority. This is something that has momentum, which as an advocate, excites me. And then when I when I was introduced to Lindsay and was able to look through all her work, I thought, my goodness, this is something that we actually have experts in for a long period of time. It's not jumping in with the, you know, the 5 or 6 people who are just recently started to really dive into this initiative. We've got Lindsay, who's been as pioneer, leading the way for years like this is. Yes, we can respond quickly. The the other thing I would think is that, you know, again and I know I probably say this a lot, but, you know, I have spent a lot of time in the substance misuse world. And I walk alongside one of the most incredible humans to exist are county Coroner John La Benarty. And and, you know, he says two things very often. He says, one, Alyson, I work for the most equitable, least discriminatory employer there is. C death doesn't care about your age or any of your personal identifiers. It comes when it comes and it takes everyone at some point, right? And so he said, I will never be out of a job because my employer will never stop being something that is involved in every human's life. And he said. Through that. Recognize that where you can make the loudest, most profound impact is in the space where people say. It's the experience of all the shared experience. He said, Look, nobody's talking about the methamphetamine crisis, although it's much more significant than the opioid crisis. But that's because everybody knows someone who knows someone or is touched by the opioid crisis. When you find that police of urgency, that your profession can move mountains and change lives, that everyone has a conversation about, you need to go in hard, go in fast and go all in. There's not a single person in this entire world that I've interacted with that I haven't had some conversation that reflects the pelvic floor, whether it's, you know, close friends, family members, and we share things about our experiences through pregnancy delivery, postnatal, whether it's having conversations about things like intimacy with clients that I have who have experienced trauma, whether it's literally just looking at your neighbor or at a birthday party and kids are jumping on a trampoline and you have some joke about maybe your child is the one that peed on the trampoline before, or maybe you're the one that can't jump on the trampoline anymore, right? There is no one much like death. The pelvic floor doesn't discriminate. It is in all of us. And so we need to do this now. And the other part is, Lindsey talked about we are positioned to be leaders in this space. I think it's important to acknowledge that. When when I see leaders in this space, what I see and what I have been able to observe so incredibly is that we've we've defined leadership as a culture, as a community very different than what health care leadership needs. And the perfect for community in occupational therapy defines the true leader. And that is we don't need to be leadership because in this space, because it elevates the name of occupational therapy, we don't have to be leaders in this space because it gives us relevance or we can make more money or be a better reimburse process. We have to be the leaders in the space because nobody else here. Because only occupational therapy will be able to provide best outcomes that change lives. In the pelvic floor space. It's not that we are just positioned to be. It's that we have an obligation to be. And so we need to do it now. Before before the whole world is at a loss because we didn't take the leadership we were supposed to. 

Carlin Reaume Yes, absolutely. I agree 100%. We are so perfectly suited and we need to, you know, we need to be at the forefront. We need to be pushing this forward. Lindsay So much grassroots momentum really had to be built in order to get us where we are today. And I would love if you could share some of the lessons that you've learned in this process of building your grassroots and. 

Lindsey Vestal Absolutely. Karl on your your spot on about the grassroots momentum that played such a pivotal role in our journey to where we are today and reflecting on this process, there are some things that immediately come to mind. First, I deeply appreciate the power of community and collaboration, and it's not lost on me that you've asked me this question because I think you embody those attributes so beautifully, Carlene. And it's it's just so incredible what can be achieved when people come together with a shared vision and passion. And so it's just a dream to be having this conversation with you. All right. Now, second, I've learned the importance of perseverance and resilience. Building momentum from the grassroots level often involves many obstacles and many setbacks, but it's determination to keep pushing forward that ultimately leads to that progress. You know, not knowing full on that, what you're getting into is going to have a roller coaster, a sensation, an unexpected. I'm not expecting it to happen overnight. And so that's through that perseverance and resilience comes in. Additionally, I've gained a deeper understanding of the impact of small actions. So every contribution, no matter how seemingly insignificant, can really make a difference when it adds up with others. Right? There's change is a is a collective effort and we all inspire each other on that path. Right. I see what you're doing and otak. And I'm thinking, what can I do here in Arizona? Right. So it's, it's, it's that shared experience and now we're in it together. And lastly, I have learned to embrace flexibility and adaptability. So the path from grassroots to where we are today is anything but linear. And so being open to adjusting our strategies and approaches along the way has also been a really key part of the process for me. 

Alyson Stover Can can I just add, Lindsey, One of the things that I have learned from you that I continuously am grateful for is, you know, I thought that I was a well-trained advocate, right? I had gone on to law school and into all of those spaces. You have a brilliant in an optimistic advocacy that I think is actually what is incredibly unique, but also has been able to catapult Pelvic health and Oti to where it is. Because without your optimistic advocacy, I don't think it's an inviting space in which there's an opportunity to elevate. But you have single handedly brought pelvic health to a place that is easy and welcoming to elevate through an optimistic advocacy. And and I don't know how you do it. I know it's not easy, but I continue to watch you do this and learn from you. Because without that skill and brilliance, I don't think we could be where we are right now. 

Lindsey Vestal I am incredibly honored that you say that. I know I said earlier we should have cut the podcast off with our opening statement, but I retract that now because I am absolutely humbled and blushing by that compliment. Thank you. Alyson Carlin I would love to learn a little bit more about how the position statement from attack got off the ground. For anyone listening is thinking, I want to do this on my state level, you know, what are the steps? Can you give us kind of a Cliff Notes version of your advocacy there so we can have a better understanding of it? 

Carlin Reaume I'd be very happy to have you know, each state, I think, moves forward a little bit differently in terms of how their professional associations adopt these kinds of documents. But it was about a motion being proposed. So basically collecting my thoughts and stating why I felt like this was needed and putting that into a succinct document for their consideration. They said, you know, here are the facts. This is why we need to create a statement about it, one that other practitioners can see who might be unclear of our role. So it empowers practitioners, it empowers students. It's a way for consumers to understand what our role is, and it's a way for regulatory boards to understand the involvement that we can have. I think it's really critical given the current landscape and the momentum that we are involved in active voice in this conversation. And to my knowledge, no other state has a statement. And so I felt like it was very an important opportunity for us to emerge as leaders in this way. And so I crafted a motion that was then submitted to the board by the current Vice President, and it was discussed and adopted. And so then I moved forward in collaborating, figuring out, you know, what should be in that document and really solicited a lot of input to make sure that it was as comprehensive as possible, that it said what we wanted it to say, that it spoke to the breadth of the ways in which we can have a powerful impact in supporting people with pelvic floor dysfunction and pelvic floor health across the lifespan, all genders. And we really wanted to make it be an inclusive statement, and I feel really pleased with how it turned out. Now, I have to say, like some of the qualities that you were mentioning about, you know, grassroots grassroots efforts and lessons learned. Some of those pieces are also true for me. And my perspective of moving that statement forward is just the hard work, the persistence there, really feeling deeply called to have to move it forward because there there have been places where I could have given up or, you know, not pushed to include certain language or, you know, that kind of thing. But it really has been a yeah. And effort and persistence and patience and collaboration and teamwork to get it past the finish line. So I think that if anyone is, you know, I really do encourage all of the states to move forward in position statements. I think it's really powerful for people to to see the work that we're doing and to have these position statements visible. But contact your board, contact the board or see what you can find out about the bylaws, the processes of each state's professional associations. So can kind of walk you through the how to. It is usually a multi-step process, so you have to be familiar with how that process unfolds in order to then impact the change. So I'm excited that it's finally out there. So that leads me to ask both of you what what do you see as the as the pros and potential cons of any kind of state level position papers? Are there any cons? 

Lindsey Vestal I think there actually may be a con. So there's clearly pros. I think we've been definitely heading highlighting that all this entire podcast. But there's one little con that I'd like us to consider, and that is I don't believe we need permission to do something that our practice framework already says that we're uniquely qualified to do. While that does help and move forward so many aspects of advocacy for our profession. I don't want people to to see this brilliant work. Karlin That you've helped come to fruition and think that they need that permission in order to practice pelvic health in their state. To my knowledge, there isn't a state where we can't practice pelvic health And so while there are certainly incredible benefits and perks to having a statement like this at your state level, please don't mistake that you need to wait to practice pelvic health in order for for that pay for that position to actually be there first. Please get out there and do it in whatever setting you're at. It does not have to involve internal exams. You don't need to have hours of specialized education. We innately have the ability to do this, and so those small steps forward will then crescendo into a paper like this. But don't wait for that to happen. Get started now. 

Carlin Reaume Yeah, I want to just add quickly here. I think this is something I wasn't really clear on until I started diving more deeply into this work is that there is so much gray. There is so much gray space and all things advocacy. And I, I was thinking that there needed to be clear, clearly outlined. This is what we can do, this is what we cannot do. And I have learned in this work that that's not how it is. Like the gray. The gray space allows us and allows us flexibility and it allows us opportunity. And this is where you now go. We get to practice within. We get to utilize our scope of practice to have powerful impact in the lives of our clients. And so just because something doesn't explicitly say that you can do something just like what Mozilla says has said, we can, we can. This is within our scope of practice. I really want to empower people. I do think position statements can be helpful to explicitly outline that and answer people's questions, but if there is no position statement, it does not mean that you cannot do something. So highlight underscore bold. Alyson I would love if you could touch upon kind of logistically any anything else you might want to add about this conversation. But what you're seeing happening at the national level around Pelvic health and and how this conversation relates to that, that broader conversation. 

Alyson Stover Yeah. So I mean, there's there's a lot of really great things that are happening that I think we can align with both very specific to pelvic health initiatives. But, but really how Pelvic health has helped us to move forward some of the other broader initiatives. And, and you know, going back to the position papers, I, I, you know, sometimes I think, again, it's this language thing, right? And how we consistently interpret position paper, it's not an allowable thing. It's not this. It allows us to write the position papers that we have now and that we utilize are about sharing our story. So so sometimes I almost think that they, you know, they're better off being their own fairy tale, right? Like, it's it's not about giving us permission. It's about sharing with others the power of what we are able to do. It's it's telling our story. And so I think it's vital that we have them and that we have them. And every state, oftentimes we think about this idea that federal law is what impacts state law. And that happens often. But we don't talk about the many times in which state law is actually we can build up and funnel into federal law. And so the more we see this type of this type of advocacy successfully happening, it states, the more we can then build to have it as an overarching federal, when right now we're seeing things like there are some very specific pieces of legislation related to pelvic health maternal health and having the inclusion of occupational therapy in those and in those included in those legislation. But, you know, I like to talk a little bit about that, the other processes, right? So we have long been advocating for occupational therapies, ability and the right to opt out as a Medicare provider. Right. But we haven't been successful in that space. Having the powerful stories, examples, exemplars of which every legislator can connect with through our Pelvic health community has actually opened the door for us to have these conversations that are much more successful, meaningful perspective. Whereas it didn't make sense for the maybe the individual who was doing private pay and working with the older adult with stroke, because in CMS's mind that was to Medicare covered and should not be an allowable expense to an individual. Pelvic health is this beautiful space that kind of as you said, Carlyn is the gray of not only being understood as a defined Medicare benefit, but certainly something that has value and being provided. And so it's opened our door for some of those conversations. The other conversation that I think it's really helped with is the moving the transition on the needle of collaboration into professionally. Again, it is the one space where Petey and Oti are starting to really unite and and be okay practicing in the gray. It's okay. It's okay. When the Petey and the O.T. have this kind of shared great experience, as long as it's contributing to this overarching outcome. Years ago when we saw chronic pain being treated in multidisciplinary clinics, we saw better outcomes then we had ever seen in chronic pain management before. When we had the inclusion of the physician, the psychiatrist, the occupational therapy professional, the physical therapy professional, the social worker, we didn't we did not have not just an opioid epidemic. We didn't have a chronic pain epidemic. People had incredible health outcomes. Interdisciplinary teams are a value nobody thought in the pain clinic to say, Wait a minute, I have to say this is what I do. They fight to say, As a team we create this outstanding experience of health and wellness. 

Lindsey Vestal We we were. 

Alyson Stover Put in a position where we forgot about that argument. And so for for 30 years we've been pitted against one another. And Pelvic health is the space that's reuniting us to have that conversation again and again as we talk about moving into a new space of what does wellness look like? What does the health care delivery look like? Health care delivery is going to have to be done by a team and a team that's comfortable working in the gray because we have too many needs and not enough practitioners. And so we've got to work in a team and a team that's willing to coach and support and mentor one another and dance together in the gray and pelvic health is the space that is allowing us to do that again and creating that movement in so that we can get back to where health and wellness really exists. 

Carlin Reaume Thank you so much for that, Alyson. And yeah, that's really. It's. Yes, We need to meet this need. We need to think about how we can work together. I want to specifically highlight to you, Alyson, you talked about, you know, some of the the current legislative landscape and current bills. And I, I want to highlight h r 2480. I know a lot of listeners might be familiar with that. That's the optimize to optimizing Postpartum Outcomes Act of 2023. It explicitly names physical therapy. And we are not currently included in that bill. And so that does feel like a missed opportunity or an advocacy loss. And so I would love to explore, you know, what are some learnings that we've we have from that. And I've heard you before talk about, you know, stages of change with regards to advocacy or just different stages. And I would love if you could share your thoughts about that. 

Alyson Stover Yeah. So, you know, it's about the idea really, of of getting us to that space right where we can can really envelope the idea of best advocacy. So when this when this bill came out. Right, there was still a tremendous amount of division and amongst us and the physical therapists in this specific topic area. Well, right. But but when we think about how can we really embrace advocacy in a meaningful way, we've got to meet people where they are. And our our legislators weren't there yet either. They weren't they didn't they didn't know about this this topic that well, they didn't know who was involved in this topic. Right. And and so what happened was we had a piece of legislation that, yes, in some sense feels like was a missed opportunity. But we really have now to is the idea that this piece of legislation was able to take legislators and move them from that stage of maybe pre contemplation, not even knowing that pelvic health was really a problem, right. To a place of maybe moving even more towards action, dare I say, with some of the conversations. And how powerful is it going to be now to take this initiative and say we might not have been part of that early conversation, That early conversation had to happen? If legislators aren't ready for the change, we're never going to see the regulations coming about the laws being formed. That's that's not a missed opportunity in and of itself. It's sad that we weren't there. But it's okay, because where we really need to be is where that piece of legislation brought our legislators to. And that's actually coming to an action place of actually addressing the problem. We might not have been net mentioned there, but we now have legislators with open ears and now we can talk about what it means to write us in to legislation that not just said that we can do this, but affirms that we must be reimbursed for this, that there should not be barriers to our ability to participate in this care, that we should be paid adequately for the expertise that we are delivering in this care, and that, hey, a team of pelvic health health care should never exist absent the voice of occupational therapy. And so I think we take this as the win in that it brought us to the conversation where we really need to be present. 

Carlin Reaume Beautiful. Thank you so much. As we're getting close to our time kind of winding down here, I would love Lindsay if you could share, you know, big picture, what are some of your hopes for occupational therapy advocacy, you know, related to public health are just what people can take from this conversation. And within the next five years, what would you love to see? 

Lindsey Vestal Sure. First, that it becomes a household expression to refer to us as pelvic health therapists or to include both professions by consistently saying pelvic health o.t p.T. That we are recognized, respected providers. There are the top of mind for referrals and that we see Pelvic health therapists start with learning what it truly means in concrete ways to practice from a trauma informed perspective. And Carlin. I don't just hope these things will happen. Advocacy only works when we provide clear, concrete ways to advocate for ourselves, our profession, and then have it translate to getting jobs. And this is why I know the first and only pelvic health certification that I'm creating with Kelsey Morpheus, which by the way, is specifically designed for OTPs and celebrates our unique approach, will pave the way for this because it gives the skills, knowledge and abilities or core competencies to empower occupational therapy practitioners to walk into any h.r. Department or hiring managers office and say with complete confidence I am a level three certified functional pelvic health therapist and this is what I can bring to your clinic and that hiring manager will reply with when can you start? 

Carlin Reaume Beautiful. Beautiful. Alyson, what are you hoping for in the next five years or so with our advocacy efforts? 

Alyson Stover Yeah. You know, I, I think about I what I hope, I hope that we are have become a community that looks for the common in everything that we do with each and every person next to us. So, you know, I hope that we are better at advocacy because I now know how to say how the pelvic floor is involved in the day to day work that I do with my own clients. I my hope is that in five years, every member of the community has challenged themselves to find the common in those spaces that they think they don't practice. And then, you know, my other hope is that it kind of it kind of goes along with Lindsey, right? So she has built this page, life changing certificate that is going to provide you all of the training and the expertise and mentorship that you need to be an optimal and credible pelvic health occupational therapy professional. So my hope is that you you do it right. Like, let's not be scared. Let's not put it on our our five year list every five years. Do it. Do it now. Sign up for it. And then just like she said, when you've done it and you've accomplished this, walk in and say it. Say I am a level three trained functional pelvis Occupational therapy professional. Say it. Say it constantly. My hope is that in five years, we have the confidence to say the expertise that we actually hold. 

Carlin Reaume I mean, I did go to all of those things like that would be such a beautiful world. And five years went. And I feel confident we're on the path. It's I really feel confident it's going to happen. I feel confident state professional associations are going to put out their statements. By that time, the Aot statement will be out. You know, and I, I, I think, you know, this connects to my last and final question. My final question for, for all of you is what is some a simple, simple baby step that the, you know, any of the our listeners can take with them today. And I I'm going to start because it is this saying it it's saying it it's claiming it that once you feel empowered and hopefully you do after listening to this conversation that you already have such value that you are bringing to the spaces and to meet the need. And so is there a space in your life personally, professionally, where you feel like your voice needs to move a conversation forward, move an issue forward, that you have this unique perspective or a unique way to lift up a conversation that needs to be heard. And so it's empowering people to feel comfortable and confident to just speak up. And it doesn't mean you have to speak to your senator. 

Lindsey Vestal Or your. 

Carlin Reaume Congressperson or your boss at work. It doesn't even have to be that level. Think about something that you can do you feel equipped to do right now and just challenge yourself a little bit outside of your comfort zone. I think that's the best place to start. Lindsay, Do you have any other baby steps that you might offer? 

Lindsey Vestal I, I absolutely mirror what you were going to say. And just just to add slightly to it, Carlin, because I think you said it incredibly articulately, which is define bravery for you. So for some of us, it's quite loud. For some of us it's quite quiet and that's all beautiful. Step into your style. You know, I see these incredible leaders in front of me and I'm thinking, what can I do? And so to not challenge yourself necessarily with, you know, comparing yourself with with this advocacy that you're hearing on this podcast, but just to say what fits me authentically to step slightly out of my comfort zone, whether that's, you know, talking to a hospital administrator or on a multidisciplinary team with someone who doesn't understand our role, to even just walking down the street. And when someone says pelvic floor physical therapy, you just turn and say, occupational therapist, do that to define what it is for you in your space. And I recognize that Sarah's reach is quite large. And this is you're not just a pelvic floor therapist listening to this podcast. So just taking a moment to define that for you, because I have found that when we kind of step into that challenge, that's where that growth happens. So if you're feeling slightly burnt out, slightly unsettled, slightly bored in your setting, these are those little steps that you can do. You don't have to take a course. You don't have to go off to a certification or a huge conference. It's just taking little steps because remember, you chose Oti for a reason. Something about it called you. And I know that the day to day can sometimes take that luster away. But I don't know about you guys, but just hearing this advocacy in this conversation, like revitalizes me, like I'm so excited about our profession right now and not just because we're talking about something that I'm so passionate about. It's really just our profession. Like we we actively chose this profession. And so defining in a small, quiet, loud, bold way for you what that means and reflect. I may not come to you right now, but it will come to you in a moment that if you stop and listen, you'll hear it. And I encourage you to act on it. 

Alyson Stover Wow. I mean, is there anything to say left to say, then, that you two have it? Yes. I think that these are brilliant ways. You know, I want to think about it from from a space of of some of the things that I that I have done in my own learning about how to advocate for this. Incredible. You know, and and you could do this for anything, but I'm going to challenge you to do it in the space of Pelvic health. Because again, when we unite and have a loud voice for 2 to 4 topics, we can really make huge waves and movements that actually do benefit the entire profession and the consumers of our profession. Right. But so, you know, I would say like read like so, so Google some of these individuals, Google, Lindsay, Google, Karlyn like read a blog, join their, their insta, follow them on Instagram or follow them, you know, on on a Facebook group. Ask a question, check in on that the pelvic floor and pelvic health community of practice like find something and then do it do it. So I just remember going to OTs and Pelvic health conference that Lindsey had in Arizona last year and I there was this incredible thing that like intervention type thing that Kiara Smith was talking about. And she said like how she just kind of integrates things like the poop emoji and that into to really engage in that talk with her, with her clients. So, you know, I think about that but I and so I thought, my gosh, I took this back with me, right? Like I had clients who had difficulty, like parents were talking to me about toileting difficulties. And I'm like, Hey, just play this game. I give like every three year old a little potty and a poop shooter for their birthday because they love the game. It gets the conversation going. It brings into this place of of independence with toileting. Find that thing, that thing that you read about that you heard them do that you heard them say and integrated into your practice. Because then there's two things that will happen. One, you'll start to recognize that you do pelvic floor health, too. And two, you'll share where you found it. And when you Cheri found it, you'll say the words pelvic health and pelvic floor and occupational therapy together. And just as Carlin did everything to get a tremendous amount of stakeholder input in her position paper, you'll be building our army because then that client goes home and they have a story. But in their story they have you, they have healing, they have O.T. and they have pelvic floor. And so so I challenge you, put one in into your treatment, share it and build our build our army. 

Carlin Reaume Thank you both so much for such a rich, fun, inspiring conversation today. I am so excited for, you know, the future of Pelvic health. I'm so excited for our profession. I am so excited for the future generations of advocates that we're going to move forward and do incredible things. So it has been such a joy. I am so grateful for all of the work that each of you have been doing in this space and many other spaces to promote our amazing profession. So thank you. Thank you for this conversation. This was such a special conversation. And talking with Alyson after the recording, it was clear that nothing happens without these position papers. They play a necessary role in moving policy forward. Specifically, our legislators really rely on them. I hope it gave you a sense of the many dimensions of advocacy and just how critical all players are from the trailblazers to our professional associations to OT practitioners everywhere. Just talking to the people in your circle about the value of occupational therapy. As always, we really want to hear what your thoughts are. If you are a casual listener, we'd love a review from you. You can now review us on Google from our home page or we always appreciate your comments on our YouTube video. But the best place to really discuss the implications of this is in the O.T. Potential Clown. I'll be watching for your comments in our forum. And if you are interested in earning a CEU certificate for your time today, what you're going to do next is head to O.T. potential.com and either sign in or sign up for the O.T. potential Club. Once you're in there, you can take a five question test. And when you pass, we will generate a certificate for your time. Okay. Thank you so much for joining us today. I hope this podcast helps keep you informed and inspired as an OT professional. Take care and we'll talk next time.