Breaking New Ground

Story by Dr. Anna Quigg

Jordan Valley Community Health Center (JVCHC) approaches patient care using an integrated care model. Dr. Barbara Wachtel-Nash, Psy.D., JVCHC’s Director of Behavioral Health Integration, through her clinical experience and previous collaboration with occupational therapists (OTs), recognized the value of adding occupational therapy services to the JVCHC integrated care team in Springfield, MO. 

The integrated care model is a response to the changing health care landscape in which the demand for comprehensive services in primary care is increasing as access to specialty areas and behavioral health services is declining (Robinson & Reiter, 2016). Integrated care is relationship-centered and focuses on “the whole person, [it] is informed by evidence…makes use of all appropriate therapeutic approaches…to achieve optimal health and healing” and is best-practice in medical care (p. 1; Esparham et al., 2018). 

JVCHC and the Cox College Masters in Occupational Therapy (MSOT) program are partnering to establish the first occupational therapist role in an integrated care program in Springfield, MO.  Cox College MSOT graduate, Nell Gillen, is the first to serve in this groundbreaking OT position. The American Occupational Therapy Association (AOTA) has promoted the role of OTs in primary care, stating OTs have “addressed health management, wellness, and prevention…as generalists or specialists since the early years of the (OT) profession.”  (p. 2; Halle, Mroz, Fogelberg, Leland, 2018).  One challenge for OTs in primary/integrated care sites is clearly describing occupational therapy’s unique value and impact on health. The partnership between JVCHC and the MSOT program addresses this challenge through collaborative efforts. AOTA emphasizes the importance of OTs using their trained skillset of understanding the roles of other professionals to enhance team performance and integration (Halle, Mroz, Fogelberg, Leland, 2018).

JVCHC is a Federally Qualified Health Center, where an OT is integrated into a team rather than an ancillary service. In integrated care, providers of many disciplines (e.g., medicine including obstetrics, vision,  pediatrics, and psychiatry;  behavioral health including behavioral health consultants and psychologists; dental; vision; radiology; nutrition; and physical and occupational therapy) are each valued for their unique role in providing a holistic approach to the patient’s health and wellness. 

 “I feel highly valued in this role,” states Gillen, “I am another set of eyes on the team. For example, if the physician or nurse practitioner suspects a need during a well-baby check I can be there within minutes, screening the infant or child from an OT perspective. I check reflexes, sensory, motor, or other development to inform the team, including the caregivers.” 

Gillen credits her experience-rich education and close connection with her professors in helping navigate the exciting challenges of developing this new role and finding her place in community-based health care. “Cox College provided me with the advantage to really see diverse opportunities for therapists and to see what it will really be like to work as an OT,” states Gillen. “We learn all of the hard science, human mind and body course work, but maybe more importantly, we practice our therapeutic use of self, professional development, from a diverse set of professors.

We have opportunities to participate in a great deal of service work. All of this equates to a very solid set up for a successful career.”

Professor Michelle Jackson, faculty in the MSOT program who taught Gillen for two years, described Gillen as an “excellent student with a huge heart for service”. Professor Jackson added that she is not surprised by Gillen’s fearless display for leadership. “Nell actually was a part of the group in my Leadership and Entrepreneurship class that developed a detailed business plan for a community-based OT role. It is no surprise that she would be a part of creating a role that can allow her to continue to serve low income children and families.” 

Before applying to Cox College’s MSOT program, Gillen spent seven years as a missionary in Latin America, teaching women skills that would help bring food to the table. Crafting, sewing, and up-cycling products to sell allowed the women to thrive in their community. Gillen, her husband, and their four children returned to the United States to re-acclimate to US culture before pursuing educational opportunities. She discovered OT when her youngest daughter received services and knew a career in OT would allow her to help people while using her creative skill set. Gillen 

envisions her role as an integrated care, community-based OT will continue to grow while remaining team-based and collaborative. Gillen’s journey with the MSOT program and role with JVCHC is a beautiful illustration of Cox College’s mission to meet the needs of the health care community by working together, taking reasonable risks, and daring to change. It also embodies the MSOT program’s mission to collaborate with community partners in order to meet the needs of clients while advancing the practice of occupational therapy.

Partnering with passionate community partners whose vision for meeting the evolving needs of health care consumers allows Cox College’s MSOT program to contribute to emerging practice areas; respond promptly to the evolving landscape of medical care; and implement practice recommendations. OTs are trained to use flexibility to adapt to cutting edge technology and respond to evidence as it informs best practice in applied settings. The MSOT program is grateful for the open dialog and collaboration with Dr. Nash and the JVCHC Integrated Care program in developing new roles for OT in a primary care and integrated care that strive to meet the needs of the healthcare community.



Esparham, A, Misra, S., Sibinga, E., Culbert, T., Kemper, K., McClafferty, H., … Rosen, L.  (2018). Pediatric integrative medicine: Vision for the future. Brief report. Children, 5, 111.

Halle, AD, Mroz, TM, Fogelberg, DJ, & Leland, NE. (2018). Occupational therapy and primary care: Updates and trends. Health Policy Perspectives. American Journal of Occupational Therapy, 72. 

Robinson, PJ and Reiter, JT. (2016). 

Behavioral consultation and primary care: A guide to integrating services, Second edition. Switzerland: Springer. 

On the group photo: From left to right: McKenzie Matlock, PA; Jessica Demoret, BHC;  Nell Gillen, OT; Dr. Barbara Wachtel-Nash; and Dr. Clint Strong