Individuals experiencing homelessness face significant barriers to accessing affordable and sustainable housing and to managing their health and well-being (Baggett, O’Connell, Singer, & Rigotta, 2010; Munoz, Garcia, Lisak, & Reichenbach, 2006; National Law Center on Homelessness and Poverty, n. d.). This population experiences a high rate of mental health and substance use disorders, chronic health conditions, and brain injury (Topolovec-Vranic et al., 2017). Health care and housing programs have been implemented in order to address the specific needs of those experiencing homelessness and minimize the barriers to housing and health management (Aubry et al., 2015; Zlotnick, Zerger, & Wolfe, 2013). Although these programs have seen success in increasing housing and health care access, needs remain unmet: individuals require ongoing support to successfully transition into housing, improve their health, and integrate into the community (Cherner, Aubry, & Ecker, 2017; Tsai, Mares, & Rosencheck, 2012). Occupational therapy interventions can address the .additional needs of these programs by providing evaluations of cognition and function and through the implementation of interventions with clients to increase independent living skills. Occupational therapy has demonstrated effectiveness in addressing the functional needs of those with mental health diagnoses, brain injury, and chronic health conditions, as well as with individuals living within homeless shelter settings (Gibson, Jaffe, D’Amico, & Arbesman, 2011; Ikiugu, Nissen, Bellar, Maassen, & Van Peursem, 2017; Phelan, Williams, Penninx, LoGerfo, & Leveille, 2004; Powell et al., 2016; Radomski, Anheluk, Barzen, & Zola, 2016; Roy et al., 2017; Thomas, Gray, & McGinty, 2011). An occupational therapy program was developed within a health care agency specifically serving those experiencing homelessness. This program was designed to meet the needs of the agency and its clients by increasing access to functional rehabilitation services. Occupational therapy services increased access for clients to function-based interventions, improved inter-disciplinary care, and increased knowledge of functional and cognitive abilities of clients. The significance of the outcomes of this occupational therapy program were evaluated in order to demonstrate the effectiveness of this model and provide further evidence into the efficacy of occupational therapy interventions within health care settings serving adults experiencing homelessness. / 2020-10-23T00:00:00Z

One of the distinct values of occupational therapy is its holistic and family-centered approach to care. In the area of feeding-related therapies, the child is often the focus of intervention. Current evidence suggests that caregivers most frequently consult with the Internet and online forums for additional information and support, especially those that do not pursue therapeutic services; however, these sources are not always screened for accuracy, completeness, or best evidence. In addition, these sources may not always serve the direct needs of the caregiver or provide opportunities for skill development. It is the intention of this doctoral project to provide an avenue for supplemental services to support caregivers’ knowledge and self-efficacy in their role caring for a child with feeding-related difficulties. The proposed program is an online psychosocial program to provide self-paced and interactive educational modules for caregivers, as well as an opportunity to interact with a wider community of caregivers and healthcare providers for this unique population. Educational modules will place emphasis on self-care skills in the caregiving role and information related to feeding. This doctoral project will explore the background of the problem, the theoretical and evidence-based literature, a description of the proposed program, evaluation plans, funding plans, and dissemination plans. Additionally, samples of proposed program content are included to support future implementation.

Education and student success are among the U.S. citizens’ highest priorities. Changes in educational policies have led to academic “push down,” in which children are expected to achieve academic milestones in core subjects (reading, writing, and mathematics) at younger grades. However, although performance expectations have increased, child development sequences and timelines have not changed to support expectations. Various solutions including sensorimotor, educational, and play programs have been trialed, but the academic achievement gap continues to grow. Successful programs include opportunities to develop foundational sensorimotor skills, follow developmental sequence, align with curriculum, and use aspects of a child-driven play-based approach to learning. In response to the need to better prepare students to meet academic expectations, the Play2Learn (P2L) program was developed based on the previous evidence. The program’s premise is to use play as a learning tool with an educational approach to promote student academic success. The P2L is a 6-week program (six educational modules) for occupational therapy practitioners and teachers. Each module includes 50- minute interactive lectures, expert mentoring and practical application. Topics include defining play and its benefits, risk factors of play, strategies and justification for play in the classroom, how to be playful with students, and application of play strategies. With this program, teachers will confidently and effectively use play in the classroom setting to promote learning, adapt familiar lessons to make them developmentally appropriate and playful, and justify how it aligns with the curriculum. Program objectives are to enhance student academic performance and improve behavior, attention, sensorimotor skills, social-emotional skills, language, and processing and cognition. The desired long-term outcomes are to increase play during the school day, changes curriculum design to be more developmentally appropriate, develop new ways to assess student performance, and educate all students regardless of their academic abilities.

The goal of the Supported Brewing Initiative is to advocate for OT’s role in work and supported employment by providing meaningful, occupation-based, and client-centered programs designed around unique and non-traditional environments. With a growing number of young adults and veterans entering college with TBI and planning to enter the workforce as gainful individuals, it is imperative that OTs lead the development and implementation of supported employment programs nationwide. Through implementation and redesign, the program intends to expand OT practice and improve opportunities for gainful employment and successful transitions into the working world for millions of college students with TBI. In addition to its pilot nature, review and analysis of the program’s outcomes will determine its effectiveness as an OT intervention and publish results in order to advance OT practice and rehabilitation science as a whole. In combination with the outlined dissemination plan, the Supported Brewing Initiative has the potential to significantly and positively influence OT practice and the lives of young adults and veterans with TBI.

Approximately 185 million individuals worldwide are living with low vision (WHO, 2014). Evidence suggests that individuals with low vision may have challenges with occupations such as activities of daily living (ADLs), instrumental activities of daily living (IADLs), social participation, work, functional mobility, and leisure activities (Crews & Campbell, 2004). Individuals with low vision may have difficulty adjusting to their vision loss, resulting in an increase in negative psychological outcomes such as depression (Barstow et al., 2015). Individuals with low vision may seek out support groups to connect with others with shared experiences and learn new ideas for addressing occupational performance challenges. However, evidence suggests that factors such as lack of structure and untrained peer leaders may lead to ineffective support groups (Embuldeniya et al., 2013). Occupational therapy practitioners (OTP) may be appropriately trained to address this issue. OTP have specific training to address occupational performance challenges and knowledge about group process enabling them to play a role in a support group setting. However, there are no specific and standardized guidelines to support OTP in assisting with a low vision support group. S.O.L.V.E. for Occupational Therapy Practitioners: Solutions to Optimize the Low Vision Experience is an evidence-based and theory-driven program designed to clearly define the role of OTP in a low vision support group. S.O.L.V.E. aims to make support groups immediately more productive and effective in improving occupational performance and participation outcomes for individuals with low vision in the long-term. S.O.L.V.E. was designed based on the Self-Efficacy Theory and best current evidence obtained through a thorough literature review. S.O.L.V.E. consists of six 90-minute sessions covering topics including general low vision information, use of the problem-solving approach to identify solutions to occupational performance challenges, strategies that make use of remaining vision and other senses, and information about group process and effective communication skills. S.O.L.V.E. aims to increase satisfaction in support group experience, increase knowledge of group process and leadership, and increase perceived self-efficacy with mastery of participation/performance challenges for group members. Long-term, S.O.L.V.E. is expected to increase occupational performance and participation and reduce mental health challenges of individuals with low vision.

There is a plentiful amount of children’s literature that strives to portray real social conflicts that are prevalent in society. However, few children’s books address bullying and how to problem solve effectively in common recreational settings, where there is less adult supervision and children are likely to misbehave. Current children’s books fail to acknowledge and accurately describe the hostility that may occur during social interaction among young children in a comprehensive manner. In addition, there is a scarce amount of children’s literature that is displayed in a digital format that is not only more appealing to young readers, but is also increasingly accessible to those of all abilities. Research suggests that there is a need for a children’s book that contains anti-bullying themes and is written using simple language with relatable characters. If younger children are exposed to complex social dilemmas at an early age, studies show that they are more likely to develop lasting positive morals and more tolerant, open-minded attitudes. The aim of this children’s book centered on bullying and disability tolerance is to provide education to young children from the ages of 3-6 years on the importance of accepting people with differences in a way that they can easily understand. The book will have characters of all genders and ethnicities so that readers can relate to them and apply what they learn to their own lives. Ideally, the book will be implemented across many domains such as in schools, clinical facilities, and within children’s homes. Interviewees were asked a variety of questions after being provided with three consecutive drafts of the book in order to make changes that reflect the needs of various young readers. The interviewees consisted of two occupational therapists, two speech language pathologists, a child-life specialist, two academic teachers, and a parent of a child. Responses showed that the book would beneficial in teaching children to treat all peers equally and how to effectively problem solve should a bullying crisis occur. Therefore, it is recommended that this book in both paper and digital formats could be successfully utilized in academic, clinical, and home-based settings to spread anti-bullying awareness and assist children in adopting tolerant mentalities.

Bop, Look, and Listen (BLL): A Playful Sensorimotor Approach to Address Attention-Deficit/Hyperactivity Disorder-Like Symptoms Among Young Children is an evidence-based and theory-driven treatment method that aims to support child development and learning within preschool classrooms. There has been a substantial increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD), as well as other developmental disabilities, since the turn of the century. Given that ADHD-like symptoms most frequently emerge during preschool and are associated with future maladaptive functioning, there is an imperative need for effective and optimal intervention at this life stage. Due to the controversy surrounding the act of diagnosing a child at such a young age, BLL has been created to address “ADHD-like symptoms”, regardless of diagnosis, or lack thereof. BLL was developed by an occupational therapist and may be considered: 1) an intervention that uses the meaningful childhood occupation of play to target multiple potential neurological underpinnings of ADHD-like symptoms; 2) a health promotion program that educates school-related professionals and parents about the relationship between sensorimotor play, child development, and learning; and 3) a prevention program that aims prevent or alter the trajectory of ADHD-like symptoms in preschoolers. A BLL storybook is used to guide children through specific playful sensorimotor activities, which are based on techniques that research has shown to be effective in reducing ADHD-like symptoms. Secondarily, evidence-based behavioral strategies that maintain the integrity of key concepts from Sensory Integration Theory are woven throughout the program to support participation. In addition, educational materials are provided to school-related professionals and parents. The evidence-based literature regarding the effectiveness of sensorimotor-based interventions for addressing ADHD-like symptoms is scarce, yet promising. Dissemination efforts for program expansion and the future application of an evaluative study of BLL will address this practice gap. BLL has the potential to decrease ADHD-like symptoms and positively impact children’s participation in meaningful occupations and roles within preschool classrooms and beyond.

Teach Back is a pilot education program that will target educating parents of children with ASD on play skills. It has been designed to improve parent competence, decrease parent stress and improve play skills and positive developmental outcomes in the child with ASD.

Telehealth, an emerging occupational therapy (OT) service delivery model, is defined as “the application of evaluative, consultative, preventative, and therapeutic services delivered through information and communication technology” (AOTA, 2018, p.1). Many of the positive attributes of telehealth include improved access and timing for care, care coordination, decreased travel and more (Cason, 2015). Telehealth use has the potential to offset well-documented occupational therapy practitioner (OTP) shortages globally (AAEE, 2016; BLS, 2018; WFOT, 2018). However, unlike other medical professions, the evidence literature lacks substantiation of wide-spread adoption and acceptance of telehealth for OT service delivery (Hersh, Kao, Melton & Pancheri, 2015), particularly in school-based practice. A comprehensive training program for the use of telehealth in the school setting was proposed as a solution to increase OTPs’ positive perceptions and ultimately adoption of telehealth. The Diffusion of Innovation theory posits that conveying an innovation’s attributes of relative change, complexity, compatibility, observability, and trialability can influence potential adoption (Rogers, 2003). To depict detailed attributes of telehealth in OT, perceptions of OTPs experienced in and new to telehealth in school-based practice were measured via surveys and used to inform development of an online educational program. Following the completion of the New to Telehealth Pre-training survey, only OTPs new to telehealth were invited to complete the OT Telehealth Primer: School-based Practice training program. Analysis of pre- and post-training surveys yielded information about attitudinal changes experienced post-training. Results from the OTP Experienced telehealth-user survey identified the top telehealth benefits as improved: 1) service access, 2) collaboration and carry-over with team members, 3) efficiency themes, and 4) student engagement and comfort. Results from the OTP New to Telehealth survey identified the same top benefits post-training. Most perceived barriers decreased significantly from pre- to post-training. Perceived barriers not significantly reduced post-training, therefore yielding future education and protocol development included: unreliable internet, lack of hands-on opportunity and e-helpers’ decreased comfort with technology. Post-training, 80% of participants reported a positive likelihood of adding telehealth to future OT practice. While the OT Telehealth Primer: School-based Practice training program yielded improved perceived benefits and reported likelihood of adoption into practice by OTPs, ongoing education is required for both OTPs and school administrators to achieve more widespread adoption and use of telehealth in school-based practice to offset global OTP shortages. / 2021-09-07T00:00:00Z

Children with autism spectrum disorder (ASD) are at increased risk for accidental injury or death, with the majority of recent reported deaths attributed to drowning (McIlwain & Foster, 2017). Unique differences in motor coordination, sensory processing, and cognitive function which are characteristic of ASD contribute to decreased safety awareness and problematic behaviors such as elopement from caregivers. Despite increasing prevalence of ASD, few communities in the United States have community swimming programs tailored to the specific needs of people with ASD. There is a scarcity of formal training for swimming instructors specifically relating to providing swimming and water safety instruction to people with disabilities. With background in activity analysis and modification, occupational therapy (OT) practitioners present as logical providers of adapted swimming instruction for people with ASD. A continuing education course for OT practitioners is vital to prepare practitioners to provide therapeutic intervention that promotes motor and cognitive skill development for aquatic participation. Using principles from adult learning theory and neuroscience, this continuing education course is structured to support active engagement, peer-assisted learning, and long term retention and application of new learning. Through affiliation with a continuing education provider, dissemination to promote course enrollment, as well as management of course registration fees, can be managed efficiently to expand awareness and minimize funding needed for this course. This continuing education course provides a unique opportunity to expand the role of occupational therapy into swimming and water safety education for children with ASD, and will enable participation in a meaningful leisure occupation for children with ASD and their families.