BACKGROUND: Given the rapidly aging population and the prevalence of individuals with dementia residing in long-term care facilities (LTCFs), some settings have adopted palliative approaches to care to promote optimal resident quality of life (QOL). One program, Comfort Matters®, provides interdisciplinary training and accreditation for their comfort-focused care program. However, in many of their accredited facilities, occupational therapy (OT) is not a consistent member of the palliative care team. Therefore, the goal of this project was to facilitate occupational therapy involvement in an existing interdisciplinary palliative care team for individuals with dementia at an LTCF. METHODS: A needs assessment was completed at a Comfort Matters® accredited site in Brooklyn, NY. The needs assessment included interviews and focus groups with relevant staff and families, observations of rehabilitation and the dementia-specific unit, visits to other accredited sites for Comfort Matters® training and observation, and a record review of OT services provided to residents with dementia. OUTCOMES: The needs assessment highlighted several barriers to OT participation in Comfort Matters®, which lead to two main outcomes: (1) more specific guidelines for what OT could contribute to a palliative care team and (2) recommended facility actions that have the potential to promote OT integration into Comfort Matters®. The outcomes and recommendations were presented to administrators at the facility in the hopes that implementing them would provide benefits for the residents, employees, and facility.

Strokes are a serious and sudden medical event that can impact anyone. The American Stroke Association reports that strokes are the 5th leading cause of death and the leading cause of disability in the United States (American Stroke Association, 2019). With a high prevalence amongst Americans, it is important to note that stroke survivors are at an increased risk of developing psychological disorders such as anxiety and depression (Hildebrand, 2015). One factor that increases the devastating impact of a stroke is that individuals are prone to having short hospital stays lasting approximately five days (Reeves et al., 2017). With a shortened hospital stay it is common for psychological deficits to not be addressed and for individuals to be discharged home, to acute inpatient rehabilitation or to subacute inpatient rehabilitation. This doctoral project aims to address the psychological deficits that can impact a person’s confidence and participation in their meaningful roles and routines (Andrew et al., 2018; Kessler et al., 2014; Taylor & Jones, 2017). The project is geared towards the development of a peer support group for stroke survivors within the acute inpatient rehabilitation setting. Research has found that peer support groups are helpful in addressing psychological disturbances such as depression and anxiety as well as providing individuals with the opportunity to learn and develop positive coping skills (Boger et al., 2015; Kessler et al., 2014; Harrison et al., 2017). Peer support groups are low cost and effective interventions that will ease an individual’s transition from rehabilitation to home as well as decrease the number of readmission rates, therefore saving the hospital money (Andrew et al., 2018; Kessler et al., 2014; Muller et al., 2014; Ottenbacher et al., 2012). Peer support groups afford individuals the opportunity to develop positive coping strategies to decrease secondary psychological disturbances therefore increasing self-efficacy and engagement. By having the confidence to continue to participate in meaningful roles and routines, stroke survivors are able to actively engage and continue to progress towards recovery.

INTRODUCTION: Cortical Visual Impairment (CVI) is a complex, brain-based vision impairment that is emerging as one of the leading causes of pediatric visual impairment in the world. Evidence suggests that individuals with CVI can experience improvement in their functional vision use with appropriate intervention, primarily centered around environmental modification, which may contribute to increased participation and independence within daily living skills. THEORETICAL PERSPECTIVE: Under the umbrella of the Knowledge to Action Framework, the program is guided by the Ecology of Human Performance model, and an Active Support approach to staff training. PROJECT DESCRIPTION: The project includes a needs assessment of barriers to staff ability to support students with CVI in developing their independent living skills, followed by a knowledge-based group training for residential staff supervisors. In the context of this training, staff and occupational therapists developed an individualized plan designed to support specific student CVI needs, primarily around environmental modification. Staff were encouraged to use the least restrictive level of assistance when supporting a student in completing an independent living skill. This was reinforced during an interactive training between staff and the occupational therapist, who was be present while staff supported a student in an independent living task, and provide in situ feedback to the staff member. OUTCOMES: Staff demonstrated increased knowledge of CVI and the environmental needs of individuals with CVI, as well as increased confidence in supporting individuals with CVI in the residence. Staff also demonstrated marked changes in prompting styles, and implemented less restrictive levels of prompting while supporting students during independent living skill performance.

School-based occupational therapy practitioners (OTPs) have distinct expertise in providing occupation-based interventions. OTPs are called to employ these skills to improve postsecondary outcomes (employment, independent living, postsecondary education) of students with disabilities, as a result of the rising rate of students with disabilities served under the Individuals with Disabilities Education Act (IDEA 2004) surmounting 14% of all public school students in the United States in 2017-2018, and only marginal increases in otherwise poor postschool outcomes of students with disabilities, (U.S. Department of Education, 2019; Test, et al., 2009). The domains of practice in which OTs support clients include activities of daily living, instrumental activities of daily living, rest/sleep, education, work, play, leisure, and social participation (American Occupational Therapy Association, 2014). These are all domains that are relevant to transition planning for adolescents with disabilities, however, current evidence suggests that OTs do not play a significant role in providing transition-based services to school aged youth across the United States (Mankey, 2011). Utilizing Kolb’s experiential learning theory and current research evidence, it is evident that the lack of a widely recognized life skills curriculum, lack of training on the use of occupation-based interventions, and limited use of occupation-based interventions by OTs in middle schools, are negatively impacting the life skills development of students with disabilities. In response, the author created SPOT on Life Skills, an evidence-based theory-driven model for a middle school life skills curriculum. The curriculum will be delivered by an interdisciplinary team including an occupational therapist, a special education teacher, and a speech and language pathologist, who will collaborate together and with the students and their families. The curriculum model will consist of a multifaceted intervention approach including self-care and independent living skills training, social skills training, work readiness, and a work-based experience to increase student independence and improve long-term transition outcomes (Test et al., 2009). The intention of the program, beyond exposing students to a variety of life skills, is to increase OT’s involvement in transition planning and use of occupation-based interventions in the middle school setting. It is anticipated that SPOT on Life Skills, will influence stakeholders to advocate for life skills/transition programming utilizing collaborative occupation-based practices.

Social participation is an important area of occupation and is central to an individual’s identity and sense of competence (AOTA, 2014). Social participation includes engagement in social interactions and formation of friendships, both of which support social interdependence and wellbeing. Friendships are a significant social experience for children as they create a valuable context to learn and practice skills essential to children’s psychosocial development (Guralnick, Neville, Hammond, & Connor, 2007). Forming friendships can be difficult for individuals with autism spectrum disorder (ASD) due to a variety of reasons. Social-related challenges associated with ASD place the child at risk for decreased social interactions (Bauminger & Shulman, 2003; Humphrey & Lewis, 2008). The movement towards including children with disabilities in general education classrooms has resulted in an overreliance on one-to-one paraprofessionals to provide support to these students. Paraprofessionals are offered little prerequisite training and ongoing support, and may unintentionally hinder students’ social participation by providing too much assistance or causing students to become overly dependent (Broer, Doyle, & Giangreco, 2005; Carter & Hughes, 2006; Giangreco, Edelman, & Broer, 2003; Patterson, 2006). Decreased social participation during childhood places individuals at greater risk for adjustment challenges later in life (Copeland et al., 2004; Guralnick et al., 2007; Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Paras to Peers is an occupational-therapist-led training program for paraprofessionals providing one-to-one support to students with ASD. This six-week, multi-modal program utilizes both evidence-based learning theories and paraprofessional instructional techniques to train paraprofessionals, including modeling, performance feedback, and follow-up support. The program incorporates both group and individualized training sessions to teach paraprofessionals social facilitation strategies to promote social participation for students with ASD. Data regarding students with ASD’s social interactions and paraprofessionals’ use of social facilitation strategies will be gathered via trained observers as well as through a paraprofessional survey. Paras to Peers is an innovative method for promoting social participation for students with ASD as well as improving interdisciplinary collaboration between occupational therapists and educational staff in the school setting.

Pressures on school districts to provide cost-effective special education programming have resulted in an increased reliance on outsourcing of occupational, physical, and speech language therapy services to control costs. Occupational therapists who provide services under these kinds of contracts report they often feel like outsiders and that they are left out of the communication loop between educators, parents, and administrators (Kennedy & Stewart, 2011). In addition, contracted therapists typically do not have access to the professional development opportunities available to therapists who are hired directly by the school systems. However, all school-based practitioners require preparation and ongoing development of the professional knowledge, skills, and behaviors necessary to successfully address the needs of special education students in the school environment (Doyle & Swinth, 2018). The complex environment of schools and the isolated nature of the contract therapist contribute to less than optimal interventions and documentation practices. The literature describes an absence of recognized skills and training among school-based therapists and the need for occupational therapists to engage in more collaborative practice (Brandenburger-Shasby, 2005; Kemmis & Dunn, 1996; Kennedy & Stewart, 2011; Laverdure, 2014). This doctoral project addresses the practice barrier contracted OTs encounter accessing practice-specific professional development opportunities. The Realistic Educational Application of Learning (REAL) program provides contract OTs working in school-based practice (SBP) with a two-stage eLearning opportunity for professional development. The design of the program is guided by principles of androgyny or adult learning theory. The blended learning program provides content specific to SBP in learning modules and adds a professional mentoring component for increased collaboration and carryover into SBP. Practitioners completing the REAL program will gain knowledge, learn how to apply content to SBP, and collaborate with an experienced OT professional. The program provides practice-specific content and mentoring to optimize contract OTs’ provision of services to promote the success of students across the lifespan.

The proposed vision program, the Assessment and Management of Visual Deficits within the Hospital Setting, will establish an evidence-based evaluation, treatment, and referral process for individuals with visual impairment (VI) (either neurological or due to low vision) within the acute care, hospital setting. It is reported that 80% of all VI can be prevented or cured (Pan American Health Organization/World Health Organization, 2014) and research supports a need for intervention for VI within the hospital setting, as it is often an overlooked area. Despite this high prevalence of poor vision among inpatients, vision is reportedly not routinely tested nor documented (Press et al., 2015; Roche, Vogtle, Warren, & O'Connor, 2014). The occupational therapy practitioner (OTP) is recommended to incorporate vision screening and intervention to maximize clients’ occupational performance and successful participation in daily activities. Support exists that VI and falls are prevalent in older adults (Roche et al., 2014) and addressing this gap in care shows value by reducing LOS, cost, and improving patient satisfaction (Morse, Seiple, Talwar, Lee, & Stein, 2019; Wong, Brooks, & Mansfield, 2016). This occupational therapy (OT) program will describe a vision screen for use within a hospital setting that assesses key areas of visual acuity, contrast sensitivity, visual field, convergence, and eye range of motion. This program could be implemented across settings including inpatient and outpatient rehabilitation, thus following the continuum of care, and across diagnostic categories (Balcer, Miller, Reingold, & Cohen, 2015; Cate & Richards, 2000; Roberts et al., 2016). Incorporating this vision screen into daily practice may occur as one component of a comprehensive OT evaluation or a subsequent treatment session. The screen could be administered by OTPs once clinical competence has been established through hands-on training utilizing the OT Vision Assessment/Management Manual and mentoring by senior staff and the Vision Program Coordinator. Community-based resources are reviewed to aid in the acquisition of services and proper eyewear. This program is designed to establish an educational pathway to support those patients identified with a VI within a hospital setting.

INTRODUCTION: Sensory processing is associated with occupational performance in both children and adults; however, no studies have examined adults with confirmed childhood sensory processing challenges. Additionally, no follow-up or longitudinal studies on sensory processing from childhood into adulthood have been found. OBJECTIVE: The aim of this doctoral capstone was to better understand the lived experience of adults who had sensory processing challenges as children. METHODS: Using a phenomenological design, four adults who received sensory integration therapy as children were interviewed regarding their perspective about current and past sensory processing and occupational performance. Retrospective and current data on demographics, sensory processing, and occupational performance were examined alongside interview data. Each data set was analyzed on an individual level, and then the four cases were compared and contrasted. RESULTS: Participants had completed at least some undergraduate education and were employed or seeking employment. Two of the adults report current mental health diagnoses. The participants perceived themselves as currently having mild challenges or no challenges with sensory processing and motor coordination. Participants reported social-emotional difficulties and a lack of awareness of sensory processing. They view structure and routine as supports for their daily occupational performance. CONCLUSION: Four adults who had sensory processing challenges as children reflected on their sensory processing and occupational performance. They attributed their occupational performance challenges to a range of factors, including sensory processing, motor coordination, stress, and anxiety. There is a need for therapists and caregivers to explain sensory processing and sensory integration therapy to children.

Typically developing (TD) siblings of children with autism spectrum disorder (ASD) are at risk for developing social-emotional issues, such as: behavioral issues; internalizing problems; difficulty coping with emotions; feelings of isolation or being misunderstood; and a lack of supportive networks of peers with similar home experiences (Kryzak, Cengher, Feeley, Fienup, & Jones, 2015; Vermaes, van Susante, & van Bakel, 2011). Occupational therapy is a family-centered profession that aims to enhance the health of individuals and their family members through meaningful participation in occupations. However, most ASD research and intervention programs related to family-centered care are addressed to the child with ASD and their parents, leaving the TD siblings a relatively neglected group. This is evidenced by the paucity of research and services focused on this population. Therefore, the proposed solution, and purpose of this doctoral project, is the creation of the ViSIBle Together Support Group (VTSG), which is focused on enhancing the health and well-being of the TD siblings by bettering their familial and social relationships and fostering their involvement in meaningful occupations. The current project describes the creation of a manual, known as the ViSIBle Together Manual (VTM), that occupational therapists can use to implement a VTSG in their local setting. It is my goal that the findings of this project will serve to enhance awareness of the needs of TD siblings of children with ASD and be applied to build and inform future services and policies to support TD siblings across the globe.

Grow Your Own Attachment: Gardening as a Co-Occupation to Optimize the Health and Well-Being of Parents and their Children with Physical Disabilities is a program created by an occupational therapist to address the problem of a disrupted parent-child attachment. It is a theory-guided and evidence-based program specifically designed for implementation at Claremont Medical Therapy Unit (MTU), a subunit of Los Angeles County, California Children’s Services (CCS). The Attachment Theory informs a child’s development, growth, and maturity as a result of a secure or insecure attachment with a parent; while the Theory of Planned Behavior (TPB) informs the relationship between health behaviors and an individual’s beliefs, values, and perspectives of such (Bretherton, 2014; Rimer et al., 2005). After a thorough literature review, the health and wellness of parents and their children with physical disabilities were further explored; as well as the meaningful time spent between the parent and child, known as co-occupations. Gardening was found to facilitate physical and psychological health-promoting behaviors. It served as a means to foster stress management and coping skills through the engagement and appreciation of occupations (Eriksson et al., 2011; Greenleaf et al., 2014; Joyce & Warren, 2016, Swank & Shin, 2015a). It also improved children’s exposure, education, recognition, and trailing of fruits and vegetables (Hutchinson et al., 2015; Morgan et al., 2010; Parmer et al., 2009; Spears-Lanoix et al., 2015). Grow Your Own Attachment uses gardening as a means to repair the relationship between parents and their children with physical disabilities by addressing: 1) the child’s nutritional health, self-esteem, and self-efficacy through active participation and engagement in the occupation of gardening, 2) the parent’s coping skills and stress management through the restorative and health-promoting occupation of gardening, and 3) the quality of the time spent between the parent and child through shared experiences in the meaningful co-occupation of gardening. The program evaluation is a one-group quasi-experimental fixed effects research design with the use of qualitative and quantitative data (Newcomer, Hatry, & Wholey, 2015). Open-ended survey questions, semi-structured interviews, child’s weight and body mass index, Likert scales, and parent and child reports of time spent during co-occupations will be tracked pre-, during, and one-month, three-months, six-months, and one-year post-intervention. For the specific site, program and dissemination costs are minimal as the budget is embedded into the pre-existing program. The outcomes will be used to reflect upon current service delivery to enhance family-centered care, utilization of resources, and advocacy and promotion of occupational therapy and CCS.