Occupational therapy graduate programs are not successfully equipping students to be innovative leaders or take advantage of entrepreneurial opportunities in the changing healthcare landscape. Within the evidence literature, very few studies document the inclusion of innovative entrepreneurial concepts in occupational therapy education or examples of entrepreneurial success in practice. The American Occupational Therapy Association (AOTA) Blueprint for Entry-Level Education states that “business fundamentals” and “entrepreneurial skills” are required in entry-level graduate programs. However, a review of the top 10 occupational therapy programs’ curriculum revealed only half the of these programs were including these concepts, majority of which focused on business plan creation. Furthermore, very few continuing education (CE) opportunities for the occupational therapy practitioner exist on entrepreneurship. The majority of current coursework focuses on private practice ownership and does not expose occupational therapy practitioners to other entrepreneurial methods or prepare them for a non-linear path towards entrepreneurship. Recent evidence within the literature suggests traditional pedagogical approaches and a focus on business plan creation in entrepreneurship education are not effective. Rather an increased emphasis should be put on opportunity recognition, creative thinking, and interdisciplinary collaboration to link entrepreneurial learning with personal development. The proposed program, Embracing Entrepreneurship: Occupational therapy’s introduction to design-thinking for innovation, is an evidence-based CE course that teaches occupational therapy entrepreneurs to research and build innovative solutions to problems they are passionate about solving. This doctoral project (1) investigates evidence and best practices in entrepreneurship education for health professionals, (2) proposes a teaching model for OT entrepreneurship education that draws parallels between the occupational therapy and design-thinking processes, and (3) proposes delivery of course content informed by adult learning theory. This project recognizes that not every practitioner may desire to be an entrepreneur but opportunity to build entrepreneurial awareness is critical for the advancement of the profession. Therefore, Embracing Entrepreneurship offers an open-source mini-course that provides an introduction to entrepreneurial idea generation for OT practitioners. The full-length Embracing Entrepreneurship CE course guides participants through application of the design-thinking process through multimedia content, weekly assignments, and virtual discussions. The self-guided modules are designed to be completed at the learner’s own pace and allows them to develop a unique entrepreneurial venture addressing a need they find personally meaningful. By surveying course takers of both the mini and full-length courses, the program will gain insights into practitioners’ interests, motivations, and potential barriers to pursuing entrepreneurship. Embracing Entrepreneurship will equip OT practitioners to be innovative, creative, collaborative problem-solvers capable of solving some of the populations’ most complex health challenges.

Collaborative visual art programs are already evident in the occupational therapy profession but there is still a paucity of evidence-based studies that explores the collaborative practices between occupational therapists (OT) and visual artists (VA). Based on what is known in literature, there is still a lack of focus on the OT-VA partnership because collaborators have limited knowledge of the other profession’s role and language and limited opportunities to meet (Wagenfeld, Reynolds and Amiri, 2017). Additionally, visual art programs remain few because children with disabilities tend to have less opportunities to participate in meaningful leisure occupations due to environmental barriers and physical limitations (Law, Petrenchik, King, and Hurley, 2007). To address the identified barriers and challenges in current collaborative practices between the OT and the VA, the author presents ARTS’COOL, a theory-grounded and evidence-based program that will expand leisure opportunities for children with disabilities. This doctoral project discusses the interprofessional collaborative (IPC) approach as applicable to a collaborative visual art program for children with disabilities ages 6 to 10 years old. It also describes how the person-environment-occupation model, the social exchange theory and the framework of occupational justice support the core elements of the program which are the use of art as an intervention, the IPC process and the provision of leisure programs for children with disabilities. The ARTS’COOL program proposes the use of an OT-VA collaboration guide, an eight-week visual art module and program evaluations for the participants, the parents and the OT and VA facilitators. It is the author’s proposed solution for strengthening the OT-VA partnership to develop meaningful and client-centered visual art programs that will cater to the specific needs of children with disabilities.

Patients who are critically ill in the intensive care unit (ICU) or critical care unit are at risk for cognitive, psychosocial, and physical impairments as a result of their admitting diagnosis or secondary diagnoses acquired during their hospital stay. Occupational therapy is a profession that facilitates patients’ recovery through holistic evaluation and treatment. Occupational therapy in the ICU improves patients’ strength, cognition, functional independence in activities of daily living and walking, decreases the duration and incidence of delirium, decreases time spent on mechanical ventilation, decreases the length of time patients spend in the hospital, and saves the hospital money (Alvarez et al., 2017; Lord et al., 2013; Schweickert et al., 2009; Weinreich, Herman, Dickason & Mayo, 2017). However, the problem is that a small number of patients are receiving occupational therapy when they are in the ICU. Due to the complexity of the medical environment, severity of patients’ illness, limited education on ICU care in entry- level occupational therapy and occupational therapy assistant programs, and limited research on the efficacy of occupational therapy evaluations and treatments, many occupational therapy practitioners do not have the knowledge and confidence to work in the critical care setting (Accreditation Council for Occupational Therapy Education (ACOTE) 2018; Foreman, 2005). In addition, many critical care team members are not aware of the benefits of early intervention occupational therapy in the ICU, impacting the number of referrals placed for patients while they are in the ICU setting (Zanni et al., 2010). The Occupational Therapy Intensive Care Unit Guide (OT ICU Guide) was created to improve the knowledge, confidence, and competency of occupational therapy practitioners working in the ICU in order to increase the presence of occupational therapy practitioners in the ICU. Increasing the presence of occupational therapy practitioners in the ICU will lead to an increase in the number of patients receiving occupational therapy during their stay in the ICU. The OT ICU Guide is a “one-stop shop” to guide occupational therapy practitioners on providing safe and evidence-based evaluations and treatments to patients in the ICU. The OT ICU Guide includes handouts, resources, guides, and brochures highlighting the role and benefits of occupational therapy in the ICU, safety and medical information for working with medically complex patients, and examples of occupational therapy assessments and treatment interventions for patients in the ICU. The OT ICU Guide is a steppingstone for increasing the presence and frequency of occupational therapy services in the ICU.

The prevalence and severity of mental health conditions experienced by students on college campuses has significantly grown in the last two decades (Lipson, Lattie, & Eisenberg, 2019). A serious mental health condition can be defined as a person, over the age of 18, that has a mental, behavioral or emotional disorder that causes significant functional impairment and substantially interferes with or limits one or more major life activities (Substance Abuse and Mental Health Services Administration, 2019). The evidence-based research has documented that mental health conditions impact student functioning and wellbeing and are associated with lower grade point averages and a higher likelihood of dropping out of college. The consequences of low educational attainment are severe for students with mental health conditions as it has been associated with underemployment and unemployment (Hutchinson, 2016). Seeking help for mental health conditions is associated with increased student retention (O’Keefe, 2013) and failure to seek treatment is associated with a longer course of illness and increased rates of relapse (Hunt & Eisenberg, 2010). Two-thirds of college students indicate that when in distress, they will turn to their peers for support (American College Health Association, 2012). Colleges however often do not utilize peers who live successfully with mental health conditions to help address the academic demands and social challenges experienced by other students with mental health conditions. Additionally, college aged students often do not feel equipped to help peers in need (Morse & Schulze, 2013). One of the most significant critiques of existing peer mentor programs across college campuses is a lack of structured training for the peer mentors (Yomtov et al., 2017). Research on peer mentor programs has also demonstrated that implicit biases, which are social stereotypes about certain groups of people that individuals form outside of their conscious awareness, may have an impact on the mentor-mentee relationship and may contribute to disparities in engagement (UCSF Office of Diversity and Outreach, 2019). Beyond your Biases is an evidence-based, theory-driven training module for college aged peer mentors that addresses implicit biases. This two-hour training module, developed for this project, will be incorporated into the NITEO program at Boston University, a semester long program that supports young adults with mental health conditions to develop wellness tools, academic skills, resilience and work-readiness (BU Center for Psychiatric Rehabilitation, 2019). Beyond your Biases will aim to educate peer mentors on the nature of implicit biases, challenge peer mentors to identify and acknowledge their own implicit biases, and help peer mentors to problem solve strategies to overcome their biases to best support the individual mentees. This module will better prepare mentors for their role and associated responsibilities, in order to more effectively support mentees as they navigate the complexities of the college environment. Although this module was developed for peer mentors of the NITEO program at Boston University, dissemination efforts will aim to promote incorporation of this module into other peer mentor programs across college campuses.

Homelessness is an emerging role area for occupational therapy. In the United States, occupational therapy is under-represented in all mental health settings from inpatient psychiatry to community mental health. Homelessness services represent an even narrower niche in which occupational therapists are qualified to provide evidence-based, client-centered services designed to increase safety and independence. This proposal is intended to demonstrate occupational therapy’s distinct value in being of service to people affected by homelessness. Specifically, Building a Role for Occupational Therapy in Homelessness (B.R.O.T.H.) envisions occupational therapy as a profession that is well-suited to provide services to people affected by homelessness who have been re-housed back into the community through work with housing focused social service agencies. Clinically, this B.R.O.T.H. provides a model from which occupational therapists can create a role in serving this population through the use of short-term occupational therapy treatment focused on improving skills of independent living by performing them in the natural environment (i.e., the client’s apartment). By focusing on tasks such as meal preparation, medication management, and appointment adherence, money management in the client’s natural environment, the occupational therapy practitioner will assist the client in gaining the skills they need to remain safe and independent in the community. Similarly, B.R.O.T.H. proides a framework through which such programs could be funded. Because occupational therapy practitioners typically command higher salaries than other social service staff such as social workers and case managers, the program provides recommendations around seeking out and applying for relevant grants and other funding sources to support approximately half of the occupational therapy practitioners salary. Most importantly, B.R.O.T.H proposes a program that uses evidence-based, highly-skilled occupational therapy services to improve the lives of people affected by homelessness. Project outcomes are targeted exclusively at improvement of the lives of the people served. At its foundation, this B.R.O.T.H rests on the belief that occupational therapy has a distinct value in improving this country’s homelessness crisis and the lives of those affected by it.

With an estimated prevalence of rate of 18.9% in the general population and 25% to 80% in individuals with heart failure (HF), mild cognitive impairment (MCI) results in impaired executive functioning, hospital readmissions, and increased utilization of the healthcare system (Alagiakrishnan, et al., 2017; Amini, et al., 2019). Studies suggest these cognitive impairments are often unidentified or undiagnosed (Amini, et al., 2019; Zhuang, et al., 2019). Despite the established effects of MCI and cognitive impairment in the hospitalized population, there are gaps in the research regarding a standardized approach to addressing this problem (Cameron, et al., 2017; Zhuang, et al., 2019). Currently, there are no effective pharmacological interventions that offer a long-term effect on delaying the progression from MCI to dementia. There is, however, a growing body of evidence supporting the important role of non-pharmacological interventions in MCI (Hong, et al., 2015; Sherman, et al., 2017). OTs have the skills to provide cognitive rehabilitation including global learning strategies, specific functional skills training, use of external aids, and cognitive retraining during functional activities, therefore, a standardized protocol was developed to benefit OTs and patients they are treating. The Multidisciplinary Approach for MCI has three key components: 1) educating nurses on how to assess for MCI and cognitive impairments, including how to provide cognitive stimulation daily and when to consult occupational therapy to optimize care, 2) standardizing an approach for OTs on how to screen, assess, and treat MCI and cognitive impairment in acute care and 3) increasing awareness of OT’s role within an interdisciplinary team to address MCI and cognitive impairments in acute care. This protocol aims to be a feasible and affordable method to educate nurses and OTs on how to treat MCI and cognitive deficits in acute care. Dissemination of this program is essential to its success. With more OTs implementing this program, the greater the opportunity for critical evaluation and refinement. The focus of this project was on the initial education and feasibility of the Multidisciplinary Approach for MCI, however the potential impact of its use to improve patient outcomes in the future is encouraging.

Youth with autism spectrum disorder (ASD) often have poor outcomes while transitioning to adulthood, such as experiencing low rates of employment, post-secondary education, independent living, and life-long friendships after high school graduation. Factors which may be contributing to these poor transition outcomes include the lack of understanding of their limitation and needs, and the lack of assessments designed specifically for the ASD population which address their abilities to manage the complex, multi-step life tasks of adult living. The Self-Management for Autism Rating Tool (SMART) is a clinical assessment designed for individuals with ASD, aged 16 to 35, to evaluate the self-management skills required to function successfully in adulthood. The tool was influenced by guiding theories, evidence, and assessments such as the Transition-Q and PEDI-CAT, and will be developed across three phases before clinical use. The SMART provides an increased understanding of the capabilities and needs of adolescents with ASD which can guide intervention efforts and better connect individuals with appropriate programs and supports. Addressing the self-management needs of young adults with ASD could lead to improved transition outcomes for this population, allowing them to reach their potential to live independent and productive lives.

The second-most populous country in the world, India, has many problems that need attention such as employment, providing health services in rural areas, access to education and many more (Worldometer, n.d.). Each issue that is present has multiple reasons for why they exist. The two problems addressed in this project are: a) the increase in the number of children diagnosed with Autism Spectrum Disorder (ASD) (Raina et al., 2017) b) a high number of regular children/teenagers who drop out of school, 1 in every 10 to be precise (Gouda & Sekher, 2014). Autism toolkit is an online training program for anyone, interested in helping children with ASD, who has completed their 8th grade. It aims to provide intervention to children in the Autism Spectrum Disorder in rural parts of India through training laypeople or non-specialized workers (NSWs). The training will be done using the principles of task-shifting as postulated by the World Health Organization. Task shifting involves equipping more hands to provide intervention (World Health Organization, 2008). There is evidence from studies, where task shifting was done in South Asia, suggesting the efficacy of such an approach in ASD-intervention (Divan et al., 2015). Capacity building programs that help solve problems within each community are advantageous (DHHS, National Cancer Institute, 2005). Research has also shown that interventions for autism delivered by a non-specialist provider produce benefits compared to no treatment at all or ‘treatment as usual’(Rahman et al., 2016). The program is designed to engage volunteering OTs across India and the world, who are comfortable to teach simple topics in Hindi, online.

The wheelchair evaluation process is complicated for clinicians and consumers alike. Consumers report feeling uninvolved in the wheelchair evaluation process resulting in feeling uniformed and dissatisfied and in some cases, being prescribed wheelchairs that do not meet their needs. Consequently, consumers may abandon the recommended wheelchair which may impact participation in Mobility-Related Activities of Daily Living (M-RADLs). Shared-Decision Making (SDM), used in healthcare encounters, may be used by clinicians to facilitate a collaborative process when recommending wheelchairs. This project proposes a continuing education course designed to teach the principles of SDM and guide clinicians’ implementation of SDM into their practices.

Interprofessional education (IPE), an educational concept that occurs when health care professionals from various disciplines learn about, from and with each other could ultimately enrich patient care, through use of collaborative strategy and synergistic learning between health care professions (Darlow et al., 2016). Evidence supports provision of IPE programming for occupational therapy and other healthcare student disciplines, in order to attain the diverse skill set required to effectively and efficiently communicate within an interdisciplinary healthcare team, and ultimately, to improve quality of patient care. The use of IPE in professional level healthcare education has been shown to improve students’ collaborative knowledge, skills and behavior, leading to effective task delegation (Riskiyana et al., 2018), ethical problem solving skills, and understanding of the professional roles and responsibilities required to promote efficiency in effective communication and teamwork skills (Gee et al., 2016). Despite literature supporting the justification for implementation of evidence-based IPE programs across institutions nationally, professional healthcare programs lack consistency and follow through. Diversity within IPE programming (Zahl et al., 2016) will allow for flexibility in planning and implementation of student experiences, which promote high-quality patient health care and strengthened collaborative workplace practices (O’Hara et al., 2018). With this heightened flexibility, interprofessional learning can transpire in larger student numbers, comprised of diverse healthcare disciplines, through platforms including online learning (O’Hara et al., 2018), clinical workplace supervision (Lawlis et al., 2016), and community based service learning experiences (Zahl et al., 2016). In order to investigate which interprofessional exercises and learning tools are perceived to be most effective an evidence-based, three-phase model curriculum, has been designed to be implemented across occupational therapy and other healthcare programs, in order to promote preparedness of professional level healthcare students as interdisciplinary team members. An entire cohort of master occupational therapy students will be recruited to participate in this three-phase IPE program, which will be embedded within the curriculum. Research will utilize a quasi-experimental design, using pre and post survey testing to measure the dependent variables of interest. Results will indicate students’ perception on which IPE tools/activities were most effective in preparing them for participation as an interdisciplinary team member, as well as produce evidence to support use of effective IPE tools/activities, to adequately prepare occupational therapy students for an interdisciplinary team based approach to practice. This educational program addresses a gap in knowledge and experience of interdisciplinary healthcare educators. Further collaboration and research from interdisciplinary healthcare educators is needed to attain data to support best practice in program development, as IPE falls within both the professional and ethical responsibility of occupational therapy and healthcare educators (American Occupational Therapy Association [AOTA], 2015).