Older adults who experience a fall will often sustain injuries which impact on their mobility and their ability to perform functional activities. Having one fall can lead to an increased risk of having another fall, and may also lead to a fear of the participating in functional activities, especially the activity that caused the fall. Every year, 3 million older adults are treated in the emergency room for falls, and at least 300,000 people are hospitalized due to falls (Centers for Disease Control, 2017). After hospitalization, some individuals require a stay in post-acute rehabilitation. In post-acute rehabilitation, these patients are at risk of having another fall, as they are in a new, unknown environment, and because they regularly practice mobility and functional activities with the goal of becoming independent. Preventing falls in the post-acute rehabilitation setting is critical because research has demonstrated that those who experience a fall in this setting have decreased functional outcomes and are less likely to return to their prior living environment. Stepping Up to Prevent Falls: A Fall Prevention Program for Post-Acute Rehabilitation is an interprofessional and multi-modal fall prevention program. The program consists of staff education, patient education, and implementation of environmental fall prevention interventions. The staff education component will include an in-service discussing the definition of a fall, the risk factors for falls, a fall risk assessment tool and interventions to prevent falls. Non-clinical staff will be educated on fall prevention strategies through posters in the breakroom. Patients will be educated via handouts and one-to-one discussions on how to prevent falls, the risk factors for falls, the consequences of a fall and what to do if a fall occurs. The goal is to decrease falls in order for patients to have better functional outcomes and be able to return to prior level of functioning.

Older adults experience multiple transitions as they age. These transitions may be predictable events such as retirement or unpredictable events such as the loss of a spouse or a new medical diagnosis. Age-related changes and transitions can result in functional decline, social isolation and loneliness, and decreased quality of life. The ability of older adults to adapt during transitions can have a significant impact on their overall health and well-being. Most of the current interventions for older adults in times of transition focus on the transitions between hospital and home. Other important life transitions are not being addressed effectively and there is a gap in effective interventions to support the health and well-being of older adults. Health management is an important occupation for older adults. The successful management of one’s own health can support physical, emotional, and spiritual engagement and optimal participation and quality of life. The program, Participation Matters, is specifically designed for older adults and was designed based on the current evidence-based literature to support healthy aging. The program offers an opportunity for older adults to increase their knowledge and skills in responding to the normal changes and transitions that occur during the aging process. Successful completion of the program will equip older adults with tools to respond to transitions caused by a variety of life events.

Down syndrome is one of the most common causes of developmental disability in the United States, affecting 1 in approximately 700 live births (Xanthopoulous et al. 2017). It is a neurogenetic disorder that is affecting growth, development and social participation through a lifespan. It is caused by the presence of a full third copy of chromosome 21 or part of it (Macak & Memisevic, 2008). It is this intention of this doctoral project to provide an occupational therapy program that focuses on cooking skills for adolescents with Down syndrome. Project Khushi is to be part of Gigi’s Playhouse, an already established Down syndrome Achievement Center. This doctoral project will explore the background of the problem, the theoretical and evidence-based literature, a description of the proposed problem, evaluation plans, funding plans, and dissemination plans. Additionally, samples of recipes and program manuals are included to support future implementation.

Occupational therapy (OT) is an allied health profession that works with a diverse population, but the ethnic and racial make-up of OT practitioners does not reflect this diversity. The lack of diversity among healthcare providers has been found to exacerbate healthcare disparities in minority communities. Increasing the number of minority OT practitioners helps decrease bias and improve trust and comfort of minority clients improving health outcomes. Minority students have poor awareness of OT as a viable career option and are limited by social, academic, and financial barriers. PromOTing Health Diversity is an evidence-based pipeline and mentorship program designed to help increase minority student enrollment in OT programs by addressing these barriers. PromOTing Healthcare Diversity utilizes a one-day seminar to educate students on OT, the process of becoming an OT, and resources available, and provides students with hands on community-based OT experiences. Students with increased interest in OT can participate in a mentorship program where they will work with minority OT practitioners to grow personally and professionally as they progress towards admission requirements. Participants of PromOTing Healthcare Diversity will share their knowledge of OT with their social network, which will help to increase awareness of OT as a healthcare resource in the minority community. PromOTing Healthcare Diversity helps to increase minority student enrollment into OT programs and increased minority communities’ awareness of the profession.

The college years are a transformative period for young adults, yet without sufficient supports, students nationwide have difficulty adjusting and are demonstrating lifestyle imbalance, characterized by increased stress (Pedersen, 2012). As a result, students are engaging in maladaptive stress coping behaviors, which are negatively impacting wellbeing and academic performance (Coccia, & Darling, 2014; Pedersen, 2012). There remains a gap between resources available and utilization of these resources, while a number of barriers prevent necessary care, including the mental health stigma and a lack of awareness of available resources (American College Health Association, 2019; Conley, Travers & Bryant, 2013; Goodman, 2017; Holland, 2016). This doctoral project aims to address the identified gaps through (1) identification of health behavior and adult learning theories to be applied to an innovative intervention, (2) investigation of evidence-based best practices for developing effective stress management skills and for technology-delivered health interventions, (3) development of an outline for a stress management mobile phone application for college and university students, (4) discussion of implementation and evaluation plans, and (5) development of a dissemination plan. By demonstrating a solution to improve the health, wellbeing, and quality of life for college students, this program will contribute to the field of occupational therapy (OT) by promoting the role of OT on college campuses and creating a shift towards an emerging area of practice.

The purpose of occupational therapy is to enable individuals to achieve health, well-being, and participation in life through engagement in occupation, as described in the Occupational Therapy Practice Framework (AOTA, 2014). To achieve this objective, occupational therapy practitioners may address client factors, such as higher-level mental processes, and performance skills, including a client’s ability to “modify performance when problems are encountered” (p. S25). Often children and teens with autism struggle with the executive function (EF) skill of cognitive flexibility, which may negatively impact their ability to cope when they face unexpected change (Strang et al., 2017). In turn, their occupational performance suffers in areas of academics, social interactions, and activities of daily living (Panerai et al., 2014). In pediatric occupational therapy practice, treatment of EF has been identified as an area of intervention which needs further attention and development (Case-Smith et al., 2015; Cramm et al., 2013). Yet, studies across many disciplines reflected that occupational therapy practitioners (OTs) are not typically identified as either practitioners or researchers in addressing cognitive flexibility skills acquisition among children and teens with autism. Investigators reported that pediatric OTs express both a lack of knowledge and a lack of confidence in treating EF skills, which they explain stems from limited formal education in this subject area, lack of professional development coursework, and availability of few EF treatment tools. This reveals a documented gap in knowledge and service provision within occupational therapy practice. In this doctoral project, three literature searches were completed. Results obtained supported (a) an increased prevalence of cognitive flexibility difficulties among children and teens with autism, (b) a negative impact of cognitive flexibility limitations on the occupational performance of individuals with autism, and (c) evidence that select meaningful therapeutic approaches work to improve cognitive flexibility among children and teens with autism. Through this doctoral work, the Helping Kids Master Surprise program was developed for OTs to promote cognitive flexibility skills in children and teens with autism, to improve clients’ occupational performance, and to increase clinician knowledge and confidence in addressing EF deficits. Emphasized in the Helping Kids Master Surprise program is an underlying respect for children and teens with autism, acknowledging that this diagnosis reflects neurologically-based differences in information processing and that these individuals typically have average to above average intelligence. With this consideration in mind, and in keeping with the Occupational Therapy Code of Ethics (2015), all elements of Helping Kids Master Surprise have been developed to be child- or teen-centered, to be non-triggering of anxiety, and to promote the joyful engagement of participants.

Congestive heart failure (CHF) is a prevalent disease that leads to frequent hospital admissions secondary to its disabling symptoms (Shafazand et al., 2015). Despite a substantial amount of research available regarding CHF, this disease is still perplexing because it remains one of the most prevalent and costly diseases worldwide (Jonkman et al., 2016; Shao, et al., 2013). Even though many interventions have been researched for CHF, it is often poorly managed. Almost 25% of patients are readmitted to hospitals within 30 days from their initial admission (Kilgore et al., 2017) and approximately 50% are readmitted within 6 months (O’Connor, 2017). Research studies have typically focused on outpatient, home, and post-inpatient settings which neglects the inpatient setting where patients often spend much time. Therefore, this setting should be a focal interest for research. Consequently, the Healthier Hearts for Life Pilot Program was developed to address this gap. This program is an interprofessional, inpatient support group for patients with CHF that are considered high risk for readmission. This program is led by occupational therapists but involves many other healthcare professionals. The program’s overall goal is to increase participants’ feelings of self-efficacy for managing their CHF by providing participants with education and hands-on learning opportunities. This program adopts a Social Cognitive Theory (Bandura, 1989) lens to understand the problem, while interventions were guided by the Transtheoretical Model (Prochaska & DiClemente, 1983). Additionally, interventions were based on advantageous, evidence-based findings from the literature of the various medical professions. Overall, this program was designed to support patients to be more competent in the management of their CHF by targeting ‘heart healthy’ behaviors and lifestyle changes in order to reduce readmissions.

Parents and transition-age students are by law meant to be involved in the special education plan development process. Autistic1 youth and their parents, however, are often not meaningfully involved. The overall aim of the dissertation was to understand parents’ and youth’s experiences of their involvement in Individualized Education Program (IEP) development and their perspectives on ideal involvement for diploma-track autistic youth. The first study utilized data from IEP documents and interviews with parents and autistic youth to understand how their perspectives had been taken into account in the development of the youth’s IEP. Findings illustrated considerable variability in how parents’ and youth’s perspectives were documented and incorporated into students’ special education plans. The second study utilized data from interviews regarding parents’ and autistic youth’s ideal involvement in IEP development, and resulted in an initial conceptual framework that outlines different types of desired involvement, foundational ideal elements, and variable ideal elements of parent and student involvement in IEP planning. Findings from the dissertation have implications for special education practice and support further research inquiries focused on parent and student involvement in IEP development. / 2022-09-25T00:00:00Z

Clinical data supporting the benefit of neurodevelopmental treatment (NDT) for children with hemiplegic cerebral palsy (CP) is limited due to inconsistencies in methodology across studies, including variations in: NDT definitions, intervention protocols, and outcome measures (Butler & Darrah, 2001; Graham et al., 2009; Tsorlakis et al., 2004). This has led to disagreement in the literature regarding the benefit of NDT in children with CP. Several contemporary studies indicate that the NDT approach can be effective as a motor and functional intervention for this patient population (Acar et al., 2016; Tsorlakis et al., 2004; Türker et al., 2015). In contrast, others (Novak et al., 2020) have concluded that NDT is not an effective motor intervention for children with CP and should be discontinued. In order to support consistency of evidence-based NDT service delivery, a clinical guideline project was conducted at Children’s Specialized Hospital in the Toms River, NJ outpatient pediatric center. This project was guided by the Knowledge to Action Framework (Graham et al., 2006) and involved the creation of NDT guidelines, including appraisal of current evidence on NDT for children with hemiplegic CP, the proposal of eight essential components of NDT, and recommendations for evidence-based assessments to track patient progress over the course of NDT intervention. Post-Capstone project feedback indicated that key stakeholders of the project identified the clinical guidelines as useful and practical. Recommendations included the implementation of these guidelines into practice, as well as a continual review process to incorporate future research and clinical experience in NDT effectiveness.

There is mental health crisis affecting America’s children and youth and a significant gap exists between professional knowledge and the practical application of prevention and intervention strategies for this population. Since children spend a significant portion of their waking hours in school settings, applying mental health programming within educational contexts is a logical concept. However, with such a significant need for mental health services, neither the US healthcare system nor school systems are able to keep up in providing adequate support for struggling children (Blackman et al., 2016; Franz et al., 2016; Merikangas et al., 2010; Merikangas et al., 2011; Torio et al., 2015). As holistic healthcare practitioners with a rich history in mental health, school-based occupational therapy practitioners are in a particularly advantageous position to address psychosocial issues in children and youth and are considered qualified professionals when it comes to providing both universal and targeted mental health supports for students in California Public Schools (AOTA, 2014; California Department of Education, 2012). However, several barriers pose challenges to this model of practice, and school occupational therapy practitioners rarely focus on social emotional factors (Barnes et al., 2003). This limited focus also results in misperceptions of the role and scope of occupational therapy practice, particularly as it relates to mental health (Cahill & Egan, 2017; Henderson et al, 2005; Pottebaum & Svinarich, 2005; Smith & Mackenzie, 2011). So, although schools struggle to provide adequate mental health services for at-risk students, occupational therapy practitioners are not invited to the table when it comes to discussing school-based mental health interventions or initiatives (Cahill & Egan, 2017; California Department of Education, 2012; Chan et al., 2017; Henderson et al., 2015). In order to reinforce the role and capacity of occupational therapy practitioners and educators in the promotion of positive mental health and social emotional well-being in students, a program is needed to support school-based practitioners in providing effective mental health interventions. Back2Basics aims to do this by supporting school occupational therapy practitioners’ knowledge and confidence in mental health service provision, facilitating enhanced collaborative relationships between occupational therapy practitioners and school staff and providing an evidence-based framework for teachers and administrators to create school environments and educational programming that supports the psychosocial needs of their students (Ryan & Deci, 2017). As such, the program being proposed has been aptly named Back2Basics to represent its focus on practical interventions intended to fulfill the foundational components of psychosocial health and well-being.