Healing Presence is an innovative program designed to support health professions students at a small university in developing the personal resource of resilience in order to reduce and prevent burnout. Healthcare providers experience high rates of burnout which negatively impacts individual health and wellbeing as well as patient care quality, safety, and costs. However, training in strategies for self-care and resilience are not routinely included in health professions education. A thorough review of the theory and evidence surrounding burnout and burnout interventions is described in support of the Healing Presence program which utilizes a 4-hour training in HeartMath tools and techniques as a mindfulness-based intervention to promote resilience. HeartMath biofeedback tools will be incorporated for a pilot group of participants and the training program is designed to be offered to the entire community of faculty, staff, and students at the target institution. The program also outlines a specific set of strategies to incorporate use of the intervention into the culture of the university. The program evaluation plan includes measurement of changes in resilience, burnout symptoms, depression, and anxiety. Detailed funding and dissemination plans are included.

Occupational therapy practitioners are in a unique position to address occupational injustices through social entrepreneurship—entrepreneurship for a social cause. Despite the potential contribution that occupational therapists can have in this space, they may not understand how they can address occupational injustices as social entrepreneurs and may not receive the education to develop the skills to successfully launch and sustain a social enterprise. A recent review of the top 10 occupational therapy programs in the United States indicated that only half of the programs explicitly included entrepreneurship in their curricula (Gigi, 2020). Anderson and Nelson (2011) also noted this limitation and recommended that the profession offer more academic support to advance students’ knowledge of entrepreneurship. Barriers to implementing such recommendations may include health care professors’ limited knowledge about entrepreneurship and administrators’ lack of support. Further, when entrepreneurship is included in education programs, it is aligned more often with the mission of health care professions than with social entrepreneurship. The proposed program, a certificate in innovation and entrepreneurship with a social-entrepreneurship concentration for entry level Duke University occupational therapy students, addresses some barriers that historically may have impeded the advancement of entrepreneurship education in health professions. The certificate includes two required business fundamental courses and two elective occupational therapy social-entrepreneurship courses followed by group coaching. Duke occupational therapy doctoral students will have the option to focus their capstone on certificate completion. This model can provide occupational therapy students with the foundation they need to optimally address occupational injustices as social entrepreneurs. / 2023-09-21T00:00:00Z

More than half of America’s adolescents do not obtain enough nightly rest to meet their sleep needs. Poor sleep health during this critical developmental period is linked to a myriad of negative health consequences, impairing performance and satisfaction in other meaningful occupations. Adolescents with adverse childhood experiences (ACEs) are at an increased risk of poor sleep health and associated negative outcomes. As a modifiable determinant of health, addressing poor sleep health would not only promote good quality, restorative sleep but also foster optimal occupational performance, supporting individual and societal well-being. Building on the work of previously tested cognitive-behavioral adolescent sleep health interventions, a multi-week, sleep health intervention was piloted at the Children’s Community Support Collaborative in Boston, MA. This intervention was adapted to be more trauma-informed, occupation-based, and centered around the interests of residents, aligning with the Collaborative’s philosophy of care and programming. Participant and staff feedback suggests a high degree of this intervention’s acceptability and favorability. Of the seven participants who completed the intervention, 86% reported an increased ability to sleep well, ​​achieved >70% of their primary sleep-related goals, and demonstrated improved scores in at least one self-reported measure of subjective sleep quality. Collectively, satisfaction with sleep increased from a 6.8 group average pre-intervention to an 8.0 post-intervention on a 10-point Likert scale, with a 10 representing greatest satisfaction. These findings provide support for the efficacy of a trauma-informed, cognitive- behavioral, and occupation-based approach in improving the subjective sleep quality, occupational performance, and functional well-being of this population.

In the United States, goal and value-based conversations between healthcare professionals and patients experiencing chronic critical illness (CCI) in a long-term acute care hospital (LTACH) do not occur routinely as part of the standard of care, leading to a poor quality of life and increased levels of stress, anxiety, and depression among this patient population (Kahn et al., 2015; Lamas et al., 2017a; Lamas et al., 2017b). Since the Theory of Planned Behavior is designed to both explain and predict behavior in specific contexts, such as healthcare professionals’ intentions and behavior to have goal and valued-based conversations with this patient population (Ajzen & Fishbein, 2005), and the literature supports the use of semi-structured interview tools to do so with this patient population (Chochinov et al., 2015; Johnston et al., 2015; Lamas et al., 2017a), this doctoral capstone aims to enhance patient-reported outcomes among this patient population by providing healthcare professionals, specifically occupational therapists, with the most useful semi-structured interview tool (i.e., the Canadian Occupational Performance Measure [COPM]) to facilitate goal and value-based conversations more routinely. The COPM is client-centered OT semi-structured interview tool designed to generally (1) elicit goal and value-based conversations; (2) guide collaborative goal-setting; and (3) measure patient-reported outcomes (Law et al., 2005). The results indicate both clinical and statistical significance over time across patients for the patient-reported outcomes, self-perceived performance and satisfaction, demonstrating support for the establishment of routine goal and value-based conversations as part of the standard of care between healthcare professionals and this patient population.

Occupational therapists (OT) must have a broad range of knowledge, skills, and insight to provide services required for effective clinical practice. To do this effectively, the development of clinical reasoning in OT students is essential. It is also mandated by the Accreditation Council of Occupational Therapy Education (ACOTE, 2018), and it is an essential component of OT education. However, Clinical reasoning can be challenging for students to master. Coker (2010) explains that as the healthcare system becomes more complex with clients having increased health needs with multiple co-morbidities, it is essential that OT students not only understand the medical conditions, relevant theories, and evidence-based interventions, but also have clinical reasoning to appropriately develop and implement the necessary interventions. This project is the development of an evidence-based, theory-driven, and easily replicable Level I fieldwork (FW) program using non-traditional FW experiences with under-served populations. This FW program provides rich experiential learning opportunities for the development of clinical reasoning in OT students. This innovative educational program has significant potential to improve OT student performance on Level II FW as well as in clinical practice. This non-traditional Level I FW program is specifically designed to enhance student’s clinical reasoning through a variety evidence-based method. By improving student clinical reasoning, client outcomes will also be improved. Over time, and as this program’s information is disseminated, this program could be incorporated by OT programs across the country to improve student performance on Level II FW pass rates as well as client outcomes.

Stroke is a growing problem for young people in the United States. The face of stroke is changing, and dated misconceptions based on age are limiting our ability to address this issue. For younger adults aged 21–40, ischemic stroke has been a recurring problem. Many younger adults in this group face mental health deficits, physical impairment, and a decline in socialization. In addition, current treatment costs exceed that of several other health conditions. Yet, many young stroke survivors still report feeling isolated and unheard, as psychosocial problems go unaddressed. Conventional treatment too often uses a blanket approach in treating all stroke clients, regardless of age. Through occupational therapy, young stroke survivors are provided the opportunity to engage in a course of treatment that incorporates a uniquely comprehensive approach, which facilitates the incorporation of psychosocial health and lifestyle changes that will help prevent stroke recurrence.

Children who participate in the undesirable behavior of scatolia can become alienated from participating in the daily occupations that are meaningful to them. Interventions to Decrease the Occurrence of Scatolia in Children with Developmental Disabilities has been created to address the need of stopping scatolia from happening immediately with use of restrictive garments, and to create a long-term treatment plan with a licensed occupational therapy practitioner in order to decrease the occurrence of scatolia on a long-term basis. “Scatolia” is the medical term that refers to physically touching, smearing, and handling feces. There are different reasons why a child with a developmental disability would engage in the behavior, including medical issues, behavioral issues, and sensory issues. When any child performs the act of fecal smearing, the stress falls to the caregivers to be vigilant about immediately stopping the behavior to decrease the spread of germs in society. Parents, grandparents, teachers, and caregivers can become overcome with guilt, shame, and anger over their child’s behavior. The general problems related to scatolia can make it very challenging for caregivers to bring their children out into public and to invite visitors over to their homes for fear that the child will engage in the behavior and the risk of spreading illness or disease. With the use of evidence-based research, this program has been created for pediatricians, parents, and children to assist with the rehabilitation of stopping and preventing scatolia from happening in the future.

The American Occupational Therapy Association’s (AOTA) Vision 2025 is a call to action for the occupational therapy profession to maximize the health, well-being, and quality of life of all people, populations, and communities through effective solutions that facilitate participation in everyday living (American Occupational Therapy Association, 2021). This vision aligns with the Institute for Healthcare Improvement’s Triple Aim Framework which identifies improving the health of populations as one of three dimensions in its approach to optimizing the US health system’s performance (The IHI triple aim: IHI 2021). Unfortunately, there are a limited number of occupational therapy practitioners (OTPs) who work in community-based settings at the population-health level (Andreae et al., 2021). For OTPs to contribute to achieving Vision 2025, they need to develop knowledge, skills and interest in working in this emerging practice area. It is up to academic institutions to create learning experiences for OT students that prepare them to identify and design a role for themselves and the profession in these non-traditional settings, as well as build the skills needed to succeed. A guideline for providing community-based experiences for OT students in a structured way would allow OT educators to ensure that graduating students have the skills they need to address the health and prevention needs of populations and communities, as well as the desire to do so. The proposed program is a practical, feasible guideline that occupational therapy educators and academic fieldwork coordinators can use to prepare students to meet population health needs through implementing service-learning as level 1 fieldwork.

Children with developmental delays are often not identified until they are school-aged (Chödrön et al., 2019). The American Academy of Pediatrics recognized early identification as essential; however, there are inconsistencies in best practices (Bright et al., 2019; Jimenez et al., 2017). These inconsistencies are a problem because there are missed opportunities when children are not identified early, and these problems have a greater significant impact on marginalized communities. Early preventative, proactive interventions are more effective at supporting positive outcomes than when remediation occurs later in life (Center on the Developing Child, 2017). Neuroscience research indicated that early intervention (EI) capitalizes on increased neuronal plasticity to promote infants’ and toddlers’ physical, emotional, and cognitive development (Demanster, 2017, Welch et al., 2015). Occupational therapy’s role in primary care is often underutilized (American Occupational Therapy Association, 2014; Donnelley et al., 2013, 2014). Its unique holistic approach makes occupational therapy practitioners (OTPs) valuable members of an interdisciplinary team (Dahl-Popolizio et al., 2016; Donnelley et al., 2013, 2014) and, as such, they have a role in assisting to increase the EI of children. Research indicated that parents also have a significant impact on supporting and promoting optimal development for their children (Demanster, 2017, Welch et al., 2015). It is essential to create new methods to support the EI of developmental delays (Barger et al., 2018). PlaySpace: Collaboration for Identification, Health, and Milestone Achievement for Infants, Toddlers, and Children is an initiative that aims to improve the EI of more subtle developmental delays before school age through increasing collaboration among parents, pediatricians, and occupational therapists. This initiative consists of two phases. Phase 1 consists of individualized developmental playgroups led by OTPs. Through participation, parents will gain experiential knowledge about developmental milestones, adapting the environment to promote development, appropriate handling skills, and resources to improve their ability to advocate for their child’s needs. Phase 2 will provide pediatricians with options to increase collaboration with OTPs to support the developmental screening process, support parents within their practice, and increase knowledge on evidence-based programs to provide as resources to their families. This doctoral project will present guidelines for Phase 1. This initiative aims to increase the EI of developmental differences to support optimal health and wellness for infants, toddlers, children, and their families by increasing collaboration among parents, pediatricians, and occupational therapists. / 2024-05-11T00:00:00Z

Fine motor skills are important for children to participate in their occupations, including self-care, productivity and leisure. The deficits of fine motor skills are common in children with autism spectrum disorder (ASD), and as a result, they experience difficulties performing daily tasks. Digital devices, such as touch screen devices, has been found to support children with disabilities learn and develop their life skills (Alaniz et al., 2015; Dehghan et al., 2017; Seo, 2018). However, a lack of training on how to use applications and insufficient settings have discouraged occupational therapy practitioners (OTPs) to continue using applications on a touch screen device, regardless of the effectiveness (King et al., 2017; ). In this project, an application, Finger Up, has been developed based on theoretical frameworks, evidence-based literature, and an online survey completed by OTPs. Results from the online survey revealed that the limitations of the existing applications include 1) a lack of visual display for monitoring progress, 2) a lack of visual rewards, 3) a lack of sound rewards, 4) a lack of visual effect for wrong answers, 5) a lack of sound effect for wrong answers, 6) busy background and sensitivity settings, and 7) not colorful. The features suggested from the survey results are 1) simple to use, 2) simple layout, 3) a timer, 4) sounding effect for wrong answers, 5) visual rewards, 6) visual effect, 7) simple instruction, and 8) setting a time limit for each game. OTPs will receive three training sessions prior to the implementation of Finger Up with their clients. Once the training sessions are complete, OTPs will use Finger Up with their clients, 5–11-year-old children with ASD, in a 30-minute therapy session, 5 days a week, for 3 months. A pre- and post-assessment will be conducted for comparison to investigate the effectiveness of Finger Up. Long-term impacts of the program seek to improve the fine motor skills of children with ASD using Finger Up with the suggested protocol and promote technology use in occupational therapy. / 2024-05-11T00:00:00Z