Little is known about occupational therapy (OT) practitioners’ experiences of harassment, discrimination, and aggression from patients, despite research in other health professions. It is the author’s hypothesis that the prevalence of Harmful Client Behavior (HCB) is significant and has a negative impact. A pilot study was conducted to determine the feasibility of the author’s methods to obtain prevalence and impact data that is representative of practitioners in the United States. The goals of this preliminary study were to increase awareness of the problem of HCB, to determine the need for a future larger-scale descriptive study, and to guide future actions to address this phenomenon. The quantitative arm of the study collected data on the prevalence and impact of HCB using a Qualtrics survey. Sixty-four respondents completed the anonymous survey and results indicate that HCB is common (92% encountered HCB in the last year), is under-addressed in OT degree programs (75% did not receive information about HCB during their OT degree program), is underreported (only 47% did not report), and has negative impacts (67% reported negative impacts). The qualitative arm of the study had three participants who engaged in either a focus group (n=2) or an individual interview (n=1). Results revealed that employer responsiveness appears to moderate the impact of the HCB. The most significant impact reported by qualitative study participants relates to professional role identity and job performance; when an employer was dismissive, this tended to lead to self-doubt of one’s clinical skills, whereas a supportive employer tended to minimize the harm encountered. This study has many implications for the field, especially given AOTA’s Vision 2025: Commitment to Diversity, Equity, and Inclusion. The occupational therapy profession is diversifying, thus harmful client behavior needs to be addressed at the national level in order to support and retain a more diverse and inclusive workforce. / 2023-02-28T00:00:00Z

Falls are an unexpected event in which an individual experiences a loss of balance, spontaneously or due to an external stimuli, and comes to rest on the floor. Accidental falls are the most common cause of non-fatal injury in the United States. This dissertation investigated fall risk factors in two populations with emerging fall risk, people with obesity and people living with HIV. First, we studied how weight loss four and eight months after bariatric surgery affected psychosocial factors related to fall risk like gait self-efficacy and fear of falling. Results indicated that psychosocial factors do not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower of fear of falling were correlated with longer and faster steps. Second, we studied how participants with obesity crossed obstacles while seated during an exergame task compared to controls. We found that participants with obesity hit more obstacles than controls. Third, we described a fall prevention intervention protocol for people living with HIV and alcohol use. The intervention contained three components, virtual group sessions, phone check-ins and home exercises to address the motor, psychosocial, and environmental risk factors associated with falling. Taken together, this dissertation continues to push the research forward in best ways to decrease fall risk through physical activity participation and inform future interventions. / 2024-09-01T00:00:00Z

INTRODUCTION: Common perinatal mental disorders (CPMDs) are a significant contributor to disability globally for women during and after pregnancy, though the role of occupational therapy in addressing perinatal mental health is only just emerging. CPMDs present a complex challenge for healthcare providers to identify and treat, and often remain undetected and therefore go untreated. The lack of identification in part reflects structural and psychosocial barriers to care that are influenced by mental health stigma. Low and middle-income countries have begun addressing the treatment gap by scaling up psychosocial support through primary healthcare workers, but these providers are often overstretched. Training providers to demonstrate engagement factors through culturally tailored digital methods is an effective and feasible way to scale up psychosocial support. METHODS: A cinematic training package for maternity care workers in South Africa was designed to demonstrate the important role of empathy in mental health promotion during routine perinatal care. Primary objectives included community engagement, film production and editing, and gathering feedback from key stakeholders regarding the film’s acceptability and feasibility for dissemination across South Africa. The film aims to acknowledge typical challenges faced by maternity care workers while introducing accessible methods to integrate mental health into routine maternity care. RESULTS: Stakeholder feedback revealed that the cinematic training package and its content are contextually appropriate. Feedback was synthesized to include: shortening scenes, adding on-screen text to highlight empathic skills, and inserting interactive discussion points between scenes. CONCLUSION: Interdisciplinary stakeholder collaboration that centered community needs led to the development of an innovative and relevant training package to integrate mental health care into low-resource, maternity settings. Recommendations include customizing the training package based on clinic needs, tracking dissemination, and evaluating its impact on maternity care workers and women with CPMDs. The occupational therapy lens was used to engage in strengths-based, person-centered perinatal mental health promotion. / 2023-09-12T00:00:00Z

The Crafting COmmuniTy Coalition (C3) aims to promote occupational engagement in female refugees by addressing occupational deprivation and marginalization. The 12-week program will join female refugee participants with occupational therapy students as interventionists, volunteer business consultants, volunteer artists, and sponsoring community-based social service organizations in a collaborative business venture. Utilizing the Community Coalition Action Theory and the Health Belief Model, C3 seeks to increase participants' perceived levels of self-efficacy and well-being by fostering entrepreneurial and self-care skills. Drawing from research that indicates the value of collective occupation, social support, and the promotion of purpose and belonging within a spiritually and culturally inclusive environment, C3 seeks to confirm occupational therapy's role as a critical discipline in refugee service provision.

The occurrence of mental disorders in the Indian population is increasing. In 2017, 14% of the total Indian population were affected by mental disorders of varying severity (Sagar et al., 2020). Millions of people in India were facing the struggles associated with severe mental illness (SMI) conditions such as schizophrenia, schizo-affective disorders, bipolar disorders, and severe forms of anxiety and depression in 2017 (Sagar et al., 2020). Adults with mental illness have voiced many personal definitions of recovery. Deegan (1988) & Leete (1989), from their own experiences with mental illness, defined recovery as the development of new meaning and purpose in one’s life, beyond the symptoms, disability, and stigma of mental illness. In a study conducted by Gopal et al., 2020, return to work and holding employment were considered common indicators of recovery as per clients’ and caregivers’ perspectives. However, adults with SMI continue to report unmet needs in finding a job, helping with stress at a job, and maintaining a job (Grover et al., 2015; Khare et al., 2020). My program titled “Home-based Employment: A Path to HOPE (Productive Habits, Occupational Participation, Empowerment) for Adults with SMI” is created to bridge this gap. This program will offer occupational therapy treatment sessions with an emphasis on finding and completing work assignments at home for clients with SMI. The long-term goal of this program is to improve quality of life, reduce hospitalizations, improve self-management of illness for adults with SMI, and to reduce caregiver burden. The author’s hope is that positive experiences associated with occupational participation will result in empowerment and hope for adults with SMI in India.

Since the 1970s, a national effort through federal policies has been implemented to develop secondary transition practices and improve postsecondary outcomes for students with disabilities. Despite the increasing emphasis on enhancing transition programs, transition outcomes for high school students with disabilities continue to be poor, marked by limited access to paid work experience in their communities, limited participation in postsecondary education, and independent living compared to their peers. While multiple factors can impact the effectiveness of program instruction, based on the literature review and the author’s experience, one aspect of the transition program, the implementation of life skills instruction, will be the focus of this project. CoTeaching for Life Skills Instruction is a program that emphasizes a collaborative approach with the school-based occupational therapist and special education teacher that dually serves as an embedded professional development opportunity and instructional practice. The program aims to bridge teacher knowledge gaps and meet the instructional needs of students requiring high support, such as students with intellectual disability, autism, and orthopedic impairment. Through an improved understanding of developmental levels and how cognitive and physical disability can impact task performance, the classroom teacher will develop lesson plans and activities that align with the student’s functional level leading to active rather than passive participation and increased opportunities to meet transition goals. Incorporated in the author’s work is a program evaluation plan to study the effectiveness of the pilot co-teaching approach. Positive results from the program implementation and evaluation can influence the school district to enact a policy that includes occupational therapy services as embedded support within moderate to severe classrooms. Occupational therapy practitioners in a co-teaching capacity provide an opportunity to expand the school-based occupational therapy practitioner’s role as a valued member of the transition planning team while supporting the needs of special education teachers.

Human trafficking has evolved as a heinous crime and a violation of human rights worldwide. The needs of survivors are “complex and often challenging to those who are trying to provide assistance” (Dell et al., 2019, p. 184). In 1962, the World Federation of Occupational Therapy (WFOT) declared human trafficking as an emerging area where the profession can impact, as it is a large form of occupational injustice. However, limited research on occupational therapy involves survivors of human trafficking. Occupational therapists have a distinctive skill set to treat this population as the profession looks at the individual holistically and aims to achieve function. Esperanza is a 12-week program created for survivors of human trafficking. The goals of the program are to increase independence, quality of life, and executive functioning skills in the survivors, decrease the survivors’ lengths of stay at the safe homes, and increase the knowledge of the role of occupational therapy. Esperanza was created because all survivors of human trafficking deserve occupational justice and hope.

In Saudi Arabia, occupational therapy services are not recognized in schools. There is a gap and a need for school-based occupational therapists in Saudi Arabia. Some students in Saudi Arabia are not getting the help they need at schools and that might be one reason behind the poor academic performance and the difficulty succeeding in schools. The lack of OTs in schools negatively impacts students because their problems and difficulties in the areas of motor-planning, sensory integration, muscle tone, and emotional regulation are not going to be addressed. The lack of occupational therapy services in schools in Saudi Arabia is an issue that needs to be addressed. The proposed program is a practical guide for implementing OT services for students in schools in Saudi Arabia to improve the academic performance and to facilitate their learning journey by addressing needs with handwriting, fine motor skills, transitioning from one task to another, lack of self-regulation or emotional regulation, poor attention, disorganization, behavior management issues, social participation, academic issues (reading, writing, math, etc.). This guide will result in initiating the process to add OT services to schools in Saudi Arabia. Implementing an OT school program in Saudi Arabia will be very beneficial to help students overcome difficulties in the school environment.

Traditional health care systems have a long history of marginalizing clients experiencing stress-related conditions with complex symptoms. Stress symptoms fall into the gap between physical or psychological diagnoses from providers who cannot identify their etiology and generate effective treatment plans. Whether stress is a predisposing factor contributing to a health condition or the sequelae of a health event, failure to address its impact on clients’ overall physical, emotional, and cognitive abilities contributes to their decreased function and quality of life. Occupational therapists (OTs) often treat individuals with stress- and anxiety-related conditions. Unfortunately, few studies provide measurable, objective data indicating improvement from evidence-based interventions for this population. Biofeedback and self-regulation, also called psychophysiology, can provide objective data in the form of feedback (e.g., lights, sounds, numbers, or graphs) to demonstrate individuals’ real-time status, improving their self-regulation and sense of control over their stress response. These techniques are used with the model of human occupation (MOHO), a client-centered framework that pairs well with integrative approaches such as biofeedback. The proposed “A Time for Change: Improving Occupational Performance for Clients With Stress-Related Conditions Using Biofeedback and Self-Regulation to Enhance Function in Adult Roles” program is an online education program for OTs using self-regulation and two types of biofeedback (temperature and heart rate variability) as part of an integrative treatment protocol for clients with stress-related conditions. The program includes the Functional Continuum Questionnaire (based on the MOHO), a program protocol, recommendations for a companion workbook, and a postimplementation evaluation plan.

There is a growing need within the primary healthcare setting regarding necessary proactive treatment of productive aging and health literacy strategies amongst the aging population. Elderly individuals diagnosed with many chronic health conditions, or multimorbidity, are at risk for decreased health and well-being, poor quality of life, and decreased ability to age in place. Help Older Adults Live Their Healthiest Life (HEALTH) is a holistic continuing education unit (CEU) educational program with the goal of educating occupational therapy practitioners (OTPs) on productive aging and health literacy topics to implement within the primary care setting. Implementation of HEALTH within the primary care setting will promote improved quality of life and improved health outcomes amongst elderly individuals.