Approximately 185 million individuals worldwide are living with low vision (WHO, 2014). Evidence suggests that individuals with low vision may have challenges with occupations such as activities of daily living (ADLs), instrumental activities of daily living (IADLs), social participation, work, functional mobility, and leisure activities (Crews & Campbell, 2004). Individuals with low vision may have difficulty adjusting to their vision loss, resulting in an increase in negative psychological outcomes such as depression (Barstow et al., 2015). Individuals with low vision may seek out support groups to connect with others with shared experiences and learn new ideas for addressing occupational performance challenges. However, evidence suggests that factors such as lack of structure and untrained peer leaders may lead to ineffective support groups (Embuldeniya et al., 2013). Occupational therapy practitioners (OTP) may be appropriately trained to address this issue. OTP have specific training to address occupational performance challenges and knowledge about group process enabling them to play a role in a support group setting. However, there are no specific and standardized guidelines to support OTP in assisting with a low vision support group. S.O.L.V.E. for Occupational Therapy Practitioners: Solutions to Optimize the Low Vision Experience is an evidence-based and theory-driven program designed to clearly define the role of OTP in a low vision support group. S.O.L.V.E. aims to make support groups immediately more productive and effective in improving occupational performance and participation outcomes for individuals with low vision in the long-term. S.O.L.V.E. was designed based on the Self-Efficacy Theory and best current evidence obtained through a thorough literature review. S.O.L.V.E. consists of six 90-minute sessions covering topics including general low vision information, use of the problem-solving approach to identify solutions to occupational performance challenges, strategies that make use of remaining vision and other senses, and information about group process and effective communication skills. S.O.L.V.E. aims to increase satisfaction in support group experience, increase knowledge of group process and leadership, and increase perceived self-efficacy with mastery of participation/performance challenges for group members. Long-term, S.O.L.V.E. is expected to increase occupational performance and participation and reduce mental health challenges of individuals with low vision.

There is a plentiful amount of children’s literature that strives to portray real social conflicts that are prevalent in society. However, few children’s books address bullying and how to problem solve effectively in common recreational settings, where there is less adult supervision and children are likely to misbehave. Current children’s books fail to acknowledge and accurately describe the hostility that may occur during social interaction among young children in a comprehensive manner. In addition, there is a scarce amount of children’s literature that is displayed in a digital format that is not only more appealing to young readers, but is also increasingly accessible to those of all abilities. Research suggests that there is a need for a children’s book that contains anti-bullying themes and is written using simple language with relatable characters. If younger children are exposed to complex social dilemmas at an early age, studies show that they are more likely to develop lasting positive morals and more tolerant, open-minded attitudes. The aim of this children’s book centered on bullying and disability tolerance is to provide education to young children from the ages of 3-6 years on the importance of accepting people with differences in a way that they can easily understand. The book will have characters of all genders and ethnicities so that readers can relate to them and apply what they learn to their own lives. Ideally, the book will be implemented across many domains such as in schools, clinical facilities, and within children’s homes. Interviewees were asked a variety of questions after being provided with three consecutive drafts of the book in order to make changes that reflect the needs of various young readers. The interviewees consisted of two occupational therapists, two speech language pathologists, a child-life specialist, two academic teachers, and a parent of a child. Responses showed that the book would beneficial in teaching children to treat all peers equally and how to effectively problem solve should a bullying crisis occur. Therefore, it is recommended that this book in both paper and digital formats could be successfully utilized in academic, clinical, and home-based settings to spread anti-bullying awareness and assist children in adopting tolerant mentalities.

Bop, Look, and Listen (BLL): A Playful Sensorimotor Approach to Address Attention-Deficit/Hyperactivity Disorder-Like Symptoms Among Young Children is an evidence-based and theory-driven treatment method that aims to support child development and learning within preschool classrooms. There has been a substantial increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD), as well as other developmental disabilities, since the turn of the century. Given that ADHD-like symptoms most frequently emerge during preschool and are associated with future maladaptive functioning, there is an imperative need for effective and optimal intervention at this life stage. Due to the controversy surrounding the act of diagnosing a child at such a young age, BLL has been created to address “ADHD-like symptoms”, regardless of diagnosis, or lack thereof. BLL was developed by an occupational therapist and may be considered: 1) an intervention that uses the meaningful childhood occupation of play to target multiple potential neurological underpinnings of ADHD-like symptoms; 2) a health promotion program that educates school-related professionals and parents about the relationship between sensorimotor play, child development, and learning; and 3) a prevention program that aims prevent or alter the trajectory of ADHD-like symptoms in preschoolers. A BLL storybook is used to guide children through specific playful sensorimotor activities, which are based on techniques that research has shown to be effective in reducing ADHD-like symptoms. Secondarily, evidence-based behavioral strategies that maintain the integrity of key concepts from Sensory Integration Theory are woven throughout the program to support participation. In addition, educational materials are provided to school-related professionals and parents. The evidence-based literature regarding the effectiveness of sensorimotor-based interventions for addressing ADHD-like symptoms is scarce, yet promising. Dissemination efforts for program expansion and the future application of an evaluative study of BLL will address this practice gap. BLL has the potential to decrease ADHD-like symptoms and positively impact children’s participation in meaningful occupations and roles within preschool classrooms and beyond.

Teach Back is a pilot education program that will target educating parents of children with ASD on play skills. It has been designed to improve parent competence, decrease parent stress and improve play skills and positive developmental outcomes in the child with ASD.

Telehealth, an emerging occupational therapy (OT) service delivery model, is defined as “the application of evaluative, consultative, preventative, and therapeutic services delivered through information and communication technology” (AOTA, 2018, p.1). Many of the positive attributes of telehealth include improved access and timing for care, care coordination, decreased travel and more (Cason, 2015). Telehealth use has the potential to offset well-documented occupational therapy practitioner (OTP) shortages globally (AAEE, 2016; BLS, 2018; WFOT, 2018). However, unlike other medical professions, the evidence literature lacks substantiation of wide-spread adoption and acceptance of telehealth for OT service delivery (Hersh, Kao, Melton & Pancheri, 2015), particularly in school-based practice. A comprehensive training program for the use of telehealth in the school setting was proposed as a solution to increase OTPs’ positive perceptions and ultimately adoption of telehealth. The Diffusion of Innovation theory posits that conveying an innovation’s attributes of relative change, complexity, compatibility, observability, and trialability can influence potential adoption (Rogers, 2003). To depict detailed attributes of telehealth in OT, perceptions of OTPs experienced in and new to telehealth in school-based practice were measured via surveys and used to inform development of an online educational program. Following the completion of the New to Telehealth Pre-training survey, only OTPs new to telehealth were invited to complete the OT Telehealth Primer: School-based Practice training program. Analysis of pre- and post-training surveys yielded information about attitudinal changes experienced post-training. Results from the OTP Experienced telehealth-user survey identified the top telehealth benefits as improved: 1) service access, 2) collaboration and carry-over with team members, 3) efficiency themes, and 4) student engagement and comfort. Results from the OTP New to Telehealth survey identified the same top benefits post-training. Most perceived barriers decreased significantly from pre- to post-training. Perceived barriers not significantly reduced post-training, therefore yielding future education and protocol development included: unreliable internet, lack of hands-on opportunity and e-helpers’ decreased comfort with technology. Post-training, 80% of participants reported a positive likelihood of adding telehealth to future OT practice. While the OT Telehealth Primer: School-based Practice training program yielded improved perceived benefits and reported likelihood of adoption into practice by OTPs, ongoing education is required for both OTPs and school administrators to achieve more widespread adoption and use of telehealth in school-based practice to offset global OTP shortages. / 2021-09-07T00:00:00Z

Children with autism spectrum disorder (ASD) are at increased risk for accidental injury or death, with the majority of recent reported deaths attributed to drowning (McIlwain & Foster, 2017). Unique differences in motor coordination, sensory processing, and cognitive function which are characteristic of ASD contribute to decreased safety awareness and problematic behaviors such as elopement from caregivers. Despite increasing prevalence of ASD, few communities in the United States have community swimming programs tailored to the specific needs of people with ASD. There is a scarcity of formal training for swimming instructors specifically relating to providing swimming and water safety instruction to people with disabilities. With background in activity analysis and modification, occupational therapy (OT) practitioners present as logical providers of adapted swimming instruction for people with ASD. A continuing education course for OT practitioners is vital to prepare practitioners to provide therapeutic intervention that promotes motor and cognitive skill development for aquatic participation. Using principles from adult learning theory and neuroscience, this continuing education course is structured to support active engagement, peer-assisted learning, and long term retention and application of new learning. Through affiliation with a continuing education provider, dissemination to promote course enrollment, as well as management of course registration fees, can be managed efficiently to expand awareness and minimize funding needed for this course. This continuing education course provides a unique opportunity to expand the role of occupational therapy into swimming and water safety education for children with ASD, and will enable participation in a meaningful leisure occupation for children with ASD and their families.

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.