Social participation is an important area of occupation and is central to an individual’s identity and sense of competence (AOTA, 2014). Social participation includes engagement in social interactions and formation of friendships, both of which support social interdependence and wellbeing. Friendships are a significant social experience for children as they create a valuable context to learn and practice skills essential to children’s psychosocial development (Guralnick, Neville, Hammond, & Connor, 2007). Forming friendships can be difficult for individuals with autism spectrum disorder (ASD) due to a variety of reasons. Social-related challenges associated with ASD place the child at risk for decreased social interactions (Bauminger & Shulman, 2003; Humphrey & Lewis, 2008). The movement towards including children with disabilities in general education classrooms has resulted in an overreliance on one-to-one paraprofessionals to provide support to these students. Paraprofessionals are offered little prerequisite training and ongoing support, and may unintentionally hinder students’ social participation by providing too much assistance or causing students to become overly dependent (Broer, Doyle, & Giangreco, 2005; Carter & Hughes, 2006; Giangreco, Edelman, & Broer, 2003; Patterson, 2006). Decreased social participation during childhood places individuals at greater risk for adjustment challenges later in life (Copeland et al., 2004; Guralnick et al., 2007; Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Paras to Peers is an occupational-therapist-led training program for paraprofessionals providing one-to-one support to students with ASD. This six-week, multi-modal program utilizes both evidence-based learning theories and paraprofessional instructional techniques to train paraprofessionals, including modeling, performance feedback, and follow-up support. The program incorporates both group and individualized training sessions to teach paraprofessionals social facilitation strategies to promote social participation for students with ASD. Data regarding students with ASD’s social interactions and paraprofessionals’ use of social facilitation strategies will be gathered via trained observers as well as through a paraprofessional survey. Paras to Peers is an innovative method for promoting social participation for students with ASD as well as improving interdisciplinary collaboration between occupational therapists and educational staff in the school setting.

Pressures on school districts to provide cost-effective special education programming have resulted in an increased reliance on outsourcing of occupational, physical, and speech language therapy services to control costs. Occupational therapists who provide services under these kinds of contracts report they often feel like outsiders and that they are left out of the communication loop between educators, parents, and administrators (Kennedy & Stewart, 2011). In addition, contracted therapists typically do not have access to the professional development opportunities available to therapists who are hired directly by the school systems. However, all school-based practitioners require preparation and ongoing development of the professional knowledge, skills, and behaviors necessary to successfully address the needs of special education students in the school environment (Doyle & Swinth, 2018). The complex environment of schools and the isolated nature of the contract therapist contribute to less than optimal interventions and documentation practices. The literature describes an absence of recognized skills and training among school-based therapists and the need for occupational therapists to engage in more collaborative practice (Brandenburger-Shasby, 2005; Kemmis & Dunn, 1996; Kennedy & Stewart, 2011; Laverdure, 2014). This doctoral project addresses the practice barrier contracted OTs encounter accessing practice-specific professional development opportunities. The Realistic Educational Application of Learning (REAL) program provides contract OTs working in school-based practice (SBP) with a two-stage eLearning opportunity for professional development. The design of the program is guided by principles of androgyny or adult learning theory. The blended learning program provides content specific to SBP in learning modules and adds a professional mentoring component for increased collaboration and carryover into SBP. Practitioners completing the REAL program will gain knowledge, learn how to apply content to SBP, and collaborate with an experienced OT professional. The program provides practice-specific content and mentoring to optimize contract OTs’ provision of services to promote the success of students across the lifespan.

The proposed vision program, the Assessment and Management of Visual Deficits within the Hospital Setting, will establish an evidence-based evaluation, treatment, and referral process for individuals with visual impairment (VI) (either neurological or due to low vision) within the acute care, hospital setting. It is reported that 80% of all VI can be prevented or cured (Pan American Health Organization/World Health Organization, 2014) and research supports a need for intervention for VI within the hospital setting, as it is often an overlooked area. Despite this high prevalence of poor vision among inpatients, vision is reportedly not routinely tested nor documented (Press et al., 2015; Roche, Vogtle, Warren, & O'Connor, 2014). The occupational therapy practitioner (OTP) is recommended to incorporate vision screening and intervention to maximize clients’ occupational performance and successful participation in daily activities. Support exists that VI and falls are prevalent in older adults (Roche et al., 2014) and addressing this gap in care shows value by reducing LOS, cost, and improving patient satisfaction (Morse, Seiple, Talwar, Lee, & Stein, 2019; Wong, Brooks, & Mansfield, 2016). This occupational therapy (OT) program will describe a vision screen for use within a hospital setting that assesses key areas of visual acuity, contrast sensitivity, visual field, convergence, and eye range of motion. This program could be implemented across settings including inpatient and outpatient rehabilitation, thus following the continuum of care, and across diagnostic categories (Balcer, Miller, Reingold, & Cohen, 2015; Cate & Richards, 2000; Roberts et al., 2016). Incorporating this vision screen into daily practice may occur as one component of a comprehensive OT evaluation or a subsequent treatment session. The screen could be administered by OTPs once clinical competence has been established through hands-on training utilizing the OT Vision Assessment/Management Manual and mentoring by senior staff and the Vision Program Coordinator. Community-based resources are reviewed to aid in the acquisition of services and proper eyewear. This program is designed to establish an educational pathway to support those patients identified with a VI within a hospital setting.

INTRODUCTION: Sensory processing is associated with occupational performance in both children and adults; however, no studies have examined adults with confirmed childhood sensory processing challenges. Additionally, no follow-up or longitudinal studies on sensory processing from childhood into adulthood have been found. OBJECTIVE: The aim of this doctoral capstone was to better understand the lived experience of adults who had sensory processing challenges as children. METHODS: Using a phenomenological design, four adults who received sensory integration therapy as children were interviewed regarding their perspective about current and past sensory processing and occupational performance. Retrospective and current data on demographics, sensory processing, and occupational performance were examined alongside interview data. Each data set was analyzed on an individual level, and then the four cases were compared and contrasted. RESULTS: Participants had completed at least some undergraduate education and were employed or seeking employment. Two of the adults report current mental health diagnoses. The participants perceived themselves as currently having mild challenges or no challenges with sensory processing and motor coordination. Participants reported social-emotional difficulties and a lack of awareness of sensory processing. They view structure and routine as supports for their daily occupational performance. CONCLUSION: Four adults who had sensory processing challenges as children reflected on their sensory processing and occupational performance. They attributed their occupational performance challenges to a range of factors, including sensory processing, motor coordination, stress, and anxiety. There is a need for therapists and caregivers to explain sensory processing and sensory integration therapy to children.

Typically developing (TD) siblings of children with autism spectrum disorder (ASD) are at risk for developing social-emotional issues, such as: behavioral issues; internalizing problems; difficulty coping with emotions; feelings of isolation or being misunderstood; and a lack of supportive networks of peers with similar home experiences (Kryzak, Cengher, Feeley, Fienup, & Jones, 2015; Vermaes, van Susante, & van Bakel, 2011). Occupational therapy is a family-centered profession that aims to enhance the health of individuals and their family members through meaningful participation in occupations. However, most ASD research and intervention programs related to family-centered care are addressed to the child with ASD and their parents, leaving the TD siblings a relatively neglected group. This is evidenced by the paucity of research and services focused on this population. Therefore, the proposed solution, and purpose of this doctoral project, is the creation of the ViSIBle Together Support Group (VTSG), which is focused on enhancing the health and well-being of the TD siblings by bettering their familial and social relationships and fostering their involvement in meaningful occupations. The current project describes the creation of a manual, known as the ViSIBle Together Manual (VTM), that occupational therapists can use to implement a VTSG in their local setting. It is my goal that the findings of this project will serve to enhance awareness of the needs of TD siblings of children with ASD and be applied to build and inform future services and policies to support TD siblings across the globe.

Grow Your Own Attachment: Gardening as a Co-Occupation to Optimize the Health and Well-Being of Parents and their Children with Physical Disabilities is a program created by an occupational therapist to address the problem of a disrupted parent-child attachment. It is a theory-guided and evidence-based program specifically designed for implementation at Claremont Medical Therapy Unit (MTU), a subunit of Los Angeles County, California Children’s Services (CCS). The Attachment Theory informs a child’s development, growth, and maturity as a result of a secure or insecure attachment with a parent; while the Theory of Planned Behavior (TPB) informs the relationship between health behaviors and an individual’s beliefs, values, and perspectives of such (Bretherton, 2014; Rimer et al., 2005). After a thorough literature review, the health and wellness of parents and their children with physical disabilities were further explored; as well as the meaningful time spent between the parent and child, known as co-occupations. Gardening was found to facilitate physical and psychological health-promoting behaviors. It served as a means to foster stress management and coping skills through the engagement and appreciation of occupations (Eriksson et al., 2011; Greenleaf et al., 2014; Joyce & Warren, 2016, Swank & Shin, 2015a). It also improved children’s exposure, education, recognition, and trailing of fruits and vegetables (Hutchinson et al., 2015; Morgan et al., 2010; Parmer et al., 2009; Spears-Lanoix et al., 2015). Grow Your Own Attachment uses gardening as a means to repair the relationship between parents and their children with physical disabilities by addressing: 1) the child’s nutritional health, self-esteem, and self-efficacy through active participation and engagement in the occupation of gardening, 2) the parent’s coping skills and stress management through the restorative and health-promoting occupation of gardening, and 3) the quality of the time spent between the parent and child through shared experiences in the meaningful co-occupation of gardening. The program evaluation is a one-group quasi-experimental fixed effects research design with the use of qualitative and quantitative data (Newcomer, Hatry, & Wholey, 2015). Open-ended survey questions, semi-structured interviews, child’s weight and body mass index, Likert scales, and parent and child reports of time spent during co-occupations will be tracked pre-, during, and one-month, three-months, six-months, and one-year post-intervention. For the specific site, program and dissemination costs are minimal as the budget is embedded into the pre-existing program. The outcomes will be used to reflect upon current service delivery to enhance family-centered care, utilization of resources, and advocacy and promotion of occupational therapy and CCS.

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.