Homelessness is an emerging role area for occupational therapy. In the United States, occupational therapy is under-represented in all mental health settings from inpatient psychiatry to community mental health. Homelessness services represent an even narrower niche in which occupational therapists are qualified to provide evidence-based, client-centered services designed to increase safety and independence. This proposal is intended to demonstrate occupational therapy’s distinct value in being of service to people affected by homelessness. Specifically, Building a Role for Occupational Therapy in Homelessness (B.R.O.T.H.) envisions occupational therapy as a profession that is well-suited to provide services to people affected by homelessness who have been re-housed back into the community through work with housing focused social service agencies. Clinically, this B.R.O.T.H. provides a model from which occupational therapists can create a role in serving this population through the use of short-term occupational therapy treatment focused on improving skills of independent living by performing them in the natural environment (i.e., the client’s apartment). By focusing on tasks such as meal preparation, medication management, and appointment adherence, money management in the client’s natural environment, the occupational therapy practitioner will assist the client in gaining the skills they need to remain safe and independent in the community. Similarly, B.R.O.T.H. proides a framework through which such programs could be funded. Because occupational therapy practitioners typically command higher salaries than other social service staff such as social workers and case managers, the program provides recommendations around seeking out and applying for relevant grants and other funding sources to support approximately half of the occupational therapy practitioners salary. Most importantly, B.R.O.T.H proposes a program that uses evidence-based, highly-skilled occupational therapy services to improve the lives of people affected by homelessness. Project outcomes are targeted exclusively at improvement of the lives of the people served. At its foundation, this B.R.O.T.H rests on the belief that occupational therapy has a distinct value in improving this country’s homelessness crisis and the lives of those affected by it.

With an estimated prevalence of rate of 18.9% in the general population and 25% to 80% in individuals with heart failure (HF), mild cognitive impairment (MCI) results in impaired executive functioning, hospital readmissions, and increased utilization of the healthcare system (Alagiakrishnan, et al., 2017; Amini, et al., 2019). Studies suggest these cognitive impairments are often unidentified or undiagnosed (Amini, et al., 2019; Zhuang, et al., 2019). Despite the established effects of MCI and cognitive impairment in the hospitalized population, there are gaps in the research regarding a standardized approach to addressing this problem (Cameron, et al., 2017; Zhuang, et al., 2019). Currently, there are no effective pharmacological interventions that offer a long-term effect on delaying the progression from MCI to dementia. There is, however, a growing body of evidence supporting the important role of non-pharmacological interventions in MCI (Hong, et al., 2015; Sherman, et al., 2017). OTs have the skills to provide cognitive rehabilitation including global learning strategies, specific functional skills training, use of external aids, and cognitive retraining during functional activities, therefore, a standardized protocol was developed to benefit OTs and patients they are treating. The Multidisciplinary Approach for MCI has three key components: 1) educating nurses on how to assess for MCI and cognitive impairments, including how to provide cognitive stimulation daily and when to consult occupational therapy to optimize care, 2) standardizing an approach for OTs on how to screen, assess, and treat MCI and cognitive impairment in acute care and 3) increasing awareness of OT’s role within an interdisciplinary team to address MCI and cognitive impairments in acute care. This protocol aims to be a feasible and affordable method to educate nurses and OTs on how to treat MCI and cognitive deficits in acute care. Dissemination of this program is essential to its success. With more OTs implementing this program, the greater the opportunity for critical evaluation and refinement. The focus of this project was on the initial education and feasibility of the Multidisciplinary Approach for MCI, however the potential impact of its use to improve patient outcomes in the future is encouraging.

Youth with autism spectrum disorder (ASD) often have poor outcomes while transitioning to adulthood, such as experiencing low rates of employment, post-secondary education, independent living, and life-long friendships after high school graduation. Factors which may be contributing to these poor transition outcomes include the lack of understanding of their limitation and needs, and the lack of assessments designed specifically for the ASD population which address their abilities to manage the complex, multi-step life tasks of adult living. The Self-Management for Autism Rating Tool (SMART) is a clinical assessment designed for individuals with ASD, aged 16 to 35, to evaluate the self-management skills required to function successfully in adulthood. The tool was influenced by guiding theories, evidence, and assessments such as the Transition-Q and PEDI-CAT, and will be developed across three phases before clinical use. The SMART provides an increased understanding of the capabilities and needs of adolescents with ASD which can guide intervention efforts and better connect individuals with appropriate programs and supports. Addressing the self-management needs of young adults with ASD could lead to improved transition outcomes for this population, allowing them to reach their potential to live independent and productive lives.

The second-most populous country in the world, India, has many problems that need attention such as employment, providing health services in rural areas, access to education and many more (Worldometer, n.d.). Each issue that is present has multiple reasons for why they exist. The two problems addressed in this project are: a) the increase in the number of children diagnosed with Autism Spectrum Disorder (ASD) (Raina et al., 2017) b) a high number of regular children/teenagers who drop out of school, 1 in every 10 to be precise (Gouda & Sekher, 2014). Autism toolkit is an online training program for anyone, interested in helping children with ASD, who has completed their 8th grade. It aims to provide intervention to children in the Autism Spectrum Disorder in rural parts of India through training laypeople or non-specialized workers (NSWs). The training will be done using the principles of task-shifting as postulated by the World Health Organization. Task shifting involves equipping more hands to provide intervention (World Health Organization, 2008). There is evidence from studies, where task shifting was done in South Asia, suggesting the efficacy of such an approach in ASD-intervention (Divan et al., 2015). Capacity building programs that help solve problems within each community are advantageous (DHHS, National Cancer Institute, 2005). Research has also shown that interventions for autism delivered by a non-specialist provider produce benefits compared to no treatment at all or ‘treatment as usual’(Rahman et al., 2016). The program is designed to engage volunteering OTs across India and the world, who are comfortable to teach simple topics in Hindi, online.

The wheelchair evaluation process is complicated for clinicians and consumers alike. Consumers report feeling uninvolved in the wheelchair evaluation process resulting in feeling uniformed and dissatisfied and in some cases, being prescribed wheelchairs that do not meet their needs. Consequently, consumers may abandon the recommended wheelchair which may impact participation in Mobility-Related Activities of Daily Living (M-RADLs). Shared-Decision Making (SDM), used in healthcare encounters, may be used by clinicians to facilitate a collaborative process when recommending wheelchairs. This project proposes a continuing education course designed to teach the principles of SDM and guide clinicians’ implementation of SDM into their practices.

Interprofessional education (IPE), an educational concept that occurs when health care professionals from various disciplines learn about, from and with each other could ultimately enrich patient care, through use of collaborative strategy and synergistic learning between health care professions (Darlow et al., 2016). Evidence supports provision of IPE programming for occupational therapy and other healthcare student disciplines, in order to attain the diverse skill set required to effectively and efficiently communicate within an interdisciplinary healthcare team, and ultimately, to improve quality of patient care. The use of IPE in professional level healthcare education has been shown to improve students’ collaborative knowledge, skills and behavior, leading to effective task delegation (Riskiyana et al., 2018), ethical problem solving skills, and understanding of the professional roles and responsibilities required to promote efficiency in effective communication and teamwork skills (Gee et al., 2016). Despite literature supporting the justification for implementation of evidence-based IPE programs across institutions nationally, professional healthcare programs lack consistency and follow through. Diversity within IPE programming (Zahl et al., 2016) will allow for flexibility in planning and implementation of student experiences, which promote high-quality patient health care and strengthened collaborative workplace practices (O’Hara et al., 2018). With this heightened flexibility, interprofessional learning can transpire in larger student numbers, comprised of diverse healthcare disciplines, through platforms including online learning (O’Hara et al., 2018), clinical workplace supervision (Lawlis et al., 2016), and community based service learning experiences (Zahl et al., 2016). In order to investigate which interprofessional exercises and learning tools are perceived to be most effective an evidence-based, three-phase model curriculum, has been designed to be implemented across occupational therapy and other healthcare programs, in order to promote preparedness of professional level healthcare students as interdisciplinary team members. An entire cohort of master occupational therapy students will be recruited to participate in this three-phase IPE program, which will be embedded within the curriculum. Research will utilize a quasi-experimental design, using pre and post survey testing to measure the dependent variables of interest. Results will indicate students’ perception on which IPE tools/activities were most effective in preparing them for participation as an interdisciplinary team member, as well as produce evidence to support use of effective IPE tools/activities, to adequately prepare occupational therapy students for an interdisciplinary team based approach to practice. This educational program addresses a gap in knowledge and experience of interdisciplinary healthcare educators. Further collaboration and research from interdisciplinary healthcare educators is needed to attain data to support best practice in program development, as IPE falls within both the professional and ethical responsibility of occupational therapy and healthcare educators (American Occupational Therapy Association [AOTA], 2015).

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.