The college years are a transformative period for young adults, yet without sufficient supports, students nationwide have difficulty adjusting and are demonstrating lifestyle imbalance, characterized by increased stress (Pedersen, 2012). As a result, students are engaging in maladaptive stress coping behaviors, which are negatively impacting wellbeing and academic performance (Coccia, & Darling, 2014; Pedersen, 2012). There remains a gap between resources available and utilization of these resources, while a number of barriers prevent necessary care, including the mental health stigma and a lack of awareness of available resources (American College Health Association, 2019; Conley, Travers & Bryant, 2013; Goodman, 2017; Holland, 2016). This doctoral project aims to address the identified gaps through (1) identification of health behavior and adult learning theories to be applied to an innovative intervention, (2) investigation of evidence-based best practices for developing effective stress management skills and for technology-delivered health interventions, (3) development of an outline for a stress management mobile phone application for college and university students, (4) discussion of implementation and evaluation plans, and (5) development of a dissemination plan. By demonstrating a solution to improve the health, wellbeing, and quality of life for college students, this program will contribute to the field of occupational therapy (OT) by promoting the role of OT on college campuses and creating a shift towards an emerging area of practice.

The purpose of occupational therapy is to enable individuals to achieve health, well-being, and participation in life through engagement in occupation, as described in the Occupational Therapy Practice Framework (AOTA, 2014). To achieve this objective, occupational therapy practitioners may address client factors, such as higher-level mental processes, and performance skills, including a client’s ability to “modify performance when problems are encountered” (p. S25). Often children and teens with autism struggle with the executive function (EF) skill of cognitive flexibility, which may negatively impact their ability to cope when they face unexpected change (Strang et al., 2017). In turn, their occupational performance suffers in areas of academics, social interactions, and activities of daily living (Panerai et al., 2014). In pediatric occupational therapy practice, treatment of EF has been identified as an area of intervention which needs further attention and development (Case-Smith et al., 2015; Cramm et al., 2013). Yet, studies across many disciplines reflected that occupational therapy practitioners (OTs) are not typically identified as either practitioners or researchers in addressing cognitive flexibility skills acquisition among children and teens with autism. Investigators reported that pediatric OTs express both a lack of knowledge and a lack of confidence in treating EF skills, which they explain stems from limited formal education in this subject area, lack of professional development coursework, and availability of few EF treatment tools. This reveals a documented gap in knowledge and service provision within occupational therapy practice. In this doctoral project, three literature searches were completed. Results obtained supported (a) an increased prevalence of cognitive flexibility difficulties among children and teens with autism, (b) a negative impact of cognitive flexibility limitations on the occupational performance of individuals with autism, and (c) evidence that select meaningful therapeutic approaches work to improve cognitive flexibility among children and teens with autism. Through this doctoral work, the Helping Kids Master Surprise program was developed for OTs to promote cognitive flexibility skills in children and teens with autism, to improve clients’ occupational performance, and to increase clinician knowledge and confidence in addressing EF deficits. Emphasized in the Helping Kids Master Surprise program is an underlying respect for children and teens with autism, acknowledging that this diagnosis reflects neurologically-based differences in information processing and that these individuals typically have average to above average intelligence. With this consideration in mind, and in keeping with the Occupational Therapy Code of Ethics (2015), all elements of Helping Kids Master Surprise have been developed to be child- or teen-centered, to be non-triggering of anxiety, and to promote the joyful engagement of participants.

Congestive heart failure (CHF) is a prevalent disease that leads to frequent hospital admissions secondary to its disabling symptoms (Shafazand et al., 2015). Despite a substantial amount of research available regarding CHF, this disease is still perplexing because it remains one of the most prevalent and costly diseases worldwide (Jonkman et al., 2016; Shao, et al., 2013). Even though many interventions have been researched for CHF, it is often poorly managed. Almost 25% of patients are readmitted to hospitals within 30 days from their initial admission (Kilgore et al., 2017) and approximately 50% are readmitted within 6 months (O’Connor, 2017). Research studies have typically focused on outpatient, home, and post-inpatient settings which neglects the inpatient setting where patients often spend much time. Therefore, this setting should be a focal interest for research. Consequently, the Healthier Hearts for Life Pilot Program was developed to address this gap. This program is an interprofessional, inpatient support group for patients with CHF that are considered high risk for readmission. This program is led by occupational therapists but involves many other healthcare professionals. The program’s overall goal is to increase participants’ feelings of self-efficacy for managing their CHF by providing participants with education and hands-on learning opportunities. This program adopts a Social Cognitive Theory (Bandura, 1989) lens to understand the problem, while interventions were guided by the Transtheoretical Model (Prochaska & DiClemente, 1983). Additionally, interventions were based on advantageous, evidence-based findings from the literature of the various medical professions. Overall, this program was designed to support patients to be more competent in the management of their CHF by targeting ‘heart healthy’ behaviors and lifestyle changes in order to reduce readmissions.

Parents and transition-age students are by law meant to be involved in the special education plan development process. Autistic1 youth and their parents, however, are often not meaningfully involved. The overall aim of the dissertation was to understand parents’ and youth’s experiences of their involvement in Individualized Education Program (IEP) development and their perspectives on ideal involvement for diploma-track autistic youth. The first study utilized data from IEP documents and interviews with parents and autistic youth to understand how their perspectives had been taken into account in the development of the youth’s IEP. Findings illustrated considerable variability in how parents’ and youth’s perspectives were documented and incorporated into students’ special education plans. The second study utilized data from interviews regarding parents’ and autistic youth’s ideal involvement in IEP development, and resulted in an initial conceptual framework that outlines different types of desired involvement, foundational ideal elements, and variable ideal elements of parent and student involvement in IEP planning. Findings from the dissertation have implications for special education practice and support further research inquiries focused on parent and student involvement in IEP development. / 2022-09-25T00:00:00Z

Clinical data supporting the benefit of neurodevelopmental treatment (NDT) for children with hemiplegic cerebral palsy (CP) is limited due to inconsistencies in methodology across studies, including variations in: NDT definitions, intervention protocols, and outcome measures (Butler & Darrah, 2001; Graham et al., 2009; Tsorlakis et al., 2004). This has led to disagreement in the literature regarding the benefit of NDT in children with CP. Several contemporary studies indicate that the NDT approach can be effective as a motor and functional intervention for this patient population (Acar et al., 2016; Tsorlakis et al., 2004; Türker et al., 2015). In contrast, others (Novak et al., 2020) have concluded that NDT is not an effective motor intervention for children with CP and should be discontinued. In order to support consistency of evidence-based NDT service delivery, a clinical guideline project was conducted at Children’s Specialized Hospital in the Toms River, NJ outpatient pediatric center. This project was guided by the Knowledge to Action Framework (Graham et al., 2006) and involved the creation of NDT guidelines, including appraisal of current evidence on NDT for children with hemiplegic CP, the proposal of eight essential components of NDT, and recommendations for evidence-based assessments to track patient progress over the course of NDT intervention. Post-Capstone project feedback indicated that key stakeholders of the project identified the clinical guidelines as useful and practical. Recommendations included the implementation of these guidelines into practice, as well as a continual review process to incorporate future research and clinical experience in NDT effectiveness.

There is mental health crisis affecting America’s children and youth and a significant gap exists between professional knowledge and the practical application of prevention and intervention strategies for this population. Since children spend a significant portion of their waking hours in school settings, applying mental health programming within educational contexts is a logical concept. However, with such a significant need for mental health services, neither the US healthcare system nor school systems are able to keep up in providing adequate support for struggling children (Blackman et al., 2016; Franz et al., 2016; Merikangas et al., 2010; Merikangas et al., 2011; Torio et al., 2015). As holistic healthcare practitioners with a rich history in mental health, school-based occupational therapy practitioners are in a particularly advantageous position to address psychosocial issues in children and youth and are considered qualified professionals when it comes to providing both universal and targeted mental health supports for students in California Public Schools (AOTA, 2014; California Department of Education, 2012). However, several barriers pose challenges to this model of practice, and school occupational therapy practitioners rarely focus on social emotional factors (Barnes et al., 2003). This limited focus also results in misperceptions of the role and scope of occupational therapy practice, particularly as it relates to mental health (Cahill & Egan, 2017; Henderson et al, 2005; Pottebaum & Svinarich, 2005; Smith & Mackenzie, 2011). So, although schools struggle to provide adequate mental health services for at-risk students, occupational therapy practitioners are not invited to the table when it comes to discussing school-based mental health interventions or initiatives (Cahill & Egan, 2017; California Department of Education, 2012; Chan et al., 2017; Henderson et al., 2015). In order to reinforce the role and capacity of occupational therapy practitioners and educators in the promotion of positive mental health and social emotional well-being in students, a program is needed to support school-based practitioners in providing effective mental health interventions. Back2Basics aims to do this by supporting school occupational therapy practitioners’ knowledge and confidence in mental health service provision, facilitating enhanced collaborative relationships between occupational therapy practitioners and school staff and providing an evidence-based framework for teachers and administrators to create school environments and educational programming that supports the psychosocial needs of their students (Ryan & Deci, 2017). As such, the program being proposed has been aptly named Back2Basics to represent its focus on practical interventions intended to fulfill the foundational components of psychosocial health and well-being.

Yogatise is a home-based, online yoga program that was specifically developed for children and youth with disabilities between 6 and 17 years of age to create a meaningful occupation outside of school and to increase their social, emotional and physical well-being. It has been found that children and youth with disabilities experience occupational injustice including limited participation in sports, music programs and other organized social activities in schools. The Social Cognitive Theory and the Mindfulness theory provide the theoretical foundation of the problem and the development of the program Yogatise. A search of the evidence-based literature on well-being in children and youth with disabilities and yoga-based interventions showed that important social, emotional and physical skills in these individuals can be increased through these interventions. Yogatise was developed to offer children and youth with disabilities the opportunity to practice yoga according to their unique abilities and skills. It was created to reach children and youth with a variety of disabilities internationally to improve their occupational performance, occupational participation and occupational justice. Yogatise can increase an individual’s well-being and decrease long-term challenges to their school education, future employment and housing. The program involves families and caregivers and offers a community of like-minded people. Yogatise is unique in its focus on the particular needs and abilities of each particular participant and provides the possibility to practice yoga on their terms (e.g., personal schedule, abilities). Yogatise can be implemented in health care facilities, yoga studios and schools.

The literature has shown that although, individuals with Autism Spectrum Disorder (ASD) tend to be excluded from sexual health education (Davies & Dubie, 2012). A lack of adequate sex education puts them at risk for negative factors. The literature has shown that intense and proper education usually does not take place until the individual with ASD has been the victim or committed a sexual offense (Group & Watter, 2018; Loftin & Hartlage, 2015). Sexual Health education should take place in the home, school and community settings for all individuals with ASD. The Sexual Health Education and Expression for Adolescents with Autism (SHEA) program serves an online teaching curriculum for entry and advanced level occupational therapy practitioners (OTPs) to become more competent and equipped in addressing sexuality and educational needs in ASD. The vision of the SHEA program is to provide essential sexual health education to individuals with ASD, OTPs and provide an additional resource for the caregivers and health care professionals. The author’s overall goal of the SHEA program is to improve the educational gap in learned sexual behaviors in individuals with Autism; therefore, decreasing the chance of an inappropriate behavior or experience to take place. Education is key! As OTPs, we must go over and beyond to keep our client’s safe. We must sell our expertise in all areas of practice. We are creative! We are unique!

The problem is the current challenge of the acute care environment itself, which includes significant intra-professional challenges for occupational therapists. The evidence reviewed revealed that occupational therapists have difficulty maintaining a holistic approach with a lack of standardization in how they deliver care and an ever decreasing length of stay in which to provide said care (Atwal & Caldwell, 2003; Britton et al., 2015; Crennan & MacRae, 2010). Collaborative Care is a program proposing to increase client-centeredness and client collaboration through the consistent use of subjective and objective assessments. These assessments are complementary to one another yet serve to deepen and broaden the occupational therapist’s understanding of each client as an individual. They aim to allow the therapist to capture essential, yet holistic, information about each client’s occupations for an optimal discharge and functional independence post-discharge. While many acute care settings are incorporating the use of one or more of these strategies, there is no evidence to show that all are being used as a cohesive, programmatic manner for increased standardization and quality of care (Crennan & MacRae, 2010; Griffin & McConnell, 2001).

RA Empowerment is a self-management program for young and middle-aged with rheumatoid arthritis that supports them in implementing and sustaining health-promoting habits and routines. This doctoral project explores the unique needs of this population in managing their health and describes the development of RA Empowerment.