Sleep and nutrition impact a child’s ability to participate in their daily occupations. Poor sleep has been linked to school-related attention problems and can impair executive function and cognitive control. Poor nutrition is associated with decreased cognitive function, memory, and overall mood. Children are more likely to be able to successfully engage in their occupations, such as school, play, and socialization, when they have adequate nutrition. There are several existing programs to support parents and caregivers of elementary school students with either sleep or nutrition. However, there is a lack of programs that address both sleep and nutrition together. At Home Healthy Habits: Sleep & Nutrition is a six-week virtual educational workshop offered to caregivers of elementary school students. The goals of this program are to increase caregivers’ knowledge about how sleep and nutrition are connected, how sleep and nutrition impact their child at school, and how to promote healthy habits. Addressing sleep and nutritional health through an occupational therapy lens will provide inclusive recommendations and support for all abilities and sensory preferences. Strengthened communication between caregivers and the school can provide a caring and collaborative environment to support students’ health and academic achievement.

Students in kindergarten require a solid foundation in letter formation skills to build upon this knowledge when writing their name, writing sentences or completing a standardized assessment. Embedding more of the proper and necessary kinds of writing within the curriculum was systematically planned to provide the skills the students need to move forward and make progress in writing and literacy. Once children have learned basic letter formation, they must continue to develop their writing skills to the point that they can produce letters automatically. Failing to gain automaticity in the early years may limit students’ subsequent ability to express ideas through writing, which may potentially affect their academic success, motivation, and self-esteem (Graham S., Berninger, V. W., Abbott, R. D., Abbott, S. P., and Whitaker, D. 1997). The intent of this program is to provide consultation and intervention proactively to all the kindergarten teachers so that all students in their classrooms will improve their overall writing skills. This proactive approach will benefit all students while also reducing occupational therapy referrals to focus only on students who truly require specialized intervention. Teachers participating in this program will be providing improved letter formation instruction along with consistent time for practice and reinforcement. Building a letter automaticity pathway in the brain benefits kindergarten students for their writing performance in grade 3 and beyond. The long-term outcomes of the program will produce kindergarten students that are able to write upper and lower-case letters without a model and can write (at least) their first name independently. The STAR early literacy testing should also demonstrate an improvement in standard scores along with success in the print concept goals. Parents will also become more invested at home writing and see how a little collaboration with the school can improve their child’s educational performance.

A major challenge in today’s current healthcare system is the risk of readmissions by older adults recently discharged from an acute care facility. Current evidence-based literature does not have a single contributor for the reason for the readmission following discharge, but evidence does suggest some strong indicators for risk for readmission back into hospital. The risk for readmission into the hospital following a discharge from acute care increases due to older age, multiple diseases, co-morbidities, and functional limitations (Tinetti et al., 2012; Garcia-Perez et al., 2011). One of the key risks is the fact that an older adult is physically deconditioned while staying in hospital and inadequate transition planning takes place. The older adult is quickly returned to their pre-hospital living environment and expected to resume 100% of daily living activities. Tinetti et al. (2012), suggest that enhancing functional recovery during a period of home care following an acute hospitalization may reduce the risk of readmission to hospital. Telehealth is a service delivery method that is increasingly being used by occupational therapy to reach more clients and to provide greater access and flexibility vii (AOTA, 2013). Telehealth technologies could be utilized by the OTs to help facilitate ongoing communication between the client, caregiver and the OT, as well as other health care providers to provide a cost effective model of care. The creation of a six-week program designed for older adults (over the age of 65) recently discharged from an acute care hospitalization uses telehealth to deliver the OT services but will utilize the support of an in home support worker to help deliver the restorative care program. Project Home is built upon the philosophy of targeting daily living skills that are of importance to the older adult while gradually decreasing the level of support provided to the older adult to maximize their independence.

Advanced neuro rehabilitation technology is becoming more common in upper extremity stroke rehabilitation. It uses the occupational therapy approach of restoration or remediation of function. Advanced neuro rehabilitation technology includes devices such as functional electrical stimulation, robotics, sensor-based technology and virtual reality gaming. Many of these types of devices are based on principles of neuroplasticity and motor learning, and as such, offer an intervention approach that involves high intensity repetitive movement training in engaging environments with performance feedback (Levin, Weiss & Keshner, 2015; Mehrholz, Hadrich, Platz, Kugler & Pohl, 2012); Winstein et al., 2016). Despite emerging evidence-based literature on the efficacy of using neuro rehabilitation technology for upper extremity rehabilitation post-stroke, there is very limited research on how to effectively implement and deploy technology into typical occupational therapy service delivery. Integrating Neuro Technology into the Clinic is a resource tool and mentoring program informed by evidence and grounded in theory. It was designed to encourage clinics to take an active role in adapting the program and evolving the content to support clinicians in using technology to meet their individual clinic goals as their needs change over time. The overall aim of Integrating Neuro Technology into the Clinic is to increase clinicians use of technology for clinically meaningful outcomes and to assist with improving perceived self-efficacy in the appropriate application of the technology. Integrating Neuro Technology into the Clinic consists of a resource binder of education modules and resources and a 13-week occupational therapist led peer mentoring program focusing on technology use and knowledge translation. Integrating Neuro Technology into the Clinic was created to encourage the use of advanced neuro technology in occupational therapy service delivery. The long-term outcomes of this project will contribute to emerging knowledge on technology use in occupational therapy practice and hopefully influence improved technology integration in occupational therapy practice.

Early childhood is a critical period of development. During this critical period, children under age three with developmental delays or who have been diagnosed with a disability in rural areas of the United States are having difficulty obtaining early intervention (EI) occupational therapy (OT) services they qualify for under Part C of IDEA (Cason, 2009; IDEA, 2004). Generally, the root of the problem in rural communities arises from limited access to services, provider shortages, and increased cost of providing services (Baharav & Reiser, 2010; Behl et al., 2017; Blaiser, Behl, Callow-Heusser, & White, 2013; Cason, 2009; Ciccia, Whitford, Krumm, & McNeal, 2011; Havenga, Swanepoel, Roux, & Schmid., 2015; Heimerl & Rasch, 2009; Molini-Avejonas, Rondon-Melo, Amato, & Samelli, 2015; Olsen, Fiechtl, & Rule, 2012; Taylor, Armfield, Dodrill, & Smith, 2014). Rural communities in Massachusetts are facing similar challenges. The aim of this doctoral project was to better understand the barriers to providing EI services in rural areas as well as explore an evidence-based solution to this problem. Through a review of the literature, it was found that telehealth is a viable service delivery model to address barriers to providing EI OT services in rural areas. (Baharav & Reiser, 2010; Behl et al., 2017; Blaiser et al., 2013; Cason, 2009; Ciccia et al., 2011; Havenga et al., 2015; Heimerl & Rasch, 2009; Molini-Avejonas et al., 2015; Olsen et al., 2012; Taylor et al., 2014). Since each state has different policies and challenges confronting the implementation of EI telehealth, state-specific EI telehealth training programs are needed to help develop and promote the use of EI OT telehealth delivery service models (Blaiser et al., 2015; Cole et al., 2016). The Massachusetts Online Resource Education for Early Intervention (MORE EI) Telehealth Training Program are self-paced videos aimed to increased MA provider knowledge and confidence with the use of telehealth as well as encourage advocacy for reimbursement and acceptance of EI OT telehealth as a viable service delivery model in MA.

Healthcare transition is the transfer from pediatric to adult health services and the development of related functional competencies (Sharma, O’Hare, Antonelli, & Sawici, 2014), including self-management, health self-advocacy, and health IADL performance. An estimated 4.5 million youth aged 12-18 have special healthcare needs, a number that has grown over time (McManus et al., 2013). As this mounting population enters adulthood, healthcare transition has become a topic of increasingly intense attention and research among health providers, policymakers, and disability advocacy groups (Betz, O'Kane, Nehring, & Lobo, 2016; McManus et al., 2013). However, many youth with disabilities do not successfully transition to adult healthcare settings or assume responsibility for adult health activities (Betz et al., 2016; McManus et al., 2013). There is a need for professionals to support and train youth to successfully transition to adult healthcare and to foster their abilities to manage their health and achieve positive health and participation outcomes. Occupational therapists (OT) have the opportunity to facilitate improved healthcare transitions and support youth through other contexts of transition to adulthood that mutually influence healthcare transition, including post-secondary education, vocations, independent living, and adult-oriented community and social activities (Ferris, Ferris, Okumura, Cohen, & Hooper, 2015). Facilitating Transitions to Adult Healthcare for Youth with Disabilities: Resources for OT Practitioners is a theory-driven and evidence-based continuing education program for OT practitioners. The course introduces a socio-ecological model to analyze the interrelated factors that influence healthcare transition and participation outcomes, and reviews current multidisciplinary research on healthcare transition interventions. The course aims to increase learners’ healthcare transition knowledge, increase learners’ self-efficacy in meeting the needs of this population, and in the long term, increase the OT profession’s participation in healthcare transition activities.

Telehealth is “the application of evaluative, consultative, preventative, and therapeutic services delivered through telecommunication and information technologies,” (AOTA, 2014, p. S69). The evidence literature provides support for the use of a telehealth service-delivery model in occupational therapy (OT) practice within various settings. The use of telehealth in pediatric occupational therapy has been shown to be effective by increasing access to specialist care and preventing delays in provision of services (Cason, 2014), increasing collaboration and carry-over of treatment strategies (Gibbs & Toth-Cohen, 2011), and improving overall therapist/client satisfaction (Ashburner, 2016; Criss, 2013; Reifenberg, et al., 2017; Zylstra, 2013). Despite the effectiveness of a telehealth service-delivery model, the use of telehealth in occupational therapy practice is limited, potentially due to a lack of knowledge about telehealth. Education is a critical factor necessary to promote successful implementation of telehealth in clinical practice (Nissen & Brockevelt, 2016). In order to educate schoolbased working professionals, including OT practitioners and school district administrators, about the use of telehealth, an asynchronous, online educational program about the use of telehealth is proposed. A participatory action research model was used in the initial phase of the project. School-based occupational therapists, certified occupational therapy assistants, district administrators, and related technology staff were invited to complete a survey intended to explore attitudes about the use of telehealth. Results of the survey guided the formation and implementation of a client-centered program designed to educate participants about the potential benefits and barriers to the use of telehealth in a pediatric, school-based setting. Stakeholders were invited to complete the online educational program about telehealth and complete a post-program survey to reflect on any knowledge gained as a result of the course. This educational program addresses a gap in knowledge, experience, and awareness of telehealth among occupational therapy practitioners and school district stakeholders. Further collaboration between occupational therapy practitioners and researchers is needed to continue to explore potential uses of telehealth within a school-based setting. / 2019-10-23T00:00:00Z

Inclusion of students with autism in mainstream schools presents both challenges and opportunities for stakeholders, including teachers, students, parents, and administrators (Humphrey & Lewis, 2008). Addressing these challenges requires time and resources to implement inclusion programs that meet the needs of both teachers and students. Occupational therapy practitioners use their knowledge and expertise to work collaboratively with members of the educational team to provide students with autism spectrum disorder (ASD) equal access to the curriculum and school environment. It is necessary to ensure that these students are offered the same activities as their typically developing peers, while being provided support and services to accommodate their individual differences. This proposed doctoral project, “The Sensible Teacher and the Sensational Students: Experiential Professional Development to Promote Inclusion for Students with ASD,” will provide guidelines on best-practice interventions that are most realistic and effective within the classroom for students with the ASD diagnosis. This experiential professional development program will take place over 12 weeks. The first part of this series will be a 6-hour workshop offered 4 weeks after the first day of school, followed by eight weekly 1-hour in-class sessions with an occupational therapist. A 3- week gap before the conclusion of the experiential professional development will enable teachers to implement what they learned. Teachers then participate in a final 6-hour workshop to culminate their experiences. The goal of this professional development program is to improve the evidence-based practices of teachers who work with students with ASD. Specific objectives are to increase teachers’ self-efficacy, decrease their stress and frustration levels, and improve resources and access to supports in the hopes that this collaborative process will bring lasting change that allows teachers to improve their evidence-based teaching practices and feel valued and effective as educators and colleagues.

Occupational therapists work in the school setting as related service providers, helping those students with an Individual Education Plan (IEP) access their special education curriculum. As part of the development of the IEP process, each student is supposed to be assessed for the need for assistive technology to support their educational program (United States Department of Education, n.d.). Assessing for student needs in assistive technology falls within the occupational therapy scope of practice under communication management, one area of independent activities of daily living (AOTA, 2014). However, many students do not have their assistive technology needs identified and met. Additionally, many teachers working with students with disabilities do not have access to the ongoing training necessary to integrate and use assistive technology in the classroom (Basham, Israel, Graden, Poth, & Winston, 2010; Connor, Snell, Gansneder, & Dexter, 2010; Okolo & Diedrich, 2014; Quinn, Behrmann, Mastropieri, & Chung, 2009). “Integrating Assistive Technology into the Classroom: A Program for Teacher Professional Development” was created by an occupational therapist with experience working in the school setting, including assessing students for assistive technology needs and supporting teachers, students and classrooms in using assistive technology. The goals of the project are to 1) provide classroom teachers with the tools necessary to use different types of assistive technology in the classroom and 2) address the needs of diverse learners so that all students are able to successfully participate in their educational program. The program incorporates strategies from adult learning theory and strategies for effective teacher professional development to ensure program success. The program is an innovative, evidence-based approach to teacher professional development in the use and integration of assistive technology in the classroom. It has the potential to become a model for professional development in the area of assistive technology use in the school setting.

It is important for lymphedema practitioners to know what adherence facilitators and barriers their clients face when they are discharged to their self-care programs from outpatient therapy. Client nonadherence with lymphedema self-care can lead to hospitalization, infection, wounds, and the need for additional courses of lymphedema therapy. The lymphedema clinic at Virginia Mason Memorial Hospital is located in a rural, medically underserved area and is one of a few clinics that treat lymphedema in central Washington state. Waiting lists are long and practitioners have a vested interest in promoting self-care adherence in order to reduce client demand for more therapy in a clinic that is understaffed to meet client need. There are numerous reasons why clients do not or cannot adhere with their self-care programs but there are few, if any, resources that practitioners can use to objectively identify leg lymphedema self-care barriers during the course of therapy that will help them design personalized self-care programs that promote adherence by discharge. The Information-Motivation-Behavioral Skills (IMB) model is designed to understand and promote health-related behavior. The IMB model asserts that a client who is well informed, motivated to act, and possesses the requisite behavioral skills for effective action will likely initiate and maintain health-promoting behaviors. This model has been used by the author as a framework to understand and describe the causes of the clinical problem, organize and research strategies that have been used by others to ameliorate the problem, and to design a program specifically for use at the lymphedema clinic. According to Jane Wigg, a nurse who runs a training academy for lymphedema practitioners: Clients gain more knowledge, skill, motivation, and confidence if practitioners take the time to find out their knowledge baseline, direct clients to appropriate learning experiences to fill their knowledge gaps, and provide clients with experiential and skill building opportunities. This program will provide practitioners with training on new assessment materials and how to use assessment data to design a self-care program, and introduce practitioners to new client resources to improve information, motivation, and behavioral skill gaps.