Today, there is agreement among occupational therapy researchers and professionals on the importance of treatment during the very early years of human development and the importance of hand function in regards to child development. Despite its importance, there is a gap in knowledge and skills of pediatric occupational therapy practitioners in evaluating and treating infant hand dysfunction. Thus, there is a clear need to develop educational opportunities to train occupational therapists in evaluating and treating infants with hand dysfunction in multiple settings and clinical conditions. An online educational program now in development, “Treating Infants with Hand Dysfunctions: A Continuing Education Course on Best Practices for the Evaluation and Treatment of Infants with Hand Dysfunction” (Treating Infants), will enable occupational therapy practitioners to understand the unique aspects of hand function in infants, effectively screen and assess their hand functions, and develop practical treatment techniques to improve their participation of infants with hand dysfunction. Three specific objectives were defined for this project: (a) conduct a thorough review of the professional literature to understand better the nature of the problem and its contributing factors, (b) explore whether a continuing education online course could effectively increase and promote the knowledge and skills of pediatric occupational therapy practitioners and students, and (c) develop an evidence-based online continuing education course for pediatric occupational therapy practitioners on the topic of treating infants with hand dysfunction. A mixed-method (with formative and summative approaches) study will be conducted to evaluate the initial program implementation (pilot study). Measurement instruments include pre- and post-course and follow-up assessments and surveys. Results will be disseminated to primary and secondary target audiences. Occupational therapy practitioners may benefit from this online course as a form of continuing education. After completing the online education modules, practitioners and students will have heightened knowledge of how to evaluate and treat infants with hand dysfunctions.

Cultural competence refers to healthcare professionals’ ability to self-reflect on their own values and beliefs, how these values and beliefs impact their professional behaviors, and the ability to address cultural needs of their clients. Evidence demonstrated the positive relation between the culturally competent care and clients’ satisfaction, trust in provider, treatment adherence and therapeutic alliance. Although the occupational therapy (OT) profession calls for client- and culturally-centered practice, OT practitioners are not always confident in their abilities to address cultural needs of their clients in their daily practices. This project aims to enhance OT practitioners’ cultural competence and confidence in working with diverse clients in hospitals. The first step of this project was to develop an explanatory model of the complexities in practicing culturally competent care. Inspired by the Process of Cultural Competence in the Delivery of Healthcare Services (2010) (Transcultural C.A.R.E. Associates, 2015) and Schein’s Organizational Culture Model (1996), the model exemplifies that culturally competent care is about interactions between clients and therapists’ traits that are not easily observable. Many barriers may limit the delivery of culturally competent care. However, cultural encounters offer valuable learning experiences by which providers can enhance their cultural awareness, knowledge, skill, and desire to provide higher quality of individualized care. Evidence to support the constructs of this model and the interactions among them is presented. The second step included a literature review of evidence on previous research of effective interventions used to enhance cultural competence. The essential elements of successful programs were synthesized to develop the Cultural Competence Workshop for Occupational Therapy Practitioners (CCWOT). The proposed program included (1) knowledge on cultural behaviors, values, and assumptions, (2) reflective practice, and (3) opportunities for experiential learning to foster knowledge and reflection by engaging in cultural encounters A mix-methods research design to examine the program’s effectiveness, a funding plan with available local resources, budget, and potential funding sources, and dissemination activities targeting OT practitioners, therapy directors and clients are also presented. This project provides OT practitioners an opportunity to establish respectful, collaborative and effective therapeutic alliances between practitioners and clients of all cultures. The ultimate goal is to assist our clients to live life to its fullest within their own cultures.

Adolescents with autism spectrum disorder (ASD) have poor outcomes related to education, employment and independent living as they transition out of the school system (Roux, Shattuck, Rast, Rava, & Anderson, 2015; Wei, Wagner, Hudson, Yu & Shattuck, 2015). Software applications on mobile devices, such as smartphones and tablets, are types of assistive technology (AT) that may help increase the ability of individuals with ASD to function independently and reduce their need for support from teachers, therapists, or job coaches (Gentry, Kriner, Sima, McDonough, & Wehman, 2015; Kim & Kimm, 2017; Odom et al., 2015; Walsh, Holloway, McCoy, & Lydon, 2017). However, there is a need for guidelines and implementation procedures to avoid misuse of the device, carryover of the device post-graduation, and address professional knowledge as it relates to this new technology. The Knowledge to Action (KTA) framework by Graham et al. (2006) suggests the creation of knowledge tools and products, such as guidelines and decision aids to increase access to knowledge for professionals. Using this framework, the Human Activity Assistive Technology (HAAT) model (Cook & Polger, 2015), as well as reviewing the available evidence on mobile devices, apps and assistive technology, a set of guiding documents were developed. The documents consist of a variety of tools, such as flowcharts, checklists, and guiding questions that can assist school-based teams in implementing mobile devices with transition-age students with ASD. In addition, a funding plan, evaluation, and dissemination needs of a pilot implementation of these documents in a school-based setting are proposed.

There are limited occupational therapy (OT) services available to community dwelling adults with chronic health conditions and disabilities. Inconsistency in services across the continuum provokes discontinuity in care, lack of community resources and supports, and patient noncompliance. Lack of adequate services often results in poor health management, rehospitalizations, falls, learned helplessness, and lack of purpose and identity. Long-term health outcomes and participation of individuals with chronic health conditions are dependent on a model that addresses these factors and creates a standard of care for community-based OT. The Integrating New Skills to Promote Independence Rehabilitation and Equity (INSPIRE) Model For Productive Living is a proposed process model to guide community-based intervention plans. The INSPIRE Model is grounded in theory and informed by the evidence to create a self-directed process to promote skill acquisition, carry over and long-term compliance for adults with chronic health conditions and disabilities. More specifically, occupation-based theories, including Model of Human Occupation and the Ecology of Human Performance are used as a basis to create the model, and the Adult Learning Theory to structure the conceptual themes and process. Although services at the community level are limited, best practice to promote independence and self-management of health were identified and integrated into the INSPIRE Model. Strategies for implementation, dissemination, and funding are outlined. / 2021-06-18T00:00:00Z

Current research highlights that adolescents with Autism Spectrum Disorders (ASD) are less likely to pursue and complete post-secondary education, less likely to obtain and maintain employment, have fewer social supports or friends, and are less likely to maintain independent living arrangements compared to their peers without disabilities or with other disabilities (Newman et al., 2011). These traditional markers of post-transition success embody medicalized conceptualizations of disability by implying that adolescents with ASD lack inherent skills to engage in post-secondary education, competitive employment, maintain friendships, live independently, etc. (Smith & Routel, 2010). This perpetuates disabling roles in adolescents with ASD and restricts the ways in which they can successfully participate as adult members in their communities by failing to consider the impact of social and attitudinal barriers on adulthood outcomes. Current intervention approaches to address transition primarily target the adolescent by building skills in the aforementioned areas, while few consider the role that their parents play in facilitating adolescents’ transitions (Hendricks & Wehman, 2009; Taylor et al., 2012; Whitney-Thomas, McIntyre, Butterworth, & Allen, 2004). Those interventions that do target parents of transition-aged youth with ASD focus primarily on understanding the complexities of the adult service system for individuals with disabilities, and/or the clinical presentation of autism (Taylor, Hodapp, Burke, Waitz-Kudla, & Rabideau, 2017). Similarly, a lack of evidence-based programs exists for parents of children with disabilities to explore their biases, attitudes and assumptions for more positive disability acceptance. Re-Imagine Transition and Adult Success is a theory-driven and evidence-based critical reflection program for parents of transition-aged youth with ASD that seeks to integrate disability studies content into transition planning. The course is an innovative approach to addressing transition issues in adolescents with ASD as it considers the impact of social and attitudinal barriers on this population’s success in adulthood. Employing reflective learning tenants, the program aims to increase parents’ knowledge about disability studies concepts, apply these concepts to the transition process, and support parents to become critically aware of their own assumptions regarding disability and adulthood success.

Aging in place is a process, and a choice, where older adults remain in their homes as they age. As the number of retirees rises in the US, the topic of where to live as age related changes occur gains more importance. Naturally Occurring Retirement Communities (NORCs) are buildings or neighborhoods that house a large number of older adults and support them in remaining healthy and in the community (The AP-NORC Center for Public Affairs Research, 2021). Occupational therapy practitioners (OTPs) can play a key role in aging in place at NORCs, as the profession specifically addresses participation in meaningful daily activities (American Occupational Therapy Association [AOTA], 2021). Understanding community dwelling older adults through the Social Ecological Model (Bronfenbrenner, 1974) facilitates viewing the individual surrounded by a collection on layers that impact the individual at the center, and considers factors such as skills, caregivers and support systems, neighborhoods and laws, and how they affect a person’s life (Cole & Gauvain, 2005). Lack of mobility and balance, home safety, appropriate equipment, functional independence, communal support, and access to care may result in older adults’ need to leave their homes as they age. A literature review on factors that impact successful aging found that age, chronic conditions, mobility, balance, and functional independence all play a role in balancing the challenges that arise during aging (Jeste et al., 2017; Plys & Kluge, 2016). Receiving healthcare was also found to be a barrier to older community dwellers (Vladeck & Segel, 2010), but there is limited evidence of OTPs’ role in aging in place at NORCs. This gap in the literature highlights the need for occupational therapy (OT) in supporting older adults to successfully age in place at a NORC. Home safety, including mobility, balance, appropriate equipment, and safe participation in functional tasks has been found to be linked to impact successful aging in the community (DiGennaro Reed et al., 2014; Ozturk et al., 2010; Plys & Kluge, 2016). Interventions that addressed these barriers to community-dwelling were found to be helpful to older adults (Plys & Kluge, 2016). Additionally, wellness, functional independence and social participation were found to positively impact older adults residing in the community, and the use of technology also plays a significant role in aging in place (Lee et al., 2017; Shipee, 2011; Smith et al., 2014). Aging Well: A preventive occupational therapy service in Naturally Occurring Retirement Communities (Aging Well) proposes the addition of OT services to NORCs to support older adults’ ability to age in place. Providing preventive services will equip NORC residents with the skills and support needed to remain in their homes as they age. The pilot program consists of individual home evaluations and interventions to address mobility and balance concerns, as well as safety during daily functional tasks and use of medical equipment. Group programming will be capped at 10 participants, meet weekly for cycles of six weeks, and focus on skill-development activities, such as digital literacy to promote independence in daily tasks and engagement in healthy habits that promote wellness. The author’s proposed program has potential to increase older adults’ ability to age in place successfully and establish a formal role in an emerging setting for the field of OT. A detailed overview of Aging Well is presented in this doctoral project.

Rural children and their families experience inequities related to health access and outcomes. Occupational deprivation occurs when children and their families are unable to participate in needed or desired occupations, such as health management or child rearing, due to limited access to health care services such as occupational therapy (OT). This doctoral project proposes the Carolina Mobile Clinic initiative to increase access to OT services for children and their families residing in rural Eastern North Carolina. This would in turn promote their occupational participation and justice as well as improved health and wellness. This doctoral project involved examining the literature regarding contributors to the inequities in order to create an explanatory model of the problem; considering potential solutions for promoting the health access and outcomes of rural residents; proposing and describing how a mobile OT clinic could be used to address the identified issues; developing program evaluation plans; establishing a funding plan; developing a theory-informed dissemination plan; and creating supporting materials such as an executive summary, manuals, and brochures. It is the intention that these efforts will result in a comprehensive, evidence-informed plan for a mobile clinic that could be used wholly or in part with a variety of communities of interest when proposing, implementing, evaluating, or disseminating information about this type of innovative solution in the future. By increasing the ease and likelihood of this type of solution coming to fruition, this project aims to promote access to OT services, occupational justice, and positive health outcomes.

There is a persistent lack of awareness regarding the value of occupational therapy (OT) and scope of practice in the acute care hospital. There is minimal exposure to OT during medical school education and a lack of understanding amongst practicing physicians regarding the role of OT in healthcare. There is also insufficient knowledge amongst other healthcare professionals and referring providers who may be unaware of the diverse services and potential role of OT as a resource for addressing the specialized needs of their clients. Furthermore, there is limited public awareness and understanding, as well as misperceptions, regarding OT in the community, giving rise to decreased consumer access and unmet needs. Advocating for the Advocate: A Toolkit for Becoming a Better Advocate for Occupational Therapy in Acute Care is an educational program that is designed to improve the awareness regarding OT value and scope of practice in the acute care hospital by providing advocacy skills training to occupational therapy practitioners (OTPs) working in this setting. The toolkit is grounded in theories and the profession’s philosophical foundation, based on current evidence, and reinforced by a program evaluation research plan. Advocating for the Advocate offers an innovative approach to build upon the existing capacity and knowledge of OTPs and support further skill development through a multimodal delivery of content, taking into account the distinct experiences, values, and perspectives of each participant and proposes to change mindset and transform behavior.

The sudden increase in work-from-home (WFH) arrangements during the COVID-19 pandemic has brought into sharp focus previously overlooked challenges inherent in WFH environments, revealing their profound impact on the overall health and well-being of employees. This doctoral project, Making Work-From-Home Work for You: Optimizing Work-From-Home Environments for Improved Overall Health and Well-Being, addresses the imperative need to enhance the WFH experience for optimal health and well-being. Guided by the person-environment-occupation-performance model, the program seeks to optimize the interaction between the individual, their work environment, and occupational demands. The overarching objective is to develop and implement a comprehensive program consisting of five modules that assess and address critical factors: ergonomics, aesthetics, work–life balance, and temporal environment. Uniquely positioned at the intersection of occupational therapy and workplace wellness, this initiative introduces a groundbreaking approach to occupational therapy practice in nontraditional settings. The program will be implemented virtually and delivered to a group of remote workers from the same company. Individualized assessments and benchmark check-ins aim at tailoring interventions to foster a holistic approach to employee health. Funding and dissemination are critical components to the program. Funding sources include a program fee paid by the participants’ employing companies and various grants. Furthermore, program evaluation will encompass both qualitative and quantitative measures, involving the researcher and participants and their employers. This project’s success holds the potential to pioneer new opportunities for occupational therapists, typically underrepresented in nontraditional settings such as corporations.

The purpose of the study is to explore the relationship between participation and well-being in mothers with SCI. Twenty-nine women with a spinal cord injury participated in the study. The inclusion criteria was being a mother with a spinal cord injury living in the community and actively parenting at least one child under the age of 12 who were currently living with them. Three standardized instruments were used for this study; the Parental Participation Scale, the Role Physical and Role Emotional subscales of the SF-36, and the Ryff's Psychological Well-Being Scale and six subscales. A correlation matrix was performed examining the relationship between General Role Participation and Well-being for mothers with SCI using Pearson's correlations. The overall well-being scale score for women with spinal cord injury significantly correlated with role physical and role emotional scales indicating the greater the well-being the greater the role participation (less limitation for physical or emotional reasons). Positive relations with others, environmental mastery, and self-acceptance subscales were significantly correlated with role physical and role emotional. In addition, autonomy, personal growth, and purpose in life were significantly correlated with the subscale of role emotional. Another correlation matrix was performed examining the relationship between well-being and satisfaction with parental participation, using Pearson's correlations. The total and all the subscales of well-being (positive relations with others, autonomy, environmental mastery, personal growth, purpose in life and self-acceptance) were significantly correlated with the satisfaction subscale of the parental participation scale. Occupational therapists can utilize these findings when working with mothers with spinal cord injury by addressing the personal well-being factors (such as self-acceptance, environmental mastery and positive relations with others) that significantly contribute to greater participation and satisfaction with parental participation. Also, occupational therapists can advocate in the community/home to make needed environmental modifications to normalize participation, as well as facilitating interpersonal support through educating family and friends to promote the well-being of these women. / Occupational Therapy