Occupational therapists (OT) must have a broad range of knowledge, skills, and insight to provide services required for effective clinical practice. To do this effectively, the development of clinical reasoning in OT students is essential. It is also mandated by the Accreditation Council of Occupational Therapy Education (ACOTE, 2018), and it is an essential component of OT education. However, Clinical reasoning can be challenging for students to master. Coker (2010) explains that as the healthcare system becomes more complex with clients having increased health needs with multiple co-morbidities, it is essential that OT students not only understand the medical conditions, relevant theories, and evidence-based interventions, but also have clinical reasoning to appropriately develop and implement the necessary interventions. This project is the development of an evidence-based, theory-driven, and easily replicable Level I fieldwork (FW) program using non-traditional FW experiences with under-served populations. This FW program provides rich experiential learning opportunities for the development of clinical reasoning in OT students. This innovative educational program has significant potential to improve OT student performance on Level II FW as well as in clinical practice. This non-traditional Level I FW program is specifically designed to enhance student’s clinical reasoning through a variety evidence-based method. By improving student clinical reasoning, client outcomes will also be improved. Over time, and as this program’s information is disseminated, this program could be incorporated by OT programs across the country to improve student performance on Level II FW pass rates as well as client outcomes.

Stroke is a growing problem for young people in the United States. The face of stroke is changing, and dated misconceptions based on age are limiting our ability to address this issue. For younger adults aged 21–40, ischemic stroke has been a recurring problem. Many younger adults in this group face mental health deficits, physical impairment, and a decline in socialization. In addition, current treatment costs exceed that of several other health conditions. Yet, many young stroke survivors still report feeling isolated and unheard, as psychosocial problems go unaddressed. Conventional treatment too often uses a blanket approach in treating all stroke clients, regardless of age. Through occupational therapy, young stroke survivors are provided the opportunity to engage in a course of treatment that incorporates a uniquely comprehensive approach, which facilitates the incorporation of psychosocial health and lifestyle changes that will help prevent stroke recurrence.

Children who participate in the undesirable behavior of scatolia can become alienated from participating in the daily occupations that are meaningful to them. Interventions to Decrease the Occurrence of Scatolia in Children with Developmental Disabilities has been created to address the need of stopping scatolia from happening immediately with use of restrictive garments, and to create a long-term treatment plan with a licensed occupational therapy practitioner in order to decrease the occurrence of scatolia on a long-term basis. “Scatolia” is the medical term that refers to physically touching, smearing, and handling feces. There are different reasons why a child with a developmental disability would engage in the behavior, including medical issues, behavioral issues, and sensory issues. When any child performs the act of fecal smearing, the stress falls to the caregivers to be vigilant about immediately stopping the behavior to decrease the spread of germs in society. Parents, grandparents, teachers, and caregivers can become overcome with guilt, shame, and anger over their child’s behavior. The general problems related to scatolia can make it very challenging for caregivers to bring their children out into public and to invite visitors over to their homes for fear that the child will engage in the behavior and the risk of spreading illness or disease. With the use of evidence-based research, this program has been created for pediatricians, parents, and children to assist with the rehabilitation of stopping and preventing scatolia from happening in the future.

The American Occupational Therapy Association’s (AOTA) Vision 2025 is a call to action for the occupational therapy profession to maximize the health, well-being, and quality of life of all people, populations, and communities through effective solutions that facilitate participation in everyday living (American Occupational Therapy Association, 2021). This vision aligns with the Institute for Healthcare Improvement’s Triple Aim Framework which identifies improving the health of populations as one of three dimensions in its approach to optimizing the US health system’s performance (The IHI triple aim: IHI 2021). Unfortunately, there are a limited number of occupational therapy practitioners (OTPs) who work in community-based settings at the population-health level (Andreae et al., 2021). For OTPs to contribute to achieving Vision 2025, they need to develop knowledge, skills and interest in working in this emerging practice area. It is up to academic institutions to create learning experiences for OT students that prepare them to identify and design a role for themselves and the profession in these non-traditional settings, as well as build the skills needed to succeed. A guideline for providing community-based experiences for OT students in a structured way would allow OT educators to ensure that graduating students have the skills they need to address the health and prevention needs of populations and communities, as well as the desire to do so. The proposed program is a practical, feasible guideline that occupational therapy educators and academic fieldwork coordinators can use to prepare students to meet population health needs through implementing service-learning as level 1 fieldwork.

Children with developmental delays are often not identified until they are school-aged (Chödrön et al., 2019). The American Academy of Pediatrics recognized early identification as essential; however, there are inconsistencies in best practices (Bright et al., 2019; Jimenez et al., 2017). These inconsistencies are a problem because there are missed opportunities when children are not identified early, and these problems have a greater significant impact on marginalized communities. Early preventative, proactive interventions are more effective at supporting positive outcomes than when remediation occurs later in life (Center on the Developing Child, 2017). Neuroscience research indicated that early intervention (EI) capitalizes on increased neuronal plasticity to promote infants’ and toddlers’ physical, emotional, and cognitive development (Demanster, 2017, Welch et al., 2015). Occupational therapy’s role in primary care is often underutilized (American Occupational Therapy Association, 2014; Donnelley et al., 2013, 2014). Its unique holistic approach makes occupational therapy practitioners (OTPs) valuable members of an interdisciplinary team (Dahl-Popolizio et al., 2016; Donnelley et al., 2013, 2014) and, as such, they have a role in assisting to increase the EI of children. Research indicated that parents also have a significant impact on supporting and promoting optimal development for their children (Demanster, 2017, Welch et al., 2015). It is essential to create new methods to support the EI of developmental delays (Barger et al., 2018). PlaySpace: Collaboration for Identification, Health, and Milestone Achievement for Infants, Toddlers, and Children is an initiative that aims to improve the EI of more subtle developmental delays before school age through increasing collaboration among parents, pediatricians, and occupational therapists. This initiative consists of two phases. Phase 1 consists of individualized developmental playgroups led by OTPs. Through participation, parents will gain experiential knowledge about developmental milestones, adapting the environment to promote development, appropriate handling skills, and resources to improve their ability to advocate for their child’s needs. Phase 2 will provide pediatricians with options to increase collaboration with OTPs to support the developmental screening process, support parents within their practice, and increase knowledge on evidence-based programs to provide as resources to their families. This doctoral project will present guidelines for Phase 1. This initiative aims to increase the EI of developmental differences to support optimal health and wellness for infants, toddlers, children, and their families by increasing collaboration among parents, pediatricians, and occupational therapists. / 2024-05-11T00:00:00Z

Fine motor skills are important for children to participate in their occupations, including self-care, productivity and leisure. The deficits of fine motor skills are common in children with autism spectrum disorder (ASD), and as a result, they experience difficulties performing daily tasks. Digital devices, such as touch screen devices, has been found to support children with disabilities learn and develop their life skills (Alaniz et al., 2015; Dehghan et al., 2017; Seo, 2018). However, a lack of training on how to use applications and insufficient settings have discouraged occupational therapy practitioners (OTPs) to continue using applications on a touch screen device, regardless of the effectiveness (King et al., 2017; ). In this project, an application, Finger Up, has been developed based on theoretical frameworks, evidence-based literature, and an online survey completed by OTPs. Results from the online survey revealed that the limitations of the existing applications include 1) a lack of visual display for monitoring progress, 2) a lack of visual rewards, 3) a lack of sound rewards, 4) a lack of visual effect for wrong answers, 5) a lack of sound effect for wrong answers, 6) busy background and sensitivity settings, and 7) not colorful. The features suggested from the survey results are 1) simple to use, 2) simple layout, 3) a timer, 4) sounding effect for wrong answers, 5) visual rewards, 6) visual effect, 7) simple instruction, and 8) setting a time limit for each game. OTPs will receive three training sessions prior to the implementation of Finger Up with their clients. Once the training sessions are complete, OTPs will use Finger Up with their clients, 5–11-year-old children with ASD, in a 30-minute therapy session, 5 days a week, for 3 months. A pre- and post-assessment will be conducted for comparison to investigate the effectiveness of Finger Up. Long-term impacts of the program seek to improve the fine motor skills of children with ASD using Finger Up with the suggested protocol and promote technology use in occupational therapy. / 2024-05-11T00:00:00Z

Occupational therapy (OT) is a global health care and justice-oriented profession. Preparing OT students to include justice as a part that intersects with practice—and not as an optional choice—should be an essential component of academic learning in OT programs. The American Occupational Therapy Association (AOTA) Vision 2025 adopted a strong commitment to inclusion, diversity, and equity, declaring that every individual has the right to feel valued, welcomed, and respected (AOTA, 2018). In this OT doctoral project, the author has developed an educational guide, Inclusion, Diversity, and Equity in Academic Learning - Occupational Therapy (IDEAL-OT) for OT programs. This project was designed to integrate inclusion, diversity, and equity within the OT curricula to be a woven aspect in the OT students' clinical reasoning and professional performance to serve diverse population appropriately. The author aims to fill existing gaps in the literature on adopting the cultural humility lens within OT profession through a theory driven, client-centered, and evidence-based approach as a road map to meeting the OT profession’s standards and clients’ diverse needs. By adopting this project, OT students will demonstrate and practice OT within the cultural humility scope by improving self-efficacy in serving diverse population and meet the client's culturally individualized needs, and advocate for individuals with limited opportunities as global citizens, agents of change, and life-long learners.

A therapist's Emotional Competence (EC) is their ability to navigate their own emotions and the emotions of their clients in therapeutic interactions (Brasseur et al., 2013; Wilkinson et al., 2017). EC is defined as a person's skills, confidence, and capacity to navigate emotions in different social situations (Coetzee et al., 2006, Saarni et al., 1997, Brasseur et al., 2013). It is a complex skill that draws from Emotional Intelligence and therapeutic use of self and is linked to one's self-awareness and empathy (Brackett et al., 2021; Perkins, 2018; Perkins & Schmid, 2019; Taylor, 2020). Studies show that effective emotional navigation in healthcare enhances the quality of care by improving client engagement and motivation, therapeutic relationships, and treatment outcomes (Brasseur et al., 2013; Kielhofner, 2009; Kotsou et al., 2011; Park, 2021; Taylor, 2020). Therapists also benefit from increased well-being and protection against burnout and compassion fatigue (Wong, 2016; Taylor, 2020, American Occupational Therapy Association, 2020). Despite the importance of EC, curriculums for healthcare professionals typically place little emphasis on developing effective emotional-related skills and strategies (Brown, 2018; Grant et al., 2014; Perkins, 2018). Furthermore, many healthcare organizations lack on-site education to enhance practicing professionals' EC and interpersonal communication skills (Calabrese et al., 2019). All of these may adversely affect the therapist's well-being and the quality of care. To address this gap in occupational therapy practice, the author created an intervention entitled EmOTions. EmOTions is a comprehensive, six-week- 30-hour online course for practicing occupational therapists. Its primary purpose is to build and incorporate EC skills into daily therapeutic practice. This theory and evidence-based continuing education course uses key interventional ingredients found in the literature to inform the program's content and structure. The resulting changes in participants' EC and EC's effects on therapeutic relationships and therapist well-being will be evaluated using a pre-post comparative design. Funding for the course will be tuition-based, and the research will be funded using grants to promote quality care. The dissemination plan will be directed towards potential EmOTions course participants and organizations providing healthcare services. In conclusion, emotionally competent occupational therapists will deliver better care and experience improved therapist well-being. It is the author's hope that the EmOTions course developed in this OTD project will positively impact the therapists' EC, resulting in improved therapist well-being, quality care, and client outcomes.

Children who are gifted or twice-exceptional (2e) share distinct qualities beyond academic achievement such as heightened neurological responsivity and asynchronous development (Bishop, 2019; Buica-Belciu & Popovici, 2014; Gere et al., 2009). Decreased knowledge and awareness of these shared qualities, combined with bias in the referral process for evaluation and identification of giftedness or 2e, contributes to under-identification, misdiagnosis, and misunderstanding of this population (Card et al., 2016; Webb et al., 2016). As a result, these children have decreased access to interventions that effectively address their needs. Bloom Seedlings is an inclusive preschool program in which occupational therapy practitioners play a primary role in early intervention for children with behavioral challenges related to giftedness or 2e. Social-emotional learning, sensory strategies, mindfulness techniques, and engagement in meaningful occupations are infused in the curriculum to improve self-regulation and decrease impulsive behaviors. Educational modules and support sessions for professionals and caregivers are critical components to improve relationships between caregivers, educators, and children (Zinsser et al., 2019; Zulauf et al., 2019) and are integral to the program. Through engagement in Bloom Seedlings, participants experience improved occupational performance, health and wellness, quality of life, participation, role competence, well-being, and occupational justice. Occupational therapy practitioners can become strong leaders in giftedness and 2e through program development, program evaluation, and contributions to the research. Bloom Seedlings places occupational therapy practitioners in a primary role to increase health, wellness, and advocacy for children who are gifted or 2e.

Cardiac clients do not have limitations in their body movements, but they can experience physical fatigue and weakness when they perform daily routines and may experience psychological distress and uncertainty about their heart conditions and bodies. Sometimes the people around cardiac clients can become overly protective due to concerns about unexpected cardiac crises (Albarran et al., 2004; Alsen & Brink, 2013; Altiok et al., 2015; Condon & McCarthy, 2006; Eckhardt et al., 2014; Fredriksson-Larsson et al., 2015; Hellem & Bruusgaard, 2020; Husser & Roberto, 2009; Jeon et al., 2010; Johansson et al., 2003). Such issues are related to cardiac clients’ restricted activity participation, and they need ongoing activity guidance to resume safely their desired activities. A clinical approach that facilitates safe participation in all activities for the cardiac population after discharged was developed in this doctoral project, and this author created an individualized, occupation-based, occupational therapy-led outpatient treatment program. Cardiac clients are encouraged and instructed in ways to manage their stress during activities, and they are empowered to actively participate in their own care. The outcomes of this project will contribute to increasing numbers of occupational therapy referrals for cardiac clients, increased recognition of the distinct role of occupational therapy in cardiac care, and the inclusion of occupational therapy in the continuum of post-discharge care.