Purpose: Toileting is an activity of daily living that is often difficult to perform independently for rehabilitation patients, which can be detrimental to the patient’s self-esteem and hygiene. Technology-Assisted Toilets (TATs) are commercially-available toilet seats which clean the user with a stream of water, and have a fan for drying. TATs are operated by a wall-mounted remote control. This thesis investigated whether TATs could improve stroke and geriatric rehabilitation patients’ ability to clean themselves independently after a bowel movement, and improve psychosocial outcomes when toileting. Methods: Stroke rehabilitation participants answered the Psychosocial Impact of Assistive Devices Scales (PIADS) to assess the psychosocial impact of their regular toileting, then used the TAT for a bowel movement on three occasions. In geriatric rehabilitation, participants completed two bowel movement trials; one using regular toileting and one using the TAT. In both studies, participants answered the PIADS and were visually assessed for cleanliness after each trial. Results: Stroke rehabilitation patients had significantly higher PIADS when using the TAT. TATs cleaned participants completely in 73% of BM trials. In geriatric rehabilitation, participants gave TATs higher PIADS scores than regular toileting, but the difference was not statistically significant. Cleanliness level was equal between TAT and regular toileting. Conclusions: These pilot studies show that TATs have the potential to be useful assistive devices for stroke and geriatric rehabilitation patients who have difficulty cleaning themselves independently in the bathroom. PIADS scores in both studies suggest that participants would be unlikely to abandon using TATs.

Approximately 30% to 60% of children experience a behavioral health problem such as picky eating, toileting, or sleep difficulties; however, less than half of those individuals receive the necessary services to improve their symptoms and functioning. Examining the pathway through which children access behavioral health care is crucial to understanding the gap between the need for services and actual service use. Help-seeking process models suggest that for a child to receive care, caregivers must go through a series of linear stages: problem recognition, decision to seek help, and service selection. This help-seeking process has not been previously examined for sleep, picky eating, and toileting challenges, which leaves a gap in our knowledge about how children receive access to important behavioral health care. The current study aimed to fill gaps in the literature regarding help-seeking for behavioral health concerns. Survey data was collected through Amazon’s Mechanical Turk. Participants were 151 caregivers of children ages 5 to 10 years who provided information about help-seeking and child behavioral health symptoms. Rates of caregiver problem recognition for children who exhibited clinically significant concerns were 39% for sleep, 70% for picky eating, and 52% for toileting. When caregivers identified a problem, rates of help-seeking ranged from 53% (sleep) to 69% (toileting). The severity of the child’s problem predicted caregiver problem identification and help-seeking across all concerns. Caregiver past experience with mental health predicted problem identification and help-seeking for sleep and for picky eating. Family disorganization also predicted identification of picky eating problems. Caregivers demonstrated low knowledge of treatment options for behavioral health, and specialty behavioral health services were underutilized across problem areas with 69% to 75% of caregivers in the sample indicating that they had or would seek help from a pediatrician and only 11% to 19% indicating that they had or would seek help from a therapist or psychologist. Caregivers also reported low rates of pediatrician screening for these behavioral health concerns, and results suggest that caregivers are not fully satisfied with how pediatricians address their concerns. Overall, results support and add to the findings in the literature that suggest child behavioral health problems are under- recognized and under-treated. Future research is needed to close the gap between the need for services and service use.