OT Fall Colloquium

Student name: Emily Haffner MOT, OTR/L, CDRS

Faculty Mentor: Amit Sethi, PhD, OTR/L

Capstone Committee Members: Cara Lekovitch, CScD, MOT, OTR/L, BCG; Lisa Juckett, PhD, OTR/L, CHT; Kristen Webber, OTR/L, BCPR 

Capstone site: The Ohio State University Wexner Medical Center

Background:  To help reduce the knowledge-to-action gap in healthcare, research should be completed in a collaborative model involving stakeholders who will use the evidence in practice. Frontline clinicians can collaborate with researcher to help create clinically relevant evidence. This project aims to promote clinician-researcher collaboration within an outpatient rehabilitation clinic at an academic medical center. Interviews with clinicians and researchers were used to identify barriers and facilitators for initiating collaboration. These results and evidence from the literature were combined to develop a web-based resource for educating and matching clinicians and researchers. This lays the groundwork for integrating clinicians in the full research process to produce evidence that can be more easily and quickly translated into practice. 

Method: All of the interviewees were presented with three concepts that could help initiate collaborations between clinicians and researchers: (1) matchmaking, (2) liaison, and (3) Teams channel.  They were asked to comment on which they felt would be most impactful for initiating collaborations.  During the responses, both researchers and clinicians also generated other ideas that could help to promote communication and collaboration.

Conclusion: This project is an initial step toward building research capacity within a rehabilitation clinic. The project identified areas of need for increasing knowledge of research topics among clinicians and promoting collaboration opportunities between clinicians and researchers. Recommended next steps include measuring outcomes relating to clinicians collaborating with researchers at the OSU and use of the web-based resource over time. Additional cycles of quality improvement should be pursued to implement interventions to promote behavior change and a culture shift of engaged research within the rehabilitation clinic.

For questions about this project, contact Emily Haffner at EMH199@pitt.edu.

Student name: Michele Andrianna Cary, MPH, MTS, OTR/L

Faculty Mentor: Alyson D. Stover, MOT, JD, OTR/L, BCP

Capstone Committee Members: Ann M. Marsico, CScD, MOT, OTR/L; Catheryn Johnson, OTR/L

Background: Public school administrators have limited access to resources to help them oversee the quality and accountability of their occupational therapy services. The lack of access to resources becomes more apparent when challenges arise with high caseloads, staff, turnover, missing documentation, or when advocates identify evaluation reports that are not comprehensive or defensible. Audits, litigation, and missing documentation may be the first time an administrator realizes their occupational therapy practices are not compliant with legal mandates and professional standards. This system level quality improvement project was designed to assist district administrators with overseeing occupational therapy services in the school setting. The aim was to seek multi-level stakeholder input to inform the development of the training. The overall objective of this project is to help school districts standardize their occupational therapy services so that students have equitable opportunities to succeed.

Method: A mixed methods approach was used to determine the training topics, learning needs, and interest level in a training on overseeing occupational therapy services. Two phases were implemented. Phase one identified education priorities by engaging multilevel stakeholders. Phase two focused on implementing the training and getting participant feedback. A descriptive methodology was used for the qualitative component using semi-structured interviews, field notes, and interview guide. Survey instruments and data sets captured qualitative and quantitative data.

Conclusion: This multilevel stakeholder engagement project identified the learning needs of school district administrators who oversee occupational therapy services. Stakeholders determined that training in staff retention, onboarding OTPs, workload management, OTA supervision, and implementing professional standards should be prioritized. The participant sample size was small, but feedback substantiated the need for this training. Time and cyber security issues were barriers to participation. Next steps will include gaining more feedback by increasing the sample size.

For questions about this project, contact Michele Andrianna Cary at MAC676@pitt.edu

Student name: Marilyn Bader, MPA, OTR/L

Faculty Mentor: Ketki Raina, PhD, OTR/L, FAOTA

Capstone Committee Members: Ann M. Marsico, CScD, MOT, OTR/L; Melanie Stevenson, M.Ed.

Capstone Site: Greece Central School District, Rochester, NY

Background: Occupational Therapists (OTs) have a distinct role in supporting their involvement in Multi-Tiered Systems of Supports (MTSS) and promote professional development (PD) that promotes educational access for all students. This quality improvement project aims to implement a tiered strategy toolkit and asynchronous professional development program to improve knowledge about OT, access to resources, and collaboration among OTs and educators within the school-based setting.

Method: A two-hour asynchronous course was developed based on stakeholder input from educators in the school. The course provided knowledge about OT services, processes, and tiered intervention strategies. Changes in knowledge were measured using a post-post test design. Potential success of the strategy toolkits was measured using the Acceptability of Intervention Measure, Interventions Appropriateness Measure, and the Feasibility of Interventions Measure. Checks for understanding and reflection questions were embedded in learning modules for qualitative feedback.

Conclusion: Stakeholder involvement throughout the program development allowed for successful participation in this PD. Educators viewed the quality improvement project as successful in improving knowledge of OT’s role in schools, processes, and access to strategies for targeted areas of concern. Future considerations include ongoing PD offerings and monitoring of the toolkit usage among educators.

For questions about this project, contact Marilyn Bader at MAB698@pitt.edu.

Student name: Rachel Popovich, MOT, OTR/L, CPAM

Faculty Mentor: Ketki Raina PhD, OTR/L, FAOTA

Capstone Committee Members: Cara Lekovitch, CScD, MOT, OTR/L, BCG; Susan Fletcher

Background:  Level I occupational therapy (OT) fieldwork standards have diverse applications across academic institutions. The Accreditation Council for Occupational Therapy Education (ACOTE) states that Level I fieldwork experiences “introduce students to fieldwork, apply knowledge to practice, and develop an understanding of the needs of clients” (ACOTE, 2018, p. 41). Many academic programs utilize Level I fieldwork to fulfill the “behavioral health, or psychological and social factors influencing engagement in occupation” ACOTE (2018, p. 40) standard C.1.7. 
Level I fieldwork placements branching into emerging practice environments grew in popularity in the 1990’s during the fieldwork placement shortage (Johnson et al., 2006). There is evidence of successful Level I fieldwork in camps for children with disabilities (Provident & Colmer, 2013). Evidence suggests that caring for typically developing campers positively influences interpersonal skills in adults. Therefore, Level I fieldwork may be expanded to include camps for typically developing children. This project explores the incorporation of OT students to camp programming and describes the academic impact on the students. The purpose of this community-based fieldwork placement was to determine if Level I fieldwork standards can be met at a summer camp for typically developing children where no OT services exist.

Method: A Level I fieldwork site was developed at a summer camp with input from an academic fieldwork coordinator, camp administration, and Accreditation Council for Occupational Therapy Education (ACOTE) Level I fieldwork standards. Data collection methods included a pre-experience survey related to student expectations, student assessment using the American Occupational Therapy Association (AOTA) Level I Fieldwork Assessment, and follow up semi-structured interviews with students, camp counselors, and camp leaders.

Conclusion: These findings indicate that academic Level I fieldwork demands can be met at a summer youth camp for typically developing children where no OT services currently exist with partial supervision from an occupational therapy practitioner (OTP).

For questions about this project, contact Rachel Popovich at RLP53@pitt.edu

Student name: Anne Borema, MS, OTR/L

Faculty Mentor: Ketki Raina, PhD, OTR/L, FAOTA

Capstone Committee Members: Erin Mathia CScD, MOT, OTR/L; Bridget Trivinia, OTD, MS, OTR/L

Capstone Site: Children’s Hospital of Philadelphia, PA

Background: The OTPF-IV is used to define occupational therapy (OT) practice and ground OTPs when working in an interprofessional team. The OTPF-IV describes client-centered care as the “interrelated constructs that [make up] occupational therapy practice,” which include occupations, contexts, performance patterns, performance skills, and client factors (AOTA 2020). The use of frameworks in healthcare is shown to improve cost-effective care, diagnosis-specific outcomes, and create strategies to increase engagement. Upton et al. (2014) have identified numerous barriers to evidence-based practice (EBP), including time, workload, and accessibility. Consequently, clinician engagement and sustainability are critical. When considering mechanisms of change, factors include individual readiness for change, measurement, and culture.

Method: Objectives for this capstone were created within CHOP’s department goals of enhancing documentation. A continuing education (CE) course was designed to provide baseline OTPF-IV knowledge and encourage clinician interest. Focus groups were conducted to engage clinicians further. A mixed methods approach was used, and a thematic analysis was applied to qualitative results to identify themes related to the objectives.

Conclusion: OTPs report temporal restraints and lack of sensitive measurements as barriers to using the OTPF-IV. The use of strategic mechanisms to optimize the OTPF-IV into EHR guided by clinician input is key to enhancement in care and clinician engagement in change. Future plans include utilizing a capstone student to continue with data collection, enhancing documentation to include all OTPF-IV domains, identifying additional measures to quantify the role of OT in the medical setting, and additional strategies for OTP engagement to support the implementation of change.

For questions about this project, contact Anne Borema at ANB377@pitt.edu

Student name: Ieecha Harvey, MS, OTR/L,

Faculty Mentor: Alyson D. Stover MOT, JD, OTR/L, BCP

Capstone Committee Members: Juleen Rodakowski, OTD, MS, OTR/L, FAOTA; Avital Isenberg, CScD, MS, OTR/L

Background: The experience of homelessness place young children in a circumstance of being at risk for emotional as well as behavioral challenges that impact participation in meaningful occupations and learning. Approximately 25,538 families with children are experiencing housing insecurities, as a result access to early detection resources and potential treatment is limited. Strengths-based approaches are critical tools for occupational therapist to consider when working to build self-efficacy and confidence among parents raising young children with delays. Occupational therapy Parent and Child Empowerment Skills (PACES) is an 
evidenced-based innovation that takes an approach towards attending to the capacity of the child at any age and offers parents techniques to address attachment and bonding, engagement and regulation skills that can be implemented into any daily routine.

Method: The Translating Research into Practice (TRIP) model was used to create a foundation for diffusion and utilization of occupational therapy PACES among shelter organizations. Survey feedback, focus groups, interviews and audits were used to measure perceived understanding of social-emotional development in children as well as ease of using and satisfaction with occupational therapy PACES at 2 shelters providing support to unhoused women with children. 

Conclusion: Working among families experiencing homelessness is a growing area of practice for occupational therapists. The study supports the use of a strength-based parent decision tool targeting social-emotional development in children birth-3years of age.

For questions about this project, contact Ieecha Harvey at IEH4@pitt.edu.

Student name: Kathryn Dodds, MOT, OTR/L,

Faculty Mentor: Angela Caldwell PhD, OTR/L

Capstone Committee Members: Kathryn Marino DPT; Laurie Watkin; Erin L. Mathia, CScD, MOT, OTR/

Background: This quality improvement project aimed to increase knowledge of occupational therapy services for daycare providers and promote access to occupational therapy services in the pediatric outpatient setting. The TRIP (Translate Research Into Practice) model was used to guide this quality improvement project and included a needs assessment, the creation of an in-service for daycare providers, and the analysis of data collected from pre- and post-surveys. Outcome measures included the number of screens requested, number of referrals, and pre/post survey results related to confidence in knowledge of occupational therapy services and the number of children that could benefit from occupational therapy. After the in-service, we observed an increase in the number of screens requested, an increase in the number of referrals for occupational therapy services, and an increase in the confidence in knowledge of occupational therapy services.

Method: The TRIP model is a four-step implementation framework and is based on 
Roger’s Diffusion of Innovation Model that was developed to guide research on adoption of evidence-based practices in clinical care environments (Titler, 2007). The components of the TRIP model include characteristics of the innovation, the users of the innovation, the methods of communicating, the social system, and the rate of adoption of the innovation. Each of these components are critical and can influence the rate and extent of adoption of the innovation. 

Conclusion: There is a need to improve the knowledge of occupational therapy services in the outpatient pediatric setting. Lack of knowledge can lead to decreased access to therapy services and ultimately influence overall child development. To bridge the gap between clinic referrals and new intakes at the clinic, we developed an in-service for daycare providers to increase knowledge and understanding of occupational therapy services within the outpatient setting. 

For questions about this project, contact Kathryn Dodds at KAD257@pitt.edu.

Student name: Sarah Punshon, MOT, OTR/L

Faculty Mentor: Juleen Rodakowski, OTD, MS, OTR/L, FAOTA

Capstone Committee Members: Erin Mathia CScD, MOT, OTR/L; Bridget Trivinia, OTD, MS, OTR/L

Background: An emerging concern is post-acute COVID-19 syndrome, also known as long COVID. The most common symptoms of long COVID include fatigue, brain fog, sleep disturbance, general weakness, anxiety, and depression which contribute to decreased quality of life, poorer health outcomes and decreased role participation. Some of these long COVID symptoms may be amenable to rehabilitation, such as fatigue, brain fog, sleep disturbance, anxiety and depression. As such, patients with long COVID are being referred to rehabilitation services like occupational therapy (OT), while research has not yet had the time to develop and test these interventions for long COVID. Currently, rehabilitation for patients with long COVID leverages existing symptom-focused evidence-based interventions to generate evidence-informed interventions. 

Method: A three-hour implementation skills-focused workshop was created, guided by the TRIP model. The TRIP model was selected due to the model’s multi-faceted approach to implementation that includes the innovation which would be the evidence-informed interventions, and the focus on the educational strategies used to introduce the innovations to practitioners.  The workshop introduced five evidence-informed interventions relevant to long COVID that were either created by OT practitioners or align with the scope of practice for OT. The workshop included didactics; think, pair, share group activities; a case study; and other active learning activities. Table 1 provides a breakdown of the active elements of the workshop.  

Conclusion: Intention to adopt evidence-informed interventions was measured with a validated instrument called the Evidence-Based Treatment Intention scale (EBTI). The EBTI was selected as an outcome measure for this study because it was informed by the Theory of Planned Behavior and uses behavioral action items that are not specific to one evidence-based intervention. Behavioral action items go beyond the desire to implement and measure intention to adopt. Items were rated on a 7-point Likert scale from strongly disagree to strongly agree. Comfort treating the symptoms of long COVID was measured on the Qualtrics pre- and post-workshop survey. Items were rated on a 5-point Likert scale from strongly disagree to strongly agree. Knowledge, familiarity, and confidence using the evidence -informed interventions was measured with a 5-point Likert scale from strongly disagree to strongly agree.  

For questions about this project, contact Anne Borema at ANB377@pitt.edu

Student name: Lauren E. White, MOT, OTR/L

Faculty Mentor: Ketki Raina, PhD, OTR/L, FAOTA

Capstone Committee Members: Dr. Joanne M. Baird, PhD, OTR/L, CHSE, FAOTA; Bobbi Morgan, MBA, CCM, CBI

Capstone Site: Conemaugh Memorial Medical Center, Crichton Inpatient Rehabilitation Facility, Johnstown, PA

Background: A multidisciplinary team approach (MDT) to rehabilitation can improve quality of care, while continuity of care (CoC) at the micro, meso and macro-levels facilitates patient satisfaction. The goal of this capstone is to implement operational changes to a spinal cord injury (SCI) program at an inpatient rehabilitation facility at the micro and meso-levels of CoC in conjunction with MDT approaches to promote the organization of care provided.

Method: Participants were clinical staff of an inpatient rehab facility. A descriptive survey with a pre-test/ post-test design, collecting qualitative and quantitative data was utilized. The pretest assessed staff perceptions of the current SCI program. This data was used to create SCI-specific education logs, daily schedules, and MDT meeting plans. The posttest assessed for staff perception of the quality of the program after these changes.

Conclusion: Delegating roles, increasing team communication and scheduling has facilitated CoC at the micro and meso-levels. Patient characteristics were potentially a barrier to program adherence. There may be an opportunity for changes at the macro-level in future program revisions.

For questions about this project, contact Lauren White at LEW122@pitt.edu.