Metacognition and MoHO collide: Creating effective tutor and mentoring programs for college students on academic probation

Current legislation offers K-12 students identified as having special needs support in school settings, resulting in increased opportunities including attending college. In college, these students become part of a population of high-risk students. In an effort to retain students, universities create assistive learning centers offering tutoring and mentoring programs. Best practices in these centers include implementation of metacognitive strategies which are proven to improve student outcomes, but not all students utilize them. This study implemented a tutor and mentor training program developed through Occupational Therapy consultation in a university assistive learning center. Tutors and mentors in the center were trained in the Model of Human Occupation (MoHO) theory and metacognitive strategies. An assessment derived from theoretical underpinnings of MoHO was completed by students and facilitated by tutors and mentors exploring self-perception of motivation, habituation and performance in academic-related occupations. Pre- and post-assessment data, grade point average, and demographic data were collected and analyzed. Tutors and mentors guided students in metacognitive processes, fostering self-reflection and addressing motivational aspects behind academic success. By systematically learning about the student as a complex individual through the theoretical lens of MoHO and using metacognitive learning strategies, tutors and mentors understand students better and enable students to better understand themselves, not only as students, but as holistic individuals. Findings of the study suggest modest changes in ways to address high-risk student needs for success. Implications for the role of the occupational therapist in assistive learning centers is suggested

The Home Program Adherence Tackle Box: A Fishing-Themed Toolkit for Rehabilitation Clinicians

Background: Home programs (HPs) are an important part of the rehabilitation experience and are regularly recommended by occupational therapy practitioners (OTPs) and other rehabilitation clinicians for continuation and supplementation of care, to address a client’s continual needs at home and in the community (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). Home programs created by rehabilitation professionals for clients typically include therapeutic exercises, activities, and lifestyle behavior modifications to compliment treatment and/or discharge recommendations. Issuing home programs is an established standard of care to help clients meet targeted client goals and outcomes (Proffitt, 2016). The data in the literature suggests that rates of adherence to rehabilitation home programs are lower than acceptable ranging from 40-70% across various populations (DeForge et al., 2008; Donoso Brown, & Fichter, 2017; Emmerson et al., 2017; Picha, & Howell, 2018; Proffitt, 2016). According to the World Health Organization (2003), adherence is considered a key factor influencing treatment effectiveness and optimal client outcomes, especially when considering lifestyle interventions. Adherence is a complex and multifactorial issue, which may explain why it goes largely unaddressed by practitioners due to the many associated barriers of healthcare systems, providers, and clients (WHO, 2016). Currently, literature is limited regarding occupational therapy’s role in assessing and addressing barriers to home program adherence. Purpose: The purpose of this scholarly project was to develop a user-friendly guide and toolkit designed for rehabilitation practitioners to therapeutically “tackle” the complex, multifactorial challenges and barriers associated with a client’s adherence to HPs, many of which are potentially modifiable with targeted interventions (Picha, & Howell, 2018). Methods: The contributing developers of this product conducted an extensive literature review to determine: (1) current use and prescription of HPs in rehabilitation; (2) barriers and facilitators of adherence to HPs; (3) current use of adherence tools used in rehabilitation; and (4) best practice principles for promoting adherence for HPs. Conclusion: The results of the literature review guided the development of the product, the Home Program Adherence Tackle Box. The Home Program Adherence Tackle Box contains client centered strategies and critical guiding resources that OTPs, and other clinical rehabilitation enthusiasts, can use to skillfully facilitate client adherence to home program recommendations to enhance one\u27s function and occupations in life. This themed booklet includes evidence-based strategies and intervention resources to help efficiently guide rehabilitation professionals in holistically promoting HP adherence. It includes the development, collection, and organization of a multitude of relevant tackle tools

Arts, Health and Well-Being across the Military Continuum

Is there an active, meaningful role for the arts and creative arts therapies in addressing this vast array of critical human readiness issues across the military continuum? In general, "readiness" is the #1 issue for the military at all times. The connection of the arts to the human dimension of readiness is key. Military leaders say we need every weapon in our arsenal to meet the many challenges we face today. However, one of the most powerful tools we have in our arsenal -- the arts -- is often under-utilized and not well understood within the military and the healthcare system. The arts and creative arts therapists are -- and have been -- a part of military tradition and missions across all branches, supporting military health services, wellness, and mission readiness, including family support. For example, the War Department ordered the use of music in rehabilitation for the war wounded in World War II. In June 1945, the Department of War issued "Technical Bulletin 187: Music in Reconditioning in American Service Convalescent and General Hospitals." This bulletin was a catalyst for the growth and development of music therapy being used as a rehabilitative service for active duty service members and veterans alike during and after WWII. Although many gaps exist in our knowledge regarding the arts in military settings, what we do know to date holds great promise for powerful outcomes for our service members, veterans, their families, and the individuals who care for them. Today, a growing number of members of the public and private sectors are eager to collaborate with military leaders to help make these outcomes a reality.Nowhere was the momentum for greater collaboration more evident than in October 2011, when the first National Summit: Arts in Healing for Warriors was held at Walter Reed National Military Medical Center (now referred to as Walter Reed Bethesda) and the National Intrepid Center of Excellence (NICoE). Rear Admiral Alton L. Stocks, Commander of Walter Reed Bethesda, hosted the National Summit, in partnership with a national planning group of military, government, and nonprofit leaders. The 2011 Summit marked the first time various branches of the military collaborated with civilian agencies to discuss how engaging with the arts provides opportunities to meet the key health issues our military faces -- from pre-deployment to deployment to homecoming.Building upon its success, a multi-year National Initiative for Arts & Health in the Military was established in 2012, with the advice and guidance of federal agency, military, nonprofit, and private sector partners (see Figure 2). The National Initiative for Arts & Health in the Military (National Initiative) represents an unprecedented military/civilian collaborative effort whose mission is to "advance the arts in health, healing, and healthcare for military service members, veterans, their families, and caregivers."Members of the National Initiative share a commitment to optimize health and wellness, with a deep understanding and awareness that the arts offer a unique and powerful doorway into healing in ways that many conventional medical approaches do not. The Initiative's goals include working across military, government, private, and nonprofit sectors to: 1. Advance the policy, practice, and quality use of arts and creativity as tools for health in the military; 2. Raise visibility, understanding, and support of arts and health in the military; and 3. Make the arts as tools for health available to all active duty military, medical staff, family members, and veterans

Horticultural Therapy Program for Individuals with Substance Use Disorder: A Mixed-Method Evaluation

Substance Use Disorder (SUD) is a chronic brain disorder caused by both biological and environmental factors. Although there is no panacea for addiction, holistic adjunctive therapies have been found to improve outcomes for this population. Horticultural Therapy (HT) is one such adjunct therapy that may improve treatment outcomes. Although HT has been found to support holistic healing for many mental and physical ailments, the efficacy of this intervention has not been evaluated in patients with a SUD. The goal of this controlled, mixed-method study is to evaluate whether HT could be an effective component of a holistic SUD treatment program. Volunteers recently admitted to residential treatment will be randomized to receive an adjunctive HT or a control condition (additional housework and group therapy) over a 6-month treatment period. This study will compare the change in addiction severity, sense of empowerment, stress, motivation and ability to complete long-term goals and general wellbeing between participants who received HT condition and the control condition. Qualitative interviews will also be completed to understand the most beneficial components of the HT experience. Findings will be used to determine if HT may become a recommended addition to long-term SUD addiction treatment programs

The Intensive Cognitive-Communication Rehabilitation Program for young adults with acquired brain injury

PURPOSE: This study investigated the effects of an intensive cognitive-communication rehabilitation (ICCR) program for young individuals with chronic acquired brain injury. METHOD: ICCR included classroom lectures; metacognitive instruction, modeling, and application; technology skills training; and individual cognitive-linguistic therapy. Four individuals participated in the intensive program (6 hr with 1-hr lunch break × 4 days × 12 weeks of treatment): 3 participants completed 3 consecutive semesters, and 1 participant completed 1 semester. Two controls did not receive treatment and completed assessments before and after the 12-week treatment interval only. RESULTS: All 4 experimental participants demonstrated significant improvements on at least 1 standardized cognitive-linguistic measure, whereas controls did not. Furthermore, time point significantly predicted participants' scores on 2 of the 4 standardized outcome measures, indicating that as duration in ICCR increased, scores also increased. Participants who completed multiple semesters of ICCR also improved in their therapy and personal goals, classroom behavior, life participation, and quality of life. CONCLUSION: After ICCR, participants showed gains in their cognitive-linguistic functioning, classroom participation, and individual therapy. They also demonstrated improvements outside the classroom and in their overall well-being. There is a gap between the large population of young adults with acquired brain injury who wish to return to higher education and a lack of rehabilitation programs supporting reentry into academic environments; ICCR is a first step in reducing that gap.T32 DC013017 - NIDCD NIH HHSAccepted manuscrip

Staff Training for Non-Correctional Employees Working with Justice-Involved Women

Purpose. Justice-involved women have unique pathways into the criminal justice system, so it is important staff are trained to address their needs. Staff receiving inclusive practice training and using trauma-informed care principles may be more effective when working with justice- involved populations. There is little known about the impact of inclusive practice training on staff knowledge, so this project aims to investigate the impact of a training session on the knowledge of re-entry staff. Approach. For this capstone project, I used an evidence-based process to create an employee handbook and provide a 4-hour training. I then used surveys containing Likert-type and open- ended questions to understand staff knowledge and the applicability of the work-related training. To examine the survey data, I used descriptive statistics and thematic analysis. Outcome. Three staff from two residential re-entry centers and four from Amicus Services of Volunteers of America received the handbook and attended a 4-hour training. Training topics included: Person-centered language, cultural humility, trauma-informed care, gender identity and gender expression, self-care, and crisis-de-escalation. Staff reported having little to no previous training on inclusive practices, cultural humility, person-centered language, and policy. Following the inclusive practice training, staff reported an increased desire to implement such practices in their daily work with justice-impacted populations. Implication. Regular staff training led by outside entities provides tools for addressing vicarious trauma and gender-inclusive practices

California’s Prisoner Rehabilitation Effort: Ex-Lifers’ Perceptions on Achieving Sustainable Social Reintegration

Prisoners sentenced to a life term in California’s state prisons are being found suitable for parole at record-high rates. Although macro-level policy guides California’s prisoner rehabilitation process, a specific policy does not exist to guide the rehabilitation of the lifer population. Research shows a compelling relationship between public safety resulting from reduced recidivism and an inmate’s participation in rehabilitative programming during incarceration. There is a gap in the literature about ex-lifers and their ability to achieve sustainable social reintegration upon release from incarceration. Ostrom’s institutional analysis and development framework guided this study’s examination of the gap in literature and the analysis of how institutional factors demonstrate adherence to existing policy. Data were collected through in-depth interviews with 15 ex-lifers who served their life term in California Department of Corrections and Rehabilitation. The data support findings that suggest California’s prisoner rehabilitation effort is viable. The findings generated and analyzed within the context of this study delivered an enlightened message about the implication for social change. Holistic rehabilitative programming positively influenced ex-lifers’ ability to achieve sustainable social reintegration upon release from incarceration, thereby affecting public safety through the reduced threat of recidivism. Potential implications for positive social change arising out of this study’s results include possible development of rehabilitation policies and procedures specific to this population and adaptation of current regulations guiding access to rehabilitation

Facilitating transitions to adult healthcare for youth with disabilities: resources for occupational therapy practitioners

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

College Administrator Experiences: A Phenomenological Study of Higher Education Leadership in American Prisons

Higher education for the incarcerated (HEP) is a re-energized phenomenon in the age of criminal justice reform and social change. Following the 2015 Second Chance Pell Grant Experimental Initiative (SCP), which granted select colleges tuition funding for prisoners, HEP grew exponentially. The successes of the SCP laid the groundwork for the 2020 FASFA Simplification Act. In July 2023 the 2020 FSA begins, and all those imprisoned within America may access Pell Grant Funds for higher education. Despite momentous efforts to bring higher education to the incarcerated, HEP grapples with continued challenges and lacks unified, evidence-based competency equal to normative higher education. For this new movement to be successful it needs stronger foundations for its new growth. This study presumes that HEP leaders of the SCP Era have vital leadership experiences to lend to the journey ahead of HEP. This transcendental phenomenological research study explores the dynamics of the HEP leader experience, gathers their experiences within HEP leadership, and investigates what they believe is important for HEP’s future. Thirty-five HEP leaders were interviewed to provide evidence related to their perceptions of the HEP experience and what is best for its expansion. The data equated to collective experiences dominated by Department of Corrections culture, practicalities of day-to-day needs in HEP leadership, a wealth of positive experiences that are vital to the profession and the need for foundational philosophes that guide HEP. The study revealed a style of persistent leadership that is required for HEP success and the future of its impending evolution

Attitudes of Returning Citizens in Government-Managed Post-Release Programming

Nearly 700,000 prisoners return to communities annually, and approximately two-thirds are rearrested within 3 years of release. The cyclic pattern of recidivism presents risks to both returning offenders and the communities that accept them. Reentry research tends to include the voice and experiences of juveniles, community members, and service providers, and narrowly focuses on the socioeconomic conditions of adult ex-offender populations pre- and post-release. Few researchers have explored the attitudes of those returning citizens or the perceived impact on treatment success, as related to employment-based, post-release reintegration programs. This study investigated the attitudes of 32 participants of Project Empowerment, the District of Columbia\u27s post-release program. The ecology of public administration theory and empowerment theory provided the theoretical frameworks for understanding offender reentry within employment-based programming. Interview data were coded and analyzed consistent with a modified van Kaam method. A key finding indicates job-readiness training completion is largely contingent upon development of positive attitudes from both public administrators and participants. Additionally, participants were cognizant of the attitudes of community members regarding reentry and employment, and were more likely to see program participation as beneficial if perceived community support was high. The implications for positive social change include recommendations for reentry programs, such as Project Empowerment, to create an empowerment environment conducive to attitude development concerning self and society. Such an environment creates trust and opportunities for successful engagement in employment programs and decreases the risk of recidivism among communities that support individuals returning from incarceration