Beyond Piecework: Employment for Persons with Intellectual and Developmental Disabilities

All people deserve competitive, fulfilling employment (Lysaght, Cobigo, Hamilton, 2011). Many people with intellectual or developmental disabilities (I/DD) have difficulty obtaining competitive employment despite desiring to work (Lysaght, Ouellett-Kuntz, & Lin, 2010). In past years, people with I/DD have been employed in sheltered workshops; however, they are often paid below minimum wage, do not receive benefits, and are viewed as subordinates. Workers report the desire to work outside of sheltered employment. Competitive employment (integrated/supported employment), can lead to social justice, social inclusion, personal growth, and improved financial situations (Migliore, Mank, Grossi, & Rogan, 2007). Occupational therapists are suited to assist individuals with I/DD in obtaining and maintaining employment through development of skills and environmental supports. The purpose of this session is to present the results of an evidence based review on effective interventions to increase integrated/supported work engagement for individuals with I/DD, as well as discuss the significance in occupational therapy practice. A comprehensive literature review was performed to identify best practice. CINAHL, PubMed, OT Search, Scopus, ERIC, and Cochrane databases were searched. Peer reviewed articles published between 2003-2013, relating to interventions regarding integrated/supported employment for adults with I/DD, and within the scope of occupational therapy were included in the literature review. The review examined 12 articles that investigated the most effective interventions to increase integrated/supported work engagement in adults with I/DD. Reviewers used Law and McDermid’s (2003) Appendix M+N and PRISMA Systematic Review Form to critique the articles. There was one primary and one secondary reviewer per article; discrepancies were resolved through peer discussion. Upon review and synthesis of the articles, two main outcome themes, accuracy and quality of life were identified. Accuracy was typically related to the intervention of assistive technology. Interventions related to quality of life included choice-making, microenterprise, and peer support. In addition to expanding occupational therapy’s scope of practice, understanding the most effective interventions to promote employment for adults with I/DD allows occupational therapists to make informed decisions to increase the opportunities for integrated/supported work engagement for this population. References: Law, M. & McDermid, J. (2003). Appendix M and N (pp 414-423). In Evidence-Based Rehabilitation. Thorofare, NJ: SLACK, Inc. Lysaght, R., Cobigo, V., & Hamilton, K. (2012). Inclusion as a focus of employment-related research in intellectual disability from 2000 to 2010: A scoping review. Disability and rehabilitation, 34(16), 1339-1350. Lysaght, R., Ouellette-Kuntz, H., & Lin, C. J. (2012). Untapped potential: Perspectives on the employment of people with intellectual disability. Work: A Journal of Prevention, Assessment and Rehabilitation, 41(4), 409-422. Migliore, A., Mank, D., Grossi, T., & Rogan, P. (2007). Integrated employment or sheltered workshops: Preferences of adults with intellectual disabilities, their families, and staff. Journal of Vocational Rehabilitation, 26(1), 5-19

Promoting Health Literacy through Leading Edge Occupational Therapy Education

Synopsis: Health literacy has become a vital focus of U.S. healthcare. By incorporating health literacy knowledge, attitudes, and skills into entry-­‐level education, occupational therapy professionals can enact a leading role in health and human services teams to address our national healthcare goals. Poster presentation at the American Occupational Therapy Association Annual Conference, San Diego, CA, April 2013

Effect of a peer-led behavioral intervention for emergency department patients at high risk of fatal opioid overdose: a randomized clinical trial.

Importance Fatal and nonfatal opioid overdoses are at record levels, and emergency department (ED) visits may be an opportune time to intervene. Peer-led models of care are increasingly common; however, little is known about their effectiveness. Objective To evaluate the effect of a peer-led behavioral intervention compared with the standard behavioral intervention delivered in the ED on engagement in substance use disorder (SUD) treatment within 30 days after the ED encounter. Design, Setting, and Participants This randomized clinical trial recruited 648 patients from 2 EDs from November 15, 2018, to May 31, 2021. Patients were eligible to participate if they were in the ED for an opioid overdose, receiving treatment related to an opioid use disorder, or identified as having had a recent opioid overdose. Interventions Participants were randomly assigned to receive a behavioral intervention from a certified peer recovery specialist (n = 323) or a standard intervention delivered by a hospital-employed licensed clinical social worker (n = 325). A certified peer recovery specialist was someone with at least 2 years of recovery who completed a 45-hour training program and had 500 hours of supervised work experience. After the ED intervention, the certified peer recovery specialists offered continued contact with participants for up to 90 days. Main Outcomes and Measures The primary outcome was receipt of SUD treatment within 30 days of enrollment, assessed with deterministic linkage of statewide administrative databases. Treatment engagement was defined as admission to a formal, publicly licensed SUD treatment program or receipt of office-based medication for opioid use disorder within 30 days of the initial ED visit. Results Among the 648 participants, the mean (SD) age was 36.9 (10.8) years, and most were male (442 [68.2%]) and White (444 [68.5%]). Receipt of SUD treatment occurred for 103 of 323 participants (32%) in the intervention group vs 98 of 325 participants (30%) in the usual care group within 30 days of the ED visit. Among all participants, the most accessed treatments were outpatient medication for opioid use disorder (buprenorphine, 119 [18.4%]; methadone, 44 [6.8%]) and residential treatment (44 [6.8%]). Conclusions and Relevance Overall, this study found that a substantial proportion of participants in both groups engaged in SUD treatment within 30 days of the ED visit. An ED-based behavioral intervention is likely effective in promoting treatment engagement, but who delivers the intervention may be less influential on short-term outcomes. Further study is required to determine the effects on longer-term engagement in SUD care and other health outcomes (eg, recurrent overdose)