Development and Evaluation of a Collaborative Model Level II Fieldwork Program

This project developed a Collaborative Model Level II Fieldwork (CM-FWII) program to evaluate the effect of the program on fieldwork educator and student understanding of the model and changes in knowledge, perceptions, and satisfaction. Four fieldwork educators (FWEd) were recruited from two pediatric and two adult practice settings. Eight occupational therapy (OT) students met participation criteria and agreed to participate. A pre/post design was used to evaluate change in knowledge and perceptions. Satisfaction with the collaborative model (CM) was examined after the 12-week fieldwork rotation. Analysis procedures included a priori coding, calculation of frequency distributions, and thematic analysis of transcribed interviews. Initially, the FWEds indicated knowledge of 23-54% of the essential elements of the CM and the students indicated knowledge of 23-54%. Following the experience, the FWEds indicated knowledge of 67-82% of the essential elements of the CM, while the students reported knowledge of 23-54%. The FWEds and students rated the experience as positive. The participants cited peer support and improved self-confidence and clinical competence as factors of satisfaction. Challenges included caseload, workspace, and student compatibility. Evaluation of the CM-FWII program shows positive outcomes for FWEds and OT students when structured training and support was provided from the academic program

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration.

Purpose: To compare the efficacy of behavioral activation (BA) plus low vision rehabilitation with an occupational therapist (OT-LVR) with supportive therapy (ST) on visual function in patients with age-related macular degeneration (AMD). Methods: Single-masked, attention-controlled, randomized clinical trial with AMD patients with subsyndromal depressive symptoms (n = 188). All subjects had two outpatient low vision rehabilitation optometry visits, then were randomized to in-home BA + OT-LVR or ST. Behavioral activation is a structured behavioral treatment aiming to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. Functional vision was assessed with the activity inventory (AI) in which participants rate the difficulty level of goals and corresponding tasks. Participants were assessed at baseline and 4 months. Results: Improvements in functional vision measures were seen in both the BA + OT-LVR and ST groups at the goal level (d = 0.71; d = 0.56 respectively). At the task level, BA + OT-LVR patients showed more improvement in reading, inside-the-home tasks and outside-the-home tasks, when compared to ST patients. The greatest effects were seen in the BA + OT-LVR group in subjects with a visual acuity ≥20/70 (d = 0.360 reading; d = 0.500 inside the home; d = 0.468 outside the home). Conclusions: Based on the trends of the AI data, we suggest that BA + OT-LVR services, provided by an OT in the patient\u27s home following conventional low vision optometry services, are more effective than conventional optometric low vision services alone for those with mild visual impairment. (ClinicalTrials.gov number, NCT00769015.)

Development and Evaluation of a Collaborative Model Level II Fieldwork Program

This project developed a Collaborative Model Level II Fieldwork (CM-FWII) program to evaluate the effect of the program on fieldwork educator and student understanding of the model and changes in knowledge, perceptions, and satisfaction. Four fieldwork educators (FWEd) were recruited from two pediatric and two adult practice settings. Eight occupational therapy (OT) students met participation criteria and agreed to participate. A pre/post design was used to evaluate change in knowledge and perceptions. Satisfaction with the collaborative model (CM) was examined after the 12-week fieldwork rotation. Analysis procedures included a priori coding, calculation of frequency distributions, and thematic analysis of transcribed interviews. Initially, the FWEds indicated knowledge of 23-54% of the essential elements of the CM and the students indicated knowledge of 23-54%. Following the experience, the FWEds indicated knowledge of 67-82% of the essential elements of the CM, while the students reported knowledge of 23-54%. The FWEds and students rated the experience as positive. The participants cited peer support and improved self-confidence and clinical competence as factors of satisfaction. Challenges included caseload, workspace, and student compatibility. Evaluation of the CM-FWII program shows positive outcomes for FWEds and OT students when structured training and support was provided from the academic program

Primary Care in Geriatrics: Context, Opportunities, and Resources for Occupational Therapy

Learning Objectives: 1. Discuss health care delivery trends and system changes that offer opportunities for occupational therapy in primary care for older adults in the community. 2. Describe the contributions of occupational therapy on the interprofessional primary care team. 3. Utilize current resources and evidence that support the role of occupational therapy in geriatric primary care. Agenda: 1. Overview of primary care. 2. Health trends and reform initiatives that open doors for occupational therapy. 3. Opportunities (and barriers) for occupational therapy in primary care 4. Current NIH funded study testing a primary care occupational therapy intervention. 5. Resources and Discussion. The context of health care delivery in primary care is changing and opens exciting opportunities for occupational therapy. Important health care trends and health system changes that are influencing geriatric primary care delivery were presented as a foundation to examining the opportunities that are emerging for occupational therapists and occupational therapy assistants in this evolving practice area. Current research and case examples were shared. Participants were provided with conceptual and practical resources that can expand their professional tool kit. 33 PowerPoint slide

Occupational Therapy and Family Caregiver Training: The Key to Successful Dementia Care

Most people with Alzheimer’s disease and related disorders live in the community and are cared for by family caregivers who have not received formal training. Evidence has shown that caregiving can have profound negative effects on a caregiver’s own physical and psychological health, including increasing social isolation and decreasing quality of life and wellbeing. If the demands of care exceed the caregiver’s capacity, the person with dementia can also be negatively affected. Research supports the effectiveness of teaching caregivers approaches that match the skills and interests of the person with dementia, use appropriate cues, identify and modify behavioral triggers, and use compensatory and environmental strategies. These interventions benefit the well-being of the caregiver and person with dementia, and can delay institutional placement. Occupational therapy practitioners are ideally suited to teach caregiving strategies and promote caregiver wellness and life balance while optimizing function (habilitation) in the person with dementia. Training the caregiver to obtain the just-right fit between the capacities of the person with dementia and the demands of the environment produces positive behaviors and enhanced wellness for the caregiver and the person with dementia. This short course explained why occupational therapy practitioners are distinctly skilled to provide effective caregiver training. Participants achieved a boarder understanding of the underlying theory behind the evidence, and walked away with practical approaches and strategies that they can use in daily practice. 8 page handout

Evaluating Non-pharmacological Approaches to Nursing Home Dementia Care: A Protocol

BACKGROUND: The COVID-19 pandemic has underscored the daily challenges nursing home (NH) staff face caring for the residents living with Alzheimer\u27s Disease and Related Dementias ( METHODS: This clustered randomized trial will compare CONCLUSION: This trial will be the first-ever evaluation of team- and problem-based approaches to ADRD care across multiple NHs and geographic regions. Results can provide health system leaders and policymakers with evidence on how to optimize ADRD training for staff in an effort to enhance ADRD care delivery

Cost-Benefit Analysis of the COPE Program for Persons Living With Dementia: Toward a Payment Model

Background and objectives: There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports nonpharmacologic programs that provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut\u27s home- and community-based services (HCBS), which are state- and Medicaid-funded. Research design and methods: Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or HCBS alone. Cost measures included those relevant to HCBS decision makers: intervention delivery, health care utilization, caregiver time, formal care, and social services. Data sources included care management records and caregiver report. Results: Per-dyad mean cost savings at 12 months were $2 354 for those who received COPE with a mean difference-in-difference of -$6 667 versus HCBS alone (95% CI: -$15 473,$2 734; not statistically significant). COPE costs would consume 5.6%-11.3% of Connecticut\u27s HCBS annual spending limit, and HCBS cost-sharing requirements align with participants\u27 willingness to pay for COPE. Discussion and implications: COPE represents a potentially cost-saving dementia care service that could be financed through existing Connecticut HCBS. HCBS programs represent an important, sustainable payment model for delivering nonpharmacological dementia interventions such as COPE

Psychometric Evaluation of the Functional Capacity Card Sort: Measuring Caregiver Appraisal of Functional Capacity in Persons with Dementia

Background Caregivers play a vital role in the safety and well-being of people with dementia Majority of people with dementia live at home, are cared for by families or close friends/neighbors, and require supervision or assistance with daily activities 80% of care provided in the home is delivered by unpaid caregivers (Alzheimer’s Association, 2013, Family Caregiver Alliance, 2006) Functional capacity in the person with dementia is usually assessed by caregiver interview Caregiver report is an important proxy measure in dementia care as the person with the cognitive impairment tends to overestimate function (Karagiozis et al., 1998; Kiyak, et al., 1994) Caregiver appraisal of functional capacity is an essential element to the day to day responsibilities of caregiving Cognitive process that caregivers use to judge functional capacity of the person with dementia Serves as a mediator for the actions caregivers take in providing daily care (amount and type of oversight; modifications to the home) Has consequences for safety and well-being of the person with dementia Caregivers often misjudge functional ability of the person with dementia Caregivers overestimate and underestimate function (Karagiozis et al., 1998; Zanetti, et al., 1999; Argṻelles, et al., 2001; Loewenstein et al., 2001; Davis, et al, 2006) Caregiver scales have been developed to correspond with direct assessment to determine concordance status There are inconsistencies between certain items, which make it difficult to draw conclusions about caregiver accuracy The Functional Capacity Card Sort (FCCS) was developed to measure and interpret caregiver appraisal of functional capacity by comparing the caregiver rating to the score on the standardized Allen Diagnostic Module-2 (Earhart, 2006)

The Let\u27s Go Program for Community Participation: A Feasibility Study

Community participation positively influences health and wellness. As individuals age, chronic disease and changes in physical and cognitive capacities may influence community participation in older adults resulting in social isolation, depression, and decreased health. Aims: The aim of this study was to evaluate the feasibility of implementing Let\u27s Go, a four-week multimodal community mobility program designed to prevent decline in community participation in older adults (≥60 years old) living in an urban area who self-identified as having difficulty with community mobility. Methods: Using a pre-post measure design, participants\u27 (N = 7) knowledge, confidence, and participation in community mobility were evaluated. Results: All participants increased their knowledge of alternative transportation options and their confidence in community mobility. The majority of participants maintained or increased their autonomy outdoors and social participation (85.71%) and increased the frequency of community trips (85.71%). Conclusions: A multimodal community mobility program can increase community participation in older adults who report community mobility deficits. Additional studies are needed to support these findings. © 2014 Informa Healthcare USA, Inc

Bridging the Gap between Physician Office and Home: Meeting the Needs of Patients with Dementia and their Families through Interprofessional Collaboration

Nearly 5.3 million individuals in the United Statestoday have Alzheimer’s disease or related dementias, and 70% are living at home, with varying levels of care provided by family. Patients with dementia and their family members are often under-recognized and underserved, thus informal caregivers typically receive no formal training in how to care for their family member. To meet this un-met need Jefferson Elder Care (JEC) has established a program in which patients and caregivers are served through an in-home Medicare Part B reimbursable clinical occupational therapy service. Our in-home dementia care service effectively enhances the patient’s participation in daily activities and educates the family caregiver using Jefferson’s evidence-based, Skills2Care™. This program is seamlessly integrated into the specialized dementia service to increase caregiver knowledge and to develop the skills to care successfully for their family member at home. The program improves caregiver confidence, abilities, and a sense of well-being, which collectively enhance function and safety for the patient. Strategies are developed and implemented through a customized approach addressing the unique needs and environments of each individual family. Essential to the success of the dementia is collaboration with the referring physician; in which diagnostic test results and physician impressions are shared with the in-home practitioner, and evaluation results (including home environmental characteristics, and family participation) are shared with the referring physician. In this model, physician and occupational therapist engage in an on-going exchange of findings throughout the episode of care, which can prove especially valuable in matters of safety and medication management. This seminar will present key features of this collaborative model which enhances quality of care and family involvement. Specific approaches and strategies established between JEC and M. Serruya, in the Department of Neurology will be highlighted. Cases will be presented that exemplify the benefits of interprofessional collaboration. Learning Objectives: At the end of this session, participants will: 1. Recognize the care needs of patients with dementia and their families and the challenges they face. 2. Describe key features of an effective collaborative model between referring physician and in-home practitioner when treating patients with dementia. 3. Identify successful communication strategies between physician, in-home practitioner, and administrative staff that facilitate continuity of care