Geographic Variation in Preventable Hospitalizations among US Children with Autism

There is a limited amount of research on geographic differences in preventable hospitalizations for ambulatory care sensitive conditions (ACSCs) among children with autism. The purpose of this study was to examine US regional differences in potentially preventable hospital admissions for pediatric inpatients diagnosed with autism. Hospital discharge data for six pediatric preventable conditions were obtained from the 2016–2019 National Inpatient Sample (NIS) under the US Agency for Healthcare Research and Quality. Geographic differences in preventable hospitalizations for children with autism were examined by US census regions and divisions. Multiple logistic regression analyses were conducted to examine child and clinical characteristics associated with ACSCs hospitalization across four US regions; the dependent variable was the likelihood of ACSCs hospitalization. Additionally, this study further explored the variation in preventable hospitalization among racial and ethnic groups for each region or division. Of the 138,305 autistic inpatients aged 2–17 years, about 10% had a primary diagnosis related to ACSCs. The results showed that the highest proportion of preventable hospitalizations for autistic children occurred in the middle Atlantic division of the northeast region. Racial differences were observed across all US regions, particularly in the northeast and south regions. Black children with autism were more likely to be hospitalized for ACSCs compared to White children with autism in three of the four US regions. Our results highlight the significant racial disparities in potentially avoidable hospitalizations among US children with autism. Examining geographic and racial differences in potentially avoidable hospitalizations could inform policy and practice while gaining a better understanding of pediatric patients with autism and where their families access health services. The findings of this study may help policymakers to identify where intervention is needed to tackle health inequities in the accessibility to quality primary care in the US. Further studies with more detailed investigation are recommended to better understand the mechanisms underlying these disparities, and to formulate effective regional policy and clinical practices while considering the unique needs and challenges of underserved children with autism

Racial Disparities in Hospitalization Due to Ambulatory Care Sensitive Conditions Among U.S. Children with Autism

Purpose This study was to investigate the factors associated with preventable hospitalization due to ambulatory care sensitive conditions (ACSCs) in children with autism. Methods Using secondary data from the U.S. Nationwide Inpatient Sample (NIS), multivariable regression analyses were conducted to determine the potential effect of race and income level on the likelihood of inpatient stays for ACSCs among autistic children. Pediatric ACSCs included three acute conditions (dehydration, gastroenteritis, and urinary infection) and three chronic conditions (asthma, constipation, and diabetes short-term complications). Results In this analysis, there were 21,733 hospitalizations among children with autism; about 10% were hospitalized due to pediatric ACSCs. Overall, the odds of ACSCs hospitalization were greater among Hispanic and Black autistic children versus White autistic children. Both Hispanic and Black autistic children from the lowest income level had the highest odds to be hospitalized for chronic ACSCs. Conclusion Inequities of access to health care among racial/ethnic minorities were most notable for autistic children with chronic ACSC conditions

Occupational Therapy–Related Assessments for Adults With Intellectual Disability: A Scoping Review

Importance: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. Objective: To identify occupational therapy–related tools in the peer-reviewed literature for use in practice with adults with ID. Data Sources: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy–related assessment with adults 18 yr or older who had primary or co-occurring ID. Findings: Fifty-eight articles identified 73 occupational therapy–related assessment tools. Conclusions and Relevance: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners. What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy–related assessment tools for adults with ID and an assessment reference guide

Environmental Modifications and Supports for Participation Among Adults Aging With Intellectual and Developmental Disabilities: A Scoping Review

Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face barriers to participation in meaningful occupation; moreover, the increased life expectancy of adults with IDD intensifies the need for age- and environment-specific support. Objective: To map and categorize transdisciplinary literature on environmental modifications and supports for adults aging with IDD. Data Sources: Studies published between January 1, 2000, and January 1, 2019, identified through PubMed and Scopus. Study Selection and Data Collection: Eleven articles met the inclusion criteria and contained information specific to occupational participation based on environmental modification (e.g., physical space, technology, universal design, type of living setting), social supports (e.g., family members, caretakers, peer groups, health care professionals, policies, organizational infrastructure), or both and adults age ≥35 yr with IDD. Findings: Eleven studies met the criteria for this scoping review. Thematic coding was used to examine the articles within one or more themes: definition of need, environmental risk and assessment, environmental setting, intervention and program planning, use of technology, and bureaucracy. Conclusions and Relevance: This review highlights collective and individual outcomes in the areas of assessment, intervention, and advocacy. Further research is needed within the scope of occupational therapy and disability studies that examines environmental factors and participation outcomes in this population. What This Article Adds: The authors define the interconnectedness of adults aging with IDD and environmental factors, identify barriers to participation, and guide occupational therapy practitioners’ logic on how to positively affect environmental change and supports through intervention

Evidence to inform occupational therapy intervention with adults with intellectual disability: A scoping review

Importance: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. Objective: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. Data Sources: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. Findings: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction, community participation). Conclusions and Relevance: A wide range of literature is available to support occupational therapy intervention with adults with ID. Occupational therapy practitioners may be less knowledgeable about this evidence because much of it is located in non-occupational therapy or international journals

Narrative Theater to Examine and Mitigate Anti-Black Racism Within Occupational Therapy

Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire–Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational therapists to engage in anti-Black racism

Making Visible the Ruling Relations of Participation in Occupation for Institutionalized Adults with Intellectual Disabilities

Statement of Purpose: Institutionalized adults with intellectual disabilities (ID), a disability community who has a long history of enduring grave injustices and whose voices have been absent in occupational science discourse, continue to face barriers to meaningful participation in occupation (Mahoney, Roberts, Bryze, & Parker Kent, 2016). Additionally, adults with ID are impacted by policies designed with inconsistent and contradictory values influenced by the concurrent adoption of principles from various models of practice and constructions of disability (Channon, 2014); therefore, there is a need to better understand how opportunities for meaningful participation for adults with ID are situated within and influenced by these systems and ruling relations. This paper draws on data from an institutional ethnographic study aimed to make visible the inter-relational ways national, state, and local policies mediate the possibilities for meaningful participation in occupation for adults with ID. Methods: Institutional ethnography (Smith, 2005) was used as the social theory and methodology for this study. The aim of institutional ethnography is to make visible the systems and social relationships through which occupations emerge and are coordinated (Prodinger, Rudman, & Shaw, 2015). Data were collected at a residential facility. Participants included seven adults diagnosed with profound ID and eight adult staff members. Participant observation, ethnographic interviews, and text work were the main sources of data. Narrative analysis was used to systematically relate meanings and interpretations of participants’ experiences to particular narratives on work in an institutional setting. Mapping, as a second analytic process, was used to analyze institutional practices and connect them back to the policies that coordinated work and other activities of the center (Campbell & Gregor, 2004). Results: Analyses revealed the systems and structures through which staff work was coordinated created a systematic regulation of participation in meaningful occupation. More specifically, analyses demonstrated how institutional policies placed greater value on routinization and efficiency over self-determined participation. These findings not only highlight the lack of opportunities for residents and staff to incorporate occupations of their choosing, they call attention to the ways institutional routinization is a perpetuation of the historical notions of what adults with ID should do. Implications for Occupational Science: This study contributes enhanced knowledge about the lived experiences of institutionalized adults with ID and how opportunities to participate in occupations are supported or thwarted by textually-mediated social practices, and challenges the discipline’s theoretical assumptions on participation. Key words: participation, ruling relations, institutional ethnography Discussion Questions: 1. Smith (2005) asserts that social control is increasingly discursive and textual. How might occupational scientists use mapping as a tool to address critical issues of choice and participation? 2. How does Smith’s (2005) construct of “ruling relations” add to our conceptualization of participation? Have occupational scientists given adequate attention to how texts impact participation? 3. This year’s conference theme charges the discipline to navigate the seas of change. I would argue that one way to increase the diversity of occupation (and participation) is to expand the ways we capture experience. What are your thoughts on the contributions of narrative as method and narrative as analysis in occupational science

Occupational Therapy-Related Assessments for Adults With Intellectual Disability: A Scoping Review

IMPORTANCE: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. OBJECTIVE: To identify occupational therapy-related tools in the peer-reviewed literature for use in practice with adults with ID. DATA SOURCES: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy-related assessment with adults 18 yr or older who had primary or co-occurring ID. FINDINGS: Fifty-eight articles identified 73 occupational therapy-related assessment tools. CONCLUSIONS AND RELEVANCE: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners. What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy-related assessment tools for adults with ID and an assessment reference guide

Evidence to Inform Occupational Therapy Intervention With Adults With Intellectual Disability: A Scoping Review

IMPORTANCE: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. OBJECTIVE: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. DATA SOURCES: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. FINDINGS: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction, community participation). CONCLUSIONS AND RELEVANCE: A wide range of literature is available to support occupational therapy intervention with adults with ID. Occupational therapy practitioners may be less knowledgeable about this evidence because much of it is located in non-occupational therapy or international journals. What This Article Adds: This scoping review provides occupational therapy practitioners with evidence to support high-quality occupational therapy intervention with adults with ID