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A Survey of Occupational Therapy in the U.S. Criminal Justice System Emily Moreton, OTS, Audra Sitterly, OTS & Jaime Muñoz, PhD, OTR/L, FAOTA - Duquesne University, Pittsburgh, PA
PURPOSE: To generate a descriptive analysis of occupational therapy practice in the U.S. Criminal Justice System and
to gauge interest for creating a network of practitioners, researchers, and educators
DESIGN: Survey research utilizing on-line program [Survey Monkey ®]
OBJECTIVES:
• Describe the current baseline status of OT educational training, intervention programming, and research
• Identify OT practice models guiding interventions, frequently used assessments, and 1:1 and group interventions
• Establish a foundation for creating a network for occupational therapists working in the criminal justice system
SCOPE OF THE PROBLEM
• >2 million Americans are incarcerated at any given time.1
• 67% of those released reoffend and are rearrested within 3 years of their release.2
• Women are one of the fastest growing segments of the correctional population; increasing 3.4% per year. 3
THE CRIMINAL JUSTICE SYSTEM: AN OCCUPATIONAL PERSPECTIVE
• People in the criminal justice system often present with a myriad of occupational performance problems. 4
• Occupational deprivation in the prison environment can lead to abandonment of participation in natural occupations.5
• Occupational therapists can apply principles of person environment interaction to limit the impact of occupational
deprivation and encourage opportunities for participation in meaningful occupations pre and post release.5,6,7
• Within the U.S., occupational therapists have slowly begun to address the unmet needs of this population.4,8
• Educational programs are creating SL and FW experiences in jails, prisons and community corrections settings.4,8,9
• The 42 respondents (33 females, 9 males) were practitioners and educators with experience in correctional settings
• 45% held a Masters degree, 26% had Doctorates, 26% held a Baccalaureate degree, and 3% an Associates degree
• 36% spent 0-2 years, 36% spent 2-6 years, and 28% spent 6 or more years working in a corrections setting
• The sample appears committed to this area of practice: 35.7% presented at a state OT conference, 33.3% at a
national OT conference, 11.9% published in a peer-reviewed journal, 11.9% published in a professional magazine
CONCEPTUAL FRAMEWORK SURVEY RESULTS: Demographics SURVEY RESULTS: Creating a Network
DISCUSSION
SAMPLE: Database of OTs maintained by PI (N=90); used snowball sampling and asked OT program directors to
share survey link with colleagues working in corrections; final sample N=98; overall response rate = 46%
DATA COLLECTION TOOLS:
• 5 Demographic Items: Ed. level, gender, years of experience, participation in scholarship
• 17 Experience Items: Past/current experiences, settings/population; routinely used assessments, OT practice
models, 1:1 and group interventions; and measurement of research and/or program outcomes
• 7 Networking Items: Contact info, strategies for networking, and specific goals/priorities for a network
DATA ANALYSIS METHODS:
• Organized categorical data and analyzed these data using descriptive statistics
• All open-ended responses analyzed using qualitative code-recode strategies
• Triangulation by analysts (3) to verify and confirm coding decisions
SURVEY RESULTS: Practice Settings, Group Interventions & Assessments
• Many respondents reported they did not routinely use valid and reliable OT assessments that are readily available
• Respondents emphasized that a corrections website should include information and resources on OT programming,
collaborative research opportunities, and descriptions of and strategies for OT education in criminal justice settings.
• 52% implemented OT programs in secure settings; 50% supervised Level 1 FW, 33% Level II FW, and 40% SL
experience; 31% completed independent research projects; 24% supervised student research projects
• Types of setting where respondents worked were
equally split between traditional institutions and
community-based settings
• Correction Centers • Homeless Shelters • Work Release Programs • Drug/Alcohol Treatment • Youth Offender Facility
• Jails • Prisons • Forensic MH
Hospitals Traditional Institutions:
52%
Community-Based: 48%
0 5 10 15 20 25
WRI GAS
OPHI II OCAIRS
KAWA Model COPM
Don’t routinely use any
1
3
4
5
6
15
23
Interview Assessments
0 5 10 15 20
SAQ ACS ILSS
Role Checklist Interest Checklist
OSA Sensory Profile
Do not routinely use any
1 1 1
8 10 10
11 19
Self-Report Asessments
0 10 20 30 40
OTTOS
MOHOST
COTE Scale
Don't routinely use any
2
3
4
34
Observation Assessments
0 5 10 15 20 25
EFPT
MoCA
Texas Functional Living
KELS
ACL
Don't routinely use any
1
1
2
6
11
25
Performance Assessments
MOHO
CMOP & Cognitive Disabilities
PEOP
PEO & OA
SI & EHP
KAWA
OT Practice Models
• At least half (57%) routinely used OT practice models
to guide their approach in corrections; some (37%)
used non-OT models e.g. Cognitive Behavioral,
Recovery Model or Transtheoretical Model
Percentage of Respondents Using Group Interventions
• A range of other group interventions used less often included recovery,
assertiveness, anxiety management, or cooking and nutrition skills, MH
awareness and education, computer and technology skills, addiction
management, and/or gender specific issues.
76%
62%
59%
51%
49%
46%
41%
70%
• Interpersonal Communication/Social Skills
• Problem Solving Skills
• Stress Management • Coping Skills • Goal Setting Skills
• Employment Skills; Re-entry Skills; Wellness Skills
• Leisure Skills
• Budgeting & Financial Management Skills; Health & Fitness Skills
• Anger Management
65%
REFERENCES 1. Shivy, V. A., Wu, J. J., Moon, A. E., Mann, S. C., Holland, J. G., & Eacho, C. (2007). Ex-offenders reentering the workforce. Journal of Counseling Psychology, 54(4), 466-473. doi:10.1037/0022-0167.54.4.466. 2. National Institute of Justice (2010). Recidivism. Retrieved May 16, 2014 from: http://www.nij.gov/topics/corrections/recidivism/Pages/welcome.aspx. 3. U.S. Department of Justice, Bureau of Justice Statistics ( December 19, 2014). U.S. correctional population declined by less than 1 percent for the second consecutive year. Retrieved March 13, 2015 from htttp://www.bjs.gov/content/pub/press/spus13pr.cfm 4. Muñoz, J.P. (2011). Mental health practice in forensic settings. In, C. Brown V.C. Stoffel & J.P. Muñoz (Eds.) Mental health in occupational therapy: A vision for the future (pp. 526-545). Philadelphia: F.A. Davis. 5. Molineux, M., Whiteford, G.E., (1999). Prisons: From occupational deprivation to occupational enrichment. Journal of Occupational Science, 6(2), 124-130 6. Eggers M., Muñoz, J., Sciulli, J., & Crist, P. (2006) The community reintegration project: Occupational therapy at work in a county jail. Occupational Therapy in Health Care, 20(1), 17- 37. 7. O’Connell, M. & Farnworth, L. (2007). Occupational therapy in forensic psychiatry: A review of the literature and a call for a united and international response. British Journal of Occupational Therapy, 70(5), 184-191. 8. White, J., Grass, C.D., Hamilton, T.B., & Rogers, S. (2013). Occupational therapy in criminal justice. In E. Cara and A. MacRae (Eds), Psychosocial occupational therapy: An evolving practice, pp. 715-773. Clifton Park, NJ: Delmar, Cenage Learning. 9. Provident, I. Joyce-Gaguzis, K. (2005). Brief Report- Creating an occupational therapy level II fieldwork experience in a county jail setting. American Journal of Occupational Therapy. 59,101-106. 10. AOTA (2006). AOTA’s centennial vision. Retrieved March 30, 2015 from https://www.aota.org/-/media/Corporate/Files/AboutAOTA/Centennial/Background/Vision1.pdf
• A small cadre of practitioners has established a foothold for OT in criminal justice settings.
• On the whole, these practitioners are well-educated, experienced with corrections populations/settings, and many
actively share their work in presentations and some publications.
• OT has established some presence in both traditional institutions and community-based correctional settings and many
educational opportunities for OT students to showcase OT’s role with criminal justice populations have been created.
• Enacting AOTA’s Centennial Vision10 requires evidence-based decision-making. Routine use of practice models support
this aspect of the CV, but in order to do so, more OTs must routinely use practice models to guide therapy processes.
• O’ConnelI & Farnworth advocated for OTs to use valid outcome measures in correctional settings.7 These results
suggest we have been slow to answer this call and that reliable, readily available OT assessments are not routinely
being used in corrections settings.
• The respondents in this study overwhelmingly believe that networking and collaboration on education, intervention
programming and research efforts is the key to advancing OT’s role in the criminal justice system.
Methods for Networking Most Likely to Use Less Likely to Use
• Respondents primarily favored web-based approaches for
networking including using existing AOTA platforms
Priorities for an OT Corrections Network
• Clear networking priorities were identified, with advocacy
and practice issues defined as the most important goals
Mentorship
Educational Placements
Research
Assessment
Intervention Programming
Advocacy
LIMITATIONS
• Sampling: Our sampling approach was limited by our initial database (N=98; Response Rate= 46%) and word of mouth.
It is impossible to know what percentage of the total population of OTs in corrections is reflected in our results.
• Methods: Our survey was a 2nd generation tool used in a pilot study and modified based on results and feedback.
Nonetheless, it is possible that different respondents may have interpreted some open-ended items differently.
OT Connections Page
Corrections Listserve
Corrections Webpage
AOTA Corrections SIS
Twitter Account
Wiki Site
Online Meet-up Space
Facebook Page
RESEARCH OBJECTIVES
METHODS