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Occupational Therapy’s Role in Supporting Employment
Andrew Persch, PhD, OTR/LDivision of Occupational Therapy
The Ohio State University
May 13, 2015
Resources
§ This Presentation§ Address list for OT and OTA Programs in Ohio§ Transition Resources from the American Occupational Therapy Association (AOTA)
andrewpersch.com
Objectives
4
1. Identify the scope of practice of Occupational Therapy in supporting individuals with IDD in employment.
2. Describe how to access occupational therapy services in schools and community settings.
3. List best practices in Occupational Therapy to support employment for those with intellectual disabilities.
4. Use the Occupational Therapy Process to analyze workplace problems.
Background• About 3% (9 million people) of the American population lives with an intellectual disability (ID)1
• Birth – 21, IDEA
• Total lifetime costs (healthcare, support services, lost productivity) ≥ $1 million per individual with ID3
1Administration on Intellectual and Developmental Disabilities, 20122 Newman et al., 2011;; Bureau of Labor Statistics, 20123 Centers for Disease Control and Prevention, 2006
Postsecondary Outcomes
Intellectual Disabilities
All Disabilities
General Population
Education 29% 60% 67%
Employment 39% 60% 66%2
Importance of Employment
• Work is a fundamental human occupation
• Strongly linked to identity1,SES,2 QoL,3 and health4
• Provides sociocognitive structure to view the world5
• Federal contractors must employ 7%6
• Most employment services fail to meet the needs of those in
transition7
1Corcoran, 20042 Butterworth et al., 2012 3 Eggleton et al., 1999 4 Petrovski & Gleeson, 19975 Daston, Riehle, & Rutkowski, 20126 Final Rule on Section 503 of the Rehabilitation Act of 1973
7Wehman, 2006;; Wehman & Scott, 2013
High Level of Support Low
Segregated
Environment
Integrated
Sheltered Workshops
Supported Employment
Customized Employment
Project SEARCH
Reasonable Accommodations
Occupational Therapy
§ Has a strong history in Employment (1917)§ Roots of the profession are in helping soldiers find meaning and develop employment skills after World Wars I and II
§ You are probably most familiar with our role in the schools, county boards, or in industrial rehabilitation programs (FCEs)
What do OTs do?
§ Occupational therapists prevent illness, remediate disability, and restore health by enabling participation in meaningful occupations
“Occupations,”…you mean jobs, right?
• Well…yes and no!• OTs use the term occupation in the following way, occupations are:
“Activities…of everyday life, named, organized, and given value and meaning by individuals and a culture. Occupation is
everything people do to occupy themselves, to look after themselves or others”
Areas of Occupation
1. Activities of Daily Living2. Work, Education, & Other Productive Activities
3. Play & Leisure
Occupational Therapy in Ohio
6400 Occupational Therapists and Occupational Therapy Assistants in Ohio OTR/L or OT/L Occupational Therapist
§ Registered/Licensed§ BA, MS, MOT, OTD
COTA/L or OTA/L OT Assistant§ Certified/Licensed§ Two year community college degree § The COTA needs to be supervised by an Occupational Therapist to use the COTA credential or bill for OT services
OT Graduate School CoursesAnatomy Physiology Activity AnalysisNeurology Motivation PsychologyAssistive Technology Business Lifespan
Assessment Prosthetics SupervisionPediatrics Medical Terms KinesiologySplinting Sensory Systems OrthoticsGerontology Research Wheelchairs Physical Skills Medications Lifestyle Redesign
1100 hours of Supervised Practice National Certification Examination
State Licensure
Person– Environment – Occupation
Person
OccupationEnvironment
Occupational Performance
(Teach new skill)
(Adapt) (Modify)
Typical pattern of OT Intervention for someone with IDD over a lifetime
§ Early Intervention§ Pre-School§ Grade school§ Middle School§ High School § Transition§ Adult
Why OT is less involved in employment1. Transitions handled by others2. Occupational Therapy’s role not
understand by team3. Lack of financial resources
Kardos, M., & White, B. P., (2005). The role of the school-based occupational therapist in secondary education transition planning: A pilot survey study. American Journal of Occupational Therapy, 59, 173-180Mankey, T. A. (2011). Occupational Therapists' Beliefs and Involvement with Secondary Transition Planning. Physical & Occupational Therapy In Pediatrics, 31(4)Shattuck, P. T., Wagner, M., Narendorf, S., Sterzing, P., & Hensley, M. (2011). Post–high school service use among young adults with an autism spectrum disorder. Archives of pediatrics & adolescent medicine, 165(2), 141-146.
O-H-I-O
Approaches used by OT1. Assess and adapt the environment: 2. Task Analysis: Increase efficiency 3. Skill building: Technology and tool use, community travel.
4. Functional living skills training: Cooking, hand washing, dressing, work!
5. Physical skills: Strength, coordination 6. Sensory and Sensory motor adaption: Adapt
routines, modify environments
How are OT services delivered? § Direct services
§ Evaluation§ One-on-one, groups
§ Indirect Services (CONSULTATION)§ Consulting with Job Coach/Individual§ Worksite Evaluations and recommendations§ Staff Training § Supervision of OT assistant § Monitoring progress
§ TeleHealth!
Where are services provided?§ Depends on the setting… 1. On site. 2. In an Occupational Therapy clinic3. TeleHealth (depends on state licensure laws)
Access to an Occupational Therapist in your setting? 1. Public Schools 2. County Board of Developmental Disabilities 3. Community Agency
- OOD Funding - Waiver Funding - Personal Health Insurance
§ Brown Mackie (Akron)
§ Brown Mackie (Findlay)
§ Cincinnati State
§ ClevelandState
§ Cuyahoga Community
§ EHOVE Adult Career Center
§ Kent State (East Liverpool)
§ Kent State (Ashtabula)
§ Kettering College
§ Marion Technical College
§ North Central State
§ Owens Community
§ Rhodes State College
§ Shawnee State University
§ Sinclair Community College
§ Stark State College
§ The Ohio State University
§ The University of Findlay
§ The University of Toledo
§ Xavier University
§ Zane State College
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Why do you need an Occupational Therapist on your team?
Best Practices in Occupational Therapy to Support Employment
1. Early, paid work experience2. individual involvement in transition planning3. Emphasis on individual’s social competence4. Development of life skills5. Use of assistive technology6. Collaborative interdisciplinary and interagency
teamwork
IDEA, 2013;; Lieberman, 2002
Self-Determination
§ Self-determined individuals:§ Demonstrate self-awareness and self-advocacy§ Make choices and decisions§ Problem-solve when issues arise§ Achieve self-identified goals
§ Occupational therapists work with individuals to improve self-determination and self-advocacy skills by using assessments to make the individual and team aware of strengths, weaknesses, goals and needs, as well as providing direct instruction on how to self-advocate
McConnell et al., 2012;; Wagner, Newman, Cameot, Javitz, & Valdes, 2012;; Wehman, 2013;; Wehmeyer & Shogren, 2013
Emphasis on Social Competence
§ Social competence: individual’s effectiveness in navigating interpersonal relationships with others at work, school, home, or in public situations
§ Subjective in nature, and changes given the context§ Social demands can be complicated and overwhelming for individuals with disabilities, who are less likely to have the opportunities learn, practice, and develop social competence
Orsmond, Shattuck, Cooper, Sterzing, & Anderson, 2013;; Reichow & Volkmar, 2010
Emphasis on Social Competence
§ Evidence suggests that those with higher level social skills are more likely to be employed
§ Occupational therapists work with clients to improve their social skills through:1. Direct instruction
§ Includes training in various communication devices2. Peer awareness
§ Peer mentoring and positive peer pressure3. Involvement and accommodation4. Positive climate of integration and encouragement
§ Emphasis on inclusion in businesses and other organizations
Test et al., 2009 Bedesem & Dieker, 2013 Blood et al., 2011 Carter et al., 2012, Alquraini & Gut, 2012, Stanish & Temple, 2012 Bennett & Gallagher, 2013
Development of Life Skills
§ Life skills curriculum is designed to facilitate the development of skills that are necessary for success in adult life;; designed as an alternative to traditional academic curriculum§ Acceptability of this as a valid curricular choice varies due to possible violations of federal guidelines (IDEA 2004, NCLB 2001)
§ Important option for individuals in transition, especially those whose primary target is employment and not education
§ Considerations for occupational therapists1. ALL individuals must learn and master independent living skills2. Functional life skills curriculum is a legitimate option3. Functional curriculum may be more appropriate than an
academic curriculum for some individuals4. Use of assistive technologies may prove beneficial in promoting
independence and can contribute to the functional curriculumBouck, 2013
Use of Assistive Technology
§ Assistive technology can foster participation§ Commercially available technology very useful in supporting individuals in transition;; can be customized to meet an individual’s needs
§ Tablets and smartphones are used by those with and without disabilities;; these are tools of inclusion
§ Supports for academics and competitive employment
Assessments
§ AIR Self-Determination Assessment§ American Institutes for Research and Columbia University
§ ARC Self-Determination Scale§ Morningstar, M. E., Frey, B. B., Noonan, P. M., Ng, J., Clavenna-Deane, B., Graves, P., ... & Williams-Diehm, K. (2010). A preliminary investigation of the relationship of transition preparation and self-determination for students with disabilities in postsecondary educational settings. Career Development for Exceptional Individuals, 33(2), 80-94.
§ FATCAT§ Functional Assessment Tool for Cognitive Assistive Technology§ Virginia Commonwealth University
§ Bright Futures Service Menu § Dr. Deborah Davidson
OT in Work
§ Learn about skills for jobs I am interested in§ Create a resume§ Apply for jobs§ Volunteer for community agencies§ Learn about work habits and attitudes for keeping a job§ Practice the speaking skills for a job interview§ Explore different careers based on my interests, goals, and abilities§ Receive support or coaching on the job or volunteer site§ Have a consultant to work with my employer§ Start my own business§ Learn about workplace accommodations and/or job task modifications
OT in Education
§ Organize my academic or work life§ Choose a course of study and/or institution§ Establish study habits needed for college§ Follow a schedule or routine§ Increase computer, email, or technology skills§ Use the internet to find information§ Use a planner or calendar to stay organized§ Better coordinate my educational services/ accommodations§ Find a peer mentor at my school§ Establish a transition plan for leaving or entering school
OT in Living Skills
§ Create a routine for daily living§ Live on my own§ Improve my self care or personal hygiene§ Use a bank account, budget, and pay bills § Take care of my home (chores, minor repairs, etc.)§ Do my own laundry§ Manage my own medicines§ Cook my own hot meals§ Use public transportation§ Learn to drive§ Plan a week of meals§ Work on childcare, pet care, of care of others
OT in Personal Health & Wellness
§ Make healthier food choices§ Learn about energy conservation§ Establish an exercise routine§ Set goals for myself§ Find a doctor who takes care of my health needs§ Find a lawyer to assist with long term planning or guardianship
§ Find a counselor to help with my mental health needs
§ Learn about how to disclose my disability in different situations (work, school, personal)
34
Work Oriented
Worker Oriented
“Can you…”
“Is the person able to…”
“Does the job require…”
“How often does…”
35
Work Oriented
Worker Oriented
Things
Physical tasks
Physical demands
Bending and twisting
Weeding a garden
Physical Skills
Flexibility
Bending over
Repeatedly
1 hour
Concept credit: Personnel Systems & Technologies Corporation
36
Work Oriented
Worker Oriented
Things
Physical tasks
Physical demands
Bending and twisting
Weeding a garden
Physical Skills
Flexibility
Bending over
Repeatedly
1 hour
Work: People
37
Things
Physical tasks
Physical demands
Bending and twisting
Weeding a garden
Physical Skills
Flexibility
Bending over
Repeatedly
1 hour
Work: People
Task Abilities
Task Preferences
Physical Environment
Social Environment
Novel Approach for Job Matching
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§ Systematic§ Data – driven§ Analytical
§ Our long-term goal is to improve employment outcomes for individuals with disabilities through systematic assessment and intervention techniques
How can OT Help?
39
OT Intervention
1. What does the employee need to learn, or what must change to encourage success?
2. Which Strategies will facilitate learning? 3. Who is needed to accomplish this? 4. How Should intervention be provided?
§ Direct Service, Consultation, Staff training
5. Which Methods will I use to translate my knowledge to others?
40
Strategies and Methods of OT Intervention
Strategies Method1. Teach New Skill 1. Modeling2. New Equipment 2. Direct Instruction3. Modify Environment 3. Encouragement4. Help w/ Perspective 4. Provide Resources5. Change Schedule
OT Intervention Strategies
1. Teach New Skill2. New Equipment3. Modify Environment4. Help w/ Perspective5. Change Schedule
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OT Intervention Methods 1. Modeling 2. Direct Instruction 3. Encouragement 4. Providing Resources
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Stages of Consultation1. Entry – aim for equity, realize agendas 2. Issue Definition – you are a visitor, the
problem is different to each person 3. Recommendations more likely followed
§ It is easy and convenient§Minimal interruption to the schedule§The level of effort is ‘doable’§They understand the ‘Why’§ It is effective
4. Concluding – did it work? Are Revisions needed?
44
Hanft, B. and Shepherd, J. (2008). Collaborating for Student Success: A Guide for School-Based Occupational Therapy. Bethesda, MD. AOTA Press.
Strategies and Methods of OT Intervention
Strategies Method1. Teach New Skill 1. Modeling2. New Equipment 2. Direct Instruction3. Modify Environment 3. Encouragement4. Help w/ Perspective 4. Provide Resources5. Change Schedule
Acknowledgements
Stacy Collins, Project Manager
Dennis Cleary, OTD, MS, OTR/LMaria Eismann, S/OTAmy Grooms, S/OT
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TRANSITION, EMPLOYMENT, & TECHNOLOGY LAB
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