Many Hands Working Together: Adapting Hospital Care to Support Autistic Children's Mental Health.

IMPORTANCE: Hospitals pose a threat to autistic children's mental health. Adapting hospitals to meet children's needs can address this issue. OBJECTIVE: To determine the impact of an interprofessional program (Adaptive Care) to support autistic children's mental health on nursing staff's knowledge, efficacy, and confidence. DESIGN: Pretest-posttest, quasi-experimental design. SETTING: Large pediatric hospital. PARTICIPANTS: Nursing staff were the first participants in the program implementation. Approximately 300 nursing staff received training through the program, and 107 completed program evaluation surveys. Of these, 18 nursing staff completed both the pretest and posttest surveys approximately 1 yr apart. INTERVENTION: Occupational therapy practitioners and other professionals developed and implemented the program, which consists of staff training and resources to adapt hospital physical and social environments and to ultimately improve patients' hospital experiences. OUTCOMES AND MEASURES: Researcher-developed, pilot-tested, online survey to assess knowledge, perceived effectiveness, confidence, and strategies that staff used while caring for autistic children in the hospital. RESULTS: Respondents had increased effectiveness and confidence working with autistic children in the hospital after program implementation. Respondents reported significantly more strategies to care for autistic children. CONCLUSIONS AND RELEVANCE: Interprofessional collaboration and programming can positively affect social environments in the hospital by enhancing nursing staff's self-efficacy, confidence, and strategies to support mental health and to enhance health care for autistic children. What This Article Adds: The Adaptive Care program is an example of occupational therapy practitioners and other interprofessional team members adapting physical and social health care environments to support autistic children's mental health. This program was effective at increasing nursing staff's self-efficacy, confidence, and strategies while caring for autistic children in the hospital. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

Technology for Adults with Intellectual Disability: Secondary Analysis of a Scoping Review.

Background. Technologies are embedded in all daily life activities and are utilized by occupational therapy practitioners to facilitate participation; evidence on technology for adults with intellectual disability (ID) can support practice with the population. Purpose. Summarize the evidence on technology to support adults with ID. Method. Secondary analysis of a scoping review of articles published between 2002 and 2018. Articles in the original scoping review addressed participation, assessment, or interventions with adults with ID. Authors completed a secondary analysis of 159 articles to identify articles with information on technology. Findings. In total, 56 articles met the inclusion criteria. Technology categories were cognitive supports, mainstream technologies, supplemental communication, aids for daily living, seating and mobility, control interfaces, and preparatory technologies. Implications. This secondary analysis demonstrates the range of evidence identifying technology as a key support, the impacts of the proliferation of technologies, and the need for occupational therapy practitioners to advocate for accessible technologies.

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.

Nursing care for pediatric patients with autism spectrum disorders: A cross-sectional survey of perceptions and strategies.

PURPOSE: The purpose of this study is to describe nursing staff perspectives about caring for children with autism spectrum disorders (ASD) in the hospital, strategies they use to support care, and relationships between these factors. DESIGN AND METHODS: A descriptive, cross-sectional survey design with nursing staff at a large pediatric hospital system in the United States was employed. The researcher-designed, pilot-tested survey assessed participant demographics, knowledge about ASD, perceived effectiveness caring for children with ASD, previous training, and current strategy use. Data analysis involved descriptive statistics, correlations, and group comparisons based on interaction frequency with the population and previous training. RESULTS: The participants involved 90 pediatric hospital nursing staff members providing direct care. Respondents demonstrated 90% accurate knowledge of the characteristics of ASD. Self-reported effectiveness in caring for children with ASD did not correlate with knowledge and significantly correlated with an increased number of strategies. Nursing staff with frequent interaction with people with ASD or those with previous training reported significantly more strategies to care for children with ASD. Only 35% of participants reported that they have adequate strategies to care for children with ASD in the hospital. PRACTICE IMPLICATIONS: Having more strategies was the factor associated with higher self-efficacy, so training for nursing staff should focus on increasing the number of strategies to use with children with ASD in the hospital and provide mechanisms to collaborate with other professionals to individualize strategies to meet each child's needs.

Occupational Therapy Practitioners' Perceptions About Older Adults With Developmental Disabilities in Traditional Health Care Settings.

IMPORTANCE: Health care providers' knowledge of and comfort working with adults with developmental disabilities (DD) affect the quality of care this growing population receives. Previous research on this topic has not included occupational therapy practitioners. OBJECTIVE: To determine occupational therapy practitioners' views about working with older adults with DD in traditional health care settings. DESIGN: Quantitative survey over 4 mo. PARTICIPANTS: A random sample of 310 practitioners from the American Occupational Therapy Association's Gerontology and Physical Disabilities Special Interest Sections working in traditional health care settings. OUTCOMES AND MEASURES: A researcher-developed survey to assess occupational therapy practitioners' comfort, knowledge, challenge, and supports and barriers in regard to working with older adults with DD. RESULTS: In the 310 included surveys (31% response rate), most occupational therapy practitioners reported feeling comfortable (76.1%-80.0%) and knowledgeable (66.5%-68.4%) working with older adults with DD. Approximately 93% reported that work with older adults with DD was at least somewhat challenging. Key perceived barriers included clients' cognitive needs, lack of caregiver collaboration, and challenging behavior. CONCLUSION AND RELEVANCE: Most occupational therapy practitioners in traditional health care settings found working with older adults with DD challenging, and many did not feel sufficiently knowledgeable to meet the needs of this population. Similar to other health professionals, occupational therapy practitioners may benefit from additional resources to provide services to this population. WHAT THIS ARTICLE ADDS: Older adults with DD receive occupational therapy services in hospitals, rehabilitation centers, nursing homes, and other medical settings. Because clients such as these are not common in these settings, occupational therapy practitioners who work there would like more tools to help provide good care.

Willard and Spackman's Enduring Legacy for Future Occupational Therapy Pathways.

Helen Willard (1894-1980) and Clare Spackman (1909-1992) paved the way for modern and future occupational therapy. This article validates the need for historical research in occupational therapy and presents a historical study on how the personal and professional collaboration of Willard and Spackman influenced occupational therapy. Data were gathered from archival documents, private papers, and 10 oral histories with colleagues, students, family, and friends. We used text analysis with triangulation to develop themes to reconstruct a proximity of the historical story. Two major themes that describe Willard's and Spackman's influence on occupational therapy are (1) Enduring Legacies and (2) Sacred Solitude and Chosen Gatherings. Subthemes within Enduring Legacies include Guiding Practice, Leaders in Service, and Educational Leadership. These women strongly influenced practitioners worldwide while maintaining the sacredness of their private lives. Their example can serve as a model for current and future occupational therapy practitioners and leaders.

Occupational Engagement and Adults With Intellectual Disabilities.

People with intellectual disabilities may be predisposed to occupational alienation as a result of an inherent need for ongoing support and limited understanding of how they express choice and engagement in occupation. In response to this risk of occupational injustice, this phenomenological study explored the occupational engagement of adults with intellectual disabilities in a community-based day program. Data were collected through interviews using visual supports and through observation of activity groups using the Volitional Questionnaire. Thematic analysis illustrated how participants demonstrated engagement in occupation through doing activity/initiating action, expressing positive affect, and showing focused attention. Findings can inform how occupational therapy practitioners describe and facilitate occupational engagement in adults with intellectual disabilities.