1

Occupational Therapists role in supporting Employment

Dennis Cleary, MS, OTD, OTR/L The Ohio State University

Division of Occupational Therapy

After today you will be able to…

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.

3

Month Trainings available at Ohioemploymentfirst.org

website June 30, 2014 Task analysis for job coaches

July 21, 2014 Worksite Analysis for job coaches

August 28, 2014 Tablet Computers and Smartphones as workplace supports

September 23, 2014 The Role of the Occupational Therapist in supporting

employment

October 27, 2014 The Role of Rehab Engineering and the Assistive Technology

Center in supporting employment

November 20, 2014 Video Resumes and Professional Portfolios: Presenting Job

Seekers in the best light

January 26, 2015 Augmentative Communication Devices as employment supports.

February 26, 2015 Employment supports for those with IDD and Autism.

March 16, 2015 Employment supports for those with Physical or Sensory

involvement.

April 28, 2015 The Job Matching Process

Previous Presentations: Ohioemploymentfirst.org

Handouts

This Presentation

Address list for OT and OTA Programs in Ohio

Transitions Checklist (AOTA)

OT’s Role in Employment of Young Adults

6

Free Occupational Therapy Consultation right now… type

a question for Stacy!

Background on Employment

• About 3% (9 million people) of the American

population lives with an intellectual disability (ID)1

• Birth – 21, IDEA – Mandates

• Total lifetime costs (healthcare, support services, lost

productivity) ≥ $1 million per individual with ID3

1 Administration on Intellectual and Developmental Disabilities, 2012

2 Newman et al., 2011; Bureau of Labor Statistics, 2012

3 Centers for Disease Control and Prevention, 2006

Postsecondary

Outcomes

Intellectual

Disabilities All Disabilities

General

Population

Post HS Education 29% 60% 67%

Post HS Employment 39% 60% 66% 2

Importance of Employment

• Work is fundamental to

human identity1

• Work is closely related to

Socioeconomic status 2

Quality of Life,3 and Health 4

• Work provides structure to

view the world and participate

in life 5

1 Corcoran, 2004

2 Butterworth et al., 2012 3 Eggleton et al., 1999 4 Petrovski & Gleeson, 1997 5 Daston, Riehle, & Rutkowski, 2012

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 Living

2. Work, Education, & Other Productive Activities

3. Play & Leisure

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 Courses

Anatomy Physiology Activity Analysis

Neurology Motivation Psychology

Assistive

Technology

Business Lifespan

Assessment Prosthetics Supervision

Pediatrics Medical Terms Kinesiology

Splinting Sensory Systems Orthotics

Gerontology Research Wheelchairs

Physical Skills Medications Lifestyle Redesign

1100 hours of Supervised Practice

National Certification Examination

State Licensure

Person– Environment – Occupation

Person

Occupation Environment

Occupational

Performance

(Teach new skill)

(Modify the task) (Adapt)

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 employment

1. Transitions handled by others

2. Occupational Therapy’s role not

understand by team

3. 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, 173-180

Mankey, 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

1. 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

Approaches used by OT

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 clinic

3. 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

22

Brown Mackie (Akron)

Brown Mackie (Findlay)

Cincinnati State

Cleveland State

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

Scarlett – OTR, Grey - OTA

23

Why do you need an Occupational Therapist on your team?

Best Practices in Occupational Therapy to Support Employment

1. Early, paid work experience

2. individual involvement in transition planning

3. Emphasis on individual’s social competence

4. Development of life skills

5. Use of assistive technology

6. 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 devices

2. Peer awareness

Peer mentoring and positive peer pressure

3. Involvement and accommodation

4. 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 therapists 1. ALL individuals must learn and master independent living skills

2. Functional life skills curriculum is a legitimate option

3. Functional curriculum may be more appropriate than an academic curriculum for some individuals

4. Use of assistive technologies may prove beneficial in promoting independence and can contribute to the functional curriculum

Bouck, 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

Smartphones and Tablets! Previous Presentations: Ohioemploymentfirst.org

Assessments

AIR Self-Determination Assessment American Institutes for Research and Columbia University

ARC Self-determination scales

And Procedural Guide 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 Dr. Tony Gentry 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)

OT’S ROLE IN JOB MATCHING April 28, 2015

37

Work

Oriented

Worker

Oriented

“Can you…”

“Is the person able to…”

“Does the job require…”

“How often does…”

38

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

39

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

40

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

41

Systematic

Data – driven

Analytical

Our long-term goal is to improve employment outcomes for individuals with disabilities through systematic assessment and intervention techniques

42

How Can OT help?

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?

43

Strategies and Methods

of OT Intervention

Strategies Method

1. Teach New Skill 1. Modeling

2. New Equipment 2. Direct Instruction

3. Modify Environment 3. Encouragement

4. Help w/ Perspective 4. Provide Resources

5. Change Schedule

OT Intervention Strategies

1. Teach New Skill

2. New Equipment

3. Modify Environment

4. Help w/ Perspective

5. Change Schedule

45

OT Intervention Methods

1. Modeling

2. Direct Instruction

3. Encouragement

4. Providing Resources

46

Stages of Consultation

1. 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?

47

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 Method

1. Teach New Skill 1. Modeling

2. New Equipment 2. Direct Instruction

3. Modify Environment 3. Encouragement

4. Help w/ Perspective 4. Provide Resources

5. Change Schedule

49

For Questions about this or to register for future presentations Employmentfirst@Dodd.ohio.gov For Occupational Therapy CEU’s please contact Christopher.Brown@osumc.edu

References Alquraini, T., & Gut, D. (2012). Critical components of successful inclusion of individuals with severe disabilities: Literature review. International Journal of Special Education, 27(1), 42-59.

American Occupational Therapy Association. (2006). Transforming caseload to workload in school-based and early intervention occupational therapy services. Retrieved from http://www.aota.org

Bedesem, P. L., & Dieker, L. A. (2013). Self-monitoring with a twist: Using cell phones to monitor on-task behavior. Journal of Positive Behavior Interventions.

Bennett, S., & Gallagher, T. (2013). High school individuals with intellectual disabilities in the school and workplace: Multiple perspectives on inclusion. Canadian Journal of Education/Revue canadienne de l’éducation, 36(1), 96-124.

Bennett, K. D., Gutierrez, A., & Honsberger, T. (2013). A comparison of video prompting with and without voice-over narration on the clerical skills of adolescents with autism. Research in Autism Spectrum Disorders, 7(10), 1273-1281.

Blood, E., Johnson, J. W., Ridenour, L., Simmons, K. & Crouch, S. (2011). Using an iPod touch to teach social and self-management skills to an elementary individual with emotional/behavioral disorders. Educations and Treatment of Children, 34(3), 299-321.

Bouck, E. C. (2013). Secondary curriculum and transition. In P. Wehman (Ed.), Life beyond the classroom:Transition strategies for young people with disabilities (pp. 215-234). Baltimore, MD: Paul H. Brookes Pub. Co.

Butterworth, J., Smith, F. A., Hall, A. C., Migliore, A., Winsor, J., Domin, D., & Timmons, J. C. (2012). StateData: The national report on employment services and outcomes. Boston, MA: Institute for Community Inclusion (UCEDD), University of Massachusetts Boston.

Carter, E. W., Austin, D., & Trainor, A. A. (2012). Predictors of postschool employment outcomes for young adults with severe disabilities. Journal of Disability Policy Studies, 23(1), 50-63.

Cason, J., & Richmond, T. (2013). Telehealth opportunities in occupational therapy. Telerehabilitation (pp. 139-162) Springer.

Clayton, K. S., & Chubon, R. A. (1994). Factors associated with the quality of life of long-term spinal cord injured persons. Archives of Physical Medicine and Rehabilitation, 75(6), 633-638.

Corcoran, M. A. (2004). Work, occupation, and occupational therapy. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 58(4).

Eggleton, I., Robertson, S., Ryan, J., & Kober, R. (1999). The impact of employment on the quality of life of people with an intellectual disability. Journal of Vocational Rehabilitation, 13, 95-107.

Gentry, T., Lau, S., Molinelli, A., Fallen, A., & Kriner, R. (2012). The apple iPod touch as a vocational support aid for adults with autism: Three case studies. Journal of Vocational Rehabilitation, 37(2), 75-85.

Holburn, S. & Vietze, P. M. (2002). Person-centered planning: Research, practice, and future directions. Baltimore, MD: Brookes.

References Holm, M. B., & Raina, K. D. (2012). Emerging technologies for caregivers of a person with a disability. Multiple dimensions of caregiving and disability (pp. 185-208) Springer.

Idea Partnership (2013a). Needs of the field. Retrieved from http://www.ideapartnership.org/media/documents/CCC-Collection/ccc_needs-of-field.pdf

Idea Partnership (2013b). Grounding assumptions. Retrieved from http://www.ideapartnership.org/media/documents/CCC-Collection/ccc_grounding- assumptions.pdf

Idea Partnership (2013c). The partners. Retrieved from http://www.ideapartnership.org/the-partners.html

Idea Partnership (2013d). The partnership way. Retrieved from http://www.ideapartnership.org/building-connections/the-partnership-way.html

Inge, K. J. (1988). Quality of life for individuals who are labeled mentally retarded: Evaluating competitive employment versus sheltered workshop employment. Education and Training in Mental Retardation, 23(2), 97-104.

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, 173-180.

Kober, R., & Eggleton, I. R. C. (2005). The effect of different types of employment on quality of life. Journal of Intellectual Disability Research, 49(10), 756- 760.

Kregel, J., & Dean, D. H. (2002). Sheltered work vs. supported employment: A direct comparison of long-term earnings outcomes for individuals with cognitive disabilities. In: J. Kregel, D. H. Dean, P. Wehman, Ed. Achievements and challenges in employment services for people with disabilities: The longitudinal impact of workplace supports. Virginia Commonwealth University, Rehabilitation Research and Training Center on Workplace Supports: Richmond, VA.

Lieberman, D. S. J. (2002). AOTA’s evidence-based literature review project: An overview. American Journal of Occupational Therapy, 56, 344-349.

Mank, D., O’Neill, C., & Jansen, R. (1998). Quality in supported employment: A new demonstration of the capabilities of people with severe disabilities. Journal of Vocational Rehabilitation, 11, 83-95.

McConnell, A. E., Martin, J. E., Juan, C. Y., Hennessey, M. N., Terry, R. A., el-Kazimi, N. A.,…Willis, D. M. (2012). Identifying nonacademic behaviors associated with post-school employment and education. Career Development and Transition for Exceptional Individuals, doi:10.1177/2165143412468147

Miller, A., & Dishon, S. (2006). Health-related quality of life in multiple sclerosis: The impact of disability, gender and employment status. Quality of Life Research, 15(2), 259-271.

Mount, B. (1997). Person-centered planning: Finding directions for change using personal futures planning, 2nd ed. New York: Graphic Features.

References Newman, L., Wagner, M., Knokey, A., Marder, C., Nagle, K., Shaver, D.,…National Center for Special Education Research (ED). (2011). The post-high school outcomes of young adults with disabilities up to 8 years after high school: A report from the nation longitudinal transition study-2 (NLTS2). National Center for Special Education Research.

Pedretti, L. W. & Early, M. B. (2001). Occupational therapy: Practice skills for physical dysfunction. St. Louis, MO: Mosby.

Petrovksi, P., & Gleeson, G. (1997). The relationship between job satisfaction and psychological health in people with an intellectual disability in competitive employment. Journal of Intellectual and Developmental Disability, 22(3), 199-211.

Priebe, S., Warner, R., Hubschmid, T., & Eckle, I. (1998). Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries. Schizophrenia Bulletin, 24(3), 469-477.

Orsmond, G. I., Shattuck, P. T., Cooper, B. P., Sterzing, P. R., & Anderson, K. A. (2013). Social participation among young adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(11), 2710-2719.

Reichow, B., & Volkmar, F. R. (2010). Social skills interventions for individuals with autism: Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(2), 149-166.

Revell, G., West, M., & Cheng, Y. (1997). Funding supported employment: Are there better ways? In P. Wehman, J. Kregel, & M. West, Ed. Supported employment opportunities for persons with significant disabilities. Richmond, VA: Virginia Commonwealth University, Rehabilitation Research and Training Center on Supported Employment.

Ross, C. E., & Mirowsky, J. (1995). Does employment affect health? Journal of Health and Social Behavior, 36, 230-243.

Sinnot-Oswald, M. (1991). Supported and sheltered employment: Quality of life issues among workers with disabilities. Education and Training in Mental Retardation, 26(4), 388-397.

Smull, M. W., & Harrison, S. (1992). Supporting people with severe reputations in the community. Alexandria, VA: National Association of State Mental Retardation Programs.

Stanish, H. I., & Temple, V. A. (2012). Efficacy o a peer-guided exercise programme for adolescents with intellectual disability. Journal of Applied Research in Intellectual Disabilities, 25(4), 319-328.

Stodden, R. A., Brown, S. E., Galloway, L. M., Mrazek, S., & Noy, L. (2004). Essential tools: Interagency transition team development and facilitation. Minneapolis, MN: University of Minnesota, Institute on Community Integration, National Center on Secondary Education and Transition.

Stronks, K., van de Mheen, H., van den Bos, J., & Mackenbach, J. (1997). The interrelationship between income, health and employment status. International Journal of Epidemiology, 26(3), 592-600.

Test, D. W., Mazzotti, V. L., Mustian, A. L., Fowler, C. H., Kortering, L., & Kohler, P. (2009). Evidence-based secondary transition predictors for improving postschool outcomes for individuals with disabilities. Career Development for Exceptional Individuals, 32(3), 160-181.

Wagner, M., Newman, L., Cameot, R., Javitz, H., & Valdes, K. (2012). A national picture of parent and youth participation in IEP and transition planning meetings. Journal of Disability Policy Studies, 23(3), 140-155. doi:10.1177/1044207311425384

Wehman, P. (2013). Life beyond the classroom: Transition strategies for young people with disabilities. Baltimore, MD: Paul H. Brookes Pub. Co.

Wehman, P., & Brooke, V. (2013). Securing meaningful work in the community: Vocational internships, placements, and careers. In P. Wehman (Ed.), Life beyond the classroom: Transition strategies for young people with disabilities (pp. 310-338). Baltimore, MD: Paul H. Brookes Pub. Co.

Wehmeyer, M. L., & Shogren, K. A. (2013). Self-determination: Getting individuals involved in leadership. In P. Wehman (Ed.), Life beyond the classroom: Transition strategies for young people with disabilities (pp. 41-68). Baltimore, MD: Paul H. Brookes Pub. Co.