Ruth A. Huebner

Videophone-Delivered Voice Therapy: A Comparative Analysis of Outcomes to Traditional Delivery for Adults with Parkinson’s Disease

Individuals with idiopathic Parkinsons disease (IPD) usually develop a speech disorder characterized by reduced loudness, hoarse and breathy voice, monotony of pitch, short rushes of speech, and imprecise consonants. The inability to effectively communicate impairs their ability to function in society and quality of life. A successful program developed to improve speech in these individuals is the Lee Silverman Voice Treatment (LSVT). A critical component of this treatment is intense daily therapy for 4 weeks, a regimen that is difficult for many elderly patients to complete. Treatment delivered through videophones placed in the homes of individuals with IPD offers an alternative and could improve accessibility of treatment if the results were the same. This study compared the outcomes of LSVT delivered via videophones to the outcomes of traditional treatment delivered face-to-face.

Service Dogs: A Compensatory Resource to Improve Function

Objective. This study examined the physical, emotional, social, and economic functions of service dogs, the training methods for service dog/owner teams, and problems encountered with service dogs in relationship to occupational therapy literature and domain of concern. Method. A 31-question survey was developed based on the literature and Uniform Terminology (AOTA, 1994) and was completed by 202 service dog owners from 40 states and Canada. Results. Owners reported that service dogs assisted them in 28 functional tasks, helped them to feel safe, increased their social interaction, and reduced physical assistance by others. Problems with service dogs included difficulty with dog maintenance and public awareness of their role as a worker or assistant to the owner. Over 80% of respondents desired additional training in alternative ways to perform daily living tasks. Conclusion. The use of service dogs is consistent with the occupational therapy domain of concern and practice. Occupational therapists might collaborate with service dog trainers and potential owners in referral, assessment, training, and follow-up services.

Treating Dementia: The Complementing Team Approach of Occupational Therapy and Psychology

Abstract Dementia is a chronic progressive disorder that necessitates an interdisciplinary team approach to provide the highest quality of health care. The purpose of this article is to describe and promote the collaboration of psychologists and occupational therapists as key interdisciplinary team members. Multiple sources were referenced to develop and describe an interdisciplinary team model. Occupational therapists possess skills in understanding function, maximizing residual strengths, defining small changes, modifying the environment, and developing caregiver strengths and compensations. These skills can complement the skills of psychologists in understanding behavior and emotion, developing behavioral interventions, supporting team development, and providing psychosocial support to caregivers.

The Impact of Sobriety Treatment and Recovery Teams (START) on Family Outcomes

Families with child maltreatment and parental substance use disorders are a growing population with complex needs. The Sobriety Treatment and Recovery Teams (START) is an integrated model that pairs child protective service workers with family mentors and partners with treatment providers. This is a prospective naturalistic evaluation comparing rates of adult sobriety and child placement in state custody using provider-collected data merged with state administrative data sets. All families in the served and comparison groups had equal risks to child safety. Mothers achieved sobriety at 1.8 times the rate of typical treatment; children were placed in state custody at half the rate expected. These results support START as an effective integrated program.

Violent Behaviors in Rural and Urban Schools

Abstract Despite the fact that many incidents of extreme violence have taken place in rural areas there is still some resistance on the part of rural school administrators to admit that violence is a problem in their schools. This article provides a comparison of rural and urban student and staff self-report of school violence (perpetration, victimization and weapon carrying) and discusses the implications of these findings.

School Violence Prevention: The Effects of a University and High School Partnership

Abstract Objective: This study was designed to describe the level of violence in three high schools and to test the effects of universal and targeted strategies to reduce this violence. Design:A repeated measures design with two baseline scores and two intervention scores was used during a two year period. Two rural high schools served as control schools with a single intervention high school. Participants: All freshmen at the three high schools completed a self-report measure of school violence; 420 completed the study at the end of their sophomore year. Method: Multiple universal and targeted interventions to prevent school violence were used for slightly more than one year. Scores on student Victimization and Perpetration, gathered one year apart, were compared using a pre-test post-test model. Findings: Student reports of perpetration at the intervention school were significantly lower than the combined scores at the control school. Students, teachers, and administrators reported improved awareness, knowledge, and skills to implement violence prevention programs. Conclusions: A comprehensive program that includes university and high school partnerships has the capability to reduce school violence during a short period. Despite limitations to the study, continued use of research partnerships to decrease school violence is war-ranted.

Social psychological analysis of facilitated communication: Implications for education.

Despite lack of empirical support, facilitated communication was rapidly adopted and used with individuals who have severe communication disorders. An overview of the psychological literature was provided here to support theoretical explanations for this rapid adoption. The literature suggests that cognitive biases, ambiguous stimuli, and biases in data may be associated with a tendency to adopt interventions such as facilitated communication. Psychosocial influences associated with autism, the helping relationship, and the professional career cycle may enhance a readiness to adopt alternative treatments. Social influences may create an environment in which fads arise. Suggestions were provided for students and professionals in the broad fields of rehabilitation and education on how to improve their participation in developing and monitoring innovative treatment methods.

Factors Predicting Client Satisfaction in Occupational Therapy and Rehabilitation

Client satisfaction, a widely used outcome indicator of quality in health care, is inherently client centered and important in occupational therapy. We developed an instrument called the Satisfaction With Continuum of Care Revised (SCC-R) and tested a logistic regression model of satisfaction for six predictive research questions. Data collected from 769 clients from a large rehabilitation hospital using the SCC-R were paired with data that included demographics, functional status, and measures of the rehabilitation including occupational therapy. Satisfaction was stratified into two groups, satisfied and dissatisfied. The most robust and consistent predictors of satisfaction were functional status and improvements in functional status, presence of a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of condition onset. The finding that improvements in functional status, especially self-care, were predictive of satisfaction is particularly relevant for occupational therapy. Implications for practice and future research are discussed.

Client-Chosen Goals in Occupational Therapy: Strategy and Instrument Pilot

ABSTRACT Client-centered practice and outcomes research are missions of occupational therapy. Although strategies for client goal-setting have advanced the field, the process has limitations. This study tested a self-report strategy using brief, easy to score measures. The Goals for Occupational Therapy List was completed at mostly independent intake and paired with a follow-up measure of Goal Satisfaction Rating by 40 clients in an outpatient rehabilitation center. The strategy of pairing self-report measures of goal-setting and attainment was useful for clinicians and yielded important research findings. Application to occupational therapy and future research are suggested.

Application of the Evaluation Framework for Program Improvement of START

This study applies the Childrens Bureau program evaluation framework (Framework Workgroup, 2014) to the Sobriety Treatment and Recovery Team (START) program, an integrated program between child welfare and substance abuse treatment. A cluster analysis of 673 START participants in 420 families identified three subgroups. Intact families retained child custody throughout treatment and achieved the highest rates of sobriety. Despite similar substance use disorders and loss of parental custody, group two was mostly reunified and group three was rarely reunified. Group differences in trends suggest a need for additional and innovative strategies to support program improvement.