peer reviewed presentations

AOTA Children & Youth Specialty conference 2021

Applying Purtilo’s Six- Step Approach to Guide Ethical Decision Making in Pediatric OT Practice

Shanteria Carr, OTD, OTR/L, Kathryn A. LeMonda, MOT, OTR/L & Mackenzie Sawyer, MS, OTR/L

AOTA National Conference 2020

Maternal role transition: Promoting mother-child Health & Wellness Through OT

Wendy Gaughn, MS, OTR/L & Kathryn A. LeMonda, MOT, OTR/L

Final_AOTA_Maternal Health_Updated3.9.pptx

ABstract:

Occupational therapists (OTs) are uniquely skilled to address the needs of a mother and her child during the transition to motherhood. This transition encompasses the mother inhabiting a new role as mother, which may cause a role strain with other, previous held roles. The strain which the mother feels can cause feelings of incompetence. Attempts to integrate new mothering occupations and activities into daily routine can result in both physical and psychosocial dysfunction.
New mothers must learn and integrate novel repetitive tasks and activities to effectively fulfill mothering occupations to care for a baby. Repetitive daily activities such as holding the baby during feeding and lifting and carrying the child requires efficient posturing and body mechanics to avoid injury. Additionally, the mother must also be able to continue to physically perform her own self care and household roles and occupations (Grobbelaar Fernandes, 2018).
In some instances, transition to the perinatal period can be further complicated for new mothers having experienced posttraumatic stress secondary to experiencing a loss of control, fear of losing her child, or a threat to her own health during the childbirth process (Pizur-Barnekow & Erickson, 2011). Perinatal posttraumatic stress disorder (PTSD) is a commonly occurring yet frequently misdiagnosed and mistreated condition in women around the childbirth period (National Institute of Health, 2008). As mothers are frequently the primary caregiver during the immediate perinatal period, maternal mental health deficits and subsequent symptoms can impact early child care and development (Pizur-Barnekow & Erickson, 2011).
The occupational therapy practice framework specifies health promotion as one occupational therapy (OT) intervention approach. However, literature suggests missed opportunities in the ability to intervene during this critical preventative period, due in part to the reactive and curative nature of the United States healthcare system (Grobbelaar Fernandes, 2018). Additionally, a lack of education amongst primary healthcare practitioners (PCPs) regarding the value of OT in health promotion and appropriateness for referral, further contributes to this gap in intervention. Moreover, there is a critical need to develop community awareness and knowledge as to the role of OT during the perinatal period, as most people do not currently have an understanding of OT’s unique skill set within this area (Grobbelaar Fernandes, 2018).
This community based approach offers proposed guidelines in which intervention can be implemented. These interventions strive to support the mother throughout the transition either through individual sessions or group sessions. As occupational therapists, with a knowledge base in both mental health and child development, we can offer support in both ways. Individual sessions grounded in easing role strain by assisting the mother in creating systems to support her new role. Prior to the birth, occupational therapists can run groups to assist with post-partum planning once discharged from the hospital. Occupational therapists can provide a developmental playgroup which can help the mother to learn needed milestones, while also providing a sense of community with other mothers and ultimately a sense of self-efficacy with the knowledge learned from the group. As a community based program these could be offered in a variety of settings and can be of value to multiple stakeholders (Graham, Rodger & Ziviani, 2013).

applying purtilo's Six-Step approach to guide ethical decision making in pediatric ot practice

Shanteria Carr, MS, OTR/L, Kathryn A. LeMonda, MOT, OTR/L & Mackenzie Sawyer, MS, OTR/L

AOTA_Purtilo_Approach_PosterPresentation.pdf

abstract:

Ethical behavior is defined as compliance with the standards related to right or wrong actions, and accomplishment of such ethical codes as autonomy, equality, beneficence, non-maleficence, veracity, confidentiality and fidelity (Kalantari, Kamali, Joolaee, Shafarodi and Rassafiani, 2015). Within the pediatric practice, healthcare professionals hold an obligation to provide care of maximal benefit to the child. The clinical and ethical decision-making process is further complicated through attempting to balance the child’s, family’s and other interdisciplinary members’ views in a manner which best aligns with optimal quality of life for said child. The degree to which this is executed is influenced by the constraints of one’s practice setting and own internal and external factors. Practitioners must strike a balance between adhering to systematic policy and procedure while advocating for child, family, and team. The extent to which each practitioner strives to adhere to one’s own ethical integrity drives an inherent degree of variability in decision making and the ultimate provision of services.
We will explain how internal and external factors influence practitioners’ ethical decisions in clinical practice. Ethical dilemmas and issues occur when practitioners’ values and beliefs do not align with their professional code of ethics. Although practitioners’ ethical decisions are influenced by AOTA’s Professional Codes of Ethics, practitioners also have internal factors such as personal values, beliefs and cultural experiences that influence decision making in practice (Horowitz, 2003). Internal factors inherent to each individual practitioner contribute to the variability in one’s behaviors. Kalantari et al. (2015) findings suggest each person’s values, beliefs, perspectives, and personal biases have an influence. The results also suggest a positive correlation between self-esteem and competence in relation to therapist experience. Practitioners’ perceptions of such correlation indicate self-esteem, particularly in newer practitioners may impact their inclination to speak up and act on ethical duties, particularly if involving more experienced clinicians or other professionals of influence. Moreover, practitioners believed occupational therapists with less experience are more apt to err in ethical decision making, as they lack the requisite knowledge, skill, and experience to guide this. External factors, including funding, resources, and systematic expectations also influence a therapist’s ethical behaviors. For example, facilities being understaffed with practitioners can impact a practitioner’s ethical decision making in how they problem-solve to continue to meet productivity standards by management.
In the presentation, we propose strategies therapists can implement to increase clinical competence and guide the provision of occupational therapy services. Purtilo’s Six-Step Approach (Purtilo, 1999 as cited in Horowitz, 2003) offers practitioners a structured and pragmatic means to analyze and guide one’s ethical decision making. These six steps include practitioners gathering information, identifying the problem, analyzing the problem, exploring practical solutions, developing and implementing a course of action, and evaluating the process and outcome (Horowitz, 2003). While individuals may or may not successfully execute actions to resolve their dilemma, this structured ethical approach facilitates in increasing attention and practical reflection in response to ethical principles in pediatric practice settings.

Primary and secondary outcomes of an interdisciplinary intensive model in pediatric care

Katie Haskins, MOT, OTR/L, Kathryn A. LeMonda, MOT, OTR/L & Therese Nagovan, MOT, OTR/L

AOTA_IMOT_POSTERPRESENTATION.pdf

abstract

Developmental disabilities often change and evolve as a child grows, impacting caregiver wellness and necessitating the expertise of many diverse professionals. The complex care of these children involves an interdisciplinary team approach to which occupational therapists (OTs) play a crucial role. With a holistic lens, OTs offer the team a unique perspective, with the common goal of improving functional outcomes for the individual and family throughout the lifespan. Researchers are seeing significant improvements in those who receive interdisciplinary care from initial evaluation to discharge, with subsequent reduced caregiver needs (Weaver, Wheeler, & Kersey, 2016).
Increasingly, the Intensive Model of Therapy (IMOT) is being reviewed by clinics and in research to determine if the IMOT meets the layered needs of families and children with developmental disabilities. Conventional outpatient service delivery models usually entails once or twice weekly frequency. The IMOT increases frequency of services to at least three times per week for a two-week minimum. Findings suggest children who receive services in an IMOT compared to conventional therapy frequencies show greater improvement in functional outcomes. Additionally, the functional gains in the IMOT are more significant for children under the age of two (Arpino et al., 2010).
The combination of an interdisciplinary team within the IMOT can not only yield quantitative functional motor gains for the child, but also provide secondary qualitative benefits for the child’s family unit and overall quality of life for the family. Thus for most effective service provision, it is integral to not only treat the direct needs of the child, but also support the challenges of the entire family unit. Recent literature indicates the family unit as a whole has been greatly overlooked, with research focusing primarily on the impact of disability on the individual child. From this gap, the concept of family quality of life (FQOL) has recently emerged as a critical outcome for service provision of children with disabilities and their families (Davis & Gavidia-Payne, 2009). When implementing services that address parental needs, regards to information, partnership, and understanding, have been found to be amongst the most impactful factors on FQOL driven practices. Findings indicate a significant overall positive correlation between parental perceptions, experiences with family-centered support and satisfaction with FQOL, as well as between enabling and partnership with satisfaction of FQOL. Moreover, the presence of perceived support from friends, is also indicated to be significantly correlated with emotional well-being (Davis & Gavidia-Payne, 2009).
Support through interaction with other families going through similar stresses and events related to having a child with developmental disabilities has many potential benefits. Organically a sense of community develops from these interactions, yielding social and emotional support and companionship between families. Sense of community and social support can be a significant coping resource and vehicle for reducing stress in parents. Social support can present in varying forms; formal support groups lead by professionals or informal groups that are brought together by a common denominator, in this case having a child with disabilities. Jeong, et all found “informal support has a perceptible influence on the parenting stress of mothers of children with disabilities, rather than formal support” (2013). Families going through an intensive therapy program share a mutual experience which provides a platform in which parents can share resources and as well as other experiences to inform and support one another in ways professionals may not.

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