Doctor of Occupational Therapy Capstone Project May 4, 2016

To my advisor, Dr. Rochelle Mendonca, and the faculty of the Temple University Occupational Therapy Doctoral

Program

To Dr. Cathy Dow-Royer, my mentor and role model

And to my husband, Jeff, and my children,Hannah and Abigail:

My most humble thanks and gratitude for your patience and encouragement in helping me accomplish this life-

long goal. I love you all.Allison

“Given the plight of persons with psychiatric disorders and the problems of staff recruitment and retention in psychiatric occupational therapy, we need to explore innovations in occupational therapy curricula that will enhance student attitudes toward persons with psychiatric and other disabilities” (Lyons and Hayes, 1992).

With the likelihood that few students will have Level II fieldwork opportunities in traditional mental health care settings, one challenge currently facing academic programs is:

How to ensure students’ entry-level competence in mental health skills and

knowledge?

Academic Search Premier AgelineCINAHL with Full Text Cochrane LibraryEducation Index Retrospective EbscoEducation Source ERICMedline (Pubmed) OT SearchPsycARTICLES PsycINFOHumanities & Social Sciences Index Psychology and Behavioral Sciences Collection

This search was limited to articles written in English between the years of 1990 to April 2014

The following search terms and key words were utilized in various combinations:

attitudes of college students toward disabilities health education attitudes measures disabled persons/psychology* students health occupations/psychology*

McAllister, Tower, And Walker note, citing Ironside (2004),

“…in the time-constrained, complex, specialized field of clinical practice…there may be a tendency to emphasize the technical skills and overlook the humanities and ethic of care. Technical skill acquisition serves the interests of health service efficiency and management, but it may not always serve the interests of a caring community” (2007).

Skills students demonstrate indicative of sensitivity to the “interests of a caring community” include:

Increased critical self-reflection An ability to describe new understanding with regard

to self, service users & the value of service provided Increased interpersonal communication abilities and

professional behaviors Changes in assumptions about members of the

population receiving services and their families Increased professional activity in response to specific

interactions with service users

(Edmonds-Cady and Sosulski, 2012; Gelman, 2012; Rush, 2008; Mallory, 2003)

There is evidence across domains of allied health practice literature indicating students who experience planned learning activities on the subject of disability awareness may be more likely to adopt caring practices and attitudes.

(Gelman, 2012; Gitlow and Flecky, 2005; Knecht-Sabres, 2013; Lyons, 1992; Mallory, 2003; McAllister, Tower, and Walker, 2007; and Rush, 2008)

Experts in higher education worldwide recommend curricula from diverse disciplines such as traditional business studies, rehabilitation, and residential programs for physicians intentionally incorporate curricular activities to enhance students’ caring and positive attitudes for a variety of reasons, including increased economic advantages to society and advocacy for people with disabilities (Stachura and Garven, 2003; Chan, Lee, Yuen, and Chan, 2002, Gelman, 2012; Mallory, 2003; McAllister, Tower, and Walker, 2007; Moroz, et al., 2010, and Rush, 2008)

ACOTE Accreditation Standard B.2.9: The student will be able to express support for the quality of life, well-being, and occupation of the individual, group, or population to promote physical and mental health and prevention of injury and disease considering context (e.g. cultural, personal, temporal, virtual) and environment [at all educational levels] (AOTA, 2011)

ACOTE Accreditation Standard 2.6: Analyze the effects of heritable diseases, genetic conditions, disability, trauma, and injury to the physical and mental health and occupational performance of the individual [all levels] (AOTA, 2011).

There are no studies to date that describe attitudes of occupational

therapy students toward individuals with intellectual

disabilities (ID).

(i.e. Chan, Lee, Yuen, and Chan, 2002; Gitlow & Flecky, 2005; Knecht-Sabres, 2013; Lyons, 1992; Stachura & Garven, 2007).

The purpose of this study is to answer the question:

“How will occupational therapy students perceive individuals with intellectual

disabilities before and after involvement in a fieldwork activity when compared to the attitudes of health professional students

who do not have this fieldwork?”

Because of its emphasis on the theoretical, clinical, and practical applications of the outcomes of performance on person-environment-occupation interactions, Christiansen and Baum’s Person Environment-Occupation-Performance (PEOP) model (Christiansen, C., Baum, C.M., & Bass, J., 2011), was selected as the conceptual model for this experiment

In this PEOP construct:

The student is the person The occupation is learning about people with

disabilities The environment is the school gymnasium and

the individuals engaged in the activity process The performance is the students’ attitudes, as

reflected in their knowledge, beliefs, and behavior.

This study was a non-experimental, longitudinal, descriptive design that included in sequence a pretest, intervention I (a traditional lecture), posttest I (following intervention I), intervention II (an experimental fieldwork) and posttest II (for the groups who completed the fieldwork activity).

Institutional Review Board approval was obtained prior to study inception.

Attitudes Toward Intellectual Disabilities Questionnaire

67 items on a Likert-type 5-point scale ranging from (1) completely agree to (5) completely disagree.

3 sections:

The cognitive component consists of two factors: “Knowledge of Capacity and Rights” & “Knowledge of Causes”

The affective component also consist of two factors: “Discomfort” & “Sensitivity and Compassion”

The behavioral component consists of one factor only, “Interactions”

Knowledge of Rightsand Capacities

In collaboration with a local day program for adults with ID:

Location: the college gymnasium Frequency/Duration: 1x/ week , ~ 1 hour/visit x 5 weeks Participants:

15-16 students & 15-25 day program attendees w ID Activities included: walking around the perimeter of the

gymnasium to music, shooting basketballs into the basketball hoops, and kicking soccer balls

Supervised by: the fieldwork instructor, who was the principal investigator for this study, as well as the occupational therapist at this day program

Students were given an identification number on their hard copy of the informed consent known only to them

Accessed the ATTID online using this identification number. During the first week of the semester (Pretest) After listening to an expert recorded lecture on the

subject of disability awareness (Posttest I) After the conclusion of fieldwork (OT students only).

Demographic data was collected the first time participants completed the surveys

Data was analyzed using IBM SPSS Statistics (Version 21; IBM Corp., Armonk, NY).

It was organized into a database and frequencies of responses were examined based on the three components of attitude: cognition, emotion, and behavior and the five factors that the ATTID measures within these domains.

Aggregate gain scores were computed for each factor and next put in a generalized linear model procedure (ANOVA) from pretest to the first posttest (after lecture), then from the first posttest to the second posttest (OT classes only) and once again from pretest to second posttest (OT classes only) with lecture and fieldwork as the between subjects variables.

There were no significant differences found in change of attitude factors between first year OT students, second year OT students and public health students’ groups after Intervention I, the lecture on disability awareness.

Between-groups analyses for OT students revealed significant attitude changes on each of the five factors for selected participant variables after these students completed fieldwork

Regardless of program year, after completing fieldwork, students in the OT program who had volunteer work experience with individuals with ID were more likely to be significantly more comfortable with people with ID when compared with all other OT students (F = 4.32, p> F = 0.0454).

After fieldwork, a significant majority of the students in the second year of the program (28 of 30) demonstrated a greater improvement in this component of attitude relative to students in the first year (F = 5.05, p> F = 0.0310).

Regardless of class year and program type, students who answered yes to the question “Are the people with ID you know neighbors?” (n=15) were more likely to express less positivity on this component from pretest to post-lecture than those who said no (n=50) (F=4.69, p > F = 0.0341).

This trend was reversed in OT students between lecture and the end of fieldwork; those students who answered yes (n=13) demonstrated significantly more positive changes when compared to students who said no (n=39) (F = 4.91, p > F = 0.0313).

Students who answered yes to the question “Are the people with ID you know people for whom you do work?” (n=30) were significantly more positive after fieldwork than students who answered no (n=22) (F=6.81, p > F = 0.0119).

The younger the students were, the more compassionate they became after fieldwork (F = 4.16, p > F= 0.0082)

On Factor Five, Knowledge of Causes, students who answered “very often” (n=3), “sometimes” (n=28) or “often” to the question “How often have you had contact or interactions during your lifetime with people with ID” all became significantly more positive from pretest to post fieldwork than the student who answered “never” (n=1) (F=3.13, p >F= 0.0392).

Results of this study indicate that while the traditional educational approach (lecture) did not yield meaningful differences in changing attitudes of students in two different years and two different types of programs, fieldwork significantly improved components of attitudes in each of the five factors measured on the ATTID across a number of participant variables

The younger students were when they experienced fieldwork, the more likely they were to become significantly more compassionate by its conclusion.

Students who had volunteer or work experiences with people who had ID were more likely than those who did not to demonstrate more positive attitudes on components related to knowledge of rights and capacities and professed greater comfort in interactions with this population after fieldwork.

Greater quantities of interactions were also correlated to post-fieldwork improvements regarding knowledge of causes.

Small sample sizes resulted in decreased power for analyzing differences and limits generalizability.

This study only explored the relationship between fieldwork and attitude toward individuals with intellectual disabilities at one college in the Northeast.

At this time, there is no way to determine if positive attitude changes generated through fieldwork would be retained through ensuing fieldwork or after students begin practicing in the field.

Future study should determine whether improvements in student attitudes demonstrated after this fieldwork can be replicated.

Educational interventions for students who demonstrate negative changes in attitude after fieldwork need to be identified.

Changes to student attitudes through subsequent fieldwork need to be identified.

There is insufficient evidence at this time to conclude that any one approach is the most effective method to maximize student attitudes toward people with ID.

What is known, however, is doing nothing almost guarantees our students will maintain less positive attitudes toward people with disabilities, and this represents a risk factor for poorer quality interventions and outcomes for those receiving treatment.

Fieldwork may be more effective than lecture in yielding meaningful improvements in student attitudes toward individuals with intellectual disabilities.

Student attitudes toward people with intellectual disabilities improved with increased experience with this population, suggesting that fieldwork with members from this population should be offered early in educational programs and followed by subsequent experiences as students progress through their education

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