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Full Course Details: Public course page
Learn more about our guests: Meghan Blaskowitz DrPH, OTR/L and Wanda Mahoney PhD, OTR/L, FAOTA
Agenda
Intro (5 minutes)
00:00:00 Intro
00:00:57 OT Potential Podcast Intro
Breakdown and analysis of journal article (5 minutes)
00:02:53 Introduction to OT with adults with intellectual disability
00:03:46 Intent of this research
00:04:26 Methods
00:05:17 Results
00:08:01 Discussion and takeaways
00:09:04 Conclusion
Discussion on practical implications for OTs (50 minutes)
00:09:25 Intro to Wanda and Meghan
00:16:51 How this article came to be
00:21:19 What stands out now
00:26:43 Using the perspectives of our clients
00:33:32 Helpful assessments
00:42:29 Applicable interventions
00:49:07 Creating an inclusive practice
01:01:36 Resources to support adults with ID
Supplemental Materials
- Occupational therapy–related assessments for adults with intellectual disability: A scoping review
- Technology for Adults with Intellectual Disability: Secondary Analysis of a Scoping Review
More Resources for OTs Supporting Adults with ID
See all assessments in our OT Assessment Guide
- AOTA Developmental Disabilities SIS
- Assistive Technology Program
- AT Lending Libraries – for example, TechOwl in PA (affiliated with Temple’s UCEDD)
- Open Future Learning (Instagram)
- For transition supports for people with IDD: Think College, Regional IHE Consortiums
- Charting the LifeCourse
- University Centers for Excellence in Developmental Disabilities Education, Research, and Service (UCEDD)
- Your state’s Developmental Disability Planning Council
Article Review
Read Full Text: Evidence to Inform Occupational Therapy Intervention With Adults With Intellectual Disability: A Scoping Review
Journal: American Journal of Occupational Therapy
Year Published: 2021
I became an OT because I wanted to work with people with intellectual disabilities.
But, once I landed my dream job, I felt like there was a total lack of resources on best practices for serving this population.
Today’s article flips that perceived shortfall on its head. In their quest to find evidence informing OT for adults with intellectual disabilities, the authors were surprised to discover so much research that they eventually turned it into 3 separate papers.
Here, we’ll review the evidence they found to support intervention. And next week, we’ll welcome to the podcast two of the article’s authors: Dr. Meghan Blaskowitz, DrPH, OTR/L and Dr. Wanda Mahoney, PhD, OTR/L, FAOTA.
Let’s dive in.
Introduction to OT for Adults with ID
In 2019, three of the authors of the current paper wrote a paper titled, “Occupational therapy practice for adults with intellectual disability: What more can we do?” In it, they argued that the OT profession must do more to meet the specialized needs of adults with intellectual disability (ID).
They build on this idea in the intro to the current article, explaining that to ensure the most effective and efficient care, OT practitioners must use literature to inform ethical, evidence-based intervention for this population.
While there have been previous reviews on this topic, they only focused on certain aspects of OT delivery. Which leads us to the current article…
What was the intent of this research?
The purpose of this scoping review was to:
Summarize the literature informing occupational therapy intervention for adults with ID—and then categorize this evidence by occupational performance outcomes from The OTPF.
Due to the unexpectedly large amount of literature discovered in their initial search, the team narrowed their focus to intervention only. (Eventually, though, two subsequent papers were published: one exploring assessment, and the other offering a secondary analysis on technology for adults with disability.)
As a bonus for your all, we entered many of the assessments they found into our assessment search:
Assessments for Intellectual Disability
Methods
Articles were included for review if they:
- Were published in English between 2002 and 2018.
- Were published in a peer-reviewed journal.
- Included content about people ages 18 years or older with primary or coexisting ID.
- Included information relevant to OT practice.
159 articles met the original criteria for inclusion. The current review focuses on 57 that were coded as relevant to intervention.
Results
Of the 57 intervention-focused articles, 66% were published in journals that were not specific to occupational therapy (Research in Developmental Disabilities, for example).
The articles were grouped by their outcomes of focus. There is a handy table in the article where you can reference the articles by category. Below, I’ve compiled high-level takeaways and relevant articles for each.
Activities of Daily Living
With 22 articles focused on ADL performance, it was the most common intervention outcome. Staff training and technology training were the most common strategies for improving ADL performance. Habilitation approaches such as client education and practice were also effective in enhancing ADL skills.
- Handheld Devices and Video Modeling to Enhance the Learning of Self-Help Skills in Adolescents With Autism Spectrum Disorder (2015)
- Experiences of Therapists Trying to Reduce Falls Risk for People With Intellectual Disability (2013)
- Evaluating the ability of and enabling a blind adult with learning disability to sign a tenancy agreement (2012)
- Specific treatment of Prader–Willi syndrome through cyclical rehabilitation programmes (2011)
- Case study on effect of household task participation on home, community, and work opportunities for a youth with multiple disabilities (2011)
- Training Caregivers to Provide Virtual Reality Intervention for Adults With Severe Intellectual and Developmental Disability (2011)
- Driving to Learn in a Powered Wheelchair: The Process of Learning Joystick Use in People With Profound Cognitive Disabilities (2011)
- Community cohesion: creating and using interactive whiteboard games (2010)
- Virtual reality as means to improve physical fitness of individuals at a severe level of intellectual and developmental disability (2010)
- Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality Intervention Program (2009)
- Consumer-Directed Goal Planning in the Delivery of Assistive Technology Services for People who are Ageing with Intellectual Disabilities (2009)
- The effect of active support training on engagement, opportunities for choice, challenging behaviour and support needs (2008)
- Staff behaviour and resident engagement before and after active support training (2008)
- Interactive training (2008)
- Interactive training for active support: Perspectives from staff (2008)
- Knowledge of results and learning to tell the time in an adult male with an intellectual disability (2007)
- The impact of time aids on independence and autonomy in adults with developmental disabilities (2006)
- Frequency of knowledge of results and motor learning in persons with developmental delay (2006)
- Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities (2005)
- The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs (2005)
Employment
18 articles focused on employment. Strategies utilized during intervention included: prompting, group skills training, practice, environmental modification, video modeling, and technology training.
- Feasibility of electronic peer mentoring for transition-age youth and young adults with intellectual and developmental disabilities: Project Teens making Environment and Activity Modifications (2018)
- Comparing self-directed video prompting to least-to-most prompting in post-secondary students with moderate intellectual disabilities (2017)
- A nonlinear contextually aware prompting system (N-CAPS) to assist workers with intellectual and developmental disabilities to perform factory assembly tasks: system overview and pilot testing (2016)
- Exploring paid employment options with a person with severe learning disabilities and high support needs: An exploratory case study (2015)
- People with multiple disabilities learn to engage in occupation and work activities with the support of technology-aided programs (2014)
- Two men with multiple disabilities carry out an assembly work activity with the support of a technology system (2013)
- Effectiveness of a Workplace Training Programme in Improving Social, Communication and Emotional Skills for Adults with Autism and Intellectual Disability in Hong Kong – A Pilot Study (2013)
- People with Profound and Multiple Intellectual Disabilities Using Symbols to Control a Computer: Exploration of User Engagement and Supporter Facilitation (2012)
- Ergonomics and the inclusion of people with disabilities in a Brazilian workplace (2012)
- The Apple iPod Touch as a vocational support aid for adults with autism: Three case studies (2012)
- Job support by occupational therapists for people with developmental disabilities: Two case studies (2011)
- A Demonstration of Helping Adolescents With Mild Intellectual Disability Climb Ladders (2011)
- TATE case study (2009)
- Assisting persons with multiple disabilities to move through simple occupational activities with automatic prompting (2008)
- Research Reports: A Social Validation Assessment of Cooperative versus Individual Task Engagement of Persons with Multiple Disabilities (2006)
Leisure and Social Interaction
Specific leisure and social interaction outcomes included:
1.) Improving relationships between adults with ID and their caregivers, and
2.) Increasing participation in leisure activities such as gardening or computer games.
Common strategies in this section included: sensory strategies, technology training, and specific activities (like a horticulture program).
- Resolve: a community-based forensic learning disability service specialising in supporting male sex offenders – our model, approach and evidence base for effective intervention (2016)
- The Effects of Social and Therapeutic Horticulture on Aspects of Social Behaviour (2014)
- Ludic Content in Multisensory Stimulation Environments: An Exploratory Study about Practice in Portugal (2013)
- Effect of equestrian therapy and onotherapy in physical and psycho-social performances of adults with intellectual disability: a preliminary study of evaluation tools based on the ICF classification (2012)
- Contribution of occupational therapists in positive behaviour support (2012)
- Interactive training (2008)
- Virtual reality as a leisure activity for young adults with physical and intellectual disabilities (2008)
- Snoezelen multi-sensory environments: Task engagement and generalization (2006)
- Clinical Incidence of Sensory Integration Difficulties in Adults with Learning Disabilities and Illustration of Management (2003)
- Virtual Reality Provides Leisure Time Opportunities for Young Adults with Physical and Intellectual Disabilities (2003)
Community Participation
6 articles were related to community participation. Outcomes included: traveling in the community, navigating service systems, and engaging in activities outside the home.
Strategies included: program classes, staff training, and technology applications.
- Navigating the Hidden Curriculum of Higher Education for Postsecondary Students With Intellectual Disabilities (2017)
- Supporting People with Intellectual and Developmental Disabilities to Participate in their Communities through Support Staff Pilot Intervention (2014)
- Emerging new practices in technology to support independent community access for people with intellectual and cognitive disabilities (2011)
- Staff behaviour and resident engagement before and after active support training (2008)
- Service innovation: assertive outreach teams for adults with learning disability (2007)
Inclusive Therapeutic Process
4 articles explicitly emphasized the importance of including adults with ID in the therapeutic process. These articles noted that practitioners preferred informal discussion as a means to gather and use feedback for service planning. Focusing on client strengths—coupled with coaching community partners—was a recommended strategy for improving self determination and occupational performance.
- Role of Occupational Therapy in Promoting Self-Determination Through Consumer-Directed Supports (2015)
- Gaining feedback from people with learning disabilities. (2012)
- Consumer-directed goal planning in the delivery of assistive technology services for people who are ageing with intellectual disabilities (2009)
- Service innovation: Assertive outreach teams for adults with learning disability (2007)
Discussion and Takeaways
This search uncovered much more evidence than anticipated. However, the majority of this research was published in non-OT journals—which may contribute to the impression that there is limited evidence supporting OT intervention for adults with ID.
Here are 3 implications for OT practice noted by the authors:
- OT practitioners need to use the perspectives of adults with ID to ensure inclusive and person-centered care.
- OT practitioners have distinct skills to support adults with ID in daily living—and we may need to advocate for our role in promoting their community participation, social interaction, and mental health.
- When searching for OT-related evidence for adults with ID, OT practitioners need to look more broadly and include journals outside of OT.
Conclusion
This scoping review demonstrates that evidence published in both OT and non-OT journals supports OT interventions for adults with ID.
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