D&B Chapter 2: Understanding the ACOTE Areas of Focus for the Capstone

Capstone Student Reflective Questions

• What area of focus is most important to you as you think about your capstone?

• What is your inspiration for your capstone?

• How does your plan for your capstone compare or contrast with your planned or completed fieldwork experiences?

• What type of sites are you interested in exploring that fit your planned focus area?

• What type of individuals can you see yourself being mentored by, based on your planned focus area?

Occupational Therapy Generalists

• Are expected to have comprehensive sills and knowledge from a set of core knowledge that is essential for all occupational therapy practitioners and deliver care across a spectrum of ages, conditions, and practice settings

Roles of an Occupational Therapist

• Fieldwork coordinator

• Faculty

• Program director

• Clinician

• Educator

• Scholar

• Researcher

• Consultant

• Advocate

• Practitioner

• Fieldwork educator

Capstone Focus Areas

• Clinical practice skills

• Research skills

• Administration

• Leadership

• Program and policy development

• Advocacy

• Education

• Theory development

In-Depth

• A stage or condition beyond introductory

• Being exposed to detailed and extensive

• Comprehensive and thorough

Occupational Therapist Roles and Functions: Practitioner

• Provide assessment, intervention, and program planning

• Implement discharge planning

Occupational Therapist Roles and Functions: Educator

• Develop and provide educational offering and trainings

Occupational Therapist Roles and Functions: Fieldwork Educator

• Manage Level I or Level II fieldwork in practice setting while providing opportunities for students to fulfill practitioner competencies

Occupational Therapist Roles and Functions: Supervisor

• Manage overall daily operations of occupational therapy services

Occupational Therapist Roles and Functions: Administrator

• Manage department, program, services, or agency providing occupational therapy services

Occupational Therapist Roles and Functions: Researcher/Scholar

• Examine, develop, refine, and evaluate the profession’s body of knowledge and theoretical and philosophical foundations

Dreyfus and Dreyfus Skill Acquisition Model

• Provides developmental stages of competency for the mental processing, logic, and principles that guide reasoning as one advances through the various stages of skill attainment

Four Stages of Dreyfus and Dreyfus Skill Acquisition Model

• Novice

• Competence

• Proficiency

• Expertise

5 Stages of Patricia Benner’s Skill Acquisition Model

• Novice

• Advance beginner

• Competency

• Proficiency

• Expert

Dreyfus and Dreyfus Skills Levels: Novice

• A person follows rules that are context-free and feels no responsibility for anything other than following the rules

• Rules determine action

• Considers every idea as possibility

Dreyfus and Dreyfus Skills Levels: Competence

• Develops after an individual has considerable experience

• The individual can troubleshoot

• Guidelines determine action

Dreyfus and Dreyfus Skills Levels: Proficiency

• Is shown in individuals who use intuition in decision-making and develop their own rules to formulate plans

• Individuals anticipate deviations from their plan

• Individuals are able to self-correct

Dreyfus and Dreyfus Skills Levels: Expertise

• Characterized by a fluid performance that happens unconsciously and automatically and no longer depends on explicit knowledge

• Individuals respond to situations by intuition

• Individuals establish a relevant focus

Benner’s Model of Skill Development: Novice

• Beginner with no experience, taught general rules to help perform tasks

• Learners focus on learning the rules of a particular skill

• Needs constant guidance

• Seeks affirmation regularly

Benner’s Model of Skill Development: Advanced Beginner

• Demonstrates acceptable performance, has gained prior experience in actual situations to recognize recurring components, principles are based more on experience

• Learners focus on applying the rules of a skill in specific situations that become increasingly dependent on the particular context of the situation

• Begins to apply knowledge and skills

Benner’s Model of Skill Development: Competence

• More aware of long-term goals, gains perspective from planning own actions based on conscious, abstract, and analytical thinking and helps to achieve greater efficiency and organization

• Learners see actions in terms of long-range goals or plans

• Consciously aware of their skills

Benner’s Model of Skill Development: Proficiency

• More holistic understanding, improved decision-making

• Learns from experience what to expect in certain situation and how to modify plans

• Perceives situations as “wholes” rather than “aspects,” and performance is guided by intuitive behavior

Benner’s Model of Skill Development: Expert

• No longer relies on principles, rules, or guidance to connect situations and determine actions

• Has an intuitive grasp of situations

• Learners integrate mastered skills with their own personal styles

• Performance is now fluid, flexible and highly proficient (within their focus area)

Common Themes Among the Description of Clinical or Professional Doctorates and Advanced Practice Include

• Expertise based on significant experience and training

• Focus on interpersonal competence

• Formal education beyond entry level

• Involvement in leadership, research, teaching, and mentoring

• Activities performed may be outside of the traditional scope of practice

The Joint Commission (TJC) National Patient Safety Goals

• Specific areas that accredited facilities need to address in regard to patient safety

• For hospital facilities, these include things such as correctly identifying patients, using medicine correctly, using alarms safely, preventing infection, identifying patient safety risks, and preventing mistakes in surgery

The Joint Commission (TJC)

• Accredits and certifies nearly 21,000 health care organizations and programs in the US

Commission on Accreditation of Rehabilitation Facilities (CARF)

• An independent, international, nonprofit accreditor of health and human services in the following areas

  • Aging services

  • Behavioral health

  • Child and youth services

  • Employment and community services

  • Vision rehabilitation

  • Medical rehabilitation

• Accredits more than 50,000 programs and services at 25,000 locations

• Is a voluntary accreditations that demonstrates accountability to funding sources and referral agencies

Criteria Foci for CARF Accreditation (Similar to TJC):

• Reducing risk

• Addressing health and safety concerns

• Respecting cultural and individual preferences

• Providing the best possible quality of care

Performance Measures: Administrative/Financial

• Address organizational structure for coordinating and integrating services, functions, and activities

• Capstone example:

  • Develop and evaluate facility workflow using a contingency diagram to determine worker efficiency and productivity

Performance Measures: Perception of Care/Service

• Patient/customer satisfaction

• Capstone example:

  • Create, implement, and evaluate a model for concierge care to proactively address client concerns

Performance Measures: Participants’ Health Status

• Falls, vent-associated pneumonias, urinary tract infection rate, central-line infections, restraint use, and medication errors

• Capstone example:

  • Create and implement staff training modules based on current evidence regarding fall prevention

Other Compliance Organizations that May be Relevant to Explore the Integration of a Capstone

• Department of Health

• Department of Education

• Occupational Safety and Health Administration

Team-Based Care

• The provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers -to the extent preferred by each patient- to accomplish shared goals within and across settings to achieve coordinated, high-quality care

Vision Statement

• A public way in which an organization indicates who or what they want to become

• Indicates transformation, direction, and growth

The 5 Pillars: Effective

• Evidenced-Based

• Client-Centered

• Profitable or cost-effective

• Capstone focus area examples

  • Research

  • Clinical practice

  • Administration

The 5 Pillars: Leaders

• Influential

• Change agent

• Catalysis

• Capstone focus area examples

  • Leadership

  • Advocacy

The 5 Pillars: Collaborative

• Teamwork

• Systems approach

• Outcome-Oriented

• Capstone focus area examples

  • Administration

  • Program development

The 5 Pillars: Accessible

• Responsive

• Customized

• Capstone focus area examples

  • Program development

  • Advocacy

  • Policy

The 5 Pillars: Equity, Inclusion, and Diversity

• Inclusive

• Equitable

• Capstone focus area examples

  • Advocacy

  • Policy

  • Education

6 AOTA Practice Areas

• Children and youth

• Health and wellness

• Mental health

• Productive aging

• Rehabilitation, disability, and participation

• Work and industry

AOTA Practice Areas DCE and Capstone Project Examples: Children and Youth

• Exploring the impact of hippotherapy on children with ASDs

AOTA Practice Areas DCE and Capstone Project Examples: Health and Wellness

• Understanding the benefits of a kangaroo-care protocol in the NICU

AOTA Practice Areas DCE and Capstone Project Examples: Mental Health

• Develop competency with a modality such as AlphaStim to address posttraumatic stress disorder among veterans

AOTA Practice Areas DCE and Capstone Project Examples: Productive Aging

• Understanding how sensory stimulation programs can be used with elderly adults with dementia

AOTA Practice Areas DCE and Capstone Project Examples: Rehabilitation, Disability, and Participation

• Create a practice guideline to address sexuality with individuals who have a spinal cord injury

AOTA Practice Areas DCE and Capstone Project Examples: Work and Industry

• Create a clinical pathway rooted in the biopsychosocial model to address chronic pain among individuals who have sustained a work-related injury

Capstone Focus Area: Clinical Practice Skills

• A DCE that involves identification of a site or setting where more advanced (or a narrower focus of) occupational therapy interventions are utilized

• Capstone students who choose this focus area could satisfy components of their experience by pursuing and completing continuing education courses, advanced trainings, certificates, and so on

Examples of Clinical Practice Skills Capstone Projects

• A case study

• A scoping literature review of an emerging practice focus

• A critically appraised topic

• A meta-analysis of evidence regarding a specific intervention or approach

• Creation (or refining) of a practice guideline, pathway, clinical protocol or best evidence statement

Focus Area: Research

• An experience that involves participating, collaborating and learning from recognized individuals who are actively engaged in projects that include research design and planning, data collection, analyzing and affecting evidence-based practice, and disseminating results

• Role responsibilities consist of examining, developing, refining, and evaluating the profession’s body of knowledge along with theoretical and philosophical foundations

• Could take place anywhere

Examples of Research Capstone Projects

• An outcome study

• A systematic review of evidence related to an occupational therapy program or intervention of interest

• Retrospective research study, such as looking at how many children with intensive feeding issues had NICU stays as infants

Focus Area: Administration

• Student is responsible for developing in-depth knowledge and skills in systems of practice, administrative, or management function in traditional or role-emerging sites

• May include a deeper understanding of systems theory to develop system-thinking skills such as a focus on interactions, relationships, and adaptation

• Ex

  • Working with distinguished, expert administrators, entrepreneurs, managers and supervisors who may or may not be an OT practitioner

• Could include private practices, managed care organizations, health systems, and community sites

• Requires active skill building and collaboration in administration, management, and supervision, outside of the generalist expectations

Examples of Administration Capstone Projects

• Conduct a financial analysis to compare care models and potential cost savings or return on investment

• Develop and/or evaluate care models or service delivery models

• Complete a workflow analysis on the use of transport in a health care facility and evaluate the impact on employee productivity

• Write a strategic business plan to initiate a new program or entrepreneur effort

• Write a grant proposal to secure funding for an occupation process for merit and promotion of employees

• Revamp the administrative onboarding process for occupational therapy fieldwork students at a clinical site

• Create a system-wide approach for the adoption and integration of an electronic medical record

• Create an evidence-based proposal to increase the retention of occupational therapy personnel

• Evaluate and refine processes and systems to measure client satisfaction

• Measuring the impact of “xyz” variables on reducing readmission rates

Focus Area: Leadership

• Can involve working and collaborating with recognized individuals who are involved in exercising influence and representing different areas of the profession regionally, nationally, and internationally

• May involve capstone students engaging in effective and meaningful collaboration with clients, other professionals and key stakeholders while not only adapting and adjusting to changing systems and practices, but to become transformational in their leadership outcomes

• Learning objectives:

  • Exploration of personal styles of leadership

  • Reexamination of leadership theories

  • Thorough assessment and critique of a leadership project

Examples of Leadership Capstone Projects

• Create and implement a leadership development project, such as leadership training, with your state occupational therapy association or licensure board related to occupational therapy practice and policy

• Create and implement a leadership project within a Student Occupational Therapy Association

• Create and implement a leadership initiative within your state organization to increase membership

• Create and implement staff instruction and training to create a culture of safety through education by teaching other disciplines about patient handling

Focus Area: Program Development

• Refers to the systematic process of identifying the needs of a group of individuals, community, or organization and designing evidence-based programs to meet the needs that have been identified

• Includes approaches, principles, and methods for developing and evaluating occupation-based programs and interventions for individuals and groups

• Essential component of this process is to evaluate the effectiveness and outcomes of the program once it has been implemented

• May address needs assessment, program planning, proposal writing, and measurement of program outcomes

• Could take place in clinical and/or community (role-emerging) settings

Focus Area: Clinical Program Development

• Developing and testing outcomes of occupational therapy programs in clinical settings

• Could include inpatient or outpatient rehab, medical, or mental health facilities

• Ex:

  • Hand therapy, geriatrics, pediatrics, mental health, rehabilitation, school-based occupational therapy

Examples of Clinical Program Development Capstone Projects

• Development and implementation of a sensory diet for children with ASD in a school setting

• Creation of a cognitive rehabilitation program for adults with chemotherapy cognitive-induced impairment in an acute care hospital

• Development of an aquatic therapy program for children who have ASD

• Creation of a Snoezelen room or space in a dementia-care unit

• Development of a therapeutic garden to increase participation on an inpatient rehabilitation unit

• Creation of a reverse activities of daily living program on an inpatient rehabilitation unit to address sleep routine and sleep hygiene

Focus Area: Community Program Development

• Responsible for developing a program or product idea and operationalize it based on specific need in the community, site, or population

• May entail seeking grant funding or completing a program evaluation

• Ex:

  • Homeless shelters, programs for at-risk youth, long-term structured residence (LTSR), veterans programs, inner-city outreach programs, criminal justice settings, foster care, adult day care facilities, or psychosocial clubhouse

Examples of Community Program Development Capstone Projects

• Development of and implementation of a community wellness program for individuals who have a history of polysubstance use in a halfway house

• Development of and implementation of a sleep hygiene program in a day program for veterans with posttraumatic stress disorder

• Creation of sensory-friendly programs at a museum or other public spaces, such as a zoo

• Implementation of an evidence-based program for self-management of chronic disease in a primary care setting

• Development of and implementation of a medication management program for individuals with intellectual disabilities in an adult day program

Focus Area: Policy Development

• Includes working and collaborating with recognized individuals who are engaged at federal or state legislative levels to develop and implement innovative programs or to create evidence-based health and social policy

• Ex:

  • Primary care settings, state or local legislative office, state associations, state or national political action committees

AOTPAC

• A voluntary, nonprofit, nonpartisan, unincorporated committee of members of AOTA

• Purpose is to further the legislative aims of the Association by influencing or attempting to influence the selection, nomination, election, or appointment of any individual to any Federal public office, and of any OT, OTA, or OT student member of AOTA seeking election to public office at any level

Examples of Policy Development Capstone Projects

• Analyze a local, state, or national health care policy and propose a change in the policy and implementation of the policy

• Work with a legislator to propose policy changes related to access to and reimbursement for occupational therapy

• Create and implement a professional development plan indicating that you will run for an elected position related to advocacy and legislation

• Seek out and engage in lobbying efforts with national interest groups such as the Disability and Rehabilitation Research Coalition (DRRC) as it urges Congress to fully support disability, independent living, and rehabilitation research through a variety of federal agencies

• Build and participate in a campaign with an elected official that aligns with important issues that matter to the occupational therapy profession

Focus Area: Advocacy

• Could include working and collaborating with recognized individuals that are engaged at the federal and state legislative levels regarding issues that affect our practice (such as reimbursement and scope of practice guidelines)

• Ex:

  • Community organizations, state and national organizations, offices of legislators

Examples of Advocacy Capstone Projects

• Develop and test a program that improves consumers’ abilities to navigate health systems to improve access to, delivery of, or outcomes of health care

• Create a referral pathway for occupational therapy in primary care

• Create and implement an advocacy project to help promote CarFit with local offices such as the American Automobile Association (AAA) and the American Association for Retired Persons (AARP)

• Plan and implement an advocacy project such as AOTA’s Capitol Hill Day

• Create and implement a community occupational therapy advocacy project such as backpack awareness in a public school district or fall prevention initiative in a retirement community

• Complete an in-depth analysis and policy statement regarding a particular practice issue

• Work with an advocacy special interest group within a state organization to lobby for critical scope of practice issues such as encroachment

Focus Area: Education

• Would explore the role of the OT as educator, which could include various communities of learners such as clients, staff, and students in community, clinical and classroom settings

• Collaborating and working with individuals who are actively pursuing an academic career or who have expertise in developing continuing education modules, programs, or academic publishers

• Ex:

  • School systems, higher education settings including OTA and OT degree levels, and other sites that have employees/staff who require annual training/learning

Examples of Education Capstone Projects

• Academic course development

• Curricular development and testing of learning outcomes of coursework in traditional and/or online educational environments with OT or OTA students

• Development and implementation of a hybrid OT course

• Development and implementation of a continuing education course or webinar

• Client/family education program

• Curricular development and testing of learning outcomes of coursework in traditional and/or online educational environments with clients and/or their families and caregivers

• Development of a family program at a local pool geared towards promoting water safety among the ASD population

• Staff development program

• Creating a staff development training program at a local recreation center on best practice approaches to work with children with disabilities

• Development of a training module for staff in a disaster relief organization on cultural awareness

• Development of training modules for staff in a hospice facility on end-of-care occupational engagement

• Consultation with school-system bus service to create an evidenced-based child-passenger safety protocol

• Textbook or instructional technology development

• Development of publishable teaching materials or instructional technology designed for occupational therapy or other health professional, non-health professionals, consumer or family audiences

• Development of a systematic review of best practice guidelines and an outcome product such as clinical guidelines, a tool kit, or a video that can be used for educational purposes, manuscript for children’s book on disabilities awareness, resource manual for parents of children with special needs

Focus Area: Theory Development

• Could include a dynamic process of knowledge development by the capstone student collaborating with individuals who are developing and testing models that relate to the practice of occupational therapy

• Ex:

  • Working with recognized researchers and centers of excellence where specialized models of intervention are being tested and utilized

Theory

• Promotes the development of knowledge and practice for occupational therapy

• A collection of ideas or concepts that guides action

• Are a way of explaining or understanding phenomena

Importance of Theory

• Supports our need for professional knowledge base

• Shapes and guides practice

  • Provides scientific support for practice and tests the effectiveness of occupational therapy interventions

• Provides a foundation for professional paradigm

• Assist in professional reasoning

Examples of Theory Development Capstone Projects

• Explore a mindfulness theory to use for mindful eating among individuals who are struggling with obesity

• Integrate the use of Growth Mindset among professional identity development of occupational therapy students

• Investigate a new theory to guide clinical reasoning during fieldwork education

• Develop a gender-as-occupation-based model for individuals who are transgender or gender nonconforming

Common Theories

• Erikson’s developmental stages

• Piaget’s intellectual development

• Kohlberg’s moral reasoning

• Levinson’s life stages

• Laslett’s age theory

Models of Practice

• MOHO (Model of Human Occupation)

• EHP (Ecology of Human Performance)

• PEO (Person Occupation Environment)

• OA (Occupational Adaptation)

• PEOP (Person Environment Occupation Performance)

Frames of Reference

• Psychodynamic

• Behavioral cognitive

• Allen levels

• Biomechanical

• Sensory Integration