Occupational Therapy in Carceral Settings: Qualitative Study of Practitioner Experiences and Perspectives

Abstract

Scant evidence exists regarding occupational therapy in carceral settings. Exploring perspectives and experiences to understand current practices is needed. To explore how occupational therapy practitioners (OTPs) navigate evaluation, interventions, and role delineation. Qualitative study using phenomenological and hermeneutic approaches Data gathered through semistructured interviews with seven OTPs with average experience of 16 months, representing six states and four practice settings. Themes were identified by two independent coders who analyzed the data with consensus by third researcher. Four themes emerged: managing contextual challenges, interpersonal professional relationships, evidence-informed services, and client-focused care. Practitioners applied various frames of reference, utilized self-report and observation evaluation methods, and implemented holistic direct and indirect interventions. Understanding and supporting the value of therapeutic relationships, activity/occupational performance analysis, and foci of occupational therapy (OT) domains and processes that emphasize indirect roles can further define and highlight the distinctive nature of OT within carceral settings.

Plain Language Summary

Occupational Therapy Practice in the Carceral System

Research indicates occupational therapy practitioners (OTPs) have the skills to support individuals during incarceration and community re-entry. However, practice evidence for occupational therapy (OT) in carceral settings is limited as it is still an emerging practice area. To understand current practices, it is important to identify how OTPs define their role and reason about their clients and the services they provide. Seven OTPs spread across six states in various carceral settings were interviewed. Analysis of responses revealed four themes: managing contextual and interpersonal challenges, interpersonal professional relationships, evidence-informed services, and client-focused care. This study also identified that OTPs apply various theories and frames of reference and use client self-report assessment tools and observation during evaluations to provide a holistic client profile. Ongoing advocacy, staff training, and trauma-informed interventions that can flex as needed are essential. Results suggest the OTPs’ reasoning processes are highly complex and align with OT professional reasoning literature.