Date Presented 04/05/19
Engaging clients in community-based OT (CBOT) can be a challenge due to a variety of social, environmental, and personal barriers after release from a justice setting. Through an evaluation of CBOT contact logs, this study explores methods, including telehealth technologies used for client contact and interventions to provide innovative and tailored OT interventions. Findings can be considered for applications across a variety of CBOT settings.
Primary Author and Speaker: Christine Hayes
Additional Authors and Speakers: Lisa Jaegers
Contributing Authors: Brittany Conners, Karen Barney
PURPOSE: Over 11 million individuals cycle through jails each year (Minton & Zeng, 2016), and recidivism and homelessness are high. Individuals transitioning from jail to the community face challenges with engaging in healthy occupations, seeking and securing safe housing and employment, developing supportive social networks, and accessing physical and mental health resources. Service delivery for the provision of community-based occupational therapy (CBOT) with individuals post-jail release can be challenging and have not been evaluated. Due to client challenges and limited practitioner access and resources, service delivery must be creative and tailored to the client using a variety of methods including telehealth technologies (American Occupational Therapy Association, 2013). The purpose of this study is to evaluate service delivery methods and related barriers and facilitators to implementing a post-jail CBOT program to inform this emerging area of practice.
DESIGN AND METHODS: The study design was a retrospective process evaluation using both qualitative and quantitative analyses. Contact logs from a CBOT caseload (N=17) during November, 2017 to May, 2018 were analyzed. The caseload included individuals who participated in an OT program pre-jail release and were bridged to post-jail CBOT for transition and integration services. Contact logs included the date of client contact, duration of contact, type of contact (e.g. call, in person, text message, private social media, or other) and description of CBOT activities. Descriptive analyses provided summary details of the contact logs and qualitative coding and thematic analysis were used to summarize contact notes for occupational activities. Barriers and facilitators to engaging individuals in communication and OT services were explored.
RESULTS: There were 613 points of contact during six months of service delivery with 17 clients who were bridged from pre- to post-jail release CBOT services. The most common type of communication was telehealth technologies including voice phone calls, text messages, email, video calls, or private social media messaging. Of those contacts, phone calls (n=245) and text messages (n=193) were most often utilized. There were 104 in-person contacts that often involved meetings with the client in court, with their attorney, or with a partnering community service provider (CSP). In-person meetings also included applied activities in the community to address money management, computer skills, employment preparation, and for the CBOT to observe client home management. Telehealth technologies were not only used to connect with the client to setup meetings, but were also used for skilled interventions such as community mobility, time management, accessing community resources, social skills, conflict management, and crisis assistance. Barriers to client participation included home instability, lack of transportation, and limited use of technology features. Facilitators included stable housing, supportive family, and CBOT collaboration with the client’s CSP.
CONCLUSION: Individuals experiencing post-jail community transition need a variety of service delivery options in order to participate in CBOT. This study revealed that telehealth technologies were the most often utilized methods for offering client accessibility to CBOT services, providing skilled OT interventions, and keeping clients engaged in their OT goals. A network of collaborative CSP were also valuable points of contact for sustaining client participation. Managing a CBOT caseload with individuals post-jail release is challenging and telehealth technologies combined with in-person OT interventions support client participation and increasing service provision capacity.
References
American Occupational Therapy Association. (2013). Telehealth. American Journal of Occupational Therapy, 67(6_Supplement), S69-S90. doi:10.5014/ajot.2013.67S69
Minton, T. D., & Zeng, Z. (2016). Jail Inmates in 2015. ( NCJ 250394). Washington, DC: U.S. Department of Justice Retrieved from https://www.bjs.gov/content/pub/pdf/ji15.pdf.
