Date Presented 03/28/20
Utilizing a stepped wedge randomized control and repeated measures design, this study indicated improved occupational performance and participation outcomes for incarcerated women with intellectual and developmental disabilities (IDD). The outcomes of this study have strong potential utility for enhancing the rehabilitation of incarcerated individuals with IDD and advocating for the consistent inclusion of OT within criminal justice service-provider teams.
Primary Author and Speaker: Laurie Stelter
Contributing Authors: Cynthia Evetts
PURPOSE: While occupational therapy (OT) practice in criminal justice (CJ) settings has been more commonly focused on individuals with mental illness, the specific application of OT to individuals with intellectual and developmental disabilities (IDD) involved with the CJ system is insufficiently evident. This study evaluated systematically the impact of an occupation-based program on the occupational performance and participation of incarcerated women with IDD. The overarching research question was whether participation in occupation-based programming resulted in the improved occupational performance and participation of incarcerated women with IDD. The specific research questions were: (1) How do program participants and a wait-list control group differ in terms of adverse behavioral incidents? and (2) What changes in occupational performance and participation do program participants demonstrate over time?
DESIGN: This study used an experimental design consisting of two strategies. A stepped wedge randomized control design was used to compare program participants with a delayed intervention group in terms of adverse behavioral incidents. A repeated measures design was used to evaluate changes in program participant’s occupational performance and participation. All of the study participants were recruited from a single state prison with the southwest region of the U.S., were women, aged 18 years or older, and diagnosed with a condition affecting intellectual and/or cognitive functioning. Informed consent was obtained from participants using approved procedures from the institutional review board and associated state CJ authority.
METHOD: Participant demographics and adverse behavioral incidents were collected from prison institutional records. OT program data consisted of multiple participant ratings over six months of time using Goal Attainment Scaling (GAS), the Volitional Questionnaire (VQ), Social Profile (SP), and a relative mastery scale. After data was de-identified, analyses were performed using SPSS version 25.0. First, demographic and program data was analyzed using descriptive statistics, and the frequency of cases of the delayed and intervention group were compared using a paired t-test. Second, repeated measure analysis of variance (ANOVA) was used to compare within-intervention group measures of occupational performance and participation (i.e., VQ, relative mastery rating, and SP) over the time of the intervention phase. A Wilcoxon signed-rank test was administered to compare the GAS measures from baseline to the end of the intervention phase.
RESULTS: Intervention participants had significantly fewer adverse behavioral incidents than the delayed intervention group (N=85; p = .02). Intervention participants demonstrated significant improvements in occupational performance and participation according the GAS (p < .001), VQ (p < .005), and the SP (p < .005).
CONCLUSION: The results of this study indicate a significant impact on the occupational performance and participation of offenders engaged in an OT intervention within a relatively brief amount of time. The outcomes of this study have strong potential utility for enhancing the rehabilitation of incarcerated individuals with IDD and advocating for the consistent inclusion of OT within criminal justice service provider teams. Limitations included a focused sample, short study time frame, and possible researcher bias. Future studies should allow for a post intervention follow-up and replication in other settings.
References
Cox, A., Simmons, H., Painter, G., Philipson, P., Hill, R., & Chester, V. (2014). Real work opportunities: Establishing an accessible vocational rehabilitation programme within a forensic intellectual disability service. Journal of Intellectual Disabilities and Offending Behaviour, 5(4), 160-166. doi:10.1108/JIDOB-10-2014-0016
Munoz, J.P., Moreton, E.M., & Sitterly, A.M. (2016). The scope of practice of occupational therapy in U.S. criminal justice settings. Occupational Therapy International, 23, 241-254. doi:10.1002/oti.1427
Smith, A., Petty, M., Oughton, I., & Alexander, R.T. (2010). Establishing a work-based learning programme: Vocational rehabilitation in a forensic learning disability setting. British Journal of Occupational Therapy, 73(9), 431-436. doi:10.4276/030802210X12839367526174
Withers, P., Boulton, N., Morrison, J., & Jones, A. (2012). Occupational therapy in a medium secure intellectual disability and personality disorder service. Journal of Learning Disabilities and Offending Behaviour, 3(4), 206-218. doi:10.1108/20420921211327356
