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Preface vii

The book remains designed as a textbook for entry-level occupational therapy students,
but it also proves useful to practitioners wishing to facilitate a transition from medical
model practice to community-based practice. We are grateful for the opportunity to par-
ticipate in and contribute to the profession’s expanding role in prevention, health promo-
tion, and community health.
—M ARJORIE E. S CAFFA
S. M AGGIE R EITZ
2580_FM_i-xxvi 16/07/13 3:18 PM Page viii

Contributors

Abigail Baxter, PhD Erin Guillory Caraway, MS OTR

Professor Occupational Therapist
Department of Leadership and Teacher Education Physical Medicine Department
University of South Alabama Lake Charles Memorial Health System
Mobile, Alabama Lake Charles, Louisiana
Mary Frances Baxter, OT, PhD, FAOTA Roxanne Castaneda, MS, OTR/L
Associate Professor Public Health Advisor
School of Occupational Therapy Center for Mental Health Service
Texas Woman’s University Community Support Programs
Houston, Texas Substance Abuse Mental Health Services
Administration
Mary Becker-Omvig, MS, OTR/L
Rockville, Maryland
Program Manager
Howard County Office on Aging S. Blaise Chromiak, MD
Columbia, Maryland Family Practice Physician
Mobile, Alabama
Shirley A. Blanchard, PhD, ABDA, OTR/L,
FAOTA Camille Dieterle, OTD, OTR/L
Associate Professor Director
Department of Occupational Therapy USC Occupational Therapy Faculty Practice
Creighton University Assistant Professor of Clinical Occupational Therapy
Omaha, Nebraska Division of Occupational Science and Occupational
Therapy
Peter Bowman, OTD, MHS, OTR/L,
University of Southern California
OT(C), Dip COT
Los Angeles, California
Assistant Professor
Division of Occupational Therapy Joy D. Doll, OTD, OTR/L
Medical University of South Carolina Assistant Professor
Charleston, South Carolina Director
Post-Professional OTD Program
Carol A. Brownson, MSPH
Department of Occupational Therapy
Program Director
Creighton University
Advancing Chronic Care through Excellence Omaha, Nebraska
in Systems & Support (ACCESS)
George Warren Brown School of Social Work David Ensminger, PhD
Washington University in St. Louis Assistant Professor
St. Louis, Missouri Teaching and Learning Program
School of Education
Kimberly Mansfield Caldeira, MS
Loyola University Chicago
Associate Director
Chicago, Illinois
Center on Young Adult Health and Development
University of Maryland School of Public Health
College Park, Maryland

viii
2580_FM_i-xxvi 16/07/13 3:18 PM Page ix

Contributors ix

Rebecca I. Estes, PhD, OTR/L, CAPS Susan M. Nochajski, PhD, OTR/L

Associate Professor Clinical Associate Professor and Occupational Therapy
Occupational Therapy Department Program Director
Nova Southeastern University Department of Rehabilitation Science
Fort Lauderdale, Florida University at Buffalo
State University of New York
Wendy M. Holmes, PhD, OTR/L
Buffalo, New York
Associate Professor
School of Occupational Therapy Shannon Norris, OTR/L
Brenau University Private Practice Owner
Gainesville, Georgia Kids Kount
Daphne, Alabama
Sonia Lawson, PhD, OTR/L
Associate Professor Laurette Olson, PhD, OTR/L, FAOTA
Department of Occupational Therapy & Professor
Occupational Science Graduate Program in Occupational Therapy
Towson University Mercy College
Towson, Maryland Dobbs Ferry, New York
Paula Lowrey, MOT, OTR/L, CAPS Michael A. Pizzi, PhD, OTR/L, FAOTA
Occupational Therapist Assistant Professor
Independent Contractor Department of Occupational Therapy
Home Health Long Island University
Fort Lauderdale, Florida Brooklyn, New York
M. Beth Merryman, PhD, OTR/L, FAOTA Ruth Ramsey, EdD, OTR/L
Professor Associate Professor and Chair
Department of Occupational Therapy & Department of Occupational Therapy
Occupational Science Dominican University of California
Towson University San Rafael, California
Towson, Maryland
Lauren Ashley Riels, MS, OTR/L
Emily Wilson Mowrey, MS, OTR/L Occupational Therapist
Occupational Therapist Advanced Medical Personnel Services
Westerville, Ohio Hattiesburg, Mississippi
Penelope A. Moyers, EdD, OTR, FAOTA Courtney Sasse, MA EdL, MS, OTR/L
Dean Assistant Professor
Henrietta Schmoll School of Health Department of Occupational Therapy
St. Catherine University University of South Alabama
Saint Paul, Minnesota Mobile, Alabama
Peggy Strecker Neufield, PhD, OTR/L, FAOTA Janie B. Scott, MA, OT/L, FAOTA
Community Consultant and Advocate Occupational Therapy and Aging in Place Consultant
St. Louis NORC Research and Community Liaison Columbia, Maryland
St. Louis, Missouri
2580_FM_i-xxvi 16/07/13 3:18 PM Page x

x Contributors

Theresa Marie Smith, PhD, OTR/L, CLVT Lynn M. Swedberg, MS, OT

Assistant Professor Consultant, Occupational Therapist
Department of Occupational Therapy & Occupational Outreach Therapy Consultants, Inc.
Science Spokane, Washington
Towson University
Shun TAKEHARA, OTR
Towson, Maryland
Assistant Professor
Wendy B. Stav, PhD, OTR/L, SCDCM, FAOTA Department of Occupational Therapy
Chair and Professor Yamagata Prefectural University of Health Sciences
Occupational Therapy Department Yamagata City, Japan
Nova Southeastern University
Nancy Van Slyke, EdD, OTR/L, FAOTA
Fort Lauderdale, Florida
Associate Professor (Retired)
Virginia C. Stoffel, PhD, OT, BCMH, FAOTA Department of Occupational Therapy
Associate Professor University of South Alabama
Graduate Program Coordinator Mobile, Alabama
Department of Occupational Science & Technology
Donna A. Wooster, PhD, OTR/L
University of Wisconsin-Milwaukee
Associate Professor
Milwaukee, Wisconsin
Department of Occupational Therapy
President University of South Alabama
American Occupational Therapy Association Mobile, Alabama
Bethesda, Maryland
2580_FM_i-xxvi 16/07/13 3:18 PM Page xi

Reviewers

Mariana D’Amico, EdD, OTR/L, BCP Catherine McNeil, MS, OTR/L

Assistant Professor Assistant Professor
Medical College of Georgia Worcester State College
Augusta, Georgia Worcester, Massachusetts
Carolyn R. Dorfman, PhD, OTR/L Jennifer J. Saylor, MEd, OT/L
Assistant Professor Program Director, Fieldwork Coordinator
The College of St. Scholastica New Hampshire Community Technical College
Duluth, Minnesota Claremont, New Hampshire
Karen P. Funk, OTD, OTR Stacy Smallfield, DrOT, OTR/L
Clinical Associate Professor, Program Chair Assistant Professor
University of Texas at El Paso The University of South Dakota
El Paso, Texas Vermillion, South Dakota
Susan Leech, EdD, OT
Assistant Professor
University of Texas at El Paso
El Paso, Texas

xi
2580_FM_i-xxvi 16/07/13 3:18 PM Page xii

Acknowledgments

The Second Edition of this text would not have been possible without the encourage-
ment and assistance of many people who share our enthusiasm for community practice.
We would first like to acknowledge our universities, the University of South Alabama
and Towson University, for funding graduate assistants and other forms of support.
Several exceptional occupational therapy students and graduates were valuable contribu-
tors to the organization and production of this book, including Courtney Sasse from
the University of South Alabama and Marie Chandler, Stacey Harcum, Hollie Hatt,
and Stacey Greenberg from Towson University.
We are also indebted to the fine staff at F.A. Davis Company, especially Christa
Fratantoro, Senior Acquisitions Editor, for her encouragement and unwavering faith in
our work, and Peg Waltner, freelance developmental editor, for her exceptional guidance
and assistance throughout the project.
And last, but certainly not least, we would like to acknowledge the support of family
and friends. We are fortunate to have understanding, caring, and thoughtful people in our
lives, as we could not have completed this textbook without their assistance. However, our
spouses, Blaise Chromiak and Fred Reitz, deserve the South Alabama Jaguar and Towson
Tiger share of our gratitude and love for their patience as this project unfolded, evolved,
and finally came to fruition.

xii
2580_FM_i-xxvi 16/07/13 3:18 PM Page xiii

Contents

SECTION I Basic Principles and Relevant Issues 1

Chapter 1 Community-Based Practice: Occupation in Context 1
M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA
Introduction 2
Historical Perspectives of Community-Based Practice 2
Definitions of Terms 4
Health 4
Community 5
Community-Based Practice 5
Community Health Promotion 5
Community-Level Intervention 5
Community-Centered Initiatives/Interventions 5
Trends and Roles in Community-Based Practice 6
Role Descriptions 6
Characteristics of Effective Community-Based Occupational Therapy Practitioners 7
Paradigm Shifts in Occupational Therapy 8
Community Practice Paradigm 11
Characteristics of the Community Practice Paradigm 12
Conclusion 15
Chapter 2 Public Health, Community Health, and Occupational Therapy 19
M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA, AND C OURTNEY S. S ASSE , MA E D L, MS, OTR/L
Introduction 19
Public Health 20
Prevention 21
Health Promotion 21
Community Health 21
National Health Goals and Objectives for the United States 22
A Global Perspective 25
Improving Health and Well-Being Through Occupation 26
Practitioner Roles in Health Promotion and Community Health 27
Conclusion 27
Chapter 3 Theoretical Frameworks for Community-Based Practice 31
S. M AGGIE R EITZ , P H D, OTR/L, FAOTA, M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA,
AND M. B ETH M ERRYMAN , P H D, OTR/L, FAOTA
Introduction 31
Review of Terminology 32
Concepts and Constructs 32
Principle 32
Model 32
Theory 32
Paradigm 33
Conceptual Model of Practice 33

xiii
2580_FM_i-xxvi 16/07/13 3:18 PM Page xiv

xiv Contents

Theories Related To Community-Based Practice 33

Community Organization Approaches 33
Selected Health Education and Public Health Models and Theories 35
Social Cognitive Theory 35
Health Belief Model 37
Transtheoretical Model of Health Behavior Change 37
PRECEDE-PROCEED Planning Model 40
Diffusion of Innovations Model 41
Selected Occupational Therapy Models 42
Model of Human Occupation 42
Ecology of Human Performance 44
Person-Environment-Occupation Model 46
Examples of Research Using the PEO Model 46
Conclusion 47

Chapter 4 Legislation and Policy Issues 51

M. B ETH M ERRYMAN , P H D, OTR/L, FAOTA, AND N ANCY V AN S LYKE , E D D, OTR/L, FAOTA
Introduction 51
Legislation and Disabilities 53
Protection and Care Referenced Legislation 54
Educational and Developmental Referenced Legislation 54
Medical Rehabilitation Referenced Legislation 55
Civil Rights Referenced Legislation 56
Environment Referenced Legislation 56
Consumer Referenced Legislation 57
Federal and State-Level Policy and Community Practice 57
Advocacy Activities That Support Community Practice 58
Conclusion 58

SECTION II Community-Based Program Development 61

Chapter 5 Program Planning and Needs Assessment 61
M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA, AND C AROL A. B ROWNSON , MSPH
Introduction 62
Environmental Scanning and Trend Analysis 62
Program Planning Principles 63
Plan the Process 63
Plan With People 63
Plan With Data 64
Plan for Performance 64
Plan for Priorities 64
Plan for Evaluation 64
Plan for Measurable Outcomes 64
The Planning Process 64
Preplanning 65
Needs Assessment 66
Program Plan Development 71
Planning With Evidence 77
Conclusion 77
2580_FM_i-xxvi 16/07/13 3:18 PM Page xv

Contents xv

Chapter 6 Program Design and Implementation 80

J OY D. D OLL , OTD, OTR/L
Introduction 80
Mission Statement 81
Implementation Plan 82
Program Goals and Objectives 82
Participant Recruitment 84
Location and Space Issues 85
Supplies and Equipment 86
Staffing and Personnel 86
Compliance With Practice Regulations 87
Financing Options 87
Start-Up Costs 87
Funding Sources 87
Establishing Fees for Service 88
Budgeting 88
Team Development 89
Establishing Partnerships 90
Program Management 91
Program Sustainability 92
Developing a Sustainability Plan 93
Conclusion 93
Chapter 7 Program Evaluation 96
D AVID E NSMINGER , P H D, M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA,
AND S. M AGGIE R EITZ , P H D, OTR/L, FAOTA
Introduction 96
Purpose of Program Evaluation 97
Focus of Program Evaluations 97
Needs Assessment 98
Program Theory Evaluation 98
Program Implementation Evaluation 99
Program Impact Evaluation 100
Program Efficiency Evaluation 100
Approaches to Program Evaluation 101
Objectives Approach 101
Managerial Approach 102
Participatory Approach 103
Utilization-Focused Approach 104
Appreciative Inquiry Approach 105
The Process of Planning and Conducting Evaluations 105
Identifying Stakeholders 105
Developing Evaluation Questions 106
Determining Data Needs 106
Choosing Evaluation Methods 107
Utilizing Evaluation Results 108
Communicating Evaluation Results 109
Ethical Issues in Community-Based Program Evaluation 109
Conclusion 112
2580_FM_i-xxvi 16/07/13 3:18 PM Page xvi

xvi Contents

Chapter 8 Entrepreneurship and Innovation in Occupational Therapy 114

M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA, M ICHAEL A. P IZZI , P H D, OTR/L, FAOTA,
AND W ENDY M. H OLMES , P H D, OTR/L
Introduction 114
Research on Entrepreneurs 115
The Entrepreneurial Mind-Set 115
The Entrepreneurial Process 115
Intrapreneurship 116
Social Entrepreneurship 117
Entrepreneurship and Innovation 118
Occupational Therapy Entrepreneurship 119
Identification of Trends 119
Characteristics of Effective Entrepreneurs 119
Importance of Research, Skill Building, and Planning 120
Benefits and Barriers to Starting a New Business 120
Starting a New Business: The Basics 120
For-Profit or Nonprofit 121
Incorporation Process 122
Starting a For-Profit Business 122
Developing a Business Plan 123
Starting a Non-Profit Organization 124
Strategic Planning 124
Fund-Raising 125
Grant Writing 127
Grant Proposals 128
Conclusion 129
SECTION III Children and Youth 133
Chapter 9 Early Intervention Programs 133
D ONNA A. W OOSTER , P H D, OTR/L, AND A BIGAIL B AXTER , P H D
Introduction 134
EI Programs 134
Components of Early Intervention 135
Individualized Family Service Plan 136
Team Members 136
Transition Planning 137
Occupational Therapy Services in EI 137
Occupational Therapy Evaluation 137
Sensory Processing and Neuromotor Status 140
Occupational Therapy Interventions 140
Conclusion 145
Case Study 9-1 Juan 145
Case Study 9-1 Discussion Questions 146
Chapter 10 Community-Based Services for Children and Youth With Psychosocial Issues 148
L AURETTE O LSON , P H D, OTR/L, FAOTA, AND C OURTNEY S. S ASSE , MA E D L, MS, OTR/L
Introduction 148
Mental Health Disorders in Children and Youth 149
Evaluation of Children and Youth in Community-Based Settings 151
2580_FM_i-xxvi 16/07/13 3:18 PM Page xvii

Contents xvii

Considerations in Designing Interventions for Children and Youth 152

Intervention Approaches for Community-Based Programming 153
Interventions to Develop Self-Regulation 154
Interventions to Increase Social and Task Competence 154
Family-Based Interventions 155
After School Programs 156
Family-Based Programming in ASPs 157
Summer Camps 158
Conclusion 159
Case Study 10-1 Sean and Serena 160
Case Study 10-1 Discussion Questions 161
SECTION IV Productive Aging 167
Chapter 11 Driving and Community Mobility for Older Adults 167
W ENDY B. S TAV , P H D, OTR/L, SCDCM, FAOTA
Introduction 168
Contributions of Driving and Community Mobility 168
Consequences of Not Engaging in Community Mobility 169
Alternatives to Driving 169
Driving and Community Mobility Practice 171
Driving Rehabilitation Program Development 171
Role of Occupational Therapy Practitioners in Interventions 174
Interventions With the Person 174
Interventions With Organizations 175
Interventions With Populations 176
Conclusion 177
Case Studies 177
Case Study 11-1 Mr. Martin 177
Case Study 11-1 Discussion Questions 177
Case Study 11-2 Mrs. Brown 178
Case Study 11-2 Discussion Questions 178
Chapter 12 Adult Day Services Programs and Assisted Living Facilities 180
C OURTNEY S. S ASSE , MA E D L, MS, OTR
Introduction 180
Regulatory and Accrediting Agencies 181
Continuum of Care and Program Models 181
Adult Day Services Programs and Home Care Agencies 182
Independent Living Communities 183
Assisted Living Facilities 183
Nursing Homes 184
Occupational Therapy Roles 185
Maintaining and Maximizing Independence 185
Managing Chronic Conditions 186
Enhancing Quality of Life 186
Safety, Security, and Support for Caregivers and Community 187
Conclusion 187
Case Study 12-1 Nina and Jim 188
Case Study 12-1 Discussion Questions 189
2580_FM_i-xxvi 16/07/13 3:18 PM Page xviii

xviii Contents

Chapter 13 Low Vision Services in the Community 191

T HERESA M ARIE S MITH , P H D, OTR/L, CLVT
Introduction 191
Low Vision and Occupational Performance 192
Low Vision Rehabilitation Team 193
Occupational Therapy for Clients With Low Vision 193
Low Vision Practice Settings 193
Referrals for Occupational Therapy 194
Intervention for Clients With Low Vision 195
Person 195
Environment 196
Occupation 196
Psychosocial Issues Associated With Low Vision 196
Low Vision Community Support 197
Funding and Billing Issues for Low Vision Occupational Therapy Services 197
Conclusion 198
Case Study 13-1 Mrs. Kindred 198
Case Study 13-1 Discussion Questions 199
Chapter 14 Fall Prevention 201
K IMBERLY M ANSFIELD C ALDEIRA , MS, AND M ARY B ECKER -O MVIG , MS, OTR/L
Introduction 201
Fall Prevention in a Rural Senior Center 201
Overview of the Project 201
Needs Assessment 202
Program Planning 202
Program Implementation 204
Program Evaluation 204
Aging in Place Initiative 205
Conclusion 207
Case Study 14-1 Ms. Fay 207
Case Study 14-1 Discussion Questions 208
Chapter 15 Aging in Place and Naturally Occurring Retirement Communities 210
P EGGY S TRECKER N EUFELD , P H D, OTR/L, FAOTA
Introduction 210
Societal Trends Impacting Aging in Place and Implications 211
NORC: A Solution for Successful Aging in Place 212
Research Evidence Linking Healthy Aging, Community Characteristics,
and Occupations 214
Occupational Therapy Roles in Aging in Place Communities and NORCs 214
Conclusion 217
Case Study 15-1: Morris, Finding Purpose in Helping Others 218
Case Study 15-1 Discussion Questions 219
SECTION V Work and industry 223
Chapter 16 Ergonomics and Prevention of Work-Related Injuries 223
P ETER B OWMAN , OTD, MHS, OTR/L, OT(C), D IP COT
Introduction 224
Ergonomics Definitions and History 224
2580_FM_i-xxvi 16/07/13 3:18 PM Page xix

Contents xix

Role of Occupational Therapy in Community Ergonomics 225

General Ergonomic Considerations 225
Posture, Positioning, and Lifting 225
Cognitive Workload 226
Psychosocial Factors 228
Sites for Community Ergonomics 228
Home 229
Recreation Sites 229
Workplace 230
Universal Design 230
Occupational Risks and Common Work Injuries 232
Injury Prevention 233
Comprehensive Work-Related Ergonomic Evaluation: Worker Assessment 235
Objective Assessment 235
Work Location Assessment 236
Occupational Therapy Intervention Evidence 236
Return to Work and Work Modification 237
Computer Equipment and Accessories 238
Laptop/Notebook Computer Issues 238
Program Development and Business Consultation 239
Conclusion 239
Case Study 16-1 Sandy 239
Case Study 16-1 Discussion Questions 241
Chapter 17 Work and Career Transitions 243
S USAN M. N OCHAJSKI , P H D, OTR/L, AND S. M AGGIE R EITZ , P H D, OTR/L, FAOTA
Introduction 243
Transitioning From School to Employment 244
Role of Occupational Therapy in School to Work Transition 244
Community-Based School to Work Transition Programs 245
School to Work Transitions Program 245
Transitioning to Work Following a Disability 248
Transitioning to Active Duty or Civilian Employment 249
Transition to Retirement 251
Occupation-Based Retirement Planning 251
Bridge Employment 251
Legacy Planning in Employment and Volunteer Settings 252
Conclusion 252
Case Study 17-1 Carol 253
Case Study 17-1 Discussion Questions 254
Chapter 18 Welfare to Work and Ticket to Work Programs 257
E MILY W ILSON M OWREY , MS, OTR/L, AND L AUREN A SHLEY R IELS , MS, OTR/L
Introduction 257
Welfare to Work 258
History of Welfare Reform 258
Recipient and Participant Demographics 258
Assessment of Welfare to Work Programs 259
Issues Related to Welfare to Work Transition 259
Causes of Low Job Retention 259
Enhancing Success in Welfare to Work Programs 260
2580_FM_i-xxvi 16/07/13 3:18 PM Page xx

xx Contents

Occupational Therapy in Welfare to Work Programs 260

Occupational Therapy Roles 261
Barriers to Occupational Therapy Practice in Welfare to Work Programs 262
The Future of Occupational Therapy in Welfare to Work Programs 263
Ticket to Work Programs 263
Background 264
Employment Networks 264
Implementation Process 264
Payment Systems 265
Benefits and Limitations of the Ticket to Work Program 265
Implications for Occupational Therapy 267
Conclusion 267
Case Study 18-1 Aundria 268
Case Study 18-1 Discussion Questions 268
Case Study 18-2 Austin 269
Case Study 18-2 Discussion Questions 269
SECTION VI Mental Health 271
Chapter 19 Community Mental Health Programs 271
R UTH R AMSEY , E D D, OTR/L
Introduction 272
Theoretical and Conceptual Models 273
Stress-Vulnerability Model 274
Psychiatric/Psychosocial Rehabilitation Models 274
Recovery Model 275
Occupation-Based Approach 275
Community-Based Services for People With Serious Mental Illness 276
Partial Hospitalization/Intensive Outpatient Programs 276
Home Health Services 277
Peer Support and Peer-Run Programs 278
Supported Education Programs 278
Veterans Support Services 279
Transitional Housing 279
Evidence-Based Practices 280
Assertive Community Treatment 280
Supported Employment 281
Permanent Supportive Housing 282
Illness Management and Recovery 283
Family Support and Education 283
Occupational Therapy in Community Mental Health Settings 284
Role of Occupational Therapists 284
Occupational Therapy Evaluation and Interventions 284
Funding For Community-Based Mental Health 286
Conclusion 287
Case Study 19-1 Antonio 287
Case Study 19-1 Discussion Questions 288
2580_FM_i-xxvi 16/07/13 3:18 PM Page xxi

Contents xxi

Chapter 20 Community-Based Approaches for Substance Use Disorders 292

M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA, L AUREN A SHLEY R IELS , MS, OTR/L, P ENELOPE A.
M OYERS , E D D, OTR, FAOTA, AND V IRGINIA C. S TOFFEL , P H D, OT, BCMH, FAOTA
Introduction 292
Substance Use Terminology 293
Substance Use Disorders and Occupation 293
Community-Based Substance Abuse Services 295
Crisis Intervention 295
Intensive Outpatient Programs 296
Evidence-Based Practices 298
Brief Interventions 298
Motivational Approaches 299
Motivational Interviewing 300
Motivational Enhancement Therapy 301
Cognitive-Behavioral Approaches 301
Occupational Therapy in Substance Abuse Programs 303
Conclusion 304
Case Study 20-1 Richard 305
Case Study 20-1 Discussion Questions 306
Chapter 21 Forensic Mental Health Practice Within the Community 309
R OXANNE C ASTANEDA , MS, OTR/L, AND S. M AGGIE R EITZ , P H D, OTR/L, FAOTA
Introduction 309
Entry Process to Criminal Justice System and/or the Forensic Mental Health System:
Client, Defendant, or Inmate? 310
Court System 310
Criminal Justice System 311
Forensic Mental Health System 311
Route to Community Reintegration 311
Defendant/Inmate 311
Adjudicated Not Criminally Responsible 312
Role of Occupational Therapy Community Re-entry With Forensic Clients 312
Challenges to Community Intervention 313
Public Safety 313
Cultural Dynamics of Criminal Justice and Forensic Mental Health Contexts 314
Institutional Jail/Maximum Security Hospital 314
Person 315
Community Agency Context 315
Mental Health Recovery Movement 315
Occupational Therapy Community Practice With Persons With Mental Health and
Criminal Justice/Forensic Involvement 316
Occupational Therapy Community Consultation-Liaison Service 316
Conclusion 318
Case Study 21-1 Aretha 318
Case Study 21-1 Discussion Questions 319
2580_FM_i-xxvi 16/07/13 3:18 PM Page xxii

xxii Contents

SECTION VII Rehabilitation and Participation 321

Chapter 22 Accessibility and Community Integration 321
J ANIE B. S COTT , MA, OT/L, FAOTA
Introduction 322
Accessibility Issues 322
Home Accessibility 323
Community Accessibility 323
Community Mobility 324
Personal Transportation 324
Public Transportation 325
Transportation Safety 325
Community Integration 325
Community Integration Post-Injury or Illness 326
Leisure and Recreation 327
Work 327
Wounded Warrior Project 328
Advocacy 328
Conclusion 328
Case Study 22-1 Veretta 329
Case Study 22-1 Discussion Questions 329
Case Study 22-2 Paul 330
Case Study 22-2 Discussion Questions 330
Chapter 23 Independent Living Centers 332
C OURTNEY S. S ASSE , MA E D L, MS, OTR/L
Introduction 332
History and Philosophy of the Independent Living Movement 333
History 333
Philosophy 334
Leaders and Advocates of the Independent Living Movement 334
Independent Living Programs: Meaningful Participation in the Community 336
The Four Core Services of Independent Living Programs and Centers 337
The Role of Occupational Therapy in Independent Living Centers 338
Preventive Occupational Therapy Services 339
Health Promotion Services 339
Services for Special Populations 340
The Future of Independent Living Centers 341
Conclusion 342
Case Study 23-1 Marianne 343
Case Study 23-1 Discussion Question 344
Chapter 24 Technology and Environmental Interventions in Community-Based Practice 346
R EBECCA I. E STES , P H D, OTR/L, P AULA L OWREY , MOT, OTR/L,
AND M ARY F RANCES B AXTER , P H D, OT, FAOTA
Introduction 346
Technology and Environmental Intervention Outcomes 347
Universal Design 348
Wheeled Mobility 349
2580_FM_i-xxvi 16/07/13 3:18 PM Page xxiii

Contents xxiii

Communication Technology 351

Computer Access 352
Universal Design in Computer Use 353
Adaptations for Computer Access 353
Home Modifications and Electronic Aids to Daily Living 354
Electronic Aids to Daily Living 355
Funding for Home Modification 355
Advanced Training in Home Modification 356
Conclusion 356
Case Study 24-1 RP 357
Case Study 24-1 Discussion Questions 357
SECTION VIII Health Promotion and Wellness 359

Chapter 25 Occupational Therapy in Faith-Based Organizations 359

L YNN M. S WEDBERG , MS, OT, AND S HIRLEY A. B LANCHARD , P H D, ABDA, OTR/L, FAOTA
Introduction 360
Historical Background 360
Faith Community as a Resource 360
Faith Communities and Health 360
Spirituality and Health 361
Occupational Therapy and Spirituality 361
Need for Occupational Therapy Involvement in Faith-Based Organizations 362
Health Ministry 362
Functions and Roles of the Faith-Community Practitioner as Health Minister 363
Disability Ministry 367
Missions and Outreach 367
Other Community-Based Occupational Therapy Roles in Faith-Based
Organizations 368
Recommended Training and Experience 369
Ethical Considerations 370
Self-Care 370
Future Directions 370
Conclusion 371
Case Study 25-1 Elaine 372
Case Study 25-1 Discussion Questions 372
Chapter 26 Lifestyle Redesign Programs 377
C AMILLE D IETERLE , OTD, OTR/L
Introduction 377
Lifestyle Redesign Defined 378
Development of Lifestyle Redesign 379
Key Components of the Lifestyle Redesign Intervention Created for the USC
Well Elderly Study 381
Lifestyle Redesign Programs and Applications Since the USC Well Elderly Study 382
Lifestyle Redesign Weight Management Program 383
Lifestyle Redesign for Diabetes 385
Lifestyle Redesign for Chronic Headaches 385
Lifestyle Redesign for the College Student 385
2580_FM_i-xxvi 16/07/13 3:18 PM Page xxiv

xxiv Contents

Lifestyle Redesign for Mental Health 385

Lifestyle Redesign Interventions Outside of USC Settings 386
Reimbursement for Lifestyle Redesign 386
Conclusion 386
Cases Study 26-1 Linda 387
Case Study 26-1 Discussion Questions 387
Chapter 27 Occupational Therapy in Primary Health Care Settings 390
S. BLAISE CHROMIAK, MD, MARJORIE E. SCAFFA, PHD, OTR/L, FAOTA, AND SHANNON NORRIS, OTR/L
Introduction 390
Primary Health Care Services 391
Health Promotion in Primary Care Settings 393
Weight Loss 395
Tobacco Use and Smoking Cessation 396
Low Back Pain 397
Family and Intimate Partner Violence 397
Mental Health 398
Integrating Health Promotion Practices Into Routine Primary Care 400
Brief Office Interventions 400
Health Literacy Interventions 401
Chronic Disease Self-Management 401
Developing Health Promotion Programs for Primary Care 402
Working With Primary Care Physicians 404
Marketing Occupational Therapy Services to Physicians in Primary Care 404
Funding Occupational Therapy Services in Primary Care 405
Conclusion 405
Case Study 27-1 Doris 406
Case Study 27-1 Discussion Questions 406
Chapter 28 Health Promotion Initiatives Within Academic Communities 409
J ENNA Y EAGER , P H D, OTR/L, S. M AGGIE R EITZ , P H D, OTR/L, FAOTA, M. B ETH M ERRYMAN ,
P H D, OTR/L , F AOTA , AND S ONIA L AWSON , P H D, OTR/L
Introduction 409
Policy Support for Occupational Therapy Involvement in Health Promotion in
Academic Communities 410
Healthy Campus Task Force 411
Promoting a More Inclusive Environment for Individuals With Psychiatric
Disabilities 412
Stroke Support Group 413
General Education/Core Curriculum Courses 415
Leisure and Health Course: Overview 415
Leisure and Health Course: Philosophical and Theoretical Foundation 415
Flow Theory 416
Model of Human Occupation 416
Health Belief Model 416
Leisure and Health Course: Assignments 416
Leisure and Health Course: Assessment 417
Leisure and Health Course: Replicability 417
Conclusion 418
2580_FM_i-xxvi 16/07/13 3:18 PM Page xxv

Contents xxv

SECTION IX Looking Ahead 421

Chapter 29 Future Directions in Community-Based Practice 421
M ARJORIE E. S CAFFA , P H D, OTR/L, FAOTA, E RIN G UILLORY C ARAWAY , MS, OTR,
AND S HUN TAKEHARA, OTR
Introduction 422
An Ecological Worldview 422
Creating Opportunities in the Community 423
Innovative Ideas Put Into Action 424
Transition Services for Youth With Disabilities 424
Obesity Prevention and Intervention 426
Driving Across the Life Span 427
Aging-in-Place Home Modifications 427
Telerehabilitation 428
The Influence of Occupational Justice: An International Example 429
Implications for Professional Preparation and Education 429
Community Service Learning 432
Implications for Research in Community-Based Practice 433
Diffusion of Innovations 434
Conclusion 434
Case Study 29-1 Yuriko 435
Case Study 29-1 Discussion Questions 437
Index 441
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