A Survey of Occupational Therapy in the U.S. Criminal Justice System Emily Moreton, OTS, Audra Sitterly, OTS & Jaime Muñoz, PhD, OTR/L, FAOTA - Duquesne University, Pittsburgh, PA

PURPOSE: To generate a descriptive analysis of occupational therapy practice in the U.S. Criminal Justice System and

to gauge interest for creating a network of practitioners, researchers, and educators

DESIGN: Survey research utilizing on-line program [Survey Monkey ®]

OBJECTIVES:

•  Describe the current baseline status of OT educational training, intervention programming, and research

•  Identify OT practice models guiding interventions, frequently used assessments, and 1:1 and group interventions

•  Establish a foundation for creating a network for occupational therapists working in the criminal justice system

SCOPE OF THE PROBLEM

•  >2 million Americans are incarcerated at any given time.1

•  67% of those released reoffend and are rearrested within 3 years of their release.2

•  Women are one of the fastest growing segments of the correctional population; increasing 3.4% per year. 3

THE CRIMINAL JUSTICE SYSTEM: AN OCCUPATIONAL PERSPECTIVE

•  People in the criminal justice system often present with a myriad of occupational performance problems. 4

•  Occupational deprivation in the prison environment can lead to abandonment of participation in natural occupations.5

•  Occupational therapists can apply principles of person environment interaction to limit the impact of occupational

deprivation and encourage opportunities for participation in meaningful occupations pre and post release.5,6,7

•  Within the U.S., occupational therapists have slowly begun to address the unmet needs of this population.4,8

•  Educational programs are creating SL and FW experiences in jails, prisons and community corrections settings.4,8,9

•  The 42 respondents (33 females, 9 males) were practitioners and educators with experience in correctional settings

•  45% held a Masters degree, 26% had Doctorates, 26% held a Baccalaureate degree, and 3% an Associates degree

•  36% spent 0-2 years, 36% spent 2-6 years, and 28% spent 6 or more years working in a corrections setting

•  The sample appears committed to this area of practice: 35.7% presented at a state OT conference, 33.3% at a

national OT conference, 11.9% published in a peer-reviewed journal, 11.9% published in a professional magazine

CONCEPTUAL FRAMEWORK SURVEY RESULTS: Demographics SURVEY RESULTS: Creating a Network

DISCUSSION

SAMPLE: Database of OTs maintained by PI (N=90); used snowball sampling and asked OT program directors to

share survey link with colleagues working in corrections; final sample N=98; overall response rate = 46%

DATA COLLECTION TOOLS:

•  5 Demographic Items: Ed. level, gender, years of experience, participation in scholarship

•  17 Experience Items: Past/current experiences, settings/population; routinely used assessments, OT practice

models, 1:1 and group interventions; and measurement of research and/or program outcomes

•  7 Networking Items: Contact info, strategies for networking, and specific goals/priorities for a network

DATA ANALYSIS METHODS:

•  Organized categorical data and analyzed these data using descriptive statistics

•  All open-ended responses analyzed using qualitative code-recode strategies

•  Triangulation by analysts (3) to verify and confirm coding decisions

SURVEY RESULTS: Practice Settings, Group Interventions & Assessments

•  Many respondents reported they did not routinely use valid and reliable OT assessments that are readily available

•  Respondents emphasized that a corrections website should include information and resources on OT programming,

collaborative research opportunities, and descriptions of and strategies for OT education in criminal justice settings.

•  52% implemented OT programs in secure settings; 50% supervised Level 1 FW, 33% Level II FW, and 40% SL

experience; 31% completed independent research projects; 24% supervised student research projects

•  Types of setting where respondents worked were

equally split between traditional institutions and

community-based settings

• Correction Centers • Homeless Shelters • Work Release Programs • Drug/Alcohol Treatment • Youth Offender Facility

•  Jails • Prisons • Forensic MH

Hospitals Traditional Institutions:

52%

Community-Based: 48%

0 5 10 15 20 25

WRI GAS

OPHI II OCAIRS

KAWA Model COPM

Don’t routinely use any

1

3

4

5

6

15

23

Interview Assessments

0 5 10 15 20

SAQ ACS ILSS

Role Checklist Interest Checklist

OSA Sensory Profile

Do not routinely use any

1 1 1

8 10 10

11 19

Self-Report Asessments

0 10 20 30 40

OTTOS

MOHOST

COTE Scale

Don't routinely use any

2

3

4

34

Observation Assessments

0 5 10 15 20 25

EFPT

MoCA

Texas Functional Living

KELS

ACL

Don't routinely use any

1

1

2

6

11

25

Performance Assessments

MOHO

CMOP & Cognitive Disabilities

PEOP

PEO & OA

SI & EHP

KAWA

OT Practice Models

•  At least half (57%) routinely used OT practice models

to guide their approach in corrections; some (37%)

used non-OT models e.g. Cognitive Behavioral,

Recovery Model or Transtheoretical Model

Percentage of Respondents Using Group Interventions

•  A range of other group interventions used less often included recovery,

assertiveness, anxiety management, or cooking and nutrition skills, MH

awareness and education, computer and technology skills, addiction

management, and/or gender specific issues.

76%

62%

59%

51%

49%

46%

41%

70%

•  Interpersonal Communication/Social Skills

•  Problem Solving Skills

•  Stress Management •  Coping Skills •  Goal Setting Skills

•  Employment Skills; Re-entry Skills; Wellness Skills

•  Leisure Skills

•  Budgeting & Financial Management Skills; Health & Fitness Skills

•  Anger Management

65%

REFERENCES 1. Shivy, V. A., Wu, J. J., Moon, A. E., Mann, S. C., Holland, J. G., & Eacho, C. (2007). Ex-offenders reentering the workforce. Journal of Counseling Psychology, 54(4), 466-473. doi:10.1037/0022-0167.54.4.466. 2. National Institute of Justice (2010). Recidivism. Retrieved May 16, 2014 from: http://www.nij.gov/topics/corrections/recidivism/Pages/welcome.aspx. 3. U.S. Department of Justice, Bureau of Justice Statistics ( December 19, 2014). U.S. correctional population declined by less than 1 percent for the second consecutive year. Retrieved March 13, 2015 from htttp://www.bjs.gov/content/pub/press/spus13pr.cfm 4.  Muñoz, J.P. (2011). Mental health practice in forensic settings. In, C. Brown V.C. Stoffel & J.P. Muñoz (Eds.) Mental health in occupational therapy: A vision for the future (pp. 526-545). Philadelphia: F.A. Davis. 5.  Molineux, M., Whiteford, G.E., (1999). Prisons: From occupational deprivation to occupational enrichment. Journal of Occupational Science, 6(2), 124-130 6.  Eggers M., Muñoz, J., Sciulli, J., & Crist, P. (2006) The community reintegration project: Occupational therapy at work in a county jail. Occupational Therapy in Health Care, 20(1), 17- 37. 7.  O’Connell, M. & Farnworth, L. (2007). Occupational therapy in forensic psychiatry: A review of the literature and a call for a united and international response. British Journal of Occupational Therapy, 70(5), 184-191. 8.  White, J., Grass, C.D., Hamilton, T.B., & Rogers, S. (2013). Occupational therapy in criminal justice. In E. Cara and A. MacRae (Eds), Psychosocial occupational therapy: An evolving practice, pp. 715-773. Clifton Park, NJ: Delmar, Cenage Learning. 9.  Provident, I. Joyce-Gaguzis, K. (2005). Brief Report- Creating an occupational therapy level II fieldwork experience in a county jail setting. American Journal of Occupational Therapy. 59,101-106. 10.  AOTA (2006). AOTA’s centennial vision. Retrieved March 30, 2015 from https://www.aota.org/-/media/Corporate/Files/AboutAOTA/Centennial/Background/Vision1.pdf

•  A small cadre of practitioners has established a foothold for OT in criminal justice settings.

•  On the whole, these practitioners are well-educated, experienced with corrections populations/settings, and many

actively share their work in presentations and some publications.

•  OT has established some presence in both traditional institutions and community-based correctional settings and many

educational opportunities for OT students to showcase OT’s role with criminal justice populations have been created.

•  Enacting AOTA’s Centennial Vision10 requires evidence-based decision-making. Routine use of practice models support

this aspect of the CV, but in order to do so, more OTs must routinely use practice models to guide therapy processes.

•  O’ConnelI & Farnworth advocated for OTs to use valid outcome measures in correctional settings.7 These results

suggest we have been slow to answer this call and that reliable, readily available OT assessments are not routinely

being used in corrections settings.

•  The respondents in this study overwhelmingly believe that networking and collaboration on education, intervention

programming and research efforts is the key to advancing OT’s role in the criminal justice system.

Methods for Networking Most Likely to Use Less Likely to Use

•  Respondents primarily favored web-based approaches for

networking including using existing AOTA platforms

Priorities for an OT Corrections Network

• Clear networking priorities were identified, with advocacy

and practice issues defined as the most important goals

Mentorship

Educational Placements

Research

Assessment

Intervention Programming

Advocacy

LIMITATIONS

•  Sampling: Our sampling approach was limited by our initial database (N=98; Response Rate= 46%) and word of mouth.

It is impossible to know what percentage of the total population of OTs in corrections is reflected in our results.

•  Methods: Our survey was a 2nd generation tool used in a pilot study and modified based on results and feedback.

Nonetheless, it is possible that different respondents may have interpreted some open-ended items differently.

OT Connections Page

Corrections Listserve

Corrections Webpage

AOTA Corrections SIS

Twitter Account

Wiki Site

Online Meet-up Space

Facebook Page

RESEARCH OBJECTIVES

METHODS