Occupational Therapy Service Delivery Among Medicaid-Enrolled Children and Adults on the Autism Spectrum and With Other Intellectual Disabilities

Importance: Rates of occupational therapy service utilization among people with autism spectrum disorder (ASD) or intellectual disability (ID) have not been explored in population-based samples. Objective: To describe occupational therapy services delivered to Medicaid-eligible persons younger than age 65 yr identified as having ASD, ID, or both and to evaluate demographic factors associated with occupational therapy service utilization in this population. Design: Retrospective, case–control, cohort study using claims records from Medicaid Analytic eXtract files (2009–2012). Setting: Data from all 50 states and Washington, DC. Participants: Beneficiaries identified as having ASD only, ASD+ID, or ID only who were younger than age 18 yr (N = 664,214) and ages 18–64 yr (N = 702,338). Outcomes and Measures: We analyzed Current Procedural Terminology® and Healthcare Common Procedure Coding System procedure codes, Medicaid Statistical Information System type of service codes, and Center for Medicare & Medicaid Services provider specialty codes. Results: Only 3.7% to 6.3% of eligible adult beneficiaries received occupational therapy; in contrast, 20.5% to 24.2% of children received occupational therapy. Significant predictors of service use varied by group; however, differences by race–ethnicity, eligibility on the basis of poverty, and geographic location were observed. Among children, the most frequent billing code was for “therapeutic activities” (43%–60%); among adults, it was “community/work reintegration training” (29%–39%). Conclusions and Relevance: Billed procedure code patterns do not consistently reflect the unique occupational focus that occupational therapy providers deliver to people with developmental disabilities. Disparities in occupational therapy receipt warrant further attention to understand the social and structural factors affecting service delivery. What This Article Adds: Occupational therapy services paid for by Medicaid are used more frequently by children with ASD and ID than by adults with these diagnoses. Greater understanding of the intersectional factors that drive service delivery and disparities is needed.

Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions

Importance: Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. Objective: To evaluate how acute occupational therapy service delivery factors affect readmission risk. Design: Cross-sectional, retrospective study. Setting: Single academic medical center. Participants: Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. Results: Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). Conclusions and Relevance: For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy’s role in the U.S. quality-focused health care system.

Establishing a New Music Therapy Service in an Aged-Care Centre with Multiple Settings: The Journey of a Music Therapy Student

<p>This exegesis describes my journey as a music therapy student navigating a practicum placement with older people, in a facility where there had been no previous music therapy service. My uncertainty about beginning the placement was compounded by the fact that major renovations were taking place at the facility, and low staff numbers meant I was left largely to my own devices. The fact that music therapy is a young profession was clearly going to have an impact on how I went about building my own practice as a music therapy student within the facility. This study was therefore motivated by my desire to explore my process of establishing a new service in a healthcare setting and to share the strategies I developed. Using secondary analysis of data as my research approach I have analysed my meeting notes and a self-refective journal to explore both the advantages and challenges of building a music therapy program as a student. Seven preliminary themes have emerged including ‘Developing relationships with staff and fnding support within the institution’; ‘Educating people about the role of music therapy’; and ‘Coming to terms with institutional constraints’. I needed to ‘Develop relationships with participants and family members’, ‘Develop various music therapy programmes for different settings’, and I learned about ‘Taking risks’ and ‘Engaging in self-refexive practice’. The study supports previous research about the challenges of implementing a new service in a facility, including the requirement for high levels of communication/language skills and the need to fulfl multiple roles. It also confrms research that shows that some of these communication skills go beyond the training undertaken by music therapists. This study suggests that this might be remedied through coursedevelopment within tertiary music therapy education programmes, and courses and conferences through professional music therapy organisations.</p>

Establishing a New Music Therapy Service in an Aged-Care Centre with Multiple Settings: The Journey of a Music Therapy Student

<p>This exegesis describes my journey as a music therapy student navigating a practicum placement with older people, in a facility where there had been no previous music therapy service. My uncertainty about beginning the placement was compounded by the fact that major renovations were taking place at the facility, and low staff numbers meant I was left largely to my own devices. The fact that music therapy is a young profession was clearly going to have an impact on how I went about building my own practice as a music therapy student within the facility. This study was therefore motivated by my desire to explore my process of establishing a new service in a healthcare setting and to share the strategies I developed. Using secondary analysis of data as my research approach I have analysed my meeting notes and a self-refective journal to explore both the advantages and challenges of building a music therapy program as a student. Seven preliminary themes have emerged including ‘Developing relationships with staff and fnding support within the institution’; ‘Educating people about the role of music therapy’; and ‘Coming to terms with institutional constraints’. I needed to ‘Develop relationships with participants and family members’, ‘Develop various music therapy programmes for different settings’, and I learned about ‘Taking risks’ and ‘Engaging in self-refexive practice’. The study supports previous research about the challenges of implementing a new service in a facility, including the requirement for high levels of communication/language skills and the need to fulfl multiple roles. It also confrms research that shows that some of these communication skills go beyond the training undertaken by music therapists. This study suggests that this might be remedied through coursedevelopment within tertiary music therapy education programmes, and courses and conferences through professional music therapy organisations.</p>

Developing an International Occupational Therapy Service: Perspectives and Implications

Mali is one of the poorest countries in sub-Saharan Africa. Limited infrastructure renders access to health care difficult. There is a need to establish functional ways to improve Malian people’s health and treat disability. From this point of view, our project aims to implement a remote occupational therapy service for the beneficiaries of the Kalana clinic in Mali through international cooperation. Using a spiral iterative model, a proposal for a remote occupational therapy service was developed and refined for a multidisciplinary context. The International Classification of Functioning, Disability, and Health (ICF) was used as a means to work from a multidisciplinary approach to treat all needs. The results are exemplified with a case report and qualitative impressions of the services.