Annals of International Occupational Therapy

Case Study Supplemental Data

Development and Implementation of a Viable Level II Occupational Therapy Fieldwork Program in a Juvenile Justice Setting

Virginia E. Koenig, OTD, MSA, OTR/L

Abstract

Objective:

This article introduces a paradigm that was developed and used to create a viable Level II fieldwork program in a juvenile detention center. Elements of this paradigm can be used by occupational therapy (OT) professionals and OT entrepreneurs to establish sustainable Level II fieldwork programs in juvenile detention facilities or other emerging practice settings that address the psychosocial, health, and wellness needs of children and adolescents.

Methods:

After institutional review board approval was received, retrospective data analysis was used to measure OT students' satisfaction with the Level II emerging practice fieldwork experience that was created with the paradigm introduced in this report. A convenience sample of OT students who participated in this specific fieldwork program, based at a juvenile detention center over a 3-year, period was used to determine the efficacy of the program design (N = 10).

Results:

Retrospective data analysis of student evaluation forms showed favorable responses to the overall fieldwork experience. The OT students who participated in this fieldwork program reported that the experience was well structured, purposeful, and organized. Students also reported that the learning elements that were introduced during the fieldwork experience contributed positively to their professional development and knowledge of OT practice.

Conclusion:

The paradigm presented in this report provides a resource for the development of sustainable and suitable Level II OT fieldwork programs in juvenile justice and similar emerging practice settings. Limitations include a risk of sampling error (bias) because of the small sample size and the limited number of OT articles on the development of Level II OT fieldwork programs in juvenile detention centers. Further research is needed to determine the efficacy of OT interventions in juvenile detention centers and to establish how experiential learning in this emerging practice setting contributes to students' continued professional development and expanding knowledge of OT practice. [Annals of International Occupational Therapy. 2021;4(1):44–52.]

Abstract

Objective:

This article introduces a paradigm that was developed and used to create a viable Level II fieldwork program in a juvenile detention center. Elements of this paradigm can be used by occupational therapy (OT) professionals and OT entrepreneurs to establish sustainable Level II fieldwork programs in juvenile detention facilities or other emerging practice settings that address the psychosocial, health, and wellness needs of children and adolescents.

Methods:

After institutional review board approval was received, retrospective data analysis was used to measure OT students' satisfaction with the Level II emerging practice fieldwork experience that was created with the paradigm introduced in this report. A convenience sample of OT students who participated in this specific fieldwork program, based at a juvenile detention center over a 3-year, period was used to determine the efficacy of the program design (N = 10).

Results:

Retrospective data analysis of student evaluation forms showed favorable responses to the overall fieldwork experience. The OT students who participated in this fieldwork program reported that the experience was well structured, purposeful, and organized. Students also reported that the learning elements that were introduced during the fieldwork experience contributed positively to their professional development and knowledge of OT practice.

Conclusion:

The paradigm presented in this report provides a resource for the development of sustainable and suitable Level II OT fieldwork programs in juvenile justice and similar emerging practice settings. Limitations include a risk of sampling error (bias) because of the small sample size and the limited number of OT articles on the development of Level II OT fieldwork programs in juvenile detention centers. Further research is needed to determine the efficacy of OT interventions in juvenile detention centers and to establish how experiential learning in this emerging practice setting contributes to students' continued professional development and expanding knowledge of OT practice. [Annals of International Occupational Therapy. 2021;4(1):44–52.]

Substantial evidence within the study and practice of occupational therapy (OT) shows the overall effectiveness and value of OT services with at-risk populations; however, few reproducible descriptions of Level II OT fieldwork programs in emerging practice settings, such as juvenile detention centers, have been published (Merryman & Synovec, 2017). The American Occupational Therapy Association's (AOTA) Vision 2025, which builds on the work of AOTA's Centennial Vision, identifies the psychosocial needs of children and youth and health and wellness consulting as two of five practice areas that are generating new business opportunities for OT professionals (AOTA, 2017). The goal of this report is to introduce a formalized, structured juvenile detention center Level II fieldwork paradigm to OT professionals and entrepreneurs that may also have application to other emerging practice settings, particularly those that address the psychosocial, health, and wellness needs of children and youth. Elements of this paradigm can be used as a resource by OT practitioners for similar program development. This paradigm is in alliance with AOTA's Commission of Education guidelines for Level II OT fieldwork experiences and meets state and federal regulations governing OT practice in emerging practice settings. Further, this Level II fieldwork program maximizes student learning in context and supports occupation-based practice with interventions that reflect the lifestyle and circumstances of a specific population (AOTA, 2020a). Dissemination of information on the development of emerging practice fieldwork programs helps to establish evidence-based practices and procedures to create, implement, and promote OT in emerging practice settings.

The goals of this Level II fieldwork program, at a New York secure juvenile detention center, are distinct from the goals of this report. Goals are student focused and designed to provide OT students with a hands-on fieldwork learning experience and to offer OT fieldwork students opportunities to provide youth within the facility with a variety of structured, occupation-based interventions that can help to maximize their independence with life management skills. With the use of evidence-based research, the Occupational Therapy Practice Framework, 3rd edition (AOTA, 2014), the Fieldwork Performance Evaluation for the Occupational Therapy Student, and an independent Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, I created and implemented a Level II psychosocial fieldwork program in a custody/security level New York-based juvenile detention center. The fieldwork program runs for 12 weeks, twice per year, from May to July and from October to January. The program is limited to two students per cycle. No OT is provided within this facility outside of the fieldwork program. No compensation or reimbursement is provided for the OT services provided to adolescents detained within this facility during the fieldwork series. This self-directed and dynamic Level II fieldwork program has proven successful based on its sustainability and favorable feedback from students.

This report provides examples of practice parameters used to develop this fieldwork program that can be helpful to other OT stakeholders who are developing fieldwork programs for emerging practice settings that address the psychosocial, health and wellness needs of children and youth or other at-risk populations. This program is based on the framework of occupational justice, an emerging theory of occupational justice and injustice. Structural and contextual factors, such as incarceration, can lead to circumstances that limit occupational engagement; therefore, a goal of this fieldwork program is to enable at-risk youth to transform their lives through diverse, practical, inclusive, and innovative engagement in everyday activities that can lead to opportunities and resources for effective occupational engagement status post-release (Fossey & Krupa, 2016).

Background

The dynamic nature of the U.S. health care system challenges OT academic programs to develop psychosocial and mental health experiential fieldwork opportunities for students. Services that facilitate health promotion, habilitation, and rehabilitation in traditional and emerging practice settings that comply with the Accreditation Council for Occupational Therapy Education standards are a vital component of OT education. Further, the World Federation of Occupational Therapists continues to advocate for the development of innovative fieldwork opportunities for OT students on a global level (Thew et al., 2008). Studies of occupational engagement in juvenile justice centers have shown that the time use of youth who are incarcerated is largely limited to engagement in personal care, passive leisure, and rest occupations (Stewart & Craik, 2007). Consequently, restricted occupational engagement can contribute to limited commitment to productive lifestyles. Limited participation in constructive, active occupations while serving time in a detention center could impede role development and effective community reintegration (Stewart & Craik, 2007). Consequently, a return to criminal activity and rearrest (recidivism) is not uncommon.

The goal of juvenile detention centers is to keep minors who have committed crimes separated from the public. Justifications for incarcerating juveniles range from providing rehabilitation and punishment to providing a deterrent to future criminal activity (Lambie & Randell, 2013). Juvenile detention centers are predominantly programmed around custody, sanctions, and security concerns. Juvenile detention environments are often branded by victimization, social isolation, and unaddressed or exacerbated mental health, educational, and health needs, and occupational deprivation is often used as a form of punishment. Consequently, occupational deprivation is a tacit dimension of juvenile justice environments (Eggers et al., 2006; Lambie & Randell, 2013). Because of the short-term nature of detention and associated safety concerns, some scholars emphasize a punitive approach to the management of juvenile detention centers. Conversely, other scholars emphasize a rehabilitative approach to prison management because incarceration is considered a barrier to occupational engagement; it disrupts community contact and social interactions (Koyama, 2012). Further, a punitive prison system severely limits reinforcement of societal norms and expectations because it provides insufficient opportunities for at-risk youth to model interpersonal interactions, such as conflict resolution and relationship management (Balkin et al., 2011). As their sentence time progresses, adolescents become more deeply immersed in the criminal justice system and move further away from prosocial involvement in society (Skeem et al., 2011). Restrictions and lack of meaningful activities are also associated with depression and apathy among youth in juvenile detention settings, in addition to poor community reintegration skills on release (Tan et al., 2015).

Growing evidence shows that mental health problems are linked to subsequent criminal behavior and delinquency (Underwood & Washington, 2016). According to Skeem et al. (2011), children with serious and often disabling mental illnesses are overrepresented in juvenile justice systems. This disproportionately high number has led to an increased reliance on juvenile justice systems to care for the mental health needs of youth who are incarcerated (Underwood & Washington, 2016). Although epidemiological studies of the prevalence of mental health disorders among youths in juvenile justice systems are limited, research suggests that mental health problems are significantly more prevalent among imprisoned adolescents compared with other youths. Research also shows that in any given year in the United States, 5% to 10% of youth have a serious emotional disturbance that causes impairment in function at home, at school, or in the community. Studies also show a direct link between mental disorders and youth violence and crime. Although 40% to 70% of youth who are incarcerated may have one or more diagnosable disorders, such as depression, oppositional defiant disorder, hyperactivity, and/or attention disorders, most juvenile detention settings do not have the ability to provide mental health services (Mallett et al., 2009). As a result, understanding the link between mental health problems and juvenile delinquents is paramount when considering OT treatment interventions in juvenile justice settings. Currently, in the United States, juvenile justice settings cannot support or provide mental health-based services to their detainees; therefore, OT-based fieldwork programs in juvenile detention centers may be the first step in providing mental health and psychosocial support to adolescents who are at risk while providing OT students with an opportunity to develop clinical reasoning skills and therapeutic use of self in an emerging practice setting (Hyde, 2016).

The use of OT programs that focus on the occupational performance needs of inmates while providing them with opportunities for occupational engagement, skill building, and role development can help to reduce recidivism. Balkin et al. (2011) described favorable results for rehabilitative programs over sanction-based programs in juvenile justice settings, with interventions centered on the acquisition of life skills yielding the most favorable outcomes. The rapid growth and forward-thinking changes integral to the OT profession can help these adolescents to develop and expand life skills. Through the use of occupational engagement to facilitate personal growth and social development, OT has the potential to help youth who are at risk to become functional members of society (Balkin et al., 2011; Provident & Joyce-Gaguzis, 2005).

Occupational therapists and OT students practicing in secure environments, such as juvenile justice settings, are obligated to use best available evidence as a viable resource for effective delivery of occupation-based interventions to at-risk youth. Although limited information is available on best practices for OT fieldwork programs in juvenile justice settings, studies support the concept that structured OT programs and interventions can offer youth who are imprisoned an opportunity to develop autonomy by engaging in structured education, work, play, leisure, and social activities (Shea & Siu, 2016). Principally, OT fieldwork programs in juvenile detention centers offer involved youth a first or last opportunity to acquire literacy and the social and vocational skills necessary for successful occupational engagement on release (Koyama, 2012; Shea & Siu, 2016). This Level II fieldwork program meets the needs of youth who are incarcerated while providing OT students who are enrolled in a bachelor's/master's degree professional program with a 12-week fieldwork experience that familiarizes them with population-specific issues. This program also enables students to practice and refine leadership and management skills through the development and implementation of evidence-based OT interventions and program development that promotes occupational choice and engagement for adolescents within this facility.

Program Development

In fall 2015, I seized an opportunity to develop and implement a Level II OT fieldwork program at a New York juvenile detention center. This facility is a county-based, 32-bed, secure, short-term facility designed to house juvenile delinquents who have criminal cases pending in family, county, and/or district court. Approximately 275 to 290 adolescents are admitted to this facility each year. They range in age from 10 to 16 years, although some are older. Average length of stay is 14 days; however, youths who are charged with more serious crimes may have a longer stay. Typical offenses range from petty larceny and violation of probation to gang-related crimes, including but not limited to assault, assault with a deadly weapon, attempted murder, and murder.

In October 2018, the first phase of a New York State law known as Raise the Age took effect. According to Raise the Age, 16-year-old youth can no longer be arrested or tried as adults, regardless of the crime committed. In October 2019, this law extended to those 17 years old. Under this new law, 16- and 17-year-old individuals arrested on serious charges, such as murder or attempted murder, who would typically be detained in an adult prison setting, are now sent to a youth section of criminal court and placed in secure juvenile detention centers, such as this New York facility (Schneider, 2018). Although these individuals may be housed in a separate area of the detention center, they can participate in OT group sessions if they are referred by the facility's assistant director.

Initially, I independently performed a SWOT analysis and used the SWOT analysis to develop a strategy for initial program development (Figure A, available in the online version of the article).

Sample Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis for Program Development in a Juvenile Detention Center

Figure A:

Sample Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis for Program Development in a Juvenile Detention Center

Fieldwork Prerequisites

Before beginning fieldwork, students were asked to review the Occupational Therapy Code of Ethics and Ethics Standards (AOTA, 2015). Students also consented to a New York State background check and to acquiring registered New York State mandated reporter status. The State of New York recognizes certain professionals, such as OT practitioners, as specifically qualified professionals who have the capacity to perform the role of reporting cases of suspected child abuse or maltreatment and are obligated under the law to report these cases. To establish mandated reporter status, students participated in an online course that was developed by the New York State Office of Children and Family Services. After they finished the course, students successfully completed a corresponding online competency examination. Once these requirements were satisfied, students met with the director and assistant director of the facility and underwent a comprehensive orientation on facility policies, procedures, and safety guidelines.

12-Week Fieldwork Learning Objectives

At the onset of fieldwork, students met with the OT fieldwork supervisor (the author), to discuss their specific short-term, midterm, and long-term goals. These goals were designed to ensure that students attain entry-level competency in OT in a psychosocial fieldwork setting by the end of their fieldwork experience. Goal achievement is a bottom-up process, and all progress is reviewed and discussed among students and the OT fieldwork educator throughout the 12-week placement. Objectives were routinely reassessed, and revisions were made to short-term goals and the midterm goal to ensure that long-term goal attainment was in accordance with the Fieldwork Performance Evaluation for the Occupational Therapy Student, Accreditation Council for Occupational Therapy Education, and New York State standards (Figure B, available in the online version of the article).

New York-Based Juvenile Detention Center Level II OT Psychosocial Fieldwork: Student Goals

Figure B:

New York-Based Juvenile Detention Center Level II OT Psychosocial Fieldwork: Student Goals

Students immediately began observing and interacting with inmates in closely supervised settings, such as the classroom, gym, cafeteria, or dayroom. Simultaneously, students were expected to initiate research and use research to help them to become familiar with the cultural nuances, group dynamics, and social norms of adolescents and staff within juvenile detention centers. Accordingly, students participated in an 8-week journal club with the OT fieldwork supervisor. The journal club met weekly to discuss and critically evaluate recent peer-reviewed journal articles on interventions for rehabilitation of at-risk youth, imprisoned populations, or juvenile delinquents. Students completed an OT facility-specific critically appraised topic template that summarized best available evidence and its application in an occupation-based format to adolescents within this juvenile detention center. Not all of the research was OT based; however, all evidence-based interventions were modified by OT students to promote occupational engagement. Theoretically, modifications of available research enabled students to adopt an OT lens that was used to develop autonomy and adaptability to facilitate professional development (Fisher, 2014) (Figure C, available in the online version of the article).

Facility-Specific Critically Appraised Topic (CAT) Template

Figure C:

Facility-Specific Critically Appraised Topic (CAT) Template

An important first step in developing occupation-based interventions for youth within this juvenile detention center was the implementation of a thorough needs assessment. The result of a needs assessment is an important component of program development and can be used to direct the scope of services provided to a target population, determine a practice model, and/or schedule flexibility of services (AOTA, 2020b). Consequently, during week 2, students began literature reviews (journal club) and an on-the-ground needs assessment to determine the needs of youth within this facility, examine the nature and causes of those needs, and begin to set priorities for treatment interventions. The AOTA Occupational Profile Template was used to record the results of the on-the-ground needs assessment. The Occupational Profile Template provided students with a systematic method for collecting information from youth within this facility to identify priorities and desired outcomes that would support occupation-based group interventions (AOTA, 2014). The students analyzed all components of the needs assessments to help to produce client-centered OT group interventions. In addition to a comprehensive needs assessment, students were introduced to a variety of assessment tools throughout their 12-week affiliation, including the Modified Interest Checklist (University of Illinois Board of Trustees, n.d.), Role Checklist (Oakley, 1984), Comprehensive Occupational Therapy Evaluation Scale (Brayman et al., 1976), and Problem Oriented Screening Instrument for Teenagers (McLaney et al., 1994).

The fieldwork students introduced OT interventions to youth housed within this juvenile detention center to promote health management and maintenance and improve their quality of life. Group-based activities involved developmentally appropriate activities that were designed to decrease health risk behaviors and increase participants' emotional intelligence, interpersonal, and team-building skills. Pragmatically, organized group sessions supported participants' knowledge and acquisition of appropriate social skills, problem-solving techniques, and anger management strategies to optimize participation in activities of daily living (Shea & Siu, 2016). Studies show that evidence-based OT group interventions can address individual needs and promote and support change (DeCleene Huber et al., 2015; Lee, 2010). This change can enhance participants' knowledge and engagement in meaningful and purposeful occupations. The OT students designed and implemented at least three evidence-based, 6-week group sessions throughout the 12-week fieldwork affiliation.

Through the group sessions, students analyzed group dynamics and client-specific performance skills to help participants to become actively or passively engaged in sessions, associated tasks, and activities. Didactic knowledge combined with relevant research and hands-on learning helped the OT students to further develop and refine group protocols over the 12-week fieldwork period. Students used literature reviews as a channel for identifying interventions that could be used to engage the facility's inmates in OT group sessions to promote effective life skills (Shea & Siu, 2016). Consistent with the Occupational Therapy Code of Ethics and Ethics Standards (AOTA, 2015), this fieldwork program helped students to transform from passive beginners into engaged, active participants and agents of change, using contemporary research for program development.

The Pyramid Model for research, an evidence-based hierarchy for OT, gave students a rigorous means of assembling evidence to build clinical reasoning and decision-making skills throughout their fieldwork assignment (Tomlin & Borgetto, 2011). Searching, finding, understanding, and implementing research into real-word situations helped students to develop analytical skills that they could use throughout their academic and professional careers (DeCleene Huber et al., 2015). Through structured group sessions, OT students showed directive or facilitative leadership and co-leadership skills according to group dynamics, specific participant needs, and the nature and structure of the group intervention.

Occupation-based groups at this New York juvenile detention center also helped to facilitate choice and autonomy for youth within this facility (Thew et al., 2008). The OT group sessions gave participants opportunities to socialize, pass time productively, develop skills, and make links with the outside world, in addition to exploring a variety of tasks and activities to promote healthy roles, routines, and habits (Steward & Craik, 2007). The OT group interventions supported independence, priority, and self-reflection necessary for successful lifestyle redesign and renewal through discovery or modification of routines, roles, and habits that may impede or suppress important and meaningful occupational engagement. Simultaneously, students used self-directed learning to develop their own important roles and routines throughout the 12-week fieldwork experience (Table A, available in the online version of the article).

Evidence-based, Occupation-based Group InterventionsAll groups are provided in a structured, supervised, interactive format. Learning activities are introduced using a variety of platforms such as smart boards, computers and videos. Learning activities include an individual and/or group learning assessment. For example, completion of an interest checklist, art project, or role-playing activity. All groups are run in the facility's classroom, courtyard, day room, or gym under constant supervision by correctional staff.Evidence-based, Occupation-based Group InterventionsAll groups are provided in a structured, supervised, interactive format. Learning activities are introduced using a variety of platforms such as smart boards, computers and videos. Learning activities include an individual and/or group learning assessment. For example, completion of an interest checklist, art project, or role-playing activity. All groups are run in the facility's classroom, courtyard, day room, or gym under constant supervision by correctional staff.Evidence-based, Occupation-based Group InterventionsAll groups are provided in a structured, supervised, interactive format. Learning activities are introduced using a variety of platforms such as smart boards, computers and videos. Learning activities include an individual and/or group learning assessment. For example, completion of an interest checklist, art project, or role-playing activity. All groups are run in the facility's classroom, courtyard, day room, or gym under constant supervision by correctional staff.

Table A:

Evidence-based, Occupation-based Group Interventions

All groups are provided in a structured, supervised, interactive format. Learning activities are introduced using a variety of platforms such as smart boards, computers and videos. Learning activities include an individual and/or group learning assessment. For example, completion of an interest checklist, art project, or role-playing activity. All groups are run in the facility's classroom, courtyard, day room, or gym under constant supervision by correctional staff.

Program Challenges

During the initial development of this Level II fieldwork program, a series of challenges occurred, including professional role conflicts, confidentiality issues, interface of multiple law enforcement systems, cultural barriers, and negative perceptions and bias toward youth charged with delinquency. As with other emerging practice fieldwork settings, this juvenile detention center does not have a staff OT practitioner. The limited opportunity for students to collaborate and observe OT practitioners and other health care professionals tested their ability to establish and implement pertinent roles within this facility. Students met with their OT fieldwork supervisor for approximately 8 hours per week. When the OT supervisor was off-site, the students reported to the assistant director of the facility and/or a licensed art therapist. Limited space was available for OT students to collaborate and meet with their OT fieldwork supervisor within the facility. On-site, students met with their OT fieldwork supervisor in a small room; however, if the census increased, meetings were relocated to another, more isolated area of the building. Students used their college-provided iPads for routine virtual Zoom meetings with their OT fieldwork supervisor (when off-site) and to practice on-site research for optimal development of OT group protocols. The absence of staff OT practitioners and clinical space, along with limited funding, was problematic. However, despite these challenges, the students provided much-needed educational and consultative services to the center's detainees. Services were provided in the dayroom, outside courtyard, academic classroom, or gym, under constant supervision by correctional staff. Certain group activities, which included cooking (in the kitchen), digital media use (in the classroom), or out-of-classroom participation, such as gardening (in the courtyard), which are not typical environments for OT group sessions, required special permission and additional correctional staff, secondary to security and safety protocols. Often the OT fieldwork supervisor and students brought in their own supplies to run group sessions effectively. Daily disruptions to planned group interventions occurred, including court proceedings. Other interruptions included unplanned meetings with attorneys or social workers, prisoner insubordination, limited support staff, and solitary confinement orders. These distractions altered group dynamics as well as the timing and location of planned OT group sessions.

Despite these challenges, this program did and continues to emulate the value and quality of OT services for an at-risk population. Further, the sustainability of this Level II OT fieldwork program is a testament to its resiliency. I am in the process of applying for a grant that could provide much-needed financial support for program enhancement.

Methods

After institutional review board approval was obtained, retrospective data were collected and analyzed to assess the satisfaction of OT students with their participation in this Level II fieldwork program. The outcome measure for this study consisted of completed Student Evaluation of the Fieldwork Experience (SEFWE) forms. The SEFWE form is a standardized document that is typically used to allow students to provide feedback on their Level II fieldwork experience. Information obtained from student feedback can be used by OT educational programs, fieldwork supervisors, and facility staff for quality assurance (AOTA, 2016). Information obtained from completed SEFWE forms can also be used to improve and modify fieldwork programs and the educational curriculum (AOTA, 2016). The SEFWE forms reviewed for this study contained no identifying information.

Results

Retrospective data analysis of completed SEFWE forms showed favorable evaluations of the overall fieldwork experience. The OT students found their experience to be well structured, purposeful, and organized. Students also reported that the learning elements of the fieldwork affiliation positively contributed to their professional development and knowledge of OT practice. Further, students strongly agreed that this fieldwork experience matched their expectations and that the overall fieldwork experience was challenging but not overwhelming (Figure D, available in the online version of the article).

OT Students' Summary of Fieldwork Experience: 2016–2019

Figure D:

OT Students' Summary of Fieldwork Experience: 2016–2019

Completed SEFWE forms also showed that all students considered fieldwork-related assignments to be a very valuable component of the fieldwork experiential learning process (Figure E, available in the online version of the article).

Value of OT Student Fieldwork Assignments: 2016–2019

Figure E:

Value of OT Student Fieldwork Assignments: 2016–2019

A review of the aspects of the fieldwork environment section in completed SEFWE forms showed that the Occupational Therapy Practice Framework was consistently integrated into the practice setting; staff and administration consistently showed cultural sensitivity; and students reliably had an adequate work area and supplies. Students reported that they had frequent opportunities to network with other professionals, participate in research, and interact with other OT students. Finally, students indicated that they rarely had opportunities to observe role models, collaborate with other OT professionals, expand their knowledge of community resources, or observe a multi-disciplinary approach to client or patient care (Figure F, available in the online version of the article).

Aspects of OT Student Fieldwork Environment: 2016–2019

Figure F:

Aspects of OT Student Fieldwork Environment: 2016–2019

Overall, these findings showed that emerging practice fieldwork programs can provide OT students with rich and applicable experiential learning.

Discussion

As the U.S. health care system continues to evolve, there is an increased demand for OT educators and OT fieldwork supervisors to help students to develop the skills and competencies required in increasingly complex and innovative health care environments. The practice of OT can complement the goals of juvenile justice support services by using occupation-based interventions to promote life skills that can help to prepare youth who are incarcerated for community reintegration, and OT practitioners can play a vital role in the rehabilitation of youth. Research shows that occupation-based groups that equip incarcerated individuals with the knowledge and skills to overcome common challenges involving substance abuse, education, work, leisure, and socialization before release may reduce recidivism (Herlache-Pretzer & Jacob, 2018).

Occupational therapy fieldwork supervisors in juvenile justice settings have the potential to prepare their students for 21st century health care challenges while advocating for the advancement of the profession (Shea & Siu, 2016; Tan et al., 2015; Thew et al., 2008). The dearth of current peer-reviewed and evidence-based literature describing and supporting OT services within juvenile justice settings creates a void for samples of robust research projects; however, this should not be considered a deterrent for fieldwork program planning in emerging practice settings. Credibly, OT can and should contribute to the research on interventions and outcomes to identify and contribute evidence for best practice in juvenile justice centers. In this way, OT can be an integral component of holistic, integrated health care within juvenile justice settings. The nuances of OT in emerging practice settings, such as juvenile justice facilities, should be included in professional programs designed to acclimate students to the dynamic nature of the U.S. health care system while promoting the diversity and inclusiveness exemplified by OT practice standards. Scientific inquiry in the form of research helps the OT fieldwork supervisor and OT students to develop professional and therapeutic relationships with support staff and inmates within juvenile detention centers, which can improve overall client care (Brown & Rodger, 1999). Evidence-based interventions not only help OT practitioners to provide the best services possible but also ensure that the OT profession continues to grow. For example, this program shares the importance of meaningful occupations with populations that are generally unaware of OT and the distinct services that OT professionals contribute to the rehabilitation process (Thew et al., 2008). Fieldwork programs in emerging practice settings, such as juvenile detention centers, also offer opportunities to market and raise the profile of the OT profession.

Limitations

Retrospective data were used to analyze students' feedback on this fieldwork experience. Because this report is in relation to a single institution, generalizability is limited. Other limitations included a risk of sampling error (bias) secondary to the small sample size and the limited number of OT articles that address emerging practice fieldwork programs in juvenile detention settings. Additionally, limited research on and lack of valid and reliable outcome measures for OT interventions in juvenile justice settings potentially impedes the pragmatic and fundamental value of OT in this context (Shea & Siu, 2016). Finally, this fieldwork program was in part designed to help students to transfer theories and scientific principles learned in the didactic portion of their academic studies into an experiential learning environment; however, the educational gains associated with this program have not been formally assessed. Rather, entry-level competency as an OT professional is the focus of the fieldwork evaluation process. Consequently, robust research initiatives are needed within this facility to allow comprehensive monitoring, analysis, and modification of the efficacy, educational outcomes, skill set attainment, and student satisfaction of performing Level II fieldwork in this emerging practice setting. Regardless of the limitations, retrospective data support that the information provided in this report can be used by OT professionals and OT entrepreneurs as a scaffold for the development of fieldwork programs in juvenile justice or other emerging practice settings.

Conclusion

Youth offenders can have complex health and care needs. Like anyone, youth detained within juvenile detention centers have the right to health and well-being and should have access to good integrated health and care support. The goal of OT, to improve the health and well-being of individuals, groups, communities, and populations through occupational engagement, can contribute to the well-being of youth within juvenile justice environments and similar emerging practice settings. Youth who are incarcerated may have additional needs, such as mental or physical health issues or learning disabilities, that increase the challenges they face in engaging in daily occupations and otherwise function within a juvenile detention environment. Occupational therapists can work in partnership with juvenile detention centers and similar settings to identify and address population-specific health and care needs and risk factors. They can also provide advice and interventions to enable participation and engagement within this context (Royal College of Occupational Therapists, 2017).

This article can provide a resource for the development of Level II OT fieldwork programs in emerging practice settings, such as juvenile detention centers. As with health care, successful and sustainable fieldwork programs are dynamic entities. Both traditional and emerging practice fieldwork programs must prepare students to engage in evolving practice environments while helping them to develop the skills needed to appraise evidence, articulate the care they provide for their clients, document evidence-based care processes, and examine data that may be used to measure program goals and outcomes. Although these programs are relatively new, the implementation and development of this Level II fieldwork program promotes the value of OT in emerging practice settings because it allows stakeholders to discover how OT contributes to health care delivery (Syed & Duncan, 2019). For example, OT practitioners in juvenile detention centers can provide support and services to youth who are detained so that they can effectively transition back into the community.

Fundamentally, within this New York detention center, OT provides a valuable service by facilitating occupational justice to a population in which many may have experienced occupational deprivation as a result of social, economic, and environmental factors that are beyond their control (Royal College of Occupational Therapists, 2017). The continued success and advancement of this program suggests that with creativity and perseverance, OT can become a viable intervention within juvenile justice settings, similar restrictive environments, and other emerging practice settings. Finally, this report should serve as an example for all OT practitioners and OT entrepreneurs: If you see an opportunity to expand and promote our distinct profession while justly helping others, take it. If you do not see an opportunity, make it!

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Evidence-based, Occupation-based Group Interventions

All groups are provided in a structured, supervised, interactive format. Learning activities are introduced using a variety of platforms such as smart boards, computers and videos. Learning activities include an individual and/or group learning assessment. For example, completion of an interest checklist, art project, or role-playing activity. All groups are run in the facility's classroom, courtyard, day room, or gym under constant supervision by correctional staff.

Group NamePurposeSummary of Sessions*Outcome CriteriaTheoryEvidence
Exploring Leisure InterestsTo contribute to participants' discovery and learning about different leisure activities that may be of interest for occupational engagement.

Overview of Leisure Pursuits and Activities

Drama

Art

Sports

Music

Reading/Literature

Participants will gain an overall knowledge of leisure and leisure activities in order to maximize their I with ADLs and improve their self-worth.Model of Human Education (MOHO)Pytash (2016)*Marcum (2014)*.
Getting to Know Other CulturesTo help participants learn about and increase their awareness of various cultures, which they may be unfamiliar with, in order to maximize independence with social, vocational, and educational activities.

Introduction to India

Deaf Culture

The Amish/Pennsylvania Dutch

Introduction to Israel and the Jewish Culture

Introduction to Asia

Introduction to Corporate Culture

Participants will demonstrate increase cultural awareness and sensitivity in order to facilitate positive interactions with diverse individuals. Cultural awareness contributes to optimal participation in ADLs/IADLs in today's multi-cultural and complex world.MOHOShea & Siu (2016) Whaley & Davis* (2007)
Live Stress FreeTo introduce participants to stress management techniques and coping mechanisms in order to improve participation in social and educational activities.

Overview of stress, the effects of stress, healthy and unhealthy coping skills and effective coping techniques tomanage stress.

Identifying Stressors/Know Your Triggers

Performing a Mental Body Scan for Stress Relief

Mindfulness

Yoga

How to Journal

Participants will gain awareness of stress triggers and will identify physical and emotional stress management techniques and coping strategies, which can be implemented to optimize occupational performance, while promoting health and well-being.MOHOBarnert, Himelstein, Herbert, Garcia-Romeu & Chamberlain (2014)*
Teamwork is the DreamworkTo educate participants on the importance of social skills using teamwork. Effective teamwork skills, will optimize participants' involvement in leisure, social, educational, and work activities.

Negotiation and Compromise

Organizing and Planning

Collaboration and Respectfulness

Non-Verbal Communication

Verbal Communication and Active Listening

Delegation and Problem Solving

Participants will identify and incorporate specific skills that foster teamwork into daily routines and habits. Teamwork is necessary to achieve common goals and will optimize participants' independence with occupational engagement in familial, community, educational, work, and peer settings.Cognitive BehavioralJames (2011)*Sheridan, & Steele-Dadzie (2005)*
Authors

Dr. Koenig is OT Academic Fieldwork Coordinator and Assistant Professor, Department of Occupational Therapy, Touro College, New York, New York.

The author has no relevant financial relationships to disclose.

The author thanks Director LaQueta Robbins-Kennedy, Assistant Director Laura Befumo, Supervisor Derek Ivey, and the staff at the Nassau County Juvenile Detention Center for consistently working with and supporting her by allowing occupational therapy students to provide youth within this facility with opportunities for occupational engagement. The author also thanks Dr. Stephanie Dapice-Wong for introducing her to this unique opportunity and all of the Touro College occupational therapy students for their commitment to occupational justice during their fieldwork in this emerging practice setting.

Address correspondence to Virginia E. Koenig, OTD, MSA, OTR/L, Assistant Professor, Department of Occupational Therapy, Touro College, 320 West 31st Street, New York, NY 10001; e-mail: virginia.koenig@touro.edu.

Received: May 26, 2019
Accepted: August 03, 2020
Posted Online: September 30, 2020

10.3928/24761222-20200923-02

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