Project Description
According to the Occupational Therapy Practice Framework: Domain and Process 4th edition (OTPF-4), "occupations are the everyday activities that people do to occupy time and bring meaning and purpose to their lives" (pg. 44). These can include anything from doing certain job-related tasks, performing a specific hobby, or even just accomplishing basic self-care skills like brushing your teeth. We choose occupations that help us fulfill our chosen roles, give us a sense of achievement, connect us with our past, and equip us for our future (OTPF, 2020). But when someone's ability to participate in occupations is disrupted by a devastating injury like a spinal cord injury (SCI), it affects not only the physical self but also the psychological self, including the loss of someone's role and identity, changes in active lifestyle, low self-esteem, etc. (Tully, 2019).
According to the Shepherd Center, SCI is damage to the collection of nerves that transport signals from the brain to and from the rest of the body. This damage can result in either temporary or permanent changes in sensation, movement, muscle strength, and body functions. Some of the main causes of a SCI are catastrophic falls, motor vehicle accidents, gunshot wounds, and even various forms of diseases and infections, including tumors, spinal stenosis, birth defects, etc. (“Spinal Rehabilitation Center,” 2022).
Regarding the results from previous studies, there is a mental health crisis in our society today, especially for the SCI population. The aims and implications of this study were to increase mental health awareness, advocate for this population’s needs, analyze qualitative data by comparing participants' responses to a self-designed Google Forms survey, give a professional presentation to a group of occupational therapy (OT) students on practical ways in which to address mental health in the clinical setting, and further identify the positive effects the Quality of Life Index, Spinal Cord Injury Version - III assessment can have with addressing mental health issues and/or adjusting to a new normal after sustaining a devastating injury.
Needs Assessment
While gathering information from other professionals and individuals with a SCI at a local SCI support group program at Turnstone in Fort Wayne, IN, one of the major areas that were brought up was on addressing mental health problems for this population.
According to Pisengna et al. (2022), adjusting to a disability can be emotionally challenging for anyone throughout the transition process. Not being able to do the things they enjoyed prior to their injury can be extremely devastating for anyone physically, emotionally, mentally, and spiritually. For anyone suffering from a terrible injury, it is normal to have feelings of uncertainty and loneliness at times. However, if those mental health factors do not get addressed effectively, it can be difficult for someone with a SCI to adjust to a new normal, which could lead to mental health problems, especially anxiety and depression (Pisengna, 2022).
There is a lack of mental health awareness in the SCI population.
There is a lack of quality summaries of individuals with a SCI sharing about their experiences adjusting to a new normal through an OT perspective.
Literature Review
According to the World Health Organization (WHO), mental health is not simply the lack of psychological issues. Instead, it is defined as when a person “realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (Herrman, 2004, p. 12).
Based on the OTPF-4, health management is an occupation that involves “developing, managing, and maintaining health and wellness routines” (pg. 45). This includes learning to regulate emotions, such as coping strategies, establishing healthy behaviors, and seeking help from others when needed (OTPF, 2020).
Those who experience depressive and anxiety symptoms are at an increased risk for poor adjustment to disability, which could result in decreased self-efficacy, quality of life, and progress in the rehabilitation process (Pisengna, 2022).
Findings from previous studies should prompt healthcare providers, including OTs, to be more cognizant of the effects of mental health issues on the SCI population. New studies have shown that people with a SCI are more likely to be diagnosed with a mental health disorder than someone who does not have a SCI (51% compared to 30.9%). In other words, individuals with a SCI are nearly 20% more likely to experience mental health issues than someone who does not have a SCI. Adults living with a SCI have a nearly 80% risk of having mental health issues, especially depression and anxiety (Peterson et al., 2022).
Areas of Focus
Advocacy | Education | Research Skills
Target Population
Individuals across the United States who have sustained a traumatic complete or incomplete SCI, any type of spinal cord syndrome (e.g., Brown Sequard, Cauda equina, etc.), or any type of spinal cord stenosis that causes damage to the spinal cord.
Primary Site
Secondary Site
Project Mission Statement
To increase awareness of mental health issues impacting individuals with SCI through transcribed interviews, analyzed themes, and United Spinal Association blog posts.
Project Vision Statement
To further increase mental health awareness, advocate for the SCI population's needs, and identify the positive effects OTs can have with addressing mental health issues and/or adjusting to a new normal after sustaining a devastating injury.
Project Leader
The Project Leader was responsible for all-encompassing factors related to the current project, including the planning, implementation, management, dissemination, and sustainability components while communicating with all key stakeholders.
Project Mentors
Expert Mentor
Lindsey Elliott, MSW supported the project by providing continual guidance on the project design and providing connections with other individuals with a SCI through a variety of SCI Facebook private groups and online support group meetings.
Faculty Mentor
Dr. Jill Linder, DHSc, OTR, CBIS, CSRS supported the project by providing continual guidance on the project design and providing expertise in analyzing, identifying, and comparing data and responses between different participants from the Google Forms survey and interviews.
Outcome Measures (OM) & Related Learning Objectives (LO)
OM #1: The student will advocate for individuals with spinal cord injuries through transcribed interviews and blog posts that highlight the lived experiences of SCI survivors and bring awareness to the psychosocial issues commonly experienced by this population.
Related LO: The student will demonstrate increased knowledge by conducting at least two interviews utilizing an assessment with the participant.
Related LO: The student will demonstrate increased knowledge by completing at least two continuing education courses on mental health and/or suicide prevention for the purposes of increasing competency when interacting with the target population.
Related LO: The student will analyze results from a self-designed survey reflecting on lived experiences following injury.
OM #2: The student will design a professional presentation aimed to educate occupational therapy students on the importance of mental health awareness for the SCI population through an OT lens, as well as learn how to impact the community.
Related LO: The student will demonstrate increased knowledge of media-based advocacy through the creation of step-by-step guideline resources.
Deliverables
The doctoral capstone project had a total of six deliverables completed which are outlined below.
Deliverable #1: Transcribed interviews with three individuals with SCI
Deliverable #2: Advocacy blog post with post-interview summaries
Deliverable #3: Certificates of completion from three continuing education (CE) courses related to mental health and SCI
Deliverable #4: Analysis of qualitative data
Deliverable #5: Professional presentation
Deliverable #6: Educational resources
Descriptions & visual depictions of each area of study & deliverable
Advocacy
With the approval of an Institutional Review Board (IRB) by the Huntington University committee, the Project Leader sent a self-designed Google Forms survey to various SCI Facebook private groups and support groups, established a series of interviews with three individuals with a SCI who also completed the survey, summarized their answers for each question, and uploaded them in a blog post format onto the United Spinal Association website (with each participant's consent) for anyone to access and read about others' experiences with a SCI. These summaries can be useful resources for people with SCI to access and read about others’ similar circumstances, which will emphasize how important mental health awareness is to this population.
Each interview began with the following semi-structured background questions:
1.) When was the onset of your SCI and how did it happen?
2.) What major obstacles have you encountered and/or still working through?
3.) How have those obstacles affected your relationships with others and your ability to participate in meaningful occupations?
4.) What coping strategies have you found beneficial in accepting your new normal?
5.) What are some recommendations for other individuals with a SCI who may be dealing with a variety of obstacles and struggling to acknowledge the onset of their new injury?
6.) What are some possible suggestions on how occupational therapy and other healthcare practitioners can better meet this population's mental health needs and other barriers in the future?
(Attached below are the links to each of the blog posts that are on the United Spinal Association website).
In addition, an assessment called the Quality of Life Index, Spinal Cord Injury Version - III was completed during each interview to advocate and raise awareness for the OT profession and the SCI population in measuring patient outcome measures.
For each assessment, there is an overall score and 4 subcategory scores, which include: 1.) health & functioning, 2.) social & economic, 3.) family, and 4.) psychological & spiritual. Scores range from 0 to 30 for the subcategory scores and overall score. Scores of 19 and below usually indicate a poorer quality of life. Below are the following overall scores from each participant that completed the assessment:
Participant 1 (sustained a traumatic SCI 15 years ago): 18.5
Participant 2 (sustained a traumatic SCI 42 years ago): 19.61
Participant 3 (sustained a SCI from a rare neural disease 4 years ago): 20.06
The results indicate that 2/3 of the participants scored slightly below the normal quality of life in general. However, just because someone scores that low doesn’t necessarily mean there is something wrong with that person. Most importantly, it is another tool assessment that OTs can utilize in measuring patient outcomes over time in the clinical setting. For more general information about the assessment, click here.
Education
Watched three continuing education (CE) videos from occupationaltherapy.com on mental health, suicide awareness, and SCI changes and prevalence to help increase knowledge in interacting with the target population.
Gave a professional presentation to an OT psychosocial course at Huntington University OTD program about my capstone project, some of my findings, and practical tools and interventions that OTs can effectively address mental health issues in the clinical setting.
Within the PowerPoint, there are a few key tools and interventions that OTs can have in their back pockets when addressing mental health issues in all populations (particularly the SCI population). Below is an example of one of them:
Research
Attached below are the results from the self-designed Google Forms survey. Of the 26 respondents who completed the 14-question survey, 16 respondents were female and 10 were male respondents. 16 respondents have an incomplete SCI, 8 have a complete SCI, and 2 were unsure of their type of injury.
Qualitative data collection was done to compare responses by different SCI respondents from the survey. Answers to questions 11 and 13 in the survey highlighted areas of mental health, social impact, trauma, substance, and pain from the respondents. Some examples that were answered by some of the respondents include statements like feelings of “depression,” “anxiety,” “loneliness,” struggles with “PTSD,” and “alcohol.” The main obstacles that some of the male respondents answered on question 13 (3/10 males) were problems with alcohol and depression, while the main obstacles that some of the female respondents answered on question 13 (12/16 females) were issues with anxiety, pain, suicide, loneliness, depression, and trauma. These statements indicate that mental health feelings are legitimate and should be taken seriously to provide the best treatment for these individuals.
Reflection
The doctoral capstone experience provided personal and professional advanced development specific to the SCI population in the area of mental health, as well as practical ways in which OTs can assist this population.
Future Directions
My doctoral capstone project enhanced my knowledge and understanding of the various mental health issues facing the SCI population, better equipping me with the skills needed to support my decision to work with this population in the clinical setting following graduation.
Contact Information
Email: jseckert77@gmail.com
References
American Occupational Therapy Association (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74 (supplement 2). Advance online publication.
Herrman, H. (2004). Promoting mental health: concepts, emerging evidence, practice.: Summary report. World Health Organization.
Peterson, M. D., Meade, M., & Mahmoudi, E. (2022). Mental health is an issue for people with spinal cord injury. Chronic pain makes it worse. Institute for Healthcare Policy & Innovation. Retrieved April 12, 2022, from https://ihpi.umich.edu/news/mental-health-issue-people-spinal-cord-injury-chronic-pain-makes-it-worse
Pisegna, J., Anderson, S., & Krok-Schoen, J.L. (2022). Occupational therapy interventions to address depressive and anxiety symptoms in the physical disability inpatient rehabilitation setting: A systematic review. The American Journal of Occupational Therapy, 76(1). https://doi.org/10.5014/ajot.2022.049068
Spinal Rehabilitation Center: Injury and paralysis information. Spinal Cord Injury and Paralysis Types | Shepherd Center. (2022). Retrieved December 7, 2022, from https://www.shepherd.org/patient-programs/spinal-cord- injury/about
Tully, S. (2019). Psychosocial adaptation to physical disability. In C. Brown, V. Stoffel, & J.P. Munoz, Occupational therapy in Mental Health: A vision for participation (2nd ed.). F.A. Davis Company.