BACKGROUND: Occupational therapists have a long history of addressing community performance and participation challenges faced by individuals with complex, chronic conditions, including those with serious mental illnesses (SMI) and cognitive issues that present with a traumatic brain injury (TBI). Healthcare reform has shifted incentives to support practices that promote successful community life for people with complex medical conditions. Community based care models emphasizing integrated primary care, such as Federally Qualified Health Centers (FQHC) are emerging, and a generalist role for occupational therapy is being defined. Those with complex comorbid conditions such as mental illness, substance abuse and traumatic brain injury are at risk for negative health outcomes that are further compounded by homelessness. There is a critical need to understand effective treatment options for this population to reduce the negative effects of chronic health conditions. As occupational therapists further define a role serving traditional clients in less traditional settings, such as the FQHC, it is helpful to explore the perceptions of the utility of OT services on the part of provider referrers. OBJECTIVE: This study explored provider referrer perceptions of a new occupational therapy service for homeless adults in an FQHC to assist effective allocation of scarce resources. METHODS: Twelve provider referrers at an FQHC were interviewed regarding their perception of the role and utility of occupational therapy in this setting. Interviews were then coded for themes. RESULTS: Providers identified the unique value of occupational therapy, emphasizing critical information gleaned from the performance-based assessment of functional cognition, and the positive impact on team interactions and subsequent care decisions. CONCLUSION: Occupational therapy provides a distinct perspective on client performance in FQHC settings indicating benefit for inclusion of services.

Objective: Job loss has a demonstrated negative impact on physical and mental health. Involuntary retirement has also been linked to poorer physical and mental health outcomes. This study examined whether late-career unemployment is related to involuntary retirement and health declines postretirement. Method: Analysis was conducted using the 2000-2012 U.S. Health and Retirement Study (HRS) survey data with unemployment months regressed with demographic and baseline health measures on physical and mental health. Results: Individuals with late-career unemployment reported more involuntary retirement timing (47.0%) compared with those reporting no unemployment (27.9%). Late-career unemployment had no significant effect on self-reported physical health (β = .003, p = .84), but was significantly associated with lower levels of mental health (β = .039; p < .01). Conclusion: Self-reports of late-career unemployment are not associated with physical health in retirement, but unemployment is associated with involuntary retirement timing and mental health declines in retirement. Unemployment late in the working career should be addressed as a public mental health concern.

Background: Current health care policy supports occupational therapy services with individuals experiencing homelessness in primary care settings. Research on the impact of interventions is needed to support this emerging practice area. Method: : A retrospective, descriptive study was completed following the initiation of full-time occupational therapy services in an integrated primary setting and Federally Qualified Health Center (FQHC) for clients experiencing homelessness. This study evaluated: (a) percentage of referred clients who engaged in ongoing intervention; (b) diagnostic demographics of those referred; (c) functional goal types and frequency; (d) a comparison of preintervention Canadian Occupational Performance Measure (COPM) scores with postintervention scores. Results: : Analysis of data revealed clients referred for occupational therapy services present with complex co-morbidities. t tests for matched pairs (p < .05) revealed that participants had a statistically significant improvement in COPM performance scores (69%) and in COPM satisfaction scores (73%) between baseline and postintervention. Diagnostic subgroups had a similar rate of improvement. Analysis of client identified COPM goals revealed a high rate of instrumental activity of daily living focused goals. Conclusion: : Integration of full-time occupational therapy services into FQHC settings increases client access to functional-based rehabilitation services that address physical and behavioral health. Individuals experiencing homelessness demonstrate improvement toward functional goals using client-centered goal setting processes and interventions. Comments The authors report no potential conflicts of interest.

This pilot study addressed the impact of a summer camp experience on at-risk middle school youth by exploring self-reported growth in skill development and resilience. Campers who attended a five-week summer day camp were compared to a control group who maintained typical activities throughout the summer. Results showed statistically significant differences in the campers' belief of a good future for themselves (U = 179.40, P = 0.05). Campers reported sustained or positive growth in domains of social skills and positive values from the baseline to a six-month follow up. Three significant themes emerged from individual in-depth interviews including: (a) engagement influences skill competence, (b) the camp environment expands positive choice and availability of positive occupations, and (c) males developed skills and resilience from informal physical activity while no equivalent existed for females. Middle school aged at-risk youth can benefit from occupation-based summer camp programs that promote active engagement in an enriched environment and sustain gains once they return to high-risk environments. This research contributes to a growing understanding of the potential contribution of occupational therapy in the design and delivery of effective summer camp experiences for at-risk youth.

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