Running head: SUMMARY OF PROGRAM DEVELOPMENT

Due to the nature of the detailed information included in my Program Development, and the fact that

the facility is a private practice, the management had reservations about me publishing my findings to

the general public. While the review is largely positive, as they have developed an exceptional facility

and treatment program, I am omitting the full version of my Program Development Paper from this

professional portfolio out of respect for the management’s wishes. Instead, I am providing direct

feedback from my professor and the CEO of the facility, along with a summary of my work, to represent

the level of execution and clinical reasoning skills demonstrated through this extensive project.

Feedback

Tina McNulty, PhD, MOT Professor at University of Utah

“You have completed an exceptional needs and data analysis that reflects a sophistication of

insights and analysis consistent with an experienced OTR. You entered a complex healthcare

team and navigated the relationships professionally and collaboratively. I’m impressed. Your

paper is one of the best I’ve read in several years.”

Dr. Berrett PhD, CEDS, Psychologist, CEO, and Co-founder of facility. He was my direct contact for the

duration of my internship in Fall of 2018 and has since retired.

“Angela is poised, professional, fluent in expression, respectful, a great communicator,

confident, humble, helpful, and respectful. She displayed knowledge, understanding, skills, and

competence in her trade of occupational therapy. She worked well with our staff, and taught us

what we could do to improve our treatment program and help individual clients with the tools

and modalities of her profession. I was so impressed with her in every way. If I had the budgeted

resources to hire her, and wasn’t retiring next week, I would offer her a job today!”
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Summary

Needs Analysis

An in-depth analysis of the population, contextual influences, and the facility’s current program

identified strengths and areas for growth. In addition to the range of Eating Disorder (ED) diagnoses, the

common comorbidities and personalities were noted. External influences such as the sociocultural,

economic, and political factors were all analyzed as pertinent to the needs of this population.

The facility’s current program was understood through regular meetings with the CEO, semi-

structured interviews with the directors of clinical nutrition and experiential therapies, attendance of

interprofessional meetings, and observation of direct services. Both individual and group interventions

were considered, as were family/social support systems, medical and psychiatric care, client access to

formal education, and housing support.

Analysis of the services provided was represented from multiple levels of management and

employees providing direct service, the clients, and finally myself as an occupational therapy graduate

student. Each of these perspectives contributed to my working understanding of the program. In

collaboration with the CEO, a survey was developed to measure and evaluate data representing the

clients’ perspective. This was administered to clients in the residential treatment and partial

hospitalization program. This exploratory research provided valuable insight in how to optimize client-

centered occupational therapy (OT) in this setting.

Lastly, the programs strengths and areas for growth were explicitly discussed. Specific examples

of how OT would serve to augment the current provisions were mentioned. Primary themes included

the evaluation of person/environment/occupation, detailed activity analysis, therapeutic use of

occupation, adaptation and grading of tasks, remedial and compensatory approaches, sensory

intervention, and public health approach implications.

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Literature Review

Pertinent peer-reviewed scholarly publications were summarized to represent the body of

evidence currently available to inform best-practice for this population. Analysis of OT’s theoretical

models and their application to this setting was supported by research and evidentiary support. A brief

review of occupational therapy’s role, qualification, and efficacy of interventions in mental health

settings was provided. More specific research into occupation-based interventions specific to ED

demonstrated both a relevance to this population’s function in addition to the significant clinical and

statistical benefits in well-being. International research provides evidence of the following outcomes:

effective restructuring of routines and roles, lasting improved eating behavior, increased self-awareness,

self-efficacy, and utilization of adaptive skills.

This review highlighted OT’s unique strength in generalizing coping skills and psychotherapy

principles to daily occupations and personal routines for clients with a variety of eating disorders. It also

demonstrated the statistical prevalence of sensory dysfunction in ED populations, effective outcomes of

OT’s sensory-integration and sensory-processing interventions, as well as evidence supporting their

underlying neuro-plasticity assumptions. These implications are especially relevant to the treatment of

the newest ED diagnosis Avoidant-Restrictive Food Intake Disorder (ARFID). Individuals with this

diagnosis demonstrate evident hyper or hypo sensitivity, and non-adaptive behavioral responses due to

sensory dysregulation resulting in clinically significant dietary restriction and nutritional deficiency.

When compared to other ED diagnoses, studies show that ARFID displays increased comorbidities in

medical conditions, cognitive impairment, and Autism Spectrum Disorder (ASD).

A depth of experience and evidence supporting effective intervention with individuals diagnosed

with ASD was referenced, providing further support to the role of OT in this setting, specific to ARFID

diagnosis. The accumulation of the sensory-based research demonstrated that the strongest functional
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and neuronal modifications, linked to behavioral changes, were consistently more effective when

utilizing multi-sensory, task-specific, and meaningful activities. An OTR/L’s dynamic knowledge of

medical, social, psychological, and environmental influences on occupational engagement, combined

with advanced skills in activity analysis, contribute to the unique clinical reasoning skills that can

strengthen a comprehensive and interdisciplinary approach to health. This is relevant to OT practice in

general, but is noted as being specifically applicable to effective intervention of complex ED diagnoses

and cases. Effective consideration and implementation of these components requires a level of clinical

reasoning, specific to occupational therapy, that strongly suggests the need for direct services. These

findings, in conjunction with the needs analysis, contributed to the structure and development of my

program proposal.

Program Proposal

A detailed proposal, involving the incorporation of direct occupational therapy services, to

further expand and strengthen the facility’s multidisciplinary approach to evidence-based eating

disorder intervention and prevention was outlined. Problem solving of pragmatic considerations such as

space, material, and budget allocations were explicitly addressed in this section. Probable scenarios

included a breakdown of OTR/L obligations and time allocation, incorporation of COTAs, and integration

of services in both day and outpatient programs. Budgeting included in kind, start-up, and yearly direct

costs for material, assessments, and salaries.

Reallocation of day program facilitators to include an OTR/L would progress the effectiveness of

functional interventions through evaluations and interventions informed by clinical reasoning specific to

OT. With that said, the cost of employing an OTR/L for these services is more expensive than the

professionals currently employed. Since the day programs are reimbursed through bundled services, to

compensate for the cost difference of employing an OTR/L, outpatient services were incorporated into
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the schedule. A detailed summary of valid and billable diagnostic and treatment codes, specific to billing

and reimbursement of outpatient occupational therapy at the facility was included, demonstrating

promising revenue to contribute to the program’s cost.

As supported by the literature review, utilizing OT would provide skilled specialization in eating,

sensory-based interventions, and autism to strengthen effective ARFID intervention. This expansion of

their interdisciplinary approach would be unique to any other ED facility in the state, and has the

potential to expand clientele through effective marketing and networking. Lastly, specific measurements

of outcomes were outlined to evaluate the efficacy of this program, inform the development of best

practice protocol, and ensure professional competency. This includes both formative evaluations and a

summative year review of both qualitative and quantitative data.

*Note: For those interested in reviewing the full version*

For future employers seriously considering my qualifications, disclosure of the full 62-page document

could be provided with permission from the facility’s management on a case-by-case basis. If you are

interested in reviewing the full needs analysis, literature review, and program proposal, please contact

me directly.