University of Southern California
University of Southern California
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Building better doctor’s visits for adults with autism

, in General News

Newly funded study looks to improve primary health care encounters of autistic adults

By Mike McNulty

Office waiting room/Photo by Martin Kenny (Flickr)

Office waiting room/Photo by Martin Kenny (Flickr)

During his first visit to the doctor’s office, Bobby fled from the waiting room, ran outside the building and hid in the parking lot. During his second visit, the 22-year-old’s anxiety was just as palpable. Bobby began jumping in place, repeating dialogue from his favorite television show and complaining that the office’s bright, buzzing fluorescent lights hurt his eyes and ears. Because he refused to allow any care providers to touch his body, his initial physical examination had to be further postponed.

Bobby — who is diagnosed with Pervasive Developmental Disorder-Not Otherwise Specified, a subtype of autism that has since been folded under the umbrella diagnosis of autism spectrum disorder or “ASD” — is one example of how seemingly straightforward primary care medical visits can pose complex and challenging experiences for adults with ASD.

Study to identify what helps, hurts the office experience

“Adults with autism spectrum disorder face unique challenges to receiving optimal medical care due to a number of factors,” said Leah Stein Duker, assistant professor of research at the USC Chan Division of Occupational Science and Occupational Therapy.

These factors include difficulties with communication, challenges making health care decisions, overstimulation within the clinic environment and a lack of ASD-specific training for providers, she said. Some physicians interviewed in a 2013 survey, for example, erroneously considered autism as only a childhood disorder.

“There is a limited research detailing the specific needs of adults with ASD during primary care health encounters, and even fewer evidence-based strategies to facilitate these experiences,” Duker said. “They are often fraught with serious difficulties for the patients, their caregivers and their practitioners — this means that the quality of their medical care is not what it could be or what it should be.”

April is National Autism Awareness Month, an annual public service campaign for increasing awareness, acceptance and celebration of people on the autism spectrum. But unfortunately, there are no professional standards or agreed-upon best practices for primary care encounters with autistic adults. This is a population that will only continue growing as the wave of children who were diagnosed with autism beginning in the early 1990s — and which grew exponentially throughout the ’90s and ’00s — comes of age.

Duker hopes to change that with a new research grant she recently received from the American Occupational Therapy Foundation. The grant will fund Duker’s study, “Environmental Barriers and Facilitators for Adults with ASD during Primary Care Health Encounters,” in which she and her team will conduct interviews with adults with ASD, their caregivers and their providers to better understand the types of problems they face during primary care. The interviews will form the basis for a preliminary intervention plan which will likely include target strategies such as physician education, caregiver training, tips for promoting patient–provider communication and decision-making strategies for patients and caregivers.

“My objective is to improve health care services for adults with ASD, which can ultimately enhance both short- and long-term outcomes for this vulnerable and underserved population,” Duker said.

What about Bobby?

At a presentation during last month’s annual conference of the American Occupational Therapy Association, Duker and her colleague Beth Pfeiffer, associate professor at Temple University’s College of Public Health, highlighted Bobby’s case to demonstrate how occupational therapy successfully helped Bobby’s primary care providers improve his overall care access and experience.

Together, Bobby’s occupational therapist and the medical office nursing staff developed a verbal and visual “picture schedule” for each phase of subsequent office visits in order to help Bobby know what to expect. To reduce Bobby’s anxiety, his family reviewed the picture schedule and did role playing with him during the week prior to each visit.

The occupational therapist worked with office staff to section off a “quiet area” of the waiting room with dimmed lighting, a sound machine to muffle office noises and walls painted a soothing light blue color. An in-service training was given to the physicians and staff about strategies to support successful visits, including the value of visual cues and alternative methods of communication. The office also established a scheduling policy to ensure that patients with developmental and sensory needs like Bobby can book appointments when the clinic is not as busy, enabling extra time to complete exams and work with families and caregivers.

These are seemingly simple tips that can go a long way toward improving the total primary care experience for adults with ASD.

“Truly patient-centered care is respectful and responsive to individual patients, whatever their specific preferences and needs might be,” said Duker. “I see a future in which our medical system delivers exactly that.”

Mattingly among three USC faculty honored as 2017 Guggenheim Fellows

, in General News, Student News, Alumni News

Fellowship to support writing new book on stigma

By Mike McNulty with Susan Bell and Ian Geckler/USC News

Professor Cheryl Mattingly

Professor Cheryl Mattingly

Professor Cheryl Mattingly has been honored with a 2017 Guggenheim Fellowship, one of only three USC faculty members to receive the prestigious award. She joins a diverse cohort of 173 scholars, artists and scientists from across North America selected from a pool of almost 3,000 applicants by the John Simon Guggenheim Memorial Foundation on the basis of prior achievement and exceptional promise.

Mattingly, who holds a joint appointment in the Department of Anthropology at the USC Dornsife College of Letters, Arts and Sciences, is a medical and psychological anthropologist who is inspired by phenomenology, the philosophy of ethics and narrative theory.

Her research — including Boundary Crossings, a longitudinal study of health care trajectories in 30 African-American children with illnesses and/or disabilities, their families and the practitioners who serve them — has focused on the experience of disability, family care and health disparities for minority populations. Throughout her work, she has aimed to document more than large-scale forces of social injustice.

The Guggenheim Fellowship will enable her to concentrate on her new book, Category Trouble: Stigma as Moral Experience. The book will explore recent attention to “moral striving” in anthropology that has highlighted how people struggle to transform or exceed the lives they inhabit — aspirations that can sometimes increase suffering. The writing will be more experimental than in her previous works, she said.

“Can I write compelling nonfiction short stories that also have a certain theoretical, even existential, resonance? Can my stories help us rethink stigma as a painful and personal lived experience, as a social marker of marginalized groups and also as a feature of the human condition?”

Since its establishment in 1925, the Guggenheim Foundation has granted more than $350 million in Fellowships to more than 18,000 individuals including scores of Nobel laureates, Pulitzer Prize winners, poets laureate, and members of the various national academies. The program remains an especially significant source of support for scholars in the humanities and social sciences.

Mattingly said she was stunned at the news she had won a Guggenheim, but added that she felt a special connection to the honor.

“There is deep significance for me in receiving a Guggenheim because of the program’s long history as a supporter of innovation and creativity, especially in the arts and humanities,” Mattingly said.

“Although anthropology is generally classified as a social science, I have always been a humanities-oriented type. One reason I gravitated toward anthropology as a discipline was because its research approach and methods encouraged us to listen carefully to the stories people told us and to record those stories ‘in their own words.’”

Mattingly is perhaps best known to occupational therapists for her scholarship, beginning in the 1980s, on the clinical reasoning of occupational therapy practitioners. Along with Maureen Fleming, Mattingly’s 1991 articles published in the American Journal of Occupational Therapy as well as their 1994 book, Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice, are considered seminal works on the topic of occupational therapists’ clinical reasoning and actions during patient care encounters.

Two Chan students named Schweitzer fellows

, in General News, Student News

Projects aim to improve health status of vulnerable L.A. populations

By Mike McNulty

2017-18 Schweitzer Fellows Allie Schmiesing MA ’18 and Erin Malia Sako MA ’18/Photo by Kelly Tongoi

2017-18 Schweitzer Fellows Allie Schmiesing MA ’18 and Erin Malia Sako MA ’18/Photo by Kelly Tongoi

Erin Malia Sako MA ’18 and Allie Schmiesing MA ’18, first-year students in the division’s entry-level occupational therapy professional program, have been selected to the 2017-2018 class of Los Angeles Albert Schweitzer Fellows.

The Albert Schweitzer Fellowship supports university graduate students who conceive and implement projects designed to improve the health and well-being of vulnerable populations. Schweitzer Fellows partner with area organizations to identify an unmet health need, design a 200-hour service project with demonstrable impact, and usher the project from conception to implementation.

Sako will conduct her fellowship at the Painted Brain where she will serve people in Central Los Angeles County who are labeled with mental illness and address the need for accessible, affordable community-based programs that focus on managing stress and reducing stigma. With a community space located in Los Angeles’ Koreatown district, Painted Brain aims to provide sustainable community-based programs and solutions using arts, advocacy and enterprise for people living with mental health challenges.

Schmiesing has designed a program for older adults living in the greater Los Angeles community based upon research in the gerontology and occupational science literature that supports the use of reminiscence and inter-generational programs to improve quality of life among older adults. In conjunction with partners Front Porch and LifeBio, Schmiesing will facilitate participants’ reflection and storytelling to improve positive self-concept and quality of life across a variety of measures.

Painted Brain at USC’s APGSA

, in General News

By Kristina Han/Painted Brain

Suminagashi artwork courtesy of the Painted Brain

Suminagashi artwork courtesy of the Painted Brain

This past week, the Painted Brain (PB) joined USC’s Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy (OT) in an art workshop hosted by Asian Pacific Graduate Student Association (APGSA) for students pursuing to become healthcare professionals. Anna Yena Kim, an OT intern at the PB, introduced the art of Suminagashi, a Japanese marbling technique. The group grew quickly engaged and enticed by this free flowing, cathartic form of art. Although it seems to be a simple technique, requiring only droplets of paint and breath onto water, the resulting piece can range from simple to highly complex variants of pattern, ripple, and shape. Regardless, it was evident that every participant had an enjoyable experience while experimenting and expressing through this relaxing form of art.

Read the full article at Painted Brain.

Practical tips for Brain Injury Awareness Month

, in General News

By Mike McNulty

More than 12 million Americans live with a brain injury caused by any number of non-hereditary or non-developmental reasons such as disease, oxygen deprivation or tumors. The scope of brain injuries ranges from mild to severe, and symptoms can exhibit as personality changes, trouble with memory, confusion or poor judgment.

To help educate the public about the incidence of brain injury and its impact upon individuals, their families and communities, the month of March is designated as Brain Injury Awareness Month.

As members of comprehensive care teams for people with brain injury — sometimes referred to as acquired brain injury, ABI, or traumatic brain injury, TBI — occupational therapists work with patients to maximize independence in meaningful activities that ultimately improve quality of life.

Samia Rafeedie, associate clinical professor of occupational therapy at USC Chan, is a Certified Brain Injury Specialist. In recognition of Brain Injury Awareness Month, she offered these useful tips to help friends and family members support a person with brain injury throughout the rehabilitation process:

Lamp

1. When interacting with your loved one, keep the room quiet and calm; turn off or dim the lights, limit environmental stimuli and speak in short, simple phrases



Stopwatch

2. Allow the person additional time to respond after you ask a question or need information; do not expect responses to be logical or sensible



Orientation

3. Try to re-orient your loved one by letting them know who you are, where he or she is, what happened and why he or she is getting rehabilitation



Heart

4. Provide your loved one with familiar activities or meaningful occupations; these can be as simple as putting on lotion, combing hair or listening to favorite music



Checklist

5. Do not force the person to do an activity or task that is not desired; facilitate participation in activities and occupations which are meaningful, familiar and safe




Learn more about Brain Injury Awareness Month at Brain Injury Association of America.

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