As I round the corner into my second year as a doctorate of occupational therapy (OTD) student, ideas for capstone projects are beginning to emerge. Last summer I had the opportunity to attend virtual capstone presentations by the Pacific University graduating OTD class of 2020 and now, as an OTD student myself, am reflecting on how I envision my own capstone project. My coursework has provided numerous examples of capstone projects from prior occupational therapy (OT) students, including their associated scholarly articles and recorded presentations. After reviewing these resources, I have come to know better what I am looking to achieve through my capstone project.
I chose OT as my intended profession for many reasons, but one shines brightest in consideration of capstone projects: to make lasting change that enhances and/or improves lives. I endeavor to ground my capstone in advocacy while pursuing such areas as program development, leadership, and/or administration, with intent to develop clinical practice skills for myself, other students of OT, and OT practitioners. I intend to achieve these goals through the scholarship of integration and application. That is, I intend to solve real problems by drawing upon, synthesizing, and applying knowledge from both OT and other disciplines.
While my capstone project ideas are numerous, they continue to be abstract and evolving. I am delighting in this process of idea generation and eagerly anticipate the day one such idea crystallizes. Currently, I have three capstone project ideas that are at least partially realized, and they are as follows:
- Develop policy or other initiative(s) that increases coverage of OT services in palliative and hospice care (PAHC) by Medicare/Medicaid.
- Palliative care is a specialized, interdisciplinary approach to providing medical care to individuals living with serious illness. Hospice care, while also specialized and interdisciplinary, is provided to those who are in the final phase of a terminal illness. Palliative and hospice care are frequently perceived to be the same care, even spoken in the same breath. This does not stem from a poor delineation of the two, however. Rather, it is born of a misuse and subsequent misunderstanding of services. Individuals often receive palliative care too late in the stage of their illness, before they can truly benefit from the services, and are transitioned into hospice care shortly thereafter. Additionally, Medicare/Medicaid are hesitant to cover the costs of OT services in PAHC because those deemed close to or at “end of life” are similarly deemed not in need of “therapeutic services.” That is, money for OT services is better spent on those who are sufficiently “living.” This evidences a critical misunderstanding of OT services and how we can benefit those living with serious illness, for even those at “end of life” are, indeed, still alive and deserving of a high quality of life. The denial of OT services to those in PAHC is an occupational injustice that denies people their right to participate in cherished occupations and unnecessarily increases mental and emotional anguish. I have identified a need for increased education about the roles of OT in PAHC, along with a need for the development of policy that increases coverage for, and therefore access to, these services by Medicare/Medicaid.
- Develop a fibromyalgia-specific pain scale.
- Although fibromyalgia is no longer considered a mental disorder, its symptoms are persistently misunderstood and poorly treated, if at all. The U.S. healthcare system is inadequately prepared to identify symptoms of this under-researched condition, resulting in significant delays in diagnosis. Fibromyalgia symptoms change day-to-day in location, intensity, and duration, which is poorly captured by traditional pain scales like the visual analog scale (VAS). Thus, the longer these individuals live undiagnosed with fibromyalgia, the more likely they are to feel isolated by their pain and stigmatized by their providers and communities. I have identified a need for a more effective pain scale, developed in collaboration with individuals living with fibromyalgia, to decrease diagnosis times and provide a more holistic approach to symptom identification.
- Increase suicide awareness and training within Portland, Oregon healthcare systems.
- Kevin Hines jumped from the Golden Gate Bridge at the age of 19 – and survived. Now, he travels the world as a mental health advocate, raising awareness about suicide and its impact on individuals with suicidal ideations, as well as their families and communities. The documentary Suicide: The Ripple Effect documents his journey, including fighting – and winning – to increase suicide prevention at the Golden Gate Bridge (e.g., phones boxes, safety nets). When I look around my own city, Portland, Oregon, I see few of these interventions implemented. This is particularly alarming for a city that lovingly calls itself “Bridge City” on account of its many bridges. I have identified a need for greater suicide awareness and training in Portland that requires infrastructure changes, yes, but also institutional and systemic changes, in particular those that care for vulnerable populations such as the elderly and individuals living with mental illness.
