Healthy Transitions: An Opportunity For OT Intervention

Editor's Note: This text-based course is a transcript of the webinar, Healthy Transitions: An Opportunity For OT Intervention, presented by Ingrid Provident, EdD, OTR/L, FAOTA.

Learning Outcomes

• After this course, participants will be able to differentiate various life transitions as positive, neutral, and negative.
• After this course, participants will be able to compare/contrast strategies for dealing with life transitions.
• After this course, participants will be able to distinguish how OTs can assist persons who have difficulty with life transitions, examine case studies, and apply OT theory to highlight OT’s unique role in intervention.

Introduction

Thanks so much, and thank you all for being with us this evening as we transition from 2023 to 2024.

Change Vs. Transitions

• Change is always happening and is situational
• Transitions are a psychological process offering a chance for growth
• CHANGE is NOT the same as TRANSITION
• Transitions are a process with 3 distinct phases

It's interesting to reflect on transitions and how they encompass a variety of life changes, both big and small. Change itself is often seen as situational, while transitions, on the other hand, are intrinsic to the human experience. As occupational therapists, we recognize that navigating transitions isn't always straightforward, and individuals may grapple with emotions like fear, worry, anxiety, or even depression when faced with the unknown.

In our discussion, we'll delve into the literature surrounding transitions, exploring the three-phase process that characterizes this natural aspect of being human. We'll also explore strategies for navigating transitions, especially in situations commonly encountered by many. Additionally, we'll examine real case studies to understand how occupational therapists play a vital role in facilitating healthy transitions for the individuals they serve. Transitions, as we'll discover, are more than just changes—they are integral parts of our shared human experience.

Why Are Transitions Important?

• Everyone experiences them
• Everyone’s experience is unique
• Transitions can have a profound impact on a person’s well-being and development
• Provide an opportunity for examination and purposeful choice
• Can provide growth and shift in mindset

The significance of discussing transitions lies in recognizing that not everyone experiences them in a linear or predictable manner. Individualized experiences vary widely, and helping those who struggle with transitions is crucial. Whether it's a simple shift between activities causing stress or more significant life changes like moving to assisted living, understanding and assisting with transitions become vital.

Life transitions offer an opportunity for reflection and positive change. They can be transformative, prompting individuals to examine their path and make improvements. Emotions play a substantial role in this process, and as occupational therapists, helping individuals manage their emotions and fostering emotional regulation becomes an essential aspect of guiding them through transitions. Shifting mindsets to view life transitions as opportunities for growth and improvement is a key objective in facilitating healthy adjustments.

Life Transitions

• Planned or unexpected
• Bring about emotion
  • Learning to manage emotions
  • Emotional regulation
• Require coping strategies
  • Pay attention to thoughts/emotions
  • Reframe thoughts
• Support from friends, professionals

Life transitions often evoke a mix of emotions, whether planned or unexpected. Managing these emotions and promoting emotional regulation is crucial for a healthy transition. Shame and resentment, if unaddressed, can intensify and prolong recovery, leading to depression and impacting an individual's participation in life.

For instance, a person fired from their job may feel intense shame, leading to social withdrawal and even contemplating suicide. Occupational therapists can play a crucial role in addressing these emotions and exploring the life transitions contributing to such struggles. Examples abound of individuals experiencing unexpected negative emotions despite positive life events, such as postpartum depression after eagerly awaiting a child.

Occupational therapists can assist by conducting an occupational profile, allowing clients to express their feelings and explore how these emotions affect their roles and patterns. Open communication about needs and coping strategies, coupled with support systems from friends, family, and professionals, can be transformative in helping individuals process their emotions and navigate life transitions more effectively.

Coping Skills

• Difficult but has a positive aspect
• Accept change/May not understand the event
• Identify values and goals
• Identify and express feelings- Uncomfortable
• Focus on the payoffs
• Acknowledge left behind/Don’t be in a rush
• Stay sober
• Good self-care/Consistent routines
• One step at a time

When addressing coping skills for challenging transitions, it's crucial to help individuals reframe their perspective, recognizing the difficulty while finding silver linings. Encouraging acceptance of change, even if unplanned or not fully understood, is vital. Connecting with others who have undergone similar experiences and fostering an attitude that views change as a normal part of life can ease the transition.

Individuals with a strong sense of identity aligned with values and life goals tend to navigate transitions more smoothly. They exhibit a willingness to take responsibility, avoiding blame for unforeseen events. Resilience becomes a key trait, enabling them to focus on the positive outcomes, acknowledge what was left behind, and avoid turning to potentially harmful habits. Establishing good self-care practices and maintaining consistent routines contribute to a sense of calm amidst life disruptions. While adjusting to new realities takes time, guiding individuals to take incremental steps toward their goals can demystify the perceived enormity of transitions.

Three Phases of Transitions

• Ending/Goodbye
• Neutral Zone/Messy Middle
• New Beginning

Transitions comprise three distinct phases: endings, the neutral zone, and new beginnings. Contrary to conventional storytelling, transitions begin with endings. Endings involve saying goodbye and leaving something behind. It's important to understand that endings don't necessarily denote finality; they mark the start of change. The neutral zone, often perceived as unproductive, is the messy middle between endings and new beginnings. It's a time of disconnection, disorientation, and evaluation of new options. This phase involves replacing old habits with new ones, akin to making sustainable New Year's resolutions. Finally, the new beginning is when individuals embark on their new path.

Getting stuck in any of these phases can hinder a healthy transition. If someone remains fixated on what they've lost, they might be stuck in the ending phase. Alternatively, being unsure of what to do next can trap individuals in the neutral zone. Understanding these phases allows therapists to facilitate clients' progression through the transition process.

Endings

• "Endings" are about letting go of the old situation or way of doing things
• Can be difficult as it often involves feelings of loss, fear, and uncertainty
• Clearing of old to get ready for new
• Endings can be like experiences of dying

The first phase of transitions, endings, involves letting go and closing chapters. This phase can be particularly challenging, especially in the case of unplanned transitions such as job loss, the death of a loved one, or a significant move. Endings can be likened to experiences of loss, and individuals may go through stages such as denial, anger, bargaining, depression, and acceptance, similar to the stages observed in the death process.

For those who get stuck in this phase, emotions related to these stages may be overwhelming. Acknowledging and permitting oneself to experience these emotions is crucial for processing the loss and easing the process of letting go. Communication plays a vital role, as does looking for positives and focusing on the opportunities that lie ahead, thereby facilitating reframing or refocusing during this challenging phase.

Four Stages of Endings

• Disengagement
  • Break from roles, activities, settings, and ways of seeing the world
  • Gain perspective
• Disidentification
  • Give up former self-definitions
• Disenchantment
  • Question assumptions
• Disorientation
  • Confusion

In exploring the dynamics of transition, it's crucial to delve into the intricacies of the ending phase, which unfolds in distinct stages. First and foremost, there's the phase of disengagement. This denotes the necessity to break free from the roles, activities, and settings of the former situation. The challenge lies in making this break, as clinging to the familiar can impede a successful transition. Notably, disengagement doesn't strictly entail physical departure; psychological disengagement is equally significant. It is through this psychological detachment that individuals often gain valuable perspective.

Moving forward, disidentification surfaces as a pivotal aspect. This stage involves not only a shift in activities but also a relinquishing of former self-definitions. Individuals navigating this phase might feel like they are abandoning or shedding their previous identity. For instance, someone transitioning from identifying as a teenager or young adult to embracing a different life stage is essentially undergoing disidentification. Retirement, too, can be a juncture where an individual detaches from a longstanding role.

As the journey through endings unfolds, disenchantment emerges as a notable stage. Here, self-definitions undergo a transformation, prompting a contemplation of what holds true importance and reality. The individual's sense of the world, intertwined with personal belief systems, undergoes a shift. Questioning assumptions about the significance of past roles becomes a natural part of this disenchantment phase.

Finally, there's the phase of disorientation, marked by discomfort. As views change and self-definitions evolve, individuals may grapple with confusion about their current identity and circumstances. This disorientation embodies the inherent challenge of adjusting to the altered landscape.

It's crucial to underscore that the ending phase isn't a monolithic, abrupt event but comprises nuanced stages. Recognizing these intricacies enables a more comprehensive understanding of the emotional and psychological landscape during transitions.

Transitioning into the neutral zone marks a pivotal phase situated between the conclusion of an old chapter and the commencement of something new. As individuals navigate the process of letting go and embracing the impending changes, they often find themselves in a state of disconnection. This signifies a detachment from their previous identity, yet they have not fully embraced the novel aspects lying ahead. The neutral zone, characterized as messy and transitional, acts as a bridge, inviting individuals to reassess, experiment with new possibilities, and cultivate habits aligned with their evolving aspirations.

Comprehending the nuanced dynamics of both the ending and neutral zone phases proves imperative in guiding individuals through the intricate journey of transition.

Neutral Zone/Messy Middle

• The transitional period between the old and the new
• People may feel disoriented, confused, and impatient as they navigate the unknown.
• Ungeared, untethered, drifting
• Time of exploration and experimentation
• Asking self, “What do I really want?”
• Lots of inner work

Now, in this middle, often chaotic neutral zone – the transitional period between the ending and the new beginning – individuals experience a phase where they are neither tied to the past nor firmly connected to the future.

This juncture invites profound self-reflection, offering an opportunity to evaluate one's desires for the upcoming changes. It serves as a period for self-reorientation. Analogous to transitioning between years, where the prior year concludes, and the new one unfolds, individuals find themselves untethered, drifting between these two life points. This phase encourages flexibility, an open-minded approach, and a willingness to embrace new ideas and experiences.

For instance, when aiding an older person transitioning to a new living facility, this is an opportune time to explore and adapt to the offerings of the new environment. Establishing short-term goals becomes crucial, providing a sense of progress during this often uncertain transitional phase. Literature emphasizes the importance of kindness to oneself and the exploration of possibilities during this period. The neutral zone, while seemingly uneventful externally, facilitates introspection, allowing individuals to discern their true desires before leaping into the next chapter.

New Beginnings

• Embrace the new situation and build a new identity
• Feelings of excitement, optimism, and energy are common during this phase
• Develop new routines
• Establish habits supporting your unique goals and identity to create a sense of stability and familiarity in your new environment

Transitioning to the third phase, the new beginning, marks the commencement of fresh priorities and a renewed sense of the future. Occupational therapists recognize the significance of habits, rituals, and rites of passage in this phase. Starting a new job or entering a dorm room with a welcome sign signifies a ceremonial aspect that aids in crafting a new identity. New beginnings are typically accompanied by positive emotions like excitement and optimism, infusing the journey with energy and a clearer vision for the future. Establishing positive habits becomes instrumental in supporting goals and shaping the desired identity during this transformative period.

New beginnings usher in a fresh sense of identity, shaping how individuals perceive themselves in their evolving roles. Moving from one job to a higher position, such as transitioning from a clinician to a manager, illustrates this transformation in identity. Each new beginning marks a distinct phase where individuals redefine who they are and embrace the identity aligned with their current roles and responsibilities.

Common Life Transitions

• Educational
• Career
• Relational
• Geographical
• Health
• Aging and Development
• Cultural and Identity
• Personal Development

Now, let's delve into specific life transitions. Educational transitions, such as the move from high school to college, present a significant shift for students. Occupational therapists play a crucial role in facilitating this process, participating in Individualized Education Program (IEP) meetings and aiding individuals with diverse needs as they transition from an educational setting to the workforce. Similar support is extended to college students transitioning into professional roles, particularly if involved in academia, where guidance is provided during the shift from coursework to fieldwork and onward to securing positions.

Career transitions involve changes in employment or career paths, encompassing shifts from one job to another or advancements within a particular career trajectory. Noteworthy examples include the transition from a clinician to a managerial role, signifying a profound shift in identity.

Relational transitions encompass significant life changes in relationships, such as marriage, divorce, entering or ending long-term relationships, becoming a parent, or experiencing the loss of a loved one. These transitions are intertwined with the complex tapestry of human social experiences.

Geographical transitions involve changes in location, whether moving between cities or even countries. Occupational therapists contribute by assisting individuals in preparing for and navigating the cultural differences associated with such transitions, such as healthcare trips to diverse parts of the world.

Health transitions involve individuals adapting to changes in their health status, including recovery from illness or injury, or adjusting to a chronic condition. The psychological impact of transitioning from a state of perceived health to receiving a diagnosis is a key aspect addressed by occupational therapists.

Aging and development transitions cover various life stages, such as transitioning into retirement, experiencing the empty nest syndrome, or addressing the changes associated with advanced age, including caring for elderly parents.

Cultural or identity transitions pertain to shifts in cultural identity, such as immigration or travel to a new country and the adaptation to a different cultural environment.

Personal development transitions encompass growth initiatives, such as pursuing further education, starting new hobbies, or engaging in self-improvement endeavors. Initiatives like beginning a diet or adopting a new exercise plan are also considered transitions, influencing how individuals perceive and approach these aspects of their lives.

Positive Life Transitions

• Marriage
• Birth of a baby
• Starting school
• New job
• Milestone birthdays
• New home
• Retirement

Life transitions can be broadly categorized into positive, negative, and neutral experiences. Positive life transitions include significant events such as marriage, childbirth, starting school, starting a new job, celebrating milestone birthdays, acquiring a new home, and entering retirement. While these transitions are generally viewed as positive, it's essential to recognize that even positive events can induce stress and necessitate appropriate support.

Positive transitions often entail adjustments to new roles, responsibilities, or environments. The need for emotional support during these times is crucial, emphasizing the importance of having a robust support system. Individuals undergoing positive transitions may benefit from sharing their emotions and experiences with others, fostering a sense of connection and understanding.

Notably, the perceived positivity of a life transition can vary from one individual to another. Personal circumstances, coping mechanisms, and individual perspectives contribute to how people experience these transitions. Therefore, occupational therapists play a key role in recognizing and addressing the nuanced emotional and psychological aspects of positive life transitions.

Strategies for Positive Transitions

• A special place in memory
• Stress is NOT a threat
• Appreciate change
• Remember successes
• Turn to a support network
• Prepare and plan
• Opportunity to look back and forward
• Role models
• Don’t fight change

Assisting individuals in recognizing the significance of life transitions and their impact on shaping memories is a crucial aspect of the therapeutic process. Emphasizing that these transitional moments often become cherished memories and organizing principles can contribute to a positive perspective. Encouraging individuals to acknowledge stress as a challenge rather than a threat can be empowering. While stress may initially make an event seem overwhelming, it's essential to help individuals recognize their capacity to navigate and overcome challenges.

Highlighting the positive aspects of change, especially its role in stimulating cognitive growth and fostering the development of new neural pathways, can contribute to a healthier mindset. Reflecting on past successes, building a robust support network, and effective preparation and planning are integral to ensuring a smooth transition. For instance, in retirement planning, initiating discussions and preparations well in advance—ideally around two years before retirement—allows individuals to address financial considerations and plan for the lifestyle they envision.

Utilizing role models who have successfully navigated similar life transitions provides valuable insights and encouragement. Support groups and networks become instrumental in sharing experiences and providing guidance. The emphasis on allowing oneself time to adapt and grow through changes rather than resisting them contributes to the overall well-being of individuals undergoing transitions.

Difficult/Negative Life Transitions

• The loss of:
  • a role, person, place, job
  • your sense of where you fit in the world
• Accidents
• Divorce
• Illness

Negative life transitions are frequently marked by losing a role, a person, or a significant aspect of one's life. Losing a cherished home due to circumstances or the inability to maintain it, experiencing job loss, or facing the aftermath of car accidents or falls can constitute challenging life transitions. These events often disrupt an individual's sense of independence and well-being. Additionally, divorce, illnesses, and the onset of chronic conditions are commonly categorized as negative life transitions.

Stages of Negative Transitions

1. Experience a range of feelings (anger, anxiety, confusion, numbness, and self-doubt)
2. Feel a loss of self-esteem
3. Begin to accept the change
4. Acknowledge that you need to let go of the past
5. Begin to feel hopeful about the future
6. Feel increased self-esteem
7. Develop an optimistic view of the future

In the stages of negative life transitions, individuals typically undergo a range of emotions similar to those experienced in any form of loss. Feelings of anger, anxiety, and self-doubt may emerge, often accompanied by a loss of self-esteem. As these losses are gradually accepted, individuals begin to acknowledge the necessity of letting go of elements from their past. Following this acceptance, the subsequent stage gradually becomes more hopeful. During this phase, self-esteem increases, fostering an ability to look optimistically towards the future. This progression reflects the adaptive nature of individuals as they navigate the complex emotional landscape associated with negative life transitions.

Neutral Transitions

• Sleep to wake or wake to sleep
  • Sleep hygiene
• Shifting from one activity to another
  • Task switching
  • Task paralysis
• Addition of responsibilities (Work, home)
• Change of seasons/Rhythm of nature

Neutral transitions are an inherent part of our daily lives, occurring regularly as we move from one activity to another or shift between sleep and wakefulness. Occupational therapists are significant in addressing these transitions, particularly in promoting effective sleep hygiene. Daily activities, such as commuting, working, having meals, and returning home, involve transitions that can impact emotional and energy regulation. Managing additional responsibilities or adapting to seasonal changes also represents neutral transitions.

For individuals with conditions like ADHD or those on the spectrum, neutral transitions might pose specific challenges. Understanding and addressing these challenges become essential in occupational therapy, ensuring that individuals can easily navigate neutral transitions and maintain emotional and energy regulation. A case study will further illustrate the complexities of neutral transitions in specific contexts.

Strategies for Neutral Transitions

• Prioritizing
• Structured work/Break schedule
• Using timers
• Minimizing distractions
• Routines
• Breaking tasks into smaller ones
• Mindfulness
• Just take a step

Implementing effective strategies for neutral transitions is crucial for individuals struggling with time management or facing challenges during these shifts. Prioritization plays a key role, in ensuring that tasks are organized in a structured manner. Incorporating breaks into schedules and using timers can provide external cues, aiding individuals, especially young children or those with difficulties managing time, in transitioning smoothly between tasks.

In tasks requiring concentration, minimizing distractions is essential. The myth of multitasking is debunked, emphasizing the importance of focused, concentrated effort. Manipulating the environment to reduce distractions and establishing healthy routines contribute to successful neutral transitions. Breaking down tasks into smaller components fosters a sense of accomplishment, promoting a positive transition experience.

Mindfulness strategies, focused on being present and utilizing all senses, calm the nervous system. Particularly beneficial for individuals experiencing paralysis or feeling overwhelmed by numerous tasks, mindfulness encourages initiating action, ultimately facilitating a smoother transition.

Transition Anxiety

• Unease due to change
• High prevalence in ADHD, highly sensitive, ASD
• Positive vs. negative coping behaviors
• Recognizing and practicing responses vs. reactions
• Mindfulness
• Emotional intelligence

Transition anxiety, characterized by feelings of unease during significant life changes, can instigate fear, tension, and even lead to procrastination. This anxiety may drive individuals towards maladaptive coping mechanisms, such as substance abuse or avoidance, exacerbating the challenges associated with transitions. It's crucial to note that both positive and negative transitions can evoke anxiety, and individual reactions play a pivotal role in determining the overall impact on mental health.

Practicing mindfulness, being fully present, and attentively observing one's thoughts and emotions can prove beneficial in managing transition anxiety. Developing emotional intelligence, which is understanding and effectively managing one's emotions, contributes to a healthier response during periods of change. Recognizing the potential for anxiety and adopting proactive coping strategies enhances an individual's resilience in navigating transitions.

Habits, Routines, Roles, Rituals

• Habits are automated behaviors that are learned from experience; be healthy or unhealthy, efficient or inefficient, and supportive or harmful
• Behaviors repeated enough to become automatic
• Routines result from predictable activity or regular procedures
• Roles define a person’s identity
• Rituals symbolic actions
  • Your habits shape your identity

As occupational therapy practitioners, we are well-acquainted with the significance of habits – those automated behaviors shaped by experience that can either be conducive to health or detrimental. A crucial initial step in assisting individuals through transitions involves helping them identify their habits. Examining whether rumination or repetitive behaviors hinder their ability to transition smoothly is essential.

Encouraging individuals to deconstruct their routines and pinpointing the sequence of activities that structure their day facilitates the cultivation of healthier habits. Roles, integral to one's identity, are another aspect we delve into during transitions. Acknowledging the shifts in identity that may occur in the midst of transitions allows individuals to navigate these changes more effectively.

Additionally, cultural, spiritual, or socially constructed rituals play a symbolic role in signifying the completion of a transition. Understanding that habits play a pivotal role in shaping identity is emphasized, and for further exploration, James Clear's book "Atomic Habits" is recommended, providing valuable insights into this topic.

Process of Habits

• Cue
• Trigger
• Craving
• Response
• Reward

Habits, whether healthy or unhealthy, efficient or inefficient, supportive or harmful, are automated behaviors learned from experience. The process of habit formation follows a consistent sequence: cue, trigger, craving, response, and reward. Every habit commences with a cue – a prompt that initiates action. For instance, entering a dark room prompts turning on the light switch. Ensuring that the cues in one's environment align with the desired habits is crucial.

Triggers, the factors that prompt specific behavior, play a significant role. Identifying whether triggers contribute to positive or negative responses is essential for habit development. Craving denotes the perceived need or desire, such as the hunger for food or light in a dark room. Subsequently, the response involves acting based on the identified cue and craving.

The reward, the final element in this process, arises from the positive outcome of consistently following through with the habit loop. Understanding and manipulating these components can aid in cultivating positive habits and breaking free from detrimental ones.

Habit Change 4 Laws Supporting Positive Change

1. Make cues as obvious as possible
   • Use habit stacking
2. Make it attractive
3. Make it easy
   • Reduce friction
4. Make it immediately satisfying
   • Two-minute rule

When aiming to change or establish positive habits, optimizing the cues is crucial, making them as noticeable as possible. For instance, if hunger is the cue, having readily accessible, pre-cut fruits and vegetables creates a visible and convenient option. Additionally, making the cues attractive involves incorporating elements that prompt desired behaviors.

Simplifying the process by pre-planning and making it easy to execute enhances the likelihood of habit formation. For instance, if the goal is weight loss, preparing pre-packaged, healthy snacks in advance simplifies making a nutritious choice. Lastly, ensuring immediate satisfaction within a short timeframe reinforces the positive habit loop, making it more likely to be sustained. This approach is applicable even in more complex situations, emphasizing the importance of environmental support for healthy transitions.

Breaking Negative Habits

1. Make cues invisible
2. Make bad habits unappealing
3. Make the bad habit as difficult as possible
   • FOCUS ON INCREASING FRICTION
4. Use a commitment device
5. Attach immediate satisfaction to avoiding the bad habit

When aiming to break negative habits, the approach is often the opposite. Efforts should be directed towards making cues invisible. For instance, turning off the volume on a distracting phone can eliminate a potential cue for an undesirable habit. Making bad habits unappealing and increasing the difficulty, essentially raising friction, helps deter engagement in negative behaviors.

Additionally, employing commitment devices like habit trackers or involving an accountability partner can enhance the commitment to breaking undesirable habits. Attaching immediate satisfaction to abstaining from the habit, such as engaging in an enjoyable activity for a short duration, can help alleviate cravings. For more in-depth insights, "Atomic Habits" by James Clear provides a comprehensive exploration of habit formation and modification strategies.

Occupational Therapy Role

• Developmental delays – Individual child
• Transitions in education
  • Preschool to kindergarten
• Transitions to different practice areas
• Maternal health
• Adolescent transition planning

As occupational therapists, our multifaceted role is assisting individuals through various transitions. When working with children experiencing developmental delays, we focus on collaborating with parents to design environments conducive to the child's success. This involves tailoring the surroundings to meet the child's needs and promoting a supportive atmosphere.

Occupational therapists contribute to transition plans in educational settings, particularly within the school system, such as Individualized Education Programs (IEPs). They play a crucial role in helping children understand and navigate transitions, from preschool to kindergarten or middle school to high school.

Occupational therapists also play a key role in healthcare transitions, aiding individuals moving from inpatient to outpatient settings. In maternal health, they contribute to primary care, addressing issues like postpartum depression and supporting new mothers with their health needs. Additionally, occupational therapists are involved in transition planning for adolescents, including those on the autism spectrum, addressing both complex life transitions and daily routine changes.

PEO Model

• Environment matters
  • Visual cues
  • Arranging environment
• Support system
  • Family and friends
  • Culture
  • Habit tracker/contract
    • Atomic Habits- James Clear

The Person-Environment-Occupation (PEO) model is a foundational framework in occupational therapy, emphasizing the interconnectedness of the person, their environment, and the occupations or activities they engage in. In the context of transitions, the PEO model becomes particularly relevant.

The visual cues and triggers discussed earlier highlight the importance of the environment in facilitating smooth transitions. Occupational therapists recognize that arranging physical environments with thoughtful visual cues can significantly impact a person's experience during transitions, making them feel calm and connected.

Moreover, occupational therapists consider not only the physical environment but also the social environment. The support systems surrounding an individual, including family, friends, and cultural factors, play a crucial role in supporting transitions. Acknowledging the significance of these support systems, occupational therapists ensure that the broader environment contributes positively to an individual's transition experience.

Case Example 1

• Individual with autism spectrum disorder, having difficulty transitioning from one activity to another
• Use of transition strategies
  • Preparation strategies
  • Visual timer/schedule
  • Transition cards
  • “Finished” box

For individuals on the autism spectrum facing challenges in transitioning between activities, occupational therapists employ various strategies to ease the process. Preparation strategies are crucial, involving advanced notice and signaling upcoming changes. This can be achieved through verbal communication, such as letting the individual know about an impending transition to lunch in increments, like 15 or 10 minutes beforehand. Visual tools, including timers, schedules, and transition cards, enhance understanding and anticipation of transitions.

A notable strategy mentioned is the "finished box." Comparable to the satisfaction of crossing items off a to-do list, the finished box allows individuals to physically place completed tasks into a designated box. This tangible representation aids those who may struggle with a sense of time or need visual cues to comprehend progress, offering a clear transition from work in progress to completion. These external visual strategies prove highly effective in supporting individuals through transitions.

Lifestyle Redesign

• Evidence-based
• Activity centric
• Suitable for community-dwelling elders
• Therapists review participant’s strengths, weaknesses, and environmental supports
• Attempts made to reduce barriers
• Increase facilitation of activity performance
• Decrease depressive symptoms

Occupational therapists employ lifestyle redesign as an evidence-based strategy to enhance individuals' well-being by focusing on their activities, habits, and roles within their environment. Initially developed for community-dwelling elders, this approach proves versatile across various settings. The goal of lifestyle redesign is twofold: to diminish barriers and environmental cues that foster negative habits and to boost activity performance.

By conducting a comprehensive examination of an individual's lifestyle, including habits and routines, occupational therapists can identify areas for intentional modification. The intentional redesign of lifestyle promotes better performance in activities and contributes to a sense of control and reduced feelings of depression. This approach is a holistic and effective means of improving the overall quality of life for individuals undergoing transitions or seeking positive changes.

Case Example 2

• Young adult with anxiety disorder has difficulty in their new work role, which demands high productivity of detailed computer tasks
• Purposefully use non-work time in tasks different than work
• Self-Analysis – Identify habits, routines
• Look at SDOH

In the case of a young adult with anxiety disorder struggling in a demanding work role, occupational therapists can play a vital role in helping the individual regain a sense of control. Establishing specific work intervals with designated breaks is one strategy to prevent anxiety overload. Encouraging the person to engage in diverse, non-work-related activities during breaks, such as a 15-minute walk or other physically active tasks, has proven effective in enhancing concentration and breaking the anxiety cycle.

Identifying habits and routines, along with considering social determinants of health, becomes crucial in understanding and addressing the occupational profile of individuals facing anxiety challenges. By purposefully designing tasks and incorporating supportive strategies, occupational therapists contribute to creating a more manageable and accommodating work environment for those dealing with anxiety disorders.

Social Determinants of Health (SDOH)

• Safe housing, transportation, and neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Polluted air and water
• Language and literacy skills

Examining the social determinants of health is crucial in understanding the broader context of an individual's well-being. Safe housing, transportation, job opportunities, access to nutritious foods, and language and literacy skills significantly impact a person's overall health and functioning. By considering these social determinants, occupational therapists can adopt a more comprehensive and inclusive approach when working with individuals, recognizing the interconnectedness of various elements that influence health and daily life.

Case Example 3

• An elderly person of low socioeconomic status with s/p CVA and chronic health conditions is being discharged from an inpatient setting to home.
• Care transition experience can vary due to SDOH
• Effects likelihood of compliance with intervention plan
  • Examples include:
    • Cost of medication
    • Access to transportation
    • Help at home

Absolutely, the social determinants of health play a significant role in the care transition experience for individuals, especially in cases like an elderly person with low socioeconomic status who has had a cerebrovascular accident (CVA) and is being discharged from an inpatient setting to home. The availability of resources, including financial support, housing conditions, and access to healthcare services, can greatly influence the person's ability to comply with the intervention plan and manage their chronic health conditions. With their holistic approach, occupational therapists can contribute to creating realistic and effective transition plans that consider and address these social factors for better outcomes.

KAWA Model

• Kawa Model focuses on the intersection of person, occupation, and environment
• Consists of Four Components:
  • Water in a river: the flow of a person’s life
  • River banks: natural contexts, including social and physical environments
  • Rocks: barriers to function and life flow
  • Driftwood: assets and resources that promote function and happiness

The KAWA model provides a visual representation for individuals to assess themselves in relation to their environment. The metaphor of the flow of a person's life as water, the river banks as the person's context, and identifying rocks as barriers and driftwood as assets and resources is a unique and comprehensive way to engage individuals in understanding their own situation.

Case Example 4

• A caseload of students in a high school with ID and ASD are working with OT and participating in transition planning meetings as freshmen
• Secondary transition planning
• Self-advocacy
• I PLAN
  • Instruction: Provide your inventory
  • Listen and respond, ask questions
  • Name your goals
  • KAWA application

Empowering individuals with self-advocacy skills, such as providing an inventory of their strengths and teaching them to listen, respond, ask questions, and articulate their goals, aligns with the holistic approach in occupational therapy. These strategies connect with the KAWA model, emphasizing personal strengths and environmental factors in facilitating successful transitions. 

Summary

When we started this presentation, the learning objectives were that we would be able to differentiate the life transitions as positive, neutral, and negative, compare and contrast strategies for dealing with life transitions, and distinguish how we, as OTs, can assist persons who have difficulty with life transitions.

We will now look at some of the exam questions via polling.

1) Which of the following is a TRUE statement?

A. Change is not the same as transition.  

B. Change is the same as transition.

C. Transitions have 2 phases.

D. Change is not situational.

According to the poll, 86% of you chose that change is not the same as transition. Remember, transitions have three phases, change is situational, and change is not the same as transition.

2) Which is NOT an ending stage?

A. Disillusion   

B. Disengagement

C. Disorientation

D. Disidentification

We talked about the four different stages of the "ending." We have 83% of you who selected disillusion. That is correct, as the stages in an ending are disengagement, disidentification, disenchantment, and disorientation.

3) Sleep to wake is considered which type of transition?

A. Positive

B. Neutral   

C. Negative

D. None of the above

Sleep to wake is considered a neutral transition, and 86% of you have selected the correct one. All things that happen in a normal day are fairly neutral, like going from sleep to wake, going from wake to sleep, and transitioning from one activity to another.

4) Which of the following can be used to break a negative habit?

A. Habit stacking

B. Reducing friction

C. Using a commitment device   

D. Making it attractive

Using a commitment device is the correct choice, and most of you chose that correctly. Conversely, habit stacking, reducing friction, and making it attractive always facilitate a good habit. To break a negative habit, you want to use a commitment device, some way to track that, or even use an accountability partner.

5) Occupational therapy practitioners can support transitions in what area?

A. Maternal health

B. Education settings

C. Change in practice settings

D. All of the above

We have 100% of you answering all of the above, as occupational therapists can certainly support transitions in all of these areas.

I thank you all so much for your time and energy, and there are some references available for you on these last few slides.

Questions and Answers

Is it common for people to fluctuate or regress between acceptance in earlier stages?

Absolutely. None of this happens in a really linear manner.

Any ideas on how to help younger children transition from one school to another?

A lot of this has to do with preparation and letting them know what the expectations are.

Can transitions extend to not only impacting your patient and client but also their family?

We certainly need to think about the extension beyond our patients. Involving the family can enhance your treatment.

I can see integrating many of these strategies and concepts when one has a longer-term relationship with an individual. How can this best be utilized when you working with an individual for a shorter period?

If you are helping to transition a person from a particular facility to another, you can incorporate this into the discharge plan. Then, the next set of therapists can continue with that process.

Can you get stuck in a phase depending on the transition?

It can take years, and sometimes people feel stuck in that ending place. We can help them to identify other opportunities and educate them on the fact that the process is not linear.

References

Berger, S., Escher, A., Mengle, E., & Sullivan, N. (2018). Effectiveness of health promotion, management, and maintenance interventions within the scope of occupational therapy for community-dwelling older adults: A systematic review. The American Journal of Occupational Therapy, 72(4),1-26

Bridges, W. (2004). Transitions: Making sense of life's changes (2nd ed.). Perseus Publishing.

Clear, J. (2018). Atomic habits: tiny changes, remarkable results: an easy & proven way to build good habits & break bad ones. New York, New York, Avery, an imprint of Penguin Random House.

Fresnik, J.E. (2020) Participation matters: How to navigate transitions and find meaning. Doctoral Dissertation, Boston University.

Gonyea, J., Curley, A., Melekis, K., Levine, N., & Lee, Y. (2018). Loneliness and depression among older adults in urban subsidized housing. Journal of Aging and Health, 30(3), 458-474. doi:10.1177/0898264316682908