... Sexuality and Intimacy Across the Continuum of Care Courtney Cummings, OTS, PCBIS May, 2023 A capstone project submitted in partial fulfillment for the requirements of the Doctor of Occupational Therapy degree from the University of Indianapolis, School of Occupational Therapy. Under the direction of the faculty capstone advisor: Dr. Beth Ann Walker PhD, MS, OTR, FAOTA Cummings 1 Abstract One challenge occupational therapy practitioners face in practice is addressing sexuality and intimacy. This doctoral capstone project aims to increase practitioners' level of knowledge, comfort, attitudes, and willingness to address sexuality and intimacy across the continuum of care. A needs assessment across six different UC Health network locations found that each site believed occupational therapy practitioners had a role in addressing sexuality and intimacy, however only one site routinely addressed it. This project strives to establish a culture of shared understanding of the importance of sexuality by providing an education module and resources. The paper emphasizes the importance of addressing sexuality and intimacy in occupational therapy practice and highlights the need for further research to continue the development of educational programs and tools to establish a holistic incorporation of sexuality into clinical practice. Keywords: Occupational therapy practitioners, sexuality, intimacy, educational module, continuum of care. Cummings 2 Introduction UC Health Network is a large healthcare organization in the Greater Cincinnati area which provides rehabilitations services (OT, PT, SPL etc - fill in) across a variety of settings including acute care, long-term acute care, skilled nursing facilities, outpatient hand clinic, outpatient lymphedema clinic, and outpatient neuro clinic. UC Health is committed to improving the health of all people regardless of race, ethnicity, geography, or ability to pay (UC Health, n.d.). To be fully committed to improving the health of all people, healthcare workers have to look at clients through a holistic lens and need to be prepared to address all topics with patients, families, and staff. Sexuality and intimacy are important aspects of the human experience regardless of age, injury, illness, or disabilities (Couldrick, 1998; Lynch & Fortune, 2019; WHO, 2006). After completing an introductory interview at the UC outpatient Neuro clinic, it was determined that sexuality and intimacy are rarely addressed due to a gap in the therapists level of comfort and knowledge. If therapists at one location are not discussing sexuality and intimacy with patients, it is reasonable to assume other locations may not be addressing this topic either. The purpose of my capstone project was to increase therapists' levels of comfort, willingness, attitudes, and knowledge of sexuality and intimacy across the continuum of care. This capstone project aimed to create an education module on the topic of addressing sexuality and intimacy across the continuum of care by providing theoretical frameworks, assessment tools, and intervention resources for occupational therapy practitioners. The educational modules were presented across the UC Health Network to ensure therapists throughout the continuity of care are better prepared to address sexuality Cummings 3 and intimacy. Modules included a pre and post-knowledge check and a satisfaction survey to measure knowledge gain, level of comfort, change in attitudes, and willingness to address sexuality and intimacy Background Occupational therapy is a holistic, client-centered profession that aims to assist patients in reaching their optimal levels of performance in their activities of daily living (ADLs). To stay true to our profession and practice in a holistic and client-centered manner occupational therapists are obligated to address sexuality and intimacy with their clients (Fouche, 2014; Gray, 2021). Addressing sexuality and intimacy within occupational therapy practice has been highlighted within the literature for generations (Connie et al., 1979; Couldrick, 1998; Eglseder & Webb, 2018) This topic is not new or emerging, yet continues to be rarely addressed in routine practice (Dyer & Nair, 2013). The American Occupational Therapy Association (AOTA) has recognized and acknowledged sexual activity as an area of occupation within activities of daily living (ADL) (AOTA, 2020). The majority of occupational therapy practitioners recognize and acknowledge the importance of sexuality and that it is within the domain of our practice (Young et al., 2020). Despite this knowledge occupational therapy practitioners continue to be reluctant to address sexuality with their clients (Esmail et al., 2010). Literature suggests the barriers to addressing sexuality an intimacy include lack of knowledge, decreased comfort, attitudes, willingness, and perceived readiness of clients (AreskougJosefsson et al., 2016; Eglseder & Webb, 2017; Hyland & McGrath, 2013; McGrath & Lynch, 2014; Young et al., 2020). Cummings 4 A representative from each of the six UC Health therapy locations was selected to complete a needs assessment addressing sexuality and intimacy in their setting. The representatives from each site, long-term acute care, skilled nursing facilities, outpatient hand clinic, outpatient lymphedema clinic, and two outpatient neuro locations, believe that sexuality and intimacy are within the occupational therapy scope of practice. Out of the six locations, only the lymphedema clinic is routinely addressing the topic. The lymphedema clinic representative believes sexuality and intimacy are more likely to be addressed in this setting due to the nature of the work, being in patients' personal space, and the topic is an item on the Lymphedema Life Impact Scale which is administered during the initial evaluation. Additional barriers noted by representative occupational therapists included: clinician discomfort, lack of screening tools, lack of knowledge, environmental factors such as lack of private space to discuss topics, perceived readiness of clients/wrong setting, lack of resources, and no prior training. The barriers identified at UC Health align with barriers found within the literature, signify a call to action to address these barriers. Many articles highlight the importance of addressing sexuality and intimacy within the scope of occupational therapy (MacRae, 2013), yet there is a gap between professional ideology and practice in occupational therapy (Eglseder & Webb, 2018; McGrath & Lynch, 2014). Throughout the literature, it is repeated that the need for future research is to develop education and programs to establish a holistic incorporation of sexuality into clinical practice (Couldrick, 1999; Eglseder & Webb, 2018; Haag et al., 2016; Mohammed, 2017; OMullan et al., 2021; Young et al., 2020). The barriers to addressing sexuality and intimacy have been established for decades, however, very little Cummings 5 research has been explored regarding the development of educational modules for occupational therapists in practice. This capstone project aimed to create a community at UC Health to establish a culture of shared understanding of the importance of sexuality by providing education modules and resources that can enhance comfort, attitudes, knowledge, and skill set when addressing sexuality and intimacy to enhance the sexual education for our patients (Eglseder & Webb, 2017). This project strived to improve occupational therapy practitioners' level of comfort and willingness to address sexuality and intimacy by increasing their knowledge through educational modules. More recently Fortinsky and Shaham (2020) modified the needs assessment to evaluate the attitudes, knowledge levels, and skill requirements of addressing sexuality for occupational therapists in Israel. They found that due to limitations within occupational therapy education, therapists lack intervention skills for addressing sexuality with patients. They proposed the need to develop a three-part seminar to enhance the learning and skill development necessary to address sexuality with patients. Similarly, Lepage et al., (2020) explored occupational therapists' perceptions of the factors that influence their practice addressing sexuality and identified the need to develop continuing education. Lepage et al., (2020) discussed the need for educational training to address occupational therapists' attitudes to understanding client factors, as well as assessments and interventions. More recently Walker et al., (2023) presented a workshop at the 2023 AOTA conference on Using a positive solution-focused approach to enhance education related to the global practice of OT in addressing sexuality and intimacy, once again illustrating the need for educational changes in addressing sexuality and intimacy. These Cummings 6 articles are just a few of the many that highlight the need for the development of educational resources pertaining to addressing sexuality and intimacy in occupational therapy. There is a lot of literature highlighting the need for educational modules, the need for change, and the need for implication into practice, but very little is known about the success of that education or how it is created. My project aims to capitalize on the followthrough and identify how to make that change by creating an educational module. Guiding Theory Occupational therapy practitioners are uniquely skilled to incorporate the Person, Environment, and Occupation (PEO) model to address the challenges with sexuality and intimacy after injury or illness. The PEO model is dynamic in nature due to the constant transaction between person, environment, and occupation that impacts occupational performance (Cole & Tufano, 2020). The transaction goes beyond interaction, and if one area changes then every area changes and occupational performance is impacted. As these areas change they can either overlap more and maximize the fit or spread a part minimizing the fit; the better the fit the better the occupational performance. In the case of the capstone project, the Person is the individual therapist, the Occupation is addressing sexuality and intimacy and the Environment is UC Health. The aim of the educational module addressing sexuality and intimacy at UC Health was to influence the knowledge of individual therapists, thus the Person and further influence the environment, and occupation and leading to the improvement of occupational performance. Cummings 7 In conjunction with the PEO model, the Occupational Therapy Sexual Assessment Framework (OTSAF) will be utilized to guide the development of educational modules and educational resources. The OTSAF is a theoretical framework that addresses sexuality and intimacy in the context of occupational therapy. The OTSAF is made up of nine constructs; sexual knowledge, sexual response, sexual interest, sexual self-view, sexual expression, sexual activity, intimacy, sexual health, and family planning (Walker et al., 2020). As the educational module is developed, it is important to consider each to understand the occupational nature of sexuality and intimacy construct and how they impact clients at UC Health. Creating educational modules will not only help improve therapists ability to define the occupational nature of sexuality and intimacy but enable them to address sexuality and intimacy in practice, thereby potentially enhancing their clients quality of life. Project Design Educational modules addressing sexuality and intimacy within the scope of occupational therapy were developed due to the discovery of a gap between professional ideology and practice. An introductory needs assessment was conducted across six UC Health therapy locations and it was determined that sexuality and intimacy were not being routinely addressed. Barriers addressing sexuality and intimacy that were reported across the UC Health network included; lack of knowledge, lack of comfort, perceived readiness of clients, lack of assessment upon evaluation, and limited private space to address topics in the clinic. The educational module was developed in evidence-based research with a strong influence from the Occupational Therapy Sexual Assessment Framework (OTSAF). The Cummings 8 55-minute educational module was created on Google Slides and accompanied by a voiceover lecture. The educational module was distributed across the six UC health network locations via email for Occupational Therapy Practitioners to review as their schedule permits. For four weeks, weekly email reminders were sent out to ensure that the maximum number of occupational therapy practitioners were reached. Occupational Therapy Practitioners were also encouraged to participate by word of mouth. Prior to viewing the educational modules occupational therapy practioners completed a semi-structured survey from a modified version of the Knowledge, Comfort, Approach, and Attitudes towards Sexuality Scale (KCAASS) (Kendall et al., 2003) which was developed in reference to the framework - The Occupational Therapy Sexual Assessment Framework (OTSAF) (Walker et al., 2020). The original outcome measure was designed for health professionals working in Spinal Cord Injury rehabilitation to gather information about the topic of sexuality. The outcome measure was modified to suit occupational therapists working with the general physical rehabilitation population across the continuum of care. Approval to modify and use the KCAASS was granted by Kendall (2003) and was distributed across the continuum of care at the UC Health Network. The modified version of the KCAASS consisted of four sections: knowledge, comfort, willingness, and attitudes. The outcome measure was shortened from 47 to 35 questions, with 9 items addressing staff knowledge, 15 items related to staff comfort, 8 items addressing staff willingness, and 3 items addressing attitudes towards sexuality. Alterations were made to the terminology with the purpose of being inclusive and gender-neutral. Nine new items were added in place of staff knowledge to capture the Cummings 9 occupational nature of sexuality and intimacy based on the OTSAF. Five new items were added to staff comfort with the purpose of capturing the levels of comfort regarding sexual minorities. A panel consisting of an expert in the field and an onsite therapist was utilized to provide initial feedback on the modified version of the KCAASS. Suggestions were taken into consideration and the modified version of the KCAASS was refined and revised. See Appendix A for a full copy of the modified KCAASS. Project Outcomes Participants Participants were recruited for this study from the six occupational therapy practice settings at UC Health via email and word of mouth. A total of five participants completed the pre-test measure but only four completed the post-test measure. Of the four participants who completed the module, three identified as female and one identified as male. The participants' years of experience ranged from 1 to 7 years, with an average of 4.5 years. Two participants had a Master's degree in Occupational Therapy, while the other two participants held a Doctorate in Occupational Therapy. Three participants worked full-time and one participant worked PRN. The participants worked in various practice settings, including Outpatient Hands, Skilled Nursing Facility (SNF), and two worked in Outpatient Neuro rehab. Statistical Analysis A statical analysis was conducted to compare the mean scores between the pretest and post-test measures of the modified Knowledge, Comfort, Approach, and Cummings 10 Attitudes Towards Sexuality Scale (KCAASS) following the educational module addressing sexuality and intimacy within the scope of occupational therapy across the continuum of care. The category addressing occupational therapy practitioners' knowledge had 9 items, Comfort had 15 items, willingness had 8 items, and attitudes had 3 items. All together the four categories had 35 items. The total score was calculated for each pre and post test category. The total score for each category was then averaged and the standard deviation was calculated. The pretest and post test score for each category was then compared to determine the percentage of change. Knowledge The pre-test category knowledge of sexuality and intimacy (M = 20.5, SD = 4.43) and post-test (M = 27.25, SD = 7) showed increase in knowledge gained by 18% Discomfort The pretest measuring occupational therapy practitioners' level of discomfort addressing sexuality and intimacy (M = 31.5, SD = 6.08) compared to the post-test (M = 24.25 , SD = 7.68), showed a decrease in discomfort by 13%. Willingness The pre-test measuring occupational therapy practitioners willingness to address sexuality and intimacy (M = 20.3, SD = 2.63) compared to the post-test (M = 26 , SD = 5), showed an increase in willingness to address sexuality and intimacy by 18% Attitudes Cummings 11 The pretest of occupational therapy practitioners attitudes (M = 8.25, SD = 0.5 ) and post-test (M = 9.3, SD = 1.05), showed an increase in positive attitudes toward sexuality and intimacy by 8%. Knowledge, Comfort, Willingness, Attitudes Table 1. Highlights the pretest and post-test scores below. It is shown that the implementation of the education module leads to an increase in knowledge, a decrease in discomfort, an increase in willingness, and an increase in positive attitudes addressing sexuality and intimacy across the continuum of care. The Pre-test and Post-Test modified KCAASS found that knowledge Pre-test (M = 20.5, SD = 4.43) and post-test (M = 27.25, SD = 7) and willingness, a pre-test (M = 20.5, SD = 4.43) and post-test (M = 27.25, SD = 7) had the highest increase in the mean difference at 18%. This suggests that with an increase in knowledge occupational therapy practitioners may be more willing to address sexuality and intimacy. Discomfort scores, Pre-test (M = 31.5, SD = 6.08) and the posttest (M = 24.25, SD = 7.68) decreased by 13%. Attitudes had the smallest amount of change with an increase in positive attitudes by 8 %, Pre-test (M = 8.25, SD = 0.5 ) and post-test (M = 9.3, SD = 1.05). and post-test (M = 27.25, SD = 7) with an increase in willingness to address sexuality and intimacy by 18%. Table 1 Outcome Measures Mean Pretest Score (M) Pretest Score Std. Deviation (SD) Mean PostTest Score (M) Post-Test Std. Deviation (SD) Mean Difference (MD) Number of Participants (n) Knowledge 20.5 (57%) 4.43 27.2 (76%) 7 + 6.75 (18%) 4 Discomfort 31.5 (56%) 6.08 24.25 (43%) 7.68 - 7.25 (13%) 4 Cummings 12 Willingness 20.3 (63%) 2.63 26 (81%) 5 + 5.8 (18%) 4 Attitudes 8.25 (69%) 0.5 9.3 (77%) 1.05 +1 (8%) 4 Summary Throughout the literature review it was found that many occupational therapist practitioners acknowledge that sexuality and intimacy are within the scope of occupational therapy, however, are reluctant to address the topic due to barriers such as lack of knowledge, comfort, willingness, attitudes, lack of time, and professional support. This capstone project was developed for the six UC Health Network locations in the Greater Cincinnati area for occupational therapy departments across a wide range of settings including acute care, long-term acute care, skilled nursing facilities, outpatient hand clinic, outpatient lymphedema clinic, and an outpatient neuro clinic. A representative from each of the six UC Health therapy locations was selected to complete a needs assessment addressing sexuality and intimacy in their setting. The needs assessment found that each site identified that sexuality and intimacy were within the scope of occupational therapy, however only one out of six sites addresses the topic regularly in practice. The gap between professional ideology and practice in occupational therapy in regard to sexuality and intimacy highlighted the need for an educational module in sexuality and intimacy. This capstone project aimed to increase occupational therapy practitioners' level of comfort, willingness, attitudes, and knowledge of sexuality and intimacy across the continuum of care through an educational module. A dependent sample t-test was conducted to determine if there was a significant difference in scores between the pre-test Cummings 13 and post-test measures of the modified KCAAS. The study found that knowledge, comfort, attitude, and willingness all had an increase in pre and post-test scores. Conclusion As a result of this capstone project an educational module and digital resource binder to address sexuality and intimacy across the continuum of care was created. The educational module provided theoretical frameworks, a screening and assessment tool, intervention strategies, goal writing, billing codes, and a case study for occupational therapy practitioners. The educational module was presented across the UC Health Network at six locations, two outpatient neuro clinics, a skilled nursing facility, a hand clinic, a lymphedema clinic, and a long-term acute care facility. The goal was to ensure occupational therapy practitioners throughout the continuum of care are better prepared to address sexuality and intimacy. In the future, it is suggested to present the information in person to create accountability to increase participation. The initiation of conversation surrounding sexuality and intimacy relies on practitioners' interprofessional collaboration and intrinsic factors. The development of educational modules can improve knowledge, but comfort, willingness and attitudes are intrinsic factors that rely on the development of selfreflection and personal growth. To evolve and expanded our role as occupational therapy practitioners there needs to be a positive change in enhancing education as it relates to addressing sexuality and intimacy (Walker et al., 2023). To truly be a holistic client center profession and uphold our ethical obligations, we must address sexuality and intimacy. Cummings 14 Reference American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.).American Journal of Occupational Therapy, 74 (Supplement 2). Advance online publication Areskoug-Josefsson, K., Larsson, A., Gard, G., Rolander, B., & Juuso, P. (2016). 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The development of a scale to assess the training needs of professionals in providing sexuality rehabilitation following spinal cord injury. Sexuality and Disability, 21(1), 49-64. Kielhofner, G., & Taylor, R. (2017). Research in occupational therapy: Methods of inquiry for enhancing practice. F.A. Davis Company. Lepage, C., Auger, L.-P., & Rochette, A. (2020). Sexuality in the context of physical rehabilitation as perceived by occupational therapists. Disability and Rehabilitation, 43(19), 27392749. Lynch, C., & Fortune, T. (2019). Applying an occupational lens to thinking about and addressing sexuality. sexuality and disability. Sexuality and Disability, 37. MacRae, N. (2013). Sexuality and the role of occupational therapy. American Occupational Therapy Association. Mohammed, A. (2017). Addressing Sexuality in Occupational Therapy. OT Practice, 22(9), CE-1-CE-8. McGrath, M., & Lynch, E. (2014). Occupational therapists perspectives on addressing sexual concerns of older adults in the context of rehabilitation. Disability and Rehabilitation, 36, 651657. National Institute of Standards and Technology (NIST). (n.d.). Student's tDistribution Table. In Engineering Statistics Handbook. Retrieved April 10, 2023 from https://www.itl.nist.gov/div898/handbook/eda/section3/eda3672.htm. Cummings 17 OMullan, C., OReilly, M., & Meredith, P. (2021). Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice? Australian Occupational Therapy Journal, 68(3), 272281. https://doi.org/10.1111/1440-1630.12723 UC Health Mission. About UC Health. (n.d.). Retrieved December 12, 2022, from https://www.uchealth.com/about/#:~:text=Our%20Mission,and%20building%20a %20diverse%20workforce. Young, K., Dodington, A., Smith, C., & Heck, C. S. (2020). Addressing clients' sexual health in occupational therapy practice. Canadian Journal of Occupational Therapy, 87(1), 5262. Walker, B. A., Otte, K., LeMond, K., Hess, P., Kaizer, K., Faulkner, T., & Christy, D. (2020). Development of the Occupational Performance Inventory of Sexuality and Intimacy (OPISI): Phase One. The Open Journal of Occupational Therapy, 8(2), 118. https://doi.org/10.15453/2168-6408.1694 Walker, B. A., Soros, J., Reese, K., Ellis, K., Alter, A., Cummings, C., Downs, B., Elstien, K., Greenwell, I., & Luna, K. (2023, April 20-23). Using a positive solution-focused approach to enhance education related to the global practice of OT in addressing sexuality and intimacy [Conference workshop]. American Occupational Therapy Association INSPIRE 2023 Conference, Kansas City, MO. World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health 28-31 January 2002, Geneva. https://www.who.int/reproductivehealth/publications/sexual_health/defining_sexu al_healh.pdf?ua=1 Cummings 18 Appendix A Modified Knowledge, Comfort, Approach and Attitudes Towards Sexuality Scale (KCAASS; M. Kendall, S. Booth, P. Fronek, D. Miller, T. Geraghty) Characteristic of participants: 1. What sex were you assigned at birth, on your original birth certificate? a. Female b. Male c. Dont know d. Prefer not to answer 2. What is your current gender? a. Male b. Female c. Transgender man d. Transgender woman e. Non-Binary f. Other g. Prefer not to answer 3. Years of Experience in Occupational Therapy? 4. Highest Level of Education received within Occupational Therapy? a. Doctorate in Occupational Therapy b. Masters in Occupational Therapy c. Bachelors in Occupational Therapy d. Associates in Occupational Therapy 5. Position a. Full Time b. Part time c. PRN 6. What practice setting do you work in? a. Outpatient Neuro b. Long-term Acute Care (LTAC) c. Skilled Nursing Facility (SNF) d. Outpatient Lymphedema e. Outpatient hands f. Inpatient psychiatric hospital g. other: _____ 7. Do you have any areas of speciality/extra certifications or credentials? Cummings 19 8. Have you received previous education areas of sexuality and Intimacy within the scope of occupational therapy? a. Yes b. No 9. If you replied Yes to the question above, How was that education received? a. Occupational therapy Program b. Self-Selected Continuing Education c. At Work d. Self-Taught (books, videos) e. Social Media f. Other SECTION 1: Knowledge On a scale of 14, please indicate your current level of knowledge in dealing with the following topics as they relate to your patient population 1. Sexual Knowledge: What a person knows, understands, believes, and values regarding sexuality and intimacy. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 2. Sexual Activity: A persons ability to safely engage in sexual and/or intimate activities (alone or with another person). Sexual activities may include hugging, kissing, foreplay, masturbation, oral sex, anal sex, vaginal sex, and use of sexual toys or devices. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 3. Sexual Interest: A persons psychological and physiological drive, motivation, desire, or libido related to participation in sexual activities alone or with another person. a. No knowledge b. Limited knowledge c. Some knowledge Cummings 20 d. Excellent knowledge 4. Sexual Response: The bodys physical sexual response associated with sexual activity including physiological arousal, response to erogenous zones, nipple erection, clitoral excitation, erection, vaginal lubrication, prostate release, ejaculation, and/or orgasm. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 5. Sexual Expression: A persons ability to express themselves as a sexual being. A person may express their sexuality and/or gender identity through behaviors, mannerisms, preferences, appearance, pronouns, political engagement, acquired tendencies, daily routines, symbolic actions, or preferred roles. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 6. Sexual Self-View: How a person views themselves as a sexual being and includes aspects of sexual identity, gender identity (examples among many: man, woman, nonbinary, transman, ciswoman, genderqueer, gender nonconforming), sexual selfesteem (a persons comfort and confidence with how they view themselves as a sexual being), and body image (mental representation of how a person pictures themselves). a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 7. Intimacy: A persons ability to initiate and maintain close intimate relationships which includes the ability to give and receive affection needed to successfully interact in the role as intimate partner. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge Cummings 21 8. Sexual Health: A persons ability to develop, manage, and maintain routines for sexual health including practicing safe sex and identifying, understanding, selecting, and use of protection a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge 9. Family Planning: A persons ability to develop, manage, and maintain routines associated with fertility, pregnancy, and/or parenthood. a. No knowledge b. Limited knowledge c. Some knowledge d. Excellent knowledge SECTION 2: Comfort Please rate the following items on a scale from 1 (no discomfort), to 4 (high discomfort) on the amount of comfort/discomfort you would feel in these situations. 1. When you are teaching how to self-catch, the patient gets an erection. a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 2. Patient asks, Will I ever be able to have an erection? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 3. Patient with tetraplegia asks, Can I still have sex? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort Cummings 22 4. Patient who identifies as a gay man with a spinal cord injury is requesting information about intimacy. a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 5. Patient says I cant feel anything anymore, so whats the point? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 6. Partner asks Will I hurt my partner(s) during sex? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 7. Patient who identifies a bisexual female with recent SCI, Do I show my wheelchair on the dating apps or not? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 8. Patient asks, Will I ever be able to have an orgasm again? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 9. Patient who identifies as non-binary with a stroke asks, Will I ever be able to have children? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 10. Patient asks, What will I do with my catheter during sex? Cummings 23 a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 11. Patient who identifies as a heterosexual male with a TBI says I want to have sex but my partner has lost interest. What should I do? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 12. Patient asks, What if I have a bowel accident during sex? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 13. Patient says None of my friends would ever go out with someone in a wheelchair. a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 14. Patient bursts into tears stating I have never felt like the sex I was assigned at birth a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 15. Patients ask for adaptive equipment to assist with positioning during sex. a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort SECTION 3: Willingness Cummings 24 Please indicate your current level of willingness when dealing with the following topics as they relate to your patient population. Rate the following items on a scale from 1 (Very Unlikely), to 4 (Very likely). 1. How likely are you to include aspects of sexuality and intimacy in elevator speech for what it OT a. Very Likely b. Unlikely c. Likely d. Very Likely 2. How likely are you to include aspects of sexuality and intimacy in your initial evaluation a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 3. How likely are you to officially screen for client concerns related to sexuality and intimacy a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 4. How likely do you think you would be to use a formal assessment sif concerns were identified in the screening process? a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 5. How likely are you to provide interventions for sexuality and intimacy a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 6. How likely are you to write goals to address sexuality and intimacy a. No Discomfort Cummings 25 b. Low Discomfort c. Medium Discomfort d. High Discomfort 7. How likely are you to address adaptive equipment for the use of sexual activity a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort 8. How likely are you to refer out for sexuality and intimacy issues a. No Discomfort b. Low Discomfort c. Medium Discomfort d. High Discomfort e. SECTION 4: Attitudes 1. Occupational therapy has a professional role in addressing Sexuality and Intimacy a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 2. Addressing sexuality and intimacy is a priority in my setting a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree 3. My employer is willing to let me address sexuality and intimacy a. Strongly Disagree b. Disagree c. Agree d. Strongly Agree Cummings 26 Appendix B Sexuality and Intimacy Across the Continuum of Care Project Timeline Orientation Week 1: January 9th-13th: Orientate to the setting and site. Learn about cultural, intervention styles & Patient population Discuss initial project ideas with supervisor - Completed Jan 9th Set up meeting times with BA for the semester - Completed Jan 18th Updates on project Discuss Pre/Post test & Survey questions How to disseminate the OPISI across UC campus Begin setting up meeting times for the six locations to complete individual needs assessments Completed Wednesday Jan 11th, Meeting with Colton for OP Neuro Clinic @ 11 Completed Friday Jan 13th Meeting via Teams with Maureen for Lymphedema Clinic @ 3pm. Completed Thursday Jan 23rd - Jody @ Drake OP Neuro, Rachel and Amanda @ for SNF & LTAC Create an updated literature review Barriers to address S/I Find condition specific articles Screening/ Evaluation Week 2:January 17th-20th - Continue completing needs Assessment while evaluating information already gathered -Completed Jan 23rd Begin developing Outcome measures Completed Jan 19th Find methodology articles to support outcomes measures Cummings 27 Determine how to disseminate pre/post test & Survey; Google survey/qualtrics? Update literature review, research, and MOU - Completed Jan 20th o Begin writing Intro Draft (Due 1/23) Submitted MOU, IRB form & SiteMentor Resume Completed Jan 19th Meeting with Melissa Kendall,@ Hoxworth Hands @ 12:15-45 Completed Thursday 19th Friday 20th, Transgender research @12-1 pm Via teams Completed Friday 20th Capstone Check-in 1-1:30 via Teams Completed Friday 20th Reflection responses due. Completed Friday 20th Week 3 January 23rd-27th: Finalize Pre/Post survey & test, How I will disseminate information, Outline Educational modules Meeting with Sarah @ Drake SNF, Rachel @ Drake LTAC @ 1-2 Completed Jan 23rd Meeting with Jody@ DrakeOP Neuro, 12-12:45 Completed Jan 23rd Send out the Outcome measurement to BA and make sure it is ready to go live and does not need to be revised. Start writing Background Draft Completed Jan 30th Review of best evidence and use of a theory/framework to guide project Begin Outlining lesson plans for educational modules - Completed Jan 30th solidify needs assessment information to structure outline Capstone Check-in 1-1:30 via Teams Completed Jan 27th Reflection responses due. Completed, Jan 27th Implementation: Weeks 4-10: Implement of educational modules, case study examples, Smartphrase template, Intervention Ideas, and patient educational material Week 4 January 30th-February 3rd : Background Draft turned in Completed Jan 30th Begin Developing Educational Moduled Open with trigger warning - Safe space & brave space S/I Within the Domain of OT Sexual Minorities OPISI Case study Cummings 28 Interventions Questions Begin writing Project: Design & Implementation Draft (Due 2/6) Capstone Check-in 1-1:30 via Teams Completed February 3rd Reflection responses due. Completed Febuary3rd Week 5 February 6th-10th: Develop and complete Educational modules Send educational modules out for feedback Completed Feb 17th Site Mentor Capstone Check-in 1-1:30 via Teams Completed Friday 20th Reflection responses due. Completed Friday 20th Week 6 February 13th-17th: Final Version of educational modules Completed Feb 20th Revises Educational modules Record educational modules on VT Completed Feb 20th Can I make people fill out a google form that gives them a link to the educational module to ensure I have all accurate outcome measures? Week 7 February 20th-24th: Midterm Evaluation, Educational Modules goes live Educational Modules goes live - Completed March 10th Mid Term Evaluations o UC Eval - Feb 21, @ 12:30-1 Completed Feb 21th o UIndy Eval -Online Core Completed Feb 20th Week 8 February 27th-March 3rd: Epic SmartPhrase, Send out Post Outcomes Assessment Develop Smartphrase/documentation for addressing sexuality and intimacy Completed March 14th In initial eval, future assessment/OPISI Send out post test/survey Completed March 10th Via google forum Week 9 March 6th-10th:Outcomes Draft, Answer Educational Module Questions, Find resources Begin writing Project: Outcomes Draft (Due 3/13) - Completed April 10th Cummings 29 Send out email about educational module going live and encouragement to complete pre/post test for educational module - Completed March 10th Gather intervention resources Completed April 7th Week 10 March 13th-17th: Dissemination Plan, Answer Educational Module Questions, Find resources Begin writing Dissemination plan Completed March 20th Gather intervention resources Completed April 7th Send out reminder email to complete pre/post test Completed March 15th Discontinuation Week 11 March 20th-24th: Wrap up Module Questions and Outcome measures Analyze all data gathered -Completed April 12th Develop figures accordingly Completed April 12th Week 12 March 27th-31st: Make final reports of data and feedback Completed April 13th What can the presentation include in the future? Dissemination Week 13 April 3rd-7th: Begin writing Abstract, Summary & Conclusion Draft & Thank yous, Begin writing Abstract, Summary & Conclusion Draft -Completed rough draft April 10th Write Thank yous Completed April 7th Week 14 April 10th-14th: Disseminate information, Disseminate info of the project to the site -Completed April 10th Make future recommendations Final Evaluation - Completed April 14th UC @ 1 pm UIndy on Core Evaluation of Doctoral Capstone Experience Completed April 24th Begin writing reflection draft - Completed April 24th Begin Poster Draft Completed April 24th Cummings 30 Begin VT Draft Completed April 24th Week 15 April 17th-21st: Work Remote Begin Doctoral Capstone Project Poster (electronic) (Due 5/1) Week 16 April 24th -28th: On Campus Begin Summary Written Reflection on DCE learning & experience (Due 5/1) Begin Capstone Project Presentation: VoiceThread & PPT (Due 5/1) Week 17 May 1-6th: On campus, half marathon, Graduation! Pinning Ceremony May 5th Half Marathon May 6th GRADUATION May 6th ...