Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences Commons™

Open Access. Powered by Scholars. Published by Universities.®

Rehabilitation and Therapy

Institution
Keyword
Publication Year
Publication
Publication Type
File Type

Articles 4531 - 4560 of 16632

Full-Text Articles in Medicine and Health Sciences

Implementing The Use Of Lesson Plan Templates Within The Mentorship Program For Dignity Health Hand Therapists, Ronell Matthew Sueno May 2023

Implementing The Use Of Lesson Plan Templates Within The Mentorship Program For Dignity Health Hand Therapists, Ronell Matthew Sueno

UNLV Theses, Dissertations, Professional Papers, and Capstones

Occupational therapists (OT) have a wide range of specialties following graduation, one of which is hand therapy. This specialty requires a certain level of knowledge and clinical reasoning, especially concerning hand anatomy and physiology. It is hard to transition into hand therapy as a new occupational therapist due to extensive knowledge, additional patient-care hours, specialty certifications require, and lack of opportunity. A smoother transition into the workforce can be achieved through mentorship programs that allow for meetings with mentors to ask questions and get clarification on different treatments and diagnoses. This quality improvement project focused on gaining perspectives of hand …


Exploring The Usefulness Of The Alert Program On Children With Developmental Delays Or Disabilities At Positively Kids, Ashley Cassandra Manabat Tolentino May 2023

Exploring The Usefulness Of The Alert Program On Children With Developmental Delays Or Disabilities At Positively Kids, Ashley Cassandra Manabat Tolentino

UNLV Theses, Dissertations, Professional Papers, and Capstones

This quality improvement project explored the implementation of the Alert Program's (AP) first and second phases within the Foundation for Positively Kids social skills program, PK Social ETC. This study focused on three staff members' perception of the Alert Program's usefulness on their clients' self-regulation skills and occupational participation when engaged in their daily social skills group. The Alert Program was delivered through weekly education sessions for the staff, followed by two groups involving the children to provide visual demonstrations for the staff over eight weeks. Data was collected through a pre- and post-survey using a Qualtrics survey to capture …


A Kinesio Tape ® Protocol To Improve Postural Stability And Mouth Closure For Feeding And Eating In Children With Cerebral Palsy, Ariana Naomi Valdez May 2023

A Kinesio Tape ® Protocol To Improve Postural Stability And Mouth Closure For Feeding And Eating In Children With Cerebral Palsy, Ariana Naomi Valdez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Kinesio tape ® (KT) has been used in the rehabilitation of children with cerebral palsy (CP) due to its ability to increase sensory input, normalize muscle tone, improve postural stability, and improve range of motion (ROM). KT can be applied and left on the skin for multiple days, allowing the tape to simulate the effects of manual therapy techniques outside of the outpatient setting. However, its use within occupational therapy (OT) to address the occupations of feeding and eating is limited, despite it being an effective treatment method when used in conjunction with traditional OT. Gaps in research limit occupational …


An Adolescent Concussion Management Toolkit For Occupational Therapists, Coby Yoshimura May 2023

An Adolescent Concussion Management Toolkit For Occupational Therapists, Coby Yoshimura

UNLV Theses, Dissertations, Professional Papers, and Capstones

The aim of this project was to demonstrate the role occupational therapists may serve during concussion recovery, by integrating current research and findings into an instructional resource from an occupational therapy (OT) lens. An OT-based toolkit was created to prioritize the identification, assessment, and treatment of two realms of concussion management: functional cognition and vision. The development of a pre and post survey using a modified version of the Generalized Self-Efficacy (GSE) scale was used to determine occupational therapists’ perceived self-efficacy before and after reviewing the created OT-based toolkit. A related samples Wilcoxon signed rank-test was used to analyze pre …


Exploring Relationships And Intimacy With Adults With Intellectual And/Or Developmental Disabilities (I/Dd), Gabrielle Kennedy, Jazminne Orozco Arteaga, Thais Petrocelli May 2023

Exploring Relationships And Intimacy With Adults With Intellectual And/Or Developmental Disabilities (I/Dd), Gabrielle Kennedy, Jazminne Orozco Arteaga, Thais Petrocelli

Spring 2023 Virtual OTD Capstone Symposium

This capstone project, Exploring Relationships and Intimacy with Adults with Intellectual and/or Developmental Disabilities (I/DD), was completed by a Doctor of Occupational Therapy candidate at the University of St. Augustine for Health Sciences. The purpose of the project is to increase adults with I/DD's access to intimate partner relationships, sexual expression, and occupations related to intimacy by providing adaptive, community-centered, and meaningful resources.

The current occupational deprivation that the population experiences surrounding intimacy, sexual expression, and intimate partner relationships must be addressed to improve the population’s overall quality of life, health, and well-being. This project aims to inspire and …


The Importance Of Mood And Motivation Of An Individual In The Success Of Physical Therapy, Spencer Wagner May 2023

The Importance Of Mood And Motivation Of An Individual In The Success Of Physical Therapy, Spencer Wagner

Honors Program: Senior Projects (Public)

Physical therapy is a health profession that helps people improve their movement and range of motion in certain body areas. Since the time it was founded, physical therapists have mainly focused on the physical health of the patient. While that is their job, they may not have been as successful because they neglected the mental health of the patient. The mindset of an individual, particularly their mood and motivation, can influence how they progress through physical therapy and how successful they are in regaining functionality in their affected body area. The purpose of this study is to determine how the …


Kids And Canines: Pawsitively Impacting Occupational Therapy Outcomes, Jessica M. Simon May 2023

Kids And Canines: Pawsitively Impacting Occupational Therapy Outcomes, Jessica M. Simon

Occupational Therapy Capstone Presentations

Within the scope of pediatric occupational therapy, Animal-Assisted Therapy (AAT) is a new and emerging area of practice that has shown to have a positive impact in its use with pediatric clients specifically. AAT is formally defined as, “a form of therapy that includes the presence of and/or interaction with an animal to facilitate progress toward some therapeutic goal” (Hardy & Weston, 2020, p. 197). Through the completion of this Capstone, the student aimed to develop in-depth clinical practice skills related to using AAT within pediatric occupational therapy, develop professional leadership skills, and contribute meaningful research regarding the benefits of …


Sensory Integration: Improving Participation, Behavior, And Learning In Individuals With Sensory Processing Disorder, Brooklyn K. Osborne May 2023

Sensory Integration: Improving Participation, Behavior, And Learning In Individuals With Sensory Processing Disorder, Brooklyn K. Osborne

Occupational Therapy Capstone Presentations

This capstone project encompassed a two-fold focus on advanced clinical practice in the area of sensory integration and research on the effect of sensory integration on the family dynamic. Ayres Sensory Integration was implemented in clinical practice in order to enhance learning, behavior, and participation in individuals with sensory processing disorder and sensory concerns. The research study examined the lived experiences of parents/caregivers of children with sensory processing difficulties to understand how sensory integration has impacted their family dynamic. Qualitative phenomenological methodology was used for data collection and analysis. Sixteen parents were interviewed, and four major themes emerged including family …


The Relevance Of Sensory-Based Intervention In Improving Occupational Performance In Pediatrics, Jasmine M. Fritzemeier May 2023

The Relevance Of Sensory-Based Intervention In Improving Occupational Performance In Pediatrics, Jasmine M. Fritzemeier

Occupational Therapy Capstone Presentations

The present capstone experience highlights sensory processing differences in relation to occupational performance. Current literature suggests varying evidence on sensory processing differences and effective interventions. This capstone utilizes GAS to measure progress toward functional goals with sensory-based intervention. Results indicate improvements for all five clients in at least one area after 5 to 8 sessions of sensory-based intervention. Improvements noted on GAS demonstrate the effectiveness of sensory-based intervention to address functional differences. The scope of practice for occupational therapy practitioners, therefore, includes sensory-based intervention to improve functional performance and well-being across several settings.


Treating Cognition Through Occupational Performance In Individuals With Neurological Disorders In Home Health, Alcina J. Park May 2023

Treating Cognition Through Occupational Performance In Individuals With Neurological Disorders In Home Health, Alcina J. Park

Occupational Therapy Capstone Presentations

Neurological Disorders (ND) like Alzheimer’s Disease, is one of the leading chronic diseases in older adults (National Council on Aging, 2023). One of the most common symptoms of ND is cognitive dysfunction, which prevent individuals with NDs from pursuing their daily occupations (Liu et al., 2019). This makes the exploration of treatment that delays functional decline in NDs imperative. Occupational therapy is valued and recognized in literature, but limited research is specific to cognition in occupational performance in home health. This capstone project used cognitive therapy approaches Cognitive Stimulation Therapy, Cognitive Rehabilitation Therapy, and Cognitive Training, to combat cognitive decline …


The Role Of Occupational Therapy In Meeting Mental Health Needs Of College Students In The South Dakota Regental University System, Molly J. Graesser May 2023

The Role Of Occupational Therapy In Meeting Mental Health Needs Of College Students In The South Dakota Regental University System, Molly J. Graesser

Occupational Therapy Capstone Presentations

College students with mental health concerns and disabilities are at risk for poorer academic outcomes. Utilization of student support services (TRIO, disability services, and student counseling services) can mitigate these issues. However, utilization patterns and the service delivery process are not well understood in the South Dakota Board of Regents (SDBOR) system. This study aimed to investigate 1. The extent to which students utilize mental health and disability services in the South Dakota Board of Regent (SDBOR) University system. 2. How service providers deliver those services to students. Utilizing a cross sectional survey and grounded theory design, researchers found that …


Physical And Psychological Impacts Of Burn Injuries On The Pediatric Population And Their Families: An Occupational Therapy Perspective, Sadie E. Anderson May 2023

Physical And Psychological Impacts Of Burn Injuries On The Pediatric Population And Their Families: An Occupational Therapy Perspective, Sadie E. Anderson

Occupational Therapy Capstone Presentations

Background: Due to the curious nature of the pediatric population, burns are a common and leading cause of non-fatal and fatal injuries among children. Following these injuries, the impacts extend beyond the physical impairments that occur and often result in long-term psychological impacts for the child and their families. With a holistic approach to care, occupational therapy is fully equipped to aid in the mitigating of these impacts. Method: Through advanced clinical practice and the development of various questionnaires, occupational therapy interventions were explored and integrated to facilitate functional outcomes and improve mental health care. Results: With the provision of …


Quality Of Life Among Caregivers Of Individuals With 22q11.2 Deletion Syndrome And Intellectual Disability, Sandra Garza Ochoa May 2023

Quality Of Life Among Caregivers Of Individuals With 22q11.2 Deletion Syndrome And Intellectual Disability, Sandra Garza Ochoa

Theses and Dissertations

Caregiving for a person with 22q11.2 chromosome deletion syndrome (22q) often entails dealing with medically life-threatening complications and is significantly compounded when the care recipient has comorbid 22q and intellectual disability (ID). The purpose of this study was to examine the effect of support, spirituality, and resiliency on the quality of life (QOL) of caregivers of individuals with comorbid 22q/ID to ascertain if these protective factors would reduce their caregiving burden. Study participants consisted of 469 caregivers of persons with 22q/ID who were recruited through 22q social advocacy groups. Correlational analyses, analyses of variance, and multiple regression analysis were used …


Attitudes And Compassion Of Student Counselors-In-Training Toward Individuals Who Are Homeless, Kristine R. Gonzalez May 2023

Attitudes And Compassion Of Student Counselors-In-Training Toward Individuals Who Are Homeless, Kristine R. Gonzalez

Theses and Dissertations

With the increased numbers of homeless individuals over the past several years, it is important to consider factors that contribute to chronic homelessness, including barriers to service delivery that impede one’s ability to exit homelessness. The purpose of this quantitative study was to examine the attitudes and compassion among student counselors-in-training (SCITs) toward individuals experiencing homelessness as these students represent future mental health providers who will be serving the homeless, a highly marginalized population. A total of 162 graduate students from two southwestern Hispanic-serving institutions were recruited for the study. A correlational analysis, independent t-tests, and one-way ANOVAs were conducted …


Exploring The Occupational Transition Of Leaving A Cult, Justine Thompson, Baylee R. Chelossi, Emily Osborn, Christian J. Quitoriano May 2023

Exploring The Occupational Transition Of Leaving A Cult, Justine Thompson, Baylee R. Chelossi, Emily Osborn, Christian J. Quitoriano

Occupational Therapy | MSOT Capstone Projects

The emergence of cult groups has introduced a new population for occupational therapists to understand and support through the unique challenges they face after transitioning out of these organizations. While research within the field of psychology is robust, little is known about the occupational transition of individuals who leave cults and how occupational therapists can provide occupational science based intervention. In this study, the frameworks of Doing, Being, Becoming (Wilcock, 2002), and Belonging (Hitch et al., 2014b) were utilized to guide theme development and enrich interpretation of 11 hand-searched first-hand accounts. First-hand accounts were analyzed from multimedia sources such as …


A Qualitative Study On Long-Term Adherence To Home Exercise Programs In People With Parkinson’S Disease, Caroline Stafford, Brennan Decena, Shawn Lopez, Judith Thepkaisone May 2023

A Qualitative Study On Long-Term Adherence To Home Exercise Programs In People With Parkinson’S Disease, Caroline Stafford, Brennan Decena, Shawn Lopez, Judith Thepkaisone

Occupational Therapy | MSOT Capstone Projects

Exercise has been found to slow the progression of Parkinson's Disease (PD) symptoms which can increase independence for daily activities and overall quality of life. In order for the benefits of exercise to continue after a program is completed, integration of the exercises into everyday life may lead to long-term adherence. Through the use of semi-structured interviews, this study investigated if increasing facilitators while decreasing barriers improves adherence to home exercise programs, leading to the establishment of exercise integrated habits in People with Parkinson’s Disease (PwPD). This study found that long-term adherence was achieved by participants. The themes related to …


Ots Delivering Culturally Sensitive Care For Dementia Family Caregivers From Diverse Backgrounds, Abraham Lai, Lucy Palacios Mendez, Darren Sarmiento May 2023

Ots Delivering Culturally Sensitive Care For Dementia Family Caregivers From Diverse Backgrounds, Abraham Lai, Lucy Palacios Mendez, Darren Sarmiento

Occupational Therapy | MSOT Capstone Projects

As occupational therapists, addressing key cultural barriers that may obstruct access to dementia care and education for individuals with dementia and their caregivers from diverse backgrounds is a priority for client-centered care. Stress, racial discrimination, and distrust may exacerbate symptoms and prevalence of dementia in certain populations, such as Chinese- Americans and Latinx (Quinones et al. 2020). Immigrants’ experiences of aging and health are diverse due to belonging to different socioeconomic, ethnic, cultural, and linguistic groups and having varying levels of education and work experience (R. S. 2020). There are existing cultural differences regarding caregiving and family networks, perception and …


Life After Brain Injury - Survivor And Family Perspectives, Brandon Duenas, Gary Eng, Haleli Moalem, Miguel Regidor May 2023

Life After Brain Injury - Survivor And Family Perspectives, Brandon Duenas, Gary Eng, Haleli Moalem, Miguel Regidor

Occupational Therapy | MSOT Capstone Projects

Background: Acquired brain injuries (ABI) is an umbrella term for mild to severe injuries on the brain with different etiologies, such as traumatic brain injuries (TBI) caused by an external force like a motor vehicle accident, or a non-traumatic brain injury (NTBI) results from an internal force, such as a stroke or aneurysm (Oyesanya, 2017). Current practice trends anchored in traditional rehabilitation models provide the most services and interventions for brain injury survivors (BIS) within the first year post injury. Yet, ABI can have lifelong occupational engagement impacts and there is limited research focused on the brain injury survivor’s (BIS) …


Measuring Outcomes Of Occupational Therapy Facilitated In Natural Settings With Young Children, Amie Smith, Deepak Dale, Brinda Saini, Zoe Peters, Amanda Laccone May 2023

Measuring Outcomes Of Occupational Therapy Facilitated In Natural Settings With Young Children, Amie Smith, Deepak Dale, Brinda Saini, Zoe Peters, Amanda Laccone

Occupational Therapy | MSOT Capstone Projects

To date, there is limited evidence to support the effectiveness of Occupational Therapy (OT) services delivered outside in nature. This study explored the benefits of OT intervention in Natural Settings (NS) for children by examining development in the areas of self-regulation, social skills, sensory processing, confidence, and motor skills. A quantitative, quasi-experimental pre-test/post-test design was used in this study. Researchers partnered with a local outpatient OT clinic that offers an 8-week outdoor program. Seven children and their parents were recruited and participated in the study. A modified version of the COPM and two BOT-2 subtests, along with a novel log …


Promoting Cultural Arts Access Through Sensory-Friendly Theatre, Chanelle Bautista, Alyssa Cho, Jazmine Cunanan, Ariana Marino, Miko Ramos May 2023

Promoting Cultural Arts Access Through Sensory-Friendly Theatre, Chanelle Bautista, Alyssa Cho, Jazmine Cunanan, Ariana Marino, Miko Ramos

Occupational Therapy | MSOT Capstone Projects

Children with sensory processing differences have “reduced participation in recreational and community activities compared to children with both typical development and other developmental disabilities” due to their difficulties with social communication, and strict social settings (Giserman-Kiss et al., 2020). Sensory-friendly theatre programs aim to dismantle social participation barriers for individuals with sensory processing differences by creating a relaxed theatre experience that includes preparatory materials, environmental modifications, and specialized training (Umeda, 2017). We implemented a pilot sensory-friendly performance of Willy Wonka, Jr. in collaboration with youth actors at the Throckmorton Theatre in Mill Valley, CA on February 13th, 2022. Approximately 80 …


The Feasibility Of A Large-Amplitude Aquatic-Based Exercise Occupational Therapy Program For Individuals With Early Parkinson’S Disease, Brigitte Baker May 2023

The Feasibility Of A Large-Amplitude Aquatic-Based Exercise Occupational Therapy Program For Individuals With Early Parkinson’S Disease, Brigitte Baker

UNLV Theses, Dissertations, Professional Papers, and Capstones

Purpose: The purpose of this research was to determine if a 4-week aquatic-based, large-amplitude exercise program would increase strength and coordination for occupational performance in areas of activities of daily living (ADLs) and mobility in individuals with Parkinson's disease (PD) stage I-II, functional mobility as measured by Timed Up and Go test, and quality of life as measured by PDQ-39 in relation to occupational engagement.Methodology: Recruitment was through capstone placement site, Hands on Rehab, 7921 Professional Circle, Huntington Beach, CA 92648, in which a signed EAA was on file. Informed Consent was reviewed by the student-clinician as well as the …


Development And Usefulness Of An Advocacy Toolkit To Promote Systems-Level Advocacy Among Occupational Therapy Students In Nevada, Mary Angela Mendoza Terencio May 2023

Development And Usefulness Of An Advocacy Toolkit To Promote Systems-Level Advocacy Among Occupational Therapy Students In Nevada, Mary Angela Mendoza Terencio

UNLV Theses, Dissertations, Professional Papers, and Capstones

Advocating at the systems level to influence legislation and regulation can protect, promote, and progress the occupational therapy profession. This quality improvement project aimed to create and evaluate an advocacy toolkit for professional students in Nevada. The toolkit was developed under the guidance of a team of advocacy experts and leaders. Twenty-five students were recruited through convenience sampling to evaluate the toolkit. Data was collected through a one-group pretest-posttest qualitative improvement design to capture changes in awareness of Nevada-specific regulatory and legislative information, attitudes toward advocacy efforts, and the toolkit’s usability. Comparisons between the pre- and post-toolkit surveys were analyzed …


A Proof Of Concept For Detection Of Palato-Lingual Contact Without Intraoral Electrodes In A Human Participant, Amitava Biswas May 2023

A Proof Of Concept For Detection Of Palato-Lingual Contact Without Intraoral Electrodes In A Human Participant, Amitava Biswas

Master's Theses

The author of this thesis conceived and investigated an unexpected electrical signal that may not be noticed during regular electroglottography (EGG) when electrodes are conventionally placed on the anterior surface of the throat. It appears that there is a measurable electrical signal from the EGG equipment when electrodes are placed over the frontal cheek (belly of zygomatic muscle), and the tongue is elevated to contact the hard palate, or the tongue is lowered to break the contact. Therefore, this phenomenon is designated as unconventional electroglottography (UEGG, Dr. Steven Cloud, private communication, July 17, 2022).

Two distinctive patterns of waveforms were …


Targeted Alveo-Pleural Fistula Endobronchial Valve Treatment Using Ventilation Scintigraphy, Calvin Sidhu, Shoba Ratnagobal, Rajesh Thomas, Gary Y.C. Lee, Enya Drudy, Roslyn J. Francis May 2023

Targeted Alveo-Pleural Fistula Endobronchial Valve Treatment Using Ventilation Scintigraphy, Calvin Sidhu, Shoba Ratnagobal, Rajesh Thomas, Gary Y.C. Lee, Enya Drudy, Roslyn J. Francis

Research outputs 2022 to 2026

Persistent air-leaks can be difficult to localize in radiology. Bronchoscopic management of air-leaks requires identification of the leak's location to allow suitable targeted treatment. One-way endobronchial valves have become a suitable option for persistent air-leaks. In this report, a combination scintigraphy and one-way endobronchial valve treatment successfully resolved a persistent air-leak.


The Effect Of Running On The Onset And Development Of Osteoarthritis, Jordan Hekman May 2023

The Effect Of Running On The Onset And Development Of Osteoarthritis, Jordan Hekman

Senior Honors Theses

Osteoarthritis is a prominent and debilitating form of joint disease characterized by pain and deterioration of the articular cartilage and other tissues in the affected joint. Research has identified a variety of risk factors for osteoarthritis, including age, obesity, gender, previous injury, and occupation. The relationship between running and osteoarthritis is a topic of particular interest because of the prevalence of running as a simple and physiologically beneficial form of exercise. Increasing evidence suggests that recreational running has at worst no effect and at best a protective effect on joint and articular cartilage health in contrast to high-intensity professional/elite-level running …


Serving Victims Of Human Trafficking In Northeast Arkansas, Chasity Garrett May 2023

Serving Victims Of Human Trafficking In Northeast Arkansas, Chasity Garrett

Occupational Therapy Doctoral Capstones

According to (Jordan & Mossman, 2018), a study conducted in Kenya shows that a self-defense course for girls of all ages to be beneficial in decreasing the risk of sexual assault. Outcomes of the course showed improvements in self-esteem, self- efficacy, assertiveness, and physical defense skills, along with decreased levels of fear. Self-defense programs can reduce the rates of sexual victimization, increase confidence, reduce fear and decline the rates of human trafficking which would benefit the DCE at Hope Found.


Increasing Health And Wellness For Low Socioeconomic Status Children At The Bryant Boys And Girls Club, Bethany D. Hutchinson May 2023

Increasing Health And Wellness For Low Socioeconomic Status Children At The Bryant Boys And Girls Club, Bethany D. Hutchinson

Occupational Therapy Doctoral Capstones

The Occupational Adaptation Theory was used to guide the experience and project by identifying deficits and creating adaptive responses as solutions to the found deficits.


Advocating For The Implementation Of Interprofessional Collaboration In A Pediatric Private Practice, Morgan Weaver Gilbert May 2023

Advocating For The Implementation Of Interprofessional Collaboration In A Pediatric Private Practice, Morgan Weaver Gilbert

Occupational Therapy Doctoral Capstones

The purpose of the capstone project was to establish clinical pathways for Occupational and Physical Therapy within a pediatric private practice setting. The DCE focused on the interprofessional collaboration of the rehabilitation team, which includes merging the care between physical (PT), occupational (OT), and speech therapy (ST).


Mental Health Educational Program For Law Enforcement Officers, Elizabeth Allen May 2023

Mental Health Educational Program For Law Enforcement Officers, Elizabeth Allen

Occupational Therapy Doctoral Capstones

A mental health educational program was created to educate corrections officers on various mental health diagnoses, psychiatric treatments , mental health law, cultural sensitivity, and deescalation skills. The purpose of the program was to enhance mental health knowledge in corrections officers and increase the health and wellness outcomes of the inmates. Mental health resources given at the end of the program could be utilized by the inmates after leaving the facility and by the corrections officers if they required services, as well.


Effectiveness Of Life Skills Training To Increase Self-Sufficiency In Individuals With Substance Abuse: A Research Study, Shayla Dickson May 2023

Effectiveness Of Life Skills Training To Increase Self-Sufficiency In Individuals With Substance Abuse: A Research Study, Shayla Dickson

Occupational Therapy Doctoral Capstones

Drug and alcohol addiction is a growing disease of concern in society. There is also a lack of evidence regarding the contribution that occupational therapy (OT) can offer this particular population. Due to the varying needs of the individuals and the occupational disturbances that are a central component of addiction (Martin et al., 2015), diverse focus areas of OT could provide a more holistic provision of services to build life skills needed for improved self-sufficiency for sustained sobriety.