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Occupational therapy

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The Social Participation Development For Individuals With Unilateral And Bilateral Lower Extremity Amputation, Priscilla D. Omewah, Cassandra Nelson, Scott Love Apr 2024

The Social Participation Development For Individuals With Unilateral And Bilateral Lower Extremity Amputation, Priscilla D. Omewah, Cassandra Nelson, Scott Love

Spring 2024 Virtual OTD Capstone Symposium

This occupation-based program aims to help maintain and increase social participation for individuals with unilateral or bilateral lower extremity amputations. It was developed with an occupational therapy (OT) lens targeting adults with a lower limb amputation with a population of various ages (18-70), genders, and causes of injury to develop an occupation-based program with an OT focus. Individuals living with amputation often experience hardship when developing crucial ADL/IADL skills that can be vital for social participation regardless of age or cause of injury. This program focuses on developing social participation skills lost due to decreased functional mobility and skills caused …


Ot's Role With Survivors Of Sexual Assault, Myracle N. Carter, Cassandra M. Nelson Apr 2024

Ot's Role With Survivors Of Sexual Assault, Myracle N. Carter, Cassandra M. Nelson

Spring 2024 Virtual OTD Capstone Symposium

Sexual assault can lead to a multitude of symptoms that can negatively impact an individual’s occupational participation and quality of life. However, the literature and programming surrounding the use of occupational therapy (OT) with survivors of sexual assault is limited or outdated. Therefore, this program was created to be a resource and guide to increase the use of OT with survivors. This program included a total of five modules, which provided education and occupation-based activities to the participants to increase their occupational participation, specifically in work and education, and their overall quality of life. Following the conclusion of the implementation …


An Ot Program To Support Women With High-Risk Pregnancy, Mackenzie M. Morgan, Cassandra Nelson Apr 2024

An Ot Program To Support Women With High-Risk Pregnancy, Mackenzie M. Morgan, Cassandra Nelson

Spring 2024 Virtual OTD Capstone Symposium

This poster is an overview of an occupational therapy program developed at a Women's Health OBGYN Clinic in Texas. The program was designed to address the needs of women with high-risk pregnancy and focused on mental health, physical health, energy conservation, emotional regulation, and social participation. The findings indicate the needs for further research to understand how occupational therapy can support women's health and an expansion of program offerings to increase support for high-risk pregnancy.


Exploring Healthy Occupations For Adolescents At Risk For The Juvenile Justice System, Megan Vo, Dana Madalon, Mary Jan Greer Apr 2024

Exploring Healthy Occupations For Adolescents At Risk For The Juvenile Justice System, Megan Vo, Dana Madalon, Mary Jan Greer

Spring 2024 Virtual OTD Capstone Symposium

Many youth who are at risk for the juvenile justice system are likely to have spent some time in the foster care system or child welfare system. This population is often found lacking in social skills and/or life skills that contribute to the difficulties with independent living. Occupational therapy practitioners can provide independent life skills training, such as cooking/meal prepping, budgeting, and job exploration as well as providing healthy leisure outlets to promote a successful transition into adulthood. This program aims to promote the development of skills this population requires for successful independent living as an adult such as basic …


Fine Motor Integration For Children With Special Needs And Low Tone, Iliana V. Blancas, Rebecca King Apr 2024

Fine Motor Integration For Children With Special Needs And Low Tone, Iliana V. Blancas, Rebecca King

Spring 2024 Virtual OTD Capstone Symposium

The topic of focus will be a Fine Motor Integration Program for Children with Special Needs and Low Tone and provide students, parents, teachers, and therapists a resource to aid with the development of these skills. This program hopes to establish the development of the fine motor skills at an early age to reduce the issues that arise later within the school years that stem from lack of fine motor skills within this population.


Home And Community Reintegration In Chronic Phase Guillain Barre Recovery, Avani Johnson, Cassandra Nelson Apr 2024

Home And Community Reintegration In Chronic Phase Guillain Barre Recovery, Avani Johnson, Cassandra Nelson

Spring 2024 Virtual OTD Capstone Symposium

To improve the transition of individuals with Guillain Barre Syndrome (GBS) to their homes and communities following the onset of their condition, Avani Johnson, OTS, CPT, in partnership with Able Faith, Inc. and key stakeholders will present a poster presentation on the development of a home and community reintegration program. The overarching goal of this project was to identify the efficacy of community reintegration programs in yielding effective transitions to home and community roles for individuals with (GBS). This was completed through the development and implementation of a home and community reintegration program at a community center located within the …


Exploring Caregivers Of Individuals With Dementia’S Self-Efficacy: A Qualitative Study, Julia Seymour Otd, Kristin Domville Drot, Mot, Otr/L, Cody Cox Otd, Med, Otr/L, Plcc Apr 2024

Exploring Caregivers Of Individuals With Dementia’S Self-Efficacy: A Qualitative Study, Julia Seymour Otd, Kristin Domville Drot, Mot, Otr/L, Cody Cox Otd, Med, Otr/L, Plcc

Spring 2024 Virtual OTD Capstone Symposium

A qualitative research study was done by conducting in-person and virtual interviews with past and current caregivers of individuals with dementia. This study was done to get a better understanding of caregiver self-efficacy, and how Occupational Therapy can be a solution and an advocate for caregivers.


Art, Family, And A Calling To Occupational Therapy, Erin Barrus Apr 2024

Art, Family, And A Calling To Occupational Therapy, Erin Barrus

The Open Journal of Occupational Therapy

Karen Sames was born and raised in Milwaukee, WI. From an early age, she was surrounded by art. An experience with occupational therapy during the third grade jumpstarted her journey connecting art to occupation. Karen believes that art is a necessary part of life and credits much of her own personal success with art to her friends and family for their inspiration and to the instructors at the Eagan Art House in Minnesota. Her piece “Cherry Blossoms,” a pastel on paper, is based on a photograph taken by her son, who is currently living in Japan, and graces the cover …


The Relationship Between Holistic Admissions Criteria And Program Ranking Among Occupational Therapy Entry-Level Programs, Kristian Taylor, Cat-Tien Nguyen, Jenny Grant, Mary B. Brewster, Mary A. Barrett, Teal Benevides, Sharon M. Cosper Apr 2024

The Relationship Between Holistic Admissions Criteria And Program Ranking Among Occupational Therapy Entry-Level Programs, Kristian Taylor, Cat-Tien Nguyen, Jenny Grant, Mary B. Brewster, Mary A. Barrett, Teal Benevides, Sharon M. Cosper

The Open Journal of Occupational Therapy

Holistic admissions criteria are one strategy to be more inclusive of students with a variety of experiences, cultures, and beliefs. The purpose of this study is to evaluate the relationship between holistic admissions criteria and occupational therapy program ranking. We used a retrospective cross-sectional cohort descriptive study design of occupational therapy programs in the United States to understand whether top performing programs employ holistic admissions criteria. Secondary descriptive analysis from the top and bottom 50 ranked occupational therapy programs in 2020 U.S. News & World Report (Morse et al., 2020) was completed. We used a nominal scale to classify programs …


Barriers That Affect Equity In The Occupational Therapy Admissions Process: Student And Faculty Perspectives, Quinn P. Tyminski, Lenin Grajo Apr 2024

Barriers That Affect Equity In The Occupational Therapy Admissions Process: Student And Faculty Perspectives, Quinn P. Tyminski, Lenin Grajo

The Open Journal of Occupational Therapy

The use of holistic admissions in higher education has been demonstrated to increase the diversity of incoming student classes; yet, in occupational therapy (OT) research, admissions processes remain under-explored. This phenomenological study aimed to explore the process of OT admissions from the perspective of students, faculty, and staff at a single OT program with the goal to create a more inclusive, equitable, and holistic process. Focus groups were conducted with first-year students, and an online survey was sent to faculty to explore perspectives on the admissions process, necessary qualities for an OT graduate student, and suggestions for increasing inclusion and …


The Effects Of Cervical Cancer Diagnosis On Occupational Performance, Wynnet Sinclair, Christine Mcconnell, Emily Clark, Katie B. Mcentire, Caitlin Lewis, Lyndsi Pound, Katherine Wuertz Apr 2024

The Effects Of Cervical Cancer Diagnosis On Occupational Performance, Wynnet Sinclair, Christine Mcconnell, Emily Clark, Katie B. Mcentire, Caitlin Lewis, Lyndsi Pound, Katherine Wuertz

The Open Journal of Occupational Therapy

Background: In the United States, it was predicted that approximately 13,960 new cases of invasive cervical cancer would be diagnosed in 2023 (American Cancer Society, 2023). The research question focused on identifying changes in occupational performance for patients with cervical cancer. The areas of occupational performance considered were activities of daily living, leisure, work, education, social participation, and mental health.

Methods: The respondents completed a cross-sectional, mixed methods Qualtrics survey. Likert scale questions captured the degree of functional impact of cervical cancer on the predetermined areas of occupational performance.

Results: Twenty-seven subjects (ages 18 to 70) fully …


Occupational Therapists' Perceptions On Addressing Spirituality: A Cross Sectional Survey, Shannon Metzger, Jeanine Beasley, Jordan Marheineke, Amy Stites, Amy Riley, Christine Byam, Diane Maodush-Pitzer, Dawn R. Devries Apr 2024

Occupational Therapists' Perceptions On Addressing Spirituality: A Cross Sectional Survey, Shannon Metzger, Jeanine Beasley, Jordan Marheineke, Amy Stites, Amy Riley, Christine Byam, Diane Maodush-Pitzer, Dawn R. Devries

The Open Journal of Occupational Therapy

Background: Occupational Therapy (OT) was founded as a holistic profession that addresses the mind, body, and spirit. Research indicates that occupational therapists feel uncomfortable incorporating spirituality into practice. Method: This study aimed to identify perceptions of occupational therapists in addressing the spiritual needs of their clients. A cross-sectional Qualtrics survey was adapted from the Religious/Spiritually Integrated Practice Assessment Scale (RSIPAS). The survey was electronically sent out by several professional OT organizations. It was sent to occupational therapists and OT assistants to obtain their perspective of incorporating spirituality in practice. Quantitative and qualitative data analysis was completed. Results: Of the 52 …


A ‘Friendly Visitor’ Volunteer Intervention For Hoarding Disorder: Participants’ Perceptions, Susan Noyes, Sarah Van Houten, Elizabeth Wilkins Apr 2024

A ‘Friendly Visitor’ Volunteer Intervention For Hoarding Disorder: Participants’ Perceptions, Susan Noyes, Sarah Van Houten, Elizabeth Wilkins

The Open Journal of Occupational Therapy

Background: Determining and delivering effective interventions for Hoarding Disorder remains challenging, and appropriate resources are often unavailable. To address the need, the Friendly Visitor Program was designed in Portland, Maine, to pair people living with hoarding disorder with a trained volunteer to help with decluttering the living environment. The majority of the trained volunteers were occupational therapy students.

Method: This qualitative research study explored participants’ perceptions in a volunteer program that addresses hoarding behaviors. The study was conducted through an interpretivist, constructivist lens, examining the Friendly Visitor hoarding intervention program through individual, in-depth, semi-structured interviews with nine participants, …


Development Of Teacher Training Program, Manual, & Curriculum Guide For Inclusive Dance Studio, From An Occupational Therapy Perspective, Susanna C. Dunn Apr 2024

Development Of Teacher Training Program, Manual, & Curriculum Guide For Inclusive Dance Studio, From An Occupational Therapy Perspective, Susanna C. Dunn

OTD Capstone Projects

This capstone project was completed in collaboration with MOVE Inclusive Dance, a nonprofit, inclusive dance studio specifically serving individuals of all ages with various disabilities. A needs assessment conducted with the staff at MOVE necessitated a cohesive teacher manual, including teacher training protocol, disability index, safety precautions, sample class activities, curriculum guide, and more. The focus of this capstone was to create and distribute a teacher training manual to dance teachers at MOVE Inclusive Dance. The teacher training manual was created using anonymous pre and post test qualitative and quantitative surveys to assess teacher perceptions regarding feelings of confidence and …


A New Lease On Life: The Occupational Impact Of Adaptive Skiing, Caitlin Tetherow, Amy Lyons-Brown, Amy Griswold Apr 2024

A New Lease On Life: The Occupational Impact Of Adaptive Skiing, Caitlin Tetherow, Amy Lyons-Brown, Amy Griswold

Spring 2024 Virtual OTD Capstone Symposium

This research study focuses on understanding the occupational impact of adaptive skiing on well-being and identity to promote lifelong occupational engagement, representation, and inclusion within current ski culture. A mixed-method research study utilized a 25-question online survey and an optional one-time virtual interview. 50 adaptive skiers and/or snowboarders participating in a winter adaptive program between 18-65 years old completed this study. This study found positive evidence supporting outcomes related to physical, emotional, spiritual, and social well-being and positive identity formation from adaptive skiing.


Occupation-Focused Aquatic Therapy For Stroke Survivors, Amanda Chan, Amy Lyons-Brown Apr 2024

Occupation-Focused Aquatic Therapy For Stroke Survivors, Amanda Chan, Amy Lyons-Brown

Spring 2024 Virtual OTD Capstone Symposium

This capstone project explores the impact of aquatics-based occupational therapy on stroke survivors' quality of life. A needs assessment was performed at an outpatient aquatic physical therapy clinic, and an aquatic program was developed based on stroke survivors' unmet physical, social, mental, and occupational needs.


Occupational Therapy's Role For Patients With Left Ventricular Assist Devices (Lvads) In Acute Care, Rachel Roberson Apr 2024

Occupational Therapy's Role For Patients With Left Ventricular Assist Devices (Lvads) In Acute Care, Rachel Roberson

MOT Student Capstones

What is occupational therapy's (OT's) role for patients with LVADs in the acute care setting? OT addresses activities of daily living (, endurance. fine motor coordination. preparation for discharge. and evaluations for patients both pre- and post-LVAD implantation. Expectations of OT for this population are not clear to OT practitioners and members of the multidisciplinary LVAD team due to a current gap in literature. The purpose of this project is to develop an evidence-based practice guideline on OT's role for patients with LVADs in the acute care setting. The practice guideline is intended to be used by OTs working with …


Impact Of Incorporating A Sleep Hygiene Routine In Children With Developmental Disabilities, Katie Vondersaar Apr 2024

Impact Of Incorporating A Sleep Hygiene Routine In Children With Developmental Disabilities, Katie Vondersaar

MOT Student Capstones

The paper explores the impact of incorporating a sleep hygiene routine in children with developmental disabilities, aiming to decrease maladaptive behaviors and improve occupational performance. The objectives include identifying maladaptive sleep behaviors, creating a sleep hygiene routine, and completing a literature review. The methodology involves conducting an in-depth literature review, creating a PowerPoint presentation, and utilizing pre- and post-surveys to assess the effectiveness of the educational intervention. The results demonstrate an increase in knowledge of the benefits of implementing a sleep hygiene routine with children with developmental disabilities. The conclusions emphasize the importance of addressing maladaptive sleep behaviors in children …


Occupational Therapy's Role In Addressing Health Disparities In Transgender/ Gender Diverse Youth, Samantha Ryan Apr 2024

Occupational Therapy's Role In Addressing Health Disparities In Transgender/ Gender Diverse Youth, Samantha Ryan

MOT Student Capstones

This study investigated the effectiveness of an educational module in improving occupational therapists' knowledge and skills regarding transgender and gender diverse (TGD) youth. The research builds upon existing literature demonstrating positive outcomes when integrating TGD population needs into healthcare education programs. The study employs a pre-test/post-test design to assess participants' understanding of critical areas, including culturally affirming care, legal and ethical considerations, social determinants of health and health disparities, developmental stages related to gender identity, and safety considerations for TGD youth. Participant< ; who completed the module demonstrated significant improvements in several key areas. They displayed a firmer grasp of culturally affirming care principles and how to 4 implement them in practice. Additionally, their understanding of legal and ethical considerations surrounding TGD healthcare provision deepened. The study also revealed increased knowledge of social determinants of health and the impact of TGD identities on access to equitable healthcare. Participants better understood how developmental stages relate to gender identity and its influence on occupational engagement. Finally, they demonstrated increased knowledge of safety considerations and protective factors for TGD youth in occupational therapy settings. Findings reveal measurable improvements in participants' knowledge and ability to deliver affirming occupational therapy for TGD youth. The results suggest that the educational module promotes culturally competent and ethical care. Furthermore, these findings suggest that integrating TOD-specific education into occupational therapy curricula can significantly enhance practitioners' ability to provide affirming and effective care for TGD youth.


Enhancing Occupational Therapy Practitioners' Confidence In Managing Cancer-Related Fatigue Through Occupation And Performance-Based Interventions, Chelsea White Apr 2024

Enhancing Occupational Therapy Practitioners' Confidence In Managing Cancer-Related Fatigue Through Occupation And Performance-Based Interventions, Chelsea White

MOT Student Capstones

Cancer-related fatigue has the potential to have a lasting impact on the quality of life, engagement in meaningful occupations, and well-being of oncology patients, which negatively impacts occupational performance and causes an increase in demand for each task an oncology patient managing cancer-related fatigue completes. This capstone project explores the importance of enhancing occupational therapy practitioners' (OTPs) confidence in implementing interventions for cancer-related fatigue using an evidence-based educational program presentation. Based on the literature review, there is a gap in the lack of formal training in oncology and OT academic curriculum, which does not highlight general oncology and cancer-related interventions …


Benefits Of Universal Sensory Integration Interventions On Behavior In The Traditional Classroom Setting, Kayla Cannon Apr 2024

Benefits Of Universal Sensory Integration Interventions On Behavior In The Traditional Classroom Setting, Kayla Cannon

MOT Student Capstones

Traditional Classroom settings can have a negative impact on the behavior of students. In this project the student researcher compared traditional classroom behavioral strategies to integrated universal sensory intervention programs on school performance and behavior. As occupational therapy practitioners, it is important to provide education to teachers on universal sensory integration interventions to help adapt the classroom environment. These interventions can help students self-regulate in an overstimulating classroom setting. In this project, an in-service was created and presented to five primary grade level teachers and one occupational therapist. They were presented with a pre- and post-survey to be completed before …


Exploring The Occupation Of Adaptive Skateboarding, Megan Sandwith, Susan Macdermott, Amy Griswold Apr 2024

Exploring The Occupation Of Adaptive Skateboarding, Megan Sandwith, Susan Macdermott, Amy Griswold

Spring 2024 Virtual OTD Capstone Symposium

The occupation of adaptive skateboarding strives to bring inclusivity to skateboarding by means of adaptational strategies that support performance for individuals with varied abilities. The purpose of this capstone project is to explore the occupation of adaptive skateboarding to increase the occupational knowledge and to inform occupational therapy’s role. A mixed methods research study was conducted to explore the question: What are the supports and barriers for participation in adaptive skateboarding? Additional community-based capstone experiences occurred to support the comprehensive findings that consider the role of occupational therapy in promoting participation. Conclusions highlight the meaning of the occupation of adaptive …


Wellness Research & Programming For Bodybuilders, Victoria Castillo, Karen Park, Kersten Laughlin Apr 2024

Wellness Research & Programming For Bodybuilders, Victoria Castillo, Karen Park, Kersten Laughlin

Spring 2024 Virtual OTD Capstone Symposium

This project explores the occupational impact on bodybuilders and wellness & program development for competitive bodybuilders. Phase one focuses on research to understand the occupational impact on bodybuilders during competition. Phase two, which focuses on program development, highlights the alignment to the objectives as they allow for the development of an educational program intended for bodybuilder coaches to help with health prevention and wellness with their bodybuilder clients.


Stroke-Related Mental Health Challenges And Interventions: Strategies For Holistic Recovery, Christopher Walsh, Sam Lee Apr 2024

Stroke-Related Mental Health Challenges And Interventions: Strategies For Holistic Recovery, Christopher Walsh, Sam Lee

MOT Student Capstones

This capstone project examines the relationship between post-stroke and mental health. It presents the necessity for a holistic and client-centered approach in the recovery process. Through a mixed-methods approach combining a literature review and empirical research, including surveys of stroke survivors, caregivers, and practitioners, the study shows the prevalence of depression and anxiety post-stroke and the potential benefit of comprehensive mental health support. The findings emphasize the importance of community, spirituality, and proactive education in enhancing mental well-being. The effectiveness of specific interventions for this population was found to be variable, which warrants the use of personalized assessments and intervention …


The Sensory Library: Facilitating Opportunities For Success At Bellevue Elementary School, Reagan M. Trussell Apr 2024

The Sensory Library: Facilitating Opportunities For Success At Bellevue Elementary School, Reagan M. Trussell

OTD Capstone Projects

This doctoral capstone project was completed through a partnership with Lamar County School District near Hattiesburg, Mississippi. This school district has eight elementary school campuses. The purpose of this project is to provide teachers with tools to improve focus, learning, and participation to facilitate opportunities for success in the classroom. A “sensory library” was created at two elementary school campuses to service grades prek-5 to accomplish this goal.. Faculty was also provided deliverables including rules of the sensory library, instructions to access and use the sensory library digital QR checkout system, the basics of sensory processing, sensory guidebook, contents of …


Animal-Assisted Services And Occupational Therapy Within An Australian Context: A Survey Study, Jessica Hill, Carlie Driscoll, Kelly Pearse Apr 2024

Animal-Assisted Services And Occupational Therapy Within An Australian Context: A Survey Study, Jessica Hill, Carlie Driscoll, Kelly Pearse

People and Animals: The International Journal of Research and Practice

Introduction: The incorporation of animal-assisted services is an emerging field of occupational therapy. There remains varying levels of involvement and knowledge of what is involved in animal-assisted services among Australian occupational therapists. The profession of occupational therapy acknowledges that competence as a clinician requires appropriate education and knowledge guiding clinical decision making.

Research Question:
This study aimed to explore the understanding and role of Australian occupational therapists including animal-assisted services in their practice, as well as the changes required to support future service delivery.

Methods:
A cross sectional survey was conducted online. Participants were recruited through a digital mailing list, …


The Implementation Of Animal Assisted Therapy In Adult Neurological Rehabilitation, Rachel Camilleri Apr 2024

The Implementation Of Animal Assisted Therapy In Adult Neurological Rehabilitation, Rachel Camilleri

OTD Capstone Projects

This doctoral capstone project was completed through a partnership with Pi Beta Phi Rehabilitation Institute at Vanderbilt University Medical Center. The focus of this project was to develop animal assisted therapy interventions that could be utilized amongst occupational therapy practitioners with the clinic’s facility dog in an effort to increase utilization of animal assisted therapy. The process for this project required a thorough review of the literature on animal assisted therapy and neurological rehabilitation, conversations with current and past facility dog teams to learn about their work, and trialing animal assisted therapy activities in patient sessions. The outcome of this …


Education And Advocacy For Universal Design And Accessibility In Housing, Apisara Vairojanakich, Amy Lyons-Brown, Molly Wuebker Apr 2024

Education And Advocacy For Universal Design And Accessibility In Housing, Apisara Vairojanakich, Amy Lyons-Brown, Molly Wuebker

Spring 2024 Virtual OTD Capstone Symposium

In the United States, there is a lack of adequate numbers of universally designed and accessible houses in the housing market for the older population and people with disabilities. Many barriers, such as financial support and lack of knowledge for housing-related professionals, can prevent this population from participating in home occupations. The project developed educational products, including the universal design housing experience booklet, universal design housing checklist, and universal design blueprints. These products were delivered through the blog post on Uncurbed LinkedIn website. The needs assessment was conducted to provide the guidelines for the chapters in the booklet and checklist. …


Supporting Adolescent Parents Involved In Younglives, Rachel Fister Apr 2024

Supporting Adolescent Parents Involved In Younglives, Rachel Fister

OTD Capstone Projects

This doctoral capstone project focused on creating educational tools and resources for adolescent caregivers, volunteer mentors, and staff associates involved in YoungLives. YoungLives is a branch of the non-profit outreach organization YoungLife, that supports adolescent/teen parents and expecting mothers worldwide. The goal of this project was to supply accessible and user-friendly resources for the population to gain knowledge on pediatric topics such as child development, age appropriate milestones, sensory processing, as well as activities to promote occupational skills. The project outcomes resulted in a guidebook and deliverables for education and training purposes, a social media platform for nationwide connection and …


Providing Sensory Integration Education And Transition Tools For The Tennessee Baptist Children’S Homes, Thuy-Duong D. Huynh Apr 2024

Providing Sensory Integration Education And Transition Tools For The Tennessee Baptist Children’S Homes, Thuy-Duong D. Huynh

OTD Capstone Projects

This doctoral capstone project was completed through a partnership with the residential department of the Tennessee Baptist Children’s Homes, a state-wide ministry that cares for children whose families are in crisis. There were two primary focuses for this project: (1) providing sensory integration education to house parents and (2) creating tools to ease transitions. Outcomes included a presentation and training on sensory integration, a booklet with easily accessible sensory integration information, a local activity guide for day visits with families, and a routine schedule of home visits to ease transitions.