Question 1

In the Occupational Therapy Practice Framework, work includes:

Accepted Answer

In the American Occupational Therapy Association Occupational Therapy Practice Framework (AOTA, 2014, p. S20), work is defined as "labor or exertion; to make, construct, manufacture, form, fashion, or shape objects; to organize, plan, or evaluate services or processes of living or governing; committed occupations that are performed with or without financial reward" (Christiansen & Townsend, 2010, p. 423). The occupation of work is divided into six components: employment interests and pursuits, employment seeking and acquisition, job performance, retirement preparation and adjustment, volunteer exploration, and volunteer participation (AOTA, 2014).

Question 2

Work, as an occupation, is critical to a person's:

Accepted Answer

Satisfying work contributes to mental and physical health, while unemployment and underemployment are linked to poor health (Fouad & Bynner, 2008). Work, paid or unpaid, can provide a sense of mastery, competence, productivity, and achievement (Siporin, 1999). Work provides a sense of purpose and structures time. In addition, work is often a source of identity and self-worth. Identity consists of how people think about themselves, the characteristics that define them, and how they are perceived by others. When meeting someone new socially, often the first question one is asked is "What do you do?" (meaning "what is your job or work?") This question is understandable considering how much time the average adult in the United States spends on the job. In 2015, the average number of hours worked per week was 38.7, and the average number of weeks worked per year was 46.8 (Pew Research Center, 2016). Work is also a source of relationships, social networks, and social participation. Therefore, it is not surprising that when someone experiences a change in work status or setting, that person may also experience losses not only in income but also in roles, relationships, and identity.

Question 3

Greg, an 18-year-old on the autism spectrum, is graduating high school. Under the guidance of an occupational therapist, he is training for work at a local fast-food restaurant. Greg is experiencing:

Accepted Answer

All individuals experience transitions in a variety of areas throughout their life spans. Transition can be described as a process of change or movement from one place, situation, or context to another (Schlossberg, 2004). Work and career transitions include transitioning into and out of the workplace. It can include the transition of youth with disabilities from school to employment or the transition of people returning to or starting work following a disability, injury, or illness. Other types of work transition include wounded warriors returning to civilian employment; high school, college, and professional athletes retiring from a sport; parents returning to work after maternity or paternity leave; family caregivers returning after a prolonged period of caring for a family member; and older adults transitioning from the workforce into retirement. Some work transitions are made voluntarily and driven by a desire for change; others are involuntary, caused by environmental demands beyond one's control. Voluntary work transitions, typically self-initiated, provide time to consider options and prepare for the necessary changes. Involuntary transitions are frequently characterized by insufficient time and resources to prepare for, complete, and adjust to the necessary changes (Fouad & Bynner, 2008).

Question 4

Mr. Maio recently experienced a heart attack and is talking about changing his job. The occupational therapist sees this as an opportunity for:

Accepted Answer

Work and career transitions can be exciting or troubling but are almost always stressful and typically require adaptation. Occupational adaptation refers to "the extent to which persons are able to develop, change in response to challenges, or otherwise achieve a state of well-being through what they do" (Kielhofner, 2008, p. 106). A person may experience a number of work transitions throughout the life span, requiring career adaptability and a wide range of occupational competencies. It is important to recognize that work transitions not only affect the worker but also the worker's family (Fouad & Bynner, 2008).

Question 5

A significant impact of unemployment is:

Accepted Answer

Daily routines are significantly altered, and there is a dramatic shift in time use when a person becomes unemployed. Research has shown that after becoming unemployed, people tend to spend more time sleeping and watching television, and little time in goal-directed pursuits (Voss & Chen, 2015). The structured use of time during unemployment is correlated with improved coping, and engagement in purposeful activity is associated with better mental health (Van Hoye & Lootens, 2013). From an occupational therapy perspective, unemployment can be construed as occupational disruption, imbalance, marginalization, and/or deprivation.

Question 6

In order to support community reintegration, the Army established which program to better meet the rehabilitation and vocational training needs of injured soldiers?

Accepted Answer

Increasing attention is being placed on facilitating the transition of military service personnel into civilian life, including employment. Based on the results of a congressionally mandated review of care for "warriors in transition," 35 warrior transition units (WTUs) were developed by the Army to better meet the rehabilitation and vocational training needs of injured soldiers. The WTUs were designed for soldiers who required more than 6 months of medical care and were located close to medical treatment facilities across the United States, and in a few international locations. The philosophy of the WTUs was to band together soldiers who have the same duties in units, a traditional organizational structure in the military, and then train them in order to return to active military duty or to gain civilian employment (Erickson, Secrest, & Gray, 2008). Active- and reserve-duty troops, whether they are deployed in areas of conflict or are based within the United States, are eligible for services provided through WTUs.

Question 7

How did the Americans with Disabilities Act and other legislation affect employment opportunities for individuals with disabilities?

Accepted Answer

Although the purpose of the ADA was well intended, research has suggested that the employment rates of persons with disabilities did not significantly increase after the passage of this legislation. One possible reason for the lack of marked change in employment rates was that many persons with disabilities were concerned about the loss of benefits, particularly health benefits. Many persons with disabilities, because of the nature of their disability, are able to work only on a part-time basis. However, in many situations a person must be employed full-time in order to be covered by health insurance plans offered by their employer. The TWWIIA legislation enables persons with disabilities to return to work and continue to receive health-care coverage from programs such as Medicaid.

Question 8

Anna is a 19-year-old with cerebral palsy who uses a motorized wheelchair. She works in customer service at the local children's museum. Her disability and medications cause her to tire easily, making her only able to work part-time. What challenge does she face with only being able to participate in part-time employment?

Accepted Answer

Although the purpose of the ADA was well intended, research has suggested that the employment rates of persons with disabilities did not increase significantly increase after the passage of this legislation. One possible reason for the lack of marked change in employment rates was that many persons with disabilities were concerned about the loss of benefits, particularly health benefits. Many persons with disabilities, because of the nature of their disability, are able to work only on a part-time basis. However, in many situations, a person must be employed full-time in order to be covered by health insurance plans offered by their employer. The TWWIIA legislation enables persons with disabilities to return to work and continue to receive health-care coverage from programs such as Medicaid.

Question 9

More than half of adults in the United States retire earlier than they planned due to:

Accepted Answer

Retirement refers to permanently leaving the workforce, usually after midlife. Many older adults, when given the choice, choose to transition into retirement gradually, rather than abruptly. The average length of retirement is 17.2 years for men and 20.6 years for women (Organization for Economic Cooperation and Development, 2017). More than half of U.S. adults retire earlier than planned, often due to health problems, disability, unexpected job loss, or the need to provide care for a family member. This indicates a need for retirement-planning education that includes an occupational engagement focus. An analysis of research studies on 11 retirement programs indicates that such programs result in positive impacts on knowledge, attitudes, and planning activities; 2 of the 11 studies were based on the Transtheoretical Model (Leandro-França, Murta, Hershey, & Martins, 2016). While the programs involved in the study do not appear to include an occupational science perspective, it is believed that including an occupation-based theoretical model for program design, and occupational participation as part of the program curriculum, would further enhance outcomes.

Question 10

Mr. Garcia has a stroke at the age of 59, which prevents him from being able to successfully perform his job as an engineer, making him retire earlier than planned. His adjustment to retirement will most likely be:

Accepted Answer

The retirement transition can be expected and planned, unexpected and unplanned, or desirable or undesirable. Retirement is not simply leaving a job; it is also a change in identity, routine, relationships, roles, and lifestyle. There are several styles people use when approaching retirement (Schlossberg, 2004) (see Box 16-1). The findings of a systematic review by Barbosa, Monteiro, & Murta (2016) identified factors that predicted a positive adjustment to retirement. These factors included physical health, financial security, involvement in leisure activities, social participation, psychological health, and personality characteristics such as optimism, an internal locus of control, and humor. For persons who must retire earlier than expected due to a chronic health condition or disability, the challenges to a positive adjustment are greater. If their retirement is involuntary, the transition is more difficult and can result in significant economic disadvantage and limited opportunities for productive participation in society. Occupational therapy practitioners are "well positioned to ensure success with planning and carrying out transition plans because of our unique skills in tailoring education and support to the individual needs of people with illness or disability" (Brown, 2018, p. 3).

Question 11

Mrs. Flores is a 71-year-old nurse ready to retire. For a successful transition, Mrs. Flores should focus her retirement planning on:

Accepted Answer

The need for comprehensive pre-retirement (Cantor, 1981) and retirement planning (Broderick & Glazer, 1983), beyond solely financial planning, has been appreciated by occupational therapists for some time. While financial planning is essential for a quality retirement, an activity or occupation engagement plan is also needed. However, the financial planning portion of retirement planning must occur first, as occupation planning will be constrained by the projected financial resources for retirement. Preparation for retirement may include consideration of an encore career, bridge employment, legacy planning, and volunteerism.

Question 12

Dr. Glenn, a 75-year-old professor of psychology, reduces his workload to teaching one course a year at a local university. Dr. Glenn is participating in what aspect of retirement transitioning?

Accepted Answer

A phased or graded approach to retirement, known as bridge employment, can aid in the transition to the retirement role. Bridge employment is less-than-full-time employment in which people engage prior to their full retirement (Feldman, 1994). Zhan, Wang, Liu, and Shultz (2009) found that bridge employees had improved mental health if they continued their employment in the same career, and decreased functional limitations if they worked either in their original career or a new career. An occupational therapist may recommend a graded approach to bridge employment, in which a person progressively decreases his or her work hours until full retirement. Bridge employment can be a planned reduction in both work hours and responsibility in order to provide for increased time for family, volunteer activities, or other desired occupations.

Question 13

Mr. Anderson, a 68-year-old retiree, has started to feel depressed during his retirement. One strategy to help him combat his depression is to recommend:

Accepted Answer

A systematic review of studies on older adult volunteers suggests time spent in volunteer participation positively impacts psychological, physical, and social quality of life. Other benefits noted included reduced depression, increased social integration and connectedness, diminished levels of loneliness, and decreased risk of mortality. Although no ideal amount of volunteer activity was identified, it appears that benefits accrue with as little as 100 hours per year, or approximately 2 hours per week (Milbourn, Saraswati, & Buchanan, 2018).

Question 14

Grace is a 19-year-old high school student with a developmental delay who has received a job offer at a local fast-food restaurant. Grace is excited to get started but wants to make sure she can perform all the job duties. As the occupational therapist, you work with Grace and the employer to identify:

Accepted Answer

In community and population health practice focusing on the transition to work by persons with disabilities, there are numerous roles for occupational therapy practitioners, including:
• Completing ergonomic evaluations and interventions in the workplace;
• Consulting on community and transportation accessibility;
• Making recommendations for reasonable accommodations; and
• Providing individualized direct service focusing on the occupational performance areas of the activities of daily living (ADLs) and instrumental activities of daily living the (IADLs).

Question 15

Mr. Arnold is a retiree coming to occupational therapy for a frozen shoulder. He reports being bored in retirement but does not know what part-time jobs might be meaningful for him. He has been offered a part-time office-based job but is concerned about his shoulder. What is the role the occupational therapist could play here?

Accepted Answer

An increasing number of occupational therapy practitioners are involved in workplace ergonomic evaluations and interventions (AOTA, 2004), which are described in detail in Chapter 15 of this text. Evaluations might include the identification and minimization of factors that contribute to accidents or injury in the workplace. Interventions might focus on the modification of tools and equipment, and the provision of education and training on injury prevention.

Quiz 16: Work and Career Transitions Introduction