Interview on Virtual Worlds for Health and Human Service Professionals

Conducted by colleague Anne C. Smith, from Queensland, Australia

Everyday language in depression and anxiety – OT student presentation

On Saturday, May 2nd, Amanda and I, both entry level Masters students in Occupational Therapy at Thomas Jefferson University in Philadelphia, had the opportunity to present at the Virtual Ability Mental Health Symposium in Sojourner Auditorium, Second Life.  Our presentation was titled “Everyday Language and Clinical Diagnosis in Depression and Anxiety” and focused on comparing everyday language used to describe the mental health conditions of major depression and generalized anxiety disorder with definitions of the clinical diagnoses. We were very excited to present on this topic because we both are very interested in mental health.  We chose to focus on the language associated with depression and anxiety as well as the stigma that can surround these conditions because we both feel that these are very important topics that generally do not get much attention.

Jenna and Amanda presenting in Sojourner Auditorium

Jenna and Amanda presenting in Sojourner Auditorium.

We began our presentation by discussing the importance that language plays on our everyday interactions.  We explained the importance in understanding that medical terms can be quite different from the words we use every day to describe health conditions – including mental health. The first mental health condition that we focused on was clinical depression.  We gave examples about the way that the term depression is used in everyday language and contrasted them to the actual diagnoses of clinical depression.  Clinical depression is a mood disorder that is diagnosed by a doctor.  In order to be diagnosed with major depressive disorder, an individual must meet 5 out of 9 criteria established by the DSM-V , which is a diagnostic tool for mental health conditions.  In addition to defining clinical depression, we detailed the difference between the feeling of sadness and clinical depression.

The next mental health diagnosis that we described was generalized anxiety disorder.  Generalized anxiety disorder is a clinical diagnosis that goes beyond the common feeling of anxiousness. To be diagnosed with generalized anxiety disorder, a person must have at least three out of the six criteria listed in the DSM-V.

In addition to defining these mental health diagnoses, we also discussed myths and facts about depression and anxiety disorders.  For example, it is a common myth that people can control their depression and “snap out of it” if they want to. But in fact, people with depression cannot just “snap out of it.” Most people with depression benefit from treatment including medications and counseling.  A common myth about anxiety disorders is that they are not very common, when in fact about 18 percent of American adults experience some type of anxiety disorder in any given year.  It was interesting to hear from the audience about their take on these different myths.  One audience member said that she was surprised to hear that some people actually thought that anxiety disorders were uncommon, while others shared that they were surprised to hear just how common they are.

Presenting in Second Life was an incredibly unique experience.  As this was our first presentation in Second Life, Amanda and I were both rather nervous to begin.  Once we started, however, we both became much more comfortable with presenting and came to really enjoy the process.  Something that made the presentation very unique was the lively discussion with the audience.  Being able to engage with the audience and hear about their real life experiences with the topics we were presenting on was fascinating.  One audience member recounted her previous experience with having difficulty naming and explaining her emotions to her doctor.  This led us deeper into discussion about complications associated with “invisible” conditions, such as the mental health disorders we were focusing on.   In addition to this, we also talked with the audience about their reactions to the fact that depression is the leading cause of disability in the United States.  One audience member remarked that she only thought that depression was caused by disability, and had never realized that it could also go in the other direction.  Being able to spread information like this was very rewarding, and we are glad that the audience was able to learn from our presentation.  Having the opportunity to hear firsthand from individuals in the Second Life community about their experiences with these topics and their interactions with healthcare providers was extremely valuable to both Amanda and me.  We later discussed how hearing these experiences and learning from them will help us to become better healthcare providers.  We had a wonderful time presenting and are looking forward to presenting again in the future.

References:

Generalized Anxiety Disorder. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi: 10.1176/appi.books.9780890425596.dsm05

Major Depressive Disorder. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi: 10.1176/appi.books.9780890425596.dsm04

Virtual Worlds, Best Practices in Education Conference (VWBPE) 2015

On Saturday, March 21 at 10 am EDT (7 am SLT), I will present  7 Years of Adaptation and Renewal in Second Life at VWBPE 2015.

Please see the full description of this and other presentations at: http://vwbpe.org/conference/vwbpe-2015-calendar

Hope to see you there!

Graduate Student Reports on the International Disability Rights Conference

OT Graduate Student Nicole Matyas, from Thomas Jefferson University, discusses the International Disability Rights Affirmation Conference held at Virtual Ability on October 3-4, 2014.

What is OT? Promoting our profession in a virtual world

presentation, What is OT?

Presentation at Virtual Ability: What is OT?

With every new presentation we hold in Second Life we learn a little more about the virtual community and a lot more about ourselves as future occupational therapists.  Our most recent discussion, “What is OT?” was held at the Sojourner Auditorium in Virtual Ability. The discussion was an exciting one for us; we continually learn throughout our courses about the importance of advocacy for our future profession, meaning we need to act as educators and proponents for OT and all that it entails.  Widespread understanding of our skill set is important because only through increased awareness will we be able assist all potential clients and communities that may benefit from our services.  Professionals and clients alike need to comprehend the impact we could possibly have on various situations so that the necessary requests and referrals can be made to begin therapy.  Without an accurate understanding of our scope of skills, accommodations and interventions may be withheld, thereby withholding progress from people.  Therefore, we were especially motivated for this presentation because it gave us a way to get the word out about OT and act as advocates for the profession to which we have devoted our lives!

The prior knowledge we gained through our courses at Thomas Jefferson University, Jefferson School of Health Professions this year definitely shaped the structure and content of our discussion.  We began by asking our audience what OT means to them to try to gain an idea of the experiences people have had with OT.  As we anticipated, there was some confusion about what OT encompasses, though some attendees did report prior OT interactions.  We used this opportunity to outline occupational therapy, including the populations served, the environments addressed, and the interventions used.

According to The American Occupational Therapy Association (AOTA), occupational therapy “helps people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).”  Our audience was extremely forthcoming in their responses and shared many activities that they do every day that hold meaning for them beyond just the activity itself.  Responses reflected a desire for mastery and independence in daily functioning; for instance, putting on a woman’s undergarment meant much more to one attendee than just getting dressed; it meant she could take care of herself.  OTs play a key role in helping people to attain goals such as this one.

We also discussed why OTs use meaningful occupations in therapy specific to each client.  The audience members recognized that OT works this way in order to utilize people’s own intrinsic motivation to progress.  One attendee shared an experience her mother had in a session that was not meaningful or stimulating for her because it did not include activities that were personally meaningful for her, so her motivation to progress was absent.  Though we never like to learn about negative experiences, stories such as this one help us OT students realize the importance of staying client-centered in therapy.  We are excited that our graduate experience is preparing us to work with our clients in this way.

Nicki and Kristina discuss OT

Nicki and Kristina discuss OT

Our discussion then progressed to cover some of the specifics of OT, including the environments in which we work (schools, clinics, hospitals, industries, senior centers, and many more), the populations we work with (across the lifespan and all diagnoses), and the practices we use and believe in.  One of the practices that sparked a lot of conversation was Universal Design.  Universal Design has 7 principles: equitable use, flexibility, simple and intuitive nature, perceptible information, tolerance for error, low physical effort, and adequate size/space.  These principles are meant to guide the construction of spaces so that everyone can participate and engage equally within the space, regardless of size, shape, ability, and needs.  Our audience thought of many ways this idea could be applied, and we hope to see more UD in the future since all people have the right to a comfortable, safe environment that meets all needs.

This discussion was one of our favorites because OT is our passion.  We were fortunate to have such an interactive audience, filled with participants of many backgrounds with a wide range of experiences and knowledge about OT.  We hope we shed light on our profession, its goals, and its services.  We plan to continue to act as advocates for OT and for our clients throughout the future.

Note: You can see our slideshare presentation here

Relationships in Second Life

As graduate students new to Second Life, we continue to learn about the similarities and differences between “real life” and the virtual world. For example, we know that in both, technology adds a new layer to the ways we define and experience relationships. But, while we are very familiar with how people communicate through texting, email, and various social media outlets in real life (RL), we wanted to understand the relationship experience in Second Life (SL). Do people build and maintain relationships differently than in “RL”? How are relationships structured in SL? Do SL and RL relationships overlap?

relationships_002Our preparations for this event differed from our past events, which were largely scripted, beginning with an informative presentation and leading into open discussions. Since we are SL newcomers, we felt that our points of view on this topic did not hold much value. We went in with quotes from users found on community forums, a few relevant statistics on SL relationships, and some formulated questions to guide the discussion. From there, the attendees took the reins.

The attendees expressed a sort of translation between SL and RL social behaviors and relationships of any kind—friendship, companionship, or romantic: there are boundaries, norms, and expectations. With that said, some individuals indicated that SL is a place where they can compensate for challenges in RL, such as disabilities, relationship troubles of their own, or self-esteem issues. As explained in Leshed & McLeod’s (2012) article and shown throughout the discussion, people in SL reveal their “layers” in different arrangements than in RL: “…individuals share experiences, emotions, and who they are from the inside while holding back information such as material life name, contact details, occupation, and age.”

This goes hand-in-hand with “alt-avis,” a theme discussed in depth. People use these to adopt identities for different purposes—education, social interactions, etc. The majority of attendees expressed their choices to keep their identities separate. There seemed to be no overlap between these avis; lives were organized and structured on SL accordingly. Dr. Boellstorfff’s talk delves deeper into the structure of the SL community and how individuals with disabilities fit into these communities.

We left the discussion with the realization that Second Life relationships are not different from RL. In our lives, we take on different identities that we share…or don’t share…depending on the context. We often separate our professional life from our social life, and although we don’t call it an “alt-avis,” isn’t that what it really is? The only difference is that in RL, our external layers are the first to show. With the use of technology, however, this line is being blurred, and the ways in which we reveal our layers is jumbled. The discussion was an educational insight into the world virtual relationships, as well as a way to understand interactions in all dimensions.

Conveying information about spirituality without words

How we are using an occupational therapy model to design an interactive exhibit in a virtual world

Have you ever engaged in a discussion about spirituality only to find yourself stuck? What is spirituality? How does it differ from religion?  How do different people experience it? And, why does it matter?  Answering these questions can be challenging for anyone.  But, imagine not being able to use words to talk about it.

The team behind the Garden of Healthy Aging has been working hard to streamline the exhibits in Second Life and the linked wiki pages using the principles of Health Literacy.  In the past few months, we updated exhibits and wiki pages on topics such as diabetes, healthy hearts, caregiving, social supports, healthy activity, and brain health to make them more user-friendly.

gha_composite_edited-1

Though we experienced hurdles with each of these topics, by far the most challenging exhibit to develop was the exhibit on spirituality and aging. We wanted to address the difference between spirituality and religion and focus specifically on spirituality and its effects on aging.  We found that while there was plenty of research on religion and aging, evidence on spirituality was more limited.  We wanted the exhibit to be inclusive of all beliefs and practices, as well as being concrete enough to convey the meaning of spirituality and how it can be cultivated to improve health outcomes for aging adults.

Because the possibilities for interaction in Second Life are bound only by one’s imagination and building skills, we did not want to limit ourselves to using words as the primary medium.  The most effective way to convey this information was to harness interactive capabilities such as animation, object/person interfacing, sound, and links to our wiki pages.  The question was how to make it feel intuitive.

The first order of business was to identify a model or theme to guide the design of the exhibit and to ensure consistency of the information presented within it.  In our theory class, we had studied the Kawa ‘River’ Model, designed by Japanese occupational therapist, Michael Iwama.  This model is used by occupational therapists to help clients map or draw out their lives in a visual way in an effort to help the client identify supports and obstacles in their particular life circumstances.

There are several key features of the Kawa Model.  The river itself represents the course of life, with a beginning and end.  The river walls and bottom represent an individual’s social and physical environment (family, friends, co-workers).  The water represents one’s energy or life flow.  Objects in the river, such as rocks or driftwood, change the flow of the water, both positively and negatively.  Rocks represent life circumstances (health conditions, injury, illness) and driftwood represents assets and liabilities (personality, values, skills, living situation).  The idea is that fewer or smaller  objects in the river promote a stronger flow, or better well-being.

The Kawa Model seems to suit the topic of spirituality and aging perfectly.  The metaphor of the river and its grounding in elements of nature is fitting for the discussion of spirituality.  The Kawa Model is open-ended, allowing for more client-centered exploration of spirituality, and individuals of any culture can relate to the image of the river.  The Kawa Model also allows for change across the lifespan, which is an extremely important consideration in a forum focused on aging.

We chose the Kawa Model for use in Second Life because we could effectively convey ideas about spirituality across the lifespan using an interactive river within the exhibit.  Visitors in the Garden of Healthy Aging will have the opportunity to obtain their own river models by clicking on a sign that gives them a kit comprising the river, rocks, and driftwood. They can then take the kit home with them and put together a personalized version by naming and positioning the rocks and driftwood as challenges, opportunities, life events, and so forth. For example, enrollment in OT school could be a “rock” that has moved the river in a particular direction. A piece of driftwood covering a portion of the river could represent a challenge or an opportunity presented to the student. In this way, visitors can examine their own lives by experimenting with their models, to show how these factors in their lives change or could change the course of their lives.

Below are screenshots of the spirituality exhibit within the Garden of Healthy Aging, including a close-up of the interactive model. The Kawa Model elements will be added to the Garden and the team will have a public event in which graduate students and faculty will explain the Kawa model as it applies to human adaptation. This event will take place later in September or in early October.

While the interactive model can be used as means of exploring spirituality, it does not necessarily have to serve that purpose and can be used however the visitor would like. Visitors can also give their models to Garden of Healthy Aging staff to be added to the river and become part of the exhibit.

The spirituality exhibit in Second Life is complemented by a corresponding wiki post which describes the Kawa Model, gives definitions and examples of spirituality, and provides evidence to support the cultivation of everyday spiritual experiences to promote health and well-being in older adults.  The wiki was intended to be used as a springboard to enhance understanding of the topic of spirituality before diving into the exhibit in Second Life.

Our hope is that purposeful interactions within the Spirituality & Aging exhibit will enhance visitors’ understanding of this complex topic so that they can identify the rocks and driftwood in their river. Reflecting on their own opportunities, challenges, and life events may then help them understand the “flow” of their lives and avoid the feeling of being stuck.

Spreading the Word: New Opportunities in Health Literacy

It has been an exciting few months for our work in health literacy.  We are thrilled with the opportunities that continue to arise; opportunities to spread the word about health literacy to our peers, professors, and the occupational therapy community at large.  As we continue to learn about health literacy, we are increasingly convinced of its importance and transformative power in health care.

I recently read Helen Osborne’s book entitled Health Literacy from A to Z.  Osborne talks extensively about how all health care professionals can change the way they interact with clients and promote health literacy.  This makes the health care environment more accessible to all of our clients.  We’re now reading the book as a team and working hard to apply the principles we’ve learned to our other projects.  It is exciting to see my own writing and observation skills improving particularly in our work in Second Life ®.

Our updated Diabetes exhibit include a “Living with Diabetes Listening Station” featuring one individual’s experience managing their blood sugar.

When you visit the Garden of Healthy Aging, you’ll notice that we are updating our exhibits to be more user-friendly and provide information more clearly.  In addition, we’re working to update our wiki pages.  This is one of the most exciting ways to apply our knowledge of health literacy in writing, formatting, and design.  Our hope is that we can create a useable site that provides a lot of “need to know” information in a way that people of all different reading levels can understand.  We are making progress towards our goal, but still have a long way to go and a lot to continue learning!

We are excited to announce that Pfizer Inc. granted us permission to use their “Newest Vital Sign”, a health literacy screen for clients, within our Second Life ® exhibit.  This will give users the opportunity to test their level of health literacy as well as tips for improving health literacy.  We hope to empower clients to take a greater control in their health and gain confidence in asking health professionals questions.

Dr. Toth-Cohen, PhD, OTR/L is currently developing a course in health literacy for students in a variety of professions at Thomas Jefferson University. This is a great opportunity to help future health professionals gain a greater understanding of the importance of health literacy and how they can interact most effectively with their patients.  This class also comes a time when the occupational therapy department at Thomas Jefferson is looking to incorporate the principles of health literacy into the curriculum.  We presented to the faculty about health literacy which opened to the door for great discussion about the future of health literacy within the department and the future of our project

Annalisa, Dr. Toth-Cohen, and I will be presenting at the Pennsylvania Occupational Therapy Association conference this September  about why health literacy matters to occupational therapists.  This is an exciting opportunity to have our work recognized by other occupational therapists in our state and for us to encourage them to integrate health literacy principles into their area of practice.  We are looking forward to sharing what we have learned and hope to be a catalyst for change within occupational therapy practice.

This is a thrilling time of change and progress with our program and I am honored to have the opportunity to be a part of it!  My hope is that others will continue to catch the dream that we have and empower others to change the way the health care system operates.  We are hoping to have many more opportunities to spread the word.

Spreading the Word: Taking Every Opportunity to Teach Others About Health Literacy

By: Annalisa (ALiesel) and Alyssa (alzimarie)

 On January 19th, we presented our work on health literacy to our classmates in our Jefferson School of Health Professions class OT 560, “Interventions: Environmental Competence.” The focus of this interventions class is to understand the therapy process in terms of the dynamic interaction between the client, their occupations, and their environment, and apply this knowledge in practice by developing client-centered environmental modifications. In our concurrent course, OT 562, “Environmental Competence in Action”, pairs of students conduct an environmental analysis project with a community dwelling client. The OT students make seven visits to the client’s home and collaborate with the client to identify and carry out five adaptations to the environment that will support the client’s health and participation in daily occupations.

For many of us, this is our first time working as an OT consultant interacting with a client, as well as our first time performing a home environmental assessment. Prior to our first visits with our clients, our instructor, Tracey Vause-Earland, MS, OTR/L, prepared a series of classes designed to give us strategies for delivering client-centered, collaborative services. It was in planning these classes that Tracey asked us to present what she believed would be “imperative information” for the class to hear: the facts about health literacy.

Tracey was familiar with our work on health literacy in the virtual world of Second Life® (read about our presentation), and felt strongly that our classmates needed to develop health literacy skills in order to effectively interact with clients. We whole-heartedly agreed. Our research on health literacy has shown us just how critical it is for health professionals to support their clients’ ability to understand and use health information to make health decisions.

We began by showing a youtube clip created by the American Medical Association that contains first person accounts of what it is like to have low health literacy.  It was obvious following the video that we had our classmates’ attention. They expressed shock and amazement that their clients could be experiencing such low health literacy without their awareness.  We discussed what health literacy is and how the healthcare system places demands on individuals to independently manage their health. This creates an environment that is difficult for our clients.  We asked our classmates to brainstorm ways in which occupational therapists could improve clients’ understanding.  We did not anticipate the enthusiastic and thoughtful answers our classmates posed to this question.  They quite literally stole our thunder!  Knowing that our peers were able to apply the small amount of information we had given them and make connections to their interactions with clients was exciting.  The room was abuzz following our presentation. Classmates kept saying, “That was great- thank you. I had never thought about health literacy like that before.”

In the three weeks since delivering our presentation, several classmates have voluntarily approached us to tell us how they have seen applications of health literacy in their own lives, and how their awareness of health literacy has shaped their interactions with their clients One classmate said, “I thought of your presentation over the weekend when I was at the doctor’s office. I had a question I wanted to ask my doctor, but I didn’t know how to phrase it, and I was too scared to bring it up in the end.” Another classmate said, “My OT 562 partner and I recalled what we learned about health literacy in your presentation when we worked with our client for our project this week. When we asked our client what kind of medication he was taking, he said he didn’t know what it was, but he takes it anyway ‘because the doctor tells him to’. He said he usually takes two kinds of medication before breakfast, but he doesn’t know if that’s the correct time of day to take them. He showed us the medications- he’s taking a blood thinner and a laxative, but he didn’t know why. We recognized this as an example of low health literacy!”

Our hope is that we can continue to educate those around us about health literacy: our peers, our professors, our clients, and our future employers and colleagues.  Evidence shows that the health care system is demanding more and more of clients to manage their own health (Smith & Gutman, 2011). This means that health professionals need to become skilled in supporting health literacy in their clients. We have developed a firm belief that health literacy is the future of health care and that it is imperative that we continue to spread the word.

For additional resources and information, visit our wiki.

References:

Smith, D. L., & Gutman, S. A. (2011).  Health literacy in occupational therapy practice and research.  American Journal                                                    of Occupational Therapy, 65, 367-369.  doi: 10.5014/ajot.2011.002139

Health Literacy Grant

This fall, we were funded by the Jefferson School of Health Professions‘ (JSHP) Research and Scholarship program to develop a program that uses Second Life as a training center for JSHP graduate students in occupational therapy. This program is designed to help students learn best practices for promoting health literacy in older adults by implementing evidence-based consumer education.

The current phase of the program provides students in the Fall 2011 class, Older Adults and Their Living Environments with the opportunity to learn about health literacy and develop a presentation on area relevant to older adults.  The four participating students, Mollie Bear, Bonnie Bennett, Aly Binck, and Lauren Lovinger first attended a presentation on basic tenets of health literacy. They then developed and presented talks on Transitioning to the Caregiving Role and  Staying Involved throughout Life. These talks will be summarized in a subsequent post.