A social health focus for OT interventions

Researcher Jessica Kersey, PhD, OTR/L, wants to give a stronger voice to individuals with traumatic brain injury

by Stephanie Stemmler • December 18, 2023

Kersey works with a client with a brain injury to develop strategies that will help him succeed with a key social role: parenting. 

Jessica Kersey, PhD, OTR/L, clearly remembers a time while she was working in a community-based practice when an incident occurred that impacted the course of her career.

“I was with a client who was in rehabilitation after a traumatic brain injury (TBI), and we went to a coffee shop together,” Kersey recalls. “She placed her own order, but when the worker asked a follow-up question, the worker directed that question to me and not my client. I realized my client didn’t have the ability to really advocate for herself. She wasn’t ‘seen.’”

Kersey, the director of the new Social Health and Participation Laboratory within the Program in Occupational Therapy at Washington University in St. Louis School of Medicine, wants to give a stronger voice to individuals with TBI by identifying and developing evidence-based interventions focused on supporting social and community activities. She’s focused on a key issue — many people with brain injury often have shrinking social networks and withdraw from their social activities, and Kersey wants to change that.

“In the inpatient setting, we are concerned about cognition and movement; in other words, rehabilitation of brain injury symptoms,” she says. “But there is a wide-open gap between motor and cognitive rehabilitation and the skills that are needed to manage social and environmental challenges that come into play when returning to life in the community, such as when a barista doesn’t acknowledge someone’s competence and autonomy. Occupational therapists could maximize those other critical skills during outpatient rehabilitation as a way to make sure people have all the tools they need to do all of their meaningful activities as they wish, but we don’t always do a good job of leveraging that.”

Fully participating in the community, then, means more than just regaining the ability to get out into the community. To address that, Kersey started an innovative research study and program in Pittsburgh while she was completing her doctoral degree. Called ENGAGE-TBI, the program was a community-based intervention model designed to optimize social learning in a group setting so that individuals with TBI could identify social and environmental barriers and then collaborate with an occupational therapist to problem-solve strategies and implement them during community outings. Kersey continued her research and a similar program when she moved to Chicago and now is bringing the model to St. Louis to further expand her studies. Already, she is finalizing a grant application to fund the project. She also is in the process of assessing people with TBI recently discharged from the hospital to hone in on the right time to intervene with social support strategies. “I want to know when in the full recovery process people with TBI begin to experience changes in their support and relationships,” she says. “Timing and validation of evidence-based interventions are my current goals.”

The critical need for proven social support measurement tools as well as social health and environmental interventions would result in strategies that could benefit a wide swath of individuals. Kersey notes that isolation has fueled loneliness and, in some cases, personality and cognition changes among a broad population during the recent COVID-19 pandemic. She has OTD students in her lab not only helping to assess clients with TBI, but also leading their own projects researching the impacts of post-traumatic stress disorder (PTSD) as well as spirituality on long-term social support and participation.

“Recovery is not all about just cognition and motor skills rehabilitation,” says Kersey. “In tandem with my research on TBI community-based group participation, I also am looking at how we can build stronger social support through occupational therapy services that involve a TBI client with a family or friend learning the interventions together. That could build a sustainable two-way relationship versus just caregiver to patient. It also should help identify effective communication skills to self-advocate and participate in mutually enjoyable activities.”

She adds, “My hope is that the research will validate the critical significance of social health and why it must be addressed as part of the depth and breadth of occupational therapy services.”