Creating a Capstone

by Michele Berhorst • October 25, 2024

Broaddus (left) prepares lunch for the children with colleagues Jessica Holt (middle), art therapist, and Samantha Kleinschrodt (right), child specialist.

Experiences with children with functional needs in China through volunteering and internships led Allie Broaddus, OTD ’22, to become an occupational therapist. She had worked with 3-year-old Sadie, born with cerebral palsy, and 2-year-old Matthew, who had physical and cognitive delays, both orphaned because of their complex disabilities and medical needs. “I saw such a need for occupational therapy (OT) in that setting, and I fell in love with working with children with disabilities and therapy in general,” says Broaddus. “Beyond pediatric clinical practice, I also became interested in program development.”

That interest factored into her decision to choose Washington University’s (WashU’s) Program in Occupational Therapy and pursue a clinical doctoral degree (OTD) over a master’s degree (MSOT). The differences between the OTD and the MSOT include additional coursework, scholarship and experiential learning requirements that emphasize self-directed learning in one or more areas of interest such as clinical practice, program development, research, leadership, education, advocacy and policy, or administration. The capstone is the final degree requirement and consists of two parts: a culminating 14-week experience and completion of a project related to the student’s capstone experience. “When looking at the curriculum, I was excited about the mentored experience during capstone. It was the opportunity to select an experience and create a project around my career goals and interests. It ended up being my favorite experience of graduate school.”

The capstone process at WashU incorporates the Program’s mission and values, the Accreditation Council for Occupational Therapy Education standards for capstone development and implementation, and the student’s career goals by using the Person-Environment-Occupation-Participation model as a framework for self-discovery, followed by integration of personal beliefs and values with the collective values of the OT profession. “Self-discovery occurs through key assignments in the Professional Identity and Practice course series, such as the personal narrative, values statement, and developing a professional vision and mission statement,” explains Jessie Bricker, OTD, OTR/L, the academic fieldwork and capstone coordinator. “These serve as building blocks for students to envision their potential contribution to the field, identify an area of focus, and to be intentional about their own professional growth as they develop learning objectives for the capstone and seek out mentorship.”

Broaddus partnered with the St. Louis Crisis Nursery, a nonprofit organization providing trauma-informed emergency intervention, 24-hour respite care, and support to families in crisis for up to 72 hours, for her 14-week capstone experience and project. Broaddus felt the children and staff could benefit from OT services. “We know therapy is often best when it’s delivered long term. I started asking, ‘How can OT be helpful in this short-term setting? Is it doable, and is it practical? And if so, what does the model look like?’” shares Broaddus.

These questions formed the foundation for her capstone project. Broaddus mapped out four learning objectives for herself: (1) gain experience with conducting needs assessments for program development, (2) advocate for OT at St. Louis Crisis Nursery, (3) raise awareness of community resources and systems that support children and families and (4) gain experience applying for grants.

Guided by her faculty mentor, Lauren Milton, OTD, OTR/L, and site mentor, Rachel Crowe, Broaddus conducted her needs assessment that included a literature review, more than 400 hours of direct observation and participation at two Crisis Nursery locations, and interviews with current employees on how an occupational therapist could serve the children and staff. She found that there was a unique role for OT needs stemming from executive function, emotional skills, sensory modulation and fine motor skills and from diagnosed and undiagnosed conditions such as autism, deafness, prematurity, and developmental delays. “Occupations affected include social and play participation, feeding, dressing, toileting, bathing and sleep. These are things that can be addressed by an occupational therapist at the Crisis Nursery and could carry over into the home, reducing caregiver stress through independence,” Broaddus says.

To advocate for OT at the Crisis Nursery, Broaddus wanted to educate employees on the many benefits OT could have for the children and the staff in a short-term setting. She created an educational module that defined OT, explained the occupational needs of children at the Crisis Nursery she discovered during the needs assessment, and explained how an occupational therapist could benefit the children and families in a short-term setting. Broaddus likens it to an acute care setting, where occupational therapists work with patients for a limited time.

“I started with what we know. We know our children come from stressful environments. Let’s figure out how we can cope. Let’s figure out how we can play with others. Let’s make this fun for the children. Our therapy is child-led and play-based. We work on the occupational skills we can in the short time we have,” Broaddus says. “However, we do have families that come in more frequently based on their situation. With those children, we can continue to work on those skills. But in most cases, we focus on the time we have to offer a safe, positive experience for the children.”

She researched early intervention services to address her third learning objective, to raise awareness of community resources and systems that support children and families. “I found there was little awareness within the community of the services available and the referral process itself. We know early trauma affects the developing brain, and most of our children have experienced at least one adverse childhood experience. We see behavioral issues, developmental delays, and diagnosed or undiagnosed disabilities,” Broaddus explains. “With the situations our families are going through, it can be difficult to care for a child with a disability, especially when day cares are not accepting them.”

Broaddus created an information sheet to refer a child to First Steps, Missouri’s early intervention system for infants and toddlers 0-36 months who have delayed development or diagnosed conditions that are associated with developmental disabilities, and to explain why it’s important to refer to them when appropriate. She created an educational module with the information that was distributed to Crisis Nursery employees.

Her final learning objective was to gain experience applying for grants—specifically, to apply for funding so the Crisis Nursery could hire a staff occupational therapist full-time. Broaddus researched current funding for related services, such as art and play therapy, and discussed with staff what funding opportunities were available. She communicated with stakeholders, occupational therapists, and trauma-informed practitioners and wrote a comprehensive and persuasive grant proposal. She successfully delivered her capstone project as a PowerPoint presentation to Bricker, her cohort, and the Crisis Nursery leadership and staff. Broaddus graduated and took some time off to study for her national board certification. She kept in touch with the Crisis Nursery, but behind the scenes, they were applying for grants and reaching out to stakeholders on their own.

“About six months after my capstone ended, they secured funding for an OT program. I received a call from Molly Brown, the chief executive officer, offering me the occupational therapist position,” Broaddus recalls. “Of course I accepted. It felt like it was where I was supposed to be.”

Reflecting on the capstone experience, Broaddus describes it as fulfilling. “Looking back at my experiences in China and what I wanted to do, I’ve been able to meet those goals through the doctoral program and the capstone. When I first came in, I wasn’t sure how OT would work in this setting. I built rapport with the Crisis Nursery staff and worked with them to determine what would work through the interviews. I formed meaningful relationships and have confidence in myself and my skills as a practitioner. To come back later to start the OT program and dive into the program development piece has been incredibly fulfilling.”




 

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