Exploring the Depth and Impact of Occupational Therapy in a State Prison

As a student in the final year of my doctoral program, I had the privilege of completing a unique and eye-opening 12-week Level II fieldwork rotation at a local state prison. During this time, I had the opportunity to work alongside reentry professionals in an environment where an occupational therapist was noticeably absent. My experience challenged me academically and offered invaluable insights into the potential value that occupational therapy (OT) could bring to these interdisciplinary reentry teams and further emphasized the numerous opportunities and avenues for OT in the criminal justice system. Personally, this experience afforded me the awareness of my ability to adapt and empathize, as well as the importance of clear communication and setting boundaries in a professional setting. 

During this fieldwork, I met a prison resident preparing for release who exhibited a quiet nature, yet displayed attentiveness and enthusiasm throughout attending the substance abuse classes provided. Working closely with the Substance Use Disorder and Cognitive Behavioral Programming team, I further appreciated the crucial role that OT could play in addressing substance use issues shown to be prevalent in incarcerated individuals (Bronson et al., 2020). Recognizing his potential and motivation for change, I scheduled individual meetings with him outside of the group sessions to conduct an occupational self-assessment and occupational questionnaire. As an occupational therapy student, I leaned on my knowledge in activity analysis, habit formation, lifestyle redesign, providing personalized interventions, and promoting meaningful activities that foster higher self-esteem and a sense of mastery to help this resident develop healthy coping skills to facilitate reintegration into society.

Upon completing these assessments, I was confident that empowering this individual to take accountability for his actions and progress could significantly benefit his rehabilitation journey with substance abuse. To achieve this, I utilized motivational interviewing techniques to foster intrinsic motivation for change and empower this individual to take ownership of his recovery journey. This approach helped him to develop self-awareness and encouraged him to make conscious changes in his life, both within prison walls and upon release. This resident had also expressed feeling anxious when expressing his feelings or emotions solely through verbal discussion. Therefore, one of the tools used to facilitate dialogue was journaling prompts. Encouraging him to write down his thoughts allowed for more in-depth exploration during our discussions as he could articulate feelings and insights that may not have surfaced otherwise. This approach enabled us to identify challenges and barriers affecting reentry success and design targeted interventions for overcoming them. Additionally, I facilitated the creation of a Wellness Recovery Action Plan (WRAP), which provided him with personalized strategies to cope and manage his substance use. Furthermore, integrating various self-regulation strategies, such as mindfulness and emotion regulation techniques, helped him to develop healthy coping skills to navigate cravings and triggers effectively. During the course of our sessions, I witnessed tangible progress, evident through discussion and self-report, in the resident's ability to manage relationships, cope with confinement-related stress, and address anxieties about reintegration. 

Barriers to Occupational Therapy in Prisons

Despite the clear need for OT services within prisons, several barriers exist:

1. Limited Awareness: Prison administrators may not fully understand the role or benefits of occupational therapy within their facilities. Advocating for our profession's value is imperative in facilitating OT's integration into the interdisciplinary team.
2. Funding Constraints: Incarceration is costly, and budget restrictions often limit the availability of resources for rehabilitation programs. Securing funding for occupational therapy services requires persistence and creative approaches in demonstrating the long-term benefits of our interventions.
3. Regulatory and Logistical Challenges: Occupational therapy practitioners must navigate complex regulations within the correctional system, be adaptable to unique security measures, and find ways to deliver interventions despite limitations on equipment and space.
4. Presence of Occupational Therapists Within the Criminal Justice System: To gain a foothold in the conversation, occupational therapy practitioners must demonstrate their distinct value to justice-related professionals, including those who can influence hiring and programming (Jaegers, Skinner, et al., 2020). For the occupational therapy presence to be expanded, interprofessional education and descriptions of the benefits of services in this setting are needed (Jaegers, Dieleman, et al., 2020) (Jaegers, Skinner, et al., 2020). 

Embracing Non-Traditional Fieldwork Rotations

Non-Traditional fieldwork rotations, like a prison, offer unique learning opportunities for occupational therapy students while addressing the needs of underserved populations. 

Some benefits that I experienced from embracing this non-traditional fieldwork rotation include:

1. The opportunity to work with diverse populations and gain cultural competency.
2. Exposure to interdisciplinary team collaboration and networking with professionals from various disciplines.
3. Developing innovative intervention strategies tailored to the unique demands of diverse settings.
4. Building adeptness in adapting to new environments and expanding the scope of occupational therapy practice.

Conclusion

My personal fieldwork experience demonstrates the positive impact occupational therapy can have on addressing the complex needs of prison residents dealing with substance use issues. By tailoring interventions to target specific challenges related to substance use and providing support for rehabilitation and reintegration, occupational therapy facilitates meaningful change and promotes overall well-being within the prison environment. As a student placed in an untapped setting with mentorship and supervision from a professor, I was pushed to maximize my creativity and problem-solving skills throughout the 12 weeks. The overall success of my fieldwork experience in prison reinforced the importance of casting our professional nets wider – be it through exploring novel roles in prisons or other non-traditional settings. By embracing these opportunities, occupational therapy professionals can play a critical role in breaking barriers and promoting a wider audience's overall health and well-being. 

References

Bronson, J., Stroop, J., Zimmer, S., & Berzofsky, M. (2020, August). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009. U.S. Department of Justice. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf. 

Jaegers, L. A., Dieleman, C., Dillon, M. B., Rogers, S., Muñoz, J. P., & Barney, K. F. (2020). Justice-bBased occupational therapy initiative: Advancing occupational justice in criminal justice systems. Annals of International Occupational Therapy, 3, 200–208. https://doi.org/10.3928/24761222-20200309-02  

Jaegers, L. A., Skinner, E., Conners, B., Hayes, C., West-Bruce, S., Vaughn, M. G., … Barney, K. F. (2020). Evaluation of the jail-based occupational therapy transition and integration services program for community reentry. American Journal of Occupational Therapy, 74, 7403205030. https://doi.org/10.5014/ajot.2020.035287  

Riley Pfeifer, OTD, is a recent graduate (2024) of the University of Saint Mary in Leavenworth, KS. She is eager to learn, grow, and make a meaningful impact in the lives of others by exploring the vast possibilities in the field of occupational therapy.