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Psychedelic-assisted occupational therapy for treatment-resistant depression
Full text link2026Mental health disorders significantly impact the quality of life (QOL) for those affected, their families, communities, and society at large. In the United States, depression is one of the most prevalent mental disorders and a leading risk factor for suicide. Despite available evidence-based treatments, many individuals with major depression respond inadequately to first-line therapies and are considered to have treatment-resistant depression (TRD). This doctoral project was designed to develop and evaluate a manualized intervention that integrates principles within psychedelic-assisted therapy (PAT) with an occupational therapy (OT) approach for adults, aged 45 to 65 years, diagnosed with TRD. The rationale for combining PAT with OT is to address not only TRD's clinical symptoms but also improve occupational performance and QOL. This single-group, mixed-methods, proof-of-concept study tests the Psychedelic-Assisted Occupational Therapy (PAOT) intervention program and evaluates its feasibility, acceptability, safety, and preliminary effectiveness.Quantitative measures of the PAOT program's effectiveness include the Canadian Occupational Performance Measure, the World Health Organization Quality of Life Assessment, the Montgomery-Åsberg Depression Rating Scale, and the Generalized Anxiety Disorder Scale. Qualitative data gather participants' and providers' experiences to assess treatment fidelity and acceptability. Thirty participants will complete baseline, posttreatment, 6-month, and 1-year follow-ups. Findings will determine whether the PAOT improves occupational performance and QOL and reduces depression and anxiety. Overall, this proof-of-concept study aims to establish a foundation for future randomized clinical trials, define OT's role in PAT, and address a gap in current mental health practice.
Keywords: occupational therapy, psychedelic-assisted therapy, treatment-resistant depression, quality of life, occupational performanc
End-user centered dissemination: using co-design to advance evidence-based behavioral health practice in the Veterans Health Administration
Full text link2026BACKGROUND: The Veterans Health Administration (VA) implemented an evidence-based mental health program, the Behavioral Health Interdisciplinary Program – Collaborative Chronic Care Model (BHIP-CCM). Although BHIP-CCM research findings were published in scientific literature, no systematic dissemination with staff, providers, and patients (i.e., end-users) occurred to increase awareness of the BHIP-CCM evidence. This project aims to engage staff, providers, and patients to disseminate BHIP-CCM findings using end-users’ preferred modes of communication.
METHODS: BHIP-CCM experts used a prioritization matrix and nominal group technique to select evidence to disseminate with end-users from 13 peer-reviewed publications. At 4 VA sites, 13 staff and providers and 9 Veterans participated in co-design sessions to create products tailored to end-users’ preferences.
A mixed-methods evaluation, guided by the Fit-to-Context framework for Designing for Dissemination and Sustainability, contained a validated 12-item survey to measure implementation outcomes: acceptability, appropriateness, and feasibility of dissemination. Survey also measured change in awareness of research findings, and intent-to-use dissemination products. The Consolidated Framework for Implementation Research guided qualitative analyses of interviews, assessing experiences and factors affecting dissemination of BHIP-CCM evidence.
RESULTS: Five VA researchers identified BHIP-CCM effectiveness, sustainability and impact on all-cause mortality among research findings for dissemination. Co-design with end-users led to the creation of 3 products: a PowerPoint resource and 2 infographics. The resource was shared locally and nationally and received 251 online views from 104 unique BHIP-CCM team members within 1-month.
Quantitatively, staff and providers found the resource acceptable (mean 4.84; SD 0.23), the dissemination strategies appropriate (mean 4.64; SD 0.51) and feasible (mean=4.73; SD 0.47), on 5-point scale. Staff and providers awareness of BHIP-CCM evidence increased, and their intention-to-use the resource was high (mean=4.73; SD 065). Qualitatively, barriers to dissemination included: time constraints, clearance to disseminate the resource, and organizational context. Nonetheless, staff and provider end-users were satisfied; they acquired new learning experience and knowledge that reinforced the value of giving BHIP-CCM consistent care.
CONCLUSIONS & IMPLICATIONS: Collaborative dissemination of BHIP-CCM evidence led to increased knowledge transfer to end-users. This process of designing for dissemination can optimize widespread adoption and sustained use of BHIP-CCM and other evidence-based practices for improved health outcomes
Effects of Medicaid expansion and state inclusionary policies on immigrant health and healthcare use in the United States
Full text link2026The United States is home to an estimated 51.9 million immigrants, a growing population that experiences substantial disparities in health insurance coverage and access to care. These disparities are shaped and perpetuated, in part, by a complex and often exclusionary policy environment, exemplified by recurrent changes to the public charge rule and the recent enactment of the One Big Beautiful Bill Act (OBBBA). Among the most consequential policies reinforcing these barriers is the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, which bars legal immigrants from accessing public benefits including Medicaid, Children’s Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and Supplemental Security Income (SSI) during their first five years in the U.S., a restriction commonly known as the “five-year bar”. PRWORA also replaced the Aid to Families with Dependent Children (AFDC) entitlement program with the TANF block grant, and added complexity to the determination of benefit eligibility through the strict definition of “qualified alien”. The effects of PRWORA extend beyond immigrants themselves, impacting U.S.-born children in mixed-status households. Although the vast majority of children in mixed-status families are U.S. citizens (88%) and therefore eligible for public benefits, their access and experience is often undermined by the restrictive provisions of PRWORA and the chilling effects of related immigration policies. In response, there have been efforts to improve healthcare access for immigrants through the adoption of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), as well as inclusionary state Medicaid policies providing coverage to otherwise ineligible immigrants by using state or local funds. Despite these efforts, the uptake of public benefits remains low among eligible immigrants and U.S.-born children in mixed-status households—often due to the fears of immigration-related consequences, especially in light of recent changes to the public charge rule and rising anti-immigrant sentiment. In 2023, an estimated 18 percent of lawfully present immigrant adults were uninsured compared to 8 percent of U.S.-born adults. Among U.S. citizen children, 4 percent were uninsured among those with U.S. citizen parents compared to 8 percent among those with noncitizen parents, demonstrating that disparities based on immigration status persist decades after PRWORA. Similarly, following changes to the public charge rule, participation in critical food and nutrition programs like SNAP and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) declined among households with immigrant parents as compared to those with U.S.-born parents. This dissertation evaluates the compounding impact of federal and state health insurance policies—specifically PRWORA, Medicaid expansion, and inclusionary state Medicaid policies—on healthcare utilization, total healthcare expenditures, health outcomes, and experiences of care among multigenerational immigrant families. Guided by the Social Determinants of Health Framework, this research leveraged multiple years of restricted-use data from the Agency for Healthcare Research and Quality (AHRQ), linking the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) with AHRQ’s Medical Expenditure Panel Survey (MEPS), along with state policy data from the Urban Institute State Immigration Policy Resource (SIPR). The long-term goal of this research is to strengthen the evidence base on the impact of health and social policies on immigrants and their families in the United States. Chapter 1 provides a review of the literature motivating this work, including a historical overview of U.S. immigration policy with a particular focus on PRWORA and its implications for public benefit use across generations. Chapters 2 through 4 present the three specific aims of the dissertation. Chapter 2, To Quantify Differences in Immigrant Adult Healthcare Use and Expenditures Following Medicaid Expansion, examined changes in healthcare utilization and expenditures following Medicaid expansion among immigrant adults based on years of residence in the U.S. Chapter 3, To Identify the Effect of Inclusionary State Medicaid Policies on the Physical and Mental Health of Immigrant Adults, assessed changes in physical and mental health functioning associated with the adoption of inclusionary state Medicaid policies among immigrant adults based on years of residence in the U.S. Chapter 4, To Assess the Timely Receipt of and Experience of Care for Children of Immigrants Following Medicaid Expansion, evaluated differences in the quality of care for children following Medicaid expansion based on household immigration status. Chapter 5 provides concluding remarks on the findings of Chapters 2 through 4, as well as directions for future research
Dysregulation of the N6-methyladenosine epitranscriptome in Alzheimer’s disease and its implications in aging, synaptic function, and RNA metabolism
No full text2026Alzheimer’s disease (AD) is the most common cause of dementia and is characterized by cognitive decline and behavioral deficits. Despite recent therapeutic advances with amyloid-β–targeting antibodies and tau antisense oligonucleotides, there remains a critical need to investigate alternative mechanisms contributing to AD. Extensive work has been done in the field of AD analyzing disease-linked changes in transcription, splicing, DNA epigenetics and chromatic structure. Altered RNA metabolism is also well documented in AD, with increased aggregation of RNA-binding proteins. However, the epigenetics of RNA are only beginning to be studied in AD. N6-methyladenosine (m6A) is the most common epigenetic modification of mRNA and a key determinant of mRNA fate, including synaptic localization and activity-dependent translation. The site-specific regulation of m6A in the cognitively normal or AD brain has yet to be determined. Here, we mapped the m6A epitranscriptome in post-mortem human AD and Control cases using deamination adjacent to RNA modification targets and sequencing (DART-seq), an antibody-independent approach for nucleotide-resolution detection of m6A-modified sites and transcripts. DART-seq reveals a 3’ untranslated region (UTR)-enriched, age-associated increase in the number of m6A sites in Control cases, which is absent in AD cases. We hypothesize that this age-related increase in m6A labeling reflects a protective role of age-associated methylation. Instead in the AD brain, m6A-modified transcripts are globally hypomethylated. We observed a group of transcripts whose m6A methylation correlates with gene or protein expression levels; these correlations occur selectively in genes encoding astrocytic glutamate importers and GABAergic ionotropic receptors, implicating m6A in regulation of the tripartite synapse, and potentially contributing to excitotoxicity. These findings are consistent with a known imbalance between excitatory glutamatergic and inhibitory GABAergic signaling that is an important feature of AD leading to excitotoxicity, synapse loss, and disease progression. We also revealed differentially abundant m6A sites on translational stress response genes and a loss of m6A-governed transcript regulation for GABRA1, consistent with altered RNA metabolism in AD. These findings provide the first nucleotide-specific m6A landscape in the human brain, show clear changes associated with AD, and open novel therapeutic strategies, such as gene editing, to site-selectively modify m6A levels with the goal of restoring synaptic function and RNA metabolism in the AD brain
Gay male choir teachers who model vulnerability in their classrooms
Full text link2026Teaching and learning are embedded with a certain amount of vulnerability. Learners may struggle with a concept, wrestle with feelings of being uncomfortable, and even fail when learning something new. Teachers may need to model vulnerability in order for students to be willing to take a risk and grow emotionally and intellectually. Impediments to vulnerability may limit what learning is possible in classrooms. In this study, I was interested in understanding the lived experiences of four gay male choir teachers who modeled vulnerability in their classrooms. I asked the following questions in the study: (a) What educational, professional, or personal experiences, if any, prepared the participants, gay male teachers, for modeling vulnerability in their choral classroom?; (b) How did participants consider the ways a choir teacher embodies vulnerability, and how, if at all, does mutual vulnerability manifest in their teaching and learning?; (c) How, if at all, do gay male choir teachers foster connection and mutual empathy in student-teacher relationships?
Relational Cultural Theory (RCT) was used as a framework for this study. The authors of RCT lifted being in relationship and connecting with others as opposed to the Western concept of individualism and self-determination. I was curious how RCT could be used to understand choir classrooms and the dynamics between teachers and their students.
In this qualitative study, I employed a multiple case study in which I interviewed each participant four times and conducted one group interview. Prior to the second interview, each participant read Jordan (2008) article “Valuing Vulnerability.” I also asked participants to provide artifacts to further reveal aspects of their case. Then I provided within-case and across-case analysis of the data. My findings included that each gay choir teacher’s lived experience is unique and contextually dependent. Participants revealed their gay identity and modeled vulnerability as they developed relationships with colleagues, students, and parents, and became a fixture in their communities. In addition, as society became more welcoming of LGBTQ+ people, so did the constituents in their communities. Choir teachers modeled vulnerability in a number of ways including acknowledging their partners or husbands, revealing their connection to a piece of music, or a willingness to have difficult conversations with students. Teachers reported that mutuality was achieved in their choirs. For example, mutuality was realized when students shared musical ideas with their teachers, when students asked teachers what they needed from them, or wanted to hear their teacher’s response to a question. Teachers were able to build connections and model empathy for students through their choice of repertoire, community-building activities, engaging students in discussions, and revealing aspects of their personal life (e.g., vacations they took with a partner, when they decorated for Christmas, etc.).
Implications include that gay choir teachers may find it meaningful to be out in their classroom and that by doing so they begin to deconstruct homophobic and heterosexist practices. Building community and developing student-teacher relationships can become an essential part of choral programs. Choir teachers may want to consider intentionally developing mutuality in their classrooms and shift the paradigm in their classrooms from power-over to power-with. Pre-service teachers who study the concept of vulnerability in their music education coursework might be more prepared for the realities of teaching choir in the 21st century.
An extracellular vesicle therapeutic attenuates inflammation and damage in a Rhesus monkey model of cortical injury
No full text2026Cortical injury in the aged brain leads to acute cell death and inflammation, which trigger chronic secondary neurodegeneration resulting in long-term cognitive and motor deficits. There are no U.S. Food and Drug Administration (FDA)-approved therapeutics that address cortical injury pathologies. Recent studies in rodents and pigs have identified mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) as a promising therapeutic for cortical injury, reducing inflammation and enhancing neuroprotection. We have used MSC-EV treatment in a Rhesus monkey model of primary motor cortex injury which impairs fine motor function of the hand. When treated with MSC-EVs 24 hours and 2 weeks following injury, monkeys recovered pre-injury levels of function within the first 3-5 weeks post-injury, while untreated monkeys had an incomplete recovery. Analysis of brain tissue harvested 16 weeks post-injury found that MSC-EVs promoted homeostatic microglial phenotypes, neuronal plasticity, and myelin maintenance. These findings demonstrated the efficacy of MSC-EVs, but at which stage of recovery MSC-EVs acted remains unclear. Here, we assessed the progression of biomarkers of inflammation and damage across recovery and examined the brain at an earlier timepoint, 6-weeks post injury. The current study addresses the hypothesis that in the early stages of recovery, MSC-EVs attenuate the inflammatory response and reduce tissue damage. We first assessed how MSC-EVs affect the temporal progression of the inflammatory response, using a multiplex protein quantification platform (Olink) on plasma and cerebrospinal fluid (CSF) collected across recovery (pre-injury, 24 hours, 2-, 4-, and 6-weeks post-injury). MSC-EV treatment decreased inflammatory proteins in plasma 2 weeks following injury, with reductions in pro-inflammatory proteins persisting throughout recovery. Assessments of brain tissue revealed that at 6-weeks post-injury, MSC-EV treatment increased homeostatic microglial phenotypes, supporting an early shift towards an anti-inflammatory environment. Next, we assessed if MSC-EV treatment affected the progression, clearance and resolution of neurodegeneration across recovery. MSC-EV treatment was associated with increased levels of neurofilament-light (NF-L) chain, an axonal damage biomarker, in CSF after, coupled with increased neuronal structural integrity markers (MAP2) in brain tissue, suggesting an MSC-EV-mediated clearance of neuronal debris. MSC-EV treatment was also associated with a decrease in Galectin-3, presumably phagocytically active, microglia. Finally, to identify potential mechanisms of action, we performed lipidomic and metabolomic analyses of MSC-EV contents. We found sex-differences in MSC-EV cargo, female EVs were enriched in sugars, while male EVs were enriched in nitrogen-rich compounds. MSC-EVs cargo were related to cellular energy metabolism, supporting its potential role in metabolic efficiency in aging and after injury. Overall, these findings present a role of MSC-EVs in the early resolution of inflammation following cortical injury, creating a neuroprotective environment that supports recovery of motor function.2027-01-23T00:00:00
Exploring the communicative repertoire of a signing deaf adolescent
No full text2026This ethnographic case study explores a signing deaf adolescent’s (Brady, age 16) practices through careful, close study of his communicative interactions with limited-signing others (parents, friends, strangers) in everyday life. The study centers joint interactions with and around texts broadly defined to include graphic novels, text messages, digital media, images, maps, and drawings. The analysis takes a sociocultural approach, framed by studies of deaf individuals’ semiotic repertoires (Kusters et al., 2017), ethnographies of home and community literacies, and Goodwin’s (2018) co-operative action theory. Findings illuminated the ways in which Brady navigated the hearing world by creatively and dynamically drawing on a variety of resources in his environments. He drew from an expansive semiotic repertoire, which included a dynamic combination of sign, talk, images, technology, gesture, pointing, gaze, movement, body orientation, and the manipulation of objects (Goodwin, 2000). Findings also illustrated the parents’ different orientations to Brady, their joint interactions, ASL and other languages, and the semiotic field. In particular, the analysis highlighted Mom’s sensibility of ongoing attunement to her son—his languages, his development and growth, and his expanding and expansive communicative practices. Dad shared an appreciation for Brady’s ingenuity and flexibility, noting the ways in which Brady adapts his communicative strategies for the situation. He also described relying on Mom to interpret or mediate his communication with his son. In all, this study speaks to both researchers and educators who seek to a) better understand deaf adolescents’ heterogeneous communicative repertoires as dynamic, multimodal, and embodied, and b) design more inclusive and expansive literacy pedagogies.2028-01-14T00:00:00
The occupational therapy vision screen-OTVS: a vision screen tool for school-based and pediatric occupational therapists
Full text link2026Visual delays impact children across the nation and are often left undiagnosed and untreated. These visual delays impact a student's academic performance, achievement, and occupational performance. Many children in the United States are not receiving adequate visual care. Occupational therapists evaluate and screen children with visual delays with a variety of standardized tests and tools. Currently, there is no vision assessment, specific for occupational therapists to use with elementary age children. Occupational therapists are left to create their own screening procedures to fill this gap. The Occupational Therapy Vision Screen-OTVS is a vision screen tool designed for school-based and pediatric occupational therapists. The mission of The OTVS is to provide occupational therapists with a vision screening tool and resources that allows for comprehensive testing during occupational therapy evaluations, screens, and progress monitoring. To allow students to reach their full potential occupational therapists must understand the importance of vision and vision screens, have access to a screening tool that is affordable and easy-to-use, and have an avenue for follow-up care. The OTVS will allow for early detection of visual issues, will improve the frequency and quality of screens, provide an evidence-based approach, provide clear guidelines for occupational therapists, allow for more visual skills to be tested, improve occupational therapy evaluations, and allow therapists to impact functional vision early, when it is most crucial and beneficial for young children. Occupational therapists will be able to impact student’s functional vision skills, promote full student participation in academics, occupational performance, and improve a child’s independence, sense of self, and quality of life, so children may thrive within the classroom and beyond
Project nurture: occupation-based support for parental well-being in the neonatal intensive care unit
Full text link2026Parents of premature infants in the neonatal intensive care unit (NICU) are at high risk for experiencing perinatal mood and anxiety disorders. These conditions are the most common and underdiagnosed complications of pregnancy and childbirth, affecting half of the NICU parent population, resulting in negative long-term consequences for families. These include poor developmental outcomes, difficulties with attachment, childhood behavior challenges, and negative long-term mental health outcomes. Mothers of infants in the NICU are particularly susceptible to these conditions due to traumatic birth, occupational deprivation, inadequate support, and low self-efficacy. The Project Nurture project is a multidisciplinary, evidence-based program designed for the NICU setting. The program includes scheduled mental health screenings for all parents, structured group-based education and social support sessions, and occupation-based mindfulness, attachment-promoting, and cognitive-behavioral strategies to reduce parental distress and improve self-efficacy. Project Nurture proposes a 6-month pilot to evaluate its effectiveness in promoting psychological wellness among NICU parents. Occupational therapists in the NICU setting offer a distinct lens to support new mothers with medically fragile newborns experiencing acute and chronic distress. The Project Nurture program provides a straightforward framework for occupational therapists to improve infant outcomes and help prevent perinatal mood and anxiety disorders
Beyond academics: a holistic program for youth wellness and empowerment
No full text2026The Holistic Health & Fitness for Youth (H2F-Y) program is a 24-week, after-school wellness initiative designed to address critical declines in adolescents’ physical, emotional, nutritional, spiritual, and sleep health. Grounded in occupational therapy principles, Self-Determination Theory, and the U.S. Army’s Holistic Health and Fitness framework, the program provides a comprehensive, activity-based curriculum for middle school youth in a designated Virginia public school division. Delivered by an interdisciplinary team led by occupational therapists, H2F-Y integrates daily movement, hands-on nutrition activities, mindfulness, sleep education, journaling, and mentoring within an autonomy-supportive, screen-free environment. The doctoral project includes a detailed needs assessment, a theoretical and evidence-based program design, an evaluation plan, a sustainability framework, and a funding strategy to support future implementation. The proposed program aims to improve students’ self-regulation, life skills, and overall wellness while enhancing academic engagement and readiness for future roles. Through a mixed-methods evaluation approach, H2F-Y will examine feasibility, acceptability, and preliminary outcomes across wellness domains. Strong collaboration with school staff, families, and community partners positions the program as an innovative, scalable model of school-based wellness. This capstone project demonstrates how occupational therapy can lead interdisciplinary initiatives that promote youth resilience, address contemporary wellness challenges, and advance holistic, prevention-oriented practices in educational settings