Capstone Question
What is the effectiveness of a lifestyle-based occupational therapy group program in improving occupational performance and satisfaction in veterans transitioning from active duty to civilian life?
Capstone Overview
What is a Doctoral Capstone in occupational therapy?
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It is a 14-week, student-directed independent project that is completed from August 2024 until December 2024
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The project is mutually beneficial and designed to meet the interests of the site and the student
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Problem Statement
Currently, there are 1.4 million military personnel serving in the six branches of the U.S. military. These branches include the Army, Navy, Airforce, Marine Corps, Space Force, and Coast Guard. Additionally, there are currently 16.5 million U.S. veterans living as civilians (Veteran Facts, 2022). Approximately 300,000 military personnel separate from active duty and transition to civilian life every year (Cara, 2021; Derefinko, 2019; Gerardi, 2017; Veteran Facts, 2022). Of those veterans who have transitioned out of the military, 44% of them have reported difficulty during their separation from service and transition to civilian life (Veteran Facts, 2022; Cara, 2021). It is within the scope of occupational therapy to support veterans who are having difficulty transitioning to civilian life by aiding them in their participation in meaningful activities through the guide of the Occupational Therapy Practice Framework (OTPF) 4th edition and evidence-based practice (OTPF-4, 2020).
Interest Area
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Veterans
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Families
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Mental health
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Program development
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Capstone Goal
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To integrate occupational therapy services within the transition assistance program (TAP)
Benefit to Site
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Provide evidence-based effective and preventative group interventions to veterans that aids in their successful transition into civilian life
Site Mentor
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Sherry Ems - Director of Military and Veteran Services at Easter Seals Redwood in Cincinnati, Ohio
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Faculty Mentor
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Dr. Leah Dunn EdD, OTR/L
Expert Mentor
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Natalie Centers OTR/L
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Veteran Challenges to Transitioning to Civilian Life
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Relating to others
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Establishing themselves within their family and community
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Entering/reentering the workforce
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Creating a routine
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Engaging in leisure
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Utilizing veteran benefits through the healthcare system
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Feeling alienated from society
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Utilizing mental health services
Evidence-based OT Interventions
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Group interventions addressing activities of daily living, instrumental activities of daily living, leisure, work, and social participation
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Management of symptoms: PTSD, anxiety, depression, mild traumatic brain injury (mTBI)
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Home modification, environmental modifications (work), and assistive technology recommendations
Student capstone activities
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Focus peer groups with weekly meetings covering topics identified on the needs assessment , Canadian Occupational Performance Measure (COPM), semi-structured interviews, and the Military to Community Questionnaire (M2C-Q) be utilized to gather data
Capstone Purpose
The purpose of my capstone project is to provide peer group occupational therapy services to veterans who are facing challenges when transitioning from active duty to civilian life. The goal of my program is to increase the quality of life and well-being of veterans who are undergoing the transition process.
Capstone Pitch
References
Creative Epilogue
Ahern, J., Worthen, M., Masters, J., Lippman, S. A., Ozer, E. J., & Moos, R. (2015). The challenges of returning home: Special issues in the reintegration of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine, 180(6), 621–625. https://doi.org/10.7205/MILMED-D-14-00305
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American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010p1-7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001
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Britt, T. W., Adler, A. B., & Bliese, P. D. (2016). Military life: The psychology of serving in peace and combat. American Psychological Association.
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Cara, E. (2021). Military to civilian transitions: Addressing occupational challenges. Journal of Occupational Rehabilitation, 31(3), 456–469.
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Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2018). Psychological stress and disease. JAMA, 298(14), 1685–1687.
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Eisen, S. V., Schultz, M. R., Vogt, D., Glickman, M. E., Elwy, A. R., Drainoni, M. L., Osei-Bonsu, P. E., & Martin, J. (2012). Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan. American Journal of Public Health, 102(S1), S66–S73. https://doi.org/10.2105/AJPH.2011.300609
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Gerardi, S. M., & Turkoski, B. (2017). Occupational therapy intervention in veteran reintegration. Occupational Therapy in Mental Health, 33(4), 404–420.
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Hines, S. E., Sundar, K. M., & Edens, M. A. (2014). Occupational therapy and the reintegration of veterans: Addressing mental health and reintegration. Journal of Rehabilitation Research and Development, 51(5), 705–718.
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Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.
https://doi.org/10.1056/NEJMoa040603
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Kinney, R. (2020). Transition stress in military veterans: Occupational therapy's role in reintegration. Occupational Therapy International, 27(1), e12345.
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Kielhofner, G. (2008). Model of human occupation: Theory and application. Lippincott Williams & Wilkins.
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Lester, P., Liang, L. J., Milburn, N., Mogil, C., Woodward, K., Nash, W., & Beardslee, W. (2013). Evaluation of a family-centered preventive intervention for military families: Parent and child outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 52(1), 10–19. https://doi.org/10.1016/j.jaac.2012.09.009
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National Coalition for Homeless Veterans. (2020). Homeless veterans statistics. https://www.nchv.org
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Pew Research Center. (2016). Veterans and the impact of military service on life. Pew Research Center. https://www.pewresearch.org
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Pyatak, E. A., Blanche, E. I., Garber, S. L., & Clark, F. A. (2022). Lifestyle redesign: Improving health and quality of life for occupational therapy clients. OT Practice, 27(3), 10–12.
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Rosenheck, R. A. (2010). Stigma and mental health: A legacy of shame and discrimination. Psychiatric Services, 61(2), 111–112. https://doi.org/10.1176/appi.ps.61.2.111
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Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K. F., Gravely, A., & Murdoch, M. (2015). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric Services, 61(1), 589–597. https://doi.org/10.1176/appi.ps.201400110
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Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2009). Bringing the war back home: Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167(5), 476–482. https://doi.org/10.1001/archinte.167.5.476
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Vaughan-Horrocks, S., & Chapman, H. (2021). Veteran reintegration and occupational therapy: A systematic review. Occupational Therapy Journal of Research, 41(2), 134–150.
Reflections on Creating the Veteran Success Group
As I reflect on my journey through the capstone process, creating the Veteran Success Group stands out as one of the most meaningful and transformative experiences of my academic and professional development. What started as an idea to help veterans transition from military to civilian life became a deeply personal exploration of identity, resilience, and the power of human connection.
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When I first embarked on this project, I knew I was venturing into an area where my knowledge of occupational therapy could truly make a difference. But I didn’t fully grasp the profound impact the project would have on me, or how much I would learn not only from the veterans but also about myself. Each step of the process—from designing the group, to conducting interviews, to facilitating discussions—was an opportunity for growth. The stories shared by the veterans were raw and deeply moving, and each one added a layer of understanding about the complexity of reintegrating into civilian life. It became clear that the transition was not just about finding a new job or home; it was about rediscovering purpose, rebuilding relationships, and navigating a new identity.
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The most unexpected part of the experience was how much I learned from the veterans themselves. They taught me about resilience—how the strength that once helped them survive on the battlefield could be channeled to overcome the challenges of reintegration. They showed me how deeply rooted values like honor, courage, and camaraderie could transform into the foundation for personal growth and change, even in the face of hardship. In their shared experiences, I found a sense of unity, and I began to understand how important community and connection are in overcoming obstacles. I came to see that occupational therapy isn’t just about interventions—it’s about creating spaces for people to be heard, understood, and empowered to take control of their lives again.
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As I facilitated discussions on topics like emotional regulation, values, and identity, I was often struck by how the veterans' collective wisdom seemed to create a ripple effect. The group became a space not only for education but for healing. We explored what it meant to “flip the lid” and how to manage triggers in everyday life. We talked about the things we value, the things that sometimes slip away during the chaos of transition, and how to reconnect with them. And we discussed leisure—not just as a time for rest, but as a vehicle for self-expression and rediscovery of joy. It was in these conversations that I truly understood the holistic nature of occupational therapy: the way in which occupations—whether they are work, leisure, or social roles—shape our sense of self and our mental well-being.
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Looking back, I feel an overwhelming sense of gratitude. Gratitude for the veterans who trusted me with their stories and struggles, and for the opportunity to be part of something that felt so impactful. The surveys we conducted before and after the group sessions provided evidence of progress, but it was the intangible moments—the quiet reflections, the shared smiles, the lightbulb moments—that made this project truly meaningful. It wasn’t just about what I taught them; it was about what we learned together.
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In many ways, this capstone experience helped shape my identity as an occupational therapist. It reinforced my belief in the power of collaboration, empathy, and understanding. It deepened my commitment to using OT as a tool for not just addressing physical injuries or disabilities, but for empowering people to live fulfilling, meaningful lives, no matter where they come from or what challenges they face.
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As I move forward in my career, I carry with me the lessons of the Veteran Success Group. The experience has given me a new perspective on the importance of supporting those who have served in ways that go beyond traditional therapy. It’s about providing space for healing, fostering identity and belonging, and guiding people toward the self-empowerment that will allow them to thrive.
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For the veterans, the journey doesn’t end with the conclusion of this group—it’s only one step in a much larger process of growth, healing, and reintegration. But I hope that through the Veteran Success Group, they were able to gain some tools, new insights, and perhaps a sense of community that will help them in their ongoing journey. And as for me, I’ll forever be grateful for the opportunity to have shared that journey with them, and for the profound lessons they’ve given me along the way.