BOSTON UNIVERSITY

SARGENT COLLEGE OF HEALTH AND REHABILITATION SCIENCES

Doctoral Project

ROLE FOR SEL:

USING DUNGEONS & DRAGONS® TO PROMOTE

SOCIAL-EMOTIONAL LEARNING WITH MIDDLE-SCHOOLERS

by

HARJAS KAUR CHILANA

B.S., Boston University, 2011

M.S., Boston University, 2013

Submitted in partial fulfillment of the

requirements for the degree of

Doctor of Occupational Therapy

2022
© 2022 by
Harjas Kaur Chilana
All rights reserved
 Approved by

Academic Mentor
Craig E. Slater, Ph.D., MPH, OT
Clinical Assistant Professor of Occupational Therapy

Academic Advisor
Karen Jacobs, Ed.D., OT, OTR, CPE, FAOTA
Associate Dean for Digital Learning & Innovation
Clinical Professor of Occupational Therapy
 DEDICATION

I would like to dedicate this work to all the oddballs, dorks, nerds, kooks, and geeks. Find

something you’re interested in, go with it, and let your freak flag fly high and proud!

iv
 ACKNOWLEDGMENTS

I entered this program at the beginning of the COVID-19 Pandemic shutdown.

There is no way I would have been able to make it through this process if it was not for

my supportive adventuring group. First and foremost, I would like to thank my family—

mom, dad, Meetu, Atish, Jagjot, Monica, Kulpreet, and baby Zian—who guided me in

realizing what I really wanted to focus on for this doctoral project and supported my

craving for higher education.

I cannot begin to express my thanks to Craig Slater, my academic advisor and

mentor. Craig provided more than just guidance with my doctoral project. He accepted

my procrastination, while still keeping me on track. He continuously expressed a

profound belief in my work, writing, and abilities, silencing my inner critic. I sincerely

thank you from the deepest depths of my heart.

Particularly helpful to me during this time was Adrianne, my peer mentor and

classmate and now, friend, who kept it real and eagerly provided resources, clinical

support, and constructive criticism. I hope to meet you in-person one day. Special thanks

to Seth, my former co-worker turned fellow adventurer. Seth invited me to my first

Dungeons & Dragons® campaign and asked me to help in a deep dive of the game with

his students. This was where I realized the potential for its application. He has been an

invaluable resource during this process for understanding DMing and using D&D with

students.

I’d like to acknowledge the expertise and support of my former supervisor turned

friend, Nathalie, who instilled the importance of social-emotional learning and has

v
always been available to chat during this process. A thanks to Jenny, my best friend, who

I met at Boston University in the Master’s Occupational Therapy program 10 years prior

(Thank you BU!), for being there to vent to and always up to play some games. Lastly,

thanks should also go to my primary physician, Dr. Tang, for prescribing me Lexapro and

my therapist for supporting my mental health during this time.

vi
 ROLE FOR SEL:

USING DUNGEONS & DRAGONS® TO PROMOTE

SOCIAL-EMOTIONAL LEARNING WITH MIDDLE-SCHOOLERS

HARJAS KAUR CHILANA

Boston University, Sargent College of Health and Rehabilitation Sciences, 2022

Major Professor: Craig E. Slater, Ph.D., MPH, OT, Clinical Assistant Professor of
Occupational Therapy

ABSTRACT

Social-emotional learning (SEL) is an essential area of development for

adolescents. The Collaborative for Academic, Social, and Emotional Learning (CASEL)

presents a well-researched, broad, conceptual framework for systemic social and

emotional learning (CASEL, 2020), which has been used to guide the development and

implementation of the proposed pilot. It identifies five competencies of SEL: self-

awareness, self-management, social awareness, relationships skills, and responsible

decision-making. The CASEL framework also emphasizes the importance of

coordinating SEL across key settings and contexts—classroom, schools, families, and

communities. Lack of SEL can have suboptimal effects during adolescence and later in

life, consequently, impacting occupational engagement.

A literature review on SEL found that appropriate SEL programming results in

positive outcomes, such as improved school-related attitudes and behaviors, increased

academic performance, decreased negative behaviors, and less reports of emotional

distress (Durlak et al., 2010, 2011). Additionally, various school-related professions

address SEL, however, there is limited evidence of occupational therapy practitioners’

vii
involvement in the literature. Thus, adolescents’ occupational needs relating to SEL may

not be being addressed.

Play’s significance in developing adolescents’ skills is rooted in SEL. Play

“develop[s] physical coordination, emotional maturity, social skills to interact with other

children, and self-confidence to try new experiences and explore new environments”

(AOTA, 2012, p.1). Dungeons & Dragons® (D&D) is a popular table-top role-playing

game, which draws interest from many adolescents and adults. A second literature review

found that play interventions for adolescents, and research using D&D appears to be

limited.

Role for SEL is a play-based intervention group using D&D (5th ed.) developed to

promote SEL. In the pilot program, three to five middle-school students will participate

in 90-minute after-school sessions, for 10 weeks. Participants will learn how to play

D&D, receive explicit instruction on two SEL competencies (self-management and

relationship skills) and engage in D&D scenarios and campaigns designed to support

development in the relevant SEL areas. The author’s proposed pilot program has the

potential to improve adolescents’ SEL and occupational engagement. This doctoral

project discusses the case for the proposed pilot program, and presents a detailed

overview of Role for SEL.

viii
 TABLE OF CONTENTS

DEDICATION ................................................................................................................... iv

ACKNOWLEDGMENTS .................................................................................................. v

ABSTRACT...................................................................................................................... vii

TABLE OF CONTENTS................................................................................................... ix

LIST OF TABLES ............................................................................................................. xi

LIST OF FIGURES .......................................................................................................... xii

LIST OF ABBREVIATIONS .......................................................................................... xiii

CHAPTER ONE – Introduction ......................................................................................... 1

CHAPTER TWO – Project Conceptual and Evidence Base .............................................. 9

CHAPTER THREE – Overview of Current Approaches and Methods ........................... 27

CHAPTER FOUR – Description of the Proposed Program ............................................. 42

CHAPTER FIVE – Program Evaluation Research Plan................................................... 54

CHAPTER SIX – Dissemination Plan.............................................................................. 65

CHAPTER SEVEN – Funding Plan ................................................................................. 76

CHAPTER EIGHT – Conclusion ..................................................................................... 83

APPENDIX A – Sample Session Plan 1 (David) ............................................................. 86

APPENDIX B – Sample Session Plan 2 (Tristin) ............................................................ 88

APPENDIX C – Social Skill Improvement System (SSIS) SEL Brief Scales K-12

Assessment........................................................................................................................ 90

APPENDIX D – Dungeons & Dragons® Resources ........................................................ 91

APPENDIX E – Social-Emotional Learning Resources .................................................. 93

ix
APPENDIX F – Executive Summary ............................................................................... 94

APPENDIX G – Fact Sheet ............................................................................................ 101

REFERENCES ............................................................................................................... 103

CURRICULUM VITAE ................................................................................................. 115

x
 LIST OF TABLES

Table 5.1 Program Evaluation Research Questions .......................................................... 58

Table 6.1 Key Messages for Target Audiences ................................................................ 67

Table 6.2 Anticipated Budget for Dissemination Activities ............................................. 73

Table 6.3 Evaluation of Dissemination Activities ............................................................ 74

Table 7.1 List of Available Local Resources. ................................................................... 77

Table 7.2 Two-Year Budget. ............................................................................................ 78

Table 7.3 Needed Resources and Justification. ................................................................ 80

xi
 LIST OF FIGURES

Figure 2.1 Social-Emotional Learning Framework. ......................................................... 10

Figure 2.2 Explanatory Pathways. .................................................................................... 14

Figure 4.1 Vignettes. ......................................................................................................... 44

Figure 4.2 Logic Model. ................................................................................................... 50

Figure 5.1 Simplified Logic Model. ................................................................................. 57

xii
 LIST OF ABBREVIATIONS

ADL ............................................................................................ Activities of Daily Living

AGAS .............................................................................. Analysis of Group Activity Scale

ANOVA .............................................................................................. Analysis of Variance

AOTA .......................................................... American Occupational Therapy Association

BU ............................................................................................................ Boston University

BUSD ............................................................................... Berkeley Unified School District

CASEL ................................ Collaborative for Academic, Social, and Emotional Learning

CBT ...................................................................................... Cognitive Behavioral Therapy

CINAHL ..................................Cumulative Index to Nursing and Allied Health Literature

D&D .................................................................................................Dungeons & Dragons®

DM ............................................................................................................. Dungeon Master

ECE ........................................................................................... Early Childhood Educators

EMAS ............................................................ Engagement in Meaningful Activity Survey

EOAQ ....................................................... Engagement in OTTP Activities Questionnaire

ERIC ................................................................... Education Resources Information Center

IADL ...................................................................... Instrumental Activities of Daily Living

LARP ...........................................................................................Live Action Role Playing

LMFT .................................................................. Licensed Marriage and Family Therapist

MTSS ................................................................................. Multi-tiered System of Support

NPC ..................................................................................................... Non-player character

OTAC ...................................................... Occupational Therapy Association of California

xiii
OTTP-SF ..................................... Occupational Therapy Training Program-San Francisco

PC ............................................................................................................... Player Character

PRPP .................................................................................. Perceive, Recall, Plan, Perform

RtI .................................................................................................Response to Intervention

SAFE .........................................................................Sequenced, Active, Focused, Explicit

SDQ .......................................................................Strength and Difficulties Questionnaire

SEL ........................................................................................... Social-Emotional Learning

SLP ........................................................................................ Speech-Language Pathologist

SSIS .............................................................................. Social Skills Improvement System

TTRPG ..................................................................................Table-Top Roleplaying Game

xiv
 1

CHAPTER ONE – Introduction

Social-emotional Learning

Social-emotional learning (SEL) is a “process through which all young people

and adults acquire and apply the knowledge, skills, and attitudes to develop healthy

identities, manage emotions and achieve personal and collective goals, feel and show

empathy for others, establish and maintain supportive relationships, and make responsible

and caring decisions.” (Collaborative for Academic, Social and Emotional Learning

[CASEL], 2020, para 1). Many children and adolescents experience challenges with the

five main competencies of SEL: self-awareness, self-management, social awareness,

relationship skills, and responsible decision making (CASEL, n.d.). These challenges

may impact their participation in academic, social, or community activities (Anderson &

Grinder, 2017) such as developing and maintaining meaningful relationships, using

appropriate judgement to assess safe situations, regulating emotions during times of

frustration, and recognizing and adapting to emotional experiences.

Occupational Therapy & SEL

At the core of occupational therapy is how individuals engage in, and perform,

meaningful occupations, that is “the everyday activities that people do as individuals, in

families, and with communities to occupy time and bring meaning and purpose to life”

(American Occupational Therapy Association [AOTA], 2020). Occupational therapy

practitioners focus on “achieving health, well-being, and participation in life through

engagement in occupation” (AOTA, 2014, p. S4). For children and adolescents,

occupational therapy practitioners adapt and modify interventions and strategies to align
 2

with the individual’s changing needs. The aim of these interventions is to maintain and

promote health and well-being in the areas of social participation, activities of daily

diving (ADLs), education, work, play and leisure, and instrumental ADLs (IADLs)

(AOTA, 2013). Active engagement is a key component in facilitating and promoting

health.

Social-emotional skills are often integral aspects of both occupational engagement

and performance, and therefore, occupational therapy practitioners are uniquely skilled in

addressing social-emotional skills to enable participation in meaningful occupations.

AOTA (2013) states that “social and emotional competencies are required for successful

participation in almost all areas of occupational performance” (p. 1). Delayed or

ineffective intervention for social-emotional challenges could impact an individual’s

participation in aspects of life including ADLs, IADLs, social participation, work, play

and leisure, and education. As experts in occupational analysis, occupational therapy

practitioners determine how occupation, environment, and person factors, including

social-emotional well-being and development, enable participation in meaningful

occupation (AOTA, 2014). Occupational therapy interventions targeting social-emotional

learning are, therefore, critical in maximizing individuals’ abilities to engage in

meaningful and purposeful occupations.

While occupational therapy has this distinct value, practice limitations in some

settings may impact the degree to which occupational therapy practitioners address

social-emotional skills. For example, in some pediatric settings, occupational therapy

practitioners primarily receive referrals for handwriting, sensory processing, or fine

 3

motor challenges. In these settings, pediatric occupational therapy practitioners do not

commonly address mental health or social-emotional skills; rather, these issues are

addressed by other professions. In this author’s own experience as a school-based

occupational therapist, social skills are typically addressed by the speech-language

pathologist, and emotional or behavioral skills addressed by a counselor or member of the

behavior intervention team. While each of those professions have distinct value and

expertise in addressing these skills, occupational therapy provides a unique perspective

which considers social-emotional skills in the context of meaningful occupation.

Dungeons & Dragons® as a Meaningful Occupation

Children and adolescents have a variety of occupational interests which may

change or develop as they get older. For many children and adolescents, table-top role-

playing games (TTRPG), specifically Dungeons & Dragons® (D&D), are a meaningful

occupational interest. D&D is a fantasy role-playing experience in which a group of

adventurers, in person or via electronic media, adopt the role of characters and navigate a

fantasy narrative created by a Dungeon Master (DM). There is no winning or losing in

D&D, but characters can wield fantastic weapons, be eaten by dinosaurs, speak with

animals, breathe fire, or be permanently turned into a frog. The DM guides the players

and characters through the storyline by presenting situations and challenges, while also

reinforcing the rules of the game, ensuring they are followed.

If an individual is not the DM, then they are a player. Within certain guidelines,

players construct player characters (PC) with backstories and specific characteristics,

attributes, and skills, which may include proficiency or weaknesses in spellcasting/magic,

 4

strength, specific weapons, stealth, investigation, setting traps, deception, animal

handling, sleight of hand, survival, or athletics. In general, the PCs work together to

move through the challenges, battles, and situations presented by the DM. As the story

continues, players gain experience points and “level up” which increases the PCs skills

and abilities.

The main game mechanic is dice rolling. When players make decisions and

actions to move through the challenges and story, they typically roll a d20, or 20-sided

die, to determine the effectiveness of their action. For example, if a player is trying to

sneak past a group of elves, they may have to roll to see how they fare. If they roll a

higher number, they are able to stealthily pass the elves quietly. If they roll a lower

number, they may step on a branch, making a noise which might alert the elves. Conflicts

may arise within the group, and the group will have to problem solve and work through

any disagreements. With reference to the manual and guidelines, the DM will set

parameters to determine the effectiveness of actions, what is and is not permitted, and

play the part of other characters in the story setting, known as non-player characters

(NPC), such as the elves from the earlier example.

Promoting SEL through D&D

The game structure and play of D&D allows for different applications,

particularly SEL. The game itself is play-based and social in nature. Players work

together, problem solving and overcoming conflicts and challenges. The DM can

integrate specific storylines and situations to address social-emotional skills. The idea to

explore D&D, or role-playing games, as an occupational therapy intervention developed

 5

through the author’s first-hand experience of its application with upper elementary-aged

students. When working with these students, the author noticed individuals utilizing

creative problem-solving and executive functioning skills to address roadblocks. Through

participation in D&D, individuals also developed confidence in approaching and

establishing friendships with new peers, and demonstrated increased imagination and

emotional regulation.

Although D&D has been a meaningful occupation for children and adolescents

for many decades, it is not commonly used therapeutically by occupational therapy

practitioners. There are, however, some exemplar programs which have used D&D as an

intervention for specific populations groups. For example, the STAR Institute

(https://www.spdstar.org/) in Denver, CO runs a role-playing group for teens (ages 12-

17) utilizing Critical Core, an adapted version of D&D, to develop social-emotional

skills.

In research, there is limited literature regarding utilizing D&D and TTRPGs as an

intervention. Research has explored the impact of TTRPGs and D&D on singular

characteristics such as, moral development (Wright et al., 2017) and alienation

(DeRenard & Klein, 1990). There has also been a case study of its use with a young adult

male with schizoid personality (Blackmon, 1994). Other research has studied the

personalities of individuals who play D&D (Carter & Lester, 1998), and clinicians’

(social workers and psychiatrists) perceptions of role-playing games (Lis et al., 2015,

Ben-Ezra et al., 2018). At present, there are no known studies investigating D&D in

occupational therapy literature.

 6

Gap in Occupational Therapy SEL Interventions

Occupational therapy interventions must be tailored to individuals’ occupational

interests to effectively enable occupational performance. If an occupational therapist is

addressing social-emotional skills with children and adolescents but the methods utilized

are of little interest, it is unlikely that the child or adolescent will engage meaningfully in

therapy. Therefore, knowledge of different interventions and tools, such as D&D, allows

occupational therapy practitioners to implement intervention approaches which best align

with individuals’ occupational interests.

The therapeutic use of D&D has registered interest among the author’s fellow

colleagues and coworkers, however, until now, advancing this interest has not been

pursued. This has been due to reports of limited resources, including time and access to

materials and limited understanding of D&D and its potential as a therapeutic tool in

occupational therapy practice.

Some of the challenges for implementing SEL and/or D&D based interventions in

occupational therapy include: (i) clinician’s lack of knowledge of D&D, (ii) practice

limitations on occupational therapy’s role, (iii) lack of resources, (iv) an educational shift

toward academic occupations over play-based occupations as children age, and (v) lack

of available research.

Lack of knowledge. D&D has been a product since 1974 and, although some occupational

therapy practitioners might know of the game, many are unaware of how to play D&D

and other TTRPGs. The game play may appear complicated and consist of many

components upon initial consideration. However, once the basics are understood, D&D
 7

will seem more accessible, and clinicians can begin to better contemplate the wide

implications and applications of utilizing D&D as a tool for intervention.

Practice limitations on occupational therapy practice. As mentioned previously,

occupational therapy practitioners have unique skills in analyzing the personal,

environmental, and occupational factors that influence engagement in meaningful

occupations. Unfortunately, in many settings, pediatric occupational therapy practitioners

are often referred to only for handwriting, sensory processing, and fine motor issues; and

therefore, have a limited role in addressing social-emotional skills.

Lack of resources. For clinicians interested in exploring and utilizing D&D as a tool and

addressing SEL and moving away from their expected role, resources, such as time,

materials, and collegial support, may not be available to develop and implement a new

intervention.

Shift in focus. Adolescence is “a distinct developmental stage characterized by growth

and maturation, the refinement of skills, self-determinism, relative individuation, and

development of a sense of identity that culminates in a positive self-concept as a healthy

adult” (Vroman, 2015, p. 124). As children get older, their occupational interests change.

For young children, play is a primary meaningful occupation; however, through

adolescence, individuals begin to learn more about themselves, what their interests are,

and may engage in new and different meaningful occupations. Through their own

professional experiences, the author has observed that occupational therapy practitioners,

too, shift the focus of their interventions as children age. In many cases, academic

occupations are prioritized over play occupations, and social-emotional skills may not be
 8

addressed.

Lack of research. As previously discussed, there is currently limited literature which has

investigated D&D and TTRPGs as an intervention tool in occupational therapy practice.

Proposed Project

To address this gap in occupational therapy practice and research, the author has

developed the program, Role for SEL: Using Dungeons & Dragons® to promote social-

emotional learning with middle-schoolers. This program will be led by an occupational

therapist and will use D&D (5th ed.) with groups of up to five middle-school students to

support their development of skills in two key SEL competencies: self-management and

relationship skills. Role for SEL is a 10-week, school-based program. Each session will

be 60-90 minutes and will be held after-school. In the sessions, students learn how to play

D&D, and then engage in D&D scenarios which focus on the two key SEL competencies.

Role for SEL has developed an evaluation and research plan involving the use of

qualitative and quantitative measures such that the program can contribute to

occupational therapy literature on the use of TTRPGs to promote SEL. Following the

piloting and evaluation of the program, the author will develop resources for occupational

therapy practitioners to support their use of D&D as an intervention tool for promoting

SEL.
 9

CHAPTER TWO – Project Conceptual and Evidence Base

Conceptual Framework

The Collaborative for Academic, Social, and Emotional Learning (CASEL)

Framework for Systemic Social and Emotional Learning (CASEL, 2020) is a conceptual

framework which establishes the areas of SEL competence and presents a systemic

approach to establishing equitable SEL environments for school-aged individuals

(CASEL, n.d.). According to CASEL (2020), SEL is a “process through which all young

people and adults acquire and apply the knowledge, skills, and attitudes to develop

healthy identities, manage emotions and achieve personal and collective goals, feel and

show empathy for others, establish and maintain supportive relationships, and make

responsible and caring decisions” (para 1). The CASEL SEL framework (CASEL, 2020)

presents the components of social-emotional learning, and the various practice settings

and contexts to address these components to facilitate comprehensive service delivery.

For this doctoral project, the CASEL SEL framework is used to distinctly outline the

aspects of SEL and gain further understanding of a current practice gap in occupational

therapy and addressing SEL with children and adolescents.

The CASEL SEL framework (CASEL, 2020) highlights five core areas of SEL

competence, which can be supported by coordinating interventions between the

classroom, school, family, and community settings. This framework is illustrated in

Figure 2.1.
 10

Figure 2.1

Social-Emotional Learning Framework (CASEL, 2020)

Ó
2020 CASEL. All Right Reserved.

From Collaborative for Academic, Social, and Emotional Learning (2020). CASEL’S
SEL Framework: What are the core competence areas and where are they promoted?
[website]. https://casel.org/fundamentals-of-sel/what-is-the-casel-framework/

The CASEL (2020) framework identifies five interrelated areas of SEL competence:

1. Self-awareness - The abilities to understand one’s own emotions, thoughts, and

values and how they influence behavior across contexts.

2. Self-management - The abilities to manage one’s emotions, thoughts, and

behaviors effectively in different situations and to achieve goals and aspirations.

3. Social awareness - The abilities to understand the perspectives of and empathize

with others, including those from diverse backgrounds, cultures, & contexts.
 11

4. Relationship skills - The abilities to establish and maintain healthy and supportive

relationships and to effectively navigate settings with diverse individuals and

groups.

5. Responsible decision making - The abilities to make caring and constructive

choices about personal behavior and social interactions across diverse situations.

The framework also highlights key settings where SEL skills are nurtured and

practiced and approaches to support SEL most effectively in each of these settings.

Although CASEL has emphasized SEL and the academic setting, the framework

recognizes the importance of incorporating SEL in all settings and contexts – classroom

curriculum and culture, school-wide policies and practices, and on-going collaboration

with families/caregivers and communities to align opportunities (CASEL, 2020). Despite

this, much of the literature regarding the CASEL framework has primarily been applied

in the school setting. For example, Lawson et al. (2019) utilized the five competencies to

identify core components addressed in SEL programs for elementary-aged students.

Additionally, Elliot et al. (2018) studied the initial validation of a new universal SEL

screening in Australia that was based on the CASEL framework. The framework has

“influenced the development of dozens of school-based intervention programs in the

United States and an entire national curriculum on Personal and Social Capability in

Australia” (Elliot et al., 2018, p. 40).

The CASEL (2020) SEL framework consolidates the wide array of SEL skills into

five over-arching competencies and four key settings. By doing so, the framework

supports clinicians, educators, schools, caregivers, and community settings to address

 12

SEL in a systemic, evidence-based method. The framework provides a comprehensive

definition of SEL and the contexts to consider which facilitates understanding of the

influence social-emotional skills have on occupational engagement/performance.

Development of the SEL framework

The development of the CASEL (2020) SEL framework was informed by the

work of several academics in the late 20th Century. In the 1960’s, James Comer, professor

at the Yale School of Medicine’s Child Study Center, began a pilot program in two low-

achieving elementary schools in New Haven, Connecticut (Anderson & Grinder, 2017).

A team consisting of teachers, parents, the principal, and a mental health worker

reviewed the school’s academic and social programs, and the procedures that seemed to

be engendering behavior problems, to better create an environment where students feel

comfortable, valued, and secure (George Lucas Educational Foundation, 2011). By the

1980’s, truancy declined, and academic achievement increased; demonstrating the

importance of SEL and beginning the SEL movement (George Lucas Educational

Foundation, 2011).

From 1987 to 1992, Professor Roger P. Weissberg and Timothy Shriver from

Yale University worked to develop and implement the K-12 New Haven Social

Development program (Anderson & Grinner, 2017). Shriver would be the future co-

founder of CASEL. Around this time, the W.T. Grant Consortium on the School-Based

Promotion of Social Competence (1996) also established a list of the emotional

skills necessary for emotional competence. The list included: ‘identifying and labeling

feelings, expressing feelings, assessing the intensity of feelings, managing feelings,

 13

delaying gratification, controlling impulses, and reducing stress’ (George Lucas

Educational Foundation, 2011).

The Collaborative to Advance Social, and Emotional Learning was created in

1994 by co-founders Daniel Goleman, Mark T. Greenberg, Eileen R. Growald, Linda

Lantieri, Timothy P. Shriver, and David J. Sluyter. That same year the first CASEL

conference was held at the Fetzer Institute and the term “social and emotional learning”

was introduced. CASEL was established with the goal of developing and incorporating

“high-quality, evidence-based social and emotional learning” (CASEL, n.d) as a critical

aspect of the education curriculum. Since then, CASEL has conducted research linking

academic achievement and positive outcomes to SEL, set standards for school SEL

programs, and promoted the understanding, advancement, and implementation of SEL

amongst educators, school districts, and policy-makers. In 2001, the organization

changed its name to Collaborative for Academic, Social, and Emotional to Learning to

reflect the close relationship between academic learning and SEL.

CASEL has become one of the leading organizations in promoting the integration

of SEL practices in the school environment through research, practice, and policy.

CASEL advocates for district and state-wide SEL standards and recommends a process to

develop and implement standards and characteristics the standards should have, which

includes alignment with the CASEL competencies. Additionally, CASEL has developed

program guides that identify and rate school SEL programs that meet CASEL standards

to allow professionals to select “carefully evaluated curricula with well-documented

impact and efficacy on student outcomes” (Lawson et al., 2019, p.457).

 14

Explanatory Model

This doctoral project addresses the issue that occupational therapy practitioners in

some practice settings may have limited involvement in the development of social and

emotional skills in children and adolescents. The factors impacting this gap are illustrated

in the explanatory pathway presented in Figure 2.2 and described in detail following the

illustration.

Figure 2.2

Explanatory Pathways

Children and adolescents may experience social-emotional challenges specifically

relating to self-awareness, self- management, social awareness, relationship skills, and

responsible decision making. Challenges with social-emotional skills can negatively

impact occupational engagement/performance in various areas of life, including, but not

 15

limited to, academic achievement, managing friendships and social interactions, and

coping with stress and unexpected events. Occupational therapy practitioners are trained

and skilled professionals to address social-emotional skills, however, they may not

address these skills in pediatric practice setting due to a range of factors. These factors

include practice limitations on occupational therapy’s scope of practice, and limited

resources, including time and support. In some settings, other professionals, such as

speech language pathologists (SLPs), social workers, counselors, and psychologists have

typically addressed social and/or emotional skills, whereas occupational therapy

practitioners may not have had a role in SEL. When occupational therapy practitioners

are not involved in SEL, children and adolescents may not receive interventions and/or

outcomes that meet their occupational interests.

Literature Review on Factors Contributing to the Issue

To investigate the relationships between factors presented in the explanatory

model, a literature search was conducted. The literature review sought to answer the

following research questions:

1. Is there evidence that social-emotional skills impact occupational performance?

2. What evidence is there that speech-language pathologists, social workers,

counselors, or psychologists address social-emotional skills in pediatric practice?

3. What evidence is there that occupational therapy practitioners address social-

emotional skills in pediatric practice?

The following five databases were searched to identify relevant articles and

research studies: Cumulative Index to Nursing and Allied Health Literature (CINAHL),
 16

APA PsycINFO, Education Full Text, Education Resource Information Center (ERIC),

and Social Services Abstracts. Search terms utilized included combinations and

variations of the terms “social-emotional”, “CASEL framework”, “occupational

performance”, “professions”, “pediatrics”, and “occupational therapy” in title/abstract, as

relevant to the research question. Results were limited to peer-reviewed articles published

from the year 2000 onwards. The abstracts and full-text of the retrieved articles were

reviewed, and the most relevant included in this literature review.

Social-Emotional Learning’s Impact on Occupation

It is apparent from the literature review that SEL competencies (self-awareness,

self-management, social awareness, relationship skills, responsible decision-making) are

associated with positive occupational performance outcomes. Durlak et al. (2011)

completed a meta-analysis of 213 school-based, universal SEL programs and found that

students who participated in SEL programs exhibited improved school-related attitudes

and behaviors (e.g., motivation to learn, school commitment), increased academic

performance, decreased negative behaviors (e.g., aggression, disruptiveness, non-

compliance, disciplinary referrals), and less reports of emotional distress (e.g.,

depression, anxiety, stress, etc.). Another meta-analysis (Durlak, Weissberg, & Pachan,

2010) reviewed 75 after-school SEL programs. The study found that enhanced personal

or social skills demonstrated “significant increases in youths’ self-perceptions, bonding to

school, positive social behaviors, school grades, and achievement test scores [and]

…significant reductions also appeared for problem behaviors” (p. 302). Both studies also

found that programs that incorporated the four SAFE elements (sequenced, active,
 17

focused, explicit) had more statistically significant positive outcomes.

Ross and Tolan (2018) completed a confirmatory factor analysis using

longitudinal data on a normative, nationwide, diverse adolescent sample collected

previously by the National 4-H Study of Positive Youth Development. The purpose of the

study was to test the validity of the CASEL model and competencies for early

adolescence and its relation to youth outcomes. Overall, social and emotional

competencies were associated with positive outcomes across early adolescence. The

study found a significant reduction in risky behaviors, depressive symptoms, and

delinquency, a significant increase in grades, and an increase in school engagement.

Two studies reported on the impact of specific SEL programs. Voith et al. (2020)

implemented a non-experimental, mixed method design with no control or comparison

group to examine the feasibility and effects on student outcomes (aggression,

concentration/attention, emotional competence) of the Peace Program with 287 students

from grades 1-8. The intervention showed different effects for different grade levels as

measured by teacher survey, resulting in mixed outcomes. Contrastingly, Coombs-

Richardson et al. (2009) studied the impact of the ‘Connecting with Other: Lessons for

Teaching Social and Emotional Competence’ social-skills program with 25 students, age

9-13 with a learning disability or behavior disorder. Teachers’ pre- and post- scale

measures found that teachers’ perceived student growth following the program in all

social skills outcome measures (concept of self and others, socialization, problem

solving/conflict resolution, communication, sharing, caring/empathy). The ‘Connecting

with Other: Lessons for Teaching Social and Emotional Competence’ curriculum
 18

appeared to improve social skills in students with disabilities, which may improve social

participation, an important occupation for children and adolescents.

Additionally, a few studies did not explicitly refer to occupation, but did discuss

mental health, which is well-understood to impact occupation. For example, as previously

mentioned, Durlak et al.’s (2011) meta-analysis exhibited less reports of emotional

distress in students. van de Sande et al. (2019) completed a systematic review on school-

based SEL programs for secondary school students, age 11–19, that targeted two or more

SEL competencies and included a comparison group or waitlist control group. The study

concentrated on whether the programs enhanced SEL competencies and impacted

psychosocial health outcomes (depression, anxiety, aggression, and substance use). The

review, which included 40 studies, found that a "majority of the studies that measured

outcomes for psychosocial health problems found decreases in those problems in students

who participated in the evaluated SEL programs" (van de Sande et al., 2019, p. 1559).

Yang, Chan, and Ma (2020) utilized a correlational and cross-sectional research

design involving 23,532 students in grades 4–12. The study measured student perceptions

of their SEL competencies (responsible decision-making, social-awareness, self-

management, relationships), frequency of being bullied, school climate, and how these

factors related to each other and bullying victimization. The study found that social

awareness positively related to the students’ experiences of bullying victimization.

Students with higher self-management and relationship skills experienced less bullying

victimization. Responsible decision making, however, did not have significant

relationship. From this study, it appears that the level of competency in certain SEL skills
 19

can influence student's bullying victimization experiences, which may impact school

related occupations.

Helping Professions’ Role Addressing Social-Emotional Skills in Pediatrics

The literature review for the second research question established that teachers,

school psychologists, social workers, school counselors, and SLPs address social-

emotional related skills in pediatric practice, specifically the school setting. Of these

professions, teachers were frequently the ones implementing the intervention, either

independently or in collaboration with other school professionals.

Kopelman-Rubin et al. (2021) conducted an intervention study with 419 fourth

grade students in Israel. Students were assigned to either the intervention group or the

treatment as usual group. The intervention group received the ‘I Can Succeed’

intervention, a weekly 45-minute SEL program for 2 school years. Although, the teachers

facilitated the program, a whole school approach was utilized where the school leadership

team (principal, psychologist, counselor, special education teacher) and fourth grade

teachers met for supervision.

Durlak et al. (2011) considered the intervention implementer as an independent

variable in their meta-analysis. Of the 213 studies, 53% were implemented by teachers,

21% by non-school personnel, and 26% consisted of multi-component. Of the 32

programs reviewed in van de Sande et al.’s (2019) systematic review, 20 programs were

facilitated by teachers (63%) and 12 programs were facilitated by “Other” (researchers,

master students; 37%).

The ‘Connecting with Other: Lessons for Teaching Social and Emotional
 20

Competence’ curriculum in Coombs-Richardson et al.’s (2009) study was implemented

by 18 general education teachers, two SLPs, and one counselor. However, at the end of

the article, recommendations for social workers were provided. This was the only study

that included SLPs, but SLPs role in social-emotional well-being has been discussed by

Stark (2017). Stark (2017) provides an overview of literature and clinical insight about

language/communication skills and primary school students with social, emotional, and

behavioral difficulties in Victoria, Australia. The literature suggests there is an

association between language skills impact on behavior and behavior's impact on

language skills. Clinical insight disclosed that SLPs get involved when a student is

categorized under the Program for Students with Disabilities to rule out a language

impairment. It also described a special tiered SEL program that included SLPs, though,

there was no report on the impact that SLP involvement had on student outcomes.

Ruegg (2006) provides an overview of social skills difficulties in children with

learning disabilities and suggests that teachers may address social skills with students

with learning disabilities universally in the general education classroom.

Psychotherapists, counselors, and social workers can assist teachers in modify social

skills interventions to be more targeted and build better relationships in the classroom.

Psychotherapists, counselors, and social workers can also provide specific services to

groups or individual students to address social skills.

Social work’s involvement in addressing social-emotional skills was also

mentioned in Caldarella et al. (2019). In this time-series intervention study, 28 high

school students participated in the Strong Teens program facilitated by the school
 21

counselors and social workers to address internalized symptoms and resilience.

Implications for school counselors were also discussed.

Briesch et al. (2017) conducted a multiple-baseline single-case intervention study

with three students to address self-management skills and “academic enabling behaviors”

specific to each student. The group counseling intervention was headed by school

psychologists or school psychologist interns, but the authors do not state why or if it must

be this profession. Additionally, they state that group counseling is commonly

implemented by “school mental health professionals” (p. 853)

In addition to Coombs-Richardson et al. (2009), Ruegg (2006), Caldarella at al.

(2019), and Kopelman-Rubin et al. (2021), school counseling is also mentioned in

Harrington et al. (2016), which discusses a grant project to create a data-based, district-

wide elementary school counseling program in an urban suburb in a Northeast region of

US. The grant was specifically for school counseling (Elementary and Secondary School

Counseling Program Grant) and the program was specifically developed to increase or

involve school counselors. This was not an experimental study, so no outcomes or causal

relationships are presented. Interestingly, one of the programs used to ground their

universal Tier 1 curriculum was the Zones of Regulation, which was developed by an

occupational therapist.

One article discussed a SEL and mindfulness program, not for students, but for

early childhood educators (ECE). Harrison & Harrison (2014) completed a

phenomenological study of the lived experiences of six ECEs from three Head Start

programs in the southwest US. The ECEs participated in a weekly, semi-structured

 22

meeting with a counselor for 12 weeks. The type of counselor is not specified; however,

the article is presented in the School Social Work Journal.

Occupational therapy practitioners’ Role Addressing Social-Emotional Skills in

Pediatrics

The third research question was initially meant to focus on the barriers to

occupational therapy practitioners’ involvement with SEL, however, this question was

unable to be examined as the literature review did not yield sufficient relevant results.

Therefore, the research question was adjusted to observe occupational therapy’s

involvement in SEL. Three articles consisted of systematic reviews of studies related to

occupational therapy’s involvement in pediatric practice. Case-Smith (2013) conducted a

systematic review to investigate the interventions used by occupational therapy

practitioners that focus on improving social–emotional development for children birth to

5 years. This review included 23 studies, and found that occupational therapy

practitioners address social-emotional development in children birth to 5 years to address

social skills, social-emotional performance, or related behaviors with touch-based,

relationship-based, joint attention, and instruction-based interventions, and interventions

to promote peer-to-peer engagement.

Arbesman, Bazyk, & Nchajski (2013) also a conducted a systematic review to

understand whether activity-based interventions are effective for mental health

promotion, prevention, and intervention with children and youth. The review included

124 articles from 1980–2012. The review explored studies with participants aged 3–21

where the "intervention described in the study was embedded in activities and within the
 23

domain of occupational therapy, although it did not have to be a common occupational

therapy intervention or administered by an occupational therapist or occupational therapy

assistant" (p. e122). Studies needed to also measure social or peer interactions, or

compliance with adult directives or social rules and norms (including ADLs). Overall,

occupation- and activity-based interventions can be used in all tiers of intervention

(universal, targeted, intensive). Many of the studies were conducted by researchers

outside of the field of occupational therapy. This demonstrates the gap in literature

regarding occupational therapy practitioners’ involvement in SEL for younger

populations. However, because these interventions are occupation- or activity-based, it

justifies occupational therapy’s involvement or role in addressing mental health or being

involved in mental health care.

Novak & Honan (2019) completed a systematic review of literature that involved

providing any type of occupational therapy intervention, where the participants were

children of any childhood disability diagnosis. The review included 129 articles ranging

from 1980-2016. The study brought attention to the fact that occupational therapy

practitioners are involved in many areas of pediatric development and service provision,

including areas with "behavioral outcomes" as the focus. Surprisingly, SEL was not

mentioned, but may be included under behavioral, social, or mental health outcomes.

Three studies focused on addressing social skills or competence. Gutman,

Raphael-Greenfield, & Salvant (2012) conducted a multiple baseline, single subject study

with three teenagers (two 15 years old, one 16 years old) with Asperger’s syndrome.

Occupational therapy practitioners provided a role-playing intervention focused on target

 24

verbal and non-verbal social skills. Results of the study found that all participants

demonstrated an increase in targeted social skills from baseline to intervention that was

statistically significant and were able to maintain the skills at one-month follow-up.

Kaur & Pathak (2019) completed a case series on three children (aged 4–5) with

attention deficit hyperactivity disorder or autism spectrum disorder in New Delhi, India.

In this study, occupational therapy practitioners implemented play-based interventions to

promote and practice social skills twice weekly for 24 weeks. Baseline data from the first

and last day of intervention suggested that all three children showed improvements. This

article demonstrated that occupational therapy practitioners in India have implemented a

play-based intervention with focus on addressing social skills

Challita et al. (2019) implemented a quantitative, experimental crossover design

to study intervention effectiveness of a playground social skills program based on the

Perceive, Recall, Plan, Perform (PRPP) system of intervention (Chapparo & Ranka,

2010) for 16 children (aged 3-10). Compared to simply engaging in routine playground

activities, children who engaged in the PRPP intervention demonstrated improved social

performance and cognitive strategy use as measured by goal attainment scaling and the

assessment component of the PRPP system of task analysis. Occupational therapy

practitioners can implement a PRPP intervention aimed at changing cognitive strategy

use and increasing social competence during playground interactions.

Specific intervention programs or curriculums were reviewed in two studies.

Tokolahi et al. (2018) performed a two-arm pragmatic, cluster randomized control trial of

an occupational therapist-led intervention in New Zealand, ‘Kia Piki te Hauora: Uplifting

 25

out Health and Wellbeing’. The intervention was designed to use activity-based

interventions to reduce symptoms of anxiety and depression and increase self-esteem,

well-being, and participation. The intervention was not found to significantly impact

child- and parent-rated anxiety, depression, self-esteem or wellbeing outcomes, as

compared to the control, but children did show significant improvement in their

satisfaction with how they perform in occupations they wanted to improve on. Although

this was an occupational therapist developed and implemented intervention, the authors

do suggest modifications to the intervention to co-facilitate it with teachers and embed it

in the curriculum.

Mac Cobb, Fitzgerald and Lanigan-O’Keeffe (2014) developed and adapted

content from the Alert Program, a program focused on self-regulation/self-management.

The authors completed phase 1 of a pilot study aimed at obtaining teacher’ and students’

impressions of the program. This program was developed and adapted by occupational

therapy practitioners to create teaching strategies and resource materials for teachers to

implement. However, ongoing collaboration with the teachers was integrated during the

intervention and will likely continue to be useful to provide the most appropriate sensory

supports to students.

In addition to the literature found in the current literature review, there is gray

literature which discusses the occupational therapy practitioners’ role in addressing SEL.

AOTA (2013) has published a fact sheet on the role of occupational therapy in addressing

SEL that references the CASEL framework. Additionally, AOTA’s OT Practice

magazine published the article “Occupational Therapy’s Role in Social-Emotional

 26

Development Throughout Childhood” (Anderson & Grinder, 2017), which also

references the CASEL framework, discusses occupational therapy’s domain within SEL,

and intervention areas to address SEL across development. The interventions and

examples discussed in both texts are catered to the school setting, particularly their

implementation as a part of Response to Intervention (RtI).

Conclusion

The articles found in this literature review support the explanatory model

presented in this doctoral project and demonstrates the impact of SEL on occupation,

which justifies occupational therapy’s involvement in addressing and promoting SEL.

However, research including occupational therapy and SEL promotion appears sparse

despite its evident need. As a result, adolescent’s occupational needs related to SEL may

not be adequately met. It is also apparent in the literature that SEL is being addressed by

other health and helping professions, and that SEL has application with differing

professional lenses. This highlights the irreplaceable value of each profession, including

occupational therapy, in addressing SEL and that interprofessional collaboration will

likely be important when devising and implementing SEL interventions.

 27

CHAPTER THREE – Overview of Current Approaches and Methods

Literature Review on Play-Based Interventions

Adolescence is “a distinct developmental stage characterized by growth and

maturation, the refinement of skills, self-determinism, relative individuation, and

development of a sense of identity that culminates in a positive self-concept as a healthy

adult” (Vroman, 2015, p. 124). Critical changes and growth occur in adolescence which

have implications later as an adult. During this period of life, social participation shifts

from a family focus to that of “fitting in” with peers, which can be facilitated through

play or leisure group activities. Thus, play-based, group interventions, like Dungeons &

Dragons® (D&D) have the potential to promote skill development, such social-emotional

learning, in adolescents. To further investigate this notion, a literature search was

conducted to answer the following research questions:

1. What is the evidence to support play-based interventions for adolescents?

2. How has Dungeons & Dragons® been used by health and helping professions?

3. What strategies do group facilitators use to foster, support or enhance group

dynamics for adolescents?

Five databases were utilized to identify relevant articles and research studies:

CINAHL, APA PsycINFO, Education Full Text, ERIC, and Social Services Abstracts. As

relevant to the research question, variation of the terms “play-based intervention”,

“intervention”, “adolescents”, “social emotional”, “strategies”, “group dynamics”,

“Dungeons & Dragons”, “tabletop role playing games”, and “therapeutically” were

searched within title/abstract. Articles were limited to those published in peer-reviewed

 28

journals from 2000 to 2021, and available in English. Following the literature search,

abstracts and full-text of the retrieved articles were reviewed, and the most relevant

included in this chapter.

Play-based Interventions for Adolescents

Play is an essential childhood occupation. It is how children and adolescents make

sense of the world, develop skills, and experience joy (AOTA, 2011; 2012).

Opportunities to engage in play and be playful can have an impact on health and well-

being. “Physical health, social and emotional well-being, and positive mental health are

promoted through play. When a child plays, [they] experience new ways to solve

problems and learn skills needed to become a healthy adult” (AOTA, 2011, p. 1).

Unfortunately, opportunities to play appear to have decreased and “playful” aspects of

school are disappearing (Tanta & Knox, 2015), particularly as children get older and the

focus on academics and maturity increases. However, research exists to support the use

of play within adolescence.

Ewing, Monsen, and Kwoka’s (2014) conducted a research study in the UK to

investigate whether a non-directive, school-based play intervention with trained school

staff supervised by play therapists had similar benefits as play therapy. The intervention

was implemented with 253 participants between the ages of 3 years 10 months and 14

years 18 months. Pre- and post-scores on the Strength and Difficulties Questionnaire

(SDQ) (Goodman, 1997, 1999) revealed that the intervention may be beneficial in

increasing child pro-social behavior and decreasing hyperactivity/inattention, difficult

emotional symptoms, conduct problems, peer problems and total difficulties in children
 29

aged three to fourteen. However, greater improvements were seen for younger children,

specifically between ages three and eight.

Frazier et al. (2015) completed a research study to examine the “feasibility and

promise” of Leaders @ Play, a 10-week afterschool public parks program for middle

school youth that incorporates roleplaying activities, sports, and recreation; emphasizing

social problem solving, emotion regulation, and effective communication. Along with

this program, a park and mental health staff co-facilitated group, Families @ Play, was

conducted twice a month with families and youth. During this group, target skills were

introduced and strategies to model and reinforce the skills at home discussed. Park staff

scores on the Social Skills Improvement System (SSIS) (Gresham & Elliott, 2008)

indicated that adolescents demonstrated a significant increase in social skills and decrease

in problem behaviors. There were, however, no significant change in the adolescents’

social skills on the parents’ SSIS scores. Parents scores did indicate an increase in middle

schoolers’ problem behaviors post intervention, but scores returned to baseline at two

months follow-up. The authors suggest this may indicate that additional effort is needed

to increase family participation in Families @ Play.

In Goldingjay et al.’s (2020) exploratory study, the researchers assigned 12

adolescents identified as having “social difficulties” to either an implicit play-based

intervention group or explicit cognitive behavioral therapy (CBT) group. The study

aimed to compare the impact of the groups on social competence, cognitive flexibility,

and narrative ability after 8-weeks of intervention. Adolescents in the play-based

intervention displayed increases in narrative ability and insight into socials skills, while
 30

maintaining cognitive flexibility. Whereas the CBT group “impacted negatively on

flexible thinking and positively on social and emotional engagement with small effects in

understanding character roles and generation of problems" (Goldingjay et al., 2020, p.

370). This suggests that a play-based intervention may be more helpful than CBT in

developing the social skills targeted in the study.

Shea and Siu (2016) utilized existing data from the Occupational Therapy

Training Program-San Francisco (OTTP-SF) to perform an exploratory, retrospective

study and determine the extent of engagement in the group. OTTP-SF conducted a

weekly group for incarcerated youth aged 14 to 18. The primary purpose of the group

was to provide inmates an hour-long opportunity to engage in play through activities such

as: games with rules, ice breakers, arts and crafts, and puzzle. Participants (n = 253)

completed the Engagement in OTTP Activities Questionnaire (EOAQ), modified from

the Engagement in Meaningful Activity Survey (EMAS) (Goldberg et al., 2002).

Responses revealed that youth found the play activities “meaningful.” Additionally,

results of the Analysis of Group Activity Scale (AGAS) based on 203 participants’ work

samples showed high levels of engagement. The results of this study imply that play,

particularly structured play, is an important, meaningful adolescent occupation and may

have influence on their development.

Two articles (Thorpe, Willbourne, & Burdock, 2020; Weaver et al., 2021)

discussed Theraplay®. Theraplay® is “a short-term therapeutic intervention that is

attachment-informed, play-based, and modeled after the natural patterns of healthy

caregiver–child interactions…[It] emphasizes moment-to-moment interactions that are

 31

attuned, structured, joy- filled, and designed to help with regulation” (Weaver et al.,

2021, p. 125). Thorpe, Willbourne, and Burdock (2020) utilized qualitative methods to

understand facilitators’ experiences running the Theraplay®-informed ‘Thingymiboby

Group’ with four adolescents (aged 16–17) in a secure hospital in the UK. Through semi-

structures interviews, facilitators reported multiple benefits, including having the

opportunity for playfulness and shared enjoyment, observed improvements in confidence

and social skills, and increased ability to meaningfully engage with peers.

Weaver et al. (2021) completed a phenomenological study to explore the

experiences of 21 middle school students, aged 11–13, exhibiting “social, emotional,

and/or behavioral difficulties” who participated in a Theraplay® group during lunchtime

in school. Themes and subthemes that appeared during semi-structured interviews and

focus groups include relationships, perspective taking, teamwork, and interpersonal

skills, which “highlight an increased ability to meaningfully engage with peers and to

perform relationship-maintaining behaviors, including the ability for emotion regulation."

(Weaver et al., 2021, p. 132).

This body of research demonstrates that play and play-based interventions are

beneficial to the adolescent population. The studies have demonstrated favorable results

related to improved emotional development, social skills, meaningful engagements in

activities and with peers, and decreased “problem” behaviors. The study outcomes

highlight the importance of and justify play as a vital occupation for adolescents to

engage in for their development whether as a goal or as an intervention. Overall, the

research particularly appears to suggest utilizing structured play activities.

 32

Dungeons & Dragons® & the Health and Helping Professions

Dungeons & Dragons® (D&D) is a fantasy tabletop role-PLAYing game

(TTRPG) where players embrace the role of a character and adventure together through a

narrative created by a Dungeon Master (DM) (Wizards of the West Coast, n.d.). The

storytelling, gameplay, creativity, and adaptability of D&D make it a versatile tool with

many potential applications for intervention. However, limited research is available on its

application and use. Below is a summary of relevant articles.

Two reports specifically referred to D&D in their study. Abbot, Stauss, and

Burnett (2021) conducted a qualitative, exploratory study to assess whether a role-playing

skills group with seven adults, aged 18-45, with mental health history of trauma, anxiety,

or depression could increase social connectedness. The initial session of the group

provided a brief introduction to D&D, reviewed norms and expectations, and members

started working on characters. The first two to three sessions were less structured and

focused on character creation, asking questions, building rapport, and providing

feedback. Subsequent session included semi-structured initial check-ins and playing the

role-playing game. The last 10-15 minutes was dedicated to debriefing. Following the

group, during a semi-structured interview, three participants reported increased

confidence and sticking up for themselves and transfer of skills to real life. The authors

recommend facilitators have previous knowledge or experience playing role-playing

games.

Causo and Quinlan (2021) also performed a qualitative, exploratory study with 13

active D&D players who “identified as in recovery from mental health difficulties.” The
 33

study explored the participants’ "experiences playing D&D, playing their characters and

whether they believed D&D contributed to their mental health recovery" (Causo &

Quinlan, 2021, p. 259). Semi-structured interviews revealed multiple themes: the game

provided respite/distractions from mental health challenges but not a "complete escape",

the game provided opportunities of exposure to topics related to mental health recovery,

participants were able to safely practice skills for mental health recovery (cognitive,

social, emotional), and the game met their social needs and provided connection.

However, the potential realism of the game may not always be safe, and participants

sometimes felt the experiences of their characters. The experience of D&D, per this

article, can be useful in supporting mental health recovery and social connection, though

game implementers should be thoughtful regarding the potential impact that realism may

have on participants.

Rosselet and Stauffer (2013) reference a TTRPG with a “D&D-like format.” The

authors "propose a psychosocial model of interactions during role-playing games based

on Goffman’s theory and Adlerian play therapy techniques and suggest that role-playing

games are an effective way of intervening with gifted children and adolescents to

improve their intra- and interpersonal skills" (Rosselet & Stauffer, 2013, p.173). The

article describes a weekend role-playing game workshop for 8- to 16-year-olds and

discusses the potential benefits through the case study of Matthew. Some of the benefits

presented included: having a secure environment to explore aspects of themselves

through a character, a place to express emotions in a safe way, opportunities to consider

the different aspects of the self, and opportunities to develop interpersonal skills. The
 34

weekend role-playing game workshop included time to meet the players, learn the game,

create a character, and process. While this paper does not provide empirical evidence to

support the use of D&D, it does provide valuable anecdotal information on the potential

application and advantages of D&D on social-emotional skills.

In Dyson et al.’s (2016) non-equivalent control group pretest-posttest quasi-

experimental study, the authors do not specify which specific TTRPG is being used,

however, the description of the game is very similar to that of D&D. A weekly TTRPG

group was conducted with 19 native Taiwanese undergraduate and graduate students to

assess the programs impact on creative potential and emotional creativity. When

compared to the control group (n = 20), the treatment group showed statistically

significant higher scores on the creativity index. Fluency, flexibility, originality, and

elaboration did not achieve statistical significance. Emotional creativity showed minor

improvements but did not achieve statistical significance. Of note were the preparatory

steps and materials incorporated by the facilitators: an instruction manual on how to play,

players were expected to stay in character as much as possible, the authors developed

four story modules (intended to be about three hours long) written to encourage creative

potential and emotional creativity, and character sheets were provided with questions to

think about the psychology of their character to avoid stereotyping.

Cook, Gremo, and Morgan (2017) discuss their experience of implementing

Pathfinder, a different TTRPG with similarities to D&D, to teach English Language Arts

text and foster critical thinking and problem solving in middle school youth. The authors

describe suggestions and changes they made to the game that are of interest, such as:
 35

• streamlining or simplifying the game to the essential mechanics and materials,

• adding four pre-made characters,

• creating a visual map,

• creating a narrative related to the book,

• dedicating one class period to teaching and understanding game mechanics (Open

World and Initiative stages),

• providing students with gaming objectives before starting game which can drive

decision making,

• beginning with reading the intro narrative

• providing group time to strategize (two to three minutes),

• facilitators keeping notes,

• debriefing the class after the game to facilitate reflection, and

• facilitators having experience with game.

Although this article does not describe a research study, the authors provide practical

strategies and suggestions to consider to effectively implement a TTRPG.

Bagès, Hoareau, and Guerrien (2020) examine an intervention with live-action

roleplaying (LARP), a different type of roleplaying game. The authors performed a quasi-

experimental study where 86 French sixth grade students were randomly assigned to

either the experimental group (LARP) or a non-equivalent control group (empathy

training program) to assess the effect on empathy, aggressive behavior, and bullying. For

the LARP group, there was a significant increase in empathy and decrease in aggressive

behavior and bullying from baseline to posttest 6-weeks after the final session. For the
 36

control group, there were no changes over time. Although LARP is different, it is in some

respects part of TTRPG as players do have to “act” as their character during gameplay.

Despite the limited body of research, these six papers provide preliminary

information as to the usefulness of D&D and TTRPGs in addressing confidence,

supporting mental health recovery and social connection, providing opportunities to

safely develop interpersonal and intrapersonal skills, improving creativity, and fostering

critical thinking and problem solving in a variety of contexts, countries, and age-ranges.

Additionally, multiple strategies and suggestions for how to implement and structure

D&D most efficiently are specified, including providing instruction on the game,

incorporating rapport building activities and a character-building session, pre-making

characters, visuals, and story modules, having an experienced facilitator familiar with

D&D, and providing time to debrief.

Strategies to Support/Facilitate Group Dynamics

D&D is a group-based activity that is heavily influenced by the function and

cohesion of the group. Strategies and techniques to facilitate positive group dynamics are

beneficial when leading a group. The literature search for research question three yielded

seven results, six of which referenced Irvin Yalom’s work discussing the “therapeutic

factors” present in group therapy.

In Thompson and White’s (2010) article, the authors discuss the importance of

play and the benefits of a restorative practice with reference to the four stages of groups

as established by psychologist Bruce Tuckman—forming, storming, norming, and

performing (Tuckman, 1965).

 37

• Forming: The group is unfamiliar and has little trust. The authors suggest low-

risk activities and to prioritize safety. The facilitator provides support and

guidance and opportunities to model behavior.

• Storming: Group members test limits. The facilitators stop to process and

reinforce safety of the environment and reinforce members understanding that

they have not failed. It is important to maintain expectations.

• Norming: Members demonstrate increased trust, are more invested, and take risks.

They are familiar and ready for the game, which allows for exploration

• Performing: The group is higher functioning and work together towards common

goal. The authors suggest higher-risk trust activities and values exercises.

They suggest beginning the group in a circle and to end with time to process and debrief.

Three articles discussed group cohesion/processes as a focus of the report.

Averett, Crowe, and Johnson (2018) discussed a community-based arts program for 8–

18-year-old at-risk youth that uses sketchbooks to promote inter- and intra-personal

skills. Facilitators and group members engaged in ice breakers, set norms together,

focused on a common issue, self-reflected, and share reflections with the larger group to

facilitate group process. The authors noted that many participants maintained their

friendships outside of the group.

Fluhr’s (2004) exploratory paper presented a social work method for facilitating

group cohesion, using “tangible and palpable” subject matter, in a heterogeneous group

via two specific examples—Animal World group at a continuing day treatment program

for older adults with mental illness; and a fashion show group for females ages 7–19 at a
 38

community center. The first session of each group included ice breakers and

introductions meant to bring members closer. Through the examples, Fluhr illustrated

that "(1) tangible content is non-threatening; (2) non-personal content helps clients

discuss taboo issues; (3) concrete subject matter brings clients to a common focus; and

(4) specific material levels the playing field, reducing differences among group

members." (p. 40). While the two groups were structured differently (i.e., time,

frequency, age, context), both group topics and focus (animals and fashion show) came

about as a means to facilitate group cohesion and engagement after the author realized the

diversity of participants in each group. Program implementation varied based on the

facility requirements and expectations and population served. However, the positive

effects of “tangible and palpable” subject matter were witness in both groups.

Harris et al. (2012) implemented a five-week strength-based program in a

residential program for 36 adolescents (aged 15–18) experiencing substance abuse

challenges. The authors’ strength-based approach built upon a traditional group CBT

intervention and was executed in the following sequence: “(a) taught about the

importance of strengths, (b) challenged to identify their strengths, (c) help others identify

their strengths, (d) work on developing their own strengths, (e) work with the group to

learn how these strengths can be used to address their substance use problems, and (f)

plan with the group how their strengths can be used once they return to their home

environments” (Harris eta al., 2012, p. 337). Following the program, qualitative methods

were utilized to understand adolescents' perspectives on whether the program contributed

to group cohesion or not. Adolescents reported the group "helped facilitate positive group
 39

cohesion between: (a) themselves and other individual group members, (b) themselves

and the group as a whole, and (c) themselves and the group leaders" (Harris et al., 2012,

p. 340).

Three studies discussed programs aimed at various skills but reported on aspects

of the intervention that positively support group cohesion. In Brogan et al.’s (2020)

quasi-experimental study with pre- and post- measures, the authors assessed the effects of

a 7-week solution-focused brief counseling group for Latino middle-school students

aimed at boosting ethnic belonging and self-esteem. Significant increases in both

variables were noted. Additionally, the authors detailed the impact of group members

discussing and sharing: “they were able to identify with others’ experiences, which also

decreased their sense of isolation or alienation...group process provided opportunities for

universality, imitative behaviors, and group cohesion" (Brogan et al., 2020, p. 20).

A research study carried out by Prince, Ho and Hansen (2010) explored the

program efficacy of a group process-oriented program that reinforces positive, pro-social

behaviors for at-risk youth in grades two through five. The authors found small to

moderate effect in reducing school problem behavior and in increasing social

competencies. Two of the objectives of the group included providing “a safe group

environment with norms that foster positive interaction with peers [and] solidify group

norms, skills, and desired behaviors by providing positive models and rewards for

normative prosocial behaviors” (Prince, Ho and Hansen, 2010, p. 42). Examples of how

the objectives can be incorporated were provided:

 40

• Positive, honest, and non-judgmental facilitators

• Maintain an open dialogue

• Set group norms together (increases "buy-in")

• Supportive group reactions without punishment or rejections

• Reinforcement of norms and preferred behaviors

• Direct, specific verbal praise, and

• Avoid punishment

Ball et al. (2015), which did not mention Yalom’s work, conducted a qualitative,

exploratory study to examine factors that promote and impede program implementation

and outcomes of the Expect Respect Support Group, a group for middle and high school

students who have experienced violence in relationships. Aspects of a successful group

reported by group facilitators during semi-structured interviews include establishing

positive group norms and safety, facilitators modeling key behaviors, and the facilitator

assuming the role of a non-authoritative group leader.

Conclusion

Adolescence is an important stage of development that has later implications in

adulthood. “It is a child’s ‘job’ or ‘occupation’ to play to develop physical coordination,

emotional maturity, social skills to interact with other children, and self-confidence to try

new experiences and explore new environments” (AOTA, 2012, p. 1). Since critical skills

are acquired in adolescence and play is important for development, activities and

interventions must be available for this population that incorporate play and playfulness.

Unfortunately, research regarding play interventions for adolescents appears sparse;

 41

however, from the available literature, it appears that play interventions are both

meaningful and effective in supporting development during this critical period of youth.

Considering this, a play-based, group intervention utilizing Dungeons & Dragons® is

proposed and detailed in the next chapter.

 42

CHAPTER FOUR – Description of the Proposed Program

Program Description

The author’s proposed program, Role for SEL: Using Dungeons & Dragons® to

promote social-emotional learning with middle-schoolers (Role for SEL), is an

intervention group developed to promote social and emotional learning in middle-school

adolescents using the popular table-top role-playing game, Dungeons & Dragons®

(D&D) 5th edition. Role for SEL is a 10-week afterschool program which is facilitated by

an occupational therapy practitioner and support staff. Up to five students participate in

each group going through the program. In the sessions, students learn how to play D&D,

and then engage in D&D scenarios which are designed to support students to develop

skills in two key SEL competencies: self-management and relationship skills. The

program aims to increase students’ abilities in SEL, and to generalize these skills in

everyday situations at school and home. Ultimately, it is hoped that following

participation in this program, students will improve their ability to manage their

emotions, behaviors, and thoughts and have more successful interactions with their peers.

This chapter presents a detailed description Role for SEL including reference to the

evidence base supporting the development of the program.

Basis of the Proposed Program

SEL is “the process through which all young people and adults acquire and apply

the knowledge, skills, and attitudes to develop healthy identities, manage emotions and

achieve personal and collective goals, feel and show empathy for others, establish and

maintain supportive relationships, and make responsible and caring decisions” (CASEL,
 43

2020). SEL is critical for human development, and research has demonstrated the impact

of addressing SEL on occupations, such as improved school-related attitudes and

behaviors (e.g., motivation to learn, school commitment), increased academic

performance (e.g., school grades, academic achievement), decreased negative behaviors

(e.g., aggression, disruptiveness, non-compliance, disciplinary referrals), and less reports

of emotional distress (e.g., depression, anxiety, stress) (Durlak et al., 2010, 2011). While

SEL impacts occupational performance, there is limited evidence in the literature of

occupational therapy practitioners addressing SEL, as described in Chapter 2.

Unfortunately, occupational therapy practitioners may not commonly address SEL in

some settings, and frequently experience time and organizational barriers to addressing

SEL competencies. This may lead to students’ occupational needs being overlooked,

therefore, impacting occupational performance. Considering this, the author developed

Role for SEL to address this gap in occupational therapy service provision.

The Collaborative for Academic, Social, and Emotional Learning presents a well-

researched, broad, conceptual framework for systemic social and emotional learning

(CASEL, 2020) which underpinned the development of Role for SEL. The CASEL

framework identifies 5 competencies of SEL: self-awareness, self-management, social

awareness, relationships skills, and responsible decision-making. It also emphasizes the

importance of coordinating SEL promotion and practices across key settings and

contexts—classroom, schools, families, and communities.

 44

Program Participants

The intended program participants include middle-school students at the

participating school. The author has intentionally not specified any diagnostic or social

characteristics for participation, as Role for SEL is designed to reach the breadth of

middle-school children who may find the program beneficial. Vignettes of three middle-

school students who may benefit from participation in the program are presented below

in Figure 4.1.

Figure 4.1

Vignettes.

David
David is a 7th grade student. Their teacher reports David becomes upset when things do
not go as expected. For example, when playing Uno, they did not say “Uno” fast
enough, resulting in them having to pick up an extra card. They became frustrated,
repeated, “I said it! That’s not fair!”, kicked their chair three times, and walked out of
the room.

Tamia & Tristan

Tamia is student in the 6th grade. During history class, she sits quietly, alone when
students are instructed to pair up. Her written assignments demonstrate that she has
extraordinary ideas that could elevate learning, but when working in a group, she
gestures or motions as if to share them and then stops herself. On the other hand, her
peer, Tristan, tends to take over the conversation and dictates to groupmates what to
do.

All three students could benefit from a targeted SEL intervention. For example, David
could benefit from learning how to manage their emotions. Additionally, Tamia and
Tristan could benefit from learning how to communicate effectively and work as a
team.

To recruit students to the program, the author will send emails to school staff

describing the program and SEL skills being addressed. Classroom teachers may then

identify students who they feel may benefit from the program. Students may also be
 45

recruited through Response to Intervention (RtI)/Multi-tiered system of supports (MTSS)

referrals for students who require additional support or demonstrate difficulty with SEL.

Parents will be informed of the purpose and structure of the study and consent will be

obtained. Additionally, assent from participants (via age-appropriate terms) will also be

acquired.

Program Resources

Role for SEL will be conducted afterschool at the participating middle-school. The

program will be run in-person in a designated classroom or assigned occupational therapy

room. It will primarily be run by this author (occupational therapist) with the support of

one or two additional personnel who are familiar with D&D. The additional personnel

will be recruited via staff email requesting volunteers. Table and chairs will be necessary

for students and staff to engage in the game in addition to D&D gaming materials. A

whiteboard, computer, projector, and screen will be useful when providing education to

the participants on SEL skills.

Interventions and Activities

Role for SEL will run in-person weekly, afterschool for 10 weeks for 60-90

minutes. The program will involve groups of up to five student participants. In the

sessions, students will learn how to play D&D, and then engage in D&D scenarios which

are designed to support students to develop skills in two key SEL competencies: self-

management and relationship skills. Research has shown that SEL programs that include

the CASEL recommended four SAFE elements have more statistically significant

positive outcomes (Durlak et al., 2010, 2011). The following four SAFE elements will be
 46

integrated into the program:

• Sequenced—connected and coordinated activities to foster skills development

• Active—active forms of learning to help students master new skills

• Focused—containing a component that emphasizes developing personal and

social skills

• Explicit—targeting specific social and emotional skills (CASEL, 2015, p. 8)

Session 1 will focus on collaboratively developing norms and safety mechanics,

discussing the purpose of the program, and introducing the game of D&D and its

mechanics to the participants. Sessions 2 and 3 will center on the participants developing

their pre-made character’s backstory and how to role-play consistently. The next six

sessions (sessions 4–9) will concentrate on SEL—teaching, role-playing in D&D, and

debriefing. The final session (session 10) will consist of a wrap-up to debrief about the

whole program and conduct a focus group to determine the participants’ perceptions

about their progress with the program, and how they may be able to incorporate the skills

learned in other everyday situations. There will also be discussion about how they felt

about the program, what worked well, and what they would change about the program.

The sessions will incorporate traditional instruction paired with active learning.

Each student will receive their own set of dice and a “cheat sheet” with the game

mechanics. Game mechanics will be reviewed, and example scenarios provided where

the participant will have the opportunity to roll their dice to determine the outcome.

Additionally, each student will receive a pre-made character sheet with the character’s

statistics, equipment, etc. However, the participants will have the opportunity to
 47

personalize certain aspects of the character, such as the name, alignment, personality

traits, and backstory. Following instruction and examples with visuals, the participants

will brainstorm alone and will peers to develop and share what they have come up with.

Sessions 4–9 will begin with 10-15 minutes of instruction on a specific SEL skill

area, which will include, discussion, examples, and practice. The next 60 minutes will

focus on game play and storylines where the participants will have the opportunity to

practice or utilize the relevant SEL skill. The role of the Dungeon Master can either be

assigned to the author or support personnel depending on experience. The author’s

primary role is to facilitate SEL by creating opportunities for students to apply SEL

related skills and supporting students through cueing, prompting, and encouragement to

implement skills. As a result, the D&D storyline and scenarios will be guided by the

author’s expertise. The support personnel will participate in the D&D game with the aim

of reinforcing and setting up the SEL skill of focus. The last 10–15 minutes of the session

will focus on debriefing what was experienced and learned as it related to the skill of

focus for that session. “Homework” activities, such as writing down a time the

participants performed a skill in the past week, may be provided to facilitate

generalization of the skill in other contexts and environments. Time to discuss homework

will be incorporated in the first 10-15 minutes of the session when necessary.

Two example session plans for David and Tristan (discussed in Figure 4.1) are

presented in Appendices A and B. These plans illustrate how the sessions integrate SEL

within the D&D campaign and during the game play of D&D.
 48

Evidence Informing Program Development

As described in Chapter 3, the literature identified several approaches/strategies

which are effective in facilitating groups for middle-school aged children. These include

enabling group cohesion by creating a safe and comfortable environment, incorporating

ice breakers, and setting norms together. Additionally, providing time to process, share

experiences, and debrief can enable group bonding. Group leadership is also a factor in

group processes, research suggests non-authoritative leadership, supportive group

reactions, and verbal praise has impact. These group characteristics and strategies have

been integrated into this program.

Program Outputs and Outcomes

Anticipated program outputs include the number of participants involved in the

program, number of sessions and D&D groups, and educational materials and modules

created for future cohorts and occupational therapy practitioners.

The immediate, short-term outcome is ultimately intended to increase knowledge

and use of targeted SEL skills (self-management and relationship skills) by the end of the

10-week program. School staff/teachers will be invited to complete an online survey pre-

and post-program participation to determine teacher perceptions of the impact of the

program on student attitudes and behavior. The survey will include standardized

measures which are discussed in detail in the next chapter, Chapter 5. There will also be a

focus group with the participants to determine changes in their knowledge of D&D and

explore their perceptions about their experience with the program.

Although improvements in SEL skill following program completion is critical, the

 49

ultimate goal is for participants to generalize skills and demonstrate continued use and

implementation of SEL skills outside of sessions, at home, and in the classroom. Thus, it

is hoped that the students will be able to demonstrate maintenance of these skills levels at

three months post-program participation. Hopefully, by this time, administration will

recognize the value of occupational therapy’s involvement in SEL, which will increase

the profession’s involvement in the process.

As previously discussed, SEL impacts occupational performance and well-being,

including academic achievement. The long-term outcome expected as a result of

implementing the program is improved occupational well-being and academic

performance, such as test scores and grades. Additionally, the increased implementation

of SEL programming overall will lead to school policy change to incorporate SEL into

the curriculum, resulting in future financial benefits. Although, the SEL competencies

addressed are self-management and relationship skills, the eventual expectation of the

program is that it will be adaptable to address other SEL competencies.

A logic model is presented in Figure 4.2, which provides an overview of the

inputs, problem, theories, outputs, and outcomes associated with Role for SEL.
Figure 4.2

Logic Model

50
 51

Launching the Program

To facilitate the program launch, the author will email the middle-school

principals of her school district of employment. The email will provide a brief overview

of the program and the potential benefits for the students and school to garner interest. If

responses are received, a virtual meeting will be scheduled to provide additional

information. The importance of SEL skills would be stressed first, this would include

summaries of research articles on its impact on function and cost benefit as it related to

the principals. It would be presented in a visually appealing format. This would be

provided in the email to get buy-in and reiterated during the meeting. During the meeting,

the author would provide more detailed information on the benefits of addressing SEL,

play-based interventions, role-playing, and details of what the intervention is expected to

include.

Valuable stakeholders in program launch include the schoolteachers, RtI/MTSS

coordinator/team, and the principal. The principal and RtI/MTSS staff can provide

valuable information regarding the processes they implement, what type of structure is

possible, and approval to implement the program. The schoolteachers provide important

information regarding the students and areas of need as they relate to school function.

The author’s program has the potential to provide targeted SEL support, lessen teacher

stress, and improve student outcomes

Anticipated Barriers and Challenges

The are several organizational barriers which will impact the launch of this

program. These include time, approval, workload management, and staffing. In the long-
 52

term, an important stakeholder to include will be the school district administration and

policymakers. Right now, the author’s school district employs a caseload model for

occupational therapy practitioners, who are frequently overlooked to be included in

RtI/MTSS. The occupational therapy practitioners do not have the time to participate in

the process, but if the district changes to a workload model and have policies to support

SEL, occupational therapy involvement could be critical to the students and the district.

Occupational therapy practice can be frequently misunderstood or misinterpreted.

Due to this, school administration and staff may not understand the full scope and role of

a school-based occupational therapist. This may result in occupational therapy being

overlooked as a valuable and valid profession to address SEL. Additionally, with high-

caseloads, frequent meetings, and compounding work responsibilities, school-based

occupational therapy practitioners may not have the time to address SEL or implement

SEL programs. Scheduling the program afterschool may mitigate some of the time

constraints, however, this may make having support staff available difficult, since it is

after work hours. Offering a gift card as an incentive may be beneficial.

With increased focus on academics, skills like SEL may be overlooked and its

benefits unrecognized, resulting in a lack of interest. The author plans to accentuate the

developmental and monetary benefits of addressing SEL to procure stakeholder interest.

Lastly, obtaining funding to run the program and obtain materials and supplies

may be challenging. In emphasizing the benefits of SEL, principals and relevant

stakeholders will, hopefully, recognize its value and divert funding to the program.

Otherwise, the author plans to apply for grants as a funding source.

 53

Summary

SEL is a critical area of development in adolescents. As an adolescent matures,

lack of SEL can have later adverse implications and impact occupational engagement.

Furthermore, sufficient SEL exposure and programming can facilitate occupational

performance in adolescents, such as academic achievement, improved well-being, and

decreased negative behaviors. Role for SEL is an afterschool, play-based program that has

the potential to promote SEL development in middle-school students. The definition of

SEL and its competencies are grounded in the CASEL (2020) SEL framework and

research. The anticipated outcome is to improve participants SEL function, however, the

long-term goal is to expand the reach and value of SEL and increase occupational

therapy’s visibility in addressing SEL.

 54

CHAPTER FIVE – Program Evaluation Research Plan

Program Scenario and Stakeholders

As discussed in the previous chapter, Role for SEL is a group-based afterschool

intervention program for middle-school adolescent students which aims to promote SEL

using the popular table-top role-playing game, Dungeons & Dragons®. The program

evaluation research will be useful for occupational therapy practitioners and school and

district administration. The results may demonstrate the importance of occupational

therapy’s involvement in SEL. Additionally, school and district administration can

consider the results in its effectiveness in providing additional SEL support to students

across the school site or district.

Vision for Program Evaluation Research

With program evaluation research, the author hopes to meet middle-school

adolescents’ occupational needs as they relate to SEL. By promoting SEL using D&D, a

fun, play-based tool, occupational therapy practitioners can influence the important

student occupations of academics, mental wellbeing, and developing relationships with

their peers (Durlak et al., 2010, 2011). CASEL (n.d.) states the supporting SEL can lead

to long-term benefits, including an 11:1 return on investment. Additionally, program

evaluation research can support occupational therapy’s involvement in addressing SEL in

school-based practice. Hopefully, in the future, this will lead to more school-based

occupational therapy practitioners addressing SEL in clinical practice.

 55

Engagement of Stakeholders

To initiate implementation of the program, the school principal or administration,

and the RtI/MTSS team are key stakeholders. An email will be sent to make initial

contact describing the program and its potential benefits. Hopefully, as is the case with

the author, the principal will be familiar with D&D and understand its usefulness and

show interest in the program. The RtI/MTSS team will be vital in referring students. A

formal presentation will then be scheduled to present more detailed information. Support

staff with knowledge of D&D would be recruited via email as well. A school-wide staff

email will be sent with information regarding the initiative and what involvement entails.

An incentive, such as vouchers, meals, or gift card, might be included to garner further

interest.

Long-term stakeholders would be school district administration and school-based

occupational therapy practitioners. Once sufficient data has been gathered, it will be

compiled into a presentation for the district administration demonstrating its use in order

to widen its use to other schools/districts. Contact will be made via email to their

secretarial staff to schedule a time to formally present the materials. This would,

optimistically, increase awareness of occupational therapy’s role in addressing SEL, and

occupational therapy’s involvement in SEL initiatives.

Simplified Logic Model for Use with Stakeholders

During formal presentations with stakeholders, the author will present a

Simplified Logic Model, shown in Figure 5.1. This figure will provide a visual for

stakeholders to better understand the structures and impact of the intervention program.
 56

Aspects of the logic model that will be focused on will vary depending on which

stakeholder is present. For example, with District administration, the 11:1 return on

investment will be emphasized. For school administration, the improvement on academic

achievement may be the highlight.

Preliminary Exploration and Confirmatory Process

Confirmatory meetings would ideally be held in-person. However, if participants

are unable to meet in-person, meetings would be held using virtual media, such as Zoom.

Separate meetings would be scheduled for different stakeholders to focus on the point of

information relevant to those in attendance. The importance of SEL skills will be stressed

though summaries of research articles on its impact on function and cost benefit as it

related to the stakeholders. It will be presented in a visually appealing format. This will

be provided prior to the meeting to get stakeholder buy-in and reiterated during the

meeting. During the meeting, the author will provide more detailed information on the

benefits of addressing SEL, play-based interventions, and role-playing. The author will

also provide details of what the intervention is expected to include, such as materials,

personnel, expected time frame, cost, how data would be collected, and the time

commitment of other professionals.

During the meetings, the author will listen to all the stakeholders’ input and

acknowledge their concerns and comments. A discussion will continue to achieve an

agreement about the program, where the program would not be compromised, and the

goals and objectives were still being addressed with fidelity.

Figure 5.1

Simplified logic model for the author’s proposed program evaluation research showing expected program input and outputs,

plus short term, intermediate and long-term outcomes. Short-term outcomes will be measured during initial program launch

57
 58

Program Evaluation Research Questions by Stakeholder Group

Table 5.1 provides a list of the pertinent qualitative and quantitative research

questions for the relevant stakeholders. These questions are expected to be answered

through the pilot launch of this intervention program.

Table 5.1

Program Evaluation Research Questions.

Stakeholder or
Stakeholder Types of Program Evaluation Research Questions
Group
Quantitative:
Researcher
• Does a targeted D&D campaign improve SEL skills in middle
school adolescent students?
• Do the students/participants maintain improved SEL levels at 1-
month post-intervention?
Qualitative:
• Did the participants find enjoyment or value in participating in
the D&D SEL program?
• What did students enjoy or learn from the D&D group?
Middle-school Qualitative:
adolescent • Was the D&D group fun?
students • Was the program duration adequate, or should it be shorter or
longer?
• What did participants learn about yourself from the D&D group?
• Is there anything that should be changed to improve program
content or delivery?
• What other key issues or problems faced by participants were not
addressed in the program?
• How do you get along with the other group members? How has
this changed since the beginning of the program?
o Do you plan to maintain these relationships after the program?
Quantitative:
• Did participants demonstrate improvements in SEL skills?
• Did participants maintain SEL skills at 1-moth post-intervention?
 59

School Qualitative:
administration, • Does the content of the program match organizational goals?
RtI/MTSS • Were improvements in SEL function observed in the classroom?
team, teachers • What did participants get out of this experience in terms of
classroom functions?
• Were there any differences in participant behavior/relationships,
etc. related to their participation in this program?
• Were any problems or issues reported?
• Did external factors impede execution of the research
methodology?
Quantitative:
• Will the research data show that the intervention led to desired
change in SEL function?
• Are outcomes consistent with the proposed theoretical
justification?
• Did participants demonstrate improvements in SEL skills?

District Qualitative:
administration, • Will school and District administration report increased
occupational understanding of the distinctive role of occupational therapy in
therapy provision of services relevant to SEL?
practitioners • Are the long-term goals of the project realistic and achievable?
Quantitative:
• Will the research data demonstrate the importance of the role of
occupational therapy for providing services relevant to SEL?

Research Design

The research design for the pilot launch of the program is a non-experimental,

cohort study with pre- and post-program qualitative and quantitative data collection. Prior

to collection of data, the author will seek approvals from a local Institutional Review

Board and the relevant school district, so that the findings can be published and

disseminated.

Qualitative Methods

Qualitative data will be obtained from student participants and the participants’

teachers using focus groups and an open-ended question survey.

 60

The focus group will be conducted with student participants during the final

session of the group to gather information as to whether they enjoyed the D&D group,

what they liked/disliked, and what they learned. It is expected to last no more than 30

minutes and will be audio recorded. The focus group will be led by this author with

support staff available to encourage student participation throughout and manage the

recording device. Possible questions may include:

• Did you have fun in the group?

• What did you like about the group?

• What did you dislike about the group?

• Did you learn any new skills with how to [ENTER RELEVANT SEL SKILL]?

• Have you been doing things different in school?

• Did you learn something new about yourself during the group?

The online survey containing open-ended questions will be administered using

SurveyMonkey® (https://www.surveymonkey.com). The survey link will be sent to the

work email of the primary teacher of each participant within a week of the final group

session. Questions will center around what observable changes teachers have seen during

the school day regarding the participant and their specific SEL area of needs. The

following are example questions from the survey:

• Have you noticed a change in the student’s behavior? How?

• What changes have you seen in the student ability to [ENTER RELEVANT SEL

SKILL]?

• What did the students get out of this program in terms of classroom functions?
 61

• Were there any differences in behaviors/relationships following their participation

in this program?

• Provide specific examples.

Qualitative data from the focus group and online survey will both be thematically

analyzed. The focus group will be recorded and transcribed on a Microsoft Word

document by either the author or a research assistant. NVivo is also able to transcribe

materials; however, the accuracy may have to be double-checked. A qualitative thematic

analysis will then be conducted. Software, such as Nvivo or MaxQDA, which allows for

qualitative and quantitative analysis, will be used to identify, code, and synthesize

relevant themes from the transcripts and surveys. However, this may have to be carried

out manually by trained researchers if funding and access is limited. Analyses completed

by software will be reviewed by 1-2 research personnel to cross-check coding and

themes. If materials are to be manually coded, each transcript/survey will be coded by

two researchers. Any ambiguous items will be further discussed and coded by the

research team. Findings will be reviewed and discussed by all those involved in the

research process and will also be requested to be reviewed by other professionals who did

not engage in the research procedure but are familiar to provide feedback and input.

Quantitative Methods

Quantitative data will be collected using a standardized instrument completed by

the participant’s primary teacher to measure the specific SEL competency of concern

determined by the RtI/MTSS team or teacher. Teachers will complete a digital version of

the Social Skill Improvement System (SSIS) SEL Brief Scales K-12 Assessment (Elliott
 62

et al., 2020) prior to intervention implementation, after intervention implementation, and

1-month post intervention implementation. The SSIS SEL Brief Scales K-12 Assessment

is a “brief, multi-informant (teacher, parent, & student) rating scales of children age 5-18

focusing exclusively on Social-emotional Learning skills (20 items, 5 subscales: Self-

Awareness, Self-Management, Social Awareness, Relationship Skills, and Responsible

Decision Making” (SSIS CoLab, n.d.). The assessment takes five minutes to complete.

This will provide information on the effectiveness of the program in addressing what it is

designed for—SEL.

The SSIS SEL Brief Scales K-12 assessment (Elliott et al., 2020) incurs a cost for

use, and therefore funding would be required. In the event funding is not secured, pre-

and post-program data will be obtained via a non-standardized rating scale completed by

the participants’ teachers. The scale will identify the SEL competencies being addressed

in the pilot program—Self-Management and Relationship Skills. Under each competency

will be a list of the SEL skills related to the relevant competency as identified in the

CASEL (2020) framework with a Likert scale. Teachers will be asked to rate their

student’s performance with each skill.

Since SEL is developmental, the effects of time should be considered to

determine whether changes in SEL skill were due to time or the intervention program.

Additionally, participants may be receiving other services or supports in addition to the

independent variable, which may influence SEL. While it would be ideal for participants

to only engage in the pilot intervention, this cannot be ethically guaranteed. Therefore, a

record of other concurrent services should be noted and accounted for during analysis.
 63

A statistical analysis will be conducted using a software program such as the

Statistical Packages for the Social Sciences (SPSS). To determine the pre- and post-

program difference in SSIS SEL Brief Scales K–12 Assessment scores, repeat measures

analysis of variance (ANOVA) will be used. Additionally, the effects of time and the

moderating effects of other services being provided to participants would be taken into

consideration and calculated if possible. This information would be saved as a Microsoft

Excel spreadsheet on a secure laptop. However, this analysis is dependent on resources

available to the author. With limited resources, a more readily accessible analyses method

would be utilized.

Confidentiality

After receiving consent from parents and assent from participants – after they

have been educated on the purpose of the study in age-appropriate terms – each

participant/student will be assigned an exclusive ID number to ensure confidentiality.

Electronic data will be stored on a password protected computer with a separate file with

additional password protection that contains participant information and their

corresponding ID number. Transcripts will be scrubbed of student names. Paper/hardcopy

data, which may contain the names of participants, will be uploaded to the computer, and

then stored in a locked file cabinet in a locked room. All data will only be accessible to

the author and approved research staff.

Disseminating the Findings of Program Evaluation Research

Preliminary results from the pilot will be electronically sent to stakeholders,

specifically district administration, school principals, and the occupational therapy

 64

department. The email will consist of a bolded two-sentence summary with a relevant and

impactful visual to garner the stakeholder’s interest. The visual will be followed by a

“killer” paragraph with summary of the program and its results to provide additional

information to the stakeholders. At the end, contact information will be provided for

email recipients to utilize to access more detailed information of the program and results.

This will most likely be provided in the form of an outline with visuals as it is this

author’s experience that the stated stakeholders have limited time resources. If interest

within the district grows, these results and information may be circulated to other school

districts to broaden the reach of the program.

 65

CHAPTER SIX – Dissemination Plan

Program Overview

Role for SEL is an occupational therapy-led, afterschool intervention program that

uses D&D (5th ed.) to promote SEL in middle-school adolescents. The pilot phase of the

program will focus on addressing two of five CASEL (2020) SEL competencies, self-

management and relationship skills, through explicit instruction paired with role-playing,

playing a D&D campaign that incorporates scenarios that integrate the SEL area of

emphasis, and debriefing as a group at the end of the game/session. By engaging in Role

for SEL with the occupation-focused lens of an occupational therapist, participants can

work on relevant SEL competencies and potentially have their occupational needs met

(Durlak et al., 2010, 2011).

Goals

The overall goal of dissemination of this project is to increase awareness of the

program, SEL skills, and occupational therapy’s involvement in addressing SEL.

Therefore, the dissemination goals for this project include two long-term goals and three

short-term goals.

Short-Term Goals (12–18 months)

§ Through dissemination of Role for SEL intervention program and results, school-

based, pediatric occupational therapy practitioners and school

administration/districts will increase awareness of Role for SEL.

§ Through dissemination of Role for SEL intervention program and results, school-

based, pediatric occupational therapy practitioners and school

 66

administration/districts will increase awareness of the importance of addressing

SEL.

§ Through dissemination of Role for SEL intervention program and results, school-

based, school administration/districts will increase awareness of the benefits of

occupational therapy practitioners’ role in addressing SEL in school-based

practice.

Long-Term Goals (2–5 years)

§ Through dissemination of Role for SEL intervention program and results, there

will be an increase in school-based, pediatric occupational therapy practitioners in

the United States addressing SEL in school-based practice.

§ Through dissemination of Role for SEL intervention program and results, the

prevalence of SEL interventions and programing in middle school will increase.

Target Audiences

The primary target audience for the Role for SEL dissemination plan are school

districts’ administration (e.g., principals, department supervisors, student support teams)

within the United States. This group has been chosen as the primary audience because

they are the decision makers for school-based programs and budget allocation and have

influence on who and how school personnel are involved. The secondary audience

targeted during dissemination of Role for SEL include school-based, pediatric

occupational therapy practitioners in the United States. As this program was developed

with the anticipation of occupational therapy practitioners running it, it is important to

advertise and promote the results of the group to occupational therapy practitioners.
 67

Key Messages for Target Audience

Table 6.1 lists the key messages for each target audience, primary and secondary.

Some key messages are similar between the two groups, however, there are a few key

messages specific to each group as well.

Table 6.1

Key Messages for Target Audiences

Primary Audience
1. Quality SEL programming can improve academic performance (i.e., test scores,
grades).
2. Quality SEL programming can improve school-related attitudes and behaviors
(e.g., motivation to learn, school commitment), decrease negative behaviors
(e.g., aggression, disruptiveness, non-compliance, disciplinary referrals), and
report less emotional distress (e.g., depression, anxiety, stress, etc.).
3. Role for SEL is an evidence-based intervention program to promote SEL for
middle-school adolescents.
4. Role for SEL is a play-based occupational therapy intervention and approach
for addressing SEL.
5. Occupational therapy practitioners have a unique role in addressing SEL.
6. Quality SEL programming can result in an 11:1 return on investment.
Secondary Audience
1. Role for SEL is an evidence-based intervention program to promote SEL for
middle-school adolescents.
2. Role for SEL is a play-based occupational therapy intervention and approach
for addressing SEL.
3. Occupational therapy practitioners have a role in addressing SEL in school-
based practice.
4. Promoting SEL impacts occupational performance.

Sources or Messenger

Primary Audience

The dissemination of Role for SEL can be strengthened and more impactful if

presented by individuals involved in the pilot. Personal accounts, whether written or in-

person, of school administration, students, teachers, and parents involved in the pilot will
 68

be valuable in demonstrating the impact of Role for SEL and the potential impact it may

have for the school district of interest. In the author’s current work setting, if there are

enough requests from parents, this puts pressure on school district to act. Hopefully,

word-of-mouth from those involved in the pilot will garner additional significance to

influence the school district.

Additionally, STAR Institute (https://www.spdstar.org/) in Denver, CO has run

and continues to run a Critical Core group for teens age 12-17 to address social-emotional

skills. Critical Core is a social-skills intervention in the form of a TTRPG like that of

D&D. STAR Institute is a well-known institution that provides occupational therapy

services and that could be a potential source of advice and support for the Role for SEL

program.

Secondary Audience

Personal accounts and STAR Institute are also valuable sources and

spokespersons for the secondary target audience of the dissemination plan. Personal

accounts demonstrate the benefits to occupational performance in a personal manner for

occupational therapy practitioners. The STAR Institute establishes occupational therapy

as a SEL provider and TTRPGs as a useful intervention tool. Furthermore, AOTA

provides helpful resources, such as information sheets and articles, discussing the role of

occupational therapy within SEL.

 69

Dissemination Activities and Tools

Written Information

Informational Fact Sheet.

The first source material the author will develop is an informational fact sheet

using CANVA. This document will contain an overview of what the program entails and

a summary of the results of the pilot program. Specific pieces of information will be

emphasized, such as the relatively low cost for materials and resources, the impact on

student outcomes, and qualitative information. The fact sheet will be offered to

occupational therapy practitioners at conferences, posted on Instagram and relevant

blogposts, and attached to the initial email to school districts and administration. At the

end of the document, contact information and social media usernames will be listed.

Email to Local School Districts.

To garner school district and administration interest in the program, the author

will construct an email briefly describing the program, the results, and how they relate to

the school district. Attached to the email will be the informational fact sheet. The author

will offer times to set up an in-person meeting to further discuss the program. Follow-up

emails will be sent with additional information regarding Role for SEL and information

related to the sources, spokespersons, and messengers discussed above.

Informational Handbook.

Following the information fact sheet, the author will design and create a more in-

depth handbook. This handbook will provide program overview and pilot research design

and result information in greater detail. The handbook will manualize the available player
 70

characters for participants to choose from. Additionally, greater detail will be provided

with examples and sample session plans for addressing specific SEL competency areas,

similar to that of Figure 4.1 and Appendices A and B. This handbook will be available for

free electronically as a PDF or for the cost of printing, shipping, and applicable taxes if a

hardcopy is wanted by occupational therapy practitioners interested in running their own

group. The handbook will also include a section with information on how practitioners

can initiate a Role for SEL program in their own school district.

OT Practice.

With each issue, OT Practice magazine has the potential to reach 60,000

occupational therapy practitioners (AOTA, 2022). As such, the author will write and

submit an article about Role for SEL for consideration by OT Practice. This will increase

the visibility of the program. The end of the article will include the program Instagram

account and relevant contact information.

Electronic Media

Instagram.

An Instagram account will be setup for Role for SEL (@RoleforSEL). Contact

information will be listed (an email specific to the program) and interested occupational

therapy practitioners will be able to direct message the author to obtain further

information, fact sheet, or handbook. Fact sheet information will also be published as

individual posts with hashtags related to school-based or pediatric occupational therapy

listed below it. Instagram allows for interaction between accounts and followers where a

follower can ask a question and the account can publish the question and answer into an
 71

Instagram Story. This will be a fun tool to use for practitioners to gain advice if they are

running a program. Additionally, posts with suggested scenarios or strategies to use and

where the author is next presenting will be displayed. This Instagram account will be

linked to a Facebook account for Role for SEL.

Blogs and Websites.

A common resource for many school-based occupational therapy practitioners are

occupational therapy blogs and websites, such as Miss Jaime OT

(https://missjaimeot.com), Mama OT (http://mamaot.com), OT School House

(https://www.otschoolhouse.com/blog), Therapy Fun Zone (https://therapyfunzone.net),

The Inspired Treehouse (https://theinspiredtreehouse.com), etc. These blogs and websites

provide information, activities, strategies, and tools to address various areas of pediatric

practice, have a large social media following, and are frequented by occupational therapy

practitioners. The author will email and reach out to the websites with the informational

factsheet and offer to be a guest blogger, write a guest post, or be a guest interviewee on

associated podcasts, like OT School House.

Person-to-Person Contact

Conferences.

The program author will submit a poster proposal to the annual AOTA conference

to disseminate they key messages to the secondary target audience. Occupational therapy

practitioners attending the conference, including school-based practitioners, will have the

opportunity to view the program research information on the poster and key messages

will be shared with the viewers. The informational fact sheet will be provided to
 72

observers, along with a business card with contact information, social media information,

and a QR code that scans you to the program’s Instagram account. The QR code will also

be on the poster. An email sign-up sheet will be available for observers to provide their

contact information.

Meeting with School District.

If response from local school districts and administration is favorable, a formal

meeting with school district personnel will be scheduled either in-person or via virtual

methods. The author will prepare a formal PowerPoint with visuals, budget information,

source materials, and program materials to present at the meeting. Detailed information

regarding program structure, expenses, occupational therapy’s role, results, and short-

term and long-term impact will be provided and will be catered to the specific persons

being presented to. The PowerPoint can be made available to practitioners if they wish to

use it to present to their own school district.

Budget

Many of the dissemination activities, such as emails, reaching out to blogs,

developing a social media presence, and meetings, will require little to no expenses.

Much of the dissemination budget will go towards conference costs to present to the

secondary target audience. Other expenses will be allocated for printing materials and

resources for the primary and secondary target audiences. Table 6.2 provides a

breakdown of the necessary costs for dissemination.

 73

Table 6.2

Anticipated Budget for Dissemination Activities

Dissemination Activity Resource Costs

Written Communication
Informational Fact Sheet CANVA Pro - $119.99/year $119.99
Printing (500 copies) $240.00
Email to School District $0.00
Informational Handbook CANVA Pro - $119.99/year $119.99
OT Practice magazine $0.00
Electronic Media
Instagram $0.00
Occupational Therapy $0.00
Blogs/Websites
Person-to-Person Contact
Conferences (AOTA and AOTA Conference fee $425.00
OTAC) AOTA Conference travel $1000.00
AOTA Conference lodging $600.00
OTAC Conference fees $320.00
OTAC Conference travel $100.00
OTAC Conference lodging $600.00
Poster $117.00
Business cards (250 ct) $32.99
Meeting with School District $0.00
Total $3,674.97

Evaluation

Efforts put towards disseminating Role for SEL will be evaluated to determine

their impact and effectiveness. Table 6.3 describes the measurements that will be utilized

to evaluate each dissemination activity or tool.

 74

Table 6.3

Evaluation of Dissemination Activities

Dissemination Activity Measurement of Dissemination Effort

Informational Fact Sheet
Email to School District
Informational Handbook
OT Practice magazine
Instagram
Occupational Therapy
Blogs/Websites
Conferences (AOTA and
OTAC)
Meeting with School District
Written Communication
Number of responses to obtain further details and resources
Number of responses to email with offer to set up meeting
Number of requests for handbook
Follow up emails to see if program initiated and/or
implemented
Acceptance of article
Number of contacts resulting from article
Electronic Media
Number of followers and likes to posts
Acceptance of offer to write guest blogpost
Person-to-Person Contact
Number of attendees, occupational therapy contacts made, e-
mail addresses or followers gathered
Number of follow up contacts
Agreement to develop and implement Role for SEL

Conclusion

Dissemination of Role for SEL will focus on increasing awareness of the program,

SEL skills, and occupational therapy’s involvement in addressing SEL, primarily for

school districts and administration. Occupational therapy practitioners will be targeted

secondarily to expand interest in a unique, play-based program to promote SEL. Various

methods and activities, such as email communication, writing articles for prominent

occupational therapy magazines, reaching out to blogs, developing a social media

presence, meetings with school district, creating and printing informational material, and

presenting at conferences, will be utilized to disseminate the program and influential

organizations and spokespersons will boost credibility. A budget has been developed and
 75

is considered in the overall funds for the complete project and an evaluation of

dissemination efforts has been established to determine the effect of dissemination

activities. Through the dissemination of Role for SEL, the author ultimately hopes to

spread the importance of promoting SEL and positively impact adolescents’ occupational

needs.
 76

CHAPTER SEVEN – Funding Plan

Project Overview

A funding plan has been developed for Role for SEL. Staffing is a key aspect of

the program and is an important consideration in the funding plan. The group will be

facilitated by an occupational therapist with the assistance of support staff. Depending on

staffing, each group can accommodate up to five students. Two cycles of the program are

expected to be conducted per year. Each session will focus explicitly on a particular

social-emotional skill of importance for the students, then the students will engage in

D&D scenarios which are designed to support their development of said SEL skill. With

participation in the program, the author aims for students to improve their ability to

manage their emotions, behaviors, and thoughts and have more successful interactions

with their peers. Specific resources will be necessary to successfully run the program.

Available Local Resources

As Role for SEL is an afterschool program, the author intends to use their

relationships and connections at the school district, Berkeley Unified School District

(BUSD), they are employed within. At the author’s current school of employment, the

author has access to a computer and the occupational therapy services room to conduct

the group, as well as the desks and materials available in the room. Initially, at least for

the first year of the program, volunteers would be elicited and requested from the school

staff to provide support during the program. If school staff volunteers are difficult to

acquire, the author will reach out to colleagues and friends familiar with the game of

D&D and enthusiastic about teaching others D&D to support program implementation.
 77

The district has a print shop in which printed materials needed for Role for SEL

can be produced. Printed materials include character sheets and maps for the D&D game,

poster with list of group norms, informational posters for relevant SEL skills, and

handouts, worksheets, and homework for the students to complete or refer to during the

program. Table 7.1 presents a list of local resources available to the author and how they

can be utilized.

Table 7.1

List of Available Local Resources

Local Resources Purpose

Computer, space, and general
classroom materials
Volunteers
Colleagues/friends
District print center
Location to conduct Role for SEL
Support staff to assist group and game facilitation
Support staff familiar with D&D to assist group and
game facilitation
Resource to produce printed materials

Needed Resources: Budget

Creating a funding plan allows for better understanding of the necessary resources

and costs to execute a pilot Role for SEL program. Table 7.2 presents the breakdown of

costs and a projected two-year budget needed to pilot Role for SEL. Costs will primarily

fall into two categories: personnel and supplies. For the first year of implementation, the

cost for startup totals $3,207. For the second year, personnel and supply costs plus the

budget to attend the AOTA and the Occupational Therapy Association of California

(OTAC) conference equate to $6,835.97.

 78

Table 7.2

Two-Year Budget

Resources Cost Year 1 Year 2

Occupational therapist/author None; volunteering services $0.00 $0.00
Support staff Gift card: $100 gift card per $200.00 N/A
program cycle
2 cycles per year
Compensation: $16/hour N/A $480.00
15 hours per cycle, 2 cycles
Snacks/drinks Snacks: $5.39/6 count (Target) $77.19 $77.19
Drinks: $3.59/8 pack (Target)
5 students per cycle, 10
sessions, 2 cycles
Folders $10.79/10 pack (Staples) $10.79 $10.79
5 students per cycle, 2 cycles
Notebooks $9.99 /6 pack (Staples) $19.98 $19.98
5 students per cycle, 2 cycles
Playing board $19.99 (Amazon) $19.99 $0.00
Dry erase markers $17.79 (Staples) $17.79 $17.79
Pound O’Dice $35.00 (Amazon) $35.00 $35.00
D&D Manuals $87.17 for set (Amazon) $87.17 $0.00
Beginners D&D Books $20.99 (Amazon) $20.99 $20.99
Storage box $15.49 (Staples) $15.49 $15.49
Locked cabinet $218.99 (Staples) $218.99 $0.00
SurveyMonkey $384/year $384.00 $384.00
Social Skill Improvement $2100/year for digital access $2100.00 $2100.00
System (SSIS) SEL Brief
Scales K-12 Assessment
AOTA Conference fee $425 N/A $425.00
AOTA Conference travel $500 each way N/A $1000.00
AOTA Conference lodging $200 a night N/A $600.00
OTAC Conference fees $320 N/A $320.00
OTAC Conference travel $100 for gas N/A $100.00
OTAC Conference lodging $200 a night N/A $600.00
Dissemination costs (minus CANVA Pro, business cards, N/A $629.97
conference fees, travel, and fact sheet printing, conference
lodging) poster
TOTAL: $3,207 $6,835.97
 79

Personnel

Personnel necessary for running Role for SEL include the occupational

therapist/author and support staff, whether paid or volunteer. The occupational therapist

will be the program lead and is expected to run, implement, and coordinate the program

and data collection. They will be responsible for providing education to the student

regarding the specific SEL skill and determine how to implement SEL within the D&D

game. The author will be volunteering their time for the first few years of the program.

Support staff and volunteers will assist the occupational therapist/author with

program implementation. Depending on their knowledge of and familiarity with D&D,

the support staff will either participate as the Dungeon Master or as a player within the

game. Support staff will be recruited on a volunteer basis and will be compensated with a

$100 gift card per program cycle. By Year 2, the author hopes to be able to provide a

compensation rate of $16 per hour for support staffs participation.

Supplies

Supplies for Role for SEL will be the largest cost, specifically for the assessment

tool Social Skill Improvement System (SSIS) SEL Brief Scales K-12 Assessment (Elliot

et al., 2020) and SurveyMonkey. These tools allow for the author to measure student’s

progress and determine program effectiveness. Additionally, a locked file cabinet will be

needed to securely store research materials and information to maintain confidentiality.

Many resource costs are related to the actual implementation of D&D. Supplies

for the game, such as the map board, dry erase markers for the board, dice set, D&D

manuals/books, beginners’ D&D books for students to refer to and better understand
 80

D&D lore, notebooks to take notes in during the game, and snack/drinks to consume

during the group. The author considered adding miniatures (miniature figures to represent

characters during the game) to the budget, however, these are not a necessity for pilot

implementation and vary in cost. Miniatures will be considered for future groups and

cohorts.

Lastly, once research results have been obtained, the author will consider

presenting the results to other professionals and colleagues within the field. This will

likely be during professional conferences. Expenses, such as travel, lodging, and

conference fees will have to be considered. Presenting the program and program results

will increase visibility of Role for SEL. Table 7.3 lists the needed resources and their

justification for inclusion in the Role for SEL pilot.

Table 7.3

Needed Resources and Justification

Resources
Personnel – occupational therapist
Personnel – support staff year 2
compensation
Supplies – meal voucher/gift cards
Supplies – snacks/drinks
Supplies – notebooks
Justification
Program lead, responsible for program
implementation and coordination
Responsible for supporting occupational
therapist in program implementation and
coordination; collaboration with
occupational therapy practitioner, run D&D
scenario or play as character depending on
D&D knowledge
Provides support staff volunteers with a sort
of compensation for participation during
first year
Snacks and drinks for students to consume
during group to maintain engagement and
energy
For students to take notes regarding D&D
scenarios
 81

Supplies – D&D gaming materials (map
board, dry erase markers, dice, manuals
minis, beginners’ books)
Supplies – storage box
Supplies – locked cabinet
Supplies – SurveyMonkey
Supplies – Social Skill Improvement
System (SSIS) SEL Brief Scales K-12
Assessment
Conference costs – travel, lodging, fees
Dissemination costs
Materials needed for student to become
familiar with and play D&D
Houses program materials
Storage for confidential files and research
materials
Measurement of student progress
Measurement of student progress and
program effectiveness
Needed to present research information
and/or program at conference
Required to publicize and distribute
program increase access, and achieve long-
term and short-term goals

Potential Funding Resources

As part of the BUSD organization, the author is eligible to apply for the Berkley

Public Schools Fund Learning for Equity grant. This grant is for small to medium sized

projects that involve multiple educators and allocates $1000 to $15,000 to approved grant

applications that “support and amplify work that levels the playing field for the students

furthest from opportunity” (Berkeley Public School Funds, n.d.). Previous projects

funded by the grant include, but are not limited to, Zones of Regulation reading resources,

monthly Restorative Justice trainings, diverse dolls & paired storybooks, purchase of

laptops, printers & scanners for new Family Resource Center, etc. The author plans to

elicit the interest of the school principal and Response to Intervention team to support the

grant process. This grant has the potential to fund, at least, the gaming supplies necessary

for the Role for SEL.

If the program is not eligible for the Learning for Equity grant, as a school-based

occupational therapist, the author is able to set up a funding request project through
 82

DonorsChoose (https://www.donorschoose.org). DonorsChoose is a website that allows

public school educators to make classroom project requests that anyone can donate to and

help fund. The author has previously utilized DonorsChoose to request funding to secure

a prom location for their special education students. DonorsChoose has the potential to

fund most of the program implementation costs.

Conclusion

Implementing programs and projects is difficult without funding. Due to the

authors employment, major costs, such a space and volunteers, are more accessible and

cost efficient. Funding for specific gaming materials, standardized assessment materials,

notebooks, snacks, meal vouchers, conference costs, and year 2 personnel compensation

will still need to be covered. However, with access to grants and DonorsChoose,

monetary costs have the potential to be filled allowing for easier program implementation

and presentation.
 83

CHAPTER EIGHT – Conclusion

Social-emotional learning (SEL) is a fundamental area of development for youth,

including adolescents. Lack of SEL can have suboptimal effects during adolescence and

later in life and, consequently, impact occupational engagement. As discussed in Chapter

2, the literature supports that when appropriate SEL programming is provided, positive

outcomes can result, such as improved school-related attitudes and behaviors (e.g.,

motivation to learn, school commitment, etc.), increased academic performance (e.g.,

school grades, academic achievement), decreased negative behaviors (e.g., aggression,

disruptiveness, non-compliance, disciplinary referrals), and less reports of emotional

distress (e.g., depression, anxiety, stress, etc.) (Durlak et al., 2010, 2011). However,

although the influence on occupation is documented, limited evidence of occupational

therapy practitioners’ involvement in addressing SEL exists in the literature. As a result,

adolescents occupational needs relating to SEL may be overlooked or neglected.

Per the AOTA (2012), “it is a child’s ‘job’ or ‘occupation’ to play to develop

physical coordination, emotional maturity, social skills to interact with other children,

and self-confidence to try new experiences and explore new environments” (p. 1). This

quote demonstrates the importance of play and its significance in developing skills rooted

in SEL (e.g., emotional maturity, social skills, self-confidence). Unfortunately, per

Chapter 3 literature review, play interventions for adolescents also appears limited. Role

for SEL is a creative answer to addressing SEL and incorporating play.

CASEL (2020) presents a well- researched, broad, conceptual framework for

systemic social and emotional learning. The framework identifies five competencies of
 84

SEL, self-awareness, self-management, social awareness, relationships skills, and

responsible decision-making, and emphasizes the importance of coordinating SEL across

key settings and contexts—classroom, schools, families, and communities. It is this

framework that guides the development and implementation of Role for SEL.

Role for SEL is a 10-week pilot afterschool intervention group for three to five

students developed to promote SEL in middle-school adolescents using the popular table-

top role-playing game, D&D (5th ed.). The program is expected to be executed by an

occupational therapist and support staff. With participation in the program, students will

learn how to play D&D, receive explicit instruction on two key SEL competencies, self-

management and relationship skills, and engage in D&D scenarios and campaigns

designed to reinforce and support development in the relevant SEL areas.

The author’s proposed pilot program has the potential to improve adolescents’

SEL and occupational engagement and generalize these skills to everyday life. With the

results, the author plans to disseminate the outcomes to school districts and school

administrations primarily and school-based pediatric occupational therapy practitioners

secondarily. Dissemination will include email communication, writing articles for

prominent occupational therapy magazines, reaching out to blogs, developing a social

media presence, meetings with school districts, creating and printing informational

material, and presenting at conferences. Through this process, it is anticipated school

districts and administration will increase their awareness of the importance of SEL and its

impact of school-related occupations, the financial benefits of SEL, the dynamic role

occupational therapy has in addressing SEL, which could lead to increased programing
 85

and more involvement of occupational therapy practitioners. Occupational therapy

practitioners are expected to increase their awareness in Role for SEL and how to possibly

increase their involvement.

With the implementation of Role for SEL and the dissemination of the results, the

potential to address SEL expansively and positively impact occupational engagement and

performance are substantial. At the very least, by learning about Role for SEL,

occupational therapy practitioners and school districts and administration will be inspired

to develop creative solutions or programs to address relevant concerns or gaps in practice.

 86

APPENDIX A – Sample Session Plan 1 (David)

Date:
SEL Skill of Self-Management
Focus • Managing one’s emotions
• Identifying and using stress-management strategies
Introduction/In 1. Review norms
struction 2. Review homework – List 1-2 times or occurrences that made you
(10-15m) upset, angry, or frustrated in the past 2 weeks.
a. Participants are welcome to share, but not required
3. Introduce SEL skill
§ Have visual ready on board
§ Discuss unexpected event and unexpected behaviors (e.g.,
when things don’t go our way, when someone act different
than expected, being frustrated, stressed, etc.)
o Explore what the emotion and what is really means
o Name what these emotions are and what embodying them
looks like (physical and physiological signs and reactions
– fast hearts beat, tense body, raised voice, heavy
breathing, etc.); Students can practice the physical
responses to allow them to really feel the impact (e.g.,
stomping feet)
§ Collaborate on strategies to manage unexpected
emotions/behaviors
o Have list visible on board for reference during game
o Important to include giving self- compassion and
acceptance of how you feel
§ Role-play strategies – have scenarios available for them to
choose at random
o Staff and student
o Whole class or pairs
D&D Campaign storyline to include:
(60m) Adventure group arrives at town square. Notice a group of children
playing a game. One of the non-player characters (NPCs) in the
group of children becomes angry when receives a penalty and begins
to throw pieces around, tries to take the winnings/holds them out of
reach from the winner. —Opportunity for participant to lead NPC in
strategy or observe role-play.

Separate from this storyline, players may react if they lose a battle or
if there is an undesired outcome. This will allow for teachable
moments during the game.
Facilitators in game structure:
§ Extra experience points or advantage if use strategy during game
 87

Prompting/Cuing techniques:
• Before revealing effectiveness of dice roll, remind participants
that outcome may not be as expected
• Prompt or cues for students or PCs
o To pay attention to what their body is telling them (signs,
reactions)
o To utilize discussed strategies when needed
Debrief 1. Remind participants of focus skills
(10-15m) 2. Prompting questions:
§ How did the game go today?
§ Did you use the skills we discussed earlier? When?
§ How did you know? What did you do?
§ How will you use this outside of group?
 88

APPENDIX B – Sample Session Plan 2 (Tristin)

Date:
SEL Skill of Relationship Skills
Focus • Practicing teamwork and collaborative problem-solving
Introduction/In 1. Review norms
struction 2. Review homework – What does it mean to be a team player?
(10-15m) § Participants are welcome to share, but not required
3. Introduce SEL skill
§ Have visual ready on board
§ Discuss the meaning of teamwork (what it is and is not)
o Important to discuss the idea of co-regulation
§ How not being a teammate might make others feel?
§ Brainstorm how to work as a team and collaborate
o Have a list of steps to take for being a team player visible
on board for reference during game – Decision Tree
§ Role-play – have teamwork scenarios available for them to
choose at random
o Staff and student
o Whole class or pairs
D&D Campaign storyline to include:
(60m) Leave a note that gives hints of what they needed to work on.
Incorporate an obstacle, puzzle, trap that requires teamwork to move
forward/find their teacher/mentor. Incorporate proficiencies that
group may not be aware of, and participants will have to inform them
of. (ex. runestone puzzle).

As the DM, you are allowed to put consequences within the story. If a
group is not working together, this might lead to a trap being set off,
etc.
Facilitators in game structure:
• All participants go around and share idea or option before action
in game.
Prompting/Cuing techniques:
• Staff prompt or cue that would like to hear everyone’s ideas.
• Remind that splitting up the party typically does not result in
favorable outcomes. Can allow the party to split up where
everyone does their own action, but the consequences can
demonstrate the importance of sticking together.
• To fade from explicit prompts/cues, refer to Decision Tree on
board. For future games, type up and laminate as card for students
to reference.
 89

Debrief 1. Remind participants of focus skills

(10-15m) 2. Prompting questions:
§ How did the game go today?
§ Did you use the skills we discussed earlier? When?
§ How did you know? What did you do?
§ What were the consequences of not working as a team? What
might have been different if you had worked together? What
will you do differently?
§ How will you use this outside of group?
 90

APPENDIX C – Social Skill Improvement System (SSIS) SEL Brief Scales K-12

Assessment (Elliott et al., 2020)

The SSIS SEL Brief Scales is copyrighted and may not be used without permission or
purchase. The online rating scales (teacher, parent, and student forms) consists of 20
items divided into 5 subscales, each focusing on a SEL competency (Self-Awareness,
Self-Management, Social Awareness, Relationship Skills, and Responsible Decision
Making) for children aged 5-18. The scale takes 5 minutes to complete and can be used
as a screening tool, plan SEL instruction, monitor intervention program progress, and
evaluate outcomes of RtI/MTSS services.

Additional details about purchase and use of the instrument can be found at the following
website: https://ssiscolab.com/product/ssis-sel-brief-scales-k12-assessments/

For information regarding the long-form assessment:

https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-
Assessments/Behavior/SSIS-Social-Emotional-Learning-Edition/p/100001940.html
 91

APPENDIX D – Dungeons & Dragons® Resources

1. Wizards of the West Coast, Inc. Dungeons & Dragons: https://dnd.wizards.com

• Official website for the producers of D&D materials. Provides information on
D&D products, gameplay, stories, and events.
• Basic Rules: https://dnd.wizards.com/basics-play
• Basics of DMing: https://dnd.wizards.com/products/tabletop/dm-basic-rules
• Player’s Rules: https://dnd.wizards.com/products/tabletop/players-basic-rules
2. Player’s Handbook: https://dnd.wizards.com/products/rpg_playershandbook
• Official D&D core reference guide for players. Contains rules for character
creation and advancement, exploration and combat, equipment, spells, and more.
3. Dungeon Master’s Guide: https://dnd.wizards.com/products/dungeon-masters-guide
• Official D&D core reference guide for DMs. Provides tips and tricks for running a
campaign, inspiration and guidance for building a world, and more.
4. Monster Manual: https://dnd.wizards.com/products/monster-manual
• Official D&D core reference guide for DMs. Provides list of creatures and their
statistic to include in the campaign.
5. Dungeon Masters Guild: https://www.dmsguild.com
• Marketplace for community created content available for purchase. Can provide
inspiration for campaigns and pre-made D&D materials to utilize for groups.
6. Dungeon Influence: https://taplink.cc/dungeoninfluence
• Website with DM resources. Contains purchasable campaigns and free reference
PDFs.
7. D&D Beyond: https://www.dndbeyond.com
• Digital tool and companion to D&D (5th edition). Allows to digitally create and
store character sheets, purchase digital versions of official D&D content, and
create homebrew content.
8. Important articles/blogs discussing the race and racial biases in RPGs and D&D
• https://www.publicmedievalist.com/race-fantasy-genre/
• https://jamesmendezhodes.com/blog/2019/1/13/orcs-britons-and-the-martial-race-
myth-part-i-a-species-built-for-racial-terror
• https://jamesmendezhodes.com/blog/2019/6/30/orcs-britons-and-the-martial-race-
myth-part-ii-theyre-not-human
9. Critical Core Website: https://www.criticalcore.org
• TTRPG game developed to address social skills for individuals on the Autism
Spectrum
10. STAR Institute Critical Core Group: https://sensoryhealth.org/basic/teens-tweens-
group
• Link to STAR Institutes’ group, a TTRPG group using Critical Core.
11. Dice Sets
• Dice are an important aspect of D&D. Sets typically include 7 dice: one 20-sided,
one 12-sided, two 10-sided, one 8-sided, one 6-sided, and one 4-sided. Chessex
and Gamescience are popular dice brands.
 92

12. Popular dice superstitions: https://nerdist.com/article/15-of-the-craziest-superstitions-

about-dice/
• Link to article with common superstitions about dice.
13. Roleplaying game board
• A game board is not required to play D&D, but can be useful during battle and to
draw maps/settings on as a visual for players.
14. DMs Screen
• A screen to separate the DMs materials from the players. The screen also lists
common rules and terms for reference during game play.
 93

APPENDIX E – Social-Emotional Learning Resources

1. CASEL: https://casel.org
• Official website for the Collaborative for Academic, Social, and Emotional
Learning.
2. CASEL Framework: https://casel.s3.us-east-2.amazonaws.com/CASEL-SEL-
Framework-11.2020.pdf
• PDF of the CASEL SEL framework.
3. CASEL Guide for Schoolwide SEL: https://schoolguide.casel.org
• CASEL website with resources and CASEL process for coordinating,
incorporating, and building upon SEL in schools.
4. AOTA Info Sheet:
https://www.aota.org/~/media/Corporate/Files/Practice/Children/SchoolMHToolkit/S
ocial-and-Emotional-Learning-Info-Sheet.pdf
• PDF of AOTA Info Sheet on SEL.
5. OT Practice Article: https://www.aota.org/~/media/Corporate/Files/Publications/CE-
Articles/CE-Article-April-2017.pdf
• PDF of OT Practice article from 2017 about occupational therapy’s role in SEL
throughout Childhood.
 94

APPENDIX F – Executive Summary

Introduction

Social-emotional learning (SEL) is an essential area of development for

adolescents. It is the “process through which all young people and adults acquire and

apply the knowledge, skills, and attitudes to develop healthy identities, manage emotions

and achieve personal and collective goals, feel and show empathy for others, establish

and maintain supportive relationships, and make responsible and caring decisions”

(Collaborative for Academic, Social and Emotional Learning [CASEL], 2020, para 1).

Social-emotional skills are often integral aspects of both occupational engagement

and performance, and therefore, occupational therapy practitioners are distinctly skilled

in addressing social-emotional skills to enable participation in meaningful occupations.

The American Occupational Therapy Association (AOTA, 2013) states that “social and

emotional competencies are required for successful participation in almost all areas of

occupational performance” (p. 1). Delayed or ineffective intervention for social-

emotional challenges could impact an individual’s participation in aspects of life

including activities of daily living (ADLs), instrumental activities of daily living

(IADLs), social participation, work, play and leisure, and education. As experts in

occupational analysis, occupational therapy practitioners determine how occupation,

environment, and person factors, including social-emotional well-being and development,

enable participation in meaningful occupation (AOTA, 2020). Occupational therapy

interventions targeting social-emotional learning are, therefore, critical in maximizing

individuals’ abilities to engage in meaningful and purposeful occupations.

 95

Occupational therapy interventions must be tailored to individuals’ occupational

interests to effectively enable occupational performance. If an occupational therapy

practitioner is addressing social-emotional skills with children and adolescents but the

methods utilized are of little interest, it is unlikely that the child or adolescent will engage

in therapy. Therefore, knowledge of different interventions and tools, such as Dungeons

& Dragons® (D&D), allows occupational therapy practitioners to implement intervention

approaches which best align with individuals’ occupational interests. To address this gap

in occupational therapy practice and research, the author has developed the program, Role

for SEL: Using Dungeons & Dragons® to promote social-emotional learning with

middle-schoolers (Role for SEL).

Conceptual Framework

The Collaborative for Academic, Social and Emotional Learning presents a well-

researched, broad, conceptual framework for systemic social and emotional learning

(CASEL, 2020). It identifies five competencies of SEL: self-awareness, self-

management, social awareness, relationships skills, and responsible decision-making. The

CASEL framework also emphasizes the importance of coordinating SEL across key

settings and contexts—classroom, schools, families, and communities. The development

and implementation of Role for SEL is guided by the CASEL SEL framework.

Project Overview

Dungeons & Dragons® (D&D) is a fantasy role-playing experience in which a

group of adventurers, in person or via electronic media, adopt the role of characters and

navigate a fantasy narrative created by a Dungeon Master (DM). There is no winning or

 96

losing in D&D, but characters can wield fantastic weapons, be eaten by dinosaurs, speak

with animals, breathe fire, or be permanently turned into a frog. The DM guides the

players and characters through the storyline by presenting situations and challenges,

while also reinforcing the rules of the game, ensuring they are followed.

This pilot program will be led by an occupational therapist and will use the 5th

edition of D&D with groups of up to five middle-school students to support their

development of skills in two key SEL competencies: self-management and relationship

skills. Role for SEL is a 10-week, school-based program. Each session will be 60-90

minutes and will be held after-school. In the sessions, students learn how to play D&D,

and then engage in D&D scenarios which focus on the two key SEL competencies.

Session 1 will focus on collaboratively developing norms and safety mechanics,

discussing the purpose of the program, and introducing the game of D&D and its

mechanics to the participants. Sessions 2 and 3 will center on the participants developing

their pre-made character’s backstory and how to role-play consistently. The next six

sessions (sessions 4 - 9) will concentrate on SEL—teaching, role-playing in D&D, and

debriefing. The final session (session 10) will consist of a wrap-up to debrief about the

whole program and conduct a focus group to determine the participants’ perceptions

about their progress with the program, and how they may be able to incorporate the skills

learned in other everyday situations. There will also be discussion about how they felt

about the program, what worked well, and what they would change about the program.

Role for SEL has developed an evaluation and research plan involving the use of

qualitative and quantitative measures such that the program can contribute to
 97

occupational therapy literature on the use of table-top roleplaying games (TTRPG) to

promote SEL. Following the piloting and evaluation of the program, the author will

develop resources for occupational therapy practitioners to support their use of D&D as

an intervention tool for promoting SEL.

With available local resources (space, district resources), funding for program

implementation and dissemination is relatively low. Costs will primarily fall into two

categories: personnel and supplies. For the first year of implementation, the cost for

startup totals $3,207. For the second year, personnel and supply costs plus the budget for

to attend the AOTA and the Occupational Therapy Association of California (OTAC)

conference equate to $6,835.97.

Key Findings

D&D is a popular table-top role-playing game, which draws interest from many

adolescents and adults. The game structure and play of D&D allows for different

applications, particularly SEL. The game itself is play-based and social in nature. Players

work together, problem solving and overcoming conflicts and challenges. The DM can

integrate specific storylines and situations to address social-emotional skills.

An evidence-based literature review supports that when appropriate SEL

programming is provided, positive outcomes can result, such as improved school-related

attitudes and behaviors (e.g., motivation to learn, school commitment, etc.), increased

academic performance (e.g., school grades, academic achievement), decreased negative

behaviors (e.g., aggression, disruptiveness, non-compliance, disciplinary referrals), less

reports of emotional distress (e.g., depression, anxiety, stress, etc.) (Durlak et al., 2010,
 98

2011). Additionally, various school-related professions address SEL, however, there is

limited evidence of occupational therapy practitioners’ involvement in the literature.

Per the AOTA (2012), “it is a child’s ‘job’ or ‘occupation’ to play to develop

physical coordination, emotional maturity, social skills to interact with other children,

and self-confidence to try new experiences and explore new environments” (p. 1). This

quote demonstrates the importance of play and its significance in developing skills rooted

in SEL (e.g., emotional maturity, social skills, self-confidence). Unfortunately,

opportunities to play appear to have decreased and “playful” aspects of school are

disappearing (Tanta & Knox, 2015), particularly as children get older and the focus on

academics and maturity increases. Activities and interventions must be available for this

population that incorporate play and playfulness. Unfortunately, research regarding play

interventions for adolescents appears sparse; however, from the available literature, it

appears that play interventions are both meaningful and effective in supporting

development during this critical period of youth. Additionally, research using D&D

appears to be limited.

Recommendations

Despite the limited body of research, the literature review provided preliminary

information as to the usefulness of D&D and TTRPGs in addressing confidence,

supporting mental health recovery and social connection, providing opportunities to

safely develop interpersonal and intrapersonal skills, improving creativity, and fostering

critical thinking and problem solving in a variety of contexts, countries, and age-ranges.

Additionally, multiple strategies and suggestions for how to implement and structure
 99

D&D most efficiently are specified, including providing instruction on the game,

incorporating rapport building activities and a character-building session, pre-making

characters, visuals, and story modules, having an experienced facilitator familiar with

D&D, and providing time to debrief. The literature also found that SEL programs that

incorporated the four SAFE elements (sequenced, active, focused, explicit) had more

statistically significant positive outcomes (Durlak et al., 2010, 2011). The sessions will

incorporate traditional instruction paired with active learning. Each student will receive

their own set of dice and a “cheat sheet” with the game mechanics.

D&D is a group-based activity that is heavily influenced by the function and

cohesion of the group. Strategies and techniques to facilitate positive group dynamics are

beneficial when leading a group. These include enabling group cohesion by creating a

safe and comfortable environment, incorporating ice breakers, and setting norms

together. Additionally, providing time to process, share experiences, and debrief can

enable group bonding. Group leadership is also a factor in group processes, research

suggests non-authoritative and non-judgmental leadership, maintain open dialogue,

supportive group reactions, avoiding punishment, and verbal praise has impact. These

group characteristics and strategies have been integrated into this program.

General Conclusions

The author’s proposed pilot program has the potential to improve adolescents’

SEL and occupational engagement and generalize these skills to everyday life. With the

results, the author plans to disseminate the outcomes to school districts and school

administrations primarily and school-based pediatric occupational therapy practitioners

 100

secondarily. Dissemination will include email communication, writing articles for

prominent occupational therapy magazines, reaching out to blogs, developing a social

media presence, meetings with school districts, creating and printing informational

material, and presenting at conferences. Through this process, it is anticipated school

districts and administration will increase their awareness of the importance of SEL and its

impact of school-related occupations, the financial benefits of SEL, the dynamic role

occupational therapy has in addressing SEL, which could lead to increased programing

and more involvement of occupational therapy practitioners. Occupational therapy

practitioners are expected to increase their awareness in Role for SEL and how to possibly

increase their involvement. With the implementation of Role for SEL and the

dissemination of the results, the potential to address SEL expansively and positively

impact occupational engagement and performance are substantial.

 101

APPENDIX G – Fact Sheet

102
 103

REFERENCES

Abbott, M. S., Stauss, K. A., & Burnett, A. F. (2021). Table-top role-playing games as a

therapeutic intervention with adults to increase social connectedness. Social Work

with Groups, 1–16. https://doi.org/10.1080/01609513.2021.1932014

Anderson, M. & Grinder, S. (2017). Occupational therapy’s role in social-emotional

development throughout childhood. OT Practice, 22(7), CE1–CE8.

American Occupational Therapy Association. (2011). Building play skills for healthy

children & families. https://www.aota.org/-

/media/Corporate/Files/Practice/Children/Browse/Play/Building%20Play%20Skill

s%20Tip%20Sheet%20Final.pdf

American Occupational Therapy Association. (2012). Learning through play.

https://www.aota.org/about-occupational-therapy/patients-

clients/childrenandyouth/play.aspx

American Occupational Therapy Association. (2013). Occupational therapy’s role in

mental health promotion, prevention, & intervention with children & children and

adolescents: Social and emotional learning (SEL).

https://www.aota.org/~/media/Corporate/Files/Practice/Children/SchoolMHToolk

it/Social-and-Emotional-Learning-Info-Sheet.pdf

American Occupational Therapy Association. (2020). Occupational therapy practice

framework: Domain and process (4th ed.). American Journal of Occupational

Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

 104

American Occupational Therapy Association. (2022). OT practice FAQs.

https://www.aota.org/publications/ot-practice/faq

Arbesman, M., Bazyk, S., & Nochajski, S. M. (2013). Systematic review of occupational

therapy and mental health promotion, prevention, and intervention

for children and youth. American Journal of Occupational Therapy, 67(6), e120–

e130. https://doi.org/10.5014/ajot.2013.008359

Averett, P., Crowe, A., & Johnson, T. (2018). Using Sketchbooks to facilitate the group

process with at-risk youth. Social Work with Groups, 41(1–2), 125–138.

https://doi.org/10.1080/01609513.2016.1273694

Bagès, C., Hoareau, N., & Guerrien, A. (2020). Play to reduce bullying! Role-playing

games are a useful tool for therapists and teachers. Journal of Research in

Childhood Education, 1–11. https://doi.org/10.1080/02568543.2020.1810834

Ball, B., Holland, K. M., Marshall, K. J., Lippy, C., Jain, S., Souders, K., & Westby, R.

P. (2015). Implementing a targeted teen dating abuse prevention program:

Challenges and successes experienced by expect respect facilitators. Journal of

Adolescent Health, 56(2), S40–S46.

http://doi.org/10.1016/j.jadohealth.2014.06.021

Ben-Ezra, M., Lis, E., Błachnio, A., Ring, L., Lavenda, O., & Mahat-Shamir, M. (2018).

Social workers’ perceptions of the association between role playing games and

psychopathology. Psychiatric Quarterly, 89(1), 213–218.

https://doi.org/10.1007/s11126-017-9526-7
 105

Berkeley Public Schools Fund (n.d.). Learning for equity grants.

https://www.berkeleypublicschoolsfund.org/learning-for-equity/

Blackmon, W. D. (1994). Dungeons and Dragons: The use of a fantasy game in the

psychotherapeutic treatment of a young adult. American Journal of

Psychotherapy, 48(4), 624–632.

https://doi.org/10.1176/appi.psychotherapy.1994.48.4.624

Briesch DuBois, J. M., Briesch, A. M., Hoffman, J. A., Struzziero, J., & Toback, R.

(2017). Implementing self‐management within a group counseling context:

Effects on academic enabling behaviors. Psychology in the Schools, 54(8), 852–

867. https://doi.org/10.1002/pits.22029

Brogan, J., Bloomdahl, S. C., Rowlett, W. H., & Dunham, M. (2020). Using SFBC group

techniques to increase Latino academic self-esteem. Journal of School

Counseling, 18(11).

Caldarella, P., Millet, A. J., Heath, M. A., Warren, J. S., & Williams, L. (2019). School

counselors’ use of social emotional learning in high school: A study of the strong

teens curriculum. Journal of School Counseling, 17(19), 1–35.

Carter, R., & Lester, D. (1998). Personalities of players of Dungeons and Dragons.

Psychological Reports, 82(1), 182. https://doi.org/10.2466/PR0.82.1.182-182

Case-Smith, J. (2013). Systemic review of intervention to promote social-emotional

development in young children with or at risk for disability. American Journal of

Occupational Therapy, 67(4), 395–404. https://doi.org/10.5014/ajot.2013.004713

 106

Causo, F., & Quinlan, E. (2021). Defeating dragons and demons: Consumers’

perspectives on mental health recovery in role-playing games. Australian

Psychologist, 56(3), 256–267. https://doi.org/10.1080/00050067.2021.1890983

Challita, J., Chapparo, C., Hinitt, J., & Heard, R. (2019). Effective occupational therapy

intervention with children demonstrating reduced social competence during

playground interactions. British Journal of Occupational Therapy, 82(7), 433–

442. https://doi.org/10.1177/0308022619832467

Chapparo, C. & Ranka, J. (2010). PRPP intervention: Training and research manual.

Discipline of Occupational Therapy, Faculty of Health Sciences: The University

of Sydney, Australia.

Collaborative for Academic, Social and Emotional Learning (n.d.). About CASEL.

https://casel.org/about-2/

Collaborative for Academic, Social and Emotional Learning (n.d.). CASEL Milestones?.

https://casel.org/casels-20-year-timeline/

Collaborative for Academic, Social and Emotional Learning (n.d.). History.

https://casel.org/history/

Collaborative for Academic, Social and Emotional Learning (2015). CASEL guide:

Effective social and emotional learning programs—middle and high school

edition. http://secondaryguide.casel.org/casel-secondary-guide.pdf

Collaborative for Academic, Social and Emotional Learning (2020). CASEL framework.

http://casel.org/sel-framework/
 107

Collaborative for Academic, Social and Emotional Learning (2020). What is SEL?.

http://casel.org/

Consortium on the School-Based Promotion of Social Competence. (1996). The school-

based promotion of social competence: Theory, research, practice, and policy. In

R. J. Haggerty, L. R. Sherrod, N. Garmezy, & M. Rutter (Eds.), Stress, risk, and

resilience in children and adolescents: Processes, mechanisms, and interventions

(pp. 268–316). Cambridge University Press.

Cook, M. P., Gremo, M., & Morgan, R. (2017). Playing around with literature: Tabletop

role-playing games in middle grades ELA. Voices from the Middle, 25(2), 62–69.

Coombs Richardson, R., Tolson, H., Huang, T.-Y., & Lee, Y.-H. (2009). Character

education: Lessons for teaching social and emotional competence. Children &

Schools, 31(2), 71–78.

Denham, S. A. (2018). Keeping SEL developmental: The importance of a developmental

lens for fostering and assessing SEL competencies (Frameworks Brief). CASEL.

https://measuringsel.casel.org/wp-content/uploads/2018/11/Frameworks-

DevSEL.pdf

DeRenard, L. A., & Kline, L. M. (1990). Alienation and the game Dungeons and

Dragons. Psychological Reports, 66(3), 1219–1222.

https://doi.org/10.2466/PR0.66.4.1219-1222

DonorsChoose (2022). DonorsChoose. https://www.donorschoose.org/about

Durlak, J. A., Weissberg, R. P., & Pachan, M. (2010). A meta-analysis of after-school

programs that seek to promote personal and social skills in children and
 108

adolescents. American Journal of Community Psychology, 45(3–4), 294–309.

https://doi.org/10.1007/s10464-010-9300-6

Durlak, J. A., Dymnicki, A. B., Taylor, R. D., Weissberg, R. P., & Schellinger, K. B.

(2011). The impact of enhancing students' social and emotional learning: A meta-

analysis of school-based universal interventions. Child Development, 82(1), 405–

432. https://doi.org/10.1111/j.1467-8624.2010.01564.x

Dyson, S. B., Chang, Y.-L., Chen, H.-C., Hsiung, H.-Y., Tseng, C.-C., & Chang, J.-H.

(2016). The effect of tabletop role-playing games on the creative potential and

emotional creativity of Taiwanese college students. Thinking Skills and

Creativity, 19, 88–96. https://doi.org/10.1016/j.tsc.2015.10.004

Elliot, S. N., Davies, M. D., Frey, J. R., Gresham, F., & Cooper, G. (2018). Development

and initial validation of a social emotional learning assessment for universal

screening. Journal of Applied Developmental Psychology, 55, 39–51

https://doi.org/10.1016/j.appdev.2017.06.002

Elliott, S. N., Athnony, C. J., DiParna, J. C., Lei, P.-W., & Gresham, F. M. (2020). SSIS

SEL Brief Scales: Multi-informant assessments of students’ social emotional

learning competencies. SAIL CoLab, LLC. https://ssiscolab.com/product/ssis-sel-

brief-scales-manual/

Ewing, D. L., Monsen, J. J., & Kwoka, M. (2014). Behavioural and emotional well-being

of children following non-directive play with school staff. Educational

Psychology in Practice, 30(2), 192–203.

https://doi.org/10.1080/02667363.2014.907128
 109

Fluhr, T. (2004). Transcending differences: Using concrete subject-matter in

heterogeneous groups. Social Work with Groups, 27(2), 35–54.

http://doi.org/10.1300/v27n02_04

Frazier, S. L., Dinizulu, S. M., Rusch, D., Boustani, M. M., Mehta, T. G., & Reitz, K.

(2015). Building resilience after school for early adolescents in urban poverty:

Open trial of Leaders @ Play. Administration and Policy in Mental Health and

Mental Health Services Research, 42(6), 723–736. http://doi.org/10.1007/s10488-

014-0608-7

George Lucas Educational Foundation. (2011). Edutopia. Social and Emotional

Learning: A Short History. http://www.edutopia.org/social-emotional-learning-

history

Goldberg, B., Brintnell, E. S., & Goldberg, J. (2002). The relationship between

engagement in meaningful activities and quality of life in persons disabled by

mental illness. Occupational Therapy in Mental Health 18(2): 17.

Goldingay, S., Stagnitti, K., Robertson, N., Pepin, G., Sheppard, L., & Dean, B. (2020).

Implicit play or explicit cognitive behaviour therapy: The impact of intervention

approaches to facilitate social skills development in adolescents. Australian

Occupational Therapy Journal, 67(4), 360–372. https://doi.org/10.1111/1440-

1630.12673

Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note.

Journal of Child Psychology and Psychiatry, 38(5), 581–586.

 110

Goodman, R. (1999). The extended version of the Strengths and Difficulties

Questionnaire as a guide to child psychiatric caseness and consequent burden.

Journal of Child Psychology and Psychiatry, 40(5), 791–799.

Gresham, F., & Elliott, S. N. (2008). Social Skills Improvement System (SSIS) Rating

Scales. Bloomington: Pearson Assessments.

Harrington, K., Griffith, C., Gray, K., & Greenspan, S. (2016). A grant project to initiate

school counselors' development of a multi-tiered system of supports based on

social-emotional data. The Professional Counselor, 6(3), 278–296.

https://doi.org/10.15241/kh.6.3.278

Harris, N., Brazeau, J., Clarkson, A., Brownlee, K., & Rawana, E. P. (2012).

Adolescents’ perspectives on strengths-based group work and group cohesion in

residential treatment for substance abuse. Journal of Social Work Practice in the

Addictions, 12(4), 333–347. https://doi.org/10.1080/1533256X.2012.728485

Harrison, K., & Harrison, R. (2014). Utilizing direct observation methods to measure

social-emotional behaviors in school social work practice. School Social Work

Journal, 39(1), 17–33. https://search.proquest.com/docview/1680214342

Kaur, K. S. & Pathak, R. (2019). Play-based occupational therapy intervention on social

skills in children with autism spectrum disorder and attention deficit hyperactivity

disorder: A case series. Indian Journal of Occupational Therapy, 51(1), 31–36.

https://doi.org/10.4103/ijoth.ijoth_5_19

Kopelman-Rubin, D., Mufson, L., Siegel, A., Kats-Gold, I., Weiss, N., & Brunstein-

Klomek, A. (2021). I can succeed, a new social emotional learning program for
 111

children based on interpersonal psychotherapy for adolescents. European Journal

of Developmental Psychology, 18(1), 112–130.

https://doi.org/10.1080/17405629.2020.1768068

Lawson, G. M., McKenzie, M. E., Becker, K. D., Selby, L., & Hoover, S. A. (2019). The

core components of evidence-based social emotional learning programs.

Prevention Science, 20(4), 457–467 http://doi.org/10.1007/s11121-018-0953-y

Lis, E., Chiniara, C., Biskin, R., & Montoro, R. (2015). Psychiatrists’ perceptions of role-

playing games. Psychiatric Quarterly, 86(3), 381–384.

https://doi.org/10.1007/s11126-015-9339-5

Mac Cobb, S., Fitzgerald, B., & Lanigan-O'Keeffe, C. (2014). The Alert Program for

self-management of behaviour in second level schools: Results of phase 1 of a

pilot study. Emotional and Behavioural Difficulties, 19(4), 410–425.

https://doi.org/10.1080/13632752.2014.903593

McConville, J. R., Rauch, S., Helgegren, I., & Kain, J. (2017). Using role-playing games

to broaden engineering education. International Journal of Sustainability in

Higher Education, 18(4), 594–607. http://doi.org/10.1108/IJSHE-08-2015-0146

Novak, I. & Honan, I. (2019). Effectiveness of paediatric occupational therapy for

children with disabilities: A systematic review. Australian Occupational Therapy

Journal, 66, 258–273. https://doi.org/10.1111/1440-1630.12573

Prince, K. C., Ho, E. A., & Hansen, S. B. (2010). Effects of a school based program to

improve adaptive school behavior and social competencies among elementary

 112

school youth: The living skills program. Journal of Research in Character

Education, 8(2), 39–59.

Ross, K. M., & Tolan, P. (2018). Social and emotional learning in adolescence: Testing

the CASEL model in a normative sample. The Journal of Early Adolescence,

38(8), 1170–1199. https://doi.org/10.1177/0272431617725198

Rosselet, J. G., & Stauffer, S. D. (2013). Using group role-playing games with gifted

children and adolescents: A psychosocial intervention model. International

Journal of Play Therapy, 22(4), 173–192. https://doi.org/10.1037/a0034557

Ruegg, E. (2006). Social skills in children with learning disabilities: Using psychotherapy

in the classroom. Annals of the American Psychotherapy Association, 9(3), 14–21.

Shea, Chi-Kwan, & Siu, Andrew M.H. (2016). Engagement in play activities as a means

for youth in detention to acquire life skills. Occupational Therapy International,

23(3), 276–286. https://doi.org/10.1002/oti.1432

Stark, H. (2017). The role of the speech-language pathologist in supporting primary

school students with social, emotional and behavioural difficulties: Clinical

insight. Journal of Clinical Practice in Speech-Language Pathology, 19(3), 125–

130.

Tanta, K.J. & Knox, S.H. (2015). Play. In J. Case-Smith & J. Clifford O’Brien (Eds.),

Occupational therapy for children and adolescents (7th ed., pp. 483–497).

Elsevier.

Thompson, P., & White, S. (2010). Play and positive group dynamics. Reclaiming

Children and Youth, 19(3), 53–57.

 113

Thorpe, A. H., Willbourne, J. A., & Burdock, M. J. (2020). Thingymibob group: Staff

experiences of implementing a play-based therapy group in an adolescent secure

hospital. Educational & Child Psychology, 37(4), 25–56.

Tokolahi, E., Vandal, A. C., Kersten, P., Pearson, J., & Hocking, C. (2018). Cluster‐

randomised controlled trial of an occupational therapy intervention for children

aged 11–13 years, designed to increase participation to prevent symptoms of

mental illness. Children and Adolescent Mental Health, 23(4), 313–327.

https://doi.org/10.1111/camh.12270

Tuckman, B. W. (1965). Developmental sequence in small groups. Psychological

Bulletin, 63(6), 384–399. https://doi.org/10.1037/h0022100

van de Sande, M. C., Fekkes, M., Kocken, P. L., Diekstra, R. F., Reis, R., Gravesteijn, C.

(2019). Do universal social and emotional learning programs for secondary school

students enhance the competencies they address? A systematic review.

Psychology in the Schools, 56(10), 1545– 1567.

https://doi.org/10.1002/pits.22307

Voith, L. A., Yoon, S., Topitzes, J. & Brondino, M. J. (2020). A feasibility study of a

school-based social emotional learning program: Informing program development

and evaluation. Child and Adolescent Social Work Journal, 37, 329–342.

https://doi.org/10.1007/s10560-019-00634-7

Vroman, K. (2015). Adolescent development: Transitioning form child to adult. In J.

Case-Smith & J. Clifford O’Brien (Eds.), Occupational therapy for children and

adolescents (7th ed., pp. 102–128). Elsevier.

 114

Weaver, J. L., Medyk, N. V., Swank, J. M., Daniels, P. F., & Smith-Adcock, S. (2021). A

phenomenological study of Theraplay groups within a middle school.

International Journal of Play Therapy, 30(2), 125–135.

https://doi.org/10.1037/pla0000139

Wright, J. C., Weissglass, D. E., & Casey, V. (2020). Imaginative role-playing as a

medium for moral development: Dungeons & Dragons provides moral training.

Journal of Humanistic Psychology, 60(1), 99–129.

https://doi.org/10.1177/0022167816686263

Wizards of the West Coast. (n.d.). Overview. Dungeons & Dragons.

https://dnd.wizards.com/dungeons-and-dragons/what-is-dd

Yang, C., Chan, M. K., & Ma, T. L. (2020). School-wide social emotional learning (SEL)

and bullying victimization: Moderating role of school climate in elementary,

middle, and high schools. Journal of School Psychology, 82, 49–69.

https://doi.org/10.1016/j.jsp.2020.08.002
 115

CURRICULUM VITAE

PERSONAL
Harjas Kaur Chilana

FORMAL EDUCATION
OTD Boston University, Boston, MA anticipated graduation May 22, 2022
Title of Doctoral Project: Role for SEL: Using Dungeons & Dragons® to
Social-Emotional Learning with Middle-Schoolers
M.S. Boston University, Boston, MA January 25, 2013
B.S. Boston University, Boston, MA May 22, 2011

CREDENTIALS
Registered Occupational Therapist, National Board for Certification in
Occupational Therapy (NBCOT)

LICENSES
Licensed Occupational Therapist, (California, New Jersey)

POSITIONS HELD
§ School-based Occupational Therapist
General responsibilities
§ Provided occupational therapy services (formal evaluation, goal development,
consultation, collaboration, intervention provision, modifications,
accommodations, etc.) to student in special education with various abilities to
modify tasks and/or acquire, develop, or maintain the skills necessary for
students to access their academic program.
§ Addressed fine motor, visual motor, sensory processing, perceptual, executive
functioning, and neuromuscular functioning.
Berkeley Unified School District, Berkeley, CA, June 2019–Present
§ Served as school-based occupational therapist for preschool and elementary
age students for the school year.
§ Planned and lead weekly push-in motor groups for classes of 7–15 students in
preschool.
§ Provided distance learning services March 2020–March 202.
Reed Union School District, Tiburon, CA, August 2018–June 2019
§ Served as school-based occupational therapist for students in kindergarten
through 8th grade with various disabilities for the school year.
DC Public Schools, Washington, DC, August 2013–August 2015, August 2016–
August 2017
§ Served as school-based occupational therapist for students in pre-kindergarten
through age 22 for the school year.
 116

§ Implemented occupational therapy services for Pre-kindergarten–12th grade

students with focus on modifying tasks and/or acquiring, developing, or
maintaining the skills necessary for student’s academic-based program
§ Worked with students aged 18–22 in vocational program with focus on
modifying tasks and/or acquiring, developing, or maintaining the skills
necessary for student to participate in the job-market and complete job
requirements at worksite.
§ Worked with students aged 18–22 in life skills program with focus on
modifying tasks and/or acquiring, developing, or maintaining the skills for
post-school living.
§ Pediatric Occupational Therapist
Occupational Therapy Training Program-SF, San Francisco, CA, September 2019–
June 2020
§ Lead sensorimotor groups at Rooftop Elementary School with the focus of
promoting social-emotional well-being utilizing sensorimotor principles
§ Co-planned groups designed to increase sensory input and cognitive load
through motivating, rewarding, and developmentally appropriate activities
§ Collaborated with teachers to promote carryover of methods and strategies to
facility continued student growth throughout the school setting
§ Travel Occupational Therapist
Pacific Heights Transitional Care Center, San Francisco, CA, March 2018–July 2018
§ Provided occupational therapy services (evaluation, treatment, goal and plan
development, patient and family collaboration, documentation, discharge
planning, etc.) to patients and initiate referrals in skilled nursing facility when
appropriate and in accordance with Occupational Therapy Department
Procedures.
§ Supervised and direct Certified Occupational Therapy Assistant (COTA) in
the implementation of the treatment plan.
Oxnard School District, Oxnard, CA, September 2017–February 2018
§ Served as school-based occupational therapist for students in pre-kindergarten
through 8th grade with various disabilities for the School Year.
§ Skilled Nursing Facility Occupational Therapist
(PRN) Unique Residential Care Center, Washington, DC, May 2016–July 2017
§ Provided occupational therapy services (evaluation, treatment, goal and plan
development, patient and family collaboration, documentation, discharge
planning, etc.) to patients and initiate referrals in skilled nursing facility when
appropriate and in accordance with Occupational Therapy Department
Procedures.
HealthPRO Rehabilitation-Brinton Wood of Dupont, Washington, DC, July 2015–
April 2016
§ Provided occupational therapy services (evaluation, treatment, goal and plan
development, patient and family collaboration, documentation, discharge
planning, etc.) to patients and initiate referrals in skilled nursing facility when
 117

appropriate and in accordance with Occupational Therapy Department

Procedures.
§ Supervised and directed the Certified Occupational Therapy Assistant
(COTA) in the implementation of the treatment plan.
 ProQuest Number: 29162113

INFORMATION TO ALL USERS

The quality and completeness of this reproduction is dependent on the quality
and completeness of the copy made available to ProQuest.

Distributed by ProQuest LLC ( 2022 ).

Copyright of the Dissertation is held by the Author unless otherwise noted.

This work may be used in accordance with the terms of the Creative Commons license
or other rights statement, as indicated in the copyright statement or in the metadata
associated with this work. Unless otherwise specified in the copyright statement
or the metadata, all rights are reserved by the copyright holder.

This work is protected against unauthorized copying under Title 17,

United States Code and other applicable copyright laws.

Microform Edition where available © ProQuest LLC. No reproduction or digitization

of the Microform Edition is authorized without permission of ProQuest LLC.

ProQuest LLC
789 East Eisenhower Parkway
P.O. Box 1346
Ann Arbor, MI 48106 - 1346 USA