"Behind every behavior is a feeling and behind every feeling is a need"

I think this not only is prevalent in the neurodivergent community as Aaron and Kristen discussed but also in me and Steph's podcast where is someone recognizes a behavior an older adult may be eliciting can fully determine the older adults mental health and if they receive the proper supports or not.

I think something that we could see be developed in the near future is a healthcare social media peer support.

This ties into what Kimmy and Caitlin as well as Kristin and Aaron were sharing about individuals turning towards social media and people who are similar to them to feel a sense of community. There is one girl in her 20s on social media that I have been following for a few months now and she started a channel after being diagnosed with cancer. She was immediately curious how fast she would lose her hair and looked online to see if she could find anyone to watch that could share their experience of going through chemo/ radiation and hair loss. Not being able to find anyone she created her own channel and each day post a short video of her brushing her hair and giving a quick update as to how things feel and what is going on. The comment sections on her videos seem to be such a supportive place where people who were once like her searching for videos are able to form a community of peers going through similar situation.

I am seeing this more and more and am curious how this will develop in the future as it could be a really supportive environment for people to build community.

Aaron, do you think as an OTP you would refer all clients experiencing the same thing to the same support group? Would that be beneficial? Do you think there would be a conflict of interest to refer all of your grieving clients to the same support group? I'm curious if talking to someone once (such as the pro bono clinic) would give them ideas of things they could do on their own as they feel comfortable or if they would need services for X amount of time to work through personal things? Do you think a grieving older adult would have the motivation to seek out the help they really need or would they already feel isolated and alone and allow depressive symptoms to take over and begin thinking that they are next so healing a loss isn't worth the work it may take?

However if the topic does seem appropriate for the individual to talk about grief and loss, I believe it is appropriate to directly talk to them about it. Occupations are something you do in your life and death is an occupation. Working with your client to address their own occupation of death be an important conversation because there will be things that are culturally relevant, as well as important and meaningful to them. Similarly setting a goal for this plan they create and discuss with you to get put into writing or be told to a family member can help others prepare for the grief and loss.

If you are in a group setting discussing grief and loss, I think it is important to start the meeting by saying that you understand everyone has lived long lives that were not the same by any means. I had the opportunity to lead a group discussion on death in my undergrad experience and starting the group discussion off like this really set the tone for the meeting. When I posed a question I would make sure everyone had the opportunity to share and that the questions were phrased in a way that required "I statements". Having everyone respond with their personal "I statement" really made it more of a learning experience of listening to each other rather than telling everyone your opinions on the process.

When it comes to older adults and their changing social circle, it is often due to loss from a person passing away. When is comes to residents in the prison system, their changing social circle is often due to loss from a person leaving the system and often not coming back to right where they came from. Or, due to entering the prision system and not being able to return to the outside world.

Seeing these similarities, I think it would definitely be possible for similar support techniques to be used for residents in a prison and older adults experiencing loss.

This brings up an interesting question of: If an individual has been sentenced to enter a prison system and is unlikely to be released for a prolonged period of time, family members may be experiencing grief due to the loss of a loved one in their lives. What can we do as OTPs to support this population that may not be welcomed at the traditional grief group but is experiencing a very similar form of loss.

Through Facebook posts, I have seen how a fellow alumna from my high school has navigated a difficult diagnosis for her young son, and has expressed appreciation for the support of her social network, and shared resources/experiences of favorite providers. On the one hand, this person is really open about their experience, and shares moments of grief and loss for her expectations around motherhood and the health she wishes her son experienced. In a similar way, the patient influencers that Kimmy and Caitlin brought up are able to connect with others through shared experience, in a peer support kind of way.

Hannah, I know you think separate groups may be better, but what if someone could make just one connection in the group that helps them more and is stronger than any other connection in another group? Do you think it has to be about true situational relatability?

I think the population would have a very different and unique perspective on mental health and groups/group therapy. I wonder how this could be done safely so the prisoner and others all feel comfortable and supported. What benefits could an OT offered group have inside the prison vs a group hosted by someone who works for the prison and is not a therapist? Do you think there would be better and more open communication in the group?

In regards to groups/group therapy inside the prison, I think a mix of both an OT run group and a group not run by an OT would both be beneficial to the individuals. The benefit to an OT group is that the OT can come in with their OT lens and evaluate and assess the individuals and the environment and potentially help with increasing occupational performance and satisfaction while in the prison and with targeting goals for when the client leaves the systems. At the same time, the non therapist group leader may help the group to feel less like a treatment session (incase people feel that way with a therapist) and more so just like a bunch of people hanging out because they enjoy doing activities together. I think both of these should be done to help better the communication with the group and other inmates. Regardless any group exposure will likely help the growth of a sense of community and partnership in the system.

In regards to support groups, I think the type of group is going to vary from person to person since loss can come from a variety of situations. At the same time, I think being in any group talking about these subjects could be beneficial since every member is going through a loss of some kind and it is nice to know that one is not alone.

I do agree that inmates should have more opportunities to connect with others while they are on the inside but also understand the need for limited communication and connected, especially depending on the crime. I think finding someone to monitor these interactions would be difficult and kind of defeat the purpose of the social media groups. I think a secure system for connection on the inside may be most beneficial. I think considerations of the crime and reason for incarceration could also be considered for online community involvement and participation.

I also agree with your perspective on OT vs prison run groups. I think OT run groups could really offer a lot to the inmates as well as many opportunities and perspectives that would not otherwise be thought about, considered, or shared. I wonder how open to this inmates would be, especially for those who are really trying to change and do better upon release.

Steph, you spoke to observing cognitive decline in your grandmother after your grandfather's passing. I'm curious, do you think your grandfathers passing directly correlated to decreased cognitive abilities, or were these dementia-like symptoms present prior to the loss of your grandfather?

I am curious because I had never thought of grief as a causing cognitive decline in older adults-- I would have contributed your grandmother's symptoms entirely to old age given that she is in her 80s. However, given that we know depressive symptoms can significantly impair cognition, it makes a lot of sense the experience of grief and loss could cause or speed up cognitive decline in older adults. I am glad you brought this up, it is something I had never considered before. Do you think that the effects of grief and loss on older adults is often missed because we contribute cognitive deficits to old age before considering other potential factors?