The role, challenges, and impact of occupational therapists in custodial settings: A scoping review.
Elizabeth Elder, Shannon Werner, Julia Crilly
PMID 40776569WHAT IT FOUND
Occupational therapists in custodial settings delivered direct care focused on communication, emotional and sensory regulation, independence and employability.
Detainees reported benefits, but the included studies could not show the therapy alone caused them.
Key findings
01All included studies described occupational therapists providing direct detainee care, often focused on communication, emotional and sensory regulation, independence and employability.
02Seven studies reported challenges grouped as engagement, environment, governance and resources.
03Included programmes reported decreased aggression and recidivism, but the review could not establish causation.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This is a scoping review, not a trial, so it maps the evidence but does not test whether occupational therapy caused outcomes. Only 11 papers were included, and only three met all appraisal criteria, so the evidence base is uneven. Eight of the 11 studies were from the USA, so findings may not fit other countries. The included studies were not randomised, and some had no control group, so other factors may explain the reported changes. Some included studies did not report the total number of participants, and many were single-site studies, so generalisation is limited. The review searched only English publications from January 2013 to May 2024 and excluded grey literature, so relevant non-English or policy documents were not captured. The search was run by one author with librarian support, which can create collection bias.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read the reported decreases in aggression and recidivism as proof that occupational therapy caused them. The included studies were not randomised, and other rehabilitation or therapy sessions may have occurred at the same time.