Building Self-Efficacy Through Occupation: An Occupational Therapist’s Work Supporting Youth Transitioning from Orphan Care in Honduras
Nathan Grizenko, OTD, OTR/L
Occupational therapy’s global impact is often most visible where participation opportunities are limited and the need for occupational justice is profound. Occupational therapist Kacey Barahona’s work in Honduras illustrates how occupation-based intervention, mentorship, and life skills education can empower youth transitioning out of orphan care to build self-efficacy and meaningful participation in their communities.
A Path Rooted in Service and Occupational Justice
Kacey’s journey began through volunteer service abroad, where exposure to disparities in access to healthcare and developmental resources revealed significant unmet needs among children living in institutional settings. Through lived experience supporting youth in orphan care, she recognized that many children lacked opportunities to engage in everyday occupations essential for independence, identity formation, and community integration.
This experience ultimately led her to pursue occupational therapy education at The Ohio State University with the intention of returning to Honduras to serve institutionalized and transitioning youth. The holistic nature of occupational therapy—addressing physical, cognitive, emotional, and social participation—aligned closely with the needs she observed among adolescents preparing to age out of care.
“For me, with our youth, they’ve been institutionalized. So they’ve been deprived of the opportunity to participate, which leads to dysfunction in participation because you don’t know how to engage,” Kacey said. “I think occupational justice for us is related to community participation and integration. That’s where you get your job…your education…that’s how you access transportation.”
Understanding Occupational Deprivation in Institutionalized Youth
Youth raised in institutional environments often experience occupational deprivation, particularly in areas of community participation, independent living skills, and social engagement. Many adolescents approach adulthood without prior exposure to everyday activities such as grocery shopping, managing transportation, interacting with employers, or navigating community services.
Without opportunities to practice these occupations in low-risk environments, participation can become anxiety-provoking and overwhelming. Kacey emphasized that occupational justice, in this context, centers on restoring opportunities for participation and reducing the consequences of early failures so youth can develop resilience and confidence.
From Crisis Response to Evidence-Based Programming
Initial involvement with transitioning youth began as crisis response—providing housing stability, mentorship, and emotional support to adolescents facing homelessness, gang violence, and exploitation after aging out of orphanages. Over time, the work evolved into a structured organization supporting young adults through long-term mentorship and life skills development.
Guided by occupational therapy principles, the program intentionally shifted from reactive support toward proactive, evidence-based intervention. Capstone work focused on identifying best practices for implementing life skills education within institutional settings, while mentorship training initiatives now prepare program graduates to support younger peers navigating similar transitions.
“Within our organization, we keep the doors very open,” Kacey said. “Like, if you want to be a part of this, you get to be a part of this. We’re a family that lasts.”
Occupation-Based Life Skills Education
The life skills curriculum emphasizes participation in authentic community contexts, allowing youth to practice and grade tasks such as:
- Financial management and budgeting
- Meal planning and grocery shopping
- Job seeking and workplace communication
- Transportation navigation
- Health management and appointment scheduling
- Social participation and community engagement
Interventions prioritize task grading, modeling, and repeated low-stakes practice to support skill acquisition while protecting psychological safety. By normalizing mistakes and encouraging guided participation, youth gradually develop competence and occupational identity.
Importantly, the program incorporates trauma-informed care and mentorship, recognizing that skill acquisition is inseparable from emotional regulation, trust, and relational safety.
Building Self-Efficacy Through Participation
Central to the program’s philosophy is the intentional cultivation of self-efficacy. Youth are supported in experiencing success, recovering from setbacks, and developing confidence in their ability to manage real-world demands. Structured opportunities for practice—such as ordering food independently, navigating public spaces, or managing employment responsibilities—create meaningful experiences that reinforce independence and belonging.
This approach reflects the core occupational therapy belief that participation drives development. As youth gain repeated opportunities to engage in meaningful occupations, they demonstrate increased resilience, improved self-concept, and greater willingness to pursue education, employment, and community integration.
Implications for Occupational Therapy Practice
This work highlights several considerations relevant to occupational therapy practitioners across practice settings:
- Participation is foundational to justice. Occupational deprivation can profoundly impact identity, self-esteem, and long-term outcomes.
- Transition planning must be occupation-centered. Youth preparing for adulthood benefit from experiential learning in authentic environments.
- Mentorship enhances sustainability. Peer mentoring reinforces skill generalization and fosters leadership.
- Trauma-informed care is essential. Emotional safety supports risk-taking, learning, and self-efficacy development.
- Global practice expands the profession’s reach. Occupational therapy frameworks are uniquely suited to addressing disparities in participation worldwide.
A Family-Centered Model of Support
Beyond structured programming, the organization emphasizes relational continuity and belonging. Youth are supported not only through skill development but also through consistent mentorship and long-term connection—addressing the relational void many experience after leaving institutional care.
This family-centered approach reinforces the therapist’s belief that occupation occurs within relationship, community, and culture. By integrating clinical reasoning with authentic connection, the program demonstrates how occupational therapy can meaningfully transform life trajectories.
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