Increasing life skills for adolescents who have ......developmental disabilities. The needs...

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Increasing life skills for adolescents who havedevelopmental disabilities: a program developmentplanRenae C. SauterThe University of Toledo

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Increasing Life Skills 1

Increasing Life Skills for Adolescents who have Developmental Disabilities:

A Program Development Plan

Renae C. Sauter

Faculty Mentor: Melanie Criss,

Site Mentor: Maureen Kane Wineland, Ph.D., OTR/L

Department of Rehabilitation Sciences

Occupational Therapy Doctorate Program

The University of Toledo

May 2012

Note: This document describes a Capstone Dissemination project reflecting an individually planned experience conducted under faculty and site mentorship. The goal of the Capstone experience is to provide the occupational therapy doctoral student with a unique experience whereby he/she can demonstrate leadership and autonomous decision-making in preparation for enhanced future practice as an occupational therapist. As such, the Capstone Dissemination is not formal research.


Table of Contents

Introduction------------------------------------------------------------------------------------------------6

Definitions----------------------------------------------------------------------------------------6

Program Site--------------------------------------------------------------------------------------6

Program Needs-----------------------------------------------------------------------------------7

Demographics and Literature Review---------------------------------------------------------9

Model of Practice---------------------------------------------------------------------------------13

Federal Initiatives---------------------------------------------------------------------------------16

Objectives---------------------------------------------------------------------------------------------------18

Marketing and Recruitment-------------------------------------------------------------------------------19

Potential Participants------------------------------------------------------------------------------22

Inclusion Criteria ----------------------------------------------------------------------------23

Programming------------------------------------------------------------------------------------------------24

Literature for Programming----------------------------------------------------------------------24

Assessment-----------------------------------------------------------------------------------------26

Programming with Role Acquisition-----------------------------------------------------------27

Interventions---------------------------------------------------------------------------------------29

Program Outline-----------------------------------------------------------------------------------31

Direct and Indirect Services---------------------------------------------------------------------33

Documentation Systems--------------------------------------------------------------------------34

Program Discharge--------------------------------------------------------------------------------35

Budgeting and Staffing------------------------------------------------------------------------------------35

Personnel-------------------------------------------------------------------------------------------40


Funding Sources-----------------------------------------------------------------------------------40

Self-Sufficiency------------------------------------------------------------------------------------43

Program Evaluation-----------------------------------------------------------------------------------------44

Timeline------------------------------------------------------------------------------------------------------47

Letters of Support-------------------------------------------------------------------------------------------48

Reference-----------------------------------------------------------------------------------------------------49

Appendix A: Organizational Chart------------------------------------------------------------------------55

Appendix B: Self-Care Assessment-----------------------------------------------------------------------57

Appendix C: Home-Care Assessment--------------------------------------------------------------------61

Appendix D: Adolescent Autonomy Checklist----------------------------------------------------------66

Appendix E: Results from the Self-Care Assessment, Home-Care Assessment, and Adolescent

Autonomy Checklist-----------------------------------------------------------------------------------------72

Appendix F: Semi-Structured Interview and Answers-------------------------------------------------76

Appendix G: Living Independently Marketing Flyer---------------------------------------------------83

Appendix H: Living Independently Marketing Letter--------------------------------------------------85

Appendix I: Living Independently Assessment---------------------------------------------------------88

Appendix J: Living Independently Progress Note------------------------------------------------------98

Appendix K: Living Independently Evaluation Summary--------------------------------------------100

Appendix L: Living Independently Budgeting and Staffing Outline--------------------------------102

Appendix M: Living Independently Job Description--------------------------------------------------109

Appendix N: Living Independently Job Newspaper Advertisement--------------------------------112

Appendix O: Living Independently Program Evaluation---------------------------------------------114

Appendix P: Living Independently Timeline-----------------------------------------------------------116


Appendix Q: Living Independently Letter of Support------------------------------------------------119

Appendix R: Living Independently Additional Supporters ------------------------------------------121


Executive Summary

A needs assessment was conducted with the Maureen Kane-Wineland, an occupational

therapist at Rehab Dynamics along with multiple caregivers of adolescents who have

developmental disabilities. The needs assessment and literature review identified a clear need for

a life skills program for adolescents who have developmental disabilities.

The goal for the Living Independently program at Rehab Dynamics is to increase

independent living skills in occupations of daily living and instrumental occupations of daily

living among adolescents who have developmental disabilities. Objectives to measure the Living

Independently goal are to increase functional level in dressing, hygiene, cleaning, laundry, meal

preparation, shopping, emergency, and telephone skills from the beginning of the program, end

of the program, and to the four week follow-up.

The participants will be males and females that are between the ages of 12-18 years old.

All participants will have at least one type of developmental disability. Participants must have an

average of moderate assistance or less in the skill areas that are identified on the Living

Independently Assessment. Eight students will participate in the Living Independently program

held at Rehab Dynamics.

The seventeen week program will teach participants a variety of life skills. All sessions

will be occupationally based with an emphasis on hands-on learning. The levels of independence

will be measured by the caregivers completing the Living Independently Assessment with the

Functional Independence Measure scale. Caregivers will be asked to complete the assessment at

the start, end, and the four week follow-up. The occupational therapist will use the assessment to

measure any improvements in independent skills. The caregivers will also be asked to evaluate

the overall quality of the Living Independently Assessment through a questionnaire.


Introduction



living among adolescents who have developmental disabilities.

Definitions

Independent living is defined as the control over one’s life, with the ability and

opportunity to make choices to perform everyday occupations (National Council for the

Dissemination, 2006).

Skills are observable, goal-directed actions that a person uses while performing

(Crepeau, Cohn, Schell, 2009).

Occupations of daily living (ODL’s) are defined as the tasks directed toward

taking care of one’s own body. These occupations facilitate basic survival and well-being

(American Occupational Therapy Association, 2008).

Instrumental occupations of daily living (IODL’s) are the occupations that support

daily living. Often IODL’s occur within the home or community and require more

complex interactions than the skills needed for ODL’s (American Occupational Therapy

Association, 2008).

Program Site

The Living Independently program will be conducted at Rehab Dynamics in Toledo,

Ohio. Rehab Dynamics is a well known pediatric setting that provides occupational, physical,

and speech-language services to children who have various types of developmental disabilities.

Rehab Dynamics provides services geared toward learning new skills and increasing

independence to approximately 250 children and their families who have developmental


disabilities. The mission of Rehab Dynamics is to guide children to be successful in their lives

and help family members by providing support and education (Rehab Dynamics, 2002). Please

see Appendix A for Rehab Dynamics staff organizational chart.

Rehab Dynamics is a private therapy practice but has associations with the Lucas County

Board of Mental Retardation and Developmental Disabilities, the Fetal Alcohol Diagnostic

Clinic through DOUBLE ARC, and Mary Immaculate School (Rehab Dynamics, 2002). Rehab

Dynamics provides services for clients with and without health insurance coverage as well as,

self-pay services. Rehab Dynamics utilized grant funding from several resources in order to

provide more services to individuals in the Northwest Ohio community.

Program Needs

A needs assessment was conducted to determine the needs for a life skills program. The

needs assessment consisted on a semi-structured interview, the Self-Care Assessment (see

Appendix B), Home-Care Assessment (see Appendix C), and the Adolescent Autonomy

Checklist (see Appendix D). Stakeholders involved in the needs assessment include; Maureen

Wineland, an occupational therapist at Rehab Dynamics; Tammy Lamb, a mother of an adult

with autism and the creator of Breaking Barriers; multiple caregivers of adolescents using Rehab

Dynamics services; HOPE Community Center staff and members; and the Lenawee Intermediate

School District special education teachers.

The semi-structured interview provided the opportunity to ask the stakeholders questions

and develop a baseline of the general needs for this population. The interviews left space to ask

additional questions as they arose in the conversation (Fazio, 2008). Interviews with the

caregivers were conducted in focus groups and in single person interviews. The focus groups

were a casual but productive interaction between the caregivers and interviewer to explain


experiences, attitudes, and views of the caregivers (Lehoux, Poland, & Daudelin, 2006). Two

focus groups with two sets of mothers were conducted while the children were participating in a

group therapy session. The focus groups with the caregivers were beneficial because the

caregivers were comfortable talking amongst other caregivers who have children with similar

disabilities. The caregivers opened up and shared stories about their personal experiences of

having a child with a developmental disability. Individualized interviews were conducted with

caregivers who were unable to attend the focus groups. These interviews were structured and ran

the same as the focus groups.

The Self-Care Assessment, Home-Care Assessment, and Adolescent Autonomy Checklist

were completed by the caregivers. The caregivers are the only stakeholders that could truly

answer the questions which ask about the specific occupational functions of the child in various

occupations. Other stakeholders were not as knowledgeable about the individual participant’s

ability to complete the identified skills. These assessments asked caregivers to check their child’s

level of mastery in tasks and to identify the level of motivation for addressing each task in the

life skills program. The assessments covered a detailed breakdown of occupations of daily living

and instrumental occupations of daily living. Using these assessments allowed parents to identify

a need for additional tasks that were not mentioned in the focus group. The focus groups and

assessments provided a thorough evaluation of the program needs.

Results from the needs assessment supported the need for a life skills program. All the

stakeholders were very knowledgeable about the functional status of the participants and were

able to provide accurate and detailed information. Caregivers identified their child as having a

variety of skills ranging from no basic skill, can complete the task with assistance, and can

complete the task independently. Although it was evident that each child had individualized


needs, the general need for a life skills program was apparent. Interviews with the HOPE staff

and members were also helpful in identifying an extensive variety of ODL’s and IODL’s that

needed to be addressed in a life skills program. Please see Appendix E for results from the Self-

Care Assessment, Home-Care Assessment, and Adolescent Autonomy Checklist. Also see

Appendix F for the semi-structured interview questions and answers.

Demographics and Literature Review

The diagnosis for developmental disabilities is a classification for an individual having

severe impairment or an absence in the process of human development (Brown, 2007). The

Developmental Disabilities Assistance and Bill of Rights Act Amendments of 2000 have defined

developmental disability as a disability occurring at 5 years of age and up to 22 years with

physical and/or mental impairments, limitations in major life activities (occupations), and

required assistance for a lifetime or for an extended duration of time (Brown, 2007). In the years

2006-2008, approximately 1 in 6 American children were reported as having a developmental

disability (Boyle, Boulet, Schieve, Cohen, Blumberg, Yeargin-Allsopp, Visser, & Kogan, 2011).

The prevalence for individuals diagnosed with a developmental disability increased from 12.84%

to 15.04% between the years of 1997 and 2008 (Boyle et al, 2011). Intellectual disabilities were

the most common type of developmental disability along with cerebral palsy, vision impairment,

hearing loss, and autism spectrum disorders (United States Department of Health and Human

Services, n.d.).

Often times, services dwindle for the adolescents who have disabilities. Generally,

toddlers and young children are provided with early intervention services. However, once in

school, therapists have large caseloads and discharge students if progress is inconsistent (Scott,

2001). When a child with a disability reaches adolescence, the occupational therapy services are


typically reduced or discontinued (Scott, 2001). Powell (1994) surveyed one hundred thirty six

Michigan school-based occupational therapists and found that the therapists provide more

services to preschool and elementary students compared to middle and high school students.

Approximately 35% of special education directors across the United States recommend their

school district to provide additional occupational therapy services for adolescents in transition

programming (Spencer, Emery, & Schneck, 2003). Inge (1995) proposed that occupational

therapists are not providing as much secondary transition services as expected.

Dr. Paul T. Shattuck noticed the high rates of adolescents and young adults who are no

longer receiving special supports (2011). In fact, Dr. Shattuck discovered 39.1 percent of youth

with autism were not provided with therapy, mental health, medical diagnostics, or case

management services (2011). Occupational therapy services should not be discharged when an

individual reaches a certain age or gradates from school; instead, occupational therapy services

can facilitate continued increases in independence and quality of life regardless of age (Winkle &

Cobb, 2010). A large majority of a lifespan is spent in adolescence and adulthood. Services

should be provided for the entire lifespan rather than primarily focusing on young children.

There are several barriers that exist for schools in providing life skill programming for

children with developmental disabilities. Kardos and White (2005) revealed the false belief that

transition programming is being provided by another faculty of the school, the lack of

understanding of occupational therapy by other transition team members, and the lack of funding

are the three most identified barriers to transition services. The lack of services and barriers in

schools for providing independent living skills for adolescents indicates the strong need for

additional private therapy providers to offer life skills programs.


A person who has a developmental disability may have problems with skills necessary to

live independently. The individual may have impairments in skills including: social skills,

education, employment, leisure, occupations of daily living, and instrumental occupations of

daily living (Rogers, 2010). Allowing adolescents to engage in meaningful programs can

increase his/her level of knowledge, skills and ability to apply skills to new situations (Kohler &

Field, 2003). Cronin (1996) reviewed the existing literature about the available life skills

programs for students who have learning disabilities. General outcomes were concluded that

students do not learn life skills on their own and require services to teach these skills (Cronin,

1996).

Benz, Lindstrom and Latta (1999) and Benz, Lindstrom, and Yovanoff (2000) reviewed a

Youth Transition Program (YTP) for adolescents who typically have poor academic, social and

independent living skills with little to no job experience. Interventions during the program

included: functional academics, vocational skills, personal and social skills, and independent

living skills (Benz et al., 1999; Benz et al., 2000). Overall, the participant’s active in the YTP

had higher rates of success in receiving a standard diploma, finding and maintaining a job, and

continuing education compared to the non-YTP students (Benz et al., 1999; Benz et al., 2000).

Although vocational skills will not be covered in the life skills program, many of the skills

learned can crossover from employment to basic life skills. The YTP is a great example of the

need for a life skills program and the positive outcomes that can result.

Meal preparation is another important factor to consider with individuals who have

intellectual disabilities. Arnold-Reid, Schloss, and Alper (1997) discussed the importance of

meal planning for independent living. People with disabilities tend to have more health problems

and are more susceptible to eating disorders (Arnold-Reid, Schloss, & Alper, 1997). Teaching


meal planning introduces the individual to independent living skills, functional leisure, nutrition,

and financial management (Arnold-Reid, Schloss, & Alper, 1997). Results from the study found

that adolescents with intellectual impairments were able to plan a menu for three days, create a

shopping list, and select and purchase items at the store (Arnold-Reid, Schloss, & Alper, 1997).

Results also found that the participants were able to maintain the meal planning skills for a

minimum of two months (Arnold-Reid, Schloss, & Alper, 1997). This study demonstrates the

potential for independent living skills and the need for life skills experiences.

Smith and Belcher (1985) found that adults with autism can complete occupations with

fewer verbal prompting after repetitive practice. The participants had an increase in

independence in cleaning the sink, cooking spaghetti, face washing, hair combing, and teeth

brushing (Smith & Belcher, 1985). The conclusions from this study support the need for a life

skills program that gives participants the opportunity to practice each occupation with the

guidance of the therapist.

Skills such as grocery shopping should also be considered. Morse and Schuster (2000)

conducted a research study about teaching elementary students with moderate intellectual

disabilities how to shop for groceries. The students had the opportunity to shop in a real grocery

store and receive storyboard education about the process of shopping. Results found that during

the posttest, the six students who achieved criterion performed the steps of the task analysis with

90% to 100% accuracy (Morse & Schuster, 2000). Seven parents completed a post intervention

survey, five of the parents reported their child had an increased participation in grocery shopping

outside the classroom (Morse & Schuster, 2000). Overall, this study concluded that six students

learned how to purchase two items at the store, maintain the skills to shop for six weeks and

were able to generalize the skills to a different store (Morse & Schuster, 2000). Shopping at the


store requires many IODL skills. The students had to demonstrate competences in transportation,

money management and shopping for meal preparation. This study supports the Living

Independently program with the significant results in successful grocery shopping. Grocery

shopping is one example of an occupation that has many benefits. Developing a similar program

will educate the students on the skills required to shop along with many other IODL’s necessary

to live independently.

The presented literature supports the program goal by demonstrating evidence of

successful life skills programs geared toward increasing skills. The existing literature provides

confirmation that a young adult with a developmental disability can have an increase in skills for

occupations of daily living and instrumental occupations of daily living when receiving the

proper instructions. These articles can be used as a foundation for the program development plan

in order to reach the overall goal. The Living Independently program will focus on areas

identified in the needs assessment in order for each adolescent to live as independently as

possible. Using resources such as; articles, books, online resources, and other life skills programs

will assist in developing an occupationally enriched program.

Model of Practice

The Role Acquisition model developed by Ann Mosey (1986, Chap. 26) is a teaching

model that will complement the Living Independently program. This model emphasizes the

dynamic relationship between skills (task and interpersonal) and roles (family, ODL’s,

play/leisure, work, temporal adaptation) (Mosey, 1986, Chap. 26). Role Acquisition is used for

individuals who are experiencing difficulty transitioning between roles or who must engage in

their social role in a different manner (Mosey, 1986, Chap. 26).


Role Acquisition acknowledges that learning is a complex process (Mosey, 1986, Chap.

26). Learning involves individualized goals, an understanding of what is to be learned,

motivation, active participation, feedback, trial and error, repetition and an enriched environment

(Mosey, 1986, Chap. 26). There are key components of the Role Acquisition model that an

instructor must consider. These considerations include: 1) Engaging the student in active

participation to help with the development of skills, 2) conscious awareness of materials being

learned, 3) the use of realistic and symbolic learning experiences, and 4) the use of simulated and

natural situations (Mosey, 1986, Chap. 26). The therapist would want to use these considerations

to facilitate growth from conscious to unconscious or skill mastery.

Many of the learning principles established in the Role Acquisition model support the life

skills program. Active participation is an effective learning process to facilitate learning and

develop skills (Mosey, 1986, Chap. 26). All sessions in the life skills program will be hands-on

learning with the participants actively engaging in each occupation. Learning starts at the current

level and increases as the individual becomes more comfortable and skilled (Mosey, 1986, Chap.

26). The life skills program will start with simple skills and eventually combine the skills into a

more complex occupation. Repetition and practice aides in the learning process (Mosey, 1986,

Chap. 26). The teaching techniques of the Role Acquisition model are similar to the learning

styles identified in the needs assessment.

Role Acquisition focuses on mastering certain skills at a time. These skills are based on

what the adolescent and his/her parents want to master (Mosey, 1986, Chap. 26). The life skills

program will also consider the participants interests and attempt to assist the adolescent to reach

independence through those interests. Information about the interest was gathered through the

needs assessment and general discussions with the stakeholders or participant. However, some


life skills, such as housekeeping, will be included in the life skills program even if it is not the

participant’s most desired occupation.

While learning new skills, the participant must be conscious of what is being learned

before they can fully master the skills (Mosey, 1986, Chap. 26). The adolescent must also

receive feedback about his/her occupational performance (Mosey, 1986, Chap. 26). The Living

Independently program will include both the conscious learning and the feedback. Prior to the

occupation, the instructor will explain to the participant why they are completing the designated

occupation. The participant will be given feedback about their quality of performance and advice

for ways to improve.

Mosey (1986, Chap. 26) reviews the intervention process for ODL’s. She lists grooming,

cooking, homemaking, and community survival as an example. Mosey continues to state that

ODL’s can be taught within a group context, but it is important for each individual to be able to

perform the ODL’s independently (1986, Chap. 26). Learning ODL’s should be done in real life

situations that allow a hands-on experience (Mosey, 1986, Chap. 26). The therapist should break

down and sequence the tasks (Mosey, 1986, Chap. 26). The Living Independently program will

provide the most naturalistic environment by completing some of the ODL’s in the facility

bathroom and kitchen along with providing many opportunities for hands-on learning.

The long-term goal of Role Acquisition is geared toward the expected environment

(Mosey, 1986, Chap. 26). The overall focus for the life skills program is to increase independent

living skills. The skill areas identified in the Living Independently program are skills that are

identified by Mosey (1986, Chap. 26) and from the needs assessment that will help the individual

to become more independent. The life skills program will implement principles of learning to


provide opportunities for the participants to gain skills and possibly move to an expected

environment.

Federal Initiatives

Governmental efforts such as Healthy People 2020 and Individuals with Disabilities

Education Act (IDEA) have had an impact on the services provided to adolescents who have

developmental disabilities. Healthy People 2020 identified that 28,890 children and youth live in

congregate care residences. The target number is 26,001 children and youth with disabilities to

live in those settings (U.S. Department of Health and Human Services, 2010). The life skills

program can help reduce these numbers by teaching youth the skills necessary to live

independently. The 1997 reauthorization of IDEA was to ensure that students had free

appropriate public education (FAPE) with an emphasis for special education and related services;

including independent living to meet the needs of each student (U.S. Department of Education,

2007). In 2004 IDEA required transition services to be part of the student’s individualized

education plan (IEP) by the time the student is 16 years old (U.S. Department of Education,

2006). The goals of the IEP must have measurable postsecondary goals related to education,

employment and independent living skills. The transition services must help the students to reach

these goals (U.S. Department of Education, 2006). IDEA requires that students with special

needs are provided with services that (a) have an outcome-orientated process that supports post-

school activities (occupations), including independent living, (b) are directed toward the

individual student’s needs, interests, and preferences, and (c) contain instruction for related

services such as daily living skills (Kardos & White, 2005). The life skills program is compatible

with the focus for IDEA because these skills help with the transition process.


The Administration on Developmental Disabilities (ADD) through the U.S. Department

of Health and Human Services Administration for Children and Families is a strong federal

organization to promote the Independent Living program. The ADD promotes the

Developmental Disabilities Assistance and Bill of Rights Act of 2000 which was established to

assist individuals with developmental disabilities and their families to engage in community

supports, individualized supports, and additional supports to assist in self-determination,

independence, and inclusion in community life (Administration on Developmental Disabilities,

2011). ADD offers funding, monitoring, and policy regulation to developmental disabilities

programs Nationwide (Administration on Developmental Disabilities, 2011).

Another federal agency involved in providing independent living skills for individuals

with disabilities is the National Council on Independent Living (NCIL). The NCIL fosters equal

opportunities for people with disabilities to contribute in society through work, community, and

how he/she lives (National Council Independent Living, 2006). The NCIL is involved in the

legislative process to promote social changes, abolish disability-based discrimination and

barriers, and create more opportunities for individuals with disabilities (National Council

Independent Living, 2006). The NCIL has filed a bill to the Senate HELP Committee to create a

new Independent Living Administration (ILA). The ILA will promote America’s Independent

Living (IL) Program to the federal level (National Council Independent Living, 2011).

The World Health Organization (WHO) acknowledges the needs for individuals who

have disabilities and attempts to integrate these individuals into a universal human experience

(World Health Organization, 2011). One attempt to improve services to individuals with

disabilities is to include these students into educational programming (World Health

Organizations, 2011). WHO also works with the UN Department of Economic and Social Affairs


(UNDESA) to integrate individuals with mental health and disabilities into programs by

recognizing barriers and providing opportunities for the involvement in desired programming

(World Health Organizations, 2011). The Living Independently program is a type of service that

would be beneficial for these individuals with developmental disabilities or mental health.

Objectives



living among adolescents who have developmental disabilities.

Participant will improve a minimum of one performance level in five or more basic

dressing skills on the Living Independently Assessment upon completion of the program.

Participant will improve a minimum of two performance levels in six or more grooming

and personal hygiene skills on the Living Independently Assessment upon completion of

the program.

Participant will improve a minimum of two performance levels in six or more cleaning

and house maintenance skills on the Living Independently Assessment upon completion

of the program.

Participant will improve a minimum of two performance levels in five or more laundry

skills on the Living Independently Assessment upon completion of the program.

Participant will improve a minimum of two performance levels in seven or more food

preparation skills on the Living Independently Assessment upon completion of the

program.

Participant will improve a minimum of two performance levels in three or more shopping

skills on the Living Independently Assessment upon completion of the program.


Participant will improve a minimum of one performance levels in three or more

emergency skills on the Living Independently Assessment upon completion of the

program.

Participant will improve a minimum of one performance levels in three or more

telephone skills on the Living Independently Assessment upon completion of the

program.

Marketing and Recruitment

Stakeholders approached in the marketing efforts would include caregivers of children

that receive services through Rehab Dynamics, local school directors, local special education

teachers and teaching aids, school Parent-Teacher Association’s (PTA), local pediatric

physicians, local pediatric therapy providers, Community Mental Health (CMH), Lucas County

Board of MR/DD, and additional organizations that provide services to individuals with

disabilities such as The Ability Center, Sunshine, and the Autism Society of Northwest Ohio

(ASNO). Each of these stakeholders would be sought out due to his/her relevance to the Living

Independently program. These stakeholders have some influence on the services that each

potential Living Independently participant receives. Marketing to a spectrum of pediatric and

disability services will spread the information about the Living Independently program and

potentially recruit more participants.

The Living Independently program will be discussed with caregivers of children aged 10

and older who are receiving services at Rehab Dynamics. The program is for adolescents age 12

and older, but informing the caregivers early will allow for the caregivers to make future therapy

plans. The caregivers will also be given a flyer (see Appendix G) describing the program as a

reminder after the initial conversation. In person discussions and flyers are the most appropriate


approach for marketing to caregivers because they are already at Rehab Dynamics with their

children and have an open relationship with the therapists. The Living Independently program

can be introduced and discussed while the caregivers are at the facility with their children. The

flyer reinforces the discussions and provides opportunities for caregivers to pass the flyer along

to other caregivers who have children that would benefit from the program.

A brief letter will be sent to the local school district directors and special education

teachers, CMH, pediatric physicians, pediatric therapy providers, Lucas County Board of

MR/DD, The Ability Center, and ASNO describing an overview of the Living Independently

program and contact information. The letter (see Appendix H) will contain a brief summary of

the life skills that will be addressed in the program as well as a brief review of existing literature

that identifies the benefits of a life skills program. A phone call to these stakeholders, especially

the school directors, physicians, therapy providers, and case managers at CMH will also be used

for further marketing purposes. A phone call establishes a rapport with these stakeholders and

allows dialogue and questions to be addressed. The phone call will summarize the goals of the

Living Independently program and contact information for future needs. These stakeholders are

very busy and receive a variety of mail. The phone call ensures that information about the

program was received and validates the therapist’s dedication to the program.

The special education teachers, at-risk teachers, PTA, and Community Mental Health will

also receive a flyer. The flyer will be eye-catching and provide a brief summary about the

available life skills program held at Rehab Dynamics. Contact information will also be provided

on the flyer for an opportunity to ask questions. These stakeholders will be able to pass the flyer

along to others service providers or recipients.


Additional information about the Living Independently program will be posted on the

Rehab Dynamics website. The website can be accessed by anyone searching the internet for

adolescent resources. These marketing strategies are highly cost effective with few materials

needed. Aside from the website and personal conversations, the flyers and letters will only

require the cost of paper, printing, and mailing. The flyer will be clear and organized with the

appropriate amount of information necessary without overwhelming the reader. The flyers would

need to have color printing due to the font color and pictures, therefore costing more than

standard black and white printing. The letter will be brief and to the point. The necessary

amount of literature review and Living Independently information will provide the reader with

the exact amount of content to keep his/her attention. The letter will be professional looking and

printed on letterhead.

The marketing strategies identified are appropriate for each population. The letters are

sent to the local school faculty, Community Mental Health, pediatric physicians and therapy

providers because the individuals in these positions tend to have a higher level of education and a

busy schedule. The letter gives each individual the ability to read the letter when it best fits into

his/her schedule. The review of literature is mentioned within the letter to provide additional

evidence in order to convince the reader that the life skills program will be effective.

Informing the caregivers through conversation is appropriate because the caregivers have

an awareness of the program due to prior conversations during the needs assessment. They have

already been involved in the development of the program. Discussing the Living Independently

program with the caregivers gives the staff and families the opportunity to ask questions

immediately face-to-face. The caregivers demonstrated interest in the life skills program during

the needs assessment and would likely be eager to have more discussions.


The flyer will be used as a tool to spread the information about the Living Independently

program to others. The caregivers and service provides can pass the flyer to someone that would

benefit from the services. The flyer will be written using simple and direct language. It is

important not to assume the recipients of the flyer have an advanced reading and comprehensive

reading level. The flyer is used because a letter might be too time consuming or advanced and

lose the attention of the readers. The colorfulness of the flyer is a great attention grabber.

The marketing strategies cover a wide range of promotional mix. Each marketing strategy

provides enough information for the reader to have a clear understanding of the Living

Independently program with contact information for additional questions. The diversity in

marketing strategies matches the targeted population. Providing information to the local school

systems, PTA, Community Mental Health and other organizations increases the chances of the

program being spread through word of mouth. Word of mouth can increase program awareness

and potentially recruit more young adults who have developmental disabilities who are not

recipients of Rehab Dynamics services. Posting the information on the website gives other

people in the community the opportunity to learn about the program.

Potential Participants

The potential participants participating in the Living Independently program will be between

the ages of 12-18 years old. Both males and females will be participating in the program. All

participants must have at least one type of developmental disability. The program will be held in

Toledo, Ohio but participants from other locations are welcome. Even if living independently is

not the goal of the participant and caregiver, learning the skills in the program will decrease the

participant’s overall level of dependence on his/her family. Participating in the program may

give the caregivers more confidence and comfort allowing their child to be more independent in


the home. The Living Independently program will provide services to eight participants at one

time.

Inclusion Criteria

Inclusion criteria for the program include:

Males and females are invited to participate

Must be between the age of 12-18 years old

Participants will not be turned away due to their current living situation

Participants must have an average score of moderate assistance or less assistance in areas

identified on the Living Independently Assessment

Participants must have the motor skills and coordination to make purposeful movements

Participants must be able to follow at least one-step directions

Participants will not be turned away due to medical diagnosis. All types of developmental

disabilities are invited to participate

Participants living outside Lucas County will not be turned away

Participants will be requires to pay a small fee to participate in the program

The Living Independently program will describe the total number of participants, the number

of males and females, average age, current level of functional independence based off the Living

Independently Assessment, type and generalized description of the disability, the current living

situation, future plans for living environment, and any identified goals from the participant or

caregiver which deals with independence.

The recruiting process will begin at Rehab Dynamics. The therapist will discuss with the

current adolescents, soon to be adolescents and the caregivers about the program. The therapist

will tell the families information such as details about the program, the overall program goals,


and the dates and times of the program. Next the therapist will follow up with phone calls

received from interested caregivers. The therapist will call the families with details about the

program including a description of the life skills, the overall goal of increasing independence,

and the dates and times of the group. Potential participants and families will be invited to a mini

open house before the Living Independently program starts. The open house will give

opportunities for the families to meet the therapist and discuss the program. The open house will

give families insight about what to expect from the program by asking the participants to prepare

a light snack such as pretzels and a drink. During the recruitment process the therapist will

emphasize that the program is not geared toward having the participants move out of his/her

current living situation, but to increase skills to become more independent.

Programming

The programming will be directly related to the objectives. The objectives are to increase

skills in the ODL’s and IODL’s that are addressed during the program. The program will include

the tasks that are measured in the objectives identified on the Living Independently Assessment.

Literature for Programming

Creating a program is a multi-step process that takes time and dedication. Many factors

contribute to developing a program, and completing all the steps will provide the best service

possible. The Living Independently program has utilized program development techniques to

provide the most efficient program for adolescents who have developmental disabilities.

Pearson-Bethea (2001) states the first step to developing a program is to understand the

organizational structure of the facility. The organizational structure has been explored through

the organizational chart (see Appendix A) along with many discussions with the faculty at Rehab

Dynamics. The program must also support the mission of Rehab Dynamics (Pearson-Bethea,


2001) which is to guide children to be successful in their lives and help family members by

providing support and education (Rehab Dynamics, 2002). As previously mentioned, the Living

Independently program will reflect the mission of Rehab Dynamics by educating adolescents on

increasing independent living skills.

Existing literature that addresses a similar plan can assist in the creation of a new

program. The program should be supported by an evidence-based literature review that verifies

the need for a program (Robinson, Herz, & Brennan, 2009). The Living Independently program

is supported by various different types of life skills courses and studies. For example, the Youth

Transition Program (Benz, Lindstrom & Latta, 1999; Benz, Lindstrom, & Yovanoff, 2000) has

found positive outcomes related to teaching adolescents life skills. Other literature such as Steps

to Independence (Baker, Brightman, Blacher, Hinshaw, Heifetz, Murphy, 2009) has provided

resources for teaching life skills. A thorough review of the literature was conducted to confirm

the success of life skills programs.

A very crucial part of program development is the needs assessment. A needs assessment

must be completed in order to determine the need of the community (Robinson, Herz, &

Brennan, 2009). The needs assessment helps the programmer to discover the primary needs of

the population as well as common characteristics, concerns and goals of the participants

(Pearson-Bethea, 2001). The needs assessments were conducted via focus groups and semi-

structured interviews (Fazio, 2008). A thorough needs assessment was completed to ensure the

Living Independently program addresses the current needs of adolescents who have

developmental disabilities.

A strong support group is needed to assist with the development of a program (Robinson,

Herz, & Brennan, 2009). The Living Independently program has a large support group ranging


from University of Toledo faculty; Maureen Wineland, founder of Rehab Dynamics; staff at

Rehab Dynamics; staff at HOPE Community Center; and local caregivers in the Lucas County

area. All stakeholders have played an active role in identifying the need for life skills and

supporting the creation of the Living Independently program.

Marketing is another essential component to program development (Robinson, Herz, &

Brennan, 2009). The Living Independently program is marketed to a diverse variety of

stakeholders with the appropriate marketing materials. According to Robinson, Herz, and

Brennan (2009) stakeholders must have a good understanding of what the program will and will

not include. The letters, flyers and discussions assist with painting a clear picture of the program.

The marketing efforts will continue beyond the letter and flyer by inviting caregivers and

participants to attend a mini open house to learn more about the program.

The next components of program development; design and planning, preparation and

implementation, and program evaluation (Fazio, 2008), all take place after the needs assessment

and marketing. The Living Independently program has been designed based on the results from

the needs assessment and is ready to be implemented. The program will conclude with a program

evaluation asking for the caregivers and participants input about the quality of the program and

areas for improvement.

Assessment

The caregivers will be asked to complete the Living Independently Assessment

(see Appendix I) at the beginning, conclusion, and four week follow up of the program.

Caregivers will be asked to rate their child’s functional performance in various ODL’s and

IODL’s. Sections covered in the assessment include; dressing, hygiene, house maintenance,

laundry, food preparation, shopping, emergency, and telephone use. The Living Independently


Assessment is derived from a combination of the Self-Care Assessment, Home-Care Assessment

(Baker et al., 2009) and the Adolescent Autonomy Checklist (University of Washington, 1984-

1987). All three assessments were compared and combined to develop the Living Independently

Assessment in order to analyze the functional performance of adolescents. Collectively, the

assessments provided a more thorough evaluation tool than separately.

The seven point scale used in the Living Independently Assessment is from the

Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987). The

Living Independently Assessment has a description of the seven point scale on the first page. The

FIM scale will replace the typical scale provided for the Self-Care Assessment, Home-Care

Assessment, and the Adolescent Autonomy Checklist to account for sensitivity. In the original

form, the three assessments measure participants by; no basic skills, needs assistance, and can

complete independently. These measurements provide little opportunity for changes in the

overall score. Since a participant may increase skills and require significantly less assistance

without seeing progress on the existing scale, the seven point FIM scale will be implemented as

an alternative.

Programming with Role Acquisition

The Role Acquisition model was designed to help an individual who is experiencing a

role transition or is having difficulty completing roles in his/her current living situation (Mosey,

1986, Chap. 26). The participants in the Living Independently program are experiencing a shift

as he/she matures into adulthood. These participants are also experiencing a shift from having

services as a child to a reduction in the total amount of services available. As services for

adolescents decreases, these individuals are lacking the support needed and are experiencing a

hardship in completing social roles such as independent living skills.


The Role Acquisition model has a large focus on the learning process (Mosey, 1986,

Chap. 26). Many of the learning principles identified in the Role Acquisition model are

implemented in the Living Independently program. According to Mosey (1986) learning is

increased when the participant is able to learn at his/her current level and learn at a pace that is

comfortable. The Living Independently program provides a review session to allow each

participant to work at his/her own speed. The group addresses the topic as a whole, with the

opportunity to work individually during the review session. Parallel to Role Acquisition, the

Living Independently program also provides active participation with frequent reinforcements,

opportunities for trial and error, and repetition during the session and the review.

The Living Independently program also uses a variety of simulated and natural

interventions. Participants will practice using a simulated approach to develop the conscious

awareness of the task. When possible, the participants will move to the naturalist approach to

further develop skills and decrease overall level of attention necessary for the task (Mosey, 1986,

Chap. 26).

The Living Independently program focuses mainly on the role section of the Role

Acquisition. However, many of the skills are concurrently addressed throughout the program.

The task skills such as willingness to participate, ability to follow directions, use of tools, and

attend to detail (Mosey, 1986, Chap. 26) will all be challenged in the program. The participants

must develop the acceptance of engaging in the task and be able to follow along with the

therapist’s directions. The participant will have several opportunities to utilize tools and increase

the ability to notice details during sessions such as cleaning and meal preparation.

Mosey (1986, Chap. 26) states that ODL’s should be demonstrated before the participant

attempts to complete the task, and learning should start in a treatment center but follow up in the


community if possible. A majority of the sessions in the Living Independently program starts

with the therapist demonstrating how to complete the task. Unfortunately a majority of the

program will take place in Rehab Dynamics. However, the sessions will be taught in the natural

and appropriate rooms. The participants will have the Also, the opportunity to practice shopping

at a local grocery store.

Mosey (1986, Chap. 26) also states that the therapist should break down the steps for

each ODL and determine the proper sequencing. The steps can be taught through chaining or

successive approximation (Mosey, 1986, Chap. 26). Each of the life skills covered in the

program are broken down into small steps. Frequently, the recommendation to use backward

chaining is suggested if participants struggle with the task.

Interventions

The Living Independently program will be conducted at Rehab Dynamics. The program

will use a variety of spaces such as the gym, kitchen, craft room, and other rooms to keep the

attention of the participants. One shopping session will be completed at the local Kroger store to

provide the most naturalistic occupation. A variety of occupational forms and learning principles

will be used for the interventions to maximize the participants overall learning experience.

The use of groups is a beneficial approach to the occupational interventions. Groups work

together to reach a common goal, acquire new skills, and complete a task (Kielhofner, 2009).

Groups based on life skills such as meal preparation would be an effective teaching method. The

group would learn the skills together and be able to work as a team to problem solve and

complete the task. The participants would have to work together to identify what utensils are

required and the steps necessary to prepare the food.


Each session will start by “setting the stage” for learning (Baker et al., 2009). The

therapist will select the most appropriate room that is relevant to the topic and has few

distractions. The therapist will introduce the topic and discuss with the participants the

components of the task and reasons for learning the identified skill. Setting the stage is a

technique used to orient the participants and get them ready to learn.

Using a checklist or establishing a routine is a common learning approach used for

individuals who have disabilities (Baugher & Pyne, 2012). During the hygiene sessions,

participants will be asked to organize the steps of showering. The participants will be able to

keep the organized steps and use as a checklist for home when showering. Similarly, the

participants will be asked to put the steps of washing dishes in proper order. Each participant will

receive a copy of the correct dish sequence to follow at home.

Considering the student’s zone of proximal development is another effective approach to

the Living Independently program. The zone of proximal development is the distance between

the child’s current level of development and the possible level reached though independent

problem solving and the child’s potential (Kaplan, 2010). Mosey acknowledges that learning is

enhanced when the interventions start at the participants current level of functioning. The task

can become more challenging when the client feels comfortable (Mosey, 1986, Chap. 26). Using

this approach in the Living Independently program would allow each participant to advance in

skills at his or her individual level. The therapist would gage the participant’s current level of

development and determine his or her potential to complete tasks.

This approach is used frequently through the simulated practice and modified

occupations. When learning how to wash dishes, the participants are asked to simulate washing

the dish with the dish rag without the water. Once participants feel comfortable cleaning all


surfaces of the dish, the occupation increases the challenge by washing the dish in water.

Another example of this approach is the sweeping session. Participants are first asked to

demonstrate the proper hand positioning and sweeping motion without sweeping the floor. Next,

large pieces of crumpled newspaper are thrown on the floor to sweep. As the participant’s

comfort and competence level increases the size of the items to sweep decreases. In addition, the

review session provides additional opportunities for the participant to continue practicing the

skill at his/her level.

Choice is another important factor to consider. Giving participant’s choice in the life

skills program can increase overall participation. Mosey (1986, Chap. 26) found that the

participants overall motivation is very important in the learning process. Giving the participants

the ability to make a choice can increase their overall level of motivation. The meal preparation

area is a great opportunity for the participants to make choices. The therapist will give the

participants the opportunity to select the meal they would like to cook. The entire cooking

session will be based on what the participant wants in the attempt to increase his/her level of

participation.

Practice is another principle identified in the Living Independently program. The

participants will be able to repeat their practice on the skills during the session and review.

Having the opportunity to practice increases the chances of the participants exhibiting long-term

learning with carryover (Kaplan, 2010). This provides evidence that the students will be able to

perform the occupations even after the program has concluded. During the practice approach, the

therapist will want to consider the participants overall performance in daily occupations and

routines (Palisano, Snider, & Orlin, 2004). The therapist will use the progress notes to record

each participant’s performance during all sessions. The therapist will refer back to the progress


notes and address these skill areas during the review for further practice. Repetition and practice

is considered to be an effective technique to facilitate learning (Mosey, 1986, Chap. 26; Kotler &

Koenig, 2012)

Examples of practice would be during the telephone occupations. The therapist will

practice proper telephone manners with the participants. The participants will also practice

dialing the correct numbers on the phone and looking up different phone numbers from various

locations (phonebook, newspaper, menu, or internet). The therapist will give each participant the

opportunity to practice making a phone call to another participant in a separate room using two

phones. Each of these skills will be practiced multiple times until the participant feels

comfortable.

Program Outline

The Living Independently program is made up of several different sessions. Each ODL

and IODL is taught over consecutive sessions before the next skill is introduced. The Living

Independently program will meet twice a week for one and a half hours each session. The Living

Independently program will run for 17 consecutive weeks. The order of the sections is as

follows:

Safety section will meet for a total of four sessions

Telephone section will meet for a total of three sessions

Hygiene section will meet for a total of four sessions

Dressing section will meet for a total of two sessions

Cleaning section will meet for a total of five sessions

Laundry section will meet for a total of five sessions

Shopping section will meet for a total of four sessions


Meal preparation section will meet for a total of six sessions

The very last session of the program will be a party to celebrate the success of the

program

Each section has one review session at the conclusion of the section. The review session is

designed to provide an additional opportunity for participants to practice the occupation. The

therapist will have the progress notes to keep track of each participant’s performance in the skill

area. During the review session, the therapist will review the progress note and have each

participant practice the skill that needs the most improvement. Please see the separate Living

Independently binder for the Living Independently program.

Direct and Indirect Services

Direct services are the services the therapist provides to the participants while they are at

the Living Independently program (Fazio, 2008). These include the physical attendance during

the occupations, the assistance, feedback and suggestions, the group discussions, and the group

and individual interactions during the skill areas.

Indirect services for the Living Independently program include discussions before or after

the sessions with the caregivers. The therapist will provide suggestions and encouragement to the

caregivers about techniques for his/her child to practice at home. The therapist will emphasize

the importance of providing additional opportunities for the participants to practice skills outside

of Rehab Dynamics. The information discussed may be very beneficial for the caregivers and

offer support in the process of teaching his/her child to become more independent.

Writing progress notes and preparing for the review session will be another indirect

service. The therapist will write individualized progress notes at the conclusion of each session.


These progress notes will be used when preparing for the review session. The therapist will have

to decide which areas need more practice, according to the progress note.

Additional indirect services include the preparation and clean up for sessions. Some

sessions such as the meal preparation and hygiene require set-up before the participants arrive.

The therapist must purchase some of the food required for the meal preparation section. The

participants will have a scavenger hunt to find the steps of washing dishes. The therapist must

organize the scavenger hunt and hide the clues around the facility. The therapist will also have to

clean up the area by putting the equipment in the proper location.

Documentation System

Each participant will have his/her own folder that contains personal information about the

Living Independently program. The folders will be stored in a locked filing cabinet in the front

office when the therapist is not using them. The Living Independently Assessment that was

completed by the caregiver at the beginning, conclusion and four week follow-up of the program

will be in the chart. The therapist will also have individualized goals for each participant based

on results from the Living Independently Assessment in the chart. The folder will also contain

the progress notes (see Appendix J) that are written after each session. The therapist observes the

participant engaging in the ODL’s and IODL’s and summarizes the quality of performance, level

of assistance needed, and progress toward each goal pertaining to that life skill. The progress

notes will be analyzed prior to the review session to determine what skills each participant needs

extra practice. Lastly, an evaluation summary (see Appendix K) will be in the folder. The

evaluation summary is used for the therapist to document each participant’s progression

throughout the entire Living Independently program. The summary will identity which goals


were and were not met, areas of improvements, areas that need additional practice, and

recommendations for the future.

Program Discharge

All participants will be discharged from the Living Independently program at the

conclusion of the 17 week course. At that time the therapist will complete an evaluation

summary (see Appendix K) about the participant’s overall occupational performance. The

therapist will suggest the participant returns to the program again if the therapist believes that

he/she has potential for more improvement in independent living skills.

Budgeting and Staffing

Please see Appendix L for budgeting and staffing outline. The occupational therapist

(OT) and certified occupational therapy assistant (COTA) personnel hired must be certified by

the National Board for Certification in Occupational Therapy (NBCOT) and licensed in the State

of Ohio. The OT will be hired to facilitate the life skills program 5 hours each week during the

17 week program. The OT will also be allotted 1 week to prepare for the program and 1 week to

analyze the four week follow-up information from the caregivers. The COTA will be hired to

assist for 3 hours a week during the 17 weeks for programming. The Living Independently

program will be held on Tuesday and Thursday afternoons for one and a half hours each session.

The OT will be responsible for the preparation for each session, instructing the participants about

the specific life skill being taught, clean-up after sessions, writing a progress note for each

participant, and discussing progress and strategies to use at home to facilitate independence with

caregivers before or after sessions. The therapist will have one hour each session for the

preparation, clean-up and discussions. The sessions do not require a great deal of preparation or

clean-up in which the participants cannot assist in completing. The COTA will be available to


assist with facilitating the group and provide an opportunity for the therapist to document

throughout the session to reduce the amount of documentation after the participants have left the

program. The extra hour each session will be sufficient amount of time for the OT.

The average hourly wage for an occupational therapist in the state of Ohio earns

approximately $31 per hour (American Occupational Therapy Association, 2010). The therapist

will be working a total of 95 hours during the program. Therefore, the occupational therapist will

be paid $2,945. No fringe benefits will be offered for this part-time position. The average hourly

wage for a certified occupational therapy assistant in the state of Ohio earns approximately

$20.50 per hour (American Occupational Therapy Association, 2010). The COTA will be

working a total of 51 hours during the program and will be paid $1,045.50. No fringe benefits

will be offered for this part-time position.

The Living Independently program will require some basic essentials. The computer,

printer, ink, and paper will all be used for the marketing efforts, printing the Living

Independently Assessments, and to create the documents for note writing. The stamps and

envelopes will be used to send out the marketing tools to various stakeholders. The 3-ring

binders will be used as the folder that contains information about each participant. The folders

will be stored in the locked filing cabinet in the front office. The dry-erase board will be used

frequently during the Living Independently program for the therapist to write notes for all

participants to see. Rehab Dynamics has multiple landline phones and a phone provider. There

are two working phones that can be used for the telephone sessions. Rehab Dynamics is willing

to cover the cost of the phones and phone line.

The grooming section will cover basic life skills such as washing hands, managing finger

nails, washing hair, using a mirror, washing face, brushing teeth, managing hair, and applying


deodorant. The liquid and bar soap will be used during the hand washing and showering

sessions. The participants should practice using the type of soap that is used at home. Hand soap

may be too harsh for the face; therefore, participants will practice washing his/her face with

simple face wash. For sanitary purposes and opportunities to practice, each participant will have

his/her own finger nail clipper and nail file to use. The participants will practice squeezing the

proper amount of shampoo out of a typical shampoo bottle. The shampoo does not have to be a

certain brand but should be a full sized bottle for a realistic practice. The participants will use the

mirror to practice spot checking self in the mirror. One mirror can be shared between two

participants. Using handheld mirrors ensures that all participants have the chance to use the

mirror in an environment which is not distracting. The mirrors in the bathroom would be too

distracting and interrupt the group dynamics.

Each participant is being taught about the importance of not sharing hair brushes or

toothbrushes. Each participant will have his/her own toothbrush and hair comb to practice using.

The individual brushes are more sanitary and prevent spreading germs. Only one tube of

toothpaste is needed among the group. The toothpaste can be any brand but should be standard

sized to practice squeezing the toothpaste. In addition, the program only needs one roll of the

dental floss and mouthwash. The participants can get him/her a piece of dental floss and put

some mouthwash into a small solo cup. Lastly, the deodorant should also be for each individual

for sanitary reasons. Deodorant does not need any adjustments in squeezing or manipulation

based on size, therefore, travel sized deodorant can be used to decrease overall cost. It is

important to note that special products may need to be purchased due to allergies.

The dressing sessions are relatively inexpensive with many in-kind costs. The program

will purchase one package of calf-high and knee-high socks. Each participant will only need one


sock to practice putting on socks. Rehab Dynamics will split the cost for button-up shirts and

jackets. The shirts will be used to practice buttoning actual clothes and the jacket will allow for

participants to practice zipping. Rehab Dynamics has four of both the button-up shirt and jacket.

Rehab Dynamics is also able to cut the cost for the cleaning sessions. Rehab Dynamics is

willing to provide the brooms, vacuum, and garbage cans. Each participant will have the

opportunity to practice using a standard flat kitchen broom, push broom, and a vacuum. One can

of shaving cream is needed to practice the proper motions for cleaning. Participants will practice

using a spray bottle filled with water before using a spray bottle filled with cleaner solution. All

participants should have a spray bottle to keep the attention and focus during the session. One

bottle of all purpose cleaner and window cleaner will be a sufficient amount of cleaning supplies.

Each participant will practice removing and replacing a garbage bag in the garbage can. A

garbage bag for each participant will provide opportunity to practice opening the garbage bag

and maneuvering the bag into the can. Rehab Dynamics has all dishes, dish rack, and wash cloths

for washing dishes. The program will need to purchase the dish soap.

Practicing making the bed is a common need identified on the needs assessment.

Purchasing a twin sized air mattress gives the opportunity to practice making the bed. The size of

the air mattress is realistic to a bed but can be easily deflated and stored. A regular mattress is

more costly and consumes more space while not being used. One set of sheets and one pillow

will be needed to practice making the bed. The fabric and pattern on the sheets is irrelevant to the

program.

Laundry skills are another area that was commonly mentioned during the needs

assessment. Rehab Dynamics is able to cut the cost by providing various clothing items to wash

and hang on hangers. Rehab Dynamics currently does not have a washing machine or a dryer and


the program will require the purchase of a washer and dryer. Although washers and dryers may

vary among style, participants can learn the basics at Rehab Dynamics and continue practice at

home. The washer and dryer will give participants a naturalistic experience instead of simulated

occupations. The program will also need to purchase the laundry detergent and fabric softener

sheets for washing and drying clothes. One package of tubular, wire, plastic, and wood hangers

will also be purchased. Participants will learn the different styles of hangers and in what

situations each type of hanger should be used.

Participants will practice basic shopping skills. Food items of various densities will be

purchased for participants to practice bagging groceries. The participants will also construct a

shopping list based on items that are needed at Rehab Dynamics. The group will meet at a local

grocery store and purchase the items on the list. The staff at Rehab Dynamics will pre-approve

the list, and cover the cost of the items purchased.

The meal preparation sessions will require a stovetop oven, various kitchen appliances,

utensils, and food. Rehab Dynamics has most of the appliances and utensils that are required.

The Living Independently program will require the purchase of a stovetop oven. Currently,

Rehab Dynamics only has a toaster oven. Participants will be learning the basics of cooking on a

stovetop and in the oven. An electric stovetop oven will be purchased for the group. The group

will be learning how to make basic sandwiches, prepare fruit, cook microwave foods, cook in the

oven, and make an entire meal. The program is providing $100 to cover the cost of all meal

preparation food items to be purchased.

Lastly, the program will conclude with a party. The group is allowing $40 to throw the

party. The $40 will include some decorations and food.


Rehab Dynamics will not charge the Living Independently program a fee for space or

utilities that are being used.

Each participant will have a participation fee of $40. The small fee is to reduce the

overall cost of the program. Rehab Dynamics is willing to work with the families to create

payment plans if families cannot afford the $40 at one time.

Personnel

The occupational therapist and certified occupational therapist assistant must be certified by the

National Board for Certification in Occupational Therapy (NBCOT) and licensed in the State of

Ohio. The occupational therapy practitioners will be preferred, but not mandated, to have at least

one year of experience working with adolescents who have intellectual or developmental

disabilities. Please see Appendix M for job description. The personnel positions will be enlisted

in the Toledo Blade Newspaper Please see Appendix N for advertisement.

Funding Sources

The Living Independently program will be grant funded to reduce the overall cost for

families. Insurance companies will not be billed for the Living Independently program due to the

variety of insurance and coverage. Instead, the program will be funded with a small fee from the

families and grants. Three potential funding sources are; the Stranahan Foundation, Reinberger

Foundation, and May and Stanly Smith Charitable Trust.

The goal of the Stranahan Foundation is to help people become independent and

responsible citizens (Stranahan Foundation, 2010). The Stranahan Foundation supports nonprofit

organizations that have reliable leadership and programs that are effective in meeting the current

needs of the community (Stranahan Foundation, 2010). Proposals should identify a plan to meet

the current needs in a unique approach, use of community resources, support from the


community, measurable results, and a plan to continue financial support (Stranahan Foundation,

2010). The Living Independently program is a great match to receive a grant from the Stranahan

Foundation. Both goals from the Stranahan Foundation and Living Independently program focus

on increasing independence. The Living Independently program meets the current needs of the

community as identified from the needs assessment. The program provides a variety of

interesting educational approaches and is a unique service for adolescents. The community is

largely involved in the program, with stakeholders throughout the community supporting the

program and community members participating in the program. The success from the program

will be evident with the Living Independently Assessment administered at the beginning,

conclusion, and four week follow-up. Lastly, the plan is for the program is to reduce the total

cost and will not require much funding in the future.

The Stranahan Foundation prefers programs that fall within the five priority areas of

interest: education, physical and mental health, ecological well-being, arts/culture, and human

services (Stranahan Foundation, 2010). The Living Independently program falls into the

education area by providing an alternative educational opportunity. The life skills program also

falls under the category of human services. The Foundation is committed to strengthening the

community by helping disadvantaged individuals with the ability to; access services that meet

basic needs, have opportunities to engage in community life, and achieve self-sufficiency and

contribute to the community (Stranahan Foundation, 2010). The life skills program teaches basic

life skills in order for each participant to become active in the community.

All applicants applying for a grant must be a nonprofit organization as defined in Section

501. To apply for a grant from the Stranahan Foundation, all applicants must submit a letter of

inquiry. Letters of inquiry should be sent via the e-grant system; stranahan.egrant.net. The

http://stranahan.egrant.net/


applicant can submit the full proposal after the letter of inquiry is reviewed and approved

(Stranahan Foundation, 2010). The deadline date to submit a letter of inquiry is May 1, 2012 and

November 1, 2012 (Stranahan Foundation, 2010). The Foundation website did not identify a

floor or ceiling amount of money for funding.

Another local funding source would be the Reinberger Foundation. The Reinberger

Foundation is dedicated to improving quality of life for all individuals. The Foundation supports

programs that include one of the areas of arts, education, human service-health, and human

services-other (Reinberger Foundation, n.d.). The Living Independently program would qualify

under the human services-other category, where child and Youth programming are listed. The

Living Independently program will assist the adolescent population by providing services that

increase independent living which could increase overall quality of life.

The Reinberger Foundation will accept applications from non-profit organizations,

preferably from the Northeast Ohio or greater-Columbus area. Applicants for the human

services-other grants must submit a letter of inquiry by September 1. Letters of inquiry are

limited to two pages. Letters of inquiry should be mailed to 30000 Chagrin Blvd., #300

Cleveland, OH 44124. The letter of inquiry will be reviewed and the applicants will be notified

within one month for a request for a full proposal or a decline. The deadline for the full proposal

is November 1. The Foundation website does not identify a ceiling or floor amount of money

granted (Reinberger Foundation, n.d.).

The May and Stanley Smith Charitable Trust is dedicated in providing opportunities for

children, youth, elderly, people with disabilities or who are critically ill, and disadvantaged

adults and families (Adminitrust LLC, 2012). The opportunities for these populations are geared

toward improving overall quality of life, the promotion of self-sufficiency and assistance in


reaching one’s highest potential (Adminitrust LLC, 2012). The Trust grants funding to

organizations that provide direct services to individuals in the effort to make a long-term

difference in the life of each person served (Adminitrust LLC, 2012). In the area of children and

youth, the Trust is devoted to promote healthy development and future independence for all

children (Adminitrust LLC, 2012). The goal of the Living Independently program is to educate

the students about the skills necessary to live independently. The May and Stanley Smith

Charitable Trust is highly interested in programs that encourage independent living situations by

providing educational, physical, and life skills programs for individuals who have disabilities or

are critically ill (Adminitrust LLC, 2012). The content in the life skills program matches

perfectly with the values and interests of the May and Stanley Smith Charitable Trust.

Independent living and achieving one’s highest potential is the overall goal for the Living

Independently program and the May and Stanley Smith Charitable Trust.

The May and Stanley Smith Charitable Trust does not have a limit on amount of money

being requested. Applicants can submit a letter of inquiry at anytime throughout the year. A

deadline will be determined if the applicant is asked to submit a full proposal. Prior to submitting

the letter of inquiry, the website provides an eligibility quiz for applicants to complete to

determine if their request matches the criteria for the Trust. The application process in a two-

stage process: the online letter of inquiry and the full proposal. Staff reviews the letter of inquiry

and determines if the applicant should submit the full proposal (Adminitrust LLC, 2012).

Applicants will be notified within a month of submitting the letter of inquiry. If the review board

accepts the letter of inquiry the applicant will be asked to submit the full proposal. Applications

are accepted based on the potential for success, capacity of the requesting organization,

compliance to the application guidelines, and appropriateness of the proposal to May and Stanley


Smith Charitable Trust’s mission. The entire application process takes between four to six

months (Adminitrust LLC, 2012).

Self-Sufficiency

The Living Independently program will be able to maintain self-sufficiency beyond the

first year. The total cost to run the program will decrease after the first session. The expensive

equipment such as the washer, dryer, and stovetop oven can be reused and will not have to be

purchased again. The Living Independently program does not have a long expense list to run

each session. The total cost for personnel can also be reduced. After the program has been

successful, the program will be able to hire new personnel. The certified occupational therapist

assistance (COTA) can take over the program and run the sessions. Rehab Dynamics will be able

to pay the COTA less money than the occupational therapist. A group assistant without any type

of certification can assist the COTA during the group. Rehab Dynamics has many students

completing school assignments. The program will also be able to utilize the students to assist

with the class, which would eliminate the cost of a group assistant. The overall cost of the

program will decrease the following years.

Program Evaluation

Caregivers will be asked to complete the Living Independently Assessment at the start of

the program, end of the program, and four weeks after the program. The Living Independently

Assessment will measure the participant’s performance level using the seven point scale from the

FIM. Caregivers will score their child’s level of independence in dressing, grooming,

cleaning/house maintenance, laundry, food preparation, shopping, emergency, and telephone use.

The therapist will compare the answers from the beginning, end, and follow up assessments to


determine if the participant showed any progress. The therapist will be able to determine if the

objectives were met based on the score of each of the life skills.

The objectives are geared to measure an increase in each skill category. The objectives

account for all independence levels and allow each participant to progress at his/her own pace.

The participants do not need to become completely independent in order to meet the objectives.

Each objective identifies the performance level to be achieved in each skill category for a certain

amount of skills. For example, the dressing category states that the participant will improve a

minimum of one performance level in five or more dressing skills. If one participant is scored as

needing moderate assistance for putting on socks, starting a zipper, buttoning, putting on a front

open shirt, and selecting clothes appropriate for the weather at the beginning of the program and

at the end of the program the participant is able to complete these tasks with minimal assistance,

the participant met the objective. However, if the participant still required moderate assistance in

four of the five skills, the objective would not be met. At the same time, if a participant was

scored to need supervision in the same five skill areas at the beginning of the program and is able

to complete the skills with modified assistance, that participant also met the objective. Each

participant is able to meet the objectives regardless of performance compared to one another.

The therapist must compare the results from the assessment at the start, conclusion, and four

week follow-up to determine if the objectives were met.

Prior to starting an occupation, the therapist will discuss with the participants the purpose

and intentions for each occupation. The therapist will summarize the discussion and ask all

participants if they understand the occupation. The therapist and COTA will facilitate each

session and provide opportunities for each participant to attempt the occupation. The OT and

COTA will evaluate the performance through observations and document the participant’s


performance on the progress note. The therapist will compare the performance to the answers on

the Living Independently Assessment and decide if the participant needs further practice. Further

practice will be determined based on performance and progression toward each objective. This

process will be repeated for each life skill category.

The caregivers play a key component in the evaluation process. Each caregiver will be

asked to evaluate his/her child at the beginning, end, and four week follow-up. The therapist will

also meet with the caregivers frequently to discuss progress and any potential concerns. The

therapist will reassure that the caregivers and the therapist both agree on the progress and

objectives. In addition to the Living Independently Assessment, the caregivers will also be asked

to complete a Living Independently Program Evaluation (see Appendix O). The evaluation will

be a survey that contains questions regarding usefulness of discussions and suggestions provided

by the therapist, the overall quality of the program, and how the program could improve. The

surveys will be mailed out by the office staff, three weeks after the program has ended. The

surveys will contain a pre-stamped envelope for the caregiver to return the survey. The

caregivers will be asked to return the survey within one week. The therapist will inform

caregivers about the survey during the last week of the program.

The evaluation methods to evaluate the participant’s progress and caregiver’s satisfaction

are achievable and will provide a thorough evaluation of the program. The Living Independently

Assessment and caregiver survey will be an effective way to conduct a summative evaluation of

the program. The therapist will also formatively evaluate the program by observing the

participant’s performance throughout the course of the program. The therapist will have the

opportunity to work one-on-one with all participants during each of the life skills. The therapist

will watch the participant’s overall performance and monitor his/her progress. The therapist will


also communicate with the caregivers about the participant’s progress. The therapist will make

any necessary changes to the rest of the program based on the observations and conversations

with the participants and caregivers. If major discrepancies are found between the results on the

Living Independently Assessment and the therapist observations, the therapist will use the results

on the Living Independently Assessment for consistency and true occupational performance at

home.

Timeline

The timeline of responsibilities for the occupational therapist is available in Appendix P.

The therapist will start the program by conducting a needs assessment, marketing, recruiting

participants, printing the forms, facilitating the open house, asking caregivers to complete the

Living Independently Assessment, and creating individualized goals for each participant. The

therapist will have to purchase the non-perishable items at the beginning of the program. The

therapist will also be responsible for shopping for more supplies as the program progresses into

sessions that require a shopping experience or food.

The therapist will be responsible for communicating with the caregivers, facilitating the

biweekly life skills classes, writing progress notes, observing the participants, and making

adjustments as needed throughout the entire program. The therapist must be active in these steps

to ensure the best quality of education and program thoroughness. The therapist is responsible

for overseeing the entire program process.

The therapist will also be responsible for asking the caregivers to complete the Living

Independently Assessment and analyzing the results. The therapist will have to compare the

results from the assessment at the beginning, end, and four week follow-up. The therapist will

also have to evaluate each participant’s performance at the conclusion of the program. The


therapist will review the results from the caregivers on the Living Independently Program

Evaluation (see Appendix O).

Letter of Support

A letter of support will be signed by Maureen Kane-Wineland, the co-owner of Rehab

Dynamics (see Appendix Q). The letter will contain a brief summary about the needs for the

program and predicted program outcomes. Please see Appendix R for a list of additional

stakeholders who would be able to write letters of support for the Living Independently program.

The letters would be from staff, caregivers, disability advocates, and other key stakeholders that

support the program. The letters will be available to provide evidence for potential participant

families, community members or funding sources about the quality of the program. Letters of

support will be printed on letter head if applicable.


References

Administration on Developmental Disabilities, (2011). About ADD. Retrieved from

http://www.acf.hhs.gov/programs/add/addabout.html

Adminitrust LLC. (2012). May and Stanley Smith Charitable Trust. Retrieved from

http://www.adminitrustllc.com/may-and-stanley-smith-charitable-trust/for-grantseekers/

American Occupational Therapy Association, (2008). Occupational therapy practice framework:

Domain and process (2nd ed). American Journal of Occupational Therapy, 62, 625-683.

American Occupational Therapy Association. (2010). Occupational therapy compensation and

workforce study. Retrieved from

http://www.nxtbook.com/nxtbooks/aota/2010salarysurvey/index.php

Arnold-Reid, G.S., Schloss, P.J., & Alper, S. (1997). Teaching meal planning to youth with

mental retardation in natural settings. Remedial and Special Education, 18, 166-173.

Baker, B.L., Brightman, A.J. Blacher, J.B., Hinshaw, S.P., Heifetz, L.J., & Murphy, D.M.

(2009). Steps to independence: Teaching everyday skills to children with special needs

(4th ed.). Baltimore, MD: Paul H Brookes Publishing Co.

Baker, B.L., Brightman, A.J. Blacher, J.B., Hinshaw, S.P., Heifetz, L.J., & Murphy, D.M.

(2009). Setting the stage. Steps to independence: Teaching everyday skills to children

with special needs (pp. 27-30, 4th ed.). Baltimore, MD: Paul H Brookes Publishing Co.

Baugher, E., & Pyne, K., (2012). Family minded: Supporting families with children with autism.

OT Practice, 15-19.

Benz, M.R., Lindstrom, L., & Latta, T. (1999). Improving collaboration between schools and

vocational rehabilitation: The youth transition program model. Journal of Vocational

Rehabilitation, 13, 55-63.


Benz, M.R., Lindstrom, L., & Yovanoff, P. (2000). Improving graduation and employment

outcomes of students with disabilities: Predictive factors and student perspectives.

Exceptional Children, 66, 509-539.

Boyle, C.A., Boulet, S., Schieve, L.A., Cohen, R.A., Blumberg, S.J., Yeargin-Allsopp, M.,

Visser, S., & Kogan, M.D. (2011). Trends in the Prevalence of Developmental

Disabilities in US Children, 1997-2008. Pediatrics, 127, 1034-1042.

Brown, I. (2007). What is meant by intellectual and developmental disabilities. In I. Brown & M

Percy (Eds.), A comprehensive guide to intellectual and developmental disabilities. Pp. 3-

15. Baltimore, MD: Paul H. Brookes Publishing Co.

Crepeau, E.B., Cohn, E.S., & Schell, B.A. (2009). Glossary. In E.B. Crepeau, E.S. Cohn, & B.A.

Schell (Eds.), Willard and Spackman’s occupational therapy. (11th ed, pp. 1153-1170.).

Baltimore, MD: Lippincott Williams & Wilkins.

Cronin, M.E. (1996). Life skills curriculum for students with learning disabilities: A review of

the literature. Journal of Learning Disabilities, 29, 53-68.

Fazio, L. (2008). Developing occupation-centered programs for the community. (2nd ed,). Upper

Saddle River, NJ: Pearson Education Inc.

Functional Independence Measure, (n.d.). Functional Independence Measure and Functional

Assessment Measure [pdf document]. Retrieved from http://www.dementia-

assessment.com.au/symptoms/FIM_manual.pdf

Inge, K. (1995). A national survey of occupational therapists in the public schools: An

assessment of current practice, attitudes and training needs regarding the transition

process for students with severe disabilities. Unpublished doctoral dissertation, Virginia

Commonwealth University. Richmond, VA. Individuals with Disabilities Education Act


of 1990. In Kardos, M., & White, B.P. (2005) The role of the school-based occupational

therapist in secondary education transition planning: A pilot survey study. The American

Journal of Occupational Therapy,59, 173-180.

Kaplan, M. (2010). A frame of reference for motor skill acquisition. In P. Kramer & J. Hinojosa

(Eds.), Frames of reference fort pediatric occupational therapy. (3rd ed., pp. 390-424).

Philadelphia, PA: Lippincott Williams & Wilkins.

Kardos, M., & White, B.P. (2005) The role of the school-based occupational therapist in

secondary education transition planning: A pilot survey study. The American Journal of

Occupational Therapy,59, 173-180.

Keith, R.A., Granger, C.V., Hamilton, B.B., & Sherwin, F.S. (1987). The Functional

Independence Measure: A tool for rehabilitation. Advances in Clinical Rehabilitation, 1,

6-18.

Kielhofner, G. (2009). The functional group model. In G. Kielhofner (Ed.), Conceptual

foundations of occupational therapy process. (4th ed., pp.108-126). Philadelphia, PA:

F.A. Davis Company.

Kohler, P.D., & Field, S. (2003). Transition-focused education: Foundation for the future. The

Journal of Special Education, 37, 174-183.

Kotler, P.D., & Koenig, K.P., (2012). Authentic partnerships with adults with autism. OT

Practice, 6-9.

Lehoux, P., Poland, B., & Daudelin, G. (2006). Focus group research and “the patient’s view.”

Social Science and Medicine, 63, 2091-2104.

Morse, T.E., & Schuster, J.W. (2000). Teaching elementary students with moderate intellectual

disabilities how to shop for groceries. Exceptional Children, 66, 273-288.


Mosey, A.C. (1986). Role Acquisition: An acquisitional frame of reference. Psychosocial

components of occupational therapy. New York: Raven, 450-476.

National Council for the Dissemination of Rehabilitation Research (2006). In E.B. Crepeau, E.S.

Cohn, & B.A. Schell (Eds.), Willard and Spackman’s occupational therapy. (11th ed, pp.

184.). Baltimore, MD: Lippincott Williams & Wilkins.

National Council Independent Living, (2006). About NCIL. Retrieved from

http://www.ncil.org/about.html

National Council Independent Living, (2011). News and Advocacy. Retrieved from

http://www.ncil.org/news.html

Palisano, R.J., Snider, L.M., & Orlin, M.N. (2004). Recent Advances in Physical and

Occupational Therapy for Children with Cerebral Palsy. Seminars in Pediatric

Neurology,11, 66-77.

Peterson-Bethea, D., (2001). Developing programs in community-based practice, OT Practice

Online. Retrieved from http://www.aota.org/Pubs/OTP/1997-2007/Features/2001/f-

061801.aspx

Powell, N. J. (1994). Content for educational programs in school-based occupational therapy

from a practice perspective. American Journal of Occupational Therapy, 48, 130–137.

Rehab Dynamics. (2002). Rehab Dynamics. Retrieved from

http://www.rehabdynamics.com/index.htm

Reinberger Foundation, (n.d.) Apply for Support. Retrieved from

http://www.reinbergerfoundation.org/proposals.html

Robinson, M., Herz, N.B., & Brennan, C. (2009). Program development and beyond: Creating a

sustainable program, OT Practice, 15, 37-44.

http://www.ncil.org/about.html

http://www.rehabdynamics.com/index.htm


Rogers, S.L. (2010). Common conditions that influence children’s participation. In J. Case-Smith

& J.C. O’Brien (Eds.), Occupational therapy for children (pp. 146-192). Maryland

Heights, MO: Mosby Elsevier.

Scott, J. (2001). Occupational therapy for adolescents with autism. Developmental Disabilities

Special Interest Section Quarterly, 24, 1-3.

Shattuck, P., (2011, February 24). Adults with autism and their families often left without help

after high school [Web log post]. Retrieved from http://blog.autismspeaks.org/tag/dr-

paul-t-shattuck/

Smith, M.D., & Belcher, R. (1985). Teaching life skills to adults disabled by autism. Journal of

Autism and Developmental Disorders, 15, 163-175.

Spencer, J.E., Emery, L.J., & Schneck, C.M. (2003). Occupational therapy in transitioning

adolescents to post-secondary activities. The American Journal of Occupational Therapy,

57, 435-441.

Stranahan Foundation. (2010). Application Instructions. Retrieved from

http://www.stranahanfoundation.org/index.php?src=gendocs&ref=ApplicationInstruction

s&category=Main

United States Department of Education. (2006). Individualized education program. [pdf

document]. Retrieved from

http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,10,.

United States Department of Education. (2007). Topic: Secondary transition. Retrieved from

http://idea.ed.gov/explore/view/p/,root,dynamic,TopicalBrief,17,.


United States Department of Health and Human Services. (2010). Healthy People 2020 Topics

and Objectives. Retrieved from

http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx.

United States Department of Health and Human Services: Centers for Disease Control and

Prevention. (n.d.). Developmental disabilities. Retrieved from

http://www.cdc.gov/ncbddd/dd/dd1.htm

University of Washington Division of Adolescent Medicine: Youth in Transition Project. (1984-

1987) Adolescent Autonomy Checklist [pdf document]. Retrieved from

http://www.aacpp.com/pdf/parents/English/Teens/Adolescent-Autonomy-Checklist.pdf

Winkle, M.Y. & Cobb, A.L., (2010). Plotting next steps: Transitions for adults with

developmental disabilities. OT Practice, 13-16.

World Health Organization. (2011). People with mental disabilities cannot be forgotten.

Retrieved from

http://www.who.int/mediacentre/news/releases/2010/mental_disabilities_20100916/en/

https://outlook.com/owa/redir.aspx?C=6f659a13941e4f8c97eef9761bcae1e3&URL=http%3a%2f%2fwww.healthypeople.gov%2f2020%2ftopicsobjectives2020%2fdefault.aspx

http://www.cdc.gov/ncbddd/dd/dd1.htm


Appendix A

Organizational Chart


Appendix A

Rehab Dynamics Organizational Chart

Office Manager

Jill Delbrocco

Assistant Office Staff

Lauren Danko

Physical Therapy

Michelle Lemon

Megan Gicote

Occupational Therapy

Brynn Barga

Lynn Campbell

Alysia Kusner

Danielle Nelson

Brooke Paulski

Howard Luebke

Eric Polz

Speech Language Pathology

Marianne Briggs

Kim Long

Lauren Wright

Felicity Strause

Co-Owners

Ann Nagle & Maureen Kane-Wineland


Appendix B

Self-Care Assessment

The Self-Care Assessment was created by Baker, B.L. & Brightman, A.J. (2009) in Steps to independence: Teaching everyday skills to children with special needs.

The Assessment is available for public access to download from the publishing website http://www.brookespublishing.com/steps/


Appendix B

Self-Care Assessment


Appendix C

Home-Care Assessment

The Home-Care Assessment was created by Baker, B.L. & Brightman, A.J. (2009) in Steps to independence: Teaching everyday skills to children with special needs.

The Assessment is available for public access to download from the publishing website http://www.brookespublishing.com/steps/


Appendix C

Home-Care Assessment


Appendix D

Adolescent Autonomy Checklist

The Adolescent Autonomy Checklist was developed by the Youth in Transition Project (1984-1987) at the University of Washington Division of Adolescent Medicine. The checklist is based on a Model developed by the Children's Rehabilitation Center at the University of Virginia. The checklist can be found and downloaded at http://www.aacpp.com/pdf/parents/English/Teens/Adolescent-Autonomy-Checklist.pdf


Appendix D



Appendix E

Results from Self-Care Assessment, Home-Care Assessment, and



Appendix E

Results from Self-Care Assessment, Home-Care Assessment, and


Dressing

Tie shoes Put on socks

Start a zipper Buttons

Put on front-button shirt

Laundry

Fold clothes Hang clothes

Wears clothes that are clean and pressed Clothes that fit

Clothes that match Clothes appropriate to weather

Appropriate to social occasion

Grooming/hygiene

Shaving Combs and brushes hair

Use tissue Take care of eyeglasses or contacts

Uses toilet paper and toilet Washes and rinses hair

Take bath or shower with soap and washcloth Brushes teeth and uses mouthwash

Uses a mirror to spot-check appearance Trims fingernails/toenails

Wipes food/dirt off clothes and face

Health Care

Gets enough sleep Identify cold symptoms

Cleaning

Puts things away Empties baskets and puts out trash

Sweeps Dusts

Vacuum Washes windows or mirrors

Mops floor Cleans sink

Cleans toilet Cleans stove

Cleans oven Washes and dried dishes, pots, and pans

Loads dishwasher properly Shovels snow

Laundry


Separates machine from hand washables Separates dry cleaning from washables

Separates clean from dirty clothes Separates light from dark clothes

Washes items by hand Hangs items on clothesline

Properly loads washing machine Measures soap

Uses dryer Hangs clothes neatly

Folds clothes neatly Puts clothes away appropriately

Iron clothes as needed

Food Preparation

Puts groceries away Sets table

Clears table Prepares cold breakfast

Makes sandwich Cooks prepared foods

Prepares hot breakfast Uses oven

Fixes salads and desserts Helps plan and prepare meals

Cooks main dish Cooks complete meal

Stores leftover foods Identified and discards spoiled foods

Uses toaster Uses mixer/blender

Uses can opener Uses measuring utensils

Familiarity with content of packaged foods

Replacing used items

Replacing burned-out light bulb Replaces toilet paper roll

Replace bar of soap in bathroom Replace trash liners

Routine adjustments and maintenance

Adjust thermostat Secures the residence

Makes bed Changes bed

Clean room Feeds and waters house plant

Know tool safety

Non-routine repairs

Hangs a picture Stops continuously running toilet

Unclogs toilet or sink Glues broken items

Unjams toaster

Emergency


Plan fire exits and emergency procedures Use a fire extinguisher

Know where extra key is located

Personal skills

Uses phone Manage personal grooming

Health care skills

Know height, weight, and birthday Know health emergency telephone numbers

Discuss role in health maintenance

Community skills

Get around city (pedestrian skills) Use public transportation

Leisure time skills

Invite a friend over


Appendix F

Semi-Structured Interview and Answers


Appendix F

Semi-Structured Interview and Answers

Semi-Structured Interview with Maureen Wineland

What are the interests of the participants?

Quite variable based on age and ability. Hard to give any one answer many video games. Some

like DVD’s, jokes, and video games.

How do the participants learn best?

Again there is no one best way. Many need multiple ways modeling demonstrations one on one

instructions visual schedules

What occupations do the participants struggle with the most? A home? At school?

Most that I am concerned with fall between cracks as can dress do shower etc and function, but

not good at self independence things like making a meal, shopping for food, ordering at

restaurant, getting things out to prepare a meal of knowing what they need, following multi step

directions without lots of help, participating with peers without getting mad

Which occupations are the most important for the participants to master?

Independent living skills or at least skills that would allow them to do some of the things that

they need to be more independent from parent. Possibly be able to get themselves dinner. Shop

and get food they need, or work with peers to complete a task. Are the participants able to get a

job and be able to follow the directions without getting distracted or wondering off

Are there any specific services/programming you'd like to see provided for the

participants?

I don't know how to provide programming that meet these needs and get it covered by insurance

or how to meet needs when they are so diverse and it would take so much staff. Social

participation is one part that we have tried to address and we try to incorporate more tasks where

they have to plan, organize, work with peers to make meal or food and I have tried to set up


some work tasks to help one participant get ready for a simple job but what else can we do in the

clinic setting to help with these goals

What is the current level of independence of the participants and where would you like to

see them function independently?

Highly variable. Some are competent in many areas and are more independent, while others need

much more help

Are there any triggers or situations that cause a behavior?

Kid specific. People touching them, being in their space, too many directions, winning and

losing, not getting the attention they seek

What is the best way to manage behaviors?

Same as above varies kid by kid. We tend to use 1-2-3 magic strategies

Semi-structured Interview with Caregivers at Rehab Dynamics

What are some of the interests of your child?

Common interests of the adolescents at Rehab Dynamics include computers, watching tv,

playing video games, swimming, reading, electronics, animals, and role playing.

How does your child learn best?

Rehab dynamic participants learn best with:

Visual aids

Providing rewards and punishments

Prompting

Breaking tasks down into steps

Schedules

Time frame for tasks

What tasks have you noticed your child is having the most difficulties completing? At

school? At home?


Social skills- screening words, determining appropriate/inappropriate words and times to

speak, blurting out, perseverance of topics, interrupting, listening skills, peer interactions,

small talk, phone skills

Anger management

Money management- counting, Dollar up, understanding change

Shopping- finding items in store, creating a list, recognizing items, using cart,

Kitchen skills

Following directions

Manners

Laundry- sorting, folding, vocabulary/supplies

Cleaning- entire surface

Hygiene- brushing hair, finger/toe nail maintenance

Safety at home, steps before and after calling 911

Exercise and health

Knot tie- garbage bags, shoes

Light kitchen skills- cutting apples, cleaning grapes, making toast, preparing bowl of

cereal, spreading butter, using microwave

What level of independence does your child have now, and where would you like them to

be?

The boys discussed in this needs assessment live at home. The parents predict the boys to live in

a group home or independent if possible.

What are the occupations you think are the most important for your child to master?

Parents feel their child should master safety skills, manners, social skills, light kitchen skills,

basic life skills.

What type of programs/services would you like to see implemented for your child?

Life skills

Cooking


Safety

Cleaning skills

Social skills training.

Is there anything that causes reactions/behaviors for your child?

One participant is afraid of flies and has a severe reaction.

What types of behavior management techniques do you us to address your child’s

behaviors?

Remind participant that the fly won’t hurt him, or remove him from area

Are there any precautions to know when working with your child?

Food allergies- dairy and gluten

Semi-Structured Interview and Focus Groups with HOPE members, staff and LISD staff

What are some of the interests of your participants?

Common interested include: watching TV, reading, going for walks, completing puzzles, basic

adult education, social clubs/activities, socializing, sports and recreation, comic books, karaoke,

music, food, volunteering

How do your participants learn best?

Participants learn best with:

Hands-on tasks

Handouts/notes

Providing step by step directions

Visual aids

Optimal engagement in sessions

Repetition

Interactive


What tasks have you noticed your participants are having the most difficulties completing?

At work? At home?

Common themes of occupations include:

Fine motor skills- coin manipulation, folding paper, opening containers,

Fast food restaurant skills- filling cup, getting condiments and napkins, throwing away

food, tray manipulation, menu reading, money transaction

Hair management- brushing, washing, drying, styling

Money management, coin manipulation, coin counting, paying bills, cashing checks

Cooking, microwave skills

Shopping, store orientation, community skills, transportation

Ironing, folding, hanging, sorting, washing, and putting clothes away

Donning coats, fasteners, zippers

Following directions

Cleaning- dishes, clearing table, dusting, vacuuming, garbage liners,

Shaving

What level of independence do your participants have now, and where would you like them

to be?

HOPE members live in variety of settings including; home with family, group home, or living

independent with and without staff checking in occasionally. Some independence is limited due

to the restrictions in group home policies. Majority of HOPE members are fairly independent in

basic self-care. Some members have potential to increase level of independence but will most

likely continue to need assistance/supervision. However, HOPE staff does not wish to promote

HOPE members to move out of current living situation.

What are the occupations you think are the most important for your participants to

master?

Task initiation and motivation to complete occupation

Money management for monthly allowance, outings, and special events

Basic life skills


Emergency skills

Social awareness

Safety

Navigate transportation.

What type of programs/services would you like to see implemented for your participants?

HOPE members and staff expressed desire for cooking, shopping, community safety, money

management, independent living skills,

Is there anything that causes reactions/behaviors for your participants?

No real behavior issues that would interfere with programs

What types of behavior management techniques do you us to address your participant’s

behaviors?

Seek assistance from HOPE staff

Are there any precautions to know when working with your participants?

Seizures, diabetic, weight lifting restrictions


Appendix G

Living Independently Marketing Flyer


Are you a caregiver seeking help

to teach your child life skills?

Living Independently A life skills program for adolescents who have

developmental disabilities

The Living Independently program is a group-based series

designed to increase independence in the following areas:

Dressing

Hygiene

Laundry

Housekeeping

Meal preparation

Telephone skills

Shopping

Emergency

For more information please call

Renae Sauter: (517) 902-6158

Living Independently program will be held at Rehab Dynamics

3160 Central Park West Drive, Toledo, Ohio 43617


Appendix H

Living Independently Marketing Letter


Appendix H

Living Independently Marketing Letter

Renae Sauter Rehab Dynamics 3160 Central Park West Drive Toledo, Ohio 43617 419-841-1840 To whom this may concern: This letter is to inform you about a new program available for adolescents who have developmental disabilities. The Living Independently program is a series of sessions that teach adolescents various types of life skills. A certified occupational therapist will be facilitating each session at Rehab Dynamics.

As literature shows, adolescents have fewer services and therapy opportunities available through the school and community as caseloads increase. School therapists often have large caseloads and frequently discharge adolescent students if progress is inconsistent (Scott, 2001). Dr. Paul T. Shattuck, a national expert on disabilities, has discovered that 39.1 percent of youth with autism were not provided with therapy, mental health, medical diagnostics, or case management services (2011). Winkle and Cobb (2010) identify that occupational therapy services can continue increasing independence and quality of life regardless of age. Life skills programs have been proved effective for individuals with disabilities. A Youth Transition Program has been implemented in Minnesota which has fostered significant independent living skills for the participants. Research has proved that an individual with a disability can learn and sustain skills. Life skills such as meal preparation, grooming, and shopping have all proven successful when given an opportunity to learn (Arnold-Reid, Schloss, & Alper, 1997; Smith & Belcher, 1985; Morse & Schuster, 2000). The Living Independently program is designed to provide an opportunity for adolescents who have developmental disabilities the chance to learn life skills. The program is a group-based approach that will meet during after school hours. Please pass this information about the program to families you think would benefit from this opportunity. If you have any questions or comments, please do not hesitate to call me at 419-841-1840. I am available Monday thru Friday 9:00am-5:00pm. Thank you for your time and I look forward to hearing from you. Sincerely, Renae Sauter, OTD/S Please see attached page for list of references mentioned within this letter.


References

Arnold-Reid, G.S., Schloss, P.J., & Alper, S. (1997). Teaching meal planning to youth with

mental retardation in natural settings. Remedial and Special Education, 18, 166-173.

Morse, T.E., & Schuster, J.W. (2000). Teaching elementary students with moderate intellectual

disabilities how to shop for groceries. Exceptional Children, 66, 273-288.

Scott, J. (2001). Occupational therapy for adolescents with autism. Developmental Disabilities

Special Interest Section Quarterly, 24, 1-3.

Shattuck, P., (2011, February 24). Adults with autism and their families often left without help

after high school [Web log post]. Retrieved from http://blog.autismspeaks.org/tag/dr-

paul-t-shattuck/

Smith, M.D., & Belcher, R. (1985). Teaching life skills to adults disabled by autism. Journal of

Autism and Developmental Disorders, 15, 163-175.

Winkle, M.Y. & Cobb, A.L., (2010). Plotting next steps: Transitions for adults with

developmental disabilities. OT Practice, 13-16.


Appendix I

Living Independently Assessment


Appendix I

Living Independently Assessment

For each of the skills identified in this assessment evaluate your child’s level of independence according to the scale below:

Scale measurements according to the Functional Independence Measure (FIM)

Total Assistance- Subject contributes less than 25% of the effort or is unable to do the task

Maximal Assistance- Subject provides less than half of the effort 25% to 49% of the task Moderate Assistance- Subject performs half or more than half (50-75%) of the task Minimal Assistance- Subject requires incidental hands-on only and performed greater

than 75% of the task Supervision or Setup- Subject requires only standby assistance or verbal prompting or

help with setup Modified Independence- Subject requires the use of a device but no physical help Complete Independence- Subject is fully independent

(Functional Independence Measure, n.d.)


SKILLS

Act

ivit

y D

oes

Not

Occ

ur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Basic Dressing

Puts on underpants

Puts on undershirt

Puts on socks

Puts on pants

Puts on pullover shirt, sweater

Puts on front-button shirt, blouse

Takes off pullover shirt, sweater

Pulls zipper up/down (if started)

Threads a belt

Starts a zipper

Buttons

Fastens snaps, hooks

Ties shoes

Puts on a slip

Puts on a bra (if appropriate)

Puts on nylons/pantyhose (if appropriate)

Ties a necktie (if appropriate)

Wears clothes that are clean and presses

Selects clothes that fit


Act

ivit

y D

oes

Not

Occ

ur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Selects clothes that match

Selects age-appropriate clothes

Selects clothes appropriate to weather

Selects clothes appropriate to social occasion

Grooming and Personal Hygiene

Uses toilet and toilet paper

Washes and dries hands

Washes and dries face

Takes bath or shower, with soap and washcloth

Uses deodorant

Washes and rinses hair

Brushes teeth and uses mouthwash

Cleans ears

Shaves (if appropriate)

Applies makeup (if appropriate)

Combs and brushes hair

Uses a mirror to spot-check appearance

Trims fingernails/toenails

Uses aftershave/perfume


Act

ivit

y D

oes

Not

Occ

ur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Uses a handkerchief/tissue

Takes care of eyeglasses or contact

lenses (if appropriate)

Wipes food/dirt off clothes

Uses tampons or sanitary napkins (if

appropriate) and disposes of them properly

Cleaning/ house maintenance

Puts things away

Empties baskets and puts out trash

Replaces trash liners

Sweeps

Dusts

Vacuums

Washes windows or mirrors

Mops floor

Cleans sink

Cleans toilet

Cleans stove

Cleans oven

Washes and dries dishes, pots, and pans


Act

ivit

y D

oes

Not

Occ

ur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Loads dishwasher properly (if appropriate)

Changes linens

Makes bed

Replaces burned-out light bulb

Replaces toilet paper roll or bar of soap in bathroom

Replaces batteries in toy, radio, or flashlight

Replaces vacuum cleaner bag

Laundry

Puts dirty clothes in hamper

Separates machine from hand washables

Separates dry cleaning from washables

Separates clean from dirty clothes

Separates light from dark clothes

Washes items by hand

Hangs items on clothesline

Properly loads washing machine (knows what setting to use)

Measures soap


Act

ivit

y D

oes

Not

Occ

ur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Uses dryer

Hangs up clothes neatly

Folds clothes neatly

Puts clothing away appropriately

Irons clothing as needed

Food Preparation

Helps plan meals

Puts groceries away

Sets table

Clears table

Follows recipe

Gets snack

Prepares cold breakfast

Makes sandwich (no mixing, no cooking)

Cooks prepared foods

Prepares hot breakfasts

Uses microwave (sets for setting/times correctly)

Uses oven (sets for temperature/times correctly)

Fixes salads and desserts


A

ctiv

ity

Doe

s N

ot O

ccur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Cooks main dish

Cooks complete meal

Finds/replaces food and utensils in designated areas

Identifies canned or boxed food by labels

Stores leftover foods

Identifies and discards spoiled foods

Identifies and uses utensils and appliances:

Toaster

Blender

Can opener

Ice cream scoop

Uses spatula

Uses measuring utensils

Shopping

Creates a shopping list

Locate areas in store (produce, toiletries, toys)

Use shopping cart or basket

Finds/selects item


A

ctiv

ity

Doe

s N

ot O

ccur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Places items on conveyer belt

Places items In bags

Loads and unloads items in car

Puts items away

Emergency

Plan fire exits and emergency

Know where candles and flashlights are stored

Know how to use a fire extinguisher

Know community emergency procedures

Know where extra house key is located

Know procedure for 911

Know emergency contacts

Know personal information (address, phone number)

Recognize household hazards

Telephone use

Locating numbers (phone book, newspaper, menu)

Dialing correct number


Act

ivit

y D

oes

N

ot O

ccur

Com

plet

e A

ssis

tanc

e P

rovi

ded

Max

imal

A

ssis

tanc

e P

rovi

ded

Mod

erat

e A

ssis

tanc

e P

rovi

ded

Min

imal

A

ssis

tanc

e P

rovi

ded

Sup

ervi

sion

or

Set

up P

rovi

ded

Mod

ifie

d In

depe

nden

ce

Com

plet

e In

depe

nden

ce

Leaving a message

Taking a message

Maintain phone conversation


Appendix J

Living Independently Progress Note


Appendix J

Living Independently Progress Note

Student: _____________________________________ Date: ___________________

Life skill session: ______________________________________________________________

Progression toward individualized goal(s) for life skill: ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Overall occupational performance and type of assistance provided:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Areas to review:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Signature: _______________________________________________ Date: ________________


Appendix K

Living Independently Evaluation Summary


Appendix K

Living Independently Evaluation Summary

Student: _________________________________________

Individualized goal(s): Met?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Areas of improvement:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Areas to keep practicing:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Recommendations for future:

______________________________________________________________________________

______________________________________________________________________________

Signature: _________________________________________________ Date: ______________


Appendix L

Living Independently Budgeting and Staffing Outline


Appendix L

Living Independently Budgeting and Staffing Outline

The budget estimates the overall cost for the 17 week Living Independently program. Personnel

Position Hours per week Salary from Grant Money

Total

Program Occupational Therapist

5 $2,945.00 $2,945.00

Program Occupational Therapist Assistant

3 $1, 045.50 $1,045.50

Subtotal: $3,990.50

Program Supplies and Equipment Item Description of

Items Quantity Cost per Item Total Cost

First aid kit Travel 195 piece all purpose first

aid kit

1 kit $11.88 $11.88

Blank paper Package of blank computer paper

1 package $3.49 $3.49

Black and white ink

Printer ink cartridge

1 cartridge $21.99 $21.99

Colored ink Printer colored ink cartridge

1 cartridge $24.98 $24.98

Pretzel Large bag of pretzels for open

house

1 large bag $1.69 $1.69

Stamps Standard mailing stamps

1 booklet $8.80 $8.80

Envelops Standard letter size envelopes

1 box (25 count) $3.99 $3.99

Folder 3 ring binder to use as a chart for

participants

1 folder per participant (8 folders total)

$3.99 $31.92

Construction paper

Package of construction

paper. Various colors

1 package of 50 sheets

$2.79 $2.79

Dry-erase board 4’ X3’ standard white dry erase

board

1 board $131.99 $131.99

Dry-erase markers and

Kit of four markers, spray,

1 kit $7.00 $7.00


cleaner and eraser Liquid hand soap Liquid hand soap

from traditional bottle

1 bottle $2.49 $2.49

Bar hand soap Bar of traditional hand soap

1 bar $1.09 $1.09

Nail clippers Fingernail clippers

1 per participant (8)

$1.99 $15.92

Nail file Nail file with smooth and rough sides

1 pack (8 count) $2.74 $2.74

Solo cups Plain paper cups (3 ounces)

1 pack (100 count)

$4.19 $4.19

Alcohol wipes Individually wrapped

cleaning pads

1 box (100 count)

$16.99 $16.99

Shampoo Standard sized bottle. Any brand

1 bottle $2.74 $2.74

Hand-help mirror Small mirror with frame

around edges of mirror

4 $11.99 $47.96

Milk Half gallon of milk. Can be soy

for dairy allergies

1 half gallon $1.99 $1.99

Paper towel Standard paper towel roll

1 roll $1.98 $1.98

Face wash Generic face wash. Liquid of foam for general

cleaning

1 bottle $4.97 $4.97

Toothbrush Adult medium bristles.

1 per participant (8). 2 four packs

$3.69 $7.38

toothpaste Average sized tube. Any brand

1 tube $2.49 $2.49

Dental floss Floss from roll. Not in stick form

1 roll $1.00 $1.00

Mouthwash Safe mouth wash for adolescents

1 bottle $4.59 $4.59

Hair comb Combination packs to provide

diversity of combs

1 package (10 count)

$7.49 $7.49

Hair brush Typical hair brush. Handle

5 $2.99 $14.95


and tipped bristles

Deodorant Travel sized generic

deodorant

1 per participant (8)

$1.00 $8.00

Socks Calf height socks. Any color

2 packages of 6 count calf socks

$4.99 $9.98

Socks Knee high socks. Any color

2 packages of 6 count tube socks

$6.99 $6.99

Button up shirts Shirts that button up the front with

large buttons

1 per participant (4 shirts)

$9.49 $37.96

Zip up jacket Lightweight sweatshirt or

jacket with front zipper

1 per participant (4 jackets)

$14.00 $56.00

Shaving cream Unscented shaving cream

1 bottle $1.99 $1.99

Spray bottles Plastic spray bottle

8 bottles $1.00 $8.00

Cleaning bucket Plastic 1 gallon bucket with

handle

1 $7.78 $7.78

All- purpose cleaner and

window cleaner

Cleaner that is safe for contact

1 bottle each (2) $2.99 $5.98

Bed sheets Set of twin sized bed sheets

1 set $16.99 $16.99

Pillow Average sized bed pillow

1 $6.99 $6.99

Air mattress Twin sized inflatable mattress

1 $29.99 $29.99

Garbage bags Kitchen sized 1 box (30 count) $7.79 $7.79 Washing machine

Top loader washing machine

1 $379.99

$379.99

Drying machine Front loader dryer

1 $373.99 $373.99

Laundry detergent

32 load bottle 1 bottle $12.99 $12.99

Fabric softener sheets

50 sheet box 1 box $5.79 $5.79

Hangers Tubular, wire, wood, plastic

1 pack each $2.29 $9.16

Supplies for shopping

Bread, chips, bags of apples,

2 of each $15.00 $30.00


practice box of cereal, four cans of food

Food items for meal preparation

Bread, fruit, meat, microwave

meal, etc

1 each $100.00 $50.00

Stovetop oven Electric stovetop oven

1 $399.99 $399.99

Supplies for party

Party at conclusion of

program

1 party $40.00 $40.00

Subtotal: $1,949.82

*In-kind Program Supplies and Equipment Item Description of


Pens Basic ballpoint pen

10 In-kind $1.00

In-kind $1.00

Printer Black/White and colored printing

1 In-kind $179.99

In-kind $179.99

Printing The therapist will be able to use the

computer and printer to print the template for

copies

Up to 20 pages total

In-kind $0.10

In-kind $2.00

Paint Bottle of tempera paint. Washable.

Any color

1 bottle $1.29 $1.29

Crayons Box of 24 crayons to use

during occupations

1 box In-kind $1.50

In-kind $1.50

Chalk Box of plain white chalk

1 box In-kind $1.29

In-kind $1.29

Tape Invisible clear tape

1 roll In-kind $1.39

In-kind $1.39

Masking tape Roll of masking tape

1 roll In-kind $3.99

In-kind $3.99

Glue Elmer’s glue 4 tubes In-kind $1.50

In-kind $6.00

Scissors Safety scissors 8 pair In-kind $1.00

In-kind $8.00

Phonebook Phonebook with yellow and white

pages

8 books In-kind $0.00

In-kind $0.00

Newspaper, Information that 1 per participant In-kind In-kind


menu, flyers contains a phone number

(8 minimum) $2.99 $2.99

Hand towels Standard sized hand towel. Any

color

1 per participant (8 minimum)

In-kind $2.79

In-kind $22.32

Wash cloth Standard sized wash cloth. Any

color

1 per participant (8 minimum). 2

Four packs

In-kind $4.99

In-kind $9.98

Body towel Standard body towel. Any color

1 towel In-kind $4.99

In-kind $4.99

Button up shirts Shirts that button up the front with

large buttons

1 per participant (4 shirts)

In-kind $9.49

In-kind $37.96

Zip up jacket Lightweight sweatshirt or

jacket with front zipper

1 per participant (4 jackets)

In-kind $14.00

In-kind $56.00

Blanket Twin sized blanket

1 In-kind $12.99

In-kind $12.99

Broom (indoor) Standard flat kitchen broom

1 In-kind $9.99

In-kind $9.99

Broom (outdoor) Standard push broom

1 In-kind $14.99

In-kind $14.99

Vacuum Standard push vacuum

1 In-kind $119.96

In-kind $119.96

Trashcans Small trashcans 2 In-kind $6.97

In-kind $6.97

Dish towels Towels to wash and dry dishes

2 each In-kind $2.99

In-kind $11.96

Dish rack Rack to hold dishes

1 In-kind $3.79

In-kind $3.79

Dish soap Dawn dish soap 1 bottle In-kind $3.49

In-kind $3.49

Dishes Set of plastic dishes

8 In-kind $6.00

In-kind $48.00

Clothing items Shirts, socks, pants, etc

1 laundry basket full

In-kind $50.00

In-kind $50.00

Laundry basket Plastic standard sized basket

3 In-kind $4.49

In-kind $13.47

Rags Pieces of cloth that can be used

for cleaning purposed

10 In-kind $0.00

In-kind $0.00

Supplies that are on shopping list

Items that are needed at Rehab

Dynamics


In-kind $30.00


Kitchen appliances and

utensils

Various appliances and utensils that are used for basic

cooking


In-kind $200.00

In-kind Subtotal: $866.30

Other *In-kind Supplies and Equipment Item Description of


Working landline phone

Phone for students to send and receive calls

2 phones In-kind $100.00

In-kind $100.00

Computer with internet access

Computer with internet browsing

software

1 In-kind $679.99

In-kind $679.99

Filing Cabinet Locked cabinet to contain

student’s folders

1 In-kind $59.99

In-kind $59.99

Chalkboard Chalkboard for cleaning and writing notes

1 In-kind $69.99

In-kind $69.99

Space payment Cost to pay for building

1 In-kind $400.00

In-kind $400.00

Utilities Heat, lights, water, electricity

1 In-kind $250.00

In-kind $250.00

Subtotal: $1,556.97 Other In-kind Subtotal: $866.30 Total In-kind cost: $2,423.27

Participation Fee Item Quantity Cost per Item Total Cost

Participation fee 8 $40 $320 Total Cost $5,620.32 * Rehab Dynamics is willing to provide in-kind support for the Living Independently program.


Appendix M

Living Independently Job Description


Appendix M

Living Independently Job Description: Occupational Therapist

Employed by the Rehab Dynamics Living Independently program

Position Title: Occupational Therapist, Living Independently program Professional Requirements:

1. Current registration as an occupational therapist by NBCOT 2. Current license to practice occupational therapy in the State of Ohio 3. A Bachelors, Masters, or Doctorate degree in occupational therapy 4. Prior work with adolescents who have developmental disabilities preferred, but not

required Responsible to: Executive Directors; Maureen Kane-Wineland, Ph.D., OTR/L and Ann Nagle, P.T. Position Summary: The occupational therapist will facilitate the Living Independently program at Rehab Dynamics. The occupational therapist will instruct and educate adolescents who have developmental disabilities, ages 12-18 years-old about life skills. The occupational therapist will also oversee the certified occupational therapist assistant. Performance Requirements:

Assist in the recruitment process Ask caregivers to complete the Living Independently Assessment Score and interpret results from assessment, develop needs list for each student, write

individualized goals Communicate with caregivers about participants’ progress and helpful suggestions for the

home Write progress notes and complete evaluation summary for each student Send program evaluations to caregivers Facilitate weekly life skills sessions two times a week for one and one half hour each

session Accept other duties as needed

Working Conditions:

Work at Rehab Dynamics Walking, sitting, standing, bending, twisting, lifting, pushing, and carrying Interactions with other staff, caregivers, participants, and other stakeholders

Physical Requirements: Must be able to tolerate simple repetitive arm motions, have adequate vision, and proper body mechanics to complete all responsibilities of the Living Independently program.


Appendix M

Living Independently Job Description: Certified Occupational Therapist Assistant

Employed by the Rehab Dynamics Living Independently program

Position Title: Certified Occupational Therapist Assistant, Living Independently program Professional Requirements:

5. Current registration as an occupational therapist by NBCOT 6. Current license to practice occupational therapy in the State of Ohio 7. An Associate’s degree in occupational therapy assistant 8. Prior work with adolescents who have developmental disabilities preferred, but not

required Responsible to: Occupational Therapist facilitating group Position Summary: The certified occupational therapist assistant will help with the Living Independently program at Rehab Dynamics. The certified occupational therapist assistant will aid the occupation therapist in teaching life skills to adolescents ages 12-18 who have developmental disabilities. Performance Requirements:

Communicate with the occupational therapist about the program and teaching strategies Communicate with caregivers about participants’ progress and helpful suggestions for the

home Assist with set-up, clean-up, and facilitation of session Write progress notes with occupational therapist approval Accept other duties as needed

Working Conditions:

Work at Rehab Dynamics Walking, sitting, standing, bending, twisting, lifting, pushing, and carrying Interactions with staff, caregivers, participants, and other stakeholders

Physical Requirements: Must be able to tolerate simple repetitive arm motions, have adequate vision, and proper body mechanics to complete all responsibilities of the Living Independently program.


Appendix N

Living Independently Job Newspaper Advertisement


Appendix N

Living Independently Occupational Therapist and

Certified Occupational Therapist Assistant

Newspaper advertisement

Occupational Therapist Part-time

Occupational therapist needed to facilitate the Living Independently program at Rehab Dynamics in Toledo, OH. This grant funded program teaches adolescents ages 12-18 who have developmental disabilities life skills to increase levels of independence. The occupational therapist must be certified by NBCOT, licensed to work in the State of Ohio, and a have Bachelor’s, Master’s or Doctorate degree in occupational therapy. Please call Renae Sauter at 419-841-1840 for more information.

Certified Occupational Therapist Assistant Part-time

Certified occupational therapist assistant is needed to assist with the Living Independently program at Rehab Dynamics in Toledo, OH. This grant funded program teaches adolescents ages 12-18 who have developmental disabilities life skills to increase levels of independence. The certified occupational therapist assistant must be certified by NBCOT, licensed to work in the State of Ohio, and have an Associate’s degree in occupational therapy assistant. Please call Renae Sauter at 419-841-1840 for more information.


Appendix O

Living Independently Program Evaluation


Appendix O

Living Independently Program Evaluation

Please return this survey to Rehab Dynamics within one week of receiving the survey! Please answer the follow questions regarding the Living Independently program. 1= strongly Disagree, 2= Disagree, 3=Agree, 4= Strongly Agree, 5= N/A 1 2 3 4 5 Comments 1. My child enjoyed the program

2. The life skills were presented in a logical order

3. The life skills were relevant to my child’s individual needs

4. The Living Independently program was helpful for my child

5. I have noticed an increase in skills from my child

6. I incorporated some of the Living Independently program at home

8. The occupational therapist was professional and knowledgeable about the Living Independently content

9. The occupational therapist provided useful suggestions for home

10. My discussions with the therapist were very helpful

10. The overall quality of the Living Independently program was good

What life skills did you see the most improvement in your child’s performance? ____________________________________________________________________________________________________________________________________________________________ In what areas did you notice little or no change in the child’s performance? ____________________________________________________________________________________________________________________________________________________________ How could the program improve? ____________________________________________________________________________________________________________________________________________________________ Signature:______________________________________________ Date:_____________


Appendix P

Living Independently Timeline


Appendix P

Living Independently Timeline

Task Week 1 2 3 4 5 6 7 8 9 10 Conduct needs assessment

X

Market to stakeholders

X

Recruit program participants

X

Print out documentation forms

X

Purchase supplies

X

Ask caregivers to complete Living Independently Assessment

X

Create goals for each participant

X

Invites families and facilitate open house

X

Conduct biweekly life skills sessions

X X X X X X X X X

Write progress notes about student performance and progress toward goals

X X X X X X X X x

Observe student performance and make necessary adjustments

X X X X X X X X X

Communicate with caregivers

X X X X X X X X X X

Evaluate participant’s progress

Program evaluation


Task Week 11 12 13 14 15 16 17 18 19

Conduct needs assessment

Market to stakeholders

Recruit program participants

Print out documentation forms

X X X

Purchase supplies

Ask caregivers to complete Living Independently Assessment

X X

Create goals for each participant

X

Invites families and facilitate open house

Conduct biweekly life skills sessions

X X X X X X X X

Write progress notes about student performance and progress toward goals

X X X X X X X X

Observe student performance and make necessary adjustments

X X X X X X X X

Communicate with caregivers

X X X X X X X X

Program evaluation

X

Complete evaluation form for each participant

X


Appendix Q

Living Independently Letter of Support


Appendix Q

Living Independently Letter of Support

Rehab Dynamics 3160 Central Park West Drive Toledo, Ohio 43617 April 6, 2012 Renae Sauter Living Independently Coordinator The University of Toledo Judith Herb College of Education, Health Science, and Human Service Toledo, OH 43606

Dear Miss Sauter,

I am writing this letter to show my support and enthusiasm for the Living Independently program. I am an occupational therapist and the co-owner of Rehab Dynamics. I have discovered the need for adolescent services and am looking forward to the day when adolescents are provided with the proper programming that fits their unique needs. I have been an occupational therapist working with youth for many years; and have grown to notice the need for additional life skills training into adolescent years. Many of the adolescents receiving services at the facility need assistance with basic daily occupations and are very reliant on caregivers. I have noticed the trend that caregivers tend to complete many life skills for their child which leaves little opportunity for the child to learn how to help themselves. This life style can lead to a lifetime of dependence with little independence. The Living Independently program will give the adolescents the opportunity to learn and improve skills that would allow them to be become more independent. Improvements in life skills could ultimately lead to more independent living. I believe some of the adolescents have the potential to become less dependent of family and possibly live independently. I strongly think the goal of the Living Independently program is reachable and would be a great benefit to all of the adolescents. The Living Independently program is exactly what the youth needs to experience. Each individual adolescent and family would benefit greatly from this program. I strongly hope that you will recognize the impact this program can have for the adolescents and families. Sincerely, Maureen Kane-Wineland Occupational Therapy and co-owner of Rehab Dynamics


Appendix R

Living Independently Additional Supporters


Appendix R

Living Independently Additional Supporters 1) Maureen Kane-Wineland, Occupational Therapist and Co-Owner of Rehab Dynamics

Mrs. Kane-Wineland provides treatment to various pediatric clients. She is very knowledgeable about the need for a life skills program and would be a key stakeholder for recruiting participants. Caregivers are very familiar with Mrs. Kane-Wineland and will be comfortable allowing their child to participate in the program. She is also willing to provide assistance and guidance in facilitating the Living Independently program. Mrs. Kane-Wineland 3160 Central Park West Drive Toledo, Ohio 43617 (419) 841-1840

2) Lynn Campbell, Occupational Therapist Mrs. Campbell is another occupational therapist that works at Rehab Dynamics. Mrs. Campbell has taken an active role in assisting with providing resources for the Living Independently program. Mrs. Campbell has also discovered the need for services for the adolescent population. The caregivers feel comfortable around Mrs. Campbell would take comfort in Mrs. Campbell’s confidence in the Living Independently program. Lynn Campbell 3160 Central Park West Drive Toledo, Ohio 43617 (419) 841-1840

3) Marianne Mader, Community Supports and Services Mrs. Mader is the Senior Director responsible for Community Supports and Services at the Lucas County Board Developmental Disabilities. The Board of DD is dedicated to assisting individuals with developmental disabilities to be self-determined and successful in the community. Mrs. Mader is responsible for managing the Community Supports and Services which contains transitioning into adulthood. Mrs. Mader would support the program and become a means for marketing the program. Marianne Mader (419) 380-4000

4) Kay Treanor, Ohio Developmental Disabilities Council Mrs. Treanor is on the Children and Health Committee through the Ohio Developmental Disabilities Council. The Children and Health Committee assist children and young adults who have developmental disabilities to live, work, and be included in the community. Mrs. Treanor would support the concept behind the Living Independently program as another resource in Ohio. Kay Treanor 899 East Broad Street, Suite 203 Columbus, OH 43205


(614) 466-5205 5) Tammy Lamb, Breaking Barriers

Mrs. Lamb is a local stakeholder and has a 30 year-old son who has autism. Mrs. Lamb has shared her frustration in finding services for her son when he was in his adolescent years. Mrs. Lamb has created a funding source called Breaking Barriers to provide small financial assistance for individuals who have developmental disabilities. Mrs. Lamb is a strong supporter of the Living Independently program and may be willing to provide financial assistance to families to pay for the program. Tammy Lamb (734) 847-2203

6) Mark Armstrong, Community Connections Coordinator Mr. Armstrong is the Community Connections Coordinator at the Ability Center of Greater Toledo. The Ability Center assist individuals with disabilities to live, work, and socialize within the accessible community. Mr. Armstrong is the resource that informed individuals of program available in the community. Mr. Armstrong would be a supporter of the Living Independently program and would assist in the recruiting process. Mark Armstrong 5605 Monroe Street Sylvania, OH 43560 (419) 885-5733

7) Kathy B., Parent

Mrs. B is a grandparent of an 11 year-old girl who has autism. Mrs. B has been seeking resources for her granddaughter. She is greatly appreciative of any resources available and strongly supports the development of new program that provide services to adolescents. Mrs. B has shown great enthusiasm about her granddaughter participating in the Living Independently program. Kathy B can be contacted through Rehab Dynamics 3160 Central Park West Drive Toledo, Ohio 43617 (419) 841-1840

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