Final Program Proposal Gabby Skoczylas

Running Head: TRANSITIONING SKILLS 1
Transitioning Skills for At-Risk Teenagers:
An Occupation-Based Program for Students of Limitless Transition Services
Gabriela Skoczylas
University of Utah
TRANSITIONING SKILLS 2
Introduction
The purpose of this needs analysis and program proposal project paper is to determine
how occupational therapy services may be incorporated into a program serving an underserved
community. The specific underserved population that this project has focused on is the students
of Limitless Transition Services (LTS) at East Hollywood High School (EHHS). A needs
assessment was conducted which included observations of students and staff within a variety of
settings, one-on-one interviews, group interviews, surveys regarding transitioning into adulthood
and available program services, as well as an interpersonal support measure. Through the needs
analysis and literature review, an occupational therapy program was developed in order to fill the
service gaps and fulfill the needs of the students.
Description of Setting
Limitless Transition Services, located at East Hollywood High School in West Valley
City, is a program that aides youth who are at risk or have special needs in acquiring skills
necessary for transitioning into adulthood. LTS focuses on “social skills, personal growth, and
life skills in an experiential format,” ("About Us," n.d.) and enables the youth to acquire self-
worth and improved self-esteem. The mission of LTS is to “provide support to qualifying young
adults in the areas of academics, social skills and self-esteem (“Limitless Transition Services,”
n.d.). The philosophy of LTS is the following:
We know that every student has a story, and that sometimes, that story isn’t an easy one
to live. We believe that students must have their needs met in all areas in order for them
to move forward. They must have their basic needs met, feel a sense of safety and
security, and build a positive relationships with an adult. Our aim is to help meet these
needs so that our students find success not only academically and socially, but also in
ways that will make them successful for the rest of their lives. Our goal is for them to see
that their potential is limitless! (Limitless Transition Services [Brochure], n.d.)
History
Limitless Transition Services was established in 2011 by Nicole Broberg, who is the
current founder/director, as well as the special education director at EHHS, which is a public
charter school specializing in film production. Initially, LTS provided only a weeklong summer
program for youth that included workshops on resumes, interviews, public transportation and etc.
Since then, the summer program has transitioned into a five week long program that addresses
the following topics: social skills, community access, independent living, employment skills,
transition skills, transportation, and adult living (Limitless Transition Services [Brochure], n.d.).
Within the last several years, LTS also partnered with EHHS and established a course within the
special education department: What People Do. Three years ago, a job skills program was
established in partnership with the Salt and Vinegar Syndicate. To build upon the job skills
program, about a year ago, Land Locked Surfer Café began operating on a weekly basis at
EHHS. This food cart is run by the students of LTS, with assistance from the LTS directors and
paraprofessional. Two years ago, Annie Munk joined LTS and became the associate director, as
well as the teacher for the course mentioned previously.
Target Population
The target population that LTS is providing services for includes high school students
and recent high school graduates who are “at-risk” and have special needs or other mental health
conditions. The term “at-risk” refers to students who “are considered to have a higher
probability of failing academically or dropping out of school” (The Glossary of Education
Reform, 2013). Majority of the LTS teenagers have limited or no support from parents or
families, and require additional academic support, specialized instruction, as well as social and
behavioral support. These students come from low socioeconomic status families, mainly from
the West Valley area. They receive free or reduced lunch, and majority cannot afford public
transportation. Currently, one of the students in the program is repeating his senior year, and
others are in the Credit Recovery Program. These teenagers come from “broken” households
with single and/or incarcerated parents, and some belong to gangs. Majority of the students are
not affiliated with any religion, or are non-practicing. Conditions and diagnoses of the LTS
participants include autism, learning disabilities, ADHD, anxiety, depression, and other
behavioral and mental health conditions. There are currently 7 students in the LTS program: six
males and one female. Although all current LTS students are from EHHS, LTS also provides
their services to the students of Utah Military Academy and Merit College Preparatory Academy.
Services Provided
Staff. The staff of LTS is quite small, as this is a fairly new and time demanding
program. Fulltime staff members include the directors, Nicole Broberg, who is in the process of
acquiring a master’s degree in learning and technology, and Annie Munk, who has a master’s
degree in management and leadership. Other staff members include two post-high student
mentors, a current LTS student who is a mentor in training, and a paraprofessional who assists
Annie Munk in the classroom.
Services. Limitless Transition Services provides a variety of services including the
summer program, job skills program, social club, as well as the adult living skills program
through the What People Do course at EHHS. The summer program is a five week program that
consists of the following topics: healthy eating, transitioning skills, job surveys, interviewing,
resumes, workplace etiquette/expectations, navigating trax, navigating downtown, food handler’s
permit, social club planning, and various social activities (Limitless Transition Services
[Brochure], n.d.). The job skills program is run year round. Through this program, students of
LTS gain hands on job experience by running the Landlocked Surfer Café food cart during the
school year. Students also participate in pickling and seasoning salt making for Salt and Vinegar
Syndicate, owned by the directors of LTS. The Salt and Vinegar Syndicate participate as
vendors in several Farmer’s Markets during the weekend, allowing students to gain customer
service and money management experience. The social club, which is still in its beginning
stages, includes monthly activities such as going to the movies or bowling, that enable the
students to build upon their social skills.
Lastly, the What People Do course, taught by Annie Munk, teaches these students a
variety of adult living skills and counts towards a career and technical education (CTE) credit.
Majority of the students who sign up for this course through the high school are on an
Independent Education Plan (IEP), although this is not required. Other students may be referred
to the course/program by their teachers, parents, or LTS directors themselves. The topics taught
in this course vary depending on the needs of the students in the class, in any given school term.
The topics may include but are not limited to goal setting, personal hygiene, laundry,
communication and relationships, organizing mail, meal preparation and cooking, banking and
budgeting, resumes and interviews, and navigating public transportation. Through this class, the
directors then decide which students would benefit from the job skills program.
Related services. Limitless Transition Services has partnered with EHHS in providing a
free, after-school Credit Recovery Program. It occurs on a biweekly basis and may only be used
for failed courses. The Credit Recovery Program is available to all students of EHHS. Limitless
Transition Services also has a partnership with the Advanced Education in General Dentistry
(AEGD) Residency Program of Roseman University of Health Sciences. Through this program,
the students of LTS are provided with free dental care, regardless of the price or procedure.
Funding sources. Limitless Transition Services receives funding from a variety of
sources. The What People Do course and Credit Recovery Program are both funded by EHHS.
The LTS summer program is also funded by EHHS due to the students receiving IEP extended
services. East Hollywood High School, which is a public charter school, receives most of its
funding from the state’s School LAND Trust Program ("School Land Trust," n.d.). Other
funding is received from donations from supporters and alumni of EHHS. The Landlocked
Surfer Café food cart and Salt and Vinegar Syndicate Farmer’s Market vendor are both for-
profit. They generate funds, which are then put right back into purchasing all of the necessary
items and equipment that they need in order to maintain the businesses.
Future Plans
In the future, LTS plans to become its own non-profit entity. They plan on expanding
their social club to include all at-risk high school seniors as well as post-high youth in the entire
Salt Lake valley. This social club would require a membership fee, which would then be used to
fund various social activities. Planning social activities throughout the valley would also enable
the participants to practice time management and community mobility skills. In regards to the
job skills program, LTS’s vision includes expanding the Salt and Vinegar Syndicate to a “large
company entirely accommodating to the sensory and learning needs of Autistic or at-risk
persons” (May, 2018). Limitless Transition Services also has tentative plans of creating a music
club for their students at EHHS.

Factors Influencing Service Delivery
Policy. East Hollywood High School has several risk management policies put in place
to ensure the safety and academic performance of their students. These policies include a
nondiscrimination policy, technology policy and data governance plan, attendance policy,
parental involvement policy, transporting students policy, bullying, cyber-bullying, hazing and
harassment policy, and more. Despite the parental involvement policy, which requires parents to
be involved in their child’s academics and extracurricular activities, few parents participate in
their child’s education and extracurricular activities within the LTS program. Out of the six or
seven students participating in LTS each term, there are usually only one to two parents
involved, and this involvement is sometimes quite minimal. Another policy that has directly
influenced LTS, is the transporting students policy. This policy enables the safe transportation of
students during fieldtrips, and requires the parents to sign permission slips for each trip. Since
the LTS program frequently organizes trips, such as to the bank or Farmer’s Market, they run
into the issue of constantly sending permission slips to parents, which may or may not be signed
due to the lack of parental involvement mentioned previously.
Another policy that directly affects the students of LTS is the Individuals with
Disabilities Education Act (IDEA), which is a “law that makes available a free appropriate
public education to eligible children with disabilities throughout the nation and ensures special
education and related services to those children” (Menu, n.d.). Majority of the students who
participate in LTS services have disabilities, and are therefore covered by IDEA Part B, which
covers youth until the age of 21. Each student has an Individualized Education Plan (IEP) which
provides “a series of specific actions and steps through which educational providers, parents and
the student themselves may reach the child's stated goals” (American Psychological Association,
2018). The directors of LTS are involved in the students’ IEPs, which enables them to
accommodate the needs of these students more effectively during LTS activities.
Sociocultural. Since LTS provides services to at-risk youth and youth with disabilities,
they do not encounter very many sociocultural issues within the program. The program is all-
inclusive, and since majority of these children are considered “outcasts,” they enable each other
to feel accepted, supported and understood. External factors include fellow high school students,
parents, teachers, and stigma. Some students may not be understanding of the LTS students,
which can cause discrimination and bullying. Parents of “typical” students have been known to
discriminate against students with disabilities or the special education program, which can distort
their child’s view of their LTS classmates and increase stigma. A few teachers at EHHS also
lack understanding and knowledge of at-risk and special needs youth, and frequently refuse to
provide the necessary accommodations for these students within the classroom. This typically
occurs to the students who do not “look” like they have a disability. This prevents successful
accommodations and learning strategies acquired in LTS from transferring into other classrooms.
Although these factors do not directly influence the service delivery of LTS, they do directly
influence the students and may decrease motivation and self-esteem (N. Broberg and A. Munk,
2018).
Economic. Since LTS is primarily located in EHHS, the economic factors of EHHS and
West Valley City influence its service delivery options. The current median household income
of West Valley residents is $55,933, which is lower than that of the state median household
income of $62,518 (U.S. Census Bureau QuickFacts: Utah, n.d.) The poverty rate in West
Valley City, which is 16.3%, is also higher than the state and national average (West Valley City,
UT, n.d.). Over half (52%) of the students at EHHS have a low socioeconomic status. Some
students at LTS suffer from homelessness. Students that come from such impoverished families
suffer academically, have poorer transitioning and adult living skills, and may not afford to
purchase necessary books and technology for succeeding in school. The majority of West Valley
City residents are employed by manufacturing, retail trade, and construction industries. Students
pursuing jobs in these areas may not be as motivated to succeed academically, since these
industries do not necessarily require high school diplomas or college degrees.
The funding for EHHS, which comes from the state’s School LAND Trust, may also be
insufficient. The technology and computers the students and teachers use are outdated.
According to a survey that was completed in January, “44% of students reported that they do not
have enough classroom support in developing the academic skills they need to be successful in
the classroom,” and “16% of teachers reported that they do not have enough support in keeping
students interested and engaged” (School Land Trust, n.d.). East Hollywood High School
believes that new technology will support students in their learning and success within the
classroom. Although EHHS has received $39,187.00 for the year 2018-2019 from the Trust
Lands funds, administrators believe that this will not be enough to meet the needs of the
classroom (School Land Trust, n.d.). Lastly, since LTS is solely operated by Nicole Broberg and
Annie Munk, their finances alone are insufficient for facilitating the expansion of their program.
They have expressed interest in applying for grants, however, have not been able to apply due to
their busy schedules and lack of assistance for grant writing.
Political. West Valley City is located within Salt Lake County. According to statistics
collected in June 2016, 37.0% of the county is registered as Republican, whereas 15.8% is
registered as Democratic (Voters by Party and Status, n.d.). The school itself is not affiliated
with a specific political party and there are no political statistics regarding the students. Since
LTS is a privately owned for-profit organization, there are currently no political issues that are
directly influencing its service delivery options.
Geographic. West Valley City is located within Salt Lake County, on the northwest side
of the Salt Lake valley. Utah Transit Authority (UTA) provides public transportation all
throughout West Valley City. The Green Line TRAX light rail service runs bidirectionally from
the Salt Lake City International Airport, through the downtown area and to West Valley. There
are also several buses that serve the residents. Both the bus and TRAX operate on a daily basis,
throughout the majority of the day. Although there are numerous transportation options
available, majority of the students of LTS do not know how to access or navigate these options.
Students may also avoid public transportation for fear of getting lost and lack of funds for bus or
train tickets. Due to this issue, not all LTS students are able to participate in weekend Farmer’s
Markets or other social activities in the valley. The directors of LTS frequently accommodate
their schedules and provide transportation for students who need it, however, this is not always
possible due to the lack of manpower.
Demographic. According to the PACE Accountability Report from the school year
2015-2016, out of the 338 students enrolled that year at EHHS, 23% were of an ethnic minority,
52% were of low SES, 18% of students had disabilities, and 60% exhibited chronic absenteeism
(PACE Accountability Report, n.d.). Although EHHS is accepting of all of its students, coming
from an ethnic minority, having a disability, or identifying as part of the LGBTQ community can
make “fitting in” quite difficult. These students may also be subject to bullying, discrimination,
hazing and sexual harassment due to being “different” and misunderstood by others. In regards
to educational attainment of West Valley City, in the year 2016, 20.2% of 18-24 year olds
attained less than a high school graduate degree, 41.3% were high school graduates, 36.2%
attained some college or an associate’s degree, and only 2.3% attained a bachelor’s degree or
higher (Data Access and Dissemination Systems, 2010). Majority of the students in the LTS
program also come from families with single or incarcerated parents, while others have no
parental support. These family dynamics may decrease a student’s ability to adequately
participate in academics, extracurricular activities, social activities, and to maintain healthy and
safe relationships with other students or adults.
Data Collection: Programming Strengths and Areas for Growth
Directors Perspective
Several one-on-one semi-structured interviews were conducted with both the
founder/director and associate director of LTS (see Appendix A). The current strengths of the
program included LTS being an all-inclusive program, and not rejecting even the most “difficult”
students, as well as being able to provide the students with a safe workplace environment where
they can learn, grow and make mistakes. A major weakness that both directors stated was not
having enough time and money to efficiently provide services. Due to a lack of funding, LTS
cannot currently hire additional staff. Another weakness included a lack of practical application
of skills taught in the classroom. Although the directors and other staff attempt to be as hands on
as possible, there is simply not enough time and staff to meet the needs of all of the students at
LTS. An example of this weakness includes grocery shopping skills. The students of LTS
learned about the layout of grocery stores and various grocery shopping tips and strategies,
however, they were not able to practice what they learned and receive feedback. An additional
barrier that LTS is currently experiencing is classroom interruptions from non LTS students.
Students who are not in the program frequently interrupt the What People Do course because
they need a safe place to cope with a crisis, need emotional or tangible support, or simply want to
make a food cart purchase during its non-operating hours. Although the support and assistance
from the LTS directors is available to all students, these interruptions interfere with important
classroom lectures or activities, and distract the LTS students from their studies.
The founder also believes that for some students, the program gives them a “false sense
of security.” Majority of the students make great improvements in their life skills and social
interactions while in the program, however, this does not always transfer into real life. The
directors are currently analyzing this issue, in hopes of discovering the cause, as well as a
solution. Despite the program efforts, there were several gaps identified in regards to the
students functioning and skill levels: unrealistic expectations of the adult life, money
management issues, low or no understanding of consequences, low self-esteem, personal care
and hygiene issues, difficulties maintaining engagement in the classroom, as well as difficulties
maintaining a job.
Student Mentor Perspective
Currently, there are two post-high student mentors. At least one student mentor is always
present during LTS activities. Both student mentors were interviewed informally. The mentors
stated that current strengths of the program included LTS providing job experience opportunities,
educating the students about what happens “behind the scenes” of a job, and teaching students
how to navigate public transportation. The design of the program was also mentioned as a
strength; the program is designed in a way that in order for students to benefit from it, they need
to be motivated and have desire to help themselves. The student mentors did not express any
areas for growth. However, one mentor stated that not all students who are in LTS want to
participate, or feel that they need to be in the program; this attitude makes it more difficult for
the staff to provide services to those specific students, and may negatively affect the LTS
students who desire to be there.
The mentors also expressed that LTS students could benefit from additional opportunities
to practice navigating public transportation. One mentor also stated that teaching students with
autism how to communicate more efficiently, and how to adapt to various life situations would
be beneficial.
Paraprofessional Perspective
There is currently one paraprofessional that co-teaches the What People Do course, and
provides assistance with the Landlocked Surfer Café food cart and Farmer’s Market vendor
stand. The paraprofessional has her own caseload of around twelve freshman students who have
IEPs; these students are currently not in the LTS program. She assists them coursework if they
are falling behind, provides accommodations and advocates for the students’ needs. A semi-
structured interview was conducted with the paraprofessional. Strengths that were discussed
included LTS providing the students with job experience, basic hygiene and living skills, and a
good support system. Weaknesses included not having enough time and staff to consistently
meet the needs of every student.
Student/Client Perspective
To gain an understanding of the students’ perspectives, informal interviews, group
discussions, surveys and an interpersonal support measure were conducted. Informal interviews
and group discussions occurred during the Farmer’s Market and food cart events (see Appendix
A for list of questions). During these interviews and discussions, students informed me that
many of them did not have healthy ways to cope with their stress, anxiety and depression. When
feeling too overwhelmed, they would “shut down” and not be able to function. Their inability to
respond to stress in a healthy way, along with their various diagnoses, frequently prevented them
from participating in certain occupations such as working and engaging in novel social
interactions. The students expressed interest in learning more about healthy ways of managing
and coping with stress.
The LTS survey and Interpersonal Support Evaluation List-12 (ISEL-12) were conducted
prior to the start of a regular class period (see Appendices B and D). All five students present
that day completed the survey and measure. On the LTS survey, the students listed things that
they liked about the program. The following are their answers listed in no particular order:
1. “Everything and I like how you guys help at risk or special needs kids”
2. “It’s a fun class”
3. “I love the feeling of acceptance and desire to help”
4. “I love how helpful everybody is, and how nice and understanding”
5. “The teachers”
In regards to what could be improved about LTS, majority of the students stated “nothing,” and
one student expressed that they wish the program activities occurred more frequently. All
students also indicated that a stress management program would be beneficial to include in LTS.
Other services that students selected as beneficial included a social support group, social
interaction skills program, everyday life skills, and additional job skills training.
The ISEL-12 is a “short-form measure of the traditional ISEL, which measures functional
(i.e., perceived) social support” (Merz et al., 2017). The purpose of this measure was to
informally gain a better understanding of the student’s perspectives of their social support
system. Majority of the students circled more than one answer, therefore it was not be scored.
The answers regarding each of ISEL-12 statements varied from student to student, yet they
indicated that majority of the students lacked social support in one way or another. Some
students felt unsure if they had someone to divulge their most private worries and fears with, or
whether they had someone they could turn to if they needed advice regarding family problems.
Other students felt that if they wanted to have lunch with someone, they probably would not be
able to find someone to join them.
Data was also gathered from the online Transition Survey that the students fill out at the
beginning of the semester in the What People Do course (see Appendix C). This survey, which
is provided by the directors of LTS, enables them to gain information regarding the students’
dreams, barriers, learning styles and beneficial accommodations, employment skills and
interests, independent living skills, as well as recreation/leisure interests. Majority of the
students indicated that they would like to have a part-time or fulltime job, and that they
recognize they need to attend college or a trade school in order to achieve their goals. The
students determined these following factors as being the greatest barrier to achieving their
lifetime goals:
1. Anxiety
2. Depression
3. No one wanting to hire me
4. Lack of self-confidence
5. Lack of working as hard as I can
6. Life
7. Being a bad actor or being bad at spelling

8. Procrastinating
9. Not believing in myself
10. Executive functioning
In regards to daily occupations, out of the six students that completed the survey, only two felt
independent with meal preparation, using the newspaper or internet to locate jobs, apartments or
vehicles, and making appointments with the doctor, dentist, and etc. Other activities that the
students lacked independence in included cooking a simple recipe, grocery shopping, budgeting
their money, using the postal services, and washing, drying, ironing and folding their clothing.
Graduate Student Perspective
In order to understand the LTS program strengths and weaknesses, and its gaps in current
services, data was gathered through semi-structured and informal interviews, group discussions,
open one-on-one conversations and observations of the What People Do course, as well as the
operations of the Landlocked Surfer Café food cart and Farmer’s Market stand.
Strengths. A major strength of LTS is its dedicated staff and the social and emotional
support that they provide for students. The staff dedicate their personal time, working even
weekends, in order to provide these teenagers the assistance and support they need. Another
strength includes the amount of job experience opportunities and knowledge LTS provides for its
students, which includes setting up and working the food cart, creating seasoning salts, pickling,
and working the Salt and Vinegar Syndicate Farmer’s Market stand. Limitless Transition
Services also provides assistance with acquiring Food Handler’s Permits and creating resumes,
which enables students to be more successful when applying for jobs.

The current size of the LTS class is also a strength. The small size of around seven
students each term enables the staff to form relationships with each student, and determine what
their specific needs are. It enables the students to get to know each other and build their own
friendships and support systems amongst each other. The directors are also able to adjust the
course curriculum to address the needs of the students in a given term. The course curriculum
addresses numerous topics that are important for effectively transitioning into adulthood such as
goal setting, personal hygiene, laundry, communication and relationships, organizing mail, meal
preparation and cooking, banking and budgeting, resumes and interviews, and navigating public
transportation.
Weaknesses and Barriers. A major weakness and barrier of LTS includes a lack of
funding for additional services and staff. Currently, LTS is unable to hire staff, which then limits
the frequency and type of services they can provide to the students. The lack of funding also
prevents the program from expanding and providing other additional services that would benefit
their students. Limitless Transition Services would also benefit from volunteers, however, they
currently cannot afford to hire a volunteer coordinator. Another barrier that LTS has
encountered is inadequate ability and knowledge for grant writing. Hiring a grant writer would
increase the program’s chances of receiving funding.
Other weaknesses include insufficient hands on application of life skills and
implementation of coping strategies for stress, anxiety and depression. Occupational therapists
(OT) would be able to help in this domain by providing the students with opportunities to
practice their skills in and out of the classroom. Client factors, performance skills, performance
patterns, and contexts/environments of each student would be analyzed by the OT, which would
enable more efficient, effective and client-centered interventions for improving the students’
living skills and mental health. The students of LTS would benefit from a social support group
and stress management program.
Another current weakness and area for potential growth is data collection. Although
LTS measures outcomes by student pre and post transition surveys, attendance, grades,
employment and accomplishments, there is little quantitative data. Limitless Transition Services
would also benefit from incorporating occupational therapy assessments that measure social
interaction skills, transitioning skills, sensory processing/integration, behavior, and overall
occupational performance.
Evidence-Based Practice
A thorough literature review was conducted in order to gain a better understanding of the
occupational needs of the population of LTS, as well as to determine what interventions are
currently effective in treating at-risk youth. Databases used included Cumulative Index of
Nursing and Allied Health Literature (CINAHL), PsyhINFO, and the American Journal of
Occupational Therapy (AJOT). These databases were searched with combinations of the
following key terms: at-risk youth, intervention, occupational therapy, mindfulness, life skills,
adult skills, transition, self-regulation, emotional regulation, sensory, disabilities, psychosocial
factor, assessment, and cognitive orientation to occupational performance. The majority of the
articles gathered were accessed through CINAHL. The articles that were chosen were published
within the last ten years, peer-reviewed and relevant to the at-risk population. Fourteen articles
were used for this literature review.
Characteristics of At-Risk Youth
Eismann et al. (2017) completed a study that sought to identify characteristics of youth
who were receiving transitional occupational therapy services. They found that most students
were male, white, and had diagnoses of autism, cerebral palsy and mental retardation, and had
some difficulty with verbal comprehension. Other characteristics and barriers of at-risk youth
included emotional and mental disabilities, executive dysfunction, sensory processing
difficulties, low socioeconomic status and homelessness, unsafe social and physical
environments, and having experienced abuse, neglect, trauma and grief. Shea and Jackson
(2015) also stated that at-risk youth have “little experience exploring their occupational interests
and are making occupational choices that result in isolative, self-destructive, and/ or socially
problematic behaviors” (p. 174).

Negative Impact on Life. Many of these youth suffer severe occupational consequences
caused by the barriers they encounter and their problematic behaviors. These consequences may
include “not attending or dropping out of school, social isolation from peers and family, self-
cutting, substance abuse, shop-lifting/petty thefts, and/or incarceration” (Shea & Jackson, 2015,
p. 174). These consequences may hinder an individual’s ability to effectively transition to
adulthood and acquire the necessary coping skills for future life problems. Studies have also
shown that low socioeconomic status, poverty and chronic stress during adolescence might
impair the brain’s ability to adequately develop executive functioning and language (Weiner et
al., 2012, p. 700). This deficit has been linked to decreased self-regulation and goal-oriented
behaviors, risky behaviors and substance addictions (Weiner et al., 2012, p. 700).
Toglia and Berg (2013) further studied executive functioning by comparing strategies
used by at-risk youth and community youth while completing the Weekly Calendar Planning
Activity. They found that at-risk youth used fewer strategies, made more errors, and used
uncommon strategies such as talking aloud, while neglecting useful strategies such as crossing
items off a list (Toglia & Berg, 2013, p. 520). Additionally, the emotional dysregulation that
stems from executive dysfunctioning may lead to poor coping skills and maladaptive behaviors.
Transitioning into Adulthood
Transitioning into adulthood can be a time of stress and vulnerability for youth. This
transition usually includes a variety of changes that the youth need to manage and cope with.
Weiner et al. (2012) stated the necessary executive functioning skills for acquiring success
include “organization, planning, sustained attention, timeliness, management of distraction,
multitasking, and strategy use” (as cited in Conley, 2008; Harris & Pressley, 1991). Toglia and
Berg (2013) mentioned additional important skills that youth typically develop, which include
“capacity to hold in mind multiple concepts, suppress inappropriate thoughts and responses,
delay gratification, self-monitor and reflect on performance, think more strategically, and sustain
goal-directed actions” (as cited in Best & Miller, 2010; Crone, 2009; Zelazo & Carlson, 2012).
As mentioned in the previous section, many at-risk youth have impaired executive functioning,
thus making the transition into adulthood quite difficult.
Current Interventions for At-Risk Youth
Interventions from varying disciplines such as public health, social work, medicine,
education and psychology were found to be effective in treating at-risk youth. Rapp-Paglicci,
Stewart and Rowe (2011) studied the Prodigy program which offers at-risk youth various arts
classes, which indirectly address the self-regulation skills of social interaction, problem-solving
and anger management (p. 312). They found that this arts program decreased both internalizing
and externalizing mental health symptoms, and improved the youths’ academic self-efficacy
(Rapp-Paglicci et al., 2011). Yoga and mindfulness interventions were also found to be effective
in treating anxiety, self-regulation and overall well-being in at-risk youth. A systematic review
(Weaver & Darragh, 2015), revealed that yoga reduced anxiety and its associated symptoms and
behaviors, especially when practiced frequently. Two structured mindfulness-based programs
that focused on yoga, meditation and breathing techniques were effective in improving emotional
regulation, relationships, school participation, physical activity, sleep hygiene, while decreasing
rumination, negative thoughts, and hostility (Mendelson, Greenberg, Dariotis, Gould, Rhoades,
& Leaf, 2010; Sibinga, Kerrigan, Stewart, Johnson, Magyari, & Ellen, 2011).
Occupational Therapy and At-Risk Youth
Role of OT. Currently, the number of OTs practicing with at-risk youth is quite minimal,
despite the fact that OTs possess the necessary skills to work with this population. Occupational
therapists are skilled in analyzing occupations, client factors, performance skills, performance
patterns, and contexts and environments, and therefore may enable youth to participate in
activities and fulfill their various roles (American Occupational Therapy Association [AOTA],
2014). Occupational therapists may assist at-risk youth with transitioning to adulthood,
improving daily life skills and social skills, managing sensory processing difficulties, and
discovering healthy coping skills. In regards to the transitioning process, Eismann et al. (2017)
found that OTs may:
facilitate a student’s involvement in early, paid work experience; (2) help the student
prepare for IEP meetings; (3) give instruction in social competence and daily living
skills; (4) provide consultation on assistive technology needs; and (5) participate in
interdisciplinary and interagency teaming (as cited in Cleary et al., 2015).
Occupational therapist’s role may also include providing evidence-based interventions and
assessments for at-risk youth.
Interventions. Although OTs are adequately trained to serve the at-risk youth
population, not very many OTs are employed within this area, with only 7.5% of youth with
disabilities receiving transitional OT services (Eismann et al., 2017, p. 6). The current
occupational therapy programs for at-risk youth found in the literature focused on participation
in meaningful activities and occupations, increasing self-awareness, improving social skills and
life skills, advocating for oneself, mindfulness, goal-setting and planning for the future.
Read, Roush and Downing (2018) completed a systematic review regarding early
interventions for youth suffering from mental health challenges. The transitioning period is a
vulnerable time when the risk of onset of mental illness increases, therefore, it is necessary to
know what interventions are most beneficial. Interventions that were found to be effective
included cognitive remediation, cognitive-behavioral therapy, supported education and supported
employment, and family psychoeducation. The researchers believe that occupational therapists
should incorporate cognitive remediation strategies into treatment, due to evidence that these
strategies “promote quicker recovery, prevent progression of the illness and further cognitive
decline, and help clients maintain engagement in work, school, and social relationships” (Read et
al., 2018, p. 6).
Shea and Jackson (2015) completed a pilot study in order to determine at-risk youths’
perceptions regarding a client-centered and occupation-based community program. The purpose
of the occupational therapy training program (OTTP) was to improve occupational engagement
in a variety of settings and improve overall health and wellbeing. Clients typically participate in
this program for two to three years, and receive up to 50 hours of individual OT treatment per
quarter. During this program, occupational therapists evaluate each client and determine
potential strengths, interests, and potential process skills and client factors that may be impacting
their occupational performance (Shea & Jackson, 2015, p. 174). The OTTP provides client-
centered interventions, enabling the youth to be in charge of their therapy process. The results of
this study showed that the youth found this program to be effective; they valued the therapeutic
relationship they had with the OT and made improvements in self-awareness, social skills,
emotional regulation, self-advocacy and community and work involvement.

Arbesman, Bazyk and Nochajski (2013) conducted a systematic review of occupational
therapy interventions regarding the three levels of service in the public health model: universal,
targeted and intensive tiers. In regards to at-risk youth, which is a “targeted” population, they
found that social skills interventions improve social interaction and communication skills,
attention, and functional skills, and decrease aggression and misbehavior (Arbesman et al.,
2013). Additionally, a retrospective study (Keenan, King, Curran, and McPherson, 2013),
evaluated the effectiveness of goal-focused life skills coaching on youth with disabilities which
was provided in two different formats: one-to-one coaching and a life skills group. The one-to-
one coaching enabled the interventions to be client-centered and address specific skills, while the
life skills group included 10 youth and focused on skills that were relevant to the group as a
whole, such as public transportation. Both formats were found to be effective, as proven by the
youths’ significant improvements on the Canadian Occupational Performance Measure and Goal
Attainment Scaling (Keenan et al., 2013).
Cognitive OT interventions have also been found to be effective in students who have
various disabilities. Cognitive Orientation to daily Occupational Performance (CO-OP) is a
problem-solving approach that enables individuals to choose their own goals, create a plan for
how to accomplish those goals, implement the plan, and then check whether or not the plan
worked and how it can be modified. The goal of CO-OP is to learn how to problem-solve and
acquire skills, and then be able to generalize and transfer strategies to other situations (Rodger,
Ireland, & Vun, 2008, p. 24). Rodger et al. (2008) examined two case studies of boys with
Asperger’s syndrome, and found that CO-OP was effective in improving social skills and
organizational skills, as well as generalization and transfer of learning (Rodger et al., 2008).
Lastly, sensory integration (SI) approaches have been proven to be effective in children
and youth with autism. Pfeiffer, Koenig, Kinnealey, Sheppard, and Henderson (2011) described
SI-based treatment as “a program of intervention involving meaningful therapeutic activities
characterized by enhanced sensation, especially tactile, vestibular, and proprioceptive, active
participation, and adaptive interaction” (as cited in Bundy, Lane, & Murray, 2002, p. 479). A
pilot study by Pfeiffer et al. (2011) found that SI interventions reduced autistic mannerisms, and
facilitated positive improvements in Goal Attainment Scaling (GAS) scores in the sensory
regulation, social and emotional functioning, and fine motor skill domains (pp. 81-82).
Measures. The literature does not currently provide much information regarding specific
occupation-based assessments valid for at-risk youth. Two assessments were found to be useful:
the Weekly Calendar Planning Activity (WCPA) and the Double OT (DOT). Other measures
found in the literature that were useful for assessing goal attainment included the Goal
Attainment Scaling form (GAS) and the Canadian Occupational Performance Measure (COPM).
The WCPA is a dynamic assessment that evaluates executive function through an
individual’s performance of a task. Weiner, Toglia and Berg (2012) performed a study that
included demoing the WCPA and determining a baseline for at-risk youth. This assessment
consisted of the participants scheduling appointments for one week on a calendar, while
following five very specific rules regarding the schedule. These rules were meant to assess the
participants’ memory, and ability to solve problems and manage distractions (Weiner et al.,
2012, p. 701). The results of the study showed that the WCPA is a valid tool for assessing
executive function in at-risk youth transitioning into adulthood. The WCPA was able to discover
elusive executive functioning deficits, provide the participant insight to their performance, and
assess cognitive strategies used and errors made during the task (Weiner et al., 2012, pp. 704-
705).
The DOT is a client-centered and occupation-based assessment tailored to at-risk youth,
and was developed by the OTTP mentioned previously. The assessment is conducted in a game-
based format, and requires the participants to engage in tasks that measure work skills (Haworth
& Cyrs, 2017, p. 22). The DOT includes eleven modifiable tasks, and assesses the following
skills: self-care, community mobility, financial management, generalization, organization,
planning, time management, insight, judgement, problem solving, confidence, impulse control,
motor skills, direction following, clarification, initiation, sequencing, social interaction skills,
conflict management and attention. The participants are also required to self-reflect after each
task and describe how each skill they are being assessed on relates to the workplace (Haworth &
Cyrs, 2017, p. 22). Through this assessment, OTs are also able to determine recommendations
and strategies that may be beneficial for each participant, as well as areas for potential growth.
The COPM is a semi-structured interview that enables clients to determine their
occupational priorities/goals and rate their importance, performance and satisfaction of those
occupations, before and after the intervention. The rating is based on a Likert scale of 1 (unable
to perform/not satisfied) to 10 (able to perform/extremely satisfied) (Keenan, King, Curran,
McPherson, 2014, p. 122). The GAS includes levels of outcomes for each goal, which include -2
(present level or much less than expected), -1 (somewhat less than expected), 0 (expected level
or program goal), +1 (somewhat better than expected), and +2 (much better than expected)
(Keenan et al., 2014, pp. 122-123). Keenan et al. (2014) found the COPM and GAS to be
beneficial outcomes when combined to assess the same goal; the COPM enabled the client to
identify goals, while the GAS offered a way to objectively measure intervention success (p. 129).
Summary of Needs Assessment
The mission of LTS is to “provide support to qualifying young adults in the areas of
academics, social skills and self-esteem” (“Limitless Transition Services,” n.d.). Limitless
Transition Services currently provides its students with a variety of services addressing
academics, life skills, work skills and social skills. The data collected during the needs
assessment indicated that LTS lacked sufficient funds for programming, and was unable to
provide adequate practical application for skills taught in class. The directors of LTS also
indicated that there was insufficient transfer and generalization of skills from the classroom into
real life. The data gathered from the literature review presented valuable information regarding
interventions that may combat these issues.
The literature review presented more insight into the characteristics of at-risk youth and
the consequences they may suffer, such as social isolation, school absenteeism, substance abuse,
self-harm, incarceration, emotional dysregulation and executive dysfunction (Shea & Jackson,
2015; Weiner et al., 2012; Toglia & Berg, 2013). It was learned that low executive functioning
was directly related to maladaptive coping skills and poor transitioning into adulthood. The
literature suggested that at-risk youth would benefit from OT interventions and assessments to
facilitate healthy occupational engagement and transitioning. Analysis of the needs assessment
and literature review indicated a need for a client-centered, occupation-based and goal-directed
program implemented by an OT. This program would improve self-awareness, emotional
regulation, social skills, self-advocacy, work skills, strategy use and organizational skills, all of
which are essential for accomplishing a health transition into adulthood (Shea & Jackson, 2015;
Roger et al., 2008).

Program Proposal: Transitioning Skills for At-Risk Teenagers
Program Overview
This proposed program is a client-centered, occupation-based and goal-directed program
for at-risk youth of Limitless Transition Services at East Hollywood High School. It builds upon
the already existing LTS course What People Do. This program will fill the gaps in services that
were found in the needs analysis regarding the students’ functioning and skill levels, and will
also address various characteristics and barriers of at-risk youth identified in the literature
review, such as executive dysfunction and emotional regulation. The overall aims of this
program will be to improve life skills and coping skills in order to facilitate a healthy and
successful transition into adulthood.
This proposed program will take place during the What People Do class period. A
contracted OTR will be hired to attend and assist with the course, complete evaluations and
assessments, create and track progress of goals, and facilitate hands on application of skills as
well as participation in community outings. Occupations and topics addressed in class will vary
depending on the needs of the students enrolled in the class during each term. The following are
potential occupations and topics to be addressed throughout the term: personal hygiene and
grooming, community mobility, financial management, health management and maintenance,
home establishment and management, meal preparation and cleanup, shopping, education, work,
leisure, social participation, self-awareness, emotional regulation, sensory processing strategies,
mindfulness and cognitive strategy use.
The proposed program was influenced by various social, economic, political, geographic,
and demographic factors identified in the needs analysis. The main factors that directly
influenced service delivery options were economic, geographic and demographic. Many of the
students come from impoverished families and may not afford any extra school materials. This
was taken into consideration by maintaining the cost of the program free for the students. In
regards to geographic factors, majority of the students of LTS live in West Valley City and do
not have their own form of transportation, nor are they proficient in navigating public
transportation. To address these factors, the proposed program will remain in EHHS (with the
exception of class community outings) for ease of access, and will also incorporate public
transportation lessons and activities. Lastly, these teenagers come from families with single or
incarcerated parents, while others have little to no parental support. This demographic factor
will be addressed by providing these teenagers with a safe place for peer and adult interaction,
where emotional and social support will be provided.
Program Value
The services provided by this program are valuable to this population because they
address the numerous barriers and issues that these at-risk teenagers may be experiencing. The
program aims to improve the occupational engagement and well-being of these individuals in
order to prepare them for transitioning into adulthood. This program is unique in the sense that it
shifts its focus depending on the needs of the students in each given term, thus making it more
client-centered. The practical application and goal setting that will be incorporated will enable
the students to safely practice skills under the supervision of a qualified professional, and will
enable them to learn how to self-monitor their own progress and abilities. The services provided
by this proposed program are consistent with the mission of LTS which is to “provide support to
qualifying young adults in the areas of academics, social skills and self-esteem” (“Limitless
Transition Services,” n.d.).

Occupational Justice. This program addresses two types of occupational justice:
occupational deprivation and occupational imbalance. Occupational deprivation is a “the result
of external circumstances or limitations that prevent a person from participating in necessary and
meaningful occupations” and it may be caused by “poor health, disability, poverty, isolation, and
homelessness” (Scaffa, Guillory Caraway, & Takehara, 2014, p. 429). Many of the adolescents
participating in the LTS program come from impoverished homes with little to no social support.
They do not have the financial means and parental support to successfully participate in
instrumental activities of daily living (IADLs) such as home and health management, meal
preparation and shopping, as well as the occupations of education, work, play, leisure and social
participation. This program would address occupational deprivation by providing the
adolescents with a safe place to practice and become proficient in these occupations.
Occupational imbalance is a “lack of balance between self-sustaining, productive, and
leisure occupations that fails to meet an individual’s physical or psychosocial needs, thereby
resulting in decreased health and well-being” (Scaffa et al., 2014, p. 429). Many of these
teenagers do not have balance among the occupations that are crucial to their development, such
as education, social participation, leisure, and play. They overwork to compensate for parental
financial instability or focus too much time on leisure and play, preventing them from
maintaining balance among occupations. This program would improve their occupational
balance by providing peer interaction and opportunities to effectively participate in a variety of
occupations. Addressing both of these occupational injustices would improve the mental health,
physical health and occupational engagement of this population.
Prevention. There are three levels of health promotion and disease prevention. Since
this program is tailored to at-risk youth, it does not address primary prevention, as these
individuals already have an existing condition. Secondary prevention is addressed in this
program by targeting at-risk youth in order to reduce/prevent school dropout, low grades and
unemployment. The program also seeks to prevent progression of mental health symptoms and
occupational decline, as well as to improve life skills before the transition into adulthood begins.
Assessments such as the Child Occupational Self-Assessment, Volitional Questionnaire and
Adolescent/Adult Sensory Profile will be used as secondary preventative measures in order to
identify potential areas of concern that may need to be addressed.
The program will address tertiary prevention by providing clients with interventions that
will enable them to manage their condition and improve their quality of life. The therapist will
teach clients with sensory processing dysfunction how to adapt to their environment and teach
internal and external cognitive strategies to individuals with executive functioning deficits.
Clients who have mental health conditions such as anxiety, depression, and psychosis will be
taught various coping and mindfulness strategies that will enable them to manage their stress and
diagnosis.
Rationale for Occupational Therapy’s Role
Occupational therapists are essential to this program because of their ability to skillfully
analyze individuals and the environments and occupations that are a part of their everyday lives.
They are skilled in modifying and adapting environments and occupations to improve
performance in individuals of varying conditions and diagnoses, such as executive dysfunction
and sensory processing disorder. They are experts in analyzing occupations, client factors,
performance skills, performance patterns and contexts and environments (American
Occupational Therapy Association [AOTA], 2014). An OT would address all of these factors
throughout the program, thus enabling the at-risk youth to improve their ability to effectively
participate in their various roles and occupations. Since occupational therapy is a client-centered
profession, the OT would ensure that the needs of each client are met.
In this proposed program, the OT would be a provider of direct services by attending
class, assisting in creation and modification of the class curriculum, completing evaluations and
assessments, setting and tracking progress of goals, and providing hands-on life skill
interventions. This program is occupation-based due to its focus on performing and practicing
meaningful and/or purposeful activities and occupations. An OT is therefore necessary to
analyze the client’s performance and demands of the activity, and to determine potential
solutions and strategies that will improve client functioning.
Theoretical Foundation
Occupational therapists may use the Person-Environment-Occupation (PEO) model and
the Model of Human Occupation (MOHO) to guide their evaluation and intervention when
working with at-risk youth. The PEO model analyzes the relationship between the person,
environment, and occupation, and seeks to determine optimal congruence between these three
factors (Law, Cooper, Strong, Stewart, Rigby & Letts, 1996). This model can be used with the
at-risk youth population by changing their environment or the way in which they perform
occupations, in order to promote success and occupational engagement. MOHO is especially
relevant for this population because it seeks to improve occupational participation and adaptation
by improving an individual’s volition (motivation), performance capacity (how mental and
physical abilities are utilized) and habituation (organization of actions into patterns and routines)
(Kielhofner, 2009). Through the use of MOHO, at-risk youth can develop positive roles, habits,
and volition, thus improving their occupational competence. The MOHO model will manifest in
the program through the use of the Child Occupational Self-Assessment (COSA) (Cohen, Cohen,
Aiken, & West, 1999) and the Volitional Questionnaire (Chern, Kielhofner, de las Heras &
Magalhaes, 1996). The PEO model will be incorporated by analyzing the client, environment
and their occupations, as well as by using the COPM to determine goals and progress.
Complimentary models that will be incorporated into the program include the Sensory
Processing Model and the Dynamic Interactional Model of Cognition (DIM). The Sensory
Processing Model aims to improve an individual’s ability to adapt to sensory information and
their environment in order to increase and improve their occupational engagement (Dunn, 1997).
This model is important to include in this program because many of the teenagers have sensory
processing difficulties. The Adolescent/Adult Sensory Profile (Brown, Tollefson, Dunn,
Cromwell, & Filion, 2001) will be administered at the beginning of the program in order to gain
more information regarding the student’s sensory processing abilities. On the other hand, the
DIM seeks to improve occupational performance through application of internal and external
cognitive strategies, improvement of self-awareness and modification of activity demands
(Toglia, 2011). This model is especially relevant to this population because many of these
students have executive functioning difficulties. It will guide intervention through teaching the
clients strategies that will enable them to succeed in school and work tasks. The Weekly
Calendar Planning Activity (Weiner et al., 2012) will be used to assess the students’ executive
functioning deficits and will also serve as an intervention.
Goals and Objectives
Goal 1: To increase clients’ abilities to effectively perform daily life skills necessary for a
successful transition into adulthood.

Objective 1. By the end of the term, 60% of clients will independently implement internal
or external cognitive strategies during 80% of class activities/homework as measured by
therapist or program director observation.
Objective 2. By the end of the term, 80% of clients will improve their baseline COPM
and/or GAS scores by at least 1 point.
Goal 2: To improve the clients’ abilities to manage and cope with stressful situations in a healthy
and effective manner.
Objective 1. By the end of the term, 60% of clients will independently incorporate
mindfulness techniques (yoga, deep breathing, meditation) into their daily routine, per
client report.
Objective 2. By the end of the term, 70% of clients will independently incorporate coping
techniques (such as listening to music, taking a walk, talking to someone) during stressful
situations, per client, therapist or program director report.
Transitioning Skills for At-Risk Teenagers
The Transitioning Skills for At-Risk Teenagers program builds upon the Limitless
Transition Services’ already existing course What People Do. This proposed program will take
place in the LTS classroom at EHHS, and in various community settings. The staff will include
the directors of LTS, current paraprofessional and a newly hired OTR. The program will operate
Monday through Friday during a two-hour class period. Since this is a client-centered and
dynamic program, the skills and occupations taught throughout the term will be dependent upon
the students’ needs and interests. This program will seek to improve various life skills and
coping techniques necessary for the teenagers to successfully transition into adulthood.
During the first week of the program, the students and staff will get to know each other
and start forming relationships. All students will be required to take the transition survey and
quantitative confidence pre survey, and will be assessed by the OT through the COSA and
Volitional Questionnaire. The COPM will also be administered to all students by the OT or LTS
directors. By the end of the week, all students will have completed a GAS scale chart for at least
one of their goals identified in the COPM. The therapist will use their clinical judgement to
determine whether certain students in this particular term will benefit from being assessed by the
WCPA or Adolescent/Adult Sensory Profile. This first week will also include lecture and
practical application of mindfulness techniques and coping strategies. Reviewing this topic in
the first week will enable the students to determine which strategies work for them, so they can
be prepared to manage stressors that arise in the remainder of the program, especially during the
hands on activities, as well stressors that arise in their daily lives. During these sessions, the
students will learn about what stress is, how it affects the body, and how it can be managed in a
healthy way. Meditation, deep breathing and yoga will be practiced during these sessions as
strategies for managing stress.
Each of the remaining weeks will focus on a specific skill. Monday and Tuesday of each
week will be used to introduce the skill/occupation and learn about ways to improve success in
that skill/occupation. This will be done in a lecture and group discussion format. Worksheets,
various preparatory activities, and homework will be assigned in preparation for the hands on
application of the skill. The Food Cart will continue to operate on Wednesdays, as this is already
an existing part of the LTS program. Thursdays and Fridays will be dedicated to the functional
activity/occupation that the students had been preparing for in the beginning of the week. The
students will practice this in the classroom or out in the community. For example, the students
will head to the LTS director’s kitchen on Thursday to practice kitchen safety, sanitation and use
of appliances. On Friday, the students will practice cooking simple hot meals in the kitchen,
utilizing all the information they had learned throughout the week. The LTS supervisors will
provide assistance during the tasks, while the OTR observes task performance and provides the
appropriate amount of cueing to facilitate learning and independence. At the end of each week,
goals will be reviewed and updated if necessary. The OTR will also document on a daily basis,
and will provide additional cognitive and sensory interventions to the students who require more
assistance in those areas.
During the last week of the term, the students will be required to complete an open-ended
survey regarding their progress and program efficacy, as well as a quantitative post survey
measuring their confidence in various occupations. The COPM will be readministered, and the
GAS scale chart will be updated. The OTR will complete the Volitional Questionnaire for each
client to determine changes in volition over the course of the program. The OTR or LTS
directors will meet with each student to discuss their progress, goals, and any additional concerns
moving forward. A social event will be planned for the last day of the term to recognize the
students’ achievements and progress throughout the semester.
Program Considerations. The proposed program, Transitioning Skills for At-Risk
Teenagers, addresses relevant educational, community and social systems. Education is
addressed through teaching the clients a variety of cognitive and coping strategies and techniques
for goal-setting. These skills will enable the clients to improve their academic performance and
independence within the school system. Community and social systems are addressed by
providing clients with safe peer and adult interaction and community outings to a variety of
settings.
The program will accept all EHHS students that are considered “at-risk,” which entails
students at-risk for school dropout, low grades, incarceration, as well students who suffer from
various mental, physical, and intellectual disabilities. These students will be referred to the
program by their teachers and the LTS directors. Although majority of the students currently
involved with LTS are on IEPs, this is not required for participating in the program. Students
who do not have disabilities and are not at-risk for occupational imbalance or decline will not be
eligible to participate in this program at this time. This may or may not change in the future as
the program grows and evolves.
Since LTS and EHHS already provide numerous community resources to their students,
additional resources through this program will not be provided unless there is a need for a
specific resource the OT needs to identify and locate. The following resources may be found on
the EHHS website: United Way 211, Youth Services, Services for LGBTQ Youth, National
Alliance on Mental Illness, Utah Youth Suicide Prevention Toolkit, National Suicide Prevention
Lifeline and SAFE UT (“Community Resources,” n.d.).
Program Start-up. At the time of program start-up, the staff will be educated on the
responsibilities of the OT and how to administer the COPM, and the OT will be trained in all
necessary assessments. The program will initially begin with the current staff and the 7 students
enrolled in the first term. Depending on the program outcomes after the first 6 week term,
changes will be made if necessary. As the program evolves, more staff and volunteers will need
to be hired, and more time will need to be allocated for the program activities. The program may
eventually evolve into including students outside of EHHS and an afterschool program may be
added depending on the needs of the students and financial means of LTS.
Space Requirements. The majority of this program will take place within the LTS
classroom in East Hollywood High School. This classroom already has the necessary office
supplies such as filing cabinets, printer, pens, desks, chairs, paper, and etc. The directors of LTS
have a kitchen which will also be used during the program for meal preparation and cooking
activities. Other space requirements include areas such as the grocery store and laundromat,
which are available within the community. Transportation to these areas will be provided by
school bus or van, or by public transportation. No extra storage space will be necessary, due to
storage space available within the school and kitchen.
Time Requirements. Since this proposed program will take place within a high school,
the time requirements will remain the same. The activities of the program will take place during
the What People Do course, which is a two-hour long class period that occurs Monday through
Friday, during every 6 week term in the school year. The contracted OTR will attend this course
on a daily basis to assist with course content, format, and the students’ involvement during
lecture. Practical application, assessments/evaluations, documentation, telephone consultation
and preparation will be included in this 12 hour per week position. See Appendix E for a more
detailed schedule.
Staff Involvement. Since this program is building upon the current LTS program, staff
involvement will be crucial. The directors of LTS will continue to lead the What People Do
course, with assistance from the OTR. The directors’ and paraprofessional’s schedule will
remain the same. Additional staffing, such as a paraprofessional, aide or volunteers, may need to
be considered as the program evolves. Additional staffing would provide the students with more
assistance during hands on classroom activities and outings. Teachers of EHHS whose students
are enrolled in the What People Do course will be informed of their student’s goals, progress,
and strategies in order to promote carryover of occupational performance in other classes.
Assessments and Interventions. Throughout this program, the occupational therapist
will be in charge of conducting a variety of assessments and interventions. The COPM will be
used at the beginning of each term to determine clients’ occupational goals and priorities, and
will serve as a pre and post measurement of these occupations’ performance and satisfaction.
The GAS scale will also be used as an objective way to measure the progress of each client’s
goals.
The WCPA, Adolescent/Adult Sensory Profile, COSA, and the Volitional Questionnaire
will be used to assess specific clients throughout the program. The WCPA will be used to
evaluate executive function and will also serve as an intervention method that will allow the
clients to practice organization skills and cognitive strategies. The Adolescent/Adult Sensory
Profile will be used to determine the client’s sensory preferences and strategies for adapting to
their sensory dysfunction and environment. Not all students will be assessed through the WCPA
and Sensory Profile; the therapist will use their clinical judgement to determine which students
would benefit from these assessments.
All students in the program will be evaluated through the COSA and Volitional
Questionnaire. The COSA will be used to determine which occupations are important to the
client as well as the client’s perception of their own occupational performance abilities. The
results of this assessment will guide the therapist’s intervention and client goals. The Volitional
Questionnaire will be completed for each student by the OT at the beginning and end of the term.
This questionnaire will provide the therapist and staff with a better idea of the client’s volition
(inner motives) and how this is impacted by the environment (Chern et al., 1996).
Interventions that will be provided by the OT throughout the course include practical
application and modification of skills, cognitive interventions utilizing CO-OP and
external/internal strategies, sensory processing interventions, and mindfulness-based activities.
During skill application, clients will receive the appropriate amount of cueing and feedback from
the OT. The OT and client will also work collaboratively to determine which cognitive
strategies are most beneficial, and will utilize the CO-OP approach to create plans for
accomplishing goals and generalizing strategies to other situations. Sensory processing
interventions will include adapting the environment to meet the sensory preferences of the client,
and mindfulness-based activities will consist of yoga, meditation and deep breathing techniques.
Community resources will also be utilized throughout the term. Outings into the communing
will be an integral part of the program and the client’s learning experience. These outings will
occur in locations such as grocery stores, laundromats, banks, restaurants and more. They will
enable students to practice public transportation and a variety of other skills associated with the
occupation they are practicing.
Program Marketing. This program will be marketed to at-risk teenagers enrolled at
East Hollywood High School. Teachers, administrators and parents will receive an email from
the OT and program directors describing the program and its benefits. The students within the
program will also create marketing material such as flyers, posters or short videos depicting
skills and concepts learned in the program. Since this program is specifically for the students of
LTS and EHHS, no marketing outside of the school will be necessary.
Relationship building has also been successfully used to promote the current LTS
program. The students and program directors of LTS have formed relationships with other
students, teachers and administrators by working at the food cart each week. This has made the
entire school more familiar with the LTS program. The contracted OT would also form
relationships with the teachers and promote the program by providing data on student life skill
improvement. Students who are unsure if they want to be enrolled in this class/program, could
come volunteer during activities (such as food cart, laundromat outing, etc.) to see what the
program has to offer, and to get to know the current students and administrators.
Budget. The budget for this program includes multiple start-up, direct, and indirect costs.
The start-up costs include the registered occupational therapist (OTR) training and a variety of
assessments/evaluations. The direct costs of the budget include the OTR salary, community
outings, travel/transportation costs such as UTA bus/trax fare, marketing materials, as well as life
skills supplies such as laundry detergent and cooking supplies. The indirect costs, which are in-
kind contributions, include rent, maintenance and utilities. See Appendix F for a detailed outline
of the proposed budget.
Funding Options
Two specific funding sources were found that are consistent with the nature of the
proposed program and can realistically provide the adequate amount of funding: the George S.
Eccles and Delores Dore Eccles Foundation and the R. Harold Burton Foundation.
The George S. Eccles and Delores Dore Eccles Foundation was founded in 1960 to
provide assistance to the people in the state of Utah for programs and projects in the following
areas: arts and culture, community, education, health care, and preservation and conservation.
The total annual giving that this foundation has supplied is $26,305,627. In the educational
domain, this foundation has provided grants ranging from $1,000 to over $1,000,000 (“Investing
in Education,” n.d.).
The R. Harold Burton Foundation services the greater Salt Lake Metropolitan area and
provides support to the following areas: education, science, literacy and health (“R. Harold
Burton Foundation,” n.d.). The total annual giving from this foundation is around $1,172,958.
Audit Trail. Utah Foundations website provided in the 2018 Funding Sources Worksheet
(http://www.tgci.com/funding-sources/UT/top) - Top Giving Foundations: UT - 1st and 9th
foundations on the list. Results include https://www.tgci.com/funding-sources/funders/eccles-
foundation-1 and https://www.tgci.com/funding-sources/funders/burton-foundation. (Foundation
websites and additional information were accessed through these links)
Program Evaluation
Expected Outcomes. The expected outcome of this proposed program is improvement of
life skills necessary for a healthy and successful transition into adulthood. This client-centered,
occupation-based and goal-directed program will aim to improve these client’s self-awareness,
emotional regulation, social skills, self-advocacy, work skills, strategy use and organizational
skills. The clients will also learn coping strategies and mindfulness techniques that will enable
them to cope and manage their conditions and daily life struggles. Through the improvement of
these factors and skills, the clients will be prepared to transition into adulthood. It is important to
note that client willingness and motivation to learn and succeed is essential for facilitating the
projected program outcomes. Clients who do not want to participate or learn will be less likely
to achieve the same amount of progress as their peers.
Evaluation Methods. The efficacy of this program will be evaluated in a variety of
qualitative and quantitative measures. In order to track qualitative data for client progress and
program efficacy, surveys will be conducted halfway through the term and at the end of the term.
The clients will be provided with a variety of open-ended questions regarding their progress and
the program. The sample survey questions include: 1) How has this program helped you
improve your life/work skills, 2) What aspect of this program helped you the most, 3) What other
skills would you like this program to address, 4) Why or why not do you think this program has
helped you achieve your goals, 5) How has this program changed your peer relationships, 6)
What do you like about this program, 7) What could be improved about this program. The data
gathered from these surveys will be coded in order to determine what aspects of the program
were beneficial to client progress and what possible changes can be made.
Quantitative data for client progress and program efficacy will be gathered by the
transition survey, pre and post surveys, the COPM, the GAS scale and the Volitional
Questionnaire. The transition survey was created by the LTS directors and will continue to be
used throughout the program (See Appendix C). The pre and post program survey questions will
be rated using a Likert Scale. The following is a sample pre and post survey question: How
confident are you in (insert skill such as cooking, cleaning, grocery shopping, laundry, public
transportation, etc.)? The Likert scale corresponding to this question would include the potential
answers: 1) not confident at all, 2) slightly confident, 3) somewhat confident, 4) fairly confident,
5) completely confident. The COPM will be used with each client to identify goals and measure
pre and post-performance and satisfaction ratings of activities and occupations (See Appendix
G). The GAS scale will also be used with each student to keep track of progress of specific goals
(See Appendix H). The Volitional Questionnaire will be used to compare the clients’ volition at
the beginning and end of term (See Appendix I).

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Appendix A: Interview Questions
Director(s) Questions
What programs does LTS offer? How often?
What is the curriculum of the What People Do course?
What are the expected outcomes/goals of LTS?
How many teenagers are part of the LTS program?
How does LTS decide which students qualify to be in this program?
How do you measure change within students throughout the program (pre/post assessments)?
How long do students usually stay in this program?
What skills do these teenagers struggles with the most?
What are the conditions/diagnoses of students participating in LTS?
In which specific area/areas, do you feel your program could improve?
What background (academic, work experience) do the directors of LTS have?
How was LTS established?
Who currently works for LTS?
What are the funding sources for LTS?
What are the strengths of this program?
What are the weaknesses/barriers of this program?
What are your future plans for LTS?
Mentor and Paraprofessional Questions:

What are the greatest barriers for these students?
What are the greatest supports for these students?
What are the strengths of this program?
What are the weaknesses of this program?
What other services would benefit these students in transitioning to adulthood?
Student Questions:
What barrier do you struggle with the most? (anxiety, disability, low SES)
What coping mechanisms do you use in stressful situations?

What support (LTS, family, friends) can you rely on in times of need?
Appendix B: Interpersonal Support Evaluation List-12 (ISEL-12)

Appendix C: Transition Survey Questions

Appendix D: LTS survey for students

Appendix E: Proposed OTR Schedule of Typical Week during the Term
Monday  Attend two hour long course regarding specific skill (ex: grocery
shopping or laundry)
 Assist with course content, format, and lecture
 Perform assessments if needed
 Review client goals
 Document at the end of the day
Tuesday  Attend two hour long course regarding specific skill (ex: grocery
shopping or laundry)
 Assist with course content, format, and lecture
 Perform assessments if needed
 Review client goals
 Document at the end of the day
Wednesday  Food Cart (this is already part of the LTS program and occurs every
Wednesday)
 OTR can participate and assess clients during the food cart, or use this
time to document/reevaluate or update goals/prepare for application
activity
Thursday  Hands on application of specified skill in the LTS classroom or out in
community (ex: practice folding clothes, ironing, sorting clothes,
learning about laundry detergent, fabric softener, prepare for laundromat
outing)
 OTR observes and assists clients in performing these
activities/occupations, assesses performance and enables students to
identify potential strategies to improve their performance
 Documentation
Friday  Continued hands on application (ex: community outing to laundromat so
the clients can practice using public transportation and the laundromat)
 OTR observes and assists clients in performing these
activities/occupations, assesses performance and enables students to
identify potential strategies to improve their performance
 Documentation and reevaluation of progress and goals
*Additional 2 hours a week will be allocated for course/activity preparation and

telephone consultation
Appendix F: Proposed Program Budget
Source of Specific costs or sources of Cost

income
Start-up Costs
OTR training $2,592
Assuming 15% of total salary as some
training has already occurred
Assessments/Evaluations
 Weekly Calendar Planning Activity $99
(WCPA) book (from AOTA) x1
 COPM Assessment Forms (pk of $18.50
100)
 Adolescent/Adult Sensory Profile $148.50
Complete Kit x1
 Child Occupational Self- $40
Assessment (COSA) x1
 Volitional Questionnaire $40
Total= $2,938
Direct Costs
OTR Salary- Part Time .30 FTE (~12 hr/wk) $17,280
$40 x 12hrs per week x 36 weeks
Community Outings $1,500
 Ex: laundromat fees, grocery
shopping cost for clients, etc.
Travel/Transportation
 UTA bus/trax fare for students $1,500
Life Skills Supplies/Miscellaneous $1,500
 Ex: cooking supplies, laundry
supplies, paper, etc.
Marketing (internal)- flyers $50
Total= $21,830
Indirect Costs
In-kind Rent (Classroom space) $0
In-kind Maintenance $0
In-kind Utilities $0
In-kind Filing cabinet $0
In-kind Laptop (OT’s own laptop) $0
In-kind Printer, pens, paper, all other office $0
supplies
Income
The students are not required to pay for the
service
Total= $0
Budget Summary
Total costs $24,768
Total income $0
or in-kind
contributions
Net cost of $24,768
program
Appendix G: Canadian Occupational Performance Measure (COPM)

Appendix H: Goal Attainment Scale (GAS)

Appendix I: Volitional Questionnaire

Final Program Proposal Gabby Skoczylas

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Running Head: TRANSITIONING SKILLS 1

Transitioning Skills for At-Risk Teenagers:

An Occupation-Based Program for Students of Limitless Transition Services

service gaps and fulfill the needs of the students.

n.d.). The philosophy of LTS is the following:

that their potential is limitless! (Limitless Transition Services [Brochure], n.d.)

well as the teacher for the course mentioned previously.

probability of failing academically or dropping out of school” (The Glossary of Education

Annie Munk in the classroom.

Services. Limitless Transition Services provides a variety of services including the

resumes, workplace etiquette/expectations, navigating trax, navigating downtown, food handler’s

students to build upon their social skills.

Funding sources. Limitless Transition Services receives funding from a variety of

club for their students at EHHS.

Factors Influencing Service Delivery

due to the lack of parental involvement mentioned previously.

industries do not necessarily require high school diplomas or college degrees.

their busy schedules and lack of assistance for grant writing.

directly influencing its service delivery options.

possible due to the lack of manpower.

safe relationships with other students or adults.

Data Collection: Programming Strengths and Areas for Growth

Several one-on-one semi-structured interviews were conducted with both the

management issues, low or no understanding of consequences, low self-esteem, personal care

Student Mentor Perspective

students who desire to be there.

meet the needs of every student.

To gain an understanding of the students’ perspectives, informal interviews, group

and coping with stress.

2. “It’s a fun class”

3. “I love the feeling of acceptance and desire to help”

able to find someone to join them.

interests, independent living skills, as well as recreation/leisure interests. Majority of the

3. No one wanting to hire me

5. Lack of working as hard as I can

7. Being a bad actor or being bad at spelling

9. Not believing in myself

10. Executive functioning

Graduate Student Perspective

which enables students to be more successful when applying for jobs.

increase the program’s chances of receiving funding.

Other weaknesses include insufficient hands on application of life skills and

and stress management program.

interaction skills, transitioning skills, sensory processing/integration, behavior, and overall

adult skills, transition, self-regulation, emotional regulation, sensory, disabilities, psychosocial

were used for this literature review.

Characteristics of At-Risk Youth

included emotional and mental disabilities, executive dysfunction, sensory processing

problematic behaviors” (p. 174).

p. 174). These consequences may hinder an individual’s ability to effectively transition to

Transitioning into Adulthood

include “organization, planning, sustained attention, timeliness, management of distraction,

thus making the transition into adulthood quite difficult.

Current Interventions for At-Risk Youth

behaviors, especially when practiced frequently. Two structured mindfulness-based programs

Occupational Therapy and At-Risk Youth

found that OTs may:

interdisciplinary and interagency teaming (as cited in Cleary et al., 2015).

assessments for at-risk youth.

included cognitive remediation, cognitive-behavioral therapy, supported education and supported

al., 2018, p. 6).

perceptions regarding a client-centered and occupation-based community program. The purpose

emotional regulation, self-advocacy and community and work involvement.