Salt Lake County Adaptive Recreation

Program Proposal

SIGNIFICANCE
Introduction/Background
According to the Centers for Disease Control and Prevention (CDC), approximately 61 million
American adults have a disability, which is approximately 1 in 4 (26%) people (CDC, 2018). In Utah alone,
17.8% (1 in 5) residents have a disability, the most prevalent being mobility-related disabilities (9.1%) (Utah
Department of Health, n.d.). In addition, recent studies have shown that 5.6% of children in America (ages 5-
17) have a disability, and 0.7% of children under 5 years old have a disability (Kraus, Lauer, Coleman &
Houtenville, 2018). The World Health Organization (WHO) describes the term ‘disability’ as impairment, activity
limitations, and participation restrictions; activity limitation is the difficulty in executing a task or action, whereas
participation restriction is defined as the problem that one experiences with involvement in life situations
(WHO, 2017). The term ‘disability’ can also be categorized into 6 different sections that include: cognitive, self-
care, mobility, hearing, vision, and independent living disabilities (CDC, n.d.).Therefore, disability is a complex
phenomenon, apart from simply being a health condition, which indicates that people with different disabilities
may experience different limitations in areas of performance during daily tasks and recreation.
Furthermore, the CDC indicates that people with disabilities do not engage in frequent recreation as
their peers that do not have a disability. Approximately 25.6% of individuals with a disability indicated physical
inactivity in a week, compared to 12.8% of people without a disability (CDC, 2011). This is comparable to a
recent statistic from Disability and Health Data System, reporting that approximately 34.7% of adults that
have a disability are inactive, which continues to increase each year (Disability and Health Data System,
2018). Because of this, individuals with disabilities are at a possible risk of complications and possible
secondary medical conditions. As reported by the CDC (2018), people with disabilities are more likely to have
obesity, diabetes, smoke, or have cardiovascular diseases.
Gaps in service
In people with disabilities, barriers to participation in recreation include: lack of staff support
while attending activities and environmental barriers (Anaby et al., 2013; Shields & Synnot, 2014). Barriers
to participation for older adults with intellectual disabilities also include: lack of confidence, lack of skill for the
activity, and lack of options for programs and physical activities (van Schijndel-Speet et al., 2014). These areas
could potentially be remedied by staff training to support participation; however, Marchand, Russell, & Cross
(2009) have found that there is a high turnover rate of adaptive recreation (AR) staff, which may be related to
insufficient training resources and experience in leading AR activities. However, with appropriate staff
engagement (building rapport, reinforcement with praise, confidence, and encouragement), participants with
disabilities feel better supported to engage in adaptive recreation (van Schijndel-Speet, et al., 2014; Shields &
Synnot, 2016; Jull & Mirenda, 2016).
Existing Programs
A study by Jull & Mirenda (2016) describes the efficacy of a staff training program on participation of
children with Autism Spectrum Disorder (ASD) during swimming classes; the instructors demonstrated
improvements on instructional skills (building rapport, providing instruction while the child is attending and
within arm’s length, and reinforcing correct answers with praise), while the children with ASD demonstrated
overall improved compliance and participation. This program demonstrates that staff training has the
potential to enhance a person’s experience while engaging in adaptive recreation.
Introduction to Program
We propose that a staff training program is necessary to promote safety, active participation, and
inclusion in recreation for individuals with disabilities. STEP Into Inclusion is intended to provide education and
training on transfers, goal setting, and other concepts to improve client’s performance and active engagement
to enhance their experience while they participate in various AR programs. Although this program is aimed
toward staff training, it will have a direct affect on clients’ experiences during AR, by increasing knowledge and
skill to increase active engagement.
The Model of Human Occupation (MOHO), Person-Environment-Occupation (PEO) model, and the
Self-Efficacy Theory are relevant frames of reference for our proposed program at Salt Lake AR. They have
been used to develop and guide the delivery of concepts that help staff members enhance the participation
and inclusion of individuals participating in their programs. MOHO (Kielhofner & Burke, 1980) describes how
volition (motivation) leads participation and performance, which is applicable for both the direct participants of
the training program (staff members) and the clients who may indirectly be affected by the training program. It
outlines how staff may be motivated to learn, and content of the program will encourage staff to identify what
motivates clients to participate, thereby promoting occupational participation. PEO identifies how the person,
task, and environment may work together to support participation in a challenging task (Law et al., 1996).
Content of the program will support staff to both identify when the task is too difficult, and how strategies can
help the client to adapt to the demands of the task. The Self-Efficacy Theory breaks down steps to allow a
person to feel encouraged by smaller accomplishments that may reinforce confidence in being able to do an
activity, which promotes occupational participation (Soaker, 2012).
By providing these tools in an effective manner (under the guidance of theoretical models), this
program will inadvertently address staff’s competence and confidence, which have been recognized to
enhance participation in activity.

INNOVATION
How is the Program Innovative
Currently, Salt Lake AR does not have an on-boarding training program for new staff members and
volunteers. STEP Into Inclusion will be the first staff training program that is aimed to enhance clients’
participation in adaptive recreation through training sessions that address: goal setting, transfers, stabilization,
the Just Right Challenge, and the relationship between skill and motivation. STEP Into Inclusion will introduce
these new concepts with an occupational therapy perspective to promote active participation.
Advantages and Differences
STEP Into Inclusion is valuable due to its occupational therapy perspective, of which activity is
supported through the holistic lens of activity analysis, motivation, the Just Right Challenge, and others.The
program focuses on the training of staff members who are able to apply concepts to multiple programs, which
creates the potential to impact many more clients.

APPROACH
Needs Assessment
A needs assessment was conducted partially through an informal group interview of staff, which
included the Department Head, Recreation Inclusion Manager, Adaptive Recreation Manager, program
developers/leaders, an intern, and head custodial staff. The group interview consisted of semi-structured
questions that were intended to elicit discussion among staff members. Data was also collected in informal
interviews from approximately 15 participants, caregivers, and their support staff during participation in various
programs.
It was found that the majority of staff were interested in a staff training program, the second of interest
being a self-care skills class. There were a variety of responses from staff when discussing the staff training
program, which included:
● “I think it would be beneficial to teach eye contact when giving directions.”
● “It would be good to teach staff how to deal with behaviors.”
● “Most of us have never had training on transfers”
In addition, through observations, we noticed a deficit in staff members’ abilities to enable participants
to engage at their full potential during AR programs. An example of this is that, during a crafting class, a
participant in a wheelchair with limited verbal communication, was prematurely judged unable to make a
beaded bracelet. The staff member chose the bead colors and design of the bracelet, and placed the beads on
the string. This limited the AR participant’s opportunity to engage, when, at the minimum, he demonstrated the
ability to make and indicate choices to a staff member who arrived with him.
Through this needs assessment, it became apparent that a staff training program was most sought
after, and would assist staff members in providing quality services to AR participants, which in turn, promotes
active participation and inclusion in recreation in people with disabilities.
Program Details
I. Recruitment/Marketing:
Marketing is not necessary to recruit participants. If approved, the program will be required of all
staff members and volunteers of Salt Lake Adaptive Recreation. In addition, weekly email reminders
from the Recreation Inclusion Manager, will be sent to all staff and volunteers to remind them of the
upcoming date and time of the staff training session.
II. Participants:
 Participants of this program include management, staff members, and volunteers of Salt Lake
Adaptive Recreation. This will consist of approximately twenty participants that lead and assist various
programs at Salt Lake Adaptive Recreation around the Salt Lake Valley.
III. Resources:
A. Personnel:
A skilled occupational therapist is an essential resource for this program. The
occupational therapist will effectively teach concepts, which are then implemented directly to
clients.
B. Materials:
Materials needed to make this program successful include: space, tables, chairs,
notebooks, pens, projector, laptop, and wheelchair. In addition, we will be using program
specific equipment for transfer training, which includes: sled for sledge hockey, adaptive sports
wheelchair, transfer boards, and gait belts. We will also be using powerpoints to lead the
discussions, and will be providing printouts for each of the staff members. Additional printing will
include evaluation forms and reference pages to act as a resource for staff.
C. Budget:
Based on the above, our budget total is $2,582.90. This is necessary to operate the
program for 6 months, including post-data collection and compilation. The majority of the
required materials are in-kind donations, which includes: space, tables, chairs, projectors, and
AR equipment. However, the budget accounts for the cost of printing material, writing utensils,
and transfer equipment. In addition, a skilled occupational therapist is needed for the delivery of
the program, and is a significant cost in the budget. See Program Budget in Appendices (A1).
IV. Topics Covered:
A. Training Session 1: Just Right Challenge and Occupational Justice
1. The Just Right Challenge allows a staff member to focus on what aspects of a task a
participant can perform and what they may need help with. It allows the staff to adapt a
task/activity to better fit the needs of the participant, which then promotes engagement.
During this session, we will discuss possible ways to adapt a task.
B. Training Session 2: Relationship between Skill vs. Motivation (Leading to Behaviors)
1. During this session we will discuss the difference and relationship between skill and
motivation, as both can lead to disengagement from the activity. At times, an individual
may appear to have a lack of motivation when participating in a task; however, it could
be due to the activity being too difficult which leads to avoidance. However, an activity
can be adapted to become more of a motive for a participant, or it can be adapted to
better fit the skill set that the participant has.
C. Training Session 3: Addressing both Positive and Negative Behaviors
1. This training session will provide tips and techniques of interaction that will encourage
positive behaviors, as well as tips of interaction when participants are disengaging,
becoming irritable, or showing other negative behaviors. By encouraging positive
behaviors, participants are better supported to engage in occupation.
D. Training Session 4: Base of Support and Stabilizing
1. Engaging in activity requires a stable base of support (sitting position, proximal
strength/stability) in order to allow use of hands or distal limbs. Examples include: a wide
base of support also allows tennis participants to use limbs to hit balls with strength and
without falling, as well as providing support at the elbow to further provide hand stability
while painting. This session intends to provide ideas on how to support movement, and
in-turn enable active participation.
E. Training Session 5: Safe Transfers
1. By focusing on safe transfers, staff will feel more prepared to help an individual from
their wheelchair into the adaptive recreation equipment. This will focus on using transfer
boards, gait belts, and rails. In addition, this will promote both staff and participant safety
and reduce the risk of falls.
F. Training Session 6: Goal Setting for Each Individual
1. It is imperative that each staff member know and understand the goals of each of their
participants, otherwise they are just their in attendance. However, the moment a staff
 member knows of a participants goals, they are better equipped to help them progress
and participated actively within the activity. This session will focus on how to help an AR
participant develop goals, and how you as a staff can empower the participant to reach
their goals.
V. Frequency
STEP Into Inclusion program will consist of six different 30-45 minute training topics, over the
course of six months. Each topic will be provided four times a month to provide all staff the opportunity
to attend one of these sessions. In addition, every first and third week the training session will be held
on Tuesdays; whereas, on the second and fourth week they will be held on Thursdays in order to
accommodate all staff and volunteers schedules to the best of our ability.
Goals
● Goal 1: Participants in adaptive recreation programs will feel more empowered to engage in the
recreational activity.
○ Objective 1a: AR participants will report increased feelings of active engagement and
empowerment.
○ Objective 1b: Within the first two sessions of each AR program, staff will have gathered at least
80% of participants’ individual goals.
● Goal 2: Staf will demonstrate an increase of knowledge to promote clients’ safety and active
participation in their adaptive recreation programs.
○ Objective 2a: Occupational therapist will provide the 6-session staff training program to 80% of
staff within 6 months.
○ Objective 2b: Upon completion of the staff training program, staff will demonstrate increased
knowledge and ability of transfers.
○ Objective 2c: Upon completion of the staff training program, staff will demonstrate improved
knowledge and ability of the just right challenge for AR participants.
Potential Problems
Potential issues that were identified include: participant buy-in to the program and scheduling conflicts.
Both of these impact the reception and delivery of concepts, which may then impact the results. However,
discussions would be aimed towards different programs to elicit potential buy-in of each staff member, as it will
apply to their individual programs. Scheduling conflicts arise because many staff members and volunteers
have variable schedules. Some staff members are only responsible for one program that spans 1-3 hours
every week, and some volunteers are only on-board for about 3 months.
Program Evaluation/Analysis
In order to evaluate the program, quantitative and qualitative data will be collected and examined
through surveys given to staff participants, caregivers, and clients of AR programs. Surveys and practicum are
developed by program developers, and are aimed to help identify skill and knowledge acquisition as well as
clients’ sentiments related to engagement and staff support. Upon completion of the program, the occupational
therapist will compile all data collected to analyze the effect of the STEP Into Inclusion Program on staff’s
comfortability of topics and client engagement.
***Reference stated goals above, and evaluation forms in Appendices
Goals and
Program Evaluation and Measurements
Objectives
Goal 1
AR participants or their caregivers/staff will be given a pre- and post-program Likert Scale,
discussing their feelings about active engagement and empowerment within the activity.
Example:
Objective 1a - I feel supported by the Adaptive Recreation staff to do my best during this program. (1 -
strongly disagree, 2 - somewhat disagree, 3 - neutral, 4 - somewhat agree, 5 - strongly
agree)
- I feel involved and encouraged to participate in the program. (1-5 like above)
This will be measured through the evaluation forms, which will ask about specific participant
goals. In addition, we will conduct qualitative semi-structured interview surveys with
Objective 1b participants during the third and sixth months, asking:
- Do you feel that the staff know and understand your personal goals?
- Do you feel your goals are being addressed?
 - Do you feel supported to engage in the activities?
Goal 2
This will be measured through attendance roles as a quantitative form of administrative data.
Objective 2a (see Appendices). We will compare the results to the amount of employees.
- How many staff members participated in the training program during the six months?
- How many staff members attended all sessions?
Staff will be given pre- and post- questionnaire about appropriate transfer steps (quantitative)
and will be given an informal transfer practicum at the end of the session to evaluate safe
transfer techniques into AR equipment, which will be given a nominal score (quantitative).
Objective 2b - List two things you should do before beginning a transfer.
- List three tools that might help with a transfer.
- Practicum: Demonstrate a safe transfer into AR program equipment (either sled or
adaptive wheelchair).
- Graded nominally by OT (unsafe, needs improvement, adequate)
Staff will be given pre- and post- Evaluation Form related to the “Just Right Challenge”
(qualitative).
Objective 2c - List two things you can do if someone is struggling with an activity/task.
- List two things you can do if a participant becomes frustrated and begins to disengage
from the activity.
 APPENDICES
Program Budget Form:
Budget Item Cost Rationale
Space (e.g., rent or reservation fees)
- n/a $0.00 In-kind contribution
Supplies (e.g., materials, printing costs)
Printing
- Evaluation Forms ($0.09 x 1 pg x 20 people $10.80 Evaluation forms are necessary to
x 6 lessons) assess the effectiveness of the program,
and allows for improvement throughout
***(Each lesson will be provided for four consecutive the program.
weeks during the month, and staff can choose
which week they would like to attend).
- Presentation print out ($0.09 x 2 pg x 20 $21.60 Print outs allow participants to engage
people x 6 lessons) with a tactile representation of the
material, in order to promote learning.
- Resources ($0.09 x 2 pg x 20 people x 6 $21.60 A variety of paper resources will act as
lessons) reference pages for participants to
quickly obtain or review information.
Pens (16 pack: $3.39 x 3) $10.17 Necessary for staff to take notes during
training sessions and to complete
evaluation forms. It will also promote
learning through interacting more with
the material instead of passive listening.
Equipment (e.g., tablets, computers)
- Computers, projectors, chairs, tables $0.00 In-kind contribution
- Wheelchairs, program-specific recreational $0.00 In-kind contribution
equipment
- Transfer boards ($13.92 x 3) $41.76 Transfer boards will be necessary when
discussing how to safely and properly
transfer someone in a wheelchair to AR
program equipment.
- Gait belt ($8.99 x 3) $26.97 Gait belts will also be necessary when
discussing how to safely and properly
transfer someone.
Projector/screen and computer access $0.00 In-kind contribution
Wheelchair $0.00 In-kind contribution
AR Program Equipment (sled-sledge hockey, $0.00 In-kind contribution
adaptive wheelchair)
Marketing (e.g., flyers, advertising)
- n/a, reminders will be sent via email n/a n/a
Personnel (e.g., salary with % time/effort, hourly
wage, benefits, consultant fees)
Occupational Therapist - ($35/hr x 2.5 hr/week x 24 $2450.00 An OT is necessary for the delivery of
weeks) + (additional 10hrs for compiling all results this program. It requires the specialty of
post training) the OT to describe each concept and
how to enhance the active participation
of each individual.
Total Requested $2582.90

Pre- and Post-Evaluation Tests:

Staff Evaluation Forms
Pre- and Post-Evaluation
GOALS:
1. Please list three of your client’s personal goals for participating in the AR Program.
a.
b.
c.
JUST RIGHT CHALLENGE:
1. List two things you can do if someone is struggling with an activity/task.
a.
b.
2. List two things you can do if a participant becomes frustrated and begins to disengage from the activity.
a.
b.
SAFE TRANSFERS:
1. List two things you should do before beginning a transfer.
a.
b.
2. List three tools that might help with a transfer.
a.
b.
c.
3. Practicum: Demonstrate a safe transfer into AR program equipment (either sled or adaptive
wheelchair).

Please list any concerns or items you would like to improve personally:

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
__________
Attendance Roll:
STEP Into Inclusion Attendance

***Please initial and write date.

Staff Session 1: Session 2: Session 3: Session 4: Session 5: Session 6:

Member: Just Right Skill vs Behaviors Base of Safe Goal Setting
Challenge Motivation Support Transfers

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