A consultative approach to improve outcome measurements:

An Occupation-Based Community Program at Wasatch Adaptive Sports

Jilianne Normandy

University of Utah
 Introduction

The purpose of this project paper is for an occupational therapist to use their skills and

knowledge to develop a program for an underserved community-based organization. The needs

assessments consisted of semi-structured interviews, review of initial assessments and

documentation, observation of participation in activities, and review of current and desirable

funders and grants for Wasatch Adaptive Sports (WAS). After analyzing the needs and wants of

WAS, it was found that there is a need for collecting more useful data, intake, and

documentation of their students in order to benefit the organization to receive more funding and

grants. With the use of extensive research and gathering information about the organization, an

occupational therapy consultation was developed to meet the current needs to create appropriate

assessments and documenting to assist WAS efforts to continue achieving their goal to help

individuals be independent in sports and in life.

Description of Setting

WAS programs aim to build strength, stamina, and self-esteem while enhancing the

quality of life for all of their students. WAS values increasing independence and mobility in a

social environment by providing high quality adaptive equipment for sports to offer services to

individuals with every type of disability.

The mission of WAS is to:

Encourage individuals with adaptive needs and their families to realize their potential

and engage in active living through year-round recreational, educational, and social

program. WAS programming focuses on increasing independence and mobility in a

social environment.

(Wasatch Adaptive Sports [WAS], 2017)

History

According to WAS (2017), WAS was established in 1977 by Peter Mandler to provide

affordable recreational and educational opportunities for children, adults, and veterans to share

with their support network or family. In 1983, WAS received 501©(3) nonprofit status for the

purpose of providing affordable ski lessons to children and adults with disabilities from a low-

socio-economic background. In 1986, WAS developed the Steve Young Ski Classic, a

fundraising event for WAS that is a recreational ski race, competing against professional

athletes, Olympians, and Paralympians.

Target Population

WAS has a broad population with various diagnoses, and all ages across the lifespan,

typically ages 4 and up. Recreation activity limitations and decreased participation is a

significant factor for these individuals due to few accessibility options and the need for adaptive

equipment. Although they mostly serve to stroke survivors, cerebral palsy, spina bifida, brain

injury, amputees, and spinal cord injury, WAS never turns anyone away from being able to

participate in their programs (E. May-West, personal communication, September 26, 2018).

WAS retrieve their students through outreach events, referral type relationships with

rehabilitation centers, the Veterans Affairs (VA), various therapists and providers, direct

recruitment, advertising from their trailer that they bring to each event, and their online website.

Last year, WAS served a little over 500 individuals from July 1st 2017, to June 30th 2018, with

2,800 lessons provided (E. May-West, personal communication, September 26, 2018).

External Influences on Wasatch Adaptive Sports

Policies. According to Centers for Disease Control and Prevention (CDC) (2018),

inclusion of people with disabilities into everyday activities involves practices and policies
designed to identify and remove barriers such as physical, communication, and attitudinal, that

hamper individuals’ ability to have full participation in society, the same as people without

disabilities. Inclusion involves making products, communications, and the physical environment

more usable by as many people as possible, modifying items, procedures, or systems to enable a

person with a disability to use them to the maximum extent possible, and eliminating the belief

that people with disabilities are unhealthy or less capable of doing things (CDC, 2018). There are

three federal laws that protect the rights of people with disabilities to ensure their inclusion in the

society: Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act

(ADA) of 1990, followed by the ADA Amendments Act of 2008 in an attempt to restore the

original intent of the legislation, and The Patient Protection and Affordable Care Act in 2010.

WAS does not discriminate on the basis of race, color, national and ethnic origin in

administration of its educational policies, admission policies, scholarship and athletic and other

administered programs (WAS, 2017).

Political. Nonprofit organizations have huge impact on communities, and in order to

maximize their potential, they need support of the people and the government (Utah Nonprofits

Association [UNA], 2018). The right laws need to be made and supported to help and not hinder

nonprofit organizations. Public Policy directly impacts what nonprofits are able to do as they

continue to improve the community. Public Policy is the set of laws that apply specifically to the

public, both as individuals and as organizations (UNA, 2018). Different levels of public policy

for every level of government include: city, state, and federal. Each policy influences how

nonprofits work and engage in the community. As new policies are implemented, they become

the law of the land, where all nonprofit organizations are required to abide by the new policies.

Associations such as UNA encourages awareness and active involvement for nonprofits
everywhere to assist policymakers to make good decisions that will have positive outcomes that

allow nonprofit organizations to work at their full capacity (UNA, 2018).

Geographic. Salt Lake City sits in a mountain valley between the Wasatch Mountains on

the east and north, and the Oquirrh Mountains along the western edge of the valley, at an

estimated 109 square miles (Visit Salt Lake, 2017). Salt Lake City’s elevation is 4,330 feet above

sea level. The city was once covered by Lake Bonneville, which existed within areas of Utah,

Nevada, and Idaho, with its elevation rising from 4,200 feet to 5,200 feet. Nearby mountains

include Snowbird, Hidden Peak, Alta, Solitude, Brighton, and Lone Peak.

The WAS offices are located at Snowbird Ski Resort and their new office in Murray,

Utah, however, their program and activities are held in Provo, Salt Lake City, Little Cottonwood,

and many other locations. Salt Lake and its surrounding areas offer ample opportunities for

outdoor recreation.

Demographic. According to the U.S. Census Bureau (2018), the population in Salt Lake

City on July 1, 2017 estimates to 200,544. It is estimated that people with disabilities make up

9.5% of the population in Salt Lake County (Disabled World, 2018). A new report shows there

are 17.8% Utah adults that are living with a disability. The most common disabilities in the state

are mobility-related disabilities (9.1%), cognitive disabilities (8.8%), vision disabilities (2.8%),

disabilities that impact independent living (4.5%), and disabilities that impact self-care (2.3%)

(Utah Department of Health, 2017).

WAS primarily chooses the programs they provide based on what is popular in Utah.

Unlike many other states, Utah has many organizations that provide adaptive sports, such as Salt

Lake County, National Ability Center, Adaptive Sports Snowbasin, Copperview Recreation

Center, Splore, Superior Adaptive Utah Adventures, and Westpointe Park (Active Cities, 2018) .
Because of this, WAS tries to avoid duplicating programs that other organizations provide and

does this well. Other than providing programs that are popular within the Utah demographic,

WAS also chooses their programs based on their relations with Snowbird. Since many programs

are provided and based out of Snowbird, they have the opportunity to provide activities such as

skiing, snowboarding, hiking, and fishing for little to no money, and can also provide free trips

and passes to their students.

Sociocultural. The WAS programs provide affordable and educational opportunities for

their students to participate in activities and sports in a social environment with other students,

caregivers, family members, and friends. By being in a social environment, it allows students to

socially engage with others, whereas it is common for people with diagnoses or disabilities to

live a sedentary and socially isolated life. WAS engages their students in sports that are popular

in Utah culture, and teaches and encourages their students to become more independent than

when they first started the program. By training the staff and volunteers and creating client-

centered lessons, the primary goal and focus is for students to become independent, which is

valued in western society.

Economic. Salt Lake City has an unemployment rate of 3.1%, and as of January 2017,

Salt Lake City had the lowest unemployment rate among large metropolitan areas (Bureau of

Labor Statistics, 2018). Salt Lake City’s job market has increased by 2.1% in the past year, with

further job growth predicted to be 40.4% in the next ten years, which is higher than the U.S.

average (Best Places, 2018). The current minimum wage in Salt Lake County is $7.25, and the

median household income is $50,353 a year. The economy of Salt Lake City employs 103,181

people (Data USA, 2018). Salt Lake City’s economy specializes in educational services, arts,

entertainment, recreation, and accommodation and food services. The largest industries in Salt
Lake City include educational services, healthcare and social assistance, retail trade, mining,

quarrying, oil, gas extraction, utilities, and professional, scientific, and tech services (Data USA,

2018).

Internal Influences on Wasatch Adaptive Sports

Services Provided. WAS is a community-based program that provides entry-level to

advanced instruction of winter and summer recreational activities for individuals with adaptive

needs and their families (WAS, 2017). Services are provided based on their yearly budget, which

is ~1 million dollars, what Snowbird offers, as well as what the staff can teach, and what sports

their students can be independent in (E. May-West, personal communication, September 26,

2018). WAS staff and volunteers are trained to match the student’s goals with an individualized

progression with the use of individual assessment, using specialized and adaptive equipment. To

participate, students need to fill out an application form once for winter and once for summer

recreation. Once they apply, students are allowed to attend any event throughout the year using a

virtual sign-up sheet. WAS also provides a scholarship assistance program, which about 95% of

their participants are a part of. All students are qualified to receive a scholarship, however if they

want to pay per event, they can enter the amount they want to give (WAS, 2017).

WAS provides summer programs, winter programs, veteran programs, and rental

programs (WAS, 2017). Summer programs include cycling at Liberty Park in Salt Lake City,

Legacy Parkway in Farmington, the Rail Trail in Park City, and the Jordan River Parkway in

Murry, mountain biking in Park City, paddle boarding and kayaking at Jordanelle and Tibble

Fork reservoirs, fishing at Snowbird’s Austin Pond, hiking/orienteering at the Barrier-Free Trail

at Snowbird, and adaptive yoga. During their winter program, WAS provides skiing and

snowboarding at Snowbird, Sundance, and Alta, snowshoeing, indoor cycling at the Utah
Olympic Oval, and adaptive yoga. For veterans, WAS provides summer retreats that include

paddle boarding and/or mountain biking with all meals included, adaptive yoga, and backcountry

awareness clinic for veterans, a six-part program ran by veterans and professional mountain

guides for veterans throughout the winter season in the WAS yurt at Snowbird. Veterans that

participate in this program learn about companion rescue, the avalanche triangle mountain

weather and terrain, snowpack, human factors and more as they explore recreating in the

backcountry. Lastly, WAS rental program provides their current students to rent their equipment

for use on their own time so that they can lead an active and independent life extending beyond

WAS year-round programming. Rates are $10 per day or $50 per week with scholarship

opportunities available.

Staff. Up until six years ago, WAS was run independently by Peter Mandler. WAS now

has 6 full-time, year-round staff, and 12-16 part-time paid instructors. The full-time staff include

the founder, program director, program coordinator, operations coordinator, program manager,

and program specialist. During summer time, there are about 20 consistent volunteers, and 40-60

volunteers during the winter time (E. May-West, personal communication, September 26, 2018).

Upon hiring staff and volunteers, WAS provides mandatory formal training at the

beginning of summer and winter season. Summer season’s training is one week long, where the

staff and volunteers are taught about internal policies and procedures, program specific hands-on

training, typical diagnoses including risk factors, assessments, and transfers, as well as teaching

progressions such as one-on-one instructional lessons, typical cycling progressions, and how to

fit bikes to the students. Although instructor meetings are mandatory for instructors, volunteers

and allowed and encouraged to attend the meetings. For winter season, instructors are provided

training over 2 weeks, and volunteers are required to be trained for a minimum of 3 days. The
meetings primarily consist of instructions for skiing, where they learn how to progress on alpine,

fundamental space, snow, and safety. For volunteers, they are able to provide their services based

on the skills they already obtain and learn, and are required to get checked off on a list of things

they are able to do. WAS teaches their staff and volunteers contraindications, safety precautions,

various ways of communication, and typical functioning on common diagnoses they work with.

WAS does not have any official documentation rules, however they encourage language used in

training and provide prompts on progress notes (E. May-West, personal communication,

September 26, 2018).

Assessments and Documentation. All students are required to fill out an intake form

and liability waivers for the summer and winter seasons. Every time they participate in a

program, the instructors are required to fill out a progress note for each student (refer to

Appendix B). At the end of the season, they provide a questionnaire to the students to document

improvements from their participation of the programs. There are currently no standardized

assessments or measurements for intake, progress notes, or for the collection of data at the end of

the season. The assessments that are currently being used are internal, original assessments that

have been based off of information that WAS learned they needed, while attempting to measure

things anecdotally (E. May-West, personal communication, September 26, 2018). The WAS

intake form has been evolving over the past two years. Required information has been

formulated through experiential evidence through figuring out what information is valuable,

consultations with physicians, therapists, and their liability insurances. Liability waivers are

extremely important for WAS and were made and given from their liability insurance.

Funding Sources. WAS receives funds through donors, events, and grants. WAS is

primarily funded from three major fundraising events: the Steve Young Ski Classic, Summit
Gala, and Highly Decorated, a veteran focused event (E. May-West, personal communication,

September 26, 2018). The Steve Young Classic is a ski event and gala dinner that holds silent

and live auctions, and makes up one-third to half of WAS yearly budget. The veteran-focused

event Highly Decorated revolves around a reception and tree lighting at a plaza. Lastly, the

Summit Gala is a dinner and live auction held at Snowbird that supports three nonprofit

organizations, including WAS. Other funders include individual donors and corporations.

Their most recent grant submission was to the Cross Charitable Foundation, who funded

them last year (A. Sauter, personal communication, October 2, 2018). WAS is currently in the

process of preparing an application to the George S. and Dolores Dore Eccles Foundation, and

next month, they will be submitting a proposal to the Sorenson Legacy Foundation, which both

are current funders. Other than funders previously listed, WAS receives additional funding from

the Willard L. Eccles Foundation, R. Harold Burton Foundation, DAV Charitable Trust, the

Reeve Foundation, Utah Medical Association Foundation, Lawrence T. and Janet T. Dee

Foundation, Janet Q. Lawson Foundation, and other corporate entities and foundations (A.

Sauter, personal communication, October 2, 2018).

WAS has been declined by the Milbank Foundation, the Katherine R. & Ezekiel R.

Dumke Jr. Foundation, the North Face Explore Fund, and the Dralla Foundation. New funders

that they are currently interested in are the Ray & Tye Noorda Foundation and the May &

Stanley Smith Charitable.

Future Plans. At WAS, plans for different or additional services in the future is always a

conversation. As of right now, they want to add more snowshoeing locations and start a golf

program (E. May-West, personal communication, September 26, 2018). However, their future

plans depend on the demands of the students, staffing, grants, and funding that are available.
 Programming Strengths and Areas for Growth

During this level I fieldwork, a combination of semi-structured and informal interviews,

review of documentation, and observation were completed with the staff and students to

determine the gaps of needs and services for students at WAS. Refer to Appendix A for the

interview questions.

Staff perspective

Program Director. A one-on-one semi-structured interview was conducted with the

program director of WAS. According to the program director, there are many things that are

working well for WAS. Some examples include their model and philosophy of teaching, focus

on independence, teaching skills, providing high quality lessons, and the people that make up the

staff. She stated that the personality of the program is a powerful impact on the students and the

organization, as well as their family atmosphere and focus on getting to know their students.

Although she sees students gain the knowledge and skills to improve their independence in their

program, there is a lack of carryover of this independence seen in their activities of daily living

(ADL) outside of their program. Some improvements and areas for growth are the overall

organizational efficiency and attention to detail. Since WAS has grown vastly over the past 6

years, there needs to be planning on the longevity of the program, consistency and accuracy in

their policies and procedures, and being able to meet national standards at a local organization

level. Other areas for improvement are formatting their documents better and the documenting of

their outcome measures. The program director stated that through tracking and proving that

WAS provides positive outcome measures, they will be able to receive more funding and grants.

Program Coordinator. A semi-structured informal one-on-one interview was conducted

with the program coordinator at WAS. She stated that she wanted to work at WAS because she
wanted to work in adaptive sports, and liked that WAS offered year-round programs and focused

on independence. Her background includes a master’s degree in recreation management, a

bachelor’s degree in exercise physiology, and has also worked as a physical and occupational

therapy aide for 7 years. Since she was hired late in the season, she received most of her training

on the job, and was able to learn quickly because of her experience with adaptive sports. She is

knowledgeable with diagnoses from her undergraduate program and working at other adaptive

agencies. She feels good about working with people with cognitive and physical disabilities and

documenting. What she likes about WAS is “we have a wide variety of students, and they enjoy

doing multiple sports with us. We also have amazing instructors and volunteers that are very

caring.” She stated that strengths of WAS include accessibility, affordability, and that they offer

many programs five days a week. Areas for growth and improvement in her opinion include

enhancing the skills and knowledge of their instructors and volunteers and offering programs in

more locations and with more populations.

Instructor. A semi-structured informal one-on-one interview was conducted with one of

the instructors at WAS. She was interested in working for WAS because she wanted to help

people the way WAS had helped her. She is a United States Air Force (USAF) Security Forces

veteran, a combat veteran with 4 deployments to the Middle East. She described her job training

as learning on the job, and she enjoys continually learning new things since she has been

working for WAS. She stated that she learned about diagnoses through what was provided on

paperwork and what WAS decides to share. However, she has personal knowledge about anxiety

disorders, distress tolerance, and de-escalation strategies through her own therapy, which she

finds valuable for her job. She stated that she feels confident in working with people with

cognitive and physical disabilities, as well as documenting. What she likes about WAS is that
they accommodate everyone without judgment. She stated “they save lives and help with

emotional pain due to isolation, due to physical and mental struggles.” A strength she sees in

WAS is “they help people achieve more independence in their lives, [and] other programs don’t

focus on that recovery aspect. They mostly focus on the recreational therapy experience, which is

also important too!” She stated that an area for improvement and growth is getting better

equipment, which requires more funding.

Student perspective. A one-on-one semi-structured informal interview was completed

with a student that has been a part of WAS for the past 10 years. She participates in WAS

cycling and skiing programs. She will be mentioned as K.W. to maintain confidentiality. K.W.

had a left middle cerebral artery stroke 9 years ago, and has right hemiparesis as well as memory

and speech deficits. She wanted to participate with WAS because it sounded like fun and she

thought it would be good for her. She stated that her wellness and WAS goals are to have fun and

be active. Before her stroke, she was very active, however, she lived a sedentary lived after her

stroke before joining WAS. She currently engages in walking and cycling with WAS at least

twice a week. K.W. stated that what she likes about WAS is that it helps her live a healthy

lifestyle, and she has learned how to be independent and a lot about herself through the

programs. She has seen overall improvements physically, emotionally, and spiritually, and that

she keeps getter better. Since starting the cycling program, she has become independent in tying

her shoes and shifting gears on her bike. She stated that her overall quality of life is great. K.W.

believes that strengths of WAS are Peter (the founder) and the people. “Everyone is so friendly

and helpful, and they help me be social.” She likes that there are instructors that ride with her to

make her feel safe and comfortable. When asked if there are any improvements or areas of

growth that can be made, she happily replied “no! WAS is good the way it is.”
Graduate student perspective

Strengths. WAS provides a variety of programs in variety of locations, making access to

their activities attainable by their students as well as desirable. WAS main focus is bolstering

their students’ independence, not just participating in recreational and leisure activities. The staff

is very friendly and family-oriented, and make the students feel safe and comfortable. The staff

also creates a fun and social environment for their students, and make sure to give their students

multiple opportunities for social and activity participation. WAS provides instruction and a

variety of adaptive equipment that can be adjusted to fit every student’s needs to be successful.

The instructors and volunteers are formally trained to ensure safety, appropriate documentation,

and knowledge of their students diagnoses and disabilities. The staff, instructors, and volunteers

come from all types of backgrounds and professionals, which allows them to use the knowledge

and skills of their staff to continually improve and grow their organization. After reviewing

intake forms and progress notes, students demonstrated more independence in the program they

participated in and in cycling specifically, students increased their mileage with each lesson.

Areas for growth. Aside from donors and events, WAS also relies on grants and

foundations to fund their organization. While reviewing their documentation, it was clear that

they lack sufficient evidence of outcome measures to receive more grants and funding, which

could affect the amount and quality of adaptive equipment they have, what programs they can

offer, and how to pay their staff. There has also been a confusion of wording on their intake

form, for example, when they have the student fill out what side has been affected, they will

write out the side of the brain that was affected, or what side of the body has been affected. Their

documentation does not track quality of life (QOL), progression of level of independence or
mental health. On their progress notes, they only allow 1-3 sentences to be written, inhibiting

them to include more valuable information when necessary.

Since students are allowed to participate in their programs at any time, as many times as

they want, students do not consistently attend lessons, therefore some lessons can consist of 6

students, and other lessons can consist of only 2 students. Although the program director stated

that the staff, instructors, and volunteers receive formal training, it appears that there could still

be a plethora of skills and knowledge to be taught, and that staff and instructors reported

receiving training on the job. Lastly, barriers include not offering many programs outside of the

valley to reach more populations, as well as finding locations and recreational activities that are

accessible for all of their students.

Evidence-Based Practice

A literature review was completed in order to better understand what outcome measures

are used in adaptive sports for people with disabilities in the community setting. The American

Journal of Occupational Therapy, Google Scholar, and the University of Utah Library online

catalogs were searched for relevant articles. Search terms included combinations of the following

terms: occupational therapy, adaptive sports, disabilities, stroke, spinal cord injury (SCI),

wellness, outcome measures, independence, quality of life, mental health, social participation,

recreation, and health promotion. The University of Utah Library online catalogs provided the

most articles, therefore, most of the articles have been accessed through that search engine. The

decision to keep or discard an article was based on its relevance of outcome measures used in

adaptive sports programs. Sixteen articles were kept for this literature review, and will be

referenced in the sections below.

Characteristics of Adaptive Sports Programs

 In order to better understand what adaptive sports are, and how their outcomes are

typically measured, literature was reviewed to obtain a more evidence-based perspective on the

definitions and characteristics of adaptive sports programs of the disabilities population,

including veterans. The definition of adaptive sports, according to Lastuka & Cottingham (2015),

states that adaptive sports are conventional sports, such as basketball, that have been modified to

meet the needs of people with disabilities. According to Ryan, Katsiyannis, Cadorette, Hodge &

Markham (2014), there are seven common adaptive models used in the community that include:

Special Olympics, Paralympics, Mixed Paralympic, Reverse Integration, Marathon, Minimally

Adapted Mainstream, and Mainstream type sports. These models are differentiated based on (a)

disability requirement for participation, (b) level of athletic skill required, (c) level of adaptation

or accommodation allowed, (d) level of competitive intensity or seriousness, and (e) degree of

interaction between athletes with and without disabilities. Common populations that participate

in adaptive sports programs mentioned in the reviewed articles include: SCI (Chun, Lee,

Lunberg, McCormick, & Heo, 2008; Hanson, Nabavi & Yuen, 2001; Prout & Porter, 2017),

stroke (Hreha, Kirby, Molton, Nagata & Terrill, 2018), veterans with post-traumatic stress

disorder (PTSD), depression, amputations, and/or traumatic brain injury (TBI) (Katon & Reiber,

2013; Lunberg, Bennett & Smith, 2011; Rogers, Mallinson & Peppers, 2014), children with

moderate to severe disabilities such as cerebral palsy (CP), down syndrome, and autism spectrum

disorder (ASD) (Chang, Pan, Autruong, Ma & Davies, 2016; Feitosa, Muzzolon, Rodrigues,

Crippa & Zonta, 2017; Groff, Lundberg & Zabriskie, 2008; Ryan et al., 2013), wheelchair users

(Cote-Leclerc et al., 2017), persons with intellectual disabilities (Lynnes, Nichols, & Temple

2009), persons with physical disabilities (Yazicioglu, Yavuz, Goktepe & Tan, 2012), persons
with hearing disabilities, persons with visual disabilities and persons with mental disabilities

(Crnkovic & Rukavina, 2012).

Lunberg et al., (2011), hypothesized that participation in adaptive sports would lead to

increases in a person’s physical, psychological, social, and environmental quality of life (QoL),

increases in sports related competence, and reductions in mood disturbances such as depression

and anger. Latsuka and Cottingham (2015), hypothesized that participation in adaptive sports is

associated with increased rate of employment (where individuals benefit directly from their

increased earnings), and also from an increased sense of independence, self-esteem, and social

grounding. Participation in well-constructed exercise training for individuals with intellectual

disability can improve cardiovascular fitness and muscular strength, and psychosocial wellbeing,

and decrease bodyweight (Lynnes et al., 2009). For children and adolescents with disabilities or

disorders, sports and recreational activities have been important in promoting QoL, increasing

physical capacity, minimizing the lack of condition, promoting inclusion, reduction of

maladaptive behavior, and the improvement of self-esteem, mood, cognition, and anxiety, as

well as social competence (Feitosa et al., 2017). For veterans, adaptive sports are used as

interventions for mental health treatment, symptoms of PTSD and depression, and social

participation (Rogers et al., 2014).

Role of Occupational Therapy in Adaptive Sports Programs

Occupational therapists (OTs) are optimal professionals to promote sports in

rehabilitation due to their knowledge and skills in activity analysis, equipment adaptation, and

psychosocial issues (Hanson et al., 2001). Occupational therapists focus on returning function

and satisfaction into their clients’ lives, and engagement in sports can increase life satisfaction

for clients who are interested in or have premorbid experiences. According to Hanson et al.
(2001), OTs can provide reintegration into the community for their clients on a micro

(individual) and macro level (community). Occupational therapists can instruct in adaptive

techniques to complete various activities of daily living (micro level), as well as facilitate social

interaction in the home and community (macro level). Client participation in sports for

rehabilitation can assist with “developing mastery in certain areas that can transfer to

accomplishing life tasks” (Hanson, 1998, p.35).

Occupational therapists can provide direct and indirect services for adaptive sports

programs. Direct services include developing complementary sports-oriented treatment programs

to be incorporated as part of an OT practitioner’s treatment plan (Rogers et al., 2014) and using

the occupation of sports to integrate occupation-based treatment with the cultural demands of

society. They can also assist with adapted sports instruction, and assist with set up and fitting of

adaptive equipment (Hanson et al., 2001). Indirect services include being an administrator

(planning activities, arranging for sponsors, training volunteers), being a researcher (conducting

outcome studies on the effects of sports on function) (Hanson et al., 2001), recruiting clients to

programs, and performing assessments on clients.

Theoretical Framework

The Person-Environment-Occupation (PEO) model can be adopted for participation in

adaptive sports programs for people with disabilities. The PEO model uses assessment and

intervention to enable optimal occupational performance by addressing the transaction between

person, occupation, and environment, and providing satisfaction with the congruence between

the three spheres (Law et al., 1996). Adaptive sports programs focus on adapting the occupation

and environment in order for people with disabilities to have the opportunity for social

participation within the community. In one study (Brown, Kitchen, & Nicoll, 2012), participants
with multiple sclerosis (MS) participated in aquafitness (AF) programs to enhance their QoL.

The “person” was defined as the person accessing or attempting to access AF programs, the

“environment” includes the pool environment and the city environment as the person accesses or

attempts to access the program, and the “occupation” is the AF programs themselves.

Outcome Measures

After reviewing 16 articles on adaptive sports and the outcome measures used, there were

five common domains that were being measured: mental health, social participation, physical

and sport capabilities, and QoL. Each of these themes, respectively, measured multiple types of

independence, such as physical, resilience, self-efficacy, and competence. These common

domains were measured using questionnaires, pre-and post-surveys, screenings, interviews, and

pre-and post-assessments.

Mental Health Measures. According to the World Health Organization (WHO) (2018),

mental health is defined as “a state of well-being in which every individual realizes his or her

own potential, can cope with the normal stresses of life can work productively and fruitfully, and

is able to make a contribution to her or his community.” Aside from measuring outcomes for

people with disabilities, many articles also focused on the mental health of veterans, specifically

those with PTSD, depression, and anxiety. The literature review showed that adaptive sport

programs measured mental health outcomes using pre- and post-tests, semi-structured interviews,

questionnaires, and assessments. Mental health related assessments used in the literature include

Profile of Mood States-BREF (POMS) (Lunberg et al., 2011; Prout & Porter, 2017), Behavior

Checklist for Children/Adolescents (Feitosa et al., 2017), PTSD checklist (military version),

Major Depression Inventory (Rogers et al., 2014), State-Trait Anxiety Inventory (STAI), the
Centre for Epidemiological Studies Depression Scale (CES-D) (Prout & Porter, 2017), and the

Hospital Anxiety and Depression Scale (HADS) (Prout & Porter, 2017).

Social Participation, Community Integration, and Social Support Measures. Social

participation, social support, and social integration were also common domains found in the

literature review for adaptive sports programs. Social participation is an outcome of occupational

therapy, defined by the occupational therapy practice framework (OTPF) (American

Occupational Therapy Association [AOTA], 2014) as “the interweaving of occupations to

support desired engagement in community and family activities as well as those involving peers

and friends” (p.S21). Community integration, or participation in society, has been defined by

three main areas: employment or other productive activity, independent living, and social activity

(Sander, Clark, & Pappadis, 2010). In the literature review, social participation and community

integration was measured in adaptive sports programs using assessments and questionnaires,

including Craig Hospital Assessment and Reporting Technique (CHART) (Hanson et al., 2001),

Community Integration Measurement (CIM) (Chun et al., 2008; Prout & Porter, 2017), and CI

Questionnaire (Prout & Porter, 2017). Social support was also an outcome measure used in the

literature review, including Supports Intensity Scale (SIS) (Lynnes et al., 2009) and Interpersonal

Support Evaluation List (Hreha et al., 2018).

Physical and Sport Measures. Physical outcome measures were abundant throughout

the literature review to measure mobility, endurance, strength, function, and physical

independence. Physical outcome measures were measured using assessments and tests. Outcome

measures used in adaptive sports programs include resting heart rate, 10 meter walk test

(10MWT), 2-minute walk test (2MWT), and Timed Up and Go (Hreha et al., 2018). Other aspect

of sports being measured were sports competence and participation, which was measured with
pre- and post-tests for sports related competence (Lunberg et al., 2011), as well as assessments

including Perceived Competence Scale (Lunberg et al., 2011), Program Satisfaction (Lynnes et

al., 2009), Sports Participation Questionnaire (Prout & Porter, 2017), and Athletic Identity

Measurement Scale Athletic identity measurement scale (Groff et al., 2009).

Quality of Life Measures. Quality of life is an outcome of occupational therapy as

defined by the OTPF. According to WHOQOL group (1996), QoL is “the individuals’

perceptions of their position in life in the context of the culture and value systems in which they

live and in relation to their goals, expectations, standards and concerns” (p.5). The literature

review showed that adaptive sport programs measured the QoL of participants through

standardized assessments, pre- and post-tests, surveys, interviews, and questionnaires.

Standardized assessments and questionnaires used to measure QoL include: Life Satisfaction

Questionnaire (LiSat-9) (Prout & Porter, 2017), NeuroQOL Satisfaction with Social Roles and

Activities (SSRA) (Hreha et al., 2018), QOL index (Cote-Lederc et al., 2017), QOL Scale (Groff

et al., 2008), and KIDSCREEN-52 (Chang et al., 2016).

The most commonly used standardized assessment, which was used on five of the 11

articles that measured QoL, was the World Health Organization Quality of Life Instruments

(WHOQOL-BREF) (Chun et al., 2008; Crnkovic & Rukavina, 2012; Katon & Reiber, 2013;

Lunberg et al., 2011; Yazicioglu et al., 2012). According to WHO (1996), the WHOQOL-BREF

was developed from the WHOQOL-100 quality of life assessment, a detailed assessment of each

facet relating to quality of life, which was too lengthy for practical use. The WHOQOL-BREF is

based on four domains; physical health, psychological, social relationships, and environment and

contains a total of 26 questions (WHO, 1996). The facets incorporated within domains are as

follows:
 1. Physical health: ADL, dependence on medicinal substances and medical aids, energy

and fatigue, mobility, pain and discomfort, sleep and rest, and work capacity

2. Psychological: bodily image and appearance, negative feelings, positive feelings, self-

esteem, spirituality/religion/personal beliefs, and thinking, learning, memory and

concentration

3. Social relationships: personal relationships, social support, sexual activity

4. Environment: financial resources, freedom, physical safety and security, health and

social care: accessibility and quality, home environment, opportunities for acquiring new

information and skills, participation in and opportunities for recreation/leisure activities,

physical environment (pollution/noise/traffic/climate), and transport

To determine a raw item score, items are rated on a 5-point Likert scale, with a low score

of 1, to a high score of 5 (Shirley Ryan Ability Lab, 2014). The WHOQOL-BREF is self-

administered and takes about 15 minutes to complete. It is free of cost and can be used for

participants ages 18 and up. It is also available in 20 languages, including English, Chinese,

Spanish, Odia, an Indian language, and New Zealand Sign Language. Common populations

include arthritis and joint conditions, brain injury, multiple sclerosis, Parkinson’s disease,

neurologic rehabilitation, pulmonary disorders, spinal cord injury, and stroke recovery.

A study was recently completed this past year to examine the effects of adaptive cycling

participation on aspects of physical psychological and social resilience in stroke survivors with

WAS students (Hreha et al., 2018). Although the study did not use the WHOQOL-BREF

outcome measure, they used the NeuroQOL-PAWB and NeuroQOL-SSRA assessments to

measure QoL outcomes for the cycling program at baseline, 8-weeks, and 16-weeks. The results

showed improvement in QoL from baseline to 8-weeks and 8-weeks to 16-weeks, demonstrating
overall QoL improvement from baseline to 16-weeks through participation in adaptive recreation

(Hreha et al., 2018).

Summary

The mission of WAS is to “encourage individuals with adaptive needs and their families

to realize their potential and engage in active living through year-round recreation, educational,

and social programs (WAS, 2017). In order for WAS to continue to succeed in their mission,

they need to obtain the appropriate amount of funding and grants to continue programs they

provide, as well as developing new ones. According to the needs analysis, outcome measures are

necessary to implement into their programs in the beginning, during, and end of their seasons to

show improvements in their participants QoL, mental health, social participation, and physical

capabilities, based on their engagement of the programs. Currently, WAS collects intake data,

progress notes to track mileage and independence level, and surveys at the end of the seasons to

see who is participating in which programs. It was learned in the literature review that outcome

measures can be obtained through the use of semi-structured interviews, questionnaires, surveys,

and assessments to measure QoL, mental health, social participation, and physical capabilities.

The WHOQOL-BREF is a standardized assessment that can provide outcome measures on QoL

based on physical health, psychological, social relationships, and environment. This assessment

covers a range of domains, is easy to administer, free of cost, and time friendly.

Four of the five studies that used the WHOQOL-BREF outcome measure found

significant positive results in all domains of QoL of people with disabilities from adaptive sports

programs (Chun et al., 2008; Crnkovic & Rukavina, 2012; Katon & Reiber, 2013; Yazicioglu et

al., 2012). In the fifth study, Lunberg et al. (2001), results indicated a promising trend towards

potential improvement in overall QoL and psychological health, and suggested that with regular
participation in programs. Overall QoL can eventually increase as mood states and perceived

competence in the associated activities are enhanced.

At this time, a contract or PRN occupational therapist would benefit WAS to provide

indirect services for staff and volunteer training, researching, and performing assessments on

students. An occupational therapist has the skills and knowledge to do extensive research on

outcome studies on the effects of sports on function in order to find an outcome measure suitable

for WAS. Occupational therapists also have the skills to perform the outcome measure on the

students, specifically the WHOQOL-BREF. Occupational therapists can provide staff and

volunteer training on how to administer and score the WHOQOL-BREF. The assessment can be

easily implemented to every student upon baseline, every 8-weeks, and at the end of the season.

This will provide reliable outcome measures for WAS programs to show current and potential

funders, grants, and donors the positive outcomes for their students in QoL, physical health,

psychological, social relationships, and environment.

After meeting with Eileen May-West, the program director and recreational therapist, and

presenting her the literature review, it was agreed that developing a pre- and post-assessment

specifically for WAS that included aspects of the WHOQOL-BREF as well as other assessments

would be the most beneficial to their program. Eileen presented two more assessments from her

knowledge that included the Lifespan Self-Esteem Scale (LSE) (Self Lab, 2016) and the National

Sports Center for the Disabled (NSCD) Progress Report (NSCD, 2015). After collaborating with

Eileen, it was also agreed on to include student physical and cognitive limitations, learning style,

communication style, preference of instructor, current knowledge and experience of program

(cycling), and establishing student goals.

 Occupation-Centered Community Program Proposal

After completing a needs analysis through interviews, observation, meetings, and a

literature review, a consultation indirect service was proposed to address outcome measures for

WAS. A collaboration between Eileen May-West and an occupational therapy student through

meetings were established to develop a pre- and post- assessment as well as the decision to revise

the current progress note format. The purpose of this occupation-based program for WAS is to

show current and future grantmakers and funders the positive effects WAS has on its students, as

well as improve the documentation skills and communication between volunteers and staff, to

provide the best service and assistance to their students.

The mission of WAS is to “encourage individuals with adaptive needs and their families

to realize their potential and engage in active living through year-round recreational, educational

and social programs” (WAS, 2017). The consultation aims to coincide with the mission to

continue providing programs and adaptive equipment to people with disabilities by

demonstrating outcomes of those participating in their programs. The consultation also aims to

achieve WAS mission by improving the services and assistance that the staff, instructors, and

volunteers provide. By improving outcome measures for WAS, the program can continue to

provide leisure and physical activities for people with disabilities to continue improving their

quality of life.

Occupational injustice

It is common for people with disabilities to live sedentary and socially isolated lives due

to lack of resources and accessible occupations, social events, socioeconomic status,

transportation, and environments. People with disabilities have limited access to non-ADA

approved buildings, outdoor recreational and leisure activities, and inclusive social opportunities.
It is important to provide opportunities for funding WAS so that people with disabilities have

access to desired occupations, outdoor leisure and recreational activities, and social events.

Wasatch Adaptive Sports also provides scholarship opportunities to their students so they can

participate in their programs free of charge.

Contextual factors

Demographic factors. While developing the outcome measures, the demographic factors

of the staff and volunteers were considered while designing the pre- and post-assessment and

progress note. As previously mentioned, the staff and volunteers come from different

backgrounds and expertise, such as recreational therapy, veterans, firefighters, athletic trainer,

students, etc. Since many of the staff and volunteers have different backgrounds, it is important

to develop assessments and progress notes that are easy to use and understood, while also

tailoring to their skills and knowledge. To adapt to the demographics of WAS, common language

was used to avoid jargon as well as appropriate prompting to ensure that the staff and volunteers

fill out the documents efficiently. Staff training will also be implemented to improve the

competency of the staff and volunteers documenting skills.

Economic factors. Economic factors of WAS were also considered while developing this

program. Since WAS is a non-profit organization, the program relies heavily on money from

donors, funders, and grants to provide staff salary, adaptive equipment, office and warehouse

space, and offer a variety of programs to their students. It is important to provide outcome

measures for the funders so that they can see the effects that the programs have on their students

cognitively, physically, and occupationally not only in the programs, but in their students

everyday lives.
 Social factors. Lastly, social factors of the students were addressed with this program. As

previously mentioned, WAS promotes social participation for people with disabilities, who are at

risk of social isolation. By providing more funding through improved outcome measures, WAS

can continue to create social opportunities outside of their students’ homes through interaction

with the staff, volunteers, and other students participating in the program. Other contextual

factors that are not directly addressed in the program include policies, political factors, and

geographic factors.

Prevention

The consultation program supports indirect tertiary prevention of the students. Since

WAS focuses on providing leisure and physical activities for people with disabilities, their

participants will likely already have a condition, diagnosis, or disease. Tertiary prevention is

implemented when a person is already ill or impaired, and the initial damage has already

occurred (Scaffa & Reitz, 2014, p.21). Wasatch Adaptive Sports provides physical, leisure, and

social participation for people with disabilities who are at risk for living sedentary lives,

secondary diseases, diabetes, social isolation, and limited to desired occupations due to

accessibility. New outcome measures will help show potential funders see students gain more

function, prevent comorbidities and risk factors, and improve overall quality of life.

Role of Occupational Therapist

In order to improve WAS current outcome measures, inclusion of a contract occupational

therapist is necessary to provide consultative indirect services. Occupational therapists have the

required skills and knowledge to complete a literature review on outcome studies on the effects

of sports on function and developing and performing assessments on clients. Occupational

therapists can develop consultative indirect services using theoretical frameworks, specifically
assessing how the person, occupation, and environment (PEO model) intertwine with each other,

and improve their congruence through activity analysis and problem-solving. By using this

model as a guide, the OT can address the three domains to conduct staff training and developing

an assessment (occupations) with consideration of the population implementing the assessment

and the students it will be performed on, and the physical and social environment (different

programs and locations). Other characteristics that OTs attain are the knowledge and ability to

problem-solve, complete an activity analysis to identify strengths and areas of growth in the

program, and provide proper training such as teaching strategies to promote efficiency of the

staff and volunteers. Lastly, OTs have the skills and knowledge to analyze collected data from

the outcome measurements to make any necessary adjustments, and to determine if WAS has

positive effects on their students participating in their programs.

Theories and Practice Models

While developing a consultation program, theories and practice models are considered

and utilized. The PEO model is used when addressing outcome measures and staff training, as

the purpose of this model is to use assessment and intervention to enable optimal occupational

performance by addressing the interaction between person, occupation, and environment, and

providing satisfaction with the congruence between the three spheres (Law et al., 1996). The

PEO model will consider the staff and volunteers, the environment of adaptive sports, and the

structure of the outcome measures, to design the measurements to find the congruence between

the three. This can be met by creating outcome measures that are easy to use and understand by

the staff and volunteers and meets the needs of WAS programs, which will ultimately improve

the documenting skills of the staff and volunteers and the reliability of the outcome measures.

The PEO model will also be incorporated for staff training by teaching the new outcome
measures to the staff and volunteers while considering personal factors such as values and

beliefs. The PEO model will also promote an environment that will help improve their

competency while considering the physical and social environment of WAS and their students.

The Model of Human Occupation (MOHO) will be utilized for staff training, as this

model focuses on occupational adaptation, including the creation of an occupational identity and

the ability to perform competently (Keilhofner, 2009). This model uses volition to help improve

occupational adaptation. Since the pre- and post-assessment and revised progress note will be

new to the staff and volunteers, it is important to motivate them to utilize the new outcome

measurements during each lesson with their students. Through observation, the staff and

volunteers currently demonstrate the lack of motivation and willingness to fill out the progress

notes after each lesson, as they would rather focus on the actual lessons and activities. In order to

increase motivation, it is important to identify why they do not have the desire to fill out the

forms, and figure out how to improve their drive and willingness to take ownership in

completing the progress notes. Staff training will be implemented to address the identified

problems and education of the outcome measures. It is important to provide information on the

connection between the documentation and the overall program, and how measureable outcomes

can help continue to provide services and equipment to their students, while also improving

communication between each progress note. They will learn about the effects that documentation

has on their students, and how accurate documenting can provide exemplary services and

assistance to their students, as well as see the improvements their students make such as

becoming more independent in their transfers and ADL. By increasing competency, the staff and

volunteers will increase their motivation to take ownership and fill out the progress notes
accurately, understand their role in documenting, and see the value of outcome measures and

how it relates to the overall services they provide.

Goals and Objectives

These are the goals and objectives that will be used to measure outcomes for the

effectiveness of the developed outcome measures:

Goal 1: To provide positive outcome measures for funders and grant makers to see the

positive effects on individuals that participate in the cycling program

Objective 1: Within 3 months, the OTR/L will develop a new pre- and post-assessments

with 15 or more client-centered questions to better accommodate the needs of people

with disabilities participating in the cycling program

Objective 2: Within 3 months, the instructor will independently complete the progress

note accurately and measure 4 or more outcome measures for a student in the cycling

program

Goal 2: To train staff members, instructors, and volunteers how to document outcome

measures to increase documentation competency, volition, and ownership.

Objective 1: Within 2 months, the staff members and volunteers will attend staff training

and independently identify 3 reasons why documenting is important, per report.

Objective 2: Within 5 months, 90% the staff members and volunteers will independently

fill out the progress notes accurately for every individual receiving a lesson.

Program Details

As previously mentioned, the purpose of the consultation program is to improve outcome

measurements by developing a pre- and post-assessment as well as a new progress note. Once
the OT develops the outcome measures, a staff training meeting will be held for the upcoming

cycling season that focuses on documenting. The meeting will be run by the OT and program

director, Eileen May-West. At the end of the season, the OT will analyze and collect data from

the documents to track the outcome measures, and make improvements in the format and

information of the documentations if necessary. Over time, this program will promote the staff

and volunteers to be competent and have the volition to continue to fill out the documentation

consistently and accurately, without the need of the OT. The aim of the program is to provide the

staff and volunteers training to complete outcome measures to show current and potential

funders the outcomes of their program on their students. Providing more funding to the program

will ultimately address tertiary prevention, where WAS can continue to provide social

opportunities, recreational, sports, and leisure activities, and desired and accessible occupations

to their students.

Educational care. The proposed consultation program addresses education for the staff

and volunteers of WAS. The development of the assessment and progress note as well as staff

training will assist in educating them on the what, why, and how aspects of the new outcome

measures to increase documentation competence.

Criteria. The criteria for participating in this indirect service is that the people utilizing

the pre- and post-assessment and progress note must be associated and hired on with WAS,

specifically the instructors and volunteers. They will also be required to attend staff training for

documentation at the beginning of each season to improve their competency on the new outcome

measures and documenting skills. People who are ineligible to participate in the indirect service

are people who are not hired or associated with WAS.

 Time Requirements. To develop the program to improve outcome measures, an

estimated time of 35-40 hours was required from the OT. This time included observation hours,

interviews, meetings, research, and the development of a pre- and post-assessment and revising

the progress note. The staff training will be 30 minutes, per the program director’s request. Once

the staff is trained, they, along with the OT, will spend time filling out the pre-and post-

assessment at the beginning and end of the season. This can take 15-30 minutes each time the

assessment is taken, depending on the student. The progress note will be utilized by the staff and

volunteers at the end of each lesson that is given under the supervision of the program director or

OT. The progress note can take about 10 minutes to complete after a lesson, depending on the

competency of the staff and volunteer, and the student.

For the cycling program, they offer two different time slots over a three and half hour

period. For example, on Wednesday mornings, WAS offers their cycling program at the Jordan

River Parkway from 10-11:30am and 12-1:30pm. During these hours, the instructors and

volunteers arrive 30 minutes early to set up the equipment, provide lessons to the students, and

are given 30 minutes between lessons to document. The number of students that attend the

cycling lessons can range from one to eight students, excluding group rides. Each instructor and

volunteer work with one student at a time, unless it is a group ride (two to three students). Each

student will be on site at the Jordan River Parkway for about one and a half hours for a lesson.

Staff involvement. Following staff training, the staff and volunteers will perform the

new pre- and post- assessment on their students and fill out the revised progress note after each

lesson, with the OT there to help with the pre-assessment and assist the staff members and

volunteers as necessary during the first week of the season.

 Assessments. The OTs skills and knowledge, collaboration with Eileen May-West, and

the utilization of multiple assessments were used to tailor specific outcome measures to meet the

needs of WAS. The OT used the literature review to determine common domains assessed and

types of measurement outcomes in adaptive sports programs. The common domains measured

were mental health, social participation, physical and sport capabilities, and QoL, which were

gathered through the study of standardized questionnaires, pre-and post-surveys, screenings,

interviews, and pre- and post-assessments. According to the literature review, the WHOQOL-

BREF was utilized the most (five articles) out of the 11 articles reviewed. The OT incorporated

10 questions from the WHOQOL-BREF to the pre- and post-assessment to measure the students’

physical health, psychological, social relationships, and environment (WHO, 1996). The

collaboration with Eileen May-West, the program director and recreational therapist, provided

the knowledge of two assessments, the Lifespan Self-Esteem Scale (LSE) and the National

Sports Center for the Disabled (NSCD) Progress Report, that were incorporated in the pre- and

post-assessment and in the revision of the progress note. The Lifespan Self-Esteem Scale (LSE)

measures self-esteem across multiple ages of childhood, adolescence, and adulthood (ages 5 to

93), using a 4-item Likert scale (Self Lab, 2016). The NSCD Progress Report measures multiple

outcomes for people with disabilities participating in their ski program (NSCD, 2015). The

NCSD Progress Report measures the participants goal performance, milestones and

independence levels, and ski/snowboard skill level, as well as collects information on the lesson

summary, satisfaction with the lesson, and the goal for the next lesson plan. All four questions on

the LSE were included in the pre- and post-assessment, as well as many aspects of the NCSD

Progress Report for the revision of the WAS progress note. Refer to Appendix B for the current
progress note, Appendix D and E for the rough draft, and Appendix F and G for the final

assessment and progress note after meeting with Eileen May-West.

Services & Program Promotion. The program provided was chosen after completing an

activity analysis of WAS cycling program. The activity analysis consisted of observation of

cycling program for four hours once a week, over a four-week time period, several meetings and

interviews with different staff members and students throughout 14-weeks, and a literature

review. A collection of data was also completed to gather data for progress notes, intake forms,

interviews to gather perspectives from different people at WAS, possible outcome measures, and

more information about WAS. After the activity analysis, the development and rough draft of the

pre- and post-assessment and the revised progress note was completed. To finalize the

documents, the OT and program director had a meeting to make any adjustments or suggestions

to the outcome measures.

Once the new outcome measures we approved and completed, the development of staff

training was necessary to promote the consultative program to the staff and volunteers. The goal

of staff training is to provide the staff and volunteers the confidence, knowledge, and volition to

fill out the new outcome measures accurately and consistently. At the beginning of the training, a

small discussion will be guided by the OT, to see what the staff and volunteers know about

documentation, such as what the importance of documenting is, and how it effects the whole

organization. The staff and volunteers will also fill out a pre-survey about documentation, to help

evaluate the effects of staff training (refer to Appendix C). Lastly, the staff and volunteers will

learn about documentation in general, and how to fill out the new outcome measures. They will

be educated on how documentation is related to the organization, such as outcome measures

assisting with receiving grants and funds will in turn provide more equipment and improve
services. They will also learn why documentation needs to be completed for every student.

Documentation allows the staff and volunteers to get a better understanding of the student, such

as what their communication and learning styles are, what impairments or limitations they have,

what their goals are, and what skills they are working on or has been achieved. Through

documenting, the instructor is able to gather information on their student to get a better picture of

who they are, and why they are participating in the program. Teaching the staff and volunteers

how to accurately fill out the outcome measures is important as well, because it will improve the

communication between each instructor, and they know exactly what to work on with their

student during the lesson. By informing the staff and volunteers on documenting, they see the

value and the role they play on collecting outcome measures, and will ultimately take ownership

to complete documenting on every student they give a lesson to.

Community resources. Wasatch Adaptive Sports currently provides leisure and

recreational activities out in the community. Some places include Liberty Park and Jordan River

Parkway for their cycling program, and Snowbird Resort for their skiing, fishing, and hiking

programs. Since the consultation is providing an in-direct service, new community resources will

not be provided.

Space Requirements. For the staff training meeting, a large space is required to hold 20-

40 staff members and volunteers. The new WAS warehouse in Murray, Utah will be used to fit

the number of people attending the meeting. There will need to be 20-40 chairs for seating, and

one to two tables to place items used for the meeting. Filling out the pre- and post-assessment

and progress note will take place in the location that the cycling program is at for that day, such

as Liberty Park and Jordan River Parkway. Wasatch Adaptive Sports currently provides about 12
chairs to use for students to put their equipment on, and for the staff and volunteers to sit on

while they document on the iPads also provided by WAS.

Budget. In order to put the consultation program into fruition, a contract OT will need to

be hired on. The contract OTR/L charges $40.00/hr, with an estimated time of 78 hours to

complete the program for one season. These hours include 12 hours of research, 12 hours of

developing outcome measures, 4 hours for meetings with staff members, 1 hour for staff training

twice a year, and 4 hours for the first 6 days and last 6 days of the season to perform the pre- and

post-assessment and progress note on students. The total cost to hire a contract OT for this

program is $3,843.20 for the year. Please see Appendix H for an outline of the budget.

Other expenses include office supplies for staff training, such as two 1” binders ($8.22),

10-pack report cover folders ($9.99), and 60-pack Bic pens ($5.99), coming out to a total of

$24.20. In-kind costs include work space for meetings, utilities, maintenance, a black and white

printer, printer paper, printer ink, and WiFi. Since the OT will be developing the assessment and

progress note, they will be provided free of cost, excluding contract OT fees. Other parts of the

program that are free of cost include iPads that are already provided by WAS, and future OT

student volunteers or interns to help assist with collecting data from the outcome measures and

performing assessments.

Funding Options. Wasatch Adaptive Sports is currently funded by three major

fundraising events, multiple grants, and individual donors and corporations. These sources of

income could be a potential source of income for the program, as well as reaching out to new

grantmakers.

In order to find funding sources for the consultation, a funding search took place using

the funding search engine, Foundation Directory Online (2018). The Foundation Directory
Online website was accessed through the University of Utah Library website,

www.library.med.utah.edu. To find two funding sources, an advanced search was performed

using adaptive sports as the subject area, Utah for geographic focus, and people with disabilities

for population served. This search provided the following results: 178 grantmakers, 527 grants, 9

recipients, and 23 990 tax forms. Of these results, two funding sources were chosen, the George

S. and Dolores Dore Eccles Foundation and the Lawrence T. and Janet T. Dee Foundation. These

two foundations were selected due to meeting the program requirements and previously funding

WAS.

The George S. and Dolores Dore Eccles Foundations is a family foundation with a vision

to improve the lives of all citizens in Utah (George S. and Dolores Dore Eccles Foundation,

2011). The foundation has five program areas that they fund: arts and culture, community,

education, health care, preservation and conservation. Their funding interests include four areas:

subjects, geographic focus, population groups, and support strategies (Foundation Directory

Online, 2018). Their subject interests, regarding WAS are health, disease and conditions, mental

health care, and sports. Their geographic focus is Utah. Population groups related to WAS

include children and youth, economically disadvantaged people, and low-income and poor

people. Lastly, their support strategies regarding WAS are providing equipment, general support,

program development, research, and annual campaigns. The George S. and Dolores Dore Eccles

Foundation looks for specific criteria in making grants for organizations. For organizations, they

want their efforts to be focused primarily within Utah, a history of achievement, effectiveness,

and good management demonstrating good financial stability, and being able to distinctively

contribute to the community without duplicating other services. Funding requests will not be
considered if the organization does not have 501(c)(3) status, political nature, other private

foundations, and conduit organizations.

The Lawrence T. and Janet T. Dee Foundation is a family foundation dedicated to

promoting charitable activities and furthering the growth and well-being of the people in

northern Utah (Lawrence T. & Janet T. Dee Foundation, 2018). This geographic preference for

the organizations receiving their grant to be based in Utah, with consideration and limitations for

organizations outside of Ogden and Salt Lake communities. This foundation has the same areas

of funding interests as the George S. and Dolores Dore Eccles Foundation (Foundation Directory

Online, 2018). Their subject interests pertaining to WAS are disease and conditions, family

services, and health. The geographic focus is Utah, specifically, Ogden and Salt Lake City. Their

Population groups interests include children and youth, economically disadvantaged people, low-

income and poor people. Their support strategies regarding WAS include providing equipment,

general support, program development, and research. In order to be eligible for this grant, tax-

exempt organizations and institutions must have purposes that are charitable, educational,

artistic, promoting conservation, or care giving (Lawrence T. & Janet T. Dee Foundation, 2018).

Organizations applicants must have a 501(c)(3) non-profit tax-exempt status, while individuals

or lobbying organizations are ineligible to apply.

The George S. and Dolores Dore Eccles Foundation and Lawrence T. and Janet T. Dee

Foundation are both suitable funding options for the consultation program. Both support non-

profit organizations and favor Utah, specifically Salt Lake City, where WAS is located, as their

geographic preference. Both foundations have also provided grants to WAS in the past. In 2016,

the George S. and Dolores Dore Eccles Foundation granted WAS $12,000 under the subject of

health. In 2009 and 2010, the Lawrence T. and Janet T. Dee Foundation granted $1,500 and
$2,000 under the subject of adaptive sports. With the consultation program being less than

$5,000, these foundations together would be realistic funding options for submitting a grant

proposal.

Program Evaluation

The results of this program will be to have new outcome measures, a pre- and post-

assessment, and a revised progress notes for instructors and volunteers to utilize with each

student that participates at WAS. Another expected outcome is to improve competency, volition,

and ownership of the staff and volunteers in order to independently fill out the new outcome

measures over time with the use of staff training and assistance. Ultimately, the new outcome

measures will support WAS in receiving more funds and grants from their donors to continue to

achieve their mission and provide services for people with disabilities within the community.

To evaluate the effectiveness of the new outcome measures for the students, a collection

and analyzing of data is required. Once the post assessments have been filled out at the end of

the season, data will be collected from every student that has filled out the pre- and post-

assessment. For each student, the pre- and post-assessment will be compared to see if students

achieved their goals, self-esteem, and overall quality of life. Progress notes will also be collected

and analyzed for each student at the end of the program to see if they progressed throughout the

program. Their progress can be tracked by improvements in the equipment used, number of

independent measures checked, progress on their goals, decreased safety needs, and process and

other skills checked (refer to Appendix G).

To evaluate the outcomes of the staff and volunteer’s competency and volition, a pre-and

post-survey will be provided for the staff and volunteers to fill out at the beginning and end of

the season. The survey will consist of qualitative and quantitative questions that refer to
documenting (refer to Appendix C). The pre-survey will gather information on how the staff and

volunteers currently view documentation such as the importance, their competence, and accuracy

of filling them out. The post-survey will have the same questions to compare their answers and

see if their competency and ownership has improved.

 Appendix A: Interview Questions

Program director questions

What group of individuals do you serve?
What are the characteristics of this group?
How are you funded?
How do you get your students?
How many students do you serve?
Based upon your knowledge of your clients and how they function in your program or after they
leave, what gaps do you see in their functioning or skill levels?
What do you think is working well for your program?
What do you think could be improved?
What types of measurements/assessments do you use?
How many volunteers do you have? Staff?
How did you choose what sports/activities you provide?
What plans for different or additional services, etc are in the future?
What was your most recent grant submission?
Are there any big proposals that you’re looking at currently?
Are there any funders in mind? Are there any grants you are interested in? Foundation grants?
Are there specific outcome measures that you want to be able to collect or that you find
beneficial?
If you can, please provide as much information for the funders/foundations and grants so I can
take a look at what types of outcome measures they are looking for.
How are you currently training staff/volunteers?
Do you teach them about typical diagnoses?
How do you train them to document?

Staff questions
Why did you want to work/volunteer at WAS?
What was training for the job like? How long did it take for you?
How is your knowledge on the diagnoses the participants have? How do you know this
information?
How comfortable are you working with cognitive and physical disabilities?
How comfortable are you with documentation?
What is your background in? (kinesiology, nurse, RT, PT, OT, etc.)
What do you like about WAS?
What are some strengths of the program?
What are some areas for growth/improvement?

Student questions
Why did you sign up to participate in WAS?
What does wellness mean to you?
What are your wellness goals?
How active were you prior to participating with WAS?
What are some strengths of the program?
What are some areas for growth/improvement?
What do you like about the program?
How is this program different from other activities you participate in?
Have you seen any improvements in yourself since joining WAS?
- physically, emotionally, spiritually
- level of independence
o in the program
o outside of the program
- mental health
- quality of life
Appendix B: Current Progress Note
 Appendix C: Pre- and Post-Survey for Staff and Volunteers
Quantitative
Likert scale questionnaire to assess how comfortable and knowledgeable the instructors feel in
terms of working with the students and documentation. The measure will be on a 1-5 scale,
where 1 is strongly agree, 2 is agree, 3 is neither, 4 is disagree, and 5 is strongly disagree. Some
example questions include:
- Documenting after every lesson is important
- I feel confident in my documenting skills
- I understand the terminology on the documents
- I can understand other instructors’ notes
- The previous documentation clearly states what adaptive equipment is needed for the
student
- The previous documentation clearly states preferred learning styles and communication
style of the student
- I know what to expect of my student based on reading previous documentation
- It is my responsibility to fill out the documentation accurately
Qualitative
- What is the value of documenting? How does it affect WAS?
- If you do not document after each lesson, why not?
- How long do you take documenting?
- What problems do you find when reading other progress notes written by others?
- What improvements can be made on the progress note?
- What prompting is difficult to understand on the progress note?
 Appendix D: Rough draft of pre- and post-assessment
WAS Pre/Post Assessment
Name:
Age:
Primary Diagnosis:
Impairments:
Learning style: Auditory Visual Kinesthetic Other:
Communication style: Yes/No Open-ended questions Non-verbal Other:
Program:
- Current knowledge/experience:
- Current strengths:
- Current weaknesses:
Goals:
1. Physical:
2. Cognitive:
3. Social:
4. Emotional:
5. Leisure:
Really Sad Sad Neutral Happy Really Happy

1. How do you feel about

yourself?

2. How do you feel about

the kind of person you
are?

3. When you think about

yourself, how do you feel?

4. How do you feel about

the way you are?

5. How do you feel when you Very Dissatisfie Neither satisfied Satisfied Very
participate in leisure/physical dissatisfied d nor dissatisfied satisfied
activity?

6. How would you rate your Very poor Poor Neither poor nor Good Very good
quality of life? good

7. How satisfied are you with your Very Dissatisfie Neither satisfied Satisfied Very
health? dissatisfied d nor dissatisfied satisfied

8. How much do you need any Not at all A little A moderate Very An extreme
medical treatment to function in amount much amount
your daily life?
9. To what extent do you find your Not at all A little A moderate Very An extreme
life to be meaningful? amount much amount

10. Do you have enough energy for Not at all A little Moderately Mostly Completely
everyday life?

11. To what extent do you have the Not at all A little Moderately Mostly Completely
opportunity for leisure
activities?

12. How well are you able to get Very poor Poor Neither poor nor Good Very good
around? good

13. How satisfied are you with your Very Dissatisfie Neither satisfied Satisfied Very
ability to perform your daily dissatisfied d nor dissatisfied satisfied
living activities?

14. How satisfied are you with Very Dissatisfie Neither satisfied Satisfied Very
. yourself? dissatisfied d nor dissatisfied satisfied

15. How often do you have negative Never Seldom Quite often Very often Always
feelings such as blue mood,
despair, anxiety, depression?
 Appendix E: Rough Draft of Revised Progress Note

WAS Progress Note

Student name: Instructor:
Date: Location:
Impairments:
Mileage/time:
Type of lesson: Individual Group Rental
Learning style: Auditory Visual Kinesthetic Other:
Communication style: Yes/No Open-ended questions Non-verbal
- Positive triggers:
- Negative triggers:
- Interests:
Equipment used:
● Bike: Catrike Sunseeker Other
○ Set-up:
● Add-ons (calf pedal, etc): Calf pedal Theraband Rope Glove Other:
● Shoe size:

Independent measures
Independence level key Description Independence level Description
key

1: Full physical support Instructor manipulates and gives verbal or 4: visual support Instructor provides gestures and/or models
auditory cues throughout entire skill skill as needed throughout skill
performance performance

2: Partial physical support Instructor manually assists and gives 5: independent Instructor observes student perform skill
verbal or auditory cues as-needed without prompt or assistance
throughout skill performance

3: verbal/auditory support Instructor gives verbal or auditory cues as

needed throughout skill performance

Set-up
Task Ind. level Comments: (what types of instruction worked?)

Shoes

Helmet

Flag

Bike set up

Bike assignment?

Transfer (# of people assisting, etc)

Other:
vs
Add-on:
 Cycling
Task Ind. level Comments: (frequency, specific instructions provided)

Pedaling

Braking

Steering

Shifting 1
derailleur

Shifting both
derailleurs

Student goals:
1.
2.
3.

Lesson Summary:
Did the client report anything significant?
Student behavior:
Goals:
- What was done to achieve the client’s goals?
- What can be worked on for the next lesson plan?
Safety needs:
Downhill speed Turning speed Avoiding people/objects Looking Navigating trail Other:
Comments:
Process skills addressed:
Memory Attention Initiation Sequencing Navigating Other:
Comments:
Other skills addressed:
Following 1 step instructions Following 2-3 step instructions Social skills Leg strength Hand
manipulation/grip Other:
Comments:
Additional information:

After lesson questions for students:

1. How much did you enjoy your experience?
2. What did you accomplish today?
3. What would you like to work on for the next lesson plan?
4. How did you progress towards your goals/meet your goals?
5. Do you have any new goals?
 Appendix F: Final Draft of Pre/Post Assessment
WAS Pre/Post Assessment
Name:
Age:
Primary Diagnosis:
Physical/cognitive limitations:
Learning style: Auditory Visual Kinesthetic Other:
Communication style: Yes/No Open-ended questions Non-verbal Other:
Preference of instructor: Male Female No preference
Program:
● Current knowledge/experience:
● Current strengths:
● Current weaknesses:
Goals and Expectations:
Please checkmark things you would like to improve or provide more information in each category
Physical:
❏ Walking (with or without assistance) ❏ Range of motion
❏ Balance ❏ Endurance
❏ Transfers ❏ Coordination
❏ Arm and hand strength ❏ L/R side weakness
❏ Lower body strength ❏ Other:
❏ Core strength
Physical Goal:

Cognitive:
❏ Learning and Memory ❏ Decision-making/problem-solving
❏ Following directions ❏ Sequencing
❏ Organizing and planning ❏ Other:
❏ Attention
Cognitive goal:

Social:
❏ Support network ❏ Socially engaging with others
❏ Caregiver present ❏ Using etiquette and manners
❏ Social participation (community, family, peers) ❏ Demonstrating modeled actions
❏ Expression of needs ❏ Other:
❏ Cooperating
Social Goal:

Emotional:
❏ General outlook (positive/negative) ❏ Responding to external motivator
❏ Behavioral concerns ❏ Display moods
❏ Signs that the student is frustrated or upset ❏ Other
Emotional Goal:

Leisure:
Current participation in leisure activities

Current participation in physical activity

How many hours/days a week?

Leisure goal:
 Really Sad Sad Neutral Happy Really
1. How do you feel about yourself? Happy

2. How do you feel about the kind

of person you are?

3. When you think about yourself,

how do you feel?

4. How do you feel about the

way you are?

5. How do you feel when you participate Very Dissatisfied Neither satisfied nor Satisfied Very satisfied
in leisure/physical activity? dissatisfied dissatisfied

6. How satisfied are you with your health? Very Dissatisfied Neither satisfied nor Satisfied Very satisfied
dissatisfied dissatisfied

7. How satisfied are you with your ability Very Dissatisfied Neither satisfied nor Satisfied Very satisfied
to perform your daily living activities? dissatisfied dissatisfied

8. How satisfied are you with yourself? Very Dissatisfied Neither satisfied nor Satisfied Very satisfied
dissatisfied dissatisfied

8. How much do you need any medical Not at all A little A moderate amount Very An extreme
treatment to function in your daily life? much amount

9. To what extent do you find your life to Not at all A little A moderate amount Very An extreme
be meaningful? much amount

10. Do you have enough energy for Not at all A little Moderately Mostly Completely
everyday life?

11. To what extent do you have the Not at all A little Moderately Mostly Completely
opportunity for leisure activities?

12. How well are you able to get around? Very poor Poor Neither poor nor Good Very good
good

How would you rate your quality of Very poor Poor Neither poor nor Good Very good
life? good

15. How often do you have negative Never Seldom Quite often Very Always
feelings such as blue mood, despair, often
anxiety, depression?
 Appendix G: Final Draft of Revised Progress Note
WAS Progress Note
Student name: ____________________ Date: ________ Location: ______________ Instructor:
_______________ Mileage/time: _______
Physical/cognitive limitations:
Type of lesson: Individual Group Rental Learning style: Auditory Visual Kinesthetic
Other:
Communication style: Yes/No Open-ended questions Non-verbal Other:
● Positive trigger/Interests:
● Negative triggers:
Student long-term goal:
● Daily objective:
Equipment used:
● Bike: Upright Recumbent Hand cycle Other trike: _______________ Specific bike used:
o Sizing adjustments:
● Add-ons: Calf pedal ( R / L ) Theraband Tether Tetra Glove Crank shorteners Yoga
blocks Other:
● Shoe size:
Independent measures Set-up Cycling
1: Full physical Instructor manipulates and gives verbal or Task Ind. Task Ind.
support auditory cues throughout entire skill leve level
performance l
2: Partial Instructor manually assists and gives verbal or Shoes Pedaling
physical support auditory cues as-needed throughout skill Helmet Braking
performance Flag Steering
3: Verbal/ Instructor gives verbal or auditory cues as
auditory support needed throughout skill performance Bike set-up Shifting 1
derailleur
4: Visual support Instructor provides gestures and/or models skill
Bike Shifting both
as needed throughout skill performance
assignment derailleurs
5: Independent Instructor observes student perform skill
Transfer
without prompt or assistance
Adaptive
equipment

Lesson Summary:
Did the client report anything significant?
Student behavior:
Goals:
● What was done to achieve the client’s goals?
● What can be worked on for the next lesson plan?
Safety needs: Process skills addressed:
Downhill speed Braking Steering Turning speed Memory Attention Initiation Sequencing
Avoiding people/objects Navigating trail Other: Navigating Other:
Comments: Comments

Other skills addressed:

1 Step instructions 2-3 Step instructions Social skills
Leg strength Hand manipulation/grip Pacing Other:
Running Head: OUTCOME MEASUREMENTS 52

Comments:
Additional comments:

1. I enjoyed my experience today. ____

2. I accomplished my daily objective. ____
3. I now have a clear objective for my next lesson. ____
4. What would you like to work on for the next lesson plan?
Running Head: OUTCOME MEASUREMENTS 53

Appendix H: Budget

Line-Item Budget Detail

Source of Specific costs or sources of income Cost

Start-up Costs Research $480.00
Contract OTR/L $40.00/hrx12 hr
Developing internal outcome measures $480.00
Contract OTR/L $40.00x 12 hr
Meetings with Program Director $160.00
Contract OTR/L $40.00 x 4 hr
Total= $1,819.00
Direct Costs
Staff training for 2 seasons (Winter/Fall) $80.00
Contract OTR/L $40.00x1hr/2 times a year
Pre and post assessments/outcome measures $1,920.00
performed on students
Contract OTR/L $40.00x 1 hr/12 days (48 hrs)
(4hrs x 6 days at the beginning and end of
season)

Analyzing/researching outcome measures data Free

OT grad student volunteers/interns $0.00x 8 hr
Office supplies $8.22
- Binders- 1” $4.11 x2=$8.22 $9.99
- Report cover folders 10-pack $5.99
- Pens Bic 60-pack
Total= $2,024.20
Indirect Costs
In-kind costs
Work space, utilities, maintenance $0.00
$449.99
Printer (Xerox® WorkCentre 3345/DNI
Monochrome Laser All-In-One Printer, Copier,
Scanner, Fax)

Printer paper to print outcome measure (500- $34.99

pack 8.5”x11” multipurpose paper-white)
$116.59
Printer ink (Xerox Original Toner Cartridge –
Black)

Wifi ~$100.00
3-5 hrs 2x a year for staff training an set-up
4 hrs for staff training
Total= $701.57
Income
Total=
Budget Summary
Running Head: OUTCOME MEASUREMENTS 54

Total costs $4,544.77

Total income or $701.57

in-kind
contributions
Net cost of $3,843.20
program
Running Head: OUTCOME MEASUREMENTS 55

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