Scenicview Academy-1

Running
head: EXECUTIVE FUNCTION 1

ScenicView Academy- Executive Function Program for Staff and Students: An Occupation-
Based Needs Assessment
Shayna Roberts
University of Utah
Executive Function 2
Purpose
The purpose of this project was to conduct a needs assessment and determine how
occupational therapy can benefit an underserved population. A needs assessment was completed
through formal interviews with various staff members, attendance at staff meetings, informal
interviews with students, and observations. This took place 1-2 times per week for 3 weeks.
Following the needs analysis a literature review was performed. The information gathered was
utilized for the development and proposal of an occupation-based wellness program that meets
the needs of the staff and students of the organization.
Setting
ScenicView Academy (SVA) opened in February of 2001. Ray and Tye Noorda
discovered the need for an establishment that was committed to helping adults with learning
differences learn and grow while they were searching for options to help their son, who had high
functioning Autism. The Noordas built SVA near the mouth of Provo canyon in Provo, Utah.
Over the past 17 years, this special education school has grown to serve up to 80 students, with
housing accommodation for up 54 residential students and room for an additional 26 day time
students. These students are empowered to reach their goals and develop the skills needed for
independence (ScenicView Academy, 2016).
SVA is a nationally recognized school for adults with Autism Spectrum Disorders (ASD)
and learning disabilities (ScenicView Academy, 2016). Their mission is:
To help students obtain and maintain gainful employment, develop independent living
skills needed to live on their own, engage in meaningful social relationships &
interaction, progress in their educational abilities, understand & engage in productive
leisure time (ScenicView Academy, 2016).

They provide students with training and support in independent living, vocational experiences,
education, health and fitness, fine arts, and social skills. Students also have access to
psychotherapy, recreation therapy, speech therapy, and animal therapy services.
The outcomes of SVA include cultivating a willingness to learn, demonstrating basic
functional ability, establishing appropriate and healthy relationships, successfully working
towards achieving their academic potential, developing the skills and habits necessary to obtain
and maintain employment, and mastering methods of transportation. These outcomes are
achieved through the four pathways: vocational, educational, residential, and enrichment. In the
vocational pathway students build the skills they need for job readiness. They are employed on
campus and work towards obtaining internships and employment in the community. The
educational pathway offers academic classes for those working towards getting their high school
diplomas and academic support for those who are in college or trade school. Skills needed for
independent living are addressed in the residential pathway. The enrichment pathway helps
students tap into unknown talents and live balanced lives that include positive relationships and
meaningful activities.
SVA is a non-profit organization. A three-member board of directors oversees SVA
while the advisory council, which is made up of various community members, advises on a
variety of specialty topics. The program is run by the executive director, Marty Matheson,
LCSW, with Ryan Miller, LCSW and Jared Stewart, M.Ed. as program directors.
The organization is funded by the Noordas endowment, donations from members of the
community, and monthly tuition. SVA does not receive any state or federal funding. The staff
carries out various fundraising events such as annual galas and rallies to help increase
community awareness of SVA and to raise money for the school. The students are required to
pay a portion of their paycheck back to SVA for rent and to help them learn how to budget their
paychecks. SVA is able to survive on interest as well as fees for tuition, student payments, and
fundraising efforts. If they want to develop a new program and require additional funding they
need to receive approval from the board of directors in order to draw on the endowment. The
endowment is also used for financial aid for students who are unable to afford the cost of tuition.
There are currently 51 students at SVA between the ages of 18-37. Of the 51 students, 20
are female and 31 are male. The majority of students live below the poverty line, without support
from their parents. Students come to SVA from California, Arizona, Nevada, Oregon,
Washington, Colorado, and Wyoming. There are currently only 30 students from Utah at SVA.
Students are admitted to SVA regardless of religious preferences or ethnic origins. According to
the admission director, 95% of students are Caucasian, 5% are African-American or Hispanic.
80% of students are of the LDS faith while the remaining students are Catholic, Jewish, Baptist,
or not religious.
Students at SVA have diagnoses of ASD (80%) as well as ADHD and learning
disabilities (20%). Some students have multiple diagnoses. The majority of current students
came to SVA with their high school diplomas (90%). Six students are receiving academic
support from SVA while they are enrolled in college or trade school courses. Student typically
stay at SVA for 2-3 years, although length of stay is dependent on successful employment and
demonstration of independent living skills so it is not unusual to have students at SVA for up to
10 years. Students may be dismissed if they are not progressing or if they are consistently
breaking rules.
As an organization, SVAs ultimate goal is to be the experts in serving adults with ASD.
Their future plans include fine-tuning their program and making sure that everything they do has
a purpose and effectively empowers their students. They want to continue to add more
prescriptive interventions and hope to be involved in research.
External Factors
Current policy. SVA is a private organization that falls within the guidelines of human
services. They follow all rules and regulations regarding business licensing, ethics, and standards
that pertain to those in the services industry. There is no entity that oversees this type of
program. SVA is certified through the National Association of Private Special Education
Centers. They follow the ethics and policies of this national organization such as providing
specialized educational services based on individual needs, maintaining no greater than a one-to-
twelve staff to client ratio, and applying the least restrictive environment for learning (National
Association of Private Special Education Centers, 2017).
Social factors. There are only twelve programs similar to SVA in the country (M.
Matheson, personal communication, September 20, 2017. Of those twelve other programs, none
offer as many services as SVA offers. Matheson and the staff at SVA take great pride in their
place as a leader among these organizations. They want to continue to grow and develop in order
to keep leading the nation in services for adults with ASD and learning disabilities. One way
they would like to do this is by bringing occupational therapy into the organization.
Geographic and demographic factors. SVA is located in Utah. The state of Utah is rich
with service agencies and resources due to a culture of service and volunteer work (M.
Matheson, personal communication, September 20, 2017). Utah also has a high ratio of top
universities leading to a large proportion of the community being relatively highly educated and
qualified to work in these service agencies (M. Matheson, personal communication, September
20, 2017. Agencies are able to participate in and access research through the universities. ASD
demographics in Utah are high, which has led to the development of many programs for
children. SVA is the only program for high functioning adults with ASD in the state of Utah. A
large portion of the staff and students at SVA are of the LDS faith.
Program Strengths and Areas for Growth
Staff Perspective
Information about various staff perspectives on SVAs strengths and weaknesses as well
as potential areas that could be addressed with occupational therapy was gathered though formal
interviews, informal conversations, staff meeting attendance, and a survey. Two occupational
therapy students were assigned to SVA for this project so data was gathered through a
collaborative process. Formal interviews were conducted with 13 staff members with
representation from each discipline in order to attain information regarding SVAs needs and
strengths (see Appendix A). Three additional staff members were included through informal
discussion. Staff members included in this process represented: recreation therapy, vocational,
housing and budgeting, education, psychotherapy, finance, administration, and health and
wellness as well as the executive director and program directors. Following this information
gathering process, an electronic was sent to all staff members in order to select which programs
they believed would most benefit the students at SVA (see Appendix B).
One of the most widely mentioned strengths was how passionate the staff at SVA is.
Nearly everyone interviewed talked about the staffs commitment to helping the students at SVA
and how much they genuinely cared for the students. The staff attributes a lot of SVAs success
in helping adults with ASD to their passion and commitment to helping the students. Another
strength that was frequently mentioned was individualized care. The students at SVA are
included in all of the planning and goal setting processes. The staff works hard to meet each
students individual needs through classes and one-on-one sessions. They are flexible in the
classes they offer and in the way they teach and present information to the students, allowing
them to address the students specific interests and needs.
The biggest strength of the program, as seen through the staffs perspective, is the
programs comprehensiveness. There are other programs in the country similar to SVA that
address education, vocation, or independent living skills but SVA is the only program that
addresses all three. Their vocational program is also unique in that it provides students with the
training and practice implementing job skills by employing every student at SVA before sending
them out on internships and helping them find permanent work out in the community.
The gaps and weaknesses were viewed as similarly between staff members as the
strengths were. One theme that was prevalent in many interviews was a weakness in the
generalization of skills across settings. Staff members brought up things such as emotional
regulation, coping skills, and sensory regulation as areas that are addressed but that require more
for the students to generalize those skills to many different settings. Another weakness
mentioned was assessing what the students understand and learn from classes as well as in
tracking the changes students are making. Some staff members brought up all of the assessments
they do on the students and how good they are at gathering data, but how once they have that
information they arent sure that it is being analyzed and integrated into therapy as well as it
could be. Research is another area that is seen as a weakness. Some staff at SVA would like to be
more evidence-based and want all staff members to understand the science behind what they do
with the students. Other staff members were more interested in being involved in research and
collaborating with local universities in research projects.

The most common area of need that could be addressed through occupational therapy
was sensory integration. Other areas included hygiene, executive functioning, emotional
regulation, motor skills, and self-awareness When asked specifically about wellness programs
the staff identified three areas of need: sleep, nutrition, and disease prevention.
Many of the students at SVA have difficulty establishing a sleep schedule. Despite setting
schedules that promote good sleeps schedules like night time quiet hours for residential students
and morning work schedules, the students tend to stay awake playing video games, watching TV,
and using their phones. This makes it difficult for them to wake up on time the next morning,
which has negative consequences for work and school. The staff believes addressing the
importance of sleep and strategies for developing healthy sleep habits would be beneficial to the
students. Nutrition is another area that students struggle with. Many of the students at SVA have
very limited food preferences and do not eat a lot of healthy foods. The staff would like to
improve their nutrition classes to better address the value of healthy eating. The students at SVA
often have a hard time with delayed rewards, which makes it difficult for them to manage their
health. This has led to many students acquiring diseases such as diabetes. The staff would like to
increase awareness of common acquired diseases and the importance of developing healthy
habits to promote good health.
Client Perspective
Following staff interviews, 20 students at SVA completed a survey on their preference
for a wellness program (see Appendix C). These students also provided information through an
informal interview. They answered 3 questions: What do you like about SVA? What would you
change about SVA? How has SVA helped you the most?
The students at SVA view the programs biggest strengths as providing them with a
community of friends and increasing their social opportunities, offering fun classes and activities
to participate in, and giving them an increased sense of independence and freedom. The majority
of students would not change anything about SVA. Some indicated wanting more activities,
others said they would like more free time and days off. One student said she would like to see
the staff and students at SVA reaching out to the quieter and more reserve students.
SVA has helped many of the students learn and grow. The students said that during their
time at SVA they have increased their independence, developed more confidence in their ability
to do difficult things, increased their confidence in who they are as a person, improved their
social skills and made friends, learned how to work and utilize public transportation, and
improved their ability to cope and control their emotions. The wellness areas that the students
expressed the most interest in were sleep and disease prevention.
Student Perspective
The staff at SVA was very willing to work with occupational therapy students. Many
staff members reported great excitement to finally having occupational therapy services available
to the students. The executive director, Matheson, is a huge proponent of occupational therapy
and wants to be able to demonstrate to the board and staff members how beneficial having an
occupational therapist at SVA can be so they can hire one. There was some confusion in exactly
what the role of the occupational therapy students was supposed to be, but once the purpose of
this project was explained everyone was on board and willing to help.
After learning more about SVA through interviews, meetings, observations, and
conversations I was able to see exactly how many services SVA provides for its students. While
it is good that they have found ways to meet so many of their students needs, the
comprehensiveness of the program has created a very complex organization. It is challenging to
understand each persons role because each staff member does so much. Staff members are
involved in multiple areas, such as the fitness specialist who also teaches sewing classes. Having
each staff member involved in multiple service areas creates a few problems.
First, the organization is confusing. SVA has attempted to simplify their structure by
hiring specialists. More of this needs to be done in order to decrease confusion and improve the
quality and continuity of services. By simplifying the organizational structure, students will
better know who to go to with specific questions, it will be easier for everyone to see gaps in
services, and communication between staff members will be more efficient. With the current
structure, there is some confusion between staff members on how different areas are being
addressed. One of the psychotherapists indicated that no one directly addressed any executive
functioning deficits in the students and that it was a gap in their services while a teacher
mentioned that addressing executive functioning deficits is one of the strengths of the academic
pathway. This type of confusion could be solved by simplifying the services each staff member
provides.
Another issue with the current structure creates is the opportunity for staff members to
practice outside if their scope of practice. In order to provide best services to the students at
SVA, staff members need to be qualified for everything they are asked to do. Initially, it was
hard to see how occupational therapy could fit into the already very comprehensive services
provided at SVA. By keeping every staff member practicing within their scope of practice, there
is a very clear place for occupational therapy to bring a unique perspective and more effectively
address the occupational needs of the students.

Observations and conversations with the students at SVA provided the occupational
therapy students with additional insight into the needs of the students at SVA. The kitchen staff
at SVA provide good healthy lunch options but many of the students choose to eat a bowl of
cereal, ramen noodles, or cheese quesadilla rather than the healthy lunch from the kitchen. They
often eat large portion sizes of sugary foods and go back for more. There are nutrition and
cooking classes available for the students to take, but in order for the students to expand their
diet and implement those healthy options they need additional assistance with sensory and
executive functioning needs.
Hygiene is also an area of concern. The staff attempts to teach and track the students
hygiene habits. They encourage teeth brushing, deodorant application, daily showering, and
wearing clean clothes. The occupational therapy students observed how while this is an area the
staff tries to emphasize, the students required additional support in improving their awareness
and incorporation of good hygiene habits.
During a morning tour of the dormitory and apartment style housing, students could be
seen running from their rooms to make it to work on time. This, in addition to information gather
from the staff, indicates that occupational therapy could be beneficial in addressing the sleep
habits of the students at SVA. Another independent living skill that occupational therapy would
be able to address is organization and home maintenance. Many of the students have difficulty
organizing their belonging in the spaces provided for them and would benefit from exploring
alternative options for room organization.
After analyzing the information from staff, students, and observations the areas of
greatest need for the staff and students at SVA include: generalization of skills, organization of
services, and facilitating behavioral and lifestyle change. Any of these areas could be addressed
through the development of an occupation-based program and implementation through skilled
occupational therapy services.
Evidence-Based Practice
This literature review will address the deficits commonly seen in adults with Autism
Spectrum Disorder as well as the functional impact of those deficits. It will focus on how
occupational therapy is beneficial in targeting these deficits in order to improve
participation and performance in multiple aspects of life. It will provide evidence to
support the development of an occupational therapy program that addresses executive
functioning and leads interdisciplinary care in adults with Autism.
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD) is the most common neurodevelopmental disability
seen in children (Fortuna et al., 2015). There has been a large effort to research how it impacts
the way children learn and experience the world. While there has been a large focus on the
impact of ASD during these earlier developmental periods, little research has been done on the
presence of ASD through the lifespan (Gadke, McKinney, & Oliveros, 2015). Every child with
ASD eventually grows and transitions into adulthood and the symptoms and impact of ASD
persist. One on 160 individuals worldwide live with ASD (Tomcheck, Lavesser, Watling, &
Delany, 2015). In order to help these individuals live satisfying and independent lives, the
impacts of ASD in adulthood need to be understood.
There is a wide range of symptoms that make up the autism spectrum. The cause of the
disorder is unknown but there are several characteristic symptoms that lead to an ASD diagnosis.
Individuals with ASD display deficits in social communication and interaction as well as
restricted and repetitive behaviors and interests (American Psychiatric Association, 2013). They
commonly exhibit stereotypical movements, resistance to change, and altered sensory responses
(Tomcheck et al., 2015). While these signs and symptoms are hallmark characteristics of
individuals with ASD, severity is variable.
The symptoms of ASD can lead to difficulties in school, work, and independent living
performance. Participation in leisure activities and the ability to maintain relationships can also
be impaired (Gadke, McKinney, & Oliveros, 2015). Through increased understanding and the
use of evidence-based practice, adults with ASD can receive the necessary services for increased
performance and independence throughout all aspects of life.
Executive Dysfunction. Executive function in adults with ASD is often overlooked and
less understood but can greatly impact performance in various areas of life. Executive functions
are used to integrate, manage, and coordinate cognitive skills (Brady et al., 2017). These
functions include cognitive flexibility, task initiation, planning, working memory, self-
regulation, and response inhibition (Blijd-Hoogewys, Bezemer, & van Greet, 2014). When these
executive functions are impaired, individuals can have difficulties attending to relevant
information, retaining and utilizing information, sequencing actions and responses, inhibiting
inappropriate behaviors, and switching between different cognitive strategies (Brady et al.,
2017). Intact executive functioning builds the foundational skills for successful performance in
school, work, leisure, and relationships.
Impairments in ASD. Executive dysfunction can be seen in adults with ASD during
self-care routines, social interactions, and work tasks. They often report difficulties getting
started, understanding expectations, and breaking tasks into manageable components. Difficulties
recognizing the need for additional information and knowing when to ask questions can also be
observed (Cramm, Krupa, Missiuna, Lysaght, & Parker, 2013). Individuals with high-
functioning Autism Spectrum Disorder (HF-ASD) exhibit impaired educational, vocational, and
social participation despite having intact intellectual and verbal abilities (Eack et al., 2013). This
further suggests that executive dysfunction underlies and contributes to functional deficits in
adults with ASD.
A meta-analysis examining executive dysfunction in ASD found three core executive
function deficits: working memory, flexibility, and initiation (Lai et al., 2017). Additional
common areas of impairment include inhibition, planning, and self-monitoring. These
differences in executive function contribute to the preference for sameness, difficulty switching
attention, poor impulse control, and perseverations that are common in individuals with ASD
(Brady et al., 2017).
Differences in executive functioning, specifically in attaining and utilizing information,
have also been linked to difficulties with adaptive behavior. Adaptive behavior refers to the
ability to function independently in various environments. These skills are generally picked up
by children as they experience new situations and environments but are impaired in individuals
with ASD (Pugliese et al., 2016). Individuals with HF-ASD have markedly lower adaptive skills
when compared to individuals without ASD with similar IQ (Pugliese et al., 2015). This
difference in executive function requires individuals with ASD to be taught basic
communication, vocational, social, and independent living skills as well as how to use their
knowledge to guide decision-making.
Behavioral Manifestation. Executive functioning differences can lead to functional
impairments. Deficits related to initiation, working memory, and flexibility may include
interrupting, engaging in lengthy monologues, inappropriate use of informal language, and
misunderstanding appropriate discussion topics (Scattone & Mong, 2013). Deficits in self-
monitoring can impact employment acquisition, job performance, leisure exploration, and
community participation (Loukas, Raymond, Perron, McHarg, & LaCrioux Doe, 2015). Lower
adaptive behavior and daily living skills can lead to difficulties with cooking, cleaning, money
management, and utilizing public transportation. These difficulties are compounded when new
environments or non-routine tasks are introduced. With the proper interventions, individuals with
HF-ASD can overcome their executive dysfunctions and successfully execute goal-directed
behaviors that will assist in their development of real world communication, daily living, and
social skills (Pugliese et al., 2016).
Occupational Therapy
Occupational therapy is one of the most common services received by people with
ASD (Welch & Polatajko, 2016). According to the Occupational Therapy Practice
Framework, occupational therapists help individuals achieve health, improve well-being,
and increase participation in life through engagement in meaningful and purposeful
activities (American Occupational Therapy Association, 2014). Occupational therapists use
their expertise to help improve performance in self-care, school, employment,
relationships, and leisure activities. They perform task analysis in order to identify deficits
and address those deficits through compensatory and rehabilitative approaches in order to
improve participation. Occupational therapists consider how people shape and are shaped
by the environment as part of their holistic approach to patient care (Welch & Polatajko,
2016). For individuals with ASD, an occupational therapist will analyze behaviors and
occupational performance in real life contexts and focus services on client specific goals
and priorities (Tomcheck et al., 2015).

Autism Interventions. For individuals with ASD, an occupational therapist will
analyze behaviors and occupational performance in real life contexts and focus services on
client specific goals and priorities (Tomcheck et al., 2015). Occupational therapy services
can include direct, indirect, and consultative services given at the person, group, or
population level. Occupational therapists provide support to the person, family, staff, and
community agencies involved with individuals with ASD. Individual interventions address
social engagement and participation, strategies for adaptive behaviors, specific skill
acquisition, promotion of pivotal behaviors such as joint attention, problem solving,
initiation, and executive functioning, as well as addressing contextual factors for improved
occupational performance (Tomcheck et al., 2015). Traditional approaches when working
with individuals with ASD include fine motor, gross motor, and visual-perceptual
interventions (Cramm et al., 2013). Sensory integration techniques are also commonly
used.
Occupational therapy is a vital service during life transitions. Occupational
therapists facilitate improvement in social cognition and participation and the
development of adult occupational choices, roles, habits, and levels of independence
(Loukas et al., 2012). Occupational therapists are also skilled at identifying difficulties with
executive functioning, self-regulation, and anxiety (Welch & Polatajko, 2016). Once these
difficulties are identified, they provide targeted interventions and teach appropriate
strategies in order to set that individual up for success.
Interventions for Executive Dysfunction. Executive dysfunction is commonly
addressed in occupational therapy services. Fading cues and errorless learning are often
used in order to help individuals learn specific skills and tasks. These are effective methods
for skill attainment but they do not help with generalization and transfer of daily living
skills. Occupational therapists utilize a multicontextual approach when addressing
executive dysfunction in a functional task. In this approach, individuals with executive
dysfunction learn to recognize, monitor, and manage errors in task completion (Toglia,
Goverover, Johnston, & Dain, 2010). Learning these self-monitoring skills promotes
generalization and transfer of skills in a wide range of activities and contexts. Using this
approach increases the efficiency and effectiveness with which strategies are selected and
utilized (Toglia et al., 2010).
Compensatory strategies are taught to assist individuals in occupational
performance. For example, the use of appropriate strategies can be beneficial in reducing
the load on working memory, decreasing impulsive actions, enhancing organization, and
promoting cognitive shift from one step to the next (Toglia et al., 2010). By educating
individuals on various compensatory strategies they are better able to select appropriate
strategies for various tasks. This promotes a generalization of skills and increased success
in real world environments.
One metacognitive strategy that is commonly used with individuals who had
executive dysfunction is the cognitive orientation to daily occupational performance (CO-
OP) approach (Welch & Polatajko, 2016). This approach is a problem solving technique that
can assist in planning and finding solutions for completing tasks. CO-OP uses universal
processes of goal, plan, do, and check during real world activities and contexts (Dawson et
al., 2009). Therapists help guide individuals to identify performance problems, discover
strategies, and develop plans to solve those problems. It is an iterative process that
engrains self-evaluation, flexibility, and modification of task steps. This process is effective
in improving self-efficacy and can be generalized to a variety of skills and contexts (Dawson
et al., 2009).
Occupational therapists are skilled in facilitating group interventions so they are
also able to address executive dysfunction in a group setting. Additionally, they are
advocates for addressing and meeting an individuals needs within the community. At the
systems level, occupational therapists are involved in educating staff and designing
programs and environments to be more effective and inclusive for persons with ASD
(Toglia et al., 2010).
Interdisciplinary Care. Traditional cognitive intervention approaches are effective
in improving specific skills but have little efficacy on functional improvement (Fleeman et
al., 2015). These approaches, such as repetition and specific training, occur in isolation.
However, cognition functions as a system situated in context (Fleeman et al., 2015). This
notion has caused a push for integrated and interdisciplinary care for cognitive and
executive functioning impairments.
The best outcomes in care are achieved when professionals with shared
perspectives combine their knowledge and skills (Fleeman et al., 2015). Effective teams
establish profession specific roles and emphasize collaboration in order to provide holistic
care (Fleeman et al., 2015). In order to establish effective team care, roles need to be clearly
defined and understood and team members have to collaborate and communicate
continually. This model allows for all aspects of cognition to be addressed in an integrated
way.
One way that effective interdisciplinary care can be established is through the use of
case managers. Occupational therapists are well suited to manage care. Through clinical
practice they have developed strong skills in activity analysis, psychosocial interaction,
daily life habits and routines, and environmental assessments (Robinson, Fisher, &
Broussard, 2016). They analyze performance, determine needs, and advocate until those
needs are met. Occupational therapists have the skills necessary to determine needs,
coordinate services, and educate staff members on the needs of individuals. They can help
ensure that effective interdisciplinary care is provided and that overall wellness and
occupational participation in improved.
Programs for Adults with Autism
The vast majority of programs available for adults with ASD address vocational and
social skills. A workplace training program developed by Liu et al. (2013), utilized a
psychoeducational approach to address specific social, communication, and emotional
performance problems in adults with ASD in order to help participants fulfill their life roles
as productive workers. This program included 14 participants ages 18-40 years-old who
had a diagnosis of ASD and mild to moderate intellectual disability. The program was
developed by eight occupational therapists. It was designed to provide structure,
predictability, and clarity throughout the therapeutic process (Liu et al., 2013).
Participants attended the program five days per week for six hours each day over
the course of six months. It consisted of one-hour group education session two times a
week where social, emotional, and work behaviors were taught, modeled, and role-played.
The program also consisted of specific work task instruction, practice, and feedback (Liu et
al., 2013).
Occupational therapists assessed performance at baseline, each month, and at six
months follow-up. An occupational therapist ran the program and provided training to
rehabilitation assistants who provided instruction to the participants. This workplace
training program resulted in significant improvements in workplace social behaviors
including, appearance, self-control, and level of supervision. The program also resulted in
improvements in workplace social skills and work adaptation. While specific skills were
improved through this program, generalization to an open work-place is questionable
and the skills learned could only be applied to structured, predictable, and controlled
environments (Liu et al., 2013).
In order to promote generalization of skills and improvements across various
contexts, a meta-cognitive approach should be included along with specific task training.
Dawson et al. (2009) completed a study based on theory and research that supports the use
of executive functioning in the process of solving daily problems by analyzing factors
related to the person, environment, and occupation. This program used a CO-OP
intervention to address real-world, individualized goals in adults 18 and older who
displayed executive dysfunction.
There were three participants in this program, all of which experienced executive
dysfunction following a traumatic brain injury. Occupational therapists used the Canadian
Occupational Performance Measure to collaboratively select goals with the participants
(Dawson et al., 2009). The participants self-rated their current level of performance and
satisfaction for each of their goals and completed the DEX questionnaire, which is a daily
life measure of executive dysfunction (Dawson et al., 2009). A significant other for each
participant also rated performance and satisfaction for each goal and completed the DEX
questionnaire. Measures were taken prior to participation in the program, at the end of the
program, and at three months follow-up.

Each participant set three goals to be addressed through therapy and three
additional untrained goals. Examples of goals include cooking dinner, managing finances,
improving cleaning skills, and decreasing the frequency of getting lost while driving
(Dawson et al., 2009). Occupational therapists provided services two times a week for ten
weeks. Sessions were one hour long and occurred in natural environments including in the
home and community locations. The sessions included guided discovery, specific task
practice, and homework assignments that were individualized and dependent on the
participants goals.
The CO-OP intervention taught the global strategy (goal-plan-do-check) through the
use of cue cards and goal sheets. Participants were taught to consider overall goals, plans to
meet their goals, how to identify successful goal achievement, and how to assess their plan
(Dawson et al., 2009). This strategy was used during therapeutic interventions to address
trained goals. Transfer training was implemented through guided planning of how to use
the global strategy in addition tasks and situations (Dawson et al., 2009).
This program resulted in positive changes in both performance and satisfaction for
all trained goals as rated by participants and significant others (Dawson et al., 2009). This
indicates that the global strategy of the CO-OP intervention is an appropriate and effective
strategy for adults with executive dysfunction. The participants had increased performance
ratings for untrained goals and significant improvements on the DEX questionnaire. Self-
ratings on the DEX at the three month follow-up indicated that the participants maintained
their improvements while the significant others ratings indicated continued improvement
(Dawson et al., 2009). The CO-OP intervention resulted in positive goal-specific effects in
both trained and untrained goals. Although the effects were much more significant in
trained goals, the improvements in untrained goals and on the DEX questionnaire suggest
that the participants were able to generalize and transfer strategy use to additional skills
and situations (Dawson et al., 2009).
Summary
Adults with HF-ASD experience a wide range of functional impairments, impacting
all aspects of life, despite intact intellectual abilities. They display differences in the way
they attain, store, access, and use information due to executive dysfunction. While there are
many programs for adults with ASD that address social and vocational skills and
performance, in order to effectively teach these individuals, executive functioning needs to
be considered. By including executive functioning strategies in skill training programs,
these individuals will be able to better gain and maintain new skills as well as increase
their ability to generalize and transfer skills. This will result in improved performance
throughout all aspects of life and in the unpredictable and chaotic environments that exist
in real-life situations.
Occupational therapists are skilled in cognitive, social, motor, and environmental
assessment and interventions. They are trained to address general well-being and
participation in roles, routines, and activities in all aspects of life. Occupational therapists
have a broad, holistic perspective that enables them to successfully coordinate care. They
are also skilled in education and advocacy. They should be utilized to plan and carry-out
executive functioning interventions and in educating staff members on appropriate
strategy use for helping individuals with ASD increase participation and improve
occupational performance.

Program Proposal: ScenicView Academy Executive Function Program
Solving Everyday Problems: A Program for Staff and Students
Program Overview
The preceding needs analysis and literature review revealed a gap in assessing and
addressing executive functioning differences in the students enrolled at ScenicView
Academy. While ScenicView Academy offers many beneficial services and classes related to
independent living, vocational, and social skills, the effectiveness of the program could be
enhanced through the addition of an occupational therapy program focused on executive
dysfunction and meta-cognitive strategy implementation. Assessing and addressing the
students executive function needs would allow them to learn the skills required for
increased independence and generalization of skills to a variety of situations and
environments. This type of program would facilitate the development of self-monitoring,
problem solving, and adaptive skills that would improve all aspects of the students lives.
An occupational therapist would be beneficial in providing the staff at ScenicView
Academy with quality training in cueing and strategies to use to assist the students in skill
development. Additionally, an occupational therapist would be effective in coordinating
services and promoting staff communication related to the students strategy use in daily
skills. This would help ensure that the students are receiving the services they need in
order to improve well-being and participation in all aspects of life and that effective
strategies are encouraged and implemented in various settings for increased generalization
and transference of skills.
The overall aim of this program is to identify executive functioning deficits and help
students learn and utilize metacognitive strategies for improved occupational performance
and life satisfaction. This will be done by facilitating appropriate cueing and strategy use by
staff members. This program will also allow progress and outcomes to be tracked in order
to provide evidence for the effectiveness of the services provided at SVA.
Value of the Program
The mission statement at SVA emphasizes independence through improved
participation in the areas of vocation, independent living, social, education, and leisure.
This program complements the mission statement by bringing a comprehensive and
holistic view of the students and giving the students the tools they need to improve their
performance across domains. Students will receive executive functioning and performance
assessments in order to ensure their areas of deficit are identified and being addressed
across services. Staff will receive training in metacognitive strategies and cueing during
functional performance in order to promote effective teaching and generalization of skills
for individuals with executive dysfunction. This will allow the students to learn and apply
new information for improved performance in all areas of life.
Rationale for Occupational Therapy Services
Occupational therapists are trained to take an expansive and holistic approach to
assessing function and determining how it impacts independence, productivity, and
participation (Robinson, Fisher, & Broussard, 2016). They consider the interaction
between the person, the environment, and the task, including the context of performance
and individual strengths and abilities. This allows them to promote meaningful
participation through the therapeutic use and modification of activities and environments
(Robinson, Fisher, & Broussard, 2016). Occupational therapists are not only able to identify
executive functioning differences in adults with ASD, but are able to assess how those
differences influence performance in work, school, independent living, leisure, and social
tasks. Occupational therapists are uniquely skilled to address the mental and physical
health of individuals with ASD as it relates to functional performance (Robinson, Fisher, &
Broussard, 2016).
In this program, an occupational therapist will provide direct services to the
students and consultative services to the staff at SVA. The occupational therapist will
ensure the students needs are being met based on assessments of skills and performance
and will assist the staff in helping the students progress toward their individual goals.
Through this occupational therapy program, students will demonstrate improved
proficiency in their roles and routines and will experience greater well-being and life
satisfaction.
Occupational Justice
This program addresses a lack of balance between work, rest, self-care, and leisure
activities in the students at SVA. It works to eliminate limitations that are preventing them
from engaging in meaningful occupations. Through a tertiary prevention approach, this
program will identify the students executive functioning deficits in order to prevent
occupational imbalance and deprivation. It also targets the staff who work with the
students to improve their effectiveness in working with individuals with executive
dysfunction in order to prevent the promotion of occupational injustice.
Theoretical Foundation
Occupational therapy practice is guided by theoretical approaches. These
approaches provide a framework for assessing and addressing different barriers to
performance. In this occupational therapy program three theoretical approaches will be

utilized: Person, environment, occupation model, the dynamic interactional model, and the
cognitive orientation to occupational performance.
PEO. The person, environment, occupation model is an overarching theoretical
approach that guides occupational therapy practice. It is based on the inter-related
transaction and dynamic experience of the person engaged in purposeful activities within
the environment (Law et al., 1996). Occupational performance is the outcome of the
person, environment, and occupation transaction.
This model postulates that the qualities a person exhibits influence the way they will
interact with the environment and that intervention at the level of the person can improve
the fit between person, environment, and occupation (law, et al., 1996). Additionally, the
environment can influence, and be influenced by, behavior. The environment contains
enabling and constraining factors and is most amendable to change (Law et al., 1996).
Occupations meet intrinsic needs and can also be addressed to increase occupational
performance. In order to obtain an optimal transaction between the person, environment,
and occupation all three components should be considered and addressed (Law et al.,
1996). Taking this approach for this program allows the person, environment, and
occupation to be considered in order to improve occupational performance across
domains.
DIM. The dynamic interactional model of cognition (DIM) looks at the conditions
and processing strategies that influence performance as they interact with the person,
activity, and environment (Toglia, 2011). This dynamic interaction results in cognitive
abilities, which are analyzed according to underlying strategies, the ability to monitor
performance, and learning potential. In this model, cognition is the capacity to acquire and
use information in order to adapt to environmental demands (Toglia, 2011). Cognition
includes information processing, learning, and generalization.
Self-awareness and processing strategies are core to cognition and can be modified
in order to maximize information processing and enhance occupational performance
(Toglia, 2011). DIM will be used as changes to activity demands, the environment, self-
awareness, and use of strategies are recommended for improved performance.
Independent occupational performance requires the ability to recognize limitations, self-
monitor performance, and use efficient processing strategies. A decreased understanding
of cognitive strengths and weaknesses will lead to distorted judgments and expectations
(Toglia, 2011). This disrupts self-monitoring and self-regulation which can impede
effective strategy use.
Referrals to occupational therapy and additional services following evaluation will
increase students understanding of their cognitive strengths and limitations as well as
effective and efficient use of compensatory strategies, leading to improved occupational
performance. The occupational therapist will provide cues, teaching strategies, and
reduced demands for improved performance. This multi-context treatment approach will
be used to promote generalization through improving activity management with effective
strategy use across activities.
CO-OP. The cognitive orientation to daily occupational performance (CO-OP)
approach was developed for use with adults with executive dysfunction. It is based on four
main principles: meta-cognitive and problem-solving training have positive effects on daily
life, verbal self-instruction is an effective strategy, contextualized therapy in a persons own
environment has positive benefits, and goals should be individually meaningful (Dawson et
a., 2009). CO-OP contains a problem-solving strategy at its core: goal, plan, do, check. This
approach combines both generic and domain-specific theories as it embeds the global
strategy of goal, plan, do, check into therapy done in context. Occupational therapists are
able to guide participants to discover strategies that will solve their task-performance
problems, which allows the strategies to be founded on individual strengths and abilities
and results in self-efficacy (Dawson et al., 2009).
This approach will be used as the occupational therapist identifies performance
problems through analyzing the fit between abilities, task demands, and the environment.
The occupational therapist will introduce cognitive strategies to bridge the gap between
performance and demands and will work with the staff at SVA to encourage the use of
verbal self-instruction in order to enable strategies to be internalized. Staff education and
consultation services will help with reinforcing the use of the global strategy and other
domain specific strategies, which will promote generalization transfer of strategy use.
Solving Everyday Problems: A Program for Staff and Students
Two occupational therapy students have created one occupational therapy program
to benefit the students and staff at ScenicView Academy. This proposal represents .5 full-
time equivalent of one full time occupational therapist position. In order to fully
understand the program both proposals should be considered. This portion of the
occupational therapy program will consist of annual assessments of all students at SVA,
coordination of services to promote improved occupational performance and participation,
and staff consultation to assist with cueing and metacognitive strategy techniques for
greater effectiveness helping the students learn and generalize new skills.
Annual Evaluations
Every new student at SVA will receive annual occupational therapy evaluations.
During the initial assessment each student will collaborate with the occupational therapist
to set desired goals and cognitive and sensory limitations will be identified. The
occupational therapist will examine how these limitations are impacting function and
determine if and how they need to be addressed in order to improve occupational
performance. Barriers and limitations will be identified through administration of the
Canadian Occupation Performance Measure (COPM), Dysexecutive Functioning
questionnaire (DEX), and the Executive Function Performance Test (EFPT) as well as
through interpretation of the sensory profile.
COPM. The Canadian Occupational Performance Measure detects change in a
clients self-perception of occupational performance. It is administered through interview
at the beginning of services in order to establish goals and is often given throughout the
intervention process to determine progress and outcomes of therapy. The COPM addresses
occupational performance in self-care, productivity, and leisure. Problems are identified by
the client and rated on a 10-point scale based on importance (1- not at all, 10- extremely).
The client then chooses and rates their top 5 areas of concern based on current
performance (1- not able, 10- do extremely well) and satisfaction with performance (1- not
at all, 10- extremely satisfied). Scores are compared after reassessment in order to detect
changes in occupational performance and satisfaction (Canadian Association of Occupational
Therapists, 2017). The COPM can be accessed through the COPM app on a computer, tablet,
or smartphone as well as in paper form. This program will utilize the COPM app.
DEX. The dysexecutive questionnaire is a self-rating assessment of everyday
problems associate with executive dysfunction that was developed as part of the
Behavioral Assessment of the Dysexecutive Syndrome. It contains 20 questions concerning
emotional, motivational, behavioral, and cognitive performance. Items are rated on a five-
point scale from 0 (never) to 4 (very often). Scores range from 0-80, with higher scores
indicating greater functional problems related to executive dysfunction. It can also be used
as a measure of awareness (Pearson Education Limited, 2017).
EFPT. The Executive Function Performance Test is a standardized assessment of
cognitive function. It assesses performance of functional tasks and identifies the ability to
initiate tasks, to execute tasks with appropriate organization, sequencing, judgment, and
safety, and to complete tasks. It uses levels of cueing to score task performance. The cueing
hierarchy includes no cure required (0), indirect verbal guidance (1), gestural guidance (2),
direct verbal assistance (3), physical assistance (4), and complete assistance (5). The total
score includes performance for each task and subtask; it ranges from 0-100, with a higher
score indicating that more cueing was required and executive function difficulties were
observed (Pulin & McDermott, 2013).
Sensory Profile. The Sensory Profile for Adults and Adolescents is completed upon
arrival at SVA. It is a 60-item trait measure that identifies sensory processing patterns and
the effect they have on functional performance. It explores patterns in sensory processing
of tastes and smells, movement, visual perception, touch, auditory information, and activity
level. It can be used to help develop awareness and strategies to optimize performance
based on sensory preferences (Brown & Dunn, 2002). This assessment will be interpreted
by the occupational therapist as part of the initial assessment and evaluation report.
Coordination of Services
The occupational therapist will compile the information from the occupational
therapy assessment as well as information from additional assessment findings from
education, psychotherapy, recreation therapy, and other disciplines into a formal
evaluation report. This report will contain evaluation findings, overall program goals, and
service specific goals as well as a plan of care containing the occupational therapists
recommendations for services needed in order to address performance deficits and to
improve participation and independence.
Students who display cognitive, sensory, or other deficits resulting in functional
limitations will receive occupational therapy services (detailed in the other portion of this
occupational therapy program). Evaluations will be done annually to track progress and
ensure that the plan of care is adequate for meeting the students goals. Students who
display a lack of progress at their annual evaluation may be picked up for occupational
therapy services. Discharge assessments will also be completed as the students are leaving
SVA in order to collect data on the outcomes of SVA and to make recommendations to
community resources. Evaluation reports and annual updates will be shared with all staff
members who will be working with the student in order to increase communication and
collaboration amongst staff members.
Staff Trainings
It is very important for acquisition, generalization, and transfer of strategy use for
students to be encouraged to use strategies consistently across domains. In order for this to
happen all staff members have to have a basic understanding of the cognitive cueing and
strategies that are being used with the students. The occupational therapist will provide
staff trainings on cueing and strategy use as well as consultation to staff members who are
having specific problems with students. The occupational therapist will teach cueing and
strategy techniques to all staff members at a general staff training and will facilitate
practice and use of these techniques at small group trainings. This will allow the staff to be
educated on the techniques and to have the chance to practice and ask questions on how to
apply them. Each month the staff will be taught and practice using a new cueing technique
or metacognitive strategy.
The occupational therapist will evaluate proper use of cueing and strategies during
classes. The occupational therapist will also be available to provide one-on-one assistance
with cueing and strategy techniques for staff members with specific concerns. Following
the initial and annual evaluations, all appropriate staff members will be given examples of
appropriate cueing and strategy techniques for that student. These will be updated
monthly.
In addition to recommending services and providing consultation to staff, the
occupational therapist will facilitate frequent communication between staff members. A
goals sheet will be created for each student and staff will be expected to document their
services weekly and update the students progress towards goals monthly. The
occupational therapist will send out monthly reports to staff members who are working
with the students on how they are doing in different areas and tips for continued progress.
Program Development
Initially this program will look slightly different. The occupational therapist will
have to complete evaluations on all current and new students. Staff can recommend
students who they believe will require occupational therapy services to be the first
students evaluated. Five to six evaluations will be completed each month in order to spread
the annual evaluations out evenly throughout the year. The occupational therapist will also
spend more time getting to know staff members and educating them on how occupational
therapy will benefit the students at SVA. It will also take time to develop staff trainings. It
will take three to four months for the program to be up and running.
While an occupational therapist can teach the staff different cueing and strategy use
techniques to use with students, an occupational therapist is uniquely qualified to assess
performance, determine underlying limitations, and determine specific cognitive strategies
and cueing techniques to use in order to promote skill acquisition, generalization, and
transfer in individual students.
Goals and objectives
Goal 1. To improve performance in work and independent living skills through the
use of cognitive strategies.
Objective 1: Within 2 weeks of training, 80% of staff members will implement 2 new
cognitive strategies with selected students as described in occupational therapy
evaluation recommendations.
Objective 2: Within 3 weeks of the program, 60% of selected students will
accurately implement 1 new cognitive strategy during daily occupations per student
report.
Goal 2. To promote generalization and transfer of skills to a variety of situations and
environments for greater independence in real-world settings.
Objective 1: Within 1 month of training, 80% of staff will demonstrate effective use
of 1 new cueing technique during group classes.

Objective 2: By discharge from occupational therapy services, 90% of students will
improve performance in at least 3/5 occupation-based goals.
Participant Criteria
All students who come to SVA will receive annual occupational therapy evaluations,
which consist of the COPM, DEX, and the EFPT as well as interpretation of the Sensory
Profile. The occupational therapist will compile information from the evaluation as well as
from additional assessments given in other disciplines in order to create a formal
evaluation report. By utilizing a holistic approach to performance across domains and
areas of limitations, the occupational therapist will recommend appropriate services and
classes at SVA. Services and classes for all students will be recommended based on
functional assessments, task analysis, and environmental assessments as well as
knowledge concerning adaptation, compensation, and remediation in order to enhance
successful and satisfying performance.
Staff Involvement
The OT will refer students to additional services based on occupational
performance, goals, and deficits identified during evaluations. All staff will receive training
on cueing and metacognitive strategies for working with individuals with executive
dysfunction. They will be involved in both group and individual consultation and training
services in order to promote appropriate use of cueing and strategies. Staff will also be
expected to participate in weekly communication through collaborative documentation.
Space Requirements
This specific occupational therapy program will not require the acquisition of any
new space. The occupational therapist will need an office with enough space for a desk and
two chairs where they will complete assessments and documentation. The occupational
therapist will also require a computer, office supplies, and access to living and cooking
spaces to complete assessments. For staff consultation and trainings, they will need access
to larger meeting rooms with enough seating for small groups and spaces where the entire
staff can gather.
Time Requirements
This program will consist of annual occupational therapy evaluations for all
students as well as consultative services and training for staff delivered by an occupational
therapist. This will require 20 hours of work each week. The occupational therapist will
spend four hours each week in direct service to the students, performing executive function
and performance assessments in order to identify areas of need. They will spend eight
hours each week in indirect services including: staff training on metacognitive strategies
and cueing, consultation services in order to ensure the use of efficient and appropriate
cueing strategies and to promote application and generalization of skills, and coordinating
student care. The occupational therapist will spend six hours each week completing
documentation and two hours each week in staff meetings.
Role of the Occupational Therapist

This program represents half of one full time occupational therapy position, in order
to fully understand the roles and responsibilities of the occupational therapist, both
programs need to be considered. A typical week in this portion of the program will include
two annual assessments in which the occupational therapist will complete the COPM, DEX,
and EFPT as well as interpret Sensory Profile results. It also includes compiling all
assessment results in order to determine recommended services. Consultation services will

include instruction for staff members on appropriate strategies and techniques to use with
each student for improved performance. These services will be provided four hours each
week. Coordinating services will include referral to services, assessing and tracking
progress with various services and making new recommendations in order to meet goals,
and facilitating communication regarding the students needs. This will require five hours
each week. The occupational therapist will spend the remaining seven hours will include
attending staff meetings, creating official evaluation reports, and documenting the
students needs and services. The schedule will be flexible and will be able to be adjusted to
meet the needs of the staff and students at ScenicView Academy.
Marketing
ScenicView Academy markets their services through hosting booths and presenting
at ASD and special education conferences as well as marketing on social media and through
radio ads. Because they provide bundled services for the price of tuition, the addition of an
occupational therapy program within their organization would beneficial to marketing
their program. Occupational therapy services should be included in brochures, posters,
social media posts, online ads, and their website. SVA should continue to target adults and
adolescents with ASD as well as parents and professional who work with these individuals
through conferences. With the addition of occupational therapy services they could expand
their target audience to include occupational therapy conferences in order to help spread
the word about what they have to offer to adults with ASD. Additionally, relationship
building and personal selling with the staff at SVA will enhance understanding of the
services and benefits of occupational therapy for the students.
Budget
The projected budget takes into consideration factors concerning only this portion
of the occupational therapy program (see Appendix D). For full understanding of the
budget please consider both program proposals. This portion of the program will make up
.5 FTE, requiring 1,040 workload hours per year. Direct costs for this portion of the
program include purchase of assessments. Space for assessments and trainings, including
desks, chairs, computer, and projection equipment are already onsite and can be obtained
through in-kind contributions from ScenicView Academy. The total cost of this portion of
the occupational therapy program is expected to be $28,185.
Expected Outcomes and Evaluation
This portion of the occupational therapy program targets both students and staff at
ScenicView Academy. Through this program, students will understand their executive
functioning and barriers to performance, which will prepare them to learn to compensate
and overcome barriers to performance. The staff will incorporate appropriate cognitive
strategies and cueing techniques to promote skills development and generalization.
Ultimately, this program will lead to an improved effectiveness in teaching and generalizing
skills and improved performance in occupation-based goals.
The programs effectiveness and outcomes will be measured through student
interviews, staff questionnaires, and observations made by the occupational therapist. This
data will be gathered as part of each students annual assessment and during an annual
program evaluation process. The program evaluation will contain both qualitative and
quantitative data.
Qualitative data will measure staff use of appropriate cognitive strategies to
promote generalization of skills and student understanding of how to compensate for

specific executive dysfunction. The staff will complete self-report questionnaires where
they report the strategies they are incorporating while working with the students and the
improvements they see in performance (see Appendix E). The occupational therapist will
also report on observed strategy use among staff members. The students will report areas
of difficulty and strategies they use to improve performance as part of their annual
assessment (see Appendix F).
Quantitative data will be gathered through before-and after likert scales and
observation. Improved effectiveness in teaching and generalizing skills will be measured
through staff ratings and measured number of sessions to teach skills (see Appendix E).
Improvements in performance of occupation-based goals will be measured through
observation of progress. The occupational therapist will measure the number of goals each
student has improved in and the number of goals that have not improved (ex. 5/6
occupation based goals improved, 1/6 occupation based goals had no change). Changes and
adaptations to the program will be made based on these program evaluation results.
Funding Options
Funding for the occupational therapy program will come from the tuition paid by the
students. The implementation of this program may lead to restructuring of the current
system at SVA, leading to funding for the occupational therapy program. Additional
resources may include grants.
Source 1. The Adult Independence grant through the Doug Floutie, Jr. Foundation
for Autism seeks to meet needs by ensuring access to services, active lifestyles, and adult
independence. They provide funding to organizations who emphasize job training,
vocational skills, employment, housing, transportation, and healthcare delivery for adults
with ASD. Grant size ranges from $10,000-$20,000. The grant committee is looking for
programs who will make an impact and provide measurable results of their program (Doug
Floutie Jr. Foundation for Autism, 2017).
Audit Trail 1. SciVal Funding- Opportunities- Search Funding (Adults, Autism).
Results: http://www.funding.scival.com/opportunities/
results?searchSolText=ALL%28adults%2C+autism*%29&searchTerm=adults%2C+autism
&id=973605376&quicksearchText=adults%2C+autism&quicksearchContent=s&searchTer
mDisplay=adults%2C+autism&addToHistory=true&newSearch=true&displayQueryString=
adults%2C+autism%21S%21R%21&quickSearchSponsor=false&searchAwardText=ALL%
28adults%2C+autism%29#b
Source 2. The Nellesen Family Foundation is an independent foundation that gives
primarily to organizations in Utah. They are interested in ASD and other disorders and
promoting higher education and development for individuals with disabilities. In 2016 they
awarded $42,300 in grant donations (Foundation Directory Online, 2017).
Audit Trail 2. Eccles Library- Research Databases- F- Foundation Directory Online-
Search Grantmakers- Fields of Interest (Autism), Geographic Focus (Utah). Results:
https://fconline-foundationcenter.org.ezproxy.lib.utah.edu/search/results?
collection=grantmakers&activity=form&_new_search=1&fields_of_interest=autism&geogra
phic_focus=utah&location=&country=&state=&county=&city=&metro_area=&congressiona
l_district=&zip_code=&name=&keywords=&government_grantmaker=1&ein=&support_str
ategy=&transaction_type=&trustees_officers_donors=&type_of_grantmaker=&range=total_
giving&range_start=&range_stop=&save_sort=y&sort_by=total_giving&sort_order=1

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Influence of executive function. Journal of Autism and Developmental Disorders, 46,
467-477. doi: 10.1007/s10803-015-2584-5
Robinson, M., Fisher, T. F., & Broussard, K. (2016). Health Policy PerspectivesRole of
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7004360020. http://dx.doi.org/10.5014/ajot.2016.018689
Appendix A
Staff Interview Questions
1.What is your role here at SVA?
2. What skills do you work on with the students?
3. Do you work with students one on one or in groups?
4. What gaps do you see in services?
5. What areas do you think would be helpful to have addressed?
6. Are there any wellness programs that you think would be beneficial for the students that arent
already implemented?
7. What are your programs specific strengths?
8. How is ScenicView funded?
Admissions Director
How many students attend SVA? Male? Female?
How long are students here?
Level of education of students?
Why was SVA chosen to be at this location?
What type of fundraisers do they do at SVA?
Chief Financial Officer
Do you have a budget set aside for each program/department?
Do you have money set aside for if you want to add on programs?
Do students receive financial aid? If so, from where?
Executive Director
1. Can you tell us about the history of SVA?
2. Are there any current policy issues and social, economic, political, geographic, and
demographic factors that influence service delivery options here at SVA?
3. What future plans does SVA have for program development?
4. What is your programs specific strengths?
5. Are there any wellness programs you think would be beneficial for students?
6. What gaps in services do you see?
7. Do any of the other programs nationally have OTs?

Appendix B
Staff Survey
After to talking to many of you we have come up with four possible occupation based
wellness programs to develop and implement at Scenic View. Please read through the
basic description of each program and select the top 2 programs that you feel will benefit
the students the most. We will continue to collaborate with the staff in order to create
effective programs for the students and appreciate your input and feedback. Thanks!
Sleep Group: Facilitation of group discussion on how to improve sleep and
implement healthy sleep habits.
Healthy Eating Class: Educate and emphasize the value and importance of healthy
eating. Use sensory techniques to incorporate new healthy foods into diet.
Prevention and Health Awareness Group: Facilitation of group discussion on
prevention of common acquired diseases and bringing awareness to healthy habits
to incorporate in everyday life.
Motor Skills Curriculum: Introduce an assessment for fine and gross motor skills
and develop prescriptive curriculum to address various deficits.

Appendix C
Student Survey
What do you like about ScenicView?
If you could change anything what would you change?
How has ScenicView helped you the most?
What are you most likely to attend?
Sleep group: Group discussion on how to improve sleep and implement healthy sleep
habits
Healthy Eating Class: Learn about healthy eating habits and how to incorporate new
foods into the diet
Prevention and Health Awareness Group: Learn about common acquired diseases and
how to prevent them through incorporating healthy habits

Appendix D
Line-Item Budget Detail
Source of Specific costs or sources of Cost

income
Start-up Costs
COPM Start up fee for COPM app $10
EFPT Collection of needed materials $50
Space Room, desk, computer, chairs In-kind contribution
Total= $60
Direct Costs
COPM 100 measures (on COPM app) $0.15 per measure ($15)
DEX Self and independent rater sheets (25) $30
EFPT Individual scoring sheets and forms $0
Sensory Profile Individual forms In-kind contribution
OT Salary $28,080
$27/hr x 20 hrs/week x 52 weeks
Total= $28,185
Indirect Costs
Building Rent In-kind contribution
Utilities In-kind contribution
Maintenance In-kind contribution
Income Potential grant ($10,000)
Total= $0
Budget Summary
Total costs $28,185
Total income or $0
in-kind
contributions
Net cost of $28,185
program
Appendix E
Staff Questionnaire
1) What cognitive strategies have you implemented while working with this student?
2) What skills were specifically addressed?
3) What improvements in performance have you seen in this student?
4) What skills improved the most with the use of cognitive strategies?
5) How has incorporating cognitive strategies and cueing techniques improved your sessions
with this student?
List 3 skills the student has mastered and how many session it was addressed
1)
# of sessions:
2)
# of sessions:
3)
# of sessions:
Rate the effectiveness of your group classes on skill development from 1 (not effective at all) to
10 (very effective)
Before incorporating cognitive strategies and cueing
1 2 3 4 5 6 7 8 9 10
After incorporating cognitive strategies and cueing
1 2 3 4 5 6 7 8 9 10
Appendix F
Student Interview Questions
1) What areas have you improved in over the last year?
2) What cognitive strategies are you using?
3) What areas do you need to improve in?
4) How could cognitive strategies help you?
5) What are the most and least effective classes you took in the last year?

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Running

head: EXECUTIVE FUNCTION 1

Based Needs Assessment

the needs of the staff and students of the organization.

independence (ScenicView Academy, 2016).

and learning disabilities (ScenicView Academy, 2016). Their mission is:

interaction, progress in their educational abilities, understand & engage in productive

leisure time (ScenicView Academy, 2016).

psychotherapy, recreation therapy, speech therapy, and animal therapy services.

The outcomes of SVA include cultivating a willingness to learn, demonstrating basic

functional ability, establishing appropriate and healthy relationships, successfully working

SVA is a non-profit organization. A three-member board of directors oversees SVA

prescriptive interventions and hope to be involved in research.

Association of Private Special Education Centers, 2017).

Program Strengths and Areas for Growth

them to address the students specific interests and needs.

collaborating with local universities in research projects.

habits to promote good health.

Following staff interviews, 20 students at SVA completed a survey on their preference

expressed the most interest in were sleep and disease prevention.

comprehensiveness of the program has created a very complex organization. It is challenging to

address the occupational needs of the students.

executive functioning needs.

and incorporation of good hygiene habits.

alternative options for room organization.

through the development of an occupation-based program and implementation through skilled

occupational therapy services.

occupational therapy is beneficial in targeting these deficits in order to improve

participation and performance in multiple aspects of life. It will provide evidence to

support the development of an occupational therapy program that addresses executive

functioning and leads interdisciplinary care in adults with Autism.

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is the most common neurodevelopmental disability

impacts of ASD in adulthood need to be understood.

individuals with ASD, severity is variable.

performance and independence throughout all aspects of life.

school, work, leisure, and relationships.

adults with ASD.

A meta-analysis examining executive dysfunction in ASD found three core executive

common areas of impairment include inhibition, planning, and self-monitoring. These

(Brady et al., 2017).

Differences in executive functioning, specifically in attaining and utilizing information,

difference in executive function requires individuals with ASD to be taught basic

knowledge to guide decision-making.

Behavioral Manifestation. Executive functioning differences can lead to functional

interrupting, engaging in lengthy monologues, inappropriate use of informal language, and

social skills (Pugliese et al., 2016).

Framework, occupational therapists help individuals achieve health, improve well-being,

and increase participation in life through engagement in meaningful and purposeful

activities (American Occupational Therapy Association, 2014). Occupational therapists use

their expertise to help improve performance in self-care, school, employment,

and priorities (Tomcheck et al., 2015).

Autism Interventions. For individuals with ASD, an occupational therapist will

acquisition, promotion of pivotal behaviors such as joint attention, problem solving,

occupational performance (Tomcheck et al., 2015). Traditional approaches when working

Occupational therapy is a vital service during life transitions. Occupational

therapists facilitate improvement in social cognition and participation and the

development of adult occupational choices, roles, habits, and levels of independence

strategies in order to set that individual up for success.

Interventions for Executive Dysfunction. Executive dysfunction is commonly

skills. Occupational therapists utilize a multicontextual approach when addressing

executive dysfunction in a functional task. In this approach, individuals with executive

utilized (Toglia et al., 2010).