Master Program Design Document

Running Head: Staff and Caregiver Education Program 1
Staff and Caregiver Education Program for Participation in Adaptive Recreation
An Occupation-Based Community Program for Salt Lake County Adaptive Recreation
Kellen Lewis
University of Utah
Staff and Caregiver Education Program 2
Introduction
The purpose of this paper is to propose an occupation-based community program
utilizing the skills and expertise of an occupational therapist to provide services for individuals
with disabilities who currently attend programs at Salt Lake County Adaptive Recreation. A
needs analysis was conducted with administration, staff, clients and caregivers at Salt Lake
County Adaptive Recreation using structured and semi-structured interviews. Onsite
observations of clients and staff participating in various activities was conducted. Upon
conclusion of the needs analysis, it was determined that needs were focused on education and
training for staff and parents to help increase participation of clients in adaptive recreation and
provide engagement in meaningful occupations. The needs analysis combined with a literature
review on relevant topics, an occupational therapy program has been developed to address the
above mentioned needs.
Description of Setting
Salt Lake County Adaptive Recreation is a program offered through Salt Lake County
Parks and Recreation department. Salt Lake County Park and Recreation department mission is;
“Improving lives through people, parks, and play”. Specifically, the adaptive recreation program
through Salt Lake County aims to “...[provide] the opportunity to play sports in inclusive
environments as well as in our specialized programing” (Salt Lake County Parks & Recreation,
n.d.).
History
Salt Lake County Parks and Recreation department was created on May 11, 1946 due to
“...civic-minded citizens who wanted to coordinate recreation activities throughout the County,
build more park space, trails infrastructure, and manage the rapid growth of recreation programs
for the benefit of county residents” (Salt Lake County Parks & Recreation, n.d.). Furthermore,
the adaptive program through Salt Lake County Parks and Recreation was created in the early
1990’s to provide recreation and afterschool programs for individuals with disability.
Currently, the parks and recreation department is “...now managing and maintaining 104
parks, 6 golf courses, over 20 recreation facilities, as well as trails and open space…”(Salt Lake
County Parks & Recreation, n.d.). The adaptive recreation program operates throughout the Salt
Lake Valley utilizing numerous recreation centers, parks, and other public venues to deliver
various adaptive recreation options.
Target Population
Salt Lake County Adaptive Recreation (SLCAR) offers services to youth and adults with
a wide range of disabilities that include; Autism Spectrum Disorder (ASD), Down Syndrome,
Spinal Cord Injury (SCI), Stroke, Spina Bifida, Cerebral Palsy (CP) and mental, behavioral,
developmental and intellectual disabilities. The majority of individuals that participate in
SLCAR have ASD, CP, down syndrome or intellectual disabilities that vary in degree of
severity. The number of individuals currently participating in the program is ~100-200, but
participation rates regularly experience fluctuations due to numerous factors that include; courses
offered, season changes, and individual socio-economic factors of participants.
Since SLCAR offers programs for youth and adults, the age range of participants is vast.
SLCAR states the following in regards to age requirement:
With every program offered, there is an age range for individuals who are able register.
We offer programs for most age ranges. The age range is determined by the Adaptive
Recreation Coordinator based on the appropriateness of the activity.
(Salt Lake County Parks & Recreation, n.d.).

The majority of youth participant age range is 6-12 years old and adults is 13-40+ years old.
Influencing Factors
Policy. The main policy driving force for SLCAR is Title II of the Americans with
Disability Act (ADA). Section 35.130 of Title II of the ADA states:
No qualified individual with a disability shall, on the basis of disability, be excluded
from participation in or be denied the benefits of the services, programs, or activities of a
public entity, or be subjected to discrimination by any public entity.
(Americans With Disability Act, 2010)
Due to SLCAR being an entity that is owned and operated by the local government, all physical
locations, activities and programs need to be accessible, inclusive and non-discriminatory to
individuals with disabilities. This policy ensures that SLCAR will continue to be a program
offered through the parks and recreation department thus providing individuals with disabilities
the opportunity to participate in desired recreational activities for years to come.
Another policy that influences SLCAR is the program’s designation as a public,
community-based, government-run agency. This designation prohibits delivery and billing of
therapy services to participants. Without the ability to provide skilled therapy interventions,
participants may experience a lack of impactful fulfillment and engagement in the recreational
programs due to the severity and/or complexity of their disability.
Furthermore, due to liability concerns, Salt Lake County has enacted policies that
prohibit SLCAR staff to provide self-care services to participants that are non-emergency in
nature (i.e., transfers). This policy then dictates that caregivers must be present to provide self-
care needs if/when needed. Therefore, concerns with regular participation arise due to potential
inability of caregivers to be present during activities for low-functioning participants.

Geographic. Salt Lake County is located in the Salt Lake Valley of Utah. The valley is
roughly 500 square miles and is surrounded on most ends by various mountains and the Great
Salt Lake on the Northwest end. The county seat is Salt Lake City, but the remainder of the
county is made up of various suburbs of the city. The valley is within close proximity to ski
resorts and outdoor activities located in the surrounding mountains, which makes access to
outdoor recreation readily available.
Being highly developed and populated, Salt Lake County has many surface roads that
include three interstates that transect the valley and numerous highways and byways. Salt Lake
County implements the Utah Transit Authority (UTA) to provide public transportation for the
large population. UTA has robust bus routes, three light-rails, and one commuter heavy-rail.
UTA offers SLCAR participants the ability to use public transit to activities across the valley, but
the large scale complexity of using UTA and the cost to regularly use may discourage
participants. UTA does offer Paratransit; a program that provides personal, curbside service for
individuals with disability. This option provides extreme convenience for SLCAR participants,
but an application and approval process is required to qualify for services. Individuals who have
been involved with the application process describe it as long and difficult to obtain approval.
Political. The majority of Salt Lake County politically identifies with the Republican
party and are mainly conservative. The US two Senate members, congressmen/women and
governor are Republican. The majority of the state government are Republican elected officials.
This political orientation has influence on SLCAR due to being a government service that is run
and regulated by elected officials. Conservative Republicans have historically been known to
seek tax reductions for their constituents, which directly impacts operations of SLCAR as they
are operated entirely on state tax revenue. This presents a potential barrier of offered services if
elected officials seek tax cuts and/or view tax revenue towards SLCAR as poor allocation of
funds.
Economic. The economic status residents within Salt Lake County falls within the
middle-income status, with the average yearly income at $50,353 as of 2016. The poverty level
in Salt Lake as of 2016 is at 19.1% (U.S. census bureau quickfacts: Salt Lake City, Utah, n.d.),
and current unemployment is at 3%. As of 2016, the average annual spending of residents in
Utah was $64,833 (Salt lake city area economic summary, 2018). The with the average spending
exceeding the average income, higher than normal poverty level, and increasing cost of housing,
many SLCAR participants may find it hard to pay for registration fees for programs.
In addition to typical economic conditions in Salt Lake County, families and caregivers
of SLCAR participants likely pay for more health-related services (e.g., outpatient therapy,
regular medical visits, pharmacology, etc.) than average residents in the area. This adds
additional financial burden on these individuals making justification of paying for adaptive
recreation programs difficult.
Demographic. According to the U.S. Census Bureau, the racial makeup of Salt Lake
County in primary white, sitting around 72% of the population as of 2017. Hispanic or Latino is
the largest minority making up around 21% of the total population (U.S. census bureau
quickfacts: Salt Lake City, Utah, n.d.). Being predominantly white, lack of diversity in the
SLCAR programs is prevalent and may present an apprehensive attitude of minorities to
participate in the programs. Although this may be of less concern in Salt Lake County due to this
area being the most racially diverse compared to other parts of the state.
Another important demographic aspect is that the homeownership from 2012-2016 in
Salt Lake County is around 48% (U.S. census bureau quickfacts: Salt Lake City, Utah, n.d.),
which indicates that the majority of the population rents. This presents a potential problem
because there is less stability in long-term participation/commitment of individuals in SLCAR
programs. With a higher turnover rate of participants, SLCAR experiences a lack of
advertisement of services to the community.
Social. There are social factors to consider with participants in SLCAR. A positive social
factor of participants is indeed the fact that this population experiences decrease in social
participation, as stated by staff and caregivers. SLCAR offers opportunities for individuals with
disabilities to interact and socialize with peers outside of their private or group homes. There is,
however, a caveat to socializing with their peers. According to caregivers, many of the
participants social contact involves others with disabilities; whether in school special education
programs or through their own group homes. There is little social interactions with peers without
disabilities. Caregivers express concern that participants may feel ostracized from the rest of the
population and not have opportunities to integrate into their communities.
While the majority of SLCAR participants have either a mental, developmental and/or
intellectual disability, there are some participants who have acquired disabilities (e.g., stroke,
SCI, TBI). These individuals with acquired disabilities may feel that the activities offered
through SLCAR are more tailored for individuals with mental or intellectual disabilities,
therefore not appropriate for them who experience more physical barriers.
Lastly, a negative social construct that applies to this population is the stigma that the
word “adaptive” has. This title holds an idea that because an individual engages in adaptive
recreation, they are considered unable to perform recreation “normally”. This stigma may turn
many away from participating in recreational activities.

Service Provided
Staff. The head administrator is the Adaptive Recreation Manager who oversees the
entire program and staff. The staff includes ~6 full-time paid employees and ~20-30 volunteers.
The staff help set up, facilitate, and run the adaptive activities through SLCAR. There are at least
2 employees present for each activity. The majority of the paid employees and some of the
volunteers are recreational therapist or recreational therapy students. There are some volunteers
that are physical therapy students or special educators at local schools. The remaining volunteers
are parents or others who have had personal acquaintance or relationships with individuals with
disabilities. All staff are required to be Basic Life Support (BLS) and CPR certified. The staff are
also trained in de-escalation techniques, of which includes restrainment of participants if
absolutely needed.
Services Provided. SLCAR offers recreational programs for individual with a variety of
disabilities. These programs include, but not limited to; soccer, basketball, tennis, softball,
swimming, weight training, archery, rugby, theater, cooking, martial arts, arts & crafts, and many
more activities. Participants fill out forms prior to engagement in activities that ask questions
about their disability, needs and any other medical information that is relevant to participate in
activities. Being a community-based recreational program, no other related services are provided
by SLCAR, although staff have mentioned that many, if not all, of the participants are receiving
related services outside of the program.
Funding Sources. As stated above, SLCAR is funded through tax revenue collected by
Salt Lake County. The county mayor and council determine allocation of tax revenue to each
service department the county provides. Tax bonds are voting on by county residents to supply
revenue to county departments. As of November 2016, county residents voted to approve $90
million in bonds to build/improve trails, parks, recreation centers and maintain existing programs
(Salt Lake County Parks & Recreation, n.d.). The Adaptive Recreation Manager stated that
SLCAR is very well funded and will continue to be so in the foreseeable future. SLCAR also
receives little funding through program registration fees. These fees are typically $20-$25 per
course.
Future Plans. The main priority of the future is to increase overall
attendance/participation in SLCAR programs. Administration stated that SLCAR has the
infrastructure and funding to accommodate more participants than currently participating. Future
efforts are being made to increase publicity and advertisement of SLCAR.
Some of the other future plans are to have programs that are graded appropriately to
different levels of functioning. All participants engage in the same level of activity, regardless of
level of function. Another future plan is to increase and expand wheelchair sports, as there are
not many currently. Lastly, SLCAR wishes to provide more day programs.
Program Strength and Areas of Growth
Administrative and Staff Perspective
Adaptive Recreation Manager. A formal one-on-one structured interview was
conducted with the Adaptive Recreation Manager (see Appendix A for interview questions). The
recreation manager stated that one of the strengths the program has is the funding and
infrastructure currently in place. The manager stated that SLCAR has plenty of physical
space/physical structures, money, and staff to run a much more robust program than is currently
taking place. Another strength that was listed by the manager was good support from caregivers
of the participants. Family or group home leaders are very invested and dedicated in having those
under their care participate in SLCAR. Lastly, the adaptive recreation manager stated that
SLCAR has sufficient equipment for individuals to participate in adaptive recreational activities.
A weakness that was identified by the recreation manager is that the total number of
participants in the program is lower than they would like. She feels that a lack of publicity and
advertisement of SLCAR stunts the growth of the program. Currently there is little headway on
resolving this issue. Another weakness of the program is the lack of autonomy and independence
of individuals in their participation. The recreation manager said that many of the staff and/or
caregivers will simple “do” and/or “complete” the activities for their participants, especially if
they are low functioning. The manager identified that the lack of knowledge of staff on how to
appropriately adjust activities for low functioning individuals is an issue she would like to
improve.
Finally, the recreation manager has a concern that participants are not engaging in any
recreational or social activities outside SLCAR. The manager believes that this may be do to lack
of caregiver training or education on implementing these activities at home or in their
communities.
Staff. As stated above, the staff consists of 6 paid employees and about 20-30 volunteers.
A lot of the paid staff have training and skills in recreation therapy. Semi-formal one-on-one
interviews were conducted with staff using the same structured questions (with some variations)
that were used with the adaptive recreation manager (see Appendix A for interview questions).
Collectively, the staff share a general consensus that strengths of SLCAR include being very
well managed and offers a good variety of adaptive activities for individuals with disabilities.
Another strength identified by staff is that SLCAR harbors a very inclusive environment for both
participants and staff. Everyone who is involved with SLCAR feel welcomed and non-threatened
One staff member stated that a weakness in SLCAR is the lack of general knowledge on
the disabilities seen in the program. This staff member specifically said, for example, that she
knows a good deal about ASD, but wouldn’t know how to provide adaptive recreation for
someone who suffered a stroke or a TBI. This staff member is a recreational therapist, so she
admits that she has more knowledge on specific disabilities, but many of the staff do not have
that educational background that she has.
Similarly with the previous staff member, another paid employee stated that she has
experience and knowledge with working with individuals with mental or intellectual disabilities,
but hardly any knowledge on how to work with individuals who have physical disabilities. This
staff member echoed that the majority of the staff don’t really know how to provide adaptive
recreation to people with physical disabilities. With the lack of education and knowledge about
various disabilities, staff agree that the effectiveness of adjusting/adapting activities in
accordance with functioning of different disabilities is decreased.
Transportation to SLCAR activities was also identified by staff as a weakness of the
program. Participants must rely on caregivers or public transportation to arrive at SLCAR
locations around the Salt Lake Valley. Many caregivers are apprehensive in letting their
participants ride Utah Transit Authority due to the risk of getting lost, so that leaves
transportation solely on caregivers, which staff believe is a burden for them.
Client and Caregiver Perspective
Client. Unstructured, informal one-on-one interviews were conducted with 5 participants
of SLCAR (see Appendix A for interview questions). This format was chosen due to majority of
the participants have mental or intellectual disabilities. All of the participants enjoyed the
services that SLCAR provide, especially the social aspect of being with their peers. Participants
really liked the staff and felt that they were helpful and fun.
One of the weaknesses identified by participants is the scheduling of location and time of
SLCAR activities. All but a couple of the activities offered occur during the evenings at various
location throughout the valley. There are different activities that occur at the same time and date
during the week, but at completely different locations. Since these individuals rely on caregivers
to provide transportation, it can be difficult for them to go to all the activities that they want to
during the week.
Caregivers. Data collection from 7 caregivers was completed through structured, semi-
formal interviews. Caregivers perceived strengths of SLCAR are that the program meets their
expectations, meets the needs of those they take care of, and the variety of activities offered. The
caregivers also appreciated that activities are at least 90 minutes in length, which they feel is a
good amount of time for everyone to participate.
The main weakness that caregivers identified was the lack of transportation options to get
participants to SLCAR locations. One caregiver refuses to let his son take public transportation
due to an incident where his son got lost on public transportation for 2 hours before being safely
found. Now this caregiver has no other option than to drive his son to the activities, which can be
burdensome due to weekly scheduling conflicts.
Student Observations
The following strengths and weaknesses from occupational therapy student were gathered
through noted observations and interviews with participants, caregivers and staff during various
activities offered through SLCAR. No standardized assessments were used due to time
limitations during activities and constant changing of activities, participants and locations within
the program.
Strengths. SLCAR has numerous strengths that were observed, many of which were
echoed by staff and participants during individual interviews. The primary strength of SLCAR is
the vast variety of adaptive activities offered. As mentioned previously, activities include
everything from theater and craft to archery and rugby. Having numerous activities to choose
from seems to encourage increased participation from clients due to covering a large scope of
recreational interests.
Other strengths observed were the infrastructure and the equipment that SLCAR has at
their disposal. SLCAR operates in numerous recreational centers around the Salt Lake Valley
and other privately run sites that host activities/events. These spaces are accessible and have
reserved spaces that offer appropriate space to accommodate group size and the activity. SLCAR
also has plenty of adaptive and non-adaptive equipment to supply a larger participation
population than is currently attending. Sufficient equipment ensures that every participants can
fully engage in activities in a fulfilling manner.
Lastly, staff and caregiver support and investment in the participants is a strength of
SLCAR. The staff is mainly comprised of volunteers who are very dedicated in serving the
population at SLCAR, which indicates the passion these staff members have for the participants.
Likewise, the caregivers of the participants were observed to consistently bring the participants
to their weekly desired activities. Providing the sole transportation for this population presents a
large barrier, but the caregivers are invested enough to make the sacrifice of transporting those
whom they take care of. This investment by staff and caregivers could potentially cultivate a
desire for education and training to offer better services and opportunities for participants to
engage in recreation.
Weaknesses. With the numerous strengths that SLCAR has, there are gaps in service in
the program that were observed. One of the gaps observed was a lack of knowledge by the staff
on how to grade the difficulty of the activities for individual participants to increase
participation. Generally, activities are taught and demonstrated in one way, and if participants
cannot complete the steps, either the caregiver or staff members perform the tasks for them. An
example was the cooking class; a teenager with cerebral palsy was not able to perform some of
the steps of making the dish, so the instructor did the whole task for them while the participant
watched. This disengaged the teenage participant and appeared to be uninteresting to them.
Another weakness observed, which could be tied to the weakness stated above, is a more
in depth knowledge on the disabilities present in the participant population, especially the
disabilities that are more physical in nature. It has been observed that staff working with
individuals with moderate to severe cerebral palsy, significant tone from CVA, and SCI did not
know how to adapt the activities to suit the disability. In those cases, many of the staff and
caregivers ended up performing the tasks for these individuals or given more than enough
assistance to complete.
It was also observed that many of the caregivers lacked knowledge on the purpose/benefit
of their participants engaging in recreation, especially when the participant’s performance did
not appear “normal” compared to typical performance. Also, many of the caregivers did not
know how to implement adaptive recreation at home and in the community outside of SLCAR.
Finally, there seems to be a lack of social skills training for participants. The participants
perform all activities in groups, and there is even a monthly social dance, but there are no
services that specifically target social skills training. As a result, many participants miss great
opportunities to develop and improve social skills while in groups of their peers.
Literature Review
A literature review was conducted to better understand the needs that an occupational
therapist could fill at Salt Lake County Adaptive recreation based on current evidence and gaps
in the literature. Databases utilized to search relevant articles included Google Scholar, American
Journal of Occupational Therapy, and CINHAL. Search terms used include the following:
Diagnosis, adaptive, recreation, long-term, outcomes, limitations, participation, programs, staff,
participants, family, short-term, benefits, social skills, transportation. 14 articles were used
based on comprehensive/relevant content and reputable publishing. Ideally, articles were selected
that fell within <10 year publication date, but due to limited literature on the subjects, older
articles were used to achieve a more comprehensive understanding. The majority of the articles
were located through CINHAL database.
It is important to note that while many of these articles focus on specific diagnosis in
their populations, the articles were applied as general concepts to the population at large that
participate in Salt Lake County Adaptive Recreation (SLCAR). This was done due to the vast
heterogenous population that attend SLCAR activities, and it was deemed unnecessary to locate
articles that would address every diagnosis, age and gender that participate. Also, many articles
utilize leisure and/or recreation nomenclature within their texts. To avoid confusing nuances in
verbiage, all leisure and/or recreation words will be collectively referred to as recreation. Lastly,
most articles refer to recreation in the general sense, not necessarily adaptive. Due to near non-
existent research with adaptive recreation specific programs, these articles that refer to general,
non-specific recreation hold value and relevance for programs such as SLCAR.
Need of Community-based Adaptive Recreation
Understanding the need of adaptive recreation is important to validate and justify
participation by those with disabilities. The following subsections were identify as the main
overarching themes in the existing research and will be expounded upon further.
Social participation. In general, most individuals with disabilities experience decreased
rates of social isolation (Simplican et al., 2015). Perhaps due to this trend, social participation
was a constant theme identified by the literature that motivated participation in recreation. In
participants with spinal cord injury (SCI), Tasiemski and associates (2005) stated that over a
quarter of the individuals in the study identified social contact with friends as the main reason for
participating in an adaptive recreation sport. Furthermore, the majority of children with disability
prefer social leisure/recreational activities whereas, this is not true of children without disability
(Shields, Synnot & Kearns, 2015).
One way that adaptive recreation increased social participation was its tendency to reduce
loneliness and isolation, especially in those with austim spectrum disorder (ASD) (Garcia,
Datillo & Mulea, 2017). Also, the social aspect of recreational activities may increase
independence from family members by establishing friendship with peers for children with
disabilities (Berger, 2008). Parents of children with disability sought value in social relationships
during recreation for their children with disability. Specifically, these parents thought recreation
with peers presented an opportunity to mimic and learn socially acceptable behaviors by
interacting with others (Schleien, Miller, Walton & Pruett, 2014).
The body of literature is clear that a large reason for participating in adaptive recreation
for individuals with disability is the social aspect, but the research is silent on community-based
adaptive recreation activities focused on the acquisition of social skills for individuals with
disabilities.
Physical health. Participating in recreation activities, especially physical activities, helps
individuals perform physical exercise. According to the Center of Disease Control and
Prevention (CDC), people who engage in physical activity tend to live longer and are at lower
risk of developing some forms of cancer, type II diabetes, stroke, depression, and heart disease.
Also physical activity can help control weight and improve academics in students (CDC, 2018).
Specifically concerning individuals with disabilities, there seems to be a big health
disparity compared to individuals without disability. According to Healthy People 2010:
Understanding and Improving Health (USDHHS, 2000), people with disability experience
earlier deaths, more preventable secondary conditions and chronic conditions, and make more
visits to the emergency room. Given that individuals with disability makes up the population that
participate in SLCAR, physical exercise/activity is important to engage in.
Getting physical exercise is also a motivation to participate in adaptive recreation by
individuals with disabilities. The majority of individuals with SCI reported that their
participation in adaptive sports was due to maintaining physical conditioning and increasing
upper-body strength (Tasiemski et al., 2005). Parents of children with disability also agree that
participation in adaptive recreation is important to maintain physical health and set patterns for
future physical activity (Schleien, Miller, Walton & Pruett, 2014).
Family Relationship. An interesting finding indicates that building family relationships
is a benefit of engaging in recreation. Zabriskie, Lundberg, and Groff (2005) stated that
individuals with disabilities that participated in adaptive recreation with family members not
only reported higher satisfaction with the activity, but that their relationship with their family
was strengthened as well. They additionally found that families who participated in adaptive
recreation with their child experienced a positive impact on the quality of their family lives
(2005).
Participation in Recreation
The above section clearly shows the need of recreation for individuals with disabilities.
Understanding the need for adaptive recreation, it is important to consider the current
participation trends of individuals with disabilities in recreation. Currently, female and male
children with disability experience a lower rate of participation in recreation activities compared
to those of their peers without disabilities (Schreuer, Sachs, & Rosenblum, 2014).
In a study that examined the outcomes of adaptive sports and recreation among veterans
with acquired disability, 83% of the participants had never participated in adaptive sports or
recreation prior to the study (Lundberg, Bennett, & Smith, 2011). While it is impossible to
extrapolate this data and apply to the population at large, this study may indicate a possible trend
where the majority of adults with acquired disabilities do not participate in adaptive sports and
recreation.
There is very limited research that shows the participation rates of individuals with
disabilities in community-based adaptive recreation programs. But general trends (as shown
above) across age and gender suggest that individuals with various disabilities experience
decreased participation in recreation overall.
Limitations in Adaptive Recreation Programs
Knowing that participation in recreation and leisure activities is low among individuals
with disability, it is important to consider what limitations are present in community-based
adaptive recreation programs that aim to increase participation and satisfaction in this
population. Understanding these limitations also gives valuable insight on how occupational
therapy can address these issues and find a place within community-based adaptive recreation
programs.
Transportation. Wilder (2011) stated that the majority of adults with disabilities who
participate in social and recreational community-based programs identified transportation as a
barrier to fully engage in desired activities. Specifically, participants in the study said that
obtaining transportation during evenings and weekends was especially difficult. This presents a
potential issue with SLCAR considering that the majority of adaptive recreational activities
occur in the evening and Saturday mornings.
Children with ASD have stated their desire to interact and play with their peers in
recreation activities, but that travel distance was a determent in being able to participate in these
activities (Brewster & Coleyshaw, 2010). In addition to traveling distance, many recreational
activities that children with disability participate in are individually tailored to them by
caregivers, thus making it more convenient for these activities to take place in the home without
the burden of transporting the children (Shields, Synnot & Kearns, 2015).
While public transportation is an option, research shows that many individuals with
disabilities find public transportation inadequate. The problems identified with public
transportation included: unreasonable amount of travel time, inaccessible routes to desired
location, inaccessible physical stops and stations, and limited route options. Another interesting
public transportation barrier identified was the lack of bus driver training on the needs of
individuals with disabilities while utilizing services. Many riders with disabilities felt that the
drivers did not call out stops, ask them where they needed to go, or give verbal geographical
orientation identifiers (Bezyak, Sabella, & Gattis, 2017).

Staff training. Older adults with intellectual and/or developmental disabilities stated that
one barrier for their participation in adaptive recreation is inadequately trained staff. This
population said they would like staff to receive more cross-training in aging, disability, and
recreation. Many felt that engagement and enjoyment of adaptive recreation hinge on the ability
of staff to provide appropriate activities that matched skill-set and diagnosis of participants
(Wilder, 2011).
Parents of children with disability share a common apprehension about the safety that
staff can provide for their children during recreational activities. While parents admit and
recognize that the intentions of staff are good, they just cannot risk the safety of their children
due to staff lacking necessary training and knowledge to accommodate their children (Schleien,
Miller, Walton & Pruett, 2014). Likewise, parents who have children with CP stated that for
participation in recreational programs, the services had to meet their children's needs; including
equipment, accessibility, and staff training (Chiarello et al., 2016).
There may also be additional evidence where more education for staff could be
beneficial; though the evidence is subtly nested within the literature. Tasiemski and associate’s
(2005) study with adults who had SCI noted that a large percentage of the participants did not
engage in adaptive recreation due to having high-levels of caregiver assistance in performing
basic self-care tasks known as activities of daily living (ADL). The authors state:
“Too high dependency in ADL is a serious problem which limits participation in sports,
but there are sports available even for people with high tetraplegia which do not require
high efﬁciency in ADL, such us bowling, bocce, swimming or quad-rugby (defence
players)”.
It is possible this statement indicates that staff may be unaware of recreational options for
complex disabilities due to a lack of knowledge about conditions/diagnosis and functional
outcomes associated with them. This lack of knowledge in-turn, affects participants by not
giving more options and opportunities to engage in adaptive recreation.
Family training. As mentioned above, there is evidence that supports the role of
adaptive recreation in strengthening family relationships when family members participate.
Research states that an indicator for participation in leisure and recreation for children with
physical disabilities is the extent that their parents participate in these activities with them (King
et al., 2006). Therefore, Zabriskie and associates (2005) stated, “...that therapeutic recreation
professionals should provide more family interventions with their clients and that research
continues to provide empirical support [for this]”. This statement indicates that family
interventions within adaptive recreation is lacking in programs.
Parents of children with disability said that they felt exhausted when participating in
recreation with their children, even if access to programs were obtained. They mentioned that
they would run around with their children non-stop, having little time to rest. The parents wanted
their children to participate in recreation independently without them, but that their children
would not. Parents stated they felt frustrated with this pattern of recreational engagement with
their children (Schleien, Miller, Walton & Pruett, 2014). Though family engagement in
recreation is important, this study shows that most parents do not have the skills or knowledge on
how to provide recreational opportunities for their children with disabilities in a manner that
supports and provides enjoyment for both the participant and family.
Summary
The objective of SLCAR is to improve“...lives through people, parks, and play” and
“...[provide] the opportunity to play sports in inclusive environments as well as in our specialized
programing” (Salt Lake County Parks & Recreation, n.d.). SLCAR seeks to include and involve
all people with disabilities to engage and find enjoyment in adaptive recreation. The literature is
very clear that recreational involvement for individuals with disabilities has very positive
benefits in a number of outcomes. Therefore, there is a need for a community-based adaptive
recreational program such as the one SLCAR offers to the community.
Though SLCAR is a very well developed, staffed, and funded community recreational
program, there are opportunities to bolster and strengthen the existing program. The finding of
this literature review and the information gathered in the data analysis from staff, participants,
and caregivers present the following gaps in service within SLCAR: limitations in transportation,
need for social skills training, and comprehensive education/training for staff and participant
families to facilitate increased participation and satisfaction of clients. These barriers are
primarily external in nature both contextually and environmentally. With that consideration,
coupled with SLCAR policy prohibiting therapy services, an occupational therapist could
address these gaps of service by providing indirect services through education and consultation
to staff and caregivers of the participants. Occupational therapists are appropriate and
recommended to provide these services due to extensive education and experience in providing
therapy for a spectrum of diagnosis, skills in educating clients and caregivers, performing
activity analysis, and skill in adapting and grading activities. This program would fill a need that
has been identified by staff, clients, and caregivers at SLCAR and provide meaningful and
satisfactory engagement in adaptive recreational activities.

Program Proposal
General Description
Program Overview. The occupational therapy program proposal for Salt Lake County
Adaptive Recreation (SLCAR) is a staff and caregiver education/training program designed to
improve adaptive recreational services provided, in order to increase recreational participation
and satisfaction of the participants. The program will utilize an occupational therapist to educate
on specific diagnosis and train staff and caregivers on how to adapt, adjust, and grade adaptive
recreational activities according to the functioning level and diagnosis of the participants. In
addition to education classes, the occupational therapist will provide one-on-one
training/consultation with staff and caregivers who are experiencing difficulties with individual
participants in their activities. The occupational therapist will observe, and in some cases,
evaluate the individual participant in order to provide education and training to the staff member
or caregiver.
According to the onsite data collection and literature review, individuals with disability
do in fact experience decrease rates of participation in adaptive recreation for numerous reasons,
as stated in previous sections. One of the most striking reasons for decreased participation in
adaptive recreation as perceived by participants with disability is the lack of staff training in
providing adequate services. In addition to limited staff training, many caregivers express doubt
in their own abilities to provide recreational opportunities that are meaningful for those whom
they take care of. Generally, both staff and caregivers lack knowledge in providing appropriate
recreational activities for a wide population of diagnosis and the participant’s levels of
functioning within each diagnosis.

In conjunction with the above concerns with staff and caregivers, this program is also
appropriate when considering external factors such as demographics, social, economic, and
current policy. With SLCAR providing services for such a wide demographic of participants that
include various diagnosis, races, and ages, educating staff on these demographics can improve
the quality of adaptive recreational activities by adjusting and adapting them to fit the needs of
the participants.
Since current SLCAR policies prohibit the use and billing of direct therapy services to
participants, an education program would be the most ideal way to incorporate occupational
therapy services. This program is also advantageous economically since the classes and training
giving to staff and caregivers by and occupational therapist would be free of charge, thus
participants are not impacted financial to pay for the benefit of these services. Finally,
educating/training staff and caregivers to help increase participation in adaptive recreation for the
participants will help increase social interactions among the participants. The literature points to
socialization as a large reason for recreational participation for individuals with disability, so
increasing participation that in-turn increases socialization, will ultimately provide satisfaction
among participants.
Value. An education/training program for staff and caregivers at SLCAR is valuable to
both the population and SLCAR itself. As mentioned above, providing knowledge and skills to
staff and caregivers on how to adapt, adjust, and grade adaptive recreational activities based on
the participants in their class and at home, will help increase participant’s recreational
participation and satisfaction. By increasing recreational participation and satisfaction,
participants could experience improved physical health, social interactions among peers, and
social bonds with caregivers. Since most individuals with disabilities are at risk for decrease in
those areas, this program can help address them, thus demonstrating its value.
The value of this program is further reflected in its ability to address occupational
injustices experienced by the participants. Occupational justice refers to the ability and right all
people have to engage in meaningful, daily activities of their choosing. The two areas of
occupational injustice that is experience by participants in the SLCAR program are occupational
deprivation and occupational marginalization. There are few adaptive recreation options for
individuals with disability, so this program will address that deprivation of occupations they
experience. Also, this population is marginalized from most recreational activities because they
cannot perform the required actions to complete these activities, compared to those that typically
perform them.
The proposed program will address these injustices by providing participants
opportunities to fully engage in adaptive recreation regardless of their diagnosis and/or
functioning level due to increase knowledge and skills of SLCAR staff and caregivers. As stated
above, these individuals could experience increases in physical health, socialization, and
strengthened bonds with caregivers.
SLCAR mission is to “Improv[e] lives through people, parks, and play” (Salt Lake
County Parks and Recreation, n.d.). To truly improve lives through play, individuals need to: 1)
participate in play and 2) feel that their participation is worthwhile and satisfying. This program
addresses those two needs that individuals need to experience for Salt Lake County Adaptive
recreation to be successful.
Role of Occupational Therapist. Occupational therapist could and should have an
integral part in community-based recreational programs. Recreation falls underneath leisure in

the domain of practice for occupational therapy (AOTA, 2014), so adaptive recreation is
considered an occupation (or meaningful activity) that is appropriate to address in occupational
therapy practice. Occupational therapist are highly educated and trained to help individuals
engage in meaningful daily activities.
Occupational therapists possess a strong knowledge of a person’s psychological,
emotional, physical, cognitive, and social makeup. In addition to a strong foundational
knowledge of conditions and diagnosis, occupational therapist “... are the only professionals who
look at the relationships among the person, the environment, and the occupation to support health
and well-being through everyday activities” (AOTA, n.d.). With a strong knowledge of diagnosis
and an understanding of the relationship between person, environment, and the occupation,
occupational therapists have the skill to adjust, or grade activities to match the skill set of the
individuals (Breines, 2013). This skill set is critical in ensuring volition, enjoyment and
satisfaction for clients participating in desired occupations like adaptive recreation.
Within a community-based recreational program, occupational therapists can serve as
consultants in recommending adequate accessibility options and a range of adaptive recreational
equipment that is appropriate for the site and participant population. Furthermore, occupational
therapists can collaborate with families and individuals to determine social environments and
recreational opportunities that fit their needs (Scaffa & Reitz, 2014). Therefore, in this program,
the role of the occupational therapist will be to provide indirect/consultative services to staff and
caregivers through education and training to ensure optimal satisfaction and participation of
participants in adaptive recreation.
Level of Prevention. The occupational therapy program is mainly tertiary prevention.
The population that utilizes SLCAR has already received their diagnosis, so the focus will be on
maximizing function and reducing decline in recreation participation to prevent secondary
conditions such as social isolation and a sedentary lifestyle. This tertiary prevention will be
carried out by the staff onsite and the caregivers, due to SLCAR policy prohibiting direct therapy
to participants.
Theoretical Practice Models
Two practice models will serve as the theoretical basis of the program: the Person-
Environment-Occupation (PEO) model and the Rehabilitation (Rehab) model. PEO will serve as
the overarching, occupation-based model due to its focus on the interplay between the person,
environment and occupation to achieve occupational satisfaction. PEO states that occupational
performance and satisfaction occur when there is a proper congruence between the person,
environment and occupation. This model also postulates that if a change needs to occur in one of
those areas, the environment and/or occupation are more easily changed than the person (Law et
al., 1996). This model supports the proposed program because the aim is to have staff and
caregivers adjust, adapt, and grade recreational activities and/or the environment to increase
participation and satisfaction of individuals who participate in SLCAR.
The Rehab model is a complimentary model that states independence can be restored
through compensatory strategies and techniques when the underlying impairment cannot be
remediated. The compensatory strategies and techniques could involve the use of adaptive
equipment, adapting the activity, using adaptive technology, etc.(Cole & Turfano, 2008;
Crepeau, Cohn & Schell, 2003). The program will train and educate staff and caregivers to use
compensatory strategies to adapt activities and the environment, thus supporting the postulates of
the Rehab model.

Goals and Objectives
The goals and objectives of the proposed program are as follows:
● Goal 1: Increase client participation and satisfaction in adaptive recreation
program by educating and training staff in various diagnoses and how to
appropriately grade, adapt, and adjust activities to fit client needs.
○ Objective 1: In 6 months, 80% of staff will independently attend at least
one OT directed education class to increase knowledge base.
○ Objective 2: In 5 months, 75% of staff will independently report
confidence in ability to appropriately adjust, grade, or adapt recreational
activities according to client needs from baseline.
● Goal 2: Increase caregiver confidence in providing meaningful and appropriate
recreational opportunities for clients in an environment outside of Salt Lake
County Adaptive.
○ Objective 1: In 6 months, 75% caregivers who attend OT directed
education classes will independently report increase confidence compared
to baseline in providing recreational opportunities outside of Salt Lake
County Adaptive Recreation.
○ Objective 2: In 5 months, 70% of participants whose caregivers attended
the OT directed education classes will independently report an increase in
participation of recreational activities provided by caregivers outside of
Salt Lake County Adaptive Recreation.

Salt Lake County Adaptive Recreation Staff and Caregiver Education Program
The education program for SLCAR staff and caregivers is an indirect, consultative
program that will be offered during weeknights at the various recreation buildings used by
SLCAR. The program will consist of two, 1-hour staff and caregiver weekly classes, along with
3 hours of one-on-one consultation with staff throughout the week. These education classes will
build upon each other from week-to-week and will culminate at the end of 6 months. After the 6
months, the education classes will restart from the beginning.
The first section of classes for staff and caregivers will begin with education on diagnoses
that are commonly seen in the SLCAR program. Mainly these diagnoses will include, but not
limited to: Autism Spectrum Disorder (ASD), Stroke, Spinal Cord Injury (SCI), Cerebral Palsy
(CP), intellectual disabilities, developmental disabilities, and mental disabilities. The layout of
the class will follow the general guideline: 1) definition of disability, 2) prevalence in
community, 3) general pathophysiology, 4) signs and symptoms, 5) the disability across the
lifespan, and 6) general functional outcomes within occupations (specifically recreation). These
classes will provide both staff and caregivers the basic knowledge on what to expect from the
various disabilities of participants in the program. The staff will be highly encouraged to attend
all diagnosis classes and caregivers will be encouraged to attend the ones that are most relevant
to those individuals they provide care to.
The next section of classes will focus on the ability to alter the environment and/or the
recreational activity to fit the needs of the participants. The class topics will generally be as
follows: activity analysis skill building, grading activities, adapting the environment, and
exploration of assistive technology (AT). Both caregivers and staff will be encouraged to attend
all the classes due to them not being specifically tailored to individual diagnosis, but rather
building a general skill set in adjusting the activity and/or environment to suit the needs of
participants.
The last section of classes will involve the application of acquired skills and knowledge
obtained from the first two sections into the adaptive recreational activities offered through the
SLCAR program. The classes will cover the activities of adaptive basketball, soccer, rugby,
cooking, theater, arts/crafts, martial arts, baseball/softball, etc. These classes will have case
studies of participants with different diagnosis and level of functioning, and the class will be
asked how to adjust the activity to fit the participant’s needs. Additionally, the caregivers will be
given a class designed around offering adaptive recreational opportunities for the participants in
the community and at home.
This section, along with the previous two sections, will include a mixture of lecture and
active participation from attendees. This final section of classes will ideally integrate all the
education that staff and caregivers have received into a skill set where they will feel confident in
providing increased recreational opportunities for participants, that in-turn will increase
participant participation and satisfaction.
Along with the education classes, this program will involve one-on-one consultation with
staff and caregivers and the occupational therapist about specific individuals in the SLCAR
program. The consultation will be voluntary on behalf of the staff and caregivers who are
experiencing difficulties providing appropriate recreational opportunities for participants in and
outside of SLCAR. The consultation of the occupational therapist will consist of observation of
the participant during recreation, individual evaluation of participant (if needed), and co-
planning with staff and/or caregiver for optimal solutions to increase participation and
satisfactions of individuals in the program. While the occupational therapist may decide to
evaluate a participation during the one-on-one consultations, occupational therapy treatment of
the participant will not occur and the data gathered during the evaluation will only be used to
consult with the staff or caregiver. Some of the assessments that the occupational therapist may
use are, but not limited to, the following: Sensory Profile, Allen Cognitive Screen, Movement
ABC, and Leisure Competence Measure. These assessments will provide valuable data on motor
movement within the context of play, cognition, sensory processing, and general competence and
preference of participants in recreation. These factors directly contribute to the ability or inability
of participation in adaptive recreation.
This educational program for staff and caregivers will address the educational,
community, and social systems. The staff and caregivers will receive quality education from a
qualified occupational therapist on how to address barriers in adaptive recreation for individuals
with disability. The caregivers that participate in this program will be prepared and encouraged
to transfer the skills they gained to their communities outside of the SLCAR program. Finally,
increasing the participation of individuals with disability in the activities offered by SLCAR will
decrease social isolation.
Program Start-up. The above described program will first be focused on staff
education; primarily due to the fact that the staff can be recruited more easily through
administration and promotion (see below marketing and promotion section). Since caregiver
attendance varies in the SLCAR program, the education classes for caregivers will be expected
to roll-out more slowly. The one-on-one consultation is expected to be the final section to be
rolled-out in the program due to decreased exposure to the occupational therapist and knowledge
of the resource available to staff and caregivers. As staff and caregivers become acquainted with
the occupational therapist through the education classes, it is expected that the one-on-one
consultation will increase in use.
Eligible Participation Criteria. The criteria for participation in the program will be
minimal. Being an indirect program, the education classes and one-on-one consultation services
will be open and free for all staff and caregivers who provide care for current participants
enrolled in at least one SLCAR program. The classes and consultation will be on a voluntary
basis by staff and caregivers.
Time Requirements. The program will consist of a total of 8 hours per week for the
occupational therapist. The occupational therapist will teach two, one-hour staff classes on
Tuesday and Thursday evenings and two, one-hour caregiver classes on Wednesday and Friday
evenings. The subjects of the four, weekly classes will be the same, but taught in both the
Copperview Recreation and Northwest Community Center. The classes will take place in the
evening from ~6:00 pm to 7:00 pm, or depending on the consensus needs of the staff and
caregivers. The occupational therapist will also have three open hours per week for consultation
services. These services will ideally be scheduled before hand by staff and caregivers, but the
occupational therapist will “float” between activities and locations (mainly on Saturdays) and be
open to consultation if approached or if the occupational therapists offers consultation to staff
based on observation of the activity. The occupational therapist will also have a one-hour
meeting with administration to discuss progress on outcomes and goals of the programs and
other matters that pertain to the program.
Staff Involvement. The staff at SLCAR will be directly involved with the occupational
therapy program entirely, considering the program is tailored for their education in providing
appropriate recreational opportunities to participants. Staff can refer participants to the

occupational therapist, but as stated previously, only for the purposes of the one-on-one
consultation with the particular staff member.
Space Requirements. The education classes will require a classroom (at both
Copperview Recreation and Northwest Community Center) with at least 1000 sqft. The
classroom will need tables and chairs to fit at least 40 individuals. For the one-on-one
consultation, the typical recreation spaces utilized for SLCAR activities in various recreation
centers will be used. These spaces include gyms, fitness rooms, basketball courts, baseball
diamonds, etc. These spaces will offer adequate space to perform observation and evaluation if
needed. The occupational therapist will not require a personal office or desk space since most of
their time will be used in classrooms and in the various SLCAR spaces.
Community Resources Utilization. Since SLCAR is a community-based recreation
program, all physical locations used for the program are available for use by the community.
Therefore, the program is primarily using community resources by default. To assist caregivers
in offering additional recreational opportunities to participants outside of SLCAR, the following
resources could be recommended: TRAILS adaptive sports, Wasatch Adaptive Sports, and
National Ability Center.
Marketing and Promotion. The promotion of the program will primarily start with the
administration staff of SLCAR encouraging and advising staff to attend the weekly staff
education classes. Email reminders can be sent to all staff on a weekly basis and calendar
reminders set on the online, staff community calendar. The occupational therapist can also travel
to the various activities and encourage staff to participate in the classes. For caregivers, printed
flyers will be distributed throughout the physical locations that SLCAR uses for its activities.
Also, staff will be asked to assist in recruiting caregivers to attend the education classes,
especially considering that the staff has had extensive interactions with caregivers. As with staff
recruitment, the occupational therapist can recruit caregivers while they are at the various
SLCAR sites.
Budget. The yearly expense of implementing this occupational therapy program will
increase overall cost slightly for SCLAR. Most of the operating costs will be in-kind
contributions from SCLAR including: classroom space, tables, chairs, whiteboard, projector,
printer, and adaptive recreational equipment. The majority of the operating expense will come
from the paid wages of the occupational therapist running the program. But, as previously
mentioned, the occupational therapist will only work 8 hours per week, therefore the yearly
wages paid will be minimal. Other expenses will include material necessary to maintain the
functioning of the program. Due to this program being free for staff and caregivers, no revenue
will be gained by implementing this program. For more specific budget information, a detailed
itemized line budget sheet can be found in appendix B. The following is a basic rundown of
yearly operating costs:
● Start-up costs
○ One-time purchased items $708.64
○ Occupational Therapy Assessments $1,796.99
● Direct Cost
○ Materials and resources needed for education classes $1,252.92
○ Part-time occupational therapist wages $14,560.00
Funding Options. SLCAR is a community-based adaptive recreation program that is
offered through Salt Lake County Parks and Recreation department. Based on this description of
the site, there are two potential funding sources that have been identified to contribute to the
implementation of the staff and caregiver education program. The first funding source is the
Spencer F and Cleone P Eccles foundation from Salt Lake City, Utah. This funding source was
found on www.foundationcenter.org using the advanced search with the following key search
words: community recreation, Utah. The Spencer F and Cleone Eccles foundation is apart of the
larger George S and Dolores Dore Eccles foundation. Most grants given through this foundation
are to education and sports and recreation, with the average grant amount equaling ~$10,000.
Those seeking a grant can call the following number; 801-246-5348, or visit the following
website link: https://www.grantinterface.com/Home/Logon?urlkey=gseccles.
The second funding source found is the Tommy Wilson Grant. This grant was found
through a Google search using the following search terms: community recreation grants. The
website that was selected was the National Park and Recreation Association (npra.org). Through
this site, there was a link to another website called Shape America (shapeamerica.org). It was on
this latter site that the Tommy Wilson Grant was found. This grant supports recreational
programs for individuals with disabilities and applicants can apply for amount from $500-
$1,500. Grant applications can be filled out through the following link:
https://www.shapeamerica.org/grants/tommywilsonmemorialgrant.aspx.
Program Outcome. The desired outcome of the staff and caregiver education program is
to increase the knowledge and skill set of staff and caregivers in offering appropriate adaptive
recreational opportunities for participants of the SLCAR program. Giving staff and caregivers
the skills to adapt, adjust, and grade recreational activities according to the needs of the
participants in their classes will help increase participation and satisfaction of the participants.
Also, this program will increase the confidence of caregivers in providing adaptive recreational
opportunities outside of SLCAR to those whom they provide aid to. By increasing appropriate
adaptive recreational opportunities for participants, it is expected that physical activity,
socialization and strengthened familial bond will improve for these participants, which will
increase overall health and well-being.
Program Evaluation. Evaluation of the program will consist of quantitative and quality
data collection in the form of survey questionnaires given to both staff and caregivers. The
qualitative survey will be given to staff and caregivers after their completion of the education
classes. This data will be used to determine the effectiveness of the program and offer insight on
improvements that could be implemented into the program. The complete list of questions can be
found in appendix C.
A five-point Likert scale questionnaire will be used to gather quantitative data on the
effectiveness of the program. This questionnaire will be given to staff and caregivers at the
beginning of the classes and at the end of the classes to get pre (baseline)/post comparison data
of the program. The complete questionnaire can be found in appendix D. The two questionnaires
will determine the perceived knowledge and skill set gained by staff and caregivers by
participating in the education program.
Also, since this program targets staff and caregiver attendance of education classes,
attendance rolls will be taken of the classes to gauge the participation rate. This participation rate
is essential in determining the exposure the program has to staff and caregivers of SLCAR. It
will also indicate the consistency of participation in the classes, which is of paramount
importance in gaining the above mentioned knowledge and skill set of the staff and caregivers.
Conclusion
Through the onsite data collection, literature review and program design, it is proposed
that the education program for staff and caregivers at SLCAR be implemented to increase the
knowledge and skill set of staff and caregivers alike, in providing appropriate adaptive
recreational opportunities for the participants. The proposed program will not add a heavy
financial burden on SLCAR and potentially increase participation and satisfaction for individuals
with disability in adaptive recreation. The administrative staff appointed to review this program
proposal is encouraged to provide input on the feasibility of implementing this occupational
therapy program at SLCAR. The ultimate goal of this occupational therapy program is to benefit
the participants of adaptive recreation in the SLCAR, which coincides with the mission and
values of SLCAR itself.

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Appendix A: Interview Questions
Recreation Manager
1. What is the purpose of your organization? (Mission statement, philosophy, etc.)
2. What is your title and role within the organization?
3. What group of individuals do you serve?
4. What are some of the characteristics of this group? Diagnoses, LOS, what other services do
they usually get?
5. Are there any psychosocial considerations with this group? And if so, what kind?
6. What are the titles of the employees that work here?
7. Do your employees have training/professional backgrounds with working with individuals
with disability?
8. How many employees approximately work here?
9. What are your funding sources?
10. How do you obtain your AE and from what sources?
11. What kinds of programming/services do you currently offer?
12. What kinds of facilities do you use?
13. Do you offer transportation options for those who do not have means to make it to these
activities?
14. What plans are there for different or additional services in the future?
15. What goals/vision do you have for the future of your program?
16. What are some of the barriers you believe are present in accomplishing current and future
goals of your organization?

17. Based upon your knowledge of your clients (e.g., participants, members, patients, etc.) and
how they function in your program or after they leave, what gaps do you see in their
functioning or skill levels?
Staff Questions
1. What is your title and role within the organization?
2. What group of individuals do you serve?
3. What are some of the characteristics of this group? Diagnoses, LOS, what other services
do they usually get?
4. Are there any psychosocial considerations with this group? And if so, what kind?
5. Do you have training/professional backgrounds with working with individuals with
disability?
6. What kinds of facilities do you use?
7. What goals/vision do you have for the future of this program?
8. What are some of the barriers you believe are present in accomplishing current and future
goals of your organization?
9. Based upon your knowledge of your clients (e.g., participants, members, patients, etc.)
and how they function in your program or after they leave, what gaps do you see in their
functioning or skill levels?
Caregiver and Participant Questions
1. What is(are) your favorite activity/activities you like to participate in and why?
2. Do you feel that SLC Adaptive Rec. offers activities that you are interested in? If not, why?
3. What activities do you wish were offered?

4. In the current activities you participate in, do you feel they meet your expectations/needs?
Why or why not?
5. Does the current weekly schedule of activities convenient or inconvenient for you? Why?
6. Do you feel the staff meet your needs? Why/how?
7. Do you any difficulty in getting transportation to activities? If so, why?
8. Name some area where you think SLC Adaptive Rec. can improve their program.
9. Are there current programs offered that you are not able/cannot attend? If so, why?
10. Any additional comments?

Appendix B: Line-Item Budget Detail
Source of Specific costs or sources of income Cost

Start-up Costs Laptop $700.00
Dry-erase markers $8.00
White board eraser $1.64
OT evaluations:
 Sensory Profile $410.00
 Allen Cognitive Screen Assessment (ACLS-5 and $224.99
LACLS-5)
 Movement ABC
$1,092.00
 Leisure Competence Measure
$70.00
Total= $2,506.63
Direct Costs
Articles/database access $300.00
Internal Promotion Materials
 Software $27.97
 Paper (for handouts and promotion) $24.95
 Ink (for promotion and handouts)
$200.00
OT part-time $14,560
8 hours/per week x $35/hour X52 weeks
(hours include two hours of staff training classes, two
hours of caregiver classes, 3 hours of one-on-one
consultation, 1 hour management meeting)
Total= $15,812.92
Indirect Costs
In-kind Facility, classroom, adaptive equipment, utilities $0
Projector $500
Total $500
Income
Education classes for staff and caregivers at no charge
Total= $0
Budget Summary
Total costs $18,319.55
Total income or in- $500

kind contributions
Net cost of program $17,819.55
Appendix C: Staff and Caregiver Qualitative Survey Questionnaire
1. Describe how these classes have benefited your ability to provide adaptive recreation
opportunities to your client or caregiver?
2. Describe at least one principle you have learned during the education classes that you did
not previous know.
3. What principles from the classes have you implemented for your participants and how
have you done that?
4. What principles do you feel have been the most effective in providing increase
participation and why?
5. What principles do you feel have been least effective in providing increase participation
and satisfaction and why?
6. Describe how these classes could improve to help you increase your confidence in
improving participation and satisfaction of your clients?
7. What were the benefits you experienced with the one-on-one consultation service with
the occupational therapist?
8. What improvements would you suggest for the one-on-one consultation service with the
occupational therapist?
Appendix D: Staff and Caregiver Quantitative Survey Questionnaire
Name:____________________________________
Q1 I feel confident in my knowledge of different diagnosis and the impact it has on participation
in adaptive recreation.
5 4 3 2 1
Strongly Disagree Disagree Undecided Agree Strongly Agree
Q2 I feel like I can implement grading into activities to fit the needs of the clients.
5 4 3 2 1
Q3 I have a good understanding of activity analysis and how to utilize it for various recreational
activities.
5 4 3 2 1
Q4 I have a good understanding of different adaptive equipment that can be used during
recreational activities.
5 4 3 2 1
Q5 I have implemented the skills that I learned in the classes regularly.

5 4 3 2 1
Q6 The participants have increased their participation in recreational activities since

implementing the skills I have learned.
5 4 3 2 1
Q7 The participants have increased their satisfaction in recreational activities since

implementing the skills I have learned.
5 4 3 2 1
Q8 I have utilized the one-on-one consultation service with the occupational therapist.
5 4 3 2 1
Q9 I have found the one-on-one consultation service with the occupational therapist to be
useful.
5 4 3 2 1

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Running Head: Staff and Caregiver Education Program 1

Staff and Caregiver Education Program for Participation in Adaptive Recreation

An Occupation-Based Community Program for Salt Lake County Adaptive Recreation

The purpose of this paper is to propose an occupation-based community program

County Adaptive Recreation using structured and semi-structured interviews. Onsite

above mentioned needs.

various adaptive recreation options.

developmental and intellectual disabilities. The majority of individuals that participate in

offered, season changes, and individual socio-economic factors of participants.

SLCAR states the following in regards to age requirement:

Recreation Coordinator based on the appropriateness of the activity.

(Salt Lake County Parks & Recreation, n.d.).

Disability Act (ADA). Section 35.130 of Title II of the ADA states:

No qualified individual with a disability shall, on the basis of disability, be excluded

from participation in or be denied the benefits of the services, programs, or activities of a

public entity, or be subjected to discrimination by any public entity.

(Americans With Disability Act, 2010)

locations, activities and programs need to be accessible, inclusive and non-discriminatory to

the opportunity to participate in desired recreational activities for years to come.

Another policy that influences SLCAR is the program’s designation as a public,

community-based, government-run agency. This designation prohibits delivery and billing of

programs due to the severity and/or complexity of their disability.

inability of caregivers to be present during activities for low-functioning participants.

outdoor recreation readily available.

recreation programs difficult.

SLCAR programs is prevalent and may present an apprehensive attitude of minorities to

Another important demographic aspect is that the homeownership from 2012-2016 in

because there is less stability in long-term participation/commitment of individuals in SLCAR

programs. With a higher turnover rate of participants, SLCAR experiences a lack of

advertisement of services to the community.

population and not have opportunities to integrate into their communities.

many away from participating in recreational activities.

also trained in de-escalation techniques, of which includes restrainment of participants if

related services outside of the program.

Future Plans. The main priority of the future is to increase overall

attendance/participation in SLCAR programs. Administration stated that SLCAR has the

efforts are being made to increase publicity and advertisement of SLCAR.

Program Strength and Areas of Growth

Administrative and Staff Perspective

Adaptive Recreation Manager. A formal one-on-one structured interview was

of caregiver training or education on implementing these activities at home or in their

that educational background that she has.

various disabilities, staff agree that the effectiveness of adjusting/adapting activities in

accordance with functioning of different disabilities is decreased.

Transportation to SLCAR activities was also identified by staff as a weakness of the

program. Participants must rely on caregivers or public transportation to arrive at SLCAR

transportation solely on caregivers, which staff believe is a burden for them.

Client and Caregiver Perspective

Client. Unstructured, informal one-on-one interviews were conducted with 5 participants

during the week.

good amount of time for everyone to participate.

burdensome due to weekly scheduling conflicts.

fully engage in activities in a fulfilling manner.

Diagnosis, adaptive, recreation, long-term, outcomes, limitations, participation, programs, staff,

were located through CINHAL database.

Need of Community-based Adaptive Recreation

Understanding the need of adaptive recreation is important to validate and justify

Social participation. In general, most individuals with disabilities experience decreased

(Shields, Synnot & Kearns, 2015).

interacting with others (Schleien, Miller, Walton & Pruett, 2014).

Physical health. Participating in recreation activities, especially physical activities, helps

Specifically concerning individuals with disabilities, there seems to be a big health

disparity compared to individuals without disability. According to Healthy People 2010: