Date Presented 04/04/19
Project TEAM teaches transition age youth to identify and resolve environmental barriers to participation. In this quasi-experimental study, youth in Project TEAM sustained increases in problem solving and self-determination, and attained more participation goals than goal setting only.
Primary Author and Speaker: Jessica Kramer
Additional Authors and Speakers: Christine Helfrich, Ariel Schwartz, ITing Hwang, Preethy Samuel
Contributing Authors: Eric Kolaczyk, Aleksandrina Goeva
PURPOSE: There is a need for interventions that prepare transition-age youth with developmental disabilities (DD) to identify and resolve environmental barriers to participation (1). Project TEAM (TEAM) teaches a problem solving strategy to identify and resolve physical and social environment barriers to participation goals in school, work, and the community (2). This study examined the effects of TEAM on attainment of participation goals, problem solving skills, and self-determination.
DESIGN: Quasi-experimental, repeated measures with two groups. Intervention: Project TEAM is a multi-component, 12 week intervention focused on a personal participation goal and includes group sessions, peer mentoring, and a community-based trip. TEAM cohorts (5 New England, 2 Midwest) implemented in community-based agencies (4 cohorts) and schools (3 cohorts). Comparison group: Youth work towards a personal participation goal over 12 weeks.
PARTICIPANTS: Convenience, matched samples. Inclusion criteria: 14 to 22-years; diagnosis of DD; ability to attend to activities for 10 minutes and follow two-step directions. At baseline, TEAM youth (n = 47, mean age = 17.49) had significantly lower IQ than comparison youth (n = 35, mean age = 17.46) (p = 0.04); no other significant group differences.
METHODS: Measures completed at baseline (B), after 12 weeks of TEAM or goal attainment period (O), and at 6-week follow up (F). Participation: Goal attainment scaling (GAS) with goals set at B by youth and rated at O and F. Problem solving: Two part assessment; Part I assessed knowledge of environmental barriers and modification strategies; Part II assessed ability to problem solve standardized participation scenarios. AIR self-determination scale (3) included parallel youth and parent reports.
ANALYSIS: Changes over time and between groups on problem solving and self-determination were analyzed using linear mixed effect models. Nonparametric tests compared GAS achieved/not achieved.
RESULTS: Participation: TEAM youth more likely to attain participation goal (O: 88.4%, F: 97.6%) than comparison youth (O: 73.5%, F: 77.1%); significant at F (p = .009). Problem solving Part I: TEAM youth had significantly higher scores than comparison group at O (CI: 0.90, 2.74) and F (CI: 0.38, 2.22). TEAM youth significantly increased between B and O (CI: 1.98, 2.96) and B and F (CI: 1.68, 2.66). Problem solving Part II: No significant differences between groups. TEAM youth significantly increased between B and O (CI: 1.04, 14.65) and B and F (CI: 1.60, 15.21). Comparison youth significantly increased between B and F (CI: 2.75, 18.52). Self-determination: Youth report: No significant differences between groups; comparison youth reported a significant increase in between B and O (CI: 0.49, 13.57). Parent report: No significant differences between groups; parents of TEAM youth observed a significant increase between B and O (CI: 0.37, 7.02) and B and F (CI: 1.32, 7.98).
CONCLUSIONS: TEAM participants, although more cognitively impaired, increased problem-solving, increased self-determination, and attained more goals. These changes were sustained 6 weeks after the completion of the intervention. Although comparison youth reported some change in self-determination after setting and attaining participation goals, these changes were not sustained and were not observed by parents. These findings suggest youth in TEAM were prepared to take action to resolve environmental barriers to participation goals.
IMPACT STATEMENT: OTs may use TEAM to support the participation of transition-age youth with DD in everyday life situations in which they typically experience disparities, including community participation, postsecondary education, and employment (4).
References
1. Kramer, J., et al. (2012). Youth with disabilities’ perspectives of the environment and participation: A qualitative meta- synthesis. Child: Care, Health, and Development, 38 (6), 763-777. doi:10.1111/j.1365-2214.2012.01365.x.
2. Kramer, J., et al. (2013). Involving youth with disabilities in the development and evaluation of a new advocacy training: Project TEAM. Disability and Rehabilitation, 35(7), 614- 622. doi:10.3109/09638288.2012.705218
3. Shogren, K. A., et al (2008). Understanding the construct of self-determination: examining the relationship between the Arc's Self-Determination Scale and the American Institutes for Research Self-Determination Scale. Assessment for Effective Intervention, 33(2), 94-107. DOI:10.1177/1534508407311395
4. Newman, L., et al. (2011). The Post-High School Outcomes of Young Adults with Disabilities up to 8 Years after High School: A Report from the National Longitudinal Transition Study-2 (NLTS2). National Center for Special Education Research.
