Youth and Parent Perspectives of an Environment Problem-Solving Intervention for Transition-Age Youth With Disabilities

PURPOSE: Youth with disabilities and their families have called for rehabilitation services that increase participation in school, work, and the community. To respond to this call, occupational therapists need access to participation-focused interventions that youth and families find acceptable and beneficial. Project TEAM is a 12-wk problem-solving intervention that teaches youth to identify and resolve physical and social barriers to participation. TEAM includes manualized group sessions, personal participation goals, and peer mentoring. The aim of this study was to evaluate the social validity of TEAM for transition-age youths with developmental disabilities (DD) and their families. The study sought to answer the research question, Do youths and their parents find TEAM’s purpose, procedures, and perceived benefits socially valid?

DESIGN AND METHOD: This study used a mixed-methods evaluation design. Study participants were a convenience sample drawn from TEAM implementation in schools and agencies with seven cohorts in two states. Forty-two youths with DD (M age= 17.5, n = 26 male, n = 31 White, n = 28 with intellectual disability) completed TEAM and were eligible, along with their parents, for this optional evaluation. Youths (n = 39) completed three confidential evaluation activities: (1) a vote for TEAM activity preferences, (2) a survey about TEAM, and (3) group discussion about TEAM. Parents (n = 37) were enrolled in an online forum moderated by an independent evaluator and answered open-ended questions about TEAM purpose, procedures, and benefits.

Quantitative and qualitative data were entered, transcribed, and masked by independent evaluators. Quantitative data included descriptive statistics of activity preference votes and survey responses. Qualitative data included content coding of group discussion and online forum responses. Data were integrated for interpretation by aligning each data point to a social validity matrix (purpose of TEAM, TEAM procedures, and perceived benefits of TEAM).

RESULTS: Almost all youths liked learning how to resolve environment barriers, although some TEAM content was difficult to understand. Parents valued the youths’ increased ability to resolve barriers to participation now and in the future, along with skills gained while pursuing personal goals (e.g., community mobility). All TEAM learning activities had ≥92% positive preference votes; the least preferred activities required role-playing. Youths were most satisfied with TEAM leaders and community trips (97% positive ratings) and least satisfied with peer mentoring calls (6% negative ratings). Parents indicated that community trips, peer mentoring, and group sessions were acceptable and beneficial. Parents had difficulty balancing homework demands and felt their son or daughter struggled during peer mentoring phone calls. Perceived benefits were as follows: 89% of the youths reported using TEAM concepts in their everyday lives, and parents observed increases in the youths’ confidence, self-awareness, problem-solving, and communication skills and increased participation in vocational activities and social relationships.

CONCLUSION: Transition-age youths with DD and their parents found Project TEAM acceptable and relevant to the youths’ current and future lives. Youths with DD may need more assistance with peer mentoring phone calls, and a complementary parent training may increase the generalizability of TEAM concepts to youths’ everyday lives.

IMPACT STATEMENT: A number of pediatric interventions now target the environment as the primary mechanism of change to increase participation. Establishing the social validity of a new environment-focused intervention such as Project TEAM is critical given the significant shift it represents from rehabilitation’s more traditional focus on body structures and function. Our results highlight the salience of environment- and participation-focused interventions such as TEAM for youth and families.