Abstract
This study examined how occupational therapy practitioners can use an intervention called Journeys with youth at risk in an educational setting.
Adolescence is a critical period marked by significant physical, emotional, and cognitive changes (Follesø, 2015). Youth at risk are adolescents, ages 12 to 18 yr, with average to above-average intelligence and no active mental illness, who live in conditions that could endanger their safety, health, and development. They experience heightened vulnerability, which often leads to behavioral problems that are predictive of negative outcomes, such as dropping out of high school or having poorer academic performance (Sinclair et al., 2021; Toglia & Katz, 2018). They are often alienated from school or work and show patterns of delinquency (Jones, 2024; Müller & Pollak, 2015; Toglia & Berg, 2013).
Regardless of whether a given task is performed correctly or not, there may be discrepancies in people’s self-evaluation of their own performance compared with an objective evaluation; that is, they may either underestimate or overestimate their own abilities (McIntosh et al., 2022). This phenomenon is more common among low-performing students compared with high-performing students, with greater gaps between performance and self-evaluation of performance as the level of proficiency decreases (Schoo et al., 2013). Indeed, youth at risk may exhibit characteristics that lower the awareness of their performance, abilities, and limitations (Savage & Fearon, 2021). Individual factors, such as academic underachievement, can hinder acceptance of their own capabilities and potential (Lichner et al., 2021). Therefore, both public and private organizations advocate for the development of interventions to reduce these youth’s risk behaviors and to promote their well-being and self-efficacy (Etzion & Romi, 2015).
Interventions proposed for youth at risk that are based on mindset refer to a cluster of beliefs and perceptions that influence an individual’s interpretations of their abilities and responses to successes and failures (Burnette et al., 2013). Growth mindset entails self-efficacy, self-belief, and self-perception. Those with a growth mindset believe that abilities can be developed and improved; mistakes lead them to increase their efforts and look for alternate strategies (Billingsley et al., 2023). In contrast, a fixed mindset leads to low motivation and fear of effort and investment; students with a fixed mindset tend to see failures as a measure of their personal shortcomings and may have a low sense of competence (Burnette et al., 2018). A person’s type of mindset may be related to the effective activation of strategies that affect their ability to function and participate.
Interventions that facilitate a growth mindset should therefore aim to encourage students to reflect on their thoughts and actions and become aware of the regulatory and adaptive strategies they use when performing relevant tasks (Lin-Siegler et al., 2016). Growth mindset and self-awareness seem to make significant contributions to a student’s ability to respond to failure as well as to meet various daily challenges, from achievements on test scores to sound mental health and well-being (Yeager & Dweck, 2020). Even a single session of growth mindset intervention can result in somewhat improved growth mindset among adolescents with anxiety and depression (Schleider & Weisz, 2018).
We therefore developed an intervention called “Journeys”—Exploring Beyond Classroom Walls. The Journeys intervention, detailed below, was designed to provide meaningful, relevant, and reflective learning activities based on current educational constructs (Park et al., 2016). These constructs refer to learning beyond formal schooling, covering a wide range of extracurricular activities that are not limited to school-based activities, including additional outdoor learning environments. Such environments may be especially beneficial for youth who struggle in traditional indoor classroom settings (Park et al., 2016). Moreover, by incorporating extracurricular activities, community engagement, and project-based learning that involves students designing, developing, and constructing their own solutions to problems (Kokotsaki et al., 2016), the intervention can cater to different learning styles. The intervention was also designed to encourage improvement in daily performance, task analysis, and self-perception of one’s ability (Park et al., 2016).
The aim of this study was to examine the extent to which performance, self-perception of performance, and growth mindset changed following participation in the Journeys intervention. The implementation of this intervention was expected to highlight the unique contribution that occupational therapy practitioners have among the educational team in supporting youth at risk overcoming daily challenges.
Method
Participants
Of a total 77 students, 46 students (59.7%) who attended Grade 10 or Grade 11 in a special education school for youth at risk agreed to participate in the Journeys intervention. Sixteen students (14 boys [87.5%], 2 girls [12.5%]) were in Grade 10, and 30 students (19 boys [63.3%], 11 girls [36.6%] were in Grade 11. Their mean age was 16.5 yr (SD = 0.62). Among the participants, 11 students had no formal diagnosis, and 16 students were diagnosed as having attention deficit hyperactivity disorder (2 students were taking medication during the study period, and 14 had previously taken medication but were not at the time of the study). Another 2 students were diagnosed with learning disabilities, and 1 student had a borderline disorder.
Measures
We used the following measures for the study. The demographic questionnaire included general information such as age, gender, grade, and health status.
The Weekly Calendar Planning Activity (WCPA; Toglia, 2015) is a performance-based assessment of functional cognition that involves the performance of a multistep, everyday cognitive instrumental activity of daily living. For this study, we used the 10-item Hebrew version of the WCPA. The examinees are asked to record meetings and errands over a 1-wk schedule while following rules and instructions and filtering out distractors. The examiner observes the examinee and records accuracy, efficiency, and total task duration as well as the use of strategies. Self-evaluation of performance is determined by a posttask interview.
The 10-item WCPA version is based on the full 18-item version that had been shown to be a sensitive measure of functional cognitive performance and suitable for evaluating executive functions, awareness, and the use of strategies for adolescents with and without disabilities (Arora et al., 2021; Jaywant et al., 2021; Zlotnik et al., 2020; Zlotnik & Toglia, 2018). The 10-item version, created to decrease the administration time for those with greater cognitive deficits, was previously used with healthy adults and was shown to be a sensitive measure of functional cognitive performance (Arora et al., 2021). For the current study, we used accuracy and efficiency scores, analysis of the error patterns, total time and planning time, number of strategies, and number of kept rules.
Because of COVID-19 social distancing regulations and restrictions, we assessed the performance of the WCPA during an online Zoom call. This change was preceded by consultation with the developer of the WCPA (J. Toglia, personal communication, October 1, 2021), and a small pilot study (not published) was conducted in which the optimal location of the camera was determined.
We used the “Kind of Person” Implicit Theory Scale (Dweck, 1999) to measure growth mindset and fixed mindset. The test was translated into Hebrew (and back translated to English to verify the validity of the translation in accordance with standard procedures) for the current study. It uses a 6-point Likert scale (from 1 = strongly agree to 6 = strongly disagree). We divided the scores into a growth mindset, fixed mindset, and mean score, with higher scores representing a higher growth mindset. The wording of the scale was simplified to make it easier to understand and be more culturally relevant while preserving the original meaning of the statements. For example, the expression “You can’t teach an old dog new tricks” does not have a corresponding phrase in Hebrew, so we used “It is not possible to change old habits.” Data from six validation studies of the original scale demonstrated high internal reliability (.85 to .98) and test–retest reliability over a 2-wk interval ranging from .80 to .82 (Dweck et al., 1995).
Research Design and Procedures
We used a pre–post study design (Graham et al., 2012) to investigate the change in outcomes before and after a 2-mo intervention. Students with mental health difficulties were not referred by the teachers and were excluded from the study. Reasons for declining to participate included concerns about issues related to the COVID-19 pandemic. We obtained approval from the Ethics Committee of the University of Haifa (No. 369/19) as well as from the chief scientist of the Ministry of Education (No. 10964). Participating students and their parents signed an informed consent. After completion of each test, we sent the WCPA forms to a single examiner for offline analysis.
Educational Intervention
The Journeys intervention is a collaborative effort between the educational staff and the occupational therapy practitioners and was rooted in shared concepts of growth mindset and metacognition. It is an in-depth learning experience that runs over several consecutive days at various locations within and outside the school. It aims to address personal, social, and emotional issues. The intervention focuses on students’ involvement in formulating and carrying out learning activities with a particular focus on proactive, reflective observation. The program strives to expand and deepen students’ growth mindset and sense of competence.
Grade 10 students participated in planning and preparing a 2-day field trip. They were divided into committees (e.g., content, logistics) and supervised by teachers who advised on goals, values, procedures, and independent work structures. Students managed the budget within a framework set by the teachers.
Grade 11 students met with people involved in social activities that contributed to the community, such as nonprofit organizations. They attended lectures, participated in group discussions, and developed simulated organizations to meet societal needs, presenting their work during a hackathon.
Metacognitive Principles and the Contribution of Occupational Therapy Practitioners to the Intervention
Occupational therapists conducted a workshop on metacognitive principles and guided discovery for the educational staff, providing ongoing feedback and guidance. The metacognitive aspects were detailed in a brief given to the staff to adhere to the guidelines of metacognitive mediation and guided discovery principles. Sharon Zlotnik advised the school educational staff to keep the study blind, and Sivan Regev evaluated the students.
Before the intervention, the occupational therapists conducted a workshop on metacognitive principles and guided discovery and provided ongoing feedback and guidance to the teachers. The educational staff then oversaw the intervention, which was embedded into the ongoing curriculum (see the Appendix). That is, the occupational therapists contributed the functional cognition elements and framework, and the teachers provided the learning experiences. The intervention spanned a period of 2 mo, occurring both within and outside the school. It centered on students’ active participation in designing and executing learning activities and emphasized proactive and reflective engagement, such as planning a 2-day field trip by analyzing the task demands. The students were divided into committees, each tasked with a distinct mission, and were supervised by teachers who guided them in setting goals, defining procedures, and creating an independent work structure. For example, the overall budget for the event was set by the teacher, but the active ingredient—the allocation of money for each task—was carried out by five to six students achieving consensus as a group.
The 2-mo Journeys intervention was conducted by the school staff, and the assessments were conducted prior to and following the intervention by a single research assistant who was blinded to the students’ academic performance. Each student completed the Kind of Person scale and then performed the WCPA 1 mo before and 1 mo after the intervention.
Data Analysis
We used IBM SPSS Statistics (Version 25) for statistical analysis. Descriptive statistics included means, standard deviations, and ranges of both Kind of Person and WCPA scales, alongside strategy prevalence pre- and postintervention. We used multivariate analysis of variance and Wilcoxson tests to assess gender and grade-level differences. Significance was set at .05.
Results
WCPA Performance
Both the accuracy scores (M = 5.00, SD = 3.44) and efficiency scores (Mdn = 109.59, SD = 52.45) were significantly higher after the Journeys intervention compared with before: for accuracy, M = 3.37, SD = 2.69, F(1, 00) = 4.67, η2 p = 0.14, p < .05; for efficiency, Mdn = 190.9, SD = 101.43, Z = –2.49, p < .01. No significant differences were found for duration (total time and planning time), the number of strategies, or number of kept rules.
An in-depth analysis of the error patterns before and after the intervention showed a range of performance errors that decreased significantly (see Table 1). Each participant had several types of errors or repeated the same error more than once. As a group, before the intervention, the most common errors (73.9%) related to location (e.g., assigning appointments on the wrong day) and name mistakes (e.g., writing the wrong name or only partial appointment name). Self-recognition error and time error decreased after the intervention but were not statistically significant.
Differences Between the Weekly Calendar Planning Activity Error Patterns Before and After the “Journeys” Intervention
Note. Ranges are the range of participants’ scores.
WCPA Awareness
Before the intervention, most participants (93%) correctly estimated the duration of their performance time, and all participants correctly estimated the duration after the intervention. However, 61% of students overestimated the number of accurately scheduled appointments before the intervention, and 78% overestimated their performance after the intervention.
Growth and Fixed Mindset
Students’ mindset scores did not differ significantly by gender. The fixed mindset scores showed a small decrease following the intervention (from 3.26 to 3.17), and the growth mindset scores also decreased (from 4.70 to 4.40). Mean scores remained moderate both before (M = 3.98, SD = 0.57) and after (M = 3.78, SD = 0.80) the intervention, and no significant differences were observed. However, a significant interaction effect was found between school grade and growth mindset scores. That is, the changes in mean scores for 10th-grade students before and after the intervention (M = 4.32 to M = 4.62) differed significantly from those of 11th-grade students (M = 5.02 to M = 4.22) such that the growth mindset of 11th-grade students decreased significantly after the intervention, whereas those of 10th-grade students did not.
Discussion
This study aimed to evaluate changes in growth mindset and functional performance among youth at risk following an intervention outlined by occupational therapists and directed by educators. The observed postintervention scores in the students’ performance of the WCPA accuracy, efficiency, and strategic application point to an improvement and a change in how students approached the WCPA task. In addition, to our knowledge, this study represents the first use of the 10-item WCPA version for youth at risk, demonstrating its ability to detect changes in students’ functional performance following an intervention.
The observed postintervention improvements in accuracy, efficiency, and strategic application point to what appears to be a transformative shift in how students approach tasks. Nevertheless, although the growth mindset scores of 11th-grade students decreased significantly after the intervention, those of 10th-grade did not. We do not have sufficient data from this pilot study to speculate whether this difference was due to a greater maturity of the older students or to one or more unique aspects of this group’s participants (e.g., a particular student playing an influential leadership role).
From an educational perspective, the content of the Journeys intervention was in line with the existing curriculum, whereas its innovative approach related to the teaching methods for learning and evaluation, allowing for adaptive learning through experience, informal learning, self-reflection, and self-observation. Previous studies have found that interventions that are geared exclusively toward creating change in a teacher’s mindset are not as effective as interventions that also involve the students (Yeager & Dweck, 2020). Moreover, teacher–student relationships are crucial to support growth mindset as well as metacognitive development (Wang et al., 2021). Therefore, the intervention in the current study was specifically developed to entail direct mediated interaction between the students and their teachers, guided and supported by the occupational therapists. It is likely that both the Journeys intervention with its complex and cognitively demanding functional tasks and the feedback received from teachers helped the students to approach their tasks in a more organized manner.
Most of the students accurately estimated the duration of their WCPA performance both before and after the intervention. This is consistent with previous studies of typical adolescents (Zlotnik & Toglia, 2018). Although most of the errors were significantly reduced, accuracy overestimation occurred, which may be related to the way students experienced their performance in similar contexts at school. It may be that the amount of support and accommodation they received (as evident from one teacher’s remark that “some [students] were not able to manage their schedules independently and needed much support”) can account for the sense of completion and overconfidence. It should be mentioned that to facilitate accurate evaluation of performance, mediation should be directed at self-monitoring of the performance, enabling the students to make future use of this information and encouraging a growth mindset (Dweck et al., 2014). This was one of the lessons learned from our research: As awareness grew, the mediator encouraged and guided the learners to consider appropriate ways to deal with their challenges (Jaywant et al., 2022; Toglia et al., 2012), which was expected to facilitate more awareness and enable the transfer of strategies to other functional domains. During the intervention, repeated experiences accompanied by the teacher’s mediated feedback and their guided discovery of strategies appeared to allow students to more clearly perceive how they were performing. This method was expected to encourage the students to make future use of the information and facilitate greater knowledge of their abilities (Pigeon et al., 2017).
Limitations
Although most of the students (approximately 60%) who participated in this small, convenience sample pilot study were able to persist throughout the research period, some were unwilling or unable to attend both pre- and posttest points and thus completed only one of the questionnaires or declined to answer some of the questions that demanded self-evaluation or introspection. In several cases, the students expressed considerable frustration. Therefore, different numbers of participants contributed to each measurement. This is not surprising because youth at risk have been shown to have a high dropout rate, lack persistence, and to have a wide range of challenging behavior patterns (Zaff et al., 2017). Nevertheless, motivation was also affected by awareness and could be temporarily decreased as students’ awareness developed (Toglia & Foster, 2021).
We note that socioeconomic status and parents’ education are very relevant to the demographic data of youth at risk, although these data were not available. In general, however, the students at this school did not come from a low socioeconomic background.
As previously mentioned, because of COVID-19 social distancing regulations and restrictions, the performance of the WCPA was assessed during an online Zoom call, which was authorized by the developer of the assessment. Finally, the procedure of translation and adaptation of the Kind of Person scale was not further tested.
Implications for Occupational Therapy
This study has the following implications for occupational therapy practice: The novelty of this study is that it provided students an opportunity to monitor self-awareness and growth mindset as they reflected on their potential for change while engaging in the Journeys intervention. We advocate for continued exploration of the Journeys interventions tailored to youth at risk as they experience incremental engagements in problem-solving, seamlessly woven into the school routine. These efforts can be enhanced via structured guidance on task analysis, discovery of strategy, and mediated feedback—an essential role that occupational therapy practitioners can provide to the educational team.
Conclusion
The “Journeys” intervention demonstrated significant improvements in the functional performance and self-awareness of youth at risk, particularly in their ability to plan and execute complex tasks. The study results indicate that the intervention effectively enhanced students’ accuracy and efficiency in task performance, as measured by the WCPA. Because the growth mindset scores showed mixed results, the objectives of the study were partially met; however, the overall findings suggest that the intervention facilitated greater engagement and strategic application in daily activities.
These outcomes highlight the critical role of occupational therapy practitioners in educational settings, where they can provide valuable guidance and support to both students and teachers. By fostering a growth mindset and improving metacognitive skills, occupational therapy practitioners contribute to increasing real-life function, engagement, and satisfaction with occupations among youth at risk. The study objectives were met, demonstrating the potential of the “Journeys” intervention to have a positive impact on the daily lives and future prospects of participating students.