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Prepared and Ready: Equipping Students for Meaningful Post-secondary Opportunities

By Shelby Miller, SPT

 

Background of Project Development

This project is related to preparing students with disabilities for post-secondary opportunities, including utilizing evaluations and interventions focused on work preparedness. This project directly relates to my clinical practice and professional development goals because it addresses the patient population that I hope to work with throughout my career. With aspirations to work in the public-school system, I aim to improve the lives of children with disabilities. Clinicians working with students with disabilities should seek to promote independence both in current setting and in the development of skills needed to foster independence in the future. Clinicians can improve not just the current lives of the students as they help to cultivate accessibility and independence in the school setting, but also the future lives of students as they help to equip them up for meaningful post-secondary opportunities. However, in my clinical experience and discussions with clinicians, these aspects are not always considered by physical therapists in the school system. I hope to advance the practice of physical therapy in the school system by contributing to the body of knowledge, adding useful and effective resources, and widening perspectives of how we can functionally benefit students.

While considering my Capstone project, I had discussions with two of my previous clinical instructors about current initiatives in their school system. These fantastic school-based physical therapists, Dr. Sharon Antoszyk, PT, DPT, PCS and Dr. Jenny Mah, PT, DPT, helped to direct my ideas towards products that would be practical and tangibly useful for physical therapy practice in the school system. Additionally, they offered advice and resource suggestions to help incite inspiration for this project. Sharon and Jenny helped to focus my ideas, and we were able to align my interests to contribute to an initiative that they were considering in their county for developing evaluation tools related to work preparedness for children with disabilities.

Throughout the development of this project, their guidance, along with the guidance of my advisor, the incredible Dr. Laurie Ray, has been invaluable in creating an excellent direction and vision for this Capstone. I am thankful to have such wonderful teachers and mentors, who are all magnificent leaders in the field, supporting me in my development of this project in order to help turn grand ideas into reality.

 

Statement of Need

This project addresses the need to consider the elements of post-secondary transition for student with disabilities from an early age. Additionally, it addresses the need to implement physical therapy evaluation and interventions related to work preparedness for children with disabilities in order to equip and prepare them for post-secondary opportunities for community engagement. A review of the literature distinctly demonstrates that students with disabilities face high unemployment rates and are not adequately supported in post-secondary transition.^2-11 Clearly, implemented practices, and then resulting research on the effectiveness of those practices, are both needed related to post-secondary transition strategies and plans of care focused on work preparedness for students with disabilities.

Individuals with disabilities have lower employment prospects as compared to their peers.^2-4 While 78% of people who do not have disabilities report part- or full-time employment, this is only true of 35% of people with disabilities.² The Office of Disability Employment Policy cites employment rates for individuals with disabilities as 60-70% less than those without disabilities.³ Furthermore, research shows that nearly three times as many people with disabilities live in poverty with less than $15,000 in annual income, when compared to those without disabilities.² However, there is evidence that transition services and education can successfully decrease the unemployment rate for this population.² Research suggests that “for individuals, with or without disabilities, to obtain and maintain employment, they must possess a strong foundation of transferrable and general employability or work-readiness skills.”⁴ While individuals with disabilities face a variety of barriers when considering transition to adulthood and employment opportunities, these barriers can be addressed through evaluation and intervention strategies in order to optimize their success and equip them for meaningful post-secondary opportunities. Addressing areas related to post-secondary transition is essential to quality of life for people with disabilities.⁵ However, having an effective impact on these areas requires early planning and skill development so that students can be prepared and ready.⁶ Nonetheless, research shows how post-secondary transition needs are inadequately addressed for people with disabilities.^5,7-10

Furthermore, there is a lack of current structures to assist students with disabilities in developing functional skills needed for employment and specific workplace skills. Additionally, there is a lack of impetus on interventions addressing these useful domains for students with disabilities starting from a young age. Though it is needed, evaluation and intervention related to work preparedness is not yet fully established in physical therapy practice.¹¹Not only is the implementation of work preparedness in plans of care limited as a standard of care, the resources that are available to assist physical therapists are sporadic, uncoordinated, disorganized. Therefore, there is need not only to highlight the pertinence of a focus on work preparedness and beginning post-secondary transition planning from an early age, there is also a need to provide supportive resources and compilation of knowledge in order to effectively implement concepts in practice.

 

Purpose and Overview

The purpose of this project is to provide materials to enhance physical therapy practice related to post-secondary transition for students with disabilities, including a focus on work preparedness. These materials are intended to inform and impact physical therapy practice for school-based physical therapists related to developing impactful plans of care, as well as provide useful evaluation and intervention structures. Use of the materials from an early age helps to provide structure and support for students with disabilities to progress towards community engagement goals based on unique interests, preferences, strengths, and talents. The materials can help to:

• cultivate student independence and self-determination
• draw focus on the student’s authentic interests and preferences
• foster their capabilities, and
• optimize their opportunities as engaged members of the community

Additionally, the goals of this project are to:

• optimize continuity of care for students with disabilities through addressing post-secondary transitional elements between pediatrics and adulthood
• enhance patient and family education through providing resources, as well as customizable templates for personalized recommendations for organization and community resources, related to post-secondary transition for students with disabilities
• provide structure for identifying interests/preferences, strengths/skills, weaknesses/impairments, and outcome measure assessment performance related to functional areas of work preparedness for students with disabilities
• ensure student success through creating patient-centered preparatory intervention strategies related to functional areas of work preparedness for students with disabilities
• enrich the body of knowledge related to post-secondary transition and work preparedness for students with disabilities

 

Products

The intended audience of all the products developed as deliverables for this Capstone project includes pediatric school-based physical therapists.

A literature review relevant to the topics of this project was performed and evidence tables were produced based on the available evidence. This literature review researched current structures, or lack of structures, for addressing work preparedness in children with disabilities within the school system. On a broader level, this literature review also explored gaps related to transition of care from pediatrics to adulthood. Current evidence was gleaned in order to demonstrate knowledge gaps as well as support successful interventions and strategies.

1. P&R Literature Review
2. P&R Evidence Tables

The materials developed and created for this project include a Compendium, a Guide, and a Survey. Extensive research of evidence-based practice and existing resources, along with clinical experience and clinician advice, were all utilized to develop these materials. The survey was developed for the evaluation component of this project, as described below. The Compendium includes a compilation of checklists, tools, measures, and resources that can all be used to evaluate students related to work preparedness in order to comprehensively consider their function and guide plans of care. Additionally, it provides information for how to access formal outcome measures cited in its content. The Guide includes sections on:

• timeline for post-secondary transition planning
• post-secondary transitional elements to consider
• resources for help with post-secondary transition planning
• incorporating work preparedness into plans of care
• work preparedness physical therapy interventions
• collaborative partners during post-secondary transition
• helpful post-secondary transition resources and organizations
• helpful physical activity resources and organizations
• customizable helpful resources and organizations reference chart template
• places to find in your community
• customizable resource patient/family handout template

 

3. P&R Compendium of Evaluation Checklists, Tools, and Measures for Students with Disabilities Related to Work Preparedness
4. P&R Clinician Resource Guide
5. P&R Clinician Feedback Survey (also available online)

 

Health Literacy Consideration

Health Literacy was taken into consideration in the development of this project to ensure that materials are understandable and accessible. Various guidelines, such as Plainlanguage.gov Guidelines,¹² and assessment tools, such as The Patient Education Materials Assessment Tool (PEMAT),¹³ were used to analyze the patient and family materials that are embedded with the Clinician Resource Guide. All patient and family materials were written using patient-friendly concepts including the use of simple wording, short sentences, 4-6^th grade level reading material, focus on key points, and emphasis on patient concerns and actions. All of the materials for this project were developed to be easy to read and include bullet points or charts where possible. Further details regarding Health Literacy trainings, resources, and tools utilized during development of this project can be found by viewing the Health Literacy Assignment for this Capstone project.

 

Evaluation Component

The evaluation component of this project includes a Clinician Feedback Survey (also available online) that was developed to gather feedback from practicing physical therapists. The purpose of the survey was to receive opinions on the usefulness of the Compendium and Guide – “Compendium of Evaluation Checklists, Tools, and Measures for Students with Disabilities Related to Work Preparedness” and “Clinician Resource Guide.” The survey included two parts, with separate evaluations of the Compendium and Guide. Within each part, a sliding scale and open response questions were utilized to assess clinician opinions for each of the two materials. Items include information related to things such as ease of use, relevancy to patient population, usefulness, practicality of implementation in clinical practice, and suggestions for further improvement.

The survey was created and dispersed in both a paper format and online version in order to promote accessibility of the survey. The survey, and accompanying Compendium and Resource materials, were distributed to all school-based physical therapists in North Carolina with generous help from Dr. Laurie Ray, who is the Physical Therapy Consultant for the North Carolina Department of Public Instruction, Exceptional Children Division.

The evaluation results of the Clinician Feedback Survey were very positive. Many respondents mentioned that they found the materials organized, comprehensive, and useful. They appreciated the provided resources within the materials, as well as the completeness of the guide which also offered helpful ideas. A common suggestion for improvement from respondents was the idea to include a goal bank with examples of goals that could be individualized to students. Respondents indicated that they could use the materials both as a framework to guide thinking and also to print and individualize for patients. Respondents also indicated that they could see themselves using the materials in their future clinical practice. Further information and specific responses can be found by viewing the Clinician Feedback Survey Response Data or Clinician Feedback Survey Summary Report.

 

Future Plans

Future plans for this project include posting the materials as resources on the North Carolina School-Based Physical Therapy website in order to facilitate further dissemination of the products. Additionally, while the materials have already been disseminated to all school-based physical therapists in North Carolina, there is potential for the materials to be distributed to school-based physical therapists throughout the country. Moving forward, the products from this project will be offered to the Academy of Pediatric Physical Therapy, which is the Pediatric Section of the American Physical Therapy Association (APTA).¹⁴ Additionally, the products from this project will be offered to the School-Based Physical Therapy Special Interest Group of the APTA and the Adolescents and Adults with Developmental Disabilities Special Interest Group of the APTA. The products of this project have already been offered to the consultant for the Intellectual Disabilities Program of the North Carolina Department of Public Instruction, Exceptional Children Division.

This project contributes to physical therapy practice in important ways, however widespread dissemination of the products is essential to informing and impacting future physical therapy practice. Inquiries for additional posting of the materials on other websites, resource databases, or listservs is gladly welcome.

 

Self-Assessment and Reflection

I am extremely pleased with the outcome of this Capstone project. I have invested a lot of hard work and dedication into developing and creating these materials, and I am proud of what was produced. It has been a pleasure to work with my Capstone team, and it is exciting to see things come to completion! I have learned the value of working closely alongside trusted mentors and peers to incorporate feedback and ensure high excellence of work through teamwork. I have grown and learned so much through this process. I also feel that I have successfully completed all of my established personal learning objectives including to:

• understand details related to the legislation and the curriculum of children with disabilities within the school system in order to be informed for affecting future legislation
• cultivate skills needed for material production that integrates evidence-based research and practical clinical recommendations in order to produce a useful and effective resource
• learn how to effectively disseminate new evidence-based materials and resources to various healthcare providers in order to create an impact on clinical practice
• broaden my knowledge of work-related prognosis and opportunity for children with disabilities in order to best use clinical skills to foster, encourage, and optimize their capabilities to be productive members of society

I have thoroughly enjoyed working on this Capstone project! I hope that the dissemination of the products of this project successfully and effectively make an impact on physical therapy practice in order to positively influence the lives of students with disabilities.

 

Acknowledgements

I would like to wholeheartedly thank:

The impressively marvelous Dr. Laurie Ray for her mentorship, support, and invaluable contributions as my advisor for this project. You are an irreplaceable and treasured mentor in my career! I am so grateful for your commitment and dedication to my work, my professional development, and supporting my career. You have been so generous with your wisdom and resources, having an immense impact on my potential. Thank you for being such an inspiration to me now and in the future! I am so thankful to know that you continue to support me in all my endeavors and I cannot wait to work alongside you in my career. Thank you!

The incredibly fantastic Dr. Sharon Antoszyk and Dr. Jenny Mah for their mentorship, guidance, and instrumental contributions to this project as a part of my Capstone committee. You have been monumental in teaching me, leading me, and shaping my career! You have inspired me with your kindness, compassion, and dedication to your students. I would not be where I am without you, and I am forever grateful for your influence in my life! I am thrilled to get to continue to work alongside you in my career. Thank you!

My astoundingly remarkable family and friends for their love, support, care, and encouragement. I am blessed to be a part of such an amazing family and magnificently wonderful community. Your unwavering support and abounding love have been a solid rock for me throughout my time in this doctorate program, and I know will continue to be forever. You have supported me in every way imaginable, and then more! Thank you!

My unbelievably wonderful classmates in the UNC DPT program. You all uniquely inspire me and motivate me in so many ways! You are all brilliant, dedicated, caring, and will be excellent physical therapists! Thank you for your support, love, and encouragement throughout this program. I would not have made it through without the laughs, love, and bond that we all shared together as a family. Cheers to graduation! I have gained lifelong friends, who are more like family, from this program. I cannot wait to continue to work alongside you, learn from you, and be inspired by you throughout our careers. Thank you!

My tremendously awesome teachers and mentors in the UNC DPT program. Words could never describe how impactful you have been in my professional development. Thank you for your dedication, service, and commitment to helping challenge, grow, and develop us into excellent professionals. You teach with kindness, wisdom, and support in ways that are unmatched by any other. I am so excited to have you as professional peers, lifelong teachers, and friends. Thank you!

 

Thank you,

Shelby Miller, SPT

shelby_miller@med.unc.edu

shelbymiller.nc@gmail.com (post-graduation August 2020)

 

References

1. Image sourced from: Exceptional Lives. exceptionallives.org. Accessed April 28, 2020.
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3. Project SEARCH. North Carolina Council on Developmental Disabilities. https://nccdd.org/images/article/initiatives/NCCDD_InitiativeProjSEARCH2017.pdf. Accessed April 26, 2020.
4. Pacha JK. The Effects of Structured Work Experience on the Work-Readiness Skills of Students with Disabilities. ProQuest LLC; 2013.
5. Gabriel P, McManus M, Rogers K, White P. Outcome Evidence for Structured Pediatric to Adult Health Care Transition Interventions: A Systematic Review. The Journal of Pediatrics. 2017;188:263-269.e15.
6. Transition from children’s to adults’ services for young people using health or social care services NICE guideline – National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng43. Accessed December 9, 2019.
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8. McManus MA, Pollack LR, Cooley WC, McAlliser JW, Lotstein D, Strickland B, and Mann MY. Current Status of Transition Preparation Among Youth with Special Needs in the United States. Pediatrics. 2013. 131(6): 1089- 1097.
9. Blackman JA, Conaway MR. Adolescents With Cerebral Palsy: Transitioning to Adult Health Care Services. Clinical Pediatrics. 2014;53:356-363.
10. Crowley R, Wolfe I, Lock K, McKee M. Improving the transition between paediatric and adult healthcare: a systematic review. Archives of Disease in Childhood. 2011;96:548-553.
11. Johnson C. Fit4Work: Fitness for Vocational Tasks for Youth with Disabilities: Second Edition. 2018. ISBN: 1722093382.
12. Plain Language Guidelines. https://plainlanguage.gov/guidelines/. Accessed April 28, 2020.
13. The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide. https://www.ahrq.gov/ncepcr/tools/self-mgmt/pemat.html. Accessed April 28, 2020.
14. Academy of Pediatric Physical Therapy. https://pediatricapta.org. Accessed April 28, 2020.