Program - Facilitating Healthy Habit and Routine Development in Blind and Visually Impaired Youth

Running Head: FACILITATING HEALTHY HABIT AND ROUTINE 1
DEVELOPMENT
Facilitating Healthy Habit and Routine Development in Blind and Visually Impaired Youth: An
Occupation-Based Program for the Utah Schools for the Blind STEP Residential Program
Jessica E. Smith
University of Utah
FACILITATING HEALTHY HABIT AND ROUTINE DEVELOPMENT 2

Introduction
The purpose of this assignment was to perform a needs analysis and develop an evidence-
based and occupation-based program for a rural or underserved population in the state of Utah.
A key component of this project was for the graduate student to learn how to successfully
implement their occupational therapy skills and knowledge into a setting not directly receiving
services by a licensed occupational therapist at this time. In order to more fully and
appropriately design a program to benefit the population, a needs analysis was performed for the
residential portion of the Supported Transition Extension Program (STEP) at the Utah Schools
for the Blind, Ogden campus. The needs assessment was conducted via observation of
occupational performance and general practices of the program, and through face-to-face, semi-
structured interviews with students, administrative staff, Expanded Core Curriculum (ECC) staff,
and live-in blind mentors. Upon completion of the needs analysis, and a literature review
specific to the needs and characteristics of this population and setting, an occupation-based
program was developed for implementation at the Utah School for the Blind STEP residential
program.
Description of the Setting
The Utah Schools for the Deaf and Blind (USDB) are intensive, disability-specific
schools with three main campuses across the state, located in Utah, Salt Lake, and Weber
counties. The Weber county campus of the Utah Schools for the Blind (USB) is located in the
beautiful foothills of Ogden city, on a 13-acre campus with mature trees, fully accessible
playgrounds, indoor swimming pool, full-size gymnasium, spacious school facilities, residential
cottages, a lab, and on-site access to health care and disability-specific professionals. This

Ogden USB campus is where the data collection portion of this needs analysis was conducted
and where the program development will be designed for, and potentially implemented.
History of USDB
The Utah Schools for the Deaf and Blind have been providing services to sensory
impaired students throughout the state for over 100 years. Prior to Utah becoming an official
state in 1896, the need for the establishment of a school specific for deaf students was
recognized, and a specialty school was formed. Upon Utah becoming an official state, the
members of the Constitutional Convention similarly recognized the need for a specialty school
for the blind, and recognized the appropriateness of providing services for both visually- and
hearing-impaired individuals, and thus, the Utah Schools for the Deaf and Blind were
established. The USDB were originally located in Ogden, in a facility which was once a Reform
School; it has since grown to fill three separate campuses across the Wasatch Front, providing a
wide range of services to thousands of deaf, blind/visually impaired, or deaf-blind students.
(Utah Schools for the Deaf and Blind [USDB], 2018d)
The USB Mission and Vision
The USDB provides services to a substantial portion of the blind, deaf, and deaf-blind
community across the state, and has, thus, developed individual mission statements and visions
for both the deaf and blind schools. The mission of the Utah Schools for the Blind campus
program states the following: “providing exceptional, comprehensive, and research-based
education for students with vision impairments and their families to positively impact the
community” (USDB, 2018e). Along with this mission, is the USB vision, which exemplifies
what they as an organization wishes to achieve, and is as follows: “we will focus our determined,
compassionate, and collaborative efforts to empower our exceptional students to lead fulfilling

lives, committed to life-long learning and belonging to their community” (USDB, 2018e). The
motto of USB “Our Vision Has No Limits” (USDB, 2018e), embodies both the mission and
vision for the students and blind community, and serves as a reminder to continue challenging
perceived limitations.
Services Provided
The Utah Schools for the Deaf and Blind (2018) are established organizations that
provide support and services to approximately 1,800 students across the state of Utah; when
including the Educational Support Services provided by USDB, approximately 3,900 students
are served state wide (2018b). The Utah Schools for the Blind (USB) provide intensive school-
based vision instruction and education utilizing the ECC at all three campus locations (Ogden,
Salt Lake City, and Orem) for students from pre-kindergarten, through high school and post-high
school, and also provide school-based outreach services to Utah students in their local school
community (USDB, 2018e). According to the National Center for Educational Statistics, the
North Region Blind school (USB’s Ogden site) was serving 38 students age Kindergarten
through grade 12 for the 2015-2016 school year (United States Department of Education, 2018).
In addition to the school-based programs, the USB also provide support and services through a
variety of non-school-based programs, including the Infant Parent Program for children birth
through age three, various enrichment programs (ECC short-term academies, online-academies,
weekend short-programs, athletics, study abroad opportunities, and summer camps), and a
residential-based transition program known as the Supported Transition Extension Program
(STEP) for students age 16-21 years old (USDB, 2018e).
The STEP residential program.


This STEP program provides residential transitional training with a strong emphasis on
the ECC, or the Expanded Core Curriculum, for high school, post-high school, and college-
transition students. The students live on-campus in newly renovated, gender-specific cottages,
where they share a bedroom with one of their peers, share one of two fully-accessible bathrooms
in the cottage, and share a communal kitchen and comfortable living space. The USB cottages
are currently housing male and female students from Sunday evenings, through Friday
afternoons, for the duration of the 2018-2019 school year. In addition to students, the cottages
are also home to two adult employees fulfilling the valuable role of being a Blind Mentor for the
students; one Blind Mentor resides in each cottage. The additional part-time support staff, and
full-time Blind Mentors provide modeling, guidance, and life experience, as well as provide
opportunities for students to learn and practice residential, pre-vocational, college and career
readiness, and general life skills, that will be essential for this population as they transition into
independent adult roles (USDB, 2018a). The STEP residential program is the specific portion of
the Utah Schools for the Blind that this occupation-based program will be designed for.
The expanded core curriculum.
The Expanded Core Curriculum is a set of “nine unique educational needs for students
with visual impairments”, that should be implemented in addition to the general education core
curriculum (English language arts and other languages, mathematics, science, health physical
education, fine arts and social studies, economics business education, vocational education and
history) of their sighted peers (American Foundation for the Blind [AFB], 2018). The ECC
provides disability-specific specialized instruction in areas that are essential for blind and
visually impaired student success; these nine areas include: vision efficiency skills, use of
assistive technology, independent living skills, social interaction skills, career education, self-

advocacy/self-determination, orientation and mobility, recreation and leisure skills, sensory
efficiency skills, and compensatory skills or functional academic skills, including
communication (AFB, 2018).
Staff disciplines.
As USDB is a well-established group of facilities across the state of Utah, the variety and
availability of educational support services is impressive. In addition to the educators,
paraprofessionals, interveners, and braille educational service aides that help to build the
foundation for the Utah School for the Blind (USB), the following disciplines are also available
for student and family assistance: optometrist, school psychologist, occupational therapist,
physical therapist, speech language pathologist, orientation and mobility specialist, certified low-
vision therapist, expanded core curriculum (ECC) coordinator and educators, family support
specialists, social worker, school counselor, registered nurse, audiologist, adaptive physical
education instructor, job coaches, instructional coaches, dorm staff, and resident blind mentors
(USDB, 2018e; & USDB, 2018a).
Funding USDB
According to Finance Manager at the Ogden campus of the USDB, the schools receive
their funding from a variety of sources, including government funding as a public school, grants
for disability- or program-specific needs, donations, and USDB’s Land Trusts. According to the
Utah Budget Quick Facts, 46% of the $7.3 billion dollars of state funding, was used to pay for
public education in Utah in 2017 (Utah State Legislature, 2018). According to the Public
Education Appropriations Summary for 2017, the Utah Schools for the Deaf and Blind were
appropriated $10.5 million for planning and development at the Utah County campus, $1.0
million for Interpreters and Educators, and $491,000 for Teacher steps and lanes (Utah State

Legislature, 2017). In 1894, shortly before Utah was granted statehood, “Congress created a
land trust including one-ninth of the land of the state to support public schools.”; today, public
schools in Utah still have 3.3 million acres across the state, managed by the School and
Institutional Trust Lands Administration, and these lands provide “tens of millions of dollars
annually to academic programs in public schools across Utah” (USDB, 2018c). Due to the
current availability of funding for the Utah Schools for the Deaf and Blind, program growth and
campus development is currently possible, and will ensure that the continued needs of deaf,
blind, and deaf-blind students across the state are being met.
Future Plans of Agency
The USDB are continuing to grow in order fulfill student and family needs across the
state; part of this growth will occur in Springfield, Utah, where land has been purchased and a
new campus is currently being developed. In regards to the Ogden Campus, growth is also
occurring, but on a less-dramatic scale. The Ogden campus received funding to renovate both
the indoor and outdoor spaces on the campus, in order to provide a more accessible and low-
vision friendly atmosphere. Two adaptive playgrounds have been installed, and the residential
cottages have been completely updated with features more conducive for blind/visually impaired
individuals. In addition to these cosmetic and accessibility changes, three years ago, the USDB
came under new management, which has resulted in a collaborative, driven, and visionary
administrative staff who are more aware of and more supportive of the specific needs of the
students and staff than ever before. The last five years have also brought about implementation
of the Expanded Core Curriculum across all school programs, with increased emphasis in the
STEP programs. The implementation of the ECC across all blind schools, has resulted in the
development of numerous enrichment and ECC specific programs for students and their families.

A few examples of these ECC-based programs are, weekly cooking classes and in-depth
seminars for STEP students, the creation of a multi-use sensory room, plans to grow a sensory
garden on campus, and a long-term goal for the development of a USDB Nature Camp in the
mountains near Ogden to provide unique and enriching experiences for students of all ages.
Target Population
The USDB provides services to students from birth to age 22 with hearing impairments,
visual impairments, blindness, and deaf-blind duel diagnoses; in addition to these conditions,
many of the students may also be affected with comorbidities such as Cerebral Palsy or Autism
Spectrum Disorder. According to the American Foundation for the Blind, Utah had a prevalence
rate of 54,042 persons with vision difficulty in 2016; with 3,939 of those individuals being
between the ages of five and 17 years old, and 8,484 between the ages of 18 and 35 years old
(American Foundation for the Blind, 2018). It is important to note, however, that it is difficult to
determine the actual percentage of visual impairments in school-aged youth due to comorbidities
potentially overshadowing the visual impairments of those students in a special education setting
(Project IDEAL, 2013), and due to many vision-based statistics including vision loss related to
aging conditions. There are currently 13 students receiving services through the STEP
residential program; seven female students and six male students, and more are planning to join
throughout the school year as students reach their 16th birthdays. According to the Occupational
Therapist from the Ogden USDB campus, the majority of blind/visually impaired students have
vision loss as a result of a Cortical Visual Impairment (CVI), or an Optic Nerve Hypoplasia
(ONH), and therefore, have likely experienced their visual impairment for their entire life.
According to Project IDEAL (2013), all students with visual impairment share one experiential
characteristic, that they have a “limited ability to learn incidentally from their environment”; this

therefore, requires that youth receive additional training and education via the Expanded Core
Curriculum.
Social
It is common for visually impaired students to lack the opportunity to develop
appropriate social skills, and is also common for them to have reduced motivation to initiate
social interactions (Project IDEAL, 2013). The school and residential setting at USB, therefore,
provides a unique opportunity for students to live and interact with peers of their same age, who
share similar life experiences and challenges. These shared characteristics, experiences and
proximity of school and home life provide an opportunity for students to build lasting and
meaningful relationships with their peers, that they may not have experienced in a mainstream
school setting. Within the STEP residential setting, the students have quickly become friends
with each other and are often observed advocating for their one another. Additionally, many of
the events in the cottages promote social interaction with each other, such as eating dinner as a
group or occasionally engaging in group recreation activities. There is a risk, however, that if
students become accustomed to only socializing with peers and individuals who are low vision or
blind, then they may have a more difficult time transitioning into society or into the community
where they will be engaging more regularly with individuals who are sighted, and may have
varying perspectives on the world.
External Influences on Service Delivery
Policy
Adolescents who are blind or visually impaired will likely be influenced by many
different policies and laws throughout the course of their lives; at this stage however, there is one
specific policy that directly affects each of them. In 1975, the Individuals with Disabilities

Education Act (IDEA) was passed as a federal law in an attempt to provide access to “publicly
funded, individualized education, including school to adult life transition services”, and
appropriate education to all youth with disabilities in the United States (Cleary, Persch, &
Spencer, 2015). Amendments and improvements were made to this law in 1997, 2004, and again
in 2015, continually attempting to improve the availability and appropriateness of free education,
in an individualized way (Individuals with Disabilities Education Act [IDEA], 2018). All
students at the USB receive services through IDEA, and these services ensure that each student is
appropriately evaluated, provided with professional services (such as occupational therapy) that
are appropriate for them, and that an Individualized Education Plan (IEP) is put in place for the
student, their family, and their education team.
Geographic/Cultural
The USB residential STEP cottages are located on the Ogden USDB campus. This
campus, as described above, is on a large area of land in the foothills of Ogden, resulting in
many of the campus grounds to be on a hill with uneven ground, when on the designated
sidewalk and path areas throughout the grounds. Additionally, this campus is located near a
relatively busy road, Harrison Boulevard, and near a public high school. The proximity of a
busy intersection and a public high school with less experienced drivers often coming and going,
may create a potentially dangerous environment for the blind and visually impaired students
from USB when exploring their environment or practicing their cane skills for community
mobility. Additionally, with the school located in the foothills, the public transportation services
are available less often throughout the day, and may require students to walk approximately 0.5
mile near busy roads in order to access desired bus routes. For example, one of the students in
STEP commutes to Salt Lake City two days per week for college classes, and expressed that the

public transportation typically takes anywhere from three to five hours in one direction, limiting
which classes she is able to register for. It is also important to note that the STEP cottage
program is the only residential program offered through USB, and is accessible for any eligible
student living in the state of Utah, which means that many of these students travel for many
hours on Fridays and Sundays in order to access their school. Therefore, while the Ogden
campus is beautiful and fully accessible to all students enrolled in the school, the surrounding
community can occasionally cause additional challenges for blind and visually impaired students
that may ultimately impact their willingness or ability to participate in roles and activities outside
of their school’s campus.
Data Collection
Structured Data Collection
Staff and student perspectives were collected by the graduate student via semi-structured
interviews with pre-written questions (see Appendices A-C for a list of questions used during
semi-structured interviews), and via participation in and observation of general practices of the
school, the cottages, and the daily activities of students within the STEP and ECC-based
programs. Semi-structured interviews were performed both individually and in small groups of
two to three students or staff, in an attempt to disrupt the student and staff schedules as little as
possible. These interviews and observations assisted the graduate student with gaining a more
holistic and realistic perspective of general practices within these settings and in regards to this
population of young adults.
Perspectives
Student perspectives.

As should be anticipated, each student had unique perspectives and ideas about their lives
and about the intensive educational experiences provided through USB, with specific emphasis
on those provided through the STEP residential cottages. One association observed by the
graduate student throughout this process, is that student perspectives of USB were highly
influenced by the student’s experiences with mainstream education in their home communities.
Meaning, the students who had positive experiences with highly accommodating and supportive
general education programs, appear slightly less invested in the core values of education offered
through USB. On the other hand, students who had poor or non-supportive general education
experiences in their home environments appear more appreciative and accepting of programs
offered through USB.
One challenge afforded to the graduate student while gaining student perspectives and
ideas, was that many of these students could benefit from additional individualized intervention
sessions with an occupational therapist or other professionals, but for the purpose of this program
development, there was a challenge to find common topics that were applicable and of interest
for the majority of students in the cottages. Perspectives shared by the majority of students
included the following: 1) enjoyment of freedoms that come from living in the cottages, which
often offers students more freedom than was experienced in their family homes, 2) appreciation
of mentorship within the setting, 3) slight frustration with participation in and expectation of
chores and activities within the cottages, 4) desire to have more influence on what they are able
to do every day within the cottages, 5) slight frustration with staff-student communication
approaches, and 6) enjoyment of being surrounded by friends more often than they were in their
family homes or in previous school settings.
Blind mentor/support staff perspectives.


Interviewing the on-site Blind Mentor as well as the direct support staff was extremely
beneficial. Overall, the two staff members felt that while the school and cottage programs are
experiencing substantial growth in comparison to recent years, they both expressed that more
classes or seminars need to be implemented with students in a way that promotes specific skill
mastery and task completion with realistic but challenging expectations. Both staff members felt
that students should continue to be challenged to meet higher expectations, and begin to also set
higher expectations for themselves, as it is apparently common with this population to be given
lower performance expectation thresholds in many areas of their lives. The Blind Mentor was
able to provide a lot of personal insight about what helped her succeed when she was the
students’ age, as she had experienced similar challenges. The main student challenges that were
noted from these staff perspectives include the following: lack of self-initiating tasks, lack of
independent problem-solving skills, student unwillingness to try and fail as a mode of learning,
low rates of self-advocating for their individual wants/needs/concerns (the students in the
cottages appear more likely to advocate for their peers than for themselves), and overall, a lack
of willingness/desire to challenge themselves to learn skill mastery and adequate task
completion. The staff members expressed how each of the factors listed above are negatively
affecting major areas of the student’s lives, especially in regards to poor hygiene, health
management, and basic home maintenance habits.
School-based Occupational Therapy perspective.
The graduate student was able to perform a face-to-face semi-structured interview, and
shadow the school-based Occupational Therapist (OT) at the USDB in order to gain a more
comprehensive understanding of what OTs are capable of doing within this unique setting. Due
to the Utah Schools for the Blind recognizing the need for and implementation of the Expanded

Core Curriculum, this has allowed the school-based OT to address more aspects of the students’
individual lives and needs, rather than being constrained to only address school-related tasks, as
is often a limitation observed by school-based OTs in the general education school systems. This
freedom of providing OT services can still occasionally be limited by the availability of the
therapist’s time, due to many students having needs, many staff/educators requiring consultation,
and additional therapist responsibilities for the school district. Despite the extensive
responsibilities and students on this therapist’s caseload, she does not feel that she is at her
maximum caseload capacity at this time.
While shadowing the OT during typical school day practices, the graduate student
learned that many students within the blind or visually impaired school share the following
characteristics: decreased body and general spatial awareness, poor utilization of additional
senses in compensation of lack of visual sensory input, poor ability to use tools (i.e. using a
butter knife to spread butter on bread), or any item they must use that is apart from their body,
decreased opportunity and/or ability to maintain meaningful relationships, difficulty developing
and maintaining healthy habits, poor self-initiating of participation or behaviors, and
occasionally poor emotional regulation skills.
The OT feels that there are countless needs to address with the students at USB, and she
expressed that the cottage environment can provide a unique opportunity to integrate
supplementary programs or instruction into the students’ typical daily routines. The OT also
suggested that some staff may benefit from training on how to best implement strategies and
assist students in order to facilitate independent living skill mastery.
ECC educational services aide perspective.


The ECC educational services aide provides specific in-depth training for small groups of
these students as part of the enrichment programs and as part of the transition to adult-life
programs offered through STEP; she is currently implementing a program to teach basic cooking
skills, including tool use (measuring ingredients, peeling vegetables, pouring, scooping, mixing,
following a recipe, etc.). Of the many staff members interviewed, this individual had the most
extensive experience with educating this population, and has been one of the professionals
assisting the USB as they begin to further implement components of the ECC into general
practices. Through this semi-structured interview, the graduate student was able to hear about
where the programs have been in the past, how they have grown in recent years, and future areas
of growth planned for the years to come. This individual explained that some challenges she has
noticed with students lately is their ability to adequately manipulate and use tools, while
maintaining awareness of themselves and their environment, in order to adequately complete a
task. I was informed that she is a supervisor for the Blind Mentors, and that they had recently
had a discussion similar to this interview, and that as a team, they had collectively recognized the
need for students to not only learn new skills, but re-learn how to perform familiar skills in more
complete and efficient ways. This educator also felt that hygiene is a large area that is currently
being overlooked or overshadowed by other program needs, but that the cottage environment is
the perfect opportunity to enhance these skills. In addition to the student aspect of learning to
adequately perform and develop self-care hygiene skills, this educator also expressed the need
for developing specific techniques for teaching these skills to the students, so that resources of
these techniques can be shared with all staff members/educators as well as with
parents/caregivers of the students in order to ensure carryover of learning until students become
proficient and self-accountable. In addition to hygiene, this educator also mentioned similar

needs in areas of basic household tasks and routines; for example, how to properly make a bed,
and how often is an appropriate amount of time to wash the bedding, in essence, how to help
them recognize and implement independent living skills and routines.
Graduate student perspective.
I have been able to observe many aspects of general practice for the STEP program,
including ECC-based seminars, recreational activities, cooking classes with the ECC educational
services aide, typical evening routines within the cottages, enrichment activities, and some
classroom activities when shadowing with the school-based OT. Due to the extensive domains
included in the Expanded Core Curriculum specifically designed for these students, it initially
appeared as though this program did not have many needs to fill. Initially, it seemed that
students only required supplemental opportunities and strategies to use for self-managing their
emotions, increase body awareness, and improve communication skills. While those areas are
still important, it has come to my attention that what these students could benefit the most from
is a program that can support the domains of the ECC by providing skills specific training within
the areas of self-care, routine home task maintenance, and healthy habit development.
Programming Strengths and Areas for Growth
Strengths.
One of the main strengths of the Utah Schools for the Deaf and Blind is the collective
drive and desire to provide opportunities for learning and growth for all students. Another
strength is the extensive availability of funding for the school and the programs, which has
enabled USB to provide free and appropriate education to students across the state. I feel that one
of the greatest strengths and assets of the Utah Schools for the Blind, as well as for the Supported
Transition Extension Program, is the consistent use and implementation of the Expanded Core

Curriculum. More specifically, the USB residential STEP program is ever-developing, is
supported by an excellent team of motivated and visionary staff, and is home to some incredible
youth who are intelligent, caring, and driven individuals who desire to live independent and
fulfilling lives as they transition out of the USB education program.
Areas for growth.
Areas for continued growth were more challenging to pinpoint within this school
program. It appears that staff members could benefit from additional training and support to
more effectively assist students by facilitating successful educational experiences. It also
appears that students could benefit from assistance during skill development procedures,
specifically in regards to healthy habit and routine related skill development, while also
emphasizing the importance of attaining adequate mastery and proficiency in all independent
daily living tasks. Additionally, students may benefit from improved self-initiating, self-
motivating, and problem-solving behaviors, all of which are essential for successful transitioning
into adult-life roles. Overall, it also appears that the recognition and utilization of positive
communication skills would benefit both staff and students within the STEP residential program.
Literature Review
A literature review was conducted in order to better understand the occupational needs of
the students in the residential STEP cottages and to explore the role of occupational therapy in
supporting and facilitating healthy routine development unique to this population. The following
databases were used to locate relevant articles: The Journal of Visual Impairment and Blindness,
the American and British Journals of Occupational Therapy, and the extensive online journal
catalog available through the University of Utah, Eccles Health Sciences Library. Relevant
articles were found using a combination of the following search terms: visually impaired,

blind/blindness, activities of daily living, daily living skills, independent living skills, self-care
skills, hygiene, transitional services, youth, young adults, teens, adolescents, students, school-
aged students, program planning, self-efficacy, expanded core curriculum, educating students
with visual impairments, occupational therapy, lifestyle, activity level, skill acquisition, routines,
habits.
Although extensive research exists concerning the low vision of older or aging adults,
few research articles are available for this specific youth portion of blind/visually impaired
population. Articles, were therefore, chosen based on relevance to this specific demographic, and
based on relevance to daily living, habitual or routine development topics and training strategies.
Approximately 30 articles were initially chosen based on apparent appropriateness of topic or
population; however, 12 articles and one book chapter were ultimately utilized for the purposes
of this literature review and are referenced below.
Health and Lifestyle Risks for Youth with Visual Impairments
Literature was reviewed to gain a more holistic understanding of common lifestyle
choices and risk factors unique to this adolescent population. Kozub and Oh (2004) labeled
youth with visual impairments as being “at risk” for health-related illnesses due to their “habitual
inactivity”, and stated that visually impaired youth choosing sedentary lifestyles may be creating
functional limitations which are negatively impacting daily living skill acquisition. Similarly,
Engel-Yeger and Hamed-Daher (2013) found that children with visual impairments often
experience limited opportunities to participate in activities outside of school, commonly resulting
in an embraced “passive lifestyle” within their home and community environments. This passive
lifestyle may result in limited opportunities to develop life satisfaction, emotional well-being,
and positive peer relationships (Engel-Yeger & Hamed-Daher, 2013), all of which can negatively

impact an individual’s overall health. Although there is little data on developmental milestones
for youth with visual impairments, healthy lifestyle and daily living skill development is
identified as a key area of the ECC, and as such, is an essential component of skill competency
necessary for successful transitioning into adult life roles (Lewis & Iselin, 2002; Lohmeier,
2005).
Delay of Independent Living Skill Acquisition
To further investigate potential areas impacting independent living skill competency,
additional articles were analyzed, common themes were identified and findings are discussed
below. When comparing the independent living skill acquisition of primary students, Lewis and
Iselin (2002) found that students with visual impairments may not master acquisition of these
daily living skills at the same rate as their sighted peers. Campion, Awang and Ward (2010)
similarly identified that there is an increased prevalence of difficulties performing tasks such as
Activities of Daily Living (ADLs), or Instrumental Activities of Daily Living (IADLs) for
individuals with visual impairments. Findings from these studies suggest that youth with visual
impairments are likely to experience a delay in independent living skill acquisition, but that the
full extent of the delay is currently unknown; additional articles were, therefore, analyzed in an
attempt to identify potential causes for these delays.
Lack of incidental learning opportunities.
Children with visual impairments are less likely than their sighted peers to learn through
incidental learning (Teras, Matson and Felps, 1993), meaning that they are less likely to obtain
skill acquisition through observation and modeling of a skill by another individual. Similarly,
Papadopoulos, Metsiou, and Agaliotis (2011) hypothesized that the delay in daily living skill
development of children and adolescents with visual impairments is likely due to their inability

to observe and imitate as part of their learning process. Vision accounts for approximately 80%
of sensory stimulation received from the environment; low visual sensory input can, therefore,
adversely affect many aspects of an individuals’ life, including their ability to perform every day
skills and activities (Smith, 2014). This provides educators of children with visual impairments
with a unique challenge: how can learning of every day skills be facilitated without relying on
incidental learning experiences?
Overprotectiveness and lower expectations.
During the needs analysis interviews, a Blind-Mentor at the USB cottages mentioned the
negative impact that overprotectiveness and low expectations can potentially have on skill
mastery for children with visual impairments. In a study by Papadopoulos, Metsiou, and
Agaliotis (2011) it was hypothesized that parent overprotectiveness and/or parental perceptions
about the abilities of children with visual impairments may result in these children experiencing
fewer opportunities to learn independent living skills, especially if tasks are perceived as being
“too dangerous” by parents. Enge-Yeger and Hamed-Daher (2013) expressed the availability of
therapy services for both parents and educators that may help increase awareness of the child’s
actual abilities, thereby, decreasing unnecessary overprotectiveness, and positively influencing
the child’s participation in everyday activities.
By more accurately understanding a child’s abilities and potential for skill mastery,
opportunities can be developed in order to appropriately and safely challenge every child’s
functional potential. Performance expectations for children with visual sensory impairments
may often be established at lower thresholds than are necessary, which may inadvertently limit a
child’s opportunity for age-appropriate skill development. By recognizing the possibility that
youth with visual impairments are capable of achieving higher skill acquisition levels, educators

and parents can positively influence the youth’s self-perceived abilities, which may also
positively affect the youth’s willingness to set higher expectations for themselves in many areas
of daily living. (Papadopoulos, Mesiou, & Agaliotis, 2011; Taras, Matson, & Felps, 1993)
The Role of Occupational Therapy
Occupational Therapy practitioners have a dynamic set of skills which allows for
successfully assessing the occupational needs and unique contexts of any individual within any
setting. School-based OT practitioners, for example, have traditionally worked with students to
address academic-related needs as outlined in a child’s IEP. Whereas, the OT practitioners
working in early intervention or outpatient clinic settings, are likely less restricted to address
only school-related challenges, and are, therefore, able to address child needs specific to ADL
and IADL participation and/or performance. The Utah Schools for the Blind, thereby, create a
unique opportunity for occupational therapy practitioners to provide holistic approaches for all
youth with visual sensory impairments by not being limited to address only academic-based or
ADL/IADL-based needs. By utilizing this broad skill set, OT practitioners are able to facilitate
participation in all areas of occupation, including those impacted by low vision, visual
impairment, or blindness (Smith, 2014).
Low vision, an AOTA emerging practice area.
The American Occupational Therapy Association (AOTA) recently recognized low
vision therapy as an emerging area of practice for occupational therapy practitioners (Smith,
2014). Campion, Awang and Ward (2010) found that vision-related therapy provided by an OT
can help individuals maintain independence in mobility and daily living activities. Due to the
growing need for providing services to low vision populations, two certificates have been
developed in order to improve practitioner competence in low vision practices; 1) a Certified


Low Vision Therapist (CLVT) certificate, and 2) a Specialty Certification in Low Vision
(SCLV) (Smith, 2014).
Person, environment, occupation theory.
The Person-Environment-Occupation (PEO) theory used by occupational therapy
practitioners, assists with understanding the dynamic and complex relationship between a
Person, their Environment and an Occupation in order to develop a more holistic perspective of
any given therapy situation (Law, Cooper, & Strong, 1996), and to provide the “just right”
challenge for every individual. As an OT practitioner, it is essential to consider all elements that
may support or hinder occupational participation and performance, as this awareness will be
essential for facilitating opportunities for optimal growth. In the literature, Houwen, Visscher,
Hartman, and Lemmink (2007) identified that a visually impaired child’s task performance
depends on specific characteristics of the task demands. Similarly, Papadopoulos, Mesiou, and
Agaliotis (2011) expressed the importance of adapting an individual’s behavior, the environment
and the intervention to more appropriately meet the needs of blind and visually impaired youth.
In essence, both of these articles were describing elements of the PEO model, thus, validating the
use of this occupation-based theoretical model with this specific population.
Successful Facilitation of Independent Living Skill Acquisition
Although the literature was sparse with information specific to independent living skill
acquisition of blind/visually impaired youth, there was adequate evidence to support similar
programs and training techniques which can be easily adapted and implemented to meet the
specific needs of this population.
Teras, Matson, and Felps (1993) utilized a task-specific training known as “Independence
Training”, to perform a detailed analysis outlining key components of each task in order to

provide more achievable steps necessary for successful performance of independent living skills.
This training was conducted with groups of children and young men with visual impairments,
and was found to be a successful intervention to introduce and master independent living skills.
In addition to performing detailed task analyses for each independent living skill, this program
also utilized modeling, physical guidance, peer feedback (when appropriate/possible), positive
reinforcement, and errorless learning in order to promote accurate skill mastery. In addition to
the training techniques listed above, this study was unique in that individuals were provided with
basic self-evaluation pre- post-assessments (1- not so good, 2- good, 3-very good performance)
to increase their awareness of perceived versus actual performance levels for any given task.
The addition of these self-rating pre- post-assessments may naturally facilitate individuals to set
gradually higher expectations for themselves, thus, eventually influencing higher self-expressed
expectations for skill mastery.
Gardner and Wolfe (2015) utilized video prompting with errorless learning as a mode for
teaching daily living skills to students with developmental disabilities. Although the video
prompting may not be the most appropriate form of presenting a detailed task analysis for
blind/visually impaired youth within the cottage setting, the use of an audio recording or a script
depicting a consistent breakdown of steps necessary for a task completion may be beneficial if
implemented appropriately. This study also utilized errorless learning via an error correction
procedure, which allowed student to practice the sequential steps of a task, provided that they
were immediately interrupted if an error occurred, requiring the student to return to the previous
step performed correctly, at which time they would receive additional prompting, guidance or
physical assistance as needed. Errorless learning was found to be a successful training technique

for persons with visual impairments and for persons with developmental disabilities (Gardner &
Wolfe, 2015; Teras, Matson, & Felps, 1993).
When considering specific program development components, skill acquisition was
found to be more successful with direct instruction (Lewis & Iselin, 2002), repeated exposure of
topics to promote increased opportunities to practice new skills, and integration of learned skills
into daily schedules and routines for skill generalizability (Lohmeier, 2005; Opie, 2018;
Pogrund, Darst, & Boland, 2013; Taras, Matson, Felps, 1993).
Summary
The mission of the Utah Schools for the Blind campus program is to provide exceptional,
comprehensive, and research-based education for students with vision impairments and their
families (USDB, 2018e). The USB staff are dedicated individuals aiming to achieve this mission
by providing intensive vision instruction through the implementation of the Expanded Core
Curriculum across campus programs, including within the Supported Transition Extension
Program. The STEP cottages are currently providing housing and transition planning support for
13 young adults, and while the ECC is successfully addressing many unique educational needs of
this population, the data collection process revealed potential areas for continued growth. It is
now apparent that the STEP residential cottages could benefit from a program that supports the
domains of the ECC by providing skill-specific training and technique implementation in order
to facilitate healthy habit and routine development, as well as mastery of independent living
skills imperative to this population.
The Literature review revealed that although very little data exists to determine
appropriate developmental milestones for youth with visual impairments (Lewis & Iselin, 2002),
low visual sensory input has been found to adversely affect many aspects of an individuals’ life,

including their ability to perform every day activities (Smith, 2014), thus, potentially delaying
skill mastery within every day activities into adolescence or even into adulthood. These results
support the importance for transition planning, development of healthy routines and habits, and
adequate independent living skill mastery, within the STEP residential cottages.
Occupational Therapy’s theoretical background of considering the person, the
environment and the occupation, as well as OT’s ability to perform detail task-analyses and
facilitate errorless learning will provide an appropriate environment for the STEP youth with
visual impairments to develop healthy habits and routines through daily living skill acquisition
and mastery.
Program Proposal: Facilitating Healthy Habit and Routine Development
Program Overview
The USB residential STEP program could better facilitate healthy habit and routine
development of their youth with visual impairments by providing the direct-support staff with
instructive and supportive training on specific techniques and strategies to be utilized in real-time
during educational interactions with the program students. Providing staff with comprehensive,
easy-to-implement, and evidenced-based tools will improve staff competency for educating
students, but more importantly, will positively influence the life-long independence of the
students by promoting occupation-based, independent living skill mastery. If adequate support
and fundamental tools can be provided to staff, the program as a whole will continue to grow,
and the ECC-based seminars and classes will become more efficient and effective, all of which
may inadvertently result in students becoming more receptive to educational opportunities
offered within the STEP program, further influencing student success as they transition into
adult-life roles.

Instruction and training for support staff would be developed and implemented by a
licensed occupational therapist, and would take place annually, allowing for continued training
and reinforcement of learned skills. This training would preferably occur prior to the start of
each new school year, and would be provided to all staff involved with the USB, STEP
residential program. The initial training period would ideally involve a minimum of 20 hours of
instruction in small groups lead by the occupational therapist, dispersed across five sessions. In
addition to this initial training period, the occupational therapist would oversee staff
implementation of these techniques and strategies in real-time with the students in the cottages,
preferably beginning within the first month of the new school year, and subsequently occurring
throughout the school year. In order to more fully support staff success with implementing the
learned techniques and strategies, the occupational therapist would also develop a resource
binder for staff use which would provide occupation-based examples of how and when to best
implement the tools learned. The resource binder would also contain detailed task analyses of
common self-care, home maintenance, or other related tasks which are relevant for healthy habit
and routine development in youth with visual impairments (please refer to Appendix D for an
example of a relevant task analysis). These detailed task analyses would be utilized by staff
during direct instructional opportunities with students in the program, allowing staff to provide
accurate, consistent, and effective feedback as a means of facilitating healthy habit and routine
development.
Program Value
This proposed program aims to provide an opportunity for staff to gain confidence and
competence to positively impact the development of independent living skills in blind/visually
impaired students. This program would emphasize the education and support of staff members,

in order to facilitate healthy habit and routine development of the STEP students, resulting in
improved student independence in everyday activities and adult-life roles.
Occupational justice.
The concept of occupational justice suggests that all humans deserve “the right to engage
in diverse and meaningful occupations to meet individual people’s needs and develop their
potential” (Durocher, Gibson, & Rappolt, 2013). Occupational injustice, therefore, can present in
various forms, the most relevant of which for this population of blind/visually impaired youth,
occupational marginalization, will be addressed via implementation of this proposed program.
Occupational marginalization would be addressed through this program by ensuring that all
students have the opportunity to participate in tasks within the cottages, which are important for
independence in life, but which may have been previously considered too difficult, unattainable,
or unnecessary in previous home, community, or school settings, by individuals who were overly
cautious of these students’ perceived abilities (Durocher, Gibson, & Rappolt, 2013). By
addressing this occupational injustice, the students in the STEP program will have the
opportunity to develop independent living skills which may otherwise have been deemed
unmanageable for this population, and as a result, would have had potentially limiting influences
on the students’ opportunity to transition into a successful, independent, and community-
dwelling adult.
Prevention.
Implementation of this proposed program will address primary, secondary, and tertiary
levels of prevention for this population of youth with visual impairments. Primary prevention
will be addressed by providing all youth with opportunities to take care of themselves, their
living environment, and their school and life responsibilities in preparation for successful

transitioning into life after USB; these opportunities would be synonymous to similar
opportunities provided to sighted youth of a similar age. Secondary prevention will be addressed
through provision of special strategy- and technique-based instruction, for how to become
independent and self-reliant individuals. When addressing secondary prevention within the
cottages, it will be essential to take into consideration the varying levels of visual impairment of
each student, to remain cognizant of relevant safety precautions during specific tasks, and to
implement basic adaptive technology as necessary. Tertiary prevention will be addressed
through further adaptation of the environment and tasks, and through providing additional
adaptive technology/equipment, utilization of which will prevent injury and maximize
independence during functional task performance.
OT’s Role in Program Implementation
As previously stated, occupational therapy involves a very unique, dynamic, and broad
skill set which allows OT practitioners to adapt easily to any environment, and utilize tools to
facilitate optimal learning opportunities for their clients. OTs provide a holistic approach to
solving problems and finding solutions by continually analyzing contextual factors related to
each individual client, thereby, making appropriate changes in real-time to provide the “just
right” challenge for clients in any given moment as a means of facilitating optimal learning.
These skills and this specific therapeutic lens contributes to why occupational therapists would
be the most appropriate and most successful professionals to develop and implement this
proposed program. Occupational therapy practitioners would be able to effectively communicate
with and provide instruction for direct support staff, as these staff would be considered the OT’s
clients for the duration of the training program and during the overseeing process of skill
implementation. The students in the STEP program would not be the OT’s direct clients, but

rather, would be the direct recipients of the improved training techniques and strategies adopted
by the direct support staff, with continued direction and support provided by the OT as
necessary. In addition to these reasons for OT’s appropriateness, it is also important to note that
OTs are expert educators in all areas of ADLs and IADLs, and that OTs regularly utilize the
techniques and strategies introduced in this program during every day therapeutic interactions,
and, thus, have extensive knowledge to be shared. Therefore, occupational therapy is the most
appropriate professional to develop and implement this proposed program due to OT’s unique
ability to remain client-centered, occupation-based, and performance-focused.
OT’s theoretical foundation.
The field of occupational therapy utilizes theoretical practice frameworks as a means for
guiding the clinical reasoning of therapists. Although OT is science-based profession, utilization
of the profession’s theoretical roots helps therapists to facilitate client outcomes by imposing
change postulates appropriate for each client/situation; these change postulates vary depending
on the theoretical model used. The theoretical practice models that will be utilized for the
purposes of this program proposal are the Person-Environment-Occupation model, which was
briefly discussed in the literature review, and the Acquisitional frame of reference.
The person-environment-occupation model.
The literature review conducted for this program development revealed that utilization of
an occupation-based theoretical model that emphasizes the congruence and dynamic interaction
of a Person, their Environment, and an Occupation, is an appropriate and valid approach to use
with youth with visual impairments to supporting skill development. This model postulates that
“the person is a dynamic, motivated, and ever-developing being”, and also postulates that “the
environment may be easier to change than the person”, as “the environment is dynamic, but can

have an enabling or constraining effect on the individual’s occupational performance” (Law,
Cooper, & Strong, 1996). These postulates are important to keep in mind when working with
youth with visual impairments, as awareness of these considerations may guide therapeutic
interventions to be more successful. Although the person’s vision may be unlikely to improve,
the environment and the occupation/task may be easily modified in order to promote increased
occupational performance and improve overall independence of the individual. Basic
components of the PEO model will be integrated into staff training sessions, in order to increase
staff awareness of the dynamic relationship between a person, their environment, and an
occupation/task, and also to help staff appreciate the necessity of PEO congruence for successful
development of healthy habits and routines for the STEP residential students.
The acquisitional frame of reference.
The Acquisitional Frame of Reference (FOR) aims to support the development of
functional skills through the systematic learning of skills, sub-skills, and appropriate behaviors
which will eventually result in skill mastery (Kirsh, 2016). This FOR is essential for the
successful implementation of this proposed program. If the staff are unable to develop skill
mastery of the training techniques and strategies introduced in the training sessions, such as task
analysis, errorless learning, how to provide appropriate and effective feedback, etc., then,
subsequently, students will not have the support necessary to develop healthy habits and
routines. The Acquisitional FOR postulates that “if an individual acquires specific skills, and
those skills are reinforced, then the skill has the potential of being self-reinforcing, and can be
generalized to other settings”, therefore, “if component parts of a skill are reinforced, then
behavior will be shaped so that the individual can acquire the skill” (Kirsch, 2016). These
postulates are especially important for guiding both the development and implementation of this

program; if the OT can successfully facilitate skill acquisition in the initial training sessions with
staff, and can also successfully reinforce these skills during direct staff interaction with students,
then, it is to be expected, that both staff and student skill proficiency will improve with repeated
exposure to practice skills, and with integration of these skills into regular or daily schedules.
Goals and Objectives
Goal 1. Direct support staff will demonstrate adequate training skill proficiency in order
to support the successful development of healthy habits and routines for students with
visual impairments within the STEP residential program at USB, as they prepare to
transition into adult-life roles.
Objective 1. Staff will accurately utilize task analysis training techniques on 80%
of observed educational opportunities with students, in order to facilitate healthy
habit and routine development skills in students with visual impairments, as per
occupational therapist report.
Objective 2. Upon completion of staff skill training program provided by the
occupational therapist, 80% of direct support staff will be able to accurately
facilitate an errorless learning scenario while utilizing a task analysis breakdown,
in preparation of attempting this technique with students in the residential school
setting, as a means of promoting skill acquisition for healthy habit and routine
development, as per occupational therapist report.
Goal 2. Improve the healthy habit and routine development of students with visual
impairments in a residential school setting, through detailed task-specific training and
support opportunities facilitated by the direct support staff, and in preparation of students
transitioning into adult-life roles.


Objective 1. By the end of the school year, 80% of students will increase
independence in a self-care, home maintenance, or other healthy habit and routine
development task within the residential school setting.
Objective 2. By the end of the school year, 80% of students will be able to
develop skill mastery of a task after supported training by the direct support staff.
The Proposed Program: Facilitating Healthy Habit and Routine Development
This proposed program was designed to help facilitate healthy habit and routine
development for students enrolled in the Utah Schools for the Blind, Supported Transition
Extension Program; a program which provides residential and life-training services for
blind/visually impaired students, 16 to 21 years old. The STEP residential program is currently
implementing educational domains from the Expanded Core Curriculum, and through a needs
analysis process, it was discovered that the students and staff within this program may benefit
from additional support in areas of skill mastery related to healthy habit and routine
development. From this recognized area for growth, this proposed project was designed and split
into three distinct parts. Part I consists of an initial training period; designed for STEP program
staff to receive skill-specific educational training administered by a licensed occupational
therapist. Part II consists of the occupational therapist overseeing staff as they implement the
learned skills during real-time interactions with STEP students, as they attempt to develop daily
living skills within the cottage setting. Part III consists of the occupational therapist developing
a resource binder for staff to utilize within the STEP program as needed.
Part I.
All USB staff members associated with the STEP residential program are eligible to
attend the initial training sessions offered during Part I of the program. As mentioned briefly

earlier, these training sessions would take place annually, in an attempt to support the continued
development of staff skills, and would ideally occur prior to the start of each new school year.
Part I would consist of a minimum of 20 hours of skill-specific educational training administered
by the occupational therapist. These sessions could realistically be split up over five days, and
therefore, could be completed on-site at the USB, Ogden campus on the week prior to the start of
term. Each session would be designed to address key strategies or techniques that staff can
implement during skill acquisition opportunities with students in the cottage setting.
The majority of the time during the first session would be designated as an accelerated
training about basic PEO concepts. This initial session would facilitate staff member
comprehension of the basic components of a person, their environment, and any relevant
occupations/tasks. As basic comprehension is achieved, the staff will be further challenged to
recognize the importance of congruence between the P, E, and O components, and also recognize
how this congruence can either enhance or inhibit the individuals’ occupational performance
success.
Subsequent sessions will continue to integrate PEO concepts into real-life examples,
however, the major focus of the remaining sessions will be to provide staff with easy-to-
implement, evidence-based techniques and strategies to influence student skill acquisition. The
following training techniques and strategies are examples of a few that will be taught: 1) how to
conduct and utilizes a detailed task analysis, 2) how to facilitate accurate skill acquisition
through errorless learning practices, 3) what are the best ways to provide effective feedback and
reinforcement during skills training, and 4) education on the importance of repeated exposure for
students to practice skills, the provision of direct instruction of skills appropriate for students,

and overall, how to best facilitate integration of these skills into the student’s/cottage’s
daily/weekly schedules and routines.
Part II.
The second portion of this program will consist of periodic observations by the OT
during direct staff interaction with students in the cottages. The OT will be observing the staff as
they implement techniques and strategies learned during the Part I training sessions. The staff
members will implement the techniques and strategies as a means of facilitating a more
consistent and effective educational style during skill acquisition opportunities with students.
Ideally, these observation sessions will take place periodically throughout the school year,
providing opportunities for continued development of staff competence, and for ensuring
adequate maintenance of learned training skills. It would be preferable for the OT to observe
each staff member a minimum of six times throughout the school year; three times during the fall
term, and three additional times during the spring term. Allocating these observations in this
way provides ample time between observations for staff to practice facilitating skill development
with STEP students, and also provides staff adequate time to formulate specific questions for the
OT as their competence continues to grow.
Observation sessions will last an average of 30 minutes for each staff member, allowing
the OT to observe staff interactions in the cottage setting within a two- to four-hour time period;
this time period obviously depending on the number of eligible staff available for participation in
this training program. In addition to observation of staff performance implementing techniques
and strategies, the OT would also be evaluating the progress of each staff member throughout the
course of the year, and will provide continued instruction and intervention as necessary.
Part III.

The third portion of this program implementation involves the OT developing resources
applicable to the staff and student skill development process. The OT will provide these
resources to staff via a resource binder, which can be utilized as needed within the cottage
setting. This collection of resources would be developed prior to Part I of the program
beginning, but would be systematically introduced to staff throughout both Parts I and II of the
program; integration of these resources would be utilized during training exercises between staff
to ensure competency and ease-of-use for all supportive resources.
Resources in this binder would include 1) detailed task analyses of common tasks
relevant to healthy habit and routine development of youth with visual impairments (please refer
to Appendix D for an example of a relevant task analysis), 2) materials for reviewing strategies
and techniques taught in Part I, during the initial training, and 3) supportive material for
implementing skills, such as occupation-based, realistic examples of best implementation
practices.
The development of this resource binder would require approximately 40 hours of work
by the OT in addition to the time allocated for developing Part I training sessions. This amount
of time is required in order to ensure that resources developed are accurate, reflect evidence-
based practice, and to ensure that the identified needs of the STEP residential program are met.
Space requirements.
This program will be administered on the Ogden campus of the Utah Schools for the
Deaf and Blind, and will, therefore, utilize an empty classroom within the facility for the training
sessions in Part I of the program, while the observations of staff skill implementation in Part II of
the program will occur within the STEP cottage setting. Both Parts I and II will utilize facilities
that are openly available to for use by students, staff, and professionals associated with the

USDB, and will, therefore, not require additional costs for renting a conducive space for skills
training and observation of implementation. The planning and development portion of the
program will be conducted by the OT in the designated therapy office space on-site at USDB, as
OT already has this office space at their immediate disposal.
Time requirements.
This program for facilitating healthy habit and routine development in youth with visual
impairments will be designed and administered by a licensed occupational therapist. Part I of the
program will require staff to attend a minimum of 20 hours of direct educational skills training
with the OT. Part II of this program will require each staff member to be observed six times
throughout the school year, for approximately 30 minute-increments at a time, during which, the
staff will be implementing learned skills in real-time interactions with students.
The OT will require approximately 120 hours for the planning and the development of
evidence-based training sessions appropriate for staff during Part I of the program; and will
require an additional 25 hours of direct services with the staff for the administration of these
training sessions, accounting for an additional five hours for setting up before and cleaning up
after each training sessions. During Part II of the program, the OT will provide direct observation
of staff while also indirectly influencing service delivery to students for a minimum of three
hours for each staff member throughout the course of the school year. These observational hours
will likely result in a total of approximately 18 hours of direct observation by the OT throughout
the course of the school year, with nine hours allocated in the fall term and nine hours allocated
in the spring term, with special regard given to flexibility, availability, and eligibility of staff
members participating in the entirety of the training program. Additionally, the OT will require

approximately 40 hours for the planning and development of an easy-to-implement and
evidence-based resource binder for Part III of the program.
In total, the OT will be providing approximately 160 hours of planning and development,
25 hours of direct training with stuff, and an additional 18 hours of observation of staff in real-
time throughout the course of the year. Staff will, therefore, need to be available for
approximately 20 hours of training on the week prior to the start of the new school term, and will
need to be observed for approximately three hours throughout the course of the year, during their
regularly scheduled shift, as the OT will accommodate the staff schedules for the purposes of
these observations. If necessary, the OT and the staff members may have an opportunity for
continued training throughout the course of the program implementation, depending on
situational and individual needs, during which time, appropriate accommodations and time
requirements of both the staff and OT will be further discussed.
Budget.
The budget for this program will not be consistently dispersed across the school year
timeframe, but rather, will be heavily weighted in the fall, near the beginning of the new school
year, with few budgeted needs existing throughout the duration of the school year.
As a full-time occupational therapist is already employed with the Utah Schools for the Deaf
and Blind, Ogden campus, it is possible that this program would not necessitate the hiring of a
new OT, but the administration of this program may interfere with the OT’s ability to fully
support the needs of the clients on her caseload, and the educators at the facility, therefore, it
may be worth the time and money to bring in a contracted OT to fulfill the program development
and needs. If USB chose to hire a contracted OT to plan, organize, develop, and administer this

program, the following would represent a comparable yet competitive fee for receiving these
services from a licensed occupational therapist.
• For planning and development of program materials: $34.49/hour x 160 hours =
$5,518.80
• For providing direct instruction and training for support staff in the week prior to the
school year starting: $44.49/hour x 25 hours = $1,112.25
• For direct observation of staff skill implementation: $44.49/hour x 18 hours =
$800.82
• Total net cost for a contracted, licensed occupational therapist to implement this
proposed program = $9,344.94
Additional program expenses to consider include:
• Cost of printing services for skill training sessions and for resource binder
development, estimated at approximately $200.00.
• Support staff hourly wages (unknown to this graduate student)
No additional expenses are anticipated at this time due to the facility use availability for all
USB programs, office space availability for OT, and computers/printers available through the
school, thus, requiring little if any additional expenses for this program implementation.
Funding options.
Potential funding sources were identified through initiating a search within the
Foundation Directory Online – Professional organization. For both potential funding sources
identified, an advanced search was used with the following search terms: eye diseases, education
(school recipient), and Utah. The identified potential funding sources are the United States
Department for Health and Human Services, and the ALSAM Foundation. In addition to the

above stated search terms, locating the funding source of the United States Department for
Health and Human Services required a secondary search of choosing independent living for
individuals with disabilities living in an organization as a search option. The Department for
Health and Human Services is well known for providing funding for educational services across
the country, and would, therefore, likely be a reliable source of funding for this proposed
program. The ALSAM Foundation was developed by the Skaggs family of southern Idaho; the
founder, L. S. Skaggs, was the owner of a grocery and drug store chain, and has been generously
donating funding to education, medical research, human services, catholic agencies, and charities
since its establishment in 1984 (Foundation Center, 2018). The ALSAM Foundation has been
known to donate millions of dollars, including a grant of $10 million awarded to the Moran Eye
Center in 2003 (Health and Medicine News from the U, 2003), suggesting that this foundation
would likely support developing programs at a school for visually impaired students in Utah.
Program marketing.
The STEP residential program does not currently need marketing to fill student or
staffing positions, as all positions are currently filled and needs are being met. However, if this
program design of providing direct support staff with tools and resources to utilize while
facilitating the healthy habit, routine, and independent living skill development of students with
visual impairments, then this program design could potentially be marketed to other disability-
specific schools/programs throughout the country. If this program positively influences the
development of skills for youth with visual impairments, then sharing this program design and
implementing it in similar school-based programs throughout the country could bring about,
potentially, large-scale change in the overall preparedness and functional independence of
individuals who may have been previously overlooked or underappreciated due to previously

perceived limitations or barriers to success. Breaking down these previously perceived
limitations and barriers will ensure occupation justice for all persons, and will ultimately lead to
a more equal and diversified society.
Program evaluation.
Evaluation of this program’s success will be determined by tracking qualitative and
quantitative measures for the duration of the school year during which this program is
implemented.
Quantitative measures.
Quantitative measures would track the ability of the staff members to accurately perform
a task analysis on a skill related to this population and to the development of healthy habits and
routines. This measure would be developed and evaluated by the OT administering the
program. Preliminary skills evaluations would take place during the initial training sessions, as
an opportunity for the OT to provide constructive feedback; these preliminary skill evaluations
would not constitute success of the program, but would rather provide a baseline for skill
acquisition. Formal evaluations of quantitative measures would occur during each of the six
observations of skill implementation with students, which will occur periodically throughout the
school year. The OT would then each staff’s performance based on the frequency of observed
utilization of task analysis strategies during each observation on a five-point Linkert scale (1 –
Never Observed, 2 – Rarely Observed, 3 – Occasionally Observed, 4 – Frequently Observed, and
5 – Very Frequently Observed). These measures would be evaluated at the end of the school
year to identify if improvements in staff skill utilization and implementation had improved.
Qualitative measures.

The qualitative measures that would be tracked by the OT for the purposes of
determining program effectiveness would be more subjective and more individualized than the
quantitative measures identified. Qualitative measures would exist in the form of OT feedback
notes written up for each staff member upon completion of the initial training sessions, and
subsequently with each observation. These progress notes, so to speak, will provide constructive
feedback to support staff and will be documented throughout the program. Upon completion of
the initial year of program implementation, the progress notes would be reassessed and themes
would be identified for each staff member, with the expectation that these themes would
represent some type of competency skill progression or confidence improvement for the staff
member.
Expected outcomes.
Overall, the implementation of this proposed program should improve staff competency
and confidence as they implement skill specific training techniques and strategies into their
everyday staff and educator roles within the STEP residential program. Additionally, as staff
begin to implement these techniques and strategies more consistently and efficiently, it is to be
expected that the independence and skill acquisition of students will also show progress.
Therefore, the implementation of this proposed program has the potential to greatly improve
individual and program outcomes, which will eventually result in blind/visually impaired
students becoming more independent in adult life roles as they gradually became proficient in
skill mastery, essentially leading to the improvement of healthy habits and routines development
that these students will have the skills necessary to maintain throughout their adult lives.

References
American Foundation for the Blind. (2018). The expanded core curriculum for blind and visually
impaired children and youths. Retrieved from http://www.afb.org/info/programs-and-
services/professional-development/education/expanded-core-curriculum/the-expanded-
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American Foundation for the Blind. (2018). Utah: 2016 prevalence rates of vision difficulty.
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Appendix A
Student Questions
The following questions were utilized during semi-structured interviews with USB students
within the STEP cottages.
1. Do you mind if I interview and ask you about yourself? / Do you mind if I take some
notes while we talk?
2. How long have you been a student at USDB/what school did you attend before coming
here?
a. How long have you lived in the cottages?
b. What do you like/ dislike about living in the cottages?
i. How would you add on to this program to make it better/ address you
needs?
3. Please tell me about what a typical day at school/in the cottages is like for you.
a. What is your favorite/least favorite part of school/your day?
b. If you could design the perfect day/school day, what would it include?
4. What activities do you enjoy doing? Interests/hobbies?
a. Are there any activities that you are interested in, but that you haven’t tried
before?
5. What is something you feel that you are really good at?
a. Is there anything (activities, for example) that you wish you could be better
at/would like to learn how to do better/differently?
6. What are your plans for after you leave school? Where would you like to live after
school?

a. What careers are you interested in? Why?
b. Are there any skills that you think you will need for that job that you don't have
yet?
7. Physical activity? Preferences/ how often?
8. Is there any technology/devices that you enjoy using or that you use to make things easier
for you?
9. Can you tell me about something in your life that is especially frustrating for you?
a. How do you address these frustrations? / calm down? Does this happen often?
10. If you don't mind, can you please tell me about your vision? / how would you prefer
others to ask about your vision?
11. Is socializing at school/in the cottages different for you then socializing at home or in
your community?

Appendix B
Staff Questions
The following questions were utilized during semi-structured interviews with USB staff.
1. What is your official job title, and what roles and responsibilities come along with this
title for the facility?
a. What do you think is the most challenging part of your job? What do you think is
the most challenging thing for your staff in their roles?
b. How long have you been with USB? How did you find out about USB? Were
you involved in the blind community prior to being employed at USB? If so,
how? (if you were a student prior to being an employee), what was the most and
least beneficial experiences/assistance you had while a student in this program?
Based on your experience, what changes would you recommend?
2. What are your program’s funding sources?
a. Who funds the STEP residential program? Are all students/their families required
to pay a tuition or any school fees to attend this school?
b. Donations? - what do the funds go to/how are they split up
3. Do you feel that your school is at capacity, or would it be possible/would you preferred to
have more students attend?
a. Is it easy for students to be recruited into this school? Into the cottages?
b. Do all students in the school have to have an IEP? (Or 504)?
4. What kinds of programing/services do you currently offer?
5. Are there any plans for different or additional services to be offered in the future? If so,
what are they?


a. Where do you see the school being in 5 years as compared to where it is now?
b. If you had unlimited funds and resources, what areas of the School/program could
the funds benefit?
6. Based upon your knowledge of your students, and how they function in your program or
after they leave your program, what gaps do you see in their functioning or skill levels?
a. Do you feel there are any gaps in the current programs offered by your
facility/gaps in accessibility/service provision for this population? If so, what are
they, and where are the gaps located? Do you have any ideas for appropriate
ways to fill these gaps?
7. Do you feel that the expanded core curriculum is fulfilling all student needs as they
transition out of the school system/age out of the system? If you have noticed any gaps,
please explain.
8. How many students at what ages are currently receiving services at the Utah school for
the blind?
9. What do you feel are strengths & areas of growth within your program?

Appendix C
Occupational Therapy Questions
The following questions were utilized during a semi-structured interview with the school-based
Occupational Therapist at USDB.
1. How is OT funded at USDB? - is it student by student (IEPs), do you bill through IDEA
or through private insurance?
2. What is your current caseload size?
3. What do you feel is a strength of USB? Are there any areas where you see potential to
grow?
4. Have you developed any programs/ groups at USB - or is there anything you wish you
were able to do/had the time/funds to do?
5. What type of evaluations do you do with these students? Do you ever find it challenging
to used standardized assessments d/t them not being validated for low vision populations?
Are there any low vision assessments you prefer?
6. Do you find that it is easier/more successful to work with this population of students one-
on-one, or in a group setting?
7. Have you ever provided or participated in in-services at this setting?
8. Do you have any advice to professionals who are new to working within this
setting/population?
9. Do you ever feel limited by what you are allowed to bill for due to being in the school
setting?

Appendix D
Task Analysis Example
The following task analysis represents an example of what would be included in the staff
resource binder, and would be provided to the STEP residential program as a means of facilitate
accurate skill acquisition of students.
Detailed Task Analysis for Washing Hair
Steps:
1. Wet hair fully while in shower or bath
a. Wetting hair fully means that there are no dry spots left in any portion of your
hair.
b. Double check thoroughness of hair being wet by running fingers across all regions
of the scalp, and running fingers through hair to check the ends of your hair.
c. If dry spots are located, thoroughly douse with water and re-check for dry spots
d. Repeat steps 1b and 1c until all of hair is adequately wet.
2. Locate and pick up appropriate hygiene container - taking note of the location the
container was found, as this product will be returned to that location after use
a. first, locate your shower products, and
b. then identify which product is the shampoo bottle in tub/shower
3. Open shampoo bottle
a. (specific instructions for opening depend on bottle used by client)
4. Squeeze bottle until desired amount of shampoo is in the palm of one of your hands.

a. An appropriate amount of shampoo may be roughly the size of a quarter in the
middle of your hand
b. Provide students with a quarter, if this model may be beneficial for appropriate
amount comprehension
5. Set down Shampoo bottle
a. Back into initial location
6. Lightly touch hands together to transfer equal parts of shampoo from one hand to
the palms of both hands
a. Make sure that this step is performed in a position where hands will not be
washed clean of shampoo from the faucet, without first getting shampoo into hair.
7. Begin applying shampoo to the scalp in sections
8. Using fingertips, gently massage the shampoo into the scalp until shampoo begins to
lightly lather (become sudsy) – apply shampoo in sections using the following
pattern
a. anterior and superior aspect of the scalp (the top and front portion of the scalp
often shows signs of “greasy-ness” first)
b. posterior and superior aspect of the scalp
c. posterior and inferior aspect of the scalp
d. and, if applicable, continue lathering out to the tips of all hair strands
9. Gently massage and lather for an adequate amount of time
a. Count to at least 20 seconds during lathering in each of the above sections of
the scalp/hair,

10. When adequate lathering/massaging of product into scalp is achieved, Rinse hair/scalp
with water to fully remove soap suds.
a. Fully rinsing hair means that no additional soap suds are being rinsed from hair,
and the water flowing over hair runs clear/free of bubbles
11. Double check that hair feels free of shampoo by running fingers through hair and
checking the texture
a. Using the sensation of touch, explore hair with fingers/hands to search for any
portions that have not been fully rinsed – these sections may feel slimy, sudsy, or
may feel as though the hair is still coated with something, suggesting that it is not
fully clean yet.
12. If the individual wants to use Conditioner, then have them follow the same steps as
were used for shampoo, but on step #9, they should allow the product to sit in their
hair for approximately 2-4 minutes prior to rinsing out the product.
a. Reinforce the correct sequencing of hair washing products – shampoo first,
and then conditioner.

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Running Head: FACILITATING HEALTHY HABIT AND ROUTINE 1

Description of the Setting

wide range of services to thousands of deaf, blind/visually impaired, or deaf-blind students.

(Utah Schools for the Deaf and Blind [USDB], 2018d)

The USB Mission and Vision

program states the following: “providing exceptional, comprehensive, and research-based

residential-based transition program known as the Supported Transition Extension Program

(STEP) for students age 16-21 years old (USDB, 2018e).

The STEP residential program.

The expanded core curriculum.

efficiency skills, and compensatory skills or functional academic skills, including

communication (AFB, 2018).

availability of educational support services is impressive. In addition to the educators,

(USDB, 2018e; & USDB, 2018a).

Future Plans of Agency

It is common for visually impaired students to lack the opportunity to develop

varying perspectives on the world.

External Influences on Service Delivery

student, their family, and their education team.

of their school’s campus.

Structured Data Collection

population of young adults.

offered through USB.

family homes or in previous school settings.

Blind mentor/support staff perspectives.

of willingness/desire to challenge themselves to learn skill mastery and adequate task

management, and basic home maintenance habits.

School-based Occupational Therapy perspective.

maximum caseload capacity at this time.

decreased opportunity and/or ability to maintain meaningful relationships, difficulty developing

and maintaining healthy habits, poor self-initiating of participation or behaviors, and

occasionally poor emotional regulation skills.

assist students in order to facilitate independent living skill mastery.

ECC educational services aide perspective.

maintaining awareness of themselves and their environment, in order to adequately complete a

them recognize and implement independent living skills and routines.

Graduate student perspective.

Programming Strengths and Areas for Growth

fulfilling lives as they transition out of the USB education program.

Areas for growth.

more effectively assist students by facilitating successful educational experiences. It also

Approximately 30 articles were initially chosen based on apparent appropriateness of topic or

of this literature review and are referenced below.

Health and Lifestyle Risks for Youth with Visual Impairments

Literature was reviewed to gain a more holistic understanding of common lifestyle

experience limited opportunities to participate in activities outside of school, commonly resulting

Delay of Independent Living Skill Acquisition

To further investigate potential areas impacting independent living skill competency,

attempt to identify potential causes for these delays.

Lack of incidental learning opportunities.

incidental learning experiences?

Overprotectiveness and lower expectations.

actual abilities, thereby, decreasing unnecessary overprotectiveness, and positively influencing

the child’s participation in everyday activities.

The Role of Occupational Therapy

address academic-related needs as outlined in a child’s IEP. Whereas, the OT practitioners

impairment, or blindness (Smith, 2014).

Low vision, an AOTA emerging practice area.

The American Occupational Therapy Association (AOTA) recently recognized low

developed in order to improve practitioner competence in low vision practices; 1) a Certified

(SCLV) (Smith, 2014).

Person, environment, occupation theory.

The Person-Environment-Occupation (PEO) theory used by occupational therapy