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Happy Occupational Therapy Centennial! What better way for SeekFreaks to start the month than by focusing on the postsecondary occupations of employment, education and independent living!

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Predictors

The ability to predict is very useful in our profession as therapists. One way of predicting is via the use of assessment tools like the Gross Motor Functional Classification System and the Manual Ability Classification System that help prognosticate the abilities that an individual with cerebral palsy would likely have at a certain age. Such foresight allows us to design more efficacious interventions.

Another tool that helps with prediction is by looking at research into the effects of interventions. It is through this type of research that we know that context-focused is just as effective as child-focused interventions.

Better yet, look for systematic reviews or meta-analyses, which compiles the results of multiple studies. The systematic review of Novak et al (2013), for one, provided us a practice-enhancing and/or practice-changing graphical representation of medical and therapeutic strategies that have been found to be effective or ineffective in achieving outcomes such as management of contracture and spasticity, and improvement of motor activities, self-care, communication, etc.

How about for postsecondary outcomes of employment, education and independent living? Wouldn’t it be great if we know that the interventions we are implementing is helping students with disabilities achieve these outcomes? Luckily, systematic reviews have also been conducted in this area.

The systematic review of Test, et al (2009) identified 16 predictors of postsecondary outcomes. Mazzotti, et al (2016) found an additional 4 predictors after systematically reviewing articles that utilized data from the National Longitudinal Transition Study-2 (NLTS-2). By the way, the NLTS-2 is a great topic to discuss…we’ll leave that for another time.  

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18 Predictors of Postsecondary Outcomes

We decided to give the predictors identified a SeekFreaks treatment by creating an infographic of the 18 Predictors of Postsecondary Outcomes to easily remind school-based therapists and other educators what works!

You might be asking, why 18? Isn’t 16 + 4 = 20? Two of the 4 other predictors found by Mazzotti, et al (decision-making and goal setting) fall under 1 predictor identified by Test, et al (self-determination), so we excluded them.

The infographic above lists the 18 predictors and shows the connection between these predictors and postsecondary outcomes.

  • All 18 items predict employment
  • 12 items predict both postsecondary education
  • 4 items predict independent living skills

These 18 predictors include moderate and potential predictors! This means that some have been shown to be more effective than others. This is based on the number, size, type and strength of the studies and results. You can find out which is which, by reading Test, et al (2009).

If you would like operational definitions for each of these 18 predictors, I would refer you to Rowe, et al (2015) that clearly defines the 16 identified by Test, et al (2009a); while Mazzotti, et al (2016) defines the 2 indicators (parent expectations and travel skills) they identified and we are discussing in this article.

SeekFreaks, simply repeating those definitions here would not be adding anything new to the discussion; hence, we just refer you to the above articles. This means we also have more space to discuss the fun stuff of how we can apply them to our practice. Read on!

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Applying the 18 Predictors in our Practice

Mazzotti, Test & Mustian (2014) and Rowe, et al (2015) provided great suggestions for policymakers and educators based on the 18 predictors. So, again, I encourage you to read them (great bedtime readings!…but keep a highlighter handy to mark many of them.

Below we will discuss some of the predictors and how OTs, PTs and SLPs. Some of these suggestions you may be doing already, others you may need to do more often. Note that each of these predictors are interconnected, such that addressing one should be done together with others. For example, travel skills may be necessary for paid employment.

Inclusion in General Education

  1. Participate in team decision-making with regards to class placement.
  2. Resist the temptation to recommend special education classroom. Rather, ask the team what do we need to do to include the child in general education.
    1. Brainstorm with the team how OT, PT and SLP services can make sure that the student can participate in a general education classroom.
    2. What adaptations would the student need for communication? For completion of classroom tasks? For safe mobility and participation?
  3. General education is not a yes or no option. If full-time participation in general education is not appropriate, determine which specific general education class or classes the student can successfully participate in, so that they are at least included part-time in general education.  
  4. Use your medical expertise and educate classroom teachers and other educators on how they can support the student’s success in their classroom. Don’t reinvent the wheel, read SeekFreaks’ article Do Teachers Know the Impact of Preterm Birth for some ideas.
  5. Conduct an inservice training for all school personnel. (Use the same resource as in #4 above)

Paid Employment/Work Experience

  1. Assess the student’s strengths, weaknesses and preference. Use participation evaluationt tools.
  2. Participate in team decision-making when determining vocational/work experiences the student will participate in.
  3. Perform an ecological analysis of the workplace. Can modifications be put in place to promote success?
  4. Perform an analysis of tasks relevant to the work the student will engage in. Can the task be modified?
  5. Help strengthen the skills that the student would need to succeed in employment.
    1. Is it physical skills like lifting and squatting?
    2. Is it computer skills?
      • Work in collaboration with the teacher to integrate these skills into the classroom so the student can gain more practice.
      • Or together with the team, look for teaching tools like Digitability.
  6. Help the team decide what assistive devices the student will need to succeed, for example:
    1. SLPs can help select the most efficient communication device
    2. OTs and PTs can help decide appropriate adaptive equipment
  7. Practice situational communication with colleagues, customers and managers.

Self-care and Independent Living Skills

  1. Don’t ignore self-care skills! Spend more therapeutic time in the bathroom for toileting, hygiene clothing management and other self-care skills. This skill is not just essential at home but also for paid employment. Remember that at some point during their work day, the student will have to use the bathroom.
  2. Take therapy out of the therapy room, closet or corner table. Instead, practice household chores, money management, shopping, cooking, and many other independent living skills. For range of motion and strengthening, stop reaching for cones or beanbags, and reach for groceries instead. For fine motor skills, don’t handle beads…handle and count money instead.
  3. Collaborate with the parent/guardian and decide which chores the student will be completing at home.

Self-determination/Self-advocacy

  1. Provide the student opportunities to develop the different elements of self-determination in your intervention. Allow them to make choices, make decisions, solve problems, set goals, become a leader, self-advocate and self-manage. self-management.
  2. Together with the school team, use Whose Future Is It Anyway. It’s a free online lesson plan that helps student gain self-determination.
  3. Let the student direct their related services. Use the Self-Determined Learning Model of Instruction in your own intervention. It is a free, 3 part module that the student can use to create his/her own goals, intervention and monitoring plan.
  4. Involve the student in their IEP planning, and let them lead if possible. The IEP is about the student after all.

Social Skills

  1. Include peers in your intervention time. This can be done by providing services in the classroom or in groups. You are not just supporting social interactions, you are also enhancing motor learning (read the Demonstration section in this article to learn why).
  2. Implement a communication device that can facilitate communication with peers. Teach the student strategies to initiate conversations, and not just be a passive communicator.
  3. Educate school staff and parents on strategies to facilitate social skills. Your medical skills will once again be useful in this area.
  4. Include the student in different social situations and teach him/her as to what is appropriate. When should you use your indoor vs. outdoor voice? What’s appropriate in a meeting? How would you approach a grocery employee for help?
  5. Teach the student to self-monitor and self-regulate in social situations.

Parent/ Family Involvement

  1. Involve the parent/family from your assessment to your intervention.
  2. Make sure that the parent/family understands the child’s IEP and the role of every member of the IEP team.
  3. Be welcoming to the parent/family. Take extra effort to find out and include in discussions the parent/family’s concerns, needs and goals.
  4. Practice cultural competence. For resources on cultural competence, read 10 Handy ASHA Resources – this resource is applicable to OTs, PTs and other educators, not just SLPs.

Travel Skills

  1. Teach mapping skills. Learn to go from one place to another. Educate student on use mobile apps such as Google maps.
  2. Practice navigating different surfaces, concrete, gravel, curbs, ramps, etc. Determine the appropriate assistive device(s).
  3. Learn street and traffic signs.
  4. Bring your therapy outdoors and practice hailing and riding a bus, subway, train or car services. What adaptive devices would they need? What app mobile app can they use?
  5. Teach useful communication and self-advocacy skills when in the community. How to seek help, ask for directions? And whom to ask.

Student Support

  1. Link student and family with appropriate community agencies.
  2. Provide the student opportunities to build friendships. Provide group instead of one-on-one interventions. Encourage development of recreational skills in the playground with other peers, instead of in a therapy room with a therapist.
  3. Help student and family select appropriate community activities, clubs and advocacy groups.

Transition Program

  1. Participate in transition planning meetings.
  2. Include the student and family in their IEP discussions and transition planning. Consider the student’s needs, strengths, goals and preferences.
  3. Do all of the suggestions above!

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Final Words: Start Early!

If I may add one more thing…some of the skills described above (e.g., communication, social, self-determination, and physical skills) take a long time to develop. Why wait until they are in middle school to practice these?

Start early! We now know the predictors of postsecondary outcomes, let’s practice them when the child is in elementary school or even earlier to give them the time and opportunity to master these skills.

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References and Resources:

Mazzotti, V. L., Rowe, D. A., Sinclair, J., Poppen, M., Woods, W. E., & Shearer, M. L. (2016). Predictors of post-school success: A systematic review of NLTS2 secondary analyses. Career Development and Transition for Exceptional Individuals, 39(4), 196-215.

Mazzotti, V. L., Test, D. W., & Mustian, A. L. (2014). Secondary transition evidence-based practices and predictors: Implications for policymakers. Journal of Disability Policy Studies, 25(1), 5-18.

National Technical Assistance Center on Transition (NTACT)

Rowe, D. A., Alverson, C. Y., Unruh, D. K., Fowler, C. H., Kellems, R., & Test, D. W. (2015). A Delphi study to operationalize evidence-based predictors in secondary transition. Career Development and Transition for Exceptional Individuals, 38(2), 113-126.

Test, D. W., Fowler, C. H., Richter, S. M., White, J., Mazzotti, V., Walker, A. R., … & Kortering, L. (2009). Evidence-based practices in secondary transition. Career Development for Exceptional Individuals.

Test, D. W., Mazzotti, V. L., Mustian, A. L., Fowler, C. H., Kortering, L., & Kohler, P. (2009). Evidence-based secondary transition predictors for improving postschool outcomes for students with disabilities. Career Development for Exceptional Individuals.

National Technical Assistance Center on Transition (NTACT)

American Pediatric Physical Therapy Adolescents/Adults with Developmental Disabilities Fact Sheets

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What strategies can you add to the above?

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