Running head: Seeing the World Beyond: An Occupation-Based Program

Seeing the World Beyond: An Occupation-Based Program

Dawn C. Yearsley
University of Utah

SEEING THE WORLD BEYOND

Introduction
The purpose of this paper is to conduct a needs assessment and to propose an occupationbased program for an underserved community in Salt Lake City, Utah focusing on individuals
with a mental illness or substance abuse problem. A needs assessment was completed and the
data analyzed to determine the needs of the population served. This program will focus on the
residents at Valley Behavioral Healths Valley Plaza program.
Needs Analysis
Setting
Valley Behavioral Health is a non-profit company that serves individuals who experience
mental illness and substance abuse. They have over 800 employees with 69 different programs
serving 16,000 people every year throughout the Salt Lake Valley. Their vision states, We are
inspired by helping those we serve lead more fulfilling lives, one person at a time. (Valley
Behavioral Health, n.d.). and their mission statement is A leading community partner providing
and promoting accessible, quality behavioral and physical health care (Valley Behavioral
Health, n.d.). The company has six values that it strives to include in all of its decision making
processes they are: empathy and compassion, team focus, excellence, resilience, integrity and fun
(Valley Behavioral Health, n.d.). The program that this paper will focus on is Valley Plaza.
Valley Plaza is considered transitional supported housing located in downtown Salt Lake City,
Utah. It is part of Valleys supported housing program. It houses 72 adults with serious and
persistent mental illness who have Medicaid (Valley Plaza, n.d.). A majority of the clients are
coming from Utah State Hospital, University Medical Center, University Neuropsychiatric
Institute and at times from the community. Valley Plaza implements a client centered, recovery
based method of rendering services to clients to promote self-reliance, growth, and
empowerment. All services are geared toward helping clients become as self-reliant as possible,

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moving on to more independent living situations. (Valley Plaza, n.d.). Services are provided 24
hours a day 7 days a week. The facility has 40 apartments, totaling 72 beds: 8 studios and 32
two-bedroom apartments.
The facility offers individualized treatment tailored to fit the clients needs. The staff includes:
Clinical Social Workers, Social Service Workers, Nurses, Prescribers, Case Managers, and Peer
Specialists all work together as an interdisciplinary team. The site offers a variety of group
sessions and other specific services as needed such as teaching them how to keep an apartment
clean, money management, and helping them work through grief to name a few. Each resident is
required to attend at least 2 groups per week (Valley Plaza, n.d.).
While the residents are allowed to have a personal vehicle, most of them do not own one. For
transportation, they can either walk, use the public transportation system or ride in a van that
Valley Plaza provides to take residents shopping or to other treatment facility. Valley Plaza is
within walking distance of many resources including: public library, grocery store, thrift stores
and fast food restaurants. Each week the residents apartments are inspected, and each resident is
expected to provide their own meals. All of the apartments have a fully equipped kitchen. Valley
does provide one meal a day, dinner, that can be purchased for two dollars (Valley Plaza, n.d.).
Valley Plaza is a drug free zone. Smoking is prohibited on the property and no other drugs are
allowed in their rooms. If a client is caught using in their apartment they may be asked to vacate
the premises. Valley Plaza recently had to renovate 4 apartments after discovering some of the
residents were cooking meth in them.
When meeting with the director of Valley Plaza, Jim Jones, (personal communication,
September 28, 2016) it was revealed that Valley Plaza currently has limited funds to use for
leisure activities and outings. They were given some grant money this year, but it has been used.

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He is hoping that next year they will be able to receive more funding. Jim has been in his
position for less than a year, but he wants to obtain more funds in the future to help provide more
resources for the clients such as access to computers.
Data Collection
Staff Perspective. To collect information about the strengths and weaknesses of the
facility from the staffs perspective, formal and informal interviews were conducted with the
director and some of the case managers. (See Appendix A). When talking with the staff it was
apparent that they care about their residents and they want to see them succeed. Every day the
case managers check in with the clients to see how they are doing and they run various groups
throughout the week. Valley Plaza is considered transitional housing, which typically means
temporary housing, but when asked how long residents normally stayed the answered varied.
One of the residents had lived there for 20 years, another was there for 12 years, and some
people as little as three weeks. When discussing this with Jim (personal communication,
September 28, 2016) he talked about how for some of the residents this becomes their home, a
place where they are comfortable. He went on to say how there is not a specific timeline or
ideal time for a client to stay there. He believes that every client is different and declared that it
differs from person to person.
One of the main concerns mentioned during the interviews was the need for the residents to
become involved in leisure activities outside of the facility. It was reported that most of the
residents spend their free time smoking and watching television. One of the case managers
mentioned how she was worried about a few of her clients because they rarely leave their room,
they do not like attending groups and they do not do other things in the community. Those who
have been here the longest have been to all of the groups and get bored so they go back to using

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[illicit drugs] again to fill their time Jim said (personal communication, September 28, 2016). It
was also mentioned how residents do not understand how to use computers or how to get access
to them. The staff describes their clients as fairly low functioning with concerns that they do not
know how to use the public transportation system.
The residents have access to many resources at the facility including groups, shopping trips,
24-hour support to name a few. Through Valley Behavioral Health they have access to even more
programs that offer professional counseling and more groups. Nearby there are more options for
treatment including Volunteers of America Detox Center, and YWCA, other resources including
a food bank, local library, and thrift store. Currently they have no connections to local business.
It is an area they would like to see grow, in order to be able to offer discounts to residents to help
them become more involved in more leisure activities.
Residents Perspective. A leisure interest survey was provided and follow up questions
were asked to 12 of the residents at Valley Plaza (See Appendix B). In exchange for their
participation each of the residents received a coupon for a free dinner at the facility, a two-dollar
value. After comparing all of the leisure surveys it became apparent that they all had interest in
many different areas. Some of top areas of interest include: exercise (mainly walking), social
groups, watching television, listening to music, and cultural activities (e.g. museums,
symphonies etc). When asked about using a computer a few expressed an interest in learning
how to use one, while others were adamant they wanted nothing to do with a computer. While
reading was listed among the top interests a few of the residents mentioned that they did not read
very well. Some of the residents complained of back pain or leg pain and reported that it kept
them from being able to walk very far or even do physical activities in general.

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When asked how they usually spend their free time most reported just watching television and
relaxing. One resident likes to go visit his wife, while another likes to sleep. While discussing
groups it became apparent that there is a wide variation on who actually attends groups. One
resident, who spent two years at Utah State Hospital, said the she was grouped out since she had
to go every day at the state hospital. She also expressed how she has a hard time keeping track of
time and remembering to come to groups or to come down and collect her medication. She
expressed an interest in wanting to be able to keep her medication in her room because it would
be easier for her to remember. It is a policy that all medication has to be kept locked up
downstairs and is distributed by the nurse. One resident mentioned how some of the residents
will sometimes get together to go to the symphony or other events such as the fair, one client said
she had season tickets to the symphony, although it is unclear how many residents actually
participate in activities outside the facility. When asked what the residents liked about the facility
they all mentioned they liked that it was nice and clean. Others liked how it was drug free,
peaceful and honest. Each of the residents were asked if they would be interested in going on
more outings with other residents and almost all of them replied with a yes.
My Personal Perspective. While at Valley Plaza I have talked with many of the residents
and was able to attend their karaoke group. During those times, I observed the facilities, what
they looked like and how they felt along with observing the residents interactions with each
other and what they did. The facility is set up like an apartment building with a common room
and dining area on the bottom floor. The building is always locked and requires a key to enter.
The staff offices are located behind a closed door and residents have to knock on it if they would
like to speak to their case managers, calling their case manager is also an option.

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Every time I have come to the facility there are residents in the lobby sitting around hanging
out. Sometimes they are talking to others but usually they are sitting there doing nothing. The
same can be said for the common room and dining room. There is usually always someone down
there hanging out. Sometimes the television will be on but not always. When I attended the
karaoke group more interaction was observed. The residents all knew who each other was and
they looked out for each other. While I was there a resident was going around and asking if
anyone had an extra pair of mens shoes because one of the male residents had lost his shoes. For
some of the residents I observed that personal hygiene and cleanliness was a problem. At one
point when I got on the elevator a resident was bringing down his garbage and there were fruit
flies flying around. Outside the facility, you can usually see a few residents smoking. After my
observations, I feel like the residents would benefit from learning more about the importance of
participating in leisure activities and how to become more involved in activities outside of the
facility.
Literature Review
A literature review was conducted to better understand supportive housing and how it
contributes to helping with recovery of individuals with a mental illness. Along with examining
the effects that mental illness has on an individual, time use was also looked at to see how a
individuals with a mental illness used their time and to see what their desires were for their life.
Next the use of leisure time to aid in recovery was studied to see if it helped with relapse or
caused any changes in their daily routine. Last the role of occupational therapy in the field of
mental illness and what can they contribute.

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Supportive Housing
There are many research articles on supportive housing model and the benefits that it can bring
to the individuals who live there. It was found that the more housing choices that were given the
greater satisfaction people with mental illness had with where they lived (Sylvestre, Nelson,
Sabloff & Peddle, 2007). Living in an environment that someone with a mental illness chooses
helps to ensure that he or she feel comfortable and want to be there. Supportive housing usually
houses individuals with similar diagnoses. In another study, it was found that living with people
with the same kind of difficulties helped them be able to relax and be themselves (Argentzell,
Hakansson & Eklund, 2012). The supportive housing model was also found to reduce
homelessness, increase housing tenure, and decrease emergency room visits and hospitalizations
(Rog et al, 2014)
Effects of Mental Illness
Having a mental illness can affect many different areas in a persons life. After reviewing
different articles the areas that will be focused on include: comorbidity, loss, and time use. All of
which can better help the reader understand why someone with a mental illness acts the way they
do.
Comorbidity. Most of the residents at Valley Plaza have more than one diagnosis with a
common one being substance abuse. It was found that people with mental illness have a higher
rate of substance abuse (Hodgson, Lloyd & Schmid, 2001). Substance abuse brings on a different
set of symptoms and can make recovery and treatment even harder. Roush (2008) found that an
individual who has co-occurring disorders had increased symptom severity with regular relapses
of symptoms and increased episodes of violence. Persons with severe mental illness appear to
recover from substance abuse just as others do, by developing satisfying lives that include

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regular activities, including jobs hobbies, meaningful relationships and safe living environments
away from the substance abuse (Drake, Wallch, Alverson & Muesser, 2002 p.104).
Loss. Individuals who have a mental illness have suffered loss in their lives that can lead
to limited opportunities for participation in daily community life (Baker & Proctor, 2014;
Edlund, Hansson, & Ahlqvist, 2004). This loss can become a chain reaction. At first they might
lose their job which leads to them losing their house. This affects their relationships and can
contribute to losing their roles such as mom, husband, coworker etc. The loss of roles can bring
on feelings that they are losing a sense of self or their future in some way. (Baker & Proctor,
2014). These events can lead to exclusion from family and friends (Argentzell, Hakansson &
Eklund, 2012; Baker & Proctor, 2014). Loss of relationships aide in making them feel like they
have let someone down which leads to a loss of motivation. The loss of motivation is connected
to loss of interest, routine and feeling overwhelmed by even the smallest tasks such as losing the
energy to perform basic ADLs (Baker & Proctor, 2014). Loss of motivation, or not knowing
where to even start, can lead to boredom which is a risk factor for relapse (Baker & Proctor,
2014; Hodgson et al 2001). Since individuals have a loss of motivation and at times suffer a loss
of identity due to loss of roles, it is important to know how they spend their time.
Time Use. A common use of time through all of the studies was sleeping. (Baker &
Proctor, 2014; Leufstadius, Erlandsson, & Eklund, 2006; Minato & Zemke, 2004). The more
time that these individuals spent on sleep the less time they had for occupations. This leads to
increased passive leisure, decreased productivity and less active leisure compared with the
general population (Minato & Zemke, 2004). Minato and Zemke (2004) also discovered that out
of all the participants in their study 100% of them participated in sleep, meals, and mass media,
such as, watching television, but only 9% volunteered.

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These irregular sleeping patterns make it difficult for them to keep routines. Their activities
usually circulated around watching television and if they went out it was to visit family members
or friends (Baker & Proctor, 2014; Mayers, 2000). Leufstadius and Eklund (2014) found that
individuals who had been diagnosed with psychosis spent less time performing daily activities
and out of those individuals, women usually spent more time on self-care.
Desires and Barriers. The important thing to remember is that individuals with mental
illness are human beings that have feelings, thoughts and desires. They need to be involved in the
decision-making process of their treatment and living arrangements. It was found that these
individuals had a strong desire to be seen as competent and to feel accepted in society and that
they were happy when asked their opinions on their priorities (Argentzell, Hakansson & Eklund,
2012; Mayers, 2000). Mayers (2000) identified the top priorities that affected their quality of
life, including; lack of personal achievement, lack of job, difficulty forming and maintaining
relationships, loneliness, health problems, lack of leisure activities and looking after self
(p.g.596). Mayers also found that very few people were happy with their current occupation
[ shopping, eating etc] aspects in life, but admitted that even if options were made available they
might not go because they cannot always relate to people. Other barriers that contribute to a
persons desire to participate in activities include: their diagnosis of mental illness, social issues,
transportation barriers, and financial issues (Hodgson et al, 2001).
Use of Leisure Activities to Aid Recovery
Many studies have been done to evaluate the use of leisure activity to aid in recovery of
someone with a mental illness, showing positive results. (Argentzell, Hakansson & Eklund,
2012; Edgelow &Krupa, 2011; Iwasaki et al, 2014; Leufstadius et al., 2006). Leisure activities
help prevent boredom and help shift occupational balance away from wanting to sleep, which

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creates these cycles of activity and rest, toward an increase in overall activity level. Becoming
involved with leisure activities helps them to create routines, aid them in feeling a sense of
accomplishment, and helped them feel like they were competent and accepted (Argentzell,
Hakansson & Eklund, 2012; Baker, & Proctor, 2014). It was found that many different types of
activities were successful including social group, swimming, arts and crafts, and writing in a
diary (Argentzell, Hakansson & Eklund, 2012; Mayers, 2000).
Besides helping decrease boredom it was found that involvement in leisure activities plays a
crucial role in relapse prevention (Iwasaki, Coyle & Shank, 2010). The individuals who
participate in leisure for intellectual reasons were found to recover better and had stronger
motivation (Lloyd, King & McCarthy, 2007). The use of leisure both for coping with stress and
reducing boredom significantly predicted fewer psychiatric symptoms (Iwasaki et al, 2014 p.
148). Ussher et al (2000) found that leisure activities led to positive changes in smoking, eating
and alcohol behaviors. Roush (2008) found that individuals with co-occurring disorders that did
not engage in the community through meaningful occupations, were unlikely to sustain their
recovery. Other studies found that involvement not only gave them a way to pass the time but
helped them to feel productive and capable of doing and finishing tasks (Argentzell, Hakansson
& Eklund, 2012; Baker, & Proctor, 2014). It is important to note that the activities need to have
the just right challenge meaning that they cant be too easy or too hard, otherwise the clients
would get bored or would become overwhelmed (Argentzell, Hakansson & Eklund, 2012).
Leisure gives strength, peace of mind, inspiration, and more depth and color to ones life and
makes it more well-rounded in the journey to recovery (Iwasaki, Messina, Shank & Coyle, 2015
p.548).

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Role of Occupational Therapists

Throughout the different studies the role of occupational therapists in this role to recovery
became very apparent.
Occupational therapy practitioners are ideal members of supportive housing teams as
team leaders or consultants. Evaluating strengths and skill challenges of persons with
serious mental illness and chronic substance use disorders is needed to assist with the
acquisition of skills to manage home cleaning and tenancy ,client-centered approach
is to help consumers live as independently as possible in community and move
toward self-sufficiency (Nolan &Swarbrick, 2002).
Occupational therapists cannot only help residents reach their goals but they can help them
develop meaningful occupations and help them develop the necessary skills to aid them in
becoming self-sufficient (Minato, & Zemke, 2004; Swarbrick, 2016; Ussher et al, 2000).
Engagement in occupation to support participation in context is the focus and targeted end
objective of occupational therapy intervention (AOTA, 2002). An occupational therapist also
has the ability to aide in role development, stress management and social skills of an individual
helping them not to depend on substance abuse. (Roush, 2008 p.2).
Summary
The vision of Valley Behavioral states, We are inspired by helping those we serve lead more
fulfilling lives, one person at a time (Valley Behavioral Health, n.d.). This is the goal of
occupational therapists as well. The literature revealed that supported housing is effective in
treating individuals with mental illness and substance abuse. It also found that these individuals
have a hard time keeping a routine and tend to spend most of their day watching television or
sleeping. This was also mentioned in the data collection section of the needs analysis by the staff

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members. The literature also revealed that those with a mental illness like to have a choice and
are happy when they are included and asked about their priorities and decisions. This was
evident in the data collection portion of the needs analysis when the residents were given a
survey to fill out and asked a few questions. They were all eager to respond and wanted to talk.
During the literature review it became apparent that involvement in leisure activities can have
a major influence on the recovery and relapse prevention of someone with a mental illness. It not
only helps people with a mental illness to regain a sense of identity that was lost but also helps
them to create new role identities, routines and fill in the gaps in their day to decrease boredom.
An occupation based program that explores different leisure activities, teaches the residents how
to access those resources and how to modify activities, and why it is important would be a great
addition to Valley Plaza.
Program Proposal: Valley Plaza- Resident Leisure Involvement Program
Seeing the World Beyond
Program Overview
As the needs analysis and literature review suggest there is a need for a program that will help
the residents at Valley Plaza increase their motivation and their desire to participate in daily
leisure activities in order to help decrease boredom and reduce symptoms associated with mental
illness. Research has shown that leisure activity will help reduce these symptoms and boredom.
Reducing boredom was identified as important because when residents get bored they tend to go
back to old habits of substance abuse. This program will follow Valley Plazas vison to help
others lead a more fulfilling life by teaching residents about the importance of having a balanced
lifestyle and including leisure activities in their everyday life. It will teach them how to access
leisure activities in the community and expose them to different leisure activities to see what

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things they enjoy. The program will also help them create a routine to help restore some of the
roles lost when they were diagnosed with mental illness. Valley Plaza currently has several
leisure activities available for residents throughout the month. This program will compliment
those activities by helping the clients have a greater desire to participate and develop a greater
desire to explore new leisure activities that could be incorporated into their lives.
Over the course of the program clients will explore different roles they have lost, gain a new
self-identity and discover why they have lost motivation to participate in those roles. They will
then have a chance to create new roles and identities for themselves through leisure activities.
Whether they become a painter, or a team captain the program will help them develop the skills
necessary to plan and carry out their own leisure activities. Group members will have a chance to
plan an activity for the group.
This program will have an occupational therapist provide direct services to the residents
through individual interactions in a group setting. An occupational therapist will also provide
consultative services with the case managers at the facility to help them know how they can
better help residents function and perform activities of daily living. This program will address
tertiary prevention, maximize function and reduce injury for those with a mental illness. Many of
the residents who have been diagnosed with a mental illness also battle substance abuse. This
program will aim to help decrease any further complications and to reduce symptoms associated
with their illness. Occupational justice or ensuring someone is able to participate in chosen
occupations is also addressed. Most of these residents stay at home all day. They spend the
majority of their day either sleeping, smoking or watching television. Because of their financial
situation, they have limited personal funds. This program will address occupational deprivation
and occupational imbalance. These residents have a right to be able to live a fulfilling life that

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has meaning to them and be involved in occupations that are meaningful to them. In order to be
eligible to attend the weekly program, residents will need to have been at Valley Plaza for at least
3 months and be compliant with their treatment plan of care. This will allow them time to get
used to a new environment and get a sense for what their new life is like before they begin
exploring different occupational activities.
Justification to Hire an Occupational Therapist
Occupational therapists are ideal to run and provide consultation to the residents and case
managers at Valley Plaza. As mentioned previously an occupational therapist in a supportive
housing setting can help residents develop a variety of skills including: social skills, activities of
daily living (e.g. hygiene, dressing), instrumental activities of daily living (e.g. cleaning,
cooking, budgeting) and stress management. Occupational therapists have been trained in
activity analysis meaning they are able to look at different tasks or skills and break it down to
determine why a resident is having trouble being successful. Other typical services that an
occupational therapist can provide include: comprehensive home and job site evaluations with
adaptation recommendations, performance skills assessments and treatment and adaptive
equipment recommendations and usage training (AOTA, 2016). These skills would be invaluable
to the care team at Valley Plaza. With their unique set of skills an occupational therapist could
help the residents have more success in their treatment and help with the transition process.
Theoretical Foundations
Different theoretical models have been established to help the practitioner understand the
best way to evaluate, assess and treat a variety of populations in different settings. This program
will utilize the Model of Human Occupation (MOHO), (Kielhofner, 2009) which is an
occupational based practice model. This model encompasses a variety of theories that make up

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the foundation including: anthropology, psychology, social psychology, environmental

psychology and the dynamic systems theory. One of the set outcomes for MOHO includes:
improving individuals participation and adaptation in life occupations and to improve problems
of occupation that occur through changes in volition, habituation and performance capacity and
environmental context. It recognizes that occupation participation is influenced by multiple
areas. MOHO has a holistic approach that looks at the person as a whole and encompasses all
aspects of their life. MOHO addresses their life roles, habits and routines; personal causation;
physical and social environment; and occupational identity.
There are many different assessments that can be used when evaluating a client with MOHO in
mind. In this program an interest survey will be used to establish what occupation/leisure
activities the residents have an interest in, and the Occupational Performance History Interview
(OPHI-II) which is a semi- structured interview that looks at a client's life history in the areas of
work, play and self-care performance will be used on future group members. These assessments
can be administered before a resident begins attending the group thus the group leader will have
a clearer picture of a residents interests but also of why they have struggled with occupations in
the past.
The Lifestyle Balance Model (Christiansen and Matuska, 2006) will be used as a supporting
model. One of its postulates for change is that the resident experiences an ideal balance which is
represented by equal involvement in physical, mental, social, and rest occupations. It aims to
help individuals gain that balance through meaningful occupations.
The residents at Valley Plaza are currently living an unbalanced. These models will benefit the
program by helping the group members develop motivation to participate in different leisure
activities and to help them understand and learn the importance of a balanced lifestyle.

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Goals and Objectives

The following are the goals and objectives for the proposed program:
Goal 1:
To inspire residents to lead more fulfilling lives through participation in leisure activities.
Objectives:
1) In 6 weeks 80% of group members will participate in at least 1 leisure activity per week.
2) In 3 weeks 80% of group members will be able to explain why leisure activities are
important for occupational health.
Goal 2:
To reduce mental illness symptoms and decrease substance abuse of group members through
leisure participation.
Objectives:
1) In 12 weeks 75% of group members will have reduced mental illness symptoms by
following a daily routine as reported by case manager.
2) In 6 weeks 50 % of group members will demonstrate use of leisure participation to reduce
boredom, member will self-report along with report from case manager.

Seeing the World Beyond: An Occupation Based Program

Fully Describe Program
Program Implementation. This program will consist of 12 group sessions that meets
weekly. Before the group starts each group member will meet with the occupational therapist for

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an assessment using the Occupational History Interview (OPHI- II) (See Appendix C for
Sample). The first session will discuss the purpose of the group and will have each member
complete various worksheets that help them reflect on their current lifestyle and what they feel
are their current routines and roles. This will provide a baseline to build on throughout the
duration of the group. The other sessions will focus on using public transportation, the
importance of have a balanced lifestyle and exploring old and new roles helping them create a
new identity. More than half of the sessions will be used to explore various leisure activities at
Valley Plaza and out in the community. The group members will have a chance to plan their own
activities for the group to do. Thus, practicing the skills, they have been taught. Each group will
have no more than 10 participants.
Participant Criteria. As mentioned previously, in order to participate in the program
residents will need to have been at Valley Plaza for at least three months and be compliant with
their current treatment plan of care. This means that they have attended other group meetings and
are meeting the other requirements. The three-month rule allows the resident time to get
acquainted with their new environment and become comfortable with what is expected of them.
Staff Involvement. The staff will play a role in helping determine which residents are
ready to participate in the program and meet the pre-determined requirements. Since the group
will include community outings some of staff members may be asked to come along to help with
facilitation if needed. The staff will also be involved in the weekly staff meeting to report on how
they feel the program is going and any improvements or suggestions they may have.
Role of Occupational Therapist. The occupational therapist (OT) will be the leader of
the Seeing the World Beyond program providing direct services to residents in a group setting.
The OT is in charge of performing the assessment on each group member before a new 12- week

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block. The OT is will plan and prepare for each weekly group session altering content to adjust
to clients needs. As stated earlier the therapist will also provide consultative services with the
case managers concerning the individual residents progress and offer suggestions for treatment.
It is anticipated that the OT will attend staff meetings each week in order to report on the group
and discuss any barriers. The meeting will provide a good opportunity to discuss past group
members progress and potential future group members. The OT will need to document the
services provided for each group member to be included in their individual charts.
Community Resources. The second half of this program will consist of various
community outings that will help participants learn how to access resources and expose them to
several leisure activities available to them in the community. Outings include going to the local
library, to the park, museums, concerts and sporting events depending on the time of year.
Participants will also be provided with a handout containing a list of free and affordable activities
near-by that they can participate in (Appendix D).
Space Requirements. The majority of the group sessions will be held out in the
community, but for those times when it is at the residency, Valley Plaza has a large dining room
that will be used. The dining room as many chairs and tables available for use. A small drawer or
closet would be needed to store weekly supplies and assessments. The occupational therapist will
also require office space for documentation and meeting individually with clients when
performing an initial assessment.
Time Requirements. The groups that are held at Valley Plaza will be one hour long. On
the days that they do community outings the time will vary between two to three hours
depending on the activity. The actual meeting times may change to afternoon or evening
contingent on the activity planned. At times the group members may be asked to complete

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homework assignments outside of class that should never take more than an hour. The group
runs for 12 weeks with the weekly time commitment being between 1-3 hours with a total time
commitment ranging between 12-36 hours.
Budget. The main cost for this new program will be hiring an occupational therapist
(OT). The OT will be hired to work about 5 hours a week. Their hourly rate of $38 is comparable
with this geographic area especially since the OT will also be providing consultative services
along with direct services to the clients. Assessments including the OPHI-II, Interest survey and
other worksheets will need to be purchased/printed. Since the program is exploring various
leisure activities some sporting equipment and outdoor games will need to be purchased to aide
in the residents exploration. Since the group members funds are limited; an activity budget of
$100 per 12-week course has been added to help aide the cost of public transportation along with
cost of various activities. The facility has a room with table and chairs that can be used for group
sessions when not in the community. The facility also has a van available for transportation on
days when public transportation will not be used. For a detailed outline of the proposed budget
see Appendix E.
Expected Outcomes. At the end of the group it is anticipated that each group member
will have gained confidence in their ability to enter their community becoming more involved in
various leisure occupations. The program will provide opportunities to explore new occupations
and expose the residents to what is available in the community. The group members will be able
to identify their new roles and have established new routines creating a new identity helping
them to live more full-filling lives.
Funding Options
Two different grants were identified as possible sources of funding for the new program.

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Option 1. Robert A. and Barbara M. Patterson Family Memorial Foundation founded in

1986 in Utah. The foundation supports a wide variety of populations including: adults,
economically disadvantaged people, low income and poor people in a variety of subjects ranging
from education to health and human services. The foundation offers grants ranging between
$1000- $3000.
Audit Trail. Foundation Directory Online- Search Grantmakers- State/Province: Utah;
Fields of Interest: Adults OR Housing for people with disabilities OR Housing
rehabilitation OR Occupational health
URL: https://fconline-foundationcenter-org.ezproxy.lib.utah.edu/search?collection=grantmakers
Option 2. May and Stanley Smith Charitable Trust located in Sausalito, California.
Their mission States: The Trust supports organizations that offer opportunities to children and
youth; adults and families; elders; and people with disabilities that enrich the quality of life,
promote self-sufficiency, and assist individuals in achieving their highest potential (May &
Stanley Smith, n.d.). The foundation offers grants ranging between $0- $2M.
Audit Trail. Foundation Directory Online- Search Grantmakers- Geographic Focus:
Utah; Fields of Interest: Adults OR Mental health care OR Mental and behavioral
disorders
URL: https://fconline-foundationcenter-org.ezproxy.lib.utah.edu/search?collection=grantmakers
Foundation URL: http://www.adminitrustllc.com/may-and-stanley-smith-charitable-trust/
Program Evaluation
In order to measure the effectiveness of the program both quantitative and qualitative
measures will be used to evaluate the program. During the last group session, a few minutes will
be set aside to discuss with the group how they felt the group went. Did they enjoy it? What did

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22

they learn? Do they now feel like they have the knowledge and skills needed to participate in
various leisure occupations? This will provide a qualitative measure without having to meet one
on one with each participant.
At the beginning and end of the 12 group sessions a survey will be administered to each
participant. A likert scale will be used with 1 being strongly disagree and 5 being strongly agree.
The following questions will be used: 1) I participate in a leisure activity more than twice a week
2) I participate in a leisure activity less than twice a week 3) I never participate in any leisure
activities 4) My quality of life has improved after being in the group. 5) I now understand how to
get involved in leisure activities. Questions 4 and 5 will only be answered after the group has
been completed. Using a quantitative measure allows for a quick measurement to see if a
participant experienced any change after being in the group. The post survey will be
administered 1 month after the group has finished thus allowing the participants a chance to
create their own habits and routines.
In order to get an outsiders perspective, the therapist will talk with the case managers about
each participant upon completion of the group sessions. The discussion will talk about what
changes have been seen in the participants and whether or not the case managers felt the group
impacted the participants and what they would like to see changed. The case managers work with
the residents on an individual level and might therefore see more changes in the participants than
is reported through the surveys.
Summary of Agency Reaction to the Program
During one of the weekly staff meetings I had the opportunity to share the research I had done
concerning the residents of Valley Plaza and treatment of mental illness. After reporting my
findings, I shared my proposal of the program. All in attendance thought it was a good idea. The

SEEING THE WORLD BEYOND

director expressed that I did well and that it was an area in need. He also expressed the
importance of including outside sources such as occupational therapists to help bring new
expertise and experience to the facility to further treatment of the residents.

23

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References
American Occupational Therapy Association. (2002). Occupational therapy practice framework:
Domain and process. American Journal of Occupational Therapy, 56, 609-639.
American Occupational Therapy Association (2016). Patients and Clients. Author. Retrieved
from: http://www.aota.org/About-Occupational-Therapy/PatientsClients.aspx#sthash.02AE9VkQ.dpuf
Argentzell, E., Hkansson, C., & Eklund, M. (2012). Experience of meaning in everyday
occupations among unemployed people with severe mental illness. Scandinavian Journal
of Occupational Therapy, 19(1), 49-58
Baker, A. Z., & Procter, N. G. (2014). Losses related to everyday occupations for adults affected
by mental illness. Scandinavian Journal of Occupational Therapy, 21(4), 287-294
Christiansen, C., & Matuska, K. (2006). Lifestyle balance: A review of concepts and
research. Journal of Occupational Science, 13(1), 49-61.
Drake, R. E., Wallach, M. S., Alverson, H. S., & Mueser, K. T. (2002). Psychosocial aspects of
substance abuse by clients with severe mental illness. Journal of Nervous and Mental
Disease, 190(2), 100106.
Edgelow, M., & Krupa, T. (2011). Randomized controlled pilot study of an occupational time-use
intervention for people with serious mental illness. American Journal of Occupational
Therapy, 65(3), 267-276.
Eklund, M., Hansson, L., & Ahlqvist, C. (2004). The importance of work as compared to other
forms of daily occupations for well-being and functioning among persons with long-term
mental illness. Community Mental Health Journal,40, 465-477.

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Hodgson, S., Lloyd, C., & Schmid, T. (2001). The leisure participation of clients with a dual
diagnosis. British Journal of Occupational Therapy, 64, 487492
Iwasaki, Y., Coyle, C., & Shank, J. (2010). Leisure as a context for active living, recovery, health
and life quality for persons with mental illness in a global context. Health Promotion
International, 25(4), 483-494
Iwasaki, Y., Coyle, C., Shank, J., Messina, E., Porter, H., Salzer, M., ... & Ryan, A. (2014). Role
of leisure in recovery from mental illness. American Journal of Psychiatric
Rehabilitation, 17(2), 147-165.
Iwasaki, Y., Messina, E., Shank, J., & Coyle, C. (2015). Role of leisure in meaning-making for
community-dwelling adults with mental illness: Inspiration for Engaged Life. Journal of
Leisure Research, 47(5). doi: http://dx.doi.org/10.18666/JLR-2015-V47-I5-5305
Kielhofner, G. (2009). The Model of Human Occupation. Fratantoro, C. and Pine, J. (Eds).
Conceptual Foundations of Occupational Therapy Practice (pp. 145-173). Philadelphia,
PA: F.A. Davis Company
Leufstadius, C., & Eklund, M. (2014). Time use among individuals with persistent mental
illness: Identifying risk factors for imbalance in daily activities: Previously published in
Scandinavian Journal of Occupational Therapy 2008; 15: 2333. Scandinavian Journal
of Occupational Therapy, 21(sup1), 53-63.
Leufstadius, C., Erlandsson, L., & Eklund, M. (2006). Time use and daily activities in people
with persistent mental illness. Occupational Therapy International, 13, 123141. doi:
10.1002/oti.207
Lloyd, C., King, R. & McCarthy, M. (2007) The association between leisure motivation and
recovery: a pilot study. Australian Occupational Therapy Journal, 54, 3341.

SEEING THE WORLD BEYOND

26

May & Stanley Smith Charitable Trust - Adminitrust. (n.d.). Retrieved December 03, 2016, from
http://www.adminitrustllc.com/may-and-stanley-smith-charitable-trust/
Mayers C (2000) Quality of life: Priorities for people with enduring mental health problems.
British Journal of Occupational Therapy, 63, 591-97
Minato, M., & Zemke, R. (2004). Time use of people with schizophrenia living in the
community. Occupational Therapy International, 11, 177191. doi: 10.1002/oti.205
Nolan, C., & Swarbrick, M. (2002, June). Supportive housing occupational therapy home
management program. Mental Health Special Interest Section Quarterly, 25(2), 13.
Rog, D., Marshall, T., Dougherty, R., George, P., Daniels, A., Ghose, S., & Dephin-Rittmon, M.
(2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services, 65,
287294. http://dx.doi.org/10.1176/appi.ps.201300261
Roush, S. (2008, June). Occupational therapy and co-occurring disorders of mental illness and
substance abuse. Mental Health Special Interest Section Quarterly, 31(2), 14.
Swarbrick, M. (2016). Support models to enhance community transitions. SIS Quarterly
Practice Connections. 1(2), 1113.
Sylvestre, J., Nelson, G., Sabloff, A., & Peddle, S. (2007). Housing for people with serious
mental illness: A comparison of values and research. American Journal of Community
Psychology, 40, 125137.
Ussher M, McCusker M, Morrow V, & Donaghy M (2000) A physical activity intervention in a
community alcohol service. British Journal of Occupational Therapy, 63, 598-604.
Valley Behavioral Health. (n.d.). Employee Handbook. (Unpublished document), Valley
Behavioral Health Salt Lake City, Utah.

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Valley Plaza. (n.d.). Program Manual. (Unpublished document), Valley Behavioral Health Salt
Lake City, Utah.

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Appendix A
Staff Questions
1.
2.
3.
4.
5.

What resources are available at this facility? Games? Newspaper? Computers?

What connections does the facility have with the community?
What funding is available and where does it come from?
Is there a schedule of groups/activities that clients can see?
Is there a resource area available for residents? Do they have access to the transportation

binder?
6. When did Valley Plaza change to transitional housing?
7. How long do residents normally stay at Valley Plaza?
8. Do you have an ideal length of stay time?
9. How do you know when a client is ready to leave Valley Plaza?
10. Do residents go to fresh start?
11. How do residents usually spend their free time?
12. What changes would you like to see?

Appendix B
Leisure Interest Survey
Activity

Gardening, planting
flowers etc
Spectator Activities:
watching sports,
concerts
Sports
Music: playing
instrument, listening
to music
Computer Activities:
Games, surfing the
web, word
processing
Reading

Lik
e It

Woul
d Try

Dont
Like

Specific Areas of interest/ Time spent on

activity
What stops you from doing this activity?

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Arts and Crafts:
(Woodworking,
sewing, hand crafts)
Creative Activities:
Composing, painting,
journaling
Social: groups,
church, day treatment
Exercise: relaxation,
Walking, running
Animal Care
Table or Mind games:
Chess, card games,
crossword puzzles
Dance: Type:_______
Collecting Objects
Television or Radio
Volunteering: Type____
Shopping:
Cultural Activities:
Museums, travel,
concerts, symphonies.
Culinary Activities:
Eating out, cooking,
baking
Repairing and
Refinishing Objects:
(cleaning, cars,
household etc)
Other:

Client Interview Questions

1. How long have you lived here?
2. What do you like about the facility?
3. Are you aware of current services available at Valley Plaza?
(Transportation binder, groups, library etc)
4. Do you participate in the activities and groups? Why or Why not?

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5. How do you currently use your free time?

6. Would you be interested in a group that taught you how to access
different leisure activities and taught other basic skills such as email,
surfing the internet, and/or using public transportation?
7. Would you be interested in going on community outings with a group?
8. Do you feel you have changed since being here? If so how?
9. Is there anything that you wished would be different here at Valley
Plaza? Available Services etc?

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Appendix C

Appendix D

Cheap and Free Activities

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Cheap Activities
Movies
$5 - on Tuesday nights
Festivals
Festa Italiana
Greek Festival
Usually has free entertainment and food to buy
Many more keep a look out in newspaper
Concerts
Twilight Concert Series
o $5 ticket in advance $10 at the entrance
o Pioneer Park
o http://twilightconcerts.com/
Murray Amphitheater
o Plays/ Musicals
o During the Summer
o http://www.murray.utah.gov/index.aspx?NID=853
Lights at the Zoo
$8 for adults
Month of December
Hogle Zoo
Tracy Aviary
$1 Admission every Wednesday: November through February

Free Activities
Farmers Market
Every Saturday 8am-2 pm June-October at Pioneer Park
Winter Market: Nov April 10am-2 pm at Rio Grand Depot
www.slcfarmersmarket.org
Museums
Museum of Contemporary Art
o 20 S West Temple
o Open TuesdaySaturday
Fort Douglas Military Museum
Daughters of Utah Pioneers Museum
Trivia Night at The Leonardo
o Every 3rd Friday
Galivan Center (Free concerts)
Various free events year round. Check out their website for more information
www.thegallivancenter.com
Events include concerts, food trucks, ice skating and more

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Animal Shelter
Walk a dog
Clark Planetarium
Free interactive exhibits
Family History Library
Learn about your family history
Find out who your great- grandparents were.
Temple Square
Conference Center
o Get free Tours
Tabernacle on Temple Square
o Free concerts throughout the year. See website for details
o http://www.templesquare.com/events/
o Free Organ Recitals M- Sat at Noon and Sundays at 2pm
Music and the Spoken Word
o Every Sunday at 9:30 am
o http://www.musicandthespokenword.com/
Museum of Church History and Art
Parks
International Peace Gardens
o 1060 South 900 West
This is the Place Heritage Park
Red Butte Gardens
o Free Entrance on
Arbor Day- The last Friday of every April
Pioneer Day- July 24
Labor Day- The first Monday of every September
Zeke Dumke, Jr Day- The first Monday of every October
Annual Holiday Open House and Art Fair- The first weekend of December
Liberty Park
Pioneer Park
Miscellaneous
Movies in the Park
o At Capitol Building
https://utahstatecapitol.utah.gov/uncategorized/movieunderthestars
o At Local Parks
http://millcreektownship.org/community-life/item/6-community-events
Murray Arts in the Park
o Free Concerts every Tues at Noon- during Summer
o See schedule for more activities
o http://www.murray.utah.gov/index.aspx?NID=853
Hogle Zoo

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o Offers Various Free days through the year. Look on Website for details
o https://www.hoglezoo.org/

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Appendix E
Line Item Budget Detail
Source of Specific costs or sources of
income

Cost

Start-up Costs
Sports Equipment
Disc Golf- Starter set (Includes 3 discsdriver, mid-range and putter) - 2 @ $ 19.69
(Amazon)
USA Advanced Volleyball Set (Includes net
+ volleyball) $31.77 (Walmart)
Frisbee- set of 6 10 disc $ 12.47 (Walmart)
Bocce Ball Set- $10 (Walmart)
Total=

$39.38

$31.77
$12.47
$10
$93.62

Direct Costs

In-Kind

Indirect Costs
In-Kind

In-Kind
In-Kind

OTR Salary$38 x 5 hours per week x 52 weeks

Supplies
COPM Assessment Online- 100 measures
($10 registration fee, $15 for 100 measures)
OPHI II Manual
Printing Interest Survey ($0 .07/page)
Paper and Writing Tools (~$10 per group x 4
groups per year = $40)
Activity Costs- (Budget ~ $100 per group x 4
groups per year)
Transportation- Van (~ $30 for 2-3 hrs x 12
outings)
Total=

9880

$25
$40
$5
$40
$400
$360
$10,750

Rent Room for group sessions (in-kind)

20 x 20 room reserved for 2 hours per
week (~$13 per sq ft)
Utilities
Maintenance
Total=

Total=

$0

Income
N/A

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Total costs

Total income or
in-kind
contributions
Net cost of
program

Budget Summary
$10,843.62

$360

$10,483.62

36