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Carmen B. Pingree Center for Children with Autism:

A Needs Assessment and Program Proposal
Danielle Oberg
University of Utah

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Introduction
Throughout the course of the semester, students of the occupational therapy

program spent time at rural or underserved community settings. The purpose of the visits
and this project paper was to conduct a needs-based assessment and develop an
occupation-based program that would benefit these sites. The needs assessment included
interviews with management staff, teachers, and some clients. The site was visited
weekly and information was gathered through the observation and interaction with the
children and teachers during varying activities. This paper is a review of the needs
assessment results and offers a proposal of a program that could be implemented at the
site in order to offer occupation-based services to improve the quality of life of the target
populations.
Description of the Setting
The Carmen B. Pingree Center is a service provided by Valley Mental Health.
The center offers full-day school programs for children from preschool through
secondary grades. The Pingree center specifically offers services to school-age children
with autism. The mission statement of the Carmen B. Pingree Center for children is to
provide:
comprehensive treatment, education and related services for children with autism
and their families. We use and develop best practices, validated by research, while
treating students and their families with dignity and respect. We partner with
families, universities, service agencies, the government and our community to
assist those affected by autism. We undertake and support research to better

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understand autism, its causes and eventual cure (Carmen B. Pingree Center for
Children with Autism, n.d.).
Their philosophy of their program is based on achieving behavior change through the
use of shaping and reinforcement (Carmen B. Pingree Center for Children with Autism,
n.d.).
The Pingree Center opened in November of 2002 and is located on Guardsman
Way, near the University of Utah. The community where the center is located is
accessible and in a central location in Salt Lake City. There are many transportation
options provided by the center as well as publically that allow for the children to access
the center. The center is located near the University of Utah Autism Research Project,
which allows for more opportunities for research to be completed to further
understanding of autism (Carmen B. Pingree Center for Children with Autism, n.d.).
Funding for services at the Pingree Center comes from both public and private
sources. The preschool program is publicly funded through the State Division of Mental
Health. The elementary and secondary programs are privately paid through tuition from
the childrens families. The families may also apply for a scholarship offered by the state
of Utah to assist in payment. Options for funding to assist with mental health services
provided may include personal fees, insurance, and other third parties (Carmen B.
Pingree Center for Children with Autism, n.d.).
When children first start at Pingree, they are given formal assessments in order to
find target areas of concern and are used to develop treatment plans (Carmen B. Pingree
Center for Children with Autism, n.d.). Progress is tracked throughout their time at the
center. Areas that are targeted in the Autism Program include attending and following

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directions, imitation, language skills, cognition, social skills, fine motor skills, academic
skills, etc. Progress is monitored by data taken daily throughout the day in order to track
progress towards treatment goals.
The staff at the Pingree Center for Children with Autism prides itself on its
knowledge and experience working with individuals with autism. Management staff
includes the unit director, an elementary and secondary program manager, and a
preschool program manager. The directors oversee all the programs and staff to ensure
that each child is receiving the best education and care. Each classroom at the center
includes one autism specialist (teacher), at least two full-time assistants, and three to four
part-time assistants. There is usually at least one adult to work with and monitor two to
three children in the classroom. The center also has on staff a Speech and Language
Pathologist, Social Worker, Clinical Psychiatrist, and nurse (Carmen B. Pingree Center
for Children with Autism, n.d.).
The Carmen B. Pingree Center offers so much support and services for children
with autism and their families. Additional services provided include individual treatment
for psychosocial rehabilitation, individual skill development, individual and family
therapies, sibling camps, parent support groups, psychiatric testing, individual speech and
language treatment, and social work consultations. Currently, the center is working
towards expanding their services in the future. According to the elementary and
secondary director, the center is working to grow and build on their adolescent program
as well as working towards being able to provide training for Behavior Analyst students.
The center has wanted to hire an occupational therapist for some time now; however,
they are still trying to find the funding in order to do so.

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Programming Strengths and Areas for Growth

Staff Perspective
Initial information gathered at the site was obtained from the elementary and
secondary director through a structured interview (See Appendix A). This interview was
focused on gathering information on the site, their current program strengths, and their
needs. Some information that was gathered regarding the site was reviewed in the
previous section. The director stated that the center currently had many programs in
place that are strengths for the site, such as their teaching methods, speech therapy, social
work, etc. However, the director thought that the site would really benefit from
occupational therapy services to help address areas such as self-regulation, sensory
concerns, and writing or fine motor skills. The site has accepted several occupational
therapy students for their Level I fieldworks over the past few years and the staff have
been impressed and appreciated the knowledge they have brought. The director
emphasized how the site is working toward hopefully hiring an occupational therapist in
the future.
Following the formal interview, the director was able to take me around the site
and inform me more regarding the set up, background, and areas specific to cater to the
childrens needs. I was shown areas that I would be able to work with students and other
staff as needed. I was also introduced to the preschool director who was very excitable
about having an occupational therapy student at the school. At the conclusion of our
meeting, the director was able to provide me with specific names of teachers and students
to see based on requests to her from the staff.

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Clients Perspectives
Further perspectives and information were gathered from the teachers and
assistants during the weekly visits through informal interviews. Specific questions were
prepared (See Appendix B), however interviews varied based on the situations, activities,
and children being discussed. The teachers and assistants expressed their appreciation for
past occupational therapy services that had been provided by previous students. They felt
that they had received good information and techniques from the students, but would like
to have an on-staff occupational therapist for consult. The staff stated they felt
comfortable with some sensory strategies and fine motor exercises, but feel more
expertise would be greatly beneficial. One staff member expressed the desire for a
sensory room that an occupational therapist could use for individual sessions with the
students.
Areas of concern that have brought me the most referrals for students include
sensory concerns with feeding and self-regulation and handwriting. Most of the staff
appears to have a basic knowledge in these areas but have asked me to come into the
classrooms to assist with group sessions and to provide them with additional information
and ideas. I have been able to come in and provide some education and provide some
equipment to assist the students and teachers in the classroom. There are many students
who the staff have concerns about and feel they could use some extra attention.
The children at the Pingree Center all present with varying levels of function,
abilities, and areas of concern. Many of the students from referrals are lower functioning
and lack many cognitive and language skills. Due to majority of the childrens nonverbal communication or inability to self-reflect, obtaining perspectives on the centers

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current programs and their desires has proven difficult. I have been able to observe and
interact with the children in a variety of settings within the center including the
classroom, the lunchroom, and the playground. Through my interactions, I have been
able to observe positive body language and responses to various activities I have done.
While helping to run a handwriting group, a couple students seemed very excited and
happy about getting the extra attention. A few students have responded well and shown
changes in behavior following implementation of some sensory strategies in the
classroom and while eating. I have also been able to find specific toys and activities that
each student prefers or uses as a comfort.
As mentioned above, it has been difficult to get very accurate information from
the students regarding strengths and weaknesses of the sites programs. I am using the
reactions from the students to help guide my reasoning for the needs of the center and the
students. I did not feel it would be accurate or appropriate to complete a formal
assessment with the students I was seeing.
Student Perspective
I have made weekly visits to the site making rotations among classrooms and
children based on schedules and needs each week. I have found the Pingree Center to be
an excellent environment for children with autism. The site takes extra steps to ensure
the students are provided with excellent learning in a safe setting. The staff all has a
great understanding of autism and it allows them to provide them with programs that are
benefitting the students. The center offers a variety of programs to benefit the children
and their families as well. The centers promotion of continuing research with autism
makes the site a leader to help in the understanding of autism.

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Through talking with the staff, I have found that they really appreciate and look
forward to having an occupational therapy student helping at the site. Due to the nature
of the facility and the population, the center runs on a very structured schedule, which
limits the amount of time I have been able to see students and the activities I observe
them participating in. The staff have been taught and are actively using many strategies
that past students have provided to them. However, it is apparent that they could benefit
from many more. There are many children who have more specialized needs than some
of the other students, and it seems like they would benefit from more individualized and
varied treatment. I believe that the development of an occupational therapy position
would greatly benefit this site and offer more support to the students and the staff.
A major area of concern is that of education at the site. Educations should

include: education about occupational therapy and its relevance to the autism population,
education about sensory processing and strategies, and education about adaptive devices.
I think continued education of the staff would allow them to feel more comfortable to
hand the students and be able to support the work of an occupational therapist if they
were to hire one. I believe another area of concern I have noticed is the lack of a space
for the children to be able to go in order to self-regulate or receive sensory input. I only
have a very small office to work in and it has made it difficult to have an individualized
session with the students in a safe and interactive environment.
Evidence- Based Practice
Occupational Therapy and Autism
Autism is a developmental disorder that is still not fully understood today.
Individuals with autism may present with varying function of abilities and disabilities,

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mostly involving social and communication skills. As the children are developing, they
may have difficulty performing and participating in typical childhood roles. Currently,
occupational therapy is one of the most frequently used therapies for children with autism
(Ashburner, Rodger, Ziviani & Jones, 2014). The focus of occupational therapy when
providing services for these children including enhancing participation in the
performance of activities of daily living (e.g., feeding, dressing), instrumental activities
of daily living (e.g., community mobility, safety procedures), education, work, leisure,
play, and social participation (Scott, 2011, p. 1). Because each child with autism is an
individual, each one receives specific evaluations, goals, and services to meet their own
needs and priorities to promote occupational participation.
The process of providing services to children with autism includes evaluation,
treatment, and outcome measurement. It is crucial that the occupational therapist
collaborate with the child, family, caregivers, teachers, etc., in order to successfully assist
the child with functioning in their everyday life (Scott, 2011). In a study conducted by
Ashburner et al. (2014), they examined the current treatment practices of therapists in
Australia who work with children with autism. Their work found that services were most
frequently provided in community-based centers, followed by schools or early
intervention centers, and clients homes (Ashburner et al., 2014). The most frequent
focus of treatments and goals found within the study included: Addressing sensory
processing issues; self care skill development; support/information to parents or carers;
social skill/relationship development; play skill development; etc. (See Figure 1)
(Ashburner et al., 2014).

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Occupational therapy can play a crucial role in the lives and development of
children with autism. Services can be provided in many different settings and address a
variety of goals that are specific to the child and the people who support them in their
daily lives (Ashburner et al., 2014). Not only is working directly with the children
important, but educating and including the parents, teachers, caregivers, etc. in each step
of the way. It is clear that the services occupational therapy can provide for a child is
vast and can help them to build skills throughout their lives.
Sensory Interventions
As mentioned above, one of the areas addressed by an occupational therapist is
assisting with difficulties with sensory processing. Sensory processing disorder (SPD) is
reported quite frequently among children with autism spectrum disorders (Pfeiffer,
Koenig, Kinnealey, Sheppard & Henderson, 2011). These children have difficulty
regulating incoming sensory stimuli and their responses to these sensations. Responses
may include seeking out sensations or self-stimulation to compensate for inadequate
sensory input or avoidance of overstimulation (Pfeiffer et al., 2011). Due to the
difficulties in modulating this sensory input, it can affect the childs ability to function
normally and be able to participate fully in their daily activities.
The use of sensory interventions is common in occupational therapy practice with
children with autism. A specific theory that is often used by occupational therapists and
was designed to address this population was the Sensory Integration (SI) theory,
originally developed by A. Jean Ayres. Treatment is designed to allow the child to
participate in controlled sensory experiences; then they are able to adapt their responses
to varying stimuli and improve sensory modulation (Pfeiffer et al., 2011). In a pilot study

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conducted by Pfeiffer et al. (2011), they examined the effectiveness of the use of SI
interventions with children with autism spectrum disorders. The results of the study
found significant changes in autistic mannerisms, as well as progress in areas of sensory
processing, sensory regulation, social-emotional function, and fine motor skills (Pfeiffer
et al., 2011). In a case report written by Schaaf, Hunt, & Benevides (2012), they
described the behaviors and changes in participation of a 5-year-old boy with autism who
received 10 weeks of occupational therapy using a sensory integration approach.
Following the program, the child was reported to show improved skills with dressing,
requiring less help from a parent, improved bedtime routine with less problematic
behaviors, reported improved attention in the classroom and improved interaction with
peers (Schaaf et al., 2012).
From the studies referenced above, there is convincing evidence to support
sensory interventions with occupational therapy. However, there is still a lack of
sustaining evidence to fully support it. Each child has different sensory needs in addition
to their autism, which makes it difficult to track effectiveness with every case. Overall,
sensory therapies are widely used among therapists to help with the autism population
and many find it effective in addressing these needs and improving overall participation.
Fine Motor Skills and Handwriting
Handwriting is a developmental skill important for any child during their school
years. It is often that children with autism have difficulties with handwriting and fine
motor skills. One study of 10-14 year old children showed that out of 100 children with
autism spectrum disorder, 79% demonstrated impairments on the fine motor hand skills
(Kushki, Chau, & Anagnostou, 2011). Other areas that may affect handwriting with

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those with autism include visual-motor integration and kinesthetic feedback. Kushki et
al. (2011) noted in their article that legibility and letter formation is consistently impaired
with children with autism, which are correlated with motor deficits. Addressing motor
control and visual-motor integration are common practices among occupational therapists
to address handwriting (Kushki et al., 2011). It is important that an occupational
therapist assist by completing comprehensive evaluation to identify the underlying
problem in order to assist within the classroom to improve handwriting.
There are different approaches that can be taken to address handwriting. One
approach is based on the theory of motor learning and emphasizes practice in order to
learn and improve motor skills. Another approach is the visual-perceptual-motor
approach, which focuses on use of sensory-motor activities and visual-motor integration
(Howe, Roston, Sheu, & Hinojosa, 2013). In a study conducted by Howe et al. (2013),
they examine the effectiveness of two approaches to handwriting intervention. The study
consisted of a sample of 72 first and second grade students split into two intervention
groups: a visual-perceptual-motor group and an intensive practice group. Intervention
lasted for 12 sessions and administered by two occupational therapists. Results found
both groups showed improved legibility, however the intensive practice group showed
more significant improvement than the visual-perceptual-motor group. Research
supports occupational therapists using structured, direct approaches to handwriting and to
include repetition. It is also important for therapists to coordinate and collaborate with
staff in order to maintain consistency within curriculum and work towards the needs of
the students (Howe et al., 2013). Occupational therapy can play an important role in the

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development of motor skills and handwriting for children with autism using evidence,
collaboration, and using comprehensive evaluations.
Occupational Therapy in the School setting
One of the most prominent settings for occupational therapists to see children
with special needs, including autism, is the school (Ashburner et al., 2014). School is an
important context for any child as they spend a good majority of their week in school
learning and interacting with peers. There is a lot an occupational therapist that can be
done within the school settings to assist in helping children with autism function within
the context. Difficulties with sensory processing, problematic behaviors, difficulties with
communication, decreased muscle tone, and sleep patterns may affect their participation
in school activities (Kinnealey et al., 2012). Occupational therapists will often work
directly with the students to address the mentioned areas of concern as well as others
within the school setting.
Aside from direct treatment, there are other ways for an occupational therapist to
help improve participation within the school setting. Modifications made to the
classroom environment help to facilitate learning and promote participation. Kinnealey
et al. (2012) conducted a study to report on the effect of classroom modifications on
attention and engagement of students with autism or dyspraxia. Researchers installed
modifications that included sound-absorbing walls, halogen lighting, and soundabsorbing ceilings. Results showed that making modifications to improve overall
sensory comfort and accessibility within the classroom can help to improve attention,
engagement, mood, and performance (Kinnealey et al., 2012).

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The focus in the school setting should not just focus on the students. The teachers
and staff are large parts of their education and care. Rens and Jossten (2014) examined
teacher and therapist experiences in order to find ways to promote collaboration within
practice in the community. Information was gathered through questionnaires, focus
groups and interviews. Results included possible recommendations for practice
including: occupational therapists spend more time in the school, explain the role of
occupational therapy effectively to staff, build relationships with staff and family,
understand the child in their context, make realistic recommendations by being
considerate of the teacher, not to see themselves as an expert, and to be inclusive of all
parties involved with the child (Rens & Joosten, 2014). These are important for
occupational therapists and teachers to take into consideration in order to work together
and provide efficient intervention for the students. School settings can benefit from the
presence of occupational therapists, especially when there is active collaboration
involved.
Summary
The Carmen B. Pingree Center offers children with autism spectrum disorders a
school-type setting in which they can learn in a safe environment with other peers and
specially trained staff. As mentioned throughout this section, there is much evidence to
support the role an occupational therapist can play with children with autism as well as in
a school-type setting. Occupational therapists work with the children, staff, family, and
caregivers to provide them with skills, knowledge, strategies, etc. to help the child be able
to participate in their daily life. Major areas of treatment were discussed above, including
supporting evidence on the benefits and types of intervention that can be provided by an

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occupational therapist. Based on the evidence presented, it would be advantageous to

employ the services and knowledge of an occupational therapist at the site.
An Occupational Therapy Program at the
Carmen B. Pingree Center for Children with Autism
Summary of Needs Assessment
Based on the data gathered through interviews with staff and clients, observations,
and review of evidence-based literature, I believe that an occupational therapy program
would benefit the Pingree Center. Interviews at the center brought attention to the desire
of both staff and clients for the presence of an occupational therapist at the site. The
children at the center have a variety of abilities as well as special needs that need help
being addressed. Although the site has very knowledgeable teachers and staff, it was felt
that having an occupational therapist that had more knowledge on specific strategies and
treatments to help the children on an individual level would be effective. The literature
reviewed above offers a view at how an occupational therapist can help to improve
function and occupational participation for children with autism as well as those a schooltype setting.
The teachers at the site identified specific students with special needs as well as
areas they wished to gain more knowledge in. Each child and teacher had such
specialized needs and I was able to observe and offer assistance in many areas such as
feeding, sensory processing, and fine motor skills/handwriting. From my research, I
found that occupational therapy could effectively assist in many of these areas. Due to
the uniqueness of each child and their needs, I felt that a program addressing one area
would not be as effective at this site. It is because of this that I propose the

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implementation of a part-time occupational therapy position to address the occupational

needs of the children and staff at the Pingree Center.
Program Overview
The program I have developed to be implemented at this site is to hire and offer
part-time occupational therapy services to the children, as well as education and support
for staff and families that are part of the Carmen B. Pingree Center for Children with
Autism. The occupational therapist that is hired would provide a variety of services at
the site. The therapist would conduct in-depth evaluations and individualized direct
treatment of students and small groups both in a private therapy office and within the
classroom. Areas that are to be addressed may include: sensory processing, social skills,
feeding, fine motor skills and handwriting, gross motor skills, self-care, etc. The
occupational therapist would receive referrals from the teachers and staff, complete an
overall evaluation to identify the childs current abilities and areas to be addressed, and
then provide intervention to meet the childs needs as necessary. Education would also
be provided to teachers, staff, and family/caregivers in similar areas of concern (as
requested by those participating) in order to provide knowledge and promote consistency
and generalization from school to home. The therapist would track progress of the
children and be able to report improvements or improved evaluation scores to family and
staff. I feel a part-time position would be appropriate at this time in order to assess the
efficacy of the services before the site invest more financially.
Why An Occupational Therapist?
A registered occupational therapist would be the most qualified to fill the position
of this program in order to address the childs needs and because of their specialized

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knowledge on the population and their occupational needs. An occupational therapist is

someone who helps an individual live the most independent and meaningful life as
possible. They use a holistic approach, viewing the individual as a whole, in order to
help them to be a functional and perform the occupations in life that they want and need
to do.
The general focus of services is to enhance participation and performance in
activities of daily living (feeding, toileting, dressing, etc.), instrumental activities of daily
living (safety, community mobility, etc.), rest and sleep, education, work, play, leisure,
and social participation (American Occupational Therapy Association, 2008). The
occupational therapist intended to take over the program would have special education
and gained knowledge in areas such as activity analysis, evaluation of an individual and
assessing occupational barriers, sensory processing, and pediatric development. It is
because of their knowledge and expertise that occupational therapists can help
individuals with autism adjust tasks and conditions as well as gain skills in order to be
able to participate more fully to live a meaningful life (Scott, 2011).
Theoretical Foundation
Occupational therapists have established several theoretical models of practice
that help to guide practice and provide a frame of reference for intervention. These
models can be broad and applied to many populations and settings, while others are
narrow and for a specific population or purpose. Two theoretical models were chosen to
assist in the development and implementation of the program.
The Person-Environment-Occupation (PEO) model focuses on finding maximum
congruence between the person, environment, and occupation in order to achieve optimal

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occupational performance (Law et al., 1996). Changes may be made to any of the three
areas in order to assist in overcoming barriers to enhance performance. This model is an
occupation-based model that can be used with almost any population or setting. This
model is appropriate to use with a child with autism as well as in a setting like the
Pingree Center. There are a variety of factors that could be affecting a child with autism
to have difficulty with their occupational performance. The PEO model allows for the
therapist to adapt the environment, make changes to a task, or identify and promote skills
for the individual in order to encourage and assist with success in performing a desired
occupation (Law et al., 1996). Since these children are so unique and have individualized
needs, this model allows for changes to be made based on the needs of the child or the
demands of the task or environment. Following this model, a therapist could make
changes to the environment to decrease distracting sensory stimuli or help to build skills
in order to handle transitions in a more efficient way.
The Sensory Integration (SI) theory was developed by occupational therapist A.
Jean Ayres. According to the theory, learning is dependent on ones ability to take in and
process sensory stimuli and use it to plan and organize their behavior. Individuals with
sensory processing disorders have difficulty organizing and processing sensory
information and responding to it in an appropriate manner. The senses addressed include
tactile, vestibular, proprioceptive, visual, auditory, and gustatory. As referenced above,
many children with autism have difficulties with sensory processing. The models
therapy intervention provides opportunities for sensory intake in an environment that
allows for play and opportunities to plan and organize behavior. It works towards
improving the brains ability to integrate and process sensory information in order to

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enhance behavior and motor learning (Kielhofner, 2009). Core elements of the
intervention process include: providing sensory opportunities, providing just-right
challenges, collaborating on activity choice, guiding self-organization, supporting
optimal arousal, create play contexts, maximize the childs success, ensure physical
safety, arrange room to engage the child, and foster a therapeutic alliance (Kielhofner,
2009). The theory would help guide the program by offering a framework for providing
sensory experiences and strategies to assist children at the site to improve their sensory
processing and modulation of the information in order to function and perform their
occupations in varying contexts.
Goals and Objectives
Goal 1:
1) Clients will improve their behavior, academics, and occupational performance
through implementation and practice of therapy strategies at the site and at home.
Objectives:
1) By month Three, 75% of clients will be consistently seen and be able to
tolerate/participate in 30-minute occupational therapy session at least twice a
week.
2) By month Six, 50% of clients will be able to use at least one strategy within
the classroom to assist with participation or behavior with minimal assistance
from occupational therapist or staff.
Goal 2:
1) Staff and family will gain knowledge of at least one area of concern (as
presented by occupational therapist) and confidently implement strategies

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within the classroom and at home in order to promote participation and

generalization.
Objectives:
1) By the third month, at least 10 family members or staff will attend a
presentation of requested topic by occupational therapist.
2) Within 1 month of education, at least 50% family or staff will report
implementing at least one strategy in the classroom or at home.
Implementation of the Program
The implementation of the program is contingent on the hiring of an occupational
therapist. I recommend hiring a part-time occupational therapist to offer services at the
site approximately 20-30 hours per week. I believe a part-time position will be effective
to start the program until solid funding or program effectiveness is established. The
position may move to a full-time position if the sites needs dictate so. The occupational
therapist will start the program by receiving referrals from staff. The therapist will
perform comprehensive evaluations with each client depending on their needs.
Standardized evaluations may include: The Sensory Processing Measure, The Sensory
Profile, The Beery-Buktenica Developmental Test of Visual-Motor Integration, etc. The
occupational therapist will use knowledge and results from evaluation process to provide
direct treatment for the child in individual and group sessions. The occupational therapist
will also be able to provide modifications and treatment within the classroom setting.
The therapist would be available for consult and education privately and by presenting to
teachers and families. The therapist would create their own caseload and determine how
often to see the children and be open for consult. Areas that may be applicable in

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practice include: sensory processing, feeding, fine motor skills/handwriting, gross motor
skills, emotional regulation, social skills, self-care, life skills, etc.
Participant Criteria
All the staff, children, and their families who attend or are associated with the
Pingree Center would be eligible to receive treatment or education from the occupational
therapist. The therapist would be the one to assess how many children are seen on their
caseload at a time and create the schedule for providing service to participants based on
referrals. Participants would be part of the program for as long as therapist sees fit in
order to reach desired client goals.
Staff Involvement
The primary role of the staff will be to assist in providing referrals to the
occupational therapist for children who may need service or for personal consultation for
education. The staff and therapist will collaborate together in order to promote the
progress of goals and generalization of skills within the classroom. Staff will assist in
tracking behaviors and promoting use of strategies from therapy in order to help track
progress for the therapist. Staff will be an important method of communication for the
therapist to know what goes on in the classroom and providing feedback. The staff will
help to direct the topics of education provided to other staff and family by the therapist
based on their desires and discussions with family/care givers.
Occupational Therapist Role
The occupational therapist will be the primary provider for the program. The
therapist will be the one providing direct treatment for children as well as consultation
and education for staff and family/caregivers. During the weekly time at the site, the

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therapist will review referrals, perform comprehensive evaluations, and provide treatment
and consult as needed. The therapist will be expected to meet and consult with staff at
least once a week to discuss areas of concern and progress for students. The therapist
will provide support and education of staff to promote overall occupational performance
for children in the classroom. The occupational therapist will assist by contributing to
research at the site for treatment of children with autism.
Community Resources
The current structure and plan for the program will not require the use of
community resources. The treatments and other elements of the program will take place
at the Carmen B. Pingree Center. This may be re-evaluated in the future if felt necessary.
Space Requirements
As of now, there is not an established room set aside for delivery of occupational
therapy services. The needs for a space were discussed with the elementary and
secondary director. The therapist would at least need an office or small room in order to
privately see children for treatment and evaluations and be able to document and interpret
results of treatment and testing. The director stated that they had an office space that
could be used for an occupational therapist. There is a small room that includes tables,
chairs, and computers that acts as a testing area for psychiatry students and acted as space
of work for myself during my needs analysis. This space could also act as an area for
evaluation and treatment for the occupational therapist. The therapist would be able to
utilize other rooms and areas of the site as needed, including working within the
classrooms. I believe in the future, there may be a need for a larger room that will enable
the therapist to provide more extensive sensory treatments for the children.

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Time Requirements
It is expected that the occupational therapist will be providing services at the site
20-30 hours per week, as this is a part time position. The site currently offers
programming Monday - Thursday from 08:00 to 3:00, and Friday from 8:00 to 12:00 (for
elementary and secondary grades only). The therapist would provide services during
working hours at the site. It would be up to the discretion of the therapist and staff
members exact hours to be worked during the week. The time requirements depend on
the caseload and need for the therapist at the site. The therapist and staff would
coordinate to maintain a schedule for treatments, evaluations, and education. The
sessions for children will be based on the needs of each session, but should be expected
to last at least 30 minutes each.
Budget
As with any new program, it will an analysis of cost and estimated budget for the
cost. Costs would include supplies (i.e. paper, scissors, toys, weighted blankets, etc.),
assessments or evaluation tools, salary. See Appendix C for detailed budget analysis.
Expected Outcomes
The expected outcome of this program is to improve the overall occupational
performance for children with autism and to empower and educate their
family/caregivers. Through treatments, the children will learn strategies and gain skills to
help enable them to participate more fully in their occupational roles and live a
meaningful life. By educating and empowering family and caregivers, we promote
generalizability of learned skills from a school setting to the home. By providing
treatment, the program will help the children continue to develop skills and work towards

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the sites goal of assisting the child to go to a public school setting. The children will
have more occupational opportunities and have more meaning in their life.
Funding Options
Option 1: The George S. and Delores Dore Eccles Foundation offers funding
throughout Utah with a goal to improve the lives of the citizens. They have made grants
for small projects less than $1,000 to multi-million dollar investments. The foundation
awards grants in a variety of area, including healthcare. They offer grants for equipment,
facilities, and program support for those involved in medical diagnosis, treatment and
education, disease prevention, then promotion of health lifestyles, and the development of
creative new ways to address health-care challenges (George S. and Dolores Dore
Eccles Foundation, 2011). They have assisted with grants for other Valley Mental Health
programs in the past as well (George S. and Dolores Dore Eccles Foundation, 2011).
Option 2: The Autism Council of Utah helps to provide funding for children with
autism in Utah. Grants have been awarded for as little as $100 to over $5,000. The
council has awarded grants to many various settings that serve individuals with autism.
They seek to award grants to sites and programs that will help to enable each person of
any age who has autism or a related disorder, and their families, to have access to
resources and responsible information (Autism Council of Utah, n.d.). I believe that the
program would meet that standards of the councils mission and be a candidate to receive
funding.

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Program Evaluation
The effectiveness of the program will be measured in a variety of ways. Having
methods to evaluate the program will give insight into the strengths and weaknesses of
the program and indicated where changes can be made. The most effective way to gather
information would be to use both qualitative and quantitative methods. One of the most
prominent ways of obtaining information will be the tracking of progress toward
individual goals as set by the occupational therapist. Tracking the progress of goals will
be a major indicator that treatments and interventions for the clients are indeed making a
difference.
Qualitative methods for evaluation of the program may include: Feedback from
teachers, parents, or caregivers, observation of children and their behaviors, and
observation of teachers and staff in the implementation of strategies and treatments in the
classroom. These methods will allow for information to be gathered through interactions
and observation and provide a unique perspective when gathering the information
needed.
The use of quantitative measurement methods will allow for more measurable
data to be gathered in order to provide evidence for the programs effectiveness.
Quantitative methods of gathering information include: tracking number of occurrences
of problematic behaviors (both by the therapist and staff), looking at grades to view
performance improvements, and looking at legibility (as a percentage). Other methods
may be implemented as needed once the program is started and as needs may arise.

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Summary of Agency Reaction

I had the opportunity to present the idea for the program to the elementary and
secondary director of the Pingree Center. The director seemed very interested in reading
the proposal and reading in more detail how an occupational therapist position can be
implemented at the site. The director once again stated their interest in hiring an
occupational therapist and hoped this report would assist in giving the site the
information and promotion it needs in order to create this position. The director
acknowledged the benefits an occupational therapist would bring to the site and is
looking forward to the future of occupational therapy at the site.

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References
American Occupational Therapy Association. (2008) Occupational therapy practice
framework: Domain and process (2nd ed.). American Journal of Occupational
Therapy, 62, 625-683.
Ashburner, J., Rodger, S., Ziviani, J. A., & Jones, J. (2014). Occupational therapy

services for people with autism spectrum disorders: Current state of play, use of
evidence and future learning priorities. Australian Occupational Therapy Journal,
61, 110-120.
Autism Council of Utah. (n.d.). Grants. Retrieved from
http://autismcouncilofutah.org/grants/.
Carmen B. Pingree Center for Children with Autism. (n.d.). Carmen B. Pingree center
for children with autism. Retrieved from http://www.carmenbpingree.com.
George S. and Dolores Dore Eccles Foundation. (2011). Health care. Retrieved from
http://www.gsecclesfoundation.org/health/index.html.
Howe, T., Roston, K. L., Sheu, C., & Hinojosa, J. (2013). Assessing handwriting
intervention effectiveness in elementary school students: A two-group controlled
study. American Journal of Occupational Therapy, 67, 19-27.
Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed.,
p. 203-227). Philadelphia: F.A. Davis Company.
Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. (2012). Effects
of classroom modification on attention and engagement of students with autism or
dyspraxia. American Journal of Occupational Therapy, 66, 511-519.

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Kushki, A., Chau, T., & Anagnostou, E. (2011). Handwriting difficulties in children with
autism spectrum disorders: A scoping review. Journal of Autism &
Developmental Disorders, 41, 1706-1716.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The personenvironment-occupation model: A transactive approach to occupational
performance. Canadian Journal of Occupational Therapy, 63, 9-23.
Pfeiffer, B., Koenig, K., Kinnealey, M., Sheppard, M., & Henderson, L. (2011).
Effectiveness of sensory integration interventions in children with autism
spectrum disorders: A pilot study. American Journal of Occupational Therapy,
65(1), 76-85.
Rens, L., & Joosten, A. (2014). Investigating the experiences in a school-based
occupational therapy program to inform community-based paediatric occupational
therapy practice. Australian Occupational Therapy Journal, 61, 148-158.
Schaaf, R., Hunt, J., & Benevides, T. (2012). Occupational therapy using sensory
integration to improve participation of a child with autism: A case report.
American Journal of Occupational Therapy, 66, 547-555.
Scott, J. B. (2011). Fact sheet: occupational therapys role with autism. Retrieved from
http://www.aota.org//media/Corporate/Files/AboutOT/Professionals/WhatIsOT/CY/FactSheets/Autism fact sheet.ashx

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Appendix A: Phase I Interview Questions

1) What is the purpose of your organization?
2) What group of individuals do you serve?
3) What are some of the characteristics of this group?
4) What are your funding sources?
5) What kinds of programming/services do you currently offer?
6) What are your plans for future programs/services?
7) What services do you think could be added by an occupational therapist?
8) Is there a particular age group or area that you feel should be focused on?

Appendix B: Phase II Interview Questions

1) What type of programming or changes would the teacher(s) like to see?
2) What are the major areas of concern for the site? Classroom? Students?
3) Are there specific students/age groups that are felt need more attention or focus?
4) What have you seen from other occupational therapy students in the past? Was it
helpful?
5) What do the students feel they are having difficulties with?
6) What do students want to work on or improve?

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Appendix C: Budget Justification
Source of Specific costs or sources of
income
Start-up Costs
Sensory Profile
Manual &
Assessment
VMI Manual &
Assessment
Weighted
Blankets

Annual Cost

$196

$137.50
3x $56.99

$170.97
Total= $504.47

Direct Costs
OT Salary
Malpractice
Sensory Profile
Sheets
VMI Sheets
Other supplies
(paper, pencils,
toys, etc.)

$34/hour x 30 hours/week x 52 weeks

$35 annual premium
$59.50 (for 25 Questionnaire) + $36.00 (for
25 Score sheets)
$79.50 (for 25 short forms)

$53,040
$35
$95.50
$79.50
$200

Total= $53,450
Indirect Costs
Utilities
Rent
Maintenance

Income

$100/month x12 months

10 x 10 x $13.00 x 12
15,600 x .10

In-kind contribution: Rent, maintenance, and

utilities

Rent
Maintenance
Utilities

Total costs

Total income or
in-kind
contributions
Net cost of
program

$1200
$15,600
$1,560

$15,600
$1,560
$1200
Total= $ 18, 360
Budget Summary
$ 53,954.47

$ 18,360

$ 35,594.47

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Figure 1: Most Frequent Focus of Identified Goals (Ashburner et al, 2014)

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