Isabel Austin & Alice Pugh

Program Proposal: Life Skills Program

Utah Pride Center
November 2021
SIGNIFICANCE:

Utah contains blossoming and resilient LGBTQ+ communities, encompassing individuals

who identify as lesbian, gay, bisexual, transgender, gender queer, intersex, and any identity
considered a gender or sexual minority. The Utah Pride Center (UPC) is a local resource that
offers a variety of programs for anyone from these communities seeking services. Programs
include mental health services, suicide prevention, youth and family services, adult programs,
senior programs, education and training, and rainbow wellness (community classes). UPC’s
services are affordable due to the use of a sliding scale method which increases accessibility. At
the Utah Pride Center, we would like to create a life skills training program to assist queer
individuals in improving their performance in essential every day activities (occupations) that
can be difficult due to the variety of potential ailments and societal barriers that they may face.
This will be accomplished through small groups in order to ensure that each member’s personal
needs are being attended to.
The LGBTQ+ population is at high risk for development of mental illness primarily due
to stigma and discrimination. According to the American Psychiatric Association (APA),
LGBTQ individuals are more than two times as likely to have a mental health disorder than
heterosexual men and women (APA, n.d.). This includes but is not limited to depression, anxiety,
substance abuse disorders, gender dysphoria, suicidal ideation, and disordered eating. The
Centers for Disease Control and Prevention (CDC) found that LGB youth are at high risk for
bullying and both non-sexual and sexual violence which can lead to school absence and therefore
risks to educational success that can impact future opportunity as well as overall wellbeing
(CDC, 2017).
Research also demonstrates elevated rates of autism spectrum disorder (ASD), other
neurodevelopmental disorders (ADHD, learning disabilities), and psychiatric conditions (bipolar
disorder, OCD, schizophrenia), specifically in gender-diverse populations (Warrier et al., 2020).
Sensory processing difficulties commonly occur in individuals with ASD, ADHD, anxiety,
depression, PTSD, and schizophrenia (AOTA, n.d.; Case-Smith et al., 2008; May-Benson et al.,
2016) which indicates high prevalence in the queer community. LGBTQ+ adults with ASD are at
high risk of not only poor mental and physical health, but also “unmet healthcare needs,
inadequate insurance provider networks and rates of being refused services by a medical
provider” (Hall et al., 2020 p. 3072).
The combination of challenges associated with these conditions and the stigma and
discrimination dealt with on a daily basis can heavily impact the occupational performance
participation and overall wellbeing of this population. Our findings demonstrate a need for
occupational therapy (OT) services that are tailored to the unique needs of this population and
can address deficits from a culturally competent, trauma-informed, and intersectional lens.
Currently, there are OT programs that address each diagnosis previously mentioned, however,
none of them are specifically geared towards treating the LGBTQ+ community.
UPC is founded on the theory of self-determination, which postulates that the key
psychological needs for wellbeing are those of competence, autonomy, and relatedness. If a
program can meet these needs for improvement, then its participants will have a higher rate of
success. By signing up for programming they are recognizing a skills deficit, acknowledging a
need for growth, and demonstrating autonomous motivation. By engaging in this skill training as
a group, the participants are able to harbor a sense of connectedness and belonging as they learn
together. Positive feedback is also a key to boost one's self-determination. Through use of
positive feedback during sessions, the participants will increase their motivation and investment
in their growth (Deci et al.; 2012).
Creating this program supports the initiative of Healthy People 2020 to “Improve the
health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals”
(Healthy People 2020, n.d.) by providing an accessible and tailored healthcare resource. It is
accessible in its lack of barriers to participation, as participants do not need to quality, as well as
by its affordability.

INNOVATION:

Although many programs exist that are focused on meeting the needs of members of
LGBTQ communities, there are no occupation-based interventions being implemented in Utah to
fill the gaps in care related specifically to financial literacy, sleep hygiene, play, and cooking.
One-on-one occupational therapy is available at hospitals and clinics, mental health therapy is
available at the pride center, and Rainbow wellness at the pride center offers some OT-based
classes. Rainbow wellness was developed by a mental health therapist at the center who is also
trained as an occupational therapist. The program is run by community members who apply to
teach classes in their area of specialty, such as yoga, mindfulness, or sensory integration.
However, none of these resources offer a group-based option that addresses the instrumental
activities of daily living (IADLs) we have identified. IADLs are activities that support daily life
within an individual’s home as well as their community. This includes laundry, cooking,
managing money, navigating transportation, taking medication, communicating with others,
cleaning, and so on.

A unique aspect of this program will be the incorporation of sensory integration

strategies to address barriers that could be sensory-related, specifically during sleep and play.
This will involve the creation of personalized sensory kits that clients will be able to take home
to ensure translation of strategies within their natural environments. These kits are individualized
due to the nuances of the sensory challenges. Sensory kits should encourage rest and relaxation
for sleep and higher levels of stimulation for play.

One-on-one sessions are deeply valuable, but our program will have the added ability to
build community and connections as participants grow together. This is a targeted program for
LGBTQ+ communities that is occupation-based and focused on the development of IADL skills
that will support overall health outcomes and participation for this population. It is unique in
offering two-day sessions, each with their own topic so that clients can decide where their
biggest needs lie.

APPROACH:

Interviews with UPC Mental Health staff reveal a need for interventions focused on the 4
specific identified areas of financial literacy, cooking, play, and sleep & rest. The literature
review and an assessment of existing services show a need for an occupation-based, trauma
informed targeted prevention and intervention programs to support those within these
communities in order to close the gaps in care that exist between cis-gendered, heterosexual
individuals and members of LGBTQ+ communities. Without the unique skills of occupational
therapists with experience working closely with these communities, individuals are at higher risk
for elevated levels of homelessness, occupational deprivation, limitations to participation in
education, employment, leisure activities, disturbed sleep patterns, IADL barriers, and elevated
rates of mental and physical disabilities.
Recruitment and marketing strategies for this program will be consistent with the
methods utilized by other programs at the Utah Pride Center. This will include social media
posts, posters in public with information about the program, and targeted Facebook
advertisements. To be eligible to participate, one just needs to self-identify a need to improve on
the area of occupation being addressed. They will be able to sign up online through the Rainbow
Wellness program page on the Utah Pride website.
The Life Skills Program runs the course of a month, with each of the 4 weeks focusing on
a specific topic. Topics include financial literacy, cooking, play, and sleep and rest. Each week
there are 2 sessions, each 2 hours, that address the topic of the week. The first day focuses on
goal setting and education, while the second day involves the process of doing and grading the
activities up and down to meet the goals of each participant, as well as to make a plan to move
forward and continue their growth. Participants can sign up for just one week, or can choose to
sign up for multiple.
Recruitment at the start of a new program is a potential barrier, so a variety of outreach
methods and marketing will be utilized in order to identify which strategies engage the most
clients over the first months of the program. Covid precautions and changes in safety policies
present a possible problem regarding rules on gathering in person. If Covid limitations are too
severe to meet in person, the program can be moved temporarily virtual and be adapted to that
format.
The program's success will be evaluated using a variety of both formal and informal
assessments to measure objectives. The clients individual progress and growth through the
program will be measured using their Canadian Occupational Performance Measure (COPM),
Goal Attainment Scale (GAS) and Quality of Life - Occupational Therapy (QOL-OT) scores,
which will be completed at the start of each week's program, as well as a month after they have
completed the program via a follow-up call.
 An Occupational Therapy Assistant (OTA) working beneath the UPC Occupational
Therapist will spend 10 hours per week planning and implementing the program. The program
can also be run by Level II Fieldwork students who are placed in this setting throughout the year.

Goals and Objectives

By Jan 1, clients seeking resources from the UPC will have access to an OT
Goal 1
Life Skills program with 4 different topic options, each 2 hours on 2
consecutive days.
Objective
UPC will advertise Life Skills services by January 1st.
1a
Objective UPC will hire guest speakers for Life Skills training portions of each
1b occupational topic by January 1st.
Objective
All clients will return for their second day of their group.
1c
Clients participating in the UPC Life Skills programs will report improved
Goal 2
sleep patterns, financial literacy, cooking skills, and/or play
engagement/exploration via GAS scores at 1 month follow up.
Objective At the end of each session, each client will have their own written goal relating
2a to the day’s topic.
Objective
2b Clients will verbalize a plan of action to support them in reaching their goal.

Goal 3 After completion of 1 occupational Life skills session series, clients will report
improved overall quality of life as measured by QOL-OT at 1 month follow up.
Objective
Group leaders will create a follow-up plan to reflect on GAS and QOL goals.
3a
Objective All participants will complete follow-up reflection.
3b
 References
American Association of Occupational Therapy (AOTA) (n.d.). Occupational therapy using a
sensory integration-based approach with adult populations. https://www.aota.org/about-
occupational-therapy/professionals/hw/using-sensory-integration-based-approach-with-
adult-populations.aspx
American Psychiatric Association (APA) (n.d.). Lesbian, gay, bisexual, transgender and
queer/questioning[LLF1] .
https://www.psychiatry.org/psychiatrists/cultural-competency/education/lgbtq-patients
 Case-Smith, J. & Arbesman, M. (2008). Evidence-based review of interventions for autism
used in or of relevance to occupational therapy. American Journal of Occupational
Therapy, 62(4), 416-429.
CDC (2017). LGBT youth. https://www.cdc.gov/lgbthealth/youth.htm
Deci, E. L., & Ryan, R. M. (2012). Self-determination theory. In P. A. M. Van Lange, A. W.
Kruglanski, & E. T. Higgins (Eds.), Handbook of theories of social psychology (pp. 416–
436). Sage Publications Ltd. https://doi.org/10.4135/9781446249215.n21
Hall, J. P., Batza, K., Streed, C. G., Jr, Boyd, B. A., & Kurth, N. K. (2020). Health disparities
among sexual and gender minorities with autism spectrum disorder. Journal of autism
and developmental disorders, 50(8), 3071–3077. https://doi.org/10.1007/s10803-020-
04399-2
Lesbian, Gay, Bisexual, and Transgender Health | Healthy People 2020. (n.d.).
Healthypeople.Gov. Retrieved November 20, 2021, from
https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-
transgender-health
May-Benson, T., Teasdale, A., Amin-Arsala, T., Dunwell, C., Smith-Howe, A., Valliere, E., &
Weber, B. (2016). Performance of typical adults on the adult/adolescent sensory history.
American Journal of Occupational Therapy, 70, 1. https://doi-
org.ezproxy.lib.utah.edu/10.5014/ajot.2016.70S1-PO3088
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., &
Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and
psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals.
Nature communications, 11(1), 3959. https://doi.org/10.1038/s41467-020-17794-1

Budget

Budget Item Cost Rationale

Space (e.g., rent or reservation fees)
Community space $0 Seeking free location spaces
● Library with computers such as existing center and
● Pride center space library
 ● Play space - climbing gym, sensory
experience, Quack
Supplies (e.g., materials, printing costs)
COPM (electronic) $10 Necessary to assess pre/post goal
performance and satisfaction in
clients
Printing $300 Booklets that provide essential
information regarding sessions
and relevant information to track
each clients own goals post
session
Pens $12 For clients to fill out essential
forms during sessions
Food $300 Provide food at sessions to help
clients engage and feel healthy
during sessions
Sensory diet kits 5 per month x 12 months $1,200 Kits to distribute to clients after
sensory and sleep sessions to
support occupational
engagement post intervention
Cooking supplies $300 Cooking supplies (ingredients, to
go containers, etc.) needed for
cooking activities
Marketing (e.g., flyers, advertising)
Paid Facebook advertising $200 Ads are needed to reach
individuals that are not currently
affiliated with UPC
Flyers (color) $100 Flyers are needed to inform
individuals that are already
utilizing services at UPC of our
program

Personnel (e.g., salary with % time/effort,

hourly wage, benefits, consultant fees)
OT 10 hrs/week, .70, $35 hr x 52 weeks $18,200 An OT is required to facilitate
and carryout program
Benefits $18,200 x 0.27 $4,914
Guest speakers 1 session/week, $100 per $4,800 A guest speaker is required to
session teach the educational aspect of
the financial and cooking session
series.
Total Requested $25,536
 Budget Justification
This program requires the financial assistance of a grant in order to provide services that will
meet the unique occupational needs of the LGBTQ+ community. An outcome measure that we
will be utilizing to demonstrate the efficacy of our program is improvement in results of COPM
post intervention. Due to this, purchasing the COPM assessment is essential. For each group
topic, we will need to create and print booklets that provide essential information regarding
sessions and relevant information to track each client's own goals post session. Designing and
printing booklets will require coverage for costs of creative software and printing services. Each
session will require pens to enable clients to fill out booklets and take notes during sessions.
Food will be provided for clients during sessions due to the length and to ensure that energy
levels remain functional. Sensory kits will be created and provided to clients during sleep and
play sessions to ensure that sensory intervention strategies can be utilized in their everyday life
to improve performance in these areas. For cooking sessions, ingredients will need to be
purchased for each session in order to provide a hands-on learning experience to ensure positive
outcomes. In order to market and advertise our program to the public, both Facebook
advertisements and flyers will be utilized. This will allow us to inform individuals that already
utilize the pride center and those who are not currently affiliated about our program. In-kind
contributions include kitchen and group room space of the pride center, kitchen equipment and
tools, and computers at the pride center or public library. An OT will need to be hired and
compensated with hourly pay in order to facilitate and carry out this program.