Implementing the Pathways and Resources for Engagement and Participation (PREP) program into an Australian context with young adults with complex disability (The PREP Project):

The PREP, designed by Dr Anaby and colleagues in Canada, is a 20-week client-centered intervention. PREP aims to improve individuals’ participation in activities of choice by modifying aspects of their environment, including physical, social, attitudinal and institutional elements. We will study the feasibility of implementing PREP in an Australian context, and evaluate participant outcomes using an interrupted time series design. The PREP protocol involves five steps: (1) Make goals, after which is a 4 week period during which baseline measures are collected; (2) Map out a plan; (3) Make it happen (over a 12 week period); (4) Measure the process and outcomes (weekly, throughout the phases of the study including over a 4 week follow up period) and (5) Move forward to the next goal. The intervention will be delivered by trained and supervised occupational therapy students, and begins with a meeting with the participant at their home or other community location of the participant’s preference. During the first 2-hour meeting, the young person will set three new participation goals or activities that they would like to engage in yet find difficult. The Canadian Occupational Performance Measure (COPM; Law et al.) will be used to identify participation issues from the young person’s perspective. This process will lead to pinpointing three specific community-based activities that are a priority for the young person to engage in (e.g., drawing, playing a musical instrument, joining a cooking club, participating in a sport). Thereafter, is a 4-week period during which baseline measures are completed. Together with the young person, the interventionist will identify barriers within the environment for engaging in each activity and develop and implement a plan to remove these barriers and to build on supports so that young people can participate in activities of their choice. The 12-week intervention period includes 12 hours of therapy time; a 4-week intervention period is designated for each activity, and involves four therapy sessions, for a total of 12 sessions (4 sessions X 3 activities). Following the 12-week intervention, a further 4 weeks is allocated to follow up assessment. The baseline, intervention and 4-week follow-up periods span 20 weeks. Using an interrupted time series design, data will be collected twice weekly throughout the 20 week period using the COPM Performance scale (rated 1-10) for each of the participants' individualised goals (3 goals per participant). In addition, COPM Satisfaction with Performance will be collected on five occasions: first assessment, at the end of 4 weeks, 8 weeks, 12 weeks, 16 weeks and 20 weeks. Prior to testing the intervention as described, an additional PREP feasibility component will be implemented as follows: First, applicability will be assessed by stakeholder review and revisions made if needed of the PREP materials. This is conducted in partnership with our research advisory partners. Then, perceptions of 3-4 young people with disability and their families/support network, and clinicians about the applicability, acceptability and feasibility of the revised PREP intervention will be assessed qualitatively through mock implementation of the revised PREP and individual and/or group interviews – all completed remotely. Mock implementation involves completing only the first 2 steps of the 5 involved in PREP. The stage adds a methodologically rigorous step enabling a stronger evaluation of the revised PREP prior to implementation as an intervention package in 2021. The Mock interviews will be undertaken using videoconferencing technology to be COVID-19 safe, and are anticipated to take 40-60 minutes. The Mock interviews will be delivered by the occupational therapy student under the supervision of a qualified therapist and audio-recorded for later analysis.