Limited involvement of youth with developmental disabilities (DD) in mentoring programs has resulted in limited knowledge about the quality and impact of these relationships. The self-disclosure process has been identified as one factor impacting relationship development (Reis & Shaver, 1988). We proposed a theoretical model to examine the role of the self-disclosure process as a mechanism in peer mentoring relationship development for transition-age youth with DD by determining if self-disclosure occurred, the type of information shared, how peer mentors responded, and if the process differed by perceived relationship quality. This retrospective, observational study purposefully selected nine peer mentoring dyads from a problem-solving intervention with a peer mentoring component to examine relationships judged by the researchers, peer mentors, and peer mentor supporters to be of variable quality (strong, moderate, weak), including 9 youth and 5 peer mentors with DD. Peer mentoring included 8 structured calls each with specific objectives. Phone call recordings were coded and dyads were grouped by perceived quality to determine how the self-disclosure process differed by relationship quality. The findings indicated self-disclosure occurred in each relationship at high rates (59%) and peer mentors responded to almost all self-disclosures (98%). A higher quantity of self-disclosure and more frequent disclosure of emotions were found in relationships of higher quality. Peer mentors in higher quality relationships more frequently responded to self-disclosure with advice or their own self-disclosure. Implications of findings and use of the self-disclosure process as a mechanism for promoting high quality peer mentoring relationships are discussed.

INTRODUCTION: The OTPN at Massachusetts General Hospital works to reduce barriers to care and implement tailored accommodations to improve patients with ASD/IDD access to and participation in healthcare. A quality improvement project was conducted to understand the OTPN interventions perceived as valuable by the recipients of care. THEORETICAL PERSPECTIVE AND EVIDENCE: Patients with ASD/IDD experience unmet healthcare needs and low patient satisfaction when accessing healthcare. Wagner’s Chronic Care Model was used as a framework to understand the factors that contribute to this problem. Current literature provides evidence-based strategies to improve the quality of care for patients with ASD when accessing healthcare services, but lacks descriptive evidence from the patient and caregiver perspective. DESCRIPTION OF PROJECT: Semi-structured interviews were conducted with three clients of the OTPN (one former patient with ASD and two parents of former patients). Using the phenomenological method, data was collected and analyzed to develop themes identified among participants. A follow-up interview with the OTPN obtained the OT perspective that informed the interventions valued by project participants. RESULTS: Participants identified barriers to care prior to collaborating with the OTPN, as well as valued OTPN interventions that involved patient-centered anticipatory planning, advocacy, and coordination of care. The OTPN used her OT perspective to understand the intersection of the person, environment and occupation to inform interventions that improved the patient experience. CONCLUSION: Customized interventions provided by the OTPN were highly valued by previous clients and were perceived to improve their healthcare experience by addressing unique patient needs and preferences.

Thesis (M.S.O.T.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this study is to understand if readiness for advocacy is associated with attainment of participation and advocacy goals for youth with developmental disabilities transitioning into adulthood. The transtheoretical model is used to conceptualize youth’s readiness to act when new knowledge and advocacy skills are gained through Project TEAM (Teens making Environmental and Activity Modification). Project TEAM is a 12-week group curriculum that teaches a problem-solving approach to identify and resolve environmental barriers to participation. Parents (n=17) and youth (n=12) ages 14-20 with developmental disabilities each rated the youth’s readiness for advocacy at initial, outcome and six week follow-up. Initial responses were grouped into preaction (precontemplation, contemplation and preparation) and action (action and maintenance). Each youth set a participation goal prior to Project TEAM for which the primary interventionist and principal investigator wrote goal attainment scaling (GAS) levels. Attainment of this participation goal and the application of three advocacy knowledge goals were evaluated at outcome. At outcome, GAS T-scores were calculated based on the attainment of the four goals. No significant difference was found in the GAS T-score between youth who began Project TEAM at the preaction versus the action stage. Youth with varying levels of readiness for advocacy at initial achieved their goals at outcome. Parents reported a significant increase in the youth’s readiness for advocacy between initial and outcome, and youth showed a similar, statistically non- significant trend. There appeared to be no relationship between attainment of a participation goal and change in readiness for advocacy; some youth who have no change in readiness for advocacy still achieved a participation goal, and youth who do not attain a participation goal still had changes in their readiness for advocacy. Results point to the potential benefits of Project TEAM to support changes in readiness for advocacy and attainment of a participation goal for youth with varying levels of readiness for change. / 2031-01-01

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