1Perceptions Surrounding the Role of Recreational Therapy within Transitions Services as a Pathway to Employment for Individuals with Intellectual and Developmental Disabilities by Alexa Clatfelter July 2025 Director of Thesis: Cari E. Autry, PhD Major Department: Department of Recreation Sciences and Sport Management ABSTRACT The current rate of employment in the US for ages 16 and over is 60.2% (US Department of Labor, 2024); however, individuals with intellectual and developmental disabilities (IDD) are underemployed. In comparison, the employment rate for individuals with IDD in the United States is 34%, with only 18% holding a competitive job (Avellon et al., 2021). In K-12, students with disabilities including IDD are eligible and required to receive a free and appropriate education deemed necessary under the Individuals with Disabilities Education Act (IDEA). This includes transition services starting at the age of 16 focusing on functional skills for work and community life (US Department of Education, 2017). Recreational therapy (RT) as a related service to education, special education, and transition services is included under IDEA; however, RT is not prevalent within schools nor transition services. Nevertheless, one of recreational therapy’s mandates is to facilitate skills and opportunities for community life for their clients with disabilities. Therefore, this study aimed to gauge the perceptions of RT within transition services as a pathway to employment for individuals with IDD through a grounded theory approach of qualitative research. The study primarily focused on a community located in the eastern region of NC as the population of individuals with IDD in NC (18%) (NCDHHS, 2023) is noted to be higher than the national average of approximately 3% (US Census, 2019). Data collection included interviews with individuals with IDD, their parents/ family, and/or caregivers, employers, recreational therapists, and those working within related disciplines. Data analysis used the method of constant comparison of emerging codes and axial codes where utilization of two additional reviewers on the research team triangulated the data for credibility and trustworthiness. Five themes were constructed from patterns of similarities and differences from transcribed interviews. The findings of this study included the societal perceptions of individuals with IDD, their characteristics in the workplace, and what is needed for them to achieve employment and maintain it. This study also has multiple implications for both practitioners and future research, including the underutilization of recreational therapy services as a pathway of employment for individuals with IDD and types of settings for such employment. Perceptions Surrounding the Role of Recreational Therapy within Transitions Services as a Pathway to Employment for Individuals with Intellectual and Developmental Disabilities A Thesis Presented to the Faculty of the Department of Recreation Sciences and Sport Management East Carolina University In Partial Fulfillment of the Requirements of the Degree of: M.S. in Recreation Sciences Concentration: Recreational Therapy Administration by Alexa N. Clatfelter July 2025 Director of Thesis: Cari E. Autry, PhD Thesis Committee Members: Lindsey R. Oakes, PhD David P. Loy, PhD Clifton E. Watts Jr., PhD ©Alexa Clatfelter, 2025 ACKNOWLEDGEMENTS First, I would like to express gratitude to my thesis chair who never stopped believing in me. I could not imagine doing this with anyone else and your continual guidance and encouragement were instrumental. I would also like to sincerely thank all my committee members for their valuable time, input, and expertise throughout this process. To the participants in the study, thank you as well for your time, openness, and honesty. Your voices and experiences are so valuable and the heart of this thesis. I am also especially grateful to my key informant whose connections and support were invaluable. Thank you to my family and my Fiancé who were continually my comforts and strengths always there to calm my anxiety and cheer from the sidelines. This thesis, as a whole, is a testament to the collective support, belief, and kindness of all of those around me and those who contributed and I am deeply thankful to each of you. TABLE OF CONTENTS LIST OF TABLES ......................................................................................................................... vi LIST OF FIGURES ...................................................................................................................... vii SECTION 1: MANUSCRIPT ............................................................................................................... 1 INTRODUCTION1 ..................................................................................................................................... 1 PROBLEM STATEMENT ............................................................................................................................ 4 LITERATURE REVIEW ..................................................................................................................... 6 INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) ........................................................................ 6 LEGISLATION AND EMPLOYMENT FOR INDIVIDUALS WITH IDD ................................................................... 7 TRANSITION SERVICES ............................................................................................................................ 9 POST-SECONDARY EDUCATION PROGRAMS ............................................................................................. 10 RECREATIONAL THERAPY AND IDD ........................................................................................................ 12 GUIDING THEORETICAL FRAMEWORK .................................................................................................... 13 RESEARCH QUESTIONS ......................................................................................................................... 15 METHOD ........................................................................................................................................ 17 STUDY DESIGN ..................................................................................................................................... 17 PARTICIPANT RECRUITMENT ................................................................................................................. 18 DATA COLLECTION ............................................................................................................................... 20 INSTRUMENTATION/MEASURES .............................................................................................................. 20 DATA ANALYSIS .................................................................................................................................... 21 CREDIBILITY AND TRUSTWORTHINESS .................................................................................................... 23 RESULTS ......................................................................................................................................... 25 CHARACTERISTICS OF THE SAMPLE ........................................................................................................ 25 MAJOR FINDINGS ................................................................................................................................. 26 Theme 1: “Challenging, Rewarding, Magical Individuals” .................................................................. 27 Theme 2: “Support Pushes Forward Inclusion and Possibility” ........................................................... 31 Theme 3: “Lateral Spread” ............................................................................................................... 34 Theme 4: “Training, Training, Training” .......................................................................................... 37 Theme 5: “They Can Do It, Watch” ................................................................................................... 39 DISCUSSION ................................................................................................................................... 40 KEY FINDINGS ...................................................................................................................................... 40 IMPLICATIONS FOR RT .......................................................................................................................... 45 IMPLICATIONS FOR FUTURE RESEARCH .................................................................................................. 46 LIMITATIONS ........................................................................................................................................ 47 CONCLUSION ........................................................................................................................................ 47 REFERENCES ................................................................................................................................. 48 APPENDIX A ................................................................................................................................... 57 APPENDIX B ................................................................................................................................... 59 APPENDIX C ................................................................................................................................... 60 APPENDIX D ................................................................................................................................... 64 INTERVIEW GUIDES .............................................................................................................................. 64 Individuals with IDD ....................................................................................................................... 64 Parents/Caregivers/Family Members ................................................................................................. 65 Employers ....................................................................................................................................... 66 Recreational Therapists .................................................................................................................... 67 Related Disciplines .......................................................................................................................... 68 APPENDIX E ................................................................................................................................... 69 LIST OF TABLES 1. Research Participant Information………………………………………………………..26 2. Themes and Subthemes………………………………………………………………….27 LIST OF FIGURES 1. Bronfenbrenner’s Ecological Systems Theory.……………………………………….14 2. Conceptual Model of the Perceptions Surrounding the Role of Recreational Therapy in Transition Services as a Pathway of Employment for Individuals with Intellectual and Developmental Disabilities.……………………………………………………...…....44 SECTION 1: MANUSCRIPT Introduction1 Employment is highly valued in society, especially today. So much is dependent on the job that one holds, not only as a societal expectation, but also as an economic pressure. In the United States according to the Fair Labor Standards Act, teens can hold their first job starting at the age of 14 so long as it does not jeopardize their wellbeing (Kalleberg et al., 2000) and having a job as soon as they can is something that is not just what most teens want, but it is also the expectation. This expectation is something that not only increases but also becomes a need the older that an individual gets, and an independent lifestyle is reliant on employment due to living expenses including, car, medical care, and groceries. For individuals with intellectual and developmental disabilities (IDD), constraints exist to their pathway to employment not only in their teenage years, but more so as an adult. Holding employment has many benefits beyond finances, including a higher sense of self-worth, higher self-esteem, better physical health, customer service skills, leadership, and responsibility (Modini et al., 2016). Employment is also developmentally important to the growth of an individual and meaningful participation in society. The employment rate for individuals with IDD in the United States is 34%, with only 18% holding a competitive job (Avellon et al., 2021). A survey conducted by the University of Massachusetts showed that unemployment rates among individuals with IDD are more than twice as high as the general population (Siperstein et al, 2013). The major effect from this result is that unemployment keeps individuals with IDD in a system that makes them dependent on others (income) and in turn causes low self-esteem, decreased social skills, and depression ________________________________________________________ 1 Manuscript adheres to the style and headings of the Therapeutic Recreation Journal. 2 (Siperstein et al, 2013). Employment is seen in our society as a “rite of passage,” something that is expected, and individuals with IDD are not being given that opportunity (Arnett, 2000). This human right is not met (Allvelon et al., 2021). Along with this need that remains unmet, with employment comes fundamental skills and development that help shape individuals and provide skills for the future (Hennessey et al., 2023). With less opportunities for employment, individuals with IDD are not receiving those benefits. Individuals with IDD are also shown to have higher levels of depression and anxiety due to environmental factors such as stigma (Hennessey et al., 2023). Caregiver and support knowledge of societal attitudes and stigma leads to them unconsciously not providing the individual with IDD their dignity of risk. Dignity of risk, introduced by Perske (1972) is a principal that all individuals with disabilities have the right to take reasonable risks and make choices that may have the possibility to result in failure. This promotes autonomy, personal growth and self-determination. When service providers and supports interpret and manage/control the risks for an individual for IDD, it directly undermines autonomy (Wright et al., 2010). When supports, while vital to an individual’s growth and access, are overprotective, they risk limiting opportunities for natural growth, relationship development, and community involvement (Robertson et al., 2001). Societies’ shifting of everyday language use and perspectives of individuals with IDD can provide further access to autonomy and growth of individuals with IDD (Cluley, 2017). This can also increase the likelihood of dignity of risk occurrence due to a safer and more accepting environment and is essential to person centered planning (O’Brien & O’Brien, 2000). To have the least restrictive environment for individuals with IDD, dignity of risk should be incorporated in all spaces including employment. 3 Employment of individuals with IDD in inclusive settings can decrease some of the stigma that surround disabilities in our society and increased contact coupled with higher levels of inclusion in both schools and community settings has been shown to be linked with decreased levels of prejudice within society (Keith et al., 2015). However, there are foundational constraints to hiring someone with IDD in the first place. The underemployment of individuals with IDD is caused by a few different factors including unconscious bias that an employer may have and limited resources for transition services to facilitate pathways to employment through the community, school and what is available at home. Another factor that can influence underemployment and a pathway to various services, including transition and vocational services is the disability support cliff. The disability support cliff refers to the abrupt loss or reduction of vital public benefits including but not limited to Supplemental Security Income (SSI), Medicaid, and Home and Community-Based Services (HCBS). Individuals with IDD lose these resources either due to “aging out” of them or due to receiving a certain amount of compensation through employment and therefore no longer fitting the financial criteria to receive the resources (Nord et al., 2013). Individuals with IDD rely upon the public benefits for both income support and access to needed support services such as personal care, residential supports, day programming, or vocational rehabilitation. Support services such as the ones stated are typically funded through Medicaid waivers which have income and asset limits (Hall et al., 2007). These income and asset limits disincentivize individuals with IDD from seeking and gaining employment especially jobs that are full time or competitive, higher paying jobs due to the individual not wanting to risk jeopardizing their needed supports (Winsor et al., 2021; Tucker, 2006). 4 Recreational therapists can serve as a bridge in the pathway to employment within transition services for individuals with IDD. As individuals with IDD get older and gain the desire to hold employment, resources that individuals with IDD have access to dwindle. This access is something that decreases due to external factors such as age, geographic location, transportation services, and overall, less services offered because of being out of the primary and secondary education system. Recreational therapy is written into the Individuals with Disabilities Education Act (IDEA) as a related service but mainly has focused on services during the school ages within K-12 for students with disabilities (Gok, 2021). To allow for more access, there may be a greater space within transition programs and post-secondary education programs where recreational therapy could serve as a relevant service area and pathway. Problem Statement Individuals with IDD are underemployed. As a pathway to employment, programs such as post-secondary education and transition programs exist; however, the involvement of recreational therapy is minimal. Post-secondary education programs have highlighted that programmatically there is an inconsistency in how staff provide services and the training of the staff (Oakes et al., 2018). Through exploring and potentially introducing recreational therapy into this gap, individuals with IDD could have another resource to explore social and emotional aspects from leisure activity and gain the skills related to employment through recreational therapy services. The purpose of the study was to better understand this process and to identify the role that recreational therapy has as a pathway to employment for individuals with intellectual and developmental disabilities (IDD). Due to the limited research on this role, an exploratory approach was implemented and examined employment of individuals with IDD from an ecological perspective. This approach helped gain different stakeholder perspectives to better 5 understand the process of recreational therapy’s role in the pathway to employment for adults with IDD. Literature Review Intellectual and Developmental Disabilities (IDD) According to the DSM-V (TR) (American Psychological Association, 2022), neurodevelopmental disorders are a group of conditions that have an onset during the individual’s developmental stages of life (typically before the age of 18). Common characteristics of a neurodevelopmental disorder include deficits or differences in the brain process that result in impairments in areas such as personal, social, academic, or occupational functioning. Neurodevelopmental disorders range and are very different from individual to individual. Neurodevelopmental disorders also typically occur in tandem with other neurodevelopmental disorders (American Psychological Association, 2022). According to the DSM-V (TR), neurodevelopmental disorders directly include attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), autism spectrum disorder (ASD), and communication disorders, but they can also include cerebral palsy, Down syndrome, and fetal alcohol spectrum disorder. Risk factors that could lead to someone being more likely to be diagnosed or develop a developmental disability includes genetic and chromosomal disorders, premature birth and low birth weight, prenatal exposure to toxins, maternal infection during pregnancy, brain injury or trauma, lack of access to healthcare and early intervention resources. The DSM-V (TR) states that intellectual and developmental disorders are characterized by different deficits that may occur in areas such as general mental abilities, reasoning, problem solving, planning, abstract thinking, judgement, academic learning, and learning from experience. These difficulties can directly impact and affect areas of quality of life including independence, social responsibility, communication, social participation, and academic or occupational functioning (American Psychological Association, 2022). 7 Developmental and intellectual disabilities have a likelihood to co-occur with one another which means that if an individual is diagnosed with one developmental disability, they may also have another one. Between the years 2017 and 2021, it was reported that the most prevalent developmental disability was ADHD with 9.57%, and it most commonly co-occurred with learning disabilities with 3.7% in individuals between the ages of three and 17. The prevalence of individuals diagnosed with a learning disability was 7.86% for the years between 2015 and 2017, for ASD it was 2.4% for 2017-2018, and ID was 1.17 between the years 2015-2017 (Li et al.,2023). Legislation and Employment for Individuals with IDD Historically, individuals with intellectual and developmental disabilities (IDD) have faced discrimination and stigmatization in society. In the United Stated until 1955 (when deinstitutionalization began) it was very common for individuals with IDD to be institutionalized and separated from not only their homes, but also society. Deinstitutionalization of individuals with IDD occurred between the years of 1955 and 1980. Neglect and abuse were common in institutions home to those with IDD. In 1963, President John F. Kennedy signed what is now known commonly as the Developmental Disabilities Assistance and Bill of Rights Act also referred to as the DD Act. The DD Act states: Disability is a natural part of the human experience that does not diminish the right of individuals with developmental disabilities to live independently, to exert control and choice over their own lives, and to fully participate in and contribute to their communities through full integration and inclusion in the economic, political, social, cultural, and educational mainstream of United States society (The Developmental Disabilities Assistance and Bill of Rights Act of 2000, 2021). The DD act also “defined and expanded supported employment services as an 8 option for” those who have developmental disabilities and are participating in vocational rehabilitation programs (Simmons & Flexer, 1992, p.2). The Americans with Disabilities Act (ADA) has many components that directly impact individuals with disabilities, and one of the areas that it encompasses is employment. Prior to the ADA being enacted, it was determined that employer attitudes towards individuals with disabilities overall were negative and furthermore led to the underemployment of those with disabilities. There was also a discrepancy that was identified between employer attitudes where they concluded that they were willing to hire those with a disability, and them employing them. In 1997, the largest barrier that was identified for individuals with disabilities access to employment was employer attitudes. The employer attitudes toward the ADA employment provisions were overall received moderate attitudes where the highest levels of concern were the costs that were related to modifications. Ninety-six percent (96%) of the employers that were surveyed that were also local stated that they were aware of what the ADA directly states in relation to the employment of individuals with disabilities, but only four studies stated that they did not feel that there would be adverse effects to the company by employing individuals with disabilities (Keys and Balcaz, 2000). The Individuals with Disabilities Education Act (IDEA), originally titled the Education for All Handicapped Children act of 1975, ensured that children with disabilities have access to and are provided free public education within the least restrictive environment. IDEA also provides individuals with disabilities with an Individualized Education Plan (IEP) which ensures that the student has their needs met within the educational environment to be successful (Gok, 2021). In 1990, Congress mandated that an individual transition plan, or ITP, must be developed 9 as a part of a student’s IEP to help the student transition to post-secondary life. Transition services must start at the age of 16 focusing on functional skills for work and community life (US Department of Education, 2017). In fact, Section 300.43 Transition Services states: (a)Transition services means a coordinated set of activities for a child with a disability that— (1) Is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation; (2) Is based on the individual child’s needs, taking into account the child’s strengths, preferences, and interests; and includes— (i) Instruction; (ii) Related services; (iii) Community experiences; (iv) The development of employment and other post-school adult living objectives; and (v) If appropriate, acquisition of daily living skills and provision of a functional vocational evaluation. (b) Transition services for children with disabilities may be special education, if provided as specially designed instruction, or a related service, if required to assist a child with a disability to benefit from special education. (US Department of Education, 2017, Section 300.43). Transition Services Transition services were developed for students with disabilities to provide more access and relevant education to those with IDD, provide more control over their lives, and to give an opportunity for them to focus on goals that are personally important to them (Bakken & Obiakor, 2020; 2019). Prior to the 1970, small, segregated programs for individuals with IDD included severe restrictions. These programs did not provide individuals with IDD a normalized lifestyle and was not conducive to their needs. Coinciding with the de-institutionalization movement, legislation such as the DD act and IDEA was developed to meet needs and provide support. 10 Vocational rehabilitation services were not recognized as a meaningful service for individuals with IDD until the late 1960s. Between the late 1960s and 1970s, there was a dramatic growth recorded of 300% of sheltered programs for individuals with disabilities and the primary growth in these programs targeted individuals with developmental disabilities (Simmons & Flexer, 1992). Perez and Crowe (2021) identified three major areas in community programs for transition aged youth with intellectual disabilities, which included: (1) collaboration with community supports, (2) leisure education, and (3) social skills training. The article identified that social skills training is vital for transition aged youth to establish connections with peers as the first step to community engagement. Different programs developed to establish and work on social skills include volunteer work, employment, specific goals related to individual social skills, etc. Of the leisure education programs, some examples of those that were offered were in schools specifically targeted to the transition needs for after high school. The authors also identified that a barrier to having community programs that offer such help included the amount of people required for the 1:1 help not just within the field of recreational therapy, but also interdisciplinarity between recreational therapy, occupational therapy, and social work (Perez & Crowe, 2021). Post-Secondary Education Programs Post-secondary education programs (PSE) are an option for individuals with IDD to pursue either employment or education pathways. PSE were first developed in the 1980s and have further been developed to offer those with disabilities other pathways in which they may pursue in life. Individuals that participate in PSE programs have been linked to show that there have been higher employment rates associated (Alquazlan et al., 2019). PSE programs equip 11 individuals with skills that are useful when entering the workforce. In terms of the attitudes towards PSE, stakeholder groups generally had positive outlooks regarding their experience and the students themselves that had participated reported that they were happy with the programs that they had participated in (Alquazlan et al., 2019). While the students with ID had positive views, parents showed that they had mixed views regarding PSE. The barriers that were identified for PSE services for participants include personal social attitudes, physical barriers (such as difficulty with opening doors, going up stairs, things being too high, cobble stones, hard to read signs), and social attitudes of others. Barriers identified by PSE staff include different program models, varying skillset of the staff members, parent attitudes towards inclusion (thought it did not apply to their child), parking, accommodations, transportation (Alquazlan et al., 2019). The implication for practice is that overall PSE services are well received by those who participate, however some models of PSE were not as well received by parents and staff receiving mixed reviews. Due to a lack of research in this area, the role of recreational therapy within transition services as a pathway to employment was explored and a holistic view within various ecological systems surrounding individuals with IDD was important to review. Such systems were represented by and include adults with IDD, their parents, guardians, and/or caregivers, recreational therapists, related disciplines, and employers (Alquazlan et al., 2019). In total, are 361 PSE programs that are targeted towards college students with IDD that are on a college campus. There is a continual growth of these programs with a reported increase of 67.5% from 2012 to 2018. The scope of service provided by the Certified Therapeutic Recreation Specialist directly relates to that of PSE programs (Oakes et al., 2018). 12 Recreational Therapy and IDD Recreational therapy (RT) as a related service to education, special education, and transition services is included by law under IDEA; however, RT is not prevalent within schools nor transition services or post-secondary education programs. With this acknowledged and in relation to all three laws and services/programs discussed above, one of recreational therapy’s mandates is to facilitate skills and opportunities for community life for their clients and this holds particularly true for those with IDD. This includes learning emotional regulation and social and communication skills, through leisure and recreation, which in developmental psychology is known to help with employment preparation as well. Leisure and community participation are important life aspects for anyone but can be especially important for individuals with IDD. Badia et al., (2013) examined the relationship between what leisure activities individuals with developmental disabilities participated in compared to those in which they would want to participate, and the factors associated with participation. The study found that individuals with developmental disabilities want to engage in social activities in the community with others, but it also found that the activities in which individuals with developmental disabilities participate were typically solitary and did not involve going out into the community. This occurred more due to environmental factors as opposed to personal factors (Badia et al., 2013). The study by Badia et al. showed the need for community programs targeted specifically for individuals with IDD. Community programs for individuals with IDD would focus on aspects such as social skills, independence in areas regarding living such as budgeting, living alone, grocery shopping, or cooking. It is also important that each program be specific to the individual, their goals, outcomes, and needs. 13 Social inclusion for individuals with intellectual and developmental disabilities involves interactions between two major life domains. These domains include interpersonal relationships and community participation. Social inclusion has been identified as a key factor for the well- being of individuals with IDD. There is also a higher rate of social isolation present for individuals with IDD (Simplican et al., 2015). Organizational inclusion exists within both formal and informal settings, one of which is employment settings. Furthermore, within employment, this is applicable to manager attitudes, company mission statements, training opportunities for staff, and access to communication services (Simplican et al., 2015). Guiding Theoretical Framework The ecological model (see Figure 1) was introduced by Bronfenbrenner and is described as “the processes and conditions that govern the lifelong course of human development in the actual environment in which human beings live” (Bronfenbrenner, 1994, p. 37). The first proposition that the ecological model presents is that human development takes place due to processes that include reciprocal and progressively more complex interaction between an evolving biopsychological human organism and the persons, objects, and symbols in its immediate environment. For the interaction to be considered effective, it must occur in a regular basis over extended periods of time. The forms of interaction that exist within one’s immediate environment are considered and referred to as proximal processes. The second defining proposition is “that the form, power, content, and direction of the proximal process effecting development vary systematically as a joint function of the characteristics of the developing person; of the environment-both immediate and more remote-in which the processes are taking place; and the nature of the developmental outcomes under consideration” (Bronfenbrenner, 1994, p. 38). 14 Figure 1 Bronfenbrenner’s Ecological Systems Theory – developed by SimplyPsychology Note: Permission to use diagram from Saul McLeod (June 24, 2025). When considering the ecological model, Bronfenbrenner describes different layers of systems as “a set of nested structures” (Bronfenbrenner, 1979, p. 3). The first level of the structure is the immediate setting that an individual is in this could include someone’s home, workplace, or school. The next level that is identified is the relations between settings. The next level includes the events that take place outside of the setting of the individual that have the potential to directly impact them. Lastly, the culture of a setting has very distinct impacts on both 15 the individual and the environment that they are in. Within the ecological theory, the mesosystem is a “set of interrelations between two or more settings in which the developing person becomes an active participant” (Bronfenbrenner, 1979, p. 209). In the mesosystem, multisetting participation occurs when there is an individual that engages in activities in more than one setting. The second section that Bronfenbrenner utilized to describe the layer outside of the mesosystem is the exosystem. The exosystem is comprised of parents, friends, parents’ jobs, local governments, teacher training institutes, and mass media. The final external layer is the macrosystem. The macrosystem is comprised of laws, the nation, legal systems, economic systems, political systems, culture, and social norms. Ecological transition occurs then when there is the switch from one setting into another. Linking occurs when multiple individuals interact between settings. An indirect linkage occurs when two individuals may not interact at the same time or setting, however, a third party serves as the indirect linkage between the two. Intersetting knowledge and intersetting communications occur when messages and information are shared between different settings or knowledge that is obtained from an outside source. The mesosystem is therefore defined by the people and the places that one interacts with and relates to both directly and indirectly through others (Bronfenbrenner, 1979). Research Questions The review of literature describes that there is value in the use of transition services and that there is a positive relationship between individuals with IDD participating in these services and employment; however, there is still a significant number of individuals with IDD that continue to experience unemployment and the need for transition services continues to grow. In relation to recreational therapy’s role in transitions services, there is a gap in knowledge related to the potential role the field can play within a pathway of employment for individuals with IDD. 16 Along with this, there is also a lack of research to determine the perceptions surrounding transition services and involvement of recreational therapy. As a result of this overview of the literature, this study will address the following research questions. From the viewpoint of internal and external (ecological) agents including and involved with individuals with IDD: RQ1: What are the perceptions surrounding employment for individuals with IDD? RQ2: What are the perceptions surrounding the benefits and challenges of transition services as a pathway to employment for individuals with IDD? RQ3: What are the perceptions of recreational therapy and recreational therapy’s role as a transition service and pathway to employment for individuals with IDD? To answer these research questions, the study includes individuals with IDD, their families and/or caregivers, recreational therapists, those in related disciplines, and employers. Method Study Design The study design focuses on drawing clear conclusions based on the data to develop and form grounded theory. Grounded theory is meant to generate an explanation (theory and/or model) of a process or action/interaction that is understood by several various participant perspectives (Creswell & Poth, 2018). The study directly looks at the process and perceptions of those that have an intellectual and/or developmental disability that do and do not hold a job, their family members (parent/guardians, siblings, etc.), caregivers (if applicable), recreational therapists, employers, and those within related fields such as special education and social work. The grounded theory approach within qualitative research is meant to take the researcher into the real world so that the findings center around the empirical world. Grounded theory within qualitative research includes conducting data collection and analysis simultaneously. The approach utilizes comparative methods, draws on data to develop new conceptual categories, develops inductive categories through systematic data analysis, emphasizes theory construction, engages in theoretical sampling, searches for variation in studied categories where thematic categories emerge (Patton, 2015). The grounded theory approach for this study is also guided by the ecological model by exploring perceptions from the individuals themselves and those directly surrounding and impacting individuals with IDD. Interview questions within an interview guide will be asked to better understand the individual, microsystem, mesosystem, exosystem, and macrosystem. As a result, by utilizing research data guided by the ecological model and accompanying agents (Bronfenbrenner, 1994), the purpose of this study was to provide a better understanding that the role recreational therapy may have as a pathway to employment for individuals with IDD 18 through the perceptions of internal and external agents with and/or involved with individuals with IDD. Participant Recruitment Participants for the study were recruited through purposeful and snowball sampling (Creswell & Poth, 2023). Purposeful sampling was utilized through both already existing relationships established by the primary researcher and use of the key informant to facilitate introductions. Snowball sampling occurred naturally during data collection as participants recommended and introduced the primary researcher to other individuals who they thought were appropriate for the study. among local networks, agencies, and community programs that serve and/or hire individuals with IDD. A local church ministry for adults with disabilities was utilized to recruit individuals with IDD and their families. Additionally, a local restaurant which employs individuals with IDD for individuals, their parents, and employers. Recreational therapists and related disciplines who work with individuals with IDD were recruited through networks already established by the primary researcher. The primary researcher also has a contact with what is referred to as a “key informant” or associate who assisted with networking opportunities for this type of sampling method. A key informant can be a trusted connection for other internal and external agents in qualitative research to help in recruitment to research studies (Creswell & Poth, 2023). Recruitment began with gaining a letter of support (see Appendix A) from this associate who the primary researcher already had in their network. This person is a parent, church member, and contact for various non-profits/employers, RTs, and related disciplines in the community. After IRB approval (see Appendix B for approval letter), the researcher continued to work with and through this connection to recruit more participants as part of the snowball sampling technique (Creswell & 19 Poth, 2023). A recruitment script with the researcher’s contact information (phone and email) was then developed by the researcher and distributed by the associate to their contacts who would be appropriate participants in the study. The key informant also assisted through introductions in person utilizing the verbal script. Upon recruitment, participants were given the consent form to read over either in person or via email (see Appendix C). Once it was established that the individual met all the inclusion criteria and wanted to participate, the consent form was signed by all relevant parties. Two copies of the consent form were signed one for the researcher’s records, and one for the participants records. After the signing of the consent forms, an interview at the participants convenience was then set up via Webex. To be included in the study, all participants had to be 18 years of age or older, consent to video and audio recording being taken, and have access to the internet and Webex. For someone to be considered as a participant as an individual with IDD they had to have a diagnosis of an intellectual and/or developmental disability, ability to comprehend interview questions and verbalize their answers, no identified behaviors that could make their participation harmful in any way to their wellbeing and have a parent who was available and willing to participate. For the parent group they had to have a child with IDD that was also able and willing to participate. For related disciplines and recreational therapists, they had to either currently or previously worked with individuals with IDD, and employers had to currently be employing individuals with IDD. In summary, participants within a qualitative study should be carefully selected to best aid the researcher in answering their research questions to the best of their ability (Creswell and Creswell, 2018). The total number to target for the grounded theory approach is typically in the 20 range of 20-30 participants but it can go as low as 15 depending on the saturation of the data collected (Creswell & Poth, 2023). The study had a total of four individuals with IDD, their four parents, three employers, three RTs, and one individual of a related discipline to adhere to the guidelines. Data Collection Through grounded theory, this qualitative study focused on the perceptions of individuals with IDD and those both directly and indirectly involved in their lives and the role of recreational therapy within transition services for individuals with IDD. As such, the method of gathering information to understand the process that is occurring from an ecological standpoint was through interviews. By obtaining the information through interviews, a more substantial and meaningful breadth of information was used to uncover and explore the personal knowledge and experience of the participants (Creswell & Creswell, 2018). The researcher conducted the interviews using an interview guide (see Appendix D). The length of interviews on average were no more than one hour and dependent on the category of participants. Individuals with IDD and parents/family may have taken the entire hour due to the number of questions. The location of the interview occurred online via the university approved software Webex, which also recorded and transcribed the interview. Once the interviews were transcribed, the researcher reviewed them and made clarifications if the software did not accurately transcribe any part of the interview. Instrumentation/Measures The questions asked within the interview guide reflected upon the different systems within the ecological model that was outlined by Bronfenbrenner above. This was done to ensure that the viewpoints and perceptions of both the inside and outside agents are considered and 21 accurately explore as much possible to understand the process that is taking place- this process ultimately being the role that RT can play in transition services as a pathway to employment for individuals with IDD. Interview guides were utilized for all the interviews conducted. A different interview guide was used dependent on the category that the participant falls under (individual with IDD, parent/guardian, family member, recreational therapist, related field, and employer). The areas addressed through the interview guides include leisure interests of individuals with IDD/perceptions of leisure interests, awareness of recreational therapy and its scope as it is related to employment, and barriers to employment. The interview was styled so that an accurate representation of thoughts, feelings, and opinions could be captured to the highest extent (Creswell & Poth, 2023). The questions included within the interview guide (see Appendix D) were derived from the literature review and in tandem with the ecological model developed by Bronfenbrenner. The questions were asked with both the research questions and grounded theory approach in qualitative research in mind. The interview questions aimed to better understand the perceptions of those with IDD and to see how they compare to the perceptions that they themselves have. Questions surround topics such as inclusion, leisure, recreational therapy, employment, and transition services. The interviewee categories were based on the different ecological systems. Data Analysis Creswell and Creswell (2018) identify that data analysis procedures (constant comparison) for qualitative method includes simultaneous procedures, which involves analyzing the data while collecting, coding, and the writing up of findings is occurring. This hand-in-hand process occurs through the use of writing memos during the interviews and data collection to be 22 included in the final report. Grounded theory consists of three phases of coding- open, axial, and selective (Creswell & Poth, 2023). Open coding examines the transcripts and notes using the constant comparative approach where saturation may occur of emerging categories or themes. Saturation occurs when new information is not providing further insight into the process being studied. Axial coding then occurs when the categories start interconnecting and selective coding builds or tells the story that connects the categories. The “story” then ends with theoretical “propositions” that explain the process- which is then known as the grounded theory and/or can be explained through a model (Creswell & Poth, 2023). In qualitative data analysis, another important step to take is known as winnowing. Winnowing the data is the process in which the researcher may choose to focus on some of the data that has been collected while disregarding others that may not be as relevant. Creswell and Creswell (2018) also outline specific steps to be followed in the qualitative research process. Step one is to organize and prepare the data for analysis, step two is read or look at all the data, step three is to start coding all of the data, step four is to generate a description and themes, and step five representing the description and themes. Tesch’s 8 step coding process which is highly recommended for use by Creswell and Creswell (2018) states: 1. Get a sense of the whole, read all transcriptions carefully, jot down some ideas as they come to mind as you need them. 2. Pick one document (one interview), choose the one which is most interesting to you or the shortest. Go through it and ask yourself what you deem to be interesting about it, what the information means, and write thoughts in the margins. 3. Once step two has been completed for multiple of the interviews, create a list of all topics. Cluster the topics that are similar. 23 4. Take the list that you created and go back to the data, abbreviate topics as different codes and write them next to the corresponding segments of text. In doing so, new categories and code may emerge. 5. Find the most descriptive wording for the topics and convert them to categories, look for way to reduce your total list through grouping topics that are related. 6. Make final decisions about the abbreviations created for each category and alphabetize them. 7. Assemble data material that belongs to each category in one place and perform preliminary analysis. 8. If needed, recode existing data. Credibility and Trustworthiness In qualitative research, the terms credibility and trustworthiness are used instead of the terms validity and reliability. The way that this study maintained credibility and trustworthiness was through the use of multiple reviewers (i.e. as part of the research team) to review transcribed interviews; this ensured that the same conclusions were being drawn about what was found during the research process. This allowed for the process that we were looking to understand and best addressed the research questions explored by this study. This occurred when determining the codes/themes and checking and re-checking the codes/themes that are emerging as noted and supported by the multiple reviewers. The interview guides were also specific in the instructions and the questions asked so that everyone within the same groups were asked the same questions and that across all interview guide questions were related and similar. Finally, the researcher utilized both recordings and a detailed journal. This was referred to throughout the process to ensure every interview was captured and details were not left out. 24 The intelligent verbatim approach was utilized in transcribing the interviews through utilizing Webex’s software which has an accuracy of 90-95% (Cortland IT Services, n.d.). Transcripts were also cleaned by the primary researcher following each participant interview without waiting more than 3 hours. To maintain consistency, each participant with IDD was interviewed first, followed by their parent. The consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups also guided the primary researcher to ensure credibility and trustworthiness in the findings. The goal of using the criteria listwas to ensure and to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations (Tong et al., 2007). (See Appendix E for the checklist.) Results Characteristics of the Sample The sample consisted of 15 participants who were identified through the utilization of snowball sampling and met the inclusion and exclusion criteria. Of those that were interviewed, four participants were adults with an intellectual and developmental disabilities (IDD) diagnosis, four are the parents to each of those individuals, three are recreational therapists, three of the participants employ individuals with IDD, and one person works in a related discipline. These divisions are being reported as their primary category; however, several participants in the study crossed over into other secondary categories. See Table 1 for participant pseudonyms, categories, and additional information. Table 1 Research Participant Information Category Pseudonym Additional Information Individual With IDD (I1) Amber 45 yo female from Eastern North Carolina. Diagnoses: microcephaly, cognitive and fine motor limitations, and visual impairment. Individual With IDD (I2) Clide 41 yo male from Eastern North Carolina. Diagnosis: attention deficit disorder. Individual With IDD (I3) Henry 18 yo transgender male from Western North Carolina. Diagnoses: attachment disorder, cognitive limitations specific to numbers, attention deficit disorder, anxiety, and autism spectrum disorder. Individual With IDD (I4) Jeff 25 yo male from Eastern North Carolina. Diagnosis: autism spectrum disorder. Parent (P1) Bonnie Parent of Clide Parent (P2) Mary Parent of Amber 26 Parent (P3) Peggy Parent of Henry and prior career as a Social Worker. Parent (P4) Bridget Parent of Jeff Recreational Therapist (RT1) Rebecca Community-based Recreational Therapist (RT2) Asa Vocational rehabilitation Recreational Therapist (RT3) Juliet Community-based; post-secondary education Employer (E1) Veronica Restaurant employer, works in secondary education, and has a sibling with a disability. Employer (E2) Sunny Restaurant employer and has a nephew with IDD diagnosis. Employer (E3) Amanda Restaurant Employer and has a sibling with an IDD diagnosis. Related Discipline (RD) Shakira Parent of an individual with IDD; works in community-based programming and post- secondary education, community advocate. Major Findings As a result of constant comparison analysis during data collection and coding of the interview transcripts, saturation occurred, and five major themes emerged from the data with their own sub-themes related to IDD and employment. These themes along with their in vivo code name/participant quote (Creswell & Poth, 2023) include: 1) “Challenging, Rewarding, Magical Individuals” with three subthemes; 2) “Support Pushes Forward Inclusion and Possibility” with two subthemes; 3) The “Lateral Spread” of Skills with three subthemes; 4) “Training, Training, Training with three subthemes and 5) “They Can Do It, Watch” with two subthemes. See Table 2 for the titles of the themes and sub-themes. 27 Table 2 Themes and Sub-Themes Major Theme Sub-Theme “Challenging, Rewarding, Magical Individuals” Challenges Rewards Magic “Support Pushes Forward Inclusion and Possibility” The Support Cliff Bigger Support Leads to Bigger Access The “Lateral Spread” of Skills Soft Skills Leisure Skills Academic vs. Life Skills “Training, Training, Training” The Individual The Microsystem The Exosystem “They Can Do It, Watch” Gaining Employment Maintaining Employment Theme 1: “Challenging, Rewarding, Magical Individuals” The first theme as quoted from Bridget (P4) describes positive characteristics as employees and the barriers individuals with IDD may face to overcome challenges related to employment. This theme was apparent throughout the perceptions of the research participants and represents that when you take those characteristics into account and find ways to overcome the challenges, and accommodate needs, there is so much to gain from a relationship or connection with an individual with IDD. 28 If they [individuals with IDD] only had a chance to show off their skills, if they only had a chance to have a say an infomercial, about their skills to some of these larger corporations and local businesses. I, I think they too would be shocked and say, Oh my gosh, like I'm really missing the opportunity to have you (Shakira, RD). Challenges. The first sub-theme found throughout the interviews encompasses the challenges that may impact individuals with IDD in relation to employment. The first challenge mentioned was fear; whether it was fear based on a past experience or a fear due to not having a starting place and the anxieties that may be a result of both situations. When discussing the ways in which fear can impact individuals with IDD from seeking employment, Asa (RT2) who works in vocational rehabilitation stated: It's fear of not wanting to work, like, you know, if I get to my job, what, what would I do? Am I able to do this? Or just that kind of negative thought in the back of their head of saying, I don't want to do this because it's not gonna be fun. And if it's not fun, I'm not enjoying it and depending on that job it might even be harmful as in like physically, you know, if they're working long hours a day on their feet, they hurt, then it's like, why should I do this, right? Asa further explained past experiences, the fear of rejection and other predetermined self and societal expectations feed fears for individuals with IDD. Participants in addition to Asa (e.g., Amanda, Juliet, and Rebecca) also expressed there was parental fear (of letting go) and engaging in a false sense of independence where the parent is still there and not allowing the margin of error. Nevertheless, another challenged emerged. Research participant perceptions also identified the need for more individuals with IDD to be given the dignity of risk. Dignity of risk includes the weighing of pros, cons, and 29 consequences to a choice and being able to make the choice even if someone (a caregiver or parent) or society may perceive that choice as an incorrect one (Savage & Bowers, 2022). Rebecca (RT1) discussed how a parent or caregiver may feel that they would prefer to shelter an individual more due to their own fears that they may have and then they are nervous to push them out of their comfort zone. It is something unconscious that is being done, which leads to the individual not knowing that employment is something that is realistic, attainable, or something that they can do, especially if you do not see other people that look like you (with a disability) in that role. Veronica (E1) talked about how “it's very hard for parents even with individual tools that are able, that are capable, it's very difficult for them to see them differently, their parents. So, they need to push them.” The idea and concept of independence and the weight that the term being independent holds was also something that seemed to be present, particularly for the parent group. Most of the parents’ ideas of being independent were more holistic rather that in certain aspects of interdependence. For example, Bridget (P4) stated that her son, Jeff (I4) “likes to believe he is independent, but no. That’s something that is not true.” When he displayed independence in gaining employment by seeking out someone that they knew who had connections to where he wanted to work, and he did that on his own. When Amanda (E3) discussed her place of work, she said in relation to independence that: getting them the chance to be independent, which is harder makes a lot of parents, have a hard time just like doing that especially in like for example I need you to go you know grab things or do things independently, but, you know, really I was watching them on the camera or you know I could I could still provide doing it in a very dependent way, but cutting that street is important. It's like, it sounds bad a huge part of making them feel 30 prepared for that after life after high school, they didn't think they can do a lot of this now. Mary (P2) stated when discussing Amber’s (I2) independence that she feels: that's an area that we, I feel personally have not done well with. Because I feel that in meeting all the challenges as a parent, I think we, I personally shouldn't say we because other people may not run into this, but I feel like sometimes it was easier to do things. To be able to manage all that was going on rather than to encourage her to do. So I think that's an issue that we have a great need for, and but we've been, you know, trying to do better about that. And, she helps in the kitchen some and she helps clean up and clear the dishes and helps with her laundry and helps fold her clothes. And she does a lot of things because we've been working towards doing better about that. But I know that early on we did. Did not do as well just coping with all the different things that were going on. Rewards. The second sub-theme relates to the rewards of working with individuals with IDD. A majority of the research participants including the individuals with IDD described the importance of structure and repetition in the workplace and the benefits in which this brings. Clide (I1) worked three jobs all in fast food, Henry (I3) worked bussing tables at two restaurants, and Jeff (I4) worked 2 jobs in bakeries, and Amber (I2) volunteers every week and straightens things at the place she volunteers. Juliet (RT3) stated that the ideal work for most individuals with IDD includes “anything that's really systematic where the process is repeated, and they don't have to learn, a new thing so often or a new system so often.” Through gaining structure, individuals with IDD are provided more comfort and stability within their job and routine can help in reducing anxieties. “Most students [with IDD] who like do good in employment can follow a task list of some sort, like a to do list and have some independence” (Amanda (E3)). 31 Amber’s mom, Mary (P2) concurred that her daughter “has from the time she was very little, it really mattered to her that she kept everything straight because of her disabilities and her vision” and how this strength fit a volunteer opportunity. “So, she did a great job of stocking their shelves and straightening and getting all that organized and the way they ran it at that time”. Employment has the potential to increase self-determination of those with IDD. Self- determination in many cases is something that exists in the individual and is a motivating factor. Bonnie (P1) said that her son, Clide “wants to feel needed like anyone would”, and Clide stated that he “just wanted to try,” when asked about employment. Sunny (E2) also told a story where one of the workers who is non-verbal a majority of the time had the courage to say something to her when something was wrong at work, asked her for a hug, and then before leaving said ‘today was a great day.’ Magic. The final sub-theme within the first theme is the “magic” in working with individuals with IDD. Many participants used both the terms loyal and hardworking when describing the nature of individuals with IDD in the job setting. Peggy (P3) when talking about Henry (I3) said “he'll be the most loyal hardworking employee that they've ever had. But the first couple months are gonna be a little rocky and people are gonna have to be patient with him.” Shakira when discussing how hardworking individuals with IDD are, stated “they will do their job 100% without distractions of cell phones and caring what the world thinks.” Theme 2: “Support Pushes Forward Inclusion and Possibility” The second major theme as quoted by Juliet (RT3), represents societal influences and direct impacts that both families and individuals with IDD face due to society and societal attitudes. The first sub-theme focuses on the support cliff and the second on bigger support leads to bigger access. 32 The Support Cliff. The support cliff is a concept that stems from individuals with IDD not having enough services to meet their needs. This is specifically represented in this population due to the amount of people that heavy rely on interdependence of others and have needs that keep them from being 100% on their own. Mary (P2) described the services that are offered and stated that they are “not adequate.” Veronica (E1) stated the importance of accurate supports and mentioned how individuals with IDD are often provided with the incorrect ones and “are misunderstood or they aren't in the correct setting, and they can have, they struggle with their learning if that's the case.” Veronica (E1) also stated that “some obstacles are louder than others” which leads individuals with IDD to be misunderstood. Peggy (P3) described the struggles with testing and feeling that there was a piece of the puzzle missing and it was not until Henry (I3) was 14 years old that they learned that he has autism. Peggy (P3) said people often think that Henry (I3) is purposefully being rude or aloof when he is just processing things and maybe needs a minute, but does not know how to communicate that. Bridget (P4) said when discussing the same thing about Jeff (I4) that people will tell her he “doesn’t look autistic” and she does not know what that means or what to say to people who state that. When there is a lack of accessible services and resources, this leads to families being relied upon to fill in the gaps. Peggy (P4), Mary (P2), and Bonnie (P1) all expressed that they felt that they had to supplement where their child was not given accessible services, or they had to find a way with out-of-pocket costs. Overall, the support cliff is seen to be most significantly apparent when individuals with IDD are not in school any longer and as they age into adults. The results here show that if supports are already limited earlier in childhood, then it can make the transition even harder into 33 adulthood. However, Sunny (E2) reported the transition into employment for individuals could help those that never received services throughout childhood. She said: there's two camps [one] of totally embracing …. and we're all in…. for a, you know, autism society and everything. And then you have this other camp and and we have both of them that, we have never had any service for this adult child's whole life. And you know, we've we've just gone as a family embracing this and not seeking outside help. And so we have a couple of of our folks are just now getting services because they've, they're realizing that they're out there and they're eligible for them. So it's interesting to see. And I just think, you know, could the struggle have been less if you had had these services, but at the same time, it's hard to get the services. I mean you gotta like again, you gotta fight fight fight. I remember my my co-founder, she's had to fight for everything for her son, and nothing is easy and it shouldn't be that way. Shouldn't be that way, but we're in an imperfect world. Bigger Support Leads to Bigger Access. The second sub-theme is the opposite of the support cliff. Rebecca (RT1) talked about how when there are resources provided for individuals with IDD and bigger supports, it in turn leads to bigger access in their community. Many of the individuals with IDD identified the importance and impact of the natural supports in their lives. Henry (I3), and Jeff (I4) listed friends and siblings as people that they have in their lives that they are close to, Amber (I2) mentioned a peer, and Clide (I1) stated that it was his mom he is closest to. Additionally, all of the parents stated that they felt that they had to make sure that they were surrounding their children around environments and people that they know will include them Peggy (P3) used the phrase “chosen family.” Juliet (RT3) when talking about a family that comes to her program said: 34 Supportive families that have their child, young adult, older adults that they're still caretaking for, and involved in Parks and rec and specialized recreation. We have a participant in her 40s. Her family brings her every week, they participate in other community programs, and she volunteers, so like you have those great supportive families that never want to hold them back and like push forward that inclusion and possibility, so. One of those ideal families that you wish everyone had because they have her involved in everything and like push her to do so much. Theme 3: “Lateral Spread” The third major theme is based on this idea of the “lateral spread” as quoted by Asa (RT2). Simply stated, skills build skills. Certain skills are needed no matter where we are or where we are going, and there is always something on which to be working. The three sub- themes in this overarching idea are soft skills, leisure skills, and academic vs. life skills. To summarize these and explain the lateral spread, Asa (RT2) discussed: it's important to focus on the other things too, that help with lateral movement, right? Not just that one specific job. Just because somebody can work in a team environment in, let's say an office where there's not really a lot of dynamic things happening, doesn't mean that they are working in a team environment in the back of the kitchen, where it's very dynamic, very stressful, right? So, preparing them and building upon those skills over time, but also in a lateral way is very important. You know, not just. For example, I'll just say social skills, right? Social skills is one, one of the higher tier skills that we need to build. It's just important that every profession doesn't matter what it is, even if you're working in an office by yourself in a cubicle, there will be a time and point where you have to communicate with somebody for your profession. So social skills is at the top 35 and, you know, just because we're, just because somebody is comfortable talking to one person doesn't mean that they're comfortable talking to two people or three people or four people or a group. So that's where that lateral spread is at. It's not just building on one, but going for more. Soft Skills. Asa’s lateral spread of skills was supported among a majority of the participants to include the need for individuals with IDD to have soft skills in the transition to and within employment. Soft skills were perceived to consist of attributes and abilities that contribute to someone’s ability to function in a workplace environment. The most common soft skills that were listed across the board between parents, RTs, and the individual in a related discipline included self-advocacy, communication, social skills, and teamwork. When describing soft skills, Rebecca (RT1) said that they are “those building blocks of like soft skills, so like communication, problem solving, just interacting with other people, what's kind of learning what's appropriate according to like societal norms, like, what you wear and hygiene.” Sunny (E1) said “our generation has failed at that cause growing up, we learned a lot of the soft skills at home that people aren't learning now” when referring to her own daughter who does not have an IDD. Leisure Skills. The next set of skills that were described that need to either be developed or focused on are the leisure skills. Sunny (E2) described many employees who work with her and that the way they were best able to find where they best fit and the jobs that work best for them, was to find their individual niche. She has volunteers and workers with IDD who have either told her or she learned through trial and error and taking the time to figure out their personal leisure interests. The individuals with IDD (and parents) also shared their leisure interests during their interviews. Henry (I3) stated that he volunteers regularly at the humane 36 society due to his love for animals. Amber (I2) connected with another child with autism at the daycare she volunteered. She learned she loved childcare, was good at it and was offered a job. Jeff (I4) reported he loves to bake and has worked at two bakeries. Clide (I1) stated he loves serving people and has worked three food industry jobs and loves volunteering at church. A majority of the participants across the board stated that finding leisure that is productive and enjoyable is hard for many individuals with IDD but that leisure skills were also perceived to be important to maintain a work life balance for everyone including individuals with IDD. Rebecca (RT1) affirmed, “you don’t live to work, you work to live.” Academic vs. Life Skills. The third sub-theme for the third theme encompasses a majority of the participants’ perceptions surrounding the dichotomy of how academic vs. life skills are incorporated or not incorporated into the school and transition services for individuals with IDD. As an example, Bonnie (P1) notably said in her interview: The school helped very little, when the school started working on living skills versus a math and reading and spelling and conversation to me and got away from phonics. To me that that was a big failure for especially children with special needs because I mean living skills are great, but I can teach him how to shop and how to cook and how to clean and I have, but the part that he needs when Momma's not around are the parts that they seem to drop. Other perceptions supported the need for life skills (and trade skills as reported by Juliet (RT3)) to be part of the school’s responsibility for individuals with IDD. In summary, both sides of this dichotomy, emphasize the need to incorporate academic skills and make sure that they are not being lost in translation when choosing what is taught in the schools for individuals with IDD, but still making sure there is the balance of integrating life skills too. 37 Theme 4: “Training, Training, Training” The fourth theme as quoted by Sunny (E2) emphasizes that training is multilevel. Training is also not only needed for the individual with IDD but has to occur at the micro, meso, and exosystems surrounding the individual as well. The microsystem in reference to Bronfenbrenner’s (1979) ecological model refers to those who are directly interacting with an individual whether it is their peers, parents, or employers and how they connect. The exosystem is in reference to those in the same community who may not directly interact with the individual (e.g., local government), but maybe have impacts in other ways or the know people in common with one another and interact with those people. The Individual. The first sub-theme of this major theme is focused on individual job training. Asa (RT2) talked about how the specific job training is what comes after the soft skills and that they are the next level. He discussed: whether it's through some type of internship, whether it's through some type of guided experience, whether it's through some type of organizational experience when they invite people to come and then they show them how to do their job but how to accommodate. If we, you know, think about our experiences with internship, if we were just told, hey, this is how you do the job after you're done with college, you don't get to ever practice it before internship, you're just free to go do your job. Most likely a lot of us would not succeed as well. This training also occurs in the form of volunteerism, certifications, and apprentices that guide people to be more equipped and prepared to enter the workforce. Sunny (E2) also described how the individuals with IDD that she employs become more confident and 38 empowered through being trained that they also want to help train their co-workers that come in and they get excited and volunteer for the opportunity to train their peers. The Microsystem. The second sub-theme looks at the microsystem and the emphasis that there needs to be advocacy and exposure. Multiple participants mentioned the importance of advocacy and having those that they may work for and work with to understand individuals with IDD and the needs that may come alongside. If more people are trained on ways to accommodate those with IDD in the work force it will help with destigmatization. Additionally, environmental agents within the microsystem also need to maintain communication with each other as a part of a healthy functioning mesosystem where those within the microsystem are informed and are aware of what is occurring within the each player in the microsystem. The Exosystem. The third sub-theme focuses on the exosystem and community buy-in in this system through trainings. If the community is aware of needs and resources, there is more access for those with IDD and more support for the programming. To support the lack of awareness, Shakira reported 5000 individuals includes anyone that's been identified by the state that has a cognitive disability. Now, we only, in our particular county, we only see about 350 actually circulate out of the 5000, which puts us to believe that there's a large percentage that are in facilities that never really circulate with us on a regular basis and then the rest of the population is just sitting at home. Now these could be anywhere from the what we would can what we would define as highly functioning onto the severe and profound and so we believe a lot are just sitting at home because maybe the lack of the education for the parent or the staff or transportation permits them from getting out and then and also just knowing what's available in their community, and then a large number are in facility and 39 then there are some percentages that are being mainstreamed and they are in our community circulating. Theme 5: “They Can Do It, Watch” The fifth theme as quoted by Veronica (E1) is focused on the employment of individuals with IDD and what is important to address from the point of view of the individuals but also from society. The theme is divided into the two sub-themes of gaining and maintaining employment. Gaining Employment. The first sub-theme of gaining employment is a huge hurdle. At this point the individual has the skills and are equipped and ready, but there is still challenges in getting employment. Henry (I3) said that he has been interviewing and sending job applications but does not hear back. All of the individuals except for Clide (I1) gained their employment through their parents and knowing the person that they were going to be working for in some capacity and the parent being the advocate for the worth and skills that the individual brought to the table. Maintaining Employment. The second sub-theme is that maintenance of employment. Many participants noted that in their experience, maintenance can be the hardest part and keeping their job once they are there whether it is due to accommodations not being met, burnout, a “misfit” of the job with characteristics/needs, or physical demand of the job. Asa (RT2) also identified that while maintenance of employment is reliant upon the skills that are built beforehand, it does not end there, goals continue after the job is acquired and work continues to be done and skills continue to be built upon, and that is where new ones have the opportunity to emerge. Discussion Key Findings Bronfenbrenner’s (1979) ecological systems theory was utilized throughout the development and guided the study. This theory explains the relationships between those that have an impact in the lives of the individual and the different systems surrounding them. The systems identified by Bronfenbrenner include the individual, microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The understanding of these systems is why the research focused on interviewing and gaining the perspectives of the individual with IDD, their parents, employers, related disciplines, and recreational therapists. Bronfenbrenner’s model was also utilized in the nature of the questions asked to the participants who exist in the microsystem. The questions were developed to further understand and make connections in the mesosystem and the informal structures that exist within the exosystem and cultural impacts of the macrosystem that all have a key role on influencing each other and in turn, the individual (Guy-Evans, 2023). The findings of this grounded theory study emerged from the interview process and the analysis of the interview transcripts and strongly suggest a connection to Wolfensburger‘s (1983) theory of social role valorization. Social role valorization theory states that everyone has the right to a valued role in society and advocates for the creation and support of more valued roles for others that may be at risk of being socially devalued. It is both the right and the responsibility for everyone in society to have a valued role no matter what, and society has an obligation to allow for everyone to have a valued role without restriction or constraint. Being an employee is an example of the valued role which people have in society, and if an individual wishes to pursue and hold that role, it is a right. Fleming et al. (2019) further validate the shift towards employment as a valued role through the utilization of social role valorization principles. 41 Each theme and subtheme constructed through the analysis of the qualitative data showed an interconnected relationship which can all be brought back to social role valorization (see Figure 2). In the first theme, the individual is the focus- what their role is, what impacts them from being employed, and being able to hold and be responsible in the role that they wish to have. The term “dignity of risk” is utilized in describing what occurs when either parents or society do not push individuals with IDD out of their comfort zone and allow for risk due to them fearing implications or feeling that they already know the outcome and therefore do not allow the individual the autonomy to discover the outcome themselves. Parental and family involvement within employment transitions is crucial and with that, the open mindset is necessary in allowing individuals with IDD the freedom of dignity of risk (Wehman, 2013). In the second theme and subthemes, society is considered and the ways in which society helps or hurts the role of employment being fulfilled by individuals with IDD. The second theme also suggests that due to the support cliff, parents must fulfill the obligation of society to help their child succeed and fill the social roles that they wish. However, as seen in the first theme, parents also struggle with the balance of having to fulfill a support role, a role of which in many cases may not be something in their scope. They also may not be able to provide the dignity of risk, which further can be a barrier on the individual (Hirano et al., 2016). In the third theme and subthemes, the skills in which are needed to aid individuals with IDD to fulfill their role are defined, and social role valorization as a theory also suggests that the more skills that an individual has, the more likely that they are to have the self-esteem and resources to be able to fulfill the social role that they would like to. Skill building particularly in those that are in supported employment has tangible outcomes in self-sufficiency and role fulfillment (Cimera, 2012). 42 Autonomy and societal integration are crucial in social role valorization and employment (Tyree et al, 2011). Social role valorization also enables individuals to increase participation and expand their contributions. Leisure skills also aid individuals with IDD both to fit into their social role in employment and to have a proper work/life balance. An ecological approach to understanding the ways in which optimal transition planning can occur for individuals with IDD should emphasize leisure and work inclusion in the system mapping (Small et al., 2013). Skill development is a clear indicator of both gaining and maintaining employment and the more skills that are developed, the more likely it is for both to occur (Test et al., 2009). Additionally, these competencies increase the likelihood that an individual can fit into the valued role of employment while challenging societies negative perceptions and increase inclusion (Lysaght et al., 2012). Theme four and its subthemes identify how trainings can further the individual’s skills once the soft, leisure, academic, and life skills have been the focus; however, this theme also outlines the trainings in which others should undergo to be able to support and accommodate individuals with IDD in the workplace. When different ecological layers are brought together between family, schools, the community, and services and when interventions are more holistic rather than singular, the outcomes are stronger. According to Rooney & Young (2023) the enhancement of social image is an aspect of social role valorization that includes advocacy and how others are viewed while highlighting their strengths. If more employers know the strengths that individuals with IDD have, then the strengths outlined by many of the participants (and discussed in the first theme) would spur more employment for that population. In addition, if natural supports can advocate, then more buy in can come from society. Included as part of this society are the peers or other employees without disabilities. With training, they can become 43 better employees and colleagues in the future to create more space for the valued social role. In turn, advocacy leads to more people being trained to be better colleagues and employers and how they can accommodate individuals with IDD into the workplace and let them know that they belong. Lastly, theme five and its subthemes are about gaining and maintaining a role. Transition services at their core were designed to assist individuals with IDD in achieving goals that are important and relevant to them and to present more autonomy into their lives (Bakken & Obiakor, 2020; 2019). Through methods that are inclusive, strengths-based, and person centered, the individual is able to continually work on their skills and reach their goals. 44 Figure 2 Conceptual Model of the Role of RT in Transition Services as a Pathway of Employment for Individuals with IDD Note. This model illustrates the interconnected relationship between the societal roles and obligations and the characteristics and responsibilities of individuals with IDD in gaining and 45 maintaining employment though the lens of Social Role Valorization, occurring throughout the whole process. Social Role Valorization further enhances and emphasizes the perceptive value of individuals by promoting inclusion in their valued social role of employment. This model also outlines the distinctive role of recreational therapists in this process and where this role occurs. Implications for RT The study discovered that many participants were unaware of what RT or its scope entails. It was also found that after learning more about the definition and services, a majority of the participants agreed that RT has a role in transition services and employment. However, they also agreed this is not happening very often. With transition services being identified as under Recreational Therapy’s scope, many stated that they felt that RT should start in schools with soft skills, and the use of leisure to help find what jobs align best with an individual, develop leisure skills to do that, and to provide structure. Mann et al. (2016) included a total of 30 parents of individuals with IDD gave insight to what the optimal school life looks like for individuals with disabilities through the lens of the social role valorization theory. Many parents of the study felt that it was optimal that their children be in schooling with peers that did not have a disability and that would be a part of their valued social role, however, without the proper support from professionals and the student’s peers, the parents felt that they were putting their children into an unwelcoming environment. Recreational therapists have an obligation to fulfill this need and role that is not currently being met for individuals with IDD. Additionally, recreational therapists need to be aware of transitions and the role that there is a role to be filled. Educationally, RT programs can teach in university transition services and programs for individuals with IDD and that it is an avenue for recreational therapists. 46 Recreational Therapists have the opportunity to facilitate an inclusive environment, provide structure, and help individuals with IDD grow upon their strengths to have a valued social role in school alongside their peers both with and without disabilities. This structure provided in the schools can continue in a post-secondary setting where skills are continuing to be developed, and goals are continuing to be met to help the individual best succeed. In a study exploring inclusion of college students with IDD in campus recreation, Oakes et al., 2021 suggested that skill development can take place in on campus recreation departments and RT has a role within such services. These services can provide opportunities through inclusive post- secondary education to help shape inclusion, provide dignity of risk, and support individualization. Recreational therapists can also continue to work with individuals after they have gained their jobs to continue with training and skill development. Recreational therapists can advocate alongside individuals with IDD for change to be made and to aid employers in understanding accommodations and needs to help them be the most successful. Lastly, there is an implication for private practice in RT as this is a setting in which is in the scope but is underutilized. See Figure 2 for the conceptual model of the role of RT in transitions services as a pathway to employment for individuals with IDD. Implications for Future Research Research in the topic of RT in transition services as a pathway of employment is very limited. More research on the ways in which recreational therapists can use systematic processes to help individuals with IDD achieve their goals and how recreation therapists can assist in the areas of gaining employment and maintaining employment. It may also be beneficial for future research to utilize focus groups especially for interviewing individuals with IDD. One barrier 47 that this study faced was that many of the groups, especially the individuals with IDD were nervous at first to participate and be interviewed on their own. Focus groups may help in reducing those anxieties to be interviewed with peers that have similar experiences. Limitations While the target number of participants (e.g., 15) and saturation of the data were met according to Creswell and Poth (2023), the number of participants in the related disciplines category and the number of employers in similar fields was a limitation to this study. Ideally, more diversity in employers (e.g., those who hire individuals with and without disabilities) would be more sufficient and provide more breadth to the data from this perspective. The primary researcher had interest from other local employers; however, due to scheduling they were unable to participate. Another limitation was related to the location of where participants lived. Most of the participants were from eastern NC except for one of the four parent and child groupings were from western NC and one of the recreational therapists was from Virginia. Conclusion In conclusion, this study showed many implications for practice, future research, and a look into what families and those that interact with individuals with IDD experience in trying to gain access to community resources, supports, and experience with employment and volunteerism. The perceptions of those in this community also represented the societal attitudes experienced by individuals with IDD. 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