An exploratory, randomized study of the impact of mentoring on the self-efficacy and community-based knowledge of adolescents with severe physical challenges

An exploratory, randomized study of the impact of mentoring on the self-efficacy and community-based knowledge of adolescents with severe physical challenges

Laurie E. Powers

Adolescents with severe physical challenges face many obstacles to their development of self-efficacy and community independence. Potentially, one important source for the promotion of adolescent competence is exposure to successful role models with similar challenges. The purpose of this study was to conduct an exploratory, randomized field-test of the impact of mentoring by role models on the self-efficacy, disability-related self-efficacy, community-based self-confidence, and community-based knowledge of adolescents with severe physical challenges. The study also aimed to determine the impact of mentoring on the perceptions held by parents regarding the capabilities and community based knowledge of their children. A two-independent group, randomized block design was used to evaluate the impact of mentoring. Students in the experimental group performed twelve activities with their mentors over the course of six months. Results indicated that youth exposed to mentors demonstrated significantly higher levels of disability-related self-efficacy, community-based knowledge and self-confidence than youth in the control group. Furthermore, the parents of experimental group participants perceived their children to be significantly more competent and to possess significantly more community-based knowledge than the parents of subjects in the control group. Implications of these findings are discussed and the need for additional research emphasized.

Teenagers with severe physical disabilities are faced with unique challenges to their development of community independence and self-confidence. Challenged by numerous physical limitations that restrict their strength, mobility, speech, dexterity, vision, endurance, and cognitive capabilities, these youth often experience difficulty performing functional activities and getting around in their environments (Goldenson, Dunham & Dunham, 1978; Stopford, 1987). Many youth also experience significant health instability, requiring on-going medical care and exposure to procedures that may be uncomfortable, disempowering, and incapacitating (Steinhausen, Schindler, & Stephan, 1983).

To obtain assistance with personal care and daily activities, youth with physical challenges often use help provided by others. However, typically they are passive recipients of the help they receive (Powers & Sowers, 1994; Ulicny, Adler, & Jones, 1988). Architectural and communication barriers also unnecessarily increase the helplessness and dependence of youth with significant physical challenges (Cruikshank, 1976; Scherer, 1988), as do negative attitudes held by others regarding their worth and potential for achievement (Edgerton, 1967; Fichten, 1988; Goffman, 1973). Inadvertently, parents may encourage youth to be passive through overprotection (Cruikshank, 1976; Kessler, 1977) or excessive child management (Lindemann, 1981). Parents may also lack knowledge about how to involve their children in activities (Espinosa & Shearer, 1986) or have difficulty encouraging their children’s independence while also managing other family demands (Turnbull & Turnbull, 1986).

There currently exists a strong national initiative to provide youth who experience severe disabilities with the skills and opportunities they need to lead lives that are meaningful, productive and integrated. Normalization has become defined by community presence, choice, competence, respect, and community participation (O’Brien, 1987). The development of independent living, supported employment, and supported living programs have provided new opportunities for persons with severe physical health challenges to live increasingly inclusive lives (Sowers & Powers, 1991).

Developing personal mastery or self-determination is critical for successful independent living (Summers, 1986a; Varela, 1986; Ward, 1988). Unfortunately, lack of opportunities to learn self-determination skills and participate in empowering experiences are significant obstacles to the development of personal mastery among youth with severe physical health challenges. These youth are at risk to fail to acquire necessary self-confidence to enable them to live at their maximal level of competence and to succeed in environments that require independence and active direction of personal assistance. In addition, their lack of opportunity to develop skills such as assertiveness, choice-making, problem-solving, advocacy, and perseverance causes these students to have trouble functioning when they become adults (Lindemann, 1981; Powers & Sowers, 1994; Ward, 1988).

To facilitate the self-determination of youth with severe physical challenges, it is critical that strategies be identified to promote their learning of independence skills and their exposure to environments that strengthen their skills and attitudes of personal mastery. To be maximally effective, such strategies must also help parents to support the developing confidence and independence of their sons and daughters.

Self-efficacy theory (Bandura, 1977; 1986) suggests that the development of self-determination may involve enhancing outcome expectations and personal efficacy expectations. Personal efficacy expectations are a person’s beliefs about his or her capability to perform specific life activities. Outcome expectations are a person’s beliefs about whether his or her actions will lead to the outcome the person desires. For example, a person who believes that she has the skills necessary to manage a personal assistant has high self-efficacy expectations for managing help. Likewise, if that person also believes that, by using her skills to manage an assistant, she will get good personal assistance services, she also has high outcome expectations. Self-efficacy does not reflect a person’s skills, but rather one’s judgment of what one can do with whatever skills one possesses. Youth who exhibit high levels of self-efficacy believe that they have the capabilities to accomplish their goals and will achieve their goals if they exercise those capabilities.

There is a growing body of evidence that self-efficacy beliefs are an important predictor of academic success (Graham & Harris, 1989), motivation (Schunk, 1989), and functional well-being (Dolce, 1984) for people with disabilities and health challenges. Self-efficacy is also one of the best predictors of health-related self-care behavior (O’Leary, 1985; Sallis, Haskell, Fortmann, Vranizan, Taylor, & Solomon, 1986).

Self-efficacy can be bolstered through vicarious learning from others. This type of learning typically occurs in the course of contact with peers and role models. The importance of role models for shaping attitudes, interests, and aspirations is generally acknowledged (Gottlieb, 1981). Through peer counseling programs, many independent living programs have created opportunities for adults with disabilities to share support and advice with one another (Crewe & Zola, 1983). Typically people with disabilities who are active in their communities serve as role models for others who have not yet reached their level of independence. Such intervention by peer counselors with disabilities is believed to accelerate the transition to independent living for individuals with disabilities (Sexton, 1983).

Youth with physical health challenges often have little contact or opportunity to develop positive relationships with more experienced persons who experience similar challenges. Following graduation from high school, social isolation from others with challenges often becomes exacerbated. As a result, many young people begin to doubt their abilities to successfully overcome disability-related barriers to independence. Exposure to role models is considered important for their development of self-esteem, positive view of disability, and living skills (Fredericks, 1988; Jones & Ulicny, 1986) and programs have been developed to provide such mentoring opportunities (Patton, 1985; Rousso, 1988). However, empirical validation of the efficacy of mentoring for youth with challenges and their parents has yet to be established.

The purpose of this article is to describe an exploratory, controlled study of the impact of mentoring on the self-efficacy and community-based knowledge of adolescents with severe physical health challenges. The study was conducted in association with the development of a comprehensive model to promote self-determination among adolescents with physical and multiple disabilities. The model entitled “R.I.S.C. (Reach for Independence and Self-Confidence)” provides (a) weekly coaching to students in the application of skills such as goal-setting, managing assistance, problem-solving, self-advocacy, and planning to achieve their personal goals; (b) coaching and support to parents to help them promote their children’s independence; and (c) community-based mentoring experiences. This study was conducted during the initial phase of R.I.S.C. model development in an effort to evaluate the usefulness of the mentoring component. Students who participated in the study subsequently participated in the skill-building and parent support components of R.I.S.C.

The mentoring study investigated the following hypotheses:

1. Youth provided with mentors would exhibit significantly higher levels of general self-efficacy and disability-related self-efficacy than youth not provided with mentors.

2. Youth provided with mentors would demonstrate significantly more knowledge of strategies for overcoming barriers to community independence than youth not provided with mentors.

3. Parents of youth provided with mentors would perceive their children to be significantly more knowledgeable about strategies to promote community independence than parents of youth not provided with mentors.

4. Parents of youth provided with mentors would exhibit higher levels of confidence in the community-based capabilities of their children than parents of youth not provided with mentors.

Method

Subjects

Ten students, ages 12 to 19 participated in the study. They were identified by staff of a school district serving a community of approximately 100,000 residents in the Northwest region of the United States. School staff were requested to identify all middle school and high school students in their district who experienced severe physical disabilities that significantly restricted their mobility, arm and hand use, and functional independence. School staff identified eleven students and ten of the eleven students agreed to participate in the study while one family declined because they were planning to move out of town. Students participating in this study did not concurrently participate in the other components of the R.I.S.C. Project.

The characteristics of students are presented in Table 1. Four of the students had very severe physical disabilities (indicated by a severity rating of 3): They used power wheelchairs and had very limited use of their arms or hands. In addition, two of these students experienced mild mental retardation as revealed by standardized assessment (Wechsler Intelligence Scale for Children, 1974). Four additional students used manual wheel chairs and experienced more mild upper body impairment (e.g., tremor, weakness), indicated by a severity rating of 2. One of these students also experienced mild mental retardation. The remaining two students ambulated with the assistance of crutches or a cane and were assigned a severity rating of 1. Both of these students demonstrated low average cognitive abilities. The mean age of students in the experimental group was 16.6 years while the mean age of the wait list group was 16.2 years. The mean severity of disability of both groups was 2.2. The mean IQ score of the experimental group was 81, whereas the mean IQ score of the wait-list group was 94.6. Three females and two males were in each group.

Table 1

Subject Characteristics

Subject Age Gender Disability

Experimental 4 15 F Cerebral Palsy

6 19 M Cerebral Palsy

7 19 F Cerebral Palsy

11 18 M Cerebral Palsy

2 12 F Spina bifida

Control 10 17 M Muscular Dystrophy

9 14 M Cerebral Palsy

Juvenile Rheumatoid

5 12 F Arthritis

1 19 F Spina bifida

3 19 F Cerebral Palsy

Severity of

Subject Disability IQ

Experimental 4 2 107

6 3 69

7 1 82

11 3 59

2 2 88

Control 10 3 116

9 2 95

5 3 107

1 1 87

3 2 68

Note. Severity of Disability: 1 = Ambulatory with assistance of walker or crutches, no upper body involvement; 2 = Manual wheelchair user, mild upper body involvement; 3 = Power wheelchair user, significant upper body involvement.

Dependent Measures

The Self-Efficacy Scale (Sherer, Maddox, Mercandante, Prentice-Dunn, Jacobs, & Rogers, 1982) was used to assess the self-efficacy of students. The Self-Efficacy Scale is designed to measure general expectations of self-efficacy in task-related and social domains. It asks respondents to indicate how certain they are about their capabilities to attempt new activities and persevere through difficult activities. The Self-Efficacy Scale demonstrates good internal consistency, criterion-related validity, and construct validity (Corcoran & Fischer, 1987). Adolescent scores on the Self-Efficacy Scale also correlate significantly with measures of general well-being (Ehrenberg, Cox, & Koopman, 1991). Administration of the Self-Efficacy Scale to 28 adolescents with physical challenges participating in the R.I.S.C. Project yielded an acceptable standardized item alpha of .81.

The Disability-Related Self-Efficacy Scale was developed by the authors to measure disability-related self-efficacy, or the extent to which students believed they had the capabilities to achieve desired outcomes made more difficult due to disability-related barriers. This 8-item scale was adapted from the Self-Efficacy Scale and included items such as “When something I like to do is physically hard for me, I cannot do anything to make it easier”; “If making friends seems like it will be hard for me to do because of my disability, I will not try”; and “I am good at getting help from others when I really need it”. Field-testing of this instrument with 28 adolescents with physical challenges participating in the R.I.S.C. Project yielded a standardized item alpha of .76, adequate for research purposes. The Disability-Related Self-Efficacy Scale also correlated significantly with the Self-Efficacy Scale (r= 50, p=.006).

Two additional questionnaires were developed to measure student knowledge and self-confidence regarding specific community-based issues and strategies relevant to persons with significant physical disabilities. The 20-item Knowledge Questionnaire included questions such as “Name three types of housing programs available to people with disabilities”; “Describe the steps for managing help from a stranger”; “Name all the organizations in town that help people with disabilities and describe what each organization does”; and “Describe the solutions to problems people with disabilities face riding the bus”. Student knowledge scores were calculated as the percentage of responses that matched those responses listed on the scoring template. The 15-item Self-Confidence Questionnaire asked students to indicate on a 4-point scale how confident they felt about doing a variety of parallel activities, such as “Getting a stranger to do the right things to help you”; Figuring out if a house would be accessible”; and “Asking the right questions when visiting a community agency”. Items for both of these measures were developed to reflect areas of community-based knowledge identified as important in the independent living literature and validated by peer counselors at the local independent living program.

Two questionnaires were designed to measure parent perceptions of student community-based knowledge and capabilities. The 17-item Knowledge Questionnaire asked parents to indicate on a five-point scale how much more students knew about a variety of community topics than they knew six months earlier. Items included living independently, setting goals for the future, overcoming barriers to employment, going places independently in the community, advocating for personal rights, using community agencies that serve people with disabilities, and participating in recreation programs. The Confidence Questionnaire asked parents to indicate on a five-point scale how much more confident they felt, as compared to six months earlier, about their son/daughter’s abilities to do those activities included in the knowledge measure. Thus, parents were asked to indicate how confident they felt about their children’s abilities to live independently, go places in the community, advocate for their personal rights, use community agencies, participate in recreation programs, etc.

Brief qualitative interviews were also conducted with students, parents, and mentors in the experimental group to ascertain their general impressions of the program and their recommendations for improvement.

Procedure

A two-independent group, randomized block design was used to evaluate the impact of mentoring. Given the small sample of students participating in the study, we concluded that prior experience in the community would be the most important variable upon which to establish subject blocks. Blocking on this both controlled for experience in the community and indirectly controlled for differential effects due to age, as older students would be expected to have more community experience.

The Weekly Activity Inventory (WAI) (Sowers, 1983) was administered to parents to determine the extent of prior community experience for each student. The WAI asks parents to indicate the frequency of their children’s engagement in a variety of different community activities. It has been validated on adolescent populations of students with severe disabilities and is considered an accurate indicator of community participation (Sowers, 1983). Students were ranked on their prior community experience based on their scores on the WAI. Those students ranked in the bottom half were assigned to one block, while those ranked in the top half were assigned to a second block. Students from each block were then randomly assigned to the experimental group or a wait-list comparison group. Students in the experimental group were assigned mentors while students in the wait-list group were told they would be assigned mentors in six months.

Mentors were recruited from the local independent living program. All adults with challenges interested in being mentors were asked to complete an application and participate in an interview during which their relevant background and experiences were discussed and the study explained. Adults selected to be mentors lived independently, had an active vocation, and presented a positive view of disability as evidenced during their interview and through reference checks. The characteristics of the mentors matched to students are found in Table 2. Mentors were matched to youth based on gender, interests, and similarity of challenge. Prior to matching, mentors participated in a 4-hour training during which their roles and the procedures were detailed. Although participants in a study, mentors were encouraged to make their interactions with students as spontaneous and naturalistic as possible.

Table 2

Mentor Characteristics

Severity of

Subject Gender Age Disability Disability

4 F 31 Multiple Sclerosis 2

6 M 33 Multiple Dystrophy 3

7 F 51 Cerebral Palsy 1

11 M 27 Cerebral Palsy 3

2 F 47 Rheumatoid Arthritis 3

Subject Vocation

4 Office Manager

6 Mental Health Counselor

7 Attorney

11 Improvisational Dancer, Musician

2 Writer, community College Advisor

Note. Severity of Disability: 1 = Ambulatory with assistance of walker or crutches, no upper body involvement; 2 = Manual wheelchair user, mild upper body involvement; 3 = Power wheelchair user, significant upper body involvement.

Mentors were introduced to their matched students and parents during a visit to the student’s home. During the visit, the Project Coordinator reviewed the purpose and structure of the program with the parent and conducted a structured interview of the student’s medical and physical needs while in the community. Specific procedures for handling any special needs were defined and recorded. The Coordinator then facilitated the mentor and student’s discussion of the first activity they would do and assisted them to complete an activity form that described the activity and logistical arrangements. The parent was then requested to sign the form.

A similar procedure was utilized to organize and obtain parental permission for subsequent activities. At the conclusion of each activity, mentors and students were asked to decide what activity they would do next. They completed the activity form and the student took the form home to his or her parent for signing. The Project Coordinator assisted the student and mentor in making arrangements for each activity. All transportation costs were paid by the project and students and mentors were given $20 to cover their expenses during each activity.

Students and their mentors were asked to participate in two activities per month for six months. Nine of these activities were individual encounters between the student and his or her mentor. Three of the activities were two-hour conferences in which all students and mentors participated. The focus of each activity and conference is presented in Table 3. General activity foci were determined by the researchers to ensure some consistency in the range of activities in which students and mentors participated. However, specific activities were selected and planned by students with guidance provided by their mentors. As can be seen, each encounter was generally designed to comprise a category of activity with an associated issue. For each category of activity, mentors were requested to provide some brief information and/or model adaptive strategies relevant for the student. For example, students and mentors were asked to engage in an activity that they would require assistance to perform. In the context of performing this activity, mentors were required to review and model basic steps for managing assistance.

Table 3

Mentor Program Activities

Activity

Mentor/Student Dyads Introductory Activity

Visit Mentor’s Home

Activity in Which Help is Required

Adaptive Recreation Activity

Eat in a Restaurant

Activity with Student’s Family

Visit a Community Agency

Visit Mentor’s Work

Novel Activity

Conferences Living with a Disability

Community Resources

Personal Advocacy

Topic

Mentor/Student Dyads Accessibility

Housing Adaptions

Managing Assistance

Recreation Options

Eating and Drinking

Student Capabilities

Bus Riding Challenges

Employment Challenges

Using Public Bathrooms

Conferences Positive Coping Strategies

Agency Services

Steps in Self-advocacy

Tests of Experimental Hypotheses

Although a very small sample, preliminary analysis of the data indicated that assumptions of normality and homogeneity of variance were not violated. As a result, parametric procedures were employed for subsequent data analyses. The strategy utilized for data analysis began with multivariate analyses of variance to detect significant differences between the groups on student and parent measures. The MANOVA’s were followed by the analysis of data pertaining to specific hypotheses with t-tests. This two-step procedure is recommended to reduce error related to multiple measurements (Stevens, 1986). Multivariate analyses of variance for the student and parent measures confirmed that there was a significant difference between the groups. Analysis of the four student measures yielded a Hotelling’s T of 11.83 (p=.025). Analysis of the two parent measures yielded a Hotelling’s T of 6.82 (p=.004).

Table 5 presents the t-tests for student scores of groups, while t-tests for parent scores of groups are found in Table 4. The first hypothesis, that youth exposed to mentors would exhibit significantly higher levels of general and disability-related self-efficacy than youth not provided with mentors, was partially confirmed. Mentored youth reported significantly higher levels of disability-related self-efficacy (t=4.3; p [is less than] .01), however, a significant difference was not found between groups in general self-efficacy (t=-.46;p =.66).

Table 4

t-tests for Parent Ratings of Groups

Subject Characteristics

t-tests for Parent Ratings of Groups

Confidence Knowledge

Groups m sd t m sd t

Mentor 1.73 .36 1.61 .39

-3.86(*) -6.74

Control 2.73 .45 3.88 .64

(*) p < .01

Table 5

t-test for Global Student Score of Groups

Disability-Related

Self-Efficacy Self-Efficacy

Groups m sd t m sd t

Mentor 1.75 .36 1.40 .17

-0.46 -4.30(*)

Control 1.89 .57 2.00 .27

Specific

Knowledge Self-Efficacy

m sd t m sd t

Groups 50.20 10.23 1.62 .37

Mentor 4.37(*) -.56(*)

1.90 12.25 2.49 .22

Control

(*) p < .01

The second hypothesis, that youth provided with mentors would demonstrate significantly more knowledge of strategies for overcoming barriers to community independence than youth not provided with mentors, was also confirmed (t=4.37; p [is less than] .01). The third hypothesis, that parents of youth provided with mentors would perceive their children to be significantly more knowledgeable about strategies to promote community independence than parents of youth not provided with mentors, was confirmed (t=-6.74; p [is less than] .01). The final hypothesis, that parents of youth provided with mentors would exhibit significantly higher levels of confidence in the community-based capabilities of their children than parents of youth not provided with mentors, was confirmed (t=-3.86; p [is less than] .01).

Qualitative Findings

Youth, parents, and mentors in the experimental group expressed high levels of enthusiasm about their mentoring experience. Parents communicated that mentoring was important for their sons and daughters, who had little opportunity for contact with independent adults with similar disabilities. One parent shared that her son consistently expressed high levels of excitement following visits with his mentor, coming home with numerous ideas for strategies he could use to be more independent. Other parents reported that, in conjunction with mentoring, their children began talking more about (a) their abilities to live and work independently when they were older, (b) getting involved in community groups, and (c) self-advocating at school and in the community. Parents also reported that witnessing their children’s reactions to mentoring, meeting the mentors, talking with mentors by phone in preparation for upcoming activities, and observing events such as mentors driving to their homes had a strong impact on their own views regarding the capabilities of people with challenges and their son’s and daughter’s future potential for independence. Parents uniformly recommended that the program be extended in duration.

Youth reported that they enjoyed having opportunities to do activities they’d never done before, such as adaptive sailing, wheelchair basketball, and canoeing. Youth generally agreed that visiting their mentor’s homes was their most memorable activity because they had never seen the home of a person with similar challenges who lived independently. Of great interest to youth were adaptations and strategies they observed their mentors using. One youth recounted his interest in his mentor’s speaker phone and reported that he and his mother were planning to order a similar phone for him. A second youth was excited about riding in the sidecar of his mentor’s adaptive bike and indicated that he wanted to find out if a bike could be designed for him. Another participant reported that, after learning about and practicing self-advocacy with his mentor, he had requested and obtained a meeting with the principal of his school to advocate for the construction of a ramp. This student was particularly pleased because the principal agreed to his request. All participants indicated they would recommend mentoring to other youth. Four of the youth planned to maintain contact with their mentors. The remaining participant who was assigned to the oldest mentor, indicated that she would like to maintain contact but also wanted to meet a successful young adult with a disability similar to her own. The youth also indicated that mentoring could be improved by increasing the length of time for the program and the number of activities. They also reported that there were other activities they would have preferred doing in addition to those included in activity categories required by the study.

Mentors reported that their mentees (a) learned how to conquer disability-related barriers, (b) became more positive about their capabilities and future potential for independence, (c) became more self-reliant, and (d) expressed increased interest in working, going to college, and living in their own homes. Mentors indicated the structure of the program helped them to focus their efforts; however they recommended that future programs provide more flexibility in the choice of activities and strategies to be conveyed. They indicated that such flexibility would provide opportunities for students to make decisions about activity choices and enable mentors to tailor their interactions to meet individual student needs. Two mentors also recommended that additional opportunities be structured for interaction with parents.

Discussion

This exploratory study of mentoring provides evidence for the usefulness of this approach for promoting student disability-related self-efficacy and knowledge, and for enhancing parent perceptions of student disability-related knowledge and competence. Qualitative interviews with students, parents, and mentors also support these findings. Following interaction with their mentors, students expressed increased confidence in their abilities to perform specific community-based activities and to overcome disability-related barriers to independence. They discovered ways they could do activities such as ride the bus, participate in recreation activities, and advocate for themselves. They learned about adaptations and strategies they could use to increase their independence in the community: adapted bicycles, portable ramps, calling ahead to find out about the accessibility of buildings, requesting help from store sales persons, etc. As a result of meeting and observing mentors and hearing about the experiences of their sons and daughters, parents also expressed increased confidence in the knowledge and capabilities of their children. Parents indicated they were more confident about their children’s abilities to anticipate barriers to doing activities, get around the community safely, and establish independent lives in the future.

It remains unclear whether mentoring also impacts general self-efficacy. Although the difference between the groups was nonsignificant for general self-efficacy, calculation of the effect size attributable to the difference between the means of the groups using a formula suggested by Hedges & Olkin (1985, p. 78) revealed a moderate effect (g = .30). It is possible that replication of this study with a larger sample size would result in a significant difference between groups on general self-efficacy.

The results of this study should be interpreted cautiously due to its many limitations. Foremost, the study is constrained by a very small sample size. This limitation makes it difficult to guarantee that randomization ensured equality of the groups. However, it is interesting to note that, demographically, the groups appeared quite similar, with the exception of a small difference between the mean IQ score of the students. Fortunately, this difference does not provide evidence to refute the findings as the wait-list subjects had a higher mean IQ score than the subjects who received mentors. It is reasonable to infer that the higher mean scores of the wait-list subjects would result in their obtaining higher knowledge scores and, thus does not explain their lesser performance. Clearly, additional controlled study of mentoring with larger sample sizes is a requisite for the formulation of definitive conclusions regarding the efficacy of this approach.

A second limitation of the study is the lack of standardization of some of the dependent measures. Although the Disability-Related Self-Efficacy Scale has demonstrated acceptable internal consistency and yielded a significant correlation with the more highly developed Self-Efficacy Scale, its psychometric properties are based on preliminary validation with a small sample of youth and require further investigation. Furthermore, the measures of student knowledge and activity-specific self-confidence and the parent measures of child knowledge and capabilities were specifically designed for use in this study. Although this practice is common in studies which focus on topics not formerly investigated, it adds ambiguity to the interpretation of the findings.

A third major limitation of this study is its focus on the impact of mentoring only on students with significant physical disabilities. These youth represent a low incidence population that both has little opportunity for contact with similarly challenged adults and faces many physical obstacles that may be particularly suited to mentor-based coaching. As such, mentoring may have particular efficacy for this group and have less appeal for students with other learning, cognitive, or emotional challenges. Validation of the efficacy of mentoring across youth with various challenges is essential.

Finally, the findings of this study suggest that mentoring is an effective methodology for the communication of both knowledge and inspiration to students with physical challenges. However, the impact of mentoring on actual independence behaviors requires additional study as behavior change is generally considered the most important indicator of intervention effectiveness. Qualitative findings suggest that interaction with mentors did result in some behavior change for students. Following interaction with their mentors, students ordered equipment, self-advocated, and joined community groups. However, the level and maintenance of behavior change associated with mentoring merits further quantitative study.

A few specific elements of effective mentoring were identified during the course of this investigation. First, it appears that successful mentoring approaches should provide specific guidelines and coaching for mentors to ensure youth safety and positive experiences. Mentors, like most community volunteers, require training, ongoing technical assistance, and support.

Second, it is apparent that mentoring is facilitated when participants are provided with a process for selecting activities while being encouraged to choose activities of personal relevance. Subsequent methods for activity selection utilized by the R.I.S.C. project have included providing youth with a checklist of various issues they may be interested in investigating and assisting them to select personally relevant issues and identify activities to participate in that will provide them with the experiences they desire.

Third, parent involvement in mentoring experiences is essential to ensure student safety and mentoring success, and to provide important opportunities for parent perceptions to be positively influenced. As such, effective mentoring approach should provide explicit opportunities for parents to communicate with mentors and observe mentors with their children. Of course, it is also important to ensure that these interactions do not interfere with the primary relationship between student and mentor.

The potential of mentoring to enhance the knowledge, capabilities and self-confidence of youth appears promising. In addition, mentoring may provide a method for promoting the efficacy of clinical and educational interventions by providing resources for community-based practice. For example, one student participating in the R.I.S.C. Project wanted to learn to ride the bus. Her occupational therapist was able to provide her with limited community-based practice; however, it was her mentor who was able to devote extensive time to assisting the student to gain proficiency in bus riding. On-going communication between the therapist, student, and mentor created the opportunity for them to identify this opportunity for collaboration. Perhaps there is a reservoir of community-based mentors who would be willing to develop partnerships with medical providers and schools in an effort to expand opportunities for students with challenges.

Mentoring also may be a useful strategy for assisting youth with health challenges to learn and apply self-care skills. It is clear that adolescence is a problematic period for self-management and many parents and medical professionals find that they have limited power to influence their children’s compliance with self-care requirements (Patterson, 1988). It is possible that interaction with similarly challenged adults who can personally validate both the trials and importance of self-care would have added impact on youth.

Mentoring appears to be a promising approach to assisting youth with challenges to identify and realize their goals. Although exploratory, this study represents one of the first controlled, empirical investigations of mentoring. This approach will likely become increasingly popular as programs seek to identify alternative methods for preparing youth for adulthood. As such, it is critical that the impact of mentoring be clearly understood and successful strategies for facilitating mentoring experiences for youth be articulated.

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Received November 1993 Revision: March 1994 Acceptance: April 1994

Laurie E. Powers, Ph.D., Dartmouth Medical School, One Medical Center Dr., Lebanon, New Hampshire 03768.

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