By Robert J. Fetsch, et al. Extension Specialist,

1. AgrAbility NTW McGill QOLGrand Rapids, MI2009 National Training Workshop10:30-11:15 October 6, 2009 By Robert J. Fetsch, et al. Extension Specialist, Professor & Director, Colorado AgrAbility Project, Human Development & Family Studies Colorado State University AANTWMcGillQOL10.0609 (Rev. 9.2909 & 10.0309)

2. Evaluating the Impacts of Direct Client Services: A Four-State Report with the McGill QOL ToolBy Robert Fetsch (CSU), Ron Schuler & Mary Beck (UW), Sheila Simmons (KU), Kirk Ballin (ESVA), Bob Aherin (UIL),Tina Little (CSU), and Vincent Luke (ESC)

3. Brief Review of the Literature Quality of Life (QOL) refers to a broad construct that includes physical, social, psychological, and spiritual dimensions of one’s well-being. Many QOL and health-related scales have been used to assess the QOL of individuals with physical and intellectual disabilities, e.g. SF-36.

4. Brief Review of the Literature Historically employment outcomes have been the sole indicators of VR program effectiveness. But since vocational adjustment and adaptations to a disability/condition are linked with psychosocial adjustment, there is a need for more multidimensional measures like QOL.

5. 3 Shortcomings of Other QOL Tools Led to the Development of the McGill QOL Heavy focus on the physical aspects of QOL Emphasis on compiling lists of problems rather than assessing positive contributions of QOL Notable absence of inclusion of the existential domain.

6. The Existential Domain of the McGill QOL Tool Assesses an Individual’s: Perception of purpose Meaning in life Capacity for personal growth and transcendence

7. Brief Review of the Literature on the McGill QOL Tool Cohen et al. (1995) posit that in individuals facing life-threatening illness, “existential concerns take on a greater importance; energy resources and ability to concentrate are frequently reduced, and those who feel that they have a good quality of life may be referring to something other than physical status.” Source: Cohen, Mount, Strobel, & Bui, 1995, p. 208.

8. Brief Review of the Literature on the McGill QOL Tool The McGill QOL literature includes hundreds of published research studies, especially in palliative care and with people with terminal and very serious illnesses. The McGill QOL has considerable published research with diverse populations, cultures, and languages, e.g. Korean, Spanish, Taiwanese, and Peruvian.

9. Brief Review of the Literature on the McGill QOL Tool The McGill QOL has been cross-culturally validated in the Hong Kong Chinese culture, Malaysian culture, and in home hospice settings in Israel. McGill QOL research has been published with diverse populations in palliative care, with HIV Amyotrophic Lateral Sclerosis, terminal cancer, Multisomatoform Disorder, Pulmonary Disease, and eating disorders.

10. Brief Review of the Literature on the McGill QOL Tool Meyer and Fetsch (2006) reported the impacts of AgrAbility on 618 clients from 8 states. Today’s report is the first McGill QOL study with farmers and ranchers with disabilities.

11. History of National AgrAbility Evaluation Committee Early 2006—Kathryn Pereira, Evaluation Specialist NAP U of WI, invited all SRAP’s to join in an AgrAbility evaluation study. The National AgrAbility Evaluation Committee (NAEC) met approximately monthly (2007-2009) via teleconference/face-to-face (N = 6-25 participants/meeting).

12. History of National AgrAbility Evaluation Committee Who is an AgrAbility Client? An AgrAbility client is an individual with a disability engaged in production agriculture as an owner/operator, family member, or employee who has received professional services from AgrAbility project staff during an on-site visit.

13. History of National AgrAbility Evaluation Committee 5 Questions: Do our AgrAbility clients increase their QOL? Are our AgrAbility clients more able to live on, operate, and manage their farms/ranches if they choose? Are our group mean scores the same as those from the population groups’ mean scores? Is the McGill QOL Tool sensitive to the effects of AgrAbility information, education, & service? Who of you will join us?

14. History of National AgrAbility Evaluation Committee Five SRAP’s conducted a two-year pilot study to answer the 4 questions (June 2007-May 2009). McGill QOL—CO, KS, VA, & WI SF-36—DE & MD

15. Measures Used in CO, KS, VA, & WI Pilot Study McGill Quality of Life Tool & AgrAbility Independent Living & Operating Farmers/Ranchers’ Tool NAP Demographic Data

16. History of National AgrAbility Evaluation Committee CO, KS, VA, & WI obtained IRB approval from their Land-Grant Universities. Today we will focus on the results of the 37 closed cases from KS, VA, & WI.

17. Protocol Procedure—KS, VA, and WI mailed each new client the Pre-Survey, a cover letter, McGill Pre-Survey, and a stamped, self-addressed envelope with an invitation to complete and return it.

18. Protocol Participants were given the choice of completing the survey themselves or of having the items read aloud by the AgrAbility team member. No one was coerced.

19. Protocol A McGill Post-Survey was mailed out when the client’s case was closed (KS, VA, WI) using a modified Dillman method (KS, VA) with two-week intervals: 1) cover letter, post-survey, and stamped return envelope; and 2) two weeks later a follow-up cover letter, post-survey, and stamped return envelope was mailed.

20. History of National AgrAbility Evaluation Committee By May 31, 2009 KS, VA, & WI entered their 37 matched pre-post-survey data into Excel files and e-mailed them to CO for entering and analyzing. KS 17 VA 2 WI 18 Total 37

21. Who Were the Participants in the Pilot Study? (N = 37) 27 (73%) were male; 10 (27%) were female. 23 (62%) were new; 12 (32%) were on-going; one (3%) was re-opened; and one (3%) was closed in current grant year.

22. Who Were the Participants in the Pilot Study? (N = 37) Ages ranged from 20 to 85. M = 54.09. SD = 16.2. N = 33. Original disability occurred 1978-2008. Regarding year original disability occurred, the range was 1978 to 2008 with four in 2004, three in 1997, 2002, and 2006, two in 1989, 1998, 1999, 2000, 2005, and 2007, and one in 1978, 1987, 1992, 1995, 1996, 2001, 2003, and 2008.

27. What Were the Purposes of This Two-Year Pilot Study? (N = 37) To determine whether the McGill QOL and the AgrAbility Independent Living & Operating Farmers/Ranchers’ Tools were sensitive to AgrAbility treatment and services. To determine pre-post service changes in clients’ QOL levels and in their ability to live on, operate, and manage their farms/ranches.

29. Q: Do Our AgrAbility Clients Increase Their QOL?A: ?

30. McGill Pre- Post-Survey Changes (SIS, Physical Well-Being, & Physical Symptoms)

31. McGill Pre- Post-Survey Changes (Support, Existential Well Being & Psychological Well-Being)

32. McGill Pre- Post-Survey Changes (Total Score)

33. Q: Do Our AgrAbility Clients Increase Their QOL?A: Yes!

34. Q: Are Our AgrAbility Clients More Able to Live on, Operate, and Manage Their Farms/Ranches if They Choose?A: ?

35. AgrAbility Independent Living and Operating Tool (Manage Farm, Complete Chores, & Operate Machinery)

36. AgrAbility Independent Living & Operating Tool (Live in Home, Access Workspaces & Modify Machinery)

39. The Top Reasons Clients Were Unable to Follow AgrAbility Recommendations (N = 12) Unable to find funding Health conditions changed or Chose different career. None reported the reason as “Financial situation changed” or “Recommendations did not work.”

40. Q: Are Our AgrAbility Clients More Able to Live on, Operate, and Manage Their Farms/Ranches if They Choose?A: Yes!

41. Q: Are Our Group Mean Scores the Same as Those from the Population Groups’ Mean Scores?A: ?

42. The McGill QOL Consists of 6 Subscales and a Total QOL Score. When we look at our sample’s Pre-Survey group mean scores, on 5/7 scales they were within the normal range (MQOL Total Scale, MQOL Single-Item Score, Physical Well-Being, Physical Symptoms, and Existential Well-Being).

43. The McGill QOL Consists of 6 Subscales and a Total QOL Score. On the Psychological Well-Being Scale, our sample scored statistically significantly higher at Pre-Survey time than the population M (p = .003) and it rose even higher at Post Survey (p = .000). On the Support Subscale at Pre-Survey our sample scored statistically significantly lower than the population M. Afterwards it rose to within the normal range.

44. Conclusion WI, KS, and VA SRAP’s, keep up your good work!

45. Q: Are Our Group Mean Scores the Same as Those from the Population Groups’ Mean Scores?A: Yes, they’re as good or better!

46. Q: Is the McGill QOL Tool Sensitive to the Effects of AgrAbility Information, Education, & Service?A: Yes!

47. The data show that all of the McGill QOL group mean scores increased from pre- to post-survey. We invite you to join us! See handouts.

48. When we get more matching pre- and post-survey data from as many of you as possible, we should have even stronger empirical evidence that AgrAbility works!

49. Pros of Using the McGill QOL and Independent Living and Operating Tools Pros Today 5 states are using the McGill (CO+KS+VA+WI+WV). The McGill is a well-tested, valid, and reliable tool. It provides data that can be aggregated and/or compared across state lines.

50. Pros of Using the McGill QOL and Independent Living and Operating Tools Pros It is short (17 items) and is easy to complete. The combination of the McGill QOL Tool with the AgrAbility Independent Living & Operating Farmers/Ranchers’ Tool provides empirical evidence that AgrAbility works.