FASHION AND HYGIENE:
A SELF-ESTEEM PROGRAM FOR ADULTS WITH DOWN SYNDROME
Tina Malcolm
B.S., Colorado State University, 2000
PROJECT
Submitted in partial satisfaction of the requirements for the degree of
MASTER OF SCIENCE in
RECREATION ADMINISTRATION at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2010

© 2010
Tina Malcolm
ALL RIGHTS RESERVED ii

Approved by:
FASHION AND HYGIENE:
A SELF-ESTEEM PROGRAM FOR ADULTS WITH DOWN SYNDROME
A Project by
Tina Malcolm
__________________________________, Committee Chair
Jennifer Piatt, Ph.D.
__________________________________, Second Reader
Jennifer Taylor, M.S.
____________________________
Date iii

Student: Tina Malcolm
I certify that this student has met the requirements for format contained in the University format manual, and that this project is suitable for shelving in the Library and credit is to be awarded for the project.
__________________________, Graduate Coordinator ___________________
Greg B. C. Shaw, Ph.D. Date
Department of Recreation, Parks and Tourism Administration iv

Abstract of
FASHION AND HYGIENE:
A SELF-ESTEEM PROGRAM FOR ADULTS WITH DOWN SYNDROME by
Tina Malcolm
This project was created as a self-esteem program for adults with Down syndrome based on proper hygiene practices and the expression of personal style through fashion.
Self-esteem programs are valuable to all people, especially underserved populations, such as individuals with Down syndrome. Down syndrome is the most commonly occurring chromosomal disorder and individuals within this population often share common physical and cognitive characteristics. The presence of these characteristics may result in prejudice regarding social opportunities, independence, and acceptance. These barriers can be detrimental to an individual’s self-esteem. Currently, there is a need for selfesteem based leisure services for this population. Although indirectly linked, current research shows a relationship between fashion, hygiene, and the self-esteem of individuals with Down syndrome (Glenn & Cunningham, 2001; Jobling & Cuskelly,
2006; Pueschel, 1996).
Hygiene practices are often lacking in individuals with intellectual disabilities
(Jobling & Cuskelly, 2006). Similarly, problems often arise with finding well-fitted clothing for a population where obesity, short stature, and thicker necks are prevalent. v

Clothing options may be limited, which in turn, limits a person’s ability to express individuality, or personal style, through fashion. The program detailed in this project describes how to teach proper hygiene practices, establish a hygiene routine, identify and express personal style, and choose fashions that fit an individual’s specific body type and are also appropriate for an array of different occasions. The program is presented as an accessible website detailing the components of the program.
, Committee Chair
Jennifer Piatt, Ph.D.
______________________
Date vi

DEDICATION
This project is dedicated to my amazing parents. I could spend a lifetime trying to give back what you have given to me. vii

ACKNOWLEDGEMENTS
This project would not have been possible without the support of my family. I love you more than I can say.
Joe, your love and support have changed my life. Thank you for keeping me sane throughout this crazy adventure.
I am truly lucky to have a committee comprised of two absolutely amazing women. Dr. Jennifer Piatt, you are an incredible role model and your passion for the field continues to inspire me. Jennifer Taylor, I am so grateful to have such a wonderful mentor, colleague, and friend. Thank you both for all that you have done.
Lastly, I would like to thank the staff and participants at Therapeutic Recreation
Services for letting me explore my vision for this project. viii

TABLE OF CONTENTS
Page
Dedication ......................................................................................................................... vii
Acknowledgements .......................................................................................................... viii
Chapter
1. INTRODUCTION ......................................................................................................... 1
Need for the Project ................................................................................................ 1
Purpose of the Project ............................................................................................. 2
Structure of the Project ........................................................................................... 3
Definitions of Key Terms ....................................................................................... 3
Limitations .............................................................................................................. 4
2. REVIEW OF LITERATURE ........................................................................................ 6
Introduction ............................................................................................................. 6
Down Syndrome ..................................................................................................... 6
Quality of Life......................................................................................................... 7
Quality of Life and Down Syndrome...................................................................... 8
Self-Esteem ............................................................................................................. 9
Self-Esteem and Down Syndrome ........................................................................ 10
Personal Hygiene and Down Syndrome ............................................................... 11
The Facets of Fashion ........................................................................................... 12
Fashion and Down Syndrome ............................................................................... 13 ix

Hygiene, Fashion, Self-Esteem and Down Syndrome .......................................... 13
Current Programming ........................................................................................... 14
Proposed Programming ......................................................................................... 16
3. METHODS .................................................................................................................. 18
Purpose of the Project ........................................................................................... 18
Population ............................................................................................................. 18
Setting ................................................................................................................... 19
Design ................................................................................................................... 20
Facilitation ............................................................................................................ 22
Website Creation ................................................................................................... 22
Project Layout ....................................................................................................... 23
4. PROJECT ..................................................................................................................... 24
References ......................................................................................................................... 25 x

1
Chapter 1
INTRODUCTION
Self-esteem programs are valuable for all people and help to create and maintain a healthy quality of life. Programs focused on self-esteem can be especially beneficial to underserved populations, such as people with Down syndrome. Current research shows an indirect relationship between fashion, hygiene, and the self-esteem of adults with
Down syndrome (Glenn & Cunningham, 2001; Jobling & Cuskelly, 2006; Pueschel,
1996). By combining fashion and hygiene practices into a comprehensive program, selfesteem can be positively affected through the acceptance and outward projection of one’s individuality.
Need for the Project
Self-esteem based leisure services to underserved populations, such as people with Down syndrome, is a need that is currently not being addressed by professionals in the recreation field. In the past, this population has faced societal barriers, such as institutionalization, resulting in reduced quality of life. Recently, the idea of transition
(when the individual leaves school and enters the workforce) has come to the forefront and allowed individuals with Down syndrome to become more independent members of society (Felce & Perry, 1995; Pueschel, 1996). In addition, the ability to see oneself as competent and valuable positively affects the self-evaluation, or self-esteem, of these individuals (Steele, 1998).

2
Self-esteem, a facet of quality of life, is an essential part of the healthy social and psychological development of people with Down syndrome but may be affected by lack of knowledge and resources regarding self-care and clothing (Glenn & Cunningham,
2001). People with disabilities generally lack the knowledge of proper hygiene and may become self-conscious from the effects of poor hygiene practices. According to Pueschel
(1996), “To foster the self-esteem and self-respect of adolescents with Down syndrome, they should be helped to maximize their personal attractiveness” (p. 94). The author also states that individuals with Down syndrome should take responsibility for self-care in order to promote independence (Pueschel, 1996). Similarly, clothing allows for the formation of an individual’s unique style while reinforcing the personal image that is presented to the outside world (Guthrie, 1992). Due to an increased risk of obesity and some common physical characteristics, people with Down syndrome may find some difficulty finding flattering and appropriate clothing (Melville, Cooper, McGrother,
Thorp, & Collacott, 2005; Thornton, 1990). Although indirectly linked, it can be assumed that the combination of fashion and personal hygiene can enhance the selfesteem of individuals with Down syndrome. Currently, there is no inclusive programming that combines fashion and hygiene to promote self-esteem within this population.
Purpose of the Project
The purpose of this project is to create a self-esteem program for adults with
Down syndrome based on hygiene and fashion practices.

Structure of the Project
The project will be structured as a website showcasing the proposed self-esteem program for adults with Down syndrome. The website will touch on the importance of hygiene and fashion practices as well as the research that indirectly links these practices to self-esteem. The website will be used as a marketing tool geared towards interested participants, family members/caregivers, and organizations that work with the specified population. Interested parties will be able to contact the program creator for future facilitation of a 10-week self-esteem program. Following program scheduling, the facilitator/program creator will seek out and utilize local resources to aid in the facilitation of specific program components. Resources include vendors of hygiene products and clothing, hairstyling and cosmetology services, and venues to be used for session facilitation and the culminating fashion show.
Definitions of Key Terms
For the purpose of this project, the following definitions will be used:
Down syndrome
Down syndrome is the most commonly occurring chromosomal aberration. Also known as Trisomy 21, it occurs when there is an extra copy (3 instead of 2) of the 21 st chromosome (National Down Syndrome Society [NDSS], 2008).
3

4
Fashion
“A dynamic social process by which new styles are created, introduced to a consuming public, and popularly accepted by the public” (Sproles, 1979 as cited in
Kaiser, 1997, p.4)
Hygiene
Self-care practices that prevent illness and disease (Pueschel, 1996).
Quality of life
Quality of life is comprised of, “objective and subjective indicators, a broad range of life domains, and individual values” (Felce & Perry, 1995, p. 51).
Self-esteem
Self-esteem, also referred to as self-evaluation, “is defined as the evaluative component of self-concept” (Glenn & Cunningham, 2001, p. 163).
Limitations
The individuals participating in the program proposed in this project would likely be from varied backgrounds, including; cognitive impairment, socioeconomic status, age, gender, sex, race, and culture. Therefore, the program facilitator would not be able to control the self-esteem levels of the participants prior to involvement with the program.
Also, the program facilitator would not be able to control the cognitive level of each participant and his or her complete understanding of the session information.
For individuals who cannot drive themselves to and from activities, transportation becomes an issue of relying on others. Therefore, the facilitator could not control for

participant transportation availability. Furthermore, lack of family support could limit transportation options as well as the likelihood of enrollment in the proposed program.
5

6
Chapter 2
REVIEW OF LITERATURE
Introduction
Individuals with Down syndrome continue to face problems in both societal and personal realms (Brown, Taylor, & Matthews, 2001). Self-esteem, a facet of quality of life, is important for overcoming these barriers and allowing for successful life transitions
(Pueschel, 1996). Although the number of studies has been minimal, current research indirectly shows the relationship of fashion, hygiene, and self-esteem on adults with
Down syndrome.
Down Syndrome
Down syndrome, the most commonly occurring chromosomal aberration, occurs when there is an extra copy (3 instead of 2) of the 21 st
chromosome. In the United States,
Down syndrome, also known as Trisomy 21, is present in one out of every 700-800 live births (NDSS, 2010). It has been known for some time that the incidence of Down syndrome increases with advancing maternal age. Although age has been proven to be a recurring factor, 80% of children with Down syndrome are born to women under 35 years of age (National Association for Down Syndrome [NADS], 2010). Individuals born with Down syndrome often share common physical characteristics; however, they can be expressed differently or sometimes not at all. Physical characteristics can include short stature, thick necks, low muscle tone, and an upward slant to the eyes. Some level of cognitive delay is experienced by all people with Down syndrome but it is not

7 indicative of the unique strengths and talents associated with each individual (NADS,
2010; NDSS, 2010). Similarly, there are some common quality of life issues found within this population but they can also vary depending on the individual.
Quality of Life
There is currently no universally accepted definition of quality of life. Lui (1976) indicated that the difficulty comes from the notion that every individual has his or her own idea of what is important (as cited in Felce & Perry, 1995). There are, however, some criteria that are mutually agreed upon by those that research this elusive concept
(Brown, 1998; Felce & Perry, 1995). A holistic approach is usually taken when describing quality of life and its components. Many definitions include facets such as wellbeing development, notion of choice, individual perception, and control over one’s environment. These components can be applied to all areas of an individual’s life including, but not limited to, “employment, education, social relationships, accommodations, and leisure and recreation” (Brown, 1998, p. 324).
According to Felce and Perry (1995), quality of life is comprised of, “objective and subjective indicators, a broad range of life domains, and individual values” (p. 51).
Five areas of wellbeing were indicated that comprise the concept of quality of life: physical wellbeing, material wellbeing, social wellbeing, emotional wellbeing, and development and activity (Felce & Perry, 1995). Brown (1997) took the multidimensional idea of quality of life a step further when he stated, “There is a need to see the individual’s life as a developing array of complex perceptions, which establish

8 varying needs over the lifespan. Many of these needs are social and psychological” (as cited in Brown et al., 2001, p. 112). Although the definition of quality of life tends to vary, it should however, be seen as applicable to both people with and without disabilities
(Brown, 1998; Felce & Perry, 1995).
Quality of Life and Down Syndrome
Historically, individuals with Down syndrome have faced many barriers regarding social opportunities, independence, and acceptance. In the past, problems such as institutionalization and being viewed as “eternal children,” have made it difficult for them to participate in a positive quality of life within the community (Felce & Perry,
1995; Pueschel, 1996). Also, individuals with Down syndrome were often in dependent living situations and were not given the opportunity to transition into responsible and productive citizens. Recently, the idea of transition has become a top priority for human service workers in special education and rehabilitation settings (Pueschel, 1996). The emerging trend focuses on individuals with Down syndrome and, “transition in a broader sense, with emphasis on the total person” (Pueschel, 1996, p. 90). With support from friends, family and human service workers, adults with Down syndrome can achieve a successful transition along with the ultimate goal of a healthy quality of life (Thomson,
Ward, & Wishart, 1995; Pueschel, 1996).
Although quality of life is still considered a developing model when referring to individuals with Down syndrome, Brown, Bayer & MacFarlane (1989) agreed that it can be defined as, “the extent to which an individual has increasing control over his/her

9 environment” (as cited in Brown et al., 2001, p. 112). Brown (1998) reiterated the relevance of quality of life as a concept that is consistent regardless of disability or disability level. Furthermore, exploring quality of life as a universal concept aids in our understanding of disability and can directly affect individual progress (Brown, 1998).
Self-Esteem
Self-concept, one component of quality of life, refers to how people think and feel about themselves, in other words, how they perceive themselves. The term self-concept can be broken down further into six domains: self-recognition, self-representation, selfdescription, self-assertion, self-regulation, and self-evaluation (Glenn & Cunningham,
2001). Self-evaluation, often referred to as self-esteem, “is defined as the evaluative component of self-concept” (Glenn & Cunningham, 2001, p. 163).
Self-esteem is often referred to as one of the most important constructs in psychology but, similar to quality of life, continues to be poorly defined (Campbell,
Eisner, & Riggs, 2010; Tafarodi & Ho, 2006). Although the literature on self-esteem is extensive, researchers continue to disagree on its definition and measurement. One generally accepted aspect of self-esteem is the idea of internal and external sources.
Internal sources include independent thinking and productive projects, while approval of peers and physical appearance serve as external sources (Campbell et al., 2010).
According to Rhodewalt and Tragakis (2003), “Regardless of the bases of people’s selfesteem, their moment-to-moment feelings of self-worth are determined, in part, by how successfully they believe they are meeting their standards and expectations” (p. 69).

10
Individuals with Down syndrome, in addition to experiencing the abovementioned feelings, are also susceptible to a variety of prominent external sources.
Self-Esteem and Down Syndrome
Minimal studies were found that discussed the impact of self-esteem on individuals with Down syndrome. Studies that have been completed demonstrated that the attainment of self-esteem is a vital part of the healthy social and psychological development of people with Down syndrome (Glenn & Cunningham, 2001). Some individuals with Down syndrome, however, may have difficulty attaining a healthy selfconcept due to feeling, “discriminated against, pitied, and viewed as being ‘different’”
(Pueschel, 1996, p. 94). The media and its model of perfection can also add to an unhealthy self-concept. Women with Down syndrome, in particular, “often deal with rude and hurtful comments about their figures, fashion, looks, hair, or weight, which makes it extremely difficult for them to develop healthy self-esteem” (Hadler, 2008).
This can be very detrimental, especially during transitional periods such as adolescence
(Pueschel, 1996).
The ability and capacity to see oneself as competent and valuable is vital to the positive self-evaluation of all individuals, both with and without disabilities. Studies suggest that the sequence of self-evaluation is the same in individuals with and without intellectual disabilities (Cunningham & Glenn, 2004). Therefore, individuals with Down syndrome should be given the opportunity to build on their competencies and strengths so they may experience success. In turn, the success experienced by the individuals

11 enhances his or her self-esteem (Pueschel, 1996).
Personal Hygiene and Down Syndrome
People with intellectual disabilities, specifically Down syndrome, generally tend to be lacking in the area of personal hygiene practices (Jobling & Cuskelly, 2006).
Pueschel (1996) further states that individuals with Down syndrome should take responsibility for self-care in order to promote independence in all aspects of life.
Although they often have some knowledge of health and hygiene practices, people with
Down syndrome tend to require prompting for important hygiene practices such as hand washing after using the restroom, covering the mouth when coughing, and keeping teeth clean (Jobling & Cuskelly, 2006). Because oral health and hygiene can be a major issue for individuals with Down syndrome, teaching proper practices, such as teeth brushing, can be very beneficial in the prevention of future medical conditions (Roizen &
Patterson, 2003; Pueschel, 1996). Proper hygiene practices are most effective for people with Down syndrome when done repeatedly and consistently (Jobling & Cuskelly, 2006).
However, even with appropriate self-care, hygiene issues may be exacerbated by common physical characteristics found within this population.
The prevalence of obesity in individuals with Down syndrome has given rise to other specific hygiene concerns (Pueschel, 1996; Whitt-Glover, O’Neil, & Stettler, 2006).
Overweight individuals may experience recurrent skin infections, as well as folliculitus
(hair follicle inflammation) and abscess formation on extremities and in the genital areas.
Other skin conditions that are likely to occur include fungal infections of the skin and

12 nails which may require intensive treatment (Roizen & Patterson, 2003). Weight management, clean and properly fitting clothing, and proper hygiene can reduce the severity of these skin disorders. These factors can also lay the foundation for the enhancement of individuality through fashion (Kaiser, 1997; Pueschel, 1996).
The Facets of Fashion
Appearance as a concept, encompasses many aspects that fit together to form an overall visual impression. Clothing, the human body, and body modifications that are visually perceived, all combine to create one’s total composite image, or appearance
(Kaiser, 1997). Dress is another term used to describe modifications of the body, such as cutting hair and piercing, and items added to the body as supplements, such as garments, jewelry, and accessories. It is a more specific term than appearance because it does not include features of the undressed body such as shape and color, as well as expressions and gestures (Roach-Higgins & Eicher, 1992). Through the use of dress, individuals can make an array of specific statements regarding such areas as age, gender, and social class
(Lennon & Davis, 1989).
Even more specific, is the idea of clothing. This term is used to describe enclosures that cover the body, and basically omits body modifications (Feinberg,
Mataro, & Burrows, 1992). Although clothing tends to have a more practical function, it can also serve more than one purpose (Kaiser, 1997). Research in the field of clothing and human behavior suggests that type of clothing is directly related to impressions formed of others, as well as subsequent behavioral reactions to that person (Lennon &

13
Davis, 1989). Clothing serves as a form of nonverbal communication, and variations in clothing worn do affect the social impressions made by that person (Burns & Lennon,
1993). Clothing is “context dependent,” the specific meaning communicated by clothing depends on the social context in which it is perceived (Lennon & Davis, 1989). For specific populations, however, the nonverbal communication expressed through clothing and appearance may be hindered.
Fashion and Down Syndrome
Fashion and clothing are important parts of the outward projection of individuality (Kaiser, 1997). Due to some common physical characteristics, however, people with Down syndrome may have some difficulty finding flattering and appropriate clothing. An increased risk of obesity in persons with Down syndrome can limit clothing options. Both men and women with Down syndrome are at a higher risk of being overweight or obese than age-matched individuals without Down syndrome (Melville et al., 2005). Other common physical characteristics can exacerbate the difficulty in finding well-fitted clothing. For example, people with Down syndrome tend to have short stature as well as short, thick necks making certain styles uncomfortable and unflattering
(Thornton, 1990). Luckily, more fashionable choices have become available in recent years as the fashion industry continues to cater to larger individuals (Kaiser, 1997).
Hygiene, Fashion, Self-Esteem and Down Syndrome
It is thought that the acceptance of one’s outward appearance can be a clue to

14 one’s self-esteem (Kaiser, 1997). Beginning in adolescence, one may search for a selfimage and identity and may become preoccupied with experimentation in his/her appearance (Daters, 1990). When positive reactions are elicited from others, self-esteem can be readily enhanced (Kwon, 1994).
According to Pueschel (1996), the self-esteem of individuals with Down syndrome can be fostered by maximizing personal attractiveness. Pueschel (1996) also stated that the outward presentation of one’s uniqueness is directly linked to a healthy self-esteem and positive personal growth. Clothing allows for the formation of an individual’s unique style while reinforcing the personal image that is presented to the outside world (Guthrie, 1992). Although indirectly linked, it can be assumed that the combination of fashion and personal hygiene can enhance the self-esteem of individuals with Down syndrome.
Current Programming
After an extensive search of inclusive programming combining both fashion and hygiene for the enhancement of self-esteem in adults with Down syndrome, it is suggested that programs do not currently exist. Organizations that work with individuals with Down syndrome rarely offer programming specific to self-esteem. The fashion programs currently available for this population, which are also rare, lack the added component of hygiene and are more generalized. Programs such as these do not allow for individual expression and continued growth after the program concludes.
The Down Syndrome Connection of the Bay Area, located in Danville, California

15 offers programs for individuals of all ages. The teen and young adult groups are specifically designed for the “transition” aged population. The groups are divided into three areas: social skills, leisure/recreation and independent living. Although they focus on communication, self-awareness and empowerment, there are no specific groups based on self-esteem. A program including self-esteem through hygiene and fashion would fill this gap and provide new, exciting learning experiences for the clients (“Down Syndrome
Connection of the Bay Area,” 2010)
Similar to the Down Syndrome Connection of the Bay Area, The Janet Pomeroy
Center in San Francisco, California offers programming for individuals with disabilities of all ages. The Center’s clientele includes individuals with various disabilities, including Down syndrome, and its programs promote independence and positive selfimage. The Center provides an arts program that allows participants to express individuality while gaining self-esteem, but there are no programs that specifically address self-esteem through hygiene and fashion (“The Janet Pomeroy Center,” 2010).
In May 2010, the National Down Syndrome Society partnered with the Cono
D’Alto Society to present a fashion show for designer Anya Cole in New York City.
Twelve women with Down syndrome walked the runway flanked by two professional models who gave each woman tips on walking and “model attitude.” The models with
Down syndrome were given makeovers on the day of the show including hair, makeup, manicures and styling. The one day event did not include a hygiene component or any specific self-esteem based programming prior to the fashion show (NDSS, 2010).

16
In February 2008, The Down Syndrome Centre in Dublin, Ireland partnered with the students from University College Dublin to present a fashion show at the Royal
Dublin Society. The result was a fashion event that showcased models with and without
Down syndrome on the catwalk at one of Europe’s largest venues. The models with
Down syndrome went through a series of steps beginning with a makeover that included clothing, hair, and makeup. The next steps, correct posture and walking, had the models with Down syndrome working with professional models to help them perfect their presence on the catwalk. Although the participants spoke of their enhanced self-esteem after the show, it can be assumed that a combination of hygiene practices and more focus on individuality could provide more far-reaching benefits to the participants (“Down
Syndrome Centre,” 2008).
Proposed Programming
The program presented through this project aims to enhance self-esteem in adults with Down syndrome through both hygiene and fashion education, a combination that has not previously been explored. Although certain parts of the proposed program have been implemented in other programming for individuals with Down syndrome, there has not been an inclusive program that explores fashion, hygiene, and self-esteem within this specific population. The body of literature presented in this chapter supports each individual component of the proposed program. Because the research can be indirectly linked, it can be assumed that a multi-faceted program will be successful in achieving its intended results. Therefore, the purpose of this project is to create a self-esteem

enhancing program for adults with Down syndrome based on hygiene and fashion practices.
17

18
Chapter 3
METHODS
This chapter will review the proposed population for this project as well as the purpose and the research that influenced the methods used to create the self-esteem program. The details of the program website and its creation will be explored.
Purpose of the Project
The purpose of this project is to create a self-esteem program for adults with
Down syndrome based on hygiene and fashion practices. The project is presented as an accessible website detailing the components of the self-esteem program.
Population
Individuals with Down syndrome are living longer lives than ever before with an average lifespan of over 50 years (Brown et al., 2001). The proposed program detailed in the project is specifically designed for individuals with Down syndrome ages 18-45.
Both men and woman are encouraged to participate, as both can benefit from the individualized nature of the self-esteem based programming.
Due to the likelihood of varying participant backgrounds (i.e., group homes, cohabitating with family, independent living), individuals may have significantly different self-esteem levels prior to participation in the proposed program. All participants, however, can benefit from the sessions detailing hygiene and fashion practices. For example, participants that already have sufficient knowledge of proper

19 hygiene practices can serve as positive role models and assistants for those specific sessions. Similarly, participants that are aware of appropriate and well-fitted clothing for their body types, can explore a “new look” in the personal style sessions.
Ideal number of participants per program session falls in the range of 5-12 individuals. This range allows for individualized attention and a culminating fashion show of a reasonable length. Proper accommodations, if needed, will be made to ensure accessibility for all participants. No medical clearance is needed to participate in the program but participants should inform the facilitator of any allergies to hair or make-up products. Hypoallergenic products will be used when available.
Setting
The program will take place at a variety of locations, both within residential and community settings, depending on the needs of both the agency and the participants.
Because the program can be facilitated in any community, the program facilitator will need to contact local businesses in advance to establish locations for specific program sessions. A classroom will be the setting for sessions 1-3. When creating personal style collages, participants will sit at long work tables or desks so that magazines can be shared and sufficient workspace is available.
The location of sessions 4-5 will be dependent on the store(s) that will be donating or lending clothing for the program. Similarly, the location of sessions 6-7 will depend on the salon that will be donating hairstyling and cosmetology services. The facilitator will solicit donations and services from local businesses prior to the start of the

20 program sessions.
The remainder of the sessions, 8-10, will be on location at the site of the culminating fashion show. This facility must have adequate space to create a runway for the models with seating on each side. Also, two changing rooms, or a “backstage” area, must be easily accessible from the runway. Possible facilities include gymnasiums, banquet rooms, large hotel lobbies, or community centers.
Design
The program length is ten weeks with one session per week. The hours of the sessions will vary due to location change and number of participants, but will not exceed two hours per session.
Sessions 1 and 2:
The first two sessions specifically address personal hygiene and are facilitated in a classroom setting. Donated hygiene products are given to the participants and their uses are described in detail. These items may include toothbrushes and toothpaste, soap, and deodorant. The relationship between proper hygiene and health is explored with special attention given to hygiene concerns that are prevalent within the population and the creation of a hygiene routine.
Session 3:
The third session addresses personal style through the use of style collages.
Magazines of various types (fashion and non-fashion magazines) are available for the participants to peruse. The participants are asked to choose looks that describe their

21 current or desired personal style. They are asked to cut out the looks and attach them to the blank style sheets provided. The program creator/facilitator labels each style based on the chosen looks and the resemblance to established fashion styles. Appropriate clothing for certain body types is discussed. Also, the idea of different looks (i.e., casual, professional, special occasion) is explained.
Sessions 4 and 5:
The fourth and fifth sessions are on location at the site of the organization donating or lending clothing. The group is divided in half with one group attending session 4 and one group attending session 5. Personal shoppers, recruited by the program creator, are available to help the participants assemble three outfits for the show based on their style collages and particular fashion style. The three outfits include a casual, professional, and special occasion look.
Sessions 6 and 7:
The sixth and seventh sessions are on location at the site of the salon donating haircuts/hairstyles and cosmetology services (if applicable). Participants discuss their personal styles with a stylist and receive haircuts and/or tips on hairstyling. Makeup application (if applicable) will be discussed and makeup looks will be established to coordinate with the three different outfits.
Sessions 8 and 9:
The eighth and ninth sessions are on location at the site of the culminating fashion show. Runway walks are practiced and the model order is finalized. Posture, confidence, and personal expression are discussed. Also, there is a run-through/dress rehearsal of the

22 fashion show.
Session 10:
The tenth and final session is the culminating fashion show where the participants will show off their personal styles expressed in three different looks.
The fashion show location, DJ, photographer and videographer will be booked by the program creator prior to the culminating fashion show. Dressing assistants, hairstylists, and makeup artists will also be recruited for volunteer services prior to the show.
Facilitation
The facilitator of the program will be the program creator. Future facilitators of the program should by trained by the program creator and have sufficient knowledge regarding the population, self-esteem, quality of life, as well as clothing and fashion styling. Preferably, the facilitator should be a Certified Therapeutic Recreation Specialist
(CTRS) familiar with making accommodations prior to and during facilitations. Although designed for adults with Down syndrome, the program is transferable to other populations and disabilities that can benefit from self-esteem based programming. These different populations may include, but are not limited to, individuals with autism, cerebral palsy, and Prader-Willi syndrome.
Website Creation
The program website was created using Wix.com, a website builder that enables

23 the creation of free Flash websites, widgets, and other web content through the use of a simple drag & drop editor (“Wix.com,” 2010). The website builder allows for simple construction and easy accessibility for viewers. The pictures and video used on the website are the property of the project creator. Individuals featured on the website have signed photo releases. The website allows viewers and interested participants to explore the general research supporting the program and program session titles, as well as pictures and a video from a previous program. For more detailed session information, interested parties can directly contact the program creator through an email link on the website.
Project Layout
The website is easily accessible and allows viewers to explore various facets of the program through labeled tabs. The “About” tab touches on the current research that justifies the need for the self-esteem program with the specific population. The
“Program” tab lists the specific sessions of the 10-week program and allows viewers to watch a short video clip from a previous program. The “Images” tab showcases pictures taken throughout an actual fashion and hygiene program offered at Therapeutic
Recreation Services in Sacramento, California. The “Contact” tab allows interested viewers to directly email the project creator to learn about the specific details of the program sessions.

24
Chapter 4
PROJECT
This project was completed as a website. Therefore, the literature reviewed in
Chapter 2 and the methods presented in Chapter 3 are expressed in an online format. All information pertaining to Chapter 4 can be found at: http://www.wix.com/tmalcolm/fashionandhygiene

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REFERENCES
Brown, R. (1998). Personal reflections: Quality of life research and Down syndrome.
International Journal of Disability, Development and Education, 45 (3), 323-329. doi:10.1080/1034912980450307
Brown, R., Taylor, J., & Matthews, B. (2001). Quality of life - Ageing and Down syndrome. Down syndrome Research and Practice, 6 (3), 111-116. doi:10.3104/case-studies.101
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