Mixed-Methods Evaluation of the Pilot True Grit SCI Residential Program for Young Adults with Spinal Cord Injury.

BACKGROUND: Young adults with spinal cord injury (SCI) face unique challenges during the transition to adulthood, including limited access to community-based programs that address participation, independence, and resilience. OBJECTIVES: To evaluate the pilot True Grit SCI program, a 5-day residential camp designed to support the transition to adulthood for young adults with SCI. METHODS: This qualitatively driven, embedded mixed-methods study employed a realist evaluation framework guided by social cognitive theory. Six male participants with SCI (ages 16-20 years) attended the July 2024 pilot program. Quantitative measures included the Goal Attainment Scale (GAS), SCI-QOL Resilience Short Form, and Pediatric Measure of Participation (PMoP), administered at baseline and 3-month follow-up. Qualitative data were collected through semi-structured post-camp interviews. Data were analyzed descriptively and thematically, with integration through triangulation. RESULTS: All participants demonstrated progress toward individualized goals, with mean GAS improvement of +1.67 (SD 0.82). Resilience outcomes varied, with 3 participants improving and 3 declining. Participation scores increased modestly, with the largest gains among those with lower baseline scores. Qualitative analysis identified 4 themes: building community and belonging, shared experiences foster confidence to try new things, overcoming barriers and redefining identity, and envisioning futures and inspiring others. Integration of findings demonstrated that peer-supported, structured programming both reinforced observed goal attainment and contextualized variable resilience outcomes. CONCLUSION: The evaluation of the True Grit SCI pilot suggests that short-term residential programming demonstrated the potential to promote resilience, participation, and self-efficacy among young adults with SCI. Variability in follow-up highlights the need for ongoing community supports to sustain gains.