important considerations when educating and supporting
TRANSCRIPT
Important Considerations when
Educating and Supporting
Adolescents and Adults with Autism
Presented by:
Dr. Todd Harris
National Autism Director
Devereux
Overview of Adult Services for Individuals
with Autism- How are we doing as a field?
• Recent research tells us:
• The numbers of adults with autism will be substantially increasing in the next decade and beyond.
• 40% of young adults receive no services
• Only 11% employed FT; 19% have PT jobs; 70% are not employed
• 70% of adults with intellectual disabilities including autism live with their families
What are some of the outcomes if an adult with
an ASD does not receive effective supports?
Social Isolation
Unemployment
Homelessness
Depression
Justice System Involvement
Hospitalization
What Types of Services are Stakeholders
Looking for Today?
Effective services that are specifically designed for adults with autism
Programs with qualified and well trained staff with sufficient staffing resources
Community-based supports for: Residential living
Employment and/or post-secondary education
Community inclusion
Social inclusion
Health care
Devereux’s Guiding Principles for Serving
Adolescents and Adults with an ASD
Person-centered
Collaborative
Community-focused
Skill building emphasis
Enhanced self-determination
Accountable and effective services
Quality of life emphasis
Quality of Life
and Autism
Quality of Life and Autism
How would YOU define your Quality of Life?
Take a minute and define what quality of life
means to YOU
Quality of Life and Autism
How would you define Quality of Life for
individuals with an ASD?
Is it any different from how you would define it
for yourself?
Quality of Life and Adult Autism
Current definition for Quality of Life (QoL)?
Quality of Life encompasses the basic conditions of life such as shelter, adequate food and safety plus life enrichers such as inclusive social, leisure, and community activities. These enrichers are based on the individual’s values, beliefs, needs and interests (Schalock & Parmenter, 2000)
Nine Indicators of QoL (from the
Autism Society)
School/Employment
Inclusion
Friendships and Social
Connections
Health and Wellbeing
Academic Success
Autonomy
Maximized Independent
Living
Maximized Independent
Employment
Subjective Wellbeing
Recreation and Leisure
Quality of Life and Autism
What can a successful transition program do to
enhance Quality of Life for the individuals it serves?
Build independence and competencies across settings
Help prepare for and secure employment within
community settings
Facilitate other forms of successful community
inclusion
Ensure social connectedness with other; specifically
family, friends, and co-workers
Building Independence and
Competencies
Building Independence and
Competencies
An effective process will include:
Assessment of meaningful skills and plan
development
Use of evidence-based instructional strategies
Enhance self-determination abilities
Support and partner with families
Train and support staff
Use positive behavior support practices
Building Independence and
Competencies
Assessment of
meaningful skills and
plan development
Use skills checklists to
identify strengths and
needs in the following
areas:
Let’s look at our skills
checklist
Communication
Social competence
Self-determination
Applied academics
Independent living
Recreation
Community
Employment
Health and safety
Behavioral regulation
Building Independence and
Competencies
Assessment of
meaningful skills and
plan development:
Consider Peter
Gerhardt’s “Home
Alone” analogy
Building Independence and
Competencies
Use of evidence-based instructional strategies:
Use of instructional strategies based upon the principles of applied behavior analysis
Motivation systems
Prompting procedures
Specialized lesson formats
Chaining, Shaping; Incidental Teaching
Error correction
Progress monitoring using objective data
Let’s look at an Instructional Plan Summary
Building Independence and
Competencies
Use of evidence-based instructional strategies:
Take into account the preferences of the individual
Use of natural reinforcers whenever possible
Teach meaningful skills in the contexts that they are needed (living, community, social activities, employment)
Use of visual supports and organizers
Visual Support Examples
For Schedules- Pictures For Schedules- iPod
Visual Support Examples
For Motivation For Choices
Visual Support Examples
For Task Completion For Social Skills
Building Independence and
Competencies
Enhance self-determination skills:
Self-determination allows individuals “…to make informed decisions about where and with whom they will live, how they will spend their time, how they will participate in the community, and what supports they need and prefer.”
Key elements to enhancing self-determination include:
choice making, problem solving skills, decision-making, self-advocacy, assessing and communicating preferences, and self-management
(McDonnell and Hardman, 2010)
Building Independence and
Competencies
Support and partner with families:
Access to informational seminars and training on interventions and strategies
Ongoing support to access information and to connect with other resources
Futures planning processes
Participate fully in planning when appropriate
Update routinely on progress
Frequent opportunities to communicate with staff
Building Independence and
Competencies
Train and support staff:
Mechanisms for teaming must be in place (where a team can meet and communicate concerns, solve problems, and share success stories)
All staff must be trained on Autism Spectrum Disorders, Applied Behavior Analysis instructional strategies, and issues related to autism and adolescence and adulthood
Structured & frequent coaching, supervision, and performance feedback activities must be ongoing
24
Building Independence and
Competencies
Use positive behavior support practices:
A PBS plan is developed based directly upon the outcomes of the functional behavior assessment (FBA)
A written PBS plan emphasizes the use of positive and pro-active strategies
Objective data are used to determine program effectiveness, program fidelity, and to guide modifications
Preparing for and Securing
Employment
Preparing for and Securing
Employment
Where to start ?
Assessment and Futures Planning
Job Sampling
Customized Community Job Training
Employment
Person-centered futures planning (PCFP) is an ongoing process that brings together a group of committed individuals to help an individual with special needs plan and create a life that is fulfilling and productive
This process can start at any time, but should begin minimally at 14 years
Person-Centered Futures Planning
The following will be identified by the end
of the meeting:
Important relationships
Likes and dislikes; preferences
Skills and supports needed for communication,
social skills, and behavior
Person-Centered Futures Planning
Meeting outcomes will also include:
A description of medical and physical needs
The student’s and family’s vision for post-21 living, employment, social interactions, and community inclusion
Goals and objectives for employment education
An action plan for the upcoming year
Let’s look at an example
Person-Centered Futures Planning
Preparing for and Securing
Employment
Assessment of the Individual:
Observations during job sampling
Job task skills checklist
Situational assessment
Adolescent and Adult skills checklist
Individual, family and staff input (The Right
Match Employment Assessment)
Preparing for and Securing Employment
Learn the task (before16 years)
Employment center, classroom, and/or school
campus
Transfer into community settings
Job Sampling (14 to 18 years)- an opportunity to:
Assess skills and preferences; generalize skills
Secure employment in your local community
(18 years and beyond)
Preparing for and Securing Employment
12 to 15 Years Increase learning time in the community
Provide opportunities to engage in Service Learning activities within neighborhood/community
Begin/continue adolescent and vocational assessments, and person-centered futures planning
May be a shift toward increased chores/work tasks within school environments
Begin rotation through community-based employment training sites
Continue to help family plan for post-21 transition (autismhandbook.org)
Preparing for and Securing Employment
16 to 17 Years Continue with previous activities
Increase time in employment training sites
Begin to develop work portfolio
18 Years and Beyond Begin placement at individual site based upon results of
various assessments and proximity to home
Finalize plans for post-21 transition; begin the transition process during the year before
Preparing for and Securing Employment
Some additional considerations during job development:
Start with small family businesses compared to larger companies
Email-call-visit during job development
Offer supported volunteer job training - another set of hands
Preparing for and Securing Employment
Some additional considerations during job development:
Observe staff on site and determine jobs that your individual can do for them
Maintain each site in ongoing manner
Build natural supports….train employment supervisors and/or co-workers to implement effective supports
Let’s watch Jonathan’s Video
- provided by the ASA’s Oakland County Chapter
What supports did we see?
Initial job coaching (that was faded over time)
Stable and predictable routines
Advance warnings regarding changes in routines
Visual aids (e.g., signs with stock numbers)
Reduced need for social interactions
Preparing for and Securing
Employment – Kevin’s Story
Community-Based Instruction
Community-Based Instruction
A quick review of CBI
What is it and is it different from field trips?
CBI involves frequent and structured trips into the
community
CBI is linked directly to an individual’s learning plan with
related goals and objectives
Settings are determined by an individual’s and family’s
preferences
Instructional summaries are used to guide CBI activities
Ongoing objective data collection is used to guide CBI
strategies
Community-Based Instruction
Why is it important?
When should it start?
Who should participate?
General Objectives of CBI
Teach general and specific skills that will lead to greater independence in community settings (e.g., waiting in line at the grocery store, ordering from a menu, etc.)
Generalize other IEP objectives to community settings
Establish or maintain appropriate behavior in new (and usually less structured) settings
Increase an individual’s interactions with typically-developing peers
Teaching Social Skills to
Individuals with an ASD
PEACS
Social Skills
What are social skills?
Those behaviors in given social situations that lead to
important social outcomes (Gresham, 1986)
Important outcomes may include:
Positive relationships with family members and
others
Social inclusion and friendships
Additional opportunities for community inclusion
Enhanced employment success
Social Skills - Critical Skills Social Orientation and Approach - responding to own
name and social reinforcers; establishing eye contact
Play and Recreation Skills - solitary, imaginative,
parallel, associative, interactive
Imitation - body actions, actions with objects,
verbalizations, peers
Interaction Skills - greetings, initiating and responding,
maintaining, extending, and terminating conversations
Social Skills - Critical Skills
Social Rules - maintains appropriate distance and body
orientation, waits turn in conversations, sensitive to social
cues, shows empathy
Use of Manners- saying “please,” “thank you,” and
“excuse me”; holding the door for others; introducing others
or self; giving compliments; apologizing to others; etc.
Let’s look at the Devereux and Skillstreaming checklists
Social Skills Intervention – What Does
Research Tell Us?
Interventions should be implemented more intensely and frequently.
Instruction should be provided in natural settings.
Match intervention strategy to type of skill deficit (performance deficit v. skill acquisition deficit).
Program for generalization and maintenance.
(Bellini, Peters, Benner, & Hopf, 2007; Gresham, Sugai, & Horner, 2001)
Social Skills – Direct Instruction
Possible Teaching Components
After specific skills are selected based upon
assessments, interviews, and observations,
select one prioritized skill to target
Break the prioritized skill down into a series of
steps
Social Skills – Direct Instruction
Examples of breaking a skill down:
Greeting Others
Get your classmate’s attention (by waving or another way).
Look at, smile, and say “Hi ____________ (classmate’s name).
Wait for your classmate to respond, or say it louder one more time if they do not respond.
If your classmate asks you a question (such as, “How are you doing?”), respond to their question.
Social Skills – Direct Instruction
Possible Teaching Components
Explain the rationale for the skill
Explain the context for use
When do you greet others?
When you first walk into a classroom or lunchroom
When you see someone you know in the hallway
When you see someone you know outside of
school
Social Skills – Direct Instruction
Possible Initial Teaching Strategies
Provide a breakdown of the skill in a
checklist format
Model the skill (in-vivo; video) and have the
student complete the checklist
Rehearse the skill in a role play situation
and provide positive feedback using the
checklist
Social Skills – Direct Instruction
Strategies for generalization and
maintenance
Use priming strategies right before situations
where the skill is needed
Provide frequent performance feedback using the
checklist and reinforcement (let’s look at an
example)
Provide structured opportunities to practice skills
When appropriate, use self-management
strategies
Social Skills – Direct Instruction
Strategies for generalization and maintenance (continued) Make sure that everyone (staff, family, peers)
understands the plan and/or how they can help with implementation
Gradually fade supports and reinforcement
Use objective data and social validity measures to monitor progress
Let’s look at one last success story
Nicole
Let’s look at one last success story
Nicole was referred to Devereux for a Community-
based Work Assessment (CBWA)
Nicole’s supports coordinator from the county and
her vocational rehabilitation felt that Nicole would be
best served in a workshop program. They felt that
because Nicole has limited communication skills,
she would not do well in an employment setting.
Nicole’s mother felt that she was capable of
integrated competitive employment, and asked
Devereux to assess her skills.
Let’s look at one last success story
Nicole’s Employment Specialist set up CBWA’s in three different community work sites.
Nicole excelled in two of her work sites, and completed all tasks thoroughly with little prompting.
Devereux’s recommendation was for Nicole to pursue competitive employment.
Let’s look at one last success story
Nicole secured a job at a local Homegoods working
20 hours per week.
Nicole has been working at Homegoods for over a
year, and when she first began she had a job coach
with her at all times.
Nicole now only has a job coach for the last 30
minutes of her four-hour day, and works the rest of
the day completely independently.
Nicole works is various locations in Homegoods, and
her tasks include: unstocking and restocking shelves
with new inventory, labeling new stock, assembling
new stock
Let’s look at one last success story
Nicole is now able to assemble more lamps in the time she works than any other employee in Homegoods, and is very motivated by her work.
Nicole also has other meaningful activities as a part of her day, such as volunteering and social activities with peers.
Nicole’s mother and brother both stated they noticed a huge boost in her self-confidence once she began working.
Questions/Comments