important considerations when educating and supporting

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


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


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


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


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


Competencies

Assessment of

meaningful skills and

plan development:

Consider Peter

Gerhardt’s “Home

Alone” analogy


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


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


For Motivation For Choices


For Task Completion For Social Skills


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)


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


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


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


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


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



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)


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)


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


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


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


Employment – Kevin’s Story

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


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


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.


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


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


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


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


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.


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.


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


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.

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important considerations when educating and supporting

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