Quest Autism Programs, Inc. 1

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Meghan Wilson
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Preparing Your Young Adult with Autism for a Successful Transition to an Adult Day Program Presented at ANJ Transition Conference April, We are Quest Autism Programs, Inc.

ABA Instructional methodology Focus on development of relevant, functional goals Open year-round, Monday Friday 9-pm program days/yr (~weeks of vacation) Participants supported by Job Coaches onsite

Supported Employment and Supported Volunteer Work Daily Living & Life Skills Social Skills Recreation & Leisure Skills Community Skills Autism Prevalence: US: in NJ: in Why is this topic important?

1 Preparing Your Young Adult with Autism for a Successful Transition to an Adult Day Program Presented at ANJ Transition Conference April, We are Quest Autism Programs, Inc. Adult day program for individuals (+) with autism Community-based instruction program locations, located in northern New Jersey Our Program: Serve adults, + with autism Community-based day program ABA Instructional methodology Focus on development of relevant, functional goals Open year-round, Monday Friday 9-pm program days/yr (~weeks of vacation) Participants supported by Job Coaches onsite and in community in :, and : ratios Funding: DDD (SDS) and fundraising Our Program: - cont d Focus on community-based instruction, in addition to other pertinent skill sets that promote independence: Supported Employment and Supported Volunteer Work Daily Living & Life Skills Social Skills Recreation & Leisure Skills Community Skills Autism Prevalence: US: in NJ: in Why is this topic important? Need for adult services for this population becomes increasingly significant Many traditional adult day programs (e.g., day habilitation centers) serve individuals with multiple disabilities, in ratios significantly higher than in most specialized school programs (e.g., :) In New Jersey, there is no entitlement funding for adults Practically speaking, this will result in access to FEWER resources, relative to < Preparing these young adults for the changes in programming and setting early on, is paramount to a successful transition Quest Autism Programs, Inc.

2 Agenda for today. Define Successful Transition. Characteristics of school vs. day programs Transition Related To Individuals With Autism: Often thought of as the period during the year of st birthday when we look for adult day/residential programs post high school. Measures of success. Factors to consider When to think about transition? I want to challenge you today to view this as a process, beginning early in adolescence, where we are building the skills necessary to be successful in our next setting Transition Services should: * be a part of the Individualized Education Program (IEP). be based on a student s individual preferences and interests. begin at age (or earlier if applicable). be a long-range plan that emphasizes skills that are needed for adult life. *Source: Measures of Success Success is defined in terms of outcome We can use outcomes to measure success, but also need to proactively develop skills to prepare for better outcomes We will examine some of the measures we assess at Quest Autism Programs (outcome) and provide suggestions on goals PRIOR to transitioning into the adult day system Quest Autism Programs, Inc.

3 High School. Skills prior to entering Adult day system Transition. Factors evaluated at Intake Adult Day. Outcome Measures Transition does not begin at age It needs to begin in adolescence (more to come on this ) Characteristics of School vs Day Program Characteristics: School vs Day Location (e.g., Classroom vs community) Length of day / school year Staff to individual ratio Amount of instruction (i.e., teaching time) Instructional targets Vocational opportunities Transportation Funding Day programs in NJ: To effectively prepare for a successful transition it is important to learn about the characteristics of that target setting Quest Autism Programs, Inc.

Outcome and Next Setting Characteristics of School vs Day Programs Self Direction? College? Rec Program? DVRS Traditional Day Program? Residential Services? Location (e.g., vocation, community, center-based) Length of day / school year Staff to individual ratio Amount of instruction (i.

4 Outcome and Next Setting Characteristics of School vs Day Programs Self Direction? College? Rec Program? DVRS Traditional Day Program? Residential Services? Location (e.g., vocation, community, center-based) Length of day / school year Staff to individual ratio Amount of instruction (i.e., teaching time) Instructional targets Vocational opportunities Transportation Funding Measures of Success Considerations. Quality of Life Community Integration Employment Autonomy Independence in living Managed Problem behavior Measures of Success Some of the factors we examine include:. Time in community (Pre/Post) # of paid/volunteer positions # of hours at paid/volunteer sites Work endurance Community instruction. Rate of Learning Independence Other Measures to Consider. Length of time to train & assess new participants. Staff Ratios: Amount of day in : / : / : ratios On-task behavior in : / : / : ratios. Managing Problem behavior Quest Autism Programs, Inc.

5 Number of Placements Percentage of Day Number of Hours Worked Per Week Number of Work/Volunteer Placements Transition Data Supported Employment and Supported Volunteer hours: Hours Worked # of Placements Prev Setting Months Months year years Time Line Transition Data cont d Comparison of amount of day in community % 9% % 7% % % % % % % % of Day in Community High School Program Quest Day Program ~% Part. Part. ~% Part. Part. % % time in Community in School % time in Community at Quest Transition Data cont d Curriculum comparison: At Graduation Months Daily Program Breakdown - At Graduation - Community, % Supported Volunteer, % Rec/Leisure, 7% Academic Tasks, % Pre Voc, % Daily Living, % Quest Autism Programs, Inc.

6 Day Program - months Academic Tasks, % Other Instructional, % Community, % Supported Volunteer, 9% Bridging the Gap: School Adult Day : : : Large budgets ($,) $,-$, Daily Living, 9% Pre Voc, % Rec/Leisure, % Supported Employment, % Transportation Professional Staff Transportation Contract vs Fee for Service Varied: Minimum Wage vs FT For example Identifying key variables that differ between school and adult day settings are key to instructional goals during transition Tolerating delayed access to reinforcement Work endurance Training in low staff ratios (periods of no supervision) Etc. So what to do? What are some characteristics that we have found that facilitate a smoother transition to adult day programming: Resume of Desirable Skills Schedule following Reading comprehension is a plus (even basic word-toactivity comprehension) One of the most important teaching tools we use Vocational skills Daily living skills Recreational skills and schedules Quest Autism Programs, Inc.

Recipe Technology based schedules Resume of Desirable Skills Communication system Break away from the :

oup) History of community instruction (e.g.

) Recreational skills Resume of Desirable Skills Follow multiple step directions and complex directions (e.g.

Independent meal skills bare minimum can eat neatly, with minimal supervision Self Care Skills especially

7 Recipe Technology based schedules Resume of Desirable Skills Communication system Break away from the : ratio (paired instruction; small group) History of community instruction (e.g., training where the skill is relevant) Work and/or volunteer experience (SLE; internship; etc.) Recreational skills Resume of Desirable Skills Follow multiple step directions and complex directions (e.g., directions that take time to complete, or those that require travel to access/complete a task); Independent meal skills bare minimum can eat neatly, with minimal supervision Self Care Skills especially independent toileting Being able to fill time (e.g., by accessing leisure materials) if they need to wait for staff attention Initiating & responding to each other (e.g., being able to follow directions from a peer, requesting assistance from a peer) Quest Autism Programs, Inc. 7

8 Resume of Desirable Skills Ability to stay on-task: given lower ratios of reinforcement; and delayed reinforcement contingencies for longer periods of time (i.e., increased work endurance) In a variety of settings In the absence of a staff member Challenging Behavior Low levels / intensity of problem behavior (important for community-based activities) NOTE: it is of course possible to effectively work with individuals with higher behavioral needs but this may require additional resources such as appropriate training and supervision; increased staff ratios :; increased supervision hours; safety equipment; having staff capable of physically addressing behavior challenges (participant size); etc. Behavior Case Study - Nick Male, yrs, ; lbs History of aggression, including punching, kicking scratching, biting and pulling hair Common functions: Noise (vacuum, babies) Nick, cont d Multi modal treatment package included:. Warnings / signal. Alternative behaviors (i.e., headphones, escape). Reinforcement. Proximity (i.e., stimulus) fading Rationale. Adult systems are underfunded relative to school age programs (NO ENTITLEMENT). Adult systems have lower staff ratios (primarily due to # above). Skills adults work on are harder, take longer to complete, are more complex, may require increased endurance with lower rates of reinforcement Quest Autism Programs, Inc.

# of Programs Number of Programs # of Programs Rationale *Transition SHOULD begin in adolescence when:.

stands to reason, the more skills one has, the less restrictive setting they can be in and still continue to acquire important, long lasting, and relevant skills (and

There is funding to support individualized education Programs by Domain: Age Curricular Review Importance of reassessing goals yearly Increasing number of goals that

9 # of Programs Number of Programs # of Programs Rationale *Transition SHOULD begin in adolescence when:. There is TIME to work on the skill (if it is something they will need in - years it may take educational time to become proficient and/or independent) Rationale It stands to reason, the more skills one has, the less restrictive setting they can be in and still continue to acquire important, long lasting, and relevant skills (and have access to a higher quality of life). There is funding to support individualized education Programs by Domain: Age Curricular Review Importance of reassessing goals yearly Increasing number of goals that will address skills required as an adult E.g., Increase community-based instruction Increasing independence in self-care skills Increasing skills during down time (i.e., leisure skill instruction) 9 7 Program Domain Programs by Domain: Age vs Programs by Domain: Ages, & 9 7 yrs yrs 9 7 yrs yrs yrs Program Domain Programs by Domain Quest Autism Programs, Inc. 9

10 Number of Programs Number of Programs 9 7 Programs by Domain: Ages through yrs yrs yrs yrs 9 7 Programs by Domain: Age vs yrs yrs Program Domain Program Domain Variables that can impact transition: Communication & involvement with previous school program Access to IEPs, progress reports, behavior reports & plans, work history & any other relevant files Parent input & intake interview Factors to Consider Minimal delay between graduation & start of day program Consistency in programming (ABA- based prog) Reinforcers & preferred activities readily available Familiar contingencies & routines in place Questions to ask about your student/child when considering Intake Criteria for a Day Program Can he/she remain on-task for a designated length of time? Can he/she function in a lower ratio (paired instruction or small groups)? Can he/she follow a schedule (written or picture)? Can he/she be taken into the community? Does he/she have a functional communication system? Does he/she have some pre-vocational & daily living skills? Does he/she have any work/volunteer experiences? Does he/she have low & stable rates of behaviors? (behavior plan in place; data are collected & reviewed?) Other Factors to consider Pre-placement considerations: Timelines Questions to ask Funding Quest Autism Programs, Inc.

11 Other Factors to consider Other Factors to consider Timelines: Don t wait until your child has turned Visit programs EARLY and OFTEN Speak to your transition coordinator early on If this is not possible, initiate visits on your own **DO see as many programs as you can better to make an informed decision When you have found a program, be prepared Some Questions to Ask Length of day? What services are provided (e.g., contract? SDDS?) For Self Direction: It is important to be aware of state guidelines regarding reimbursement you may not be reimbursed for services received Do they provide transportation? How far? What community programming exists? How are they funded? (tuition? state? Medicaid?) Other Factors to consider When you have found a program: Set up times for program visitation in advance some individuals may be overwhelmed with new staff and/or settings See if the new program has a cost associated with this- see if your current school program will subsidize this cost (part of exit IEP) Prepare as many documents as you can How is intake determined? Video is helpful Other Factors to consider REMEMBER The day program does not know your son/daughter yet providing specific information about what they have learned is beneficial to the development of an individualized program Establishing new worksites takes time to develop Behavior plans may need to be carried over or reintroduced at your new program Opportunities for new day program staff to observe prior to graduation are very helpful: Current school / placement Community (worksites/leisure sites) Home visits Onsite visits Toli Anastassiou toli@questnj.org Thank you! Quest Autism Programs, Inc Quest Autism Programs, Inc.

Functional Assessment and Analysis. Functional Analysis and Positive Behavior Support for Adults with Disabilities: Part Two 4/27/2016

Functional Analysis and Positive Behavior Support for Adults with Disabilities: Part Two Functional Assessment and Analysis Research has increasingly shown that many behaviors, traditionally viewed as