Transition to Adulthood Using Comprehensive Planning Tools: An Evidenced-Based Approach

Transcription

1 Transition to Adulthood Using Comprehensive Planning Tools: An Evidenced-Based Approach Brenda Smith Myles, Ph.D. Ruth Aspy, Ph.D., & Barry G. Grossman, Ph.D. The Ziggurat Group Overview of Day Overview of the issues Underlying Characteristics Transition definition and requirements Introduce the Ziggurat Model How to assess and address underlying characteristics Five levels of intervention Apply ZM to scenario Introduce the Comprehensive Autism Planning System Common evidenced-based intervention strategies A Sign of Our Failure A Sign of Our Failure A study of 114 adults Measure outcome Good: (a) employed or engaged in education/vocational training, (b) living independently, (c) two or more friends/steady relationship Fair: (a) or (b) Poor or very poor outcome: neither (a) or (b) A study of 114 adults Good Outcome: (a) employed or engaged in education/vocational training, (b) living independently, (c) two or more friends/steady relationship 0 Billstedt Gillberg, & Gillberg, 2005 Billstedt Gillberg, & Gillberg, 2005 A Sign of Our Failure A Sign of Our Failure A study of 114 adults Fair: Either (a) employed or engaged in education/vocational training, (b) living independently, (c) two or more friends/steady relationship 8% A study of 114 adults Poor or very poor outcome: Neither (a) employed or engaged in education/vocational training, (b) living independently, (c) two or more friends/steady relationship 92% With no differences between individuals with autism who are considered high functioning and those with a more classic presentation Billstedt Gillberg, & Gillberg, 2005 Billstedt Gillberg, & Gillberg,

2 The biggest predictor of employment for adults is a job experience during high school. Underlying Characteristics Impaired Theory of Mind- Mindblindness Weak Central Coherence Difficulty understanding the thoughts, feelings, and beliefs of others Difficulty predicting the actions of others Difficulty using words to describe one s own feelings Difficulty understanding non-literal language (e.g., sarcasm) Tendency to focus on details and miss the big picture Difficulty understanding social situations Problem Solving Executive Dysfunction One way of viewing a problem Stuck thinking Sees facts instead of a whole Problems with cause and effect Does not see problems as having more than one option Problem solving is often literal Difficulty with change Problems with regulating emotion Attention problems Disorganized 2

3 Top 10 Situations that Trigger Insistence on Sameness Special Interests and Obsessions Annoying behavior Activity interrupted Losing a game Object breaks Event cancelled Event delayed Materials run out Item misplaced Sequence changed Momentary separation Narrow interests Not permanent Often appear uncontrollable Role of the interest: interest; fun; security, comfort; relaxation; stress reduction Green, Sigafoos, Pituch, Itchon, O Reilly, & Lancioni (2006). Assessing Behavioral Flexibility in Individuals with Developmental Disabilities. Focus on Autism and Other Developmental Disabilities, 21(4) The Purpose of Special Education (IDEA) Transition A Comprehensive Perspective To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique need and prepare them for further education, employment, and independent living (emphasis added) Transition Services Definition Transition Services Definition (continued) transition services means a coordinated set of activities for a child with a disability. The Ziggurat Model provides a process to develop a coordinated set of activities that matches individual characteristics to interventions. Law (A) is designed to be a resultsoriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child's movement from school to post-school activities Ziggurat Model Underlying Characteristics Checklist Individual Strengths and Skills Inventory Intervention Ziggurat IDEA (2004) emphasis added IDEA (2004) emphasis added 3

4 Transition Services Definition (continued) Transition Services Definition (continued) Law (B) is based on the individual child s needs, taking into account the child's strengths, preferences, and interests IDEA (2004) emphasis added Ziggurat Model Underlying Characteristics Checklist Individual Strengths and Skills Inventory Global Intervention Plan Guide (personcentered planning) Law (C) includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation. Ziggurat Model Intervention Ziggurat Transition IEP Requirements Age 14 (or younger, if determined appropriate), a statement of the transition service needs that focuses on the student's courses of study (such as participation in advanced-placement courses or a vocational education program); and Age 16 (or younger, if determined appropriate), a statement of needed transition services, including, if appropriate, a statement of the interagency responsibilities or any needed linkages. Adapted from: (Authority: 20 U.S.C. 1414(d)(1)(A)) Transition in Texas Beginning at any age... Futures planning for integrated living, work, community, and educational environments that considers skills necessary to function in current and post-secondary environments Texas Commissioner s Rules Concerning Special Education Chapter 89 Subchapter AA The Ziggurat Model Ziggurat n: (zig gu rat) from Assyrian ziqquratu, height, pinnacle 1. a temple having the form of a terraced pyramid of successively receding stories, erected by the ancient Assyrians and Babylonians 2. a framework for designing comprehensive interventions for individuals with autism spectrum disorders 4

5 Why was the Ziggurat Model Developed? Intervention Ziggurat Difficulty Seeing the Autism Tendency to apply one strategy to address all needs Tendency to ignore critical areas when designing an intervention Skills to Teach Task Demands Structure and Visual/Tactile Supports Sensory Differences and Biological Needs Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Characteristics Interventions Skills to Teach Task Demands Structure and Visual /Tactile Supports Sensory Differences and Biological Needs Underlying Characteristics Checklist (UCC) Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Characteristics Social Communication Repetitive Patterns Associated Features Sensory Motor Cognitive Emotional Vulnerability Medical and Biological Factors Interventions Skills to Teach Task Demands Structure and Visual /Tactile Supports Sensory Differences and Biological Needs The Ziggurat Model 2008 ASA Literary Award Winner Sensory and Biological Needs Structure and Visual/Tactile Supports Task Demands Skills to Teach 5

6 Why Comprehensive Planning With The Ziggurat and CAPS Models? Fewer behavior problems More instructional time Increased compliance with law Increased engagement time Faster IEP development Better IEPs More positive/collaborative relationship with parents Improved collaboration among staff Who is Involved in Comprehensive Planning? Parents Student General Education Teacher Special Education Teacher Para-professional Speech Language Pathologist Occupational Therapist School Psychologist Administrator Other as needed Keys to comprehensive intervention planning 4 Steps to Designing a Comprehensive Intervention Plan Characteristics Design Implement Characteristics Design Implement Underlying Characteristics Checklist 1 Helps you to see the autism Provides a snapshot of how autism is expressed for an individual A descriptive instrument Can be completed by a team Provides a tool for assessing progress/change 1 The UCC Areas Social Restricted Patterns of Behavior, Interests, and Activities Communication Sensory Differences Cognitive Differences Motor Differences Emotional Vulnerability Known Medical or other Biological Factors 6

7 Individual Strength and Skills Inventory Social Behavior, Interests, and Activities Communication Sensory Cognitive Motor Emotional Biological Social UCC-CL [3] Shows little interest in or response to praise [8] Has difficulty imitating the actions or words of others Social - ISSI Engages in conversational turn taking with parents Works near peers in classroom Steps to Designing a Comprehensive Intervention Plan UCC-HF or UCC-CL Characteristics Design 4 Implement Not a fine line. When in doubt, review the items from both and select the one that is the best fit. UCC-HF or UCC-CL Anna Sample UCC Items Classic Autism UCC-HF Average Skills UCC-CL HFA/AS Social [1] Mindblindness [5] Has difficulty making or keeping friends [7] Is naïve, easily taken advantage of, or bullied Restricted Patterns [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change Communication [25] Has difficulty with rules of conversation [27] Has difficulty using gestures and facial expressions Emotional Vulnerability [76] Is easily stressedworries obsessively [77] Appears to be sad or depressed 7

8 Anna - Individual Strengths and Skills Inventory Anna - Individual Strengths and Skills Inventory Social Enjoys interacting with others Is an avid reader and enjoys sharing information with others Wants to have friends Responds well to authority Behavior, Interests, and Activities Knows a lot about fantasy literature Beginning to understand when to share and how much to share Communication Excellent verbal skills Not shy about talking with others Excellent vocabulary Sensory Somewhat tolerant of various sensory input across various environments Beginning to recognize when she is becoming overloaded Anna - Individual Strengths and Skills Inventory Anna - Individual Strengths and Skills Inventory Cognitive Above average IQ Can use organizational sequences, when taught Flexible, especially when primed Motor Good skills related to case register operation, inventory, and shelving books Emotional Beginning to recognize the feelings of others Wants to respond to others feelings Biological Excellent health Skills to Teach Task Demands The last thing one knows in constructing a work is what to put first -Blaise Pascal 3 Sensory Structure and Visual /Tactile Supports Sensory Differences and Biological Needs Differences and Biological Needs 8

9 Sensory Differences and Biological Needs Sensory Issues Provide a sensory diet Monitor and address environmental stressors: Sound, light, proximity/personal space, textures Movement needs Monitor and address: Appetite/hunger Arousal/activity level (e.g., fatigue, hyper) Posture and movement Medical needs Asperger Syndrome and Sensory Issues Smell Taste Touch Visual Input Auditory Vestibular (balance) Proprioception (body awareness) Sensory Issues Individuals with AS have more difficulties with modulation and emotional reactivity when compared to their counterparts with autism Brenda Smith Myles Emotional Reactivity Displays emotional outbursts when unsuccessful Is stubborn or uncooperative Often gets stuck in a situation Is overly sensitive Reacts overtly when sensory systems needs are not met Brenda Smith Myles Sensory Diet Is... A planned and scheduled activity program designed to meet specific sensory needs (Yack et al., 1998) Incorporates naturally occurring opportunities for children to get the sensory stimulation they need (Willbarger, 1995) Miller & Robbins,

10 Coping Cards Take 2 deep breaths with your eyes closed If there is no reinforcer, there is no lesson -Andrew Bondy Press hands together and count to 10 slowly Amy Bixler, 2006 Reminders Selecting Reinforcers increases the likelihood of a behavior The way positive reinforcement is carried out is more important than the amount -B.F. Skinner Individuals on the spectrum may not be as motivated by money as their neurotypical coworkers are... Their motivation to work will be directly related to the extent to which they enjoy the work... A good match is of critical importance. OAR (2006). Life Journey through Autism: A Guide for Transition to Adulthood Reminders Menu You may not have to look any further than [a]... special interest to find the perfect reward -Sakai, 2005, p. 52 My School Rewards 10 minutes of reviewing baseball statistics in personal magazine/books 15 minutes to research on the internet on baseball/sports statistics/events Time to browse books in the school library Amy Bixler,

11 Home Menu My Home Rewards 30 minutes of time to browse the web Trip to local baseball card store 30 minutes of video games And it is best if you know a good thing is going to happen, like an eclipse or getting a microscope And it s bad if you know a bad thing is going to happen like having a filling or going to France. But I think it is worst if you don t know whether it is a good thing or bad thing which is going to happen. - From: The Curious Incident of the Dog in the Night Time, by Mark Haddon, 2003 Amy Bixler, 2006 Structure and Visual/Tactile Supports I like everything still. It gives you a full feeling. It gives you a full attention. With something quick, you don t get the full idea of it. With something still, you take a look at it and you get to know the whole look and feeling -Warden from Rage for Order (BBC, 1996) Structure and Visual/Tactile Supports Common Misperceptions If an individual can read then he/she does not need pictures or symbols He s in high school, he does not need an individualized schedule I can stop using a visual schedule once my student learns the routine If an individual has not looked at his/her schedule in three weeks he/she does not need it anymore Visual Schedules Highly structured environments provide an opportunity for those with ASDs to succeed Increased predictability and understanding results in: Decreased problem behavior Increased independence Visual Schedules Research on visual schedules shows that they are: Effective across age ranges Effective across settings Bopp, K., Brown, K., Mirenda, P. (2004). Speech-Language Pathologists roles in the delivery of positive behavior support for individuals with developmental disabilities. American Journal of Speech-Language Pathology 13,

12 Visual Schedules Mini Schedule Schedules are effective in decreasing off-task behaviors disruptive behavior noncompliance aggression tantrums property destruction Morning Checklist Making Coffee Check Activity Put away backpack Take out morning work Complete work Turn in morning work Take out book Pick reward from your menu Visual Schedule Visual Schedule 12

13 Incredible Five Point Scale Rating Description Setting Wait Card Screaming Emergency only Outside voice In the parking lot Talking voice With customers Soft voice/ whisper Working with employees No talking Buron, K.D., & Curtis, M. (2003). The Incredible 5-Point Scale. Shawnee Mission, KS: AAPC. Person is talking to me When I make a mistake Stress Thermometer Most stressed ever Ask for help Video-Based Instructional Procedures Improve daily living skills Promote generalization When I have hard homework Putting stuff in my backpack after bus arrives No stress Call my mom for help Pack before bus time Van Laarhoven, T. & Van Laarhoven-Myers, T. (2006). Comparison of three video-based instructional procedures for teaching daily living skills to persons with developmental disabilities. Education and Training in Developmental Disabilities, 41(4), Video Instruction How to Make Popcorn Open plastic bag Unfold bag 13

14 How to Make Popcorn Place in microwave and start time Remove from microwave Open carefully to eat Just imagine your most stressful day that you ve ever, ever had... your worst day is his best day Task Demands -Parent of child with Asperger s I m in the obstacle removal business Task Demands We don t fix things that aren t broken, we remove obstacles for kids with infinite potential - Eric Blackwell Level of Demand Easy (independent skillswith or without modification and structural supports) Challenging/Emerging (possible with assistance) Zone of Proximal Development Too demanding Ruth Aspy, Ph.D., Barry G. Grossman, Ph.D. Task Demands and Skills to Teach Too Demanding Supports Skills Ability Demands Ability Task Demands Skills to Teach Demands Group Work 14

15 To Balance Reduce Demands, Add Supports &/or Skills Examples of Task Demand Interventions Demands Task Demands Group Work Supports Ability Skills Skills to Teach Provide written instructions Allow use of laptop to take notes Give extra time for written work Teach to use a Personal Digital Assistant (PDA) Provide organizational skills support assignments, reminders Examples of Task Demand Interventions Use coping cards Create Circle of Friends Provide narration Provide high interest activities to encourage social interaction Examples of Task Demand Interventions Provide peer buddy/mentor Give highlighted text Provide monitoring teacher/contact Provide safe place Allow for breaks Prepare for change Minimize transitions The Seemingly Obvious The teacher who does not understand that it is necessary to teach autistic children seemingly obvious things will feel impatient and irritated -Hans Asperger Skills to Teach What is it about the situation that comes naturally to everyone else but is missing for this person? Why is it that others do not show the same behavior? What is it that has not occurred to me to teach? That is the seemingly obvious. That is the thing to teach. 15

16 Hidden Curriculum Hidden Curriculum The set of unwritten rules that no one has been directly taught, but everyone knows. Violations of these rules can make an individual a social outcast. Phrase associated with hidden curriculum: I shouldn t have to tell you but Everyone knows that It s obvious Differs across Age Who you are with Gender Culture Other Hidden Curriculum Areas Bathroom/Shower/Locker Room Airplane/airport Friends Eating Public/private swimming pools School rules Bathroom/shower/locker room Understand the urinal rules The HC Curriculum Series The Hidden Curriculum Calendar Book DVD Designing A Global Intervention Plan 16

17 Designing a Global Intervention UCC Areas Select Key UCC Areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Social Restricted Patterns Communication Sensory Differences Cognitive Differences Motor Differences Emotional Vulnerability Known Medical/Biological Factors Anna-Select UCC Areas Vision What is the short and long-term vision for the individual? Short-term Develop meaningful relationships Be successful at school and work Long-term Make friends Attend university Live independently Have meaningful career Vision Anna- Select UCC Areas Vision Which UCC areas would have the greatest impact on achieving this vision? Social Restricted Patterns Communication Emotional Vulnerability Remember to stay on target Anna-Select UCC Areas Settings In what settings does the individual participate? General education Job (bookstore) Socialize with peers (drama club) Home Anna- Select UCC Areas Settings Settings Which UCC areas have the greatest impact on the individual s ability to function in multiple settings? Social Restricted Patterns Communication Emotional Vulnerability Remember to stay on target 17

18 Anna- Select UCC Areas Quality of Life What is most important to the individual? What provides a sense of well-being? Acting Friends Independence Achievement Anna- Select UCC Areas Quality of Life Quality of Life Which UCC areas have the greatest impact on the individual s quality of life? Social Restricted Patterns Communication Cognitive Differences Emotional Vulnerability Remember to stay on target Anna- Select UCC Areas Key UCC Areas Designing a Global Intervention Based on your answers to the questions, place a mark next to the key UCC areas. Social Restricted Patterns Communication Emotional Vulnerability Select Key UCC areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Select Key UCC Items from UCC Areas Select UCC Items for Anna Select key UCC items for each of the Selected UCC areas. Choose items that are essential (necessary for progress) and developmentally appropriate. Social #1, 5, 7 Restricted Patterns #14, 18 Communication #25, 27 Emotional Vulnerability #76, 77 Emphasize items that are more pivotal (building blocks for additional skills). Avoid selecting redundant items. 18

19 Anna - Selected UCC Items Designing a Global Intervention [1] Mindblindness [5] Has difficulty making or keeping friends [7] Is naïve, easily taken advantage of, or bullied [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [25] Has difficulty with rules of conversation [27] Has difficulty using gestures and facial expressions [76] Is easily stressed-worries obsessively [77] Appears to be sad or depressed Select Key UCC areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Anna-Intervention Design Activity: Marrying the Underlying Characteristics and Strengths to Interventions Anna - Intervention Design Sensory and Biological Interventions 3 Underlying Characteristic(s) [18] Has problems handling transition and change [76] Is easily stressed - worries obsessively Interventions Have Anna use 5- Point Scale to recognize stress level. Provide paperclips for Anna to indicate stress. Anna should take a break, get a drink, take a walk to calm. Anna - Intervention Design Sensory and Biological Underlying Characteristic(s) [18] Has problems handling transition and change [76] Is easily stressed - worries obsessively Interventions * Ensure that Anna has a book or headphones during scheduled breaks and lunch (calming). * Inform all supervisors and fellow employees that Anna may need time for calming activities. Which Level or Levels? Use Anna s interests in Harry Potter and Lord of the Rings when scheduling Anna s placement in the bookstore. During high traffic times place her in the Fantasy section, if possible. Skills to Teach Task Demands Structure and Visual/Tactile Supports Sensory Differences and Biological Needs 19

20 Anna - Which Underlying Characteristic(s)? Anna - Selected UCC Items Underlying Characteristic(s) Interventions * Have Anna use 5- Point Scale to recognize stress level. Provide paperclips for Anna to indicate stress. Anna should take a break, get a drink, take a walk to calm. [1] Mindblindness [5] Has difficulty making or keeping friends [7] Is naïve, easily taken advantage of, or bullied [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [25] Has difficulty with rules of conversation [27] Has difficulty using gestures and facial expressions [76] Is easily stressed-worries obsessively [77] Appears to be sad or depressed Anna - Which Underlying Characteristic(s)? Which Level or Levels? Underlying Characteristic(s) Interventions * Provide an individualized daily schedule with indicator of any known changes to the routine. Use video to demonstrate how to interact with pleasant and unpleasant customers. Supplement with script. Skills to Teach Task Demands Structure and Visual/Tactile Supports Sensory Differences and Biological Needs Anna - Which Underlying Characteristic(s)? Anna - Selected UCC Items Underlying Characteristic(s) Interventions Use video to demonstrate how to interact with pleasant and unpleasant customers. Supplement with script. [1] Mindblindness [5] Has difficulty making or keeping friends [7] Is naïve, easily taken advantage of, or bullied [14] Has eccentric or intense preoccupations [18] Has problems handling transition and change [25] Has difficulty with rules of conversation [27] Has difficulty using gestures and facial expressions [76] Is easily stressed-worries obsessively [77] Appears to be sad or depressed 20

21 Time Activity Skills/ STO Structure/ Modifications Sensory Strategies Social Skills/ Communication Data Collection Generalization Anna Interventions [76] Is easily stressed worries obsessively Knows a lot about fantasy literature Use Anna s interests in Harry Potter etc when scheduling her placement in the bookstore. During high traffic times place her in the Fantasy section Comprehensive Autism Planning System Chocolate & Peanut Butter 4 The Ziggurat Model by Aspy & Grossman 2008 Literary Award by Henry & Myles COMPREHENSIVE AUTISM PLANNING SYSTEMS (CAPS) (Henry and Myles, 2007) COMPREHENSIVE AUTISM PLANNING SYSTEMS (CAPS) (Henry and Myles, 2007) Time Activity Skills/ STO Structure/ Modifications Sensory Strategies Social Skills/ Communication Data Collection Generalization CAPS is the framework tying the daily schedule to the underlying characteristics identified in the UCC and the interventions outlined in the Ziggurat Worksheet. 21

22 Why Was CAPS Developed? Students often move and new teams have to get to know these students, reinventing the wheel is not fair to the student or the teacher. Simply, what works for the individual was not being shared. Time and Activity This includes: All activities Transitions that require supports of any nature Breaks and lunch built into the schedules Required Tasks This includes: All tasks that must be accomplished as a part of an activity For example, work in an office (activity) might require the following activities: answering , writing up requisition forms, posting to accounts, answering the phone, developing budgets 22

23 Needed Employee Training Type of training needed and training materials should be specified Training can be group, individual, global or activity-specific For example, a person may be assigned to be a coach or go to person during break Taken from the or Structure and Visual/Tactile Supports sections of the Ziggurat Worksheet Social Skills/Communication Drawn from the following Ziggurat Worksheet sections: Structure and Visual/Tactile Supports Task Demands Skills to Teach 23

24 Sensory/Biological Supports Taken from the Sensory and Biological Needs or Skills to Teach or Task Demands sections of the Ziggurat Worksheet Environmental Supports/Modifications Taken from the Structure and Visual/Tactile Supports or the Task Demands sections of the Ziggurat Worksheet Visual schedule, list of tasks, coach, etc Natural Supports Available in the typical work environment. Instruction may be needed on how and when to use the support. 24

25 Data Collection How to determine if the adult is doing well on the job May include weekly or daily meetings, notes, job evaluations, etc.. 1. Transfer Interventions from the Ziggurat to the CAPS-TR Identify the Time, Activity and Required tasks 2. Identify Employee Training Identify who is to be trained and training materials 8:00 Enter work Time in All; OCALI video 3. Transfer Interventions from the Ziggurat to the CAPS-TR Items can be used in more than one activity 4. Identify Data to Be Collected Mason 15 year old with AU Non-verbal uses sign language (inconsistently). Learning how to use communication device. Attends self-contained classroom for all core subjects Prescribed medication to address anxiety, sleep, and digestion difficulties Works in the attendance office 25

26 Mason (continued) Mason (continued) Prefers to be alone. Has no friends. Responds to unexpected change with pacing or hitting/shoving adults. Becomes aggressive (hit or push adults) when unable to communicate wants and needs. Displays repetitive behaviors (e.g., opens and closes doors, lines up items). Becomes aggressive when redirected. Perfectionist. Becomes upset when makes mistakes or when others do not perform tasks just right. Mason s Services Speech and language therapy Group social skills Occupational therapy consultation Mason s ISSI Social Interacts with his sister or parents Successfully attends PE and lunch in gen. ed. setting Behavior, Interests, and Activities Likes routine and predictability Interested in animated movies, computer games, and electronics catalogues Can take apart and put back together a handheld radio 26

27 Mason s ISSI (continued) Mason s ISSI (continued) Communication Has about 100 signs Starting to use AAC device to express wants/needs Sensory Not bothered by smells Enjoys activities involving running/moving/ spinning Cognitive Does well with puzzles and sequencing/ patterning/matching Can follow 1-2 step directions when presented concretely Motor Is able to navigate climbing equipment/ heights with much ease Is beginning to use word processor Mason s ISSI (continued) Emotional Good relationship with family Is a happy young man overall Biological Health needs are known (has ongoing medical care) Steps to Designing a Comprehensive Intervention Plan Characteristics Design 4 Implement Designing a Global Intervention UCC Areas Select Key UCC Areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Social Restricted Patterns Communication Sensory Differences Cognitive Differences Motor Differences Emotional Vulnerability Known Medical/Biological Factors 27

28 Mason- Select UCC Areas Vision What is the short and long-term vision for the individual? Short-term Communicate consistently using his AAC device Participate in small group social activities in the classroom, school, or home environments Long-term Successful employment Live independently Develop friendships Improve coping skills Vision Mason- Select UCC Areas Vision Which UCC areas would have the greatest impact on achieving this vision? Social Communication Emotional Vulnerability Remember to stay on target Mason- Select UCC Areas Settings In what settings does the individual participate? School Home Warehouse Mason- Select UCC Areas Settings Settings Which UCC areas have the greatest impact on the individual s ability to function in multiple settings? Social Restricted Patterns Communication Cognitive Emotional Vulnerability Remember to stay on target Mason- Select UCC Areas Quality of Life What is most important to the individual? What provides a sense of well-being? Watching movies Playing video games Looking through electronics catalogues Mason- Select UCC Areas Quality of Life Quality of Life Which UCC areas have the greatest impact on the individual s quality of life? Social Restricted Patterns Communication Cognitive Emotional Vulnerability Remember to stay on target 28

29 Mason- Select UCC Areas Key UCC Areas Based on your answers to the questions, place a mark next to the key UCC areas. Social Restricted Patterns Communication Cognitive Emotional Vulnerability Designing a Global Intervention Select Key UCC areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Select Key UCC Items from UCC Areas Select key UCC items for each of the Selected UCC areas. Choose items that are essential (necessary for progress) and developmentally appropriate. Select UCC Items for Mason Social #6, 8 Restricted Patterns #29 Communication #32, 33, 44 Cognitive #71 Emotional Vulnerability #92, 96, 99 Emphasize items that are more pivotal (building blocks for additional skills). Avoid selecting redundant items. Mason- Selected UCC Items Designing a Global Intervention [6] Difficulty maintaining personal space [8] Has difficulty waiting [29] Has strong need for closure [32] Has little or no speech [33] Has difficulty expressing wants and needs [44] Communicates needs through behaviors [71] Demonstrates learned skills inconsistently [92] Is anxious or easily stressed [96] Exhibits aggression/meltdowns in response to minor changes [99] Has difficulty tolerating mistakes Select Key UCC areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete 29

30 Designing a Global Intervention Sensory Select Key UCC areas Select Key UCC items to address Develop interventions for each level of the Ziggurat Ensure that intervention is complete Underlying Characteristics Checklist [32] No speech/nonverbal [92] Is anxious or easily stressed [96] Exhibits aggression/ meltdowns in response to minor changes Interventions Use 5-Point Scale to monitor/stress/anxiety level Use picture/word calming cards/icons Sit in a rocking chair and/or deep breathing when feeling anxious Use AAC device to express himself Frequent breaks Structure and Visual/Tactile Supports Underlying Characteristics Checklist [13] Has difficulty waiting [32] No speech/nonverbal [33] Has difficultly expressing wants/needs [44] Communicates needs through behavior [71] Demonstrates learned skills inconsistently Intervention (Reinforce for/ when ) Demonstrates skills across settings Using AAC device to ask for help or express wants/needs Using AAC device instead of aggression Using skills to join an activity Critical skills (waiting) Task Demands Skills to Teach 30

31 Mason Mason [92] Is anxious or easily stressed Sit in rocking chair and/or deep breathing when feeling anxious [96] Exhibits aggression/meltdowns in response to minor changes Incorporate the use of change in schedule card/ icon on device Enjoys activities involving running/ moving/spinning Frequent breaks (walking, rocking chair, drink of water) Starting to use AAC device to express wants/needs Use Wait and Break card/icon Strengths of the Ziggurat and CAPS Models Provides a process and framework for designing a comprehensive individualized intervention plan Make everything as simple as possible but not simpler - Albert Einstein Strengths of the Ziggurat and CAPS Models Strengths of the Ziggurat and CAPS Models Addresses individual underlying characteristics of ASD by utilizing strengths and building skills Uses reinforcement and other positive behavior supports Skills to Teach COMPREHENSIVE AUTISM PLA NING SYSTEMS (CAPS) (Henry and Myles, 2007) Task Demands Structure and Visual/Tactile Supports Sensory Differences and Biological Needs Time Activity Skills/ STO Structure/ Sensory Social Skills/ Data Generalization Modifications Strategies Communication Collection 31

32 Strengths of the Ziggurat and CAPS Models Data are collected and analyzed to identify behaviors to be taught and to measure progress in developing skills Strengths of the Ziggurat and CAPS Models Data are collected and analyzed to measure student progress COMPREHENSIVE AUTISM PLA NING SYSTEMS (CAPS) (Henry and Myles, 2007) Skills to Teach Time Activity Skills/ STO Structure/ Sensory Social Skills/ Data Generalization Modifications Strategies Communication Collection Task Demands Structure and Visual/Tactile Supports Data Collection Sensory Differences and Biological Needs Strengths of the Ziggurat and CAPS Models Plan for transfer and generalization of skills Strengths of the Ziggurat and CAPS Models Plan for transfer and generalization of skills COMPREHENSIVE AUTISM PLA NING SYSTEMS (CAPS) (Henry and Myles, 2007) Skills/ Structure/ Sensory Social Skills/ Data Time Activity Generalization STO Modifications Strategies Communication Collection Generalization Which of these would you leave out if you want skills to transfer? Skills to Teach Task Demands Structure and Visual/Tactile Supports Sensory Differences and Biological Needs Other Strengths of the Ziggurat and CAPS Models Emphasizes and enhances evidence-based strategies Facilitates use of proactive interventions Other Strengths of the Ziggurat and CAPS Models Facilitates interdisciplinary interventions Promotes collaboration among parents, and the community 32

33 Transition Resources Transition Resources Organization for Autism Research (OAR) free transition manual and DVD for professors Wrightslaw Person-Centered Planning: A Tool for Transition 31 OCALI/Easter Seals videos on employment (available on YouTube) Changes in the workplace Social interaction on the job Starting a new job Autism & Employment Video Jug Transition Resources Contact Information Brenda Smith Myles, Ph.D. myles@texasautism.com Ruth Aspy, Ph.D. aspy@texasautism.com Barry G. Grossman, Ph.D. grossman@texasautism.com