DevelopingPositiveOutcomesinAdultswithASD:StartattheEnd

PeterF.Gerhardt,Ed.D.October27,2019

SouthernConnecticutStateUniversityNewHaven,CT

DisclaimerUnpaidAffiliations

Dr.Gerhardthasanassociationwiththefollowingprogramsororganizationsbutreceivesnocompensationforthatassociation.Noneoftheinformationcontainedinthispresentationisrelevanttothoseassociations

PaidAffiliationsDr.Gerhardthasanassociationwiththefollowingprogramsororganizationsforwhichhereceivescompensation.Noneoftheinformationcontainedinthispresentationisrelevanttothatassociation.

Endicott CollegeDepartment of Behavior Analysis

ThispresentationwasdevelopedinconjunctionwithAngelaRodriguez,M.A.,BCBA.

Whentheclassroomcloses...

MostProfessionalsUnderstandingofTransitiontoAdulthood

Bothspecialeducatorsandbehavioranalystmayhaveover-specializedtheirprofessions

• Inspiteoftheimportanceofearlytransitionplanning,mostprofessionalsinterpret”early”tomeanjustpriortoage16-yearswhichisnotreallyearly.Inaddition,absentalong-termviewoftransitionplanning,parentstendtomakeinterventionchoicesthat,whilewellintended,havelittlerelationshiptofutureoutcomes.(Gothberg,Stegenga,&Cate,2017)• Quality[behavioranalytic]interventionshouldnotadheretojustonesetofstaticprocedures(e.g.,DTT,VB,PRT).InsteadbehavioranalystsneedtobeproficientintheimplementationofawidevarietyofinterventionsallofwhicharebasedupontheprinciplesandprocessofABA(Leaf,etal,2015)

Gothberg,J.,Stegenga,S.A.,&Cate,D.(2017)Rethinkingtheparadigm.InA.L.Ellis(Ed.)TransitioningChildrenwithDisabilities,pp129-144.NewMilford,CT:SensePublishers.

Leaf,J.B.,etal.(2016).Appliedbehavioranalysisisascienceand,therefore,progressive.JournalofAutismandDevelopmentalDisorders,,46,720-731.

OurPost-21Research-Base

Shattuck,etal,(2012)conductedacomprehensiveliteraturereviewregardingoriginalresearchonservicesandinterventionsaimedatsupportingsuccessinwork,education,independence,andsocialparticipationamongadultsaged18andolderwithanASDpublishedbetween2000and2010.

Shattuck,P.,etal,(2012).Servicesforadultswithautismspectrumdisorders.CanadianJournalofPsychiatry,57,284-291.

TheyconcludedthattheevidencebaseaboutservicesforadultswithanASDisunderdevelopedandcanbeconsideredafieldofinquirythatisrelativelyunformed.

Post-21OutcomesAfteranalyzingdatafromtheNLTS-2,Rouxandcolleaguesreported“youngadultswithautismhaveadifficulttimefollowinghighschoolforalmostanyoutcomeyouchoose- working,continuingschool,livingindependently,socializingandparticipatinginthecommunity,andstayinghealthyandsafe.Tocomplicatematters,manyoftheseyouthbegintheirjourneyintoadulthoodbysteppingoffaservicescliff.Accesstoneededsupportsandservicesdropsoffdramaticallyafterhighschool– withtoomanyhavingnohelpat.”Roux,etal,2015,p.8

Roux,AM,Shattuck,P,Rast,JE.Rava,JA,&Anderson,KA.(2015)NationalAutismIndicatorsReport:TransitionintoYoungAdulthood.Philadelphia,PA:LifeCourseOutcomesResearchProgram,A.J.DrexelAutismInstitute,DrexelUniversity

2018NationalAutismIndicatorsReport(Shattuck,etal,2018)

BasedondatafromtheNationalLongitudinalTransitionStudy-2012(NLTS-2012)andtheNationalSurveyofChildren’sHealth2016(NSCH2016).• Nearlyhalf(45%)ofparentsofteenswithASDdidnotparticipateinIEPtransitionplanning.• AboutoneinthreeteenswithASDcouldnotgettoplacesoutsidethehomeverywell,orwerenotallowedtodosoatall.• Almosttwo-thirds(64%)ofteenswithASDweretakingprescriptionmedications,andnearlyhalf(48%)weretakingmedicationsforattention,behavior,ormood.TheseratesweremuchhigherthanteenswithID.• Low-incomeandminoritystatusarehighlycorrelated– minorityyouthwithautismweremuchmorelikelytobelivinginlow- incomehouseholdscomparedtowhite,non-Hispanicyouth.

Shattuck,P.T.,Rast,J.E.,Roux,A.M.,Anderson,K.A.,Benevides,T.,Garfield,T.,McGheeHassrick,E,&Kuo,A.NationalAutismIndicatorsReport:HighSchoolStudentsontheAutismSpectrum.Philadelphia,PA:LifeCourseOutcomesProgram,A.J.DrexelAutismInstitute,DrexelUniversity,2018.

• Aboutoneinsix(16%)didnotreceiveneededhealthcare• OneinfourhouseholdsofteenswithASDreceivedatleastoneformofpublicassistance.• Morethanoneinfour(30%)householdsofteenswithASDreceivedSupplementalSecurityIncome(SSI)paymentsintheprevioustwoyears.• 23%-33%percentofteenswithASDlivedinahouseholdthatreceivedSupplementalNutritionAssistanceProgram(SNAP,alsoknownasfoodstamps)withintheprevioustwoyears.• 7%ofteenswithASDlivedinhouseholdsreceivingTemporaryAssistanceforNeedyFamilies(TANF).

Shattuck,P.T.,Rast,J.E.,Roux,A.M.,Anderson,K.A.,Benevides,T.,Garfield,T.,McGheeHassrick,E,&Kuo,A.NationalAutismIndicatorsReport:HighSchoolStudentsontheAutismSpectrum.Philadelphia,PA:LifeCourseOutcomesProgram,A.J.DrexelAutismInstitute,DrexelUniversity,2018.

Aworkingdefinitionofacriticalskill

Acriticalskillisonethat:

Onceacquired,enablestheindividualtoindependentlycompleteavarietyofrelevanttasksandengageindesiredactivities,AND

Isusedwithsufficientfrequencytoremainintheindividual’srepertoire.Theexceptionherearesafetyskillswhich,ideally,arelowresponsefrequencyskills,AND

Canbeacquiredwithinareasonabletimeframe*.

TheEssentialEight(McGreevy,Fry,&Cornwall,2012)

1. Makingrequests2. Waitingaftermakingrequests3. Acceptingremovals,makingtransitions,sharing,andtakingturns

4. Completing10consecutive,brief,previouslyacquiredtasks

5. Accepting‘No’6. Followingdirectionsrelatedtohealthandsafety7. Completingdailylivingskillsrelatedtohealthandsafety8. Toleratingsituationsrelatedtohealthandsafety

McGreevy,P.,Fry,T,&Cornwall,C.(2012).EssentialsforLiving:ACommunication,BehaviorandFundamentalSkillsAssessment,Curriculum,andTeachingManual.

ApplicationofSocialValidityInABA“AtthesametimethatIwashavingtowrestlewiththeproblemsofsubjectivemeasurementinJABA,mycolleaguesandIintheAchievementPlaceResearchProjectwerehavingsomeproblemswithunsolicitedsubjectivefeedbackonsimilarissues.Colleagues,editors,andcommunitymemberswereaskingusaboutthebehavioralgoalsthatwehadchosenfortrainingtheteaching-parentsandtheyouthsparticipatinginthecommunity-based,family-style,behavioraltreatmentprogramatAchievementPlace.Theywouldaskus:"Howdoyouknowwhatskillstoteach?Youtalkaboutappropriateskillsthisandappropriateskillsthat.Howdoyouknowthatthesearereallyappropriate?”(Wolf,1978,p.206)

SocialValidityinABA“Thesuggestionseemedtobethatsocietywouldneedtovalidateourworkonatleastthreelevels:1. Thesocialsignificanceofthegoals.Arethespecificbehavioral

goalsreallywhatsocietywants?2. Thesocialappropriatenessoftheprocedures.Dotheendsjustify

themeans?Thatis,dotheparticipants,caregiversandotherconsumersconsiderthetreatmentproceduresacceptable?

3. Thesocialimportanceoftheeffects.Areconsumerssatisfiedwiththeresults?Alltheresults,includinganyunpredictedones?

Wehavecometorefertotheseasjudgementsofsocialvalidity.”(Wolf,1978,p.207)

SocialValidityinABA”Itisclearthatanumberofthemostimportantconceptsofourculturearesubjective,perhapseventhemostimportant.MartinLuther,asthestorygoes,wasseverelycriticizedforsettingPotestant [sic]hymnstothepopularmelodiesofsongsanddancesofthetime.Hereplied,"Whyshouldweletthedevilhaveallthebesttunes?"Well,whyshouldwelettheothershaveallofthebesthumangoalsandsocialproblems?”(Wolf,1978,p.210)

ApplicationofSocialValidity20Questions

Consideration Response1 Istheskillderivedfromacomprehensiveandongoing

assessment?q Yesq No

2 Istheskillaprerequisitetoamorecomplex,yetimportantskill(e.g.,LetterIDasaprerequisitetoReading)?

q Yesq No

3 Istheskillonethatcanbeofuseacrossmultipleenvironments? q Yesq No4 Cantheskillbeacquiredbythestudentinareasonabletime

frame?q Yesq No

5 Istheskillonethatwillstillbeusefulin3-5years? q Yesq No6 Istheskillonethatlendsitselftoanacceptabledegreeof

instructionalintensity?q Yesq No

7 Onceacquired,istheskillonethestudentwillusewithsufficientfrequencythatitwillbeeasilymaintained?

q Yesq No

Consideration Response

8 Istheskillthemostdirect,simplestwaytoachievethedesiredoutcome?

q Yesq No

9 Doestheskillimprovethestudent’sabilitytocommunicate? q Yesq No10 Doestheskillsupportsocialinclusionand/orpeerrelationships? q Yesq No11 Doestheskillultimatepromoteindependenceviaadaptive

behavior?q Yesq No

12 Doestheskillultimatelypromoteindependenceviaself-management?

q Yesq No

13 Doestheskillultimatelypromoteindividualsafetyskill q Yesq No14 Iftheskilluses“hitech”isitthemostcurrenttechavailable? q Yesq No

ApplicationofSocialValidity20Questions

Consideration Response

15 Istheskillaonethatstudentmightfindenjoyable? q Yesq No16 Istheskillonethecontributestothestudent’shealthorahealthy

lifestyle(e.g.,exercise)?q Yes q No

17 Istheskillonethatisculturallyrelevant? q Yesq No18 Istheskillofimportancetothestudent’sfamily? q Yesq No19 Istheskillonethathasrelevancetofutureemployment? q Yesq No20 Istheskillonethathasrelevancetofuturelifeinthecommunity,

outsideofthefamilyhome?q Yesq No

ApplicationofSocialValidity20Questions

Absentangoodunderstandingofsocialvalidity,behavioranalystswillalmostalwaysbeatalosswhenprioritizingskillstargetedforacquisitionaspartofthetransitionprocess.Except,hopefullyforthenext10…

XX

Critical Skill - Toileting (Bowel and Urine)

Goal– Independentuseofabathroom,whennecessary,includinglockingthedoor,wipingseat,wipingself(ifnecessary),washinghands,exitingbathroomandreturnto“location”

CriticalSkill- Dressing

• Goal– Closingdoorforprivacy,independentselectionofappropriateclothes,donningclothesincorrectorderandorientationandcheckingappearancebeforeopeningdoorandexitingarea.

CriticalSkill-IndependentEating

Goal– Abletocorrectlyuseallappropriateutensils(knife,fork,spoon)toeatavarietyoffoodsneatlyandataculturallyacceptedpace.

CriticalSkill–Bathing/SelfCare

Goal– Todemonstratetheabilitytoindependentlybathe/showerandcompleterelevantselfcare/hygieneskills(e.g.,toothbrushing,grooming,etc.)

CriticalSkill– HouseholdParticipation

Goal– Independentcompletionofavarietyofhouseholdchoresor,inourfield,“ADLs”.Theissueisnotwhethertotargettheseskillsbutrather,whentotargettheseskills.

CriticalSkill– Abletolearninagroup

• Goal– Toacquirenewskillswhenpresentedviadyadortriadinstructionatarateofacquisitionsimilartothatdocumentedvia1:1instruction.

CriticalSkill–Self

Management

Goal– Todemonstratetheabilitytoidentifyone’sownbehavioraseitherappropriateorinappropriatedeliverpotentialreinforcementintheabsenceofsupervision.

CriticalSkill– ProblemSolving/VariableResponding

Goal– Todemonstratetheabilitytooffermorethanonepotentialsolutionwhenpresentedwitharelevantproblemorchallenge.

CriticalSkill– MaintainPhysicalSafetyGoal1– Demonstratetheabilitytoidentifyandavoidpotential”non-human”dangersintheimmediateenvironment.

Goal2– Demonstrateabilitytodiscriminatebetween“safe”and“unsafe”peopleandrespondappropriately.

Goal3– Demonstrateareasonabledegreeofnoncompliancewhenpresentedwith“privacyrequests”fromanunapprovedperson.

Goal4– Demonstrateabilitytoparticipateinhealthcaremanagementactivities(e.g.,doctorordentistvisits).

CriticalSkill-CommunicationGoal– Demonstratetheabilitytomakeone’swantsandneedsknowntonaïvelistenersacrossmultipleenvironments.

No!Help

Stop

Give me spaceLet me

figure it out

That’s mine

That’s not

mine!

I said Stop!I don’t like this

Please don’t

touch me

Give me

privacy

Don’t help

me

Leave me alone

Yes

Not Okay

Self Advocacy

GlobalCriticalSkill–AdaptiveBehavior

Thoseskillsorabilitiesthatenableanindividualtomeetstandardsofindependenceexpectedofhisorherageandsocialgroup.Adaptivebehaviorchangesaccordingtoaperson’sage,culturalexpectations,andenvironmentaldemands.(Heward,2005).

“Adaptivebehaviorwillgetyouthroughtimesofnoacademicskillsbetterthanacademicskillswillgetyouthroughtimesofnoadaptivebehavior(Gerhardt,2014)

AndinPractice…

Student’sTransitionStatementIn5-years-timeSpencerwillbe20-yearsoldandwillbe“ready”asifheistransitioningtoliveonhisown.Thisincludesindependentinself-wakening,showering, dressing,toileting, tooth-brushing,laundry,cooking,andothergenerallifeskills.Hewillindependentlyfollowascheduleofactivitiesforupto8-consecutivehours.Spencerwilldemonstratepersonalresponsibilityrelatedtomaintaininghisroomneatly,purchasingcorrectsizeclothes,keepinginventoryforfoodshopping,etc.Intermsofthecommunity,Spencerwillbeabletoshopforhimself(includingmeals)andothernecessitiesandpreferences.Hewillbeabletoindependentlynavigateincreasinglygreaterdistancescommunitytoparticipateincommunityliving.Spencerwillbeabletodistinguishgoodvsbadtouchanddiscriminatedifferentrelationshiproles(Momvs.Friendvs.Staffvs.Acquaintancevs.Stranger).Hewillbeabletousehissmartphone tomakeandreceivecallsandtexts,contactsomeoneforhelp,describehislocationtoanotherperson(oruse“sendlocation”function)and,whenappropriate,killsometimeplayingagame.Spencerwillbeinterningatajobrequiringattentiontodetail(assemblingmotherboards).Hewillbeabletoworkfor90-minutesindependentlyandcheckhiscompletedworkforaccuracy.Hewillrespondtodirectionsfromhissupervisorsandsociallyinteracttowhateverdegreeappropriatewithhiscoworkers.Hewillmakelunchforworkorpurchaselunchatworkasappropriate.Spencerwillbeabletoinitiateindependentchoiceswithregardtoleisureactivitieswhichmayincludeteambowling,goingtoarcade,playingmini-golf,orhangingatthemall.

Define“Independence”forthisIndividual• Forthisindividual,doesindependencemean• Abletofollowanactivityschedulethatisdevelopedbyparentorstaff?• Abletofollowanactivityschedulethatisdevelopedbytheindividual?• Doesownlaundrywhendirectedtodoso?• Doesownlaundrywhenitislaundry-dayorthelaundrybasketisfull?• Shopsfora10-itemgrocerylistwithparent/stafffollowingalong“justincase”?• Shopsfora10-itemgrocerylistwithparent/staffwaitingatthefrontofthestore?• Shopsfora10-itemgrocerylistwithparent/staffwaitinginthecar?• Seeksassistancewhenneededincontrivedsituations?• Seeksassistancewhenneededinnovelsituations?• Correctlysolvesmostproblemswithoutseeingassistance?

SphereofIntervention:CareerInordertobegainfullyemployedSpencerE.needsthefollowingprograms/skillstobetargeted.

Skill Challenge RecommendationAbility toworkproductivelyfor 90minuteswith aproductionratecommensuratetootheremployees,onanassembly taskrequiringsignificantattentiontodetail(e.g.assemblingmotherboards)

• Spencercanfollowanactivityschedulebutthe extenttowhichheisfullyengagedduringthattimeisnotdocumented.

• Needtolocatetrainingtasksoftargeteddetailandcomplexity.

1. Assess actualdurationofproductiveengagementandrateofproductivityduringthattime.Developinstructionalprogramtosystematicallyincreasebothby2/18

2. CoordinationwithSLECoordinatortolocaterequiredtasks.Provideintensiveinterventioninproductionskillsby2/18

3. ProvideSpencerwithtasksthatinvolvebothseatedworkandtasksthatinvolvehimmovingaroundvariouslocationswithinthebuildingduringthesameactivityschedule

4. MonitorSpencereitherbyvideocameraorcovertlytoensureheremainsengagedwhenhethinksheisnotbeingwatchedbyateacher

Checkcompletedworkforquality controlwith100%accuracy.

• Spencer iscurrentlyunabletoidentify“correct”vs”incorrect”completionoflargenumbersofcompetedwork.

1. Develop andimplementinstructionalprogramtoteachthisdiscriminationaslaststepinproductionskillchainby6/18

Stop workwhenshortofsuppliesandeitherretrieveonownorseekassistance.

• This skillseemswellwithinSpencer’scurrentrangeofcompetenceifnotyetspecificallytaught.

1. Assessskillacrossmultipletasksandprovideinterventionifnecessaryby2/18

2. Whenoutofmaterials,Spencershouldfirstbetaughttofindmoreonhisown,thentoaskforhelp

Sociallyinteractwithsupervisorandco-workers • Spencerhasalimited, andinconsistently displayed,socialrepertoire.

1. Revisit directinstructionandcollectaccurate/consistentdataoninitiationofgreeting,latencytorespondtogreeting,andaccuracyofresponseby2/18

2. IrecommendthisbetargetedeverydaybecauseitsuchanimportantskillintheworkplaceANDitisfeasibleskillsforSpencer.Heshouldalsoworkonengagingin‘smalltalk’andknowingwhen/howtointerrupt.

SphereofIntervention:CareerInordertobegainfullyemployedSpencerE.needsthefollowingprograms/skillstobetargeted.

Skill Challenge RecommendationPurchasearealisticvariety offoodfor lunchatworkandeat neatly

• Spencercurrentlyeats alimitedarrayoffoodsandverylittleinthewayofprotein.

1. AprogramdesignedtoaddressfoodpreferenceswasdiscussedatDecemberClinicandwillbeimplementedin1/18

2. Assesssocial”niceties”atmealtime.

Safetyatworkincluding publicrestroomuse,respondingtofirealarms,respondingtosupervisor,usecellphonetoreportlocation,etc.

• Public restroomisacurrenttargetofinstructionandispracticedinvivo.

• TheextenttowhichSpencerindependentlyvacatespremisesinresponsetoalarmisunknown.

1. Spencerwillbehavehisowncellphone starting1/18andcellphonecompetenciescanbeaddressedthen.

2. Assessindependentresponsetofirealarmin1/183. Developassertiverespondingprogram.

SphereofIntervention:HomeWithinhishome,SpencerE.shouldbeabletoindependently(orwithminimalsupports),accomplishthefollowing.

Skill Challenge RecommendationSpencerneedstoindependently wakehimselfupinthemorningandcompletehisAMroutine.

• Anewskillandsoneedstobeassessed.Hedoes,however,demonstratetheabilitytorespondtoanalarm(timer)whichisaprerequisiteskill.

1. Probe respondingtoamorningalarmathome2. DevelopalistofmorningactivitiesSpencerneedsto

complete

Spencer needstoindependentlycompleteanumberadaptivetasksathomeincludinglaundry,cooking,loadingdishwasher,makingbed,maintainingroomneatly,etc.

• Giventhenumberofskillssomeprioritizationwillneedtotakeplace.

• Identificationof”normative”masteryoutcomesforeachskill.

• Mayneedtobeincorporatedintoactivityschedulewithinitiationbeingoffunctionofschedule.

1. Continue teachingadditionalsightwordsthatcanbeincorporatedintoSpencer’sactivityschedule.Theseshouldincludeactivitiesofdailyliving.Newsetincludes“makelunch”,“makecopies”,“shred”,“dolaundry”,“empty/loaddishwasher”

Spencer needstoindependentlycompleteanumberhygieneskillsathomeincludingshowering,shaving,andbrushinghisteeth.

• Giventhenumberofskillssomeprioritizationwillneedtotakeplace.

• Showeringcurrentlybeingtaughtathomebyfather.CanEPICprovideadditionalinterventiononcenewshowerisinstalled?

1. Spenceriscurrentlybeingtaughttoshowermoreindependentlyinschool.

2. Whenthenewshower isinstalledtherewillbemorefrequentopportunitiestopracticeanddevelopindividualizedprotocols.

3. TheshoweratthelifeskillshouseisavailableforSpencertopracticeeveryday.

Spencerneeds tofollowa 2-houractivityschedulewhenathome.

• Someofthetasks thatcouldbeincludedinafull,2-hourschedulewillneedtobetaughtseparatelyfirst.

1. Continue toexpandonhiscurrentactivityscheduleatanestimatedrateof1activity/month?2activities/month.Let’strytoquantifythis.

Spencer needstoexpandthelistofmealshemakesforhimself.Focusonchoiceplusnutrition.

• Spencercurrentlyeats alimitedarrayoffoodsandverylittleinthewayofprotein.

• Whenadditionalpreferredfoodsareidentifiedinstructionalprogramscanbedeveloped.

1. Familytosendinavarietyoffoods(meatballs,chicken, pastawithsauce,etc.).Followupwithfamilynolaterthan1/19/18

2. Schoolcanworkonintroducingthesefoods

SphereofIntervention:Leisure

Skill Challenge Recommendation

Spencer willparticipateinNJSpecialOlympics None, specifically. 1. Researchwebsiteforfurtherinformationand providefamilywithinfoby1/19/18

Spencer mayparticipateinaninter-ABA-Schoolbowlingleague.

League needstobedeveloped.PossibilitywillbeinvestigatedbyEDin1/18

Spencerwillexpandhisrepertoire ofpreferredvideogames(monitororarcadebased).

Thechallenge willbetofindpreferred,enjoyablegames.

1. Continue withlearningforleisurewhichincludestripstoarcades.Followuptomakecertaindataarebeingconsistentlycollected.

Spencerneedstousesmart phoneapptokilltimewhenwaitingforanactivityor”hangingatthemall”

Spencerwillhaveapersonalsmart phonein1/18.

1. When phoneisobtainedbeginintroducingnewgamesorotheractivitiesandinstructionifnecessary.

Spencerwillcontinuerunningwithstaffandfamily andcontinue hisparticipationinSpartanRuns.

Generally requires organizationandtravelsupportofstafforfamily.

1. Continuetocollaborate withfamilyforcontinuedparticipation

Arepertoireofindependentandaccessibleleisureskillsshouldbedeveloped.

Needstobemoresystematically investigatedtoidentifycharacterizesofpotentialleisureactivities.

1. Continueintroducingmoreactivitiesatschool, home,andduringlearningforleisure.Independenceandpreferencewillbeusedasindicatorsof“leisure”.

SpencerE.shouldbeabletoindependently(orwithminimalsupports),accessandutilizethefollowingleisureskills.

SphereofIntervention:CommunitySpencerE.needstobeabletoaccess,orutilize,thefollowingskillswithminimalprompting.

Skill Challenge RecommendationSpencerwillabletopurchasehisownclothes bysizeandcolor. • Doesnotcurrentlyhaveabilitytostatehissizeand

locatesizeinstore.• Considertargetingonestoreandonebrandofclothestoassurecorrectsizeandmatch.

1. Determinesizinginformationforvarioustypesofclothes

2. Probecurrentabilitytomakeanappropriateclothingselection(basedonweather,sizing,style,etc.)by1/31/18

Independentlynavigateincreasinglygreaterdistances(i.e.,malls).

• Currently walksappropriatelywithstaffincommunitybuttrueindependencehasnotbeentested.

• Communitylocationswherecanestablishandpracticeskillneedtobeidentified.

• Definitionof“greatdistance”• Cellphoneuseshouldbemasteredfirst.

1. When phonehasbeenobtainedbeginteachingtextingandresumeteachingphonecalls.

2. Developcriteriaforincreasingindependenceinthecommunityincludingobtainingriskconsentby1/31/18

Usecellphone eithervocallydescribelocationtoanotherpersonortextlocation

• Spencerwillhavepersonalcellphonein1/18.• Instructionin providingvocaldescriptionmaybedifficult.“TextMyLocation’maybeabetteroption.

• Willrequireasignificantintensityofinstructionandongoingprobestoensuremaintenanceofacquiredskills.

1. Whenphonehasbeenobtainedreintroducereportinglocationverballyandbeginteachingtextingfromamodel..

Stranger/Friend Discrimination. • Need todeterminehowmanycategoriesofpeopleandtherulesforeach.

1. Collaborate withfamilytoidentifyrulesforeachsetofpeopleandunderwhatcircumstances.Implementinstructionby2/1/18

FamilyResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career 1. CoordinatewithEPICaprogramtoexpandSpencer'sfoodpreferencesacrossenvironments

Home 1. Prioritizeskillsathometobetaughtfirst,second,etc.2. Expandcurrentactivityschedulebybothtimeandactivity..3. Coordinate withEPIC,ifdesired,regardingSpencershoweringprogramoncethenewteachingshowerininstalled.4. Expanduponcurrentfoodpreferences.5. Prioritizeandprovidedirectandconsistentinstructioninanumberadaptivetasksincludinglaundry,cooking,loading

dishwasher,makingbed,maintainingroomneatly,etc.6. Prioritizeindependentcompletionofanumberhygieneskillsathomeincludingshowering,shaving,andbrushinghisteeth.

Leisure 1. CoordinatewithEPICondevelopmentofBowingLeague2. MakecontactwithSpecialOlympicsandfindoutwhatrequirementsforparticipation.3. ContinuerunningandSpartanRuns4. CoordinatewithEPIContheidentificationofpreferredelectronicgames,etc.

Community 1. Identifysizesand preferencesforclothesshopping.Thisisalowfrequency skillbutanimportantonenonetheless.2. CoordinatewithEPIConinstructionincellphoneuseandgeneralizedapplication3. CoordinatewithEPICondeterminingboundariesandrulesforfamilyv.friend,v.co-worker,v.stranger.

School 1. Continue monitoringimplementationofthisplan

EPIC’sResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career 1. Assess durationofproductiveengagementandrateofproductivityduringengagedtime.Developinstructionalprogram

tosystematicallyincreasebothby2/18

2. CoordinationwithSLECoordinatortolocatecomplex,highdetailtasks.Provideintensiveinterventioninproductionskills

startingin2/18.Emphasisonengagement,rate,andqualitycontrol.

3. Develop andimplementinstructionalprogramtoteachqualitycontrol/self-correctionofproductionskillschainby6/18

4. Revisit directinstructionandcollectaccurate/consistentdataoninitiationofgreeting,latencytorespondtogreeting,and

accuracyofresponseby2/18

5. Developandimplementprogramdesignedtoexpandfoodpreferencesaswasdiscussed

6. Beginassessmentofcellphoneuseskills in1/18

7. Assessindependentresponsetofirealarmin1/18

8. Developassertiverespondingprogram(e.g.,afunctionalandappropriate“no”)

Home 1. Coordinateand cooperatewithfamilyasrequested.

Leisure 1. Coordinate withfamilyre:SpecialOlympics

2. Investigatepotentialofbowlingleague

3. Completepreferenceassessmentfordifferentvideogamesincludingidentificationofsmartphonegames.

Community 1. Provideinstructionincellphoneuseincommunity

2. IdentifylocationsinwhichSpencercansafelybetaughtindependenceacrossgreaterdistances..Developprogramand

provideintervention.

3. Evaluateinterpersonaldiscriminationstoestablishsocial/behavioralrulesforeachandpracticeinnaturalenvironment.

DesiredcommunityResponsibilityinSupportofTransitionPrograming

AREA RESPONSIBLITY

Career 1. Allow initialinternship/SLEopportunity

Leisure 1. EncouragemoresocialinclusioninSpartanRunandcommunityrunning.Alocalrunninggroup,perhaps?

Community 1. AcceptfeedbackandinstructionfromEPICandFamilyregardingbestwaytointeractwithSpencerinthecommunity.

Closingthoughts

Teachyourstudentstowipeafterabowelmovement