Natural Supports for People with Autism Spectrum Disorder

Building Your Future Project

Intensive Training

Does anyone work with someone that you don’t understand?

What do you do about that?Group Discussion

THE SOLUTION IS ALWAYS IN THE

PROBLEM

Who better knows the expectations within the job…

An outside person or a co-worker!

Key Questions

• What Are Natural Support?

• Why Would I Use Natural Supports?

• What is the Medium of Exchange for people who are “typical” to connect with people with ASD?

• Are you in, What do you need to know, and How do we keep you coming back

• (Recruitment, Training and Maintenance)

Social Competency Research

• Students with adequate social skills are more likely to have positive outcomes, while significant social difficulties place the child at risk for developing later problem behaviors (Koegel, Koegel, & Surratt, 1992).

• Venter, Lord, and Schopler (1992) conducted a study of children with autism and found that social skills during childhood were strong predictors of adult adaptive functioning.

Social Competency Research• Educational programming for students

with ASD should include goals for improving social skills with both adults and peers (National Research Council, 2001).

• Weiss and Harris (2001) refer to the

scarcity of research targeting social skill development in adolescents and older students.– Many interventions targeting social skills

development have inadequately addressed the social validity of outcomes.

Social Competency Research• The more traditional approaches to teaching social

skills have not been highly effective as indicated in a meta analysis conducted by Bellini et al., (2007).

• Many peer-mediated intervention programs are too

narrow in scope, such as the Circle of Friends approach, to produce significant long-term impact on participants.

• Efforts to successfully teach social skills to students with ASD can be undermined by problems with generalization to new settings, people, and materials (Parsons & Mitchell, 2002; Zager & Shamow, 2005).

What Does This Research Mean To Us?

Social Competency and ASD

Research summarized by Rogers (2000)

indicate a shift in the field of ASD, from:

Adult-Directed Instructional Strategies

TO

Peer-Mediated Interventions

Numerous studies have demonstrated the

effectiveness of peer-mediated strategies to

facilitate social interactions.

Social Competency and ASD

• The National Research Council report (2001) recommended that students with ASD be taught skills in natural contexts.

• One suggestion is the use of multiple peers in various settings to improve generalization (Kamps et al., 1997; Kamps et al., 2002).

Social Competency and ASD

Another suggestion is providing more

time for instruction and social interaction

with typically developing peers a strategy

that will likely result in both quicker skill

acquisition and better maintenance of

improvements (Strain, Kohler, Storey, &

Danko, 1994).

Evidence Based Practices: Social Skills and Peer Mediated Instruction and Intervention

“Peer mediated instruction and intervention

has been shown to have positive effects on

academic, interpersonal and personal-social

development and may be the largest and

most empirically supported type of social

intervention for learners with ASD”

(Bass & Mulick, 2007; Maheady, Harper & Mailette, 2001; McConnell, 2002)

Goals for Students with ASD

Socialization Skills

Independent Skills

Development of the Concept

Local School District - 7000 Students

40 Miles North of Detroit, Oakland County, Michigan

Center Program for Students with Autism

13 Local School Districts in Oakland County

Send Students to the Autistic Program

History of the Autistic Program

1987 - Elementary

1990 - Middle School

1992 - High School

1993 - Pre-Primary Program

1994 – 2nd Elementary

1996 - Post High School Program

1999 – 2nd Middle School

Full Continuum Concepts

• Break Card

• Modifications – Ed Strats

• Visual Supports

Two Things We Were Doing OK

• 4th and 5th Grade Students coming down during indoor recess.

• Weekly team meetings…True Brainstorming: all ideas are good ideas and the best idea in the room stays on the table

Beginning Stages of Students with Students

• Letter, Number, and Color Games

• Common Goal for both sets of students

• Reinforcing to both students with ASD and general education students

• In beginning stages use food as a motivator

Two Things We Were Doing OK

• 4th and 5th Grade Students coming down during indoor recess.

• Weekly team meetings…True Brainstorming: all ideas are good ideas and the best idea in the room stays on the table

Evolution of the Clarkston Autistic Program

Reverse Mainstream > > Moderated Behavior

Integration > > Behavioral Systems

Integration > > Academic Systems

Integration > > Socialization Systems

Reverse Mainstream > > Curriculum Makeover

Evolution of the Clarkston Autistic Program

Reverse Mainstream > > Moderated Behavior

Reverse Mainstream > > Curriculum Makeover

Integration > > Behavioral Systems

Integration > > Academic Systems

Integration > > Socialization Systems

The LINK Program

• 1990 – 17 Study Hall Volunteers

• 2002 – 800 General Education Students 72 Students with ASD

• Utilizing the Most Appropriate Resource in

Public Education to Teach Social Skills to Students with ASD

Post High School Video

• Use to educate potential job placement staff

• Assist parents in understanding ultimate goal of the program

• Creates common understanding about ASD and the workplace

Post High School Vocational Placements

• Oakland University - Library• ACO Hardware • Independence Township Library• Bank One - Clarkston• Dunkin’ Donuts• Subway

Article Written about Marty at O.U.

Post High School Vocational Placements

• F.Y.E. - Great Lakes Crossing• Target• OATS Horse Farm• C.C.A.• William Beaumont Hospital• The Greenery• Overtyme Restaurant

Goals for Students with ASD

Socialization Skills

Independent Skills

Two Ways to Address A Socialization Deficit

• Utilize social skills curriculum to teach isolated social skills to students with autism spectrum disorder in specific settings and then practice isolated skills in a generalized setting.

• Teach general education students about autism spectrum disorder and specific information about students with autism spectrum disorder in their building. Develop tolerance and acceptance within the general education population. Students with autism spectrum disorder will then be able to practice social skills in all settings within the building gaining competency in natural environments.

Peer to Peer Support Programs

Teach general education students about

Autism Spectrum Disorder and specific

information about students with autism

spectrum disorder in their building. Develop

tolerance and acceptance within the general

education population. Students with autism

spectrum disorder will then be able to practice

social skills in all settings within the building

gaining competency in natural environments.

Medium of Exchange

How to connect the typical person to the person with ASD?

Definition of Medium of Exchange

• The medium of exchange is any material, task, prop, interest area, etc. that connects a person with ASD to a typical person

• Typically the medium of exchange is something that does not require language for the connection or interaction to occur

Medium of Exchange

Material

Person with ASD Typical Person

Medium of ExchangeRain Man Example

• Creating Connections• Medium of Exchange as an Avenue

for Opportunity• Organizing the Person with ASD • Realization of Skills and Where

they fit within the Community Available to the Person with ASD

Examples of Medium of Exchange

• Work Talk• After Work Activities• Encyclopedic Interests• Computer Interests and Related

Technology• Bowling and Other Leagues• WII• Intense Interests

The STATE of Michigan

Most Bowling Leagues

What Connects You with Other People?

What are yourCharacteristics/

Interests?

What are CharacteristicsInterests of a Significant

Person in yourLife?

What is the Same?

This is the Concept of Medium of Exchange

What it is for you is what it is for the person with ASD

Connecting with Other People…

Isn’t That What This Is All About!

Medium of ExchangeVerbal Fascinations

• Movies - Matt

• Nose Game – Robert

• No Pink – Robert

AwakeningsMedium of Exchange

• Try to discover the interest areas of the people with ASD to develop mediums

• Motor Planning and Organization• Staff and Natural Supports may need to

initiate the medium in the environments for Person with ASD

• Staff and Natural Supports are excellent resources in developing new mediums

Care for the Person

Respect for the Disability

Natural Support Benefits to People with ASD

• Socialization Opportunities• Work Place Norms and Expectations• Independence• Larger Support Network• More Models of Work Tasks• Others Noticing Subtle Changes to the

Environment

Peer to Peer BenefitsNatural Supports

• Organizational Skills• Problem Solving Skills• Connection to Employment• Diversity• Responsibility• Collaboration• Self Esteem

Reciprocal Benefits

1. Opportunities for learning in

both populations.

2. Growth occurs in both

populations.

3. Cost effective and productive.

Questions or Concerns about Medium of Exchange

Determine a Medium of Exchange for the Students You Work With

P.O.C. – 20 Minutes

Recruitment of the Natural Supports

Do I Have to do This or Worse are You Going to Make Me Do This?

My Plate is Full and How Will this Help?

Steps for Recruitment• Provide information about ASD and

specific people with ASD in the job to other people

• Provide interested volunteers the opportunity

• Organize and schedule the natural supports throughout the day

Peer to Peer and Other Natural Supports Recruitment

• All People Make Great Supports

• After-Work Activities

• Management Needs to Be Involved

• What can this help us with? Will this move me forward in the organization?

How and Where Do You Find Natural Supports for People with

ASD?

How and Where?Staff Meetings

Participation in Peer to Peer Support Programs During School

Ask for Volunteers

Find the Co-Workers Looking for a Challenge

Get a Commitment Agreement

Questions or Comments about Recruitment of Peers or Other

Natural Supports?

Where will your team recruit natural supports?

POC – 15 Minutes

Natural Supports Training

Natural Supports Introductions

• Natural support’s name• Natural support’s hours of employment• Hobbies• Family members• Why they want to be a natural support

for people with ASD

Group Discussion about Autism Spectrum Disorder

• Ask the natural supports what they know about Autism Spectrum Disorder

• Write ideas on the board• Engage natural supports in discussion

about ASD

Information About ASD

• Approximately 1 in 110• Rapidly Increasing in Numbers of Students• 4 times more common in males than females• Cause is Unknown• You are born with autism spectrum disorder• You can’t catch it

Autism and IdiosyncraticBehavior - Rain Man

• Over-reaction to changes of schedule

• Personal Property is Valued/Obsession

• Material Organization is more important than Object/Material

• May use idiosyncratic speech

Characteristics of ASD

• Social Skill Issues

• Communication

• Intense Interests and Repetitive Behavior

Characteristics of ASDSocial Skill Issues

• Peer Relationships

• Sharing Information

• Misunderstanding of Social Situations

• Reciprocal Social Interactions

Characteristics of ASDCommunication

• Verbal and Non-verbal

• Talk about Interests

• May not seem interested in what others are talking about

• May say inappropriate words

Characteristics of ASD - Intense Interest and Repetitive Behaviors

• Intense Interest in Certain Topic Areas

• May Like to Do the Same Thing Over and Over

• May Like Things to Stay the Same – Difficult with Transition

• Visual Supports• Communication Systems• Self Management Systems• Case Conference (Team Process)

Strategies that Work with People with ASD

David’s Yes/No Communication System

Yes No

Ryan’s Communication System

Food Drink Bathroom

More Help Other

Break Yes No

Self Management

Systems

Self Management

Systems

Return Merchandise

Self Management Systems

Natural Supports and Case Conferences

• Weekly or Monthly Meetings

• Problem Solving Focus

• May Include the Person with ASD

• Teaching Support Strategies in the Case Conference that will Generalize to the Work Environment

Translation of Meeting Mechanics

• Enhance understanding of ASD• Translate understanding to the person with

ASD• Change Graphics to facilitate the discussion

in the location they are

• Case conference – peer to peer problem solving format

• 2 hour presentation

Case Conference Information Sheet

• Each staff fills out the sheet at the beginning of the case conference

• The facilitator collects the sheets and determines if there are any patterns in the answers

• The information from the sheet generates the discussion using the board

Case Conference Information Sheet You do not need to put your name on this sheet. This is an information sharing sheet used to enhance the information presented during this case conference Please answer the following questions as openly and honestly as possible. If you do not have an answer or if you have an answer but it is hard to put into words just do your best. 1. The best experience with (Student with ASD) this month is when ___________________________________________________ ___________________________________________________ 2. Something I wasn’t sure how to handle this month was ________ ____________________________________________________ 3. I was frustrated by (Student with ASD) this month when he/she ____________________________________________________ 4. The biggest accomplishment that (Student with ASD) made while I was supporting him/her was _____________________________ ____________________________________________________ 5. The biggest accomplishment that I have made being a (Peer to Peer Support) is ______________________________________ 6. Are you interested in continuing to be a (Peer to Peer Support) Yes No If yes, which student would you like to support________ 7. What three suggestions would you give to the (Peer to Peer Supports) supporting the (Student with ASD) ____________________________________________________ ____________________________________________________ ____________________________________________________ (Give the students directions about where to put the sheets when completed. Ensure confidentiality.)

Case Conference Mechanics and Outcomes

• Utilize meeting mechanics – always use the board

• Positives – Concerns – Brainstorming• Information from the board is written on

the Case Conference information sheet• Copies are made for each staff member,

person with ASD, and parent or guardian if appropriate

In an effort to keep the parents, staff and peers students informed of the effective strategies that work for (Student with ASD Name) had a case conference on (Date )

Some positive things discussed about (Student with ASD)were: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

Some concerns that were raised about (Student with ASD) were: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

_______________________________________________________ The action plan to resolve the concerns for (Student with ASD) is: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________

If you have any questions or concerns please contact caseload teacher _______________________ ______________________ (Staff Person’s Signature) (Date)

ETA Communication Sheet Marty Date: ________________________________ Staff Member from ETA: ___________________________________________ Technical Information: Questions about the Student: Staff Member from Clarkston Community Schools: ___________________________________________ Information about Autism? Questions about the Softwear: Questions about ETA? Other Concerns or Comments:

Time sheet for ETA Worker: ______________________________

Staff Person: ____________________________

DATE TIME IN TIME OUT TOTAL HOURS ADDITIONAL INFO

Utilizing MRS and Transition Coordinators as Facilitators of Work

Place Case Conferences

Maintenance of the Peer to Peer and Natural Supports

Have you ever volunteered for any organization?

What made you continue to stay with volunteering?

Group Discussion

Natural Supports Maintenance

• Employee of the Month• Work Talk• After Work Celebrations• League Opportunities• Fantasy Football• Sports Pools• Lotto Pools

People with ASD must be Approachable

• Socially Appropriate Dress

-Barbie Boots

-Jelly Bean Jogging Suit

• Behavioral Issues

-Stereotypical Behaviors

• Social Issues– Picking Nose – Spitting

The Network• Do the natural supports go beyond

the work environment?• Personality of the Person with ASD• Climate of the Employment

Community• Dan and the Casino• Ryan’s Party

Develop an On-Line LINK Social Network

• Track Graduated LINKS• Allow Networking Between LINKS• Post Opportunities for Graduated LINKS by

RCN• Provide Parents List of Graduated LINKS

by RCN• Social Network will be Hosted by a Person

with ASD

Imagine the Possibilities

• Co-Workers Understanding of ASD• Community College Opportunities• University Opportunities• Semi-Independent and Independent Living

Arrangements• Social Opportunities• Community Opportunities

Define Natural Supports in Terms of the Workplace Rather Than…

Alternatives to Traditional Job Coaching

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Reconsideration of Job Analysis

Focus on Cultural Analysis of the Employment Environment rather than

a Focus on Job Analysis

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Natural Supports – Two Powerful Forces that Affect the Success

1. Features of Naturalness – Gain Access

2. Individual Needs – Assure The Needs of the Individual are Met

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7 Phase Sequence for Balancing Naturalness and Individual Needs

• Determine Natural Ways• Determine Natural Means• Identify Natural People• Facilitate Successful Performance• Support/Substitute for Natural People• Suggest More Effective Natural Means• Adapt/Modify Natural Ways

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Determine Natural Ways• Methods of Performance for Targeted Job Tasks• Step by Step Procedures• The Culture of the Workplace• The Manner in Which Workers Interact• The Managerial Style of the Setting• All Other Natural Features which Describe the

Unique Characteristics of Performance and Behavior Desired by the Employer

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This Phase is Crucial…

1. Information for New Employee to Fit In

2. Easier for Supervisors and Co-Workers to Provide Assistance and Troubleshoot Problems Due to the Similarity of Performance

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Purpose of Socialization as an Instructional Variable

• Modeling

• Participation

• Social Learning Theory

Social Learning TheoryAlbert Bandura

• Attention

• Retention

• Reproduction

• Motivation

Determine Natural Means

1. Ask the Employer to Describe the Procedures Used

2. Observe Teachings Done by Employees in the Setting

3. Ask to be Taught How to Perform the Job Task by the Persons Who Would Naturally Assist the Jobs to be Performed

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How Did You Learn How to Write an IEP?

Identify Natural People

• Identify and Enlist the Natural People Who Typically Support New Employees to Perform Their Jobs

• Most Novel Aspect of the Natural Supports for Traditional Providers of Supported Employment Services

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In the Past…Job Developers Often Promised Employers…

1. Job Trainers Would Provide all the Assistance Necessary for Successful Performance

2. They Would Have No Investment in the Initial Training or Support of the Employee

3. Job Trainers Would Act as an Interpreter for All the Information, Rules, Policies and Activities

4. This Role Placed the Job Coach Between the Employer and the Employee

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Similar to Issues with the Over-reliance on the use of

Paraprofessionals in the Schools

Unnatural dependence on an adult within the general

education environment

This Practice Resulted in Isolation of Supported

Employees in their Own Work Settings

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Facilitate Successful Performance• Initial and Ongoing Assistance to the

Supported Employee• Job Developers(Facilitators) Must Now

Decide the Degree of Naturalness Which Will Be Used for Initial Training

• Strongly Suggested…Unless There Are Clear Indications to the Contrary, Natural Procedures Be Utilized Initially

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Strong Rationale For the Job Developer (Facilitator) to Take Risk

Allow Natural Means a Chance to

Be Effective

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Dignity of Risk Robert Perske

The concept of “dignity of risk” is we allow our children, and ourselves, to make choices and the accompanying mistakes, failures… because this is how we learn. This is how we build

our self-esteem and self-worth.

Our Dignity.

A Reasonable Trade-Off…

To Accept the Lessened Performance Through Naturalness

Over That Available Through Powerful Training Procedures

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Constraints to the Initial Use of Naturalness • Job Developer and Employment Facilitator

are Different People• Impact of the Employee’s Disability

Requires the Facilitator to Model Effective Techniques for the Natural Supporters

• Fragile Situations in Relation to Employer’s Low Expectations of Success

• Modifications to Job Sites and/or Job Stations

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Support/Substitute for Natural People

• Demonstrate a More Powerful Technique• Negotiate a Time for Discussion and

Feedback with the Natural Supporter• Offer Training Formally and Informally• Shadow the Natural Support and Offer On-

Going Feedback

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Suggest More Effective Natural Means• Reconsideration of the Natural Means Used

by Employers to Teach and Motivate Employees to Perform Their Jobs

• Teaching Style of One Co-Worker May Differ Significantly from Another and Further Yet from a Supervisor

• Consideration…Various Strategies Which Seem to be Working and Who Uses Them

• Specific Suggestions to Specific Natural Supports…Each Different

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Again…How Did You Learn How to Write an IEP?

Adapt/Modify Natural Ways

• Decisions of Adapting, Modifying or Negotiating for Flexibility in the Natural Ways the Work Place Operates

• Considered Last Because They Are Often the Most Consistent and Unchanging Features of the Work Places

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Job Analysis Process in Supported Employment is a…

Human Service Activity Designed to Assist Facilitators To:

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1. Organize the Information to be Performed by the Supported Employee

2. Recognize the Natural Ways, Means and People Used by the Employer to Typically Perform and Teach the Job

3. Develop a Plan for Balancing the Natural Features of Support Available at the Job Site

4. Form Relationships Necessary to Accomplish the 7 Phase Sequence

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Job Analysis Begins…

After the Employer Has Given Approval for the Job to Begin and Before the Supported Employee

Begins to WorkMarc Gold & Associatesmarcgold.com

Why Would A Job Analysis Be Performed By A Human

Service Provider?

At This Time, The Funding and Responsibility for the Provision of These Supports Rest with Human

Service Agencies

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Summary• Medium of Exchange• Recruitment• Training • Maintenance• Staff Responsibility• Development of a Natural Support

System

Activities and Profile of Change

Thank You!

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