SpEd After Graduation: Supports in Adult Services

When we think of "special education" we think of children. And rightfully so. Children with special needs generally (hopefully) attend special education classes and/or schools so they can access the general education curriculum and continue to grow as learners. Even those who don't attend special schools or are enrolled in sub-separate classrooms benefit from additional supports in the general education classroom. such as visual supports or environmental accommodations, to help them access their education. But what happens after graduation?

Transitioning from school to the real world is already challenging for most of us! Without getting into all the bureaucracy and funding difficulties within adult services, leaving special education services in the child world and entering the adult world is a beast. Limited resources and staffing, paired with challenges in maintaining an adequate budget and exemplary clinical supports, makes the on-going supports in adult services all that more difficult for the staff and administrators of the programs. The highly-structured, highly-funded, highly-ratioed dynamic of the kid-world is not easily replicated in the adult world, and if a transition plan is not given the necessary forethought and preparation, a child can easily slip through the cracks in adult services.

Photo: Pixabay

While we cannot control the budget or bureaucratic issues that arise in adult services, we can make these programs more clinically effective and supportive for our individuals. Read on to learn more about providing supports in adult services.

This is perhaps the easiest, low-tech way to provide additional supports for our individuals. We use visuals all the time in schools - even the general education classroom! We use visuals at home for ourselves, such as checklists, reminder notes, and calendars.

Visual supports are only has good as their implementation. Having visuals for the sake of having them, is not helpful. Posting labels around the home isn't going to provide any additional supports unless it is necessary for, taught to, and effective for the individual. For example, if an adult in a group home want to learn to make coffee on his own, and a visual instruction is provided for him, but it is not taught to him, what good is it? Or, let's say someone needs to remember to turn off the heat before they leave their home, so you think to write it on their to-do list in their work bag. Will this help the person remember to turn off the heat? Maybe. Could it be more effective if it were somewhere else? Probably. (I'm thinking at the front door).

A simple picture schedule for a morning routine, usual real photographs. Make it more personalized by taking pictures of the individual doing these activities.

This same morning routine, but in a written schedule instead. Use this for an adult who can read.

Here is a simple table of examples of different types of visual supports you might use with your individuals.

Make your visual supports work for both you and the individual. Developing a table based on the visual supports your individual utilizes may be very beneficial for staff.

If you've heard of Positive Behavior Supports, you know how big this is. These tend to be the least restrictive interventions to utilize when supporting our individuals. Some examples we see in the classroom include: preferential seating, altering the arrangement of the classroom, reducing visual distractions, etc. Some ways to modify the environment with adults may include:

• Preferential bedroom placement (near the staff office, on the first floor, etc.)
• Preferential seating in a work setting or day program setting
• Having areas of the space designated for breaks, sensory activities, etc.
• Limit/adapt sensory stressors, such as fluorescent lighting or shiny floors.
• Allow ability to access items in their environment independently (if they are in a wheel chair, having things be at the level they can reach it without having to ask for assistance)
• Use of visuals as described above
• Having adaptive equipment available or as part of the environment (think: railings, step stools, adapted chairs, etc.)
• And so many more!

It's important to note that aging adults, adults with dementia, or those with physical challenges will need more accommodations to remain safe and independent. Please consult with members of your team, such as the individual's physician, neurologist, occupational therapist, physical therapist, etc., to ensure the most comprehensive accommodation plan is developed and implemented.

Consistency is key! Maintaining a consistent routine and schedule will not only help  your sanity, but also allow the individuals to build indepedence. Imagine if everything were different or always "up in the air." How challenging would it be for someone to build their skills when they already struggle with maintaining their independence? Along these lines, allowing for control is important, not only to help alleviate some behavioral challenges, but as a common decency for the adutls we are serving. Things can be routinzed, but should still allow for choices and decision-making.

I don't have all the answers. My toolbox is vast, and I often have many suggestions for someone, but it's not enough. We need to take into account all ideas from the team. Taking a team approach at support our folks is key. Whether it be collaborating with a speech therapist, occupational therapist, BCBA (like me!), or another specialist, it's important to consider all thoughts and approaches and work together to provide the most comprehensive support plan for an individual. I rarely work with an individual on my own - I often work in tandem with a therapist, an SLP or OT (or both), and work together to communicate with PCPs or other medical professionals to ensure quality care for our client. Additionally, I will train staff (this is key) on procedures so they can work to build independence with the individual when I'm not there. Not only is this helpful for the individual to continue working on skills, but also helps the individual generalize the skills across settings and staff.

Having procedures in place that are based on the principles of behavior (such as reinforcement for desired behaviors). If naturally occurring reinforcement is not potent for your individuals, it may serve you, and the individual, well to employ some reinforcement procedures. A qualified clinician in the agency should be able to write up guidelines or support protocols for the individual to meet their needs. Additionally, some individuals need more restrictive programming in place. Thus, the help support staff and client, it's important to have these plans in place as well. Each state has different guidelines for implementing plans with aversive or punishing consequences, so make sure you know the guidelines before writing up any plans. However, having written out protocols for both the desired behaviors, and maladaptive ones will help support everyone involved! Not everyone will require a set of guidelines, which brings me to my next point.

It's important that, no matter the supports you implement, that they are individualized for the person. It's true you may, and probably will, have supports that several individuals utilize, such as a daily schedule, or transportation seating chart. However, it's important to ensure that all individuals who need to access these supports, are able to do so. For example, several residents may be able to read and comprehend written text, so a daily routine written out may suffice for them. What if you have someone who cannot rely on written text to be independent with their daily routine? The team needs to ensure that this individual can also access these supports, and may consider adding pictures to the text, if this proves to be an effective means for following the daily routine.

While supports are essential for the success of many individuals with special needs, we don't want them to rely on them. It's important to systematically fade any supports we provide so the individual can continue to develop their independence. Part of the struggle with individuals who transition from the schools to adult services is that the supports used in the classroom are not always faded to provide success in the natural environment (read: adult services with limited resources). This means, a student can be very successful independently utilizing the vast visual supports they have for every routine in their school life, such as accessing their visual schedule on the SmartBoard, communicating via iPad, and using idiosyncratic sign language their classroom teacher can understand. However, when this same student transitions to adult services, and their technology and teacher of 5 years is no longer part of the equation, this independence is lost. The individual relies so much on the supports that have been provided, that they are not able to function as effectively without them. It's for these reasons that we need to be conscientious of the supports we are able to provide, and fade them to the most manageable degree to allow for independence.  We may not be able to control how the schools transition their students, but we can control how we implement and fade these supports in our settings.

ABA at Play: scientific research, function-based interventions, antecedent manipulations, prompting, prompt fading, evidence-based practices, antecedent manipulations, task analyses, generalization, shaping, visuals, self-monitoring, operational definitions, socially significant behavior, individualized supports, reinforcement procedures, preference assessments, Positive Behavior Supports

I hope this post has been helpful in your quest to support the adults receiving disability services. What else might you add to this list? What are some ways you support your individuals? Comment below!

Graphics and fonts are from: From the Pond, HelloFonts, and Teagan White

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