509-ch-14

Instruction of Students with Severe Disabilities

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Eighth Edition

Fredda Brown Queens College

City University of New York

John McDonnell University of Utah

Martha E. Snell University of Virginia

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Loose Leaf Version ISBN 10: 0-13-382716-X ISBN 13: 978-0-13-382716-3

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Library of Congress Control Number: 2015939649

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For our children, grand children, partners, and for our friends and colleagues

who continue to give us support without conditions.

And to all the individuals with disabilities and their families with whom we have worked–we

thank you for allowing us to be part of your lives.

Fredda, John, and Marti

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Preface

In this eighth edition, we have, as a foundation, many of the same principles about teaching students with severe disabilities that were present in earlier editions because these principles have continued relevance: • Inclusive schools create new opportunities for all students to learn relevant skills

and to form meaningful and supportive social relationships. • Inclusive schools enable teachers to become better teachers of all of their students. • Teams of people, not any one individual, are responsible for designing, implement-

ing, and evaluating educational programs. • The skills identified for each student to learn should be functional (matching the

student’s current and future needs), suited to the student’s chronological age, and respectful of the student’s and family’s preferences.

• To be appropriate, instruction must be planned to suit the individual student. • If special education is merged with general education instead of viewed as a sepa-

rate educational structure, the diverse talents of both special and general educators will be preserved and instruction for all students will be improved.

• The teaching methods that we use need to be solidly based on research and demon- strated to be effective and appropriate for a variety of students in inclusive settings.

In this eighth edition, as in the seventh, we continue to emphasize that learning is more than increasing specific isolated skills. Learning and supportive efforts should be organized toward the achievement of three outcomes: membership, belonging, and skills. To reach these outcomes, schools need to appreciate the relationship among them and focus on supporting students and their families to follow a vision of a satisfying, meaningful, and personally determined quality of life. There is great value in building self-determination in our students, as there is for all students; the challenge is to understand the many individualized ways that this characteristic can be developed. For example, teachers can match job training opportunities to students’ preferences, and team members can teach their students to make choices and initiate preferred activities. Furthermore, when teams view their students’ problem behaviors as having legitimate motivations, then those motivations can drive the development of positive and respectful behavior support planning.

Support for InStructorS and StudentS

In addition to these principles and foundations, we have incorporated several fea- tures into the text to make it more valuable to its readers and more practical for in- structors and professors who have adopted it. One of the most effective ways to learn is through examples. Thus, we begin each chapter with case studies of students and then apply chapter concepts to these individuals. Because heterogeneity is character- istic of those with severe disabilities, our examples are diverse and include individu- als across the age range—from kindergarten to adult—and with a variety of abilities and disabilities, including intellectual, behavioral, and physical disabilities, and those with autism spectrum disorders. As the incidence of individuals with autism spectrum

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vi Preface

disorders have increased dramatically, each chapter (other than the chapter on physi- cal disabilities) includes a vignette of a student with ASD.

As in prior editions, the instructor supplements include PowerPoint presentations for each chapter created by the chapter authors, and an Instructor’s Manual with a variety of useful teaching resources. To access both go to www.pearsonhighered.com and search the catalog for this title and then click on the “Resources” tab.

new to thIS edItIon

Over the years, this text has gained a reputation for being both comprehensive and current. The aim of earlier editions was to present issues and strategies that were documented as being effective and not to “jump on treatment bandwagons.” The eighth edition maintains this reputation. The goal of this revision was to present the latest evidence-based research available with regard to all aspects of educational pro- grams for students with severe disabilities, both intellectual disabilities and autism. It has been and continues to be our aim to align the content of this text with evidence- based strategies. As the field continues to evolve, we strive to have this book evolve.

Digital Format. One of the most significant changes in the eighth edition is the format of the book. For the first time, Instruction of Students with Severe Disabilities is available as a digital book. An eText format benefits you in three ways: It is afford- able, it has a search function that allows you to efficiently locate coverage of con- cepts, and many chapters have links to videos to support its content.

New Chapters. In addition to updating each chapter, and some new author col- laborations on chapters maintained from the seventh edition, the eighth edition of this text includes five new chapters:

• New chapter on Assessment.. This chapter includes not only a comprehensive update on research and practices in the area of assessment, but has a special focus on assessment related to the Common Core State Standards.

• New chapter on Positive Behavior Support. This chapter includes updated research and a focus on moving from assessment to the development of behavior support plans. It is also updated to include the use of technology related to behavioral assessment and behavior plan development.

• New chapter on Teaching Communication Skills. This chapter includes updated research, a focus on selecting appropriate communication strategies, and embed- ding instruction on communication skills in daily routines and activities.

• New chapter on Understanding Special Health Care Procedures. This chapter includes new information on strategies for ensuring that school personnel develop the skills necessary to provide safe care to students with complex health needs, promoting effective communication among team members to meet student needs, and supporting students participation in general education classes and encouraging peer acceptance.

• New chapter on Motor Disabilities. This chapter includes updated photos on equipment, using equipment to enhance classroom participation, and integration of physical therapy in the classroom.

• New Pedagogy. Each chapter begins with learning objectives and ends with summaries based on the learning objectives.

organIzatIon of the text

We begin this edition with six chapters that lay the foundation for the rest of the book. The first two chapters focus on basic concepts that are central to the education of students with severe disabilities—inclusion and families. The discussion by Michael

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viiPreface

Giangreco, Stacy Dymond, and Karrie Shogren introduces readers to students with severe disabilities by exploring definitions of severe disabilities and how these defini- tions and societal perceptions affect the lives of these individuals and their families. These authors offer us a historic retrospective of where we’ve been, how far we’ve come, and where we need to be heading. Finally, Giangreco and his colleagues help us to un- derstand what is meant by appropriate education for students with severe disabilities.

Students grow up as members of families, and families are most often the primary advocates for their children throughout life. In Chapter 2, Kathleen Kyzar, Nina Zuna, and Ann and Rud Turnbull explore the factors that make successful partnerships be- tween home and school. Two such factors are ongoing, reciprocal communication between home and school and interactions that reflect and respect families from di- verse cultural backgrounds.

Chapters 3, 4, 5, and 6 are core chapters that set forth the basic strategies and tools that educators use in concert with other team members to plan, teach, and monitor the progress of their students. Chapter 3, a new chapter, is written by Diane Browder, Leah Wood, Jenny Root, and Caryn Allison. Chapters 4, 5, and 6 are written by the edi- tors, with Rachel Janney as first author of Chapter 6. All other chapters build on the foundations set forth in these chapters. Four key words sum up the content of this section: assessment, teaching, evaluation, and implementation.

In Chapter 7, a new chapter, Robert O’Neill and Matthew Jameson set forth the principles of positive behavior support. Using comprehensive case examples, these authors describe how the process of functional behavioral assessment is conducted and used to design effective behavioral support plans that are based on the values of self-determination, respect, and inclusion.

In Chapter 8, Donna Lehr and Nancy Harayama describe health care procedures required by some students during the school day. This chapter explains how to incor- porate special health care procedures into the school day and how educators can contribute to the prevention of related health problems and conditions.

In the new Chapter 9, Mary Jane Rapport, Amy Barr, and Maria Jones teach us about the impact of motor disabilities on school participation and learning, and how to successfully address these challenges. Because all team members interact with a student over a range of daily activities, practical knowledge about motor disabilities must be shared. When students with motor disabilities have consistent and conscien- tious management of their physical needs in their home, school, work, and commu- nity environments, they can thrive.

The skills of caring for oneself, toileting, eating, dressing, and grooming are impor- tant goals for all individuals regardless of the severity of the disability. In Chapter 10, Monica Delano, Martha Snell, and Virginia Walker provide a comprehensive and cur- rent review of effective methods for teaching self-care skills while also showing how these methods apply to specific students.

One of the most important elements that schools can offer students is social rela- tionships with peers. In Chapter 11, Erik Carter and Matthew Brock illustrate strate- gies that teams can use to promote membership and a sense of belonging and to build a variety of personal relationships among students in classrooms and schools.

In the new Chapter 12, Susan Johnston addresses functional communication and the importance of socially responsive environments. She highlights the pervasive in- fluence of communication in all aspects of life, including education, friendships, well- being, and self-determination.

Basic skills in reading, writing, mathematics, and science are increasingly impor- tant as states respond to federal laws and policies. In Chapter 13, John McDonnell and Susan Copeland present methods for identifying what academic skills to teach and evidence-based strategies for teaching those skills in inclusive settings.

Chapter 14 guides teachers on the instruction of skills to increase active participa- tion in home and community life. Linda Bambara, Freya Koger, Raquel Burns, and Dolly Singley begin with a series of guiding values and principles that characterize

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viii Preface

the outcomes of skill instruction referenced to students’ homes and communities. These themes are coupled with instructional methods that have been found to be ef- fective with students who have severe disabilities.

Our special education laws require a clear focus on and preparation for the transi- tion to adulthood. Preparing students for real work in the community is a longitudinal process requiring extensive team effort over the teenage years. In Chapter 15, Valerie Mazzotti and David Test set forth the essential elements of secondary vocational pro- grams that will allow students and their teams to plan the transition from school to adulthood and then to make the transition.

The book closes with Chapter 16, in which Dianne and Phil Ferguson discuss, both as parents and as scholars, the promises that adulthood can offer to individuals with severe disabilities. The Fergusons take us on a remarkable journey across the years with their son Ian, now middle-aged, and his friend Douglas. These family stories describe a path that has been “often confusing and frustrating, but also filled with many exciting achievements.” The concept of supported adulthood is discussed within the context of current policy, social services, educational practices, and societal expectations.

acknowledgmentS

Many people have assisted in the task of developing the eighth edition. First, we are indebted to the children, adolescents, young adults, and mature adults, who add real- ity to each chapter and whose abilities and disabilities have challenged and shaped our own skills and those of our contributors. Their families and their educators de- serve equal gratitude for providing a vast array of teaching ideas, for granting permis- sion to use their photographs, and for giving us extensive examples and information.

Finally, we are grateful for the helpful comments of our reviewers at various stages in the revision process—James Dennis Cavitt, Abilene Christian University; Jeri Katz, Bridgewater State University; and Sharon M. Kolb, University of Wisconsin Whitewater.

We would also like to thank many of our students who continually inspire our thinking and writing. Recognition also is given to the contributions of those at Pear- son including Executive Editor, Ann Davis and her assistant, Janelle Criner and also to Joe Sweeney and Kerry Rubadue. At Cenveo, we acknowledge the incredible work of Susan McNally.

Fredda Brown, John McDonnell, and Martha E. Snell

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ix

Chapter 1 Educating Students with Severe Disabilities Foundational Concepts and Practices 1

Chapter 2 Fostering Family–Professional Partnerships 27

Chapter 3 Assessment and Planning 55

Chapter 4 Measuring Student Behavior and Learning 89

Chapter 5 Selecting Teaching Strategies and Arranging Educational Environments 130

Chapter 6 Designing and Implementing Instruction for Inclusive Classes 190

Chapter 7 Designing and Implementing Individualized Positive Behavior Support 223

Chapter 8 Understanding and Meeting the Health Care Needs of Students with Severe Disabilities 264

Chapter 9 Key Concepts in Understanding Motor Disabilities 292

Chapter 10 Teaching Self-Care Skills 327

Chapter 11 Promoting Social Competence and Peer Relationships 371

Chapter 12 Teaching Communication Skills 404

Chapter 13 Teaching Academic Skills 438

Chapter 14 Building Skills for Home and Community 474

Brief Contents

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x Brief Contents

Chapter 15 Transitioning from School to Employment 508

Chapter 16 The Promise of Adulthood 554

References 588

Name Index 623

Subject Index 630

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1 Educating Students with Severe Disabilities 1 Michael F. GianGreco, Stacy K. DyMonD, anD Karrie a. ShoGren Who Are Students With Severe Disabilities?  2

Definitions, 2 ● Societal Perceptions and Expectations, 3 ● Opportunities for Interaction and Reciprocal Benefit, 4

Reasons For Optimism and Concern  4 Reasons for Optimism, 4 ● Reasons for Concern, 6

Access to Quality Education 8 Access to Inclusive Environments, 8 ● Access to Individualized Curriculum, 10 ● Access to Purposeful Instruction, 17 ● Access to the Necessary Related Services and Supports, 22

Learning Outcome Summaries  25

2 Fostering Family–Professional Partnerships 27 ann P. turnbull, h. rutherForD turnbull, Kathleen Kyzar, anD nina zuna Two Families and Two Windows for Understanding Families in Special Education  29

Individuals With Disabilities Education Act: Parental Rights and Responsibilities  29 IDEA’s Six Principles, 30 ● Assisting Families to Advocate: Parent Training and Information Resource Centers, 36

A Family Systems Perspective 37 Family Characteristics, 39 ● Family Interaction, 42 ● Family Functions, 46 ● Family Life Cycle, 48

Learning Outcome Summaries 52

Suggested Activity: A Tale of Two Families  53

3 Assessment and Planning 55 Diane M. browDer, Jenny root, leah wooD, anD caryn alliSon Assumptions of Assessment  56

Qualities and Types of Assessment  59 Technical Adequacy, 59 ● Types of Assessments, 59

Purpose of Assessment 64 Multidisciplinary Assessments Used to Determine Eligibility, 65 ● Assessments for School Accountability, 69 ● Assessments Used for IEP and Other Educational Planning, 71

Using the Assessment Information  82 Developing the IEP,  82

Learning Outcome Summaries 84

Overview to Chapters 4, 5, and 6 86

Contents

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4 Measuring Student Behavior and Learning 89 FreDDa brown, anD Martha e. Snell Why Measure Student Behavior?  89

Using an Evidence Base to Guide Instruction, 90 ● Accountability Through Evaluation, 91

Foundations of Meaningful Measurement  92 Measurement of Important Behaviors, 92 ● Measurement That Is Contextually Appropriate, 95 ● Measurement That Is Accurate and Reliable, 96

Quantitative Measures  97 Rationale, 97 ● Measurement Strategies, 98

Organizing Student Performance Data  110 Designing Data Sheets, 110 ● Graphing Your Data, 110 ● Computer-Generated Graphs, 113 ● Saving Ungraphed Data, 114 ● Frequency of Data Collection, 114

Data Analysis for Better Decision-Making  115 Measures of Accuracy, 116 ● Types of Data, 118 ● Obtaining a Baseline, 119 ● Baseline–Intervention Comparison, 119 ● Graphing Conventions, 120 ● Visual Analysis, 121

Learning Outcome Summaries  127

Suggested Activities  129

5 Selecting Teaching Strategies and Arranging Educational Environments 130 Martha e. Snell, FreDDa brown, anD John McDonnell Principles to Guide Instruction  131

Work as Collaborative Teams, 132 ● Determine What to Teach, 132 ● Understand How the Stage of Learning Affects Instruction, 132 ● Reach Agreement on How Students Will Be Taught, 133 ● Monitor Student Learning with Performance Data, 134

“Universal” Strategies that are Effective With a Wide Range of Students  134 Information About Students, 135 ● Materials and Universal Design, 135 ● The Instructor, 137 ● Schedule for Instruction, 138 ● Teaching Arrangements, 139 ● One-to-One Instruction, 140 ● Small Group Instruction, 140 ● Enhanced Group Instruction, 142 ● Observation Learning, 142 ● Cooperative Learning Groups, 143 ● Group Instruction Guidelines, 144 ● Peer-Mediated Instruction and Peer Support, 144 ● Peer Tutoring, 145 ● Peer Support Programs, 146 ● Individualized Adaptations: Accommodations and Modifications, 147 ● Self-Management, 147

Specialized Teaching Strategies that are Effective With Students Who Have Severe Disabilities  150

Visual Modality Strategies, 150 ● Visual Supports, 151 ● Video Modeling, 155 ● Task Analysis and Chaining, 157 ● Task Analysis, 158 ● Approaches for Teaching Chained Tasks, 160 ● Elements of Discrete Teaching Trials, 161 ● Discriminative Stimuli, 163 ● Instructional Cues, 165 ● Stimulus and Response Prompting, 165 ● Stimulus Prompts, 165 ● Response Prompts, 166 ● Types of Instructional Prompts, 167 ● Response Latency, 167 ● Prompt Fading, 169 ● Prompting Systems, 170 ● General Guidelines for Using Structured Prompts and Cues, 176 ● Consequence Strategies, 176 ● Positive Reinforcement 177 ● Planned Ignoring, 180 ● Response to Errors, 181 ● Arranging Teaching Trials, 184 ● Distributed or Massed Trial Instruction, 184 ● Contextualized or Decontextualized Instruction, 185 ● Embedding Instruction Within Activities, 186

Learning Outcome Summaries  188

Suggested Activities  188

6 Designing and Implementing Instruction for Inclusive Classes 190 rachel e. Janney, anD Martha e. Snell The Pyramid of Support/Response-to-Intervention Logic  191

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Collaborative Teaming for Ongoing, Day-to-Day Planning and Delivery of Instruction 192

A Model for Making Individualized Adaptations  195 Criteria for Making Individualized Adaptations, 195 ● Types of Adaptations: Curricular, Instructional, and Alternative, 196 ● Curricular Adaptations: Individualize the Learning Goal, 197 ● Instructional Adaptations: Individualize the Methods and/or Materials, 199 ● Alternative Adaptations: Individualize the Goal, the Methods/ Materials, and the Activity, 201

Using the Model to Develop Individualized Adaptations  203 Step 1. Gather and Share Information About the Student(s) and the Classroom, 203 ● Information About the Classroom, 204 ● In-depth Information About Class Activities and Participation, 205 ● Step 2. Determine When Adaptations Are Needed, 207 ● Step 3. Plan and Implement Adaptations: First General, Then Specific 209 ● General Adaptations, 209 ● Specific Adaptations, 210 ● Individualized Adaptations and Support Plans 211 ● Step 4. Monitor and Evaluate, 216 ● Monitoring Student Performance, 216 ● Evaluating Student Progress, 219

Learning Outcome Summaries  221

Suggested Activities  222

7 Designing and Implementing Individualized Positive Behavior Support 223 robert e. o’neill, anD J. Matt JaMeSon Development of Positive Behavior Support (PBS)  225

Development of PBS in Schools: Multi-Tiered Systems of Support (MTSS)  226

Inclusion of Students With More Severe Disabilities in MTSS  227

Components of Individualized PBS  228 Three Phases of Implementation, 228 ● Person-Centered Planning, 229 ● Ecological Assessment, 230 ● Why Conduct an FBA?, 230 ● Outcomes of an FBA, 231 ● Who Should Be Involved?, 231

Overview of the FBA Process  231 Assessment, 231 ● Hypothesis Development, 232 ● Direct Observations and Analyses, 232 ● Development of Behavioral Intervention Plans (BIPs), 232 ● Specify Who Will Do What and When, 233 ● Ongoing Data Collection and Evaluation, 235

Indirect Data Collection  235 Archival Review, 235 ● Interviews, 235 ● Checklists, 239

Direct Observations  239 Validation of Summary Statements, 241

Functional Analysis  241 Procedures, 241

Behavior Intervention Plan Development  242 Important Characteristics of BIPs, 242 ● Bridging the Gap from FBA to BIP: The Competing Behavior Model 243 ● Formats for Behavior Intervention Plans, 246

Potential Intervention Plan Components  246 Lifestyle Changes, 246 ● Classroom Modifications, 246 ● Setting Events/Motivating Operations, 247 ● Antecedent Strategies, 248 ● Teaching and Prompting Alternative/Replacement Behaviors, 249 ● Consequence Strategies for Appropriate and Challenging Behavior, 249 ● Crisis/Emergency Intervention Strategies, 250 ● Intervention Plan Evaluation and Monitoring, 252 ● Example Behavior Intervention Plan for Micah, 253

General Issues Regarding Ethical and Professional Behavior  253

Technology Supports for FBA  254 Direct Observation Tools, 255

Technology Tools to Support Intervention Strategies  257 Setting Events, 257 ● Antecedent Interventions, 258 ● Behavioral Teaching Applications, 258 ● Consequence Interventions, 259 ● Communication, 259

Learning Outcome Summaries  261

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8 Understanding and Meeting the Health Care Needs of Students with Severe Disabilities 264 Donna lehr, anD nancy harayaMa Introduction  265

Students with Special Health Care Needs Defined  265

General Knowledge of Health Care Procedures  267 Hygienic Practices in Schools,  267

Understanding Specialized Health Care Procedures  275 Knowledge and Training Levels, 275 ● Responsible Personnel, 276 ● Specialized Health Care Procedures, 276

Care Coordination Through Communication  281 Individualized Health Care Plans, 282 ● Record Keeping, 283

Inclusion in the General Education Setting  285 Acceptance by Peers, 285 ● Specialized Education Content, 286 ● Maximizing Educational Opportunities, 287

Other Considerations Related to the Education of Students With Special Health Care Needs  287

Medical Discrimination, 287 ● Do Not Resuscitate, 289

Learning Outcome Summaries  290

9 Key Concepts in Understanding Motor Disabilities 292 Mary Jane raPPort, aMy barr, anD Maria JoneS Impact on Education and Participation  294

International Classification on Function (ICF), 295 ● Gross Motor Function Classification System (GMFCS), 297 ● Quality of Movement, 298

Team Support for Students  302 Team Collaboration and Communication, 302 ● Service Delivery by the Team, 304

Meeting Students’ Needs  306 Daily Routines, 307 ● Lifting, Transferring, Moving, 310 ● Positioning, 311 ● Learning, 313 ● Ecological Inventory, 314 ● Playground and Recreation, 315 ● Transition to Employment or Other Postsecondary Settings, 316 ● Use of Equipment to Enhance Participation, 317 ● Use of Other Technologies and Equipment in the Classroom, 323 ● Transportation 324

Learning Outcome Summaries  326

Suggested Activities  326

10 Teaching Self-Care Skills 327 Martha e. Snell, Monica e. Delano, anD VirGinia l. walKer General Teaching Considerations  329

Identifying What to Teach,  329

Special Considerations for Toileting  336 Identify What to Teach, 337 ● Identify Teaching Strategies, 342

Special Considerations for Eating and Mealtimes  349 Identify What to Teach, 350 ● Identify Teaching Strategies for Eating and Mealtimes, 351 ● Addressing Problem Behaviors During Mealtime, 353

Special Considerations for Dressing and Grooming  358 Identify What to Teach, 359 ● Identify Teaching Strategies for Dressing and Grooming Skills, 362

Learning Outcome Summaries  368

Suggested Activities  370

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11 Promoting Social Competence and Peer Relationships 371 eriK w. carter, anD Matthew e. brocK Introduction  372

Contributions of Peer Relationships in the Lives of all Children  373 Friendships Are Important in the Lives of All Students, 373 ● For Children and Youth with Severe Disabilities, 374 ● For Peers Without Disabilities, 374

The Diversity of Peer Relationships  374 Defining Relationships, 375 ● The Variety of Interactions and Relationships, 375 ● The Role of Context and Relationships, 378

The Importance of Intentional Efforts to Foster Relationships  379 Relationships with Peers Who Do Not Have Disabilities,  379

Promoting Peer Interaction and Social Relationships  380 Assessment to Identify Needs and Opportunities,  381

Strategies for Addressing Social Needs and Maximizing Relationship Opportunities  385

Shared Space, 385 ● Shared Activities, 385 ● Shared Interests, 386 ● Student-Focused Instruction, 386 ● Peer-Focused Instruction, 387 ● Promoting Valued Roles, 387 ● Providing Appropriate Support, 387

Evidence-Based Strategies for Supporting Relationships  388 Inclusive General Education Classrooms, 388 ● Peer Support Strategies, 388 ● Informal School Contexts, 394 ● Extracurricular and Other School-Sponsored Activities, 396 ● After School, on Weekends, and During the Summer, 398

Monitoring Progress and Refining Efforts  399 Monitoring Interactions with Peers in Class, 399 ● Monitoring Participation in Extracurricular Activities, 400 ● Monitoring Student and Family Satisfaction 400

Learning Outcome Summaries  401

Suggested Activities  403

Practical Guides and Resources  403

12 Teaching Communication Skills 404 SuSan S. JohnSton The Importance of Communication  404

Features of Communication  406 Preintentional or Intentional Communication, 406 ● Presymbolic or Symbolic Communication, 407 ● Modes of Communication, 407 ● Communicative Functions, 410 ● Conversational Functions, 410 ● More Complex Communication, 411 ● Comprehension, 412

Identifying and Assessing Communication Skills and Abilities—Deciding What to Teach  412

Formal and Informal Assessment Procedures, 413 ● Indirect and Direct Observation Assessment Strategies, 413 Linking Assessment to Intervention, 416

Developing an Instructional Plan—Deciding How to Teach  417 Identify Opportunities for Instruction, 417 ● Prompting the Communicative Behavior, 420 ● Prompt Fading 423 ● Consequences, 423 ● Response Efficiency, 424 ● Monitoring Progress, 425

Learning Outcome Summaries  435

Suggested Activities  436

Additional Resources  436

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13 Teaching Academic Skills 438 John McDonnell, anD SuSan r. coPelanD Selecting Academic Skills for Instruction  440

General Guidelines, 440 ● Strategies for Developing Academic IEP Goals and Objectives,  441

Determining the Instructional Approach  443 Teaching Within Typical Instructional Routines and Activities, 443 ● Teaching Academics in Parallel Instructional Activities, 444 ● Teaching Academics in Community-Based Activities, 444

Literacy Instruction  445 Definition of Literacy, 445 ● Comprehensive Literacy Instruction, 445 ● Teaching Conventional Early Reading and Writing, 447 ● Word Recognition, 448

Math Instruction  462 Numeracy and Computation,  462

Science Instruction  470

Learning Outcome Summaries  471

Suggested Activities  472

14 Building Skills for Home and Community 474 linDa M. baMbara, Freya KoGer, raquel burnS, anD Dolly SinGley Guidelines for Planning Instruction to Enhance Skills for the Home and Community  476

Guideline One: Use Person-Centered Planning Strategies to Create a Vision, 477 ● Guideline Two: Coordinate Instruction with Families, 478 ● Guideline Three: Encourage Self-Determination Through Choice-Making, Self- Cuing, and Self-Management Skills, 478 ● Guideline Four: Select Appropriate Instructional Settings, 484 ● Guideline Five: Incorporate General Case Instruction, 487 ● Guideline Six: Coordinate Instruction with Transition Planning, 488

Strategies for Teaching Home and Community Skills  491 Skills for the Home, 491 ● Skills for the Community, 500

Learning Outcome Summaries  507

15 Transitioning from School to Employment 508 Valerie l. Mazzotti, anD DaViD w. teSt Introduction  511

Definition of Transition  511

Transition Planning  514 Indicator 13 Requirements, 514 ● Age-Appropriate Transition Assessment, 516 ● Person-Centered Planning, 519 ● Self-Determination and Student Involvement in the IEP 520

Teaching Employment Skills  523 Where to Provide Instruction, 523 ● Where to Provide Instruction: School-Based Instruction (SBI) Options, 524 ● Where to Provide Instruction: Community-Based Instruction (CBI) Options, 529 ● How to Provide Instruction, 535 ● How to Collect Instructional Data, 538 ● Using Assistive Technology, 539 ● Meeting Medical and Health Needs, 541

Adult Outcomes and Meaningful Employment Outcomes  542 Supported Employment, 542 ● Natural Supports, 543 ● Customized Employment, 544

Family Roles in Transition  544

Interagency Collaboration  546 Vocation Rehabilitation Services, 546 ● Developmental Disabilities Services, 547 ● Social Security Administration, 548 ● One-Stop Career Centers, 550

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xviiContents

Learning Outcome Summaries 550

Suggested Activities 553

16 The Promise of Adulthood 554 Dianne l. FerGuSon, anD PhiliP M. FerGuSon Exploring the Promise of Adulthood  556

Understanding Adulthood  557 The Changing Status of Adulthood, 557 ● The Dimensions of Adulthood, 559

Denying Adulthood  566 Unending Childhood, 567 ● Unfinished Transitions, 568 ● Unhelpful Services, 570 ● The Dilemma of Adulthood 572

Achieving Adulthood  573 The Concept of Support, 574 ● What Is Different About Supported Adulthood?, 575 ● Components of Supported Adulthood, 575

Living the Promise  579 Multidimensional Adulthood, 584 ● A Cautionary Conclusion About Unkept Promises, 584

Learning Outcome Summaries  585

Suggested Activities  587

References 588 Name Index 623 Subject Index 630

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1 Educating Students with Severe Disabilities

Foundational Concepts and Practices

Michael F. Giangreco University of Vermont

Stacy K. Dymond University of Illinois at Urbana-Champaign

Karrie A. Shogren University of Kansas

“Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning.” —Albert einstein

1.01 Who are students with severe disabilities? Learning Outcome Identify definitions of severe disabilities, the role of the supports model in understanding students with severe disabilities, and the influence of societal perceptions and social interactions.

1.02 Reasons for optimism and concern Learning Outcome Identify areas where progress has been made in providing individualized supports for people with severe disabilities in inclusive communities, and areas where work is still needed.

1.03 Access to quality education Learning Outcome Discuss the foundational principles of providing supports to students with severe disabilities that promote access to (a) inclusive environments, (b) individualized curriculum, (c) purposeful instruc- tion, and (d) necessary supports.

Providing relevant education for students with severe disabilities requires that we learn from our past practices, both the mistakes and the successes, by drawing on the historical bank of foundational con-cepts and practices available to us. Our contemporary challenge is to apply what we have learned within today’s context and to do so with a sense of urgency, because as we ponder, debate, and research the merits of our practices, the children who enter our schools are quickly growing up—they and their families do not have the luxury of waiting. Providing individuals with severe disabilities quality education requires that we adopt conceptually sound, evidence-based practices in our schools and confront assumptions about ability that continually threaten current and future opportunities.

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2 Chapter 1

People identified as having severe disabilities are the epitome of why Einstein’s chal- lenge “not to stop questioning” is so important. Only 40 years ago, students with severe disabilities had no legal right to attend public schools and many did not—expectations for their educational progress were minimal. Today because of people with disabilities, their family members, and professionals who never stopped questioning, people with severe disabilities are doing things that many would have thought to be unimaginable just a few short decades ago: They are (a) attending general education classes with their peers who do not have disabilities, (b) learning general education curricular content, (c) participating in general education co-curricular activities, (d) engaging in supported employment, (e) transitioning to community-based supported living options, and (f) accessing inclusive post–high school educational opportunities—but, only some.

Who are StudentS With Severe diSabilitieS?

definitions

Although the term severe disabilities is used extensively in the professional literature, no single authoritative definition exists. The amendments to the Individuals with Disabilities

Education Act (IDEA) (2004), a common source of special education terminology, do not define severe disabilities. IDEA and its corre- sponding Code of Federal Regulations (CFR) (2006) do define 13 distinct disability classifications (34 CFR 300.8), several of which rea- sonably include students considered to have severe disabilities (e.g., autism, deaf-blindness, intellectual disability, multiple disabilities,

traumatic brain injury), although not all students within these categories have severe dis- abilities. Sometimes people with severe disabilities are described as having low-incidence disabilities. Within the school context, the Code of Federal Regulations (2003) allows for up to 1% of the total student population, those with most severe cognitive disabilities, to be assessed based on alternate performance standards (34 CFR 200.13).

Historically, and all too often contemporarily, attempts to describe or define the characteristics of students with severe disabilities have focused primarily on identify- ing deficits in domains that influence human functioning, including intellectual, aca- demic, orthopedic, sensory, behavioral, and social. Unfortunately, such definitions tell us very little about people with severe disabilities (McDonnell, Hardman, & McDonnell, 2003) and may, in fact, contribute to the failures to question the capabilities of people with disabilities that have occurred throughout history and led to limited educational opportunities (Schalock et al., 2007).

Newer conceptualizations of disability are emerging, however, that shift the focus from simply identifying deficits in functioning and instead to emphasizing the reciprocal inter- action between the personal capacities of people with severe disabilities, such as differ- ences in intellectual, academic, orthopedic, sensory, behavioral, and social functioning, and environmental demands, such as the need to participate and learn in inclusive schools, communities, and classrooms (Schalock et al., 2010; World Health Organization, 2001; 2007). By identifying discrepancies between a person’s current level of functioning and environmental demands, supports needed for participation and learning in those environments can be identified; this is know as the supports model (Schalock et al., 2012; Thompson et al., 2009). Supports for participation might include assistive technologies for students as well as environmental changes like the adoption of a co-teaching model or the implementation of a peer support program. Supports for learning might include indi- vidualized curricular adaptations as well as the adoption of universal design for learning in the classroom. The supports model shifts the focus from identifying deficits within a person to understanding needed supports and building systems of supports that facilitate success in inclusive environments.

The supports model prompts professionals to never stop questioning the capabili- ties of individuals with severe disabilities, particularly when needed supports are pro- vided for participation and learning in inclusive environments. It also recognizes that

Watch the video “Classification and Intellectual Disability” at www .youtube.com/watch?v=80rc4ZAtQ0I.

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3Educating Students with Severe Disabilities

students with severe disabilities are a widely heterogeneous group in terms of their disability characteristics, capabilities, and educational needs as well as in their charac- teristics not related to disability (e.g., interests, preferences, personalities, socioeco- nomic levels, cultural heritage). By focusing on individualized supports identified through a systematic analysis of discrepancies between personal capacities and envi- ronmental demands, this collective diversity and need for individualized, lifelong sup- ports can be addressed in inclusive contexts.

A foundational assumption of the supports model is that people with severe disa- bilities share a fundamental human trait with all other people—the capacity to learn, and that appropriate supports for learning will allow individuals with severe disabili- ties to demonstrate their capabilities. Although this may seem too obvious to men- tion, as recently as the early 1980s, there were heated debates in the professional literature about whether individuals with the most severe disabilities were capable of learning and how such judgments affected their right to be educated. The words of Baer (1981) remain relevant today:

To the extent that we sometimes finally succeed in teaching a child whom we have con- sistently failed to teach in many previous efforts, we may learn something about teach- ing technique . . . Too often, in my opinion, we teach children who are not only capable of teaching themselves, but eager to do so; in their wisdom, they cheat us of learning completely how the trick is done because they do some of it for us and do it privately. It is when they cannot do much if any of it for us that we get to find out how to do all of it ourselves, as teachers. (p. 94)

Approaching all students as capable of learning provides us with the opportunity to never stop questioning our own understanding of teaching and learning. The notion of all students as capable of learning and entitled to appropriate education is consistent with the federal zero-reject principle embedded in IDEA since its passage in 1975. The zero-reject principle established that all school-aged children, regardless of the severity of their disability, are entitled to a free, appropriate public education (Turnbull, Stowe, & Huerta, 2007). This principle was tested in the case of Timothy W. v. Rochester School District (1989) when a student with severe, multiple disabilities was denied admission to his local public school because school officials deemed him unable to benefit from education due to the severity of his disability. Although the trial court sided with Rochester School District, the U.S. Court of Appeals for the First Circuit overturned this ruling, and strongly reaffirmed the zero-reject principle as a core component of IDEA, stating that

. . . educational methodologies in these areas are not static, but are constantly evolving and improving. It is the school district’s responsibility to avail itself of these new approaches in providing an educational program geared toward each child’s individ- ual needs. The only question for the school district to determine, in conjunction with the child’s parents, is what constitutes an appropriate individualized education program (IEP). (p. 973)

This decision, and all subsequent reauthorizations of IDEA, have emphasized that all students are entitled to a free, appropriate public education. Schools must continu- ously question their assumptions about supports for learning and participation, and ensure that teachers have access to state-of-the-art practices for meeting all students’ individualized needs.

Societal Perceptions and expectations

TASH (n.d.), an international advocacy and professional organization focused on pro- moting the full inclusion and participation of people with severe disabilities, states that people with severe disabilities are

. . . most at risk for being excluded from society; perceived by traditional services sys- tems as most challenging; most likely to have their rights abridged; most likely to be at

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4 Chapter 1

risk for living, working, playing, and learning in segregated environments; [and] least likely to have the tools necessary to advocate on their behalf.

Because people with severe disabilities require ongoing supports to mitigate the risks described above, the ways in which they are perceived and subsequently treated by others can have a major impact on the quality of their lives. When coupled with the historical emphasis on deficits in functioning experienced by people with disabili- ties, social perceptions and expectations have tended to be low. This can lead to dis- ability spread, defined as the tendency to make broad inferences, assumptions, and generalizations about a person on the basis of disability stereotypes within the society (Dembo, Leviton, & Wright, 1975; Liesener & Mills, 1999). Some common stereotypes portray persons with disabilities as sick, subhuman, a menace, an object of pity, an object of charity, or a holy innocent (Smith & Wehmeyer, 2012; Wolfensberger, 1975).

opportunities for interaction and reciprocal benefit

As noted by TASH, stereotypes and disability spread have a significant, negative impact on the quality of life of people with severe disabilities. However, it is not just people with severe disabilities that are negatively impacted. If you accept the notion that personal relationships are among a small set of the most defining characteristics that influence the quality of a person’s life, then disability spread is a problematic issue for those with and without disabilities alike as it limits relationships between people with and without disabilities (Bogdan & Taylor, 1989).

As you continue to read this chapter and the rest of this book about people who have the label of severe disabilities, you are encouraged to think about how these individuals are like all other people, like some other people, and uniquely like no other people. Keep in mind that first and foremost we all are human beings—someone’s child, someone’s sibling, someone’s classmate, someone’s neighbor, or someone’s friend. It is true that some people are born with or acquire disability characteristics that require lifelong systems of supports. Remember, though, that we all need sup- ports, we just differ in the level of those support needs. Our collective attitudes and responses to differences in support needs can influence how much of a barrier those support needs are (or are not) to living a full, engaged, and self-determined life.

reaSonS for oPtimiSm and ConCern

From an historical perspective, our current times are among the best for individuals with severe disabilities, at least thus far. We write this with the full recognition that our current best is relative and is quite a long way from good for far too many people labeled as having severe disabilities. This section highlights a set of key reasons for optimism about the education of students with disabilities followed by a set of con- tinuing concerns.

reasons for optimism

Table 1–1 lists five areas for optimism about our present and future. Such optimism about our collective potential to make a positive difference in the lives of students with and without disabilities is an essential ingredient of the creative problem solving necessary to

tackle these important challenges. First, nowhere is progress more evident or reason for optimism

more warranted than with regard to inclusive educational opportu- nities (see Table 1–2 for key elements of inclusive education). Across the country, students with severe disabilities are increas- ingly accessing general education classrooms and other inclusive settings with their same-age peers without disabilities (Downing,

Karrie Shogren discusses self- determination at www.youtube.com /watch?v=ZdArcPCH8FQ&src_vid =SOdHpLvpVH4&feature=iv&annotat ion_id=annotation_2241971059

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5Educating Students with Severe Disabilities

2008); such options were rare or non-existent just two or three decades ago. Inclusive schools promote equity, opportunity, and social justice for all their students ( Jorgensen, McSheehan, & Sonnenmeier, 2009; Sapon-Shevin, 2011; Theoharis, 2009). These out- comes are relevant for any student across a range of diverse characteristics (e.g., race, culture, primary language, socioeconomic level), as well as any student who simply is having difficulty becoming part of a classroom’s learning community. The tenets of inclusive schooling are increasingly being linked with broader school reform and restruc- turing efforts designed to improve educational opportunities for all students. The Schoolwide Applications Model (SAM) (Sailor, 2002; Sailor & Roger, 2005), Whole Schooling (Peterson, 2004; (Peterson & Hittie, 2010), Schools of Promise (Causton- Theoharis, Theoharis, Bull, Cosier, & Dempf-Aldrich, 2011), and Schoolwide Integrated Framework for Transformation (SWIFT, www.swiftschools.org/) offer examples of suc- cessful efforts to bridge general and special education, and transform schools into inclu- sive communities that meet the needs of the diverse array of students in our schools.

Second, curricular options for students with severe disabilities have extended beyond functional life skills to include greater alignment and access to the general education cur- riculum. Promising approaches have emerged that demonstrate positive learning out- comes for students with severe disabilities in literacy, math, and science (Hudson, Browder, & Wood, 2013; Riggs, Collins, Kleinert, & Knight, 2013; Spooner, Knight, Browder, & Smith, 2012). In inclusive settings, the principle of universal design for learn- ing (i.e., designing the curriculum with the needs of all learners in mind right from the start) has enabled teachers to create learning environments that accommodate the range of learners in their classrooms (Coyne, Pisha, Dalton, Zeph, & Smith, 2012; Dymond

TAbLe 1–1 Areas for Optimism

1. Inclusive education and schoolwide reform 2. Access to the general education curriculum 3. Positive behavior interventions and supports 4. Peer supports 5. Self-determination and transition to adult life

TAbLe 1–2 Elements of Inclusive Education

Inclusive education exists when each of the following six characteristics occurs on an ongoing, daily basis.

1. All students are welcomed in general education. The first placement options considered are the general education classes in the school that the students would attend if they did not have a disability.

2. Disability is recognized as a form of human diversity. Hence, students with disabilities are accepted as individuals and are not denied access because of their disabilities.

3. Appropriate supports are available, regardless of disability label or the level and/or type of supports needed. Given their portability, supports are provided in typical environments instead of sending students to specialized settings to receive supports.

4. The composition of the classrooms in which students are educated reflects the naturally occurring proportion of students with and without disabilities or other identified needs (referred to as natural proportions). Therefore, the percentage of students without disabilities in each class is substantially higher than the percentage of students with disabilities or other special needs.

5. Students, irrespective of their performance levels and/or support needs, are educated with peers in the same age groupings available to those without disability labels instead of with younger students. Students with disabilities need not function at or near the same academic level as their classmates (although some do) to benefit from a chronologically age-appropriate, inclusive placement.

6. Students with and without disabilities participate in shared educational experiences while pursuing individually appropriate learning outcomes with the necessary supports. Educational experiences are designed to enhance valued life outcomes that seek an individualized balance between both the academic-functional and the social-personal aspects of schooling.

(From Choosing Outcomes and Accommodations for Children (COACH): A Guide to Educational Planning for Students with Disabilities, Third Edition (2011) by M.F. Giangreco, C.J. Cloninger, & V.S. Iverson. (Baltimore, Paul H. Brookes Publishing Co, Inc.). Adapted with permission.)

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6 Chapter 1

et al., 2006). Furthermore, students with severe disabilities are now included in statewide accountability systems through alternate assessments that are aligned with state aca- demic standards (Individuals with Disabilities Education Act, IDEA, 2004; No Child Left Behind Act, NCLB, 2001). This increased emphasis on academic instruction has pre- sented new opportunities for students with severe disabilities to access challenging cur- riculum and for school personnel to be held accountable for their learning.

Third, the rapidly developing technology of positive behavior interventions and sup- ports (PBIS) has resulted in effective, non-aversive interventions for students with severe disabilities who exhibit problem behavior (Brown & Michaels, 2006; Dunlap et al., 2010; Freeman et al., 2006; Goh & Bambara, 2012; Sailor, Dunlap, Sugai, & Horner, 2008) (see Chapter 7). PBIS is based on the premise that all behavior serves a function (or purpose) and interventions must be designed to teach alternative behaviors that serve the same functions. Since the reauthorization of IDEA in 1997, schools have been required to con- sider the use of PBIS for students with problem behavior. Schools are increasingly imple- menting PBIS strategies schoolwide, which has resulted in the creation of more positive learning environments for all students, including students with severe disabilities.

Fourth, drawing upon peers to lend support to students with severe disabilities has emerged as a prominent area of research because it is central to social and academic classroom success (Carter, Cushing, & Kennedy, 2009; Janney & Snell, 2006). Peers without disabilities can effectively provide an array of supports to their classmates with disabilities in ways that enhance educational experiences. Increasingly, school personnel are recognizing the benefits of peer supports instead of the common response of relying too heavily or unnecessarily on extra adult supports (e.g., one-to- one teacher assistants) (Giangreco, Doyle & Suter, 2012) (see Chapter 11).

Finally, the focus on family involvement has expanded to include student involve- ment and self-determination. Self-determined young people have skills and attitudes that allow them to act as causal agents, to make things happen in their own lives. Self-determination emerges as students learn the skills needed to make choices and decisions about their own lives, have opportunities to make decisions, and then have those decisions honored (Wehmeyer, 2005). As succinctly summarized in self- advocacy circles, “Nothing about me without me!” Self-determination is critically important as it pertains to transition to adult life (Shogren, 2013; Thoma, Bartho- lomew, & Scott, 2009). Self-determination skills facilitate successful transitions into supported employment (Wehman, Inge, Revell, & Brooke, 2007), supported commu- nity living ( Jameson & McDonnell, 2010; Taylor, 2006), and postsecondary education (Feldman, Fialka, & Rossen, 2006; Grigal & Hart, 2009).

reasons for Concern

Although the five areas for optimism presented in the previous section are encourag- ing trends, the field of special education is not at a stage of development where the curricular, instructional, and support needs of students with severe disabilities are con- sistently and sufficiently addressed. Table 1–3 lists six continuing areas of concern.

First, inclusive educational opportunities have remained relatively static, and inconsistent access to inclusive classrooms continues to plague public school systems, especially for students with severe disabilities. Primary placement in general education

TAbLe 1–3 Areas for Continuing Concern

1. Inconsistent access to inclusive classrooms 2. Questionable quality of curriculum and instruction 3. Too many families are frustrated by the lack of professional responsiveness 4. Continued use of aversive procedures 5. Challenging working conditions for special educators 6. Limited postschool options

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7Educating Students with Severe Disabilities

means that a student with a disability receives 80% or more of his or her instruction in a general education classroom with appropriate supports. The U.S. Department of Education (2012b) indicates that for all students with disabilities (ages 6–21) in U.S. states, including the Bureau of Indian Education (BIE) and outlying areas, 61% have their primary placement in general education classrooms. A closer look at categories most likely to include students with severe disabilities (e.g., autism, deaf-blindness, intellectual disability, multiple disabilities, and traumatic brain injury) depicts a more stark reality. For example, only 17% of students with intellectual disability nationally are included in general education classrooms for 80% or more of their school day. Currently, 15 states (i.e., AZ, CA, HI, IL, ME, MN, MO, NV, NJ, NY, SC, TX, UT, WA, WY) include less than 10% of their students with intellectual disability for 80% or more of the school day. In contrast, only five states (i.e., AL, CT, IA, KY, VT) along with two American Territories (i.e., Puerto Rico, Northern Mariana Islands) include over 35% of their students with intellectual disability in general education classes for 80% or more of their school day (U.S. Department of Education, 2012a). Unfortu- nately, placement in general education classrooms depends, in large part, on where a student lives and what disability category has been assigned to him or her. Although placement does not equal inclusion, it is a telling indicator of access to general educa- tion environments and a first step toward inclusive opportunities.

Second, even in situations where access to inclusive environments is better, the questionable quality of the curriculum and instruction for students with severe disa- bilities in general education classrooms continues to be a serious and ongoing issue (Halle & Dymond, 2008/2009; Hunt, McDonnell, & Crockett, 2012). Being physically present in settings with same-age peers who do not have disabilities is necessary, but not sufficient, to be included. Too many students with severe disabilities who are placed in general education classes are subjected to undesirable conditions, such as being (a) separated within the classroom (e.g., taught primarily by a paraprofessional apart from classmates), (b) taken through the motions of a lesson or activity without having appropriately targeted learning outcomes (i.e., not learning much of value or importance to them), or (c) presented with lesson content that is inconsistent with their abilities or learning and communication characteristics. The very concept of inclusive education has become distorted because fragmented, partial, or low-quality implementation efforts have been mislabeled as “inclusive” (Davern et al., 1997). While public debates continue to be waged regarding the least restrictive environ- ment provision of the IDEA and the curriculum focus for students with severe disabil- ities, years pass and the lives of real children and their families are adversely affected.

Third, too many families are frustrated by the lack of professional responsiveness to their children’s educational needs ( Jegatheesan, 2009; Soodak & Erwin, 2000). While some educators interact with parents and students as consumers and embrace them as partners in the educational process, others still resist, preferring to retain the role of professional as expert (Turnbull, Turnbull, Erwin, Soodak, & Shogren, 2010). Families from culturally diverse backgrounds experience further frustration when school per- sonnel fail to understand or respect the values inherent in their culture ( Jegatheesan, 2009; Shogren, 2013). Family members, friends, and persons with disabilities them- selves also have expertise and knowledge concerning issues such as an individual’s likes and dislikes, understanding of behavioral challenges, rest/sleep patterns, idio- syncratic communication, personal history, and other important information that may contribute to educational and support planning. It is when the respective expertise of professionals and families are combined that teams have the opportunity to experi- ence the synergy that comes from true collaboration (Harry, 2008) (see Chapter 2).

Fourth, concern exists about the continued use of aversive procedures to manage problem behaviors (Brown & Traniello, 2010; Westling, Trader, Smith, & Marshall, 2010). Sadly and unnecessarily, some students with severe disabilities continue to be subjected to an arsenal of aversive procedures and punishments (e.g., contingent elec- tric shock, restraints, seclusion, noxious smells, white noise, physical assaults) in the

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8 Chapter 1

name of “treatment,” resulting in lost learning opportunities, degradation, psychologi- cal trauma, physical injury, and, in a small number of cases, even death (Gonnerman, 2007; National Disability Rights Network, 2009; U.S. Government Accountability Office, 2009). This problem persists despite the availability of effective, positive alternatives (Goh & Bambara, 2012; Sailor, Dunlap, Sugai, & Horner, 2008) and a national cam- paign to end the use of restraint and seclusion (www.stophurtingkids.com).

Fifth, challenging working conditions for special educators contribute to the con- cerns about the education of students with severe disabilities. Of particular alarm is the national shortage of qualified special educators, as well as the need to train and retain more of them (Boe & Cook, 2006; McLeskey, Tyler, & Flippin, 2004). Boe, Cook, and Sunderland (2008) report that annual turnover in special education has increased to one in four teachers in recent years. Some of the key factors contributing to special educators leaving the field include excessive paperwork, large caseloads, and lack of administrative support (Kozleski, Mainzer, & Deshler, 2000). Teacher shortages and high turnover rates interfere with students receiving an appropriate, high quality education. This is particularly true for students with severe disabilities, who constitute a small proportion of the overall population of students with disabili- ties and require teachers with specialized expertise and skills.

Finally, limited postschool options adversely affect young adults with severe disabil- ities. While some students with severe disabilities are accessing meaningful post- school opportunities, many are not (Certo, Luecking, Murphy, Brown, Courey, & Belanger, 2008). All too often youth with severe disabilities exit school unemployed, without basic skills, lonely, and unnecessarily isolated. At a time when the lives of their same-age peers are growing more interesting with expanding opportunities, the lives of young adults with severe disabilities is becoming smaller and more restricted.

If you are interested in improving the lives of people with severe disabilities through education, there is plenty to motivate you to act, regardless of whether you see this point in time as the glass half full or half empty. For those of you motivated by positive news, there is a continually growing set of examples and body of literature document- ing steady progress to encourage your continuing contributions to these efforts. Regard- less of what “fuels your fire”—the slow pace of progress or ongoing injustices facing people with severe disabilities—there is plenty of motivation to act and work to do!

aCCeSS to Quality eduCation

The remainder of this chapter offers foundational information and ideas about access to quality education for students with severe disabilities in four main areas including

access to (a) inclusive environments, (b) individualized curricu- lum, (c) purposeful instruction, and (d) necessary supports. All of these components of quality education and others are given in depth attention in the subsequent chapters and embedded throughout the book.

access to inclusive environments

Since its passage in 1975, IDEA has mandated that students with disabilities be edu- cated in the least restrictive environment (LRE) (Rebhorn & Smith, 2008; Turnbull et al., 2007). The LRE provisions state that “to the maximum extent appropriate, chil- dren with disabilities . . . are educated with children who are non-disabled. . . . special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only if the nature or severity of the disa- bility is such that education in regular classes with the use of supplemental aids and services cannot be achieved satisfactorily” (34 CFR 300.114).

Ironically, it has been this second part of the LRE mandate that, at times, has been used to justify the continued segregation of students with the most severe disabilities.

Watch “IDEA and Special Education Best Practices” at www.youtube.com /watch?v=lQE4zEGXOGE.

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9Educating Students with Severe Disabilities

Across the country, far too many students who have severe disabilities are automati- cally placed in self-contained special education classes or schools, and thus are denied opportunities to build relationships with their peers without disabilities as well as access to general education classrooms and curricula.

The federal government, however, expresses a strong preference for placement in general education classes for students with disabilities, including those with severe disabilities (Rebhorn & Smith, 2008). As the U.S. Department of Education wrote in the regulation’s “Analysis of Comments and Changes,” the IDEA

. . . presumes that the first placement option considered for each child with a disability is the regular classroom in the school that the child would attend if not disabled, with appro- priate supplementary aids and services to facilitate such placement. Thus, before a child with a disability can be placed outside of the regular educational environment, the full range of supplementary aids and services that could be provided to facilitate the child’s placement in the regular classroom setting must be considered. (CFR, 2006, p. 46588)

The IDEA goes on to state

In all cases, placement decisions must be individually determined on the basis of each child’s abilities and needs and each child’s IEP, and not solely on factors such as cate- gory of disability, severity of disability, availability of special education and related services, configuration of the service delivery system, availability of space, or adminis- trative convenience. (CFR, 2006, p. 46588)

Further evidence of federal support for educating students with severe disabilities in the LRE is found in a jointly submitted amicus curiae (friend of the court) brief that the U.S. Department of Justice (Office of Civil Rights) and the U.S. Department of Education wrote in support of a student with severe disabilities (named Spike who attended Valley Grove School District) to be educated in the general education class- room with supplemental supports and aids.

. . . The IDEA does not require that Spike be able to perform at or near the grade level of non-disabled students before placement in the regular class can be considered the LRE for him. Congress expressed a strong preference in favor of educating children with dis- abilities in an inclusive manner and an integrated environment and requires States accepting IDEA funds to educate children with disabilities in the least restrictive envi- ronment (i.e., with their non-disabled peers in the regular classroom) to the maximum extent appropriate. States and school districts are not asked to determine whether LRE is an appropriate policy but rather to determine how a child can be educated in the LRE. Thus, school districts must determine how a child can be educated in the regular class with the use of supplementary aids and services. Valley Grove did not even attempt to make the necessary determination of how Spike could be educated in the LRE. Indeed, Valley Grove argues instead that, directly contrary to IDEA regulations, Spike must be removed from his age-appropriate regular classroom solely because his educational level is below that of the class. (U.S. Department of Justice, 2002, pp. 13–14)

IDEA is clear that the default placement—in other words, the starting point—for all students with disabilities is the general education classroom with appropriate sup- ports. IDEA does not say that students with disabilities should be denied access to general education classes

• if they have a particular label (e.g., autism, intellectual disability, multiple disabilities) • if they require supports or accommodations (even if potentially extensive) • if they function at a substantially different level than their classmates • if they are pursuing different learning outcomes than their classmates • just because it hasn’t been done that way before in the school • if it is administratively inconvenient or if needed services are not currently in place • if the adults in the school are unaccustomed to the characteristics presented by the

students and/or their support needs

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10 Chapter 1

Despite trends toward greater access to general education classrooms, students with severe disabilities remain most at risk for segregated placements. Yet, for every student with a severe disability who remains educationally segregated there are other students with similar attributes, abilities, and needs who are successfully included and learning relevant skills. This suggests that whether a student with a severe disa- bility is meaningfully included may have less to do with his or her characteristics and more to do with the attitudes, skills, structure, and practices of the adults responsible for providing education (Giangreco, Carter, Doyle, & Suter, 2010). Placement teams must ask themselves the question, “How can we change our practices so that more students with disabilities can be successfully included and educated?”

access to individualized Curriculum

IDEA provides a potent framework to enhance the lives of students with disabilities through special education and the development of an individualized education pro- gram (IEP). Special education is defined as “specially designed instruction, at no cost to parents, to meet the unique needs of a child with a disability” (20 U.S.C. § 1400 (2004); IDEA, sec. 602(29)). Specially designed instruction means, “adapting . . . content, methodology, or delivery of instruction to meet the unique needs of the child that result from the child’s disability; and to ensure access of the child to the general education curriculum” (34 CFR 300.39 [3]).

As described in the IDEA, special education is a service, not a place (Taylor, 1988). At its heart, special education refers to the individualized ways in which we provide instruction to students in an effort to respond to their unique learning characteristics resulting from their disability. Sometimes individualization means (a) changes in curric- ulum to account for a student’s present level of performance or support needs, (b) adaptations to the delivery of instruction (e.g., sensory, physical, behavioral, environ- mental) that allow a student to have access to learning opportunities, or (c) use of differ- ent instructional methods applied to the general education curriculum or to individually determined learning outcomes that extend beyond the general education curriculum.

individualized Participation options Within General education The participation of students with severe disabilities within general education classes and activities can be broadly characterized along two dimensions: (a) their educa- tional program content (i.e., individualized curriculum, IEP annual goals with corre- sponding benchmarks or short-term objectives, and designated learning outcomes from the general education curriculum) and (b) their supports, namely, what is pro- vided to assist the student in accessing and pursuing achievement of his or her educa- tional goals (e.g., assistive technology, materials, adaptations, learning strategies, related services). As shown in Figure 1–1, this can be conceptualized as four basic options for including students with severe disabilities (or any student for that matter) within typical class activities; each is described in the sections that follow. During the course of a school day, even sometimes within a single activity, an individual student will move among these different options, depending on the nature of the activity and his or her individual needs. This approach requires deliberate collaboration among teachers, special educators, and related services providers (see Chapter 6).

option a: no accommodations required Option A exists when a student is participating in the same activity with students with- out disabilities in the same way, and is pursuing the same content at the same level of difficulty. However, supports (e.g., teacher, classmates, classroom equipment) that are typically available can and do vary widely from class to class or school to school.

The participation of students with severe disabilities may be characterized as Option A during certain parts of the day. If Option A existed all of the time, the student would not be in need of special education nor would he or she be characterized as having severe disabilities. For example, in a primary classroom, when the teacher is reading a

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11Educating Students with Severe Disabilities

story to the class, the student with severe disabilities may not require specialized instruction or specialized supports. The teacher may position the child close by so that the teacher can show each page and respond if the student’s attention wanders, or the teacher may have a peer sit nearby in case the student starts to lose his or her balance while seated on the floor with the rest of the class. However, these types of simple supports are not so specialized that they are considered “special education.”

It is important to recognize times when a student with a severe disability can partici- pate within Option A because (a) it provides opportunities for the teacher to interact with a student who has disabilities in typical (non-specialized) ways, (b) it allows class- mates to see that the student doesn’t always need extraordinary help, and (c) it allows the student to avoid unnecessary supports that may inadvertently interfere with peer interaction or teacher engagement. Many students with severe disabilities have one-to- one paraprofessional support while they are in general education class activities (Suter & Giangreco, 2009). There can be a tendency to provide such support, even at times when it is not needed. Using the previous example, having the student with a severe disability sit beside or on the lap of the paraprofessional not only may be unnecessary, but also may have unintended negative consequences such as stigmatization, unneces- sary dependency, interference with peer interactions, and interference with teacher engagement (Giangreco, 2010). Therefore, teams should continually look for Option A opportunities by considering how naturally available supports can be utilized (Carter, Cushing, & Kennedy, 2009; Downing, 2010; Giangreco, Broer, & Suter, 2011).

option b: Support accommodations required Option B exists when a student with a disability requires extended, modified, or otherwise individualized supports while pursuing substantively the same general edu- cation program. For example, in order for a student with deafness or blindness to access

FiguRe 1–1 Inclusion Options Within General Education Environments and Activities

Supports: Materials, Teaching Strategies, and Personnel

Supports that are similar to those available in general education

Supports that are extended, modified,

or individualized

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needed

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needed

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and support accommodations

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instruction is similar to general education

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instruction is extended, modified, or

individualized

(From Giangreco, M.F., & Putnam, J. [1991]. Supporting the education of students with severe disabilities in regular education environments. In L.H. Meyer, C. Peck, & L. Brown [Eds.], Critical issues in the lives of people with severe disabilities [p. 247]. Baltimore: Paul H. Brookes Publishing Co.; adapted by permission. As it appears in Choosing Outcomes and Accommodations for Children (COACH): A Guide to Educational Planning for Students with Disabilities, Third Edition (2011) by M.F. Giangreco, C.J. Cloninger, & V.S. Iverson.)

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12 Chapter 1

the general education program, he or she may require signing from an interpreter or the use of tactile materials as necessary supports. Similarly, a student with severe orthopedic or multiple disabilities might require a digital recorder and adapted switch to “take notes” during a high school class.

option C: educational Program Content accommodations required Option C exists when a student requires extension, modification, or individualization of the content of the general education program but does not require specialized sup- ports. For example, the teacher might adjust the content with regards to (a) the amount (e.g., 4 new vocabulary words instead of 10), (b) the level (e.g., posing less complex questions), or (c) the type of content (e.g., 1:1 correspondence instead of fractions). Across each of these possibilities, once the content adjustment is made, the student does not require other specialized supports—although, like Option A, natural supports might be provided.

option d: educational Program Content and Support accommodations required Option D exists at times when a student needs extension, modification, or individuali- zation of both the general education curriculum content and specialized supports to participate. In addition to adjusting the content of the curriculum with regards to the amount, level, and/or type, individualized supports are provided to assist the student with learning and participation. Some examples of individualized supports that a stu- dent with severe disabilities might receive include a visual picture schedule that iden- tifies the steps for completing an activity, individualized prompting from a peer or adult, or an adapted keyboard for use with the computer. These supports allow stu- dents to actively engage in educational activities by removing barriers that interfere with learning.

Within both options C and D, teams may employ the principle of partial participa- tion (Baumgart et al., 1982; Ferguson & Baumgart, 1991). This principle is based on the premise that students with severe disabilities “can acquire many skills that will allow them to function, at least in part, in a wide variety of least restrictive school and nonschool environments and activities” (Baumgart et al., 1982, p. 19). For example, a student with severe disabilities might have a job in the school library that involves taking returned books from the book drop and placing them on a cart. A peer may then assist the student with severe disabilities to find the correct shelf and position for the book. In this manner, the student performs some, but not all, of the skills that are typically performed by students at school who serve as library assistants.

Partial participation is designed to foster socially valued roles for people with dis- abilities that have a positive influence on their image and personal competencies. Rather than excluding students from activities because they may never be able to per- form independently or in the same way as most students, partial participation focuses on engaging students to the maximum extent possible. Consider Kendra, a middle school student with multiple disabilities who has extensive support needs related to oral–motor skills (e.g., chewing, swallowing).

Many foods that Kendra is supported to eat fall out of her mouth. When in the bustling cafeteria, she seems particularly distracted. Her parents identified eating in busy envi- ronments as a priority because the family often eats in busy restaurants.

School personnel, however, were concerned that eating in the cafeteria was socially problematic for Kendra and would detract from how she was perceived by others. So she has been eating lunch in a private area while working on goals to improve her eating and drinking skills with a paraprofessional. Unfortunately, this practice, while intended to be respectful of her, took an all-or-nothing approach. A subgroup of Kendra’s educa- tional team, including her mother, special education teacher, and occupational thera- pist, came up with a plan designed to respect her dignity while also providing her with access to the cafeteria with classmates.

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13Educating Students with Severe Disabilities

The principle of partial participation was key to various aspects of their plan that systematically shifted from eating alone to eating with peers in the cafeteria. First, rec- ognizing that Kendra quickly fatigued and her eating skills deteriorated as time went on, they decided that instead of having Kendra eat her entire lunch in one 20-minute sitting, she ate two 10-minute mini-meals spread out over 40 minutes. During the regu- larly scheduled lunch period for her class, she spent only 5 minutes in a private area working on her eating and drinking goals. The remaining 15 minutes was spent in the cafeteria with her peers, eating only foods that she could better manage and hanging out just like everyone else in the middle school cafeteria. After a couple of weeks the amount of time that she spent in the cafeteria was gradually increased. Kendra’s par- ents and occupational therapist identified a specific set of foods that she was able to chew and swallow most effectively without spilling. She would still lose food occasion- ally; this would allow her peers to learn that some people eat differently and for the adults to model that it’s not a big deal. Kendra continued to work on eating more chal- lenging foods in private. The team recorded data on both her eating goals and social interactions—they met regularly to discuss Kendra’s progress. Gradually her eating shifted to the cafeteria completely, although she still didn’t eat her entire meal during the scheduled lunchtime. The team used partial participation by offering her only cer- tain foods in the cafeteria and using only part of the time for eating; these modifica- tions in the usual lunch routine allowed Kendra to be more fully part of the life of the school.

It is often the case that Option D will be necessary, at least part of the time, for students with severe disabilities because of their extensive or pervasive support needs. Teams are encouraged to consider when options A, B, or C are possibilities and to be conscious of not overusing Option D if less intrusive options are appropri- ate. When Options C and D are warranted, care must be taken to structure the learn- ing environment in a manner that promotes access to individualized curricular content as well as access to learning with peers. Unfortunately, Options C and D are fre- quently operationalized by assigning a paraprofessional to teach individualized cur- ricular content (i.e., a parallel educational program) in the back or side of the classroom. Such an approach minimizes the potential benefits of participation in a general education class and has been linked to a host of unintended detrimental effects (Giangreco, 2010). Delegating primary instructional responsibilities to a para- professional also relegates students with the most significant learning challenges to receiving their instruction from the least qualified personnel, who tend to be under- trained and inadequately supervised (Giangreco, Doyle, & Suter, 2014). Two alterna- tives include multilevel curriculum/instruction and curriculum overlapping (Giangreco, 2007). See Table 1–4 and Figure 1–2 for shared and distinct components of these two related approaches.

multilevel Curriculum/instruction There are two requirements of multilevel curriculum/instruction. First, it occurs when a student with disabilities and peers without disabilities participate together in a shared activity such as a science lab experiment. Second, each student has individu- ally appropriate learning outcomes that may be at multiple levels (i.e., below, at, or above grade level), all within the same curricular area. While one student may be learning at a basic knowledge or comprehension level, another student simultane- ously may be working at a more advanced level.

Imagine second-grade students playing a teacher-designed, small-group, social studies board game to learn about their neighborhood, town, and state. A set of 10 game cards has been prepared for each student that targets individual learning outcomes. For three students (at grade level), the game cards require applying knowledge about the roles of community helpers (e.g., police, firefighters, store clerks, postal workers) by moving game pieces to respond to scenarios on the cards (e.g., “Move your player to the place

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14 Chapter 1

where you might go if you wanted to send a card to your grandmother for her birth- day.”). For another student who has autism and has occasionally gotten lost or sepa- rated from his family, game cards have the student answer questions about himself and where he lives (e.g., last name, street address, phone number, where his parents work). A third student (who is performing above grade level) is using map skills such as north, south, east, and west to respond to questions (e.g., “If you started at the bookstore, went two blocks north and one block east, where would you be?”). In this example, all of the students have individualized social studies learning outcomes, pertaining to different content/subject matter, within a shared activity. A

bo ve

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ev el

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CO

(Content, Level & Amount)

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Multi Level-S Curriculum (Same Content, Different Level and/or Amount)

Multi Level-D Curriculum (Different Content, Different Level and/or Amount)

Curriculum Overlapping

FiguRe 1–2 Multilevel Curriculum and Curriculum Overlapping

(© Michael Giangreco. Reprinted with permission.)

TAbLe 1–4 Components of Multilevel Curriculum/Instruction and Curriculum Overlapping

Shared Components

1. Lessons include a diverse group of same-age learners (e.g., advanced, those with disabilities, at grade level, at risk).

2. Learning occurs within a shared activity or experience within a regular class activity. 3. Each learner has individually appropriate learning outcomes at an appropriate level of difficulty.

Distinct Components

Multilevel Curriculum/instruction Curriculum Overlapping

4. Targeted learning outcomes are within the same curricular area (e.g., science or math or social studies) and students are responsible for more or less of them in terms of amount and complexity.

4. Targeted learning outcomes for the student with a disability come from a different curricular area (e.g., communication, socialization, or personal management) than those targeted for other classmates (e.g., science, math, history).

Variations: (a) Same topical subject matter in same curricular area (b) Different topical subject matter in same curricular area

(From Extending inclusive opportunities. Educational Leadership, 64(5), 34–37. Reprinted by permission of the author.)

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15Educating Students with Severe Disabilities

By definition, multilevel curriculum/instruction involves individually appropriate learning outcomes that may be provided at any level (i.e., below, at, or above grade level) and can include variations across subject content.

In one seventh-grade social studies class focusing on history from the American Revolu- tion through the Civil War, the topic is the same for Joseph—a student with disabilities— and his classmates without disabilities. But his level of learning outcomes is adapted to suit him (e.g., historical people, places, events). In Joseph’s algebra class, however, the subject content for Joseph is different from that for many of his classmates, focusing on counting and basic computation (e.g., adding is a variation within the subject con- tent). In this case, the level and quantity of the learning outcomes would be adapted as well. In both classes, Joseph is working on individualized learning outcomes within the same curricular content area as his classmates, just at a different level.

Curriculum overlapping Curriculum overlapping starts in the same way as multilevel curriculum/instruction; a student with disabilities and peers without disabilities participate together in a shared activity where each student has individually appropriate learning outcomes. Curriculum overlapping differs in that the learning outcomes being pursued within a shared activity come from two or more different curricular areas; this is unlike the multilevel curriculum/instruction examples, where they were all within the same curricular area.

In a middle school biology class, students are grouped in teams of three for lab activi- ties. They are assembling a model of a human heart. Two students have goals related to the identification, anatomy, and physiology of the human heart. The third student, who has an intellectual disability and extensive support needs, participates in helping to assemble the model heart but is working on communication and social skills (e.g., taking turns, following instructions, responding to yes/no questions, maintaining socially acceptable behavior for longer periods of time).

Curriculum overlapping is appropriate to use when there are large differences between the level of learning outcomes being pursued by most of the students in a class and the student with a severe disability. Before employing curriculum overlap- ping, the team should consider whether the student could pursue the same learning outcomes as the rest of the class or whether either of the two multilevel curriculum/ instruction variations are viable options; this helps to ensure that we do not underes- timate students with severe disabilities.

In a middle school math class, six students are arranged in a circle for a game that involves throwing and catching a beach ball covered with numbers to practice multipli- cation. The game starts by having one student call a classmate by name and then toss the ball: “Terry, I’m throwing the ball to you.” After catching the ball, the student is asked to multiply the two numbers that are touched by his or her thumbs. All of the stu- dents have math learning outcomes except for Jesse, a student with an intellectual disa- bility and extensive support needs. Jesse participates in the same activity but has a series of non-math goals. He is learning to orient himself toward a person who calls his name, react to the tossed ball by moving his arms to attempt a catch, match to a sample by pointing to a photograph of a classmate in the group, and then orient himself toward that person before being assisted to toss the ball.

At times, both multilevel curriculum/instruction and curriculum overlapping can be used within the same activity. By pursuing more than one learning outcome within class activities, students with severe disabilities are provided with numerous opportu- nities to learn and practice skills. Research has demonstrated the effectiveness of embedding individually determined learning outcomes within general class activities (Hudson, Browder, & Wood, 2013; McDonnell, Johnson, Polychronis, & Risen, 2002).

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Such approaches have become increasingly relevant with the advent of the Common Core State Standards Initiative (www.corestandards.org). Occasionally, it may be necessary to plan an alternate activity if a student needs to work on a high-priority goal that does not lend itself to being incorporated into the multilevel curriculum/ instruction or curriculum overlapping options. For example, a high school student with severe disabilities may need specific, alternative instruction on a skill that does not readily lend itself to available high school curriculum, such as how to safely cross various types of intersections to travel to a community-based work or recreation site. At other times, students’ privacy requirements dictate the need for alternatives, such as when a student is learning to use the toilet or dressing skills.

the Curricular balancing act Ensuring access to a relevant, individualized curriculum for a student with severe dis- abilities also requires a balancing act between focus and breadth (Hunt, McDonnell, & Crockett, 2012). Providing access to a breadth of learning outcomes that includes, but is not limited to, general education curriculum ensures that students with disabilities will have opportunities that may have been denied them in the past. A sound curricu- lum establishes a clear focus, based on a reasonably small set of the highest educa- tional priorities agreed to by the team; these are documented as IEP goals (Giangreco, Cloninger, & Iverson, 2011).

Historically, curricula for students with severe disabilities have emphasized the identification of chronologically age-appropriate functional skills needed to partici- pate in current and future environments (Brown, Nietupski, & Hamre-Nietupski, 1976; Brown et al., 1979). Chronologically age-appropriate skills are ones that are per- formed by same-age peers without disabilities. For example, when thinking about the use of a coat at school, a 7 year old may learn to hang his or her coat on a hook in the classroom whereas a 15 year old would learn to use a locker in the hallway. Selec- tion of age-appropriate skills is particularly important when addressing functional skills. Functional skills are skills that are used across one’s lifetime and would need to be performed by someone else if an individual was unable to perform the skills for him- or herself. Typical skills identified as functional include self-care (e.g., dressing, bathing, toileting), home living (e.g., cooking, cleaning), leisure (e.g., hobbies, fit- ness), community (e.g., using the grocery store, traveling in the community), and vocational (e.g., job and job-related skills) (Dymond, 2011).

While the foundational concepts of chronological age appropriateness and functional curriculum remain contemporary, variations on the themes have been expanded. Today, the basis for selecting IEP goals and objectives for students with severe disabilities has shifted to place a greater emphasis on determining which goals and objectives are most likely to result in positive lifestyle improvements (Giangreco, Cloninger, & Iverson, 2011; Halle & Dymond, 2008/2009; Hunt, McDonnell, & Crock- ett, 2012). By asking parents who have children with disabilities and people with dis- abilities themselves what does or would contribute to living a “good life,” we can better identify and select goals and objectives that will contribute to the development of valued life outcomes (Giangreco, Cloninger, & Iverson, 2011).

Juanita Perez is in first grade and has severe disabilities. Her special education teacher worked collaboratively with the team, including Juanita’s parents, to identify the highest priorities for Juanita from the family’s perspective that would be translated into IEP goals and objectives. These priorities included (a) expressing “more,” (b) making a selection when given options, (c) responding to yes/no questions using eye gaze, (d) calling others to her using a switch and recorded message, and (e) using a switch to activate leisure devices (e.g., digital music player, battery-operated toys). The team cross-referenced each of these priorities to one or more valued life outcomes. For example, being able to activate toys was designed to give Juanita more choices and control and was hoped to be a point of connection that might serve to extend her

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17Educating Students with Severe Disabilities

relationships with other children her age. The team also considered a set of additional learning outcomes to establish the breadth of Juanita’s educational program. They did this by systematically looking at the general education curriculum in each subject area, as well as functional skill categories, to decide which learning outcomes would make the most sense for Juanita. As a result, they selected a series of additional func- tional skills (in addition to the family’s highest priorities), such as imitating skills used in daily life, eating finger foods, drinking through a straw, and increasing the amount of time that she could sustain attention to a task. From the general education curriculum, they started with skills such as recognizing symbols, distinguishing be- tween shapes, writing her name using an adapted stamp, and using a variety of art media, among others.

A sound curriculum also balances the assessed level of appropriateness with a meas- ure of challenge. An age-old tenet of instruction is that a student’s learning outcomes should be selected at an appropriate level of difficulty on the basis of assessment data. Targeted learning outcomes should be reasonably attainable yet challenging, although not so challenging as to be unattainable or frustrating. Although it is logical to select instructional targets on the basis of the student’s current level of perfor- mance and known learning characteristics, quality instruction should provide ample opportunities for students to surprise us with their capabilities.

Therefore, we should never presume to know the upper limits of a student’s abili- ties, especially if the student has not been sufficiently exposed to a concept or skill or has not received ongoing, competent instruction using research-based interventions. This is consistent with Donnellan’s (1984) criterion of the least dangerous assump- tion, which asserts, “in the absence of conclusive educational data, educational deci- sions should be based on assumptions which, if incorrect, will have the least dangerous effect on the student” (p. 142). For example, if an individual with a severe disability is non-verbal and does not have a fluent alternative or augmentative method of communication, it would be most dangerous to assume that he or she does not understand much, if any, of what is said to or near him or her. It would be less dan- gerous to assume that he or she understands everything being said to or near him or her. Similarly, it would be most dangerous to prevent the student’s exposure to a gen- eral education curriculum and least dangerous to provide not only exposure but also instruction.

Juanita’s team did not select any science learning outcomes for her because they felt that the concepts were too advanced for her and because they were not able to ade- quately assess her science learning given her challenges with expressive communica- tion. Recognizing that this could be a dangerous assumption given the challenge of knowing how much Juanita understands, they decided to include her in science class and start with curriculum overlapping so that the learning outcomes that she focused on during science class were primarily communication and social skills. By including her in the science activities and exposing her to instruction in this area along with her classmates, they are providing her with opportunities that would not deny the possibility that she understands more than they were currently able to discern. At least at the out- set, accountability for learning during science class will focus on the non-science com- munication and social skills. Over time, on the basis of the teacher’s observations during science class activities, Juanita’s additional learning outcomes may be expanded to include science class outcomes.

access to Purposeful instruction

Over the past several decades, the field of educating students with severe disabilities has relied extensively on the use of systematic instructional methods to pursue mean- ingful curricular outcomes because of their strong theoretical foundation and docu- mented effectiveness (Alberto & Troutman, 2013). This set of instructional methods,

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18 Chapter 1

such as chaining, shaping, prompting, time delay, and error correction (see Chapter 5), offered a bright spot in a special education system that was all too often character- ized by unnecessarily low expectations, too much instructional downtime, limited access to peers without disabilities, and questionable curricula. Use of systematic instructional methods played a major role in documenting the wide range of skills and functional routines that people with severe disabilities could learn if offered con- sistent, quality instruction. In fact, the use of these methods was instrumental in help- ing to establish, once and for all, the belief in the “educability” of students perceived as having the most profound disabilities.

Ironically, as students with severe disabilities have gained greater access to general education classes, peers without disabilities, and a broader curriculum, new questions have been raised about the integrity of their instruction. The field is wrestling with the challenge of how to utilize evidence-based, systematic instructional approaches in new and contextually viable ways (Koppenhaver & Erickson, 2008; Schnorr, 2011). In part, this has included a shift from individual instruction and small homogeneous groups to mixed-ability groupings where there is only one student with a disability with classmates who do not have disabilities.

As teams pursue quality instruction, it is important to remember that the principles of teaching and learning remain the same regardless of a student’s ability or where that student receives his or her education (see Box 1–1). Many doors have been opened for people with severe disabilities using foundational principles of instruc- tion, and these remain critical for learning in inclusive settings. As with all strategies, however, the specific and changing learning environments and individual learning needs of each student will shape how strategies are used and adjusted to fit the evolv- ing context. (For more on this topic, see Chapter 6.)

Know each Student’s Characteristics Quality instruction always starts by making sure you know your students. This means more than being familiar with their disability label, although that is important to understand. It means understanding their cognitive, physical, and sensory characteris- tics that affect instruction. It also means being cognizant of their social/emotional traits (e.g., temperament, behaviors), motivations, preferences and dislikes, interac- tion patterns, and creative attributes. Understanding such aspects of your students’ support needs allows for individualization, a hallmark of special education, and encourages the development of instructional approaches that build on each student’s strengths and preferences.

Select meaningful learning outcomes Quality instruction really matters only if it is applied to meaningful learning outcomes (Halle & Dymond, 2008/2009; Hunt, McDonnell, & Crockett, 2012). Highly effective instruction applied to irrelevant, non-functional, or chronologically age-inappropriate learning outcomes is a waste of the student’s time as well as your own. Effective teams establish and maintain a positive sense of urgency about their work without simultaneously creating undue stress on the student or team. They know that,

Principles of Quality Instruction 1. Know each student’s characteristics. 2. Select meaningful learning outcomes. 3. Establish shared expectations among team members. 4. Create a motivating and welcoming learning environment. 5. Select effective teaching methods. 6. Provide sufficient and consistent learning opportunities. 7. Use data to make instructional decisions and evaluate outcomes.

Box 1–1

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19Educating Students with Severe Disabilities

relatively, they have precious little time to teach, so their curricular selections and instructional intensity matter.

In addition to considering curricular aspects related to instruction mentioned ear- lier in this chapter (e.g., functionality, age appropriateness, balance of breadth and focus), teams should also consider (a) the frequency with which a learned skill will be used both now and in the future and (b) the extent to which a learned skill will increase independence. Clearly, skills that are used frequently and have current and future utility generally are more important than those that are used infrequently or will not be useful in the future. Selecting meaningful learning outcomes is always a judgment. Sometimes, skills with a lower frequency of use can be extremely impor- tant for being safe (e.g., street crossing, evacuating a building in response to an alarm) or for personal preferences (e.g., the leisure skills that one enjoys, predictable envi- ronments, unstructured time). For individuals with the most severe or multiple disa- bilities, another major consideration is the extent to which a learned skill will allow a person to control his or her environment. For example, learning to use an adapted microswitch may allow a person with severe or multiple disabilities to activate a wide variety of electrical or electronic devices across a range of locations and activities (e.g., communication, cooking, leisure, work).

establish Shared expectations among team members Having the perspectives of a variety of team members can be an asset to planning good instruction (Giangreco, Cloninger, & Iverson, 2011; Hunt, McDonnell, & Crockett, 2012). In order for teams to plan effectively, they must share common expectations and be willing to come to consensus about the direction of instruction for each student. Establishing shared expectations means that all members should (a) know the student’s learning-related characteristics and support needs, (b) be aware of the student’s priority learning outcomes (e.g., IEP goals), (c) be aware of the breadth of learning outcomes that are targeted for instruction (e.g., general education curricu- lum), (d) know when learning outcomes will be addressed throughout the school day, (e) know what general supports or accommodations need to be made for the student, (f) know the student-specific instructional procedures and adaptations, and (g) know what information should be collected on the student’s progress.

Create a motivating and Welcoming learning environment Although it may seem obvious, the importance of creating a motivating and welcom- ing learning environment for all students cannot be underestimated. Establishing a sense of belonging is considered a key building block for effective learning (Schnorr, 1990, 1997; Swedeen, Carter, & Molfenter, 2010). In order for students with disabilities to develop meaningful relationships with peers who do not have disabilities and to have access to a broad range of meaningful learning outcomes, they must share learn- ing experiences with peers on an ongoing basis. This includes experiences not only in the academic classroom but also in typical school routines (e.g., changing classes in the hallways, eating in the cafeteria, hanging out before school), special events (e.g., field trips, job fairs, talent night), school jobs (e.g., office helper, library assistant), and extracurricular activities (e.g., drama club, student council, intramurals).

Select effective teaching methods Part of instructional access involves selecting effective teaching methods as a starting point for intervention (Alberto & Troutman, 2013). Students with disabilities often respond favorably to many of the same teaching methods that are common and effec- tive for students who do not have disabilities. Some of these common methods include modeling and demonstration, repeated practice, guided discovery, participa- tory activities, using educational games or play, using positive and negative examples, giving corrective feedback, or cooperative group learning approaches. Challenges

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arise when students do not progress adequately when you have relied on typical instructional methods. In such cases, it is often necessary to be more precise in the application of methods; break the skills down into smaller components; or use differ- ent instructional methods, such as task analysis, chaining, shaping, and time delay (see Chapters 4, 5, 6, 10, 12, 13, and 14). Consider how Tom learned a new skill because of the use of a systematic instructional procedure and its impact on his life:

Tom had a traumatic brain injury that resulted in severe physical, cognitive, and sen- sory disabilities, including cortical visual impairment, loss of language, and the inabil- ity to walk, sit up independently, or use his arms and hands. Tom was fed primarily through a gastrostomy tube, although his parents had worked with him so that he could eat soft foods and drink by mouth. His only consistent, voluntary skill was some head movement from side to side when supported from behind, the ability to open and close his mouth, and some chewing. Tom communicated primarily through vocalizations (e.g., groaning was recognized as discomfort). This usually meant that it was time to get him out of his wheelchair for a while. At a meeting when Tom was 14 years old, his parents were asked for their input into Tom’s IEP goals for the year. Tom’s father said, “I don’t care what he learns; I just want to know that he can learn.” Building on Tom’s strengths, the team decided to teach Tom to respond to the verbal instruction “Open up” so that he would open his mouth to receive food, drink, and medicine, and have his teeth brushed. The team knew that Tom currently didn’t respond to “Open up” or any other instruction, but he did open his mouth wide when his lower lip was touched lightly (e.g., by a spoon with food). Some team members wondered if he was actually responding to the lip touch or something else, such as the air movement of something coming toward him, smell, or cues from some residual vision. Their assessment convinced them that it was the touch cue only that caused him to open his mouth. They decided to use an instructional proce- dure called “time delay.” This was started by simultaneously pairing the cue that they knew Tom responded to (i.e., touching his lip with a spoon) with the cue that they wanted him to respond to (i.e., the verbal instruction “Open up”), followed by giving him a spoon- ful of fruit yogurt. This simultaneous pairing is known as a zero delay because there is no time delay between the presentations of both cues. This was done numerous times throughout the day when Tom would normally be expected to open his mouth in an effort to help Tom to make the connection between the two cues. After this had been done for a few days, a one-second time delay was inserted between the cues. The teacher would say “Open up,” then wait one second before touching his lip. Over the next couple of weeks, the time delay between asking Tom to “Open up” and touching his lip was gradually in- creased in one-second intervals, always followed by a small bite to eat or a sip to drink. When the time delay was increased to five seconds, Tom opened his mouth to accept the food before his lip was ever touched—he had responded to the instruction! He soon was opening his mouth immediately and consistently following the request. Time delay had been successfully used to transfer control from the one cue to another. Some people might think that this didn’t matter much, but it did! For the first time in years, people who worked with Tom were excited and encouraged that he had learned a new skill. People interacted with him differently, more positively, as someone capable of learning. They were anxious to find out what else Tom could learn. Tom will always need substantial support, but this small change had a big impact. Once it was clear that he could respond to the “Open up” cue, the staff was sensitive to considering that Tom might keep his mouth closed as a way to indicate that he no longer wanted more to eat. Increasingly, the team was more aware of subtle behaviors that might have communicative intent.

Provide Sufficient and Consistent learning opportunities Once instructional methods have been selected, with the individual student’s learning characteristics in mind, the team needs to ensure that sufficient and consistent learn- ing opportunities are provided for the student. A scheduling matrix (Giangreco, Clon- inger, & Iverson, 2011) provides a way for the team to ensure that the student’s IEP goals and additional learning outcomes are incorporated into the daily or weekly

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21Educating Students with Severe Disabilities

schedule. A scheduling matrix is set up as a simple grid. Listed across the top are regularly occurring class activities (e.g., arrival, language arts, math, science, physical education, lunch, recess). Listed down the left side of the matrix are IEP goals and other targeted learning outcomes (see Chapters 4 and 6 examples). It can be helpful to note the amount of time devoted to each activity. For example, arrival may be only 10 to 15 minutes at the beginning of the day, whereas a full hour might be devoted to language arts. The time frame is important to know because the number of learning outcomes that can reasonably be addressed will vary accordingly. Because daily schedules often change (e.g., on one day math is at 9:00 a.m., and on a different day it is at 10:30 a.m.), when using a scheduling matrix it is not crucial to arrange the gen- eral class activities in a specific order according to the schedule. The team examines the matrix, determines which learning outcomes will be addressed in each class, and marks those locations on the matrix. The match between the learning outcomes and the class where they will be taught will be the same regardless of what time the class occurs or on which day of the week. In this way, the scheduling matrix can then be used to clarify which of a student’s learning outcomes can be embedded within all classes (e.g., express greetings and farewells, respond to yes/no questions, follow instructions, make choices when presented with options) and which will be targeted to specific classes or activities that make the most sense.

Providing sufficient and consistent learning opportunities requires persistence and creativity on the part of team members to embed opportunities for learning within class activities. Since students with severe disabilities often present a very unique con- stellation of learning characteristics, team members need a certain level of instructional flexibility. They need room to explore new approaches and combinations of approaches and to capitalize on unscheduled, teachable moments.

use data to make instructional decisions and evaluate outcomes Along with instructional flexibility comes accountability in the form of data collection. Just as we collect data and examples of work completed by students who do not have disabilities in order to monitor and document progress and be accountable for our teaching, teams have a responsibility to do the same for students with severe disabili- ties (see Chapter 5). Individualized data provide essential information for making reasoned instructional decisions (Alberto & Troutman, 2013; Farlow & Snell, 2005).

As we think about collecting data on student learning, it is important to remember that performance related to specific IEP goals and objectives is only part of what is necessary. Regardless of the extent of student progress, it is important for each prior- ity goal to be evaluated on the basis of its real impact on a person’s life. Wolf’s (1978) classic article introduced the field of applied behavior analysis to the assessment of social validity. Wolf argued that we must augment objective observable measures of behavior with the subjective perspectives of consumers if we are to achieve outcomes of social importance. He suggested that we evaluate (a) the social significance of the goals being sought, (b) the social appropriateness of the procedures being used, and (c) the social importance of the effects. The concept of social validity acknowledges that a student’s attainment of an established goal is not necessarily synonymous with its importance or with meaningful changes in the student’s life.

Maria is learning a set of social skills (e.g., responding to the presence of others, greet- ing, taking turns) with the intent that the attainment of these skills will contribute to establishing or extending friendships with her peers. Merely knowing that she has acquired those skills is a good first step, but it is incomplete until we determine whether her relationships with peers have changed for the better and whether her improved skills contributed to those socially important changes.

Sometimes, socially important outcomes can occur even when target skills are not achieved. There may be circumstances where a student does not progress much in the development of the targeted skill, but where the nature of the instructional

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arrangement (e.g., peer involvement in typical class activities) leads to improvement in valued life outcomes because something in the environment has changed (e.g., access to typical settings, attitudes of classmates). Improvements in valued life out- comes for individuals with severe disabilities can be enhanced by a combination of skill acquisition on their part, as well as changes in the environment, especially the attitudes and actions of the people in those environments.

access to the necessary related Services and Supports

As described earlier, one of the defining characteristics of people with severe disabili- ties is their need for supports in multiple domains to meet the demands of inclusive environments. Systems of supports for students with severe disabilities typically include supports for learning and participation (such as those described in the previ- ous sections) as well as related services and supports. Related services and supports, according to IDEA, include

transportation, and such developmental, corrective, and other supportive services (includ- ing speech-language pathology and audiology services; interpreting services; psychological services; physical and occupational therapy; recreation, including therapeutic recreation; social work services; school nurse services designed to enable a child with a disability to receive a free appropriate public education as described in the individualized education program of the child; counseling services, including rehabilitation counseling; orientation and mobility services; and medical services, except that such medical services shall be for diagnostic and evaluation purposes only) as may be required to assist a child with a dis- ability to benefit from special education, and includes the early identification and assess- ment of disabling conditions in children. (20 U.S.C. § 1400 (2004); IDEA, sec. 602(26)(A))

team decisions about related Services The goal of related services is to support students with severe disabilities to receive an appropriate education in the least restrictive environment. For this reason, related services providers, education professionals, and family members must work together as a team to identify the best ways to build a system of support that meets the indi- vidualized needs of each student.

When considering how to build a system of support for an individual student, differ- ent stakeholders may bring different value systems to the decision-making process. Some related services disciplines are rooted outside of education, such as allied health fields (e.g., speech language, physical therapy, occupational therapy) that may have discipline- specific values and perspectives. Coming to an agreement on shared values can enable teams to work together more effectively. In the sections that follow three common value systems that teams might encounter are described. The first two are inconsistent with sound educational practices; the third is suggested as a desirable alternative.

More Is Not Necessarily Better. Some team members advocate for more related serv- ices. If one session of a therapy is recommended, they think that two would be better, and three better yet. The more-is-better approach is misguided because it confuses quantity with value. Although rooted in benevolent intentions, the more-is-better approach can have unintended, negative consequences for students by interfering with participation in other school activities by

• decreasing the time available for participation in the general education curriculum with peers who do not have disabilities, particularly when a student is removed from the classroom to receive related services

• stigmatizing students if the provision of special services violates contextual norms • fostering unnecessary or unhealthy dependencies • unnecessarily complicating communication and coordination among team members • causing inequities in the distribution of resources, with some students remaining

unserved or underserved

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23Educating Students with Severe Disabilities

The Fallacy of Return on Investment. Another misguided value system, called return on investment, places a high value on “fixing” student’s deficits and it gives higher priority for supports and services to those students most likely to be “fixed.” This approach fails to recognize that disability is not something to “fix,” and instead, as IDEA states, is “a natural part of the human experience.” It can lead to devaluing and discrimination based on the intensity of a person’s support needs. Anytime that schools sanction practices that imply that some students are more worthy of staff time and resources than other students, there is a serious problem. And, imagine what it might be like to continually get the message “You are not okay the way you are. In order to be okay, your disability has to be fixed and you need to be more like us (people without disabilities).”

Only as Specialized as Necessary. An alternative value system is referred to as only as specialized as necessary—providing enough but not too much support. Remember, the goal of providing individualized supports to people with severe disabilities is to address the mismatch between a person’s capacities and the demands of inclusive environments. This requires an individualized system of support that balances the capacities of the individual with the demands of the environment. The conceptual basis for this value system has a legal foundation in a U.S. Supreme Court precedent (Board of Education of the Hendrick Hudson Central School District v. Rowley, 1982).

Systems of supports for students with severe disabilities should include multiple sources of supports, including both natural supports (e.g., peers, family members, community members) as well as specialized supports (e.g., educators, related service professionals). When specialized services and supports are used, ongoing data should be collected to document the impact of the services and supports and to explore ways for the services to be provided in the most natural and sustainable way, which may involve natural supports.

It is important to recognize that the only-as-specialized-as-necessary approach does not automatically mean “less is always best” or “only a little is plenty.” Some advocates have voiced concern that this approach might be misused to justify the denial of needed services; this certainly is not its intended use. When used as intended, the only-as-specialized-as-necessary approach results in students getting the supports they need to receive an appropriate education. Further, it provides a values-orientation for members of a student’s team that can lead to educationally sound decision-making. (See Chapter 6 for further discussion of the only-as-specialized-as-necessary approach.)

educational relevance and necessity When considering a value orientation such as the only-as-specialized-as-necessary approach within the context of the IDEA definition of related services, teams must ask themselves challenging questions about the educational relevance and necessity of a proposed service. A related service has educational relevance when it can be explicitly linked with a component of a student’s educational program (e.g., IEP goals, general education curriculum).

Ms. Burns, an occupational therapist, based on an individualized evaluation has made recommendations for supports to enable Adam, a student with autism, to develop his handwriting skills. If handwriting skills are a goal or objective on Adam’s IEP or part of the general education curriculum, then the recommended occupational therapy sup- ports are educationally relevant.

Educational relevance alone, however, is not sufficient to warrant the provision of services; services must also be educationally necessary. A service is educationally necessary if, after establishing its educational relevance, the team determines that the service is essential. Many teams may start by asking themselves, “Could the proposed related service help?” and the answer is almost always, “Yes.” But, a way to ask the question that is more consistent with the IDEA and to promote educationally-sound

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decision-making, is “If the student does not receive a proposed related service, is there reason to believe that he or she will not (a) have access to an appropriate edu- cation or (b) experience educational benefit?”

To understand how this applies to a specific student, think about Jana, a student with multiple disabilities, and her team. Ms. Reeve, Jana’s mother, takes Jana to a pri- vate clinic for an evaluation, and a clinic consultant recommends that Jana receive music therapy once a week as a related service at school. Ms. Reeve brings this rec- ommendation to the school team. The clinic consultant, in making this recommenda- tion, was asking the question, “Could Jana benefit from this service?” But, remember, the question the team must start with is, “If the student does not receive music ther- apy as a related service, is there reason to believe that he or she will not be able to receive an appropriate education?” It can be particularly challenging for external clin- ics and consultants to make appropriate decisions about necessary related services when they are unfamiliar with the student’s educational program, which is why invit- ing outside consultants to be a part of the educational team can be helpful.

Some questions the team will have to ask themselves as they determine if music therapy (or any related service) is necessary for an appropriate education include the following (Giangreco, 2001):

• Could the benefit provided by the proposed related service be addressed appropri- ately by the special educator or classroom teacher or by other core school faculty or staff (e.g., school nurse, guidance counselor, librarian, physical education teacher, bus drivers, cafeteria staff, custodians)?

• Has the student been benefiting from his or her educational program without the service?

• Could the student continue to benefit from his or her educational program without the service?

• Could the service appropriately be provided during non-school hours (as estab- lished in the 1984 U.S. Supreme Court decision, Irving Independent School District v. Tatro, 1984)?

• Does the proposed service present any undesirable or unnecessary gaps, overlaps, or contradictions with other proposed services?

The answers to these questions will guide the team in making decisions about the educational relevance consistent with the Supreme Court’s decision in Board of Edu- cation of the Hendrick Hudson Central School District v. Rowley (1982). In that case, the court established that if a student was receiving educational benefit without the service, educational teams could use this as evidence that the service was not needed, even if providing the service might provide some additional benefit to the student.

In the example of Jana, the school might not agree to provide music therapy as related services if (a) Jana was receiving educational benefit without the service, (b) the service wasn’t deemed necessary for Jana to receive educational benefit, or (c) the service could be appropriately provided during non-school hours, in accordance with the reasoning presented in both the Rowley and Tatro cases. Jana’s team might, how- ever, work to provide opportunities to experience music as part of a general educa- tion music class with support from peers and the general education teacher. Ultimately, by staying focused on the supports students need to meet the demands of inclusive environments, given their personal capacities, IEP teams can consider the full range of related services, then select and implement those that are educationally relevant and only as specialized as necessary. Well-conceived and well-executed related services can make a substantial contribution to a student’s educational pro- gram and system of support, as Jamal’s case illustrates.

Jamal is a student with multiple disabilities, including deaf-blindness. The related serv- ice providers on his team have worked closely with the special educator, his classroom teacher, and his parents to ensure that his related services are both educationally

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25Educating Students with Severe Disabilities

relevant and necessary. The physical and occupational therapists have selected and modified equipment (e.g., specialized seating, arm/hand supports, adapted computer interface) to provide supports for participation and learning. The speech-language pathologist has developed an augmentative communication system and corresponding instructional approaches that create opportunities for Jamal to communicate more effectively with teachers and peers. The vision and hearing specialists have adapted materials and learning environments (e.g., tactile labels, individualized amplification) to allow Jamal to access the general education curriculum.

These are only a few of the many ways that educationally relevant and necessary related services can be imperative for some students with disabilities. Making team decisions is not always easy, but it is important.

learninG outCome SummarieS

1.01 Who are students with severe disabilities? Learning Outcome Identify definitions of severe disabilities, the role of the supports model in under- standing students with severe disabilities, and the influence of societal perceptions and social interactions.

There is no authoritative definition of severe disabilities in the field. Historically, professionals attempted to understand students with severe disabilities through their deficits, but newer models of disability focus on the interaction between personal capacities and the demands of inclusive environments. This focus brings attention to support needs and building systems of supports, with the underlying assumption that people with severe disabilities have a fun- damental capacity to learn and a right to supports that enhance learning and participation. This assumption has been codified in IDEA in the zero-reject principle, and upheld in multi- ple court decisions. In society, negative assumptions about people with severe disabilities still exist, and disability spread, which is the tendency to make broad interferences about people with disabilities because of stereotypes, can still create low expectations. But by cre- ating opportunities for social interaction and participation in inclusive communities, disability spread can be limited and people with severe disabilities can lead full, engaged, and self- determined lives.

1.02 Reasons for optimism and concern Learning Outcome Identify areas where progress has been made in providing individualized supports for people with severe disabilities in inclusive communities, and areas where work is still needed.

Substantial advancements have been made to improve the education of students with severe disabilities. These advancements include increased opportunities for inclusion in educational settings with same-age peers, access to a broader array of curricular options that includes the general education curriculum, the use of positive behavior supports and peer supports, and emphasis on teaching individuals to be self-determined as they transition into adult life. Despite these areas for optimism, many concerns continue to exist. These concerns include inconsistent access to inclusive classrooms, the questionable quality of curriculum and instruction, family frustrations with professional responsiveness, the contin- ued use of aversives, challenging working conditions for special educators, and limited post- school options for individuals with severe disabilities.

1.03 Access to quality education Learning Outcome Discuss the foundational principles of providing supports to students with severe disabilities that promote access to (a) inclusive environments, (b) individualized curriculum, (c) purposeful instruction, and (d) necessary supports.

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26 Chapter 1

Broadly conceptualized, quality education for students with severe disabilities must include access to (a) inclusive environments alongside peers without disabilities, (b) individualized curriculum, (c) purposeful instruction, and (d) necessary supports. Options for including stu- dents with severe disabilities in general education environments can be conceptualized across individualized combinations of educational program and supports; these can fluctuate over time and even within a school day. When students require educational program accom- modations, multilevel curriculum/instruction and curriculum overlapping can be implemented to meet students’ support needs within shared educational experiences with their classmates without disabilities. In order to achieve meaningful outcomes, careful decisions must be made by educational teams about the curriculum a student receives and how instruction is provided. The determination of individualized supports should be guided by educational necessity, edu- cational relevance, and an “only-as-specialized-as-necessary” approach. When conceived in this manner, individualized supports enable students with severe disabilities to pursue mean- ingful learning outcomes and self-determination through participation in inclusive contexts.

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2 Fostering Family–Professional Partnerships

Ann P. Turnbull Co-founder, Beach Center on Disability, University of Kansas, Emerita

H. Rutherford Turnbull Co-founder, Beach Center on Disability, University of Kansas, Emeritus

Kathleen Kyzar Texas Christian University

Nina Zuna The Meadows Center for Preventing Educational Risk

The University of Texas at Austin

2.01 Parent Rights and Responsibilities Learning Outcome Identify the connections between the six principles of the Individuals with Disabilities Education Act of 2004 and the rights and responsibilities of parents of students with disabilities.

2.02 Parent Training and Information Resource Centers Learning Outcome Explain the services provided by Parent Training and Information Centers and Community Parent Resource Centers.

2.03 Family Systems Learning Outcome Articulate the major elements of the family systems framework, and the implication of disability on each of these major elements.

Introducing the Campbells: An African-American Family

Please note: Both families presented in this chapter are fictional; any similarity to one real family’s circumstances is purely coincidental.

Loretta Campbell is determined that her son Jamal, 13, will be included in all school activities with his classmates who do not have disabilities. Her determination, however, encounters obsta- cles. “It has not always been easy to make inclusion happen.” Hard going? Yes. Late-night emails and frequent telephone calls to Jamal’s teachers prove how hard it is.

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Transition exacerbates the challenge. Jamal has just entered middle school. At a time when nearly all students are acutely self-conscious and socially sensitive, Jamal’s autism and intellec- tual disability inhibit his ability to establish friendships easily. But this has not stopped him from being curious about the many subjects that interest his peers, such as the nearby Dallas Cowboys football team.

Has Ms. Campbell’s insistence on inclusion been worth the effort? Yes. Jamal enjoys the rou- tine of going to school, and, with the support of his peers, he has just mastered finding his own way to all six of his classes in his middle school. He spends 80% of his day in general education classrooms and the remaining 20% in a resource room with other special education students to complete unfinished assignments and to develop self-management skills.

Ms. Campbell didn’t want to send all the emails and make all the telephone calls. She had to. Jamal’s teachers in elementary school and his new teachers in middle school were concerned about the academic challenges that middle school would present for Jamal. Many of them urged her to consider having Jamal spend the majority of his time in a resource room and then reassess his readiness for full inclusion at a later date. Admittedly, Ms. Campbell shared those concerns. Jamal has had difficulty with transitions, has been slow to establish friendships, and has exhibited behavior problems when faced with increased academic demands. However, she remembered how successful he had been in a fully inclusive elementary school when he had peer mentors who shared similar interests. Ms. Campbell trusted her instincts and advocated for Jamal’s inclusion in all aspects of middle school. Nine months have passed and Jamal’s success has exceeded everyone’s expectations. While on spring break, Jamal indicated that he would rather be at school than at home! Ms. Campbell is pleased with the progress that Jamal has made and is justifiably satisfied with her advocacy for his inclusion.

But she’s worn out: “This is hard work; I am tired both physically and emotionally from convincing teachers to do what I feel is right for my son. I don’t think that they understand everything my family has gone through in addition to my long work hours and caring for three children as a single mom. To tell you the truth, I am not sure that I will be able to keep up this level of advocacy. I am also very concerned about Jamal’s life after high school. I want him to have the same opportunities that he has now, but I just can’t think that far into the future right now. Planning one year in advance is as much as I can handle at this moment.”

Just what has her family “gone through”? Ms. Campbell has two other children, Shelia, 17, and Donnell, 15. Jamal’s father left the household when Jamal was only 7 years old, and his brother and sister were 10 and 12. She has relied on her mother, Sandra (or Ma Ma Sandy as her grandchildren affectionately call her), and close friends for support. Ms. Campbell’s father battled liver cancer for a year and died during Jamal’s last year in elementary school; grieving and advocacy are not exactly compatible—each sapped her energy and neither allowed much room for the other. The older children, while sad, are coping; however, Jamal is demonstrating increased behavioral challenges as he struggles to understand the passing of his grandfather. Ma Ma Sandy remains stoic, but is beginning to show signs of depression, mourning the loss of her husband. Indeed, this past year has been quite challenging for the Campbell family; however, with the support of friends and extended family, they are managing.

Introducing the Gonzalezes: A Hispanic-American Family

Coming to America! Those three words tell the life stories of nearly everyone in this country, at least at some point in our ancestry. Almost all of us are immigrants, some of us more recent than others.

Coming to America meant economic opportunity for the Gonzalez family. Manuel came here from Mexico, leaving his wife Lucille and two children, Isabella, seven, and Maria, six, behind. Here, he worked as a migrant farmer until he became a citizen. His citizenship assured, he sought more permanent work and now has a job with a company that builds new homes in Wichita, Kansas. With citizenship and a good job in hand, Manuel brought Lucille, Isabella, and Maria to Wichita. Why Wichita? Because Lucille’s sister, brother-in-law, and niece live there and they encouraged Lucille and Manuel to join them. At last, the family is together again. At least most of the family is together. Manuel’s and Lucille’s parents and most other family members still live in Mexico. “We aren’t entirely a family until all of us are in one place, together,” laments Manuel.

Coming to America also meant educational opportunity, especially for Isabella. She had insufficient oxygen when she was born and was diagnosed at birth as having cerebral palsy. She later acquired two other diagnoses: epilepsy and severe intellectual disability.

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29Fostering Family–Professional Partnerships

Although some general education programs and schools for children without disabilities in Mexico are beginning to accommodate children with disabilities, they are mostly for children with more mild disabilities. Isabella was rejected for admission to a regular school; its faculty regarded her disability as being too significant for them to address. Instead, she received most of her services from a specialized school and from medical personnel. After arriving in Wichita two years ago, Isabella has attended a public elementary school in a life skills classroom for children with disabilities. In this school she has some opportunities for inclusion in a few classes (e.g., art, music) with her peers without disabilities.

Isabella loves to be around other children and attends several classes (e.g., music, art, physical education) with her peers without disabilities, but Mr. and Mrs. Gonzalez wish that there were more opportunities for her to be included in a variety of school activities; they understand that it is important for her teachers to emphasize academic training for all students, but they want more social opportunities for their daughter. They have asked themselves, why don’t the teachers recognize that Isabella enjoys being with children who don’t have disabilities? Why can’t the teachers help Isabella develop more of her social skills? And why do they leave it up to Mrs. Gonzalez to make sure that Isabella has opportunities to be with children without disabilities in her neighborhood and church?

Coming to America meant even more than employment and educational opportunities. It meant adjusting to a new culture, a new language, and a new lexicon of school terminology. In their native culture, Mr. and Mrs. Gonzalez had learned to defer to educators. Here, deference is not so much the norm; partnership and advocacy are. In Mexico, the school terminology was different from what it is here; there’s “special-education speak,” as Mr. Gonzalez put it—and he speaks English better than Lucille, having been here longer.

But language remains a barrier, especially now that Isabella is beginning to have more frequent seizures. On a daily basis she has petit-mal seizures (i.e., frequent eye blinks and mouth tremors) that last only a few seconds. Mr. and Mrs. Gonzalez worry about whether Isabella’s teachers even notice these slight and frequently repeated seizures, much less appreciate the toll that they take on her body. At other times, she has grand-mal seizures that are so severe that her whole body trembles and she gets caught in the straps of her wheelchair. Mr. and Mrs. Gonzalez are concerned that the school is not properly addressing her needs or, worse yet, no one will see her when the big seizures occur. Speaking in Spanish, Mrs. Gonzalez explains the challenge: “There is not a translator every time I just want to pick up the phone and talk to her teacher or tell her on Monday morning how her weekend had been. We always have to schedule for a translator.”

Two Families and Two windows For UndersTanding Families in special edUcaTion

The Campbell and the Gonzalez families offer us two windows for understanding the relationship between special education for students with severe disabilities and the nature of family life. The first window lets us look at the law governing special educa- tion and relationships between educators and parents. The second window lets us consider the family systems perspective, a framework through which professionals can understand families’ preferences, strengths, and needs.

individUals wiTh disabiliTies edUcaTion acT: parenTal righTs and responsibiliTies

One of the purposes of the Individuals with Disabilities Education Act (IDEA) has always been to create a combined federal, state, and local system that would provide

all students with disabilities a free appropriate public education (FAPE) in the least restrictive environment. To secure that out- come, Congress created a framework within which educators and the parents of children with disabilities can be partners. The U.S. Supreme Court, in Schaffer v. Weast (2005), has said that the

Watch “Introduction to Special Education” at www.youtube.com /watch?v=MCdR2vA1g20.

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“cooperative process . . . between parents and schools” is at the core of IDEA. In this chapter, we discuss that “cooperative process” by examining the partnership as it can exist under the six principles of IDEA (Turnbull, Stowe, & Huerta, 2007). For the sake of brevity, we use the word parent to refer to the parents and other family members that IDEA covers, unless we indicate otherwise. We also use the acronym LEA to refer to local educational agencies and SEA to refer to state educational agencies.

idea’s six principles

Figure 2–1 illustrates IDEA’s six principles and provides a brief definition of each principle. These principles are zero reject, non-discriminatory evaluation, appropriate education, least restrictive environment, parent and student participation in shared decision-making, and procedural due process. In this chapter, we have focused on the partnership that parents and professionals can create under IDEA.

Zero reject is a rule that requires educators to offer FAPE to all age-eligible stu- dents with disabilities. It’s a principle that is easy to understand: All means all. The type or severity of the student’s disability is irrelevant. All includes Jamal and Isabella; their multiple disabilities do not result in exclusion but instead underscore the need for them to have the appropriate supports to have a meaningful education.

IDEA connects the zero-reject principle to parental rights and responsibilities in sev- eral ways. The first relates to the ages of the children. Under IDEA’s early intervention provisions (referred to as Part C of IDEA), infants or toddlers (ages birth through two) may receive services designed to develop their capacities, minimize their potential for developmental delays, and enhance their families’ capacities to work with their children.

When Jamal was 26 months old, he seemed to lose what little language he had and began to engage in odd behaviors such as lining up all of the coins in their change jar and spinning forks on the kitchen floor. He promptly was referred to early intervention, identified as having autism, and began receiving IDEA Part C services when he was 28 months old. These services ended when he was 36 months old. He then was evaluated and qualified for services under Part B of IDEA at the age of three.

The second connection relates to older students and their right to a free education. Part B serves children ages 3–21 who have any one of 10 types of disabilities and need special education and related services to progress in the general education

• To ensure no child is denied access to a free and appropriate educationZero reject

• To determine eligibility for special education services and to determine the type of special education and related services needed

Non-discriminatory evaluation

• To develop an individualized education program (IEP) or individualized family service plan (IFSP) and to monitor student progress toward educational outcomes

Appropriate education

• To ensure access to the least restrictive and most appropriate educational environment to implement IEP/IFSP goals

Least restrictive environment

• To ensure participation in the educational process and promote shared decision-making

Parent and student participation

• To ensure accountability throughout the educational process and additionally afford parents rights if concerns arise about the educational procedures or the quality of education provided to their child

Procedural due process

FIguRe 2–1 Process for Implementing IDEA’s Six Principles in Educational Decision-Making

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curriculum. Part B services are free; Part C services might be free or low cost, depend- ing on a family’s income. Free means that neither the Campbells nor the Gonzalezes may be required to use private insurance benefits to pay for their children’s educa- tion. They may use their insurance benefits to pay for services that their children need but that the schools do not provide (typically, medical services).

Mr. Gonzalez has health insurance for his family through his employer, but he, like other families, wants to use his insurance benefits only when absolutely necessary. But Isabella’s seizures are occurring more often and are more significant; her seizures affect her education and he may have to pay physicians for services that he cannot get free from her teachers.

A third connection is related to school-imposed discipline.

Jamal has recently begun to engage in increased challenging behavior. While most of his behavior is self-injurious (e.g., hitting and pinching himself), he has been sent home on several occasions for aggressive behavior towards his peers (e.g., lunging, pushing, and hitting), causing his mother, a single parent, to leave work each time that the school called about his behavior.

Just what do the discipline provisions mean for Jamal? Under IDEA, an LEA has the authority to remove a child with a disability who violates a code of student conduct from the child’s current placement to an appropriate interim alternative educational setting or another setting, or suspend the child for not more than 10 school days. At the same time, IDEA also protects the child’s right to an education by giving the child’s LEA the option of providing services during the 10-day period. So, Jamal could be out of school for up to 10 days for a school-code infraction, which would mean 10 days of lost income for the family.

If the LEA removes the child for more than 10 school days or changes the child’s placement as a form of discipline, the LEA must (a) continue to provide special educa- tion and related services, (b) conduct a functional behavior assessment and develop and implement (or modify and implement) a (new or existing) behavioral interven- tion program designed to address the behavior for which the LEA has disciplined the child, and (c) determine whether the child’s behavior (for which the child is being disciplined) is a manifestation of the child’s disability (20 U.S.C. § 1415(k)).

Non-discriminatory evaluation is a rule that requires educators to eliminate bias on the basis of a student’s language, culture, or other traits as they (a) determine whether the student has a disability and (b) specify what kind of special education and related services the student should receive if the student has a disability.

Educators and parents alike have the right to request an initial evaluation of a stu- dent. If educators want to evaluate a student, whether for an initial evaluation or for a re-evaluation, they must secure the consent of the student’s parents. Parents may con- sent or refuse to consent. If the school has taken reasonable measures to secure parental consent and if the parents have failed to respond, the school may try to per- suade the parents to consent by using mediation or another method of resolving dis- putes (i.e., procedural due process) or it may simply decline to conduct an initial evaluation. In that event, the school is not required to provide special education and is not liable if it does not because the parents have opted out of special education.

In partnering with families to conduct evaluations, educators have responsibilities such as providing notice of evaluations and ensuring that assessments are not cultur- ally biased and are valid and reliable. However, not all evaluations are done by a stu- dent’s educators. Parents such as Ms. Campbell and Mr. and Mrs. Gonzalez have a right to secure (at their own expense) an independent evaluation—one done by quali- fied professionals not employed by the student’s school district—and to require that the school’s evaluation team consider it. Parents also may recover the cost of an inde- pendent evaluation from the LEA if the LEA’s evaluation is not appropriate according to a due process hearing officer or court or if the reevaluation was ordered by a due

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process hearing officer or court. This means that team evaluations may not be com- pletely influenced by only LEA members.

As much as their culture teaches them to defer to educators, Mr. and Mrs. Gonzalez may want to secure an independent evaluation for Isabella if they believe the school failed to properly assess her needs and strengths in her native language, as IDEA requires, or if the school does not have a specialist physician (such as a neurologist) to evaluate her to determine the causes of, and interventions for, her seizures.

Appropriate education is a rule that requires educators to comply with all IDEA processes and thereby benefit the student (Board of Education of the Hendrick Hudson Central School District v. Rowley, 1982). The linchpin for an appropriate education is the student’s IFSP (for infants and toddlers, from birth to age 3) or individualized edu- cational program (IEP) (for students aged 3–21). When developing an IFSP and IEP, the team should consider the evaluation data, the strengths of the child, and the concerns of the parents, in addition to the academic, developmental, behavioral, and functional needs of the child. The IEP may be revised as often as necessary, but is typically revised annually. Figure 2–2 displays the required content for an IEP. For students, like Jamal and Isabella, who take alternate assessments (see Chapter 3), their IEP must include short-term objectives. These objectives are typically used as benchmarks to gauge pro- gress toward meeting the annual goals. Students have a right to related services

FIguRe 2–2 Required Contents of Individualized Educational Plan (IEP)

The IEP is a written statement for each student, ages 3–21. Whenever it is developed or revised, it must contain the following statements: 1. The student’s present levels of academic achievement and functional performance, including

• how the student’s disability affects the student’s involvement and progress in the general curriculum (for students 6–21) • how a preschooler’s disability affects the child’s participation in appropriate activities (for children 3–5) • a description of the benchmarks or short-term objectives for students who take alternate assessments that are aligned

to alternate achievement standards 2. Measurable annual goals, including academic and functional goals, designed to

• meet each of the student’s needs resulting from the disability in order to enable the student to be involved in and make progress in the general curriculum

• meet each student’s other educational needs that result from the disability 3. How the student’s progress toward annual goals will be measured and when periodic reports on the student’s progress on, and

meeting of, annual goals will be provided 4. The special education and related services and supplementary aids and services, based on peer-reviewed research to the

extent practicable, that will be provided to the student or on the student’s behalf, and the program modifications or supports for school personnel that will be provided for the student to • advance appropriately toward attaining the annual goals • be involved in and make progress in the general curriculum and participate in extracurricular and other nonacademic activities • be educated and participate in those three types of activities with other students with disabilities and with students who do

not have disabilities 5. An explanation of the extent, if any, to which the student will not participate with students who do not have disabilities in the

regular class and in extracurricular and other nonacademic activities 6. Any individual appropriate accommodations that are necessary to measure the student’s academic and functional performance

on state- and districtwide assessments; if the IEP team determines that the student will not participate in a regular state- or districtwide assessment or any part of an assessment, an explanation of why the student cannot participate and the particular alternate assessment that the team selects as appropriate for the student

7. The projected date for beginning the special education, related services and supplemental aids and services, and modifications and the anticipated frequency, location, and duration of each

8. Beginning no later than the first IEP that will be in effect after the student turns 16, and then updated annually, a transition plan that must include • measurable postsecondary goals based on appropriate transition assessments related to training, education, employment,

and, where appropriate, independent living skills • A statement of transition services, including courses of study, needed to assist the student to reach those postsecondary goals • Beginning no later than 1 year before the student reaches the age of majority under state law (usually at age 18), a statement

that the student has been informed of those rights under IDEA that will transfer to the student from the parents when the student comes of age

(From Turnbull, Ann; Turnbull, H. Rutherford; Wehmeyer, Michael L., Exceptional Lives: Special Education in Today’s Schools, 6th ed., © 2010, p. 53. Reprinted and electronically reproduced by permission of Pearson Education, Inc., Upper Saddle River, NJ.)

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(e.g., speech therapy, occupational therapy, physical therapy, music therapy, assistive technology) if, like Jamal and Isabella, the services are necessary to ensure that the stu- dent receives FAPE. While students may receive related services to ensure FAPE, families may also benefit from related services. Related serv ices specifically for families could include family training, counseling, and home visits (e.g., PBS training for Ms. Campbell); parent counseling and training; or social work services. There are also important IEP considerations for older students. When students turn 16, their IEPs must describe appropriate, measurable postsecondary school goals and transition services to prepare them for future education, employment, and independent living, as appropriate.

IDEA’s IFSP and IEP requirements enable families and professionals to work together as partners in planning and implementing the student’s appropriate educa- tion. A LEA must take certain steps to ensure that one or both of the student’s parents are members of any group (including the IEP team) that makes decisions on the child’s educational placement. These steps include advance notice of the meeting, mutually convenient scheduling of the meeting (taking into account Mr. Gonzalez’s long working hours), and arranging for interpreters for parents who are deaf or non- English speaking, such as Mrs. Gonzalez. If a parent cannot attend the meeting, he or she may participate through video conferencing or telephone conference calls, again with interpreters as needed.

The LEA may have an IEP meeting without a student’s parents only when it can document that it attempted unsuccessfully to have them participate. The documenta- tion should include detailed records of telephone calls, copies of letters to and from the parents, and the results of any visits to the parents’ homes or places of work.

Parents may invite other family members or other individuals knowledgeable about their child to attend the IFSP and IEP team meetings. The parents’ supportive allies can offer information that helps the entire team with additional information.

Ms. Campbell’s mother has attended meetings in the past, as has Jamal’s brother, Donnell. Ms. Campbell said that “having other children at a meeting can be very en- lightening. Plus, I think it’s helpful to hear their opinions because, a lot of times, they come up with better ideas on how to solve a problem with Jamal than the adults do.”

The presence of a large number of school personnel at meetings can also be over- whelming for the family. A large number may also be inefficient for a school. IDEA allows for an otherwise required member of the IEP team to be excused if the parent and school agree that the member’s attendance is not necessary. The excused mem- bers may submit written recommendations for the IEP.

Educators should be cautious about their own “excused absences.” School efficiency is one thing; student outcomes are quite another and are far more important. Schools must also consider the impression that an absence might convey. Might Ms. Campbell or the Gonzalez family regard an absence as a lack of concern or dedication to their child?

Least restrictive environment is a rule that, to the maximum extent appropriate, each child with a disability will be educated with children who do not have disabilities—that is, in the regular educational environ- ment. This presumption favoring inclusion enables Jamal and Isa- bella to have greater access to their peers without disabilities to enhance social skills (which the Gonzalez family specifically indi- cated was a high priority for Isabella) and for both Isabella and

Jamal to be exposed to the same general education curriculum as their peers without disabilities (albeit with accommodations and modifications as specified in their IEP).

The presumption may be set aside when the student’s needs are so great that, even with related services and with supplementary aids and services, educators conclude that the child cannot be educated satisfactorily in the regular educational environment. When setting aside the presumption, educators may place a student into one of several settings along a continuum of services, including resource rooms, special education classes, separate schools, and institutions and hospitals. Jamal and Isabella benefit

Watch “Are You Happy?” at www .youtube.com/watch?v=Y_r3KkRK2h4.

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from the presumption, Jamal more so than Isabella. Jamal has received the majority of his academic instruction in the same classrooms as peers who do not have disabilities, albeit through an adapted curriculum and with the benefit of a paraprofessional.

Not all schools fully embrace inclusion; the reasons provided may vary. A few rea- sons may include philosophical differences among professionals on the issue, profes- sionals’ limited knowledge of how to successfully implement inclusive practices, limited resources, district allocation of resources only to specialized schools or only to a few schools in the district, and untrained general education teachers. Inclusion does not occur naturally. A group of researchers examining one highly effective inclu- sive elementary school revealed six key themes: (a) The needs of all students were met; (b) high quality instruction was provided to all students; (c) professional devel- opment opportunities were available; (d) administrators flexibly used resources and maintained a rigid schedule; (e) shared decision-making was utilized, allowing teacher autonomy for classroom decisions; and (f ) data-based decision-making was a priority (McLeskey, Waldron, & Redd, 2014, p. 63).

Inclusion benefits the student with a disability and peers who do not have disabili- ties (Hunt & McDonnell, 2007). Regardless of their inclusion in the academic pro- gram, Jamal and Isabella have the right to participate in all other school activities, such as field trips, assemblies, social occasions, and after-school programs, often with the support of peers who volunteer to be in their circles of friends.

Isabella’s health-related needs are a legitimate factor to consider with respect to her inclusion in general education classes. But what prevents her from participating in some extracurricular or other school events? Only her teachers’ failure to understand that, at home, Mrs. Gonzalez arranges for Isabella’s peers without disabilities to be part of the Gonzalez family. If this can happen at home, Mrs. Gonzalez wonders why it can’t happen more at school.

Similarly, infants and toddlers in early intervention programs must receive services in “natural environments,” namely, those in which peers without disabilities partici- pate, to the extent appropriate for the child. Natural environments are (a) the child’s home, (b) full- or part-time participation in preschool programs operated by public agencies (e.g., Head Start), (c) segregated private schools (in which there are only children with disabilities) or integrated private schools (in which there are children with and without disabilities), and (d) classes in general education elementary schools (with children who do not have disabilities).

The natural-environments rule values the child’s needs more than the child’s place- ment. The natural-environments rule is a rebuttable presumption (i.e., it is assumed that states will provide early intervention services, supports, and programs in natural environments; however, states have the option to justify otherwise) similar to the LRE rule for children of ages 3–21 and is interpreted and applied in the same manner as that rule. LRE is a continuum of placements; while inclusion is the presumption, the team has the option to justify a different placement (e.g., one that is not in an inclu- sive environment) if the team decides another setting is a more appropriate place- ment for the provision of educational services.

Parent and student participation in shared decision-making is the fifth of IDEA’s six principles. IDEA has consistently supported the notion that children’s education can be made more effective by strengthening the parents’ roles and responsibilities. We have described the ways in which parents may participate in their child’s non-dis- criminatory evaluation, IEP development, and least restrictive setting planning. There are, however, still other ways for parents to participate as partners with educators.

Parents have the right to have access to their children’s school records and to limit the distribution of those records to only those persons who have “a need to know.” They also have the right to access the school district’s general records about special education, such as the records that show how many students receive special educa- tion services and the amount of money that the district receives and spends on special

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education. Obviously, they do not have the right to see other students’ records. In addition, parents generally have the right to see the state’s special education plan, receive public notice of hearings on the plan, and comment on the plan. They are entitled to serve on the state advisory council on special education, and parents must constitute the majority of the council’s membership. Finally, parents of infants and toddlers are entitled to serve on the state’s interagency coordinating council on early intervention and must constitute a majority of the membership of the council.

Most of all, however, parents have a right to participate in evaluation and IEP team meetings, and their children, whatever their age and however challenging their disabili- ties may be, also have a right to be members of the IEP team “whenever appropriate.” When is it appropriate? Basically, whenever parents and educators decide that it is. How- ever, IDEA specifies, at least by the age of 16, students must be invited as participants in their IEP meeting if transition planning and postschool outcomes are discussed.

To increase student participation in decision-making, educators can assist their stu- dents in (a) developing a portfolio of their work and information about their goals; (b) preparing a PowerPoint presentation about their needs, preferences, and goals; or (c) developing a recordable storybook about their achievements and their ideas about future goals to pursue. Research-based strategies are available to assist educators with facilitating IEP participation for students with disabilities (Cease-Cook, Test, & Scroggins, 2013; Griffin, 2011; Woods, Martin, & Humphrey, 2013) and teaching students self- advocacy skills (Hart & Brehm, 2013). Jamal’s mother intuitively felt his participation in his IEP meetings was important, even though he was younger than the IDEA- required age of 16. It is critical that educators be open to parents’ suggestions (even if not required by law); this builds trust and stronger family–school partnerships.

Jamal has been included in general education classrooms with his peers for the past several years; however, only recently, with his transition to middle school, were Jamal’s opinions solicited. This was so because his mother stated that she would like for him to attend his IEP meeting to have a chance to ask questions and give his opinions about his transition from elementary to middle school. While his role was minimal at this IEP meeting, his first ever, he was able to share what it meant for him to “work and have fun” with his friends. Ms. Campbell was very proud of the advocacy role her son played at such a young age. Jamal practiced his “IEP speech” at home with his mother and sib- lings using his communication board.

It is essential for other IEP team members to listen with respect to the student’s contributions, ask questions, and incorporate the contributions as collaborative deci- sions are made. A student’s mere presence at a meeting can allow educators and par- ents to emphasize the student’s strengths, instead of simply describing the student’s needs; Jamal’s presence prompted educators to consider his strengths.

Ensuring parents’ full participation in educational decision-making might require additional effort, especially with parents from culturally and linguistically diverse back- grounds or whose culture does not place much value on a child’s opinions. Cultural values strongly influence who families consider to be appropriate decision makers and the extent of autonomy that might be extended to someone who is not yet an adult.

Having Isabella participate and express her own desires about her education is a new expe- rience for them. Mr. Gonzalez states, “We typically make the decisions for all of our children because we know what is in their best interests—we’ve been through the hardships. We know what the world expects and we have an obligation to guide our children in these ways.”

Procedural due process is a technique whereby parents and educators may hold each other accountable for assuring that the student receives a free appropriate pub- lic education. One element of accountability involves parental consent to the initial evaluation, a re-evaluation, and the student’s placement into special education. With- out parental consent, educators have only limited options with respect to the child’s education.

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To ensure that parents are adequately informed in order to give consent, IDEA requires educators to give two types of notice to parents. The first notice is a “notice of action.” Educators must give parents a notice before they take any action to change or refuse to change a student’s identification (his or her classification as having a disabil- ity), evaluation, placement, or provision of a free appropriate public education. The second notice is a “rights notice”—basically, a notice regarding the parents’ and stu- dent’s rights to due process and procedural safeguards. Both notices must be written in language that the general public can understand. If the parents do not speak English, the educators must take steps to ensure that the notice is translated into the parents’ native language, the parents understand the content of the notice, and there is written evidence that the requirements related to language and understanding have been met.

It is best for Isabella’s teachers to be sure to provide her parents with a notice in both English and Spanish; Mr. Gonzalez does well with English, but Mrs. Gonzalez does not.

What if parents are dissatisfied with the educational services that educators are providing their child? They have several options. They may file a complaint with the state education agency; they may file a complaint with the U.S. Department of Educa- tion, Office of Civil Rights; or they may file a request for a due process hearing (a mini-trial to determine whether the educators are acting consistently with IDEA and providing a free appropriate public education to the student).

If the parents choose to exercise their due process hearing rights, they (or the attorney representing them) must notify their child’s local education agency and state education agency, and include in the notice (a) their child’s name and residence, and the name of the school that their child attends; (b) the nature of the problem with their child and the facts related to that problem (i.e., the action that the LEA proposes to take); and (c) how to resolve the problem.

A parent may not bring a complaint or sue an LEA for an alleged violation that occurred two years before the time the parent files the complaint. The two-year rule is known as a statute of limitations and requires a parent to act promptly so that the facts about the complaint will be “fresh” and the remedy, if any, will address the present needs of the child. The due process hearing is like a civil trial, with both the parents and the LEA having the right to be represented by lawyers and to produce evidence. The losing party may appeal to a state-level hearing officer and then to the courts. If the parents prevail (win), they may recover the fees that they paid to their lawyers.

Unfortunately, research indicates that many parents are dissatisfied with some aspect of their child’s educational program. In a national, random sample survey of parents of students with disabilities, 31% of the parents of students with severe disa- bilities reported that they had considered suing the school or had threatened to sue because of their disappointment in the quality of the services provided to their child ( Johnson, Duffett, Farkas, & Wilson, 2002). More than twice as many parents of stu- dents with severe disabilities indicated their consideration of suing than did parents of students with mild disabilities.

summary of the six principles Through each of its six principles, IDEA strengthens parents’ rights. Five principles (zero reject, non-discriminatory evaluation, appropriate education, least restrictive environment, and parent and student participation in shared decision-making) estab- lish a framework within which parents acquire rights in order to affect their children’s education; the due process principle establishes a mechanism by which parents can hold the LEA accountable for complying with IDEA.

assisting Families to advocate: parent Training and information resource centers

To advocate for informed decisions about their children’s education, families need current information about their child’s disability, special education policy, and

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evidenced-based practices. In this section, we will highlight two educational resources specifically created to meet the informational needs of families: Parent Training and Information Centers (PTI) and Community Parent Resource Centers (CPRC).

The PTI is an extensive national resource network for parents. Currently, there are 73 not-for-profit PTIs funded by the U.S. Department of Special Education, Office of Special Education and Rehabilitative Services. Each state has at least one PTI, and some states have two or more. Typically, PTIs are directed by parents of children with disabilities, and under IDEA, the majority of the staff must be parents. The purpose of PTIs is to prepare parents to be effective advocates in educational decision-making. They provide a broad range of workshops, conferences, other training opportunities, and even one-to-one assistance to families. Many have IDEA information in languages other than English and have staff who are from diverse cultural and linguistic groups.

Community Parent Resource Centers (CPRCs) are resources especially for tradition- ally underserved families. They are in communities that are characterized by cultural and linguistic diversity. CPRCs focus on parents with low incomes, parents of chil- dren who are English-language learners, parents who live in “empowerment zones” (federally designated urban areas that are eligible for additional federal assistance), and parents who have disabilities. CPRCs offer intensive, culturally relevant support to families. Currently, the U.S. Department of Education funds approximately 30 CPRCs.

Two national technical assistance centers supplement the PTIs and CRPCs. They are the Center for Parent Information and Resources (CPIR) and the Native American Parent Technical Assistance Center (NAPTAC). On the website of the CPIR (www .parentcenterhub.org), you can find many helpful resources, including a list of the names, addresses, and contact information for all of the PTIs and CPRCs by region (www.parentcenterhub.org/ptacs/).

Educators should ensure that parents are aware of these resources and encourage parents to contact their state PTI, as well as the CPIR, to learn about training opportu- nities and obtain printed information developed specifically for families. For example, the PATH program in Texas is the PTI that would serve the Campbell family. There are only two CPRCs in Texas and neither one is close to the Campbell family. In this situation, several schools might work with the closest CPRC to develop a central resource center in one of the schools to house training materials, books, videos, and contact information for other community resources (e.g., the social security office, mental health centers, employment centers, drug treatment centers, safe shelters). Schools could also assist families with developing a local support group to meet the needs of families who face additional challenges related to poverty or a child’s spe- cific disability (e.g., autism or Down syndrome). One of the best ways that schools and professionals can advocate for families is to demonstrate that they care about the unique concerns and needs of families by inviting them to their school and making resources readily available to them.

In this section, we have shared two specific resources for assisting parents, and assisting teachers in assisting parents, to become stronger educational advocates for their children. The next section presents families’ educational concerns within family systems perspective.

a Family sysTems perspecTive

A system is a “set(s) of elements standing in inter-relation among themselves and with the environment” (Bertalanffy, 1975, p. 159). Systems theory assumes that a system can be understood only as a whole. Systems theory has been applied to family sociol- ogy and family therapy in terms of how families interact as a whole system. Prior to the family systems approach within the field of special education, educators were concerned primarily about the education of the child within the context of the school

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setting (i.e., what happens between the hours of 8:00 a.m. and 3:00 p.m.). Instead, family systems theory encourages educators to think about the child within the con-

text of the whole family and how each family member interacts with and affects all other family members across multiple set- tings. When educators understand a student’s life within multiple contexts (e.g., school, home, community), multiple roles (e.g., child, sibling, grandchild, nephew), and multiple interactions

(e.g., child–parent, child–grandparent, child–sibling), they can develop more mean- ingful educational programs.

Raising a child with a disability can be stressful at times (Brobst, Clopton, & Hendrick, 2009; Guralnick, Hammond, Neville, & Connor, 2008), and research has indicated that severity of disability is negatively associated with both mothers’ and fathers’ satisfac- tion with family quality of life (Wang et al., 2004). That is, the more severe the disa- bility, the less satisfied families are with their quality of life. However, Wang and colleagues noted that “severity” is a term that is not universally well defined; they rec- ommended that, rather than broadly examining “severity,” future studies consider the impact of more specific characteristics of disabilities. Turnbull, Summers, Lee, and Kyzar (2007) conducted a systematic review of the literature related to family out- comes for families of children with intellectual and developmental disabilities, and found that, across studies, behavior problems predicted lower family well-being, adaptation, and family functioning whereas family support (informal and formal) was positively associated with these outcomes (e.g., well-being, adaptation). Educators need to understand how the child with a disability affects all family members (e.g., siblings, grandparents, aunts, uncles), understanding both positive contributions and stressors. The Campbell and Gonzalez families help us understand the positive experiences families have, for example

Jamal and his older brother Donnell have a tradition of eating chicken wings and drinking Root Beer floats every time they watch the Dallas Cowboys play on TV. Jamal loves his brother very much, although he has yet to speak these words; however, the bond between these two brothers is obvious.

The Gonzalez family practices Roman Catholicism. Isabella loves to attend church; it is the one place where she seems to be most happy, moving to the music and chanting along with the responsorial prayers in her own special way.

However, the Campbell family is not without challenges.

When Jamal’s routine is disrupted, his screams and self-abusive hits are almost unbear- able for all family members to witness. They all generally know how to intervene to help Jamal communicate, but sometimes it can be very stressful, particularly when these behaviors occur in public places.

Similarly, the Gonzalez family also faces some challenges.

They are often frightened by Isabella’s seizures. They have continued to intensify as she ages despite her being on numerous medications. Both Mr. and Mrs. Gonzalez are afraid that something might happen to her when she is sleeping so they have often traded off nights to watch her sleep when she is having frequent seizures. This has left them exhausted the next day.

Educators need to be aware of situations that can be stressors for families. Indeed, the Campbell family would benefit from information on behavioral support and in developing behavioral interventions for Jamal, particularly for crisis situations that occur in public places. The Gonzalez family might appreciate information about obtaining on-call respite care to assist with nighttime support when Isabella’s seizures are severe. Both the Campbell and Gonzalez families have multiple needs, but their teachers would not have known about these needs unless they learned from families how the child affects the entire family. They can learn if they (a) listen intently and

Watch “Abigail Branson Not Limited by Spina Bifida” at www.youtube.com /watch?v=PqUDdxm-qSA.

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39Fostering Family–Professional Partnerships

utilize empathy to acknowledge parents’ concerns, (b) ask open-ended questions, (c) take notes during the conversation, (d) utilize the notes to summarize parents’ con- cerns, and (e) develop a first step to address the concern (McNaughten, Hamlin, McCarthy, Head-Reeves, & Schreiner, 2008).

As we continue to explore family systems theory, consider the following question: Who is the consumer of your services? In the past, the student has been viewed as the sole consumer. The family systems approach, however, identifies the entire family as the consumer of services. This approach also seeks to have a much broader view instead of education or skill development only. Figure 2–3 depicts the family systems framework that we will be discussing in the remainder of this chapter. The components of the framework and their interrelationships within the family system are as follows:

1. Family characteristics describe the entire family as a unit (e.g., size and form, cul- tural background, socioeconomic status, geographic location), the family’s per- sonal characteristics (e.g., health, coping styles), and the family’s special challenges (e.g., poverty, abuse). These characteristics are the underlying input to the system that shapes the way in which the family interacts.

2. Family interaction is the hub of the system; that is, the process of interaction among individual family members and subsystems (i.e., marital, parental, extended family, and sibling). Subsystem interactions are influenced by, and in turn influence,

what family members do to respond to individual and collective family needs.

3. Family functions are the output of the interac- tional system. On the basis of its characteristics (the input), the family interacts (the process) to produce responses that fulfill family affection, self-esteem, spiritual, economic, daily care, socialization, recreation, and educational needs.

4. Family life cycle introduces the element of change into the family system. As the family moves through time, developmental and non-developmental changes alter the family’s characteristics and needs; these, in turn, produce changes in the ways that the fam- ily interacts.

The family systems framework enables educators to recognize each family’s complexity and unique- ness. Each family is composed of so many attributes that it can interact in an almost endless variety of ways. A family is not a static entity; it is constantly changing and also resists change. As a result, families and educators may have different views about educa- tional goals and how to partner in order to develop these goals. The following sections briefly address each of the four components outlined in Figure 2–3 and highlight issues relevant to special educators. For a more comprehensive description of these ele- ments, see Turnbull, Turnbull, Erwin, Soodak, & Shogren (2015).

Family characteristics

Professionals often may be impressed by the increas- ingly diverse students and families in their schools. This diversity greatly influences not only how

FIguRe 2–3 Family Systems Framework

Inputs

Process

Outputs

Family functions • Affection • Self-esteem • Spiritual • Economics • Daily care • Socialization • Recreation • Education

Family interaction

Family characteristics • Characteristics of the family • Personal characteristics • Special challenges

Extended family

Marital

Parental Sibling

A daptabilityC

oh es

io n Family life cycle

• Developmental stages • Transitions

(From Turnbull, A. P., Summers, J. A., & Brotherson, M. J. (1984). Working with families with disabled members: A family systems approach (p. 60). Lawrence: University of Kansas, Kansas Affiliated Facility. Adapted by permission.)

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40 Chapter 2

professionals interact with the child in the school setting but also how professionals understand the child’s effect on a family and a family’s responses to meeting their child’s needs. For practitioners to effectively educate their students, they need to understand and respond to various family characteristics. We focus on three types of family characteristics: (a) the characteristics of the family as a whole, (b) the personal characteristics of each family member, and (c) the characteristics of the special chal- lenges that a family faces.

The characteristics of the Family Families vary in areas such as size, form (e.g., dual vs. single parents, original vs. blended family), culture, socioeconomic status, and geographic location. Obviously, although the Campbell and Gonzalez families have much in common, they also differ from each other in many ways. For example, there are many more Gonzalez family members than Campbell family members who reside in their respective households. In this section, we focus on culture as illustrative of variations in family characteristics.

Culture provides a framework through which individuals and families form a sense of group identity (Gollnick & Chinn, 2012). It involves many considerations, includ- ing race, ethnicity, geographical location, religion, income, sexual orientation, gen- der, disability, and occupation. People often equate culture with race or ethnicity, but culture is a much broader concept. For example, the Campbell family is African American, and in some states large proportions of African Americans reside in poorer, inner-city neighborhoods. By contrast, the Gonzalez family is of a different race and has a different cultural heritage; the Gonzalezes are Hispanic, specifically, Mexican. However, the Gonzalez and Campbell families both have limited incomes; each family lives in an inner-city neighborhood and shares the concern of increased crime and illegal drugs where they live.

The two families have different cultures. Ms. Campbell and her family are devout Baptists, while the Gonzalez family is Roman Catholic, attending mass in their native language of Spanish. Each has strong ties to their extended family; however, the Gonzalez family includes several members of their extended family in one household. These cultural differences can be substantial, but they are by no means bound to be so, especially when families and practitioners work together to share and understand how culture infuses their everyday lives.

To gain insight into the importance of culture, Mrs. Gonzalez describes a difference of opinion that she had with Isabella’s teacher concerning an IEP goal that the teacher recommended for Isabella.

In their recent conference, Isabella’s teacher explained that she will soon start a unit on families. Mrs. Gonzalez was thrilled, and shared that in their culture, young children often affectionately call their aunts and uncles tía and tío, the Spanish words for aunt and uncle, respectively. Isabella’s sister, who does not have a disability, knows English but still does not use the English words aunt and uncle. Since English is taught in school, Isabella’s teacher expressed that she was unsure about whether teaching Isabella some Spanish words would be appropriate. Mrs. Gonzalez further suggested that by in- troducing the Spanish words first, she would not only be honoring Isabella’s cultural heritage, but would also allow the other children in Isabella’s classroom to appreciate her culture.

Culture influences marriage ceremonies, religious beliefs and practices, rites of passage (e.g., a bar or bat mitzvah), holiday celebrations, holy day observations, ritu- als surrounding death and burial, a person’s perception of his or her relationship to the world, political beliefs, attitudes toward independence and work, and, in general, parenting practices (e.g., the extent to which it is appropriate for children and youth to be self-determining). Although you need to be aware of cultural differences, you also need to be careful not to stereotype families on the basis of this awareness. To say that all people of color, in comparison to European Americans, value family unity

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41Fostering Family–Professional Partnerships

and permanence, interdependence, and protectiveness is contrary to the real-life experiences of many individuals in these groups. Always strive to enhance cultural self-awareness and cultural competence so that you can, in turn, create partnerships with families that are respectful of their cultural values (Lynch & Hanson, 2011), as well as respectful of their individual family characteristics.

personal characteristics The characteristics of a child’s disability include many factors, such as the nature of the disability, the extent or degree of the disability, the time of onset, and future prog- nosis. A child with medically complex needs often requires a family to make adapta- tions in daily routines, such as providing ongoing assistance, purchasing special equipment, and interacting frequently with medical personnel (Kuo, Cohen, Agrawal, Berry, & Casey, 2011). Specific disabilities also have their own unique challenges. Families of young children with autism experience challenges accessing services fol- lowing diagnosis, which increases parental stress (Braddock & Twyman, 2014). A child with a later onset of disability (e.g., disability caused by an accident during his or her school years) can cause major family readjustments (Cavallo & Kay, 2011).

Regardless of the particular nature of the disability, children and youth also pro- vide a broad array of positive contributions to their families, including greater valuing of the family and increased family closeness, appreciation of new opportunities such as advocacy, and becoming more aware of others’ strengths (King, Zwaigenbaum, Bates, Baxter, & Rosenbaum, 2012). Thus, for professionals to understand the impact of a child with a severe disability, they will need to understand both the child’s demands on the family and the child’s contributions to the family.

According to Ms. Campbell, “Jamal has contributed to the family by teaching his older siblings about responsibility, compassion, and patience.” Grandma Sandy particularly likes Jamal’s smile, his inquisitiveness, and infectious laughter. Ms. Campbell enjoys the times when Jamal shows affection and the connection between them is obvious. Thus, while the family experiences challenges related to caring for Jamal, they also experience joy from their relationships with him. And just as Jamal has affected his family positively, Isabella’s love of music unites the Gonzalez family, particularly during church services.

special challenges The final aspect of family characteristics relates to the special challenges that families face. Families face many challenges other than a child’s exceptionality, from less extreme ones (e.g., moving to a new community, changing jobs, or having a new baby) to more extreme challenges (e.g., the death of a family member, which hap- pened in the Campbell family). Additional special challenges include substance abuse, exposure to violence, having a family member who is incarcerated, having teenage parents, having parents with an intellectual disability, and living in poverty.

For example, poverty challenges many families, especially those whose children have disabilities (Hughes & Fanion, 2014). Families that live in poverty are more likely to be in poor health; have less access to health care services; and have babies who are born with a low birth weight, which is linked to later disability. Furthermore, ethnicity continues to be a distinguishing characteristic that determines who lives in poverty. Poverty can also have an impact on families’ experiences with accessing community resources and their interactions with service providers (Parish, Thomas, Rose, Kilany, & Shattuck, 2012). Silverstein and colleagues (2008) set out to examine low-income parents’ experiences with adversity and stress, but during their qualita- tive interviews they realized that many of these parents also talked about their strug- gles with navigating community and social service systems and interacting with professionals whose job it was to help them.

Ms. Campbell only occasionally receives child support payments and is too tired to fight the system or her ex-husband to collect these dollars regularly.

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42 Chapter 2

The Gonzalez family is on and off of welfare benefits, depending on Mr. Gonzalez’s ability to stay employed in the housing construction business. For the past few years, the housing market has been in a slump, forcing them to once again collect welfare bene- fits, including food stamps to obtain groceries.

Many families indicate that receiving information about their child with a disability and about family issues is their number one need. To address families’ special chal- lenges, it would be helpful for educators to develop a community resource file by working closely with other school professionals (e.g., social worker, nurse, psycholo- gist, music therapist) so that they are prepared to respond to families’ information and resource needs. This file will also be helpful when planning for family and disa- bility resource fairs at your school. Grant and Ray (2010) suggest that resources be arranged by topical area (e.g., physical/medical needs) and provide enough detail so that families can determine whether the resource will be helpful. For example, the entry should include the name of the resource, the contact information, the purpose of the resources, and helpful notes.

Family interaction

The family is a unit of interaction. Each family member is affected by the child’s disa- bility, and the child is affected by each family member. The goal of educators should be to form a partnership with multiple family members who have an interest in sup- porting the child’s education, including mother, father, siblings, and extended family members. Family–professional partnerships typically are mother–professional rela- tionships. But mother and family are not synonymous terms. The members of some families are related by blood or marriage, whereas others are related by preference (e.g., a close family friend who is regarded as a family member).

Any interaction with the child or other member ripples throughout the entire family. A home visit can be a very positive experience, or it can create family stress because of the perception of having one’s privacy violated or because of the need to alter the fam- ily’s schedule of activities or responsibilities. Even a seemingly simple request such as asking parents to follow through on instructional programs at home can strengthen their relationship with their child, but it may also create major tension.

Just how much time does Ms. Campbell have for being a “follow-through” educator for Jamal, given that she is a single working mother also raising his two older siblings?

The time required for Mr. and Mrs. Gonzalez to address Isabella’s disability-related needs is extensive. However, Mr. Gonzalez works long hours in construction and is physically tired at the end of the day. As a result, Mrs. Gonzalez maintains the home, cuts the lawn, and has learned to do minor repairs in the home. Each works long hours to make ends meet.

What support does either family have to be highly involved parents, assuming that the family wants to perform that role? Lack of support can cause tensions between parent and child. These can spill over into a marriage; sibling interactions; and inter- actions with extended family, neighbors, bosses, and co-workers. Interaction with any member of the system has implications for all members. From the perspective of family interaction, two major concepts are critical: (a) family subsystems and (b) fam- ily cohesion and adaptability in order to maintain balance.

Family subsystems The family systems framework highlights four major subsystems within traditional nuclear families:

1. Marital subsystem—marital partner interactions 2. Parental subsystem—parent and child interactions 3. Sibling subsystem—child and child interactions

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43Fostering Family–Professional Partnerships

4. Extended family subsystem—entire family or individual member interactions with relatives, friends, neighbors, and professionals

Variations in subsystems exist in many families, such as single parents, steppar- ents, families with one child or many children, families with extensive extrafamilial subsystems (such as the Gonzalez family), and families that consist of people who are not related by blood or marriage to each other but who perform the same roles as people who are related by blood and marriage. We will highlight information on marital and sibling subsystems.

marital subsystem There is a common assumption that children with disabilities—particularly severe dis- abilities—place their parents at greater risk for serious marital problems. Risdal and Singer (2004) conducted a metasynthesis of 13 studies on marital adjustment in the families of children with and without disabilities. They found that families of children with disabilities experienced a small negative impact on marital adjustment in com- parison to families of children without disabilities. These authors suggest that this is a positive finding given that the literature has tended to report that “children with disa- bilities cause severe family strain in almost all families” (Risdal & Singer, 2004, p. 101).

Raising a child with a disability can be stressful, although it does not necessarily imply that serious marital problems will occur (Brobst, Clopton, & Hendrick, 2009; Urbano & Hodapp, 2007). While Brobst and colleagues (2009) found that parents who have children with autism experience more parental stress and a higher intensity of child behavior problems than parents of children who do not have developmental disorders, they also found that respect for one’s spouse was the most significant pre- dictor of relationship satisfaction for both couples of children with and without disa- bilities, over and above variables such as parental stress or the level of the child’s disability. What we do know is that a strong marriage makes a big difference in the family’s overall quality of life. At the same time, it is also important to remember that many single parents also experience strong family well-being (Turnbull, Turnbull, Erwin, Soodak, & Shogren, 2015). Ms. Campbell is one of those families, as evidenced by her close ties to her own mother and her siblings, particularly her brother, who is a father figure for her children.

Research has demonstrated better ways to reduce parental stress in families who have children with significant disabilities (Wang & Singer, in press). Kyzar, Turnbull, Summers, and Gómez (2012) conducted a systematic review of the literature examin- ing the relationship of family support to family outcomes; support, largely defined as informal/social support, was consistently negatively correlated with stress and posi- tively correlated with family quality of life, family functioning, and family satisfaction. Further research has documented the impact of family support not only on family stress but also on child outcomes such as reduced problem behavior (Carta, Lefever, Bigelow, Borkowski, & Warren, 2013; Neece, 2014).

Providing parental support by sharing information and resources, such as helping the Campbell family implement positive behavioral support strategies at home and in community settings, is one way to let families know that you care about their well- being outside of the classroom. Even a short note to the parent to share positive news about the child may be just the thing that a parent needs to hear after a long day at work.

Mrs. Gonzalez says, “Knowing that my little Isabella is happy at school eases my mind at home; I worry, you know, that no one will like her and she will be so sad. Just reading in her communication book that she smiled a lot at lunchtime makes my day!”

Professionals can also support families’ marital well-being by listening and respond- ing to parents’ preferences for the support that they themselves need in caring for their son or daughter. For example, when Mrs. Gonzalez indicates that there is stress

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because of the long hours that her husband is working, Isabella’s teacher might ask the social worker to contact the Gonzalez family occasionally to check on their need for respite care.

Finally, professionals should be respectful of alternative family lifestyles. Parents of children with severe disabilities, similar to those of children without disabilities, may be in same-sex relationships. Same-sex relationships may occur in families in which parents have been in heterosexual relationships, had children, and then have taken those children into same-sex partnerships, legal unions, or marriages. Some children in same-sex marriages are adopted or are born through in vitro fertilization. There are many steps that you can take to welcome children from these families into schools and to welcome their parents as well. Some suggestions from Lamme and Lamme (2002) include providing electronic and library resources on diverse families, includ- ing same-sex parents, and promoting a respectful school environment.

sibling subsystem Some studies have found that brothers and sisters of siblings with disabilities have a higher incidence of emotional problems, lower self-esteem, and greater responsibility for household chores (Neely-Barnes & Graff, 2011; Mazaheri et al., 2013). However, research also suggests that there are many positive benefits to having a sibling with a disability, such as increased empathy, patience, social justice, and acceptance of dif- ferences (Dykens, 2005; Heller & Arnold, 2010; Stoneman, 2005).

The values that Ms. Campbell wants to pass on to her children include acceptance of differences and compassion for others. She is happy that Donnell and Shelia are learning these values through interactions with Jamal. Ms. Campbell speaks of the unconditional acceptance that Jamal’s siblings show Jamal, saying,

It’s just normal to them. This is who he is. I have always appreciated that in them. . . . They like to go in his room and watch movies—but they watch them with him, they don’t ignore him. They all eat popcorn together. During football games, Jamal’s brother, Donnell, will roughhouse with the NERF football; Jamal just breaks out in uncontrollable laughter. I think that’s what I like the most—seeing them do things that typical siblings do.

For Isabella’s family, however, there is not only her younger sister but also her cousin, aunt, and uncle who live in the household with them. While this is temporary for now, until her uncle can find a job, they still function as one big family. In Isabella’s eyes, it is as if she has two siblings.

A national resource for siblings is a program called Sibshops, which has the goal of providing information and emotional support for brothers and sisters. You can learn more about this program on their website (www.siblingsupport.org), as well as help parents locate a Sibshop near them. If your community does not sponsor Sib- shops, you might consider collaborating with families, educators, adults with disabili- ties, and other community citizens to start a Sibshop program. Meyer and Vadasy (2007) have published a workbook on the steps for developing a Sibshop in your own community. An evaluation of the Sibshop program with school-age siblings found that siblings were able to talk more about the positive and negative aspects of having a brother or sister with a disability and they were able to identify more specifi- cally how their sibling’s disability affected their life in four areas: school, home, play, and the future (D’Arcy, Flynn, McCarthy, O’Connor, & Tierney, 2005). McCullough and Simon (2011) found that sibling support groups connected siblings to friends and mentors who had similar experiences. The siblings supported each other in advocat- ing for their needs within the family.

An especially helpful way to become sensitive to sibling issues is to listen to sibling perspectives. Siblings can be invited to IEP conferences or to discussions with teach- ers or related service providers outside of the IEP conference. Another possibility for gaining information is to read the perspectives of siblings that are often provided in the newsletters of family organizations.

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45Fostering Family–Professional Partnerships

establishing balance: cohesion and Flexibility Family therapists have identified two dimensions in establishing balance in family relationships: cohesion and flexibility. Cohesion is the emotional bonding that family members have toward one another (Olson & Gorall, 2006). Balanced families (i.e., high cohesion and high flexibility) tend to experience greater satisfaction with their family system than unbalanced families (i.e., low cohesion and low flexibility) (Olson, Gorall, & Tiesel, 2007). Not only does family cohesion directly predict family satisfac- tion, but it also significantly alters the original relationship between family stress and family satisfaction (Lightsey & Sweeney, 2008). Thus, when families experience strong cohesion, stress is no longer a strong predictor of family satisfaction. Family cohesion mediates this relationship, acting like a buffer between the two.

So what can educators do to enhance family cohesion? One way that families can experience greater cohesion is to understand the value of each family member’s con- tributions to the family’s well-being and the importance of that person’s insights in the family decision-making process. Educators could ask families to describe how certain programs would affect their family well-being and routines (e.g., positive behavior support, circle of friends). Educators could also enhance family cohesion by ensuring that all family members (e.g., Isabella’s aunt, uncle, and cousin) are active participants in the decision-making process.

Because Isabella’s aunt and uncle are also her godparents and would be responsible for her care if anything should happen to Mr. and Mrs. Gonzalez, including them in long- term planning, such as through a MAPS process (see Chapter 3), would be appropriate.

To help families experience a balanced life instead of one that is singularly focused on the child with the disability, you may connect them with community resources, refer them to professionals to address immediate concerns, and help their child build a social support network. Help families learn not only to rely on each other but also to reach out for supports to maintain balance in their lives. If you recall Ms. Campbell’s comments in Jamal’s opening vignette, she indicated that her body and mind are tired; she is unsure of how much longer she will be able to keep up her level of advo- cacy to ensure that Jamal continues to receive appropriate services.

Although she has support from her extended family, she still feels guilty about asking for assistance because she knows that everyone has his or her own life, too. When Ms. Campbell lost her dad, she kept a lot of her emotions in check so that she could support her mother. After all, her mother was also grieving from the loss of her husband, and Ms. Campbell did not want to burden her mother with additional stress.

How might educators support Ms. Campbell and her family during such a difficult time? A teacher might work with the school counselor to locate resources and books not only for Jamal but also for his siblings to help them cope with the death of a close family member. The educator also might refer the parent or siblings to virtual peer support groups on the internet, where the older siblings could talk with other peers who are coping with the death of a family member. Finally, the social worker might spend extra time with Jamal at school to help him use his communication board to express his feelings about the death of his grandfather and to develop a story about appropriate ways for dealing with his feelings.

Family flexibility is “the quality and expression of leadership and organization, role relationship rules and negotiations” (Olson, Gorall, & Tiesel, 2007, p. 2). Many fami- lies establish interaction patterns. For example, a mother may assume responsibility for bathing, dressing, feeding, and toileting a child with severe physical disabilities. This pattern may become so ingrained that she is unable to leave town for a vacation or a visit with extended family or even to have a break from these duties. If the mother is ill or an emergency arises, a family crisis related to parents’ roles is likely to occur. One way to help families achieve successful interactions is to encourage them to develop an array of alternatives and options consistent with their cultural values.

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For families who believe that it is too much trouble to teach others how to care for their children, you might be able to persuade people who are willing to provide care- giving to come to your classroom for tips from you on how they might best provide support. This would prevent parents from having to provide this orientation for those who might be able to help them.

Family Functions

Families exist to serve the individual and collective needs of their members. Attend- ing to family functions is one way to characterize how families serve their needs. Figure 2–4 highlights these functions and some of the tasks performed by family members to meet them.

Family functions are not independent of one another. One function may facilitate another function, such as when a family member’s participation in recreational activi- ties leads to increased socialization and increased self-esteem from mastering a new hobby. On the other hand, one function may impede progress in another function area. For example, economic hardship may affect a family’s ability to meet routine care needs (e.g., nutrition, transportation, health care), in turn impinging on a par- ents’ or child’s self-esteem.

A son or daughter with a disability can affect a family in negative, neutral, and positive ways. In the next two sections, we highlight the effects on the economic and socialization functions of families. For a thorough discussion of all family functions, see Turnbull, Turnbull, Erwin, Soodak, and Shogren (2015).

economic needs All families must have income and a way to spend the money earned to meet food, clothing, shelter, and other needs. The presence of a son or daughter with a severe dis- ability can create excess expenses (Parish, Rose, & Swaine, 2010). Some of the devices and services for a child with a severe disability may include adaptive feeding utensils; special clothing; lift-equipped vans; bathroom adaptations, such as support and safety bars; ongoing medications required for seizures and other physiological or psychological needs; and adaptive mobility devices, such as walkers and crutches. Many of these devices also require ongoing servicing and periodic replacement. Even families fortunate enough to have the best health insurance coverage find that the cost of buying and

maintaining many adaptive devices and medical services is not fully covered. Mrs. Gonzalez comments,

Isabella will be nine years old soon, and we feel that she would be a good candidate for a power wheelchair; however, our insurance company will only pay for a manual chair, even with multiple requests and notes from her doctor. We desperately want her to keep up with her friends at school and a power chair would give her more independence. We know that she has the determination to learn to use a power chair, but we struggle to pay our bills some months, and purchasing a power chair is only an option for rich people.

The economic impact on families varies with the nature and extent of the child’s disability and, of course, with the family’s own resources. Because Mr. Gonzalez works in housing construction, when the housing mar- ket is good, the Gonzalez family feels secure; however, these past few years have been quite difficult. The costs associated with providing for the needs of one family member can limit the funds available for the other family members. Parents and other family members may forgo

FIguRe 2–4 Family Functions and Tasks

1. Affection: Developing intimate personal relationships, expressing sexuality, giving and receiving nurturance and love, and expressing emotions

2. Self-esteem: Establishing self-identity and self-image, identifying personal strengths and weaknesses, and enhancing belonging and acceptance

3. Economic support: Generating income and handling family finances, paying bills, earning allowances, and handling insurance matters

4. Daily care: Purchasing food, preparing meals, providing health care, maintaining the home, providing transportation, and taking general safety measures

5. Socialization: Fostering individual and collective friendships, developing social skills, and engaging in social activities

6. Recreation: Developing and participating in hobbies or clubs, setting aside everyday demands, and going on vacations

7. Education: Participating in school-related activities, continuing education for adults, doing homework, providing for career development, and developing a work ethic

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47Fostering Family–Professional Partnerships

attending to their own needs in order to afford services for the child with a severe disa- bility. Family members may become resentful, particularly siblings who might not under- stand the financial responsibilities of maintaining a household. Parents may know that a child could benefit from the purchase of a special piece of equipment and not be able to afford it, like the power wheelchair for Isabella.

The presence of a family member with a disability may prevent parents from obtain- ing employment because of the level of care and supervision required. Employment outside of the home for mothers of children with disabilities may help mitigate stress and depression (Morris, 2014). In 2012, it was estimated that more than 46.5 million families live in poverty, which represents about 15% of the U.S. population (DeNavas- Walt, Proctor, & Smith, 2013). The largest source of support for families whose mem- bers have disabilities is Title XIX of the Social Security Act, Home and Community-Based Services (HCBS) (Braddock et al., 2013). HCBS funding enables families to exercise control over how HCBS funds are spent. Studies consistently report that families who receive HCBS funding have high levels of satisfaction and an increase in quality of life (Heller, Factor, Hsieh, & Hahn, 1998; Timberlake, Leutz, Warfield, & Chiri, 2013). Understanding how to help families access HCBS funding to pay for items such as res- pite care, personal attendants, therapies, and adaptive medical equipment can help alleviate some of the financial burdens associated with raising a child with a disability. Both the Gonzalez and Campbell families would benefit from respite services through Medicaid HCBS, and Isabella might be able to obtain a power wheelchair. In addition, they should go to the websites of their Parent Training and Information Centers to find out about the state family support resources available, as well as any other programs that provide financial resources to families. The local Social Security Office can provide information about eligibility criteria for receiving Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Consider identifying appropriate com- munity contacts and providing parents with the names and telephone numbers of per- sons to contact regarding estate planning, disability benefits, or family subsidies, and encouraging parents who have been successful in obtaining financial resources or who have completed financial planning to provide assistance to other parents who have financial questions (Turnbull, Turnbull, Erwin, Soodak, & Shogren, 2015).

socialization needs Often, professionals tend to focus on developing academic and behavioral skills for their students. However, parents are often disappointed that their sons and daughters with severe disabilities have limited friendships. Children with disabilities, like Jamal, have social impairments that severely affect their ability to develop meaningful friend- ships. Including socialization goals on students’ IEPs is one way to address this need. An increasing number of studies guide educators toward effective teaching methods (Koegel, Kuriakose, Singh, & Koegel, 2012; Stichter, O’Connor, Herzog, Lierheimer, & McGhee, 2012). For example, peer models could help Jamal increase his social initia- tions and social responses.

One of Jamal’s teachers noticed his keen interest in football so she contacted the parents of two students in Jamal’s class, who also love sports, to ask if their children could be peer models for Jamal in a more formal way. After the parents and students gave con- sent, Jamal’s teacher provided them with some training that included information about autism strategies they can use to increase Jamal’s social interactions in a variety of school settings (e.g., classroom, lunch, class transitions).

Carter and colleagues (2013) provide a step-by-step guide on how to expand the peer networks of students with severe disabilities in schools by implementing a peer buddy program. These steps include (a) soliciting support from administrator and fac- ulty; (b) identifying students with disabilities and peers; (c) identifying school person- nel to facilitate the peer buddy program; (d) determining network meeting logistics and holding meetings; and (e) encouraging social connections outside of meeting time,

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reflection on the program, and maintenance of established peer network. Webster and Carter (2007) conducted an extensive review of studies examining social relationships and friendships in children with and without developmental disabilities, and concluded that while this is an under-investigated topic, there are several important findings to consider. One study in their review (Freeman & Kasari, 2002) investigated the charac- teristics and qualities of playmates of children with Down syndrome who were similar in chronological age and gender but did not have a disability, and found that the play was more responsive and interactive in the dyad of playmates in which age and gender were matched as compared to the play of dyads in which chronological age and gen- der were not matched. A second study in their review (Lee, Yoo, & Bak, 2003) reported that 33% of children without disabilities participating in the study indicated the oppor- tunity to spend time with a peer with a disability as the most important factor in devel- oping friendships. Additional responses from the peers regarding their perspectives of factors contributing to friendship formation included teacher encouragement to help and understand a child with a disability (17%), their willingness to teach or help a child with a disability (11%), and closer placement to a child with a disability (11%).

You should be cautious about peer relationships. What can seem like friendships for children with severe disabilities are really helping relationships (e.g., peer tutoring and monitoring of behavior). Despite research indicating that having peers in helping or aca- demic support roles are useful ways to initiate friendships, you should evaluate whether the characteristics of true friendships are also present in these relationships. Friendships typically revolve around companionship (e.g., going places together, participating in school activities, engaging in sports and activities), emotional support (e.g., tending to feelings, expressing affection and caring, enhancing self-esteem), and instrumental sup- port (e.g., providing information, practical help, or advocacy) (Turnbull, Blue-Banning, & Pereira, 2000). You also can encourage parents to consider how to foster friendship.

Mrs. Gonzalez has made it a point to invite children from their neighborhood to their house to spend time with Isabella and to develop a friendship with her. She teaches the children a few basic Spanish words so that they may connect with Isabella from her own cultural perspective.

Not all parents have the time to orchestrate friendships for their child with a disa- bility, as Mrs. Gonzalez does. Therefore, you should brainstorm about the many dif- ferent settings and individuals who would be available to facilitate friendship development. A broad range of people can be friendship facilitators, including gen- eral and special education teachers, related service providers, paraprofessionals, fam- ily members, community citizens, and classmates. Many teachers have used the “Circle of Friends” approach with success for students with disabilities (Thousand, Villa, & Nevin, 2002). Circle of Friends (http://www.circleofriends.org/) is a social skills training approach used to encourage friendships between students with disabilities and their peers without disabilities. Approximately 80% of the studies included in a review of research about Circles of Friends showed an improvement in attitudes and acceptance, and a smaller number (19%) showed improvements in knowledge of peo- ple with disabilities (Lindsay & Edwards, 2013).

From a family systems perspective, it is important to recognize that although you may perceive friendships to be very important, families may have other priorities. In some situations, families may also believe that friendships are important but may have no unclaimed minutes in which to take on one more responsibility.

Family life cycle

Families differ in characteristics, and those differences influence interaction patterns that affect the family’s ability to meet its functional needs. Each family changes as it goes through the stages and transitions of the family life cycle. Two dimensions of the family life cycle are (a) life-cycle stages and (b) life-cycle transitions.

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life-cycle stages The family life cycle has been described as a series of developmental stages that are periods of time in which family functions are relatively stable (Carter & McGoldrick, 2005). Researchers and theorists disagree concerning the number of life-cycle stages that exist. Some have identified as many as 24 stages, although others have identified as few as 6 (Turnbull, Turnbull, Erwin, Soodak, & Shogren, 2015). The number is not as important as the tasks that families are responsible for accomplishing at each stage. Six of the stages are (a) birth and early childhood, (b) elementary school years, (c) adolescence, (d) early adulthood, (e) middle adulthood, and (f ) aging.

Many tasks facing the families of adolescents are different from those facing the families of preschoolers, as the Campbell family illustrates. Now that Jamal is in mid- dle school, he is also about to change physically and perhaps emotionally. The impending changes raise discomfiting issues. Who, for example, will teach him about the changes in his pubescent body and appropriate times for private moments? What roles are appropriate for educators with respect to his adult physical changes? In mid- dle school, Jamal has many more teachers; luckily, he has two male teachers. How might they be included in educational planning meetings? How might Jamal’s uncle also be included in these discussions? These are sensitive issues for both the school and the family, but they are life-cycle needs that must be addressed given Jamal’s past inappropriate behavior in school.

Table 2–1 identifies possible parental issues encountered during the first four life- cycle stages, which are the stages in which families and educators have the most contact.

Inclusion. Although some families’ tasks and issues tend to be stage specific, others permeate all stages. An example of the latter is advocating for inclusive experiences. Many families strongly favor inclusion and are the major advocates for their children in obtaining inclusive experiences starting during the early childhood stage and con- tinuing throughout the life span (Resch, Mireles, Benz, Grenwelge, Peterson, & Zhang, 2010).

For Ms. Campbell, inclusion is a very important issue. She continues to work hard to ensure that her son has the supports he needs in order to be included as much as possi- ble with his peers without disabilities.

TabLe 2–1 Possible Parental Issues Encountered at Four Life-Cycle Stages

Life-Cycle Stage Possible Parental Issues

Early childhood (ages 0–5) Obtaining an accurate diagnosis Informing siblings and relatives Locating support services Clarifying a personal ideology to guide decisions

Elementary school (ages 6–12) Establishing routines to carry out family functions Adjusting emotionally to implications of disability Clarifying issues of inclusive practices Participating in IEP conferences

Adolescence (ages 13–21) Adjusting emotionally to possible chronicity of disability Identifying issues of emerging sexuality Addressing possible isolation and rejection by peers Planning for career and vocational development

Adulthood (from age 21) Addressing the need for preferred living situations Adjusting emotionally to adult implications for intensive support Addressing the need for socialization opportunities outside the family Initiating career choice or vocational program

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As inclusion advocates, families often invest tremendous energy at each stage to access experiences that enable their children to be in, and benefit from, typical set- tings. During birth and early childhood, these experiences could include attending neighborhood and community playgroups and child care, and participating in commu- nity recreation programs designed for young children. During the elementary school years, families might focus on their child attending neighborhood schools’ general edu- cation programs, and taking advantage of typical extracurricular activities such as Scouts and community recreation programs. During adolescence, participating in extra- curricular activities consistent with preferences, and enjoying friendships and dating are some examples. Finally, some inclusion efforts families may consider in early adult- hood for their young adult are supported employment, developing a home of one’s own, and participating in community activities consistent with one’s preferences.

Families who commit themselves early to inclusion and advocate for inclusive experiences across the life span often spend a great amount of time and energy edu- cating others, making logistical and support arrangements, and troubleshooting when special issues arise. Educators who strongly favor inclusion are also advocates; their advocacy takes place primarily at the school level, educating general education teach- ers and related service personnel about the importance of integrating specialized instruction into typical settings to ensure that their students have opportunities to access the general education curriculum.

Self-Determination Skills. A second pervasive issue across the life span is develop- ment of self-determination skills. Self-determination consists of the following four essential characteristics: self-realization, self-regulation, psychological empowerment, and autonomous actions (Wehmeyer, 2007). These skills help children and youth with severe disabilities live their lives according to their own personal values and preferences. Although the major emphasis within the special education field has been on development of self-determination skills at the adolescent level (Test, Fowler, Wood, Brewer, & Eddy, 2005), the foundation of self-determination starts during the early childhood stage and evolves throughout the entire life span (Wehmeyer, 2014).

Some educators and families may be unsure of how to enhance their child’s self- determination skills, particularly when children are young. Shogren and Turnbull (2006) provide the following practical strategies: (a) Place artwork and photos at the child’s eye level, (b) create a private area that the child can call his or her own, (c) use routines to ensure predictability and consistency, (d) have a childproof area that allows for safe exploration so that the child can develop a sense of control over the environ- ment, (e) allow for age-appropriate risk taking, (f ) be careful to not overprotect the child with disabilities relative to his or her siblings and peers, and (g) set up social and environmental reinforcers for appropriate behavior (Shogren & Turnbull, 2006).

From the earliest years, families and professionals must clarify their values and pri- orities related to self-determination and recognize that its development is a long-term life-cycle issue (Palmer, 2010; Palmer et al., 2013). Clarification is important now for the Campbell family and Jamal’s teachers; his entry into middle school is a good time to discuss these matters, especially because Ms. Campbell is already concerned about Jamal’s future after high school but is unsure of how to proceed in planning for the future. While IDEA requires transition planning to begin when Jamal is 16 years old, it is still not too early to ensure that Jamal’s current curriculum and IEP goals are pre- paring him to lead a self-determined life after high school graduation.

life-cycle Transitions Transitions represent the periods of change as families move from one developmental stage to another. These stages are similar to plateaus but transitions resemble peaks and valleys that divide those plateaus. Because transitional times prompt changes in expectations and often in service systems, they typically are the times that families identify as the most challenging (Rous, Hallam, Harbin, McCormick, & Jung, 2007;

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Winn & Hay, 2009; Ytterhus, Wendelborg, & Lundeby, 2008). These transitions may involve movement from the intensive care nursery to the home and community, from early intervention to preschool, from preschool to kindergarten, from elementary to middle school (as for Jamal Campbell), from middle school to high school, and from high school into adulthood. Transition is not culturally neutral.

In Mexican culture, la quinceañera is the celebration of a girl’s 15th birthday to mark her passage from young girl to womanhood. The celebration also takes place in con- junction with a religious ceremony in which the young girl renews her religious vows to the Catholic Church (Pizarro & Vera, 2001). While this celebration is still several years away for Isabella, her mother has already mentioned the significance of this event for all young girls in her culture and says that Isabella will celebrate this life event as well.

Educators can incorporate these special events within instruction. Lychner (2008) is a music educator; he provides several examples of how to celebrate students’ mul- ticultural heritage, including important life-cycle transitions, within the context of the classroom using music as a medium. Another example is to use children’s storybooks and journaling exercises. Numerous children’s texts teach students about important cultural life-cycle transitions. One text, in particular, Remembering My Roots and Liv- ing My Traditions, is a story about two young siblings who travel to their home coun- try, Mexico, for the summer. One dialogue between the siblings tells the story about their attendance at their cousin’s quinceañera. When Isabella is older, her teachers might also invite Mrs. Gonzalez to the classroom to share her story about her own quinceañera celebration.

Different cultures have various kinds of rituals that they consider important, such as baptism, first communion, bar or bat mitzvah, graduation, and voting. Because these rituals serve as symbols of ongoing development for the family, they help reori- ent family perspectives toward changes that are occurring throughout the transition. A special challenge for families who have a child with severe disabilities is that the child often does not have access to many of these rituals and therefore does not have the experience of transition. Educators can support families by encouraging and sup- porting the inclusion of their child in these rituals. (See Chapter 16 for a discussion of symbols of adulthood.)

Some families may believe that their children should not participate in certain fam- ily rituals because of their disability. For example, a mother may think that her child cannot benefit by having religious confirmation experiences. Perhaps you might con- vene parents whose children have been confirmed and parents who fear that the experience might be unrealistic for their child. Leaders in a religious community might not encourage parents because they may never have had the experience of including a person with a severe disability. Sharing resources with religious leaders or inviting them to the IEP meeting (of course, with parental consent) to learn about classroom adaptations might be a welcomed gesture to assist with adaptations in religious classes. Educators might also learn helpful tips from the religious leaders as well.

An excellent and inspiring example of a child’s inclusion in religious confirmation experiences is the film documentary, Praying with Lior (www.prayingwithlior.com). This film chronicles the experiences of a child with Down syndrome during his bar mitzvah. On the website, educators will find a schedule for nationwide showings of this film. School districts and other organizations may also purchase the video for educational purposes to teach about inclusion and family dynamics. A key point is that many parents are led to believe that normal events are unrealistic for their chil- dren with disabilities. By telling them about other families’ experiences, or referring them to books or web materials, you can help them abandon that notion.

There are many other ways that professionals can collaborate with families in enhancing successful transitions. Table 2–2 includes ideas for how professionals can help families improve their child’s transitions.

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learning oUTcome sUmmaries

2.01 Parent Rights and Responsibilities Learning Outcome Identify the connections between the six principles of the Individuals with Disabili- ties Education Act of 2004 and the rights and responsibilities of parents of students with disabilities.

Historically, family–professional partnerships have not been as positive and productive as they could have been. IDEA has established ground rules for both educational professionals and parents in their interactions with each other. Associated with each of the six major princi- ples of the law—zero reject, non-discriminatory evaluation, appropriate education programs, least restrictive environment, parent and student participation in shared decision-making, and due process—are requirements for family–professional partnerships.

IDEA alone does not ensure collaboration among parents and professionals. Parents and educators alike must work within the guidelines to develop partnerships to meet families’ individual needs and preferences. The preferred educational roles of the parents and other family members vary across families. Likewise, the level of involvement sought by different family members fluctuates.

2.02 Parent Training and Information Resource Centers Learning Outcome Explain the services provided by Parent Training and Information Centers and Community Parent Resource Centers.

Educators should assist families in becoming educational advocates to ensure that families are equal partners in making decisions about their children’s education. To this end, Parent Training and Information Centers and Community Parent Resource Centers assist parents in learning the information necessary to meet their child’s educational needs. It is important that educators seek out these training and information resource centers, and partner with the staff in addressing families’ concerns, priorities, and needs.

2.03 Family Systems Learning Outcome Articulate the major elements of the family systems framework, and the implication of disability on each of these major elements.

TabLe 2–2 Approaches for Professionals to Enhance Successful Transitions

early Childhood • Provide parents with resources and tips to assist with child separation anxiety (e.g., books parents can read to their child about

the first day of school; leaving the child with others for short periods). • Provide information about various preschools in the community to assist parents with decision-making. • Encourage participation in “Parent to Parent” programs (www.p2pusa.org), in which veteran parents are matched in one-to-one

relationships with parents who are just beginning the transition process.

Childhood • Provide parents with an overview of curricular options. • Ensure that IEP meetings provide an empowering context for family collaboration. • Encourage participation in “Parent to Parent” matches, workshops, or family support groups to discuss transitions with others.

adolescence • Assist families and adolescents in identifying community leisure-time activities. • Incorporate into the IEP skills that will be needed in future career and vocational programs. • Visit or become familiar with a variety of career and living options.

adulthood • Provide preferred information to families about guardianship, estate planning, wills, and trusts. • Assist family members in transferring responsibilities to the individual with the exceptionality, other family members, or service

providers, as appropriate. • Assist the young adult or family members with career or vocational choices.

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53Fostering Family–Professional Partnerships

Educators should view students within the broader context of family life. Student learning is not limited to skill development within the school context only; understanding the broader family system enables educators to provide services that meet the complex needs of today’s students. Disability is an aspect of some families’ characteristics that can add challenges but also many positive outcomes and experiences. A family systems perspective offers a frame- work for understanding the characteristics, interactions, functions, and life-cycle issues of families so that more effective service provision can be implemented.

sUggesTed acTiviTy: a Tale oF Two Families

The angelino Family The Angelino family has five children and a sixth is on the way. The children are ages 14 (girl), 12 (boy), 10 (girl), 7 (boy), and 6 (girl). They all attend a nearby parochial school. Mr. Angelino owns a butcher shop that had been his father’s and that was begun by his grandfather, who emigrated from Italy in 1904. The butcher shop at one time had upstairs living quarters for the family, but about 10 years ago the family moved into a large, Victorian-style house about a block away.

Mr. Angelino’s youngest brother once came back from college with ideas about expanding the business and marketing the family’s secret recipe for Italian sausage, but Mr. Angelino (the oldest son) decided against it because it would take too much time away from the family. He is fond of saying, “We are not rich, but we got a roof over our heads, food in our bellies, and each other. What more could we want?” This young- est brother is the only one in the family with a college education, and he is also the only one who scandalized the family by marrying a non-Catholic. Mr. Angelino uses his little brother as an example of the detrimental effects of “too much education.”

Both Mr. and Mrs. Angelino come from large families; most of their brothers and sisters still live in the “Little Italy” section of this large eastern city. All grandparents are dead, with the exception of Mrs. Angelino’s mother (Mama). Mama lives in the home with them and is very frail. One of Mrs. Angelino’s brothers or sisters is sure to stop by nearly every day, bringing children, flowers, or food, for a visit with Mama. They often take Mama for rides or to their homes for short visits, depending on her health, and help with her basic care.

Life with the Angelinos can be described as a kind of happy chaos. Kids are always running in and out of the butcher shop, where the older brothers and male cousins are often assigned small tasks in return for a piece of salami or some other treat. The old house is always full of children—siblings and cousins—from teenagers to tod- dlers. Children are indulged until they reach age 9 or 10, at which time they are expected to begin taking responsibility, which is divided strictly along traditional gender-role lines. Child care, cooking, and cleaning are accomplished by the women— older sisters or cousins, aunts, or mothers. Evening meals are a social event. There is nearly always at least one extended family member or friend at the table, and every- one talks about the events of the day, sometimes all at once, except when Mr. Angelino has something to say, at which point everyone stops to listen. Mr. Angelino is obviously a very affectionate father, but he expects his word to be obeyed. Bed- times, rules about talking at the table, curfews, and other rules are strictly enforced. This situation is beginning to cause conflict with the oldest daughter, who wants to date and spend more time with her friends from school. Mrs. Angelino is often sym- pathetic to her children’s requests, but her husband has the final say.

All in all, life in the Angelino home is warm, close, and harmonious. Mrs. Angelino, as she approaches her eighth month of pregnancy with this last “surprise” child, shares her contentment with her priest: “I don’t know what I have done to deserve so many blessings from the Good Lord.”

The mcneil Family Mr. and Mrs. McNeil have been married for two years, and she is expecting their first child. Mr. McNeil is the youngest partner in a prestigious law firm in a midwestern city.

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Everyone considers him upwardly mobile and thinks that it is phenomenal that he achieved a partnership only five years out of law school. Mrs. McNeil has a degree in interior design. She worked full time for a while for a decorating firm in another city. After she married, Mrs. McNeil moved to this city, where she has a part-time, on-call job with an exclusive architectural firm. She has ambitions of starting her own business.

Mr. McNeil is an only child. His parents live on the East Coast. They are both suc- cessful in business—his father is a banker and his mother is a real estate broker. They have always demanded perfection from their son, and he seems to have lived up to their expectations. Mrs. McNeil has one younger sister. Her parents live on the West Coast. They are both professionals; her father is a college professor and her mother is a social worker. Mrs. McNeil’s family has always been very close. She calls her par- ents about once a week, and the family occasionally has conference calls with the parents and the two siblings to decide some important issue or to relay some big news. Mrs. McNeil’s parents place no demands on her except that she be true to her- self. They often tell her how proud they are of her accomplishments.

Both sets of parents are experiencing grandparenthood for the first time with Mrs. McNeil’s pregnancy. They are thrilled. It sometimes seems to the McNeils that their parents vie with each other over the gifts that they give them. The McNeils refuse the more extravagant gifts to make the point that they are indeed making it on their own, and they have discussed some strategies for disengaging themselves from so much contact with their parents.

The McNeils’ avant-garde apartment is the scene of much entertaining with his law firm colleagues and her artistic friends and decorating clients. Although their social spheres overlap somewhat, each has separate groups of friends and pursues individ- ual interests. They call this “giving each other space,” and they consider it to be an important strength in their marriage. The McNeils believe strongly in supporting each other’s careers and in sharing family responsibilities; they divide cooking and clean- ing in a flexible manner, according to whoever has the time. They are also attending Lamaze classes together and are looking forward to sharing childbirth.

exercise The babies whom Mrs. Angelino and Mrs. McNeil are expecting will have severe cog- nitive and physical disabilities.

1. For both families, flash forward 5 years. a. It is January, more than halfway through the kindergarten school year, and the

Angelinos are concerned that their son, Nico, is not benefiting from his educa- tion. He has not made progress toward his IEP goals and they have not seen much improvement in his academic or functional skills at home. With which IDEA principle does this issue most closely link, and what are the Angelinos’ rights and responsibilities?

b. It is the summer before kindergarten and the McNeils have found the perfect school for their daughter, Elle; however, the school has expressed their hesita- tion for including Elle in general education for most of the day. With which IDEA principle does this issue most closely link, and what are the McNeils’ rights and responsibilities?

2. Explore information in your state/region regarding the availability of a Parent Training and Information Center and/or Community Parent Resource Center. What services are offered that you believe will be helpful to the Angelinos? What about the McNeils?

3. Use the family systems framework to predict the preferences, strengths, and needs of both families in terms of characteristics, interaction, function, and life cycle.

4. The Angelinos and the McNeils have different cultural values. How would you char- acterize the cultural values of each family? How do you think these cultural values influence what they consider to be appropriate self-determination for each of the parents (mother and father), as well as for their children with and without a disabil- ity? (Assume that the McNeils will have more children who do not have a disability.)

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3 Assessment and Planning

Diane M. Browder University of North Carolina at Charlotte

Jenny Root University of North Carolina at Charlotte

Leah Wood University of North Carolina at Charlotte

Caryn Allison University of North Carolina at Charlotte

3.01 Assumptions of Assessment Learning Outcome Describe the assumptions that create the foundation for assessment and planning that promotes student competence.

3.02 Qualities and Types of Assessment Learning Outcome Identify the different types of assessments and what makes an assessment technically adequate.

3.03 Purpose of Assessment Learning Outcome Identify the different purposes of educational assessment and describe the types of assessment that may be used for each purpose.

3.04 Using Assessment Information Learning Outcome Explain how to set priorities for a student’s educational program using assessment information.

Shawna

Shawnna is an elementary school student with multiple, severe disabilities who received pre- school services. She has cerebral palsy and a severe intellectual disability. She is receiving an updated multidisciplinary assessment and new IEP. She is in the fourth grade and will be partici- pating in alternate assessment based on alternate achievement standards for the first time. Shawnna is being raised by a grandmother and her aunt. She communicates by gazing at pic- tures, using her eyes to request basic needs. Shawnna has a strong preference for socializing with people and will make loud noises if ignored for too long.

Jose is enrolling in a middle school and recently moved from Mexico to a small town in the USA. His father has been working in the US for several years and recently relocated the family

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so Jose can receive a better education. The school psychologist’s initial interactions with Jose and his family revealed that an older sister is the most fluent in English. Jose has some behav- iors that suggest both the need for screening for autism spectrum disorder (ASD) and a func- tional behavioral assessment (FBA). Jose will repeat expressions in English or Spanish (immediate echolalia), but he initiates almost no language. Jose has prolonged tantrums if there is any change in his daily routine. He is also obsessed with string and prefers to spend most of his time twirling string or wrapping his hands in it. He becomes aggressive toward anyone who tries to take his string. He has no formal communication system in English at this time. His level of understanding or use of Spanish is not yet fully understood.

Larry

Larry is 16 years old and attends his neighborhood high school. He has Down syndrome and has been classified as moderately intellectually disabled. Larry talks and can engage in simple con- versations. Over the years, he has learned to read simple passages and can do some basic com- putation with a calculator. In recent years, he began expanding his academic skills by doing modified academics in his general education classes. Larry really likes school and doing aca- demic work. He often asks his teachers for homework. Larry’s parents worry that he likes school too much and want him to consider what he will do after high school.

Assumptions of Assessment

Educational assessment involves a process of inquiry about students to discover what they know and can do for purposes of planning educational services. It requires gath- ering information to make decisions. Perhaps most important, assessment reflects underlying assumptions about students. If these underlying assumptions are flawed, then the entire process of gathering information will be skewed and of questionable benefit to the student. Some years ago, Donnellan (1984) proposed a criterion of “the least dangerous assumption” that educational decisions should be based on assump- tions that will have the least dangerous effect on a student’s likelihood of functioning as an adult. She also advocated that all students can learn and proposed that when learning does not take place the fault probably lies with the instructional strategies. When assessment applies the least dangerous assumption, educators focus on gather- ing information on the supports and skills students need to acquire to have as optimal a life as possible. Also, the assumption that all students can learn motivates educators to conduct assessments to discover what students have learned and how they might best be taught. Assuming that all students can learn focuses the entire assessment pro- cess on promoting the student’s competence rather than emphasizing deficits.

Jorgensen (2005) built on Donnellan’s assumptions to propose that all students can learn general education content. Sometimes in the past, an assumption was made that an IQ score or mental age could be used to plan educational placement and content. For example, students with IQ scores below 55 were labeled “trainable” assuming they should be “trained” to learn basic skills, rather than being labeled “educable” for academ- ics. As Jorgensen notes, IQ and mental age scores often are not indicative of the abilities of students who have complex and multiple disabilities. It is far less dangerous to assume students can learn academic content appropriate to their grade and age than to deny them this educational opportunity. Jorgensen proposes that educators assume that all people have different talents and skills, all children can learn when supported and pro- vided with high expectations, and that intelligence is multidimensional. No single test, score, or educational label can provide a prediction of what a student can achieve.

If educators assume that all students can learn, assessment becomes a capacity- building pursuit. That is, the evaluator seeks to identify a foundation of strengths the student can use to gain additional competence. A clear picture of the student’s chal- lenges also is needed to guide consideration of the types of support that will be needed. This is much different than a deficit-finding approach to assessment in which

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57Assessment and Planning

scores or skill deficits are used to set low expectations. In a capacity-building approach, educators seek to understand how to individualize educational services for the student’s specific needs. When the assumption is that all students can learn, edu- cators exercise care in avoiding assessment strategies that are biased against stu- dents’ individual characteristics. For example, an assessment that requires speech to indicate current reading ability would be biased against a student who uses a picture communication system or manual signing. An assessment that uses a printed text for- mat would be biased against a student who is blind. An assessment given in English would not likely capture the achievement of a student who is new to this language.

Because students with severe disabilities often present unique challenges, educa- tors will need to be creative in discovering strengths and achievements. One of the first and most important goals of an assessment should be to determine how the stu- dent communicates. All behavior communicates (see Chapter 7). For example, Jose in the case study at the beginning of this chapter does not have a formal system of sym- bolic communication. He does not yet use speech, pictures, signs, or other means to express communication in English or Spanish. In contrast, all of Jose’s behavior is communicative. For example, he may pull away or scream to refuse unwanted atten- tion. He may grab for items he wants but does not know how to request. His echola- lia may be his way of saying he does not understand or it may be his attempt to begin using English, or to elicit social interaction. Whether he uses spoken Spanish at home is not yet known. What also is not yet understood is what Jose understands recep- tively in either English or his native Spanish. Obviously, there is much Jose’s teaching team will need to learn about his communication before beginning to assess other areas like reading, math, and daily living skills.

Shawnna is considered social because she has learned to use her non-verbal behav- iors in ways that procure and sustain attention from others. She will roll her eyes to joke, vocalize a high-pitched sound to gain attention, and drop her head and close her eyes when angry or upset. Because she also can use her eyes to make a selection (e.g., to choose the correct response when shown an array of four pictures), Shawnna has a strategy for showing a lot of her current achievements when she is assessed. In contrast, students who have not yet learned consistent responses like Shawnna may seem to be unresponsive. Even if the student knows the answer, he or she may not be able to indicate a response because a communication system has not been fully devel- oped. In the movie, My Left Foot, Christy Brown, a boy with a severe physical disabil- ity, is assumed to have no academic ability because he does not have a way to communicate. In one scene, Christy watches in frustration as his sister struggles to do her math homework. As their father asks his sister to solve the problem, Christy picks up chalk with his toes and writes the correct answer on the floor. Some students with severe disabilities are like Christy with no chalk within reach. That is, not having been offered a means to communicate, they have no way to tell others what they know. The least dangerous assumption would be that the student understands more than can be conveyed and to give the student full educational opportunities while working diligently to find a way for the student to communicate.

This understanding about communication leads to the second important assump- tion that will form a foundation for an assessment to build student competence. This assumption is that when students with severe disabilities have not demonstrated edu- cational achievement in the past it may be because their communication systems are underdeveloped. For example, a student cannot indicate understanding of the solar system or communicate with a peer about a favorite singer with a communication sys- tem that only has basic needs like “eat” and “toilet.” Kleinert, Kearns, and Kleinert (2010) suggest several steps to promote communicative competence. First, a team observes to consider how the student currently communicates. Potential barriers to communication, like physical challenges, also are considered. Next, the team gathers information about whether the student has sufficient opportunities to communicate and whether adequate augmentative and alternative communication (AAC) is needed. Using this information, the team identifies how the student communicates and how to

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build further competence. If needed, the team develops a communication system that includes promoting the use of symbols.

Building the student’s communicative competence will likely be an ongoing focus for team planning. All assessments need to begin with understanding how a student communicates and identifying any potential barriers for the student to show what he or she knows. For example, any assessment of Jose’s literacy skills requires under- standing how he communicates or it may lead to erroneous conclusions that he does not comprehend text.

A third important assumption is that assessment must be responsive to the student’s language, cultural heritage, and disability. When an assessment reflects the perspective of only one cultural group, results may be biased against students from other groups. Although students with severe disabilities may have a limited repertoire of speech and symbols, it is possible for them to be multilingual within this repertoire. For example, a hearing-impaired student who immigrates to the United States may have mastered sign language that differs from American Sign Language (ASL) and may be able to lip-read some words in his or her native language. Simply providing an ASL interpreter for an assessment will not likely yield information on what the student knows, but collaborat- ing with the family to gain knowledge of the student’s known signs and words could be very beneficial. A student like Jose might have a repertoire of words and symbols across languages. He might know the Spanish word for restroom, the English word “McDonald’s,” the icon to find his Angry Birds game on the computer, and a hand sig- nal his mother uses for bedtime. Students with severe disabilities who live in countries that are multilingual (e.g., Singapore) might know and use words in more than two languages. In addition to understanding what the student understands, it also is impor- tant to include the family’s perspective to know what is culturally relevant when con- ducting the assessment. Daily living and social behavior are two examples of skill areas where cultural differences can be critical to planning relevant educational goals.

To summarize, the assumptions that form the foundation of an assessment can either promote a capacity-building approach or a deficit-finding approach. If the assumption is that all students can learn and that education should promote students’ ability to function with as much independence as possible both now and in the future, educators will use assessment to identify the supports and instructional strategies needed to reach this goal. Table 3–1 states the three primary assumptions in assessing students with severe disabilities.

TAbLe 3–1 Three Assumptions for Assessing Students with Severe Disabilities

1. All students can learn. a. All students can learn skills that are appropriate to their age and grade level. b. All educational assessment should have the purpose of building students’ capacity and

opportunities. 2. All students communicate, but they may not yet be able to show all they know. a. All students communicate although they may still need to learn to use systems and symbols that

are more widely understood and capable of conveying more complex concepts. b. Current achievement may reflect a lack of educational opportunity or an underdeveloped

communication system. c. When given increased opportunity and a way to show what they know, students will likely meet

higher expectations. d. When it is difficult to determine what a student knows due to the need for developing a

communication system, it is a less dangerous assumption to assume the student will still benefit from receiving a full educational opportunity than to deny this and find out later the student knew more than realized.

3. All students live in a cultural context that has implications for assessment. a. Assessment should be unbiased and not discriminate against a student’s culture, primary

language, or disability. b. Including the family’s perspective in assessment and planning helps make outcomes more

culturally relevant.

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59Assessment and Planning

QuAlities And types of Assessment

In addition to being clear on the assumptions that will provide the foundation of assessment, educators will want to be familiar with the full range of assessments available. A concept in assessment known as the “law of the instrument” states that when all you have is a hammer, everything looks like a nail (Kaplan, 1964). Educators will want to avoid relying on one assessment tool and making decisions using only one instrument. It is also important that the instrument used has the technical quality to make informed decisions.

technical Adequacy

When evaluating the technical quality of an assessment instrument, educators will need to become familiar with the concepts of validity and reliability. Without confi- dence in the content of the instrument and consistency of outcomes, information resulting from administration of the instrument is not beneficial.

Validity Validity is the degree to which an instrument measures what it is supposed to meas- ure. In order for meaningful interpretation of results to occur, a test must be valid. If the content measured by the instrument does not align with the purpose of the instru- ment, then it lacks validity (i.e., content validity). A test of intelligence is not a valid measure of reading ability. Content validity is also lacking when test items do not sample the skill or concept to be tested. Consider the teacher who wants to assess how many fourth-grade science concepts the student has mastered. If the teacher does not understand the science constructs, the assessment may not measure the intended standards. This becomes apparent when the teacher uses a true-false ques- tion to ask whether magnets stick to metal, not realizing that magnets only stick to ferrous metals. So the answer is not true or false but true in some instances. The flawed content being assessed is not a valid science concept. Content validity may also come into question if an assessment instrument does not sample enough skills to suggest competence. If a literacy assessment only addresses sight word knowledge, it would not be a valid test of literacy skills.

Reliability While validity is concerned with content, reliability refers primarily to consistency. If a student is assessed repeatedly within a short time frame with the same assessment instrument, the student’s score should remain the same. A test is reliable if it is meas- uring a stable trait of an individual (e.g., intellectual functioning) across time, and produces a similar result each time. In contrast, if the student is being assessed on an evolving skill (e.g., vocabulary acquisition) instead of a stable trait, repeated adminis- trations of assessment are not expected to yield the same result. To assess the reliabil- ity of an evolving skill, the skill is assessed by more than one observer at the same time. If both observers recorded the same data, then the assessment is considered reliable. Reliability refers only to the consistency of measurement and is not an indi- cation of content quality. Two observers may agree that the student makes a specific response on a math assessment, but the assessment itself may poorly reflect mathe- matical content.

types of Assessments

There are many ways to describe the range of assessments that are available for edu- cators, including (a) how they are administered and scored (formal or informal), (b) when educational decisions are made (formative or summative), and (c) whether they are direct or indirect.

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formal and informal Assessments The first distinction that can be made between assessment methods is based on their administration and scoring procedures, which determine whether they are formal or informal. Formal or standardized assessments require that the conditions under which the assessments are administered are structured, and administrators must explicitly follow the testing manuals in all aspects of administration as well as scoring and interpreting results (McLoughlin & Lewis, 2008). If the test manual is not followed, the corresponding results may be invalid. These requirements can often present diffi- culties for individuals with severe disabilities, as they may not perform as well when removed from their natural routine (Brown, Lehr, & Snell, 2011). The majority of for- mal assessments require that the test administrators have some degree of training and familiarity in that particular assessment as well as with individuals with special needs and general special education assessment procedures. One way to make it possible for more students with severe disabilities to be able to participate fully in formal assessments (e.g., some state’s alternate assessments) is to teach students test-taking skills. Many assessments use picture or word arrays as a response option with a ver- bal or written directive. Teachers may use a similar format during classroom instruc- tion to give students the opportunity to show what they know. Most standardized assessments do not allow the administrator to give feedback on the correctness of the response. Teachers may introduce students to ongoing “tests” in which they are asked to make several responses before receiving feedback. Figure 3–1 provides an example of a multiple-choice picture format often used in standardized assessments. In this example, the student is to find the figure shaded to show one-third. Shawnna from the case studies may need some practice in how to respond to this “on-demand per- formance” format. She will need to learn to focus her eyes or a laser pointer on one quadrant of the four choices so an evaluator will be able to score her answer. She may need class practice to understand this response format with prompts to respond and feedback on her answers. Then she may also need to learn to practice taking a test in which she receives no prompt to respond or feedback on whether her response is correct. She may also need an accommodation such as enlarging the response board so she can tilt her head slightly to help indicate her eye-gaze answers.

Most standardized assessments allow for accommodations that do not change the construct of what is being assessed. For example, a science test may allow for a read-aloud of the written material for non-readers or braille for students who are blind. Students may be allowed to take the assessment in a private room or on a

FIgUre 3–1 A Multiple-Choice Picture Format Often Used in Standardized Assessments Directions: Which of the following shows 1/3?

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61Assessment and Planning

computer. Providing the student encouragement and reinforcement for general par- ticipation may also be allowable. Some students may benefit from having a work system (Hume & Odom, 2007) during standardized assessments to be able to antici- pate how much longer the assessment will take. In a work system, visuals or objects are used to indicate how many more responses are required before a break is pro- vided. A student may have 10 clips on an index card for a 10-item test. The student removes a clip after each answer as a way to monitor how many items are left before he or she can take a break. Additional breaks during testing may also be used as an accommodation.

Bolt and Roach (2009) note that a modification is different than an accommoda- tion because it changes how the test can be used and interpreted. A calculator can be an accommodation if the focus in the math assessment is conceptual understanding, but would be a modification if the focus were factual knowledge. Dictation to a scribe would be an accommodation if the focus were how a student composes a communication, but would modify an assessment focused on the mechanics of writ- ing. A read-aloud might be considered an accommodation for understanding the extent to which students can comprehend meaning of a text passage, but would modify an assessment focused on identifying a student’s independent reading level. In general, educators should study the administration manual of a formal, standard- ized assessment or check with the school’s testing coordinator to see what accom- modations are allowable.

When using accommodations like extra breaks, dictation to a scribe, or a work sys- tem, the method used should be the same the student receives during instruction. Thompson, Morse, Sharpe, and Hall (2005) also recommend considering the student’s and teachers’ perspectives on how well the accommodation works and any difficulty in applying it to the testing situation. If an accommodation makes it more feasible for the student to show what he or she knows, it should be included during a formal assessment.

Most formal tests not only require standard administrations, but also have stand- ardized or norm-referenced scores, meaning they compare the performance of one individual to that of the norm group. Scores are given as standardized scores or per- centiles and are therefore used to interpret an individual’s standing in relation to peers. An intelligence quotient (IQ) is an example of a standardized score. Standard- ized scores often have limited educational meaning for students with severe disabili- ties. These scores may be needed to confirm eligibility for services for students who are in the lowest percentile groups on some measure or for purposes of communica- tion about a sample in research, but otherwise knowing a student is in the lowest percentile rarely offers much information for building capacity, or developing educa- tional goals and objectives. Often test–retest reliability is poor for students in the extreme ranges of a normative sample and students with severe disabilities may not even have been included in the sample on which the test was originally norm- referenced. For these reasons, no educational decisions (e.g., educational placement) should be made on a single norm-referenced score (e.g., IQ).

Not all formal assessments use norm-referenced scores. Sometimes assessments are criterion-referenced. That is, the student’s score must meet some specified level to be considered indicative of achievement of the construct being assessed. The most prev- alent example of this for students with severe disabilities is the proficiency score given for state alternate assessments. No Child Left Behind Act of 2001 (NCLB, 2002) requires that states assess all students’ achievement of state standards. Students with significant cognitive disabilities who cannot participate in the general assessment, even with accommodations, must be given an alternate assessment. To determine whether or not students in these assessments have met expectations for achievement, standards are set for what is considered proficient, above proficient, and below profi- cient. Although there is a variety of ways to set standards, in one approach panels look at test items or students’ responses and classify them into low, middle, and high

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categories (e.g., below proficient, proficient, above proficient). These are used to develop written descriptions of performance at each level of achievement. Then cut- off scores are used to identify the number of points on the raw score of the assess- ment for each achievement level (Perie, 2010). For example, a student who gets 25 out of 33 items correct might be considered proficient. Note that alternate assessment scores are sometimes reported as percentiles, a norm-referenced score.

In contrast to formal assessments, informal assessments do not require standard administrations and can be individualized to the student. Informal assessments can be used to assess other school factors such as instructional and environmental variables (e.g., how many minutes of reading a student receives daily) as well as student learn- ing (e.g., how many new words a student can read). Informal assessments of student learning are often directly linked to a student’s curriculum and can be used to moni- tor ongoing student progress. The assessment can also be tailor-made for the stu- dent’s mode of responding. For example, an informal assessment of a student’s comprehension might allow students to respond by stating the answer, pointing to a picture, typing the answer, or signing the response. Some other examples of informal assessments are counting the number of steps a student gets correct while using a vending machine, tallying the number of times a student initiates communication, and scoring a paper-and-pencil math worksheet. While some informal assessments are commercially available (e.g., end-of-chapter test for a textbook), many will be teacher-made.

The scores on informal assessments are typically criterion-referenced, and compare the student’s performance to a set criterion or curricular goals rather than the perfor- mance of a group (McLoughlin & Lewis, 2008). The criterion set for mastery depends on the target skill. A teacher may decide the student needs to get 100% of the steps correct on using the vending machine because not doing so will not lead to obtaining a soda when the teacher is not present. In contrast, the teacher may decide that 80% correct on the math worksheet is sufficient evidence of learning to move to the next skill while reviewing this content for maintenance.

formative and summative Assessments Assessments can be formative or summative, with the frequency and purpose deter- mining which category applies. When information on student progress toward a specific skill is gathered frequently with the purpose of informing instructional prac- tices and will be used to make decisions about instruction, it is called a formative assessment. These assessments are more likely to be informal and may be seen by the student and teacher as a learning experience or part of the learning and teaching process (Sidentop & Tannehill, 2000). Summative assessments, on the other hand, occur at the end of a longer learning unit or amount of time, such as a unit, semes- ter, or year, and are used to assess overall student progress. Summative assessments generally encompass multiple skills learned over a long period of time and may be informal (e.g., teacher’s unit test) or formal (e.g., alternate assessment given at end of the year).

The pitfall of relying on summative assessments is that educational decisions may need to be made when it is too late for the teacher to improve instruction. For exam- ple, if a teacher receives information at the end of the school year that the student is not proficient in English language arts on the state’s alternate assessment, there is lit- tle that can be done until the next year. In contrast, formative assessments can be developed that permit instructional decisions throughout the school year. Formative assessments do not have to be informal. Some states and school systems may offer formal formative assessments in which students take practice items similar to the end- of-year alternate assessment in the same standard format. This can permit students to become familiar with the assessment format and help teachers determine if students are on track for mastering the content to be assessed. Teachers can also make their own informal formative assessments to create this same opportunity.

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Formative assessments are often used for progress monitoring. To monitor prog- ress, educators need both a method of assessment and a criterion for performance at a certain point in time. For example, a teacher may have an IEP objective for Shawnna to be able to initiate communication using a voice-output communication system. The criterion may be for her to make at least five initiations a day across at least three communication partners (e.g., teacher, paraprofessional, and peer). The formative assessment the teacher creates is a small tally sheet Shawnna has on her wheelchair tray table beside her communication devices. Her partners tally when Shawnna initi- ates communication. Each week, the teacher tallies how many communications per partner Shawnna had each day. Across weeks, the teacher begins to make decisions about whether Shawnna is showing enough of an increase in initiations or whether additional teaching strategies are needed. (See Chapter 4 for strategies to measure student behavior and learning.)

direct or indirect Assessments The methods of assessing student progress also can be categorized as either direct or indirect. Direct assessments gather information about the individual through assess- ments (e.g., a test of math problems or assessment of steps to put on a coat), inter- views (e.g., with teachers or parents), or observations (e.g., of duration of tantrum or frequency of use of communication system). The shortcoming of contriving a scenario to assess performance directly is that it may not provide information on whether or not the individual has generalized the skill to naturalistic settings. Observations of the student performing the skill in naturalistic settings can provide the additional infor- mation needed to determine if generalization has occurred. Larry from the case stud- ies is an example of a student for whom some observations in naturalistic settings could inform the educational team about whether he knows how to apply the aca- demic skills he loves learning. For example, can Larry apply his use of a calculator to compute tax when planning a purchase? Can he engage in an informal conversation about a favorite sports team after reading a column?

In contrast, sometimes students perform a skill in the naturalistic setting (e.g., identifying fractions during a math class or when cooking), but not in the contrived context (e.g., fractions test). This becomes especially concerning when the contrived context is linked to school or teacher accountability systems (e.g., performance on an alternate assessment that uses direct testing). One option is to give the student lots of informal opportunities for on-demand performance tasks so that he or she can learn how to take tests.

Another option is to use indirect methods to document what a student can do, especially when the student does not test well. When indirect assessment methods are used, information is gathered via other sources such as adults who are familiar with the individual or through a review of permanent student products, instructional data, or educational records. When significant others are interviewed, educators may need to use variations of “what,” “when,” and “how” questions to guide interviewees to specific descriptions of behaviors and skills (Cooper, Heron, & Heward, 2007).

State alternate assessments offer an example of direct and indirect assessments. Some states use performance-based assessments in which the teacher administers test items and scores the student’s response. The performance-based assessment is used to assess how a student will perform the targeted skill(s) at a single point in time in a novel situation (Kearns, Burdge, Clayton, Denham, & Kleinert, 2006). The assessment may be computer-based with the teacher helping the student move to each item, reading the instructions, and then waiting for the student to select a response. In con- trast, other states use indirect assessments such as a checklist that the teacher com- pletes or a portfolio of student achievements. A portfolio includes multiple artifacts or evidences of student work or performance (Kearns, Burdge, Clayton, Denham, & Kleinert, 2006), but it may also include information from other sources such as obser- vations, informal inventories, tests, questionnaires, and interviews (McLoughlin &

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Lewis, 2008). Portfolios can be organized in a traditional format of paper artifacts in a three-ring binder or accordion file or in a technology-based system. The benefit of a technology-based system is that it decreases the amount of time it takes to compile artifacts and monitor progress, and can quickly be shared in a secure manner with other team members or parents. The use of technology-based portfolios also allows for artifacts such as video recordings and screen shots to be utilized, which give team members real-time information about a student’s progress on prompting levels and social interactions (Stockall, Dennis, & Rueter, 2014).

To synthesize, an assessment can require standard administration for all recipients (formal) or be individualized to a student (informal). The process may involve collect- ing information over time (formative) or to evaluate achievement at some endpoint (summative). The format of the assessment may be a test or observation (direct) or may involve summarizing information through a checklist or portfolio (indirect). Table 3–2 provides examples of these different assessment formats.

puRpose of Assessment

The assessment of individuals with severe disabilities may have a variety of purposes, including (a) eligibility for special education and related services, (b) school account- ability, and (c) planning for instruction. Because assessment is essentially a decision- making process, it is crucial for the educational team to be clear on what decision will be made when the assessment is complete. An assessment to be used to document eligibility for special education services will need to identify the type and characteris- tics of the student’s disability and will likely include some standardized scores from formal assessments. In contrast, an assessment for progress monitoring will utilize informal, formative assessments. Examples of the types of assessment used for each purpose will now be described.

TAbLe 3–2 Methods of Assessment

Component Options

Administration of the Assessment

Formal: Evaluator must follow the specific administration procedures for every student assessed. Peabody Picture Vocabulary Test (PPVT-4)

Informal: Evaluator determines how to administer the assessment.

Classroom Vocabulary Quiz

Score to be reported Norm-referenced: Results compare performance of individual to a nor- mative group. Intelligence Testing

Criterion-referenced: Results com- pare performance to set criterion or curricular goal. Supports Intensity Scale

Timing of the Assessment

Summative: Test is conducted at the end of a learning unit to assess student knowledge.

End-of-unit math test; yearly alter- nate assessment

Formative: Test is conducted fre- quently for the purpose of informing instructional practices and to modify or validate instruction. Biweekly math probes

How Information Is Obtained

Direct: Information is gathered di- rectly from the individual through performance-based assessments or with observations. Observation of student’s off-task behavior; test of student’s reading comprehension

Indirect: Information is gathered through informants or artifacts.

Interview of classroom teacher about off-task behavior; portfolio of student’s work in reading

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multidisciplinary Assessments used to determine eligibility

The criteria for eligibility drive the assessments that are necessary when that is the purpose of assessment. For example, if a state requires an intellectual score, a multi- disciplinary team will need to utilize assessments that will provide the best informa- tion for that purpose. However, individual characteristics should be taken into consideration of which assessments may be most appropriate for the individual.

intelligence testing Intelligence testing is utilized to make identification and eligibility decisions in most school settings. The purpose of identification is to provide the supports and special- ized education necessary for individuals to be successful in their culture. However, intelligence tests should only be used to confirm the presence or nature of learning difficulties observed by others (Bierne-Smith, Patton, & Kim, 2006), not to regulate access to educational opportunities, as so often has been the case in the past. The use of intelligence tests in special education has a history of concern that the cultural bias of IQ tests discriminates against diverse students (Deno, 1970). People in different cultures develop different intellectual abilities based on those that are valued and developed within their cultural group (Cianciolo & Sternberg, 2004). Students with complex and multiple disabilities may also have their abilities underestimated in IQ testing due to attentional, communicative, or physical challenges. When IQ tests are used, they should be administered by a trained school psychologist. The report typi- cally yields a standard score (e.g., 40) and some information on how far the score deviates from the mean of the sample of participants on whom the test was norm- referenced. For example, on some IQ tests, a score of 40 would be four standard deviations below the mean of 100. Traditionally, scores of two or more deviations below the mean contribute to the diagnosis of an intellectual disability. Some classifi- cation schemas further differentiate three deviations below the mean as a moderate intellectual disability; four deviations below as severe intellectual disability. Caution should be used in interpreting scores at the extreme range of any norm-referenced test because they are more subject to measurement error and less trustworthy than scores closer to the mean (Schalock et al., 2010). For example, an IQ score of 39 ver- sus 27 may have little to no educational meaning because both are in the extreme range of the test’s normative scores. Scores below 25 typically have been derived through some process of extrapolation and may be especially untrustworthy. While the Wechsler Intelligence Scale for Children-Revised (WISC-R) is one of the most pop- ular used in schools, Schalock et al. (2010) recommend consideration of the C-TONI (Hammill, Pearson, & Wiederholt, 1997) for students who are non-verbal or the Slosson Intelligence Test (Slosson, 1983) for students with more severe impairments. Some psychologists use developmental assessments such as the Scales of Infant Development (Bayley, 2004) or the Brigance Diagnostic Inventory of Early Develop- ment II (Brigance, 2004) for students with the most severe intellectual impairments that cannot participate in a traditional testing format. Unfortunately, neither of these scales is age-appropriate for older students and can perpetuate stereotypes about teaching students based on their “mental age.” Although state eligibility criteria may require school psychologists to use some measure of intellectual functioning, this information should remain highly confidential and not be used for decisions about students’ educational priorities.

Adaptive Behavior scales A diagnosis of an intellectual disability should never be made based on an IQ score alone, but also include documentation of significant limitations in adaptive behavior established through standardized measures. Adaptive behavior is defined as the con- ceptual, social, and practical skills people learn and perform in their everyday lives (Schalock et al., 2010). Conceptual skills include language, reading and writing, and

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money, time, and number concepts. Social skills include skills like interpersonal skills, gullibility, social responsibility, and problem solving. Practical skills are those like personal care, health care, transportation, and use of the phone. As Brown, Lehr, & Snell (2011) noted, adaptive behavior scales have sometimes been criticized as being based on a vague construct, overlooking adaptability and problem solving, and for their correlation with IQ. In contrast, the American Association on Intellectual and Developmental Disabilities (AAIDD) continues to emphasize the importance of a threefold criteria for the diagnosis of an intellectual disability including (a) an age of onset before 18, (b) significant limitations in intellectual functioning, and (c) signifi- cant limitations in adaptive behavior (Schalock et al., 2010).

There are a variety of adaptive behavior scales and indirect assessments in the form of checklists and interviews that are completed by someone familiar with the student, typically the teacher or caregiver. Although adaptive behavior scales can pro- vide a broad overview of the student’s life skills, they are usually supplemented with additional informal assessments that offer more specific information for educational planning. When used for eligibility decisions, the adaptive behavior scale should be norm-referenced, standardized assessments. Some examples of frequently used adap- tive behavior scales include the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 2005), the Comprehensive Test of Adaptive Behavior-Revised (Adams, 1999), and The Scales of Independent Behavior-Revised (Bruininks, Woodcock, Weatherman, & Hill, 1996). The AAIDD has revised their adaptive behavior scale, which is now called the DABS (Diagnostic Adaptive Behavior Scale) and is scheduled to be released soon (http://aaidd.org/intellectual-disability/diagnostic-adaptive- behavior-scale#.U1VF2aROW70).

supports intensity scale The Supports Intensity Scale (SIS) was developed to identify the “extraordinary sup- port that a person needs in order to participate in the activities of everyday life” (Thompson et al., 2004, p. 11). While not a measure of adaptive behavior, it does align closely with adaptive behavior domains (Bierne-Smith, Patton, & Kim, 2006).

The SIS has an interview-based protocol that can be conducted with anyone who is familiar with the individual, such as a teacher or family member or the individual himself or herself. Informants provide three ratings for each listed activity based on how often the individual needs support in that activity, how much time they need to be supported in that activity daily, and what type of support is needed (e.g., none, monitoring, prompting, partial physical assistance, or full physical assistance). Six domains of living are addressed by the SIS: (a) home living activities, (b) community living activities, (c) lifelong learning activities, (d) employment activities, (e) health and safety activities, and (f ) social activities as well as two optional scales on protec- tion and advocacy, and medical or behavioral supports. Scores can be reported as either standard scores or percentile ranks. The SIS is available in 13 languages, with excellent internal consistency and test–retest reliability across Spanish, French, Ital- ian, Catalan, and Dutch versions (Schalock, Thompson, & Tassé, 2008a, 2008b).

Assessments of Autism spectrum disorder Autism spectrum disorders are developmental disabilities that involve a triad of core deficits in the areas of communication, social skills, and ritualistic behavior (American Psychiatric Association [APA], 2013). It is sometimes difficult to distinguish autism spectrum disorders from other conditions that cause individuals to display similar communication, social, or ritualistic behaviors, such as blindness, deafness, Fragile X, Rett’s syndrome, Landau-Kleffner syndrome, Cornelia de Lange syndrome, William’s syndrome, and sensory integrative dysfunction (Heflin & Alaimo, 2007; Walters, Barrett, & Feinstein, 1990). However, failing to provide an autism diagnosis may result in missed opportunities for educational programming tailored to the

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individual’s communication, social, sensory, and behavioral needs (Heflin & Alaimo, 2007). While the medical, psychological, and educational fields have improved in the past several decades in the area of identifying autism spectrum disorders, they are behaviorally defined disorders that lack medical tests or biological markers and the detection of autism spectrum disorder continues to rely on the observations of behav- iors and interviews of familiar adults. One observational tool is the Modified Checklist for Autism in Toddlers (M-CHAT) (Robbins, Fein, Barton, & Green, 2001) that can be filled out by parents of children aged 18–24 months. The yes/no answers to 23 ques- tions are converted to a pass-or-fail score with criteria set for further assessment. Studies of the M-CHAT have found adequate discriminate validity, interrater reliabil- ity, and sensitivity (Dumont-Mathieu & Fein, 2005; Kleinman et al., 2008; Robbins, Fein, Barton, & Green, 2001). Similarly, the Quantitative Checklist for Autism in Tod- dlers (Q-CHAT) is a parent-completed questionnaire of 25 questions on a 5-point Likert scale of frequency to quantify autism traits at 18–24 months of age. Preliminary investigations have found good test–retest reliability (Allison et al., 2008). The Q-CHAT may yield more information than the M-CHAT because it uses a Likert scale rather than yes/no responding. The Q-CHAT also has items related to social commu- nication, language development, and repetitive behavior.

One of the most commonly used rating scales and earliest that was designed spe- cifically for autism is the Childhood Autism Rating Scale (CARS) (Schopler, Reichler, & Renner, 1988). A trained evaluator with experience in giving assessments, such as a school psychologist, special educator, or speech pathologist, interacts and observes the child and makes clinical judgments based on their knowledge and experiences when filling out the CARS (Hall, 2009; Schopler, Reichler, & Renner, 1988). The results of the assessment are categorized as non-autistic, mild to moderate autism, and severe autism, although the CARS may over-identify two-year-olds, those with minimal verbal skills, or those with more severe intellectual disabilities (Heflin & Alaimo, 2007).

A third option is to use a combination of the Autism Diagnostic Interview-Revised (ADI-R) (LeCouteur, Lord, & Rutter, 2003), and the Autism Diagnostic Observation Schedule (ADOS) (Lord, Rutter, DiLavore, & Risi, 2001). The ADI-R is administered by a trained clinician and 93 questions are asked in a semi-structured interview of par- ents focusing on language and communication, social interactions, and restricted, repetitive, and stereotyped behaviors and interests. The ADI-R may over-diagnose very young children with developmental delays (Heflin & Alaimo, 2007). The ADOS is administered by trained evaluators who are familiar with individuals with autism and the protocol, and is appropriate for young toddlers through adults regardless of their verbal abilities, although it may be over-inclusive of very young children with intel- lectual disabilities (Hall, 2009; Lord & Corsello, 2005). During administration of the ADOS, the evaluator chooses one of four modules based on the individual’s develop- mental and language level. Communication and social demands are presented and the responses of the individual are recorded and coded, with cut-off scores for autism spectrum disorder provided.

Communication and language Because communication is such a critical skill for educational planning, it is helpful if a multidisciplinary assessment for eligibility includes information on student’s com- munication abilities and challenges. The content of the communication involves both the receptive and expressive communication abilities of the individual. The speech language pathologist will most likely be the member of the multidisciplinary team who conducts formal assessments about the form and content of the individual’s com- munication; however, a classroom teacher may use informal methods and behavior recording to supplement the formal data. The Peabody Picture Vocabulary Test (PPVT-4) (Dunn & Dunn, 2007) is a measurement of expressive language and

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vocabulary that is normed for individuals aged 2–90+ and can be administered in a very short amount of time. The PPVT-4 provides specific results on tasks students have as strengths and on those that should be targeted for more instruction.

There are communication assessments specifically designed for individuals with severe disabilities, such as the Receptive and Expressive Emergent Language Test, Third Edition (REEL-2) (Bzoch, League & Brown, 2003) and the Assessment for Persons Profoundly or Severely Impaired (APPSI) (Connard & Bradley-Johnson, 1998). However, these formal standardized assessments only give a general idea of what the individual is able to do; they are not conducted in a natural environment and have the same pitfalls as other direct assessments of students with severe disa- bilities (Downing, 2004).

For many students, there also is the need for some evaluation of their current AAC use and needs. For individuals who utilize AAC devices to communicate, assessments should be ongoing and focus on their needs in their current environment, plan for communication needs in future environments, and frequently reassess equipment, communication partners, and the individual’s capabilities (Beukelman & Mirenda, 2005). Identifying participation patterns and needs of AAC will help to plan and implement interventions and should be followed by an evaluation of the effectiveness of the intervention to determine whether or not the person is participating ( Beukelman & Mirenda, 2005). For example, assessment teams would assess opportunity and access barriers in order to determine appropriate corresponding interventions.

Applications to the Case studies To illustrate how assessment may be used for eligibility, consider the three case stud- ies at the beginning of this chapter.

Shawnna was classified as having a severe intellectual disability based on her mental age on the Bayley scale and severe deficits in adaptive behavior. In contrast, her fourth grade educational team questioned the usefulness of either of their scores to their edu- cational planning and rejected the ongoing use of an infant mental age score for Shawnna. Shawnna’s underdeveloped communication skills make it difficult to know her intellectual functioning. Her physical challenges have limited her ability to perform many skills of daily living without intensive supports. Because Shawnna is scheduled for an updated multidisciplinary assessment, the school psychologist will be using a non-verbal measure of intelligence that is appropriate to her age. The Supports Intensity Scale may also be useful to consider what supports Shawnna will need. The team is espe- cially interested in supports that will increase her independence through the use of tech- nology and increased mobility which the occupational and physical therapists will evaluate. The team also recognizes the importance of Shawnna receiving a comprehen- sive communication assessment including evaluation for potential assistive technology.

Jose is in middle school, however, he arrived without educational records from his home country. Working with a translator, his school psychologist will use one of the as- sessments appropriate to consider whether Jose has an autism spectrum disorder. The psychologist also wants to get a clear measure of adaptive behavior and will use a non- verbal measure of intelligence. The parental interviews for these assessments will also be given with the help of a Spanish translator. A speech language pathologist with training in English Language Learners will also help determine Jose’s level of receptive and expressive communication, in both English and Spanish, and the need for any aided communication systems (e.g., picture system).

Larry has been able to participate in IQ testing and his most recent score was a 47. His adaptive behavior scale also shows that he lacks many of the daily living and social skills typical of his age group. He continues to be eligible for special education services as an individual with a moderate intellectual disability, but these scores do not provide enough information about what he will need to learn as he transitions toward adult liv- ing. The Supports Intensity Scale can contribute to this planning, but other informal assessments are needed to develop his transition plan and IEP.

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Assessments for school Accountability

One of the newer assessment purposes involving students with severe disabilities is assessment for the purpose of school accountability. The most recent waves of school reform have focused on all students achieving educational standards. The reauthori- zation of the Elementary and Secondary Education Act, No Child Left Behind Act of 2001 (NCLB, 2002), and reauthorization of IDEA (2004) required the inclusion of stu- dents with disabilities in state assessments. Students with disabilities may participate in the general assessment with or without accommodations. Those unable to take the general assessment must be provided with an alternate assessment. The IEP team decides whether or not students will take the alternate assessment or the general assessment. This decision cannot be based on the student’s educational classification (e.g., severe intellectual disability). It should be noted that the term “significant cogni- tive disability” used in the law to describe who takes alternate assessments is not a category of IDEA (2004). Rather it helps educators recognize that these alternate assessments are reserved for students with more challenging disabilities who need an alternate achievement target for the grade level standards.

Choosing the alternate assessment is a critical IEP team decision because in some states students in the alternate assessment will not qualify for the typical high school diploma if it requires grade level achievement. One of the differences between alter- nate assessment and the general assessment is that outcomes on the general assess- ment may be used for student accountability (e.g., graduation, passing to the next grade level), but alternate assessment is only used for school accountability.

Schools are accountable for students achieving the standards of their grade level. Up to 1% of these students, those with significant cognitive disabilities, who take alternate assessments can be reported as proficient based on alternate achievement standards. Alternate achievement standards must be aligned with the state’s academic content standards, promote access to general curriculum, and reflect professional judgment of the highest standards possible (U.S. Department of Education, 2005). Alternate achievement standards often require some prioritization, adaptations, pin- pointing, and extensions of grade level achievement. For example, while all sixth graders may be expected to collect, graph, and interpret data, students taking the alternate assessment may work with smaller ranges of numbers, graphs with enhanced visual or textural features, and make a more narrow set of interpretations.

Alternate assessments are summative in nature and are typically given near the end of the school year. As mentioned earlier, states may use a variety of assessment for- mats and some use more than one format (e.g., checklist and performance-based assessment). The assessments are typically administered and scored by the special education teacher. Some states have a second observer present to verify the results that the teacher scores or require work samples to be submitted to external scorers. Alternate assessments have undergone many transformations since their inception. Perhaps most notable is that states have all moved toward aligning these assessments with their state academic content standards (Altman, Lazarus, Quenemoen, Kearns, Quenemoen, & Thurlow, 2010) and making administration more standardized ( Quenemoen, 2008).

Alternate assessments have had both negative and positive consequences for stu- dents with disabilities and their teachers. The administration of these assessments has increased teachers’ stress and workloads (Ahlgrim-Delzell, Flowers, Browder, & Wakeman, 2006). In contrast, teachers have reported that having students with severe disabilities “count” in school accountability has been beneficial overall (Kleinert, Kennedy, & Kearns, 1999; Flowers, Ahlgrim-Delzell, Browder, & Spooner, 2005). Parents have also reported seeing benefits to their children participating in alternate assess- ments, but are less confident this is true as students reach high school age (Roach, 2006). Although states have moved toward having their alternate assessments reflect their academic content standards, the assessment itself has not necessarily improved

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access to general curriculum (Flowers, Ahlgrim-Delzell, Browder, & Spooner, 2005). In contrast, improved access to the general curriculum may improve alternate assess- ment outcomes (Roach & Elliott, 2006). In reviewing the literature on alternate assess- ment, Towles-Reeves, Kleinert, and Muhomba (2009) conclude that the next generation of these instruments must provide better links to grade level content, establish how all students can participate, link to postschool outcomes, be used in school improvement, and incorporate families’ and students’ perspectives in under- standing their impact.

Educators need to become informed about their state’s policies for alternate assess- ments. Browder, Spooner, and Wakeman (2011) suggest seven questions to guide the process of learning a state’s alternate assessment system. Here are their questions:

1. How will the outcomes of the alternate assessment be used? If the school faces high stakes for all students to be proficient or if participation in the alternate as- sessment precludes receiving a diploma, there may be intense pressures on the IEP team in making participation decisions.

2. Who is eligible for the alternate assessment? Each state has eligibility guidelines that can be found on the state’s education website. Remember that the student’s disability classification cannot be used as the eligibility criteria.

3. What will be assessed? Many states have curricular resources that accompany the alternate assessment. These may be called extended standards, curricular frame- works, or some other term.

4. How will the assessment be conducted? It is important to find out if the educa- tional team is to keep a collection of student work for a portfolio, complete a checklist, or give a performance-based assessment.

5. How will the assessment be scored? Sometimes if the assessment is computer- based, scores are generated automatically. Scoring may also be completed and re- ported to the state by the teacher or provided by an outside agency.

6. What evidence exists that the alternate assessment is reliable and valid? The state should have a report on the technical qualities of the alternate assessment. If this information is not available or suggests the assessment has poor quality, edu- cators should push back on its use for high-stakes decisions; for example, by work- ing with the professional teacher education association to make a statement.

7. Does the alternate assessment system promote learning in the general curric- ulum? Even if the system is primarily developed for school accountability, it is im- portant that alternate assessments promote increased opportunity not only for learning general curriculum content, but in general education settings where this curriculum is delivered by content experts.

Shawnna’s IEP team decided that she will participate in the alternate assessment based on alternate achievement standards. Her state uses a performance-based assessment in which the teacher presents test items and then records the student’s response. Unless Shawnna learns to use some additional assistive technology this year, she will likely have to use her eye gaze to select each response option. Although the administration of the assessment must be standard, selecting the answer from the multiple-choice answers using an eye gaze is acceptable if a second observer can recognize and score each response with the teacher. The team realizes that Shawnna may tire easily during the assessment and so they seek and obtain an accommodation for her to take the assess- ment in several short sessions. She will also be assessed in a separate room so that she is not distracted by activity around the room while trying to look at the test materials. The response options will also be enlarged for Shawnna on a computer screen. To give Shawnna the best possible chance of showing what she knows, her teacher will be using small tests of academic content throughout the year in the same format as the alternate assessment. When the time comes for this summative assessment, the format itself will be familiar to Shawnna.

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Assessments used for iep and other educational planning

A third purpose for assessment, and possibly the most important, is collecting infor- mation to make decisions to improve a student’s educational program and progress. The Individualized Education Plan (IEP) is the document completed each year to summarize this assessment and focus it into an annual plan. Educators then use ongoing informal, formative assessments to determine if the student is on track for meeting annual goals and short-term objectives. Additional assessments may be used to decide how the student is progressing in the general curriculum (e.g., a science chapter test).

student and family involvement Before developing any plan to assess a student and set educational priorities, it is important to know what both the students and their families want and value. Students and parents can work collaboratively with teachers and other school personnel to plan instructional goals and make educational decisions. Assessment data alone are not sufficient to inform these decisions; the perspectives of a team of individuals can help ensure the planning that ensues will have the greatest impact on the student. Forming a team, conducting person-centered planning, and conducting family-focused planning are all important considerations for instructional planning.

Forming a Team An important component of the assessment process is the forma- tion of a team of people who will work collaboratively to gather data to improve out- comes for individuals with disabilities. These teams should include the student and the student’s family as well as teachers and therapists. In accordance with IDEA (2004), family team members should be full, active participants in the development of IEPs. The purpose of this team is to gather and interpret assessment information and generate goals based on this information. The ultimate goal of education for any stu- dent is the generalization of skills across contexts in order to promote the greatest level of postschool success and independence. Involving students and families increases the likelihood that both the process and the outcomes are socially valid or significant to the individual with a disability.

Person-Centered Planning One model for involving students and families in the planning process is person-centered planning. Person-centered planning is an ap- proach that prioritizes the individual and values the input from families and friends (Stineman, Morningstar, Bishop, & Turnbull, 1993). Through a team approach, goals are developed in response to the needs and preferences of the individual. In school settings, students can exercise ownership over their own education by collaborating with the team to provide input, develop goals, and lead IEP meetings. Additionally, several studies have demonstrated the relationships between self-advocacy and achievement of personal goals (e.g., Agran & Hughes, 2008; Arndt, Konrad, & Test, 2006).

Person-centered planning includes multiple interactions during which team mem- bers assess the individual’s strengths, areas for growth, interests, and available sup- ports. Agenda items for a planning meeting might include (a) developing a personal profile (e.g., identifying the people who are the primary supports in a student’s life, identifying the different settings the student typically encounters, identifying the stu- dent’s likes and dislikes); (b) identifying the student’s ideal vision for the future across domains of housing, leisure, employment, and community involvement; (c) creating a plan for actualizing the student’s future vision (i.e., set measurable goals and actions); and (d) identifying any systems-level changes that would support this plan (Browder, 2001). As a group, the team develops goals that will address these specific needs in a manner that is responsive to the particular characteristics and desires of the individual (Hagner, 2010). Team members should consider needs and preferences

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across domains, including community living, social relationships, communication, self- determination, and academic skill acquisition (Wells, Sheehey, & Moore, 2012).

Several models of person-centered planning have emerged from research. These models include lifestyle planning (O’Brien, 1987), personal futures planning (Mount, 1995), McGill Action Planning Systems (MAPS) (Vandercook, York, & Forest, 1989), essential lifestyle planning (Smull & Harrison, 1992), Planning Alternative Tomorrows with Hope (PATH) (Falvey, Forest, Pearpoint, & Rosenberg, 1994), outcome-based planning (Steere, Wood, Pansocofar, & Butterworth, 1990), whole-life planning ( Butterworth, Hagner, Heikkinen, DeMello, & McDonough, 1993), and group action planning (Turnbull & Turnbull, 1992).

The MAPS model of person-centered planning was initially developed as a tool for helping individuals with severe disabilities increase participation in general education contexts, improve peer interactions, and promote overall quality of life (Vandercook, York, & Forest, 1989). This method has been used to aggregate information for IEP development and include students with disabilities in the IEP process (Wells, Sheehey, & Moore, 2012). The MAPS process is intended to empower and support both indi- viduals with disabilities and their families by valuing their input and role as equal contributors to the planning process. The process includes a mechanism for ensuring the goals and targeted areas of instruction are valued by both the students and the students’ families (Turnbull & Turnbull, 2006). The three phases of the MAPS process include (a) preparation, (b) meetings, and (c) follow-up. In addition to the student, the student’s family, school personnel, and peers are included in the planning team. Peers offer insight into social strengths and needs as well as considerations for sup- ports and skills needed in general education contexts. Additionally, the MAPS plan- ning team includes a facilitator who guides the meetings and records notes and responses during team meetings.

Several research studies have examined the effectiveness of person-centered plan- ning on involving input from students with disabilities and their families. For exam- ple, Hagner, May, Kurtz, and Cloutier (2014) explored the effectiveness of person-centered planning strategies on the level of participation of transition-aged students with autism spectrum disorder (ASD). A group of 47 students with ASD par- ticipated in this study. Using the MAPS process, group facilitators provided students supports for participating in meetings, including (a) individualized preparation for meetings, (b) team-building activities to build the relationship between the facilitators and the students, (c) flexible designs for meetings, (d) the capacity to attend meetings electronically (i.e., Skype), and (e) alternative modes for communicating during meet- ings. Students met with their teams for five to eight sessions to discuss topics such as “vision for the future” and “career goals.” These strategies were effective in increasing the student participation in the planning process, even for students with ASD who experienced difficulties with communication, anxiety, and social interactions.

Direct and Indirect Preference Assessments. Another important reason to include a team of individuals with deep and varied knowledge of the student is to gather infor- mation about the student’s preferences. Everyone has likes and dislikes, and identify- ing these individual preferences across learners is one way to provide students with instruction and educational practices that are engaging, rewarding, and positive. Preference is identified when a student makes a selection or engages in an activity repeatedly over time. Incorporating preference assessment data into preference-based interventions can decrease challenging behaviors and increase desirable behaviors (Tullis et al., 2011). Assessing the preferences of students with severe disabilities can be challenging, particularly when students do not have the communication skills or physical ability to express preference to others reliably. To assess preference for these students, indirect or direct methods of assessment can be employed. Indirect methods include gathering information from the team. This information can include observa- tional notes, interviews, or checklists (Hagopian, Long, & Rush, 2004). Families and

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friends can provide a unique perspective of the student’s preferences outside of the context of school. For example, families can provide information about students’ fa- vorite music, leisure activities, food, color, character or TV personality, sports team, or toy. Gathering this information provides a bank of items that may be used to sup- port learning across contexts.

Direct assessments include the systematic testing of preferences by providing stu- dents with choices multiple times (Lohrmann-O’Rourke, Browder, & Brown, 2000). The items selected for the choices can be derived from information gleaned during indirect assessment procedures. Teachers can observe the amount of time students interact with each item or with the item the students select. Students may verbalize, use eye gaze, point, or reach for a preferred item. If a student selects or interacts with an item one time, this item should be presented again with a different set of choices to assess the potency of the student’s preference for a particular item over time. Addi- tionally, teachers should continually assess for preference, as people’s preferences naturally change over time or across contexts.

Assessing preference for activities (as opposed to preference for physical objects) can be achieved by recording how long a student engages in particular activities over time. Teachers can teach students to pair a related object with a preferred activity so that the student can use the physical object to request the preferred activity in the future. For example, Browder, Cooper, and Lim (1998) taught individuals with severe disabilities to request a preferred activity by selecting a related object (e.g., a golf ball to indicate a desire to play golf). Teaching students to express a preference may depend on the team’s ability to provide the student with the tools and instruction nec- essary to communicate these preferences.

Incorporating Student Preferences. Student preferences can be incorporated into traditional models, including multidisciplinary assessments and IEP development. Stu- dent preferences may influence decisions about who helps with accommodations dur- ing a test, the room used for testing, and the time of day a test is administered. Student preference may also be used to determine which stimuli can be used for con- tingent or non-contingent reinforcement during testing. Sometimes preferred items can be embedded in the testing materials as an accommodation for motivation. For instance, if a student loves dinosaurs, pictures of dinosaurs can be inserted in the stu- dent materials used for testing (e.g., instead of counting dots, the student can count dinosaurs).

Student preference should be used as a guide for setting instructional priorities during IEP development. For functional goals, including social skills, communication, or daily living goals, student preference can impact the types of goals that are selected and the manner in which they will be assessed. For academic goals, student prefer- ence can influence the development of goals that will help students develop the skills to access and demonstrate understanding of grade-aligned content. One way to ensure students have a voice in the development of their IEP is to teach students to plan and lead their own IEP meetings (e.g., Konrad, 2008; Torgerson, Miner, & Sehn, 2004; Test., Mason, Hughes, Konrad, Neale, & Wood, 2004). Teaching students to incorpo- rate their own preferences into their educational plans can lead to increased self- advocacy and self-determination, qualities Wehmeyer and Palmer (2003) attributed to successful life outcomes. Additionally, research attributes the practice of student-led IEPs to several positive outcomes. For instance, Mason, McGahee-Kovac, and Johnson (2004) collected participant data through observations and interviews. The authors found that students who led their own IEP meetings made more contributions during IEP meetings, understood their disability and their rights, had more self-confidence, interacted more with adults, and were more aware of the supports and resources available to them. Test et al. (2004) recommended that in addition to participating in the development of goals, students can also help monitor their own progress toward achievement of their goals.

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Consider Larry, the 16-year-old from the case study examples. To prepare for his IEP meeting, Larry works with both his teacher and his family to brainstorm ideas for his “future vision.” Larry uses a graphic organizer provided by his teacher to record his preferences for postschool education, employment, housing, and recreational activities. One of Larry’s preferences is to “go to college.” Next, Larry works with his teacher to cre- ate an IEP PowerPoint that will guide him through the essential components of the meet- ing. The PowerPoint will include cues for Larry to read that will remind him what to say or do. These activities include introducing the team, sharing his vision for the future, and planning goals. Although the meeting includes discussion of several potential goals, the team affirms Larry’s choice to achieve the goal of attending a university program. Larry and his team decide he will complete the application materials for three university programs that serve adults with intellectual disability. The final component of the meet- ing is a self-evaluation component. Larry and his teacher have agreed that Larry will use a checklist and a timeline to track his completion of the application materials.

Culturally Responsive planning with families Fostering a relationship between families and schools can promote greater family involvement in setting and achieving goals. The health of these relationships posi- tively correlates with student achievement and outcomes (Lee & Bowen, 2006). Cul- turally responsive planning and incorporating family perspectives are two ways to promote family-focused planning, a practice that can strengthen the bond between home and school and in turn support students with disabilities.

There are several compelling reasons for developing a multicultural perspective when working with families of students with disabilities. Cultural diversity within the United States encompasses ethnicities, religious beliefs, socioeconomic status, gender, sexual orientation, and geographic location. Over one third of the U.S. population is represented by Hispanic/Latino, African-American, and Asian ethnic cultural groups (Mather, Pollard, & Jacobsen, 2011). Additionally, there has been a recent influx in the number of Asian, Native Hawaiian, other Pacific Islander, and multiracial children in the United States (Ortiz, García, & Sorrells, 2010). Students who are culturally and linguistically diverse also have the highest poverty and school dropout rates and low- est rates of academic achievement (Mather, Pollard, & Jacobsen, 2011). Additionally, students who are culturally diverse are disproportionately categorized as having a dis- ability. In 2007 the U.S. Department of Education reported American Indians/Alaska Natives and African-American students were 1.5 times more likely to be identified as having a disability than all of the other ethnic groups combined, particularly for iden- tification under the categories of learning disabilities, emotional disability, speech language impairments, and intellectual disability (U.S. Department of Education, 2007). While these statistics point to the need for ongoing work to make schools cul- turally responsive overall, there also are specific strategies educators can use in plan- ning for students with severe disabilities.

Dennis and Giangreco (1996) recommended six considerations for planning with families: (a) Appreciate diverse qualities, (b) be sensitive to the influence you convey as a professional, (c) recognize your own cultural bias, (d) commit to learning and understanding different cultures, (e) become aware of cultural characteristics, and (f ) learn together with families. Another consideration is to be mindful and inclusive of family preferences. Just as educators should seek out and value student preference, family preference should be respected as well. Establishing positive and effective communication is another priority for culturally responsive planning. It is important to recognize the different styles in which different groups communicate. Differences in social norms include, for example, the familiarity with which you address families and the roles people play in meetings.

Family members each have a unique story to tell and information to contribute during planning meetings. Families should feel encouraged to lead meetings, express frustrations, set goals, and ask questions. Educators can listen for concerns from

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family members, acknowledge the concerns, and then restate the concern as a prior- ity for achievement. For example, a mother might express that she is concerned her son is not able to read. The teacher could respond, “It is important to you that your son learns how to read. I share that goal.” Many families may feel intimidated to share their perspectives, particularly families whose primary language is not English (Salas, 2004). It is important to plan meetings that are inviting and respectful of the family’s schedule. In addition to providing translators, educators should avoid jargon or other specialized terminology (Lo, 2012). Educators should also recognize that families may have perspectives about disabilities that differ from the cultural norm. Finally, family values and perspectives about goal setting may differ from the perspective of educa- tors, particularly for students with severe disabilities. It is important to work through these differences together to reach consensus about the student’s priorities. One way to honor the perspectives of families in a way that is collaborative with educators is the Choosing Outcomes and Accommodations for Children (COACH) model ( Giangreco, Cloninger, & Iverson, 1998). Through this process, families and educators discuss and prioritize student goals together.

Finally, it is important to acknowledge that the family perspective also includes the dynamic of having a family member who has a disability. Caring for a family member with a disability can impact family functioning, family satisfaction, family stress, and family quality of life (Kyzar, Turnbull, Summers, and Gómez, 2012). In a review of literature on family supports, Kyzar, Turnbull, Summers, and Gómez described the positive correlation between family supports and family outcomes. Families are the ultimate advocates for students with disabilities; by listening to families and support- ing their needs, educators can provide students with educational plans that may lead to greater and sustainable quality of life.

ecological Assessment In addition to knowing the student and family’s priorities, it is important to consider the expectations of the student’s current and future environments. The process for doing this is called an ecological assessment.

Requirements of Current and Future Environments. When considering an ecologi- cal assessment, educators will need to identify and study the current environments in which the student interacts, including where the student lives, plays, learns, and works (Brown, Branston, Hamre-Nietupski, Pumpian, Certo, & Gruenewald, 1979). Simultane- ously, environments where the student will be transitioning in the future need to be anticipated and addressed as soon as possible. When completing an ecological assess- ment for Larry, the 16-year-old from the case study example, his teacher may include Larry’s house, his high school, the shopping mall, and the park. Since Larry is consider- ing his postschool opportunities, his teacher may want to also identify future environ- ments like the university and a place Larry wants to work part time, like a movie theater.

Each environment will need to be further subdivided into smaller units known as subenvironments. The purpose of this is to accurately pinpoint activities students will need to complete in each environment. Subenvironments in Larry’s home include his bedroom, bathroom, kitchen, backyard, etc. Within his high school, Larry’s general education classroom, bathroom, hallway, parking lot, and main office all serve as sub- environments. In the university, these will include his dormitory, cafeteria, class- rooms, computer lab, and student union (see Table 3–3).

The next step after determining subenvironments is to determine which activities must occur within those units. There is no limit to the number of activities that can be completed within any environment, but when conducting an ecological assessment, educators should focus on relevant activities that are family- and student-centered, necessary for success within the environment, aligned to the student’s current skills, and meaningful for the student. By identifying these activities, the planning team begins to see the types of skills that will be a priority for the student.

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Examples of Ecological Assessment to Plan Life Skill Needs. By identifying envi- ronments and subenvironments, and the relevant skills contained within, educators can focus on life skills that students will need to exhibit to be successful in their sur- roundings. Looking at Larry’s ecological inventory, it begins to become clear which life skills he will need (Table 3–4).

Larry will need to be able to negotiate with a roommate and socialize in the student union. This will require increased communication skills. To manage his own dormitory room, he will need to acquire more independence in selecting his clothes and keeping his own supply of snacks. He also needs enhanced computer skills to learn to use a lab to read, develop, and upload assignments. Although Larry will be applying for some on- campus supports in the program for adults with intellectual disability, the more inde- pendence he achieves before college, the greater his chances are for being able to negotiate the campus.

Discrepancy Analysis. After completing an ecological assessment and determining what supports are necessary for success within the environment, student-specific goals can be generated through the creation of a discrepancy analysis. When complet- ing a discrepancy analysis, the evaluator considers three questions: What would a same-age peer without disabilities do in this situation? What can the student with dis- abilities do now? What skills does the student need to exhibit more like a same-age peer? By observing how other young men function in dormitory rooms, it becomes clear that making his bed will not necessarily be a priority for Larry, but social con- versation, negotiating boundaries, and selecting his own clothes will be.

In thinking about Larry’s interest in a part-time job at the cinema, the teacher observes a young man with a job in this context and notes that he greets customers, sweeps the theater, and runs the register to fill snack orders. The teacher arranges to have Larry try out the job during a simulation of the job in a local theater. Although she gives him di- rections and a checklist of what to do, Larry inappropriately greets customers with a hug, neglects to sweep until a customer complains, and gets flustered when he has to enter items into the register. Each of these skills can be taught at both school and in on- going community job training (see Table 3–4).

identification of Academic priorities Ecological assessments help provide an overall picture of the skills students will need for current and future environments including some academic priorities (e.g., Larry needs to learn to enter spoken numbers fluently into a register). Consideration of state standards for the student’s assigned grade level also yield academic priorities

TAbLe 3–3 Ecological Inventory: Environment, Subenvironments, and Related Activities

ecological Inventory

environment Subenvironment Activities

Larry’s Future University Larry’s Dormitory Room Get dressed, negotiate with roommate, fix snacks, study

Cafeteria Select meals, pay with student cash card

Student Union Purchase fast food, play pool, socialize with friends

Computer Lab Use course websites, read infor- mation, complete assignments on computer and upload

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and help with planning for full access to the general curriculum. State standards increase expectations for all students, and serve to promote collaboration between educational professionals and provide access while sharing accountability (Voltz, Sims, & Nelson, 2010).

The Common Core State Standards (CCSS) are a specific set of research-based standards developed by states to help students become college and career ready. The standards cover language arts and math from kindergarten to 12th twelfth grade. The ultimate goal of the Common Core is for students to develop critical thinking, problem-solving, and analytical skills that will be beneficial in their post-secondary pursuits. The Common Core State Standards have currently been voluntarily adopted by 44 states, and provide continuity of curricula across those states (National Gover- nors Association Center, 2010). For examples of the CCSS, see Table 3–5.

TAbLe 3–4 Discrepancy Analysis: Occupational Skills

Working at the Movie Theater

Work Task

Larry’s response (Simulated Work

environment) Javier’s response

(Actual Theater) Implications for

Instruction

Greeting customers Larry greeted strangers inappropriately by hug- ging; he forgot to check their tickets for the screen numbers.

Javier greeted each movie-goer with a smile and directed them to the correct theater screen.

Teach him to greet strangers appropriately; teach rule for checking tickets.

Sweeping floors Larry swept the floor when prompted to do so by a customer.

Javier self-initiated sweeping when a mess was made by a customer.

Use a signal on the clock (e.g., every 10 minutes) as a reminder to check the floors for messes.

Running the register Larry can make change accurately, but became easily confused when entering prices into the register.

Javier sold tickets, re- freshments, and accu- rately made change.

Practice entering prices into a register.

TAbLe 3–5 Common Core Learning Progressions Across Grade Levels

Language Arts: reading Literature

Kindergarten 6th Grade 11th–12th Grade

rL.K.1. With prompting and support, ask and answer questions about key details in a text.

rL.6.1. Cite textual evidence to support analysis of what the text says ex- plicitly as well as inferences drawn from the text.

rL.11–12.1. Cite strong and thorough textual evidence to support analysis of what the text says explicitly as well as inferences drawn from the text, including determining where the text leaves.

Math: Numbers and Operations

Kindergarten 6th Grade 11th–12th Grade

K.OA.A.2 Count 2 sets to find sums up to 10.

6.NS.C.6a Determine the difference between two integers using a number line.

HSN-rN.A.2 Simplify expressions that include exponents.

(© Copyright 2010. National Governors Association Center for Best Practices and Council of Chief State School Officers. All rights reserved.)

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Each academic content area of the Common Core is divided into domains, and the domains develop across grade levels. For example, the language arts standards consist of literature, informational text, foundational skills, writing, speaking and listening, and language. Similarly, content covered in math includes counting and cardinality, numbers and operations, geometry, measurement and data, ratios and proportions, expressions and equations, functions, and statistics and probability. Table 3–6 shows examples of Common Core Standards that build a progression of skills across grade levels.

From Standards to Individualized Academic Priorities. While the first step is to become familiar with academic content standards and any state resources on alternate achievement standards for the student’s assigned grade, some additional planning is needed to set academic priorities. Courtade and Browder (2011) suggest that IEP pri- orities can be set by considering broad skills needed in each content area, ways to promote self-determination, ways to access technology, and applications to real-life activities. Hunt, McDonnell, and Crockett (2012) have described how the ecological assessment that has been used for many years to identify priority skills related to the student’s environments can also help set these academic priorities. A student like Larry who has ambitions to try a college program and a strong preference for aca- demics might pursue some adaptations of more advanced content than students with differing priorities. One of the environments to consider in ecological assessments is the general education class. For example, although it may be found that Jose has no reading skills, he may be able to work on adapted versions of his grade level stand- ards in language arts through simplified text, read-alouds, or picture supports. He might also benefit from text that includes both English and Spanish.

Curriculum-Based Measurement. One way to determine student’s current level of functioning in academics is to use curriculum-based measurement (CBM). CBM now has more than 200 empirical studies published in peer-reviewed journals supporting both its technical quality and capacity to help teachers improve student outcomes in the elementary grades. Some of the standard tasks used for CBM are reading aloud from text and selection of words deleted from text (maze) in reading, writing word sequences when given a story starter or picture in writing, writing letter sequences from dictation in spelling, and writing correct answers/digits in solving problems in arithmetic (Deno, 2003). Hosp, Hosp, and Howell (2007) note that the distinctive fea- ture of CBM is that it is tied to the curriculum. Because the increased focus on aca- demic learning for students with moderate and severe disabilities is recent, educators

TAbLe 3–6 Questions to Use in Reviewing How Assessment Information Informed the IEP

1. Which of the goals/objectives in this IEP were written by the student or directly derived from his or her preferences? Which ones indirectly or somewhat promote the student’s preferences?

2. Which of the goals/objectives in this IEP incorporate the family’s priorities? Are there any goals/ objectives that need further discussion with the family?

3. Which goals/objectives in this IEP can be cross-referenced with the ecological assessments that were considered? Will these goals/objectives help the student function in current and future environments?

4. Which goals/objectives in this IEP are aligned with state standards and will promote academic learning? Are there goals/objectives to promote full access to general curriculum?

5. Which goals/objectives in this IEP build on the student’s current level of functioning as identified through curriculum-based and informal assessments?

6. Did this student need a functional behavioral assessment and, if so, which goals/objectives were derived from the FBA?

7. Overall, will the goals/objectives written in this IEP promote the student’s competence and opportunities?

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have only recently begun to consider how CBM might be applied. Skills-based meas- ures, a form of CBM, may be especially applicable. In this technique, a group of skills are assessed together with distinct items for each skill set. For example, a CBM in mathematics might include number recognition, addition, and subtraction. Sometimes curricula will include placement or chapter tests that can be adapted for use as a CBM. For example, the teacher might create an assessment of five key facts and five definitions from the general education science unit and test the student weekly to see if progress is being made toward mastering these concepts.

informal Assessments Curriculum-based measurement is a form of direct, informal assessment that can be used either to determine a student’s current level of functioning or for ongoing moni- toring of progress. Informal assessments may be either direct or indirect and used for either academic or daily living skills.

Checklists. One way to determine a student’s current level of functioning is to use a checklist of target skills. The checklist may be completed either directly by observing the student for a period of time or indirectly by interviewing the family and others who have worked with the student. Checklists can be used to assess mastery of a variety of types of skills, including community leisure, mobility, literacy, food prepa- ration, safety, or mathematics. A checklist for safety skills might include items such as avoiding strangers, asking for help, using a cell phone, and using a seat belt ( Browder, 2001). A checklist for literacy skills could include items such as identifying letter sounds, identifying rhyming words, segmenting sounds in words comprised of a con- sonant, vowel, and consonant (e.g. cat), CVC words, and answering literal and infer- ential comprehension questions. Teachers can develop checklists by collaborating with a team to create a comprehensive list of items that are both age appropriate and relevant to the students’ home, school, and community environments.

Direct Assessments. There are several ways to directly and informally assess skills in the classroom, including task analytic assessment, discrete response assessments, and time-based assessments. Information for how to use these methods for ongoing prog- ress monitoring can be found in Chapter 4. Any of these methods used for ongoing progress monitoring can also be used to clarify the student’s current level of perfor- mance when planning educational priorities.

Jose’s teacher task-analyzed the steps he will need to follow for his morning arrival rou- tine. Currently, his mother brings him into the classroom and removes his coat and walks him to his desk. She would like for him to ride the bus but worries he will not know what to do when he gets to school. To address this, the teacher includes in the task analysis the opportunity for Jose to walk from where the bus stops to the classroom. The resulting task analysis of the steps he will need to perform independently include (1) walk from the bus to the school entrance, (2) open the door, (3) walk to the first hall, (4) turn right, (5) open the classroom door, (6) walk to the coat hooks, (7) hang up his coat and put his lunch away, and (8) walk to his desk. The teacher realizes that while Jose can open doors, he will need an escort to find the way to his classroom and ongoing instruction to reach his class and eventually find his seat.

Another example is a discrete response assessment.

The teacher is interested in whether Shawnna can identify numbers. She displays an array of four numbers and asks Shawnna to find “6.” She waits to see if Shawnna indi- cates the correct number. She repeats this for all numbers to 10. Number identification is a discrete response. So too are some forms of communication. Shawnna’s teacher also uses a simple frequency count to assess the number of times each day Shawnna initiates communication.

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A time-based assessment is another option.

Because Larry will need to enter prices quickly to work the register at the movie theater, his teacher times how long it takes him to enter items and works with him to set a goal for reducing this duration.

functional Behavior Assessment Sometimes educational planning will be needed to determine how to teach students alternatives to problem behavior. Research has shown that 10 to 15% of individuals with intellectual disability display challenging behaviors (Emerson et al., 2001). These behaviors can have negative consequences on students’ academic progress, social acceptance and opportunities, as well as the well-being of their caregivers in school and home settings (Blacher & McIntyre, 2006; Chandler & Dahlquist, 2006). IDEA 2004 requires that a functional behavior assessment (FBA) is conducted and used to develop function-based interventions to address behaviors of students with disabili- ties when they negatively impact their own learning and/or the learning of others. We will briefly describe FBA and how it fits in an overall assessment plan. (See Chapter 7 for an in-depth review of FBA.)

A functional behavioral assessment (FBA) is a “process of identifying events that reliably predict and maintain problem behaviors . . . to improve the effectiveness and efficiency of behavior support.” (Horner, 2000, p. 99). The process is respectful in that the professionals involved look at the environment from the perspective of the individual to understand the context and motivation behind the problem behaviors (Horner, 2000). The assessment team does not assume that there is something wrong with the individual, but rather that the way the individual is experiencing the world is causing him or her to react through problem behaviors and that these reactions are logical from the perspective of the individual.

It is important to incorporate the family in the FBA process and to understand the influence that the family’s culture may have on the behavior as well as to give insight into possible functions and information on other settings (Browder & Lim, 2001). Due to the impact of problem behaviors on the lives of family members, their perspective on the priority of which behaviors to change should be valued by other members of the assessment team.

There are three major steps to conducting an FBA. First, the problem behavior must be operationally defined so that everyone can easily understand it; that is, the problem behavior must be described in terms that are clear, observable, and measur- able (Kazdin, 2001). Sometimes the behaviors must first be prioritized if there appears to be more than one behavior of interest (Heflin & Alaimo, 2007). Cooper and col- leagues (2007) developed a set of nine considerations for prioritizing behaviors to be considered for change: (a) safety to self or others, (b) opportunities for practice, (c) chronic nature, (d) likelihood of increase of rates of reinforcement, (e) relative impor- tance to future skill development and independence, (f ) reduction of negative or unwanted attention, (g) production of reinforcement for significant others, (h) likeli- hood of success, and (i) cost for change. The more targeted and specific the behaviors of an FBA, the more accurate the results will be (Heflin & Alaimo, 2007).

Next, the assessment team should collect data on the target behavior. Four major assessment methods are utilized when analyzing the function of a behavior: (a) inter- views, (b) checklists, (c) tests, and (d) direct observations (Neef & Peterson, 2007). It is recommended that both indirect (interviews and checklists) and direct (tests and observations) assessment methods be used when conducting an FBA. Interviews can be used with family members or teachers (Horner & Carr, 1997; Kern, Dunlap, Clarke, & Childs, 1994) or with the individual with disabilities (Reed, Thomas, Sprague, & Horner, 1997), and focus on the history of the problems and observed patterns of behaviors such as antecedents and reinforcers (Horner, 2000). While conducting inter- views, it may often be necessary to use variations of “who,” “what,” “when,” “where,”

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and “how” follow-up questions to guide interviewees to be more specific in describ- ing behaviors and move away from general terms (Cooper, Heron, & Heward, 2007).

Checklists can be used along with information obtained in interviews to identify, specify, and prioritize the behaviors that warrant further intervention. Tests are only helpful in determining the function of the behavior if they directly measure the behav- ior of interest (Cooper, Heron, & Heward, 2007). As previously explained, standardized tests only give information about how an individual is able to perform in comparison to a normative group—this information is not helpful if the normative group is not similar to the individual or if that information is not relative to the assessment purpose. Rather, non-standardized criterion-referenced assessments, which give information on specific tasks or behaviors the individual has mastered or needs continued instruction on, are most relevant to the purpose of functional behavior assessments.

Indirect assessments do begin a dialogue among adults, and possibly the individ- ual, about the function of the behavior but are not sufficient to determine the func- tion of the behavior (Heflin & Alaimo, 2007); instead direct observation is required (Horner, 2000). Bijou, Peterson, and Ault (1968) were the first to describe what is now the most commonly accepted form of direct behavioral recording, called ABC recording, or anecdotal observation. Observers devote full attention to the individual of interest for a period of time, usually 20–30 minutes, and record the behaviors, antecedents to the behaviors, and consequences of those behaviors as they occur in the natural environment (Cooper, Heron, & Heward, 2007). In ABC recording, observ- ers record a narrative description of the behavior, and while data on the antecedents and consequences are also generally recorded in narrative form, if there are specific or consistent antecedents and consequences, a checklist can be created for that indi- vidual. Direct observations should be conducted across settings and times of day to provide a good sample of behaviors (Hall, 2009).

Finally, the data gathered is analyzed to create a relationship or summary state- ment that hypothesizes the function of the behavior. It is recommended that direct observations continue until a clear pattern emerges, with a recommendation of 15–20 occurrences of the targeted behavior for a minimum of two to five days (O’Neill, Horner, Albin, & Storey et al., 1997). Enough data should be gathered that the assess- ment team feels they are able to identify the events that predict and maintain the problem behavior—meaning they can now hypothesize with certainty the function(s) of the behavior (Heflin & Alaimo, 2007). There are four main categories of functions of behavior: (a) attention, (b) access to tangibles, (c) escape, and (e) automatic (Neef & Peterson, 2007). The collection of products from the FBA—the operational defini- tions of the problem behavior(s), identification of antecedents that reliably predict when the behavior will and will not occur, identification of events that maintain the problem behavior and act as a function or reinforcer, and observations all come together to support this hypothesis (Horner, 2000). Once educators and families have determined the function of the behavior, they are able to take the next step toward designing a function-based intervention utilizing positive behavior supports. The use of positive behavior supports in increasing appropriate behaviors for individuals with severe disabilities is discussed further in Chapter 7.

Since enrolling in middle school, Jose has engaged in some behaviors that have war- ranted the use of an FBA. The goal of the FBA is to determine what is maintaining his behaviors and therefore what replacement behaviors could be taught. Jose has tantrums when his routine is changed and displays aggression when his string is taken away. The team prioritized the aggressive behavior as being more serious than tantrumming because it interfered with his engagement in school tasks, was a safety concern to Jose and others, and was pervasive throughout his school day. The school behavior specialist, Ms. Meyer, took the lead on the FBA and used an informal indirect screening tool to interview Jose’s teacher and parents, with the assistance of an interpreter. Based on the interviews, Ms. Meyer operationally defined Jose’s aggressive behavior as hitting,

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kicking, pinching, and spitting on adults. Ms. Meyer used an ABC recording form to conduct direct observations of Jose across multiple days and settings to hypothesize the function of his aggression. When teachers prompted Jose to put the string away or attempted to remove the string, he engaged in acts of aggression. Teachers would scold him for the aggression or ask him to sit in a chair away from the group, but he still had the string. Interestingly, Jose would work on tasks with the teachers while flipping the string. His aggression was not to escape the tasks, but to keep access to the string (access to tangibles). The team reconvened and, based on the products of the FBA, determined that the function of Jose’s aggression was access to a highly preferred object—his string. The team worked together toward creating a function-based intervention plan utilizing positive behavior supports. Elements of his plan included functional communication training to teach Jose to request the string or to have more time with the string. The plan was to teach Jose to sign “want.” This gross motor sign was chosen because it was easily accessible to him and would likely be easy to learn. The plan also included altering the antecedents including giving Jose a picture schedule of when he could have access to the string (using pictures for “work” then “break/string”) and visual warnings of how much time he had left on break with the string (a 3-minute sand timer). Additionally, the con- sequences for aggressive behaviors were agreed upon by the team, such as denying access to the string when aggressive behavior was displayed until he appropriately requested access using his “want” sign (with prompting if needed). The team planned to briefly meet daily when the plan was first implemented, and then, if the data indicated that the plan was working, they would move meetings to weekly, then monthly, and so on. If the plan was not successful, they would collaborate to modify the plan.

using the Assessment infoRmAtion

Assessment information is important because it is used to make a variety of educa- tional decisions. Information may be used to decide whether the student is eligible for receipt of special education services and about the types of services needed. Alter- nate assessment scores are used to decide how many students meet proficiency on state standards. Additional resources and supports may be planned for schools with high numbers of students who do not meet expectations and for students who do not reach proficiency on this summative assessment. Often assessment information is used to plan the student’s upcoming educational priorities. One way these priorities are articulated is through the IEP.

developing the iep

Once information is collected, the team summarizes their priorities in an individual- ized education plan (IEP). The purpose of the IEP is to provide the student with a supportive instructional plan based on the students’ needs and preferences and the perspectives of all team members. This plan outlines what will be taught, what sup- ports will be provided, and how student progress will be monitored and measured. The IEP itself represents a legal commitment for the student to receive the services necessary to achieve the identified goals. The required components of the IEP include (a) a state of the present level of educational performance, (b) a list of annual goals including short-term objectives or benchmarks, (c) a specific list of special education and related services that will be provided (including the frequency and duration of the delivery of these services), (d) a justification for any instances during which the student will not participate with peers in general education, (e) a description of any modifications the student will receive for participation in the statewide or districtwide assessments or alternate assessments, (f ) a description of how the student’s progress will be measured and reported, and (g) a statement of transition services (for students age 14 and older).

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While these are the legal requirements of the document, the team also needs to consider how all of the information on the student will now be used for building a plan that promotes the student’s competence. Table 3–6 provides some questions to ask of the goals and objectives to ensure that the various priorities have been consid- ered. For example, were the student’s preferences included?

Shawnna’s grandmother is her legal guardian and her aunt also participates in IEP and other team meetings. Their priority is for Shawnna to have full access to general education and an academic curriculum. Shawnna’s strong preference is for socializa- tion although she will engage in instruction especially if it includes opportunities to interact with peers. Because of these priorities, Shawnna’s special education teacher col- laborated closely with the fourth-grade teacher to determine grade level priority content in language arts, mathematics, social studies, and science. She used informal assess- ments to determine how Shawnna might engage with the content. For example, she wanted to determine how best to get Shawnna engaged with text and respond to ques- tions about content, and ways for Shawnna to use virtual manipulatives to perform math. She then used some curriculum-based measurement to see where Shawnna’s starting point was in literacy and numeracy. She found Shawnna had some number recognition and could identify the topic of a brief passage of text. These formed begin- ning points for her to access the content in general education with the help of a com- puter and some 1:1 instruction from the teacher and peers. There were other decisions made from the assessment information collected related to Shawnna’s gaining inde- pendence in skills of daily living and expanding her communication repertoire to be able to socialize with friends about age-appropriate topics.

Jose’s functional behavioral assessment described earlier was an important part of the team’s planning because of safety concerns. With the positive behavioral supports in place, the special education teacher, speech therapist, and English language learner (ELL) support teacher worked out a plan for how to get a clearer picture for Jose’s com- munication. The ELL teacher was fluent in Spanish and talked with his mother when she brought Jose to school one morning. She also observed how the mother got Jose to communicate. The speech therapist assessed him on his knowledge of everyday pictures and objects and the special education teacher made a list of the varied ways Jose com- municated during the day (e.g., pointing to get an object). From this, they determined that Jose had very limited receptive language in both English and Spanish. He also had about 10 known words in a mix of English and Spanish. His mother was eager for Jose to build his English competence. The team decided to introduce Jose to a picture com- munication system to augment what speech he used and to teach him English vocabu- lary for everyday objects and activities throughout the school day by teaching him both to label and request. The special education teacher also used an ecological assessment of his middle school classes to determine what picture systems would be needed to sup- port his academic learning. The team wanted to provide him with enough options for communication that if he had more understanding than they thought, he would have alternatives to build his communication. Jose did receive classification as a student with an autism spectrum disorder. His team decided his biggest first-year priorities were gaining communication skills, learning to navigate a middle school environment (e.g., cafeteria, restroom, getting from bus), developing social skills with peers, and catching up as much as possible in academic skills given that he had never had access to this content in prior years.

Larry led his own IEP meeting and was able to use a PowerPoint he created to con- vince the team of his strong desire to go to college. Because he had tried some commu- nity jobs in the prior year, he also wanted to focus on a part-time job in the cinema. The job coach who did the discrepancy analysis at the cinema negotiated for some goals re- lated to learning the routines of this work environment. Although Larry did not like sweeping, he was willing to do it if it was the only way to work in the cinema. This focus on the cinema job also pleased his parents who worried that Larry was not focused

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enough on his adult life. They were surprised and pleased to learn of a program at one of the universities in the state that served adults with intellectual disability and were willing to help Larry finance attending college. The special education teacher provided some ideas for goals that would take Larry’s academic skills to the next level so he would have more options for adult opportunities. She suggested goals related to applying his current skills to real-life contexts as well as skills related to the state standards for his tenth grade classes like learning to do an adapted version of a research paper. Larry was asked if he would be willing to help keep track of his progress on these goals and he eagerly agreed.

leARning outCome summARies

3.01 Assumptions of Assessment Learning Outcome Describe the assumptions that create the foundation for assessment and planning that promotes student competence.

Assessment of students with severe disabilities should focus on building the student’s capac- ity and competence versus finding deficits. This can be achieved by focusing on three pri- mary assumptions. First, all students can learn. If the educational team assumes that all students can learn, then the assessment will pursue ways to promote an individual student’s learning. The second assumption is that all students communicate. What may not be clear when the assessment begins is how the student communicates and what the student under- stands. It is essential to begin assessments by gathering information on how the student shows what he or she knows and how the student comprehends information most clearly. Without this background information, the assessment may not accurately reflect what the student knows. When ongoing work will be needed to help the student build a means to com- municate, it is a less dangerous assumption that the student will benefit from a full educa- tional opportunity. The third assumption is that the student’s culture is relevant to the assessment. This may include the culture of the disability itself (e.g., hearing impaired), the student’s ethnic background, or the use of multiple languages. By respecting the student’s capacity to learn, communicate, and function within his or her cultural context, assessment will more likely yield information to build competence.

3.02 Qualities and Types of Assessment Learning Outcome Identify the different types of assessments and what makes an assessment techni- cally adequate.

To have adequate quality for making educational decisions, assessments must be both valid and reliable. There are different types of assessment. Formal assessments require following the standard administration directions for the assessment without making modifications. Accommodations (e.g., extended time, enlarged materials) may be allowed with formal assessments if they do not change the construct being assessed. Many formal assessments yield standard scores based on how the student compares to a reference group that sam- ples the general population. In contrast, some scores are criterion-referenced and scores inform users of how closely the student’s performance matched this criterion. Informal assessments do not require standard administration and can be individualized to the student or the material being taught. Assessments can also be formative or summative. Formative assessments occur at multiple points during learning and can help educators revise instruc- tion to improve progress. Summative assessments occur at the end of instruction and are used to make some decisions (e.g., is the student proficient?). The format of the assessment may be a test or observation (direct), or involve summarizing information through a checklist or portfolio (indirect).

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85Assessment and Planning

3.03 Purpose of Assessment Learning Outcome Identify the different purposes of educational assessment and describe the types of assessment that may be used for each purpose.

The assessment of individuals with severe disabilities may have a variety of purposes, including (a) eligibility for special education and related services, (b) school accountability, and (c) planning for instruction. When the focus is eligibility for special education, state and federal guidelines will often dictate the type of assessments needed. For example, to be eli- gible for services based on the classification of an intellectual disability, students will typically need assessments of IQ and adaptive behavior. A newer purpose of assessment is for school accountability. While students with disabilities may take the general state assess- ment, students with “significant cognitive disabilities” must be provided with an alternate assessment based on the same state academic content standards. While these alternate assessments typically are not used for student accountability (e.g., student can be promoted to next grade level with scoring proficient), they are used for school accountability. Students taking alternate assessments may be reported as proficient based on alternate achievement of the state standards. For example, their assessment may target simpler or more prioritized versions of the grade level content. When the focus of planning is instruction, the first step is to form a planning team that includes not only educators, but also the student and the family. The team begins by gaining understanding of the student’s preferences and priorities. To the extent possible, the student should have the opportunity to participate in, or even lead, the IEP or other planning meetings. In these meetings student preferences can be used to help set priorities. Similarly, the family’s perspective and priorities should be incorporated. Gain- ing this family perspective requires respecting the family’s cultural background and style of communicating with professionalism as well as valuing their deep knowledge of the student’s needs. Instructional planning can also be enhanced through conducting ecological invento- ries of students’ current and future environments to identify skills needed. Additional aca- demic priorities may be derived through consideration of the state’s standards along with the student’s priorities. Curriculum-based measurements can help in pinpointing student’s cur- rent level of academic performance and for progress monitoring. Current level of perfor- mance also can be determined through using informal assessments like checklists and data collection systems such as task analyses, discrete responses, time-based responses, and frequency counts. Some students may need a functional behavioral assessment (FBA) as part of this planning for instruction. A well-implemented FBA will lead to positive behavior supports including priorities for instruction like communication skills the student needs to acquire to replace problem behaviors.

3.04 Using Assessment Information Learning Outcome Explain how to set priorities for a student’s educational program using assessment information.

Once assessment information has been collected, it should be put to use for educational decision-making. The decisions may include what special education services are appropri- ate, whether the student is proficient on alternate assessments, and what specific instruction is needed. One way instructional priorities are summarized is through the writing of the IEP. The IEP can reflect how the student’s and the family’s preferences for current and future environments, and academic standards were used to set priorities.

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Overview to Chapters 4, 5, and 6

The next three chapters describe how to measure student behavior and learning, and develop and implement instructional programs for students with severe disabilities. Even after reading these chapters, it will be evident that this proc­ ess is not straightforward and requires the efforts of a team. Each student is unique, so the process requires individualization, and the result—the educational program—is exclusive to that student. To help explain the material in these three chapters, we apply many of the concepts to three students: Marc, Jacob, and Christine. These students differ in their ages, abilities and disabilities, behavioral characteristics, and instructional goals, as well as in the supports that are needed to realize their goals.

Marc, Jacob, and Christine

Marc, who just turned six, has a history of problem behavior; he does not speak more than a few words, nor does he initiate greetings or play with peers. But Marc will greet people with a wave when prompted and does ask some adults to play tag. His tantrums have greatly de- creased as he has learned to work within defined expectations, but he does not tolerate eating in the cafeteria and he spends much of his day in the resource room.

Jacob is a member of a fourth-grade class. His classmates know that he has more difficulty completing classwork than they do, but they also have seen that memory strategies, like his personal daily schedule and calendar with picture reminders, a number line, and a calculator, help him remember.

Christine, like many others with severe disabilities, has spent most of her school years attending self-contained classrooms with little opportunity to interact with non-disabled peers at school. As a result, she does not have friends in school, does not take part in social activities with peers, and lacks the social skills that are characteristic of older teens.

To make meaningful differences in the lives of students like Marc, Jacob, and Christine, their teams have to address skill development but also must think beyond this goal. We agree with Billingsley and his colleagues that teams should structure their planning and teaching to aim for three crucial student outcomes: skills, membership, and relationships in inclusive school settings (Billingsley, Gallucci, Peck, Schwartz, & Staub, 1996). The outcomes for which team members aim influence the curriculum and the methods that they use (Snell, 2007). Attending school alongside peers without disabilities creates options and opportunities that do not exist in sepa- rate special education classrooms. Inclusion also changes teachers’ roles in many ways and requires dynamic teamwork (Snell & Janney, 2005). We recognize that while the number of schools practicing meaningful inclusion has increased in recent years, the majority of students with severe disabilities still experience isolated lives apart from typical classmates, are detached

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87Overview to Chapters 4, 5, and 6

from peers in community activities and at work, and are accompanied primarily by their family members or by paid companions (Brown & Michaels, 2003; Hunt & McDonnell, 2007). It is true that these patterns of segregated association and education are currently balanced in our coun- try by laws to prevent discrimination against persons with disabilities and to create the less restrictive educational environments. Still, the widespread prevalence of their isolation seems to be maintained both by beliefs that separation is better and by rigid traditions, such as special buildings and classrooms, programs designed for labeled groups of people, and the methods that school systems use to place students with disabilities. Another strong force, one that blocks movement toward inclusion, is the confusion that comes with inexperience and the anticipation of change. Paraphrasing Norm Kunc (1983), “Don’t confuse ‘I don’t know how to do it’ with ‘it’s not a good idea.’” The next three chapters—and much of the entire book—are written to address this confusion and to teach readers how to meaningfully educate students with severe disabili- ties in inclusive school settings.

Before you get started reading Chapters 4, 5, and 6, read some more about 6-year-old Marc, 9-year-old Jacob, and 20-year-old Christine:

Marc In April of his kindergarten year, Marc had just turned six. He is a lively boy with diagnoses of autism and developmental delay. He participates actively in many school activities at his neigh- borhood elementary school. While he still spends much of his time in the resource room with his special education teacher Ms. Wharton and several assistant teachers, he is now able to work with his peers on some kindergarten activities, including morning circle, some table work, recess, and physical education—about 30% of the school day. When his team meets, the kinder- garten teacher Ms. Kwan provides regular updates on the literacy and math work that she is teaching and on Marc’s performance in kindergarten activities. Next year, he will spend more than half of his time supported in first grade, including lunch. Marc communicates mainly through pictures, symbols, and sometimes with problem behavior. He has started to use single words and phrases to ask for help (“milk,” “zip”), to request favorite activities like tag and going outdoors (“go out”), to greet others, and to protest to stop the activities that he doesn’t like (e.g., loud intercom announcements). He enjoys computer activities and will play alone with blocks or LEGO® for long periods of time. Marc follows a picture schedule throughout the day, which involves getting a pictured item from his schedule, matching it to the activity location in the room, completing the task, and then going back to the schedule for the next pictured item. He has learned to respond to some single schedule words on a list in place of pictures. He uses a structured work system where he completes kindergarten work, such as matching sounds to pictures and writing letters, first with one-to-one instruction, then independently in the resource room, and finally in the kindergarten classroom. Next year, he will transition more of his work skills to the first-grade classroom.

Marc does not eat in the cafeteria yet at school, but his team is working on this now with the goal that he will be eating alongside his peers before the end of the school year. Just last week, with a picture schedule of the steps involved, he was able to go through the line, get his food, punch in his payment number (from a model), and return to his classroom to eat. Marc also has expanded his food repertoire from earlier this year and eats more of the school lunches, but does not consistently use utensils. Marc is not yet toilet trained. His team is cur- rently gathering baseline data to assess the times that he is most likely to eliminate and will start instruction during summer school. He washes his hands using a picture schedule to prompt him, wipes instead of blows his nose, and is becoming more skilled at buttoning his clothes and pants. Because Marc’s teeth are not healthy and he resists tooth brushing, his team has developed a plan with his family and the regional autism specialist, Ms. Soroka- Smith, to gradually desensitize his dislike of tooth brushing. They will use a social narrative about tooth brushing, along with a task analysis of easy to difficult steps that progress from getting used to various brushes and toothpastes away from the sink, shifting to the sink area, tolerating some teeth being brushed, and gradually increasing the amount of time that his teeth are being brushed. Marc’s team members are excited about the progress that he has made during the year, and they expect that his involvement with his kindergarten and first-grade class will increase the likelihood that he will develop relationships with other children his age.

Jacob Jacob is nine years old and is in fourth grade at his neighborhood elementary school. He quali- fies for special education under the classification of intellectual disability and requires limited to extensive supports in academic areas but only limited supports in functional, daily living skills.

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88 Overview to Chapters 4, 5, and 6

Jacob has significant behavioral support needs, which currently are being effectively addressed through a comprehensive plan for positive behavioral support (PBS). Whereas in past years Jacob had spent more than half of the school day in the resource room (either to prevent epi- sodes of problem behavior or to interrupt them), he now spends the majority of his school day with his class. Jacob has a foundation of basic reading and math skills, which has been built through direct instruction coupled with repeated practice and practical applications. He has a good store of general knowledge and many interests (e.g., animals, vehicles, video games), which at times can be so strong that behavior problems result when his access to those inter- ests is thwarted. His teachers (Ms. Bowers, the fourth-grade teacher, and Ms. Fuentes, the spe- cial education teacher) work closely with his occupational therapist, his speech and language pathologist, and his parents to plan and implement a supported learning program that enables Jacob to learn meaningful academic and functional skills. His PBS plan calls for numerous pre- vention strategies, including movement breaks scheduled into the day and the use of social narratives to prepare for upcoming activities. These strategies, along with interventions to teach self-control skills, have been effective in greatly decreasing problem behaviors such as crying and screaming, lying on the floor, and throwing or destroying materials.

Jacob is very active and curious, and has a mind of his own; it can be difficult to engage him in any task not of his own choosing for very long. The primary challenge in adapting read- ing, math, and content area lessons for Jacob is not finding meaningful ways for him to partici- pate, but instead finding ways to maintain his engagement and participation for more than 10 minutes or so. A second primary challenge is his strong negative reaction (in the form of active and passive refusals) to most writing tasks. A third challenge is that Jacob does not follow classroom rules and routines unless the classroom teacher’s cues to the class are supple- mented with personalized verbal and visual prompts directed specifically at Jacob. He needs organizational skills and skills for participating in large groups. Jacob’s peer relationships are fairly good, although he is hypersensitive to any sort of perceived slight and his classmates sometimes tire of dealing with his emotional needs. His teacher uses class meetings for peer problem solving for the entire class and addresses most of Jacob’s social difficulties in this context, as well as through on-the-spot interventions to repair poor interactions.

Christine Christine, who turned 20 last spring, is actively involved in the transition from school to adult- hood. She has a winning personality and often jokes with others, but she also has clear views and preferences with regard to her daily and weekly activities, her friends, and her life. Her school day is divided between the community and the post–high school program, which is held at a nearby university. Because she has cerebral palsy, she uses a wheelchair for much of the day and uses a variety of means to communicate: sounds; facial expressions; gestures; words; yes-or-no responses; and a computerized, portable communication device. Christine has limited vision, which, along with her cerebral palsy, means that she must often depend on others for help. It is her communication skills that enable her to have ongoing active involvement in “run- ning her life” by making choices, indicating her preferences, expressing her feelings, and sharing her perspective with her family, friends, and the team. Her communication device, a DynaVox™, has a low-volume auditory scanning system that allows Christine to listen and then select her response with a hand-operated switch; she is learning to efficiently select the relevant category of responses from a menu of communication categories, organized with options that fit her daily life. She scans the choices and makes a selection, activating a spoken response. It has taken Christine and her team a long time to identify, refine, and use this complex system, and the sys- tem continues to grow to reflect the changes and growth in Christine’s life.

Christine’s IEP is geared toward her transition needs: finding a job that she likes and can be actively involved in, learning the job and its related skills (e.g., interacting with others, under- standing job responsibilities, taking care of her personal needs at the work site), using commu- nity services and leisure options, and getting ready to exit school services and enter the adult services system. She also participates in the university drama club and the pep group and eats often at several campus locations. Christine is involved with Best Buddies™ (www.bestbud- dies.org), a national organization that helps universities and other groups match typical persons with persons who have an intellectual disability for the purpose of friendship. The Best Bud- dies™ group at the university has been in place for several years; students engage in activities (e.g., athletic and music events, pizza and movie parties, and just hanging out) in buddy pairs and in small groups during the academic year. Her special education teacher, Ms. Rowyer, works closely with Mr. Fuller, the faculty advisor for the drama club, and also with the Best Buddies™ organizer on campus to ensure that these activities are successful for Christine.

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4 Measuring Student Behavior and Learning

Fredda Brown Queens College, City University of New York

Martha E. Snell Curry School of Education, University of Virginia, Emeritus

4.01 Why Measure Student Behavior? Learning Outcomes 1. Describe what is meant by an evidence base. 2. Describe the difference between outcome and process measures and why each helps educators

to be accountable.

4.02 Foundations of Meaningful Measurement Learning Outcomes 1. Identify the five criteria for evaluating the validity and importance of behavior changes. 2. Discuss why measurement should be contextually appropriate as well as accurate and reliable.

4.03 Quantitative Measures Learning Outcomes 1. Identify and describe seven different measures of student performance.

4.04 Organizing Student Performance Data Learning Outcomes 1. Describe the various elements of a graph. 2. Discuss factors that influence how frequently student data should be collected.

4.05 Data Analysis for Better Decision-Making Learning Outcomes 1. Discuss the difference between probe (testing) and teaching data, and the uses for each. 2. Describe how a baseline–intervention comparison can be useful to an educator, and the limita-

tions of this type of analysis. 3. Describe the various graphing conventions that allow for a visual summary of performance data.

Why Measure student Behavior?

To evaluate the impact of a school program on a student, educators must formulate specific strategies for measurement. Four basic reasons for developing measurement strategies are (a) to document what has occurred, (b) to identify the variables respon- sible for the occurrence (Zirpoli, 2012), (c) to understand when and why learning is

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occurring or not occurring, and (d) to be accountable (Alberto & Troutman, 2012). Measurement strategies enable teachers to better predict future performance, and prediction helps teams decide whether program modifications are necessary. Further- more, knowledge of measurement strategies allows educators to better understand the findings and implications of published research and determine their relevance to teaching practices (Alberto & Troutman, 2012). Kennedy (2005) points out that human memory is fallible—what people think they see, or remember seeing, is often dra- matically different from what actually occurred. Objectively and directly measuring behavior is necessary to make the best decisions regarding our students’ education.

Teachers are now required to use strategies that have been demonstrated to be effec- tive (i.e., those founded on scientific evidence). However, using evidence-based strate- gies is only the first step. Teachers must then be accountable for student outcomes; they must demonstrate either that their students are benefiting from these strategies or that they are making data-based program modifications to try to improve the outcomes.

using an evidence Base to Guide instruction

Being accountable for student outcomes has become increasingly important and has now been explicitly stated in educational policy and law, including the No Child Left Behind (NCLB) Act of 2002 and the Individuals with Disabilities Education Act (IDEA) of 2004. These federal mandates were adopted to ensure the quality of instruction and outcomes for all students with disabilities. One requirement of these regulations is that evidence-based practices be used to guide classroom practice (Odom, Brantlinger, Gersten, Horner, Thompson, & Harris, 2005; Wang & Spillane, 2009). The term evidence-based practice refers to educational programs or instructional pro- cedures that have been determined to reliably produce positive student outcomes (Tankersley, Harjusola-Webb, & Landrum, 2008). There has been much discussion in the field concerning what constitutes an evidence basis (Horner et al., 2005; Odom et al., 2005; Tankersley et al., 2008). There are at least two considerations that must be examined in order to understand this issue (Spooner & Brown, 2011): (a) experimen- tal methodologies with adequate strength to identify research meeting quality criteria (Odom et al., 2005; Tankersley et al., 2008) and (b) the number of quality research studies necessary to establish an evidence basis (Horner, Carr, Halle, McGee, Odom, & Wolery, 2005). Although large-group randomized trials are considered to be “the gold standard” of research methodologies, most of the research focusing on students with severe disabilities has used single-subject experimental designs, and researchers in this field regard such designs as a valid methodology (McDonnell & O’Neill, 2003).

There have been several suggestions regarding the number of single-subject stud- ies required to establish an evidence base. For example, Horner et al. (2005) recom- mends that a practice have a minimum of five studies that (a) meet acceptable methodological criteria; (b) have been published in peer-reviewed journals; (c) have been conducted by at least three different researchers, across at least three different geographical locations; and (d) include a total of at least 20 participants. In addition to rigorous research support, the National Autism Center’s National Standards Project (2009) includes criteria related to the values and preferences of parents, care provid- ers, and individuals with autism spectrum disorders (ASDs), including a consideration of (a) the side effects of the treatment, (b) whether the treatment is aligned with the values of family members, and (c) whether the individual with ASD is in agreement with the specific treatment. Interestingly, there is no evidence base for determining criteria for what constitutes an evidence base! It might be generally agreed on, how- ever, that the more successful demonstrations of an educational practice, the more confidence we would have in a true functional relationship between that practice and student performance (Tankersley, Harjusola-Webb, & Landrum, 2008). For strategies that are more contentious or controversial, the criteria for establishing an evidence basis should be even more rigorous.

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accountability through evaluation

Using evidence-based strategies is the foundation of good practice. However, just because a teacher uses an evidence-based strategy does not ensure that a given student will benefit from it. Ongoing evaluation of individual student progress is an integral part of the teaching–learning process. With an increasing focus on educating students with severe disabilities alongside their typically developing peers in general education settings, data collection strategies become even more of a challenge. Each teacher must balance the need for data to make instructional decisions and to evalu- ate program effectiveness with the needs of the regular classroom. Although many teachers question the value of data and find data difficult to manage, it is widely accepted that teachers make better instructional decisions when they found them on student performance data (Farlow & Snell, 2005; Janney & Snell, 2013; Zirpoli, 2012).

Teachers need to be accountable for two levels of measurement: process measures and outcome measures (Haring & Breen, 1989). Process measures focus on precise, small units of behavior, such as a student’s performance on individual steps in a com- plex chain (e.g., number of prompts needed to complete a 20-step task analysis for using a vending machine), or a discrete skill (e.g., frequency of positive interactions with peers) (Haring & Breen, 1989). These types of data are important in the evalua- tion of instructional programs as they guide routine decision-making regarding program modifications. Outcome measures do not provide this level of detailed information. Instead, these measures offer information regarding the general effects of a program on a person’s quality of life reflecting a range of significant outcomes for the individual, school, family, and community. Outcome measures include, for example, time spent in social interactions with non-disabled peers, or presence in school activities.

Meyer and Evans (1993) included in their criteria for successful outcomes of behav- ioral interventions those which are related to self-determination and quality of life, such as less restrictive placements, greater participation in integrated school experi- ences, subjective quality-of-life improvements (e.g., happiness, satisfaction, choices, and control), improvements perceived by significant others, and expanded social rela- tionships and informal support networks. Carr (2007) encapsulates these important quality-of-life outcomes as happiness and personal satisfaction and proposes that these hard-to-define variables must be our vision for the future.

Think about the case of a young man who lived in a facility where he received con- tingent electric shock for the self-injurious behavior of scratching (Gothelf & Brown, 1998). He wore a shock device 24 hours per day at his school program and in his group home. After many thousands of shocks, his self-injury was significantly reduced although not entirely. Using the process measure of “rate of scratching” as the only measure of success, it could be concluded that the contingent electric shock was effective. However, this man’s program was judged as being far from effective, not only because it applied an unacceptable strategy, but also because there was little impact on the quality of his life. Consider the following outcomes that accompanied the behavior reduction: (a) wearing a shock device 24 hours per day, (b) the inability to manage his own behavior without the shock device, (c) going to school and living in a group home with individuals who all had severe behavior problems, (d) having no control over daily activities (e.g., what to eat, when to go to bed, or wake up), (e) limited social interaction with individuals without disabilities, (f ) limited social interaction with unpaid individuals, (g) self-reports of being unhappy, (h) no control over his future, and (i) living a great distance away from his family. Outcome meas- ures would reveal just how limited this intervention was for this young man—in terms of both the lack of qualitative life outcomes and the use of a strategy that is in opposi- tion to acceptable practice.

Measurement not only must accurately describe current performance on priority skills, but also must reach beyond this traditional assessment of isolated skill increases

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or behavior reduction to assess the outcomes that make a significant difference in the individual’s life. In the previous example of the young man who participated in an aversive intervention program, meaningful outcomes would include, for example, self-management of his behavior, living in his own home and near his family, design- ing his own daily routines, pursuing and acquiring a job of his preference, and select- ing his own personal care assistants.

Much of this chapter explains how to describe, measure, and graph student behav- ior and learning with admittedly more focus on process measures and less on out- come measures. However, it is not sufficient to just measure behavior; measurement must be meaningful. Albert Einstein had a sign in his office that read “Not every- thing that can be counted counts, and not everything that counts can be counted.” So, before we get to the details, we will begin with a discussion of basic foundations and principles for selecting measurement strategies and making measurement meaningful.

Foundations oF MeaninGFul MeasureMent

Before reviewing strategies for measuring and graphing student behavior and learn- ing, it is important to understand the nature of meaningful and accurate data. Data, if wisely used, can provide information that is critical to the development, evaluation, and revision of instructional efforts (Farlow & Snell, 1994; Zirpoli, 2012). However, measurements of behavior change are of little importance if they do not provide meaningful information. Three characteristics of student performance data must be present in order for a measurement system to be meaningful: (a) Data must reflect important behavior, (b) data must be contextually appropriate, and (c) data must be sufficiently accurate and reliable.

Measurement of important Behaviors

Data should reflect important and significant behaviors. Simply being accurate and reliable is not sufficient. For example, a teacher can accurately measure the number of times that Jacob was able to complete a preschool puzzle; however, because a pre- school puzzle is not age appropriate for Jacob, who is in the fourth grade, it would not be a meaningful measurement. Teams should consider a series of questions to determine whether their measurement strategies are meaningful:

• Do these data measure behaviors or skills that are valued by the student, his or her parents, and the community or society?

• Do these data reflect the qualitative changes that we hope to see in this student? • Are the types of changes or the amount of change in the student significant?

Many efforts have been made to describe the criteria for evaluating the validity and importance of behavior changes. Researchers and practitioners have used the follow- ing five criteria to evaluate the success of behavioral change efforts: (a) statistical sig- nificance, (b) clinical significance, (c) social validity, (d) internal validity, (e) treatment fidelity, and (f ) quality of life.

statistical significance Experimental or statistical significance involves comparing behavior during or fol- lowing an intervention with what it was prior to the intervention and asking whether that difference is beyond what might be expected by chance (Kazdin, 1976). Often, statistical analysis is used to evaluate the success of an intervention in a research study, but it is not sufficient as the sole criterion for evaluating change, nor is it prac- tical for teams to apply in school.

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Clinical significance Therapeutic or clinical significance is the importance of the change achieved in the behavior (Kazdin, 1976), or the comparison between the change in behavior that has occurred and the level of change required for the individual to more adequately func- tion in society (Risley, 1970). In other words, if the result of an intervention makes no improvement in the student’s life (e.g., enabling him or her to eat independently), even though there is statistical significance, the change does not meet the criterion of clinical significance.

social validity Social validity also refers to the significance of a change in an individual’s life. In an analysis of the development of applied behavior analysis, Baer, Wolf, and Risley (1987) stated, “We may have taught many social skills without examining whether they actually furthered the subject’s social life; many courtesy skills without examin- ing whether anyone actually noticed or cared; many safety skills without examining whether the subject was actually safer thereafter; many language skills without meas- uring whether the subject actually used them to interact differently than before; many on-task skills without measuring the actual value of those tasks; and, in general, many survival skills without examining the subject’s actual subsequent survival” (p. 322).

Social validity is a concept that addresses qualitative aspects of the educational program. It focuses on the acceptability of the educational goals, the appropriateness of the procedures used to influence behavior, and the social importance of the behav- ior change (Cooper, Heron, & Heward, 2007; Kazdin, 1977; Wolf, 1978). Social valida- tion procedures can be used to determine whether the learned behavior is functional or meaningful (Kazdin, 1980). There are two methods for determining social validity. Social comparison contrasts the student’s performance with the performance of the student’s non-disabled peers. This standard checks against imposing unnecessarily rigorous performance criteria or stopping instruction before the student reaches a socially acceptable level of performance.

At Marc’s team meeting, the psychologist suggested that a behavioral objective be devel- oped to teach him to sit in his seat and keep his hands in his lap and his feet on the floor for 15 minutes. His general education teacher, Ms. Kwan, questioned the objective, say- ing “I’m not sure any of the children in the class can sit like that for 15 minutes!” Ms. Wharton, Marc’s special education teacher, suggested that they observe Marc during a variety of kindergarten activities and record data on a few typically developing chil- dren to determine the range of their attending duration and the “styles of sitting” dis- played by the other students. Ms. Kwan agreed that observing peers would help set a more appropriate goal for Mark’s paying attention in class.

The second method used to determine social validity is subjective evaluation. In this method, the opinions of significant people, because of their expertise or familiar- ity with the student, are used to judge the significance of the behavior change. For example, Whalon and Hanline (2008) looked at the social validity of a reading and language intervention for children with autism. In this study, three students with autism, seven and eight years of age, were taught to ask questions about the book that their teacher was reading to a small group, which included their general educa- tion peers. Social validity data were collected via interviews of the children with autism, their parents, and their general education peers. Parents were interviewed to determine whether they noticed changes in their child’s reading and social behavior, and whether they thought that the intervention was important. Also, videos of the first intervention session and the last session were shown to the parents, and they were asked to describe any changes that they noted in their children’s reading and language skills. The children with autism and their general education peers were indi- vidually interviewed and were asked about the usefulness of the intervention and whether they experienced any changes in their relationships with each other. The

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results of the social validity measures indicated that the children with autism thought that the intervention helped them better understand what they read. Their general education peers reported that they thought that the intervention was helpful, they enjoyed the sessions, and they had more interactions with their peers with autism. Finally, the parents thought that the intervention was helpful for improving both reading and language skills.

internal validity Internal validity refers to the demonstration that changes in behavior are a function of the independent variable and are not the result of other uncontrolled or unknown variables (Cooper, Heron, & Heward, 2007). That is, teachers should feel confident that the behavior change occurred as a function of the educational intervention, and not some other conditions or events that may influence the behavior.

Marc’s team reached a consensus that although they did not want to set an objective that he sit in his seat for 15 minutes, having him sit in his seat long enough to complete a short activity would be a valuable goal. Ms. Wharton, familiar with the literature on the positive impact of choice on activity participation, suggested that their intervention be based on providing Marc with more choices of activities, in the hopes of increasing the length of time that he sat in his seat. Following intervention, Ms. Wharton was happy to report to the team that the use of more choices seemed to be effective—Marc was sit- ting for longer periods of time. His mother, however, questioned this finding when she shared with the team that Marc had been troubled by spring allergies, but that he began to take an antihistamine to treat his allergies. Ms. Wharton then wondered whether the change in Marc’s in-seat behavior was a function of his new choice program or taking allergy medication.

treatment Fidelity Treatment fidelity, or procedural reliability, focuses on the accuracy of the implemen- tation of the procedures. It answers the question, “Did the educational intervention occur as specified in the treatment plan?” This is an important question to ask. Con- sider trying to analyze why a new intervention is not working. If we are not sure whether the various team members are implementing the strategy in the same way, we cannot determine whether it is the program that is not effective or whether it is just the inconsistent teaching.

Quality of life In 1972 Wolf Wolfensberger introduced the term normalization to the field of devel- opmental disabilities. This created a paradigm shift in our view of what is important to teach individuals with severe disabilities. He stated that normalization is the “utili- zation of means which are as culturally normative as possible in order to establish and/or maintain personal behavior and characteristics which are as culturally norma- tive as possible” (p. 28). Characteristics that are as culturally normative as possible provided the field with a criterion to reach that focused on the quality of an individual’s life. Increasingly educational programs are looking at this criterion in the evaluation of program success. To determine if an individual has an acceptable quality of life, Wolfensberger asks if the individual experiences (a) normal rhythm of the day, (b) normal rhythm of the week, (c) normal rhythm of the year, (d) normal experiences of the life cycle, (e) normal respect, (f ) living in a sexual world, (g) normal economic standards, and (h) normal environmental standards.

Meyer and Evans (1989) delineate eight possible outcomes to evaluate the effec- tiveness of a teaching program:

• improvement in target behavior • acquisition of alternative skills and positive behaviors • positive collateral effects and the absence of side effects

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• reduced need for and use of medical and crisis management services for the indi- vidual or others

• less restrictive placements and greater participation in integrated community experiences

• subjective quality-of-life improvement—happiness, satisfaction, and choices for the individual

• perceptions of improvement by the family and significant others • expanded social relationships and informal support networks

Certain measurement procedures in community settings promote less-than- normalized lifestyles and interactions, thus detracting from the individual’s quality of life. For example, the teaching staff may be so interested in recording the prompting levels necessary to complete a leisure activity that they forget to notice whether any- one is having fun (Brown & Lehr, 1993). Professionals are recognizing that critical components of program evaluation are choice and control over one’s life (e.g., Bambara, & Koger, 1996; Bannerman, Sheldon, Sherman, & Harchik, 1990; Brown & Lehr, 1993; DiCarlo & Vagianos, 2009; Kern & Clarke, 2005; Knoster & Kincaid, 2005; Mechling, Gast, & Cronin, 2006).

It is critical that each individual, to the greatest degree possible considering the child’s age, have control over the activities in which he or she participates, retain the option to refuse participation, and maintain control over the sequence in which the activities take place and the times at which the activities occur. Opportunities for self-determination are also associated with better postschool outcomes (McGlashing- Johnson, Agran, Sitlington, Cavin, & Wehmeyer, 2003). Interestingly, Agran, Snow, and Swaner (1999) found that although most of the special education professionals whom they surveyed supported the notion that self-determination was an important outcome, they did not necessarily include IEP goals related to self-determination. Inclusion of these goals on the IEP would better ensure the team’s commitment to self-determination.

Evaluating the educational impact on quality-of-life factors is important if we are to take seriously our commitment to effecting meaningful change in the student’s life. However, measurement of the qualitative components of life is often challenging. For example, limited cognitive and communication skills make it difficult for educators and even families to understand a student’s vision of quality of life (Brown, Gothelf, Guess, & Lehr, 1998). Holburn (2002) points out that often the strategies that are used to improve students’ quality of life (e.g., person-centered planning) and the collateral outcomes of these strategies (e.g., community inclusion, improved relationships) are difficult to measure but nonetheless necessary.

Thus, recent trends look beyond simple quantitative reports of progress (e.g., acquisition of isolated skills) and see each individual within the context of a meaning- ful life. Measurement strategies must support the evaluation of these important outcomes.

Measurement that is Contextually appropriate

It is critical that a full range of student data be collected and it is equally important that we are unobtrusive in its collection, storage, and use. Always remember that evaluation information is confidential. It should be available only to the student, fam- ily members, and the professionals who are directly involved in the student’s pro- gram. Just as a typical student’s report card is never publicly displayed, neither should a student’s progress graphs or data records be displayed for others to see. Graphs and data sheets should be organized and stored in record files that are accessible only to teaching staff and to be shared with the educational team.

The methods selected for directly measuring behavior in teaching settings should be as simple and time-saving as possible (e.g., the frequency or event counts for carefully selected and distinct periods or a count of permanent products). Typically,

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teachers avoid methods that require extensive observation time (e.g., frequency counts taken across an entire day) and avoid measurement approaches that interfere with teaching (e.g., a clipboard). Teachers must make some compromises in order to obtain the maximum amount of information with the least effort and time commitment.

Minimizing the obtrusiveness, and potential clumsiness, of data collection is a goal for teachers. There are low-tech approaches as well as an increasing number of high- tech approaches to measuring student behavior that are now available to educators. Low-technology approaches include using an index card or “sticky note” to record a student’s performance of a task analysis, wrist or key-chain counters, kitchen timers, stopwatches, calculators, or quiet counters to keep frequency counts and task analytic data, or to time the duration of target behaviors.

Permanent product measures (to be discussed in next section) also offer an unob- trusive way to evaluate student performance. For example, once Marc can enter his classroom reliably and safely in his “arrival program,” the teacher may simply meas- ure two products that result from Marc’s performance of the entire arrival chain: (a) whether his coat or sweater is hung on a hook and (b) whether Marc is participating in the activity that he placed by his photo on the activity choice chart. This measure would be taken 10 minutes after his arrival. Other examples include using measure- ments of weight gain to evaluate the effectiveness of a program to reduce rumination and vomiting and using ratings of spillage to evaluate the success of a feeding pro- gram. Communication logs between home and school may be examined to ascertain a family’s perception of student improvement and satisfaction with an instructional pro- gram. The list of examples for user-friendly measures depends on the imagination of teachers and family members with regard to alternative ways to evaluate learning.

More recently, there are increasing numbers of apps available for teachers to use on their smart phones or tablets that allow observers to easily record frequency, duration, and interval measures, as well as summarize and analyze data: For example, see the Behavior Tracker Pro by Marz Consulting Inc (https://itunes.apple.com/ us/app/id319708933?mt=8); Functional Behavior Assessment Wizard by Whizz- Watt Software (https://itunes.apple.com/us/app/functional-behavior-assessment/ id573375887?mt=8).

Measurement that is accurate and reliable

When a team has decided that a change in a student’s behavior is a goal (e.g., increase social interactions, decrease inappropriate verbalizations, extend the use of a commu- nication system to peers), one of the first steps in the process is to define the behav- ior. A precise description of the behavior is necessary to ensure that the teacher is consistently observing the same behavior, that others are observing the same thing, and that there is continuity of instruction (Alberto & Troutman, 2012). For example, if “improve manners” is a goal, it is unlikely that the student, parents, teachers, teaching assistants, and therapists automatically agree on what “manners” mean. To some, appropriate table manners mean sitting up straight, arms off of the table, napkin in lap, and chewing with one’s mouth closed. Others, however, may feel that some of these components are unnecessarily formal. Indeed, for some students, eating with their mouths closed is physically unrealistic.

To prevent ambiguity, an operational definition of the target behavior is created; that is, the behavior must be described in a way that is observable and measurable. Agreement on what constitutes a behavior is critical to the development of reliable and valid measurement and evaluation systems. The description of a behavior must be specific enough to allow two or more observers to read the definition and make the same judgment about the occurrence or non-occurrence of the behavior (Alberto & Troutman, 2012). Table 4–1 compares terms that are vague and descriptions that are observable and measurable. These terms represent a sample of the goals that

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were determined for Marc and Christine. The concepts of “functional” and “meaning- ful” behaviors should not be confused with the standard of describing behaviors in

observable and measurable ways. Designing an operational defi- nition to objectively describe a behavior does not ensure that the definition is functional or meaningful to an individual. For exam- ple, the statement “When shown either a red or blue block, Christine will point to the red or blue block placed in front of

her” is observable and measurable. It is not, however, a meaningful activity for Christine, as it is neither age appropriate nor functional.

If data are not accurate and reliable, it would be impossible to make confident judgments or decisions about a student’s progress on his or her goals and objectives. Later in this chapter, we will discuss interrater reliability (i.e., whether the target behavior is being recorded accurately) and procedural reliability (i.e., the degree to which the instructional procedures are implemented accurately).

Quantitative Measures

Teams must know whether each student’s instructional program is effective in help- ing the student achieve his or her IEP objectives. Many teachers resist data collection because they feel as if they cannot afford the time. However, such teachers may find four months into the school year that their intervention is not working. Students can- not afford to participate in ineffective interventions for four months! Frequent and ongoing data collection provides ongoing feedback about the student’s progress and reveals important information that can guide program improvement.

rationale

Instructional decisions are enhanced by the use of data and such decisions positively influence student performance (Farlow & Snell, 1994; Kennedy, 2005; O’Neill, McDonnell, Billingsley, & Jenson, 2011). It has been many years since Fuchs and Fuchs (1986) demonstrated that teachers were more effective when they used student performance data instead of subjective judgment when making instructional

TABLe 4–1 Vague Versus Observable Descriptions of Behavior

Student Vague Observable

Marc Interacts appropriately with peers Waves “hi” to peers when he enters the classroom in the morning

Has improved his grooming Washes hands before meals

Asks for assistance to tie his shoes

Has increased his academic skills Identifies numbers by pointing to numerals 1 through 10

Matches letters to pictures

Christine Has shown an increase in her community participation

Goes to the grocery store with a peer once each week to purchase snacks for drama class

Uses her Dynavox to request directions and answer questions in the grocery store

Understands her job responsibilities

Completes a sequence of job tasks that are recorded on the communication device

Requests help when needed during job tasks

Watch “Defining a Behavior” at www .youtube.com/watch?v=gdQTlftjjHo.

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decisions, and also found greater improvement in student performance when the teachers used graphed data instead of ungraphed data to make decisions. In another classic study, Utley et al. (1987) established that teachers and teachers in training made more accurate judgments about student performance when they used data (graphed, ungraphed, or both) than when they based their judgments on observation. Yet many teachers continue to resist this important aspect of teaching.

When teachers begin to measure individual student performance, other advantages become obvious. Precise measurement of behavior allows teams to see even small changes in the behavior, giving everyone the message “Keep up the good work!” This encourages the continued use of promising instructional programs. Continuing an instructional strategy is frustrating when one does not feel that any progress is being made. Student performance data allow the team to determine when a program is not as effective as planned so that they can design modifications and not let precious instructional time be wasted.

Student performance data can enhance communication with others in the same ways as precise definitions of behavior. Saying, on the basis of intuition, that some- one is “doing better in cooking” or “seems to be initiating interactions more fre-

quently” is vague, subjective, and possibly inaccurate. Making a statement such as “Christine uses her communication board to greet the cashier with only two verbal prompts” or “Jacob now waves hello when he enters the classroom in the morning four out of five days each week” communicates clearer and more objective messages.

Measurement strategies

In this section, we review several ways to measure student performance. The strategy selected should suit the behavior to be measured and the situation. Some of the strat- egies are easy to use and require little time away from the usual routine; other strate- gies, however, take more planning and time. These more complex strategies may be used when a challenging situation in the classroom warrants additional measurement precision. Table 4–2 summarizes these measurement strategies: (a) permanent prod- ucts, (b) frequency recording, (c) percentage, (d) rate, (e) duration, (f ) task analytic measurement, and (g) interval recording and time sampling.

Permanent Products Many behaviors have a concrete result, or product, that lasts. Unlike behaviors that must be directly observed when they occur, behaviors that result in a product or phys- ical outcome can be evaluated after the individual has performed the behavior. For example, Marc’s parents need not sit by his bed all night long to observe toileting acci- dents. Instead, evidence of accidents can be observed by looking at or touching the child’s sheet in the morning. Jacob’s teacher can simply look at his computer journal to check for the number and length of sentences written. Permanent product meas- ures provide opportunities to detect error and quality patterns (e.g., particular words or sounds that may be problematic for Jacob). Because measurement of permanent products does not require continuous observation, it is convenient for classroom use.

Frequency recording Some behaviors are transitory and must be measured as they occur. Frequency record- ing measures the number of times that a behavior (appropriate or inappropriate) occurs within a specified period (e.g., the number of times that a student throws his or her work materials onto the floor during a 30-minute work session, the number of times that the student greets people appropriately throughout the school day). Fre- quency has been used to measure many types of behaviors. For example, Cosbey and Johnston (2006) used a naturalistic approach to teach three children with severe mul- tiple disabilities to use a voice output communication aid (VOCA) to request access to

Watch “Data Collection—Autism Therapy Video” at www.youtube.com /watch?v=B_xPqWCoHuM.

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TABLe 4–2 Measurement Procedures That Are Appropriate for Classrooms

Description of Measurement Advantages Disadvantages

examples of Behaviors Measured

Permanent products Direct measurement of the lasting and concrete results of a target behavior

• Does not require continuous observation

• Permits analysis of products for error patterns

• Must have a tangible result • No immediate feedback

• Appropriate behaviors (e.g., the number of newsletters folded and stapled)

• Inappropriate behaviors (e.g., the number of buttons ripped from clothing)

Frequency recording The number of times a behavior occurs within a specified period

• Is useful with a wide variety of discrete behaviors

• Can be easily accomplished in the classroom

• May be converted to a rate

• Necessitates continuous attention during the obser- vation period

• Yields less accurate results with high-rate behaviors or behaviors of varying duration

• Inappropriate for behaviors of long duration

• Appropriate behaviors (e.g., spontaneous requests for materials needed, initiation of greetings to peers)

• Inappropriate behaviors (e.g., talking out, hitting)

Percentage The number correct (or in- stances occurred) divided by the number of opportuni- ties (or total intervals)

• Useful when the number of opportunities varies across sessions

• Can be used to report task ana- lytic measurements, duration, interval, and time-sampling data

• Common measure used in aca- demic settings

• Cannot distinguish the num- ber of opportunities from the score

• Cannot be used if there is no ceiling on the number of opportunities

• Appropriate behaviors (e.g., independent eating, correct math problems)

• Inappropriate behaviors (e.g., hitting, self-injury, cursing, etc., if measured through interval recording or time sampling)

Rate The frequency of a behavior and its relationship to time expressed as a ratio

• Useful when the number of opportunities varies across sessions

• Reflects proficiency

• Cannot determine the total time of the observation period

• Appropriate behaviors (e.g., vocational tasks completed per minute, social interac- tions per hour)

• Inappropriate behaviors (e.g., callouts per class period)

Duration The total amount of time in which a targeted behavior occurs in a specified observation

• Yields a precise record of the length of the occurrence of a behavior

• May be used to record the dura- tion of each occurrence of a behavior

• Necessitates continuous attention during the obser- vation period

• Requires a device to meas- ure the elapsed time (e.g., stopwatch, smart phone app) for optimum accuracy

• Inappropriate for frequent behaviors of short duration

• Appropriate behaviors (e.g., attending to lesson, comple- tion of hygiene routine)

• Inappropriate behaviors (e.g., tantrums, stereotypical behavior, out-of-seat behavior)

Task analytic measurement A record of the performance of each step in a sequence of behaviors that make up a task

• Useful for most skills in the domestic, vocational, leisure, and community domains

• May be used to guide instruction • Enables a measurement of each

behavior that makes up a skill • Can be summarized as a per-

centage or as number of steps

• Requires a good task analy- sis of the skill being measured

• Not suitable for measuring inappropriate behaviors

• May focus too much on motor skills, neglecting the qualitative aspects of the task

• Appropriate behaviors (e.g., making the bed, playing a CD, assembly tasks, prepar- ing a snack)

(continued)

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preferred items and/or peers during play activities. The researchers recorded the fre- quency of unprompted responses (i.e., the student independently activated the VOCA in the presence of peers), as well as prompted and generalized responses.

In order to have meaningful frequency data, it is necessary to specify the length of time and to compare data from the same length of time only. For example, a teacher may report that her student bit his hand 15 times on Monday but only 5 times on Tuesday. This certainly sounds like excellent progress. However, if the teacher observed the student for 3 hours on Monday but only for 1 hour on Tuesday, it is not possible to conclude whether there was any progress.

Behaviors measured in this way should be readily dividable into discrete units, with a clear beginning and an end, and should be easily visible and countable. For example, stereotypical behavior, such as hand waving, may occur at such a high rate that it is impossible to count each instance accurately. Attempting a frequency count of vocalizations may also be difficult if each vocalization does not have a clear begin- ning and a clear end. For these two examples, another measurement method (such as one of the interval recording measures) should be selected in place of frequency.

Finally, behaviors measured in this way should be relatively uniform in length and not occur for long periods. For example, a parent may report that her child sucked his thumb only two times. This is not helpful information if each occurrence of thumb sucking lasts 45 minutes! The frequency, in this case, does not reflect the amount of behavior. Other measures, such as duration, would be more appropriate for such behaviors. Frequency recordings would accurately measure a student’s correct coin and value identification or the number of times that a student greets his teacher and peers.

Description of Measurement Advantages Disadvantages

examples of Behaviors Measured

Interval recording A record of the occurrence of behavior within each of the time intervals within a single observation

• Requires less effort than continu- ous frequency or duration methods

• Does not require as precise a definition of a unit of behavior

• Applicable to a wide range of behaviors

• Provides an estimate only • The size of the interval must

be appropriate for the behav- ior frequency

• Accuracy is facilitated by tim- ers or other time-based devices

• Appropriate and inappropri- ate behaviors (i.e., any of the behaviors listed for fre- quency or duration)

Whole interval Records whether behavior occurred continuously throughout each of the inter- vals within the observation session

• Useful when it is important to know that the behavior continues without interruption

• Underestimates the magni- tude of the target behavior

• Appropriate behaviors (e.g., on-task behaviors, engage- ment in play)

• Inappropriate behaviors (e.g., out-of-seat behavior, tantrums)

Partial interval Records whether behavior occurred at any time within the interval

• Useful for behaviors that may occur for fleeting moments

• Applicable to behaviors of longer duration

• Applicable to high-frequency behaviors

• Overestimates the magni- tude of the target behavior

• Appropriate behaviors (e.g., social interactions)

• Inappropriate behaviors (e.g., out-of-seat behavior, hitting, hand biting, tantrums)

Momentary time sampling Records whether behavior occurred at the moment each of the intervals ends

• Useful for behaviors that tend to persist for a while

• Does not require continuous observation

• Can be used with more than one student at a time

• Must sample at frequent and relatively short intervals

• Appropriate behaviors (e.g., on-task behaviors, engage- ment in play)

• Inappropriate behaviors (e.g., tantrums, off-task behaviors)

TABLe 4–2 Measurement Procedures That Are Appropriate for Classrooms (continued)

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Percentage A percentage score can be used when a behavior can occur a fixed number of times in an observation session instead of an undetermined number of times. Percentage is calculated by dividing the number of behaviors observed by the number of opportu- nities to perform that behavior. This type of measure is used frequently in the general education system to evaluate mastery of academic concepts (e.g., percentage of words correctly spelled, percentage of math problems correctly completed). Marc’s teacher used a percentage to measure social interactions when she counted how many times he passed the materials to his neighbor when it was his turn; on one day, she recorded correct responses for two out of the five opportunities occurring during the morning song, or 40% of the opportunities. Percentages can also be used to measure the num- ber of intervals in which a behavior occurred (Christine was on task with her book checkouts, for 8 out of 10 intervals, or 80%, of the time).

Many educators use percentages to measure performance on task-analyzed activi- ties. For example, Mechling and Stephens (2009) taught four young adults (ages 19 to 22 years) to independently complete task-analyzed (non-microwave) cooking tasks (e.g., preparing hot chocolate, chocolate pudding, ravioli, tuna, french fries) using self-prompting strategies. These researchers compared the use of static picture reci- pes and video prompting strategies, measuring performance by the percentage of task-analyzed steps completed independently. The results demonstrated that all of the students made substantial gains with both the static picture and the video prompting interventions, although the video prompting resulted in the most gains.

Percentage measures are not appropriate when the number of opportunities to perform a behavior is not fixed or controlled. For example, it is inappropriate to write an objective that states that Christine will “greet her peers 80% of the time” if her teacher cannot determine the number of opportunities that she has to greet her peers.

rate Rate can be used to determine the frequency of a behavior and its relationship to time. A rate is expressed by the ratio of the number of behaviors divided by the unit of time (e.g., Jacob got out of his seat three times during the 15-minute writing task, or 0.2 times per minute). In vocational training situations, for example, a goal may be to increase the number of cleaning tasks completed in a certain amount of time (e.g., from washing 5 windows in 30 minutes, or 0.17 per minute, to 10 windows in 30 min- utes, or 0.33 per minute).

Rate is also a helpful measure when the observation time of a session varies (e.g., to measure the number of spoonfuls of food that Christine eats per minute with her self-feeder when the length of the lunchtime varies). Using an adaptation of prelin- guistic milieu teaching, Brady and Bashinski (2008) increased the intentional commu- nication skills (i.e., gestures and vocalizations) of nine students with deaf-blindness. These researchers measured the frequency of the communication acts and then, because of variations in the length of the sessions, converted these measures to rate per minute. Another advantage of using rate to measure performance is that rate reflects both accuracy and speed, or fluency of performance, instead of just accuracy.

duration A duration recording is used if the focus is the amount of time that an individual is engaged in a specific behavior or activity. Sometimes it is desirable for a person to increase the amount of time engaged in an activity (e.g., attending to homework, brushing teeth, exercising), and sometimes it is desirable for an individual to decrease the amount of time spent in an activity (e.g., watching television, displaying self- injurious behavior). Duration measures the total amount of time in which a targeted behavior occurs within a specified time.

Delano and Snell (2006) evaluated the effects of social stories on the duration of appropriate social engagement (and the frequency) of four social skills in three elemen- tary school-age students with autism. The intervention consisted of individualized social

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stories, responding to comprehension questions, and a 10-minute play session with non-disabled peers. The researchers found that all three students increased their dura- tion of social engagement. Harvey, Baker, Horner, and Blackford (2003) used duration of sleep to explore the presence of sleep problems in individuals with intellectual impairments who were living in community settings. They found that while the dura- tion of sleep for the individuals in their sample was similar to those without disabilities, the quality of sleep was different (e.g., waking up in the middle of the night) as a func- tion of the interaction between the level of the disability and the use of medications.

Duration can be recorded in three ways: (a) as total duration, (b) as percentage of time, and (c) by measuring each occurrence. Using the total duration method, the teacher records the total amount of time that the individual spent engaged in the behavior during the observation period. For example, Marc’s teacher may be interested in measuring the amount of time that he spends in appropriate play with peers during recess. Before starting the duration measurement, the teacher must operationally define appropriate play for Marc, making sure that it is possible to clearly determine the onset and termination of the behavior. The teacher can then measure the behavior using the timer on her smart phone. All that the teacher has to do is to start the timer when Marc begins playing with his peers. As soon as he stops playing (e.g., participates instead in self-stimulatory behavior), the teacher stops the timer. The teacher starts and stops the timer accordingly for the course of the recess period. The amount of time accumulated on the stopwatch at the end of the period reflects the total duration.

A percentage of time can be derived by simply dividing the total time engaged in the activity by the length of the playtime. For example, Marc may have played with his peers for a total of 5 minutes during a 15-minute playtime. The following equation represents the process for determining the percentage of time:

Total duration of behavior 5 minutes = = 33%

Length of observation period 15 minutes

Although the duration measure is simple and accurate (if the behavior is clearly defined), another piece of information makes the duration measure even more informative: the frequency of each occurrence. For example, we know that Marc par- ticipated in playing with his peers for 5 minutes (or 33% of recess); however, we do not know whether he played for 5 minutes in a row or if he played for only 30 sec- onds at a time but kept returning to the play area. Such information may be valuable in determining the type of intervention to use with Marc to increase his interactions during recess. The method of measuring each occurrence provides this information, although it is more time consuming than the previous two methods. To measure the occurrences, the teacher would start the timer when Marc started to play with a peer, click the timer off when he stopped playing, and then record the duration on a data sheet. The teacher would then return the timer to zero. When Marc started to play again, the teacher would start the timer and have it continue until he stopped playing. When Marc stopped again, the teacher would record this duration, and so on. ( Alternatively, the teacher could record on the stopwatch in an accumulating manner as before, but record the frequency of instances of playing, which might be easier to do). At the end of the observation period (e.g., 15 minutes), the teacher would have a record of total duration (e.g., 5 minutes), as well as a count of the number of times that Marc started and stopped playing (e.g., eight times). In this case, the goal would be to increase the duration of time that Marc spent playing and to decrease the num- ber of times that he got distracted from playing.

task analytic Measurement Task analytic measurement focuses on a student’s performance on a sequence, or chain, of behaviors during teaching or during testing. This type of measurement is the most frequently used method of instruction and evaluation of student performance on routines or complex activities. To implement task analytic measurement, a teacher

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conducts a task analysis (see Chapter 5), designs a data sheet to record student per- formance, and then records the student’s performance on each of the steps delineated in the task analysis (or some portion of the steps if using backward or forward chain- ing, or partial participation).

During teaching, there are a variety of ways in which the teacher may record stu- dent performance: by recording a plus (+) or minus (−), or by recording the prompt level (e.g., verbal or physical prompt) required for the student to complete the step. If the teacher is using a total task-chaining strategy (see Chapter 5), then all of the steps in the task analysis are scored. If the teacher is using forward chaining or backward chaining or partial participation, then only the steps that the student is working on are scored. Table 4–3 shows a task analysis for the skill of making a peanut butter sandwich. Because Jacob can participate extensively in this type of activity, his teacher, Ms. Fuentes, chose to use a total task-chaining strategy and a least-to-most

TABLe 4–3 Jacob’s Task Analysis for Making a Peanut Butter Sandwich

Name: Jacob Teacher: Ms. Fuentes

Activity: Making a peanut butter sandwich

Materials: Peanut butter, bread, butter knife, plate, napkin

Record number that indicates amount of assistance: 3 – Independent, 2 – Verbal, 1 – Model, 0 – Teacher completes

Dates

Routine Steps 9/06 9/13 9/27 10/04

1. Initiate snack by going to resource room. 3 3 3 3

2. Go to refrigerator. 2 2 2 2

3. Get out peanut butter. 2 2 2 2

4. Put peanut butter on counter. 2 2 3 3

5. Get bread from bread box. 1 1 1 1

6. Put bread on counter. 2 2 2 3

7. Get butter knife. 1 1 1 2

8. Get plate. 1 1 1 1

9. Put knife and plate on counter. 3 3 2 3

10. Open bread bag. 1 1 1 2

11. Remove two slices of bread and put on plate. 3 3 3 3

12. Open peanut butter jar. 0 0 0 0

13. Scoop out peanut butter with knife. 1 1 2 1

14. Spread peanut butter on one slice. 3 3 3 3

15. Repeat until preferred thickness. 3 3 3 3

16. Put other slice on top. 1 2 1 2

17. Put knife in sink. 1 1 1 2

18. Put peanut butter away. 2 2 2 2

19. Get napkin. 1 2 2 2

20. Bring sandwich and napkin to table. 3 3 3 3

Total 36/60 (60%)

38/60 (63%)

38/60 (63%)

43/60 (72%)

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prompting procedure. But, as Jacob’s behavior has clearly indicated that he prefers not to be physically guided or touched, his team decided to teach Jacob using just the verbal and model prompts. It was agreed that if Jacob did not complete a step of the task analysis independently after a verbal prompt or a model, which was typically suf- ficient, the teacher would simply complete that step for him and allow him the oppor- tunity to perform the next step of the sequence. Jacob’s mother said that she would also practice this skill with him when he gets home from school.

In general, Jacob’s data reflect that he is slowly moving toward the criterion. At the beginning of the week, he achieved 60%, and at the end of the week, he achieved 72%. Keeping track of the individual steps of his task analysis allows more detailed analysis that can contribute to constructive program modifications. Looking at indi- vidual steps on his data sheet reveals a few steps that seem to be problematic for him. For example, Jacob is unable to open the peanut butter jar (Step 12) and consistently requires models to complete Step 5 (getting bread from the bread box) and Step 8 (getting a plate). This information will allow her team to consider some modifications or adaptations for these steps. For example, should Jacob be provided with a rubber gripper that might make opening the jar easier? Or should he be taught instead to ask someone for assistance to open the jar? Could the bread box and the plates be moved closer to him to make accessing them easier? Or might pictures be helpful as a prompt to remind Jacob of where the items that are needed are kept?

Table 4–4 shows another task analysis for the same activity, but this time for Christine, who is expected to participate partially in the activity instead of performing

TABLe 4–4 Christine’s Task Analysis for Making a Peanut Butter Sandwich

Name: Christine Teacher: Ms. Washington

Activity: Making a peanut butter sandwich

Materials: Peanut butter, bread, butter knife, plate, napkin, meal preparation overlay for communication board

Record number that indicates amount of assistance: 5 – Independent, 4 – Verbal, 3 – Model, 2 – Partial physical, 1 – Full physical, X – Teacher or peer completes

Dates

Routine Steps 10/07 10/08 10/09 10/10 10/11

1. Initiate snack by activating communication device. 3 3 3 3 4

2. Peer assists her into home economics class. X X X X X

3. Press switch when “peanut butter” is scanned on communication device. 2 2 2 3 4

4. Press switch when “bread” is scanned on communication device. 2 2 2 2 3

5. Teacher gets items, puts them on counter. X X X X X

6. Press switch when “knife” is scanned on communication device. 2 2 2 2 3

7. Press switch when “plate” is scanned on communication device. 2 2 2 2 3

8. Press switch when “napkin” is scanned on communication device. 2 2 2 2 3

9. Teacher gets items, puts them on counter. X X X X X

10. Teacher makes sandwich. X X X X X

11. Teacher gives her a sample of sandwich and asks whether sandwich is OK. X X X X X

12. Press switch when “yes/no” is scanned on communication device. 4 4 4 5 5

13. Teacher fixes sandwich as necessary. X X X X X

14. Press switch when “thank you” is scanned on communication device. 2 2 2 2 2

Total 19/40 48%

19/40 48%

19/40 48%

21/40 53%

27/40 68%

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105Measuring Student Behavior and Learning

all of the steps. Christine is scored on eight steps of the task and her teacher (or peer for Step 2) completes the steps that are marked with an X. Extension and enrichment skills (e.g., initiation, social skills, monitoring skills) are skills where Christine can likely achieve independence. These components allow for meaningful participation in, and control of, the activity even though she cannot perform most of the motor components of the task (see Chapter 5). The prompt procedure for Christine includes physical assistance.

During testing, task analytic measurement can be carried out by using either a single-opportunity or a multiple-opportunity method. The easiest, although less informative, method is the single-opportunity method. This approach is carried out as follows:

1. Conditions (including materials) are arranged as planned in the instructional program.

2. The instructional cue (if any) is given when the student is attending. 3. The student’s independent response to each step in the task analysis is recorded

until an error occurs. 4. The following rules can be used to handle errors, periods of no response, and

inappropriate behavior:

• Testing is stopped after the first error and all remaining steps are scored as errors. • After a specified latency period of no response (e.g., 3 seconds), testing is

stopped and all remaining steps are scored as errors. • After a specified period of inappropriate behavior (e.g., 10 seconds of stereotypi-

cal behavior) or after a single inappropriate response (e.g., throwing the soap or the towel), testing is stopped and all remaining steps are scored as errors.

For many tasks, the steps performed are scored as correct if they correspond to the task description, regardless of the order in which they are carried out, as long as the result is satisfactory. For example, it is not important whether Marc pulls his right or left arm out of his coat first. However, for many other tasks (e.g., certain assembly tasks), performing each step in order is crucial to the successful completion of the activity. In tasks where order is important, the first step out of sequence is scored as an error. In addition, when the rate of performance is important (as specified in the criteria or standards), the maximum length of time allowed is specified.

Once each week, Ms. Bowers probed Jacob’s performance with regard to packing his book bag. Using the single-opportunity method, Ms. Bowers observed Jacob following two instructional cues. First, she gave the entire class the instruction that they need to get their things together to go to music. Second, she told Jacob, as she always did before activity changes, to check his picture schedule to see what the next class is and what he needs to take with him. Following the natural cue of the other students in the class, he began to gather some things together. Ms. Bowers scored a plus (+) on her data sheet for the first three steps: (a) taking out his book bag, (b) unzipping it, and (c) putting in his pencils. After these first three steps of the task analysis, Jacob stood up to join his friends in the front of the room. Ms. Bowers scored a minus (−) on her data sheet to indicate that he did not independently perform the fourth step of putting his music book into his bag. According to the single-opportunity testing method, all remaining steps were scored with a minus (−). Ms. Bowers then proceeded to implement teaching by giving him a verbal prompt for the missed step.

The single-opportunity method is generally completed quickly. It provides a con- servative estimate of the student’s skills. Less instructional time is wasted because teaching can begin immediately after the first error. Furthermore, learning is less likely to occur during testing; therefore, the single-opportunity method provides a more accurate estimate of the effect of instruction. However, a disadvantage of the method is that performance on task analytic steps that occur after the first error are

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106 Chapter 4

not measured because testing is terminated at this point. Thus, the student’s success- ful performance of later steps will not be observed. If a teacher is using backward chaining (i.e., teaching the last step first), the single-opportunity probe does not reflect any progress until training advances to the earlier steps in the chain. There- fore, in such cases, the multiple-opportunity probe produces more information.

The multiple-opportunity method uses the following steps:

1. Conditions are arranged as planned in the instructional program. 2. The instructional cue (if any) is given when the student is attending. 3. The student’s responses to each step in the task analysis are recorded as correct or

incorrect (i.e., performed correctly or not performed at all). 4. Whenever an error occurs after a specified period of no response or inappropriate

behavior, the step is completed by the teacher. Instead of the probe ending, the student is given an opportunity to engage in the next step in the chain. Thus, per- formance on every step can be assessed.

With both assessment approaches, feedback is not provided to the student with regard to performance of the targeted skill. The withholding of feedback differentiates between the conditions of testing (which represent the most difficult conditions speci- fied in the objective) and the conditions of teaching (when prompts and reinforcement are available). For some students, non-contingent reinforcement may be made availa- ble (i.e., reinforcement for something other than performance of the task or generic praise like “Keep up the hard work!”) to hold their interest during assessment.

interval recording To use interval recording, the observer divides an observation session into short, equal intervals, and the occurrence (or non-occurrence) of the behavior within each interval is recorded. Some observers build in a brief period (e.g., 5 seconds) for recording between-observation intervals that can increase accuracy (Alberto & Troutman, 2012). Interval recording is useful for those behaviors that do not have discrete start or stop times and that vary in length, are continuous (i.e., of longer duration), or occur with high frequency (Alberto & Troutman, 2012). Interval record- ing has been used to measure both appropriate behaviors (e.g., peer social initiations and interactions in inclusive settings) and inappropriate behaviors (e.g., out-of-seat, stereotypical, aggressive) in schools and other community settings.

There are two types of interval recording strategies: whole interval and partial interval. In whole-interval strategies, the observer notes whether the given behavior occurred continuously throughout the interval. For example, Cox, Gast, Luscre, and Ayres (2009) used a 10-second whole-interval recording system to measure the impact of weighted vests on the in-seat behaviors of students with autism and severe disabili- ties; that is, the researchers observed whether in-seat behavior occurred throughout the entire 10-second interval. This is also what Christine’s teacher used to measure her participation in drama rehearsals.

Christine’s drama teacher thought that she was losing interest in the play. Lately, rehearsals were quite tedious, often focusing on just one or two students while the other students sat and read or did homework from other classes. In order to assess Christine’s interest, her teacher asked Christine’s teaching assistant to conduct a whole-interval re- cording for 5 minutes, once at the beginning of the class, once in the middle of the class, and once toward the end of the class. Each of the 5-minute periods was divided into 30 brief intervals of 10 seconds. The teaching assistant noted whether Christine was engaged throughout each 10-second interval in either watching the play or interacting with others. Christine’s teacher found that Christine was mostly inattentive to the play and had few interactions with her peers during these times. The first observation at the beginning of the class revealed that she was engaged for 10 out of 30 intervals (or 33%). In the middle of the class, she was engaged for 5 out of 30 intervals (or about 17%); at the end of the class, it was only 2 out of 30 intervals (or 6%). These data show that

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107Measuring Student Behavior and Learning

Christine’s engagement decreased as the class period progressed. Christine’s teacher, the teaching assistant, and two of her friends decided that they needed to make sure that Christine had something to do during these downtimes.

In partial-interval recording, the observer notes whether the behavior occurs at all during the interval instead of whether it occurs continuously throughout the interval. Once a behavior is observed and noted on the data sheet, further observation is not required for the remainder of that interval. Exactly how many times the behavior occurs during each interval is not recorded. Thus, interval recording provides an esti- mate of the occurrence of behavior. Because of this, interval size must be carefully chosen, only limited conclusions can be drawn from the data, and the data must be interpreted cautiously (Alberto & Troutman, 2009).

Marc seems to be by himself more and more during unstructured times of the day (e.g., free play), not interacting with other children. His special education teacher, Ms. Wharton, decides that they will use a partial-interval recording to get a better idea of how much time Marc is spending alone during these times. Ms. Wharton selects a 10-minute period in the middle of the 9:30 a.m. free play and a 10-minute period dur- ing the 11:30 a.m. free play. Then she divides each of these observation sessions into 10 equal 1-minute intervals. Ms. Wharton records a plus (+) in the 1-minute box if Marc has any type of interaction with another student during the interval and a minus (−) if there is no interaction.

Figure 4–1 shows that Marc had interactions with other children in 2 of the 10 inter- vals during early morning free play (or 20%). The data do not tell us, however, if Marc

FIguRe 4–1 Partial Interval Recording Form for Marc’s Peer Interactions

Name: Marc Teacher: Ms. Wharton

Date: November 2 Behavior: Peer interaction

Code: (+) peer interaction; (–) no peer interaction

9:30 Free Play

10 minutes

11:30 Free Play

Minutes

Total: 20%

10 minutes

Comments: Seemed to initiate and sustain interactions when musical toys are involved. When other children got loud, Marc seemed to move away.

– + – – – + – – – –

1 2 3 4 5 6 7 8 9 10

1 2 3 4 5 6 7 8 9 10

Minutes

Total: 60%

– + + + – + + – + –

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108 Chapter 4

had two very brief interactions with other children or spent a full 2 minutes interacting with them. Marc had interactions with other children in 6 out of the 10 intervals (60%) during the 11:30 a.m. free play.

If Ms. Wharton repeated this observation for a week, following implementation of an instructional strategy to increase interactions, she may still find no change in the data. However, it is possible that Marc is having a significantly greater number of interactions with his peers, but because the interactions were clustered within two or three of the intervals, the progress cannot be seen. In this case, the results of the interval recording may be misleading.

Data from the 11:30 a.m. free play show a higher percentage of peer interaction (60% of the intervals). Continued recording will reveal either that this is an unusual day or that it is typical for Marc to interact more with his peers during free play. Knowing this, Ms. Wharton can analyze that period to determine what variables might be contributing to the increased level of peer interaction. Comments on the data sheet suggest, for example, the possibility that when other students are loud, their noise may inhibit Marc from interacting with them. Ms. Wharton can now investigate fur- ther the role that noise plays in Marc’s peer interactions.

Selection of the appropriate interval method should be guided by the characteris- tics of the behavior and the goals of intervention. If the behavior is brief and the goal is to have the behavior occur on a consistent but not necessarily continuous basis (such as Marc’s interactions), the partial-interval method should be used or the behav- ior will not be detected (that is, it is not likely to occur continuously). Other behav- iors, such as attention to a task, appropriately occur in a more continuous manner. Such behaviors are best measured by the whole-interval strategy.

When measuring behaviors targeted for reduction, it is best to use the method that provides the most rigorous information. For example, if you were using the whole- interval method to record the extent of self-injurious behavior, the teacher would check the interval only if the self-injury occurs for the entire length of the interval. This would mean that it was possible for the data to reflect no occurrences when, in fact, the student engaged in extensive self-injury, but not continuous self-injury. In this situation, the partial-interval method would be more appropriate.

The length of the interval depends on both the behavior being observed (its aver- age length and frequency) and the observer’s ability to record the behavior. Interval length is usually measured in seconds (e.g., 5, 10, 30 seconds). The more frequent the behavior, the smaller the interval for observation should be so that the data yield a more accurate representation of behavior.

If large intervals (e.g., 15 minutes) were used with partial-interval recording to measure Christine’s frequent behavior of smiling, for example, 100% would be the typical result. In other words, it is almost certain that Christine would smile at least once during every 15-minute interval. This is not informative because it does not pro- vide information about the density of the behavior (e.g., whether Christine smiled 5 times or 150 times).

For behaviors that occur infrequently, the partial-interval method can have longer intervals. For example, because Jacob infrequently initiates interactions with his peers, observing for 30-second intervals makes no sense. It is not likely that Jacob will display the behavior within 30 seconds. However, if the interval is too large, any instance of the behavior can artificially inflate the percentage of intervals. Thus, if Jacob interacts only two times within an hour but the intervals are 30 minutes long, then, statistically, Jacob interacted for 100% of the intervals! This certainly does not reflect the quality of Jacob’s behavior. Five-minute intervals might be more appropriate.

Interval recording cannot be done casually, because a teacher’s total attention must be directed toward watching the student and timing the intervals during the entire observation period. The teacher must know when to move from one interval to the

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109Measuring Student Behavior and Learning

next. It can be challenging to teach and collect interval data at the same time (Alberto & Troutman, 2012). A timer of some type (e.g., stopwatch, iPhone) can be used to time the intervals, but checking the time interrupts the observer’s concentration; a portable tape recorder with a tape of prerecorded intervals and earplugs may elimi- nate this problem, although it is somewhat obvious. Teachers must be sensitive to the environment and should be as unobtrusive as possible. For example, it would be dis- tracting to have a beep sound every 10 seconds when observing Christine attending to her drama class.

time sampling Time sampling is a type of interval measure that can be used more practically in teaching settings. As in the whole- or partial-interval recording strategy, a specified observation period (e.g., 30 minutes) is divided into smaller units (e.g., 5-minute intervals). However, unlike interval recording, where a teacher observes the behav- ior throughout the entire interval, the teacher observes the student only at the end of the interval. Time sampling usually uses longer intervals (minutes) than does interval recording (seconds). The teacher records on the data sheet whether the student was engaging in the target behavior at the end of each interval. For exam- ple, Reinhartsen, Garfinkle, and Wolery (2002) investigated the effect of child choice of toys versus teacher choice of toys on the engaged and problem behaviors of three 2-year-old boys with autism in an inclusive preschool classroom. Using a time-sampling strategy, these researchers divided the play period into small inter- vals of time (30 seconds) and observed the children’s behaviors at the end of every 5 seconds. The researchers found that when children chose the toys to play with, there was an increase in engaged time and fewer problem behaviors for two of the three boys.

Implementation of time sampling can be done flexibly. Instead of continuously observing and recording at the end of each interval, the teacher can set up random intervals within an observation period. For example, the teacher may decide on an observation period of 1 hour and preselect six random times to observe (instead of exactly every 10 minutes).

It is also possible to use time sampling throughout the day and pre-identify obser- vation times. For example, Ms. Wharton could choose to use time sampling (instead of interval recording) to record Marc’s interactions with peers throughout the 3-hour day at school (e.g., free play, snack, lunch, circle time). This strategy is relevant if the goal is for Marc to increase interactions with his peers across many activities, not just during playtime.

Because time sampling does not require continuous observation, teaching and data collection can occur simultaneously (Alberto & Troutman, 2012). In addition, because the observation is so quick (e.g., whether the behavior was occurring or not occur- ring at that moment), teachers can use the strategy with more than one student at a time. For example, a teacher could record the on-task behavior of a group of students at the end of every 2-minute interval during independent seat work. Every 2 minutes, the teacher would look up and see which of the students were or were not engaged in their independent work (as previously defined by the teacher). She would record a plus (+) for those who were engaged and a minus (−) for those who were not engaged.

Like interval recording, however, time sampling provides only an estimate of the behavior. In fact, for low-frequency and short-duration behaviors, time sampling is even less accurate than interval recording. The less frequent or briefer a behavior, the shorter the interval must be. (Because a teacher is checking at the end of the interval only, he or she may miss the behavior if it does not occur frequently or if it is of short duration.) Thus, time sampling is most appropriate for measuring behaviors that occur frequently and are of long duration.

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orGanizinG student PerForManCe data

At this point, we have introduced you to the importance of measuring student behavior and to a variety of quantitative strategies to objectively record behavior. However, if these data are not organized and used, it will be the same as not collecting any data at all. The following section will provide examples of data sheets on which you can record data and then will instruct you on how to visually display, or graph, the data so that the team can understand each student’s progress on their IEP goals and objectives.

designing data sheets

Data sheets allow teachers to systematically record data from their observations (e.g., frequency data, task analytic data, interval data). It is important to record this infor- mation in a format that will promote subsequent data analysis. For example, some student performance data can provide information for error analyses (e.g., which steps of the task analysis are consistently missed; see Table 4–3), and most data can be converted into graphs for visual analysis.

The basic elements of a data sheet are (a) the student’s name; (b) the observer’s name; (c) the date, time, and location of the observation; (d) the length of the obser- vation; (e) the behavior(s) observed and, if necessary, a brief observable description of each; (f ) adequate space for data recording (e.g., room for a 15-step task analysis or ten 2-minute intervals); (g) a scoring code; (h) a data summary; and (i) comments (see Figure 4–1 and Tables 4–3 and 4–4). In addition to providing the range of infor- mation necessary to make effective instructional decisions, a data sheet can also assist in functional behavioral assessment (Lohrmann & Brown, 2006) (see Chapter 7 for a discussion of functional behavioral assessment). For example, for the time-sampling procedure used to measure Marc’s interactions with his peers throughout the day, his teacher could specify the time of day and the activity in which the data were meas- ured. With this type of information, it is possible to analyze the events or variables (e.g., activities, the time of day, different peers, materials) contributing to the pres- ence or absence of peer interaction. Adding an extra column on the data sheet for recording the incidence of any inappropriate behavior may enable the teacher to see a trend in the relationship between an inappropriate behavior and the time of day or the type of activity.

Graphing your data

Analysis of information on a data sheet may provide important details about perfor- mance during an instructional session (e.g., specific steps performed correctly or missed on a task analysis, number of interactions at the beginning versus the end of free play). However, significant limitations are encountered if such data are left in this raw form. For example, it is difficult to interpret or analyze behavioral data from a data sheet alone, especially when weeks of data are considered. Behavioral data can be most effectively interpreted and analyzed when they are graphed. Furthermore, graphing data soon after the observation period provides the teacher with immediate feedback regarding performance (Cooper, Heron, & Heward, 2007). Graphs allow teachers to more easily detect trends in a student’s progress and thus to make more effective program decisions. When trends are positive, many teachers also find that graphs are reinforcing because they are a continual source of feedback.

Although some teachers initially feel apprehensive or intimidated by graphs, most soon discover that graphs are actually simple to design and read (Hojnoski, Gischlar, & Missall, 2009). A graph is made up of two axes (see Figure 4–2). The abscissa, or the x-axis, is the horizontal line. The abscissa usually represents the time frame of a measurement (e.g., each data point reflects the data from a day, week, or month). The ordinate, or the y-axis, is the vertical line. It is labeled with the target behavior

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111Measuring Student Behavior and Learning

(i.e., dependent variable) being measured (e.g., peer interaction, words read) and the measurement that was used (e.g., duration, frequency, percentage of intervals). For example, on a graph of Marc’s interval data for interactions with his peers, his teacher might label the abscissa as “school dates” and the ordinate as “the percentage of 1-minute intervals of interaction with peers.”

Converting data Before any points can be plotted on the graph, data must be converted into a single numeric form for each data point. Frequency data can be tallied and presented as the total number in a given period (e.g., the number of times that Marc correctly looked at the named peers during the morning group). Total duration data may be presented as the total number of seconds or minutes during which a behavior occurred within a given period (e.g., the number of minutes spent engaged in a 15-minute leisure activity). Duration data that are collected using the method of measuring each occur- rence can be presented as a duration (the number of minutes spent interacting with peers during morning free play) or as a frequency (the number of peer interactions during morning free play), or both ways if the teacher thinks that such a presentation would be helpful. Interval or time-sampling data can be converted into the number or percentage of intervals in which the behavior occurred.

Converting task analytic data, which involves multiple steps and may have a range of scoring codes, is a little more complex. There are a number of ways to summarize the data. First, a common approach is to summarize data as the number of steps that the student performed independently out of the total number of steps. Then, these data can be converted to the percentage of total steps performed independently. For example, if the student independently performed 3 out of 10 steps on a task analysis, a 30% would be graphed. A second way to summarize the data is to calculate the amount of assistance required to complete the task analysis and convert it into a per- centage of independence. For example, in Jacob’s 20-step task analysis for making a peanut butter sandwich (see Table 4–3), data are recorded on if he did each step independently (record a 3), or required a verbal prompt (a 2 is recorded), a model (a 1 is recorded), or did not complete the step (a 0 is recorded). The steps for converting Jacob’s task analytic data into a single numeric form for graphic presentation are as follows:

1. Determine the most points that Jacob can earn during each session: The teacher multiplies the number of steps in the task analysis (20) by the number of points possible in each step (3) for a total of 60 possible points that can be earned.

2. Add the number of points earned in the session: Jacob scored a total of 36 points (out of a possible 60) on September 6.

FIguRe 4–2 Basic Components of a Graph

(y-axis or ordinate)

B eh

av io

r m

ea su

re m

en t

Time measurement

(x-axis or abscissa)

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112 Chapter 4

3. Calculate the percentage: Divide the number of points earned (36) by the total number of points possible (60) to calculate the performance percentage (in this case, 60%).

4. Plot the data: Plot the performance percentage (e.g., 60%) on the graph.

setting up a Graph Once raw data have been converted into a single number to be graphed, it is easy to plot the data point. First, be sure to label the ordinate or vertical line (the y-axis) with the behavior being measured and the type of measurement being used (e.g., percent- age of independent vacuuming, number of verbalizations during lunch). Next, divide the ordinate into equal intervals that cover the possible range of data (e.g., 0% to 100%, 0 to 50). If there are no definite upper and lower limits, the range should extend from the baseline level to the target level, with some extra space added at both ends to allow for variability.

Data points within each phase of a program (e.g., baseline, intervention, reinforcer change) are connected by straight lines, but they should not be connected across the vertical lines that indicate a phase change (e.g., the change from the baseline to the intervention phase). Each program phase is separated by a broken vertical line and should be labeled at the top of the graph to indicate the intervention used (e.g., base- line, picture prompting, peer model). Data points that represent probe data should be distinct from data points that represent teaching data because the conditions are very different. For example, a teacher might use open data points for the probe data and closed data points for training data. To enhance the effectiveness of a graph for data analysis, date the graph along the abscissa (x-axis) using the same time intervals as the data are being recorded (e.g., daily, weekly, monthly). Figure 4–3 lists every week for 3 months because probe data will be recorded for making a peanut butter sand- wich on a weekly basis. It is important to delineate the dates before recording to allow automatic skipping of spaces for missing sessions. Because missed sessions can have a detrimental effect on a student’s performance, it is important to be able to see these gaps in time. Note that no data are recorded for September 20 in Figure 4–3. Jacob’s teacher should investigate the reason for the absence of data collection and the effect of this absence on his performance.

Plotting data Points Figure 4–3 shows 4 days of probe data taken from Jacob’s data sheet. To plot data, place each data point (i.e., the total for the session) at the intersection of the session date (on the abscissa) and the level of performance (on the ordinate). Note the space between the dates of September 13 and September 27; it is best to skip the space to

FIguRe 4–3 Four Days of Graphed Probe Data for Jacob Making a Peanut Butter Sandwich

P er

ce nt

ag e

of in

de pe

nd en

ce

Intervention

Weekly data

100

90

80

70

60

50

40

30

20

10

0 9/6 9/13 9/20 9/27 10/4 10/11 10/18 10/25 11/1 11/8 11/15 11/22 11/29

Base-line

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113Measuring Student Behavior and Learning

indicate the missed session. However, all consecutive sessions in a given phase (according to the scheduled plan of intervention) are connected.

Many teachers find it useful to distinguish between graphs that reflect behavior targeted for acceleration versus graphs that reflect behavior targeted for deceleration. To distinguish between these behaviors, some teachers use a dot to represent accel- eration data and an X for deceleration data. This strategy makes successful and unsuc- cessful trends even more obvious during data analysis. It also allows two related data paths to be plotted on the same graph. Figure 4–4 shows a graph for Marc that uses dots for acceleration data (the percentage of intervals with the appropriate peer inter- actions during free play) and Xs for deceleration data (the number of times that he grabbed toys from peers). Note that Figure 4–4 uses two ordinates to identify the two targeted behaviors (i.e., peer interactions and the frequency of grabbing) with the two different measurement strategies (i.e., percentage and frequency). Figure 4–4 reflects a successful program. That is, the appropriate behavior (peer interactions) shows an increasing trend and the inappropriate behavior (grabbing) shows a decel- erative trend.

Computer-Generated Graphs

Computer-generated graphs have a variety of advantages, including easy storage of data, analysis capabilities, dissemination capabilities (although this can also be a potential danger because of privacy and confidentiality), and professional presenta- tions of data at team meetings. More and more teachers and other professionals are using computers to generate their graphs instead of using a pencil and paper. Hojnoski, Gischlar, and Missall (2009) describe (in a nine-step task analysis) how to use Microsoft® Excel® 1997 to create line graphs. Tutorials for generating computer graphs are readily available online, including how to chart single-subject designs.

using self-Graphing data sheets Some teachers find that it is efficient to combine the data recording sheet and the graph. This has been done to measure prompting levels (Alberto & Schofield, 1979), task sequences (Holvoet, Guess, Mulligan, & Brown, 1980), and task analysis ( Bellamy, Horner, & Inman, 1979). Plotting data from a task analysis in this manner has been referred to as an upside-down or self-graphing format (Test & Spooner, 1996). Figure 4–5 is a self-graphing data sheet for recording progress on hair brushing.

A self-graphing data sheet can be used to record data by making a slash ( / ) through the step number if the student responds independently and an X through the step number if the student needs assistance to complete the step. At the end of the

FIguRe 4–4 Use of Graph to Show Marc’s Progress and Program Changes During Free Play

P er

ce nt

ag e

of in

te rv

al s

w ith

ap pr

op ria

te p

ee r

in te

ra ct

io ns

d ur

in g

9: 30

fr ee

p la

y

# of tim es grabbed toys

from peers

100 Baseline Provide toys and praise Reduce praise

90

80

70

60

50

40

30

20

10

0

10

9

8

7

6

5

4

3

2

1

11 /1

11 /2

11 /3

11 /4

11 /5

11 /6

11 /7

11 /8

11 /9

11 /1

0

11 /1

1

11 /1

2

11 /1

3

11 /1

4

11 /1

5

11 /1

6

11 /1

7

11 /1

8

11 /1

9

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114 Chapter 4

session, add the number of slashes and then circle the number correct for the day. A graph is formed by connecting the circles over a number of days.

saving ungraphed data

When raw, or ungraphed, data of performance on a multiple-stepped task are sum- marized and graphed, a certain amount of information is lost. For example, teachers who look at a graph on the accuracy of Jacob’s sandwich-making would know about his overall progress on the task across sessions, but they would not know the specific information available on his data sheet, such as which steps he missed or did cor- rectly on a given day or if these missed or correct steps were consistent across days.

Teachers should preserve ungraphed data because response-by-response informa- tion may help them make decisions about program implementation when progress is poor. Even with non–task analytic or discrete data (e.g., the number of correct greet- ings made by Marc at school), graphed summaries lose some of the information that can be preserved on the data collection sheets. For example, Marc’s teacher analyzed the ungraphed data to determine whether his performance is better in the early part of the morning or in the later part of his school day, or if he greeted certain peers or adults more frequently than others.

Frequency of data Collection

Early in the development of current data-based teaching models, it was fairly com- mon to hear the advice that data should be collected each time an instructional activ- ity was implemented. In fact, data collection practices that were recommended for teachers were similar to those used by researchers. Although this may now sound excessive, it was an important phase, as it afforded educators additional understand- ing of the learning process of students with severe disabilities and increased knowl- edge of data analysis and evaluation. As educational strategies have become more integrated and community based, data collection procedures have also changed to

FIguRe 4–5 Self-Graphing Data Sheet for Hair Brushing

Teacher: Ms. Fuentes

Key: = independent = needs assistance

Task analysis

Student: JacobProgram: Brush hair

11. Put brush away

10. Check hair for neatness

9. Brush left back of head

8. Brush left side of head

7. Brush front

6. Brush right side of head

5. Brush right back of head

4. Pick up brush

3. Select desired materials

2. Locate brushing materials

1. Initiate brushing

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115Measuring Student Behavior and Learning

better fit these settings (Test & Spooner, 1996). In contexts where teachers of non- disabled peers are not recording data, conspicuous data collection procedures do not enhance an integrated view of a student with severe disabilities. Measures that are most appropriate for inclusive community settings are ones that do not interrupt instruction, take minimal time to complete, are unobtrusive and do not stigmatize the individual, and provide both objective and subjective observations.

Just how often a teacher should take data is a subject of great debate. A teacher may find a wide variety of suggestions when reading the literature (e.g., collect data once each day, every time the skill is practiced, or once a week). For example, a teacher can collect trial-by-trial data or collect probe data, and the teacher may not be the only one collecting data (Alberto & Troutman, 2012). Most discussions of the fre- quency of data collection, however, suggest that once a skill is fluently performed by the student, data collection could be reduced (Farlow & Snell, 2005).

Although there are still no definitive answers to the question of exactly how much data are needed to make accurate instructional decisions, the following guidelines can assist teachers in deciding how frequently to collect data (Browder, 1991; Brown, 1991; Farlow & Snell, 1994; Snell & Lloyd, 1991):

• Higher priority objectives (i.e., those related to the health and safety of the indi- vidual or others) warrant daily data collection. Daily data collection not only is more sensitive to changes in the trend but also contributes to an important func- tional assessment of the behavior.

• Lower priority objectives, or objectives that are scheduled for instruction on a less- than-daily basis (e.g., grocery shopping), may be evaluated less frequently (e.g., once every one or two weeks).

• Implementation of a new program requires frequent data collection. For the first two weeks of the instructional program, data could be collected daily or at every teaching session if the lessons are not held at least once a day. When the student has shown steady progress (e.g., two weeks of data), data collection could be reduced to weekly.

• Skills being taught to replace problem behaviors can be measured in the same way as any other new program (e.g., initially, data are collected daily; then, following progress, collection is reduced to weekly); however, these probes should be car- ried out in the context of relevant situations, persons, and environments.

• Data that show progress as planned, with a clear accelerating trend, may be evalu- ated less frequently, such as on a weekly basis.

• Data that do not show progress as planned or that are variable warrant evaluation on a continual basis, minimally twice a week and ideally on a daily basis.

• Anecdotal records or logs can be used once or twice weekly to record general information concerning a student’s overall daily performance and to systematically assess responses to program efforts and any conditions that might affect a student’s learning (e.g., tasks or activities that the student enjoys, tasks or activities that the student does not enjoy). Such logs may be useful supplements to more precise, quantified data.

data analysis For Better deCision-MakinG

Team members can learn a lot from their graphed data. However, teams need to make sure that the data they collect are accurate. Only if data are accurate can the team be confident that data analysis will help improve the educational program. The remainder of this chapter discusses the importance of accurate data, the use of differ- ent types of data, and then provides strategies for analyzing classroom data and ways in which this information can most effectively help educators make instructional decisions.

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116 Chapter 4

Measures of accuracy

Because important decisions are made on the basis of data, team members must have confidence in the data they collect. Consider the following example where the relation- ship between accurate data collection and effective program evaluation is obvious.

Data recorded by Jacob’s teaching assistant indicate that he can prepare his snack with only two verbal prompts. However, when his teacher assists Jacob in this activity, she finds that Jacob needs not only significant verbal prompts but also gestural cues. The discrepancy in these data may be because Jacob is not accustomed to preparing his snack with his teacher. If this is the case, then certain programmatic changes can help Jacob generalize his snack preparation skills in the presence of others. However, it is also possible that someone is not recording Jacob’s data accurately. If this is the case, changes focusing on generalization would not be appropriate. Efforts should instead focus on increasing the accuracy and reliability of the data collection.

interobserver (or interrater) reliability Interobserver reliability is assessed to determine whether the target behavior is being recorded accurately and is the most commonly used indicator of measurement quality in applied behavior analysis (Cooper, Heron, & Heward, 2007). One way to ensure that data are accurate or reliable is to have two independent observers record the behavior of a student at the same time, compare the two observations, and mathemat- ically determine the extent of agreement of the data. The percentage of interobserver reliability can be calculated by dividing the number of agreements between the two observers by the number of agreements plus disagreements and multiplying by 100. The result of this calculation is a percentage of agreement:

Agreements Percentage of = Agreements Agreements + Disagreements

For example, two teachers use a partial-interval recording to observe the presence of a specified behavior. A 5-minute observation period is divided into ten 30-second intervals. Each time that they observe the target behavior, they record an X in the cor- rect cell. The results of the observation are as follows:

30-second intervals 1 2 3 4 5 6 7 8 9 10

Teacher 1 X X — X — X — X X —

Teacher 2 X X X X — X — X X —

According to this formula, the reliability between the two teachers is as follows:

9 agreements 9 =

9 agreements + 1 disagreement 10 = 90% agreement

Generally, a reliability coefficient of 0.80, or 80%, is considered to be acceptable. Poor interrater reliability should prompt the team to improve agreement among its members in ways such as clarifying the behavioral definition of the behavior being observed, offering further training for the staff collecting the data, or simplifying the observational system (Schloss & Smith, 1998).

Procedural reliability Procedural reliability (also referred to as treatment integrity, treatment fidelity, and fidelity of intervention) is the degree to which program procedures are implemented accurately. Procedural reliability asks this question: Did the educator follow the instructional plan? If we do not assess the accuracy of the implementation of a

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117Measuring Student Behavior and Learning

program and a student is not experiencing success, then we could not determine whether it was actually the intervention that was ineffective (Hojnoski, Gischlar, & Missall, 2009; Lane & Beebe-Frankenberger, 2004). Additionally, with the increased number of individuals working with students in inclusive settings (special educator, general educator, paraprofessional), as well as with the varied individuals providing support in inter- and trans-disciplinary service delivery approaches, procedural relia- bility becomes critical. In an extensive discussion of procedural reliability, Billingsley, White, and Munson (1980) point out that all relevant variables in a program must be evaluated. Program components such as delivery of reinforcers, use of prompts, pro- gram setup, antecedent events, and consequent events should be examined. A behav- ioral checklist for each intervention procedure can be designed, and the teacher can check off each component used (Kerr & Nelson, 2009). Lane and Beebe-Frankenberger (2004) suggest designing checklists for the specific instructional components expected to be implemented by the educator. This checklist would then be used to assess whether the procedure was being followed. The following are some specific ques- tions to consider when assessing procedural reliability:

• Is the instructional plan implemented as frequently as planned? • Does the instructor use the correct sequence and timing of instructional prompts? • Does the instructor deliver the appropriate consequences? • Are instructional cues delivered in the manner designated in the program plan? • Were all of the necessary instructional materials available? • Was the program implemented in the correct environment?

Procedural reliability can be calculated in much the same way as interobserver reli- ability. Billingsley, White, and Munson (1980) offer the following formula:

(TA × 100) Procedural reliability (%) = TT

In this formula, TA is the number of teacher behaviors in accordance with the pro- gram plan, and TT is the total number of teacher behaviors that could have been per- formed in accordance with the program plan. As an example, Christine was supposed to participate in the library with her nondisabled peers eight times each month (twice each week) but participated only six times last month. Applying this formula to the intervention frequency gives the procedural reliability:

6 × 100 Procedural reliability (%) = = 75% 8

Teams must feel confident that instruction is having the desired effect on student performance. It is also helpful to know that an intervention is responsible for the change in the student’s performance, not just the passage of time or some other event. Sometimes simple, single-subject designs (e.g., reversal, changing criterion) can help teachers feel more confident about the effect of their instruction or the impact of various changes on the educational environment.

Jacob’s parents informed his teacher that he was going to be placed on a new medica- tion for a few weeks and that she should be observant to determine whether she noticed any changes in Jacob’s on-task behavior. Ms. Fuentes decided to draw a vertical change line on his “on-task” graph to mark the beginning of the medication. At the end of three weeks, Ms. Fuentes was informed that they would be discontinuing the medication; she then drew another vertical line to indicate the discontinuation of the medication. At this point, Ms. Fuentes was able to inform the team that during the time that he was tak- ing the medication, Jacob’s on-task behavior improved and that when it was discontin- ued, the behavior returned to premedication levels. The physician represcribed the medication, and Ms. Fuentes drew another change line and, within a week, saw that the on-task behavior once again increased.

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118 Chapter 4

Ms. Fuentes used what is called an ABAB, or reversal design (where A is the nota- tion for baseline, and B is the notation for intervention), to monitor the changes in Jacob’s behavior as a result of the changes in his medication regime made by his fam- ily and doctor. After seeing an initial increase in the behavior following the medica- tion, Ms. Fuentes was not confident that it was actually the medication that was responsible for the change in behavior. After all, at around the same time, she added more picture cues to his instruction; perhaps it was the picture cues that helped Jacob stay on task. However, because the behavior decreased each time that the medication was withdrawn and increased each time that it was prescribed, Ms. Fuentes and the team were more confident that the medication was, at least in part, responsible for the change in Jacob’s on-task behavior.

Although an in-depth discussion of single-subject experimental designs (e.g., rever- sal, multiple baseline, changing criterion) is not possible in this text, we recommend further reading in this area. There are a number of texts that provide comprehensive reviews of single-subject designs (e.g., Alberto & Troutman, 2012; Cooper, Heron, & Heward, 2007; Kennedy, 2005; Kerr & Nelson, 2009; Maag, 2003; Miltenberger, 2008; Zirpoli, 2012). We will limit our later discussion to the simplest classroom design that is non-experimental in nature (i.e., the baseline–intervention, or AB, design).

types of data

There are many sources of information that are available to teachers that will help them determine whether students are benefiting from instructional programs. For example, anecdotal records that teachers maintain can be a useful supplement to the quantitative data that is the focus of this chapter. These records may include staff notes on unusually excellent or unusually poor student performance, or comments sent by the teacher to the home, or from the family to the school. Different levels of quantitative evaluation can occur for each objective identified on an IEP. Test condi- tions and training conditions provide two contexts for obtaining valuable data ( Farlow & Snell, 1994).

Probes or testing data Testing or probing means that a person’s performance is checked under criterion con- ditions (i.e., conditions that as closely as possible use natural contexts, cues, and con- sequences); that is, those conditions under which we ultimately want the behavior to be performed. Thus, the teacher typically provides no prompting or teaching assis- tance, no reinforcement for task success or improvement, and no corrections. The goal of testing is to learn about a student’s current performance under criterion condi- tions (specified in the objective), not to teach the student. Because students are not being instructed when they are tested, we try to limit the frequency, but testing must be done as frequently as needed to get an accurate picture of the student’s perfor- mance under criterion conditions.

teaching data In contrast, teaching data can be recorded whenever the student is taught, or as described above, less often in certain circumstances (e.g., low-priority objective). Under teaching conditions, data are recorded while a student is being taught (e.g., least-to-most prompting, reinforcement, error corrections). Learning is the goal of teaching, so conditions are planned to promote improvement in performance and to advance the student through the various stages of learning.

Because of the absence of prompts and reinforcement during probes, a student’s performance is typically less proficient than under teaching conditions. Probe data thus represent conservative measures of learning but may more accurately represent a student’s performance in natural, unaided situations. Probe data taken for a skill before a teaching program is initiated are called baseline data.

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119Measuring Student Behavior and Learning

When Christine was first learning how to use her communication board to greet the cashier in the grocery store, her teacher initially tested her at the grocery store (i.e., she was given a baseline probe, or test). Probe data showed that Christine was unable to activate the correct greeting symbol. Instruction was implemented to teach her this skill during daily sessions at school in which her teacher recorded her performance during instruction (teaching data). When Christine went to the grocery store, her teacher again recorded probe data to determine how she was performing the skill in the natural con- text. When Christine performed some, but not all, of the steps, her teacher noted this and then immediately began teaching to prevent any more difficulty.

obtaining a Baseline

In order to objectively determine whether a student is progressing with regard to a particular objective, we must first know what the student’s skills were prior to our intervention. This is done by conducting a baseline measurement. The baseline is the period when no intervention or teaching is occurring. Baseline data measure the behavior (the dependent variable) before intervention (the independent variable) is initiated. In other words, the baseline phase of measurement describes a student’s performance under the naturally occurring conditions in his or her environment with- out instructional manipulation.

Ms. Wharton used interval recording to measure Marc’s interactions with his classmates during two unstructured periods for three days (Figure 4–1 shows the recording on one day). Because Ms. Wharton observed Marc under natural conditions, without interven- ing in any way, these three days are considered to be a baseline. After implementation of an intervention program to increase Marc’s interactions with his classmates, Ms. Wharton will compare the baseline data with the intervention data to determine whether there was an increase in peer interactions. Ms. Wharton was particularly interested in the effect of the intervention on Marc’s behavior during the 9:30 a.m. free play.

A teacher should be cautious about how long a baseline condition is in effect. Gen- erally, the rule is to continue baseline measurement until there is a stable trend in the data. It is considered unethical, however, to continue a baseline measurement in cer- tain situations. First, if a behavior is dangerous, it is unacceptable to wait for a stable trend before beginning treatment. Many times, a teacher can find other forms of data to use as a baseline (e.g., incident reports, daily logs). Second, many students have little or no behavioral activity related to the target objective (e.g., sign language for a student who has never used sign language). Again, it is considered unethical to delay instruction for an extended period of time when a student clearly cannot perform the behavior. Teachers must remember that the baseline does not refer to the absence of a program or to downtime; instead, the baseline refers to the educational context before a given program is implemented or the time when a particular program is withdrawn or stopped. Third, if the direction of the baseline trend is opposite to the direction of the desired trend (e.g., the number of peer interactions are decreasing, or aggression is increasing), collection of baseline data should be discontinued and inter- vention initiated. When this type of trend occurs, something in the baseline condition is either extinguishing the behavior (e.g., the absence of intermittent teacher praise for playing with others was once reinforced and was withdrawn during the baseline period) or reinforcing the behavior (e.g., a lack of teacher-implemented consequences for aggressive behavior allows the student to get attention from the other students).

Baseline–intervention Comparison

Comparing a baseline condition (A) with an intervention condition (B) is called an AB, or baseline–intervention, design. This design is referred to as a non-experimental design because no conclusive demonstration of a cause–effect, or functional, relationship between the intervention and the observed changes in behavior is possible. These

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120 Chapter 4

data do not rule out the possibility of other variables being responsible for the change in behavior (Cooper, Heron, & Heward, 2007). Because there is no withdrawal of the intervention or replication of treatment effects, rival hypotheses based on factors that are not controlled by the teacher may have caused the changes in the behavior (e.g., the student may have matured over time, a new medication was administered, a par- ent has been working on the skill at home).

Marc’s teachers decided to implement an intervention to increase his interactions dur- ing the 9:30 a.m. free play. Intervention consisted of seating Marc in proximity to two of his outgoing, friendly classmates, Sam and Mario, and praising the students for all in- teractions. Marc’s interactions with his peers increased. However, Ms. Wharton won- dered whether it was the new intervention (i.e., praise and environmental manipulation) that increased the peer interaction or if, perhaps, it might be the new action figures that Sam was bringing to school.

Given the lack of experimental control, the AB design is not con- sidered acceptable for experimental research, but it is appropriate for monitoring student performance within teaching settings, par- ticularly when proven teaching strategies are used. Sometimes, however, it is possible for teams to use a reversal design (ABAB), as described earlier when Jacob’s teacher had the opportunity to assess his behavior under medication and without medication.

When teams are familiar with a student’s typical learning pat- terns and are aware of various events that affect performance, they can usually judge treatment effects with a considerable degree of certainty. Because student performance is monitored before teach- ing occurs (during the baseline phase) and during different phases of teaching, the AB design provides an objective (although not sci- entifically conclusive) description of a student’s behavior before, during, and after teaching.

If a student’s performance during the baseline phase progresses in the same direction as is expected during the intervention, teach- ers have difficulty interpreting the intervention data. That is, unless the intervention has a great effect, it is difficult to judge whether the change in the data (from the baseline phase to the intervention phase) is the result of the intervention or simply a continuation of the trend seen during the baseline phase. Because of this difficulty, teachers typically wait until the baseline performance is relatively stable before starting intervention; however, in some instances, as discussed previously (e.g., dangerous behavior), teachers may not wait for a stable baseline or may not take a baseline measurement at all before beginning intervention.

An AB design is shown in Figure 4–6. This example shows an increase in Christine’s engagement during drama club after interven- tion. Intervention consisted of having her sit closer to peers, having the teaching assistant move to the back of the room to do paperwork, teaching her peers how to communicate with her, and programming her communication device with vocabulary suited to the class.

Graphing Conventions

As described earlier, the main purpose of converting raw data to graphs is to provide a visual summary of the student’s performance and progress. These interpretations guide program modification. The ability to accurately interpret graphs is enhanced by the use of certain graphing conventions. Four major graphing conventions are shown in Figure 4–4:

FIguRe 4–6 An AB Design for Evaluating the Effects of Intervention on Christine’s Engage- ment During Drama Club (with and With- out a Mean Line)

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121Measuring Student Behavior and Learning

• Broken vertical lines, or phase changes, represent changes in the instructional pro- gram. These can include planned programmatic changes (e.g., a change from base- line to intervention measurement, a modification of the task analysis or materials, a change in the time or setting of the instruction, or a change in the reinforcement or prompt). Broken vertical lines can also be used to indicate situations or events that might indirectly or incidentally affect the student’s performance. These events in- clude, for example, changes in medication, staff changes, or a new student joining the class.

• Broken horizontal lines (criteria lines) can be used to indicate the criterion for the program, in other words, what level of performance is considered successful. This criterion should match the criterion stated in the behavioral objective of the pro- gram. Seeing this line on the graph gives the team a quick visual reminder of what the goal of the program is and where the student is in relation to the goal.

• Connect data points only for consecutive days within a phase. Data points should not be connected across phase change lines or across missed data days (e.g., a stu- dent absence, a missed session, holiday break). This allows a clear picture of the effect of the program change but also allows the team to note the gaps in instruc- tional opportunities and its effect on performance.

• Show the expected trend. Teams can quickly note whether a graph represents a suc- cessful or an unsuccessful program effort by using an X to represent behavior that is to be decreased and dots to represent skill-building. This graphing convention also allows multiple data paths on one graph (e.g., increasing toy play and decreas- ing self-stimulatory behavior during free play).

Marc’s teacher graphed his progress in increasing peer interactions during his 9:30 a.m. free play. Ms. Wharton decided that it would be helpful not just to note his progress for this social interaction skill, but also to analyze the impact of the intervention on Marc’s behavior of grabbing toys from his peers. She drew a criterion line across the graph at 70% because the objective was to have Marc engage in appropriate peer interactions for 70% of the intervals during the free play (this percentage was based on her observations of other children in the class playing together). When Marc reached the criterion level for peer interactions and there was also a significant decrease in his grabbing of toys, Ms. Wharton decided that she should reduce the amount of praise she was giving to Marc and his peers so that it would be more typical of the frequency of praise she pro- vided to other children in the class. To indicate this program change, she drew a broken vertical line on the graph. She was happy to note that the appropriate peer interactions remained high and that the grabbing behavior remained at zero (see Figure 4–4).

visual analysis

Visual inspection of a graph is the most frequently used strategy to evaluate the effects of classroom data (Alberto & Troutman, 2012; Hojnoski, Gischlar, & Missall, 2009). That is, certain characteristics and comparisons of the data paths (e.g., data from the baseline compared with data from the first phase of instruction) are exam- ined to judge the effectiveness of the instructional strategy. Sometimes, the effects of a program are so strong that the impact is obvious by just looking at the graph. In these situations, when the graph itself lets you know all that you need to know, you are using visual analysis. For example, the top panel of Figure 4–6 shows a very dis- tinct difference between the baseline and the intervention. It is easy to see on this graph a positive change both in the trend (an accelerating data path) and the level of change (performance of 10% and 20% during baseline, which then jumped to 40% and higher during intervention). As described above, however, an AB design is not an experimental design, and it is possible that confounding variables may be contribut- ing to the change in behavior.

However, when such strong changes in behavior are not so obvious, teachers and researchers often find that their efforts in analyzing the trends on a graph are aided by several simple visual aids—mean line, aim line, and trend line.

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122 Chapter 4

Mean lines An easy visual addition to a graph to help analyze intervention effects is looking at the mean (i.e., the average) of each phase and comparing these lines. This can be done by calculating the mean of the data points in each phase and drawing a horizon- tal broken line that corresponds to that value on the ordinate scale (Alberto & Troutman, 2012). For example, we could calculate the average of the baseline for Figure 4–6 in the following manner:

1. Add the baseline data point values:

10% + 20% + 10% = 40%

2. Divide the total by the number of days:

40% = 13.3%

3

3. Draw a horizontal broken line across the baseline phase at 13%.

The same would be done for the intervention:

1. Add the intervention data point values:

40% + 40% + 40% + 60% + 60% + 70% + 70% = 380%

2. Divide the total by the number of days:

380% = 54.28%

7

3. Draw a horizontal broken line across the intervention phase at 54%.

The bottom panel of Figure 4–6 shows the difference in the two horizontal lines and is an additional visual representation of the success of the intervention. Mean lines can be particularly helpful in detecting change when the difference in the levels of behavior between phases is obvious.

aim lines The aim line is a more sophisticated version of the criterion line that is calculated from a student’s data collected during the baseline assessment or after several days of training. Usually, the aim line starts at the initial performance level of the student when you begin instruction and extends over the instructional period to the criterion level and date that you have set in the instructional objective (Farlow & Snell, 2005). This progress-monitoring visual aid is drawn onto a graph early in a program and allows the team to compare actual progress to their expectations for progress. Although they might look quite complicated, aim lines are simple to draw and easy to interpret. Aim lines result from connecting two points made by (a) the intersection of the mid-date and the mid-performance of the first three training days (or the last three baseline days) and (b) the intersection of the criterion performance with the goal date of accomplishment (i.e., the aim date).

In March, Jacob’s team was concerned about his organizational skills and how they would affect him in fifth grade when following the schedule was even more important. Specifically, they wanted him to learn a four-step task analysis for following his sched- ule: (a) Look at his schedule and state the next activity, (b) gather the needed materials, (c) go to the appropriate location and participate, and (d) leave when done and return to his classroom. First, the team revised his schedule so that it reflected the 15 activities that he needed to do each day, including two bathroom breaks so that he would not skip going, which had resulted in accidents. Then, Ms. Bowers met with him and showed him the plan for the revised schedule to determine the changes that he might suggest. Jacob wanted the schedule to fit into his notebook and not be so obvious to his

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123Measuring Student Behavior and Learning

classmates, and he did not want VELCRO® symbols because they were too “noisy,” but he agreed that the new schedule would help him remember. The final version of his schedule consisted of 15 small picture/word symbols that were slipped into clear plastic pockets from left to right and top to bottom on one page. This way, the schedule symbols could be adjusted during his check-in each morning, if necessary. Then the team devel- oped a teaching program and a data collection sheet and schedule (see Figure 4–7). Prior to recording the baseline data, Ms. Bowers gave Jacob the new schedule and vari- ous staff members (depending on where he was) recorded his performance over three days, withholding all prompts. The team wanted to determine whether the schedule alone would be enough. On his first day of the baseline period (see Figure 4–7), he used his schedule independently for 8 out of the 15 activities, which indicated that he needed instruction in addition to the schedule.

Student Name: Jacob

Days: Daily

Settings: Classroom, hallways, playground, lunchroom, gym, music room, computer lab, resource room, library

Instructional Cue: “Jacob, check your schedule.”

Latency: 5 seconds (probes and teaching)

Baseline/Probe Method: Multiple opportunity task analytic assessment; don’t repeat cue

Probe Schedule: Every Wednesday

Teaching Method: System of Least Prompts: verbal; verbal + gestural; verbal + physical Recording Key:

Probe codes: independent on all steps, – incorrect/no response on one or more steps

Teach codes: + Attended to activity with prompting or independently (some of 4 steps needed prompting, some independent) - Needed prompts on all steps

Materials: Visual schedule in his notebook, academic materials for scheduled activity in desk, classroom, or backpack

Objective: Jacob will use his schedule, identify the activity, get the needed materials, go to the activity and participate, and leave the activity when it is finished for all 15 daily activities

Date: 23 March baseline

Staff: MM

1. Look at schedule, name activity. - - - - - -

2. Get any needed materials. - - - - - - -

3. Go to activity. - - - - - -

4. Leave activity, return to class. - - - - - -

Summary score: 8/15 = 53% - - - - - - -

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S pe

ci al

ty **

R ec

es s

R es

tr oo

m

M at

h

Lu nc

h

S ci

en ce

/S oc

ia l S

tu di

es

W rit

er s’

W or

ks ho

p

S ha

re d

R ea

di ng

R es

tr oo

m

C he

ck -o

ut

D ep

ar tu

re

*Resource Room

Note: **Monday: Music; Tuesday and Thursday: P.E.; Wednesday: Library; Friday: Computer

Credit is given to Mandy McKee for this adaptation of her instructional program.

FIguRe 4–7 Jacob’s Schedule Use Program and Data Collection Sheet

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124 Chapter 4

Table 4–5 shows Jacob’s data for the entire program. Gray lines are probes, while unshaded lines are training data. Figure 4–8 shows a graph of these data. Jacob’s teachers drew an aim line on the graph at the beginning of his program for the pur- pose of guiding their judgments about his progress. Look at the aim line in the graph and let’s review how his teachers drew it on the graph.

Jacob’s first three teaching data points in Table 4–5 show that he scored 50%, 60%, and 73%, respectively, during the first 3 days of teaching (March 26, 27, and 30); this was a gradual improvement over his baseline performance.

Ms. Fuentes, Jacob’s special education teacher, was in charge of entering the data onto a graph for the team. After the first three training data points had been graphed, she drew the aim line. She began by setting the anchor (beginning point) for the aim line at the intersection of the second day of teaching, or mid-date (March 27), and his mid- performance, which was 60% (i.e., the middle value of the three percentages). The aim line endpoint was set at the intersection of the criterion performance that was expected

TABLe 4–5 Data for Jacob’s Program for Using a Schedule

Note: Credit is given to Mandy McKee for this adaptation of her instructional program.

D at

e

A rr

iv al

, C h

ec k-

In

M o

rn in

g W

o rk

L an

g u

ag e

A rt

s

g u

id ed

S p

ec ia

lt y

R ec

es s

R es

tr o

o m

M at

h

L u

n ch

S ci

en ce

/S o

ci al

S tu

d ie

s

W ri

te rs

’ W o

rk sh

o p

S h

ar ed

R ea

d in

g

R es

tr o

o m

C h

ec ko

u t

D ep

ar tu

re

To ta

l I n

d ep

en d

en t

P er

ce n

ta g

e C

o rr

ec t

D u

ri n

g

th e

D ay

23-Mar ✓ – ✓ – ✓ – – ✓ – ✓ – – ✓ ✓ ✓ 8 53

24-Mar ✓ – ✓ – ✓ – ✓ ✓ – ✓ ✓ – ✓ – ✓ 9 60

25-Mar ✓ – – – ✓ – – ✓ – ✓ ✓ – ✓ – ✓ 7 47

26-Mar + – – – + – + + – + Early release 5 50

27-Mar + + + – + – – + – + + – + – + 9 60

30-Mar + – + – + + + + – + + – + + + 11 73

31-Mar + – – + + – + + + + + – + + + 11 73

1-Apr ✓ – ✓ ✓ ✓ ✓ – ✓ – ✓ ✓ – ✓ ✓ ✓ 11 73

3-Apr + Late arrival – + + – + + – + + + 8 73

Spring break: 4-Apr through 13-Apr

14-Apr + – + + + + + + + + + – + – + 12 80

15-Apr ✓ – – – ✓ – ✓ ✓ ✓ ✓ ✓ – ✓ – ✓ 9 60

16-Apr + – – + + + + + + + + – + – + 11 73

17-Apr + Late arrival + + + – + – + 6 75

20-Apr + Late arrival + + – + – – + + + 7 70

21-Apr + Field trip + + + – + + + 7 88

22-Apr ✓ – + – ✓ – ✓ ✓ ✓ ✓ ✓ – ✓ ✓ ✓ 11 73

23-Apr + – – + + + + + + + + – + – + 11 73

24-Apr + – – + + + + + + + + – + – + 11 73

Shaded data are probe data.

Probe codes: ✓ Independent on all steps, - Incorrect/No response on one or more of the four task steps

Teach codes: + Attended to activity with prompting or independently (some of four steps needed prompting, some were independent)

– Needed prompts for all steps

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125Measuring Student Behavior and Learning

for Jacob (i.e., 100%) and the goal date for learning pennies (April 24). Jacob’s teacher then drew a straight line connecting these two points.

The selection of the aim criterion reflects the team’s expectations for the student. Jacob’s team wanted him to master schedule use and his baseline performance indi- cated that he was independent about half of the time. Thus, they set his criterion at 100%. The selection of an aim date is influenced by several factors, including the school’s typical evaluation periods (e.g., every nine weeks), the urgency (or timeline) for learning the skill, the difference between current performance and the criterion, and the speed of learning on similar tasks in the recent past. Aim dates should not be excessively distant from implementation dates and may be set to correspond to the more frequent marking periods used in general education (e.g., 9 to 12 weeks). Jacob’s team chose the third week in April, as they hoped to have this skill in place before the fourth graders started their state assessment testing.

trend lines A trend line roughly averages the direction and slope of a student’s performance when the performance is uneven, variable, or difficult to interpret by just looking at the graph. A trend indicates the direction of graphed data, as well as the slope, or steepness, of the data path. A trend can be of three general types:

1. Ascending trends have an upward slope on a graph and indicate improvement (or learning) when the behavior graphed is a skill or adaptive behavior. (If the goal of the program is to reduce a behavior, the ascending trend would be interpreted as regression, or deterioration.)

2. Flat trends have either no slope or a very slight upward or downward slope. When the behavior graphed is a skill or an adaptive behavior, flat trends indicate no learning or improvement.

FIguRe 4–8 Percentage of Class Activities Attended by Jacob During the School Day

100 Baseline Intervention

90

80

70

60

50

40

30

20

10

0 20-Mar 25-Mar 30-Mar 4-Apr 9-Apr 14-Apr 19-Apr 24-Apr 29-Apr

Baseline

Intervention

Probe

Aim

Trend

Sessions

P er

ce nt

ag e

of c

la ss

a ct

iv iti

es

Note: Credit is given to Mandy McKee for this adaptation of her instructional program.

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126 Chapter 4

3. Descending trends have a downward slope and indicate regression, or deteriora- tion, when the behavior graphed is a skill or an adaptive behavior. (If the goal of the program is to reduce a behavior, the downward slope would be interpreted as indicating improvement.)

When the trend of graphed teaching data is not obvious or uniform, trend lines help teachers summarize and interpret the fluctuating, or variable, nature of perfor- mance (Tawney & Gast, 1984). Some researchers have defined an ascending slope as 30° or more in the positive direction and a descending slope as 30° or more in the negative direction (DeProspero & Cohen, 1979).

When the trend is obvious, there is no need to draw a trend line, but when a stu- dent’s progress is below the aim line for three out of five consecutive data points and the trend is not obvious, a teacher should pencil in a trend line to define the trend. If the line indicates that the trend on a target skill is flat or descending (for skill-building programs), then the team should further analyze the data and other relevant informa- tion to decide whether specific program modifications are needed.

Jacob stayed above the aim line until spring break (April 4). When he returned, his per- formance varied, but was below the aim line even after a week of teaching. Ms. Fuentes drew a trend line to help summarize his performance (see Figure 4–8).

There are several ways to draw trend lines, including the “quickie split-middle trend line” (White & Haring, 1980), which can be drawn simply and clarifies the gen- eral direction of change in the data, as well as the relative rate of change (reflected in the slope). Although teachers may collect test (probe) data intermittently and add them to the same graph using differently coded lines or points, teaching or training data constitute the primary information used to make judgments about day-to-day progress (Browder, 1991; Farlow & Snell, 1994; Haring, Liberty, & White, 1980). Teachers should draw a trend line using the following six steps (see Figure 4–8):

1. Take the last 6 to 10 days of teaching data collected and draw a vertical line to divide the data in half.

2. Look at the first half of the data (the first three, four, or five data points) and locate the middle date. Draw a small vertical line through this data point. • If an odd set of data points is considered (e.g., three or five), draw the line

through the middle date. • If an even set of data points is considered (e.g., four), just sketch a pencil line

between the dates for the second and third data points. 3. Look at the middle performance level and draw a short horizontal line through this

data point. The middle performance level is not the average of the performances for the data points in the set of three to five data points. It is simply the middle performance value. • For an odd number of data points, select the middle value (e.g., for 10%, 15%,

and 12%, the middle performance value is 12%). • For an even number of data points, select a value halfway between the two mid-

dle data points (e.g., for 15%, 10%, 15%, and 11%, the middle value between 11 and 15 is 13%).

4. Extend the two lines until they intersect. 5. Repeat this process for the other half of the data. 6. Then draw a line connecting the two points of intersection from both halves of the

data.

Once the trend line is drawn, visually judge whether the trend is ascending, flat, or descending. If the trend is flat or descending, teachers should hypothesize or deter- mine why and make program modifications on the basis of the hypotheses or expla- nations. If the trend is ascending but not fast enough, teachers may (a) make changes in the program (e.g., modify the materials or prompts, change the reinforcer) to try to

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127Measuring Student Behavior and Learning

speed progress, or (b) adjust the aim line by lowering the criterion or moving the date further into the future. Alternately, teachers may do nothing to the program and look for other explanations for the student’s reduced progress.

Jacob’s trend line was drawn using six days of training data starting with April 3 and ending with April 20. Ms. Fuentes divided the data into two groups: the first three data points and the last three. For the first 3 days (April 3, 14, and 15: 73%, 80%, 60%, respec- tively), the middle date was April 14 and the middle value was 73%. For the last 3 days (April 16, 17, and 20: 73%, 75%, 70%, respectively), the middle date was April 17 and the middle value was 73%. She connected the two points that resulted by drawing a line. The trend was very slightly ascending, but practically flat. The team members discussed their options because Jacob had stopped making progress. They could lower the criterion from 100%, move the aim date to May, or improve the program. They decided to keep the criterion at 100% because this was a skill that he really needed. They also decided to move the aim date to the end of May, giving more time and a more gradually ascending aim line. Finally, they decided to improve the program in two ways: (a) As a way to help motivate Jacob, they added two other classmates to the program who also had problems following the schedule, and (b) they added high-fives to the reinforcement from each teacher following steps 1 through 3 and following Step 4 if completed correctly.

Teams may decide to use computer-generated graphs instead of hand-drawn ones. Graphs can be fairly easily drawn and data added using Microsoft Excel and the step- by-step guide of Carr and Burkholder (1998). In addition, trend lines and aim lines can be constructed, although a somewhat different version of the quickie split-middle trend line (White & Haring, 1980) is produced with this program.

learninG outCoMe suMMaries

5.01 Why Measure Student Behavior? Learning Outcome 1. Describe what is meant by an evidence base.

The term evidence-based practice refers to educational programs or instructional proce- dures that have been experimentally determined to reliably produce successful student out- comes. A strategy that is considered to have an evidence base is one that has sufficient numbers of high-quality research studies published in peer-reviewed journals.

2. Describe the difference between outcome and process measures and why each helps educators to be accountable.

Process measures focus on small units of behavior such as the student’s performance on steps of a task analysis. These measures are important when we evaluate a student’s prog- ress in an instructional program. If the data indicate that the student is not progressing, edu- cators will need to make data-based decisions regarding program modifications. Outcome measures provide a broader view of student performance. These measures offer information regarding the general effects of a program on a person’s quality of life. Examples of outcomes measure include friendships, membership in the classroom, time spent with peers in social situations, and increased self-determination. These measures are important because they give us the opportunity to evaluate the impact of the educational program on the student’s, and his or her family’s, quality of life.

5.02 Foundations of Meaningful Measurement Learning Outcome 1. Identify the five criteria for evaluating the validity and importance of behavior changes.

The five criteria that are used to evaluate the validity and importance of behavior changes in a student are statistical significance (Was the difference in behavior beyond what might be

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128 Chapter 4

expected by chance?), clinical significance (Will the change in behavior allow the student to better function in society?), social validity (Are the changes in behavior important to the indi- vidual and make a difference in his or her life?), internal validity (Are we confident that the changes are due to the intervention?), quality of life (Will the change in the behavior improve the student’s vision of a quality life?), and treatment integrity (Are the intervention proce- dures implemented in a way that is specified in the treatment plan?).

2. Discuss why measurement should be contextually appropriate as well as accu- rate and reliable.

Measurement systems must be developed that allow accurate measurement of the behavior, but also that fit into the environment in which it is being used. Professionals need to choose data collection strategies that are unobtrusive but that still provide sufficient information to determine if an intervention is effective. Measurement must also be accurate and reliable; this is accomplished by creating an operational definition of the target behavior, that is, a description of the behavior that is observable and measurable. Without defining the behavior we cannot be sure if everyone is observing and addressing the same behavior, and cannot determine if a program is successful or needs modifications.

5.03 Quantitative Measures Learning Outcome Identify and describe seven different measures of student performance.

Frequently used measures of student performance include

1. Permanent product: direct measurement of the lasting and concrete results of a target behavior

2. Frequency recording: the number of times a behavior occurs within a specified period 3. Percentage: the correct number of behavior compared with the number of opportunities

(or intervals) 4. Rate: the frequency of a behavior and its relationship to time, expressed as a ratio 5. Duration: the total amount of time in which a targeted behavior occurs in a specified

observation 6. Task analytic measurement: a record of the performance of each step in a sequence of

behaviors that make up a task 7. Interval recording: a record of the occurrence of a behavior within each of the time intervals

within a single observation. Three interval strategies are whole interval, partial interval, and momentary time sampling.

5.04 Organizing Student Performance Learning Outcome 1. Describe the various elements of a graph.

A graph is made up of two axes: the abscissa (x-axis) and the ordinate (y-axis). The abscissa is the horizontal line that usually represents the time frame of a measurement. The ordinate is the vertical line and is labeled with the target behavior being measured. Once data are converted into a single numeral, this is plotted on the graph.

2. Discuss factors that influence how frequently student data should be collected.

Just how often an educator should take data remains a subject of debate. Although there are no definitive answers to this question, several guidelines can assist in deciding how fre- quently to collect data:

1. Higher priority objectives warrant daily data collection. 2. Lower priority objectives may be evaluated less frequently. 3. Implementation of a new program should initially be measured every teaching session

until progress is consistent. 4. Data that show progress as planned may be evaluated less frequently. 5. Data that do not show progress as planned or that are variable should be measured daily.

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129Measuring Student Behavior and Learning

5.05 Data Analysis for Better Decision-Making Learning Outcome 1. Discuss the difference between probe (testing) and teaching data, and the uses for each.

Probing (or testing) means that a person’s performance is checked under criterion condi- tions (i.e., conditions that as closely as possible use natural contexts, cues, and conse- quences). When conducting a probe, the educator typically provides no prompting or teaching assistance, no reinforcement for task success or improvement, and no corrections. The goal of testing is to learn about a student’s current performance under criterion condi- tions, and not to teach the student. In contrast, teaching data can be recorded whenever the student is taught. Under teaching conditions data are recorded while a student is participat- ing in the instructional intervention. Learning is the goal of teaching, so conditions are planned to promote improvement in performance and to advance the student through the various stages of learning.

2. Describe how a baseline–intervention comparison can be useful to an educator, and the limitations of this type of analysis.

The baseline–intervention (or AB design) is referred to as a non-experimental design because no conclusive demonstration of a cause–effect, or functional, relationship between the intervention and the observed changes in behavior is possible. However, this compari- son is appropriate for monitoring student performance within the educational settings, par- ticularly when proven teaching strategies are used.

3. Describe the various graphing conventions that allow for a visual summary of performance data.

There are several graphing conventions that support the visual analysis of a graph. These include (a) broken vertical lines that represent changes in the instructional program, (b) bro- ken horizontal lines (a criterion line) to indicate the criterion for the program, and (c) connect- ing data points only for consecutive days within a phase.

suGGested aCtivities

1. Select one student in your class and examine the current measurement strategies used for each IEP objective. a. For each objective that includes a measurement strategy, consider whether that

strategy is the most appropriate one to use. Would a different strategy be more meaningful?

b. For each objective that does not include a measurement strategy, describe an appropriate and manageable strategy that could be used.

2. For this same student, design a graph for each instructional objective not currently displayed in graphic format.

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130

5 Selecting Teaching Strategies and Arranging

Educational Environments Martha E. Snell

Curry School of Education University of Virginia, Emeritus

Fredda Brown Queens College, City University of New York

John McDonnell University of Utah

5.01 Principles to Guide Instruction Learning Outcome Describe the principles that should guide the development and implementation of teaching plans.

5.02 “Universal” Strategies That Are Effective with a Wide Range of Students Learning Outcome Describe the teaching strategies that are effective for most students in general education classes.

5.03 Specialized Teaching Strategies That Are Effective with Students Who Have Severe Disabilities Learning Outcome Describe the teaching strategies that are effective for students with severe disabilities.

In this chapter, we explain and illustrate a glossary of evidence-based teaching strategies that educational teams may select from when designing teaching pro-grams. Some strategies will directly influence instructional methods, while other strategies pertain more to the classroom environment and organization. Chapter 4 described complementary approaches for measuring student progress, and Chapter 6 will explain a team process for planning and implementing instructional programs.

This chapter organizes teaching strategies in a manner recently suggested by Cope- land and Cosbey (2008–2009), using the Response to Intervention (RtI) framework (Figure 5–1). In this model, less specialized teaching interventions are used before more specialized interventions are implemented to support student learning.

Using RtI logic means that educational teams follow several guidelines:

• Every student in a general education classroom gets the basic universal teaching interventions.

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131Selecting Teaching Strategies and Arranging Educational Environments

• Student performance data are used to judge the need for more specialized interventions.

• Intervention is additive so that when data indicate a need for more specialized in- terventions, the team selects additional methods, services, or supports.

• More specialized methods do not require a change in the teaching setting because location and methods are independent.

• The need for more specialized methods in one academic area does not necessarily indicate the need for more specialized methods in other academic areas; the selec- tion of the teaching intervention relies on student performance data.

This chapter begins with five principles that influence teams as they plan instruc- tion (see Figure 5–1); then we shift to describing universal approaches and special- ized approaches to teaching.

PrinciPles to Guide instruction

Educational programs for students with disabilities should be based on individualized instructional goals and supports, and tailored to their unique learning needs. Thus, the educational program for one student will look different than the program for

FIGURE 5–1 Teaching Methods That Are Effective with Students Who Have Extensive Support Needs

Principles to Guide Instruction

Work as Collaborative Teams

Reach Consensus on What to Teach

Understand How Stage of Learning Affects Instruction

Reach Agreement on How Students Will Be Taught

Monitor Student Learning with Performance Data

“Universal” Teaching Strategies That Are Effective with a Wide Range of Students

• Information about students

• Materials and universal design

• Instructor

• Schedule for instruction

• Teaching arrangements

• Prevention strategies

• Peer-mediated instruction and peer support

• Individualized adaptations: Accommodations and modifications

• Self-management

Specialized Teaching Strategies That Are Effective with Students Who Have Severe Disabilities

• Visual modality strategies

• Task analysis and chaining

• Elements of teaching discrete trials

• Stimulus and response prompting

• Consequence strategies

• Arranging teaching trials

Less to more specialized

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132 Chapter 5

another student. The following five principles should guide teams as they develop individualized and effective educational programs for students.

Work as collaborative teams

Designing educational programs to teach students needed skills requires that team members consider many factors to make decisions about the design of teaching pro- grams. Decisions are made at numerous points, but only after team members share their different perspectives on the student, engage in relevant discussion and problem solving, and then reach consensus as a team (Friend & Cook, 2010). Members of the team draw on their separate areas of expertise as parents, special education teachers, general education teachers, speech and language pathologists (SLPs), occupational therapists (OTs), physical therapists (PTs), and, at times, school nurses, adaptive physical educators, mobility trainers, and consultants in deaf-blindness and autism to identify the goals and objectives that will be included in the student’s Individualized Education Program (IEP) (see Chapter 3).

determine What to teach

Teams start IEP planning by gathering assessment data on students using tools that less often are norm-referenced tests and more often are informal interviews and observations (see Chapter 3). These assessments are planned and carried out with the aim of identifying the student’s unique needs and characteristics. The team studies these results and selects goals and objectives from three types of skills:

Basic Skills: These skills are behaviors that contribute to participation in inclu- sive environments, including toileting, eating, and dressing skills; mobility and getting around; reaching and grasping; communicating; making choices; follow- ing routines; classroom survival skills; working with classmates; and self-directed learning.

Academic Skills: These skills are knowledge and abilities that are drawn from the general education curriculum in reading, writing, math, science, and social studies and are adapted to suit the student’s needs and learning traits.

Functional Skills: These skills pertain to everyday life, including domestic, recre- ational, community, and vocational skills, and may incorporate academic skills.

Team members then work together to identify the student’s present level of aca- demic and functional performance (PLAFP) in these targeted skill areas so that indi- vidualized goals and objectives can be written that are appropriate to the student. The IEP will (a) contain measurable annual goals that can be achieved in a year or less, (b) identify the intermediate, short-term objectives or benchmarks leading from the PLAFP to the goal level, and (c) specify the educational supports and services that address the student’s needs.

understand How the stage of learning Affects instruction

For all individuals, learning appears to move through different stages related to one’s grasp of the target skill (Browder, 2001). These stages include acquisition, mainte- nance, fluency, and generalization. Thus, the ways we teach students who are just beginning to learn a skill will differ somewhat from the ways we teach students who are more experienced.

Acquisition Stage: Typically, skills in this stage are new skills, performed with ac- curacy varying from 0% to about 60% of the steps performed correctly (Farlow & Snell, 2005). The focus of early learning is usually on approximate performance of the core steps of a skill.

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133Selecting Teaching Strategies and Arranging Educational Environments

When Marc was first learning to use a schedule in preschool, his teachers made a verti- cal set of shelves, one shelf for each major morning activity. On the shelves, they placed single objects that were used in the activity. Marc carried the object to the activity and placed it in a designated spot. Objects were changed for the afternoon so fewer objects were visible at a time. Later, picture symbol cards were added; finally, the objects were eliminated.

However, for some students, the performance of the core steps of skills may not represent the initial priority; instead, their acquisition focus may be on extension or enrichment skills (Brown, Evans, Weed, & Owen, 1987). For example, a student like Christine, who has limited ways to participate in the motor aspects (core steps) of a skill, may more meaningfully begin with learning to initiate (e.g., selecting the hair- brush option on her speaking communication device to request that someone brush her hair) or choosing among several options (e.g., selecting a preferred snack from several options on her communication device to indicate her choice).

Maintenance Stage: During the maintenance stage, students are expected to use the skill for all of the routines or activities they complete. Skills in this stage, while still imperfect, are good enough to use with some level of independence. The adage “practice makes perfect” applies to this stage and reminds us of two things: (a) For- getting is best remedied through regular and expected use; and (b) functional skills, because they are needed, offer extensive opportunities for practice. Maintenance is a stage that many teachers forget or at least find difficult to implement because it requires shifting from an active teaching role (e.g., prompting, praising) to a less active role by distancing themselves and giving intermittent attention. Researchers have found that when students cannot predict teachers’ supervision of their work on a task that they know fairly well, they attend better and complete more of the task (Dunlap & Johnson, 1985).

Instead of only teaching Jacob to tell time during math instruction using an unplugged clock and flash cards (acquisition stage), his teachers also will have him use this skill at the end of every class activity, by asking him what time it is (maintenance phase).

Fluency or Proficiency Stage: This stage uses the catchphrase “speed it up and per- fect it.” Students may be taught to monitor the tempo (the rate and duration) of the task performed (e.g., Can I count out the money fast enough so that I don’t hold up the line of customers? Am I taking too long to empty the dishwasher?). Other students focus on improving the quality of task performance (e.g., Is the floor clean enough? Did I write my name at the top and staple the top left corner of my re- port?). Still other students work on both the tempo and quality of skills while also improving accuracy.

Jacob is learning to look at the clock at the end of each activity, report the time quickly and accurately, and then identify the next activity on his pocket schedule.

Generalization Stage: The goal of this stage is to learn to “use it anywhere and whenever it is needed.” In this stage, students are exposed to more variations in task materials and environments. They particularly need to learn problem solving because natural stimuli change and adaptations in their responses are required.

Jacob will be taught to tell time using the variety of analog clocks that exist at home and school, including clocks with an incomplete array of numbers or numbers that are not Arabic numerals.

reach Agreement on How students Will Be taught

Determining how to teach what is on the IEP is a team process. When selecting teach- ing methods, teams will consider students’ stages of learning with regard to the target skill and students’ preferences and dislikes. Also, teams will review their students’

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134 Chapter 5

learning history to assess what has been effective and what might be effective with particular students. To design educational programs, teams select and combine ideas that are not only practical and efficient, but also substantiated, logical, consistent with current knowledge, and likely to realize change in the desired directions.

The principle of parsimony (Etzel & LeBlanc, 1979) provides an uncomplicated rule for teams making decisions about how to teach their students: Select the simplest but still effective approach. First, the principle cautions educators against selecting questionable methods that are not founded on evidence. Second, when team mem- bers are faced with several potentially effective teaching approaches, the principle advises them to choose the least complicated approach. Often more than one adult fills the teacher role and sometimes peers do so as well. Thus, the methods must be acceptable to all and be uncomplicated enough to be consistently applied (treatment fidelity).

Furthermore, teams will follow the guiding principle of using methods that are “only as specialized as necessary,” thereby avoiding stigmatizing materials and approaches that are not age- or grade-appropriate or that draw unfavorable attention to the student. If it is necessary to make adaptations for some students, the adapta- tions should be designed to be as non-intrusive as possible for the student and as user-friendly as possible for the teaching team.

Marc’s team adapted materials to simplify the demands of handwriting: He uses a sten- cil to help keep his letters in a smaller space and a small typing device to quickly spell out words that would take too long to print.

Jacob’s team adapted the expectations in spelling by selecting fewer spelling words from the class’s weekly list. For the class’s astronomy unit, the team identified just the core concepts that he would learn.

Because of her visual limitations, Christine’s team adapted the way that her job coach, teachers, and peer tutors presented new material to her or presented choices. They supplemented their verbal instructions with large images on a laptop or by giving demonstrations within her visual range. Thus, once at her library job, the job coach demonstrated the book scanner and her two switches; then they practiced this with the job coach role-playing a student checking out a book. When her peer tutor arrived for lunch, she began by showing Christine large images on her laptop of the campus grill lunch options while naming them.

When needed adaptations follow the “only as specialized as necessary” rule, they will not emphasize the student’s differences, will mesh better with ongoing classroom instruction, and be easier for team members to use.

Monitor student learning with Performance data

The ongoing collection and analysis of student performance data allow teams to mod- ify teaching approaches and strategies in order to maximize the effectiveness and efficiency of student learning. Chapter 4 describes the key principles, guidelines, and methods for collecting, summarizing, and analyzing student performance data to make changes to a student’s teaching programs. These data will allow teams to deter- mine whether learning outcomes will be improved by changes in the instructional context, teaching methods, and/or the nature or form of the student’s response.

“universAl” strAteGies tHAt Are effective WitH A Wide rAnGe of students

This section of the chapter will describe basic or universal strategies that have been successfully applied in general education settings with typical students and with stu- dents with disabilities. When well planned, a teaching program will involve strategies

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135Selecting Teaching Strategies and Arranging Educational Environments

that create a positive learning environment, make use of appropriate learning materi- als and supports, and involve teaching methods that are suited both to the student (the stage of learning and preferences) and to the target skill. Some approaches described are antecedent strategies in that they are planned before instruction actu- ally occurs, and they dictate the organization, mechanics, procedures, and style of teaching, and thus concern the educational setting, materials, content, directions, teaching arrangement, and methods that teachers use to motivate student learning. Other strategies focus more on the consequences that teachers provide to students (reinforcement and error correction) or on some combination of antecedents and con- sequences. Teaching strategies range from simple to complex. Simpler antecedent methods include having a logical and consistent schedule of instruction or providing all team members with information on the student’s preferences, learning challenges, accommodations, and goals for teaching. Ordinary and simple consequent strategies include giving students positive reinforcement for their improvements on target skills, providing opportunities to use their target skills, giving immediate corrective feed- back, and offering a higher ratio of positive reinforcement to individual students than corrective feedback (e.g., the four-to-one rule) (Knoster, 2008).

Earlier we described “universal” approaches as methods that were demonstrated as being successful in general education settings with most students. These teaching strategies may include antecedent or consequent elements or both.

For Jacob’s team, the primary challenge was adapting fourth-grade reading, math, and content area lessons in ways that would maintain his engagement and participation for more than 10 minutes or so. The team decided to build on his preferences (video games, animals, and “anything on wheels”) while avoiding his dislikes (loud noises, crowds, and handwriting of any kind), which often triggered problem behavior. Using interesting content to teach academics was also appealing to many of his classmates, so a “Math on Wheels” group was started and “My Favorite Things” reading clubs were ini- tiated. Jacob’s fourth-grade teacher called on the school district’s assistive technology consultant who introduced a wealth of academic video games to the fourth- and fifth- grade team and set up the school computers so that these games could be accessed. Jacob’s team now had many strategies that would lengthen his learning engagement while also benefiting and appealing to his classmates.

information About students

Including students in general education often increases the number of adults who work with a student. Thus, it is important that all adults teaching a particular student under- stand a student’s IEP goals and objectives, learning characteristics, needed accommoda- tions and adaptations, key behavioral supports, and pertinent health information. Janney and Snell (2004) and Snell and Janney (2005) have suggested that (a) the Stu- dent Information Form and (b) the Program-at-a-Glance form can be useful in helping team members access this information (these forms will be discussed in more detail in Chapter 6). After the information on these two forms is shared at an initial face-to-face meeting, the completed forms are provided to relevant classroom teacher(s), specialty teachers, and paraprofessionals who work directly with the student.

Materials and universal design

Materials must be suited to students and must facilitate learning. While this strategy seems to be obvious, suitable materials have great potential to enrich instruction and inappropriate materials can stifle learning and stigmatize students. Teaching materials (including school furniture, room arrangement, and school architecture) that possess several characteristics may promote learning and eliminate negative side effects. Most obvious among these characteristics are that the materials must be matched to the learner’s ability to use them, including books adapted for meaningful use; work

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activities that are linked to a student’s understanding and ability to respond; and even desks and chairs that are the correct height and have any needed postural supports, as well as pencils that the student can grip and use.

A second characteristic concerns age-appropriateness, or whether teaching materi- als are linked to a certain age group that matches the age of the students being taught. Many typical students will reject materials that they perceive as being unsuit- able for their age, and students who use age-inappropriate materials may be socially rejected by their peers who notice the mismatch. Sometimes teachers must make con- certed efforts to either design or to locate materials that are suited to a student’s abil- ity and to his or her chronological age. Several other characteristics with regard to instructional materials are important: (a) the student’s preference for materials and their general appeal to others, and (b) the variety and availability of suitable materials for teaching and for individual student manipulation (e.g., in science experiments and manipulatives for individual use in math).

When materials and curricula reflect a collective or common universal design, they are usable by more people. For example, curb cuts accommodate not only wheel- chairs, but also bikes, strollers, and shopping carts. Telephones with larger and lighted numbers are easier for all to use. Reading material that is available digitally (instead of only in a textbook format) can be converted easily to other languages, made larger for viewing, printed in Braille, and read aloud by a screen reader (Center for Applied Special Technology, 2004). Programs such as IntelliTools® Classroom Suite (http://aex.intellitools.com/home.php?ref=%2Fmain.php), which provides a universally designed academic support program for math, social studies, science, and language arts, were created for use by all students, both with and without disabilities, and can be accessed by mouse, IntelliKeys® keyboard, or a switch.

The logic behind universal design is that materials and curricula should be created from the start to have alternative ways of being accessed so more individuals can par- ticipate successfully with fewer teacher modifications and prompts. Universal design was applied to redesign the high school science curriculum by Dymond and colleagues (2006) so that students with mild to severe disabilities could learn alongside their peers without disabilities. Changes were made in the instructional delivery, the organization of the classroom, the ways in which students participate, class materials, and assess- ment methods; both staff and all students gave positive evaluations of these changes. Universal design requires us to think differently—not just as teachers but also as pub- lishers, architects, car manufacturers, computer programmers, and others. Because uni- versal design increases accessibility, it can reduce the need for additional supports.

After Mr. Evans, the middle school science teacher, met Jacob on his visit to the school at the beginning of his fifth-grade school year, he decided to go ahead with a universal design approach for the science lab. He had been inspired by his colleague Ms. Rayfield, who had had a student with limited vision in her geography class this year. She’d read about universal design and decided to rearrange her classroom so that every student had a direct line of vision to the chalkboard and the classroom maps. Using the same logic and some ideas that he learned from Jacob’s teacher, Mr. Evans decided to create simple word/picture directions, which he knew that all of his students would benefit from. Using the Boardmaker® Plus! software program (Mayer-Johnson, Inc., http:// store.mayer-johnson.com/us/review/product/list/id/133/category/13/#customer- reviews), Mr. Evans uploaded photos from the science lab to use in Boardmaker. With advice from the middle school reading consultant, Mr. Evans labeled the science equip- ment and work stations, took pictures of sequenced steps in planned experiments that students would carry out that fall, illustrated the directions for each experiment, and added pictures of all of the materials that students would need to gather before starting an experiment. Finally, he added simplified directions with photographic illustrations for cleanup and safety (e.g., wearing safety glasses, disposal of chemicals). When the new school year started, he introduced picture labels first to students, followed by teach- ing the word/picture directions.

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the instructor

Teaching plans are ultimately the responsibility of the special education teacher with input from other team members. The plan denotes what is taught, when, where, with which classmates, and by which adult, as well as how learning is evaluated. When the student is taught in the general education classroom or during scheduled activities like P.E., teaching programs must mesh with classroom schedules, planned activities, available staff, and feasible grouping arrangements to take advantage of the opportu- nities for learning with and around peers.

collaborative teamwork Teams have many options for determining who will teach: the general or special edu- cation teacher, a paraprofessional, related services staff, and peers. The more cohe- sive the team, the more likely it is that the teaching plans will fit into ongoing school activities and suit multiple instructors. If cooperative learning groups are used in classrooms, peers will help teach each other. In addition, older students (typical or with disabilities) in a cross-age tutoring program may be taught to serve as the tutor of younger students (typical or with disabilities). All adults who teach also need to be involved in team conversations about the student’s progress so that any problems can be solved together. When instructors communicate as a team, having multiple instruc- tors can be beneficial because it (a) encourages students to generalize their learning across people, (b) provides the team with broader experience in teaching the stu- dent, and (c) prevents over-involvement of instructors with students or their isolation from peers.

Several researchers have studied students in inclusive elementary classrooms and have found that the individual who taught (e.g., general or special educator, parapro- fessional, another student) made little difference in the student’s level of academic response (Hunt, Soto, Maier, Muller, & Goetz, 2002; Logan, Brakeman, & Keefe, 1997; McDonnell, Thorson, & McQuivey, 1998). What does seem to influence a student’s academic response in these classrooms is a combination of factors: (a) whether there is team collaboration on students’ objectives and educational supports; (b) the arrangement used: The rate of engagement is slightly higher when the number of stu- dents are fewer (cooperative group or small group or one-to-one instruction versus whole-class instruction); (c) whether instruction is directed toward the student (i.e., the student is given opportunities to respond, is given materials, and is given feed- back), which seems to improve a student’s rate of response; and (d) having individu- alized instruction: Academic responses increase when the teaching method is tailored to the student.

rethinking the one-to-one Assignment of Paraprofessionals A practice often used by schools and IEP teams is to pair students who have more extensive support needs with paraprofessionals for much of the day. Dymond and Russell (2004) confirmed this practice; they found that students with severe disabili- ties in grades 3–5 spent less time included in general education than younger stu- dents and, when included, they were more likely to be supported by a paraprofessional than a special education teacher. When a single teaching assistant spends much of the school day with a single student, problems can result. Giangreco, Edelman, Luiselli, and MacFarland (1997) studied this staffing practice and identified eight undesirable patterns that may develop when teaching assistants are in the exclusive role of assist- ing a single student. Teaching assistants may do the following:

1. Obstruct the general educator’s role by having complete control in implementing the student’s program

2. Isolate the student from classmates by removing or distancing the student from other students and activities

3. Promote dependency on adults

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4. Affect peer interactions negatively by their constant proximity and their sometimes protective approach

5. Use less-than-competent teaching 6. Encourage a loss of personal control by failing to promote choice making or peer

interaction 7. Be insensitive to the student’s gender, for example, by taking male students into

female bathrooms 8. Distract classmates, for example, by involving the student in activities that differ

from classmates

Schools and educational teams are advised to rethink their practices and policies concerning the use of paraprofessionals so that these problems are prevented. Experts who have written about pairing paraprofessionals with students who need support have made some suggestions about addressing these potential difficulties (Carter, Sisco, Melekoglu, Kurkowski, 2007; Doyle, 2008; Snell & Janney, 2005). We list seven of these suggestions:

1. It is important to broaden the responsibilities of general education classroom teachers so that they are centrally involved in the supervision of special education teaching assistants.

2. Classroom teachers and paraprofessionals should have basic training in systematic instruction, including ways to promote peer interaction.

3. Classroom teachers should feel ownership of the students with disabilities in their classrooms so that they are invested in their instruction and their learning.

4. Paraprofessionals need job descriptions that set forth their responsibilities and the line of supervision. When their responsibilities include participation on the stu- dent’s planning team, paraprofessionals have input and can benefit from team thinking.

5. Students’ schedules should be designed so that they are truly integrated into class activities and peer interactions, using adaptations as needed to promote meaning- ful involvement; simply being present with an assistant does not constitute mean- ingful inclusion.

6. Peer support interventions (described later in this section) offer a proven alternative to the use of one-to-one, adult-delivered support and redefine their role as support- ers of a network of peers (Carter, Sisco, Melekoglu, & Kurkowski, 2007).

7. Finally, for students who need more personal assistance and the support of a para- professional, several practices may reduce the possibility of isolation: (a) Assign two assistants to a single student, each for part of the day, and let assistants rotate among other students; (b) assign assistants to classrooms instead of to students; (c) vary a student’s support so it rotates among team members; and (d) design teach- ing arrangements so that team members reduce one-to-one instruction and increase instruction in pairs or small groups of students with mixed abilities.

Christine receives support and instruction at a variety of locations both on campus and off. She has different teachers in these different settings: two paraprofessionals, a job coach, the drama teacher, and her special education teacher. Three peers lend informal support and friendship instead of formal instruction. Her physical and occupational therapists and her speech language pathologist all provide input on a consultative basis, teaching only to demonstrate to others. The special educator and the job coach also supervise all of those who teach.

schedule for instruction

Classrooms need to have planned and predictable schedules from the first day of school. The schedule for students with disabilities will reflect the schedule for the general education classroom(s) where they are members and any additional instruc- tion at other locations. One way of addressing this need is through the use of a

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program planning matrix of IEP objectives by scheduled general education activities that indicates when, where, and how often instruction takes place for a student (see Chapter 6).

Marc, who has a diagnosis of autism, will be 6 years old in the spring of his kindergar- ten year. His preschool program was self-contained, but he is now included, with the needed supports, in his neighborhood elementary school and the kindergarten class. One of his IEP goals is to use pictures or words to express needs and make choices. By using a program planning matrix, his teacher is able to identify the activities in his kindergarten class (e.g., arrival, circle, small group) when he can receive instruction on this skill.

Like their peers, students with severe disabilities learn both inside and outside the classroom: in hallways, other classrooms, and the cafeteria; outside the school on playgrounds; at the bus loading areas; and in the community. As these students grow older and their IEP objectives include skills or activities not targeted for typical stu- dents, their instruction will expand into alternative settings beyond the general edu- cation classroom. As a general rule, some alternate teaching settings away from the general education classroom but in the school (with or apart from peers) are neces- sary during the later elementary and middle school years.

Instead of participating in the afternoon kindergarten activities, Marc receives one-to- one instruction in the resource room on grade-level academics and self-care skills, and in learning school routines more independently (e.g., lunch, library, fire drills). The goal for next year is for Marc to spend most of the day with his first-grade class.

Jacob spends more than half of his day with his fourth-grade class, but receives short daily instructional sessions, one-to-one, in the resource room on handwriting and lan- guage arts. These are two areas where he has particular difficulties in the fourth-grade curriculum. The success of his positive behavior support plan has meant that Jacob’s time in general education is fairly free from the tantrums that he often had from kindergarten through last year.

During the middle school, high school, and post–high school years, as the instruc- tional focus for students with severe disabilities shifts to include more functional aca- demic, community, and job-related skills, the alternative teaching settings expand to include stores, offices, libraries and other public buildings, streets and sidewalks, restaurants, and work settings in the nearby community. Teams still must plan for general education classes or school activities that maximize students’ continued contact with peers.

Christine spends the bulk of her school week learning vocational skills in community settings, but she participates in the Best Buddies Chapter on the university campus, where her post–high school class is located. With the support of a teaching assistant and several of her classmates, she is active in the university drama club.

teaching Arrangements

Most students with severe disabilities, much like their typical peers, can acquire the ability to learn in groups and can also benefit from observing others learn. While there is clear research support for teaching students with severe disabilities in various- sized, homogeneous groups (from two to five) in special education settings, there has been far less research conducted on teaching these same students along side their peers without disabilities (e.g., Collins, 2007; Wolery, Ault, & Doyle, 1992). Likewise, little research exists on the effects of varying instructional arrangements and instruc- tors in general education classrooms on learning for students with severe disabilities. One exception is a study by Carter and his colleagues (Carter, Sisco, Brown, Brick- ham, & Al-Khabbaz, 2008). They found that in inclusive secondary classrooms teacher proximity had two predictable effects on students. When teachers were close to

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students with disabilities, students interacted far less often with peers than when teachers were at a distance; however, students’ academic engagement increased when teachers were close.

The task of teaching is more complicated whenever instruction is differentiated to suit a mix of ability levels. However, it also is true that most small groups of students, with or without disabilities, reflect a range of ability and that differential instruction can only improve what the group members will learn. Teaching arrangements (one to one, student pairs, small groups, or large groups) should be chosen carefully to suit the student, the skill objective, and the setting. When students experience difficulties in remaining with a small group, or in attending or learning, the team must identify the difficulties and build the skills.

one-to-one instruction

On a practical level, one-to-one instruction has not proven to be as beneficial to stu- dents with severe disabilities as many educators have thought (Carter, Sisco, Meleko- glu, & Kurkowski, 2007; Giangreco, Halvorsen, Doyle, & Broer, 2004). Historically, the rationale for one-to-one instruction has been to minimize distractions and thus enable stimulus control (Rotholz, 1987). Some confuse the notion of individualized instruction for students with individual instruction, but they are not synonymous. Individualized instruction is teaching designed to suit a specific student and can be delivered in a variety of teaching arrangements, while individual instruction usually means that one adult teaches one student.

One disadvantage of one-to-one instruction is the increased probability of failure to generalize. Skills mastered by students with autism and other severe disabilities in one-to-one arrangements do not automatically generalize to larger groups of students (Koegel & Rincover, 1974) or to people other than the original teacher (Rincover & Koegel, 1975). Another disadvantage is that the student is excluded from being with other pupils, which means that the student does not learn how to participate in a group and loses many opportunities for peer-to-peer teaching, peer reinforcement, social interaction, and learning by observing peers (Farmer, Gast, Wolery, & Winter- ling, 1991; Stinson, Gast, Wolery, & Collins, 1991). In contrast, small group instruc- tion allows opportunities to experience taking turns, waiting, and imitating others—skills that have practical value in everyday life. Finally, one-to-one instruction is not cost effective in terms of teacher time. It results in increased downtime (i.e., non-instructional time) for students. Thus, one-to-one instruction should be reserved for teaching tasks in which (a) privacy is required, (b) other students cannot easily be included (e.g., job training), (c) an older student (or a peer) teaches a student in a supervised tutoring program, and (d) short-term intensive instruction is needed dur- ing part of the day for a specific skill.

If a student cannot work in a group, there should be IEP objectives directed toward that goal. Teams will want to consider several old but proven strategies that build these skills by varying the teaching arrangement, including tandem instruction, sequen- tial instruction, concurrent instruction, and combination instruction (see Table 5–1).

small Group instruction

Having the ability to learn in a group of two or more students is important for several reasons (Collins, Gast, Ault, & Wolery, 1991; Wolery, Ault, & Doyle, 1992): (a) Most teaching in general education happens in groups, both small and whole class; (b) teaching in groups is more efficient for teachers and creates less non-instructional time for students; (c) group instruction, when conducted skillfully, provides opportu- nities for students to learn by observing others; and (d) group instruction allows stu- dents to interact with peers and creates occasions for teaching peer interactions skills. General education and special education teachers must make several decisions when

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TAbLE 5–1 Methods to Build Group Participation Skills

Tandem Instruction Instruction begins with a one-to-one arrangement, and then other students are added gradually, one at a time, until there is a group. With students who appear to have difficulties, use simple requests or visuals to “sit quietly,” “put your hands down,” or “look at this.” Gradually fade continuous reinforcement for staying with the group and participating. Koegel and Rincover (1974) found that while slowly increasing the group size from one to eight students, attending skills were shaped along with students’ ability to tolerate less reinforcement. However, the same attending skills can be shaped in the context of the group itself. Thus, tandem instruction can be used part of the day while the same student participates in some groups for short periods at other times of the day—a strategy that reduces the disadvantages of gradually fading out one-to-one teaching (Rincover & Koegel, 1975). This approach is good for students with little experience working in groups (Collins, Gast, Autl, & Wolery, 1991; Wolery, Ault, & Doyle, 1992).

Sequential Instruction Students are taught in a sequential manner (each student gets one turn, while others wait their turn) (Brown, Holvoet, Guess, & Mulligan, 1980). Reinforcing group members who are engaged and attend to others as they take a turn increases the possibility for observational learning (e.g., Fickel, Schuster, & Collins, 1998). Alternatively, the waiting time can be replaced with another activity for students who are less skilled at waiting, although these students will have less opportunity to learn by observing others. When sequential instruction is used, it is better to give turns contingent on being ready or contingent on being prompted to be ready instead of simply giving turns in sequence and risking giving turns to students who are inattentive or misbehaving. Thus, turns should not be given in strict sequential order.

Concurrent Instruction Direct instruction is provided to an entire group, with individuals responding or with the group responding in unison (Reid & Favell, 1984). When the diversity of a group is increased, teachers must adjust their presentation of content so that all students can under- stand (e.g., use words, signs, and concrete objects to describe the task or concept being taught) and allow a variety of response lev- els and modes so that all students can participate.

Combination Groups In many classrooms, it is not unusual to address a concept within the whole group, give instructions for an activity that applies the concept, and then divide into smaller groups of mixed or similar ability levels to carry out the activity. Ideally, groups will have cooper- ative activities geared to individual abilities and goals. The teacher also may provide instruction to one group at a time or teach each group using turn taking (sequential). Students who have difficulty working in a group may be faded gradually into a group (tandem model) from a one-to-one teaching arrangement with peers or special educators in the same classroom as Koegel and Rincover (1974) did with students who have autism. Likewise, students first may be taught to work independently for brief periods on an aca- demic task related to the grade curriculum (e.g., cutting out 10 words and matching them to 10 pictures), after which they join a small group where individualized instruction is continued during turn taking (Rincover & Koegel, 1975). The latter example is a combination of tandem and sequential models.

planning small group instruction. Is the goal academic learning, social interaction among group members, or both? What will the composition of the group be (e.g., ability levels, group size)? What skills will be taught and what materials are needed to teach those skills? What will be the actual physical arrangement? When students with severe disabilities are included in a small group with typical peers, the team must dif- ferentiate instruction so that all members can understand the task, perform, and learn. The specific objectives taught will differ across group members, but it is beneficial when the academic content (e.g., math, language arts) or teaching focus (e.g., learn- ing volleyball in the gym) is the same for all students. When the academic content is the same (e.g., adding and counting amounts), multilevel instruction will need to be planned so that each student is learning at a level that is commensurate with his or her current skills. With the learning task adjusted to suit students in the group, the teaching materials also may differ across students. (The teaming process to plan mul- tilevel instruction and adaptations is described in detail in Chapter 6.)

There are two variations for teaching groups of students described in the literature (Brown, Holvoet, Guess, & Mulligan, 1980; Wolery, Ault, & Doyle, 1992). The intrase- quential arrangement involves the teacher presenting teaching trials to each student one at a time, but not programming any student-to-student interaction within the group. In the intersequential arrangement, the teacher makes use of observation learning and prompts students to attend to each other during instruction, to provide assistance as needed, and to praise each other. Both approaches require that the teacher be situated within reach of the students to present materials, to prompt, and

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to provide corrective feedback. The intersequential approach requires that students be able to see each other, thus suggesting a circular arrangement, either seated in chairs or on the floor, or standing, depending on the task. Research presented next (enhanced group instruction and observation learning) lends support to the interse- quential approach. Table 5–1 describes several other variations for building students’ skills to learn in small groups: tandem, sequential, concurrent, and combination.

By studying the amount of peer interaction and academic engagement of middle and high school students with intellectual disabilities, Carter and his colleagues (2008) made some discoveries that are important to this discussion. When in small groups without direct special education support versus other arrangements (whole group arrangements or independent work), students with disabilities interacted two to three times more often with their typical peers. But when a general or special educator was nearby, there was considerably less social interaction. However, students with disabil- ities showed substantially more academic engagement (e.g., attending to instruction and materials, responding on task) when these same teachers were in close proximity during small group arrangements or one-to-one teaching. They concluded that teach- ing students with severe disabilities in small groups alongside their typical peers was still the best intervention for promoting peer interaction and learning. Furthermore, drawing on other research, they recommended that the goal of increasing meaningful social interactions might best be achieved through peer support interventions. When peers are equipped to support their classmates with disabilities both socially and aca- demically, reliance on paraprofessionals can be reduced and substantial improve- ments in social interactions can occur (Carter, Sisco, Melekoglu, & Kurkowski, 2007).

enhanced Group instruction

Enhanced group instruction (EGI) (Kamps, Dugan, Leonard, & Daoust, 1994; Kamps, Leonard, Dugan, Boland, & Greenwood, 1991), which uses an intersequential approach, has been found to be effective in promoting responding and learning in small groups of students with intellectual disabilities and autism. Teachers working with groups of three to five students made tasks interesting and promoted learning by (a) requesting frequent student-to-student responses, (b) using fast-paced and ran- dom trials, (c) rotating materials and concepts taught, (d) using multiple examples of each concept taught (a minimum of three sets per concept), and (e) using individual- ized sets of materials for each student. These strategies meant that students were han- dling learning materials and actively and repeatedly responding to the teacher and to classmates on task concepts. As a result, they focused on the target stimuli, partici- pated in the target response, and were reported as being interested in the group activity. While all of the students in these studies had disabilities, many of these group strategies for making instruction interesting and focused are often used in het- erogeneous groups in general education classrooms and appear to have the same effects with a diverse array of students (Hunt, Staub, Alwell, & Goetz, 1994; Snell & Janney, 2000; Tomlinson, 2001). To the extent that enhanced group instruction makes teaching more effective for all learners, it has the features of a universal design in that it benefits most, if not all, students.

observation learning

It is not surprising that students with severe disabilities can learn by watching others. Researchers have shown positive learning effects from intersequential arrangements where one student observing another student acquires academic skills (e.g., spelling one’s name, adding, using a calculator, identifying community signs) and non- academic skills (e.g., sharpening a pencil) (Brown & Holvoet, 1982; Doyle, Gast, Wolery, Ault, & Farmer, 1990; Singleton, Schuster, & Ault, 1995). In these studies, which involved only pairs or small groups of students with disabilities, students not only learned the

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skills that they were taught directly, but also acquired some of their classmates’ skills that they had only observed or that had been presented to them incidentally. Learn- ing through observation in small groups works well when group members have the same type of task (e.g., identifying over-the-counter medications) but are taught with different materials (e.g., each student learns two different medications) instead of all having the same materials.

Christine’s teacher, Ms. Rowyer, places two other students together with Christine when teaching them to identify community words. They look at videos that have been taken of familiar locations in the community—locations that all of the students are learning to use more independently (e.g., several grocery stores and fast-food restaurants, two dis- count stores, and the video store). The videos show close-ups of frequently encountered words that are also target sight words that they are learning to locate, read, and act upon. When starting a new set of words, Ms. Rowyer shows and also gives them each a different word card (Christine’s words are written in large font), names the words, and states their meanings. They review these responses and then watch the video segment where the three words are naturally displayed. Ms. Rowyer uses time-delay prompts to teach them to match the words to her identical card, name the words, and state their meanings. Then they switch words and repeat the process.

Learning through observation in small groups also works well when typical class- mates model functional tasks for students with severe disabilities while stating each step that they perform (e.g., spelling their name with letter tiles, using a calculator) (Werts, Caldwell, & Wolery, 1996).

During kindergarten, Marc’s teacher often groups Marc with two peers to help teach him routines such as putting things in his cubby and getting ready for snack time. Jacob and Meredith are good models; they make sure that Marc is watching and then perform one small step at a time as they tell him with words and gestures what they are doing.

cooperative learning Groups

Strategies to promote cooperation among students working toward a group goal have had widespread application in regular education programs ( Johnson & Johnson, 1997). Many of the strategies for successful group instruction are evident in coopera- tive learning groups, with the added advantage that students learn to cooperate with others while shifting competition with others to competition with oneself (Snell & Janney, 2000). Slavin (1991) defines cooperative learning methods as “instructional techniques in which students work in heterogeneous learning teams to help one another learn academic material” (p. 177). In contrast to the group arrangements just described, cooperative learning groups work more independently from the teacher. However, cooperative learning groups receive instructions on the purpose of the activity, have ongoing supervision, interact with the teacher, and require a great deal of teacher planning.

Marc’s kindergarten teacher makes frequent use of cooperative groupings. The cooper- ative activities are changed daily and involve art (making a mural together), music and dance, building with blocks or other materials, science, cooking, or games. The small groups are balanced so that children who need extra assistance and those who are more independent are spread out among the groups. Group membership changes several times over the school year. Following simple directions given by Ms. Kwan, the kindergarten teacher, the students move with their group to the activity, get settled, receive instructions, participate together, finish the activity, and clean up. After instructions or a demonstration of the activity, Ms. Wharton, the special education teacher, and Ms. Kwan rotate among the groups and help group members decide who will do what to contribute to the activity. For example, Marc, who likes to put things in their places, is often given responsibility for putting materials away for his group.

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Marion and Charles, each with delayed language, are in different groups; they enjoy passing out items to group members and benefit from naming group members, so they are often given such tasks.

Several examples of cooperative learning groups have involved students with severe disabilities in general education classrooms. Dugan and colleagues demon- strated that fourth graders with autism could learn skills such as word recognition, peer interaction, and academic engagement alongside their peers in social studies cooperative groups (Dugan, Kamps, Leonard, Watkins, Rheinberger, & Stackhaus, 1995). Hunt et al. (1994) taught second graders to use positive feedback and prompts to assist classmates with movement, cognitive, and communication disabilities to respond in cooperative groups. The students with disabilities rotated to new coopera- tive groups in the classroom every 8 to 10 weeks. Not only did peers achieve their academic objectives even when serving as mediators, but target students also learned motor and communication objectives that were embedded within the cooperative activity and generalized these skills to new groups, peers, and activities. While the typical students focused on learning geometry from shapes and money skills, their classmates with disabilities worked on communication and motor IEP objectives because the group activity allowed many opportunities for requesting turns and mov- ing task materials. Both studies support the use of cooperative learning groups as a means for promoting meaningful inclusion of students with severe disabilities in general education classrooms.

Group instruction Guidelines

Group instruction has many benefits over one-to-one instruction but may be challeng- ing to some students. Several simple methods can maximize student motivation for working in groups:

1. Individualize instruction so that all group members actively participate. This means that the same concept will be taught at varying levels of complexity suited to indi- vidual students, while also allowing for different response modes and using modi- fied materials if needed.

2. Keep the group instruction interesting by (a) keeping turns short, (b) giving every- one turns, (c) making turns contingent on student attending, (d) giving demonstra- tions, and (e) using a variety of task materials that can be handled by the students.

3. Encourage students to listen and watch other group members as they take their turns and praise them when they do so. Actively involve students in the process of praising and prompting others.

4. Attend to students during instruction and provide task-specific praise that students can understand and individualized reinforcement. Also, use group reinforcement contingencies so that the group is reinforced on the basis of all members’ com- bined performance.

5. Allow students to participate in demonstrations and handle materials related to the skill/concept being taught.

6. Keep waiting time to a minimum by controlling group size, teacher talk, and the length of each student’s turn.

7. Prompt cooperation and discourage competition among group members.

Peer-Mediated instruction and Peer support

There is a long history in special education of engaging peers of all ages to intervene and assist with the teaching of skills to their classmates with disabilities. Phil Strain (Strain & Odom, 1986) is one of the early researchers on peer-mediated instruction with preschoolers; the focus that he and his colleagues addressed was social interac- tions, teaching peers to initiate interactions during play and then monitoring their

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efforts and the target child’s responses. Since then, many researchers have applied this basic concept of involving peers to support their classmates with disabilities. Recent work demonstrates the effectiveness of peer support arrangements as an alter- native to relying completely on support and instruction from adults (Carter, Sisco, Melekoglu, & Kurkowski, 2007; Hughes, Rung, Wehmeyer, Agran, Copeland, & Hwang, 2000).

Peer tutoring

Students without disabilities have been found to be effective instructors and social supports for their peers with severe disabilities in both one-to-one and two-to-one arrangements (two peers with one student with disabilities) (Carter & Kennedy, 2006). Not surprisingly, students with severe disabilities were found to have significantly more interactions when working with peers than when working with paraprofession- als or special educators (Carter, Sisco, Melekoglu, & Kurkowski, 2007). Peer support has also been shown to be a vehicle for students with disabilities to access the gen- eral education curriculum (Carter, Cushing, Clark, & Kennedy, 2005; McDonnell, Mathot-Buckner, Thorson, & Fister, 2001). For example, when peer tutors learned to use enhanced group instruction (Kamps, Walker, Locke, Delquadri, & Hall, 1990) to teach word reading, their tutees made as much progress as they did when taught one- to-one or in small groups by teachers or paraprofessionals. Other researchers demon- strated that adolescents who were underachievers could learn to be as effective as special educators in getting their tutees to engage in class tasks while also improving their own engagement (Shukla, Kennedy, & Cushing, 1998).

Many effective peer tutoring programs have been reported from preschool to high school in which peers have been taught to tutor classmates with disabilities on com- munication, social skills, physical education, and academic skills (Carter & Kennedy, 2006; Carter, Sisco, Melekoglu, & Kurkowski, 2007; Collins, Branson, Hall, & Rankin, 2001; Gilberts, Agran, Hughes, & Wehmeyer, 2001; Hughes, Rung, Wehmeyer, Agran, Copeland, & Hwang, 2000; McDonnell, Johnson, & McQuivey, 2008; Ward & Ayvazo, 2006). Peer tutoring programs become more acceptable when they are balanced with efforts to promote friendships and non-helping reciprocal relationships between classmates and peers with disabilities and when they are unobtrusively supervised and supported by adults (Carter, Cushing, & Kennedy, 2009; Janney & Snell, 2006).

Developing peer tutoring programs that promote equal relationships among stu- dents can be a challenge. Strategies that can help avoid the problem of one-way teaching among peers include classwide or reciprocal peer tutoring and peer assis- tance with cooperative groups, in which dyads or groups of three students take turns teaching each other (one student may have a disability) (Delquadri, Greenwood, Whorton, Carta, & Hall, 1986; Dugan, Kamps, Leonard, Watkins, Rheinberger, & Stackhaus, 1995; McDonnell, Mathot-Buckner, Thorson, & Fister, 2001). Another way to avoid having peers be teachers is to pair older students, one or more grades older, as the tutors of younger students; with this arrangement, one-way teaching is less of an issue because there is no peer relationship between the tutor and the tutee, but instead there is a mentoring relationship.

Twice a week, Jacob looks forward to sessions with his seventh-grade tutor, Steve. After checking in at the tutoring office and getting the lesson plan and Jacob’s record book, Steve takes Jacob to a tutoring station in the library. There they review what Jacob has done over the past few days in his classes: getting around the school, carrying out tasks without being distracted, and using picture or word guides to remember task steps. Then Jacob reads the task for that day from his schedule (return old class books and pick up new class books from the library), reviews the steps, gets the materials, and completes the task with reminders as needed from Steve. Afterward, Jacob self-evaluates with Steve’s input. Before returning to the middle school next door, Steve shows the tutoring supervi- sor Jacob’s record; once a month, Steve is observed by the tutoring supervisor.

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With the goal of increasing the amount of meaningful time spent in general edu- cation classrooms for students with disabilities, McDonnell and his colleagues (2001) demonstrated the success of an intervention package that involved reciprocal peer tutoring and multielement curricula with accommodations. Six middle school stu- dents (three with moderate/severe disabilities, three without) were involved, along with the rest of the middle school classes, in prealgebra, physical education, and his- tory. Classes were organized into reciprocal peer tutoring teams that included three students, each at different skill levels (above average, average, and below average); some teams included a student with a moderate or severe intellectual disability. All team members were taught to serve in tutor, tutee, and observer roles. Thus, each member of the tutoring teams learned to present instructional cues, to praise, and to correct errors. The multielement curricula involved special and general education teachers who were developing objectives for students with disabilities within the general education curriculum (prealgebra, physical education, and history) and also were identifying needed accommodations so that these students could learn related content alongside their peers. Examples of accommodations included a reduced number of problems, allowing the student to dribble a basketball with the right hand instead of alternating between the right and left hands, and pointing to indi- cate the answer instead of speaking or writing. The researchers measured students’ weekly test scores and coded their academic response and competitive behaviors (e.g., aggression, disruption, talking off task, inattention, non-compliance, self- abuse). The combined intervention (multilevel curriculum, accommodations, and reciprocal peer tutoring) appeared to lead to improved rates of academic response and reduced rates of competitive behavior in all three students. The peers without disabilities demonstrated benefits from the peer tutoring program as shown by their test scores.

Peer support Programs

In contrast to peer tutoring, peer support is less formal and more broadly directed toward social interaction and friendship, but also may focus on improving classroom engagement and task focus (e.g., looking at the teacher, asking questions about assignments, making comments in class). Recent less formal versions of peer support tested by Carter and his colleagues (2005, 2007) in secondary schools have been dem- onstrated to increase positive interactions between students with disabilities and their peers in general education settings and to improve academic engagement. In fact, interactions and engagement have been shown to be higher with support from peers than from adults (Carter, Sisco, Melekoglu, & Kurkowski, 2007). Also, the use of two peers to support one student was shown to yield even more improvements in aca- demic involvement and social interaction than did the use of a single peer to support a student (Carter, Cushing, Clark, & Kennedy, 2005).

Several steps are involved in creating peer support programs in secondary school settings. First, peers and the students whom they support are carefully recruited with team input. Second, peer supports are trained and put into place in the general edu- cation classroom. Finally, peer supports are monitored by adults for the quality of support with retraining given as needed (Carter & Kennedy, 2006). Peer support may include a variety of activities carried out during class time, small group instruction, transitions, and breaks. Peers are taught to lend support for a partner’s social IEP goals (e.g., taking conversational turns, initiating interaction), to promote their par- ticipation in class activities (e.g., cuing them to get needed materials, asking partners to work together on assignments, explaining assignments), to give partners a lot of positive reinforcement for participating and corrective feedback as needed, and to encourage their partners to interact with them and with other classmates. (These strategies are described in more depth in Chapter 11.)

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individualized Adaptations: Accommodations and Modifications

A crucial approach that is used by both general and special educators involves adapt- ing instruction for individual students so that they achieve their expected educational goals. For students with high support needs, team members must work together to find adaptations that can resolve learning problems:

Because handwriting was slow and tedious for Marc and often resulted in tantrums, the team wanted to simplify the task. The occupational therapist suggested using a slant board to position materials and a hard plastic template with 1/2- by 1-inch openings for him to write the letters in. He also was taught to use a small keyboard printer to quickly produce words and phrases instead of writing them by hand.

Adaptations is a broad term that encompasses both accommodations and modifica- tions. Adaptations occur informally whenever teachers (a) adjust their method of delivery because they see that one or more students seem to be lost (e.g., they move closer to a student while repeating the directions), (b) change their expectations of how students respond (e.g., “First tell me and then write it.”) in order to improve stu- dents’ participation, or (c) examine and modify the academic goals or performance criteria for students on the basis of their performance. Accommodations are adjust- ments that the IEP team makes to a student’s school program that do not significantly change the curriculum level or performance criteria; instead, accommodations enable a student to access curriculum content or to demonstrate learning without changing curriculum goals (e.g., Jacob’s extra time on his tests, Christine’s adapted computer mouse and moving her desk close to the board). In contrast, modifications alter cur- riculum goals and performance criteria.

Jacob’s team modified his fourth-grade curriculum goals and performance criteria for science: Jacob will show understanding of several primary concepts from the science unit on weather by matching pictures with simplified terms and definitions. Jacob’s classmates are expected to explain all of the concepts using unit terminology.

Students with severe disabilities typically will have many IEP accommodations and modifications that support their learning. For these students with more extensive sup- port needs, it is best to have a more organized approach for teachers to work together to identify and implement needed individualized adaptations (see Chapter 6).

self-Management

Self-management procedures and student-directed learning strategies have many variations and are highly flexible and can be individualized to suit different stu- dents, behaviors, and settings. The common purpose of these approaches is “to enable students to modify and regulate their own behavior” (Agran, King-Sears, Wehmeyer, & Copeland, 2003, pp. 3–4). These approaches teach students to take a more active role in their own learning. Variations of self-management strategies include the following:

Antecedent Cue Regulation and Picture Cues: Students learn to use visual, tactile, or auditory guides to remind them of the steps in a task, such as a work sequence, or to improve engagement in the classroom (Mechling, 2007).

For her job as a greeter at Walmart, Christine’s job coach created a small photo guide that would be displayed on a plasticized sheet placed on her lap tray and also dis- played on her DynaVox™ communication device. Initially, the 12 photos were large and were used one at a time to prompt each step of her role as a greeter at Walmart (e.g., job preparation, the ride to the store, check-in). Now she uses the photo grid by herself to remind her of each job step.

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Self-instruction: Students learn to give themselves verbal cues as they are carrying out a targeted task in order to complete each step in the task at work or school (e.g., Agran & Moore, 1994).

Because Jacob had become highly dependent on prompting in two routines, his teach- ers designed a self-instruction task analysis of the steps involved in arriving at school and getting ready to go home. They used a “did–next–now” procedure to teach both routines. He learned to do each step as he verbalized in a did–next–now format: “I did put my backpack in my locker; I need to give my check-in sheet to Ms. Bowers; I’m go- ing to give my check-in sheet to Ms. Bowers.” Now he uses this approach to cue himself through the steps of both routines.

Self-monitoring: Students who self-monitor have learned to (a) observe their own behavior, (b) judge whether or not they have performed a targeted behavior, and (c) determine whether their performance met agreed-upon criteria (e.g., learning to discriminate following teachers’ directions in general education classrooms) (Agran, Sinclair, Alper, Calvin, Wehmeyer, & Hughes, 2005).

Jacob’s team thought that he could learn several necessary classroom behaviors bet- ter by using a self-monitoring system instead of being instructed by Ms. Connors, the fourth-grade teaching assistant. The behaviors (taking his binder from his backpack, greeting Ms. Bowers as the other students did, and being in his seat when the bell rang) were ones that two of his classmates also needed to learn, so all three boys were involved in the project. Ms. Bowers met with Jacob and his classmates to discuss and design the simple recording form that they set up like a race car track. The students learned to pick a race car and move it forward whenever they performed the class- room skills and checked the box. Each student learned to record accurately and liked earning a favorite activity like computer time or time to read race car magazines that they had brought from home.

Jacob’s car moves

Get my binder ❏ Say hi to Ms. Bowers ❏ Get in my seat fast ❏ Computer time

Ted’s car moves

Get my binder ❏ Say hi to Ms. Bowers ❏ Get in my seat fast ❏ Computer time

Mitch’s car moves

Get my binder ❏ Say hi to Ms. Bowers ❏ Get in my seat fast ❏ Magazine time

Self-Monitoring Device

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ar th

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149Selecting Teaching Strategies and Arranging Educational Environments

Self-evaluation: Students learn to compare their own performance of a behavior to a desired level of performance (e.g., self-evaluating social responses) (Koegel, Koegel, Hurley, & Frea, 1992).

Marc was slow eating his lunch. Ms. Wharton, his special education teacher, timed him and his classmates over several days to see how long they took. Marc took 45 minutes and his classmates took 20 to 30 minutes. Marc’s team set his goal at 30 minutes, but established successive time goals of 44, 41, 38, 35, 32, and 30 minutes. Ms.Wharton showed Marc a small visual timer and challenged him to eat faster before the red on the timer disappeared. Before lunch, Marc selected a desired activity to put on his schedule, and if he “beat the clock,” he could participate in that activity.

Self-reinforcement: Students learn to compare their own performance of a targeted behavior to an agreed-upon level and administer a reinforcing consequence if they met the criterion. The reinforcement can be as simple as self-praise (“I finished my work!”) (Moore, Agran, & Fodor-Davis, 1989).

As part of the fourth-grade classroom behavior self-monitoring program, Jacob and his two classmates learned to take their checklists to Ms. Bowers at lunchtime and say “I got my binder, said hello, and got in my seat on time!”

Koegel and Koegel and their colleagues have applied self-management instruction to individuals with autism as a means for reducing problem behavior and increasing appropriate replacement behaviors (Koegel, Koegel, Boettcher, Harrower, & Openden, 2006). They suggest using a series of steps to design self-management programs and to involve students at every step as a means for encouraging commitment to a shared goal of positive behavior change (Keogel, Koegel, & Carter, 1999):

• Define the target behavior. • Identify functional reinforcers that the student will work toward earning. • Design a self-monitoring method or device that is appealing and can be learned by

the student (e.g., placing a check mark next to a picture that represents a target behavior, using a wrist counter).

• Teach the student to use the method until he or she does so accurately (identify opportunities, set up opportunities, teach using prompts, fade prompts).

• Determine whether the student’s use of self-management results in the desired be- havior change; if not, problem solve and improve the procedures.

• Validate whether the student is using the device in natural environments.

Sometimes the variations in the self-management methods applied are not very distinct or may be intentionally combined (e.g., antecedent cues, self-evaluation, and/or self-reinforcement). For example, Agran and his colleagues (2005) taught middle school students with moderate to severe disabilities in general education classrooms to self-monitor their following of teachers’ directions. Students first learned to discriminate directions from non-directions, then they learned to self- record their direction through the use of modeling and guided practice, and, finally, they learned to self-monitor through role-play (Agran, Sinclair, Alper, Cavin, Wehmeyer, & Hughes, 2005). As a result of the intervention, all of the students made rapid improvements in following teachers’ directions in class and educators agreed that their progress was significant and valuable. In another secondary school exam- ple, Hughes and her colleagues (2002) applied an antecedent cue regulation approach to teach high school students with intellectual disabilities to use a stimulus like money placed in their hands or a picture prompt card to direct themselves to carry out a relevant behavior (e.g., thanking the cashier, keeping the head upright, com- pleting assignments, and initiating a conversation) (Hughes, Copeland, Agran, Wehmeyer, Rodi, & Presley, 2002). Teaching sessions started with hearing a rationale for learning the behavior and then involved modeling, direct instruction, guided practice, and corrective feedback; after two or three teaching sessions, the students mastered self-management.

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Finally, middle school students, taught by peer tutors, learned to self-monitor their performance of teacher-selected classroom survival skills (e.g., be in the classroom and seated when the bell rings, bring appropriate materials, greet teachers and peers, ask and answer questions) (Gilberts, Agran, Hughes, & Wehmeyer, 2001). Whenever they performed the classroom skills in their general education classroom, students learned to place check marks by survival skill words and pictures on a simple record- ing form; once they became accurate in self-recording, their performance of these survival skills greatly improved. When students are taught to self-manage their own behavior, they are less dependent on others and may have mastered improved engagement, better work completion, and appropriate social behavior.

sPeciAlized teAcHinG strAteGies tHAt Are effective WitH students WHo HAve severe disABilities

This section of the chapter will describe specialized teaching approaches that have been shown to be successful with students who have severe disabilities. Some exam- ples of specialized strategies include visual supports, embedded instruction, chaining methods, and low error prompting procedures. These approaches, as a group, tend to have stronger research support with learners who have extensive disabilities than do the universal approaches. Many of these approaches rely on the use of discrete teach- ing trials whose elements we will explain in detail. While the research supporting most of these strategies has been conducted in special education classrooms or even sepa- rate school settings, most of these strategies are “portable” and all have been applied successfully to support students who are included in general education settings.

While both universal and specialized strategies range from the simpler to the more complex, specialized strategies, as a group, are often quite dissimilar from the meth- ods used with typical students, and not all of these approaches may fit well in the general education setting without some adaptation. These specialized approaches often depend on direct and systematic instruction and require an understanding of the discrete teaching trial and its elements: (a) giving a task request, (b) waiting for a response, (c) giving assistance as needed, (d) reinforcing correct responses, and (e) providing feedback with regard to errors.

Specialized approaches often look different, may require more teacher effort, and may not blend easily with general education teaching procedures. Educators, there- fore, must be cautious when planning to use specialized approaches with specific students in inclusive settings. The only-as-specialized-as-necessary criterion (dis- cussed more in Chapter 6) emphasizes the need to keep teaching strategies and adap- tations both non-intrusive for the student and user-friendly for the teaching team. The goal for applying this criterion is to acknowledge that (a) students do not want to be singled out for extra assistance or adapted treatment all of the time and (b) students who need specialized interventions can still participate in typical activities and ordi- nary relationships. Thus, when teams apply the strategies described in this section in general education settings, they will use the teaching strategy with a student only when it is needed and when less intrusive approaches have not been successful, tak- ing care that the strategy does not stigmatize the student and is not overburdening for team members to use, and keeping data on its use to judge its effectiveness. A second guide for selecting specialized teaching strategies, mentioned earlier, is the principle of parsimony (Etzel & LeBlanc, 1979)—select the simplest but still effective approach— which reminds us that teaching strategies should be based on prior evidence.

visual Modality strategies

With the increased interest in effective teaching methods for students with autism and students with limited verbal skills, researchers have begun to study the use of visual supports to replace or supplement teachers’ verbal cues. More recently, the use of

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151Selecting Teaching Strategies and Arranging Educational Environments

several types of video models have been reported and have been found to be effec- tive antecedent strategies that may accompany other teaching approaches.

visual supports

There are many different applications for using symbols to support students’ under- standing of their school day and activities outside of school. Visual symbols, such as objects and pictures have the characteristic of being concrete and permanent, instead of fleeting, like verbal requests or signs and gestures. Object and picture symbols have been demonstrated to be highly effective, especially for students whose verbal understanding or expression is limited. (The use of visual symbols for communication is discussed in more detail in Chapter 12.)

Visual Schedules. Among the most prevalent forms of visual support are schedules that use real objects, tangible symbols, picture symbols, or words to represent regu- larly scheduled events during a student’s school day. Mirenda and her colleagues dif- ferentiate between schedules that represent the activities in a day or a partial day (called between-task schedules) and schedules that represent the steps or subactivities within a single activity (called within-task schedules) (Mirenda, MacGregor, & Kelly- Keough, 2002). Both between- and within-task schedules are constructed following similar guidelines. Many give credit to Stillman and Battle (1984), as well as to Eric Schopler and his colleagues in the TEACCH program, for setting forth the use of vis- ual schedules to structure routines for individuals with autism (e.g., Schopler, Brehm, Kinsbourne, & Reichler, 1971). The TEACCH checklist for individualizing visual schedules that is shown in Table 5–2 provides teachers with six key elements for cre- ating visual schedules and teaching their use; items within each element are ordered from simple to more complex (Mesibov, Shea, & Schopler, 2004). Teams must identify the method for representing activities on a schedule in ways that students can under- stand (e.g., matching the actual object used in the activity to words naming the activ- ity). (Figure 5–2 shows a student using his symbolic object schedule and then learning to make activity choices using symbolic objects.) The schedule length can be a single activity or can contain representations of activities that last an entire day. The sched- ule items (objects, icons, etc.) must be arranged in some way and designed so that they can be manipulated by the student. The teacher may give schedules directly to beginning students, but students will need to learn either to go to a set location in the classroom to find their schedule or to use a portable schedule. Finally, learning to ini- tiate schedule use can range from teachers prompting students to use their schedule to students spontaneously checking their schedules. (Figure 5–2 shows a student using his schedule spontaneously.)

In the TEACCH system, visual schedules are coordinated with a structured work/ activity system for helping students understand the beginning, the end, and the content of a task. The structure uses visual symbols (or objects) to help students grasp answers to questions such as the following:

• What task(s) will I do? (Symbols represent the tasks in a teaching session.) • How much work is required? (The number of symbols indicate the number of

work tasks.) • How can I monitor my progress? (The symbols are removed in order once

completed.) • When am I done? (When all symbols are removed from the activity board, the task

is done.) • What happens next? (Students may refer to a final break activity symbol, or to their

between-task schedule, for the next task.) (Figure 5–4 illustrates a structured activ- ity system used by an occupational therapist.)

Activity Boards, Rule Scripts. There are numerous variations on the theme of supporting students using visuals (Beukelman & Mirenda, 2005; Downing, 2005).

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Activity boards contain a small number of symbols related to a specific activity and thus supply the visual vocabulary needed for a student to communicate and for adults and peers to augment their verbal input when they communicate with the student. Augmented input means that communication partners augment or couple their spoken word communication with the communication forms that the student uses (e.g., tangible symbols, picture symbols, signing, touching symbols on a speaking communication device). Augmented input helps reinforce the meaning of the student’s communication forms or symbols (for more on this, see Chapter 12).

Mirenda and her colleagues (2002) describe several useful approaches that can help prevent problem behavior just before and during an activity. For example, a within-task symbol script might be created to represent the required steps in a non- preferred or difficult task, such as having one’s hair washed during bath time (see Figure 5–5). Rule scripts, another visual support strategy, may be designed to clarify

TAbLE 5–2 TEACCH Checklist for Individualization of Visual Schedules

(Based on TEACCH® Autism Program; for more information: http://www.teacch.com)

Form of Representation Object that will be used in an activity Object that is symbolic of an activity/area Photograph Icon Picture/word combination Single word Phrases or sentences

Length of Schedule One item at a time, signifying transition Two items, signifying a first–then sequence Three or four items, up to an hour 2 hours 1/2 day Full day

Presentation Format One item at a time Left to right sequence Top to bottom sequence Multiple rows

Ways to Manipulate the Schedule Carry object to be used. Carry visual cue to be matched (in basket, box, pocket, on VELCRO®). Turn over visual cue on schedule as completed. Mark off visual cue on schedule as completed.

Location of the Schedule Teacher takes schedule information to student. Stationary schedule in central, neutral location on table Stationary schedule in central, neutral location on shelf or wall Portable schedule: “pull-off” segment of schedule Portable schedule: on clipboard Portable schedule: in notebook

Initiation of the Use of the Schedule Teacher takes schedule information to student. Student goes to schedule with transition symbol: from same room, schedule within view Student goes to schedule with transition symbol: from a variety of locations Student travels to schedule using verbal cue: from same room, schedule within view Student travels to schedule using verbal cue: from a variety of locations Student spontaneously checks schedule.

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FIGURE 5–2 Student Using a Symbolic Object Schedule Toby has learned to use a picture schedule. From the top box, he selects a small ball that is a symbol for a combined communication and physical therapy session in the gym. The second box has an object that symbolizes art class with his peers, while the third represents toileting. Once in the gym, Toby works with his SLP to make an activity choice as he learns to associate objects that are symbolic of an activity with the activity itself (choosing from the swing or the roller).

Photos: Martha Snell

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154 Chapter 5

the rules related to how an activity is conducted instead of the activity’s sequence of steps (e.g., rules for eating properly, rules for walking in the hallway during transi- tions). Figure 5–6 shows the approach Mirenda and her colleagues (2002) used to teach a child during a trip to a museum whether or not she could touch various exhibits.

Social Narratives. Social narratives are short accounts of activities that may cause difficulty for students. Social narratives usually consist of pictures and simple words that state what to do, instead of focusing on what not to do, and that are written in first person to take the student’s perspective. Typically, social narratives are read to students as a means of rehearsing what they should do in that activity. Social narratives are more flexible versions of Social Stories™ (Gray & Garand, 1993), but take a similar approach. The evidence behind this general approach is supportive even when the guidelines for writing Social Stories are not systemati- cally followed or when additional cuing elements are added (e.g., Delano & Snell, 2006; Kuoch & Mirenda, 2003; Lorimer, Simpson, Myles, & Ganz, 2002; Thiemann & Goldstein, 2001).

Marc’s teachers designed a five-page narrative to help him learn what he needed to do at circle time in kindergarten. The pages read as follows:

Page 1: My name is Marc [his picture]. I am in kindergar- ten. I go to two classes—Ms. Rachel’s and Ms. Kwan’s.

Page 2: I sit on the rainbow rug in Ms. Kwan’s room [pic- ture of rainbow rug with Marc and classmates sitting on it].

Page 3: Everyone is quiet on the rainbow rug [picture sym- bol of quiet]. Everyone sits criss-cross-apple-sauce on the rainbow rug [picture symbol of sitting criss-cross].

FIGURE 5–3 Student Using a Picture Schedule Spontaneously Kyle uses a picture schedule to guide his morning, icons and pictures arranged from top to bottom. Kyle has completed a work session and now goes to the computer for five minutes; after the computer, he will join his kindergarten class. While at the computer, his teacher uses a “count-down” visual to help him understand how much time he has left on the computer.

FIGURE 5–4 Structured Activity System An occupational therapist, Ms. Helene, works with Valerie to as- sess her sensitivity to fine-motor tasks. She uses a structured ac- tivity system to organize the assessment. They start by reviewing symbols for the four tasks, and then Valerie will take the first sym- bol and match it to the first task. When she is finished, she puts that symbol in a “Finished” pocket on the back of the card. This approach helps Valerie know what tasks will be performed, how much work is required, how to monitor her progress, when she is finished, and what happens next.

Photos: Martha Snell

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Page 4: I will try to be quiet on the rainbow rug. I will try to sit criss-cross-apple-sauce on the rainbow rug [picture].

Page 5: My teachers will be very happy if I do not talk when I am sitting on the rainbow rug. I will talk in Ms. Joan’s room. I will talk in Ms. Kwan’s room when I am not sitting on the rainbow rug.

There are several teaching considerations for using visually cued instruction and visual sup- ports such as schedules, activity boards, symbol- structured activity systems, rule scripts, social narratives, and so forth:

• Use objects or symbols that the student associ- ates with familiar routines or activities or can readily learn to associate.

• Use vocabulary that matches the student’s com- prehension skills or that may be understood when coupled with familiar routines.

• Rely primarily on the objects or symbols to represent the concept instead of using a lot of spoken words.

• Augment your spoken words by pointing to the symbols that match your words (augmented input).

• Provide feedback when symbols within the visual sup- port are used correctly, stating the key word(s) (“Right, P.E.’s finished.”).

video Modeling

Capitalizing on the strength of observational learning, video modeling is an intervention in which brief videos are used to teach specific skills. There is evidence of their effectiveness for teaching students with disabilities of all ages a variety of skills, including play, social com- munication, academics like spelling and reading, self- care (grooming, brushing teeth), and functional routines (ordering fast food, cooking) (Delano, 2007). Video modeling may be used alone or in combination with other teaching methods. This strategy has been shown to be particularly helpful in teaching students with autism, perhaps because of the emphasis on visual modeling over verbal instruction and because instruction involves less adult control (Charlop-Christy, Le, & Freeman, 2000). There is emerging evidence that video modeling promotes generalization and enables children with autism to acquire skills faster than in vivo (live) mode- ling, when teachers use model prompts with students (Charlop-Christy et al., 2000). Videos can be created in several different ways: basic video modeling, video self- modeling, point-of-view video modeling, and video prompting (Cox, Delano, Sturgill, Franzone, & Collet- Klingenberg, 2009).

FIGURE 5–5 Kelti’s Within-Task Symbol Script When hair washing caused severe tantrums, a within-task symbol script was devised to teach Kelti the sequence for washing hair: what came first, second, and third, and when it was finished. Initially, her parents used the script with role-play before bath time and omitted hair washing; later they used the script before bath time to help Kelti com- plete the hair-washing routine without tantrums.

shampoo

START 1 2 3 4 5 6 7 8

FINISH

shampoo on hair wash hair rinse hair

(Republished with permission of Paul H. Brookes Publishing Company Inc., from “Teaching communication skills for behavioral support in the context of family life” by J. M. Lucyshyn, G. Dunlap, & R. W. Albin; Families and positive behavior support : addressing problem behavior in family contexts, eds. Mirenda, P., MacGregor, T., & Kelly-Keough, S, 2002; permission conveyed through Copyright Clearance Center, Inc. )

FIGURE 5–6 Haley’s “Can I Touch?” Rule Script This rule script was used to clarify the rules concerning whether or not Haley could touch various items in stores and at other community locations. She practiced the script at various community locations and then used it in a mu- seum to determine whether she could touch an exhibit. The script helped Haley learn that she could sometimes touch things, but not always, which meant that she had more control and did not run away when someone told her “no”.

Can I touch?

Please answer by pointing:

yes no

(Republished with permission of Paul H. Brookes Publishing Company Inc., from “Teaching communication skills for behavioral support in the context of family life” by J. M. Lucyshyn, G. Dunlap, & R. W. Albin; Families and positive behavior support: addressing problem behavior in family contexts, eds. Mirenda, P., MacGregor, T., & Kelly-Keough, S, 2002; permission conveyed through Copyright Clearance Center, Inc.)

(Figures 5.5 and 5.6 The Picture Communication Symbols ©1981–2010 by Mayer-Johnson LLC. All Rights Reserved Worldwide. Used with permission. Boardmaker™ is a trademark of Mayer-Johnson LLC.)

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156 Chapter 5

Basic Video Modeling. The most common form, basic video modeling, simply re- quires that a peer or adult be taped as they perform a target skill. Usually these vid- eos are short and do not have narration, thus making them easy to create and use. When the video is loaded onto a classroom computer, students can easily watch the video prior to the teaching session. After watching the video, the student is prompted to perform the target skill. Most of the video-modeling research with students on the autism spectrum has used this basic approach (e.g., D’Ateno, Mangiapanello, & Tay- lor, 2003; Nikopoulous & Keenan, 2003, 2004). Advantages of video modeling over live modeling are its efficiency, the replay feature, and that steps, which a student found to be difficult during baseline testing, can be video-taped more slowly, with a closer view. Charlop-Christy et al. (2000) used these latter features when teaching elementary school-aged students with autism cooperative play, emotion labels, greet- ings, brushing their teeth, and face washing.

Video Self-modeling. The videos used in self-modeling show the student him or her- self performing the target skill. While such tapes may be very motivating to students, making the tapes requires careful editing so that any assistance given to the student is not apparent in the videotape. (Chapter 10 describes these approaches in more de- tail.) What is important for teachers to know is that there may be little or no differ- ence in effectiveness between basic video modeling and video self-modeling. Sherer and colleagues compared video self-modeling with basic video modeling in which a peer served as a model (Sherer, Pierce, Paredes, Kisacky, Ingersoll, & Schreibman, 2001). Their results suggest that students learned the task at similar rates regardless of which video-modeling approach was used. While more research would be helpful to confirm these findings, teachers should proceed as if the two methods are similar in effectiveness, thus saving time by not needing to prepare video self-modeling tapes.

Other Video-Modeling Approaches. Two additional types of videos have been used successfully in video-modeling instruction. Point-of-view video modeling (Hine & Wolery, 2006) shows the performance that a learner sees when successfully carrying out the task. Thus, during taping, the camera is held just behind a pair of hands per- forming the task. Point-of-view taping avoids the issue of whether the performer is the student or someone else because the performer is not seen. With video prompt- ing, the task and the taping are broken down into steps as a sequence of short video clips. Instruction involves having the student watch the first video clip of the first task step and then perform that behavior, moving through each video clip/task step in order. Researchers have used this approach to teach elementary school-aged students with disabilities to zip jackets, clean glasses, and put on a watch (Kamlesh, 2008) and to teach adults daily living skills (Cannella-Malone, Sigafoos, O’Reilly, de la Cruz, Edrisinha, & Lancioni, 2006). In the latter study (Cannella-Malone et al., 2006), re- searchers compared the effectiveness of video prompting with video modeling to teach six adults with developmental disabilities to set a table and put groceries away. While video prompting consisted of 10 separate video clips, one for each step of the task analysis, shot from the perspective of the performer (like point-of-view video modeling), the video-modeling tape showed all of the steps of the task analysis in one film that was taped from the perspective of the spectator. The findings showed that video prompting led to rapid acquisition, but video modeling was not effective. Because the video perspective was confounded with the type of video, it may be that the perspective from which the videos are filmed also contributes to the effectiveness of the intervention. More research will help isolate the value of video perspective apart from video-modeling type.

Our experience has been that teachers are comfortable with creating simple video- modeling sequences, that these videos may be created and played back on handheld devices such as video iPods™ (Cihak, Fahrenkrog, Ayres, & Smith, 2010), that their students enjoy watching them, and that the low-effort approach seems to contribute to student learning.

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157Selecting Teaching Strategies and Arranging Educational Environments

task Analysis and chaining

chained and discrete response skills The types of behaviors that students are taught can be divided roughly into two groups: discrete behaviors and multiple-step, or chained, behaviors. Target skills that involve a single, isolated response with an obvious beginning and end are called dis- crete behaviors; these behaviors are individually distinctive and can stand alone (e.g., naming familiar people, making numeral/quantity matches, reading words, identify- ing pictures). Target skills that consist of many behaviors chained together in sequence (e.g., sweeping the floor, playing UNO®, eating at a fast-food restaurant, brushing one’s teeth, operating a CD player, counting out combinations of coins to pay for a product) are viewed as being multiple-stepped responses or chained behav- iors. When chained behaviors are targeted for instruction, teams will need to com- plete a task analysis of the responses that are performed to complete the activity.

Examine Marc’s goals and decide whether they are discrete or contain multiple steps:

Following the use of the toilet, Marc will wash his hands by completing 8 of the 10 task steps independently.

During lunchtime at school, Marc will complete 10 of the 12 steps independently: Get in line, go to the cafeteria, move through the cafeteria line, get utensils, select three of the five food options, put them on his tray, enter his payment code using a match cue, carry his tray to the table, eat, empty his trash, get in line, and return to the classroom.

When asked to circle a word (e.g., nap, mop, map) that matches a picture (e.g., of a mop) on a worksheet, Marc will correctly circle the word on 75% of the worksheet for two probes in a row.

When given a slant board to hold his papers and a template to limit the range of writ- ing, Marc will print all of the letters of the alphabet from a model 100% of the time on two probes in a row.

If you identified the first two goals as multiple-stepped behaviors and the last two as discrete behaviors, you are correct. His team members will write task analyses for the first two skills that will guide both assessment and teaching. His teachers might teach all of the task steps in order (total task chaining) or they may “chunk” the steps and teach them as clusters of steps. Alternately, they could teach just one step in the sequence at a time in a forward or backward order (forward and backward chaining, respectively). Typically, the last response is followed by reinforcement, either natural (e.g., completing a task and enjoying the outcome, such as making popcorn, getting the help that was requested) or artificial (e.g., teacher praise, participation in a pre- ferred activity), or both.

Discrete behaviors may be taught separately from the task in which they are used (e.g., reading prices) or taught as a step within a larger chain of functionally related behaviors (e.g., reading prices during the task of getting a snack from a vending machine). The distinction between discrete and multiple-stepped behaviors is not always clear. Many discrete behaviors can be divided into steps. For example, reading words involves a sequence of behaviors: Look at the word, make the initial letter sound, and blend the initial letter sound with the medial and final sounds to say the word. How teams decide to view a target behavior depends on the behavior and the student, and this view influences instruction and measurement.

While the discrete behaviors do not require a task analysis, the team needs to agree on the skill and any prerequisites skills (often called a skill sequence).

Before Christine was taught to read new functional words that she would encounter often, she learned to match targeted words and then to match the new words to pictures of that word. Then she was taught to read the words. Her teachers used a sequence of discrete behaviors: Match identical words, match words to pictures, read the words.

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158 Chapter 5

Discrete behaviors are likely to be taught in a ladder fashion, gradually making the task expectations harder. Students advance from simpler objectives to more difficult or complex objectives, progressing toward their goal. Academic discrete behaviors like naming and counting often are taught in this manner using skill sequences—a listing of related skills arranged from simple to more difficult that are taught sepa- rately, in order, over a predetermined period. Table 5–3 sets forth a longer skill sequence that starts with the kindergarten-level focus and spans several grade levels, including Jacob’s current IEP objectives for counting out combinations of coins to match prices. Many of the skills are discrete, while some may be taught more logi- cally as a chain of responses.

After several years of money instruction, Jacob has mastered steps 1 through 12; he is now working on counting quarters and soon will learn to count combinations of all coins. His teachers schedule regular application of these skills in school, where he makes small purchases. For example, skills 7 and 12 require Jacob to count out a given amount of money, which is required for paying library fines (5 cents per day), buying his school lunch ($1.00) or milk (20 cents), and buying pencils (25 to 35 cents) and paper (2 to 5 cents) in the school store.

task Analysis

Analyzing a task and breaking it down into teachable steps for a student is not a triv- ial process. Consider how Marc’s teachers planned for his active participation in the morning arrival routine.

Before teaching Marc the morning arrival routine, Ms. Wharton, the special education teacher, worked with the school’s autism specialist. They watched other children per- form the task and then analyzed the steps. They identified both the responses that they wanted Marc to learn and the relevant stimulus that Marc needed to learn to attend to (see Table 5–4). Ms. Wharton also asked Marc’s kindergarten teacher, Ms. Kwan, to use the preliminary task analysis and to observe students upon their arrival to double-check the steps. Ms. Wharton piloted the task analysis for Marc to be sure that the steps made sense for him. When she found that some of the steps were too hard for him to do alone (e.g., Step 2: Open the door to the building), she modified those steps by adding adult/

TAbLE 5–3 Skill Sequence for Using Coins to Make Purchases

1. Identification of pennies and stating their value (discrete responses) 2. Counting pennies by ones (chained response) and identifying the total amount (discrete response) 3. Identification of nickels and stating their value (discrete responses) 4. Identification and stating the values of nickels and pennies in a mixed order (discrete responses) 5. Counting nickels by fives (chained response) and identifying the total amount (discrete response) 6. Counting combinations of pennies and nickels (counting by fives and then continuing to count by ones) (chained response) and

stating the total amount (discrete response) 7. Counting combinations of pennies and nickels to yield a written or stated price (chained response, as in making purchases) 8. Identification of dimes and stating their value (discrete responses) 9. Identification and stating the values of dimes, nickels, and pennies in a mixed order (discrete responses) 10. Counting dimes by 10s (chained response) and identifying the total amount (discrete response) 11. Counting combinations of pennies, nickels, and dimes (counting by 10s and then continuing to count by fives and then ones)

(chained response) and stating the total amount (discrete response) 12. Counting combinations of pennies, nickels, and dimes to match a written or stated price (chained response, as in making

purchases) 13. Identification of quarters and stating their value (discrete responses) 14. Identification and stating the values of quarters, dimes, nickels and pennies in a mixed order (discrete responses) 15. Counting quarters by 25s (chained response) and identifying the total amount (discrete response)

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159Selecting Teaching Strategies and Arranging Educational Environments

peer assistance or by dividing one step into two steps: (a) Take off jacket, and (b) hang jacket on the hook. Marc’s mother, who was familiar with the arrival routine, then looked at the task analysis and added her own ideas. Because Marc could perform very little of the task during the initial pilot, the two teachers anticipated that Marc would be in the acquisition stage of learning and thus left the main focus of the task analysis on the core steps of the task. The SLP suggested the enrichment skill of communicating a greeting.

Figure 5–7 shows the final task analysis of Marc’s arrival routine with 17 steps that reflect the validation process. The team decided to extend the task to include the two morning activities in kindergarten. The form allows team members to record teaching and testing data and note anecdotal comments to explain Marc’s performance.

Teams will be more successful if task analyses are carefully developed through a process:

1. Select a needed skill by using ecological inventory results to identify a functional and age-appropriate skill that is an important target for a particular student (see Chapter 3).

2. Define the target skill simply, including a description of the settings and materials most suited to the natural performance of the task.

3. Perform the task and observe peers performing the task, using the chosen materi- als in the natural settings while noting the steps involved.

4. Adapt the steps to suit the student’s disabilities and skill strengths; employ as needed the principle of partial participation, the only-as-specialized-as-necessary rule, and component analysis to design a task analysis that is both age appropriate and functional.

5. Validate the task analysis by having the student perform the task, but provide as- sistance on steps that are unknown so that performance of all of the steps can be viewed.

6. Revise the task analysis so that it works; explore adding simple, non-stigmatizing adaptations to steps that appear to be unreasonable in an unadapted form.

7. Write the task analysis on a data collection form so that steps (a) are stated in terms of observable behavior; (b) result in a visible change in the product or proc- ess; (c) are ordered in a logical sequence; (d) are written in second-person singular so that they could serve as verbal prompts (if used); and (e) use language that is not confusing to the student, with the performance details that are essential to as- sessing performance enclosed in parentheses.

TAbLE 5–4 Initial Task Analysis of the Sequence of Stimuli and Responses Involved in Marc’s Arrival Routine

Stimulus Response

• Bus stops, driver opens door, kids get up. Get out of bus. • See school door. Open and walk through door. • See lobby and hallway to the left. Walk through lobby and down hallway. • See blue classroom door on the right. Open door and go in. • See teacher (hear/see greeting). Greet teacher by waving. • See coat rack and other students removing their backpacks and jackets. Find empty space, take off backpack. • See other students putting backpack into cubby. Place backpack in cubby. • See other students hanging up their jackets. Remove jacket, hang on empty hook. • Jacket and backpack are put away (smiles and praise from teacher). Go to schedule. • See activity cards arranged vertically. Take top card for centers, match to activity. • Teacher rings start bell. Go to schedule. • See activity cards arranged vertically. Take top card for circle, match to activity. • See rainbow rug, peers, and Ms. Kwan. Sit on rug.

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160 Chapter 5

Approaches for teaching chained tasks

Chaining refers to learning to perform a sequence of functionally related responses in an approximate or exact order to complete a more complex routine or task (e.g., clearing a table of dirty dishes, making a sandwich, brushing one’s teeth, printing one’s name, or completing an addition problem). Many of the skills that we perform and that we teach students to perform consist of a chain of small component responses linked together. Learning the sequence of responses involves performing each dis- crete behavior of the chain in sequence and in close temporal succession. When responses in the chain are learned, each response becomes the discriminative stimu- lus for the next response in the chain. Reinforcement is provided by others or by the act of completing the steps or the task itself, particularly if a preferred activity follows task completion.

When she first started teaching Marc to zip his jacket, Marc’s occupational therapist would connect the zipper plackets, put Marc’s fingers on the zipper pull, start the

FIGURE 5–7 The Team’s Task Analysis Data Collection Form for Marc’s Morning Arrival Routine

Teachers: Walton, Kwan Instructional cue: Arrival at school by school bus; bus stops, kids stand up Student: Marc Settings: Bus arrival area, sidewalk, lobby, hallway, classroom Target: Morning arrival routine Day(s): Daily at arrival Stage of learning: Acquisition Teaching method: Constant time delay (0, 4 seconds) Probe schedule: First Tuesday of each month Baseline/Probe method: Multiple opportunity task analytic assessment (4-sec. latency)

Task Steps

1. Get off bus.

2. Open and walk through door (help OK).

3. Walk down the hallway (through lobby to left).

4. Open Ms. Kwan’s door, go in.

5. Wave to Ms. Kwan*.

6. Find empty cubby, take off backpack.

7. Put backpack inside cubby (on floor).

8. Take off jacket.

9. Hang it up (empty hook).

Dates 9/ 2 1

9/ 2 2

9/ 2 3

9/ 2 4

9/ 2 7

9/ 2 8

9/ 3 0

1 0/ 1

1 0/ 4

1 0/ 5

– – √ √ √ √ √ √ + +

0 0 4 4 4 4 4

– – √ √ √ √ √ √ √ – +

+

+ +

+

+ + + + +

– √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √ √

√ √ √ √ √ √ √√ √ √ √

–

– – –

– – +++

–– +++++

++

+

+++

+

– –

– –

–

–

√ √ √–

+ +

√ √ √ √ √ √ √ – √ √ √ √ ++++ – – √ √ √ √ √ √ √ √

– –

– – –

√ √ √ √ √ √ √ – √ √ √

– – √ √ √ √ +++ +

– – √ √ √ √ √ √ ++ – –√ √ √ √ √++ 3 2 0 0 1 4 6 7 10 8

B B T T T T T T T P

Total independent

Baseline/Teach/Probe

Delayed prompt

Materials: Arrival schedule, backpack, jacket

Criterion: 10 of 15 steps correct (67%) for 3 of 5 teaching days

15. Go to schedule, get Ms. Wharton’s room card (when circle done).

12. Go to schedule, get rainbow rug card (when teacher rings bell).

Recording Key: Test: + correct, – incorrect; Teach: + unprompted correct,

√ prompted correct (gestural/partial physical prompt), – unprompted/prompted error; NR no response *Social enrichment steps

Latency Period: 0 sec., 4 sec.

Date Teacher 9/23 JW 9/25 JW 10/4 LK 10/5 LK

Anecdotal Comments Waited for help most steps Sleepy, ear infection meds He’s more sure Great probe!

[Located on back of task analysis]  10. Go to your schedule, get card (first card).

11. Go to ______ and get started (first card).

13. Go sit on rainbow rug (criss-cross).

14. Listen and do ______ (use circle schedule).

16. Find Ms. Kwan, say good-bye*.

17. Go to Ms. Wharton’s room.

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161Selecting Teaching Strategies and Arranging Educational Environments

movement, and then encourage Marc to pull the zipper up an inch. When he did, he was enthusiastically praised. Over several weeks, a few more steps earlier in the chain were added so that he now grasps the zipper pull by himself right after the therapist con- nects the zipper.

Each component of the chain becomes a conditioned reinforcer for the previous response and a discriminative stimulus for the next response in the chain.

By December, when Jacob would count out a mixed pile of coins, he sometimes stopped, started over, or just paused and self-corrected, but he usually finished with the total amount, saying, for example, “That’s 85 cents!”

To teach behavior chains, the cluster of responses is first divided into an ordered list, or task analysis, of separate teachable behaviors. The number of steps into which a chain is divided varies for different students and skills. Because chaining may pro- ceed forward (like Jacob’s coin counting) or backward (like Marc’s zipping task) across the sequence of behaviors, or may involve instruction across all steps concur- rently, a team must select the manner in which it will teach the task components (i.e., forward or backward chaining, or total task). The chaining approach selected and the teaching procedures used depend on how fast the student learns under various teaching conditions, the length and complexity of the chain, the opportunity to per- form the chain, and the component responses already known. (Refer to Chapter 4 for more examples of task analytic assessment and measurement.) The three basic chain- ing strategies (i.e., total task, forward, and backward) that teams choose from when planning teaching programs are described in Figure 5–8.

elements of discrete teaching trials

A discrete teaching trial “consists of a concise and consistent instruction or question, the child’s response, and a specific consequence, the nature of which is determined by the child’s response” (Schreibman, 2000, p. 374). Learning trials form the basis of all systematic instruction, regardless of the type of student or the skill taught. “Teach- ing is a process of organizing student experience so that target behaviors come under the control of new and different stimulus conditions”; this is a process that involves establishing and transferring stimulus control over repeated learning trials (Wolery, Ault, & Doyle, 1992, p. 202). A discrete teaching trial can be represented as follows:

Discriminative Student Consequence stimulus response for response

When teaching trials are presented back to back, a pause is provided at the end of one trial and before the next trial to make each trial discrete from the next; this pause is called an intertrial interval. As we discuss in a later section, trials can be clustered together, or massed (also called repeated practice), so that many trials are presented on the same target skill (e.g., as in teaching Jacob to read vocabulary words) or can be distributed so that single trials are presented at a time when they are more natural to performing the task (e.g., teaching Marc to wash his hands after using the toilet and to change his socks after gym). Contextualized teaching means teaching at a time that is natural to the task, while non-contextualized teaching takes place apart from the natural application of the skill (e.g., pull-out speech sessions, in which the stu- dent is removed from the general education classroom to a therapy setting and follows instructions on making purchases at a table in the classroom rather than in a real store).

Learning is most likely to occur (a) when the target behavior is reinforced in the presence of the desired stimulus, and (b) when the target behavior is performed but

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162 Chapter 5

FIGURE 5–8 Chaining Approaches

Description Examples Considerations for Use

Response Chaining: Total Task

• Task-analyze steps and measure baseline performance.

• Instruction begins by starting with the first step in the chain and teaching each suc- cessive step in order until the chain of responses is completed.

• All steps that need instruction are taught in order and concurrently during each perfor- mance of the chained routine.

• Reinforcement is given quickly (e.g., praise) after each response for corrections and improved performances, and again at the end of the chain (e.g., a short leisure break).

• Has been used successfully with all sorts of chained tasks: self-care; mobility; daily living; community, vocational, and social interactions; and some multiple-step academic routines

• Works best if the chain is not too long (chained tasks can be subdivided) or a single training trial can be too lengthy

• Main advantage are that all teaching opportuni- ties are used (each step is taught each time) and that the task is completed.

• May produce faster learning than other chain- ing methods. May be combined with repeated training just on difficult step(s) of a routine, although this is usually rather unnatural.

• This seems to be a more natural approach than the other options.

Response Chaining: Forward Chaining

• Task-analyze steps and measure baseline performance.

• Begin instruction by starting with the stu- dent performing any learned steps in order

which point instruction occurs. Reinforce- up to the first unmastered response, at

ment is given quickly after the training step, while more extensive reinforcement may be given after the last step in the chain is completed.

• The remainder of the chain may be either completed by the teacher or by the student with assistance, but the routine should be finished before another training opportunity occurs.

• Once this segment of the chain is mas- tered, through additional trials, instruction shifts to the next unmastered step, while prior learned steps are performed in sequence but without assistance.

• Useful with many self-care routines (grooming tasks, dressing, using the toilet)

• May suit many home manage- ment and vocational tasks. Ap- propriate for some chained academic tasks (e.g., use of number line, telephone dialing, calculator use). (Not as useful in school or community setting when assistance through the unlearned part of the task is more obvious and may be stigmatizing.)

• Usually combined with prompting to teach the target step, as well as shaping across the entire chain

• May work better than the total task for some learners who have multiple disabilities or for longer tasks. Initial mastery of single responses in the chain may be faster but slower overall.

• Replace with backward chaining when task has an especially reinforcing end.

• Replace with total task if chain is performed less often; may want to switch to total task after half of the steps are learned.

• May need to create more training opportunities or learning will be slow

• Involves a lot of teacher effort to complete unlearned portion of task

Response Chaining: Backward Chaining

• Task-analyze steps and measure baseline performance.

• Instruction begins by either completing or helping the student perform the entire chain of behavior up until the last step of the chain, at which point instruction occurs.

• After additional opportunities and when the student has mastered the last step, teach- ing shifts to the next-to-last step of the chain, but the student is expected to perform the last step(s) unassisted.

• Reinforcement is given quickly after the training step, while more extensive rein- forcement occurs only after the last step in the chain is completed. As the remaining steps are taught, learned, and added in a backward order, the entire chain is per- formed, and the learner is reinforced.

• Useful with many self-care rou- tines (grooming tasks, dress- ing, using the toilet).

• May suit many home manage- ment and vocational tasks. Appropriate for some chained academic tasks (e.g., use of number line, telephone dialing, calculator use). (Not as useful in school or community setting when assistance through the unlearned part of the task is more obvious and may be stigmatizing.)

• Similar to forward chaining. The main advan- tages over forward chaining and total task are that the student is being assisted through the task, completes the task quickly, and gets reinforcement early in learning.

• Usually combined with prompting to teach the target step, as well as shaping across the entire chain

• May work better than total task for some learn- ers who have multiple disabilities or for longer tasks. Initial mastery of single responses in chain may be faster but slower overall.

• Replace with total task if chain is performed less often; may want to switch to total task after half of the steps are learned.

• May need to create more training opportunities or learning will be slow

• Involves a lot of teacher effort to complete unlearned portion of task

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163Selecting Teaching Strategies and Arranging Educational Environments

not reinforced whenever the desired stimulus is not present. For example, as drivers, we have learned that driving (the target behavior) through green traffic lights (the desired stimulus) is legal, but driving (the target behavior) through red traffic lights (the incorrect stimulus) is not within the law and might result in an injury or a fine. In this case, the green light is the discriminative stimulus for driving through the inter- section. This type of discrimination training is how we learned the names of our relatives (e.g., “Mama” and “Daddy”); to identify numbers, colors, and feelings; and to carry out complex behaviors like playing Monopoly® or tennis, reading books, and conducting titration experiments in chemistry class.

When students with high support needs are taught, in contrast to students without disabilities, teachers must attend closely to the elements of the teaching trial because it is important to keep student errors to a minimum. Making errors during initial instruction has been shown to slow learning, even with an error correction proce- dure (Ault, Wolery, Doyle, & Gast, 1989). Planning teaching trials so that students learn new responses fairly quickly without making many errors requires an aware- ness of the elements and the selection of strategies that support learning. Teachers might modify the expected student response so that it is a simpler version of the goal and then shape performance over time. Educators also need to be aware of the num- ber of teaching trials provided (whether repeated or distributed), knowing that a higher frequency of correct responses to the desired stimuli facilitates learning. Attention is always paid to the consequences so that reinforcement is made contin- gent on successive approximations to the goal response—that is, students are rein- forced for improvements in the target skill over time, even if they are only slight improvements. Learning is best when reinforcement is provided immediately and often during early learning; the frequency of reinforcement is faded in the later learn- ing stages and the goal is to shift to natural forms of reinforcement. Often, some type of assistance or prompt that is understood by the student (e.g., point cue, model, and physical assist) is inserted between the discriminative stimulus and the student response; this often increases the likelihood that the student will make the correct response.

Discriminative Student Consequence Prompt stimulus response for response

discriminative stimuli

Learning is the process of understanding how to behave (student response) in the presence of specific and changing signals or stimuli (discriminative stimuli) in the environment.

When Marc was three years old, he learned that at lunchtime in the presence of food at the kitchen table (discriminative stimuli), if he made the “eat” or “drink” sign (student response), his mom quickly gave him food. When Marc was given food he did not like, he also learned that making a pouting face and giving a negative vocalization meant that his mom would often take the food away.

Marc’s use of certain responses in the presence of food and drink have been rein- forced for so long that he has learned which responses lead to food. A discriminative stimulus (also referred to as an SD) is a relevant aspect of a task or situation in the presence of which a particular behavior is frequently reinforced. As shown below, discriminative stimuli can include aspects of a task setting, teacher requests, materi- als, the time of day, the student’s physical state, and other relevant contextual stimuli.

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Discriminative Stimuli Examples

Task setting Sink in the bathroom Sand table Swings at the playground

Teacher requests “Everyone line up in front of the room.” “It’s time to take out your workbooks.” “Who can tell me whether it’s sunny or rainy?”

Materials Picture schedule Workbook Spoon

Time of day Students lining up in front of class at dismissal Bell signaling the end of math class Clock says 1:10—time to go to the resource room

Student’s physical state Empty stomach Full bladder Headache

Other relevant contextual stimuli Fire alarm Overheated classroom Non-working hearing aide

Initially, a parent’s or teacher’s reminders and assistive prompts are the stimuli that control a student’s response. But once the task-discriminated stimuli are learned, they come to control the student’s response and, therefore, prompts from others are not needed. For example, when Marc was two years old, his teachers and parents created opportunities to teach him to use several functional signs; he was initially given prompts (SDs) to teach him to associate signing with eating:

Teaching involves shifting the control from teacher-supplied stimuli (request and prompts or known stimuli) to natural task stimuli (to be learned). For most students, the goal is to respond to the presence of natural cues instead of teacher-applied stim- uli, such as requests and prompts.

One of Marc’s kindergarten goals was independent hand washing. Initially, teachers and parents asked him to wash his hands at the appropriate times and then prompted him through the steps. His team expected that, over time, with repeated opportunities, he would learn (a) to discriminate the stimuli of dirt, food, or art supplies on his hands and respond by heading to a sink to wash them, and (b) to complete the task without prompts. Because the goal was for natural task stimuli to control his behavior, his teach- ers incorporated them into the teaching plan.

In February, Christine started sampling a job at an elementary school library close to campus. The job was checking out books. Initially, she did not understand what to do when someone asked her to check out a book or placed a book on the counter. After in- struction from her job coach, she became alert to critical stimuli, which “told” her that it was time to press the book scanning switch. Signals that indicated that a book was ready to be checked out included a child asking to check out a book, followed by the thud of the book against the metal end of the slanted book holder. She learned to acti- vate the scanner switch and listen for the beep indicating that the book was scanned; however, if there was no beep, the book had not been put in the holder correctly (with the bar code positioned up and under the scanner). The absence of a beep was a

SD SD (To be learned) (Known) Student Consequence Marc is hungry, at table, Mom gets close to response for response empty plate, with preferred Marc and models the Touches his lower lip “You want food? food smells and food visible sign for “eat” (approximates “eat” sign) Here you go!”

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165Selecting Teaching Strategies and Arranging Educational Environments

different stimulus, which she learned to respond to by pushing her communication device to say, “Oops! Can you put the book in the right way?”

instructional cues

Teaching in natural settings and at natural times promotes the use of environmental cues as the SD. Initially, for most tasks in the acquisition stage of learning, an instruc- tional cue or request is needed to signal the beginning of instruction and the target behavior. Instructional cues are not meant to be verbal prompts, but are used simply to initiate instruction in situations where the relevant contextual stimuli may not be ini- tially discriminated by the student. Instructional requests need to be carefully planned:

1. State requests so that the student easily understands them (e.g., show visual sym- bol and say “Wash your hands.”).

2. Phrase them as requests (“Read this,” “Tie your shoes,”), not questions (“Can you read this?” Do you want to tie your shoes?”).

3. Provide requests only when the student is attending. 4. Give requests only once at the beginning of the task instead of repeating requests

over and over. 5. Pair the request with relevant, natural task stimuli: times of day, materials, and

settings. 6. Fade instructional requests when the student starts to notice relevant task stimuli

or once the student reaches the advanced stages of learning (i.e., maintenance, flu- ency, and generalization).

stimulus and response Prompting

Prompting is an important antecedent strategy used to “get responses going” and to prevent errors. The behavior must occur before it can be shaped to a criterion level through instruction. Various types of assistance given just prior to the response in an instructional trial increase the likelihood that the learner will perform the desired behavior or will perform a better approximation. Thus, prompts can make learning more efficient because teachers need not wait for the target behavior to occur so that it can be reinforced. However, the behavior is not considered to have been learned until all prompts are eliminated or faded out. Initially, prompts are given to obtain a student response, but then are faded to shift control of the student’s response from the prompt stimuli to the natural or relevant stimuli. There are two general classes of prompt procedures: Prompts that are associated primarily with the task stimuli (mate- rials) are called stimulus prompts or stimulus modification procedures, while prompts associated with the response are called response prompts.

stimulus Prompts

Stimulus prompts, or stimulus modification procedures, involve manipulating the rel- evant and irrelevant task stimuli and gradually changing the teaching stimuli from simpler to more challenging levels. Stimulus modification procedures are used by teachers to increase the chance of a correct response. A classic example of this approach are the stimulus-fading procedures used by Gold (1972) involving color coding of several key parts of bicycle brake pieces to make the assembly task easier for workers with disabilities. Given color-coded parts, the workers simply matched the colors of the parts to be joined. Eventually, the color coding was faded or eliminated.

While stimulus prompts are more time consuming to prepare and use than response prompts, they have the advantage of being used by students independently, without the need to have a staff member present. Prompting students to be successful during instruction by modifying the curriculum, class materials, and work directions are

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important strategies for teaching in the general education classroom. When making modifications in class materials, they must be slowly faded from simple to more diffi- cult discriminations. The change in the stimulus must be so gradual that the new step will likely be achievable for the student.

Marc’s letter-writing worksheets started out with dotted letters. The dotted letters were then gradually lightened and eliminated so that Marc was writing more and more of the letters on his own.

While, most examples of these methods reduce errors to a minimum and have excellent research support, they also require that the student have accurate vision to be effective and may demand extensive preparation of teaching materials (Wolery, Ault, & Doyle, 1992). Computer-assisted versions of stimulus modification procedures may be an efficient option to teacher-made materials and have been applied to read- ing instruction for students with severe disabilities (Browder, Wakeman, Spooner, Ahlgrim-Delzell, & Algozzine, 2006).

Two commonly used stimulus modification procedures include stimulus fading and stimulus superimposition. Stimulus fading involves the pairing of an irrelevant stimu- lus (e.g., color or size) with a relevant stimulus (e.g., the word on the red card matches the picture shown, the big object matches the picture shown), and the gradual fading of the irrelevant stimulus (e.g., background color, object size). Stimulus superimposi- tion involves the placement of a known stimulus (e.g., a picture) over another that is not known (e.g., the word for the picture) in a manner that both the known stimulus (the picture) and the stimulus to be learned (the word) can be viewed. Slowly, the intensity, clarity, or salience of the known stimulus (the picture) is modified until it is not visible, leaving only the originally unknown stimulus (the word) visible. This is exemplified by learning to read flash cards that are prepared in four sets: Set 1 has cards with a picture superimposed over the word, sets 2 and 3 have cards with the pictures faded out to different degrees, and set 4 has cards with only words. Both stimulus fading and stimulus superimposition are used to teach an association between two stimuli, one known or familiar but irrelevant to the target skill (location, color, picture) and the other unknown but relevant (word, number). A simple appli- cation of stimulus modification procedures can be used to teach with a variety of task materials, allowing the student to become accustomed to changes in the irrelevant stimulus dimensions.

response Prompts

Response prompts are actions taken by the teacher before a student responds (or after an error) to increase the probability of a correct response. Response prompts are “portable” in that they are readily available whenever the teacher is present and they do not require extensive materials as do stimulus prompts. Most response prompts used during the early stages of learning require a teacher to perform them close to the student or on the student, but there are many options for “teacher-free” response prompts when students learn to use picture guides to task steps, audio- or videotaped instructions, or computer-generated response prompts (refer back to the sections on visual supports and video modeling). Teacher-free response prompts such as these seem to be more successful in the later stages of learning, but this is not a hard- and-fast rule.

Typical response prompts that teachers provide directly to students include verbal instructions, gestures or pointing movements, models (stating the answer, showing a picture symbol), and physical assists. Unlike cues added to permanently remind stu- dents (e.g., Christine’s use of picture cues to self-manage her memory of her Walmart job steps), response prompts are faded. All response prompts given by teachers need to be faded as students learn to respond to stimuli from the natural task context, to stimuli caused by their own task performance, or to other relevant internal stimuli

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167Selecting Teaching Strategies and Arranging Educational Environments

(Wolery, Ault, & Doyle, 1992; Wolery & Gast, 1984). To do this, teachers must draw students’ attention to natural stimuli by doing the following:

• Match verbal prompts with the actual words used in the setting where the skill ultimately will be performed:

At her library job, Christine’s teachers use the words “scanner” and “beep” because that’s what the library staff and the students say.

• Emphasize the type of prompt most prevalent in the natural setting:

When Jacob missed the teacher’s directions, his peer support classmate tells him to watch what he and the others seated nearby are getting and to just do the same thing.

• When a student skips an important task step, call attention (with gestures, words, and positioning) to the step that occurred just before the missed step so that the student attends to the relevant natural stimuli:

Marc pulled up his pants, flushed the toilet, and then started to leave the bathroom when the teacher called him back, positioned him facing the sink, and said, “What’s next?”

• Use natural prompts and correction procedures whenever possible during mainte- nance, fluency, and generalization:

Christine has learned to listen for the scanner beep after she activates the switch in order to judge whether the library book was placed in the book holder correctly.

• Teach students performing in the later learning stages to ask for assistance when prompts are faded:

While learning to return the classroom’s books to the library, Jacob performs well enough that his instructors assist only if there is a possibility of danger. Jacob has learned that if he needs help, he must ask for it.

types of instructional Prompts

Prompts come in many forms (e.g., words, visual demonstrations, physical movement) and are often combined. Prompts differ in the amount of assistance that they provide, the student skills required, and their intrusiveness. Teams should choose single prompts or combinations of prompts that suit the skill and setting, and the student’s preferences, abilities, and stage of learning. The prompts in Figure 5–9 are arranged roughly in order from difficult to easy, with prompts that require more student skill to be effective first and prompts that require less student skill to be effective last.

response latency

In terms of giving instructional prompts, response latency can be defined as the period allowed for a student to respond without assistance or to respond before being giving a prompt. Without the opportunity to self-initiate, students may become prompt dependent and fail to learn the target response. The length of the response latency period depends primarily on the student; the student’s stage of learning; and, in part, the response, or task step. For many students without significant movement difficul- ties and for many tasks, a latency of three to five seconds is a suitable expectation during the acquisition stage of learning. For many prompting procedures, the full latency is provided before any assistance is given to allow the student time to perform on their own. If a student does not respond during the latency period, the teacher gives a prompt and waits for the latency period again to allow the student time to respond to the prompt. If the student makes an error before the latency period is over, it is important to immediately and gently interrupt the error with a prompt (if

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FIGURE 5–9 Definitions, Examples, and Pros and Cons of Common Response Prompts

Pros and ConsDefinition and Examples

Spoken or Signed Prompts

• Words or manual signs that tell the student how to respond (“Spray the mirror”); not the same as instructional cues (e.g., “Clean the bathroom”) or directions

• Match to fit student's comprehension of words/signs and the

“What's next?” may be good later in learning but provide little amount of prompt needed (e.g., non-specific prompts like

information)

Pros: Can be given to a group and used from a distance Do not require visual attention; involve no physical contact Cons: Must be heard and understood by student and followed Level of complexity varies considerably. May be hard to fade

Pictorial or Written Prompts

• Pictures or line drawings that tell the student how to perform a behavior; pictures may show the completed task or one or more steps in the task; words may accompany pictures if student can read

• May be used as permanent prompts that are not faded • Level of abstraction needs to fit student (e.g., photos, drawings,

line drawings, letters, numbers, words).

Pros: Can be used unobtrusively; do not require reading Can promote independence even when used as permanent prompts Standard symbols may help maintain consistency. Cons: Pictures may be poorly drawn or taken; if lost, pictures may not be replaceable. Some actions are difficult to illustrate. Must be seen and understood by student and followed Level of abstraction varies.

Gestural Prompts

• Movements made to direct a person's attention to something relevant to a response

• Pointing toward the desired direction; tapping next to the mate- rial needed

Pros: These are unobtrusive, more natural cues. Can be given to a group and used from a distance; requires no physical contact Cons:-Must be seen and understood by student and followed

Model Prompts

• Demonstrations of the target behavior that students are expected to imitate

• Models often involve movement (showing a step in shoe tying)

(show one place set at a table and match to sample) or be but may involve no movement, as in showing a finished task

verbal (“Sign ‘want ball'”) • Models may be complete (show entire step) or partial (show

part of the step); if the model is done on a second set of materi- als, it need not be undone.

• Model prompts usually match task steps.

Pros: No physical contact with person is needed; can be used with a group and given from a distance. Versatile: Models suit many target behaviors. Complexity of the model can be adjusted to suit student's level of performance. Others can be effective models on a planned or incidental basis; modeling can be unobtrusive. Cons: Require students to attend (see, feel, or hear the model) and to imitate If model is too long or complex, imitation will be difficult.

Partial Physical Prompts

• Brief touching, tapping, nudging, or lightly pulling or pushing a student's hand, arm, leg, trunk, jaw, etc.

• Used to help a student initiate a response or a sequence of responses

• Follow the rule: “As little as necessary”

Pros: Give some control over student responding with little phys- ical contact. Useful when vision is limited. Cons: Can be intrusive; some students do not like to be touched; can't be used at a distance. Care must be taken not to injure or throw student off balance.

Full Physical Prompts

• Full guidance through a behavior, often involving hand-over- hand assistance (as in using a spoon or smoothing a bed- spread) or movement of the trunk and legs (as in assisting crawling or walking forward)

• Physical prompts should match task steps. • Follow the rule “as little as necessary” while being sensitive to

any student movement and easing physical control; does not involve force

Pros: Allows total control over response, thereby reducing errors These are useful when vision is limited. Cons: Highly intrusive, unnatural, and stigmatizing in public; some students do not like to be touched; can't be used at a distance Care must be taken not to injure through tight holding, to force compliance with a movement, or to throw student off balance.

(Wolery, Ault, Doyle, Teaching students with moderate to severe disabilities, 1st Ed., © 1992, pp. 38–41. Reprinted and electronically reproduced by permission of Pearson Education, Inc., Upper Saddle River, New Jersey.)

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169Selecting Teaching Strategies and Arranging Educational Environments

none had been given yet) or with a prompt that provides more assistance if a prompt had been given but was not successful.

When Marc is standing by the coat hooks, Ms. Kwan watches and waits about five sec- onds to see whether he will take off his jacket. When he does not do so or starts to, but then stops, she gets close to him, directs his attention to a peer nearby, and uses point cues to indicate that his jacket should be taken off and hung on a hook. If he does not initiate the action after about five seconds, she uses a combined gestural and physical prompt (she points to his peer and the hook, then tugs gently at his jacket) and then waits about five more seconds for him to initiate the action before giving a full physical prompt.

SD

(To be learned) Latency SD

(Known) Student

Response Consequence for response

Marc has his jacket on and is standing by the coat hooks among the other students who are just arriving.

Ms. Kwan waits five seconds for Marc to begin taking off his jacket.

Ms. Kwan kneels close and directs his attention to a peer in his line of vision who is removing and hanging his jacket. She then points to Marc’s jacket and to the empty hook and tugs gently on his jacket.

Marc removes his jacket and hangs it on a hook, but not securely.

“Great! You hung up your jacket, Marc!” Ms. Kwan rearranges the jacket.

If a student seems to require more time to initiate a response, the teacher must determine the student’s natural response latency by timing the student as he or she performs a known task involving similar movements. The time that it takes for the student to “get the response going” on those known tasks should be roughly the latency period used in teaching.

Because of her cerebral palsy, Christine is aware of the need to move before she can ac- tually make a required move. Her teachers use response latencies longer than five sec- onds for responses that involve her hands and arms.

Prompt fading

Fading is the gradual changing of the prompt stimuli that control a student’s perfor- mance, to less intrusive and more natural prompt stimuli, and finally, to only natural task stimuli. Prompt fading may also be conducted by inserting time between the stimulus to be learned and the controlling stimulus (prompt) so that students learn to perform in the presence of natural task stimuli and prior to being prompted by the teacher. Regardless of the fading approach, the goal is to fade prompts without noticeably increasing student errors or depressing student performance. Fading of prompts is not an exact science (Demchak, 1990). Often, teams must observe a stu- dent’s performance and adjust their methods so that fading is not too fast (thus keep- ing errors low) and not too slow (thus keeping motivation for the task high).

Prompts are faded in many ways. First, the number of different prompts provided can be gradually reduced in several phases: (a) model and verbal prompts, (b) only verbal prompts, and (c) all prompts eliminated. Most fading approaches involve decreasing the amount of information provided by a prompt: (a) pointing to materials with a complete verbal reminder of a step, (b) only pointing to the materials, (c) say- ing “What’s next?” and (d) giving no prompt. Additionally, the amount of physical control can be reduced over successive teaching opportunities: (a) full hand-over- hand assistance, (b) three-finger assistance, (c) one finger assistance, and (d) no phys- ical assistance. Although it is important to transfer behavior control from training prompts to natural cues quickly, removal of prompts too quickly is certain to hamper successful transition. Fading is most successful when it is planned and completed sys- tematically. Making observations of students performing without any prompts (i.e., by probing their performance) is the best way to judge whether students can carry out

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the task without assistance. Once all prompts have been faded and the student con- tinues to make the correct response, learning or independent performance has been demonstrated.

Prompting systems

Prompts may be used singularly, in combination, or as part of a specific prompting system. Some prompt systems employ a hierarchy; in other words, prompts are arranged either in order from most to least intrusive, called most-to-least prompting (e.g., physical–model–verbal), or in order from least to most intrusive, often called a system of least prompts or least-to-most prompting (e.g., verbal–model–physical). Sev- eral other prompt systems (time delay, graduated guidance, and simultaneous prompts) have also been shown to be highly successful for teaching to students who have severe disabilities a variety of self-care, play, vocational, academic, and daily liv- ing skills during the acquisition stage of learning. These prompt systems have specific rules for their use and work differently to shift stimulus control from the prompt stimuli to the relevant task stimuli.

Figure 5–10 sets forth a description of prompt systems ordered roughly from the easiest to use and potentially the least intrusive to the most difficult to use and the most intrusive. Still, no prompt system is easy to use; each requires practice for teach- ers to become fluent users. One of the main advantages of these systems, if used cor- rectly, is that students generally learn with few errors. The prompt systems we describe have varying histories of published research success with students who have moderate to high support needs. The reader is referred to several other general sources for more detail on these methods and their use with students (Ault, Wolery, Doyle, & Gast, 1989; Collins, 2007; Schuster, Morse, Ault, Doyle, Crawford, & Wolery, 1998; Wolery, Ault, & Doyle, 1992) and to specific reviews of research using time delay (Browder, Ahlgrim-Delzell, Spooner, Mims, & Baker, 2009; Dogoe & Banda, 2009) or simultaneous prompting (Morse & Schuster, 2004).

The prompt system, the prompts, and the response latency that a team selects for teaching a student should be chosen to suit that student’s skills. For example, teams will need to consider how long a student can wait for assistance, how well the stu- dent follows spoken or signed requests, whether the student imitates models or responds to pointing, whether the student tolerates physical touch, and also the stu- dent’s preferences and dislikes for assistance (Demchak, 1990). Perhaps the most efficient approaches for learners in the acquisition stage are simultaneous prompting, constant time delay, and prescriptive increasing of assistance, or the system of least prompts with individualized prompts (see Figure 5–10).

In later stages of learning (i.e., maintenance, fluency/proficiency, and generaliza- tion), these same prompt systems can also be used if the prompt intensity is lessened. Thus, a teacher might use indirect verbal prompts (such as “What’s next?” or the con- firmation “That’s right,” or the command “Keep going” if a student pauses too long) on time delay or as part of a hierarchy of two or three prompts (the least intrusive prompt system). More extensive prompts used during acquisition might be replaced by unobtrusive cues or gestures that the student understands (e.g., the teacher looks in the direction of the correct choice or the next step, nods toward materials needed in the missed step, gives hand motions to go faster).

Researchers have found that constant time delay is one of the most effective and efficient prompting methods and also is versatile across a range of academic, commu- nication, and practical skills that involve either discrete behaviors or a chain of behav- iors (Browder, Ahlgrim-Delzell, Spooner, Mims, & Baker, 2009; Dogoe & Banda, 2009; Wolery, Ault, & Doyle, 1992). For example, time delay yielded fewer errors and less disruptive behavior than did the system of least prompts when young children with autism were taught academic tasks (e.g., matching pictures to objects, receptive iden- tification of objects, numeral identification, word reading) (Heckman, Alber, Hooper,

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171Selecting Teaching Strategies and Arranging Educational Environments

FIGURE 5–10 Commonly Used Response Prompt Systems and Considerations for Use

Description of Prompt System Supportive Research and Considerations for Use

Constant Time Delay

• Select prompt that controls the response and determine how many trials will be given at 0-second delay.

• During initial requests to respond, the prompt is given at the same time as the request (0-second delay), making early trials look like simultaneous prompting.

• After a trial, several trials, or session(s), the delay between the task request and the prompt is lengthened to four seconds (or longer). If the student does not respond correctly in four seconds, the prompt is given.

• Initially reinforce prompted correct responses, later differentially reinforce.

• Always reinforce unprompted correct responses. • Continue giving delayed prompts until learning occurs (re-

sponds correctly without the prompt over several trials). • If errors occur, interrupt with the prompt; after several consecu-

tive errors, reintroduce 0-second delay for one trial or more. • Response fading is part of the procedure as students learn that

anticipating the delayed prompt enables faster reinforcement and/or completion of the task.

Supportive Research: There is strong evidence of success for both chained responses (Dogoe & Banda, 2009) and discrete re- sponses, including a range of academic skills (Browder, Ahlgrim- Delsell, Spooner, Mims, & Baker, 2009) and functional tasks (Dogoe & Banda, 2009). Considerations: Initially, student does not have to wait for assis- tance. Easier to use than progressive delay or prompt hierarchy. Only one prompt or two combined prompts (verbal 1 model) are used; prompt(s) must work for student. Requires practice in using; need to count off the delay silently. Responses made be- fore four seconds (correct anticipations) should receive more re- inforcement than prompted responses. If an error is repeated, use progressive delay, change program, or simplify task. When teaching chained tasks, delay can be used with forward or back- ward chaining or when a total task format is used. Recommended Use: Use during early to late acquisition as well as other phases, but change to a less intrusive prompt. Good with chained or discrete tasks; equally effective but easier to use than progressive delay and more efficient than increasing assis- tance system. Peers have been successful using delay to teach chained tasks to students with moderate and severe disabilities (Godsey, Schuster, Lingo, Collins, & Kleinert, 2008).

Simultaneous Prompting

• Request that student perform the target behavior while prompt- ing at the same time. Model prompts are often used.

• Reinforce both prompted correct and independent correct responses.

• Before every training session, give an opportunity to perform without prompting (probes) (or following a set number of trials) to determine when to fade prompts.

• Fading of prompts occurs when probes alert teacher to stop prompting, prompting is stopped, and student continues to respond correctly.

Supportive Research: There is broad support with wide range of students with/without disabilities and tasks (Morse & Schuster, 2004). Successful with discrete behaviors (reading aisle head- ers) (Parker & Schuster, 2002) and chained tasks (hand washing and dressing for young students) (Sewell, Collins, Hemmeter, & Schuster, 1998). Considerations: Student does not have to wait for a prompt. Pro- cedure is relatively easy to use. Must use probes to determine when to fade prompt. Recommended Use: Use during early to late acquisition phase. Seems to work well when student cannot use less intrusive prompts. Good evidence that learned skill is maintained and generalized (Morse & Schuster, 2004).

System of Least-to-Most Prompting (Increasing Assistance)

• Select a response latency and two to four different prompts that suit the student and the task; arrange prompts in an order from least assistance to most assistance (e.g., verbal, verbal 1 model, verbal 1 physical).

• Student is asked to perform the task and allowed the latency period to respond.

• Whenever a correct response (or a prompted correct) is made, reinforcement is given and the next training step/trial provided.

• If student makes an error or gives no response, the first prompt in the hierarchy is given and the latency period is allowed. If the student again makes an error or gives no response, the next prompt is given and the latency period is allowed, and so on through the last level of prompt.

• Errors are interrupted with the next prompt. • The last prompt should be adequate to produce the response. • Prompt fading generally occurs as students learn to respond to

less intrusive prompts and then become independent. Simply put, the method involves telling student what to do,

task. showing student what to do, and finally helping student do the

Supportive Research: There is extensive support with both dis- crete and chained responses; less support with students who have multiple, severe disabilities and with basic self-care tasks. In comparison with delay, outcomes are the same or less effi- cient (errors, time to criterion, etc.). It is more efficient to use a prescriptive (individually suited) set of prompts than the tradi- tional three (verbal–model–physical), but may be more difficult for staff (Wolery, Ault, & Doyle, 1992). Considerations: While hierarchies of verbal–model–physical prompts are most prevalent, many options for simpler hierarchies exist (gestural, gestural 1 partial physical, gestural 1 full physical). Requires a lot of practice to use consistently but versatile across tasks. May be intrusive and stigmatizing. Some question the amount of time between task stimuli and response, and the change of response modalities across different prompts. Can be used with forward or backward chaining or when a total task format is used. Recommended Use: If learning is in the acquisition stage, avoid

this is more efficient than decreasing assistance. Reduce intru- more than two levels of prompt. If learning is in the fluency stage,

siveness of prompts for use in later learning phases.

(continued)

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Description of Prompt System Supportive Research and Considerations for Use

Progressive Time Delay

• This is similar to constant delay, except that delay interval is gradually increased from zero to eight or more seconds.

• Determine delay levels and how many trials will be given at each level; plan error approach.

• During initial requests to respond, the prompt is given at the same time as the request (0-second delay), making early trials look like simultaneous prompting.

• After a trial, several trials, or session(s), the delay between the task request and the prompt is lengthened by 1- to 2-second in- crements up to 8 (or more) seconds, where delay remains until student learns.

• Errors and corrections are handled as in constant delay, except delay may be reduced partially or completely when the student makes errors and then increased gradually or quickly when the student responds without errors. .

• Response fading is part of the procedure as students learn that anticipating the delayed prompt enables faster reinforcement and/or completion of the task.

Supportive Research: There is extensive history of support for discrete behaviors; good for chained responses across a range of students with disabilities and tasks (Wolery, Ault, & Doyle, 1992). Considerations: Same as for constant delay. Progressive time delay is more difficult to use, particularly with chained tasks. Re- ducing and then increasing the delay for repeated errors is also complex. Produces fast learning with few errors. Better than con- stant delay for students who have difficulty waiting because the delay is gradually increased and the ability to wait is shaped. Can be used with forward or backward chaining or when a total task format is used. Recommended Use: Use during the early to late acquisition stages; good with chained or discrete tasks; equally effective with constant delay but less easy to use and less efficient (requires more trials to achieve criterion). More efficient than increasing the assistance system.

System of Most-to-Least Prompting (Decreasing Assistance)

• Select a response latency and two to four different prompts that suit the student and the task; arrange prompts in an order from most to least assistance (e.g., verbal 1 physical, verbal 1 model, verbal).

• The first prompt should be adequate to produce the response. • Determine the criterion for progressing to a less intrusive

prompt (e.g., so many minutes of training at each level, a cer- tain number of corrections in a row).

• Student is asked to perform the task and allowed the latency period to respond. Whenever a correct response (or a prompted correct) is made, reinforcement is given, and the next training step/trial is provided.

• Prompt fading generally occurs when teachers substitute less intrusive prompts for more intrusive ones and students learn to respond to less intrusive prompts and then become independent.

Supportive Research: There is convincing support for use with students who have severe disabilities and a range of skills (self- care, mobility, following directions). Considerations: Teachers must plan how to fade prompts and implement these plans, or students may become prompt depend- ent. Can be used with forward or backward chaining or when a total task format is used. Recommended Use: It may be better for teaching basic skills to some students in the acquisition stage than is a least-to-most prompting system. Works well when student cannot use less in- trusive prompts (e.g., cannot follow verbal direction or imitate, or does not wait for prompts) and makes many errors. Helps teach students to wait longer latency periods, after which constant time delay or a system of least prompts may be used (Collins, 2007). Good when target task is chained and requires fluent movement. Less useful in later stages of learning.

Graduated Guidance

• Select a general procedure to use: a. Gradually lighten physical assistance from full hand over hand,

to partial, to light touch, to shadowing. Shadowing means that the teacher's hands are close to the student's involved body part (hand, arm) but not in contact, ready to assist.

b. Hand-to-shoulder fading, which uses a full physical prompt, is applied at the hand and then faded to the wrist, forearm, elbow, upper arm, shoulder, and then to shadowing; hand-to- shoulder fading has been accompanied by ongoing verbal praise and tactile reinforcement, with concrete reinforcers given at the end of a task chain.

c. Reduce the amount of pressure from initial full hand-over-

ing, and then to shadowing. hand assistance, to two-finger assistance, to one-finger guid-

• Prompts are delivered simultaneously with the task request so that the student's movements through the task are continuous.

• Begin fading when there is evidence that the student can per- form with less assistance: (a) sensing the student's assistance with the response through tactile cues, (b) improved perfor- mance (less help or no help) during probe trials, (c) student ini- tiates the task, or (d) after what seems like an adequate amount of training.

Supportive Research: This is supported by mostly older research in institutional groups and self-care tasks with intensive training methods. There are several more recent school applications (Collins, Gast, Wolery, Holcombe, & Leatherby, 1991; Denny, Marchand-Martella, Martella, Reilly, Reilly, & Cleanthous, 2000; Reese & Snell, 1990). Considerations: This is typically used with chained tasks, a total task format, no latency period, and intensive training, but can be used without intensive training. A latency period may be used to help judge when fading is appropriate (Reese & Snell, 1990). While the procedure is not complex (physical prompt only and then fading), it requires many teacher judgments about when to fade prompts; may not be systematic. Prompts may be faded too quickly, causing errors. Can be highly intrusive because only physical prompts are used. Recommended Use: Use during early to later acquisition stages only and after other, less intrusive systems have not worked. It is a fairly easy but physically intrusive prompting method that should only be used when other less intrusive procedures have not been successful (Collins, 2007).

FIGURE 5–10 Commonly Used Response Prompt Systems and Considerations for Use (continued)

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& Heward, 1998). Clearly, teams must select prompt procedures to suit individual students and then monitor each student’s progress as instruction progresses.

Applications of Prompt Systems: Constant Time Delay. Using time delay with dis- crete behavior skills is perhaps easier than with chained responses. Many discrete academic skills (e.g., social responses, reading, and math) have been taught using constant time delay; a review by Browder et al. (2009) suggests that the use of time delay to teach literacy to students with severe disabilities qualifies as an evidence- based practice.

Marc’s team identified telling time to the hour as an expected kindergarten skill that also was functional for him to learn. After conferring with Ms. Kwan, his kindergarten teacher, Ms. Wharton, his special education teacher, created materials to teach him to match clock picture times to numbers and words (3 o’clock) and vice versa. As with many of his other skills, the team used a three-step progression: It started acquisition instruction using one-to-one teaching in the resource room using time delay, progressed to maintenance or independent use of the skill, and finally taught Marc to generalize the skill to kindergarten lessons on telling time. When Ms. Wharton used time delay, it looked like this:

Zero Time Delay

Teacher: [She places two clock face cards showing different times (12:00 and 2:00) on the table in front of Marc and then shows him the number/word time card: 12 o’clock.] “Match 12 o’clock.” [She immediately points to the match- ing clock using a touch cue at a 0-second delay.]

Marc: Picks up the number/word time card and places it below the correct match- ing clock face card.

Teacher: “Right, 12 o’clock. Good!” [Teacher repositions the two face clocks and re- peats for a second trial, again using a touch cue at a 0-second delay.]

Marc: Picks up the number/word time card and places it below the correct match- ing clock face card.

Teacher: “Right, 12 o’clock. Good!” [Teacher conducts another trial but shows Marc the 1 o’clock number/word time card and places two clock face cards, one showing 1:00, on the table.]

Four-Second Delay

After several successful zero-delay trials on 12 o’clock and 1 o’clock, the teacher pauses four seconds before giving the touch cue, hoping that Marc would try to answer before her cue:

Teacher: [She places two clock face cards showing different times (12:00 and 4:00) on table in front of Marc and then shows him the number/word time card: 12 o’clock.] “Match 12 o’clock.” [She waits four seconds to see whether Mark will give the correct response; he does not and so she gives him a touch cue.]

Marc: Picks up the number/word time card and places it below the matching clock face card.

Teacher: “Right, 12 o’clock.” Teacher: [Teacher repositions the two face clocks and repeats the trial.] “Match 12

o’clock.” [She again waits four seconds before giving a touch cue if needed.] Marc: Marc responds by matching the number/word time card to the clock before

the touch cue prompt is given. Teacher: “That’s right, 12 o’clock!”

The teacher continued trials at a 4-second delay until Marc was able to match the first two number/word time cards independently and then started two additional times at a 0-second delay, while intermittently reviewing the learned times at a

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4-second delay. She lengthened the delay for the second set of number/word time cards to four seconds until they were mastered, after which she added a third set, while continuing to intermix and review the times that had been learned. If Marc missed matching a known time, she would repeat the trial at zero delay and then fol- low with a 4-second delay trial. Each day, they started by reviewing the known num- ber/word time cards at a 4-second delay, but after weekends and vacations, review was set back to a 0-second delay. Eventually, Marc was able to match all time cards to clock pictures; at this point he worked on this task independently and his one-to-one learning focused on matching single pictures of a clock with an on-the-hour time to a choice of three time cards (e.g., 12 o’clock, 4 o’clock, and 9 o’clock).

Time delay is also effective in teaching chained responses, but it may seem a bit more complicated. For example, Jacob’s team agreed that it was important for Jacob to follow regular school routines. The team wrote an IEP goal with objectives that focused first on the morning classroom routine, then on departure, and last on prepa- ration for lunch. His first objective was “Jacob will accurately complete the morning routine within 10 minutes on two consecutive weekly probes.” After watching his peers perform the same routine over several days, the team task-analyzed the routine into 10 steps:

1. Respond to peer’s greeting. 2. Place backpack on desk; unpack agenda and homework folder. 3. Find locker; hang up backpack. 4. Take off outerwear and hang in locker. 5. Return to desk. 6. Take out homework, put in wire basket. 7. Make lunch choice. 8. Sharpen two pencils, if needed. 9. Fill in day and date on schedule and agenda.

10. Begin morning work.

Because Jacob had responded well to constant time delay with other tasks, the team se- lected that method and used it for all 10 steps, teaching each step of the task in order every morning (a total-task approach). Teaching occurred several days each week dur- ing natural opportunities, with probes conducted once a week either by his special edu- cation teacher, Ms. Fuentes, or a teaching assistant, Ms. Connors. They used gestural prompts (point to or manipulate materials, point to picture symbols) or quiet verbal prompts to watch peer models (“Look at what Ty is doing. You do it, too.”). They did not use any other verbal prompts for two reasons: Jacob was less attentive to verbal prompts and verbal prompts called attention to the fact that Jacob was being taught. For the first two days, they used zero time delay. During zero-delay trials, instruction moved quickly as the teacher prompted the first step as soon as Jacob was in the classroom among peers, then reinforced his greeting with a smile or a thumbs-up gesture, and immedi- ately prompted the next step by gesturing to his backback and showing a symbol for “agenda.” Teaching was fast paced and Jacob responded to each prompt. After two days of zero-delay trials, Ms. Fuentes delayed her prompt for four seconds for the first step and waited for four seconds after Jacob completed each step before giving a prompt. After long weekends and vacations, teachers used zero delay for a single day (assuming that he may have forgotten the routine); if he made four or more step errors in one session, they again used zero delay. The team’s goal was to increase his unprompted correct responses.

Wolery et al. (1992) give helpful general rules about using zero-delay trials:

• When all students in a group are learning the same skill, fewer zero-delay trials are needed because they can learn from each other.

• When multiple behaviors are being taught (e.g., if Marc had to both match and state the time, and in chained tasks), more trials at zero delay are needed.

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• Students with past success in learning by time delay may need fewer zero-delay trials.

• Younger students with less familiarity with direct instruction may need more zero- delay trials.

The goal is that teachers use as few zero-delay trials as they can, but that teachers not delay the prompt until the student consistently responds correctly for zero-delay trials (Wolery, Ault, & Doyle, 1992).

Applications of Prompt Systems: System of Least Prompts.

Marc’s teachers are using a system of least prompts to teach him to use the bathroom in the resource room. They teach across all steps in the task, a technique known as a total-task approach. They start by giving him a 3-second latency period to respond after showing him the toilet symbol on his schedule. If he does not respond or if he makes an error, they use a gestural prompt (point to the item associated with the step) and wait three more seconds. If this does not work, they give a gestural and a physical prompt (point and gently assist him through the beginning of the step). Given the im- portance of selecting prompts that suit the student and the task, his teachers decided that these two levels of prompts suited him better than did verbal prompts or full physi- cal prompts. Marc usually completed steps with partial physical prompts, but often re- sisted full physical prompts, so they wanted to make sure to avoid these. Marc’s instruction on the first three teaching steps [1. Goes into the bathroom; 2. Opens the door, goes in (teacher closes the door); 3. Grabs his pants, pulls them down, and sits on the toilet] looked like this:

Teacher shows Marc the toilet symbol on his schedule. [Instructional cue, waits a 3-second latency period]

Marc continues sitting. [Response: No response]

Teacher gets close to him and in his view, and points toward the bathroom. [Ges- tural prompt]

Marc looks in that direction but does not move. [Response: Prompted approxima- tion, but incomplete]

Teacher tugs gently on his sleeve and points toward the bathroom. [Gestural and partial physical prompt]

Marc gets up and moves to the bathroom door. [Response: Prompted correct on first task step]

Teacher: “Good job, Marc!”

Marc continues into bathroom and stops by the toilet. [Response: Unprompted cor- rect on second task step]

Teacher: “Good, you’re by the toilet!”

Marc stands without taking further action for the entire latency. [No response] Teacher points to his loose elastic waistband pants. [Gestural prompt] Marc grabs his pants, pulls them down, and sits on the toilet. [Prompted correct on

third step]

Teacher: “Good pulling pants down, Marc!” [Pats him on the shoulder]

After he sits for two minutes (or less if he eliminates), instruction continues on each remaining task step.

While the prompt systems just described are effective and systematic ways to teach students with high support needs, they are not simple approaches and they often look different from teaching methods used in general education classes. These two

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examples emphasize the importance of (a) determining whether such a specialized approach is needed, (b) selecting the specific prompt method and the prompts used to suit the student and the task, and (c) practicing the method until team members are consistent and comfortable in its use.

General Guidelines for using structured Prompts and cues

To effectively use prompts or prompt systems with students, team members should follow several guidelines:

1. Select the least intrusive prompt(s) that is effective for the student and the task. 2. Select a prompt(s) that suits the student; combine prompts if necessary. 3. Choose natural prompts that are related to the target behavior (e.g., responses

that involve movement may be best prompted with a gesture or partial physical prompt; verbal responses may be prompted with verbal prompts).

4. Highlight natural prompts (e.g., call attention to the bell signaling the transition to the next class or to peers gathering their books and papers).

5. Generally wait a latency period (e.g., three seconds) before and after the prompt so that learners have a chance to respond without assistance. (Or, with systems like time delay and simultaneous prompting, shift to a delayed prompt or use a prompt-free probe so that the student has an opportunity to respond without assistance.)

6. Avoid repeating a prompt for the same response. Instead, if a prompt does not work, try more assistance.

7. Prompt only when the student is attending. 8. Devise a plan to fade prompts as soon as possible. 9. Do not introduce prompts unnecessarily.

10. Reinforce a student for responding correctly to a prompt during early acquisition; later, encourage learning through differential reinforcement.

consequence strategies

We will discuss several general consequence strategies in this section, including (a) the presentation of positive reinforcement for an appropriate response, (b) planned ignoring (also known as extinction) when students do not respond in appropriate ways, and (c) the use of corrective feedback. What is considered appropriate respond- ing changes depending on the teaching objective and the student’s present level of performance or stage of learning for the targeted skill. In early learning, an appropri- ate response often includes approximate performance of target behaviors and improvements in being attentive to task stimuli. For students who have mastered some of the task and are in later stages of learning, we would expect correct perfor- mance more than half of the time, and would be teaching students to extend their performance to include, for example, initiating and terminating the task, assessing their own performance of the task, performing across settings and variations in materials, and performing at the appropriate speed. The rules or contingencies that we apply for providing planned consequences are adjusted to suit the goals for a student’s learning.

We do not address consequence strategies that are punitive in this chapter. Techni- cally, punishment includes anything that reduces the probability of a behavior occur- ring (e.g., presenting non-preferred comments or activities, or contingently removing positive reinforcers following a response); however, a broader non-technical defini- tion of punishment extends to a variety of harmful categories that cause humiliation, fear, pain, temporary loss of ability, and prolonged loss of freedom or pleasure (Singer, Gert, & Koegel, 1999). Such aversive methods are not regarded as acceptable teaching or discipline strategies on both moral and educational grounds.

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Positive reinforcement

Positive reinforcement occurs when preferred consequences (called positive reinforc- ers) are given contingent on a behavior and, as a result, there is an increase in the performance of that behavior over consecutive teaching opportunities. Thus, to rein- force means to strengthen behavior by increasing its frequency, duration, or intensity. Positive reinforcement is involved not only in shaping and chaining, but also in all the prompting methods discussed in the previous section. For example, shaping involves the reinforcement of successive approximations of a goal response. Instruc- tors provide praise and other reinforcers for better and better performance over time. Shaping is a strategy inherent in most teaching methods that use positive reinforce- ment; systematic prompting procedures all involve shaping or a gradual increase in the teacher’s expectations or criteria for reinforcement over repeated teaching oppor- tunities. This practice acts to improve the student’s response. This interdependent or contingent arrangement between behaviors and consequences (also involved in chaining and error correction) lets teachers build behaviors purposefully.

Reinforcers Versus Preferences. What is reinforcing for one person will not neces- sarily be reinforcing for another, particularly with students who have more extensive disabilities; therefore, the activities and objects that an individual student finds rein- forcing must be determined through informal assessment involving observation (see Chapter 3). The term preference is newer than the term reinforcer, but they are often, and inappropriately, used as synonyms. Preferences, like reinforcers, can be deter- mined through direct observation. The distinction between the two terms seems to relate more to who is in control: the adult (e.g., teacher, therapist, and parent) who provides reinforcement, or the student who has a preference for something. Tradi- tionally, reinforcement is manipulated by adults for the purpose of increasing the frequency or intensity of a target behavior. In contrast, the opportunity to experience a preferred event may be made available in the context of everyday routines through choice-making offered by an adult or peer (e.g., choice of activity, location, peers) or may be self-initiated by the student, as with self-reinforcement. When preferences are experienced in this way, they are more under the control of the individual student than the teacher. Preference, as a concept, is more consistent with fostering self- control or self-determination than is reinforcement. Opportunities to choose and indicate preferences encourage self-determined behavior, while the tight control of reinforcers by others may not.

Types of Reinforcement.  Although reinforcers—preferred activities and objects— have unlimited range and vary from tangible items and activities to abstract thoughts of self-approval, all reinforcers are either primary (unlearned or unconditioned) or secondary (learned or conditioned). The first category includes the universal or auto- matic reinforcers to which everyone responds (although not continuously) without instruction. Primary reinforcers for someone who is feeling hungry, thirsty, or cold include food, drink, and warmth, respectively. Primary reinforcers serve to return a person who is physically uncomfortable to a state of comfort. Secondary reinforcers develop reinforcing value through their association with primary reinforcers. Second- ary reinforcers begin as neutral stimuli, but with repeated pairings with already exist- ing reinforcers, they take on their own reinforcing value.

Marc has learned to enjoy playing with blocks with his classmates because it involves putting things in order and creating large structures, which are activities that he al- ready enjoys.

Christine began listening to rock music for pleasure because listening to music was something that her peers liked. Also, her paycheck from work is now a secondary rein- forcer because she has learned that her money buys CDs and other enjoyable items.

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Secondary reinforcers commonly used in educational settings include attention, approval, favorite activities, check marks, stickers, and tokens. It is important to cou- ple simple but specific praise with known reinforcers so that praise acquires reinforc- ing value for students. The goal is for students to not only enlarge their options for reinforcement, but also to replace artificial, primary, or age-inappropriate reinforcers for those that are naturally occurring and suited to their chronological age. Self- reinforcement, of course, is the ultimate goal.

Reinforcement Schedules. Schedules of reinforcement indicate the frequency and pattern with which a student’s responses are reinforced. Reinforcement may be given according to the number of responses performed (ratio schedules) or the passage of time in relation to the performance (interval schedules). Reinforcement schedules may be founded on an absolute, predetermined number of responses (which are then called fixed ratio (FR) schedules) or an absolute, predetermined amount of time (which are then called fixed interval (FI) schedules). For example, an FR:5 schedule is a fixed pattern of reinforcement for every fifth correct response, an FR:2 schedule is a fixed pattern of reinforcement for every second correct response, and so forth. The presentation of one reinforcer for every occurrence of the target response is a fixed ratio schedule of 1, or FR:1. This is more commonly called continuous reinforcement. All other schedules may be generally referred to as intermittent reinforcement.

Variable ratio schedules produce a changing, non-fixed number of reinforcements, but offer reinforcement on a schedule that is an average of the reinforcement pattern selected. If a teacher specified a variable ratio schedule of reinforcement of VR:5, reinforcement will be delivered an average of every fifth correct response. This VR:5 pattern may consist of giving reinforcement after three, seven, two, and then eight occurrences of a target behavior. These numbers average out to reinforcement every fifth correct response. The variable schedules of reinforcement typical in classrooms are less predictable to students than are fixed schedules and thus produce more stable rates of behavior.

For interval schedules, the first target response is reinforced that occurs after a regular period of a fixed number of seconds or minutes (fixed interval, or FI) or a variable or average number of seconds of minutes (variable interval, or VI). In many classrooms, reinforcement schedules are time based (at the end of a class period) and teacher dispensed; feedback and social praise may be as meager as once every 10 minutes. In a classroom of 25 students, this converts to an even thinner reinforcement schedule. Classroom reinforcement schedules are more likely to be variable than fixed. Teachers may provide opportunities for students to choose a preferred activity when they judge the quality or quantity of work as “good enough” or after they judge that sufficient time has passed. Because “enough” and “sufficient” tend to change over time, a variable schedule results.

Because of the powerful influence of reinforcement schedules on behavior, teachers should apply several rules for scheduling reinforcement when planning instruction:

• During the acquisition stage of learning, more instances of behavior should be en- couraged by the continuous provision of small amounts of contingent reinforce- ment (e.g., a smile and task-specific praise, fulfilling a request, sorting words read correctly into the “awesome” pile, a “high five” or a “Yes!”) instead of larger amounts of reinforcement given less often.

One of Marc’s mathematics objectives was linked to the Kindergarten Standards of Learning and also had a functional focus: Recognize a penny, nickel, dime, and quar- ter and determine the value of a collection of pennies and/or nickels whose total is 10 cents or less. When Marc was first learning to count out amounts of pennies, his teaching assistants made a “big deal” of his performance by cheering each and every time that he was right (FR:1).

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• After a higher rate of more accurate behavior has been established (later in the acquisition stage), reinforcers should be faded slowly from a continuous to an intermittent schedule, which requires more behavior for each reinforcement. This strengthens the behavior as the student learns to tolerate periods of non- reinforcement instead of abruptly giving up and not responding when reinforce- ment is not forthcoming.

After Marc was correctly counting out pennies on a frequent basis, his teachers still cheered him on, but not as much (e.g., FR:5).

• Over time, fixed schedules of reinforcement may produce uneven patterns of be- havior because the student can predict roughly how far away the next reinforce- ment is on the basis of the last instance. Behaviors on fixed schedules can extinguish quickly following reinforcement because the students recognize the absence of reinforcement.

To increase her students’ sense of responsibility for keeping their classroom neat, Ms. Bowers, Jacob’s fourth-grade teacher, and the class instituted “Clean Teams”—groups of students who have assigned responsibilities for various parts of the classroom. Initially, Ms. Bowers conducted Friday “Clean Team” inspections and gave awards, which meant that the room was clean on Friday but not the rest of the week. She then realized she should not have such a predictable reward schedule.

• Variable schedules generally produce more even patterns of behavior than do fixed schedules because the individual cannot predict the occasions for reinforcement. Behaviors that have been reinforced by variable reinforcement schedules are also more resistant to extinction, so they are more durable if reinforcement stops for a given length of time.

Now, Ms. Bowers performs random spot checks and gives awards to “Clean Teams,” and the room stays pretty neat.

• Reinforcers must be reassessed periodically (Lohrmann-O’Rourke, Browder, & Brown, 2000; Mason, McGee, Farmer-Dougan, & Risley, 1989; Roane, Vollmer, Ringdahl, & Marcus, 1998) so that they continue to be reinforcing to the student. It is also wise to offer students the opportunity to choose their reinforcer from a group of preferred activities/items; this way, teachers can be more confident that an activity/item is actually reinforcing.

For a while, Marc would almost always select Mr. Potato Head as a reinforcer. However, after a few weeks, he seemed to tire of this toy and all of the other selections that he was offered on the basis of his earlier reinforcer assessment. His teacher decided to conduct another reinforcer assessment to determine a wider selection of choices that he might like better at this time.

• Reinforcers must be suited to the student’s chronological age, the activity, and the learning situation. Aim for replacing less appropriate reinforcers with ones that have more availability in the natural environments encountered by the student.

None of the team members wanted to use food to reinforce Marc, even though his mother reported that food reinforcers had been successful at home. They talked about what ac- tivities he liked, what the other five-year-old boys liked, and what he could easily do at school. They shared this list with his mother, then tried each activity out with Marc, giv- ing him a “sample” first and then letting him choose. He showed clear preferences for Lego® toys, stories on CD-ROM, bouncing on the large plastic Hoppity Hop™ ball, and spinning in the net swing.

• The more immediately a reinforcer is presented following the performance of the behavior, the greater will be its effect.

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Marc’s teachers and his peers respond quickly when he uses his picture symbols or word approximations to initiate a request or interaction. As a result, he is using both forms more and more to communicate requests.

• Satiation results from the overuse of a reinforcer, and its reinforcing effect may be reduced. To avoid satiation, teams should (a) explore new reinforcers with stu- dents; (b) preserve the special quality of objects or activities selected as reinforcers; (c) use intermittent reinforcement because it requires fewer reinforcers for more behavior and reflects more natural schedules; and (d) whenever possible, give stu- dents opportunities to choose preferred activities instead of selecting and present- ing reinforcers to students.

Because Marc responded positively to simple praise from his teachers, they decided to quietly say “Good!” after each step performed with or without assistance during early learning. Marc also chose a preferred activity to add to his schedule after each toileting/hand-washing trial, and he reviewed this selection before the teaching trial began.

Planned ignoring

When teachers intentionally withhold reinforcement following a student’s behavior they are using a practice called extinction. When teachers have good rapport with students, they can be more confident that the student enjoys their attention. In these cases, simply ignoring a student’s behavior by withholding attention constitutes extinction and may have a reductive effect on the ignored behavior. However, because ignoring alone is less likely to teach the student what to do, it is usually coupled with reinforcement or some type of support or assistance for appropriate behavior. For example, errors made during skill instruction can be ignored while offering the stu- dent another opportunity to perform the behavior or skill step, perhaps with some assistance provided. As another example, a teacher may ignore a student for calling out during a group lesson and prompt the student to raise his hand when it is likely that he knows the correct answer. Many of the prompt procedures described earlier incorporate planned ignoring for errors along with immediate presentation of a prompt.

Christine is learning to use her DynaVox™ communication device. This speaking device is really a computer that must be programmed with categories and vocabulary to suit her daily routines. Instruction is complicated because Christine’s vision is poor so she must listen as each pictured option is named by the device through an earphone that she wears. When teaching her to go to the menu page and listen as the choices are scanned and named, Christine must select on the second cycle through the menu the item that matches her schedule for that day (e.g., Tuesday’s schedule is morning in- struction, library work site, lunch, drama club, Walmart work site, preparation for to- morrow, and home). When she clicks on the wrong menu item, Ms. Rowyer does not say anything, but instead stops the scanner so that it won’t go to the wrong choice, repeats the request to click on “morning instruction,” and restarts the scanner, ready to use a “listen” prompt right before the correct item is scanned and named. Ms. Rowyer has found that ignoring errors and repeating the trial with assistance makes instruction successful and less complicated for Christine.

Problem behavior can also be subjected to the extinction strategy in an effort to reduce its occurrence. This is discussed more in Chapter 7. Using extinction as the only means for reducing problem behavior is often ineffective because (a) it must be consistently used even when students might increase their rate of problem behavior in response to being ignored, and (b) no models for appropriate behavior are pro- vided. Thus, extinction is typically used in combination with intentional instruction of the correct response or the appropriate behavior.

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response to errors

To maintain a reinforcing environment for learning, it is important to minimize the potential for student errors. If there are many errors, instruction may need to be improved or the target behavior may need re-examination. When teachers provide repeated error correction, instruction may become aversive to students, as well as inefficient. While teachers plan instruction so that errors are minimized, when they do occur, the teacher may ignore them, provide specific feedback so that students are made aware of the errors, or gently interrupt and correct them in several ways. It is important to handle errors in a way that promotes learning.

Types of Errors.  Errors include incorrect responses, problem behavior, and non- responses. Incorrect responses can be missed steps in a chained response (e.g., not getting silverware or milk when going through the lunch line, skipping several key steps when washing dishes), discrimination errors in a discrete behavior (e.g., signing “eat” instead of “help,” or reading “men” instead of “women”), or error responses that are not related to the target response (e.g., playing with the flash cards, looking away from the task, and attending to peers). In contrast, a non-response may simply consist of the student waiting longer than the response latency, stopping in the middle of a chained response, not trying the task at all, or looking away from the task because of distraction or boredom. What the teacher does to respond to errors depends on both the type of error (e.g., incorrect response, problem behavior, non-response) and the student’s skills (e.g., performance on the target task, ability to understand teacher feedback, and preferred ways of having mistakes dealt with).

Errors that involve problem behavior often are motivated by the student’s interest in escaping from the task for some reason or needing assistance because the task is too difficult. Teams need to study the situation, determine the cause, and improve the teaching plan. For example, the teaching session may be too long, may involve lots of error correction and little success, may provide no student choice, or may be boring. (Chapter 7 addresses this functional behavior assessment process.) In particular, when academic skills are involved, teams must have a process for making adapta- tions, which may include adjusting the method of delivery, changing how a student responds, or modifying the academic goals or performance criteria for a student on the basis of his or her performance. Students with severe disabilities typically will have many IEP accommodations and modifications that support their learning and thus improve the probability that they will respond successfully. (Chapter 6 describes and illustrates a model for making adaptations.)

The cause of errors that involve non-response, such as problem behavior errors, also needs to be analyzed. When some students are motivated to escape from a task that is too long, involves too much waiting, or is somehow boring to the student, they may do so by withdrawing, not attending, not responding, or being easily distracted. Other students are challenged by a tendency to be highly distracted even when teach- ing is carefully planned to be motivating. Usually, preventing errors by improving the motivation to participate is the best means for addressing non-response errors.

For errors that involve incorrect discrimination, teachers can use one or more strat- egies: (a) Ignore errors and not give any reinforcement (planned ignoring or extinc- tion), (b) provide clear and immediate feedback to students (“No, that’s not right; try again”), (c) follow up errors with assistance, or (d) have students participate in cor- recting their own errors. The last two approaches are examples of error correction. Technically, error correction procedures are response-prompting procedures—teach- ers prompt students to make the correct response (Wolery, Ault, & Doyle, 1992). However, the timing differs in that error correction is conducted after the student responds and has made an error, while response prompting is provided before the student’s response. The example in the last section involved Christine’s teacher using two of these strategies to address her errors when learning to operate her DynaVox™

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device: strategy (a) ignoring her error, and strategy (c) following up each error with assistance to complete the missed response.

Most prompt systems that we discussed earlier in this chapter have built-in meth- ods for preventing and for handling errors; however, teams still need to decide what approach works best with a given student and task.

When adults use words to correct Marc’s errors, he does not attend or react. He is often resistant when physical corrections are attempted. But gesture cues are often effective (e.g., pointing to materials involved or moving materials associated with the missed step into his view). Thus, for the toileting sequence, they used constant time delay with a prompt that paired pointing to and showing a photo of him doing the next step. He had no problem when the prompt was given at a 0-second delay, but he sometimes failed to use the prompt when it was delayed four seconds. At these times, they used gentle physi- cal assistance (as little as possible) to get him to complete the step, and on the next trip to the bathroom, they gave the prompt at a 0-second delay for the step that had been missed.

Jacob becomes resistant if teachers verbally point out his errors. The word “no” seems to be a stimulus for anger. His teachers have found better ways to prevent and to address his mistakes during early learning tasks. First, they start by getting his attention or pausing for him to get ready. Second, they use a systematic prompt strategy, such as time delay for academic tasks and least prompts for chained tasks, because these meth- ods make prompts available before errors typically occur. So if he fails to respond or makes an error, they say nothing, provide assistance instead, and then praise his efforts. Finally, his teachers have learned that interspersing known responses with new responses is a great way to motivate him. Thus, when working on new words, problems, or routines, they add items, questions, or steps that review the responses that he already knows well.

Figure 5–11 gives descriptions of ways to handle errors and lists considerations for their use. When a student has learned more than half of a skill and moves into the flu- ency, maintenance, or generalization stage, less structured and less informative error correction procedures should be used. Because the student is now more proficient at

FIGURE 5–11 Strategies for Handling Incorrect Response Errors and Considerations for Their Use

Strategy Considerations for Use

• During acquisition, it may be best to gently interrupt errors with a prompt (as in most prompt systems).

• After an error, provide feedback (pause, hold up index finger, say “Not quite”) and give another immediate opportunity to per- form while increasing the assistance (as in a system of least prompts).

• Gently stop an error and wait to see if the student will self- correct. Direct the student’s attention to relevant task stimuli, add prompts as needed. Reinforce any self-corrections.

• Later in learning, it may be good to follow some errors by wait- ing for the student to self-correct; if this does not occur, give

.rorreehttcerrocotecnatsissa • Simplify those responses that are frequently missed or per-

formed incorrectly. • Gently interrupt errors and provide several immediate opportu-

nities to practice the missed response (or steps in a chained task) that are frequently missed.

• Incorrect responses can be missed steps in a chain or discrimi- nation errors. Repeated error correction is aversive for most students and inefficient. Analyze performance data to decide how to improve instruction. Also, consider the student’s stage of learning and motivation for the task.

• Sometimes improving the antecedents may be necessary to reduce errors: a. Improve the task analysis of the steps frequently missed. b. Select a simpler version of the same skill. c. Use backward chaining to teach these steps. d. Use simpler prompts (gestural model instead of verbal). e. Replace a prompt hierarchy with a single prompt system

(constant time delay, simultaneous prompts). f. Provide a visual cue (permanent prompt) such as a picture

sequence. g. Use stimulus prompts like color coding temporarily.

• During the later learning stages, allowing or prompting students to self-correct lets the students experience the natural stimuli resulting from the error and learn ways to improve the situation. Self-correction needs to be used carefully in order not to en- danger or embarrass the student.

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183Selecting Teaching Strategies and Arranging Educational Environments

the skill, errors are less frequent and may be caused by distraction or carelessness instead of by not knowing what to do.

For some math, reading, and spelling tasks, Jacob and his classmates are working on improving their accuracy and speed. Teachers have students (a) correct their own work- sheets, giving them time to redo the items that they missed; and (b) count the number of items that they got correct during flash card drills or timed math fact tests, and enter the number on their personalized bar graph.

When students have moved beyond acquisition into the advanced stages of learn- ing, one of the following procedures may be chosen:

1. The student who makes an error or hesitates may be given a few seconds to self- correct. Some errors, if uninterrupted, will provide natural learning opportunities for students. If a correction is not forthcoming, then one of the other procedures can be tried.

2. The error may be acknowledged (holding up an index finger, saying “Oops” or “Not quite”) without providing negative or harsh feedback. The teacher then re- quests another try at the same step (“Try it again.”). If a second error results, some assistance is given. Efforts to soften the acknowledgment of an error, however, should not result in confusing or ambiguous feedback. For example, smiling and saying “That was a great try,” in response to an error can be misinterpreted by the student as praise. Many students tune more into facial expression and tone of voice than to the specific words spoken. Thus, being neutral instead of animated is important.

3. A minimal prompt (“What’s next?”) or a verbal rehearsal of the last step correctly performed (“You just finished getting the plates, now what’s next?”) may be pro- vided as soon as the error is stopped. If the student stops before a step has been completed, the teacher may offer confirmation and urge the student to continue (“That’s right, keep going.”).

There are many other methods for correcting errors; however, to be effective, error correction procedures must reflect the following characteristics:

• be suited to the learner’s age, level of understanding, and preferences • be suited in the amount of assistance and reinforcement (if any) to the student’s

stage of learning for that task • be applied immediately and consistently, but unemotionally • be non-stigmatizing, humane, and socially valid, and do not endanger the student • provide enough help to correct the error quickly, but not so much as to create de-

pendency on the teacher • be followed by additional opportunities to respond to the task or step • encourage and reinforce independence

Precautions. Some precautions must be taken with error correction so that it is not punishing to students. Facial expression, tone of voice, and the actual correction methods need to be matched to students’ preferences. While it is important through- out learning that students discriminate making errors from making correct responses, error correction should not be aversive or reinforcing, but instead neutral and inform- ative. When there are repeated errors, it is critical that the team examine student per- formance data gathered during skill probes and also training trials to better understand possible reasons for the errors. For example, some task steps may be too difficult and simplifying the steps in the task analysis might improve the student’s performance. At other times, it may be that the type of chaining strategy needs to be revised (e.g., change from a total-task approach to a backward chaining strategy). Another option is to add extra instruction on just the difficult steps. Depending on the student, the teacher might ask the student whether he or she needs a prompt (“Need help?”) and allow the student to choose self-correction or assistance. Another option that reduces

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the probability of errors is to replace a prompt hierarchy with a single prompt system (time delay, simultaneous) or with a most-to-least approach like graduated guidance. Adding temporary stimulus prompts (such as color coding or putting a large X on a shirt label) also is a way to help students discriminate difficult steps like identifying the front and the back of a T-shirt while dressing. Teachers also might teach students to use a series of photos of the steps that will offer permanent reminders. Finally, teachers can make digitized videos that model the task and show difficult steps in slow motion or close up.

There are also numerous ways to improve a teaching plan that can reduce a par- ticular student’s errors: (a) changing the prompting system (e.g., changing to time delay or simultaneous prompts), (b) increasing or reducing the response latency (before the prompt) or the time allowed to complete a task step, (c) using a simpler prompt that does not require understanding words (gestural/model instead of verbal), (d) increasing motivation for task participation and refreshing the reinforcing conse- quences, or (e) giving choices (select task, choose order of task completion). The approaches used will be individually selected to suit the student.

Arranging teaching trials

Earlier we noted that when students are provided instruction on a targeted skill, planned teaching often consists of one or more instructional trials. Each discrete trial contains the elements described earlier: (a) the discriminative stimulus to be learned, followed by (b) a latency period, (c) a known discriminative stimulus or prompt, (d) the student response, and (e) the teacher’s consequence for that response.

distributed or Massed trial instruction

There are a number of options for arranging teaching trials. Teaching trials may be clustered and taught in a massed manner with short intertrial intervals (as in discrete trial training). Teaching trials also may be distributed over time with minutes or hours between teaching trials (as in incidental teaching, or embedding a discrete trial within a functional routine). Distributed teaching has been credited with being more effec- tive in producing generalization of skills than massed trial teaching; yet massed trial teaching is credited with faster learning during acquisition.

The teaching setting often influences the intensity of trials (massed versus distrib- uted trials) during instruction. Teaching trials may be presented within meaningful contexts (contextualized) or may be presented at times and in places that are not logi- cally connected to the skill and may be removed from the natural environment. When teaching trials are clustered together, or massed, so that many trials are presented on the same target skill (e.g., as in teaching Jacob to read vocabulary words or asking Marc to repeatedly use the bathroom), trials typically are not contextualized and gen- erally do not conform to the natural performance of the skill. However, there are some exceptions. Some skills and routines offer natural repeated teaching opportunities, such as learning to eat with a spoon, putting toys away, clearing tables in a cafeteria, and filling salt and pepper shakers in a restaurant job. Similarly, when teaching skills during natural or contextualized opportunities (e.g., greeting others, toileting), teach- ing trials are more often distributed over an activity or a day instead of massed with repeated opportunities to teach. If we consider teaching Marc to hang up his jacket, a massed trial approach would involve asking him to repeat the behavior several times in a row—not a very natural way to perform this skill. In a more natural context, the opportunities that Marc has to put his coat away occurs only upon arrival at school and after recess; thus, his teaching trials are both distributed and contextualized.

Intensive teaching or using repeated trials is not uncommon when teaching aca- demic skills. For example, reading and writing instruction in small groups offer stu- dents many opportunities to respond in a single 15-minute session. Massed discrete trial instruction has been shown to be successful in teaching some skills to some

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185Selecting Teaching Strategies and Arranging Educational Environments

students during acquisition (e.g., communication in children with autism in Lovaas & Taubman, 1981, and toileting skills in Richmond, 1983). However, despite agreement that discrete trial instruction can be effective for teaching skills to children with autism, it has many limitations. Researchers and practitioners have been critical of the unnatural intensity of such teaching, the lack of generalization for skills taught in this intensive manner, the reliance on tangible reinforcers that are not available under natural conditions, and the difficulty of using an approach that requires one-to-one adult–student interactions (Charlop-Christy & Carpenter, 2000). Recent reviews of early intensive behavioral interventions (EIBI) for children with autism have found that effectiveness is highly variable at the individual level with the child’s IQ at the beginning of training being predictive of how effective this intervention has been for preschoolers with autism (Howlin, Magiati, & Charman, 2009).

Another complication with massed trial instruction is its association with pull-out instruction. While massed trial instruction on academic skills can be used in some small group instruction, generally this approach means removing the student from peers with pull-aside, one-to-one instruction in the general education classroom or taking the student to another setting. Using massed trials also often means that natu- ral conditions must be simulated so that repeated trials can be conducted (e.g., asking Marc to take off and hang up his backpack and coat four times upon arrival, after which the natural cues of arrival have long since passed).

As we discuss further in Chapter 6, there are times when intensive instruction is appropriate. There are several criteria that should be met if teams decide to use reme- dial or compensatory instruction (the term that we use for massed trial instruction) for basic skills. First, teachers must be skilled in using direct instruction with prior training to implement a research-based model or program (e.g., discrete trial instruc- tion, functional communication training, and certain commercial reading programs) and be able to evaluate student progress. Intensive one-to-one teaching sessions may also be directed toward motor, speech, and communication goals. Second, remedial instruction should be truly specialized; be prescriptive; and yield measurable, notice- able, and valued gains (e.g., functional communication training, pivotal response treatment, discrete trial instruction, structured teaching). Third, remedial instruction should be conducted with careful team planning so that (a) skills transfer and gener- alize to general classroom activities, (b) students’ time away from their peers does not interfere with their class membership, and (c) students’ removal from the general education classroom is planned so that it is not disruptive and does not occur at times when valued activities are scheduled.

contextualized or decontextualized instruction

Teaching in context means that the relevant stimuli for the skill being taught are pres- ent and that teachers can take advantage of naturally reinforcing consequences. Con- textualized instruction appears to be more effective overall for students with severe disabilities because it promotes skill generalization. Methods that address naturalistic or contextualized communication instruction have received a lot of attention by researchers in an effort to overcome the difficulties that discrete trial instruction yields (e.g., poor generalization, segregated instruction) (Snell, Chen, & Hoover, 2006). The incidental teaching approach (McGee, Krantz, Mason, & McClannahan, 1983; McGee, Morrier, & Daly, 1999) involves discrete trial instruction in the natural classroom set- ting with teaching initiated whenever the student shows an interest in an activity or item during regularly scheduled activities. Both student-preferred items and the natu- ral consequence of communicating—such as giving the student what he or she asks for—are offered as the reinforcers for communication. Another approach is milieu teaching (Kaiser, Hancock, & Nietfield, 2000; Kaiser, Ostrosky, & Alpert, 1993), which builds on student interests and uses carefully planned instructional trials embedded into natural and created opportunities for communication. Both incidental and milieu

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teaching use time delay to prompt correct responses, but milieu teaching also makes use of models and a procedure that involves a least-to-most prompt hierarchy. Because one downside to distributed trial instruction is that there may not be enough opportu- nities to teach, teachers can increase the number of trials under natural circumstances. For example, the environment can be arranged to create opportunities for teaching the target skill, such as adding preferred items (e.g., toys, play equipment, games, and books), giving choices, and withholding help to give students the opportunity to request assistance, and so forth. (See Chapter 12 for more on environmental arrange- ments.) Another approach for addressing inadequate distributed teaching opportuni- ties is to increase the number of trials during each natural opportunity. Modified incidental teaching incorporates two practice trials following every trial taught during a natural opportunity to communicate (Charlop-Christy & Carpenter, 2000).

Some of the targeted skills for students with severe disabilities are functional skills that cannot be completed within regularly scheduled class activities. Apart from self- care skills, such instruction is less frequent for elementary and middle school stu- dents. However, during the high school and postsecondary years, students will have many functional skills targeted on their IEP and transition plans (e.g., learning to make purchases in stores, learning specific job skills). These skills are best taught using contextualized instruction in a real setting that is natural to the skill. Thus, teams will need to plan for community-based instruction.

embedding instruction Within Activities

Embedding instruction means inserting teaching trials into ongoing schedules “with- out breaking the flow of the routine or the ongoing activity” (Schepis, Reid, Ownbey, & Parsons, 2001, p. 314). This strategy is also referred to as activity-based instruction. Much instruction on functional skills and physical education is somewhat naturally embedded into the actual activity—for example, teaching students to set tables, throw balls, or open lockers (Fetko, Schuster, Harley, & Collins, 1999). But more recently, embedding has been applied to academic skills in general education settings ( McDonnell, Johnson, & McQuivey, 2008). While embedding is sometimes used with typical students, its use with students who have severe disabilities must be more sys- tematic to yield learning. Generally, with embedding, the teacher provides teaching trials to students in a distributed manner over time instead of massed in a short amount of time. One caution is that an adequate number of teaching opportunities should be scheduled to yield learning. Knowing what is adequate requires conducting periodic probes of the skill to see how well the student performs.

Younger students have been successfully taught a range of skills (speaking, cut- ting, putting things away, following instructions) through embedded teaching oppor- tunities applied during play, meals, recess, and self-care (Shepis, Reid, Ownbey, & Parsons, 2001). With older students, general and special education teachers, as well as paraprofessionals, have embedded instruction during general education classes, school transitions, and class breaks (Johnson, McDonnell, Holzwarth, & Hunter, 2004; McDonnell, Johnson, Polychronis, Riesen, Jameson, & Kercher, 2006), while parents and others have embedded their instruction on restaurant use during community- based instruction (Sowers & Powers, 1995). Embedding can make efficient use of otherwise non-instructional time, but should not be used to the exclusion of social interaction with peers.

Some researchers have suggested that learning through embedded instruction may be as good as learning through small group instruction. McDonnell et al. (2006) taught paraprofessionals how to teach middle school students with moderate intellec- tual disabilities scientific concepts and vocabulary (e.g., the cell is a basic unit of liv- ing things) and history (e.g., a citizen is a member of a country) during general education classes. They compared two approaches—embedded instruction and instruction in small groups—and found that students learned equally well whether taught embedded instruction within activities or directly in small groups; students

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187Selecting Teaching Strategies and Arranging Educational Environments

also generalized their knowledge to classroom teachers. While there is no specific guiding research, embedded trials can also supplement instruction in small groups. The key is to monitor learning through regular data collection.

When and how do you embed instruction? First, teachers identify the material to be taught during embedded trials; then they identify the opportunities for instruction that do not interfere with classroom operations or schedules; finally, they specify and use the teaching procedure. Team members can embed instruction in a number of ways:

• Instruction on academics can be embedded into opening or closing activities, activ- ity transitions, and breaks:

Several trials are given to Jacob on his weekly vocabulary words while students are set- tling into their seats.

• Instruction can be embedded as “rehearsal” trials before an activity where those skills will be needed:

Several trials are given to Marc on today’s day and month during his transition to kin- dergarten circle time.

• Instruction on communication skills can be embedded into functional routines, either occurring naturally or created:

When Christine was younger, her teachers gave her embedded instruction on using a communication device during specific situations to request (a) help on tasks that were too difficult or where needed materials were missing; (b) a snack when presented with a pair of food items, one preferred and one non-preferred; or (c) a break after being en- gaged longer than usual in a work activity. ( Johnson, McDonnell, Holzwarth, & Hunter, 2004)

• Instruction can be embedded as “instruction on the way” with regard to behavior, schedule, and upcoming activity:

Marc’s assistant teacher reviews cafeteria rules with him before leaving class and as he enters the lunch line.

Embedded instruction itself involves one or several discrete trials ( Johnson et al., 2004):

Using the fourth-grade reading curriculum, Jacob’s teachers identified three sets of five words that would be useful to him. These words were ones that his peers were learning, but also were words likely to be encountered or used by him. Then they determined six times each day when several instructional trials could be embedded and taught one set at a time. At these times, the teaching assistant or the classroom teacher would present Jacob with two words, one the target word and the other a distracter word, and ask him to “Touch ___,” naming the target word. The instructor used a touch prompt (touching the correct word card) and constant time delay so that prompts were given initially with no delay; Jacob always imitated correctly. Errors were followed by “no” and the trial was repeated with physical assistance. Once he responded correctly on all zero-delay trials two consecutive times, the delay before giving the prompt was increased to four seconds. The goal was to provide 15 trials for each word daily.

Teams will want to answer several questions when deciding whether to use embed- ded instruction:

• Is there adequate opportunity to use embedded instruction trials without interfer- ing with the student’s interaction with peers or classroom routines?

• Is the student motivated to learn during activities? • What students and skills are best taught this way? • How will you prompt and handle errors? Embedding does not specify these strategies,

only when skills are taught.

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188 Chapter 5

leArninG outcoMe suMMAries

5.01 Principles to Guide Instruction Learning Outcome Describe the principles that should guide the development and implementation of teaching plans.

Developing effective teaching plans requires that IEP team members work collaboratively to develop a consensus on the routines, activities, and skills that students should be taught and how these plans should be structured. It is critical that teams understand that students move through different phases of learning and that IEP goals and objectives, and the teaching plan, must reflect students’ stage of learning. There are four phases of learning: acquisition, maintenance, fluency, and generalization. Teaching plans should employ the simplest but most effective strategies available. Teaching methods and strategies should be only as spe- cialized as necessary to promote student learning. The effectiveness of teaching plans for students should be regularly evaluated through the ongoing collection and monitoring of student performance data.

5.02 “Universal” Strategies That Are Effective with a Wide Range of Student Learning Outcome Describe the teaching strategies that are effective for most students in general education classes.

There are a number of “universal” strategies that have shown to be effective for all students including those with severe disabilities. These include (a) providing information to team members about students’ education programs and learning needs, (b) using materials that are universally designed, (c) using instructional procedures for students with severe disabili- ties that mesh with the schedules and activities of the general education class, (d) collabora- tive team work to identify goals and develop teaching plans, (e) relying on peers and general educators to provide instruction to students rather than paraprofessionals, (f) using small group teaching formats, (g) preventive strategies to minimize inattentive or disruptive behav- ior, (h) using peer-mediated instruction and supports, (i) using individualized adaptations, and (j) using strategies that allow students to self-monitor their own learning and behavior.

5.03 Specialized Teaching Strategies That Are Effective with Students Who Have Severe Disabilities Learning Outcome Describe the teaching strategies that are effective for students with severe disabilities.

Research has validated a number of “specialized” teaching strategies for students with severe disabilities. These include (a) visual support strategies, (b) task analysis and chain- ing, (c) discrete trial instruction, (d) stimulus and response prompting, (e) and the use of both distributed and massed trial instructional formats.

suGGested Activities

1. Use the table that follows to evaluate the school program that you work in or are familiar with. If possible, gather a focus group of educators and an administrator and involve them in this evaluation process. First, work together and use the fol- lowing grid to rate your school on the following five school practices using a scale from 0 (not present) to 4 (schoolwide evidence of its practice): a. Students’ IEP objectives address priority skills and some are linked to the gen-

eral education curriculum. b. Students’ IEPs include teaching and testing accommodations that facilitate their

progress in learning.

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189Selecting Teaching Strategies and Arranging Educational Environments

c. Collaborative teaming is ongoing and supported by school staff and administra- tors. Teams plan for individualized adaptations, use problem solving, and reach consensus among team members. Relevant team members are involved.

d. All students are members of general education classrooms alongside age peers; their membership is valued.

e. Instruction is planned, individualized, and makes use of strategies that are supported by the literature.

Conduct Needs Assessment of best Practices and Complete Issue–Action Problem-Solving Form

Supportive practice Not present

Spoken about but not

practiced

Some evidence of its

application

Good evidence of its

application

Schoolwide evidence of its

application

List below: 0 1 2 3 4

Then, with the focus group, rank order the practices (issues) that need improve- ment in your school and brainstorm the actions needed to tackle each priority issue. Use the following issue–action problem-solving form:

Issue Action Taken by whom Taken when

2. Examine the IEP of a student with more extensive support needs. If the student is being included with his or her peers in general education activities, observe the stu- dent over one or several days and check how adequately his or her IEP objectives are being addressed. Complete a matrix for this student by listing IEP objectives down the left side and the class schedule across the top. Indicate with check marks the activities during which it would be logical to teach each objective. Note when (or if) pull-out instruction is being used. Explore how inappropriate instances of pull-out instruction might be replaced with adaptation of classroom activities.

If the student is not included in general education activities, observe a class (or classes) in which it might be suitable for the student to be included. Complete a ma- trix as you did previously and then explore the steps needed to include the student in that class.

Note: For the student applications, we give thanks to Rachel Dickinson, Jeanne Pfaff, Diane Talarico-Cavanaugh, Heather Grunden, and Gay Singletary of Charlottesville, Albemarle County, and Greene County Public School Systems.

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190

6 Designing and Implementing Instruction

for Inclusive Classes Rachel E. Janney

Southport, North Carolina Martha E. Snell

Curry School of Education, University of Virginia, Emeritus

6.01 The Pyramid of Support/Response-to-Intervention Logic Learning Outcome Describe the three levels of support that are necessary to provide effective instruction to students with severe disabilities in general education classes.

6.02 Collaborative Teaming for Ongoing, Day-to-Day Planning and Delivery of Instruction Learning Outcome 1. Identify the three skills that team members need to have to plan and deliver effective instruction. 2. Describe the four types of services that students may require to receive effective instruction in

general education classes.

6.03 A Model for Making Individualized Adaptations Learning Outcome Describe the three types of adaptations available to support students in general education classes.

6.04 Using the Model to Develop Individualized Adaptations Learning Outcome List and describe the steps necessary to develop individualized adaptations for students in general education classes.

T he focus of this chapter is to describe a comprehensive model for the design and implementation of instruction to teach the goals targeted by students’ indi- vidualized educational program (IEP) teams in inclusive classes. This model is founded on several assumptions and beliefs about the nature of providing instruction to students in general education classes and what it takes to do it right. Several of these assumptions and beliefs are set forth here, while others appear throughout the chapter. One assumption is that designing a comprehensive, state-of-the-art educa- tional program for a student with severe disabilities requires a team to plan several different types of learning activities, as well as the services and supports required to meet the student’s physical, health-related, behavioral, and other needs. A student’s IEP goals may include the areas of academics, functional skills, and developmental skills (e.g., social–behavioral, communication, motor skills). The learning activities

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191Designing and Implementing Instruction for Inclusive Classes

designed to teach these goals will involve different professionals and use a variety of student groupings, learning environments, instructional formats, methods, and mate- rials (see Chapter 5). Thus, team-developed plans may include (a) task analytic teach- ing guides, (b) lesson plans for direct teaching of targeted academic or developmental skills, (c) plans for how class academic tasks will be adapted for the student, and (d) less structured guidelines for supporting the student’s incidental learning. In addi- tion, planning must address physical, social, and access supports (see Chapter 1), which are needed in order for the student to participate in non-academic activities (e.g., lunch, assemblies, field days), classroom routines (roll call, lunchtime prepara- tion), and organizational procedures (e.g., how and when to turn in homework and class work, when to sharpen pencils). A second assumption is that the numerous de- cisions that teams must make to create and implement these teaching plans should be explicit, founded on sound rationales, and made by team consensus.

One key belief about the task of designing instruction is the principle of partial par- ticipation, which states that even if full participation in a given activity is not a realistic goal for a student, this does not mean that a student cannot be actively and meaning- fully involved (Baumgart et al., 1982). In order for students with severe disabilities to be meaningfully involved in all school and classroom activities, teachers and support personnel must first agree that the principle of partial participation is a valid guideline for their work and, second, have systems for putting this principle into practice. A sec- ond key belief, captured by the words only as specialized as necessary, is that adapta- tions must be as non-intrusive as possible for the student and as user-friendly as possible for the teaching team. That is, adaptations should differ as little as possible from typical instruction and, as is inherent in the principle of parsimony (Chapter 5; Etzel & LeBlanc, 1979), teams should select the simplest yet effective approach.

The Pyramid of SuPPorT/reSPonSe-To-inTervenTion Logic

As represented in Figure 6–1, the foundation or base of support for inclusive educa- tion consists of an inclusive culture in the school and classroom. Above this base is a second level of support: the use of effective, accommodating curricular and instruc- tional practices in the classroom put into place by collaborative teams. This dual foundation minimizes the need for individualized adaptations. That is, the combina- tion of a school and classroom culture that is established with a sense of community and that emphasizes the value of diversity, plus the use of curriculum approaches and instructional strategies that are known to be effective in enhancing achievement for a wide range of students, can greatly ease the task of developing adaptations for indi- vidual students. The Individuals with Disabilities Education Act (IDEA) incorporates a similar logic in its response-to-intervention (RTI) requirements. Response to interven- tion specifies that before students are admitted into special education, less specialized interventions must be implemented in an effort to remediate learning and behavior problems. In other words, universal or whole-school interventions and group inter- ventions should be applied before individualized interventions.

The model for adapting schoolwork that is described in this chapter presupposes the existence of the base of support created by the existence of an inclusive culture in the school and classroom, and the use of effective, accommodating teaching practices in the classroom. We understand that inclusive practices are not fully in place in all schools. Indeed, many—if not most—schools are on a developmental trajectory toward the implementation of inclusive practices (Williamson, McLeaskey, Hoppey, & Rentz, 2006), but these schools may be lacking some of the assumptions, values and beliefs, collabo- rative teaming structures, instructional practices, and other elements that make inclusive education work. We would not want a school to wait until its culture and all of its teach- ing practices are accommodating for all students before providing inclusive experiences to individual students with disabilities within that school. However, when a school does

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192 Chapter 6

not have inclusive practices in operation, that school needs to create an action plan aimed at improving all of the necessary elements for inclusive education, not only the element that encompasses effective ways to modify schoolwork for diverse learners.

The principles of instructional design and delivery presented in this chapter do not apply only to inclusive schools. Even in settings that are not inclusive (e.g., self- contained special education classrooms or resource rooms), students’ special educa- tion programming should be only as specialized as necessary. This means that students’ individualized learning goals will stem from or be aligned with the general education curriculum framework, materials will be age appropriate, and instructional strategies will be adapted only enough to enable success. No matter what the setting, collaborat- ing teams of teachers, specialists, and other relevant personnel should design and deliver systematic instruction and then collect and analyze progress data according to the techniques and principles described in this chapter. Some of the team planning and communication strategies that we describe and illustrate are more essential in inclusive settings; however, the instructional planning and progress monitoring strate- gies apply in any educational setting that serves students with severe disabilities.

coLLaboraTive Teaming for ongoing, day-To-day PLanning and deLivery of inSTrucTion

The ways that teachers plan and deliver instruction are related, in part, to the type of program and the age/grade structure in a school. Inclusive schools use a variety of program types (such as grade-level teams and instructional departments), which influ- ence staffing arrangements. Those arrangements are seldom static, but often change from one year to the next. What these staffing arrangements have in common is that administrators and teachers have devised some way to unify special and general edu- cation teachers and support staff into integrated educational teams. It is important to assign special educators to students located in a narrower band of grades and in one

FIgURe 6–1 The Pyramid of Support

Individualized supports, adaptations, and interventions Curriculum modifications Specialized instruction (e.g., embedded instruction, response prompting, prescriptive programs) Specialized peer support strategies

Classroom and group supports and interventions Curriculum supplements (e.g., learning strategies, self-management skills) Accommodations to instruction and assessment Buddy systems

Universal and schoolwide practices Universal design for learning & differentiated instruction Research-validated curriculum and instruction (e.g.,cooperative learning, peer tutoring, graphic organizers, active responding) Classroom community building, natural peer supports

Tier 1

Tier 2

Tier 3

(Based on Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

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193Designing and Implementing Instruction for Inclusive Classes

or a few school settings. Although this approach will result in a caseload that reflects a mix of students with disabilities categories, this approach also will avoid the impos- sible situation of special educators being allocated caseloads of students for whom they cannot logistically provide instruction or consultation. For example, if a special educator is assigned 12 students with severe disabilities who are enrolled in 12 differ- ent classrooms, this means that he or she must team with 12 different teachers at multiple grade levels and possibly in multiple schools. The corresponding scenario from the classroom teacher’s perspective is that he or she must team with multiple special educators, each of whom is an IEP manager for one or more students in the classroom. Instead, special educators assigned to students in a narrower band of grades and in one or a few schools can be linked to integrated teams as follows:

• For elementary schools: grade-level teams or clusters of grade levels, in which spe- cial educators are teamed with the classroom teachers for that grade level or cluster

• For middle schools: interdepartmental teams, houses, pod, or families in which special educators are members of specific teams

• For high schools: grade-level plus subject area(s) teams that include a special educator

Regardless of the specific staffing configuration in a school, the processes described in this chapter involve a number of personnel, with some personnel participating more in planning and some participating more in implementing instruction. We do not assume that special educators will undertake full-time co-teaching with general educators in the classroom, but we do assume (a) collaborative teaming with one or more general education teachers who are on the IEP team (typically, with one grade- level classroom teacher for elementary school, but with more for middle and high school), (b) a special educator who serves as an IEP manager and provides some instruction to the student, and the likelihood of (c) some special education aide sup- port and some involvement by related service specialists.

Team members need to adopt three practices in order to work together effectively and to meet students’ needs in inclusive settings (Doyle, 2008; Snell & Janney, 2005):

• Clear roles and responsibilities: Team members must delineate who has primary responsibility for the student’s instruction in each goal area, who adapts materials, who sends notes home, and so on. These and other responsibilities should be dis- tributed among team members and clearly articulated to avoid gaps and overlaps in services and supports. Using a Team Roles and Responsibilities Form such as the one shown in Figure 6–2 can facilitate the collaborative teaming process.

• Agreed-upon systems and strategies for making and communicating decisions about instruction and supports: These systems are designed to (a) document deci- sions, (b) facilitate educational integrity—teachers must plan instruction even if an instructional aide delivers it, and (c) make teaming an expected part of the school culture (i.e., “This is how we do it here.”).

• Team meeting skills: Necessary skills include assigning leadership roles and rotat- ing them (e.g., facilitator, recorder, timekeeper), writing and following ground rules, using meeting agendas, using problem-solving strategies to make decisions, recording decisions, taking time to process, and celebrating successes.

School systems differ in their preferred and/or required ways of specifying services on the “free, appropriate public education” (FAPE) section of the IEP, and your teams should, of course, follow those guidelines. However, as an instructional team, it will be important to distinguish among the various special education service delivery methods that are used in an inclusive context. In a resource or self-contained pro- gram model, special educators and related service providers deliver most of a stu- dent’s special education services directly to the student. In an inclusive program model, a wider array of methods may be used to deliver those services so that a stu- dent may receive full-time special education services, but also be fully included in general education. These methods include

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194 Chapter 6

• special education instruction, which is a direct service delivered by a special edu- cator. Such instruction may be delivered using various instructional arrangements, including collaborative-teaching, small-group instruction, or individual instruction. (Note that special education instruction does not require or infer that the instruc- tion is “pull-out.” Special education is a “portable” service, not a place!)

FIgURe 6–2 Team Roles and Responsibilities Form for Jacob

Team Roles and Responsibilities Form

Student: Jacob Date: September 2015

Teaching and Support Team Members: Bowers Classroom Teacher Conners Instructional Assistant Fuentes Special Education Teacher Ms. Johnson Parent

Key: X Primary responsibility input input into implementation and/or decision-making

Who Is Responsible?

Special education

Instructional aide

Classroom teacher ParentRoles and Responsibilities

• Developing lesson and unit plans inputX

X

X• Developing individualized adaptations plan input input

X input

input

inputX input

inputX input

input input

input

input

Xinput input input

Xinput

input

Xinput

input X (service

coordinator)

input input

X

X (reports, IEP)

input

input input

• Providing instruction (with accommodations and modifications):

• Communication, social, behavior

• Functional skills and school participation

• Academics: basic skills

• Academics: content areas

Adapting instructional materials input (reading) X (other subjects)

X (reading) input (other subjects)

XAssigning grades/report card

Monitoring progress on IEP goals input (data log)

Assigning duties to and supervising instructional aides X (daily) X (long term)

Training instructional aides

Scheduling/facilitating team meetings: a. IEP team b. Core instructional team

a. input a. input b. X

a. X a. X b. input

Daily communication with parents

Communication/collaboration with related services input (notes, logs)

X (lunch bunch)

X (peer

planning)

inputFacilitating peer relationships and supports

(Teachers’ guides to inclusive practices: Modifying schoolwork (3rd ed.), by R. Janney and M. E. Snell., Baltimore: Paul H. Brookes. Reprinted with permission, and Ford, A., Messenheimer-Young, T., Toshner, J., Fitzgerald, M.A., Dyer, C., Glodoski, J., & Laveck, J. [1995, July]. A team planning packet for inclusive education. Milwaukee: Wisconsin School Inclusion Project; adapted by permission.)

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195Designing and Implementing Instruction for Inclusive Classes

• special education consultation, which is an indirect service, provided by a special educator to other team members for purposes such as co-planning, providing in- formation, locating or preparing adapted materials, collecting and analyzing data, and training or coaching paraprofessionals

• special education instructional aide support, which is a direct service from a para- professional and is planned and monitored by a special educator

• related services, which may include services from a speech-language pathologist (SLP), occupational therapist (OT), and physical therapist (PT). These services may be delivered via direct service to the student or via consultation with other team members. The direct service may be pull in or pull out.

It is important to remember that special education does not mean instruction deliv- ered by a special educator; instead, it is defined in the Individuals with Disabilities Education Act Amendments of 2004 as “specially designed instruction . . . to meet the unique needs of a child with a disability.” Although co-teaching by a general educa- tion teacher and a special educator is one way to ensure that students receive full-time special education within a regular class, the reality is that many, if not most, inclusive classrooms are not co-taught all day. Instead, instructional teams must use problem solving to determine the parts of students’ special education and related services that can be delivered effectively through indirect services (consultation), instructional aide support, and/or the use of accommodations that don’t require special personnel (Snell & Janney, 2000). Like Marc, Jacob, and Christine who were described in Chapters 4 and 5, students with severe disabilities often receive their special education services through a combination of methods based on their varying needs and characteristics and the learning priorities targeted by their teams.

a modeL for making individuaLized adaPTaTionS

Often, students with severe disabilities require planned adaptations to participate meaningfully in classroom activities and lessons with their peers in general education. Teacher educators and researchers have conceptualized several models or frame- works that describe the process of making these individualized adaptations. Here, we briefly summarize a comprehensive model that builds on other adaptative approaches (e.g., Giangreco, Cloninger, & Iverson, 1998; Jorgensen, 1998; Sailor, Gee, & Karasoff, 2000; Udvari-Solner, 1995; Villa & Thousand, 2000) and suits students with many types of special education needs who are members of general education classes ( Janney & Snell, 2013). Using such a model is particularly useful because it provides a process, including a series of guidelines and decision-making rules that can be used to address a range of student needs. Also, having a model gives teams a common lan- guage to use when discussing their work and the tasks that are required of them.

criteria for making individualized adaptations

When teams decide that a student needs individualized adaptations to the typical edu- cational program, those adaptations should be made systematically and for a purpose. Ideally, the most effective adaptations meet two important criteria: (a) They facilitate both social and instructional participation in class activities, and (b) they are only as specialized as necessary. The criterion of both social and instructional participation highlights the belief that although one goal of inclusive education is for all students with disabilities to belong socially to their schools and classroom groups, the achieve- ment of academic and functional competence should not be sacrificed. When students with significant disabilities are included in general education classrooms, neither instructional nor social participation should be forfeited, although teams will, at times, be challenged to negotiate the tension between the two. It is inadequate to merely be

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196 Chapter 6

present for “socialization” or for “exposure to the general curriculum,” or to partici- pate by moving through the activity; students should be actively involved and making meaningful progress (Carter, Hughes, Guth, & Copeland, 2005).

The only-as-specialized-as-necessary criterion underscores the need to keep adap- tations non-intrusive for the student and user-friendly for the teaching team. In apply- ing the only-as-specialized-as-necessary criterion, the goal is to recognize that no one wants to be singled out for extra assistance or adapted treatment all of the time, nor should receiving such treatment deprive a person of opportunities to engage in typi- cal activities and ordinary relationships. Furthermore, adaptations that are overly technical or specialized may not suit the context; may not be implemented; and, therefore, may do little to aid students in achieving their educational goals.

When Marc completes sound–letter matching worksheet activities in kindergarten, he uses peel-off labels for the letters instead of writing the letters with a pencil, something he still has difficulty with. This simple adaptation enabled Marc to participate more ac- tively than when his teacher or instructional aide wrote the letters for him or physically assisted him through writing the letters.

Types of adaptations: curricular, instructional, and alternative

Figure 6–3 represents a model for making individualized adaptations. Before we describe the model, a note about terminology is in order. In this chapter, we use the term adaptations as an overarching term that encompasses both accommodations

FIgURe 6–3 Components of a Model for Creating Individualized Adaptations and Supports

Prerequisites to the model

• A schoolwide system for student support (see Figure 6–1) • The classroom is structurally and culturally inclusive (i.e., age-appropriate general education class, col-

laborative general and special education service delivery, welcoming culture). • Accommodating, evidence-based teaching practices are in place (e.g., universal design for learning, dif-

ferentiated instruction, active teaching and learning, graphic organizers, data-based decision-making).

Criteria for adapta- tions and supports

• Only as specialized as necessary • Social and instructional participation and progress

Three types of adaptations

Curricular adaptations: Individualize the student’s learning targets. Include all students’ IEP goals in initial, classwide planning:

• supplementary learning targets for cross-curricular skills (e.g., self-management skills, social skills, learn-

• modified learning targets: • simplified academic goals from the general curriculum and/or alternate/aligned learning standards

ing strategies)

• functional and developmental skills

Instructional adaptations: Individualize the methods and materials: • Consider changing the instructional arrangement (e.g., smaller group, particular peers, cooperative

learning). • Consider changing the teaching methods and/or materials. • Consider changing the task required of the student. • Consider providing additional personal support from peers or from adults.

Alternative adaptations: Change to an alternate activity that is coordinated with classroom instruction. The activity is often conducted before or after part of a related class activity and includes peers if possible and appropriate. • alternative or supplementary activity (often used temporarily) • specialized instruction in basic skills or other individualized learning priorities • instruction in age-appropriate functional skills (other than typical school and class routines) at school or

in the community

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

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197Designing and Implementing Instruction for Inclusive Classes

and modifications. Accommodations are adjustments to the school program that do not substantially change the curriculum level or performance criteria; they enable a student to access curriculum content or to demonstrate learning without changing curriculum goals (e.g., adapted computer mouse, extra time on a test, desk close to the board). Modifications, however, alter curriculum goals and performance criteria (e.g., Jacob will show his understanding of several primary concepts from the science unit on weather by matching pictures with simplified terms and definitions, while classmates must explain them using unit terminology.). Students with severe disabili- ties typically have numerous IEP accommodations and modifications that address support needs related to the instructional program. Students also have other support needs related to accessing and benefiting from educational opportunities, such as assistive technology, assistance with physical management and self-care, behavioral supports and interventions, and related services (see Chapters 7– 9), but this chapter focuses primarily on support needs related to the instructional program.

Next we describe three types of adaptations: curricular, instructional, and alterna- tive. Meeting the criteria of only-as-specialized-as-necessary and social-and-instructional participation is aided by differentiating among these three types of adaptations.

curricular adaptations: individualize the Learning goal

The term curriculum refers to what is taught: the knowledge, skills, and processes that are the instructional goals and targeted learning outcomes for students. For stu- dents with severe disabilities, the curriculum is often modified. The core general cur- riculum can be adapted in two ways: (a) by simplifying it—reducing the difficulty or number of learning goals—and (b) by altering the curriculum to incorporate func- tional learning priorities that are relevant to students’ everyday lives:

1. Simplified curriculum goals are academic learning targets that are drawn from the general curriculum but are reduced in complexity or number. Simplified academic goals may be chosen from several sources, depending on a number of variables, including the state’s general education learning standards and the standards used in alternate assessments, and the school system’s curriculum philosophy. In addi- tion to meeting state requirements for completing alternate assessments, academic goals for students with severe disabilities should align with their classmates’ goals, be useful now and in the future, and have high acquisition probability. (Chapter 13 elaborates more on the teaching of academic skills.)

2. Alternative curriculum goals emphasize the functional skills that will enable stu- dents to accomplish the activities of daily life that are typical for their age, gender, and culture. Alternative curriculum goals target age-appropriate activities in five domains: (a) school, (b) domestic (or home living) and self-help, (c) vocational, (d) general community use, and (e) recreational. Alternative goals also include the motor, social, communication, and academic skills required to accomplish those targeted functional activities. In addition, problem-solving, self-management, and social interaction skills that are not functional in the strictest sense of the word, but are necessary for interacting successfully with other people, must be taught if stu- dents are to become contributing members of their families, schools, and commu- nities (Ford, Davern, & Schnorr, 2001).

Table 6–1 gives illustrations of these two subtypes of curricular adaptations for Marc, Jacob, and Christine.

How are appropriate curricular adaptations chosen? The learning goals that a team targets for a student with severe disabilities comprise an individualized set of these simplified and alternative curriculum goals (meaning functional routines and social, communication, and motor skills). Educators continue to debate the extent to which the education of students with severe disabilities should emphasize simplified academic skills or alternative functional skills from the general curriculum (Clayton, Burdge, &

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198 Chapter 6

Kleinert, 2001; Ward, Van De Mark, & Ryndak, 2006). We suggest that students’ IEP teams should gather input from parents, teachers, and students to determine an indi- vidualized balance between academic and functional skills, or a “blended curriculum.”

It is important to understand that students’ learning goals should not bear an across-the-board designation as “adapted/modified,” nor should students be placed in a “functional” or “alternative” curricular track. Instead, a student’s learning goals in certain subject areas may be adapted by simplifying the general education goal, while, in other subject areas or domains, the goals may be made more functional. The bal- ance between academic and functional skills in a student’s IEP changes over time and is likely to tilt toward the functional side as a student grows older.

A case also can be made for including curriculum content that is merely culturally relevant and/or personally interesting. In other words, a well-rounded educational program will include need-to-know as well as nice-to-know learning goals. Giangreco and his colleagues (1998) stress the need to balance “depth of curriculum” (the essen- tial learning priorities that should be mastered) with “breadth of curriculum” (the goals that enhance belonging and participation with peers and the school commu- nity). Ford and colleagues (2001) assert that curricular relevance can be maintained by taking two steps. First, teams should target high-priority learning outcomes from the foundational skills that are needed to “successfully navigate the tasks of daily liv- ing, problem solving, and contributing to society” (p. 215). Second, teams should ensure that these priorities are taught throughout the day, within the rich and varied activities available in inclusive classrooms.

Although the perception persists among some that students with modified curricular goals cannot be educated effectively in general classes, both the IDEA and evidence gleaned from educational research contradict this notion. The IDEA states that “a child is not removed from education in age-appropriate regular classrooms solely because of needed modifications in the general curriculum” (34 CFR 300.116). Researchers have demonstrated that students with severe disabilities can accomplish individualized learn- ing goals within general education contexts (e.g., Hunt, Soto, Maier, & Doering, 2003; Hunt, Soto, Maier, Muler, & Goetz, 2002; Johnson, McDonnell, Holzwarth, & Hunter, 2004; McDonnell, Mathot-Buckner, Thorson, & Fister, 2001). Students should not to be identified or tracked by their curriculum goals. Instead, members of the instructional team should know what students’ priority goals or objectives are for each learning activity. Relevant members of the instructional team need to understand whether a les- son will use (a) multilevel instruction—students’ learning goals are all from the same subject area, but vary in difficulty, or (b) curriculum overlapping—students are learn- ing together in shared activities, but a student with a disability has goals that are drawn from a different subject area or domain (see Chapter 1).

TAbLe 6–1 Subtypes and Illustrations of Curricular Adaptations

Subtypes of Curricular Adaptations

Illustrations for Three Students

Marc (Kindergarten) Jacob (Fourth grade) Christine (Postsecondary School)

Simplified Academic Skills Counts objects 1–10 Reads/writes/spells high- frequency and functional words (increase by 100 words)

Selects her name from others regard- less of fonts and sizes

Alternative (Functional and Developmental) Skills

Uses gestures and words, augmented by picture sys- tem, to express needs and feelings, to make choices, yes/no

Follows class procedures from classroom teachers’ cues (organization, materials, transitions, and so on)

Uses work check-in and check-out system at three work sites (i.e., store, library, veterinary office)

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199Designing and Implementing Instruction for Inclusive Classes

instructional adaptations: individualize the methods and/or materials

The term instruction refers to how the student is taught (i.e., the teaching methods). Teaching methods include, for example, the instructional arrangements, the strate- gies and materials used to convey the content, and the ways that students practice what they are learning and demonstrate progress. Some teaching methods and strat- egies are known to be effective for most learners. Indeed, the premise of our approach to teaching in inclusive classrooms is that instructional planning should begin by considering the instructional methods that will encompass the similarities across all students instead of first planning for students without IEPs and then adapt- ing for individual students. The principle of universal design for learning (Rose & Meyer, 2002), along with the response-to-intervention logic incorporated into the IDEA suggest that evidence-based teaching practices be utilized on a classwide basis instead of limiting the focus to making adaptations or creating interventions for spe- cific students.

Even when universal design is used, teachers often must alter aspects of their teaching methods and materials to enable individual students with severe disabilities to participate fully and to benefit from typical lessons. The intrusiveness of an adapta- tion sometimes depends on the particular student and the situation, but, in general, adapting what the teacher does tends to be less intrusive than adapting what the stu- dent does. Listed next, in order from least to most intrusive, are four aspects of instruc- tion that can be adapted to enable students with disabilities to participate fully and to benefit from classroom lessons:

1. The instructional arrangement (i.e., the grouping of teachers and students) • use peer partners • while classmates work in groups of 4–6, place a focal student in a group of 3 • group a focal student with particular peers who know him or her well, share

similar interests, or have complementary learning strengths and needs 2. The methods and materials used to convey the lesson content to the students

• use more visuals—maps, pictures, or drawings • use concept maps and other non-linguistic representations (cause–effect, compare–

contrast, hierarchy) • use models, demonstrations, simulations, and role plays • use concrete materials prior to visual representations or symbolic representations • check for understanding more frequently, using methods that require active

responses • provide differentiated reading material • provide large-print books and enlarged written materials • add pictures or symbols to text

3. The task required of the student • provides written or pictorial task steps • uses the same materials but completes fewer items (e.g., on a math worksheet,

does only half of the page) • uses the same materials but in a different way (e.g., on a math worksheet, circles

numerals named by the teacher instead of completing math problems) • adapts reading demands—listens or watches DVDs instead of reading and • adapts writing demands—completes story frames, draws pictures, or fills in the

blanks instead of writing sentences/paragraphs; dictates to a scribe and then types on a computer

4. The personal assistance provided to the student

• provides additional prompts to prevent errors • gives immediate feedback and encouragement • completes some of the task steps

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200 Chapter 6

Table 6–2 provides examples of how these four aspects of instruction were adapted for Jacob.

The topic of personal assistance warrants additional discussion. Modifying instruc- tional programming by adding increased adult support is an adaptation that should be considered with great care. Research has shown that adult proximity can interfere with the development of social relationships and peer supports (Giangreco, Edelman, Luiselli, & MacFarland, 1997; Janney & Snell, 1996). Recent research on peer support in general education classrooms has demonstrated that students with moderate to severe intellectual disabilities experience beneficial effects such as increased aca- demic engagement and peer interactions. Peer support also was shown to have pro- moted better outcomes in engagement and interactions than did adult support (Carter, Sisco, Melekogu, & Kurkowski, 2007).

We offer the following guidelines regarding individualized personal assistance from an adult:

• Keep personal assistance only as specialized as necessary. That is, lend assistance during specific activities or task steps instead of at all times of day, for each and every activity. A student may need extensive adult support to use the restroom or to complete a writing task, yet be able to participate in shared stories or a science learning center with peer support and indirect adult supervision, or perhaps inde- pendently. Many students need extra help to get organized and begin an activity, but then the adult can withdraw that assistance once the student is actively en- gaged. Often, strategies can be developed that lessen the dependence on adults to initiate activities, such as the use of picture cues or teaching the student to observe natural cues in the environment. Like other adaptations, personal assistance should be gradually lessened over time.

TAbLe 6–2 Subtypes and Illustrations of Instructional Adaptations from Least to Most Intrusive

Subtypes of Instructional Adaptations Illustrations for Jacob

Change the instructional arrangement. • During guided reading, while most students work in groups of five or six, Jacob is placed in a group with just two other students who read at a similar level.

Change the teaching methods and materials used to convey content to the students.

• While Jacob’s fourth-grade teacher explains erosion, the special educator com- pletes a concept map on the Smart board; Jacob has a copy of the completed concept map at his desk.

• For guided reading, Jacob and his classmates read leveled readers—four differ- ent books on the same topic, each suited to a specific group’s reading level.

• Colored highlighting tape is used on Jacob’s science and social studies text- books: Topic sentences are red, targeted vocabulary terms are yellow, and defi- nitions are blue.

Change the task required of the student by mak- ing it easier, reducing the amount, adapting the format.

• When the class does a science investigation, Jacob’s fourth-grade teacher lists the steps to follow on the Smart board; she prints a copy of the steps for Jacob so that he has them nearby.

• Jacob uses a story frame for book summaries; the frame provides spaces in which to fill in the title, the author’s name, the characters, the setting, and so on. Jacob draws a picture of the outcome of the story.

• Jacob’s classmates have 10, 12, or 15 spelling words per week; Jacob is as- signed 5 high-frequency words or words with a particular spelling pattern.

Change the level of personal assistance pro- vided to the student—either from peers or from adults.

• During science projects, an adult prompts Jacob to watch his classmates and do what they are doing.

• When an activity requires cutting intricate or small shapes, a peer or an adult offers to do the cutting for Jacob.

• All adults working with Jacob give frequent thumbs-ups, “high fives,” and verbal encouragement when Jacob is participating and following rules.

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201Designing and Implementing Instruction for Inclusive Classes

• Make sure that personal assistance does not interfere with social and instructional participation. Ensure that adults facilitate and prompt, but do not do things for the student. Adults who provide one-to-one support should take care to reference nat- ural cues and corrections (e.g., the adult should refer the student to the classroom teacher’s instructions and feedback instead of repeating the teacher’s instructions), and lessen their prompts.

• Teach peers how to assist in natural ways. Provide informal lessons for peers on how to interact respectfully, help without doing things for the focal student, offer choices, use communication systems, and so on (Carter, Cushing, Clark, & Kennedy, 2005; Carter & Kennedy, 2006; Janney & Snell, 2006).

• Teach peers how to assist in more structured ways. Peers may teach through peer- tutoring methods or assist through peer-support networks. Rely on methods shown to achieve good effects (Carter et al., 2005; Carter, Sisco, Melekoglu, & Kurkowski, 2007; Janney & Snell, 2006; McDonnell, Mathot-Buckner, Thorson, & Fister, 2001 ; also see Chapter 11).

alternative adaptations: individualize the goal, the methods/materials, and the activity

Alternative adaptations include activities that are coordinated with classroom instruc- tion but are designed to address individualized learning priorities using methods and/ or materials that differ from those of classmates. Sometimes class lessons are just too long and students can participate for only part of the time and thus need an alterna- tive activity for the remaining time. Other times, a student’s team determines that the student needs direct instruction from a specialist in a small-group or one-to-one for- mat in areas such as reading or writing. (There also may be times when a team has yet to determine a way to integrate a student’s learning goals or support needs into ongoing class activities, and what is really needed is better problem solving.) These alternative adaptations may be implemented within the general classroom setting or elsewhere, depending on considerations such as the way the level of noise and activ- ity in the surrounding environment affect the student’s focus and motivation. Func- tional skill instruction that goes beyond teaching the student to accomplish typical school and classroom routines (e.g., arrival and departure, lunch, using the restroom) is also considered an alternative adaptation. Such instruction takes place in the crite- rion environment for that student at least part of the time, and thus may occur in the classroom or elsewhere in the school or community. The challenge is to coordinate alternative adaptations with the general education class to (a) avoid activities that are stigmatizing and separate, and (b) time these alternative adaptations so that important general education activities are not missed: “Educational priorities should be pursued through schedules and locations that are respectful of the student’s membership in a learning community” (Ford, Davern, & Schnorr, 2001, p. 220).

In Chapter 1, Giangreco describes four inclusion options within general education environments and activities: (a) no accommodations required, (b) support accommo- dations required, (c) program content accommodations required, and (d) program content and support accommodations required. The model that we are explaining for making adaptations follows that same logic, but it adds “alternative adaptations,” some of which may be consistent with the “program content and support accommo- dations required” option, but some of which are not, as they may be delivered out- side of general education environments. Teams may decide that some alternative adaptations for a student are better implemented outside the classroom (e.g., study hall, multipurpose room, or resource room), but these decisions must be balanced with an overall schedule that does not interfere with that student’s class membership. Adaptations for given students will change over time as students gain new skills and team members learn more about how to teach and support the student.

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202 Chapter 6

This category of adaptations includes three types of instructional activities:

1. Alternative or supplementary activities are designed to (a) prime the student for instruction, or (b) extend/reinforce previous instruction. To be only as specialized as necessary, such activities should match class lesson topics or themes, and are implemented before or after the focal student participates in a portion of a class activity. For example, if a student is not able to participate in an entire whole-class lesson and does an alternate activity for part of the time, the alternate activity should involve the same subject area that classmates are studying. Or, if the class lesson is part of a thematic unit, the student could do an alternate activity that re- lates to the same unit theme.

2. Remedial or compensatory instruction in basic skills requires the use of direct in- struction by a teacher trained to implement and monitor a research-based model or program (e.g., discrete trial instruction, functional communication training, cer- tain commercial reading programs). Motor, speech, and communication goals may also be the focus of intensive one-to-one teaching sessions. To be acceptable under our adaptations model, such instruction should be truly specialized, pre- scriptive, and yield noticeable and highly valued gains (e.g., functional communi- cation training, pivotal response treatment, discrete trial instruction, structured teaching). It also should be conducted with consideration for issues related to transfer and generalization of skills to general classroom activities. Remedial in- struction can be especially important for younger students whose skill deficits may be more easily remedied.

3. Instruction in functional skills that cannot be completed within ongoing, regularly scheduled class activities. Such instruction is relatively rare for elementary and middle school students but becomes more frequent during high school and the postsecondary years (e.g., learning to make purchases in stores, job sampling).

Alternative adaptations are the most specialized adaptations and should be selected judiciously, with careful consideration of the costs and benefits with regard to the stu- dent’s social and academic needs. Some alternative adaptations (e.g., a priming activ- ity that will help prevent behavior problems) may be part of an individualized plan for positive behavioral support (PBS). Often, alternative adaptations are used temporarily until the team can determine a less intrusive adaptation, or until the student learns new skills that enable fuller participation in ongoing class lessons and activities.

Although the teams teaching and supporting Marc, Jacob, and Christine were intent on including these students in every way possible with their same-age peers, all three teams still implemented one or more alternative adaptations, not because including the student was too difficult for the teachers, but because, in good faith and on the basis of good data, the teams determined that the students would be better served socially and academically at this time by these alternative adaptations.

Jacob’s fourth-grade teacher presents large-group science lessons in which she lectures and guides students through the use of interactive notebooks (Young, 2003). (Interac- tive notebooks are created for students to record, organize, and process new material; the teacher guides students in making outlines, illustrating content graphically, and exploring their opinions about new content.) Jacob participates in the first half of the whole-class lesson using an adapted version of the interactive notebook process. His notebook already has some skeleton notes in it so that he can fill in the blanks and circle or highlight key terms and definitions. He is also provided with graphic organ- izers and pictures that other students draw for themselves. During the second half of the science lesson, he goes to a learning center in the classroom where there are several activities related to the topic: a sort board, picture books, flash cards with vocabulary words and definitions, and computer quizzes. Classmates utilize the center when they finish their assignments and have choice time. (alternative or supplementary activity)

Marc receives two sessions each week of intensive communication instruction on a one-to-one basis outside the classroom with the speech-language therapist, but the rest of

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203Designing and Implementing Instruction for Inclusive Classes

his communication instruction is done in the classroom among classmates and in the context of ongoing activities. (remedial or compensatory instruction)

Christine, a 20-year-old, spends much of each school day away from the post–high school program in order to learn needed community skills and to prepare for a job when she graduates next year. She works 1 1/2 hours each day at a library helping with book checkout; she will be employed there during the summer and possibly after gradu- ation. In addition, Christine serves as a greeter at a large department store. In both set- tings, the bathrooms are different and pose challenges for her. Christine takes time from the job (pull out) when her physical therapist visits; together with the teaching assistant they determine the adaptations needed for Christine to get in, use, and get out of the re- stroom. Then the physical therapist consults with Christine’s teacher weekly to check on her progress. (instruction in functional skills)

When alternative adaptations are used they should

• be short and timed to match natural transitions in the class schedule • include peers when possible and appropriate • be coordinated with classroom content and themes • provide intensive, individualized instruction or other specialized services • be monitored and adjusted to be more normalized and less intrusive as the student

makes gains

Although alternative adaptations are more specialized—and even may be some- what intrusive—they do not have to jeopardize class membership. Individualized instruction becomes more ordinary when these conditions are in place: (a) The school is truly inclusive in both philosophy and practice; (b) all students are regularly involved in a variety of groupings, with a variety of adults and peers, in a variety of places; (c) special educators are viewed as teachers and helpers for the entire class; (d) the student is a full member of the classroom group; and (e) the only-as-special- ized-as-necessary guidelines are followed.

uSing The modeL To deveLoP individuaLized adaPTaTionS

Applying this model to plan for the inclusion of students in general education, team members follow four steps: (1) Gather and share information; (2) determine when adaptations are needed; (3) plan and implement the adaptations; and (4) monitor and evaluate.

Step 1. gather and Share information about the Student(s) and the classroom

Before school starts or during the first month, the team collects and shares informa- tion about the student(s) and the classroom. All team members must know or have easy access to essential information from the student’s IEP (i.e., special education and related services; IEP goals and accommodations; academic, social, and management needs). This information can be recorded on a Program-at-a-Glance form (see Figure 6–4) and Student Information Form (see Figure 6–5). These forms are provided to relevant classroom teacher(s), specialty teachers, and instructional aide(s) after the information is shared at an initial face-to-face meeting. Figure 6–4 shows that, in addi- tion to brief synopses of Jacob’s IEP goals, Jacob’s team was alerted about his IEP accommodations, which include the use of a daily home/school homework planner and communication log, and visual organizers or checklists for multistep activities and investigations, and his behavior/social management needs, which include the need for clear time limits and clear beginnings and endings to activities. Figure 6–5 shares cru- cial information about Jacob’s learning and behavioral strengths (general knowledge, math, and sense of humor), learning and behavioral liabilities (hyperactivity, difficulty sustaining attention, and anxiety), likes and interests (anything on wheels, video

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204 Chapter 6

games, animals), dislikes (writing, loud noises, crowds), and how he learns best (a multisensory approach).

information about the classroom

Knowing when to adapt and what kind of adaptations will be needed require famili- arity with the academic, social, physical, and behavioral demands of the classroom. In order for a student with significant disabilities to be meaningfully included, all team members need to understand the classroom’s structure and culture. The team needs to assess how the classroom operates, including organizational routines and proce- dures, types of instructional activities, behavior expectations and contingencies, and homework and testing practices. Early in the school year or semester, the special edu- cator gathers this information through observation and interviews. In middle and high schools, information must be gathered for each class in which a focal student partici- pates; in elementary school, the main classroom, as well as specialties such as music, art, and physical education, need to be assessed. Procedures for using the cafeteria

FIgURe 6–4 Program-at-a-Glance for Jacob

Program at a Glance

Student: Jacob Date: September 2015

IEP Goals (see IEP for measurable goal statements and

objectives/benchmarks)

• Use simple sentences to express needs, feelings, ask/answer questions, make choices, relate recent events. • Respond to and initiate interactions (e.g., greetings, requests) with peers. • Use self-control strategies with cues and support.

Social/communication

Functional skills and class participation

Math

Language arts

Science/social studies

• Follow class procedures from classroom teachers’ cues (organization, materials, transitions, etc.). • School arrival, departure, lunch routines • School/classroom jobs • Participate in individual work to 10 minutes, small and large groups (including specialties) to 20 minutes.

• Write numbers 0–100. • Compare (6, =, 7) whole numbers to 100. • + and - to 50, concrete objects • Time to 15 minutes (analog, digital) • Counting out combinations of coins to match prices • Measurement: pounds, inches and feet, cups and quarts • Basic geometric figures • Basic bar and line graphs

• Comprehension questions, fiction and non-fiction (purpose, setting, characters, event sequences) • Read/write/spell high-frequency and functional words (increase by 100 words). • Write a three-sentence paragraph. • Collect information from print, media, online.

• 3–4 key vocabulary/concepts for each unit • Conduct investigations (predict, observe, conclude; cause and effect; measurements).

IEP Accommodations and Modifications

• Receive special education support/instruction for academics, daily routines, transitions, social- communication. • Modified curriculum goals • Weekly curricular and instructional adaptations by special education and general education teachers • Science and social studies texts read aloud or with computer text reader, and/or summaries provided • Math, science/social studies test read aloud • Additional scheduled movement breaks • Daily home/school homework planner and communication log • Educational team familiar with and uses PBS plan • Visual daily schedule • Visual organizer/checklists for task steps of multistep activities, investigations

Behavior/social management needs

• Peer planning at beginning of year and as needed • Visual schedule • Clear time limits and beginnings/endings to activities and assignments • See PBS plan; share key strategies with all relevant teachers and staff.

Comments/special needs

• Anecdotal records for IEP progress • Core team meetings biweekly; whole team monthly

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

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205Designing and Implementing Instruction for Inclusive Classes

and other common areas of the school, as well as behavior expectations for various school environments, also should be considered.

There are no rules for how detailed this information should be, or even how much of it must be written down. If teams of classroom teachers and special educators have collaborated in the past, much of this information will be known without doing a for- mal assessment. But if the team is newly formed, the special educator and other sup- port personnel should become familiar with these classroom variables and record any information that needs to be analyzed by the team. Although the task of gathering this information for the first time may sound daunting, remember that, in all likeli- hood, the special educator will be using the information about the classroom context to develop adaptations for other students with IEPs as well, not only for the student with extensive support needs, such as those addressed in this book.

in-depth information about class activities and Participation

When a student has extensive support needs and a significant portion of his or her classroom participation is focused on teaching embedded social, motor, and commu- nication skills (as for Marc and Christine), the assessment process will include more detailed descriptions of class activities and the student’s level of participation in them.

FIgURe 6–5 Student Information Form for Jacob

Student Information Form

Student: Jacob (9 years) Grade: 4 School Year: 2015–2016

Disability: Mental retardation (requires limited to extensive support in most skill areas; academic and social–behavioral needs are more significant than functional skill needs)

Current Teachers: Bowers (fourth grade) Last Year’s Teachers: Kohn (third grade) Fuentes (special ed.) Carhart (special ed.)

Special education and related services __x Academics: All areas __x Speech/language: 20 minutes x 2 days __x Occupational therapy: Consult __ Physical Therapy: __x Aide support: 4.5 hours x 5 days for math, content areas, transitions, school/classroom routines, self-help

__x Special ed. instruction: 45 minutes x 5 days for language arts and social skills

__ Special ed. consultation: 15 minutes x 5 days

Learning and behavioral liabilities/areas of concern: General knowledge Math Sense of humor (likes to joke, laugh)

Learning and behavioral liabilities/areas of concern: Hyperactive, difficulty sustaining attention to an activity not of his choosing for more than 8–10 minutes. When bored or afraid of making mistakes, becomes anxious, cries, lies on floor. When dislikes assigned task, makes disruptive noises, uses materials for “play.” (See PBS plan for details.)

Special health, physical, or self-help needs: Uses restroom with minimal supervision; needs help with zippers, buttons, and flushing toilet (it scares him) Very picky eater; usually packs lunch. Eats with minimal assistance opening packages and cleaning up self and table/area

See guidance counselor/principal for other relevant confidential information? __ yes __x no Behavior Support Plan? __x yes __ no

Testing: State/district accommodations __ yes __x no Alternate assessment __x yes __ no

Learns best by __ Seeing (picture/video/graphic organizer) __ Teacher or peer modeling __ Hands on, labs, projects __x Multisensory approach (all of the above)

Likes/Interests anything on wheels: cars, trucks, bikes video games animals Dislikes writing of almost any kind or amount loud noises, loud music crowded areas

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

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206 Chapter 6

The special educator or other trained staff member conducts an ecological assessment of classroom activities, which is a detailed observation of the focal student’s perfor- mance on each step of lessons and routines during which the extent of the student’s participation and/or instructional benefit is in question. These observations yield val- uable information that the team uses to identify the skills needed by the student and adaptations that could be provided to increase the student’s participation.

Figure 6–6 shows an ecological assessment of classroom activities for Christine. The observation was conducted and recorded by a teaching assistant who had been taught to use the assessment procedure by Christine’s IEP manager. The assessment was recorded during the second meeting of the drama club when club routines and

FIgURe 6–6 An Ecological Assessment of Christine in Drama Club

Ecological Assessment of Classroom Activities

Class: Drama Club Student: Christine

Day/Time: Alternate Thursdays 4:00–6:00 Instructional Assistant: Ms. Washington

Club President: Paul Date: 9/16/15 (second meeting)

Faculty Adviser: Mr. Fullen Time: 4:00–6:00

Key to Participation: + social and instructional participation; +/- missing either social or instructional participation; – missing both social and instructional participation

Participation: Focal Student ParticipationTypical Sequence of Steps/Procedures +, +/-, -

1. Students file in several at a time, most socializing from prior acquaintance. 2. Students sign in on the club attendance notebook located on the stage. 3. Students get a drink and chips from the meeting refreshment area and then mingle and socialize. 4. Club president calls the group to order and reviews club business, seeks discussion and membership vote on several fund-raising issues. 5. Mr. Fullen takes ideas for drama activities and group decides to focus first on some warm-up exercises (voice and movement) and then on improvisation exercises. 6. Group is divided into five stations for different improvisations; groups rotate after about 10 minutes. 7. Paul gives club announcements and ends meeting. 8. Students talk and socialize, leaving in small groups or individually.

1. Teach peers how to interact with Christine. 2. Raise hand to signal teacher for response or turn and to vote. 3. Able to access and use DynaVox categories programmed. 4. Practice and adapt improvisations to suit Christine; teacher involves class in obtaining suggestions.

1. Christine is wheeled to a location away from other students. 2. Ms. Washington goes to the attendance book and signs Christine in. 3. Ms. Washington wheels Christine to the refreshment area and pours a drink for Christine into her sport cup on her tray. Several students talk to Christine but do not understand how to pause for her to respond. 4. Christine is quiet and looks at Paul but does not participate in voting. 5. Christine is quiet and looks in Mr. Fullen’s direction. She laughs with others when he shows some improvisations. 6. Ms. Washington wheels Christine to one group, close enough so that she can hear and see the larger movements of the students. Christine is attentive to students who act, laughs at the right times, but does not participate. 7. Christine is attentive to Paul. 8. Several students go to Christine after the meeting and make conversation. Christine listens but is not successful in communicating with her AAC device.

1. Position Christine by peers before meeting starts. 2. Adapt sign-in procedure; maybe have peer sign in for her. 3. Assistant provides some translation of Christine’s remarks or intent as needed; direct others to talk to Christine or prompt Christine to respond. 4. Program DynaVox with vocabulary suited to club activities. 5. Position Christine close to demonstrations and use extra lighting to improve her perception.

1. -

2. -

3. +/-

4. -

5. +/-

6. +/-

7. + 8. +/-

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

Adaptations Needed to Increase ParticipationSkills Needed to Increase Participation

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207Designing and Implementing Instruction for Inclusive Classes

procedures were already in place (e.g., sign in near the stage; socialize during refreshments and before call to order; when faculty advisor or club leader starts talk- ing, get quiet and come to order; review club business; decide on acting activities; participate in activities; socialize; and depart). Christine’s core team examined and discussed the findings at their next meeting. The observation provided useful ideas for the team on ways to improve Christine’s participation through additional skills and adaptations.

After implementing skill instruction and adaptations for a period of time, a repeated observation of the same activity can be conducted to determine whether the student’s level of participation has increased.

Step 2. determine When adaptations are needed

The purpose of adaptations is to enable the focal student to participate as much as possible in all class activities while also pursuing individual learning priorities. In Step 2 of the planning process, the team looks at all of the activities throughout the school day that must be adapted. The team decides when to teach functional skills or other individualized learning priorities.

The program planning matrix is a form used to plot a student’s IEP goals against the class’s daily schedule. It is especially valuable for students whose learning priori- ties include functional skills, social/communication skills, and other skills that should be used throughout the day. The matrix is useful for identifying when and where a student’s individualized learning priorities will be taught and for determining the times for the student to receive special supports and services such as health care, movement breaks, therapies, or mobility training.

As shown on Jacob’s Program Planning Matrix in Figure 6–7, the student’s IEP goals are listed in the left-hand column and the daily schedule of subjects and activi- ties is listed across the top row (for a middle school or high school student, the daily schedule of classes is listed). Cells are marked with an “x” or other symbol to indicate the IEP goals that will be addressed during corresponding class activities. Jacob’s goals include simplified academic goals, as well as goals for functional skills and social/communication skills. Obviously, Jacob’s adapted language arts, math, science, and social studies goals are addressed when the class is scheduled to work on the same subject matter, although at a different level of difficulty. Jacob’s func- tional skill goals that are related to his participation in school and classroom rou- tines are also relatively easy to enter on the matrix because they are addressed at naturally occurring times throughout the day. He engages in arrival, departure, and classroom job routines when those activities are scheduled for the entire class, although he receives instruction and support not provided for most of his classmates.

Jacob also has social and communication goals (e.g., to initiate and respond to greetings from peers and adults) that neatly correspond with typical fourth-grade instructional activities and that should be addressed at multiple times throughout the day instead of in the context of just one subject or activity. The matrix assists Jacob’s team to identify the most appropriate opportunities for providing Jacob with direct or embedded instruction in social/communication skills, as well as helping to ensure that the team provides adequate instructional opportunities in these goals throughout the day.

The program planning matrix also can be used to schedule the delivery of program supports (in contrast to the learning goals) that are delivered during the day. Sup- ports such as movement breaks, toileting, and physical therapy can be listed in the left-hand column, below the student’s IEP goals, and a symbol or color code can be added to the cells that correspond to the time during the daily activity schedule when those supports should be provided.

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208 Chapter 6

An additional use for the matrix is described in the following section, which details Step 3 of the adaptations process. The cells on the matrix can be coded (using color or symbols) to indicate whether the corresponding activity requires planning and preparation of adapted methods and/or materials.

Program Planning Matrix

Student: Jacob Class: Bowers/Fourth Date: September 2015

Class Schedule

IEP GOALS A rr

iv al

M or

ni ng

W or

k

La ng

ua ge

S ki

lls

G ui

de d

S pe

ci al

ty *

R ec

es s

M at

h

Lu nc

h

S ci

en ce

/S oc

ia l

S tu

di es

W rit

er s’

W or

ks ho

p

S ha

re d

R ea

di ng

D ep

ar tu

re

Communication, Social, Behavior

Use simple sentences to express needs, feelings, ask/ answer questions, make choices, relate recent events.

x o x x o x o x x x x x

Respond to and initiate interactions with peers. x x x x x x o x x o x x

Use self-control strategies with cues and support. x o o o x x o x o x o o

Functional Skills and School Participation

Follow class procedures from classroom teacher’s cues.

x x x x x x x x x x x x

Arrival/departure, lunch routines, classroom jobs xxx

Participate in individual work to 10 minutes, small and large groups to 20 minutes.

x o x x x x o x

Math

Write numbers 0–100 (S). x o

Compare ( , , ) whole numbers to 100 (S). x o

Add and subtract to 50, concrete objects (S). x

Time to 15 minutes (analog, digital) (S). xxxxx

Measurement: pounds, inches and feet, cups xx and quarts (S)

Basic bar and line graphs (across curriculum) (S) xxx

Language Arts

Readable handwriting for name, date, high-frequency xoxoxxx words, and phrases (S)

Comprehension questions, fiction and nonfiction xxxx (fact/fantasy, purpose, setting, characters, events) (S)

Write 3-sentence paragraph (S). xxx

Read/write/spell high-frequency and functional xxxx words (S).

Collect information from print, media, online (S). xxxx

Science and Social Studies

Conduct investigations (predict, observe, conclude; cause and effect; measurements; graphs) (S).

x

Key concepts and vocabulary from each unit (S) xx

*Monday: Music; Tuesday and Thursday: P.E.; Wednesday: Library; Friday: Computer KEY: x = Instruction provided, o = Opportunistic teaching; (S) Specific adaptations to class activities and materials may be needed.

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

FIgURe 6–7 Program Planning Matrix for Jacob

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209Designing and Implementing Instruction for Inclusive Classes

Step 3. Plan and implement adaptations: first general, Then Specific

Using the assessment information gathered in Step 1 and the program planning matrix developed in Step 2, the team now plans the adaptations that should be used through- out the day for the student. The team creates an individualized adaptations and support plan, which summarizes the curricular, instructional, and any alternative adap- tations that will be implemented. One way to make the process of creating effective adaptations more efficient is to divide it into two stages. First, focus on general adapta- tions that enable the student to participate in typical classroom routines and instruc- tional activities. Then, focus on more specific adaptations that apply to particular content and intermittently occurring activities. These two stages are not strictly sequen- tial; however, general adaptations are broader, more global supports than specific adaptations, which tend to be narrower and more time limited (see Table 6–3).

general adaptations

General adaptations are those that apply to predictable aspects of classroom activi- ties, including daily routines (e.g., arrival, bathroom use), organizational procedures (e.g., handling paperwork, sharpening pencils, seeking help, making transitions), and regularly used instructional formats (e.g., guided reading groups, interactive science notebooks, math journals). General adaptations, by necessity, include the alternate and augmentative ways that students communicate with others and others communi- cate with students.

General adaptations are, in essence, routine ways of scaffolding the focus student’s social and instructional participation in the class. General adaptations capitalize on

TAbLe 6–3 Components of a Model for Making Adaptations That Are Only as Specialized as Necessary

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, , Baltimore, MD: Paul H. Brookes. Reprinted with permission.)

Prerequisites to the model The classroom is truly inclusive (i.e., age-appropriate general education class, collaborative between general and special education, welcoming culture). Accommodating, evidence-based teaching practices are in place (e.g., active learning, multiple modal- ities, small groups, systematic lesson structure, graphic organizers, data-based decision making).

Three types of adaptations Curricular adaptations: Alter the learning goals for the student. Include the student’s IEP goals in ini- tial, classwide planning: • simplified goals from the general curriculum and/or alternate/aligned learning standards • functional and developmental skill goals

Instructional adaptations: Alter the methods or materials: • Consider changing the instructional arrangement (e.g., smaller group, particular peers, cooperative

learning). • Consider changing the teaching methods and/or materials. • Consider changing the task required of the student. • Consider providing additional personal support from peers and from adults.

Alternative adaptations: Change to an alternative activity that is coordinated with classroom instruc- tion. The activity is often conducted before or after part of a related class activity and includes peers if possible and appropriate. • alternative or supplementary activity (often used temporarily) • remedial or compensatory instruction in basic skills or other individualized learning priorities • instruction in age-appropriate functional skills (other than typical school and class routines) at school

or in the community

Two stages for creating adaptations

general adaptations: Formats for adapting predictable types of activities and routines. These are usually adaptations to goals, methods, materials, and personal support. Specific adaptations: time-limited adaptations for a specific lesson, activity, or unit; matches class lesson content

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210 Chapter 6

the fact that classroom teachers have a set of routines and learning rituals that they use regularly. General adaptations are patterns or formats for adapting those organi- zational practices and learning rituals. They are designed and then applied for a period of time—for a marking period, semester, or until the student no longer needs the adaptation; the instructional team does not need to reinvent them from week to week.

Marc has an activity communication board for each activity in which he participates. The communication boards have picture symbols for the steps of the activity and/or any needed vocabulary. Whenever Ms. Kwan, Marc’s kindergarten teacher, interacts with Marc, she touches his picture symbols on his daily schedule and on his activity commu- nication boards while she speaks softly; this procedure helps Marc understand her messages.

Christine, at age 20, spends most of her school week learning vocational skills in community settings, but she participates in the drama club on the university campus where her post–high school class is located. When Mr. Fuller calls roll at club meetings, Christine responds “here” by smiling and lifting her head up high, a response that is faster than using her DynaVox.

Because general adaptations help establish the student’s participation in class rou- tines and learning activities, they should be put in place as soon as possible at the beginning of the school year. High-priority general adaptations include plans for the use of communication devices and systems, visual supports such as individual sched- ules, and strategies for supporting students when they participate in routines such as arrival, departure, lunch, and restroom use. When school and classroom routines are targeted for instruction, an instructional program plan with a task analysis and teach- ing guide is created. These plans for task analytic instruction, which are discussed later in this chapter in the section on monitoring and evaluating instruction, and also in Chapters 4 and 10, can be considered as general adaptations, too; once they are planned and put into practice, they do not require additional collaborative team plan- ning unless performance data reveal either difficulties that should be addressed or mastery of the routine.

Specific adaptations

When general adaptations are in place, teams can then focus on the specific adapta- tions for changing class content. In contrast to general adaptations, specific adapta- tions apply to a particular lesson or activity and require more short-term planning in order to match the content being taught. The timeline for creating specific adapta- tions depends on the number of teachers involved and their usual planning methods; however, specific adaptations usually are planned and created weekly (e.g., for spell- ing words, math skills) or for each unit (e.g., for science and history/social studies). In middle school and high school, the increasing complexity of the curricula and the growing number of paper-and-pencil tasks often necessitate weekly planning.

Ms. Bowers, Jacob’s fourth-grade teacher, uses guided reading groups several days each week. Ms. Bowers, Ms. Fuentes (the special educator), an instructional assistant, and a student teacher each teach a group. Each group reads a leveled reader that belongs ei- ther to a literary genre (e.g., historical fiction, fables) being studied or is related to a current content area theme (e.g., Colonial Virginia, animal adaptations). During guided reading, while the other students work in groups of five or six, Jacob is placed in a group with only two other students. Ms. Bowers selects two students who know Jacob well and who read at a similar level. Ms. Fuentes, the special educator, instructs Jacob’s group and is able to give the extra visual prompts and immediate feedback that Jacob needs to stay focused and motivated. These general adaptations to the instructional methods will stay in force until Jacob is able to participate more independently in a

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211Designing and Implementing Instruction for Inclusive Classes

group with more members. In addition to reading aloud, students do a practice activity. They might complete a table on the basis of the features of the genre being studied, or fill in a compare-and-contrast diagram showing how the material relates to other texts that they have read. On the basis of Jacob’s language arts goals, the team has decided on several general adaptations that will be used for these sorts of tasks (e.g., letting Jacob write words or phrases instead of sentences, providing models from which Jacob copies, and adding lines to any unlined worksheets). During their weekly collaborative plan- ning, the two teachers discuss the specific adaptations required for the week, which per- tain to the content of the guided reading sessions (e.g., which of the defining characteristics of the genre Jacob will learn or how the terminology used to teach a reading strategy will be simplified).

Notice that Jacob’s Program Planning Matrix (see Figure 6–7) includes notations about which of his IEP goals require specific adaptations. Whereas instruction in functional skill routines and developmental skills that are embedded throughout the day is founded largely on general adaptations (e.g., procedures for using his visual schedule, or the task analysis and teaching guide for completing the morning rou- tine), instruction in simplified academic goals is likely to require specific adaptations to match the content being taught in class lessons. This practice is illustrated below for Marc, who uses a communication board (general adaptation) that is updated each week with vocabulary needed for upcoming lessons and activities (specific adaptation).

Marc’s functional goals for communication are embedded throughout his school day. He uses a series of small activity communication boards matched to each activity; each board has removable picture symbols that he points to or removes and shows to express himself (see Figure 6–8). His speech therapist spends 20 minutes on Tuesdays and Thursdays with him in the resource room; the focus is on expanding his symbol vocabu- lary and encouraging his emerging speech. Before these sessions in the resource room, the speech therapist checks with Marc’s kindergarten teacher about vocabulary that Marc will need for upcoming lessons and activities, and then makes these words and symbols the focus of Marc’s pull-out instruction. The activity communication board is a general adaptation; the picture symbols needed for the activity at hand (e.g., the alpha- bet or number lesson, the art project, the game being played at recess) are specific adaptations.

Conceptualizing the process of developing adaptations as occurring in two stages— general and specific—makes the task more efficient because it allows teaching teams to focus their short-term planning on the content of upcoming lessons. Teams also need to revisit general adaptations as the student’s performance improves and/or as problems arise. But having a store of general adaptations on which to build makes the task of determining specific adaptations more manageable.

individualized adaptations and Support Plans

The individualized adaptations and support plan includes

• a summary of the general adaptations (curricular, instructional, and alternative) that should be in place and implemented regularly for each type of instructional activity and routine

• notes indicating the times/activities for which specific adaptations (curricular, instructional, and alternative) must be planned on a more short-term basis

• links to the student’s IEP goals (both simplified academic and functional or embed- ded skills)

• information about the logistics of implementation—who is responsible for the adaptation and when

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212 Chapter 6

FIgURe 6–8 Marc’s Activity Communication boards Marc checks his schedule: (a) He learns to do kindergarten worksheets first with his teaching assistant in the resource room. (b, c, d) Then he learns to do them on his own. (e) Finally, he completes the activities in the kindergarten room alongside peers.

(a)

(b)

(c)

(d)

(e) Photos: Martha Snell

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213Designing and Implementing Instruction for Inclusive Classes

FIgURe 6–9 Sample of Jacob’s Individualized Adaptations and Support Plan

There are a number of ways to organize and format an adaptations plan. Figure 6–9, which shows part of Jacob’s individualized adaptations plan, illustrates one possibility. Jacob’s plan includes some general instructional adaptations to be used throughout the day, as well as detailed descriptions of how each subject and routine in his

Individualized Adaptations and Support Plan

Student: Jacob Class/Grade: Fourth grade Date: January 10, 2015

Classroom Teacher: Bowers Special Educator: Fuentes

Curriculum Adaptations

• Jacob has additional, individualized goals in functional skills (daily living, school and classroom participation), social/communication

• Jacob’s math and reading/language arts goals are simplified and stress functional applications of basic skills. His science and social

skills, and self-control skills.

studies goals are from the fourth-grade learning standards, but are significantly simplified and reduced in number.

General Instructional Adaptations to Use Throughout the Day • Use visual prompts (models, demonstrations, manipulation of materials, gestures) more than verbal prompts. Avoid using repeated

verbal prompts or corrections. Give only as much assistance as needed to achieve success. Encourage Jacob to get help from peers when appropriate (e.g., how to spell a word, assistance with cutting).

• Give a lot of encouragement for participation and following rules. Work toward greater independence and delayed feedback. Estab- lish his participation, then say, for example, “I’m going to help some other students. Raise your hand if you have any questions.”

• Cue Jacob to listen when Ms. Bowers gives instructions. If Jacob does not follow Ms. Bowers’s instructions, prompt Jacob by refer- encing natural cues (e.g., “Listen to Ms. Bowers,” “What were Ms. Bowers’s directions?” “What are your classmates doing now?”) (Do not simply repeat Ms. Bowers’s directions.)

• Throughout the day, emphasize organization and good work habits. Jacob should write his name and the date on all assignments, get out and put away materials, and throw away his own trash.

Adaptations to Class Schedule and Activities

Class Activity IEP Goals General Adaptations (Instructional and Alternative) Specific Adaptations

9:00–9:15 Morning routine: check-in, get organized, do morning work

• independence in morning routine

• readable handwrit- ing for name, date, high- frequency words

• Follow class routines and procedures from classroom teachers’ cues.

• Jacob arrives a few minutes early to avoid noisy hallways. Complete arrival routine following task analysis and brief teaching guide. Use picture cues to make lunch choice. For homework agenda, Jacob copies month, day, and date from a peer’s agenda.

• Have personal schedule on Jacob’s desk. If Jacob does not

• Morning work: For word searches, highlight first letters and

• Word study: five spelling words per week (four known and

independently check off activities throughout the day, prompt

reduce number of words, or have peer do some with him. For activity sheets: Help with cutting, use plastic box for crayons so they don’t roll off his desk.

him first by pointing to the box, then by handing him a pencil.

• Aide places pictures for daily lunch choices beside the computer.

• Ms. Bowers writes morning work and any special events on Ja- cob’s schedule.

9:15–10:15 Lan- guage arts

• Read/write/spell high-frequency and functional words.

• readable handwrit- ing for name, date, high-fre- quency words and phrases

• basic comprehen- sion questions

• Write 3-sentence paragraph.

• Collect information from print, media, online

one unknown). Spelling packet follows format for class packet, but is adapted with larger print, more space to write.

Aide gives Jacob spelling test on Fridays. Add a page for tracing words and make spelling flash cards.

• Guided reading: Jacob’s group is limited to three; Ms. Bowers chooses students and selects books close to his in- structional level. Ms. Fuentes teaches Jacob’s group.

• For written activities related to the reading selection: • Jacob writes words/phrases instead of sentences. Use

vide models. If paper is unlined, provide line guide to place cloze method (fill in the blanks) and use whiteboard to pro

underneath. • Use non-writing options to complete part of the task if

needed: (a) draw or cut out pictures, (b) write choices for Jacob to circle, (c) provide word strips to cut apart and glue onto the page, and (d) complete task cooperatively with other students.

• Spelling words are se- lected by Ms. Fuentes and Ms. Bowers at weekly conference. Ms. Fuentes makes spelling packet.

• Pictures and cloze method activities planned and created weekly.

(continued)

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214 Chapter 6

fourth-grade class’s daily schedule is adapted. The main section of the plan is created in a tabular format, with four columns to detail (a) the class schedule or activities, (b) the student’s IEP objectives/benchmarks for each activity, (c) the general adaptations made in procedures and materials to teach or support the student in that activity, and (d) the specific adaptations that will need to be created weekly. Because Jacob is in elementary school, his adaptations plan covers the entire school day; secondary school students typically have a plan for each course in which they are enrolled.

Jacob’s IEP manager takes primary responsibility for writing his adaptations plan, but it is founded on team problem solving and decision-making. A paper copy of the plan is kept in a notebook with other plans and records to document Jacob’s perfor- mance. The classroom teacher, special educator, and instructional aide make notes directly on the paper copy of the plan of what works and difficulties that arise. The plan is updated every four to six weeks in a computer file; the changes made as the plan evolves provide evidence of both Jacob’s skill gains and the team’s increased ability to facilitate Jacob’s independence and participation in fourth grade.

Teams also must devise a way to record and communicate decisions about specific adaptations. One method is to detail specific adaptations on the classroom teacher’s

Class Activity IEP Goals General Adaptations (Instructional and Alternative) Specific Adaptations

10:45–11:40 Math

• Write numbers 0–100.

• Compare (<, =, >) numbers to 100.

• + and − to 50, concrete objects

• Time to 15 minutes.

• Count and use coins and bills to $10.

• measurement: pounds, inches and feet, cups and quarts

figures • basic geometric

• basic bar and line graphs

• For large group lessons, Jacob partially participates in les- sons on numbers, measurement, geometry, and graphing. Provide visuals and manipulatives as needed.

• For individual practice activities: When possible, modify math journal pages to suit his objectives. If not, Jacob works in individualized math journal.

• For center rotation activities: Give gestural prompts and alert

• Tests are modified to focus on Jacob’s goals. Written test

Jacob to watch peer models. If he is not completing tasks, do fewer rotations, then an alternative activity.

items are supplemented with hands-on applications. • Alternative adaptation: Occasionally (e.g., when class les-

son is working on algebra), Jacob works one-to-one with teacher or aide on functional math skills such as money. Crate with suitable activities is found on the math shelf.

• Alternative adaptation: 10-minute movement break at about 11:00. Breaks are non-contingent. See PBS plan.

• Ms. Bowers and Ms. Fuentes discuss alter- native adaptations in weekly planning meeting.

• Class tests are adapted by Ms. Fuentes and adminis- tered by aide.

12:45–1:50 Science and social studies

focusing on key terms/concepts for each unit

• Conduct investiga-

• simplified goals

tions (predict, ob- serve, conclude; cause and effect; measurements).

• Textbook: Main ideas and key concepts are highlighted. For silent reading, a peer or adult reads with Jacob.

• Interactive notebooks: Jacob puts a box around each para- graph and highlights key words. When illustrating is re- quired, provide pictures to cut and paste. Assist Jacob to get out, organize, use, and put away his materials (e.g., note- book, ruler, pencil, highlighters, glue stick).

• Small group projects: Ms. Bowers places Jacob in a group of

• Tests are simplified to match Jacob’s goals, but are based 3–4 suitable peers.

on the template used for the class test. • Alternative adaptation: After approximately 15 minutes of

work in interactive notebook or other large-group lesson, Jacob goes to science or social studies center. Use pictures of center activities to make a schedule for three activities— two teacher choices and one student choice. Options:

activity sheets, and computer quizzes. Sorting board for unit concepts and vocabulary, flash cards,

• Ms. Bowers and Ms. Fuentes choose key concepts for each unit. Ms. Bowers prints any pictures needed for in- teractive notebook.

• Aide highlights textbook.

• Ms. Fuentes, using the class test as a tem- plate, simplifies tests.

(Teachers’ Guides to Inclusive Practices: Modifying Schoolwork (3rd ed.), by R. Janney and M. E. Snell, 2013, Baltimore, MD: Paul H. Brookes.)

FIgURe 6–9 Sample of Jacob’s Individualized Adaptations and Support Plan (continued)

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215Designing and Implementing Instruction for Inclusive Classes

daily or weekly planning form. An example of this approach to planning is illustrated in Figure 6–10. Ideally, the classroom teacher and special educator would meet to note any specific adaptations directly in the classroom teacher’s plan book and then make a photocopy for the student’s adaptations notebook. Alternatively, if the special educator and classroom teacher are not able to meet face to face, the classroom teacher can provide a copy (photocopy or electronic) of the class’s weekly plans to the special educator, who inserts the specific adaptations and then shares the docu- ment with relevant team members. This weekly plan gives only the adaptations for

FIgURe 6–10 Part of a Weekly Plan for Specific Adaptations for Jacob

Plans for Andi Bowers Week of 11/20/15

Monday Tuesday

9:00–9:15 Morning Routine —Check in, get organized.

—Introduce historical fiction: characteristics, compare

—Morning work: Thanksgiving word search

Jacob: Reduce number of words, highlight initial letters.

Morning Routine —Check in, get organized. —Morning work: Thanksgiving greeting card for a school helper

Jacob: Make card for his bus driver. Jacob dictates his message, fills in blanks for date, names, greeting, and closing.

9:15–10:15 Language Arts

—Guided reading: Four groups—two focus on immi- grants coming to America, two on First Americans.

with realistic fiction and fantasy.

Write summaries.

Jacob: Preview vocabulary and repeating lines that he can read. Provide story frame for his summary.

Language Arts —Morning spelling packet, one page —Morning guided reading: Continue histori-

share summaries and do Venn diagrams to cal fiction. Complete summaries; two groups

compare stories.

Jacob: Make sure that he can share at least one item from summary. Peel-and-stick la- bels for his Venn diagram.

10:15–10:45 Art P.E.

10:45–11:40 Math Multiplying 2-digit numbers: —Large group: Review partial sums and lattice methods. —Practice using individual whiteboards. —Independent work: pp. 34–35, digit × 2 digit

Jacob: During large group, count and group items for tomorrow’s Measurement Centers. During independ- ent work, p. 22 in his math journal.

Math Measurement Centers: Estimate then measure; work in cooperative groups with assigned roles to complete booklet. 1. weight—pounds and ounces 2. liquid volume—ounces, cups, pints, quarts 3. length—feet, inches to fourths

Jacob: Group with Jay, Frankie, Delia. Role of “Checker.” Enlarge checklist of steps. Focus on pounds, cups, feet.

11:40–12:05 Recess and Cleanup Recess and Cleanup

12:10–12:40 Lunch Lunch

12:45–1:45 Science/Social Studies —Review of Virginia’s First Inhabitants—Powhatan, Teton Sioux, Pueblo —Comparison matrix with region, homes, occupations, transportation

Jacob: Cut and paste pictures with captions onto his matrix. Make sure that he raises his hand to offer at least one answer.

Science/Social Studies —States of matter—interactive notebooks —Concept organizer with definitions, exam- ples of physical properties and physical changes

in his notebook. Focus on states of water Jacob: Circle terms and underline definitions

(solid/ice, liquid/water, steam/gas). Cut and paste pictures to match states of matter. Go to Science Center when finished.

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216 Chapter 6

the week’s particular lessons and activities; the general adaptations detailed on Jacob’s Individualized Adaptations and Support Plan (see Figure 6–9) are not reiterated.

Step 4. monitor and evaluate

The fourth step of the model requires that team members monitor and evaluate stu- dent learning. Responsible teaching is not possible without some written documenta- tion, but if paperwork takes too much time, teaching suffers. Especially when multiple adults, including teachers, related services staff, and instructional aides, are responsi- ble for implementing a student’s educational program, guidelines should be readily available for teaching students and monitoring their progress using simple data col- lection forms. Although plans for some lessons and activities that require limited cur- ricular and/or instructional adaptations can be incorporated into an individualized adaptations and support plan and weekly lesson plans for the class, certain adapta- tions require more specialized planning and evaluation. Written programs (e.g., lesson plans, program formats, or teaching guides) are called for when curricular and instruc- tional adaptations are extensive and constitute a specialized teaching methodology that requires systematic, accurate delivery and evaluation. Most often, when some of the more systematic teaching methods examined in Chapter 5 are used to teach IEP goals, written programs should be developed. Such programs would be needed for teaching the functional routines required for participation in an inclusive classroom, as well as for alternative adaptations designed to teach functional skills or to remedi- ate academic needs. Written programs should specify the essential elements: (a) the student, (b) objective(s) or benchmark(s), (c) start and aim dates, (d) teaching time and setting, (e) instructor(s), (f) arrangement, (g) materials, (h) evaluation procedures and schedule, and (i) teaching procedures (e.g., instructional cues, prompt and fading methods, error correction procedure, reinforcers, and a rough schedule). Written pro- grams also may give general instructions for changing procedures during later stages of learning. There are several advantages to describing teaching programs with this level of detail:

• Successful program methods can be used again with the same student (and modi- fied for others), while those that yield little or no learning can be modified more precisely.

• Programs are more likely to be implemented consistently regardless of who teaches.

It also is important to remember that although instructional assistants may provide instruction and collect data, instructional planning and evaluation are the responsibil- ity of qualified teachers.

monitoring Student Performance

Monitoring student performance means keeping reliable records of students’ accom- plishments both just before teaching begins (baseline performance) and also once instruction gets underway. Having some baseline data along with intervention data allows progress to be assessed. As described in Chapter 4, student performance can be measured during instruction by gathering teaching data and during testing by gathering probe data. Both teaching and probe data are informative and can be used to make improvements in a teaching program if students are not progressing as expected.

When student performance is graphed, several visual elements can help teams vis- ually analyze a student’s progress (see Chapter 4). Aim lines establish a visual guide on the graph of the student’s expected performance over time; aim lines suggest how fast learning should progress if the student is to achieve the desired performance by a goal date. Trend lines can be added to graphs if the student’s performance is up and

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217Designing and Implementing Instruction for Inclusive Classes

down and its slope (ascending, descending, or flat) over time is not easily under- stood. The purpose of gathering student performance data and visually analyzing the data is twofold: (a) to monitor the implementation of adaptations, and (b) to make data-based decisions that resolve any problems.

Jacob’s team has completed a task analysis data collection form for his morning routine (see Figure 6–11) that lists the target behaviors in order, along with the instructional cue and the recording key. The form is used to record baseline perfor- mance, as well as the results of teaching trials and probe (or testing) trials. His team can use information recorded on this form to detect day-to-day progress and to iden- tify particular steps that may appear either to be mastered or to be consistently diffi- cult. Dated anecdotal notes recorded on the back of the form help the team to hypothesize whether changes in performance result from learning, from problems with the teaching plan, or from problems in the classroom or at home. Using this type of form encourages teams to found their decisions on data and be consistent in their

FIgURe 6–11 Task Analysis for Jacob’s Morning Routine

Task Analysis Instructional Program Plan

Student: Jacob Teachers: Bowers, Fuentes, Conners (aide) Routine: Morning routine

Setting: Classroom Days and Time: Daily, 9:00–9:10 Start Date: 9/01/15

Probe Schedule: Every Thursday Baseline/Probe Method: Multiple opportunity task analytic assessment (4-second latency)

Recording Key: Test: + correct, − incorrect Teach: + unprompted correct, ✓ prompted correct (gestural prompt), – unprompted/prompted error, NR no response Write anecdotal comments on back of form.

Dates

Task Steps 9/1* 9/2* 9/3 9/8 9/10 9/15 9/17 9/22 9/24 9/29 10/1 10/6 10/8 10/13 10/15 10/20 10/22 10/27 10/29

Baseline/Teach/Probe ➔ B B T T T T P T P T P T P T P T P T P

Total Independent Steps ➔ 0 0 0 1 2 4 4 4 5 5 6 6 8 8 9 9 10 10 10

10. Begin morning work. − − ✓ ✓ ✓ + − ✓ − ✓ + ✓ − ✓ + + + + +

9. Fill in day and date on schedule and agenda.

− − ✓ ✓ ✓ ✓ − ✓ − ✓ − ✓ − ✓ − ✓ + + +

8. Sharpen two pencils, if needed.

− − ✓ ✓ ✓ ✓ − ✓ − ✓ − + + + + + + + +

7. Make lunch choice. − − ✓ + ✓ ✓ + + + + + + + + + + + + +

6. Take out homework, put in wire basket.

− − ✓ ✓ ✓ ✓ − ✓ − ✓ − ✓ + + + + + + +

5. Return to desk. − − − ✓ ✓ ✓ + + + + + ✓ + + + + + + +

4. Take off outerwear and hang in locker.

− − ✓ − + + − ✓ + + + + + + + + + + +

3. Find locker; hang up backpack. − − ✓ ✓ ✓ + + + + + + + + + + + + + +

2. Place backpack on desk; unpack agenda and homework folder.

− − ✓ ✓ ✓ ✓ − ✓ − ✓ − ✓ + + + + + + +

1. Respond to peer’s greeting. − − ✓ ✓ + + + + + + + + + + + + + + +

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218 Chapter 6

teaching, making it easier for Jacob to learn when multiple instructors participate. Staff members also refer to the brief teaching guide (see Figure 6–12), which describes the teaching procedures that they use with Jacob, including the constant time delay method and the types of prompts (see Chapter 5). The teaching guide also indicates the social/communication skills and aligned academic learning standards (in this case, Virginia’s Aligned Standards of Learning) that are embedded within this functional routine.

Notice that the steps of Jacob’s morning routine are listed in reverse order on the task analysis form (see Figure 6–11) so that the first step is at the bottom of the table and the last step, Step 10, is at the top. This self-graphing form allows his teacher to convert the task analytic data into a bar graph so that data do not have to be trans- ferred to a separate graph for visual analysis. The y-axis of a graph represents the measurement of the target behavior and the x-axis represents the time frame of the measurement. On the task analysis form, the numbered rows on the left side of the table become the vertical, or y-axis, of the graph and the bottom horizontal line of the table becomes the x-axis. The x-axis is already labeled with the dates on which performance data were taken, and the y-axis now represents the number of steps in the task where the student performed independently. To create a histogram, or bar graph, of the results, simply count the number of steps completed independently and shade that day’s column up to the corresponding number on the y-axis. For example,

FIgURe 6–12 Brief Teaching Guide for Jacob’s Morning Routine

Brief Teaching Guide

Student: Jacob Routine: Morning routine

Teacher(s): Fuentes (Monday); aide (Tuesday–Friday) Start Date: 9/01/15

Start Date for Objective 1: 9/01/15 Aim Date for Objective 1: 11/01/15

IEP Goal: Jacob will complete regularly scheduled classroom routines (Objective 1: Morning; Objective 2: Departure; Objective 3: Preparation for lunch). 100% steps correct on two consecutive weekly probes.

Objective 1: Jacob will accurately complete the morning routine within 10 minutes on two consecutive weekly probes.

Related/Embedded IEP Goals (social, communication, motor, or functional academic goals related to this routine): 1. Social/communication: Greet and respond to greetings from teachers and peers.

Aligned Standards of Learning, If Any, Related to This Routine: 1. Recognize and write numerals 0–100 (Math—Number Sense 9). 2. Tell time to the quarter hour using analog and digital clocks (Math—Measurement 15).

Time: 9:00–9:10 A.M. Setting(s): Classroom

Stage of Learning: Acquisition Arrangement: One-to-one, naturalistic

Teaching Days: Mon., Tues., Wed., Fri. Test Day: Thursdays (multiple opportunity: Test every step.)

Materials: Daily schedule sheet placed on desk; backpack, two pencils, homework folder, and agenda

Teaching Procedure: Constant time delay (0, 4 seconds) across total task

Prompts: Gestural (point-to or manipulate materials, point-to-picture prompts) or verbal prompt to watch peer model (“Look what Ty is doing. You do it, too.”). Do not use any other verbal prompts.

Cue: “It’s time to unpack and get organized.”

Description of Teaching Procedures: for one day after long weekends, vacations, or on all steps following four or more error steps in one session. The goal is to increase

For first two days, use zero-time delay; then delay prompt four seconds. Use zero-time delay

his unprompted correct responses.

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219Designing and Implementing Instruction for Inclusive Classes

on 9/17 Jacob performs four steps independently and that column is shaded up to 4 on the horizontal axis, while on 9/24 he gets five steps correct and that column is shaded up to 5. (Alternatively, a line graph can be made by plotting points in the columns instead of using shading to create a histogram.) On Figure 6–11, only the columns in which testing (not teaching) data were recorded are shaded. The graph shows that Jacob’s progress in completing his morning work is ascending and meets program criteria on 10/29 with two consecutive days at 100% independent performance.

If probe and teaching data are to be useful to teams, they must be accurate (inter- observer agreement). Likewise, teams need to know whether programs are being carried out as planned (procedural fidelity). To achieve these types of accuracy, all team members who are involved in teaching a particular program first should work together to review the written program directions (for probing and for teaching) for clarity. Second, team members can use role-play, practice and feedback, and in-class coaching to teach each other to use new procedures effectively and consistently (Schepis, Reid, Ownbey, & Parsons, 2001). Observing videos taken of team members demonstrating the probing or teaching procedures can also be a helpful training technique.

Once a program is implemented by team members, the special educator will want to make informal observations to ask the following questions:

• Is the program being carried out as planned? Are needed supports provided? Are the individualized adaptations made as planned? Is instruction given as scheduled? (See Procedural Reliability in Chapter 4.)

• Are the adaptations only as specialized as necessary? • Does the team consistently record and examine the student’s performance data? • Are probe and teaching data accurate? (See Interobserver Reliability in Chapter 4.)

evaluating Student Progress

Teams will regularly meet and review the student’s progress by looking at perfor- mance data and anecdotal notes, and by sharing their perspectives. During this phase of teaching, the team’s focus is primarily on one crucial question: Does the student have social and instructional participation that is adding up to mastery and accom- plishment? To answer this question, team members will

• check student performance data on IEP objectives/benchmarks • consider continuing a program if performance is at or better than the aim line • consider changing a program if performance is below the aim line or highly

variable • check to see if anecdotal data and graphed data agree; if they do not, identify po-

tential reasons and observe to verify the reason for the disagreement • check anecdotal notes on social participation and make needed improvements

The team will also want to informally assess the social validity of the teaching pro- gram by asking whether all team members and others (e.g., student, peers) are satis- fied with the teaching program and with the student’s learning outcomes.

One of Marc’s mathematics objectives was linked to the Kindergarten Standards of Learning and also had a functional focus: Recognize a penny, nickel, dime, and quar- ter and determine the value of a collection of pennies and/or nickels whose total is 10 cents or less (Virginia SOL, K.7 Measurement). He received instruction both in the re- source room and alongside his classmates in kindergarten. Additionally, his special ed- ucator provided many practical opportunities (some real and some contrived) to use pennies (and later nickels) to make small purchases at school. The first objective in the program was to teach penny. They started the program on 9/13 with an aim date of 9/28. Using a simple dated grid, the team kept track of the number of correct purchases

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made with pennies out of 10 opportunities during teaching and during probes. These data were converted to percentages and then graphed.

Graph A in Figure 6–13 shows that Marc scored 10%, 10%, and 20% during the first 3 days of teaching pennies. They set the first endpoint for the aim line at the intersection of the second day of the program, or middle date (9/17), and his mid-performance, which was 10% (i.e., the middle value of the three percentages). The aim line endpoint was set at the intersection of the criterion performance expected of Marc (i.e., 80%) and the goal date for pennies (9/28). (See Chapter 4 for an explanation of aim lines.) Marc’s teacher then drew a straight line between these two endpoints.

When Marc’s performance continued to be erratic and below the aim line after a week of teaching, they decided to pencil in a trend line (see Graph B in Figure 6–13). Marc’s team drew a trend line using data from the first seven days of training. (See Chapter 4 for a description of trend lines.) They divided these data into two groups— the first three data points and the last four. For the first three days, the middle date was 9/17 and the middle value was 10%; for the next four days, the middle date was halfway between 9/23 and 9/24, and the middle value was 15 (halfway between 10 and 20). They connected the two points that resulted and drew a line. The trend was slightly ascending, although almost flat. They decided to improve the program because this progress seemed to be too slow for Marc (see graph B in Figure 6–13).

His teacher observed Marc during math and talked with his kindergarten and re- source room teachers to try to identify a possible cause for his slow progress. Based on this information, his teacher concluded that Marc might be more motivated to partici- pate in the instructional program if two of his peers without disabilities also partici- pated in the lesson. After changing the aim to 10/11, lowering the criterion performance, and including two classmates in the sessions, his progress improved and reached and passed criterion (see Graph C in Figure 6–13).

Marc’s and Jacob’s teams used regularly gathered student performance data to monitor and evaluate their progress. When the level of learning was not what they had expected, team members engaged in problem solving.

FIgURe 6–13 Marc’s Performance During a Month of Instruction on the Objective of Making Purchases at School Using Pennies for Totals of 10 Cents or Less Graph A shows his performance during baseline and the first three days of teaching (up to September 20) when his teacher drew an aim line. Graph B shows his performance up to September 28 when the team decided to draw a trend line to better determine his slope of progress. Graph C shows his progress after making a program improvement (adding peers) up until when he reached aim on October 6.

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(Assistance on these graphs is credited to Marci Kinas-Jerome and Corey Jerome.)

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221Designing and Implementing Instruction for Inclusive Classes

Learning ouTcome SummarieS

6.01 The Pyramid of Support/Response-to-Intervention Logic Learning Outcome Describe the three levels of support that are necessary to provide effective instruc- tion to students with severe disabilities in general education classes.

The three levels of support necessary to ensure effective instruction are (a) an inclusive school and classroom culture, (b) the use of accommodating curricular and instruction prac- tices, and (c) the development of individualized accommodations. The foundation of support for inclusive educational programs is a culture that strives for a cohesive sense of commu- nity and values diversity. The second level of support, accommodating curricular and instruc- tional practices, emphasizes teaching practices that are designed to ensure the full participation of all students in the learning activities of the class. Finally, individualized adap- tations are focused on adapting the learning goals, instructional methods, materials, or the instructional activity in ways that will support the participation of students with severe disabilities.

6.02 Collaborative Teaming for Ongoing, Day-to-Day Planning and Delivery of Instruction Learning Outcomes Identify the three skills that team members need to have to plan and deliver effec- tive instruction.

Teams need to have articulated clear roles for themselves in carrying out the planning proc- ess. This includes, but is not limited to, who is responsible for instruction, developing adapta- tions, monitoring student performance, and communicating with the student’s parents. In addition, teams need to agree on the systems and strategies that they will use to make deci- sions, implement plans, and ensure that the team is part of the school culture.

2. Describe the four types of services that students may require to receive effective instruction in general education classes.

The methods or services that students may require to be successful in inclusive classrooms include (a) special education instruction, (b) special education consultation, (c) support from a paraprofessional, and (d) related services. Students may require one or more of these methods or services in combination in order to be successful in general education classes.

6.03 A Model for Making Individualized Adaptations Learning Outcome Describe the three types of adaptations available to support students in general education classes.

The first type of adaptation includes individualizing the learning goal by simplifying the expected learning outcomes or establishing alternative learning outcomes that reflect the student’s unique learning needs. Second, the team can individualize the instructional meth- ods or materials to match the student’s learning strengths and needs. Finally, the team can provide alternative learning activities that are focused on individualized learning outcomes that are different from their classmates. This often includes instruction in settings outside of the general education class.

6.04 Using the Model to Develop Individualized Adaptations Learning Outcome List and describe the steps necessary to develop individualized adaptations for students in general education classes.

It is recommended that teams complete four steps to develop individualized adaptations for students. First, the team must gather and share information about the student’s educational program, the student’s unique learning strengths and needs, and the organization and schedule of instruction in the classroom. Several forms have shown to be useful in

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completing this step. These forms include the program-at-a-glance, student information, and the ecological assessment of class activities.

Second, the team must determine when adaptations are needed by the student during the school day. This decision can be facilitated through the use of the program planning matrix, which allows the team to plot a student’s IEP goals against the class’s daily schedule.

Third, the team must plan and implement the student’s adaptations. The focus should initially be on implementing general adaptations that address predictable aspects of class- room activities like daily routines, organization procedures, and regularly used instructional formats. Next, the focus shifts to the development of specific adaptations that need to change regularly to address changing content in each subject area. These adaptations can be sum- marized for team members on an individualized adaptation plan and a weekly plan for spe- cific adaptations.

Step 4 of the process is to monitor and evaluate the adaptations to make sure that the adaptations are resulting in improved academic and social outcomes. This requires teams to regularly collect data on student performance within and across learning activities, and to summarize these data so that the student’s overall progress toward meeting his/her goals can be assessed.

SuggeSTed acTiviTieS

1. Look at Figures 6–4 (Program-at-a-Glance for Jacob) and 6–5 (Student Information Form for Jacob) and compare with the confidential information sharing proce- dures that your school uses. What are the differences? How do you think that your school’s procedures could be improved?

2. Identify a student (a) with extensive support needs whose classroom participa- tion primarily involves embedded social, motor, and communication skills, and (b) whose extent of classroom participation is questionable. Have a team member conduct an ecological assessment of classroom activities (see Figure 6–6) of this student to understand his/her performance on each step of lessons and routines. Use the information with other team members to identify skills that could be taught and activity adaptations that would lead to more active involvement by the student.

3. Involving other team members, complete a program planning matrix (see Figure 6–7) for a student to plot his/her IEP goals against the class’s daily schedule. Exam- ine the results with the team to identify (a) when and where a student’s individu- alized learning priorities can be taught more efficiently and effectively, and (b) to determine the times for the student to receive special supports and services such as heath care, movement breaks, therapies, or mobility training.

Note: For the student applications, we give thanks to Rachel Dickinson, Diane Talarico- Cavanaugh of Piedmond Regional Education Program and Greene County Public School Systems.

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7 Designing and Implementing

Individualized Positive Behavior Support Robert E. O’Neill

University of Utah J. Matt Jameson

University of Utah

7.01 Development of Positive Behavior Support (PBS) Learning Outcome Describe the important changes in the field of behavioral support as a result of the evolution of PBS.

7.02 Development of PBS in Schools: Multi-Tiered Systems of Support (MTSS) Learning Outcome Describe the three levels of MTSS in schools.

7.03 Inclusion of Students with More Severe Disabilities in MTSS Learning Outcome Describe some of the obstacles to and solutions for the involvement of students with more severe disa- bilities in MTSS.

7.04 Components of Individualized PBS Learning Outcomes 1. Describe the three phases of implementation of individualized PBS. 2. Describe the five desired outcomes of the functional behavioral assessment (FBA) process. 3. Describe some of the tools and strategies that should be considered for implementation prior to con-

ducting an FBA.

7.05 Overview of the FBA Process Learning Outcome Describe the six phases of the process for conducting an FBA and development of a behavior interven- tion plan (BIP).

7.06 Indirect Data Collection Learning Outcomes 1. Describe the different categories of strategies for indirectly collecting relevant information during the

FBA process. 2. Describe how information from indirect methods should be summarized in hypotheses/summary

statements.

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The purpose of this chapter is to describe the principles and procedures of positive behavioral support (PBS), and how they are applied to individuals ex-hibiting severe challenging behavior (e.g., self-injury, aggression, material de- struction). Such behaviors have long been documented to occur in a substantial portion of populations of persons with a variety of developmental disabilities, includ- ing intellectual disability and autism spectrum disorders (ASD). The prevalence varies across studies, ranging from 5% up to 50% of participants assessed (e.g., Kanne & Mazurek, 2011), but such behaviors clearly represent a significant concern for teach- ers, parents, and other caregivers. If you work with persons with developmental dis- abilities on a consistent basis over time, you are likely to encounter such behaviors. Persons exhibiting such behaviors are at risk for a variety of negative outcomes, in- cluding placement in more restrictive environments in schools or the community, de- clines in educational opportunities, negative interpersonal relationships, and exposure to more restrictive intervention strategies (e.g., aversive and intrusive behavioral pro- cedures, psychotropic drugs, etc.) (Benson & Aman, 1999). In addition, challenging behaviors obviously create substantial stress for parents, teachers, and other caregiv- ers (Fox, Vaughn, Wyatte, & Dunlap, 2002; Weiss, 1991). As an example, consider the situations involving Micah and Jamila.

7.07 Direct Observations Learning Outcomes 1. Describe the different strategies for collecting data via direct observation. 2. Describe how information from direct observations should be summarized in hypotheses/summary

statements.

7.08 Functional Analysis Learning Outcomes 1. Describe the general process involved in conducting a functional analysis to test hypotheses con-

cerning challenging behaviors. 2. Describe how information from functional analyses should be summarized in hypotheses/summary

statements.

7.09 Behavior Intervention Plan Development Learning Outcomes 1. Describe the basic critical aspects of behavior intervention plans (BIPs). 2. Describe the components of the competing behavior analysis (CBA) process. 3. Describe the different possible formats for writing BIPs.

7.10 Potential Intervention Plan Components Learning Outcomes 1. Describe the different possible support plan components (e.g., motivating operations, antecedent

strategies) and give an example of each. 2. Describe the process for intervention plan evaluation and monitoring, and why it is so critical.

7.11 General Issues Regarding Ethical and Professional Behavior Learning Outcomes 1. Describe why it is critical to follow ethical and professional guidelines in the PBS process. 2. List three professional organizations that provide ethical and professional standards to guide

practitioners.

7.12 Technology Supports for FBA Learning Outcome Describe two technology tools/applications and how they can be used in the FBA process.

7.13 Technology Tools to Support Intervention Strategies Learning Outcome Describe two technology tools/applications and how they can be incorporated into intervention strate- gies that are part of a BIP.

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225Designing and Implementing Individualized Positive Behavior Support

Micah’s Story

Micah is nine years old. He has been labeled as having autism and intellectual disabilities. He lives at home with his mother and his four-year-old sister. Micah cannot communicate extensively via typical verbal language, but he can make a handful of requests using single words, and can respond to a variety of one-step requests (e.g., “Pick up the book!”). He attends his local elementary school, where he spends about two thirds of his time in a self-contained classroom, and about one third in regular class settings and activities. He works on functional skills in the self-contained classroom, including communication and social interaction skills, and pre- academic and academic skills in the regular classroom settings. Micah’s parents, teachers, and administrators at his school have become increasingly concerned about his challenging behavior, which includes periodic aggression toward others (slapping and scratching), self- injury (head slapping), and frequent self-stimulatory behavior (hand-flapping and rocking when sitting). These behaviors appear to be related to a variety of situations. His aggression mainly occurs when he is being asked to engage in functional and pre-academic teaching sessions, self-injury is more likely when he is asked to stop engaging in a preferred activity (e.g., turning off the CD player), and the self-stimulatory behavior flares up when Micah has to wait for an activity such as going to recess or getting lunch in the cafeteria.

Jamila’s Story

Jamila is 21 years old. She has been labeled as having moderate intellectual disabilities. She lives in a supported living apartment situation with two other housemates, who also experience intellectual disabilities. They receive 24-hour support at home from hired staff persons. Jamila’s parents and brother visit her on a weekly basis and go on outings with her. Jamila is able to communicate using three- to five-word sentences to make requests, answer questions, and comment on events in her environment. She attends a postsecondary program in the local school district. Participants in the program spend about half of their time in a sheltered work- shop setting, learning various work tasks. The remainder of their time is spent sampling possible local supported work situations and learning community-based skills such as using public transportation and grocery shopping. Jamila’s home staff and day program staff have become increasingly concerned about behavioral issues. These include consistent refusal to engage in home and community activities (e.g., saying “No, I won’t do that!”), frequent complaints about feeling “weird,” and exaggerated fear reactions (cringing, high-pitched vocalizing) to seemingly innocuous situations, such as walking into a grocery store. These behaviors appear to be related to a variety of situations. Refusals occur in response to a variety of requests both at home and in the community, and complaints about feeling weird and loud vocalizing are more likely when Jamila is encountering novel situations.

Development of positive Behavior support (pBs)

For several decades non-pharmacological approaches to dealing with challenging behavior have been based on the principles and procedures of applied behavior anal- ysis (ABA) (Scotti & Meyer, 1999). For many years, strategies for responding to chal- lenging behavior had a reactive or consequence-oriented focus, and, along with reinforcement of appropriate behaviors, often included intrusive and aversive proce- dures (Carr et al., 1999; Repp & Singh, 1990). For example, in considering Micah’s situation, in the past a typical plan might have included (1) social and/or tangible rewards when Micah did not engage in aggression or self-injury (i.e., differential rein- forcement of other behavior, or DRO), and (2) physical restraint and/or time out in a separate isolated space when the problem behaviors occurred. Current approaches to behavior support take a much more comprehensive approach to such situations, miti- gating the need for intrusive interventions.

Partly in response to these more reactive approaches, beginning in the 1980s, cli- ents, families, advocates, and researchers began to investigate, implement, evaluate,

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and promote what has come to be known as positive behavior support (PBS) (Carr et al., 2002). The primary hallmark of this approach is that it combines the empirically validated principles and procedures of applied behavior analysis (ABA) with an emphasis on achieving community-referenced, valued outcomes for persons receiving support (Bambara, Dunlap, & Schwartz, 2004); and using intervention strategies that are considered acceptable for individuals that do not have disabilities. The primary features of PBS have been described by various authors; a general list is included in Table 7–1. PBS takes a comprehensive approach to pursuing lifestyle change and educational and other goals for students (Sugai et al., 2000).

A critical feature of PBS is functional behavioral assessment (FBA). The FBA proc- ess focuses on identifying the full range of behaviors of concern, the immediate ante- cedents that precede those behaviors, and the consequences that are reinforcing and maintaining the behaviors (O’Neill, Albin, Storey, Horner, & Sprague, 2015). This information can then be used to develop a comprehensive set of strategies to prevent problem behaviors and promote and reinforce alternative positive behaviors (see below for additional details on these strategies). A second critical area involves strate- gies for teaching and promoting alternative behaviors that can serve the same func- tion as current challenging behaviors. That is, students can be taught to use verbal utterances, sign language, or other alternative communication strategies to obtain attention or desired items/activities, or escape/avoid non-preferred activities (Carr, Levin, McConnachie, Carlson, Kemp, & Smith, 1994; Durand, 1990). These strategies increasingly make use of the rapidly developing technology that can facilitate student communication such as smart phones, various tablets/pads, and other devices (Beukelman & Mirenda, 2013).

Development of pBs in schools: multi-tiereD systems of support (mtss)

The early stages of PBS development focused on providing more intensive supports for individuals engaging in severe challenging behavior in a variety of settings (Repp & Singh, 1990). Early on in this development process, researchers and school person- nel began to expand the application of PBS on multiple broader levels, primarily in school settings (Martella, Nelson, Marchand-Martella, & O’Reilly, 2011). This develop- ment was spurred by a variety of conceptual and strategic approaches in multiple fields, including tiered public health models (Walker et al., 1996) and academic response-to-intervention models (RtI) (Burns & Gibbons, 2012). These approaches have converged into what is now typically referred to as multi-tiered systems of sup- port (MTSS) (Sugai & Horner, 2009). MTSS models typically focus on three tiered lev- els of support for students with a range of behavioral needs, from minimal general support (most students) to students with more intensive needs (Sailor, Dunlap, Sugai, & Horner, 2011).

TABLE 7-1 General Components of Positive Behavior Support (PBS)

1. Identification of valued outcomes/goals in relevant educational, community, social, and vocational areas (Koegel, Koegel, & Dunlap, 1996)

2. Comprehensive functional behavioral assessment (FBA) of the factors influencing the occurrence of challenging behaviors (e.g., setting of events, antecedents, and consequences)

3. Development of hypotheses summarizing these influential variables 4. Use of these hypotheses as the foundation for developing a comprehensive behavioral intervention

plan (BIP) that incorporates strategies to (a) manipulate antecedent variables to decrease the probability of challenging behavior, (b) teach and promote appropriate alternative behaviors, (c) provide positive consequences for desired behaviors, (d) minimize reinforcement for challenging behaviors, and (e) collect and analyze data to evaluate the impact of support in achieving the identified desired lifestyle outcomes

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Tier 1, or the universal level of support, addresses the support needs of a majority of students in a school (75–80%). Such universal support includes establishing a schoolwide PBS team, defining schoolwide behavioral expectations, teaching those expectations and establishing a reward system for appropriate behavior, and ongoing collection and review of data to evaluate impact (e.g., office discipline referrals) (Horner, Sugai, & Anderson, 2010). Not all students will be effectively supported at this level. Tier 2 supports are put into place to support the smaller percentage of stu- dents (10–15%) demonstrating greater risk for more serious problem behaviors. These are often students who are receiving more frequent office referrals for disruptive behaviors (e.g., talking out in class, distracting other students, etc.). Tier 2 or targeted interventions employ more standardized strategies that can be efficiently implemented with a larger group of students. For example, the Behavior Education Program (BEP) (Crone, Hawken, & Horner, 2010) is a check-in/check-out system. Students check in at school in the morning and receive a daily progress report listing their behavioral expectations. They carry this form throughout the day, and are periodically evaluated and rated by school personnel. They check out at the end of the day, and receive praise and other positive consequences if they meet their behavioral goals. Other Tier 2 interventions include social skills training groups and mentoring programs.

Finally, Tier 3 supports are for that small percentage of students (5–10%) who are exhibiting chronic severe challenging behaviors. Such students require more individ- ualized and intensive support, including functional behavioral assessment and com- prehensive behavioral intervention plans (Bambara & Kern, 2005), which are the primary focus of this chapter. A substantial body of research has documented the effectiveness of MTSS in achieving reductions in challenging behavior and increases in positive behaviors such as academic performance (Horner, Sugai, & Anderson, 2010; Sailor, Dunlap, Sugai, & Horner, 2011).

inclusion of stuDents with more severe DisaBilities in mtss

As the development of MTSS proceeded, a variety of groups began to raise questions about the inclusion of students with more severe disabilities in the process. One notable event was the special issue of the journal Research and Practice in Severe Disabilities in 2006 (Bambara, Lohrmann, & Brown, 2006). A variety of authors dis- cussed conceptual issues and practical strategies with regard to the integration of students with more severe disabilities in the MTSS process. Hawken and O’Neill (2006) reviewed the three tiers of the MTSS process and literature relating to the involvement of students with severe disabilities at the three levels. They concluded that there are a number of obstacles and opportunities with regard to including stu- dents with severe disabilities in all levels of MTSS. Obstacles could include limitations to these students’ receptive and expressive language. As for opportunities, on both the Tier 1 and 2 levels, teachers and students could make use of picture or symbol systems to illustrate behavior expectations, and teachers could make use of similar systems to indicate ratings or evaluations of student behavior and performance (e.g., red/yellow/green vs. written evaluations). Such students might also benefit from smaller group or one-to-one instruction when it comes to behavioral expectations and reward systems.

There is clearly a substantial need for research and evaluation on effective strate- gies for including students with more severe disabilities at all levels of MTSS. The bulk of research with such students has involved interventions at the Tier 3, or more individualized and intensive levels of support. At this level, the primary stumbling block continues to be the capacity of school personnel to provide effective assess- ment and support (Hawken & O’Neill, 2006; O’Neill & Bundock, in press). The chal- lenge is to make this happen in typical school settings with typical levels of support. Additionally, research is needed to assess the effects of such strategies when pro- vided within the context of full implementation of all three tiers of support. Some

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writers and researchers have speculated that individualized supports will be more effective when all three tiers of support are implemented (Horner, Sugai, & Ander- son, 2010).

components of inDiviDualizeD pBs

three phases of implementation

The following sections will go into greater depth on the process of functional behav- ioral assessment (FBA) and the development of effective and efficient behavior inter- vention plans (BIPs) for students with severe disabilities. We will first describe the process and procedures of FBA including a rationale for the procedures, the desired outcomes of the FBA process, and who should be involved. We also include here a description of indirect and direct data collection methods for formulating and validat- ing hypotheses/summary statements. Second, we describe processes for moving from FBA data to BIP development, monitoring, and evaluation. Finally, we will discuss some of the new technologies that can support practitioners in both the collection of direct observational data, and also in the design and implementation of interventions at each phase of the competing behavior model.

functional Behavioral assessment FBA includes strategies and tools that may be used in various ways at all three tiers of MTSS (Hawken & O’Neill, 2006). However, it has typically been considered to be a primary component of behavioral support at the Tier 3 level for students engaging in more severe or frequent challenging behavior (Crone, Hawken & Horner, 2015; Westling, Fox & Carter, 2015). An FBA is conducted to gather data that describe a stu- dent’s behavior, to document the behavior(s) through direct observation, to identify the setting events (e.g., sleep issues, medication effects) and antecedent conditions (e.g., particular staff, difficult academic activity requests) related to those behaviors as well as the maintaining and reinforcing consequences of the behaviors (O’Neill, Albin, Storey, Horner, & Sprague, 2015). These data can then be analyzed and organized to help guide the process of developing comprehensive behavior intervention plans (Bambara & Kern, 2005; Umbreit, Ferro, Liaupsin, & Lane, 2007). Numerous studies have documented the effectiveness of positive behavior support/function-based indi- vidualized interventions with students with severe disabilities in classroom and com- munity settings (e.g., Blair, Lee, Cho & Dunlap, 2011; Binnendyk & Lucyshyn, 2009; Cihak, Alberto, & Frederick, 2007; Ervin, DuPaul, Kern, & Friman, 1998). Research has also found that implementing BIP interventions that are not rooted in the function of the behavior(s) can be ineffective at best and, at worst, have potentially negative consequences for students with disabilities and practitioners (Ellingson, Miltenberger, Stricker, Galensky, & Garlinghouse, 2000; Filter & Horner, 2009; Ingram, Lewis-Palmer, & Sugai, 2005; Newcomer & Lewis, 2004).

FBA should be driven by the five primary desired outcomes of the functional assessment process (Crone, Hawken & Horner, 2015; O’Neill et al., 2015; Storey & Post, 2012):

1. The FBA should allow practitioners to develop a clear and objective description of the problem behaviors.

2. The FBA should record the events, times, and situations that predict when the be- havior will and will not occur.

3. The FBA should help identify the functions of the problem behavior. 4. The FBA should give practitioners a framework for developing hypotheses or sum-

mary statements that describe the relevant aspects of the behavior. 5. The FBA should be based on the ongoing collection and evaluation of indirect and

direct observational data.

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229Designing and Implementing Individualized Positive Behavior Support

As mentioned above, careful FBA is critical so that the BIP results in an individual being taught an appropriate alternative skill that honors the function of the behavior, and provides the individual access to maintaining the consequence or function of the behavior. For example, if Jamila demonstrates problem behaviors that result in her escaping or avoiding a novel situation, she could be taught to communicate “I don’t want to go here.” This alternative communication would honor the function of the behavior in allowing her to escape.

considerations Before initiating an fBa As the technology and tools of PBS have evolved, there is a growing emphasis on the importance of preventive interventions to support students with problem behaviors before assuming that a more intensive (Tier-3 level) intervention is necessary or appropriate. Westling and Fox (2015) present several prevention strategies that might be used to address behavioral issues that are related to the social and communicative challenges many students with severe disabilities experience. These recommenda- tions include (1) responding to the initial problem behavior as having a communica- tive intent, (2) providing supports for communicative expression, (3) providing information about activity expectations to students in a manner that is understanda- ble, (4) teaching rules explicitly, (5) providing choices, (6) considering the student’s physical comfort, (7) maximizing student engagement, (8) providing multiple ways to participate in activities, (9) using the Premack Principle (“If you do this, then you get this.”), and (10) providing high rates of positive reinforcement and meaningful cor- rective feedback. Below we offer several other preventive strategies that should be engaged in before focusing on individualized PBS interventions.

person-centered planning

A significant number of tools have been created that have foundations in the values of person-centered planning. Person-centered planning is informed by a variety of approaches, principles, or “tools” to organize and guide targeted interventions and planning for individuals with severe disabilities, as well as their friends and families. While the majority of the person-centered approaches, or tools, have different formats and processes, they, much like PBS and FBA, are all framed around a common set of principles and values. The use of person-centered planning can be seen as a preven- tive intervention. Among other factors a person-centered curriculum that is focused on meaningful outcomes may prevent many behavioral issues. The key values and principles that must be present in the person-centered planning process are listed below (O’Brien & O’Brien, 2006):

1. Person-centered planning builds on the individual and the family’s strengths, gifts, skills, routines, and activities in order to support meaningful participation and con- tribution to the family and community.

2. Person-centered planning supports self-determination and provides a structured framework for the individuals and families to identify and express their hopes, dreams, and desires and to develop informed and supported choices and interven- tions in order to achieve them.

3. Person-centered planning is a framework for providing services, instruction, sup- ports, and interventions that meet the individual and family’s needs, and is one that honors the goals and aspirations for lifestyle outcomes that are defined by dignity, respect, and familial interdependence (Kim & Turnbull, 2004).

4. Person-centered planning provides a mechanism for an equitable distribution of resources.

5. Person-centered planning processes are focused on the creation of community connections for both the individual and family. They support the development of a natural community of supports to increase the quality of life and community

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participation by supporting meaningful outcomes chosen by the individual and his/her family.

6. Person-centered planning supports individuals and families in the context of their unique cultural and family values. It is imperative that all of the aspects that define an individual and family’s “uniqueness” are considered and fully integrated into the person-centered planning process.

7. Person-centered planning supports the creation of positive relationships and col- laboration between individuals, families, and practitioners through the recognition that all participants can meaningfully contribute to the planning, and ultimately intervention, process.

The person-centered planning process can utilize a myriad of methods and tools, with the central premise that any method used must be able to accommodate any individual’s method/mode of communication. Additionally, the person-centered plan- ning process is focused on providing any needed assistance to the individual with severe disabilities and their families in articulating the support needs, behavioral objectives, and long- and short-term goals. A number of person-centered planning tools have been used in the literature to support individuals with severe disabilities. Description of planning tools, such as Essential Lifestyle Planning (Smull et al., 2005), can be found in Holburn, Gordon, and Vietze (2006), Holburn, Vietze, and Mount (2002), and O’Brien and O’Brien (2007).

ecological assessment

An ecological assessment is a comprehensive process in which data are collected about how an individual with severe disabilities functions in different environments or settings (see Chapter 3 for a more comprehensive review of ecological assess- ment). Information for an ecological assessment is often obtained through observa- tion. However, information can also be gathered through student records and interviews with the student and the family. An ecological assessment begins with defining and prioritizing short- and long-term outcomes through a lens of examining the skills, activities, and routines needed for an individual to be successful in a given environment (e.g., small reading group in the general education classroom, school cafeteria, playground, home, community settings, and place of employment). Ecologi- cal assessments and interviews can be conducted to determine students’ independ- ence and present levels of performance within the context of naturally occurring routines so that meaningful goals can be set to teach the necessary communication, social, behavioral, academic, or functional skills the students need to be able to achieve the outcomes they and their family prioritized in the planning process. As such, thorough ecological assessment is another strategy that may facilitate changes that may promote effective and meaningful educational and behavior supports across multiple environments and with different people.

why conduct an fBa?

O’Neill et al. (2015) identify two primary reasons for conducting an FBA. The first is to gather critical information about setting events, antecedents, and functions of prob- lem behavior. With this information, teams can build effective and efficient behavior intervention plans. The second is the fact that FBA has become mandated profes- sional practice in several states (Crone, Hawken & Horner, 2015; O’Neill et al., 2015), and in some instances is required by the IDEA’97 amendments, which state that schools use the FBA process to develop support strategies for students with disabili- ties. Specifically, schools must use the FBA process before either suspending (for more than 10 days) or expelling a student with a disability. Crone and Horner (2003) suggest the following decision-making rules for when and what parts of the FBA proc- ess to use: (a) If the student poses a danger to him- or herself or others or previous

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231Designing and Implementing Individualized Positive Behavior Support

assessments were not effective or the results were unclear, schools should conduct a functional analysis, (b) If the student is at risk for a change in placement or the team is not confident in the accuracy of its hypothesis/summary statement, then a full FBA should be conducted, and (c) if the student does not pose a danger, is not at risk for a change in placement, and the team is confident in the hypothesis/summary state- ment, a simplified FBA can be conducted.

outcomes of an fBa

The basic outcomes of an FBA process are to identify (1) the full range of behaviors that are of concern for an individual, and how those behaviors may co-occur or be related as response classes or escalating sequences, (2) the broader setting events and more immediate antecedents that appear to increase the likelihood of their occur- rence, (3) the consequences that appear to maintain the behavior(s) (i.e., their func- tions), and (4) hypotheses that pull all of this information together into succinct statements that can be used as a basis for developing behavior intervention plans (see below; and O’Neill et al, 2015). An example of such a statement would be “When Micah has had little sleep, and is asked to do functional and pre-academic tasks, he will slap and scratch the instructor and peers in order to avoid those task demands.” Such statements/hypotheses include information about setting events (lack of sleep), immediate antecedents (functional or pre-academic task demands), challenging behaviors (slapping and scratching), and maintaining reinforcers (avoidance of task demands/negative reinforcement).

who should Be involved?

The process of individualized positive behavior support requires the collaboration of everyone who serves as a formal or natural support for the individual with severe dis- abilities. The most current planning approaches have primarily been developed around student support and focuses on supporting the whole family and not just an individual (Kim & Turnbull, 2004). Interdependent family planning focused on family units in accordance with each individual family’s strengths and needs (Kim & Turnbull, 2004). Lucyshyn et al. (2002) indicated that family members are critical in identifying the skills activities and routines that can be related to the challenging behavior and impact the overall quality of the individual’s and family’s lives. LeRoy et al. (2007) found that the presence of a natural community of supports (family, friends, neighbors) at planning meetings is an important component in developing meaning- ful and effective intervention strategies during the FBA and BIP planning process. In the case of Jamila, residential service providers, state mental retardation/developmen- tal disability agency caseworkers, vocational instructors, friends and family should all be involved in the PBS and FBA process so that meaningful behavioral change can be established and maintained across settings and time.

overview of the fBa process

Positive behavior support for individuals with severe disabilities is focused on provid- ing the individual with problem behavior access to the skills, activities, routines, and meaningful relationships that the individual has identified as important (Westling, Fox, & Carter, 2015). There are six main steps involved in conducting an FBA and developing BIPs (Sugai, Horner & Sprague 1999).

assessment

Through archival review, ecological assessment, interviews, and/or direct observa- tions, data are collected that describe the conditions when the problem behavior is,

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232 Chapter 7

and is not, observed. Sugai and Horner (1999) indicate that the FBA is focused on objectively identifying four primary facets of an individual’s behavior. First, the set- ting events that make the problem behavior worse (e.g., medications, diet, medical/ mental conditions/illness, sleep) must be identified. This will often be dependent upon effective communication and collaboration between students, family, and practi- tioners on the BIP team. Second, the antecedent events that predictably come before and are associated with or are hypothesized to cause the challenging behavior (e.g., get/avoid attention of peers and/or teacher, obtain a tangible, escape/avoid difficult/ undesirable activities, escape difficult/undesirable requests, self-stimulatory) have to be delineated. Third, additional challenging behaviors that the student uses to serve the same function are objectively defined. Finally, the maintaining consequences of the challenging behavior must be recorded (positive or negative reinforcement).

hypothesis Development

The data gathered in step one is used to develop testable hypotheses/summary state- ments that describe when the problem behavior(s) is/are most likely to occur. A hypothesis/summary statement includes (a) an objectively defined problem behavior (i.e., slapping and scratching), (b) setting events that impact the importance of the maintaining consequence (i.e., Micah has an increased motivation to escape/avoid the difficult/undesirable pre-academic and functional instruction when he has not had enough sleep the night before), (c) the antecedent events that predict the problem behavior (i.e., Micah is asked to engage in a difficult/undesirable activity), (d) the maintaining consequence events (i.e., Micah escapes/avoids difficult tasks) (O’Neill et al., 2015).

Direct observations and analyses

After testable hypotheses/summary statements are developed, direct observation data are used to verify the accuracy of the hypotheses/summary statements. Best practice is to have multiple observations conducted across multiple settings and situations to determine whether problem behavior occurs in accordance with the hypotheses/ summary statements developed by the BIP team. These observations involve the care- ful ongoing data collection to confirm the antecedent and consequent variables that maintain the challenging behavior.

In cases where hypotheses/summary statement(s) are difficult to verify or when the challenging behavior is not responsive to FBA-based interventions, functional “analysis” may be recommended. A functional analysis involves a systematic manipu- lation (i.e., removal and addition) of antecedents and/or consequences that are hypothesized to cause the challenging behavior (O’Neill et al., 2015). For example, one could test the hypothesis that Micah engages in self-injurious behavior by provid- ing access to the preferred activity of listening to music contingent on self-injurious behavior. There are obvious practical and ethical considerations that should go into a designing and conducting functional analysis and, in most educational and clinical applications, we do not recommend functional analysis without the direct involve- ment of an experienced behavior analyst.

Development of Behavioral intervention plans (Bips)

Once the hypotheses/summary statements have been validated, individualized behav- ior intervention plans (BIPs) can be designed that delineate (a) strategies to address setting events (e.g., If Micah’s sleep log indicates he got little sleep the night before, instructional expectations might need to be modified), (b) behavioral/teaching inter- ventions that teach alternative or desired behaviors (e.g., Micah could be taught to use an augmentative and alternative communication [AAC] system to ask for a break

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233Designing and Implementing Individualized Positive Behavior Support

from a difficult/undesirable task or activity), (c) antecedent event interventions (e.g.,. task demands could be modified or adapted), and (d) consequence events (e.g., dif- ferential reinforcement of behaviors). The BIP serves as the framework for defining the implementation of the behavioral interventions in each phase. Unlike the less holistic interventions that have historically focused on reactive and consequence- based interventions (e.g., seclusion, restraint), BIPs, rooted in comprehensive FBA, include multiple intervention components that teach new skills, activities, and rou- tines (i.e., providing instruction on socially valid desired replacement behaviors and desired behaviors); are preventive (e.g., change the environment or the behavior of others before looking at changing the challenging behavior); and are environmentally based (e.g., rearrangement of the problem context).

specify who will Do what and when

Intervention and instructional plans are developed to specify how, when, where, and by whom the different interventions of the BIP will be implemented. Crisis response plans should also be developed if needed. If necessary, support from other individu- als or agencies (e.g., mental health, medical) should be arranged at this step. For example, in Table 7–2, Micah’s behavior intervention plan indicates that all staff per- sons will be involved in data collection and that some staff and Micah’s parents will meet periodically to review the data and make decisions about his intervention plan.

TABLE 7-2 Sample Behavior Intervention Plan for Micah

Behavior Intervention Plan for Micah

Student: Micah Lewison Planned Beginning Date: 6/25/2015 Date of Plan: 6/21/2015

BIP Team Members: Ms. Thompson, 3rd grade teacher; Ms. Adolphson, self-contained classroom teacher; Mr. Michaels, district behavior specialist; Ms. Jimenez, classroom assistant; Ms. Lewison, mother

General Rationale and Need for Support Micah is 9 years old and lives at home with his mother and 4-year-old sister. He has been labeled as having autism and intellectual disabilities. Micah communicates primarily via a handful of requests using single words, and can respond to a variety of one-step requests (e.g., “pick up the book”). He spends about two thirds of his time in Ms. Adolphson’s self-contained classroom, and about one third in Ms. Thompson’s regular 3rd grade class. He works on functional skills in the self-contained classroom, including communication and social interaction skills, and pre-academic and academic skills in the regular classroom setting. Micah’s parents, teachers, and administrators at his school have become increasingly concerned about his challenging behavior, which includes periodic aggression toward others (slapping and scratching), self-injury (head slapping), and frequent self-stimulatory behavior (hand- flapping and rocking when sitting). These behaviors appear to be related to a variety of situations; his aggression mainly occurs when he is being asked to engage in functional and pre-academic teaching sessions; self-injury is more likely when he is asked to stop engaging in a preferred activity (e.g., turning off the CD player); and the self-stimulatory behavior flares up when Micah has to wait for an activity such as going to recess or getting lunch in the cafeteria.

Description of Problem Behaviors Aggressive Behaviors: Micah will swing his arm wide and attempt to slap other persons with an open hand on the upper body or facial area. This behavior is of relatively lower intensity (i.e., not likely to cause tissue damage). If other persons are not wearing long sleeves, Micah will attempt to use his fingernails to rake down a person’s arm between the elbow and wrist. This behavior may cause injury in the form of red marks and may potentially break the skin and cause bleeding. Self-Injurious Behaviors: Micah will slap himself on the upper part of his head (not his face) with an open hand; this behavior is usually of relatively lower intensity (i.e., not likely to cause tissue damage). Self-Stimulatory Behaviors: When in a sitting position, Micah will rock back and forth from the waist and flap his hands in front of his eyes.

(continued)

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234 Chapter 7

Summary of FBA and Behavioral Hypotheses The FBA involved completing a FACTS form with relevant staff, and multiple days of direct observation data using the Functional Assessment Observation form. Based on this information and team discussion, it became clear that the self-stimulatory behavior was not a significant issue in that it could be easily redirected by staff and did not pose a problem for Micah or others. The team members were most concerned about the aggressive and self-injurious behaviors. They developed two hypotheses/summary statements, based on the FBA information and the competing behavior analysis (see example in Figure 7.3). These statements are Hypothesis 1: When Micah has experienced poor sleep the night before, and he is presented with difficult task/activity requests, he will attempt to slap and/or scratch staff persons to escape from the task demands. Hypothesis 2: When Micah is asked to terminate a desired activity and transition to another activity, he will engage in head slapping/hitting in order to try to maintain access to the desired activity.

Behavioral Strategies Regarding Aggressive and Self-Injurious Behavior MOs: Sleep Issues: Micah’s mother will attempt to establish a regular bedtime routine for Micah, including brushing teeth, using the bathroom, and then reading 2–3 books. Attempts will be made to maintain a quiet environment until Micah is asleep. Antecedent Strategies: When presenting Micah with typically problematic task/activity requests, classroom staff will use high-probability requests (e.g., “Give me 5,” “Do you like my shirt?” and “What color are your pants?”) prior to requesting engagement in the problematic task. To reduce the likelihood of problems with transitions, classroom staff will implement a picture schedule to communicate the sequence of activities in which he will be engaging. This will be reviewed at the beginning of the school day and then each time he transitions from one activity to another. In addition, staff will use a timer that they will set to let Micah know when he has three minutes left to go in an activity. They will provide precorrection along with the timer (e.g., “Okay, Micah, you have three more minutes to go with the CD player; when the timer goes off, it will be time to move to the next activity.”). Teaching Alternative/Replacement Behaviors: The team has determined that Micah would benefit from learning to request a brief break from undesired activities. Given his limited vocal/verbal abilities, it was decided that Micah will be taught to use the manual sign for “break.” Staff will identify 3–4 main activities where escape-motivated behavior is likely to occur. Micah will initially be taught to use the “break” sign in a one-to-one context using a discrete trial approach. Then staff will be taught how to precorrect and prompt the use of this alternative response across problematic task situations. Initially, his use of the “break” sign will be honored each time it occurs. Once he is exhibiting this response consistently, staff will begin a delay requirement; that is, when Micah requests a break, he will be required to work for an additional brief period before being given a break. Based on staff discussion and review of data, this delay will gradually be extended over time. Consequences for Appropriate and Challenging Behavior: Staff will establish a general reinforcement system linked to the activities and transitions Micah goes through. During task activities staff will provide periodic social praise contingent on task engagement and the absence of challenging behavior, and contingent on successful transitions without challenging behavior. Based on a reinforcer assessment, staff will provide Micah with a variety of more tangible rewards upon successful completion of task activities and task transitions (e.g., stickers, pencils, preferred edibles, etc.). Once Micah’s challenging and appropriate behavior has stabilized at desired levels, staff will design and begin to teach Micah the basics of a token system. He will be able to earn tokens for task engagement and successful transitions, and then be able to trade in the tokens for activity and other tangible rewards. Emergency/Crisis Management Strategies: When Micah engages in challenging behavior, he will be redirected back to the ongoing activity. If his behavior escalates to the point of being imminently dangerous to self or others, staff will employ the strategies taught during their crisis intervention training, including (1) putting distance between Micah and other people, (2) putting objects (e.g., couches, tables) between Micah and other people, and finally, if the behavior continues to escalate and Micah and others are in danger, (3) a two-person restraint involving staff blocking Micah’s aggressive behaviors and holding him loosely around his upper arms so that he cannot injure others.

Data Collection and Evaluation Procedures Data will be collected on (1) the frequency of aggressive episodes per day involving slapping and scratching others, (2) the frequency of self-injurious episodes per day involving head-slapping during transitions, and (3) the frequency of alternative communicative responses (using his “break” sign). To the greatest extent possible data will be collected across settings during Micah’s school day. Micah’s teacher from his self-contained classroom will be responsible for collecting data sheets and summarizing and plotting the data graphically at least once per week (data will be plotted as occurrences per day). Micah’s classroom teachers and classroom assistants will meet weekly on Thursday afternoons to review the plotted data and discuss any possible needs for changes to Micah’s support program. Family members will be invited to all meetings, and additional meetings will be arranged as needed to accommodate family schedules.

TABlE 7-2 Sample Behavior Intervention Plan for Micah (continued)

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235Designing and Implementing Individualized Positive Behavior Support

ongoing Data collection and evaluation

Finally, ongoing data collection on the effectiveness and efficiency of the interven- tions within the BIP should inform instructional and support plan modifications and adaptations. A formative (e.g., frequent collection) approach is emphasized for regu- lar data collection during the implementation of the BIP, while a summative (infrequent and long-term data summary) approach can be used for communication and progress- monitoring requirements.

inDirect Data collection

archival review

One form of indirect data collection common to almost all the FBA processes is a comprehensive review of all the archived information regarding the individual and the challenging behavior(s); specifically, any archived information relating to potential setting events (e.g., medical/mental illness, medications, medical records, previous BIPs), previous antecedents (i.e., any information related to triggers of the challenging behavior), and information related to consequent interventions used previously such as preference and reinforcement inventories. For example, close examination of Jamila’s residential file might record that she is especially fond of bubble gum. Not only could the reinforcer (bubble gum) be used to reduce the challenging behavior of loud vocalizations as a consequent intervention, but chewing the gum could also serve as a potential competing or alternate behavior to the loud vocalizations.

interviews

FBA interviews are widely accepted as an evidence-based PBS practice (Herzinger & Campbell, 2007). Alone or with other FBA methods such as direct observation, the outcomes of FBA interviews should minimally include an operational definition of the challenging behaviors, identification of setting events, antecedents, and consequence events as well as times, people, skills, activity es, or routines throughout the day that seem to trigger the challenging behavior, and hypotheses/summary statements about the function of the challenging behavior (O’ Neill et al., 2015).

A variety of different FBA interviews have been published. For example, the Func- tional Assessment Checklist for Teachers and Staff (FACTS; March et al., 2000) is a semi-structured interview conducted by a behavior specialist for the purpose of inter- viewing teachers or caregivers and was developed to help identify problematic skills, activities, and routines during specific times. A completed example of a FACTS form for Micah is presented in Figure 7–1. The Functional Analysis Interview (FAI; O’Neill et al., 2015) is a more comprehensive interview format than the FACTS and typically takes longer to complete. The individual with disabilities, when appropriate, and two or more people who know the individual well (e.g., family or educators) should be interviewed using the form. There are many other types of interview forms that can be used including the Brief FBA (Crone & Horner, 2003). Many of the FBA interview forms can be used specifically with individuals with severe disabilities, such as the Student-Directed Functional Assessment Interview (O’Neill et al., 2015). All of the

Staff Responsibilities All of Micah’s teachers and paraprofessionals will be responsible for implementing the behavioral support strategies described above in Micah’s self-contained and regular classrooms. Each person working with Micah will be responsible for collecting data on the frequency of challenging and appropriate behavior using a common data sheet. Micah’s two classroom teachers and other support staff who can attend will meet on a weekly basis to review his data and discuss possible changes to his BIP.

TABLE 7-2 Sample Behavior Intervention Plan for Micah (continued)

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236 Chapter 7

interview forms give practitioners a tool to record an objective description of the chal- lenging behaviors, identify the setting events and antecedents that predict the chal- lenging behaviors, identify the potential function(s) of the behavior(s), and help develop a hypothesis/summary statement that is used in the process of developing behavior intervention plans.

FIGuRE 7–1 Completed FACTS Form for Micah

Functional Assessment Checklist for Teachers and Staff (FACTS–Part A) Problem in Picture Form (Pro-form)

Student/ Grade: Micah L. Date: 6/1/15 Interviewer: Mr. Brown (school psych) Respondent(s): Ms. Thompson and Ms. Adolphson

Please identify at least three strengths or contributions the student brings to school.

Micah generally has a cheerful and happy demeanor, and looks forward to interacting with adults and peers. He enjoys a variety of activities including listening to music, working with letters, and playing with Legos.

Problem Behavior(s): Identify problem behaviors.

Student Profile:

Tardy X Fight/Physical Aggression Disruptive Theft

Unresponsive Inappropriate Language Insubordination Vandalism

Withdrawn Verbal Harassment Work not done Other

Verbally Inappropriate X Self-injury

Describe problem behavior:

Identifying Routines: Where, when, and with whom problem behaviors are most likely.

Schedule (Times) Activity Likelihood of Problem Behavior

Morning instruction periods and regular math

Letter/number ID Copying letters Receptive ID

Low High 1 2 3 4 5 6

Slapping and scratching

Specific Problem Behavior

others

Free time/leisure; lunch Music and/or computer; eating

1 2 3 4 5 6 Slapping side of head with open hand

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

1 2 3 4 5 6

Select 1–3 Routines for Further Assessment: Select routines based on (a) similarity of activities (conditions) with ratings of 4, 5, or 6 and, (b) similarity of problem behavior(s). Complete the FACTS–Part B for each routine identified.

Step 1

Step 2

Step 3

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FIGuRE 7-1 Completed FACTS Form for Micah (continued)

237

Functional Assessment Checklist for Teachers & Staff (FACTS–Part B)—Aggressive Behavior

Student/ Grade: Micah L. Date: 6/1/15 Interviewer: Mr. Brown (school psych) Respondent(s): Ms. Thompson and Ms. Adolphson

Routine/Activities/Context: Which routine (only one) from the FACTS–Part A is assessed?

Routine/Activities/Context Problem Behavior(s)

Morning instructional sessions and regular class math Slapping and scratching others

Provide more detail about the problem behavior(s):

What does the problem behavior(s) look like? • Wide arm swing to slap others on the upper body or facial area • Use of fingernails to rake down arm from elbow to wrist

How often does the problem behavior(s) occur? 4–5 times per instructional session

How long does the problem behavior(s) last when it does occur? Brief duration

What is the intensity/level of danger of the problem behavior(s)? Slapping low intensity; scratching is dangerous, can cause injury/draw blood

What are the events that predict when the problem behavior(s) will occur? (Predictors)

Related Issues (Setting Events) Environmental Features

llness Other: poor sleep drug use negative social

academic failure conflict at home

reprimand/correction X structured activity physical demands unstructured time socially isolated tasks too boring with peers activity too long other tasks too difficult

What consequences appear most likely to maintain the problem behavior(s)?

Things That Are Obtained Things Avoided or Escaped from

adult attention other: peer attention preferred activity money/things

X hard tasks other: reprimands peer negatives physical effort adult attention

SUMMARY OF BEHAVIOR Identify the summary that will be used to build a plan of behavior support.

Setting Events & Predictors Problem Behavior(s) Maintaining Consequence(s)

Poor sleep and requests to complete non-preferred tasks

Slapping/scratching others Avoid/escape task requests

Strategies for Preventing Problem Behavior

How confident are you that the Summary of Behavior is accurate?

Consequences for Problem Behavior

1

Not very confident Very confident

2 3 4 5 6

(continued)

Step 1

Step 2

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FIGuRE 7-1 Completed FACTS Form for Micah (continued)

238

What current efforts have been used to control the problem behavior?

Strategies for Preventing Problem Behavior Strategies for Responding to Problem Behavior

schedule change other: seating change

X curriculum change

reprimand other: block/redirection office referral detention

Based on March et al., (2000) 4/24/00

Functional Assessment Checklist for Teachers & Staff (FACTS–Part B)—Self-Injurious Behavior

Student/ Grade: Micah L. Date: 6/1/15 Interviewer: Mr. Brown (school psych) Respondent(s): Ms. Thompson and Ms. Adolphson

Routine/Activities/Context: Which routine (only one) from the FACTS–Part A is assessed?

Routine/Activities/Context Problem Behavior(s)

Free/leisure time involving music and/or computers, lunch time

Slapping side of head with open hand

Provide more detail about the problem behavior(s):

What does the problem behavior(s) look like? • Short arm swing to slap on the cheek or temple areas

How often does the problem behavior(s) occur? During approximately 80% of relevant situations (music, computer, lunch)

How long does the problem behavior(s) last when it does occur? Varies; 2–3 slaps per “burst,” possibly several bursts per occasion

What is the intensity/level of danger of the problem behavior(s)? Reddened skin, possible bruising, possible “internal” damage?

What are the events that predict when the problem behavior(s) will occur? (Predictors)

Related Issues (Setting Events) Environmental Features

illness other: drug use negative social

academic failure conflict at home

reprimand/correction structured activity physical demands unstructured time socially isolated tasks too boring with peers activity too long

X other tasks too difficult Asked to terminate desired activity

What consequences appear most likely to maintain the problem behavior(s)?

Things That Are Obtained Things Avoided or Escaped from

adult attention other: peer attention

X preferred activity Access to music/ computer, access to additional food money/things

hard tasks other: reprimands peer negatives physical effort adult attention

SUMMARY OF BEHAVIOR Identify the summary that will be used to build a plan of behavior support.

Setting Events & Predictors Problem Behavior(s) Maintaining Consequence(s)

Requests to terminate desired activities and transition

Slapping own head Continued access to desired items/ activities

Step 1

Step 2

Step 3

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239Designing and Implementing Individualized Positive Behavior Support

checklists

Using questionnaires or checklists is another way to help educators gather FBA data. As with FBA interviews, the purpose of using rating scales is to develop an objective description of the setting events, behavior(s), antecedents, and consequence events that are maintaining the challenging behavior(s). Brief assessments used with stu- dents with severe disabilities include the Motivation Assessment Scale (Durand & Crimmins, 1992), the Functional Analysis Screening Tool (Iwata, 1996), and the Problem Behavior Questionnaire (Lewis, Scott, & Sugai, 1994).

Direct oBservations

Data collection by direct observation is an essential part of the functional assessment process. Some research has found that indirect functional behavioral assessments (e.g., interviews, rating scales) do not provide enough information for identifying the function of problem behavior (e.g., Cunningham & O’Neill, 2007). Direct observation procedures and tools should be structured to provide clear and useful information while their use should not be an excessive burden on practitioners in applied settings (O’Neill et al., 2015). This is of particular importance, as researchers have emphasized that it is critical to conduct naturalistic (i.e., conducted in the environment in which the behavior occurs), descriptive observations (Chandler & Dahlquist, 2010), since the contextual variables of where and when the behavior occurs will have significant impact on the validity and reliability of the behavioral observation data and outcomes. It is suggested that a minimum of 15–20 behavioral occurrences over a period of 2–5 days be observed to insure validity of any hypotheses formed (O’Neill et al., 2015). These data, used in conjunction with archival reviews of existing data, indirect FBA assessment, and direct observational FBA tools, can support practitioners in develop- ing robust and accurate behavioral hypotheses that identify the setting events, ante- cedents, behaviors, and maintaining consequences/functions of problem behaviors before there is any attempt to design or initiate any interventions.

The most basic form of descriptive observation is referred to as the A-B-C model or an antecedent-behavior-consequence assessment (Bijou, Peterson & Ault, 1968; Cipani, 1994; Zuni & McDougall, 2004). For each behavior observed, there is a record of the behavior and the events that occur long before or directly prior to the

FIGuRE 7-1 Completed FACTS Form for Micah (continued)

Strategies for Preventing Problem Behavior

How confident are you that the Summary of Behavior is accurate?

Consequences for Problem Behavior

1

Not very confident Very confident

2 3 4 5 6

What current efforts have been used to control the problem behavior?

Strategies for Preventing Problem Behavior Strategies for Responding to Problem Behavior

schedule change other: seating change curriculum change

reprimand other: Prompts/reminders about end of activity, block/redirection

office referral

detention

(March, R., Horner, R. H., Lewis-Palmer, T., Brown, D., Crone, D., Todd, A. W., & Carr E. (2000). Functional Assessment Checklist for Teachers and Staff (FACTS). Eugene: Department of Educational and Community Supports, University of Oregon. Used with permission.)

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241Designing and Implementing Individualized Positive Behavior Support

behavior (i.e., setting events and antecedents), the behavior described in objective terms, and the events that follow the behavior (i.e., maintaining consequences or function) (Kauffman, Mostert, Trent, & Hallahan, 1993). For example, direct observa- tion reveals that when Jamila enters a new grocery store, she starts to loudly vocal- ize. In the A-B-C model, the behavior is first objectively defined in such a way that any observer would recognize the targeted problem behavior during an observation (the B). Behaviors should be described in objective, measureable, and observable terms (Kerr & Nelson, 2002). After multiple observations, the teacher may discover that data show demands and undesirable tasks and activities are antecedents that trigger the problem behavior (the A). Common antecedents identified during the FBA process include requests/demands from others, an absence of attention, transitions, and difficult or undesirable tasks or activities (O’Neill et al., 2015). Finally, the func- tion, or maintaining consequence of the targeted behavior is identified (the C). Com- mon functions include accessing a desired object or activity, obtaining attention, avoiding difficult/undesirable task/demands, and self-stimulation (O’Neill et al., 2015).

Another example of a functional assessment observation tool is the Functional Assessment Observation Form (FAO; O’Neill et al., 2015). Similar to an A-B-C approach, the form can be used to record the occurrence of behaviors and their antecedents, consequences, and possible behavioral functions. A completed example of an FAO is presented in Figure 7–2. These data indicate two behavioral patterns. In one case, task requests/demands seem to be consistent antecedents for Micah’s aggressive behavior, and the apparent function is to escape those demands. In other scenarios, desired items and activities are antecedents for Micah’s self-injurious head slapping, with the apparent function of maintaining access to those items/activities.

validation of summary statements

FBA can be a somewhat complex and lengthy process and has typically been consid- ered methodologically rigorous, but must be efficient and accessible to allow school- based practitioners to implement it (Allday, Nelson, & Russel, 2011; Scott, McIntyre, Liaupsin, Nelson, & Conroy, 2004; Scott, McIntyre, Liaupsin, Nelson, Conroy, & Payne, 2005). During the process, if the hypotheses/summary statements cannot be shown to be accurate through direct observation, or through the results of an intervention, then a functional analysis might be appropriate and necessary to identify the function and maintaining consequences of the challenging behavior.

functional analysis

procedures

A functional analysis (FA) is designed to elicit challenging behavior under some envi- ronmental arrangements and observe its non-occurrence under others. It is not rec- ommended unless the hypothesis of the function(s) of the behaviors are not readily identifiable, or the severity of the problem behavior makes naturalistic observation ethically questionable due to potential negative side effects for the individual. FA involves the process of experimentally manipulating previously determined environ- mental variables (either antecedents or consequences) to determine the function(s) the challenging behavior serves for an individual with disabilities (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994). Functional analyses may involve repeated sessions (typically 10–15 minutes in length) that vary with regard to the contingencies that are being applied (e.g., attention or escape being provided contingent on problem behav- ior). For example, in Jamila’s case she could either be allowed or not allowed to escape from tasks/activities when she engages in challenging behavior.

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242 Chapter 7

Bloom et al. (2011) developed a trial-based FA that is more user-friendly for use in classrooms. This approach involves implementing these procedures in periodic four- minute sessions (Bloom, Iwata, Fritz, Roscoe, & Carreau, 2011) interspersed through- out typical classroom activities. In studies implementing trial-based FA procedures in typical classroom settings the results with regard to identifying behavioral functions matched those developed in a full FA the majority of the time. Additional studies have demonstrated that special education teachers and paraprofessionals can be trained to use trial-based FA in their classrooms to effectively identify the function of behaviors of their students, as well as implement appropriate interventions that produce posi- tive effects on challenging behavior (Bessette & Willis, 2007; Lambert, Bloom, & Irvin, 2012). There are many different variations of how to conduct an FA but the key com- ponent involves the systematic observation of target behavior(s) while in clearly defined experimental and control conditions (Iwata & Dozier, 2008). For example, we may hypothesize that Micah engages in physical self-stimulation (hand flapping and rocking) when he has to wait for transitions (e.g., waits in line with the class for the bell to release students for lunch). An FA could experimentally evaluate this hypoth- esis by comparing rates of self-stimulation under a “waiting” condition versus a “no- waiting” condition. In the waiting condition, Micah would be asked to wait in line with his classmates for a brief period of time (e.g., 3–5 minutes). In the no-waiting condition, staff could wait to prompt Micah to go to lunch until the rest of his class- mates were already walking out the door. If the frequency of self-stimulation is sig- nificantly higher when Micah is asked to wait during transitions as compared to when he does not have to wait, the hypothesis/summary statement of “When Micah has to wait during transitions, he will engage in hand-flapping and rocking while seated in order to get/obtain self-stimulation” can be tested. If this hypothesis/summary state- ment is confirmed, a BIP can be developed to address the function of the behavior.

Behavior intervention plan Development

The second major phase of PBS is the development and implementation of a behavior intervention plan (BIP). The critical issue here is that the development of the BIP is guided by the information gathered from the FBA process (O’Neill et al., 2015).

important characteristics of Bips

O’Neill et al. (2015) delineated four critical characteristics of BIPs. First, it is impor- tant that the focus is on the behavior of teachers, parents, and/or other caregivers. That is, the plan needs to specify what such personnel will do differently to alter a student’s environment to make things work more successfully. Second, the plan must be based on and guided by the results of the FBA. In order to do this personnel can make use of a competing behavior analysis, a framework for analysis developed by O’Neill et al. (2015) (see below). Third, the plan should be technically sound with regard to the principles and procedures of applied behavior analysis (Fisher, Piazza, & Roane, 2011). Procedures should make the challenging behavior irrelevant, ineffi- cient, and ineffective (O’Neill et al., 2015). Irrelevant means that the student no longer needs to engage in the behavior since the problematic situation has been modified (e.g., an aversive task/activity has been modified or removed). Efficiency refers to how quickly and consistently a behavior is reinforced. Support strategies need to ensure that alternative appropriate behaviors are reinforced more quickly and consist- ently than challenging behaviors. Additionally, factors such as physical efficiency may come into play. For example, if a student engages in a relatively low-effort behavior such as headbanging on nearby surfaces, any alternative communicative behavior must be as easy, or easier, to physically perform, and be reinforced quickly and con- sistently. An alternative behavior such as a sign, or showing a card, can be taught to

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243Designing and Implementing Individualized Positive Behavior Support

the student, so that the student can easily communicate his/her desire. Otherwise the alternative behavior will not compete successfully with the challenging behavior (Horner & Day, 1991). Ineffective refers to breaking the relationship between the behavior and the consequences that are reinforcing and maintaining it (e.g., discon- tinuing attention when a student engages in challenging behavior).

Fourth, a critical issue concerns the contextual fit of the BIP. By that, we are refer- ring to whether or not the plan makes sense with regard to the situation(s) in which it is supposed to be implemented. This includes issues such as (1) whether or not the plan fits with the values and skills of persons in the setting, (2) whether it can fit into the natural routines of the setting (home, classroom), and (3) if it can be implemented effectively given the time, money, and other resources available in the setting (Albin, Lucyshyn, Horner, & Flannery, 1996; Lucyshyn, Kayser, Irvin, & Blumberg, 2002). For example, a plan calling for parents to conduct multiple 30-minute training sessions with a child each day if both parents are working outside the home and have four other children with busy schedules may simply not be feasible, and alternative inter- ventions would need to be considered. So, persons developing and implementing BIPs will often need to look at a compromise between the most effective plan possi- ble and what is logistically feasible within necessary settings. For example, in a given situation a student may require attention on a frequent basis to prevent tantrum epi- sodes. However, if the teacher and other staff are busy with many other students this may be difficult to accomplish. In such a situation the teacher and staff may need to review and modify their scheduled activities to accommodate the student’s need.

Finally, a major issue with regard to BIPs is that they need to contain a comprehen- sive multicomponent array of strategies to address all of the issues identified in the FBA process (O’Neill et al., 2015). This includes preventive/proactive strategies to decrease the likelihood of challenging behavior (e.g., manipulating antecedent varia- bles), teaching and promoting desired/appropriate alternative behaviors, and arrang- ing consequences to reinforce appropriate behavior as well as remove consequences that might be reinforcing or maintaining challenging behavior. It is also important to note that the BIP development process should be a team effort, with all relevant stakeholders involved and providing input (e.g., parents, teachers, support staff, etc.).

Bridging the Gap from fBa to Bip: the competing Behavior model

A significant challenge to many service providers and teams is moving from FBA- derived hypotheses and understanding of challenging behavior situations to identify- ing relevant strategies to include in a BIP (Van Acker, Boreson, Gable, & Potterson, 2005). Carr (1988), Horner and Billingsley (1988), and others described a framework for understanding the potential “competition” between challenging behaviors and more appropriate desired behaviors. O’Neill et al. (2015) incorporated this approach in presenting a competing behavior analysis (CBA) model to guide plan developers in the process. Figures 7–3 and 7–4 present the general outline of this model using examples of analyses completed for Micah’s and Jamila’s behaviors, based on the FBA information for each described above in previous sections.

The CBA model involves three steps. Step one involves diagramming the hypotheses/ summary statements developed based on the FBA information. This is laid out through the middle part of the CBA diagram (see Figures 7–3 and 7–4). Step two involves identifying two things: First, what is the desired behavior that is supposed to occur in the relevant situation (see top part of CBA diagram)? For example, in the first situation, the desired behavior would be for Micah to complete the requested tasks or activities. Second, it is important to identify an alternative or replacement behavior that would serve the same function as the challenging behavior, or result in the same outcomes (see bottom part of CBA diagram). In Micah’s case, he could be taught to request a break instead of engaging in challenging behavior to escape the non- preferred tasks. Step three is to develop a plan or a list of strategies that will decrease

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246 Chapter 7

the occurrence of the challenging behavior, and increase the likelihood of the desired and alternative behaviors. These plans should include strategies to address setting events (motivating operations), more immediate antecedent issues, teaching strate- gies, and consequence-related strategies. Examples of such a behavior intervention plan for Micah is presented in Table 7–3 and will be discussed below.

formats for Behavior intervention plans

There are a wide variety of formats that can be used to document BIPs. One approach is to simply make a list of the various strategies to be employed, and how to imple- ment them in various situations (see BIP plan components below). Alternatively, the plan could focus on specific problematic situations and how staff should proceed in those situations. For example, if requests to complete domestic cleaning activities are a consistent issue for Serena, the plan may describe a range of strategies to be used in that situation. Staff could employ high-probability requests (see below) and/or clean- ing tools that simplify the task(s), and schedule a highly preferred reinforcing activity at the conclusion of the task. The main issue is to be flexible in adopting a format that will be useful and effective for the staff who are responsible for implementing the plan. This includes decisions about the format of the plan, where it will be located and how it will be accessible, and how relevant staff will be familiarized with and trained on the components of the plan.

potential intervention plan components

As mentioned above, behavior intervention plans may involve a variety of compo- nents to address multiple aspects of a situation, including prevention strategies, teach- ing skills, and managing consequences.

lifestyle changes

Behavioral support does not occur in a vacuum. As with any person, students with severe disabilities lead lives that involve activities at home, in the community, at school, and potentially, in work settings. Some or all of these situations may be prob- lematic in various ways and contribute to the display of challenging behaviors. For example, in Jamila’s case certain interactions with staff and/or her apartment mates trigger challenging behavior at home. As described above, strategies such as person- centered planning (PCP) must be involved to examine the larger picture of an indi- vidual’s lifestyle, and if potential changes might be in order (Risley, 1996). For example, it may be important to review Jamila’s relationships with her apartment mates or support staff, and work with Jamila to focus on how to get along better with these individuals. Or it may be that Jamila wants to live in a different environment and with different people. There are many components that make up the determina- tion of a good quality of life. When this is compromised, an individual may engage in behavior related to these issues (e.g., to obtain attention or to avoid/escape non- preferred situations).

classroom modifications

Because students typically spend the majority of their day in classroom settings, it is important to assess components of the instructional environment that may be contrib- uting to a student’s challenging behavior. For example, student behavior may be influenced by factors such as numbers of students, noise levels, student movement and activity, and classroom routines (Alberto & Troutman, 2012). Prior to or as part of the assessment process, support personnel should consider these types of classroom

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247Designing and Implementing Individualized Positive Behavior Support

factors and whether changes in them would positively impact a student’s behavior. Such a process might reduce the time and effort involved in an individualized BIP, or remove the need for it entirely. Further, the identified issues may be problematic for other students as well. For example, it may be that greater levels of noise and student activity are aversive for Micah, and may increase his agitation and the likelihood that he will react negatively to task or activity requests. Making changes in classroom rou- tines to reduce noise and activity may result in a decrease in some of his challenging behaviors. (See discussion of setting events/motivating operations below.)

setting events/motivating operations

Teachers, parents, and other caregivers often notice that events outside of an immedi- ate situation (e.g., a classroom) may impact a student’s behavior. A student who arrives in the classroom in the morning ill, tired, or hungry, or had a negative interac- tion with a sibling before coming to school may react differently than usual. For example, in Figure 7–3, the competing behavior analysis (CBA) indicates that a lack of sleep may be an influential factor for Micah in increasing the likelihood of his responding negatively to task requests. These types of influences have been referred to by different labels over time, including setting events, and more currently, motivat- ing operations (MOs) (Horner, Vaughn, Day, & Ard, 1996).

Michael (2007) defines a motivating operation as an environmental variable that has two effects. First is to change the value or effectiveness of some object or event as a behavior (value altering), and the second is to change the likelihood of behaviors that typically produce those reinforcers (behavior altering). So, in Micah’s case, if he has had little sleep the night before, the value of being left alone and rest is going to be increased. If engaging in aggressive behavior typically allows him to escape from task requests (i.e., rest), then this behavior may be more likely to occur (see Figure 7–3). So, you can imagine a wide variety of experiences that might serve as motivat- ing operations. Some of these could be physical in nature, including sleep depriva- tion, illness, hunger, and the impact of medications. Others could be more social in nature, including fights with a sibling or peer or long periods without social interac- tion. Horner et al. (1996) described multiple strategies to prevent or minimize the impact of MOs on student behavior.

strategies to Deal with mos: prevention Perhaps the easiest approach is to try to prevent the MO from occurring in the first place so that it will minimize the likelihood of increased challenging behavior. For Micah this might mean to help his family come up with strategies to improve his sleep patterns and eat more varieties of food. Similarly, parents and other caregivers can do their best to ensure that a student’s medications are appropriately adminis- tered and monitored on a regular basis. If peer or sibling interactions are potentially problematic, steps could be taken to either keep persons apart, or monitor and facili- tate more appropriate positive interactions. Preventive strategies may be very useful, but it may not be possible to always control these factors.

strategies to Deal with mos: minimizing the impact In the event that MOs can’t be prevented, teachers and others will have to rely on more reactive strategies (i.e., what to do once the MO has occurred) (Horner, Vaughn, Day, & Ard, 1996). Horner, Day, and Day (1997) assessed the impact of neutralizing routines on problem behavior associated with MOs during instructional sessions. For example, one participant demonstrated increased challenging behavior when he had less than five hours of sleep during the night. The neutralizing routine was to allow him to have a one-hour nap during the following day. This approach resulted in sub- stantially reducing his aggressive and self-injurious behavior during instructional demand sessions. Another example described by Horner et al. (1996) involved a

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student who had difficulty when schedules and events had to be changed unexpect- edly (i.e., unpredictability). The support personnel found that a brief two-, three- minute review period explaining the changes and providing information on what would be happening and with whom was helpful in reducing challenging behavior.

Another strategy involves removing or altering the stimuli that typically evoke problem behavior. Dadson and Horner (1993) described a scenario in which a student would become agitated when her bus ride to school was late, which led to her engag- ing in challenging behavior in aerobic P.E. activities during first period. The teacher arranged for the student’s parents to call her if the bus was going to be late, and a teaching assistant would meet the student and facilitate stretching exercises versus the usual aerobic activities. This led to substantial reductions in challenging behavior.

If schedules or activities cannot be changed, support personnel could provide increased prompting for desired behavior. Precorrection can be provided to remind the students that they can ask for a break or for help if they struggle with the task requests. Additionally, support personnel could increase the frequency and quality of reinforce- ment for appropriate behavior. For example, task engagement could be rewarded more often than usual and in greater amounts (e.g., 10 minutes of free time versus 5).

antecedent strategies

Antecedent strategies are those that are implemented in more immediate circumstances that typically result in problem behavior in order to decrease the likelihood that the behavior will occur. One result of the FBA is to identify antecedents that likely precede challenging behavior (e.g., teacher requests, lack of attention, presence of a desired object that is out of reach). A wide variety of strategies have been identified that focus on such antecedents to reduce the likelihood of the challenging behavior (Luiselli, 2006). When the FBA process has identified escape from task requests as a primary function, a variety of approaches could be used. Offering choices is one option. Assum- ing that the student is trying to escape from a non-referred activity, they can be offered choices along a variety of dimensions, including choice of tasks, location, materials to be used, sequence of completion, and type of response format (e.g., computer-based vs. handwritten) (Kern, Vorndran, Hilt, Ringdahl, Adelman, & Dunlap, 1998). Brown, Belz, Corsi, and Wenig (1993) identified a variety of types of choices that may be offered within daily routines. These include providing choices of activities and materi- als, with whom to engage in an activity, where the activity will occur, choice to refuse participation in the routine, and when to terminate the activity.

High-probability request sequences or behavioral momentum is another strategy demonstrated to be effective (Killu, 1999). This process involves making a series of requests to which the student has a high probability of responding positively before making a request that has a lower probability of a positive response. For example, a student might be asked to touch or label a series of three or four body parts or colors before being asked to sit down and begin working on an academic task. This approach has been demonstrated to be effective in reducing challenging behavior in task request situations (Belfiore, Basile, & Lee, 2008).

Adapting or modifying tasks and curriculum content is another approach to reduc- ing the possible aversiveness of task request situations and related challenging behav- ior (Dunlap, Kern-Dunlap, Clarke, & Robbins, 1991). A variety of dimensions of instruction and content could be manipulated, including level of task difficulty (too easy or too hard), length of tasks/work periods, functionality of tasks, combinations of harder and easier tasks, and response format (written vs. computer-based respond- ing). Results from the FBA process should provide information that would guide the identification of relevant instructional and curricular aspects that might be altered (Dunlap & Kern, 1996). For example, in Jamila’s case, home-based tasks and activities could be modified to make them easier to accomplish so that she would be less likely to engage in problem behaviors to escape the activity requests.

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teaching and prompting alternative/replacement Behaviors

A major development in the area of PBS has been a focus on teaching communicative behaviors that can replace or serve the same function as the challenging behaviors. This strategy is most often referred to as functional communication training (FCT) (Carr, Levin, McConnachie, Carlson, Kemp, & Smith, 1994; Durand, 1990). The basic idea is that the student can produce an appropriate communicative response to obtain the same reinforcer that is maintaining the challenging behavior. For example, in Micah’s case, he could be taught to appropriately request continued access to a pre- ferred activity instead of engaging in self-injurious behavior (see Figure 7–3).

The FCT approach involves three main steps. First, the main antecedent contexts that evoke the challenging behavior and consequences that are reinforcing and main- taining the behavior are determined from the FBA. Second, the form (or topography) of the alternative behavior must be identified. That is, decisions must be made with regard to whether the alternative behavior would be taught using vocal/verbal responses, signs or gestures, pictures or symbols, or the use of an augmentative/ alternative communication (AAC) device. A variety of considerations should be taken into account in this choice ( Johnston, Reichle, Feeley, & Jones, 2012). For example, if sign language will only be understood in a limited range of contexts, it might be important to consider alternative forms of communication. The types of responses already familiar to the student might provide an important starting point; in this way the student will likely learn the alternative more quickly.

In line with the competing behavior analysis, the relative efficiency of the challeng- ing and alternative behaviors must be considered (Horner & Day, 1991). Efficiency involves a variety of factors including physical effort. For example, if a student has significant motor limitations then sign language/gestures and use of pictures or symbols might be difficult, versus a simpler AAC device involving touching panels for communication. Efficiency also involves the speed and consistency with which responses receive reinforcement. A classic example is hand raising in a classroom. A student may raise his/her hand, but the teacher’s response may be delayed and incon- sistent; in contrast, if the student hits or bangs his/her head, the teacher may respond quickly and consistently. So, a third and important aspect of FCT is to attempt to make sure that the challenging behavior receives as little reinforcement as possible, and the appropriate behavior is quickly reinforced. Research has demonstrated that implementing extinction or non-reinforcement for the challenging behavior can be a critical component for the success of FCT (Shirley, Iwata, Kahng, Mazaleski, & Lerman, 1997).

As in teaching any skill, it is important that strategies be implemented to ensure the generalization and maintenance of behavioral performance (Horner, Dunlap, & Koegel, 1988). So, in teaching the alternative behavior, instruction must include a range of settings and persons. In addition, support personnel must ensure that the alternative response is reinforced on an effective schedule and on an ongoing basis to maintain responding (Carr et al., 1999). For example, in teaching Micah to request a break from undesired activities, it would be important to teach and prompt the request in the variety of settings in which he engages in problem behavior, and ensure that the request is honored (i.e., reinforced) by giving him the desired break.

consequence strategies for appropriate and challenging Behavior

It is important to minimize or eliminate reinforcement for challenging behavior to the extent possible so that appropriate alternative behaviors can successfully compete. Extinction of challenging behavior involves preventing a reinforcer from being deliv- ered when the challenging behavior occurs. So, for example, if a behavior is moti- vated by attention (e.g., a student engages in a tantrum to get his teacher’s attention), personnel would attempt to not provide attention when the behavior occurs. For

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escape-motivated behaviors (e.g., the student throws his materials on the floor so that he doesn’t have to do the work), personnel would attempt to not allow the student to escape when the challenging behavior occurs (referred to as escape extinction) (Iwata, Pace, Kalsher, Cowdery, & Cataldo, 1990). It is important to note that in some cases this may be difficult to accomplish. For example, a student may escalate his behavior to the point where it is impossible to ignore the behavior, and intervention is necessary. Similarly, in attempting to force a student to remain engaged in an activ- ity, problem behavior may escalate to the point where it is too dangerous to try to enforce the extinction (see discussion of crisis management below). Again, the basic message is to attempt to minimize or eliminate reinforcement for problem behavior to the maximum extent possible. More constructively, we would want to understand why the student is not engaged in the activity and make modifications to the task to try to increase its interest to the student.

Along with consequences for challenging behavior, it is critical to arrange appro- priate reinforcement for desired and alternative behaviors. With regard to desired behaviors such as task completion, the full range of reinforcement procedures should be considered, such as social praise, activity access, tangible/edible items, and point/ token systems (Alberto & Troutman, 2012). Reinforcement is critical to teach and maintain alternative communicative behaviors that serve the same function as the challenging behavior. That is, unless the environment responds positively and con- sistently to the alternative behavior, it will not be established and maintained (Carr, Levin, McConnachie, Carlson, Kemp, & Smith, 1994). This often raises concerns for support personnel who may have issues with providing attention or breaks when requested by the student (e.g., “Am I reinforcing escape behavior?”). In this case, it is important to consider two issues: (1) It is preferable that the student exhibits the appropriate communicative behavior to achieve his or her desired outcome (e.g., tak- ing a break), than to continue to engage in the challenging behavior to achieve the desired outcome; (2) it is critical to consider that the situation can be altered over time so that the student is learning to tolerate delays to reinforcement when requests are made (Reichle, Johnson, Monn, & Harris, 2010).

For example, initially, a student’s requests for a break would be granted each time a request is made. Then, over time, the process can be modified so that the student learns to tolerate a delay to being reinforced. This could occur in a variety of ways. One approach would involve increasing the amount of work the student must com- plete before being given a break. For example, if a student was completing math problems, initially the student would be given a break each and every time it was appropriately requested. As the inappropriate behavior was successfully decreased, and the use of the appropriate request for break was established, the student would be required to complete one or two more problems before being given a break. Over time the number of required problems could be increased to be eligible for a break.

Another approach could involve gradually increasing the amount of time the stu- dent would have to be engaged in work before a break. A critical aspect of this approach is that the training context should include a signal to the student that the break is coming after a certain amount of work or a certain amount of time (Reichle et al., 2010). So, when the student makes the request, the teacher can say something like “Yes, you want a break, just work for 30 more seconds and we will have a break.”

Teaching and promoting functionally equivalent appropriate behaviors that serve the same function as the challenging behavior should be a critical component of com- prehensive PBS plans.

crisis/emergency intervention strategies

The primary point of this chapter is that the focus of PBS is on implementing strate- gies to prevent and avoid situations in which challenging behaviors occur, and pro- mote desired behaviors instead. The bulk of the effort of behavior support teams

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should be focused in this regard, versus focusing on strategies for reacting to chal- lenging behavior (Carr et al., 1994). However, students that engage in severe chal- lenging behaviors may sometimes escalate to the point where more intrusive intervention is required, such as physical blocking and/or restraint to prevent the individual from hurting himself or others (Peterson, Ryan, & Rozalski, 2013). There are a variety of crisis/emergency training systems that offer strategies for coping with such situations, including Mandt Training and the National Crisis Prevention Institute (NCPI). It is worth noting that these systems, like PBS, have a major focus on prevent- ing and de-escalating behavior situations before consideration of any kind of physical intervention. Physical engagement with a student must only occur as a very last resort, and then only the minimum amount needed for student and staff safety.

Prior to considering physical engagement, teachers or support staff have a wide range of possible options (Colvin, 2006). These include moving other students and staff out of a room while monitoring the student in crisis; keeping furniture or other objects between staff and the student; introducing calming stimuli into the situation, such as a favored staff person, music, etc.; and engaging in active listening. It is also important for teachers and staff to include strategies in their plan for how best to de- escalate the student and situation once the major crisis is over. Again, most training systems have prescriptive strategies in this regard. Typically there would be minimal or no demands placed on the student for a period of time (i.e., a “cool-down” period). Any detailed discussion with the student about the incident or possible consequences should be postponed to a later point in time when the student is calm. Interactions and requests can then be gradually introduced as the student appears to be able to tolerate them appropriately. It is important to note, however, that the implementation of a comprehensive FBA and a function-driven BIP will greatly reduce the probability of crises.

The use of non-emergency restraint and seclusion procedures has recently become a national issue, due to concerns with the potential highly negative outcomes of such procedures, including physical injury and death for students and/or staff. The U.S. Department of Education recently issued a report summarizing concerns and issues in this area (USDOE, 2012). An initial statement from this report exemplifies the concerns:

“Physical restraint or seclusion should not be used except in situations where the child’s behavior poses imminent danger of serious physical harm to self or others and restraint and seclusion should be avoided to the greatest extent possible without endangering the safety of students and staff.” (USDOE, 2012, p. 6)

National reports of serious injuries and deaths in seclusion and restraint situations have prompted federal lawmakers, including Senator Tom Harkin, to recently intro- duce the Keeping All Students Safe Act (February, 2014). The goal of this legislation is to stop the use of seclusion in school settings, severely limit the use of restraints, and promote the use of PBS strategies as effective alternatives. It is likely that most crises can be avoided with the skillful use of PBS; what remains at issue is that many educa- tors are not adequately prepared to work with students who engage in such severe challenging behaviors; without such skills, the likelihood of ineffective methods and consequent crises are increased.

For students who may escalate to a dangerous level, it is critical that personnel consider possible physical intervention procedures as part of a BIP. They may be acceptable when support personnel consider (1) obtaining informed parental con- sent, and, (2) obtaining district review/approval for any proposed procedures. Addi- tionally, the consideration of more intrusive procedures must involve explicit and ongoing training of relevant staff, and periodic practice in the appropriate proce- dures. Finally, as required by most school districts and state agencies, episodes involv- ing restraint or seclusion must be documented and reported to the appropriate administrative personnel. It is important to remember that the need for such

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procedures is a sign that the BIP needs revision. If school personnel do not have the skills to conduct comprehensive FBAs and develop function-driven interventions, consultation with more skilled professionals is recommended.

The practice standards of the Association for Positive Behavior Support (www .APBS.org) include specific indications that procedures not be used that cause pain or humiliation or deprivation of basic needs.

intervention plan evaluation and monitoring

The behavior support process begins with data collection and analysis, as described above in the sections on FBA. This focus on data-based decision-making must con- tinue throughout the process as well. Once a plan has been developed and imple- mentation has begun, relevant data are crucial for evaluating its impact on an ongoing basis and possible needs for modification. Several steps are important in this process.

Define the Behaviors to Be tracked The BIP should clearly identify and define the behaviors on which data will be col- lected (i.e., definitions of behavior should be observable and measureable). This could include both student and staff behaviors. For example, for a student both chal- lenging behavior and appropriate alternative behaviors might be tracked. With regard to staff, data may be tracked on rates of positive and/or negative interactions, fre- quency of prompting particular behaviors, and implementation of consequences. There must be clear definitions of what aspects of behavior are to be recorded (e.g., frequency, duration, etc.). Staff meetings and training may be needed to develop agreement on the definitions of what behaviors will be counted in which categories; this issue may need to be periodically revisited to maintain general agreement across persons.

who collects Data and when Clear responsibilities must be defined with regard to who will collect data, in which situations, and during which time periods. Various types of charts or lists can be included in student program books or other unobtrusive places as reminders to staff. For example, a frequency data-collection sheet can be included in a student program book so that all relevant staff have the opportunity to collect data when they are working with the student.

who summarizes the Data, how it is summarized, and how often Clear responsibilities must also be defined with regard to who will summarize the data, in what form, and how often this will be done. Graphic formats are highly rec- ommended for summarizing data (Farlow & Snell, 1994). For example, if data are being collected on the frequency of both challenging and alternative behaviors, these data can be plotted on a graph as the number per hour or per day, depending on the frequency of the behaviors. Graphs are capable of presenting a clear picture of stu- dent performance and whether or not there appear to be increasing or decreasing trends in the data.

Various recommendations exist for how often student performance data should be summarized and reviewed (see Chapter 4 for more on measuring and graphing stu- dent behavior). Recommendations may differ somewhat depending on what behav- iors and what stages of learning are being tracked. For example, skill acquisition data might require more frequent summary and review (e.g., at least two, three times per week) so that instruction can be maximally effective ( Jimenez, Mims, & Browder, 2012). Challenging behaviors that may be occurring on a relatively less frequent basis (e.g., 5–10 times per week) would not need to be recorded as frequently as high- frequency behaviors.

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who meets to review the Data and when to make Decisions Making data-based decisions is the most critical aspect of the process and the whole purpose for data collection. There should be a consistent process with regard to who meets, when those meetings occur, and the decision-making process. For example, the lead teacher in a classroom could plan to meet each Wednesday afternoon with his/her paraprofessionals to review challenging behavior data. The plotted data can be reviewed by the group to decide if the data are stable or demonstrating increasing or decreasing trends. Obviously depending on the performance being reviewed, this may lead to differing decisions. If the team is reviewing challenging behavior data, the ideal pattern would be a decreasing trend. If instead the data are stable or demon- strating an increasing trend, the team would need to consider possible options for modifying the intervention plan. Input from all team members would be valuable in discussing why the plan is not being successful, and possible changes that may make things work more effectively.

Basic strategies for Data collection There are a large number of resources available in the behavioral literature that pro- vides detailed procedures and tools for ongoing data collection (Alberto & Troutman, 2012; Miltenberger, 2012). The reader is referred to these and other resources for more detailed descriptions and examples of procedures.

As described above, the first step is to make sure that the behaviors of interest are clearly defined. Second, support personnel must decide on what characteristics of behavior they wish to collect data (e.g., duration, frequency, rate). This will deter- mine the types of recording procedures and tools to be used. If staff wish to collect data on the frequency of behavior (i.e., event recording), there are a large number of options. Support staff can make tally marks on a piece of paper, use a golf counter- type device, make tally marks on a piece of masking tape on the staff person’s arm, move marbles from one container to another when the behavior occurs, or use a vari- ety of apps on their tablet (see Chapter 4 for strategies for measuring behavior).

It is important to note that there is an increasing number of computer-based appli- cations available to facilitate data collection and summarization (see sections below). Some of these may be available at no cost, an important aspect for many personnel working in school settings. It is recommended that support personnel take the time to explore these options online, as many of them may facilitate the data collection and analysis process to be as easy and efficient as possible.

example Behavior intervention plan for micah

An example of a BIP for Micah was provided in Table 7–2. The plan includes the main components that have been discussed above, including the bases and rationale for the plan (including the FBA results), the primary components of the plan, and a summary of data-collection procedures, summary, and evaluation. Again, it is impor- tant to note that this is only one type of possible formats for BIPs.

General issues reGarDinG ethical anD professional Behavior

An important theme running throughout this chapter is that support personnel, along with family members, need to be guided by appropriate standards of ethical and pro- fessional behavior in making decisions about support strategies. This starts at the local level with ensuring that support personnel are working appropriately with pro- fessional colleagues and supervisors, and are following all relevant school, district, and state guidelines and regulations. This is particularly critical with regard to more intrusive or aversive interventions, such as physical restraints. On a broader national level there are a number of sets of standards available from different professional

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organizations that can provide guidance. The Council for Exceptional Children has published a set of ethical principles for special educators (CEC, 2010). These stand- ards focus on the importance of collaborative practice, working with families, and using data- and evidence-based practices. The national Behavior Analysis Certification Board (BACB) has published a set of guidelines for responsible conduct for behavior analysts (BACB, 2010). These cover a broad range of topics, including the use of evi- dence-based practices in functional assessment and interventions, appropriate interac- tions and relationships with students/clients and families, and effective supervision and relationships with colleagues. The Association for Positive Behavioral Support (APBS) has published a Standards of Practice document to guide practitioners (APBS, 2007). Similar to the BACB standards, these cover a range of relevant topics such as the foundations of PBS, collaboration with caregivers and families and other profes- sional colleagues, and the use of effective functional behavior assessment and inter- vention strategies. The APBS Standards of Practice also include a firm position against the use of aversive interventions, and support the use of person-centered assessment and collaboration with families, and emphasize the focus on quality of life as the most critical outcome of behavior support. Along with local and state standards and guide- lines it is highly recommended that support personnel familiarize themselves with these national standards as well, especially those that may be established by their particular relevant professional organizations (e.g., CEC for special education teachers).

technoloGy supports for fBa

Technology has become a ubiquitous part of the lives of most teachers and students. Public schools use computers for standardized assessment, data for teachers to indi- vidualize instruction, data collection to inform instructional planning, online assess- ment, and to access digital content (U.S. Department of Education National Center for Educational Statistics, 2010). The decreasing cost and increasing availability of com- puters have stimulated the development of computer-based FBA observation tools in the last several decades. In the 1990s, several such systems were described in the lit- erature (Storey & Horner, 1991; Kahng & Iwata, 1998). These systems were found to increase the fidelity and reliability of observations by allowing direct data entry into a computer, with automatic time stamping and compatibility with other software pro- grams for data analysis and collaborative sharing. For many practitioners, this elimi- nated the time-consuming and error-prone data transcription process with analog tools (pencil and paper) and enabled the transition to computer-based analysis tools (i.e., Excel, Numbers) and, as a result, increased the efficiency and accuracy of data analysis and graphical representation (Noldus, Trienes, Hendriksen, Jansen, & Jansen, 2000).

Technology use will certainly continue to gain momentum in schools with the increased availability of affordable and intuitive computer technology, data collection software, and intervention tools (Steege & Watson, 2009). While a number of software programs (for a review see Tapp and Wehby, 2000) have been created and used for FBA, they have all previously required a cumbersome desktop/laptop computer or expensive and specialized personal digital assistants (PDAs), which limited both the utility and feasibility of use in a classroom or other school settings. More recently, major advances in PDA software, specifically the iOS handheld operating system, and broadband wireless connectivity have been driving the development of a new genera- tion of technology supports for FBA. We suggest two considerations underlie the application of technology and FBA in classroom and community settings:

1. First, the ultimate purpose of FBA technology is not meant to be an outcome of adopting or documenting its use, but should be seen as the adoption of a

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data-collection tool that is one part of a process of comprehensive PBS that will lead to meaningful lifestyle outcomes for students with behavioral challenges (Reid, 2000). If used correctly, technology does have the potential to increase the sensitivity and utility of functional assessment processes in classroom and commu- nity settings (Hastings & Brown, 2000). But, it is important to remember that sim- ply documenting challenging behavior does not result in behavioral change without sustained interventions at all phases of the competing behavior model. Thus the simple adoption of FBA “high-tech” tools (the how) is less important than collecting FBA data for the development of function-based PBSs (the why).

2. Second, indirect (e.g., paper and pencil) functional assessment tools are still very frequently reported in scholarly journals (Horner, Sugai, & Anderson, 2010) and there are numerous analog functional analysis techniques that focus on both ante- cedent and consequent assessment that can be used in applied settings (Crone & Horner, 2003; Horner, Vaughn, Day, & Ard, 1996; O’Neill et al., 2015). However, it seems clear that practitioners would be remiss to ignore the potential of the cur- rent and evolving technology that is increasingly present in classroom and commu- nity settings to support both FBA and PBS interventions. FBA and PBS intervention technology is still in the early phases of developing an empirical evidence base. The evidence base for current handheld technologies and students with severe dis- abilities is, with a few exceptions of small subject designs (for a review see Mechling, 2011) still largely in its descriptive phase (Edyburn, 2013).

Direct observation tools

fBa Data-collection apps/technology resources Direct observation and data collection are an essential part of the comprehensive FBA process. Direct observation procedures and tools should be structured to provide clear and useful information while their use should not be an excessive burden on practitioners in applied settings (O’Neill et al., 2015). This is of particular importance, as researchers have emphasized that it is critical to conduct naturalistic/ecological (i.e., conducted in the environment in which the behavior occurs) descriptive obser- vations (Chandler, Dahlquist, 2010). The contextual variables of where and when the behavior occurs will have significant impact on the validity and reliability of the behavioral observation data and outcomes. Additionally, the number of observations within and across days can be time consuming and a challenge to accomplish in typi- cal school- and community-based settings. As discussed above, observational data, used in conjunction with archival reviews of existing data and FBA interview tools, can support practitioners in developing accurate behavioral hypotheses that identify the setting events, antecedents, behaviors and maintaining consequences/functions of problem behavior, which in turn, can be used to develop a functionally relevant inter- vention. Use of FBA observation apps and PBS intervention technologies can poten- tially reduce some of this time burden. Often there is an initial time investment to learn how to use the technology, and then, once fluent with the tool, more efficient and accurate observation becomes possible.

In the following section, we introduce the reader to a number of “high-tech” tools that can be used for FBA observations. There will be an emphasis placed on iOS- based applications (apps) as recently, in perhaps the most rapid technological evolu- tion, handheld touch-interface devices with video capture capacity, such as the iTouch, iPad, and iPhone, have become increasingly common for both student and teacher use ( Jameson, Thompson, Manuele, Smith, Egan, & Moore, 2012). Conserva- tive estimates suggest over 4.5 million iPads are currently being used in schools (Etherington, 2013). If one were to count educational apps along with other apps used to access content, such as electronic books, organizational and productivity tools, reference tools, and search engine apps, then the total number of apps would

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likely exceed 200,000 apps (Walker, 2011), with over 200 new apps being submitted for distribution each day. At this point, the number of FBA apps is limited, but the number and sophistication of the apps continue to evolve at a dizzying pace and tech- nology to support PBS and FBA will certainly decrease in cost while experiencing an increase in the sophistication of the tools and ease of use over time.

The majority of the FBA direct observation apps use the A-B-C theoretical approach described earlier (Bijou, Peterson, & Ault, 1968; Cipani, 1993; Zuni & McDougall, 2004). For each behavior observed, there is a record of the behavior and the events that occur long before or directly prior to the behavior (i.e., setting events and ante- cedents), the behavior described in objective terms, and the events that follow the behavior (i.e., maintaining consequences or function) (Kauffman, Mostert, Trent, & Hallahan, 1993). For example, ABC Data (CBTAonline, 2009), is an app allowing pro- fessionals to collect data on the frequency of behaviors while also recording session duration. It has three configurable buttons that can be assigned any label. These three buttons could be assigned to potential antecedents, behaviors, and functions or assigned to three different behaviors. It could be a very useful tool for behavior track- ing especially if time/frequency is an important dimension of the target behavior. A more powerful tool, ABC Data Pro (CBTAonline, 2010), allows the user to configure more buttons (nine) for tracking more antecedents, behaviors, and functions and allows for behavior and/or event counting, partial-interval recording, full-interval recording, and A-B-C event recording. Automatic data summary is possible for fre- quency and interval data.

Other direct FBA observation tools include iBAA (Future Help Designs, 2012), an FBA app for the iPhone designed for professionals to observe and record qualitative observations, develop cumulative tabulations of behavioral occurrences, conduct interval recording, and collect FBA data. The Functional Behavioral Wizard (WhizzWhatt Software, 2014) allows practitioners to simultaneously conduct FBAs for multiple behaviors using frequency or duration counts and allows for the individuali- zation of each assessment to accommodate the observation of several individuals with the same app (which is a common feature in almost all of the described FBA apps). BehaviorSnap (SuperPsyched, 2013) is a behavior observation tool created to identify the frequency, duration, and function of the targeted behavior(s). ABC Logbook (CBTAonline, 2011) is a data-collection app that allows for the concurrent observation of a large number of behaviors for many individuals. The app comes with built-in data analyses and the ability to calculate reliability data. The FAO Observer Tool (JBROS Software, 2012) is basically an A-B-C recoding tool, but with each behavioral incident there is a time-stamped competing behavior summary pathway developed that prompts school personnel to teach competing and desired behaviors while hon- oring the function of the observed behavior.

Perhaps the most promising FBA tools are the ones that incorporate built-in video recording of behaviors. This function allows individuals to not only record live data, but to revisit the behavior to code it at a later time, both to obtain interrater reliability and to reconsider the testable hypotheses derived during the initial stages of the FBA. These direct FBA observation apps include the Tantrum Tracker (Grant Technology Services, 2013), which has the ability to record video or take photos of behavioral incidents from within the app. However, the data collection and analysis are not linked directly to the recorded video, so one might argue that all the apps described to this point have the same capacity, given that all iOS devices have video-capture capacity as a built-in feature. Behavior Tracker Pro (Marz Consulting, 2011) allows practitioners to track behaviors and automatically develop a graphical representation of relevant behavioral dimensions (e.g., A-B-C, frequency, and duration). This app has the option to record video. Perhaps the two most powerful FBA apps are the ABC Video Pro Lite (CBTAonline, 2013b) and ABC Video Pro ($49.99) (CBTAonline, 2013a). Developed by CBTAonline (2013), these apps combine the capacity to analyze both video recordings and live observations. The ABC Video Pro app is the most powerful

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one and has 30 configurable buttons that can be prepopulated to identify anteced- ents, behaviors, and functions of observed behaviors. As a result, data entry is quick and easy and helps maximize the reliability of the FBA data. Sharing the data with team members and other pertinent stakeholders is simple as the user can easily email the data from within the app. Data output is automatically organized by a time-based index of observed events. The apps also include measures to ensure security and con- fidentiality of student data while facilitating sharing with pertinent stakeholders. Based on the examination of the previously described tools, Jameson, Bruhn, and Hawken (2015) have identified five key features of an FBA direct observation app:

1. The app should allow practitioners to track antecedents, behavioral occurrences, functions, and maintaining consequences of the behavior.

2. The app should allow the ability to assign values to buttons/fields to simplify and streamline data collection that is automatically time-tagged and automatically organized.

3. The app should be able to track multiple individuals and have individualized as- signable buttons to record the observed A-B-Cs of challenging behavior to validate the hypotheses/summary statement(s).

4. The app should have the capacity to easily export data to other software for graph- ical representation, or the ability to develop graphs within the app.

5. The app should have the ability to easily export data to relevant stakeholders via email or other file formats.

technoloGy tools to support intervention strateGies

In addition to the assorted technology tools for collecting FBA data in the classroom, multiple “high-tech” tools exist for developing/implementing function-based interven- tions for students with severe disabilities and with challenging behaviors. In this sec- tion, we examine apps that may be used to address setting events, or antecedent-based strategies for prompting desired behaviors. Other apps may be used to identify instructional options targeting deficits in specific skills, activities, or routines. Finally, we describe how apps can be used as consequence-based interventions. These apps address maintaining consequences through the use of reinforcement and provide practitioners guidelines for the selection of FBA and PBS apps.

setting events

As discussed previously, setting events often provide the environmental, social, or physiological context for challenging behavior (Alberto & Troutman, 2012). Specifi- cally, setting events can create the context for behaviors to occur, or for behaviors not to occur, as well as alter the relative value of reinforcers or maintaining consequences (Kazdin, 2011). Setting events can help explain why antecedents (i.e., events immedi- ately preceding behavior) trigger problem behaviors. Thus, setting event-based inter- ventions may be used to decrease the likelihood an antecedent will trigger negative behaviors. Setting event technologies are often rooted in developing effective meth- ods of communication with families or support providers about environmental, social, and physiological variables both proximal and in the past that will impact the occur- rence of challenging behavior. For example, Track & Share (Track & Share Apps, 2013) is an app for self-monitoring that allows individuals and families to track sleep patterns, mood states, diet, levels of stress, and pain, and communicate with practi- tioners on an ongoing basis. Medication Tracker (iMedications) (iHealth Ventures, 2013) is an app that allows an individual and family to track and manage medications as well as monitor changes that occur over time. Day One (Bloom Built, 2014) is a journaling app that allows users to chronicle the events of each day. The app

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automatically records the location, time of day, weather, and other variables associ- ated with the environment and social interactions that might influence the occurrence of challenging behaviors. Due to the number of similar apps that could be used to support individuals at the setting event level, a comprehensive review is impossible; however, much like the selection of interventions, practitioners will need to become skilled at locating apps and evaluating the quality of the information they can get from a specific app related to the environmental, social, and physiological setting events that are impacting the individual’s behavior.

antecedent interventions

Antecedent-based interventions involve immediate adaptations and modifications to the environment that will encourage the individual with severe disabilities to perform the alternate or desired behavior rather than the challenging behavior. Antecedent interventions typically focus on the environment, scheduling and rou- tines, organizational tools, visual or audio cues, securing student attention, meth- ods of instruction, opportunities to respond, self-management procedures (e.g., self-monitoring, goal-setting), sensory stimulation, and communication aids ( Jameson, Bruhn, & Hawken, 2015; Kern & Clemens, 2007). For example, Micah was hypothesized to engage in self-injurious behavior while waiting during transi- tions. iPrompts (Handheld Adaptive, 2013) allows for the creation and presentation of visual supports, such as visual schedules or task analyses to help students pre- pare for transitions and the process involved. This app could help Micah receive visual prompts to wait appropriately during transitions as well as make the daily schedule and transition times visually apparent to him. Antecedent apps are designed and selected around six basic areas of support ( Jameson, Bruhn, & Hawken, 2015): (a) the physical environment, (b) apps that facilitate organization, scheduling, and routine development, (c) apps that provide preventive visual or audio cues about the sequence of an activity or self-regulation strategies, (d) apps that support differentiated instruction that targets the student and family’s needs, interests, and strengths, (e) apps that provide instructional cues, (f) apps that focus on issues of sensory stimulation and allow access to or avoidance of sounds and visual cues that are desirable or undesirable to the student with severe disabilities, (g) apps that incorporate self-management strategies to help students take more ownership in defining the challenging behavior and setting goals to reduce it, and (h) communication apps and that can be used to assist students in communicative efforts (Kern & Clemens, 2007). There are literally thousands of iOS-based apps that could be used in individualized PBS as antecedent level interventions; there- fore, app selection should be guided by the needs identified in the FBA process and the apps should be selected and specifically targeted toward supporting function-based antecedent interventions.

Behavioral teaching applications

Self-management should be used not only as an antecedent-based strategy utilized to prompt positive behaviors, but also as a behavior-based strategy because the first part of any self-management strategy (e.g., self-monitoring, goal-setting, self-instruction) involves the student learning what the behavior is and is not. Before students can monitor and record their own behavior, they must be taught what the behavior looks like and how to be aware it is occurring. For example, Jamila vocalizes loudly when placed in novel situations. Too Noisy (Walsall Academy, 2014) is an app that could be used to help teach Jamila to self-manage the intensity of her vocalizations as the app displays a noise meter and visual indications of acceptable and unacceptable levels of noise. Other evidence-based behavioral interventions for students with severe disabil- ities include social stories and video modeling.

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259Designing and Implementing Individualized Positive Behavior Support

Video modeling, or observational learning, involves students using observation of desired behaviors to learn how to demonstrate those behaviors (e.g., positive social interactions, turn-taking, requesting assistance). For example, a student watches a video demonstration of a behavior and then is given opportunities to imitate the same skill (Bellini & Akullian, 2007). Many skills including motor behaviors (e.g., gripping a pencil), social skills, communication, self-monitoring, functional skills (e.g., brush- ing teeth), vocational skills, athletic performance, and emotional regulation can be taught using video modeling (Hitchcock, Dowrick, & Prater, 2003; Starek & McCullagh, 1999). Researchers have suggested that video modeling is an effective intervention for a variety of students; particularly students with autism spectrum disorder (ASD) are known to benefit from visually-cued instruction (Bellini & Akullian, 2007). Students with ASD tend to respond positively to video modeling for two primary reasons: (1) The anxiety often felt by students with ASD when interacting with other people might be reduced because they are interacting with technology instead; (2) students with ASD may find videos to be highly motivating and, thus, are able to focus their atten- tion on the videos (Bellini & Akullian, 2007). TherAd for Autism (Marz Consulting, 2013), My Pictures Talk: Video Modeling Tool (Grembe Inc., 2014), and Stories2Learn (MDR, 2014) are iOS-based apps that support the easy development of video-modeling lessons with video, audio, and text. There are also a number of social story apps, including iCreate … Social Skills Stories (I Get It, LLC, 2014), Social Stories (Proteon Software, 2014), StoryMaker (Handheld Adaptive, 2013), and the Social Skill Builder (Social Skill Builder Inc., 2014). Given the large number, even within specific catego- ries of apps, guidelines for the selection of appropriate and useful apps will be described at the end of the chapter.

consequence interventions

Consequence interventions are used after a behavior occurs. These strategies should be used to increase the occurrence of positive behaviors, and reinforcement should match the function of behavior. Reinforcement typically involves attention, access to tangibles, access to preferred activities, and sensory stimulation. While devices them- selves have some reinforcing effects ( Jameson, Thompson, Manuele, Smith, Egan, & Moore, 2012), there are several apps that can be used to develop systematic reinforce- ment. Additionally, many apps developed for the purpose of reward-tracking can address multiple functions at once. For example, ClassDojo (Class Twist, 2014), Live- School (Live School, 2014), and iReward (Gotclues, 2009) can all be used by practi- tioners to establish behavioral expectations and to track secondary reinforcers that can be exchanged for more powerful primary reinforcers as desired.

communication

Communication skills are among the top priorities for students with severe disabili- ties. Effective communication skills enable students to express their thoughts and needs, to respond to interactions with others, and to obtain or refuse objects or activi- ties. The ability to communicate with teachers, family, and friends supports the devel- opment of meaningful social relationships in all settings. Without an effective means of communication, individuals with severe disabilities are too often not able to express preferences and, as a result, lose much of their capacity to live a self- determined life. Participation in lectures, small and large group settings, and individ- ual interactions with others are all contexts for communication that will enable students with severe disabilities to make choices and express desires. Carr and Durand (1985) found that teaching communication strategies, which are evaluated as an intervention for a variety of problem behaviors, resulted in initial reductions in challenging behaviors. There is an increasing number of AAC apps available, includ- ing Pogo Boards: AAC (Talk To Me Technologies, 2013), SpeechHero AAC (McKinney,

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2013), TalkBoard (Ashley, 2014), urTalkerPro (ProTalker.com, 2013), iMyVoice (Techno M.A.G., 2014), VoiceSymbol AAC (Unlimiter, 2014), and Proloquo2Go (Assis- tiveWare, 2013).

Finally, perhaps one of the most important skills current practitioners can have is the ability to locate and evaluate apps among the massive number already in exist- ence and that is growing continually. There has been a number of rubrics developed to help guide app evaluation and selection. As you will see in Table 7–3, Jameson, Bruhn, and Hawken (2015) have consolidated some of the rubrics into the five most important questions to consider when selecting an app to use for PBS (for either observation or intervention).

TABLE 7-3 Questions Used to Guide the Selection of Technology Applications

(Modified from Jameson, Bruhn, and Hawken (in Crone, Hawken, & Horner, 2015).

1. Is the app user-friendly and intuitive? Apps should be simple to use. If they require high levels of technological skill or need additional information/instructions to be effectively used, then practitioners should ask additional questions such as the following: Is there a developer website, product description, or instructions the user can access for additional help? Does the app have user tips and instructions built into the tool? In the end, if the app is too complex or does not have enough support resources for the user to learn to effectively use it, the app should not be chosen for use in the FBA process.

2. Is it cost efficient? Schools continually struggle with the availability of resources. Many apps advertise as being “free,” but many of the apps that claim to be “free” allow the user only limited access to available features and the user is forced to make in-app purchases to effectively use the tool. Practitioners should get in the habit of checking on the in-app purchases available with any app chosen to ensure that the app is truly cost efficient without ongoing subscription costs or limited access to more robust features within the app. In the case of many apps, it is too often true that you get what you pay for. It is essential to carefully search the app store, read the user reviews if available, identify any in-app purchases that are essential to the function of the app, and determine if the app fits within the resource constraints of classroom, school, and community-based support settings.

Is it age and socially appropriate? The app must match the students’ abilities (e.g., can they match pictures; read), as well be age appropriate. For example, some students with severe intellectual disability may have a difficult time using complex self-management apps. Also, it would not be age appropriate for a high school student to have an app that has nursery rhyme characters.

3. Does it support the intervention you are trying to implement and the behavior you are trying to change? Too often, schools purchase technology without any clearly defined purpose or outcome identified. Unfortunately, when it is not clear how to use the technology, the tools often sit unused in classrooms or the tools are not used in a way that enhances instruction or intervention and are simply used for reinforcement. Technology should be used thoughtfully to enhance what is already being done, to engage the student, and to provide meaningful support for long-term, lifestyle-changing outcomes. Practitioners must be confident that the app supports the strategies most likely to bring about the targeted behavioral change.

4. Does the app and its intended use address relevant phases of the competing behavior model? It is imperative that the functional outcomes of the app support practitioners’ implementation of targeted interventions to the setting events, antecedents, teaching and promoting alternate and desired behavior, or consequences/reinforcements identified in the FBA process. For example, in Micah’s case, a setting event app that would be appropriate would be a sleep-tracking app to address the setting event (sleep patterns) that influence the likelihood of his problem behavior. A medication-tracking app would not be helpful as the FBA process did not identify medications as an influence on his behavior.

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261Designing and Implementing Individualized Positive Behavior Support

learninG outcome summaries

7.01 Development of Positive Behavior Support (PBS) Learning Outcome Describe the important changes in the field of behavioral support as a result of the evolution of PBS.

Behavior support for persons with severe disabilities who exhibit challenging behaviors has substantially evolved in recent decades to become more focused on assessment of the motiva- tion for such behaviors, teaching alternative skills, and reinforcement of appropriate behaviors.

7.02 Development of PBS in Schools: Multi-Tiered Systems of Support (MTSS) Learning Outcome Describe the three levels of MTSS in schools.

A significant part of the evolution of PBS has involved three-tiered levels of support in school settings. However, more work is needed to understand and ensure the participation of students with severe disabilities in all levels of support.

7.03 Inclusion of Students with More Severe Disabilities in MTSS Learning Outcome Describe some of the obstacles to and solutions for the involvement of students with more severe disabilities in MTSS.

A variety of modifications may be needed to facilitate the involvement of students with severe disabilities in all three tiers of MTSS. For example, communication adaptations may be help- ful, such as picture systems and alternative communication devices, to facilitate student understanding and participation.

7.04 Components of Individualized PBS Learning Outcomes 1. Describe the three phases of implementation of individualized PBS. 2. Describe the five desired outcomes of the functional behavioral assessment

(FBA) process. 3. Describe some of the tools and strategies that should be considered for imple-

mentation prior to conducting an FBA.

More intensive individualized PBS requires (1) a major focus on functional behavior assess- ment of challenging behavior, (2) multicomponent behavioral intervention plans, and (3) incorporation of technology supports to facilitate the process as needed and appropriate.

7.05 Overview of the FBA Process Learning Outcome Describe the six phases of the process for conducting an FBA and development of a behavior intervention plan (BIP).

Functional behavioral assessment may involve indirect assessments (interviews, rating scales), direct observations, and functional analysis manipulations. These assessments are used to collect data to guide the development of comprehensive behavior intervention plans.

7.06 Indirect Data Collection Learning Outcomes 1. Describe the different categories of strategies for indirectly collecting relevant

information during the FBA process. 2. Describe how information from indirect methods should be summarized in

hypotheses/summary statements.

Indirect data collection may include the use of interviews, rating scales, and questionnaires administered to relevant persons (parents, teachers, other caregivers). Information from

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such procedures is used to develop hypotheses or summary statements about the factors predicting and reinforcing the occurrence of challenging behaviors.

7.07 Direct Observations Learning Outcomes 1. Describe the different strategies for collecting data via direct observation. 2. Describe how information from direct observations should be summarized in

hypotheses/summary statements.

Direct observations, such as A-B-C data collection, provide more systematic information on the factors predicting and reinforcing the occurrence of challenging behaviors. This informa- tion can help confirm or disconfirm the hypotheses or summary statements being generated regarding challenging behaviors.

7.08 Functional Analysis Learning Outcomes 1. Describe the general process involved in conducting a functional analysis to

test hypotheses concerning challenging behaviors. 2. Describe how information from functional analyses should be summarized in

hypotheses/summary statements.

This is a procedure that involves manipulating environmental events (antecedents and con- sequences) to assess their influence on challenging behaviors. This procedure may help when initial assessment results are unclear, and may help confirm or disconfirm the sum- mary statements being generated regarding challenging behaviors.

7.09 Behavior Intervention Plan Development Learning Outcomes 1. Describe the basic critical aspects of behavior intervention plans (BIPs). 2. Describe the components of the competing behavior analysis (CBA) process. 3. Describe the different possible formats for writing BIPs.

A competing behavior analysis (CBA) can help guide the development of strategies for pro- moting the occurrence of positive desired behaviors and decreasing the likelihood of chal- lenging behaviors. Behavior intervention plans need to be comprehensive and include strategies for preventing challenging behaviors, teaching and promoting positive alternative behaviors, and managing consequences for both.

7.10 Potential Intervention Plan Components Learning Outcomes 1. Describe the different possible support plan components (e.g., motivating op-

erations, antecedent strategies) and give an example of each. 2. Describe the process for intervention plan evaluation and monitoring, and why it

is so critical.

Behavior intervention plans must address issues with (1) setting events/motivating operations, (2) more immediate antecedents, (3) teaching and promoting positive alternative behaviors, and (4) consequences for both desired and challenging behaviors. In addition, plans must specify who will be collecting data on the plan impact, and who will meet and how often to summarize and assess the data and make decisions about ongoing plan implementation.

7.11 General Issues Regarding Ethical and Professional Behavior Learning Outcomes 1. Describe why it is critical to follow ethical and professional guidelines in the

PBS process. 2. List three professional organizations that provide ethical and professional stand-

ards to guide practitioners.

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263Designing and Implementing Individualized Positive Behavior Support

A wide range of ethical and professional issues may arise in providing support in situations involving challenging behavior. Professional support personnel (e.g., teachers) must be knowledgeable about local, state, federal, and professional guidelines and laws governing the implementation of PBS procedures.

7.12 Technology Supports for FBA Learning Outcome 1. Describe two technology tools/applications and how they can be used in the

FBA process.

A variety of technological tools are available to support the FBA process. Support profes- sionals (e.g., teachers) should make themselves aware of these tools that can make the support process both more efficient and effective.

7.13 Technology Tools to Support Intervention Strategies Learning Outcome Describe two technology tools/applications and how they can be incorporated into intervention strategies that are part of a BIP.

A variety of technological tools are available to support various aspects of the intervention process. Support professionals (e.g., teachers) should make themselves aware of these tools that can make the support process both more efficient and effective.

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8 Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

Donna Lehr Boston University Nancy Harayama Boston University

8.01 Students with Special Health Care Needs Defined Learning Outcome Identify the types of health care conditions likely to be present in students with complex health care needs that require specialized knowledge to assure their inclusion in school settings.

8.02 General Knowledge of Health Care Procedures Learning Outcome Describe methods to help school personnel develop the essential general knowledge to assure safe care of students with complex health care needs in school settings.

8.03 Understanding Specialized Health Care Procedures Learning Outcomes 1. Describe specialized roles and responsibilities of school personnel as related to the provision of health care to students with complex health care needs. 2. Describe methods to help school personnel develop the essential specialized skills to assure safe care of students with complex health care needs in school settings.

8.04 Care Coordination Through Communication Learning Outcome Describe communication processes necessary to assure health, safety, and inclusion of students with complex health care needs in school settings.

8.05 Inclusion in the General Education Setting Learning Outcomes 1. Describe procedures to ensure that students with special health care needs are included suc- cessfully and accepted by peers. 2. Describe methods for teaching students with special health care needs so that they can partici- pate in performing the routine health care procedures; and describe methods to embed other instructional goals into health care procedures.

8.06 Other Considerations Related to the Education of Students with Special Health Care Needs Learning Outcome Identify other issues and practices essential for the safe care and effective education of students with complex health care needs.

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265Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

IntroductIon

Tube feeding, suctioning, ventilation, catheterization. These are all health care proce- dures frequently needed by individuals with specific medical conditions, and most often are provided in hospitals settings. However, they are also needed by some indi- viduals with severe intellectual and multiple disabilities, and while they are at public schools being educated in general education settings alongside their peers without disabilities. The need for these health care services for students while at school is a relatively recent phenomenon and it has come about as a result of the evolution of some practices, both medical and educational, and in society’s changed attitudes toward individuals with disabilities. In the past, often young children dependent on medical technology did not live long enough to be students (Lehr, 1990). Now, improved medical care has enabled them to live past critical care periods; however, often with a continued need for health care support, including the use of medical technology, to sustain their health. Further, if young children did survive the critical care period and they had an ongoing need for health care support, they were edu- cated in hospital settings, institutions, or at home (Lehr, 1990). Now, with the increas- ing inclusion of students with severe disabilities in general education schools and classes, and the increased portability of medical equipment necessary for the provi- sion of the needed health care services, many of these students are now being edu- cated in general education settings and receiving the needed services right there at school (Rehm, 2002).

Providing health care services, while also educating these students, is a complex task. Their care requires a great deal of specific information about and competency in implementing the health care procedures the students need. But provision of the health care services is an essential first step only. Yes, first and foremost, students have to be safe at school, but they also have to be treated as students and not just as patients. It is critical that the students’ educational, as well as health care needs, be met and that a team of professionals work to integrate the students’ care with educa- tion (Lehr, 2014).

This chapter is designed to first create a clear understanding of what it takes to meet the health care needs of students while they are at school. This understanding has to start with the definitions and terminology used in the field. But students with special health care needs are more than the terms used to describe them. Vignettes of several students with special health care needs are presented and are designed to give a clearer picture of the students and the complexities of their needs.

In subsequent sections of this chapter, we describe the basic preventive procedures that must be put in place to make school settings safe, not just for these students, but all students. These include implementation of universal precautions and hygienic care providing practices. Next we will provide general information about many of the spe- cific health care procedures that are required by students in schools. The information included is intended to give broad background information about some of the likely health care services some students need, but it is important to note the information included is insufficient to assure competence in administering the procedures. Later in this chapter, we discuss the types and level of training necessary by different personnel in school who interact with the students. Finally, we will discuss the critical need for communication among the school community, family, and health care providers, and critical issues surrounding students with special health care needs.

StudentS wIth SpecIal health care needS defIned

A broad definition of children with special health care needs is provided by the U.S. Health Resource and Services Administration, Maternal and Child Health Bureau, as “those who have or are at increased risk for a chronic physical, developmental,

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behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally” (McPherson et al., 1998, p. 138). These children have a wide range of health conditions, and those health condi- tions affect daily functioning in a variety of ways. The health conditions that may result in the need for special health care include asthma, diabetes, epilepsy, etc. The impacts include difficulty with respiration, eating, digestion, and other basic functions.

Surveys by the Child and Adolescent Health Measurement Initiative of the Maternal and Child Health Bureau (2012) reveal an increased number of children reported in this broad category of children with special health care needs over the past decade and a half. In 2001, the percentage was 12.8%; in 2005/2006, 13.9%; in 2009/2010, 15.1%, and in the more recent survey in 2012, the reported number was 19.8%. There are no data that exist regarding the number of students who have severe disabilities along with special health care needs. It is logical to assume, however, that while the number of students with severe disabilities is low (generally considered to be 1% of the general population of students), the proportion of those students with special health care needs is higher than in the general population.

It must be noted that while the phrase students with special health care needs is what is used in this chapter, others refer to this population of students, particularly those who are dependent on medical technology, as medically fragile. As Lehr noted elsewhere (1990), this terminology is not accurate and it is off-putting. While careful attention must be paid to ensure these students’ care and safety, it is the case that if the children survive long enough to become students, they are not fragile, but are instead quite resilient. Moreover, the term “medically fragile” seems to cause alarm among those who have responsibility for providing services to them: If they are frag- ile, perhaps they will break. It is for these reasons that the term students with special health care needs is used.

Anh

Anh is a five-year-old kindergartener who loves Pinkie Pie from My Little Pony and anything that is the color pink. She has cerebral palsy and has been in inclusive programs since she began preschool. She receives specialized instruction, related services, and adapted materials to participate in school activities such as morning circle, readers’ workshop, math block, lunch, etc.

She is non-ambulatory, and uses a wheelchair for mobility, and her one-to-one aide pushes her wheelchair. She uses a prone stander to strengthen her leg muscles, and is being evalu- ated for the use of a gait trainer to support her as she learns to walk. She communicates using a combination of vocalizations, eye gaze, reaching toward objects and picture communication symbols, and hitting a BigMack® voice-output device.

She was diagnosed with failure to thrive as an infant, and receives a substantial portion of her caloric and fluid intake through a G-tube. The current plan is to increase the amount of food she ingests by mouth and is now receiving small amounts of pureed foods. Strawberry yogurt seems to be Anh’s preference, as she often selects it via eye gaze when presented with sev- eral options. She uses a conversation board to engage in social interaction with her peers during lunch.

Ahn also has a tracheostomy tube (trach) through which she breathes, and she requires pe- riodic suctioning. Anh is able to signal her need for suctioning by hitting a switch on her wheel- chair. The trach cover ensures that small objects such as glitter, beads, sand, etc. used by kindergartners do not enter the trach tube.

D’Shawn

D’Shawn is a fourth grader, and he likes the cartoon, Monsters vs. Aliens. He is a survivor of a near-drowning accident. As a consequence of the accident, he lost his ability to walk, had res- piratory failure due to hypoxemia, and is dependent on a ventilator to assist his breathing. Al- though he has not yet met the criteria for ventilator weaning, he is reported to be improving.

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267Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

General KnowledGe of health care procedureS

To best accommodate students like Ahn, D’Shawn, and Hector, all schools should have in place both preventive health care procedures and procedures that can be implemented in the case of emergencies, both big and small. Knowledge of what to do if Hector has an allergic reaction is key, but it is insufficient if the only one who knows what to do in the case of an emergency is the school nurse. Data show that few schools have full-time nurses and that they travel from school to school within districts (National Association of School Nurses, 2007). What if the nurse is not in the school building at his time of need? And, since Ahn is trach dependent and her air- way must be cleared periodically via a suction tube, not only do school personnel have to have the specialized expertise necessary to perform the suctioning, but more careful attention must be paid to the general environment in terms of hygienic care- providing practices as well. Ahn is quite vulnerable to infection due to the opening in her throat. To decrease the risk of transmission of infectious diseases, including even just the common cold, careful handwashing, sanitizing, and disposal methods must be used to minimize risks to her—and to all students—in the school.

hygienic practices in Schools

Schoolwide attention to implementation of universal precautions and infection con- trol is necessary for the care of all children and critical for the care of students like Ahn, D’Shawn, and Hector. Their compromised health makes them more vulnerable to infections. Other students with severe disabilities also may demonstrate behavioral patterns (e.g., pica, lack of control of body secretions, etc.) that put them at an increased risk for disease transmission. But proper handwashing routines on the part of staff and students, as well as specific routines related to sanitization of classroom surfaces and materials and appropriate diaper disposal, decrease the risk of transmis- sion of infectious and contagious diseases for all students.

universal precautions Universal precautions “is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens” (Occupational Safety and Health Administration, n.d.).

Since transferring to the school district at the beginning of the year, he has been included in the general classroom setting. He has a nurse that accompanies him at all times, including on the bus ride to and from school. D’Shawn uses a manual wheelchair that he is learning to pro- pel and a Dynavox EyeMax® for communication.

Hector

Hector is a ninth grader who is an avid Red Sox fan and can recite many baseball statistics. He has a diagnosis of autism, and the transition from middle school to high school has been challeng- ing, but the use of video modeling has improved his social skills. He is taking core classes with his general education peers, and all materials are adapted for him. He particularly enjoys his algebra class, because his teacher often includes baseball as the context for the word problems.

Hector has a seizure disorder for which he receives medication; however, he continues to have generalized seizures about once a month. All staff members have been trained to re- spond to his seizures by providing basic first aid, and to allow him to rest after the seizures occur. After he regains full alertness after the seizure, he sometime becomes agitated, because these seizure was an interruption to his familiar and preferred routines.

Hector is also allergic to peanuts, and although the school is a nut-free environment, he has an EpiPen® (i.e., epinephrine injector) with him at all times. His teachers have been trained on the use of the EpiPen®. He has also received instruction to distinguish “safe” from “non-safe” foods (i.e., those that contain peanuts) based on food type and appearance, and the teachers are teaching him to read ingredients lists.

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Initially, the use of appropriate handwashing techniques and use of personal protec- tive equipment (e.g., gloves), regardless of the known health status, were intended to minimize risk of infection and reduce stigmatization of individuals who had tested positive for HIV. Now, The Center for Disease Control (CDC, 2011a) advises the use of standard precautions when handling blood, bodily fluids, secretions, excretions, and mucous membrane regardless of the infection status of the individuals who are being cared for. While routine in hospital and health care settings, they are not stand- ard practice in schools, but need to be.

Handwashing. Simple handwashing is a critical first step to prevent the transmission of diseases. Handwashing should occur prior to food preparation, consumption of meals, feeding children, treatment of injuries, and following the use of the toilet, dia- per changes, and potential contact with bodily fluids including those from coughing/ sneezing, playing in sandbox and playground structures, and disposal of garbage (CDC, 2013a; National Resource Center for Health and Safety in Child Care and Early Education, 2011a). The CDC recommends that all staff and students be trained to use correct handwashing techniques. They provide posters that can be printed out and posted near sinks and that delineate the following steps (CDC, 2013a):

• Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

• Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

• Rinse your hands well under clean, running water. • Dry your hands using a clean towel or air dry them.

One additional step recommended by the American Academy of Pediatrics is that the faucet be turned off using disposable paper towel, and that the used paper towel be disposed of in a trash container with lining (National Resource Center for Health and Safety in Child Care and Early Education, 2011a). Also, it must be noted that the rec- ommendation by the CDC (2013b) is that, whenever possible, soap and running water be used for handwashing and that alcohol-based sanitizers be used only when run- ning water is not available. If sanitizers must be used, the CDC (2013b) suggests the alcohol content be at least 60%.

Disinfecting the Environment. A hygienic learning environment can be maintained through adherence to a schedule of cleaning (“physically removing all dirt and con- tamination”), sanitizing (“reducing germs”), and disinfecting (“destroying germs”) of areas used for food preparation, meals, and toileting as well as the classroom furni- ture and materials (National Resource Center for Health and Safety in Child Care and Early Education, 2011b). A cleaning calendar that identifies materials that must be cleaned, sanitized, or disinfected prior to or subsequent to use, on a daily, weekly, or monthly basis should be developed. Of particular concern are the objects that have been mouthed by students, including those that may have been used during meals and for speech therapy. These objects should be placed in a separate area to be washed, sanitized, and dried before subsequent use. (For more information, see the National Resource Center for Health and Safety in Child Care and Early Education, 2011c, Appendix K: Routine schedule for cleaning, sanitizing, and disinfecting.)

Waste Disposal. For students who require diapering, a protocol to minimize contami- nation should be followed. This includes methods for decreasing transmission of body fluids between the students and the staff and among multiple students. Soiled diapers should be placed in “washable, plastic-lined, tightly covered receptacles, with

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269Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

a firmly fitting cover that does not require touching with contaminated hands or ob- jects, and should be provided within arm’s reach of diaper changing tables” (National Resource Center for Health and Safety in Child Care and Early Education, 2011d, Standard 5.2.7.4: Containment of soiled diapers). Hands-free receptacles eliminate the need to touch a lid or handle with soiled, gloved hands. (For more information, see National Resource Center for Health and Safety in Child Care and Early Education, 2011e, Standard 3.2.1.4: Diaper changing procedure.)

Allergy Control. Another type of preventive care in the classroom or school is de- signed to reduce allergens in the school environment. For some, allergic reactions can be mild (cold-like, or a mild skin irritations), while for others, allergic reactions can be life-threatening. Recognizing the possible seriousness of allergic reactions is an important step in making sure that schools are safe for all students, especially since it appears that allergies in children are increasing ( Jackson, Howie, & Akinbami, 2013). Allergies are the result of an individual’s immune system reacting to substances to which most other individuals do not react. The substances are considered foreign bodies, and the immune system works overtime to fight off the foreign bodies. The substances can be encountered via food (e.g., peanuts), the air (e.g., ragweed, animal dander), direct skin contact (e.g., poison ivy, latex), medications, (e.g., penicillin), or insect bites (bee or wasp stings). The reactions can be mild requiring no care, or se- vere, which can lead to anaphylaxis, and possibly anaphylactic shock, requiring rapid treatment. Given an understanding of the potential seriousness of allergic reactions, attempts can be made to prevent individuals’ contact with the sources of the prob- lems, or if not possible, to provide emergency treatment as necessary. What follows is information about some of the most common allergies affecting students in schools and preventive responses to them.

The most common foods that trigger an allergic response are “milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts” (Boyce et al., 2010, p. 1105). Observable symptoms may include those that impact the skin (e.g., hives and rashes), digestive system (e.g., nausea, diarrhea), respiratory system (e.g., coughing, difficulty breathing, tightness of the chest, etc.), circulatory system (e.g., changes in pulse, blood pressure, etc. that may lead to loss of consciousness), and even the mucous membrane (e.g., swelling of the lips, tongues, and eyes) (CDC, 2013c). These reac- tions may occur quickly or may occur an hour or two after eating or contact. The allergic response can be mild or acute and life-threatening and may be related to the manner of exposure (e.g., ingestion, inhalation, skin contact) as well as other factors such as age, speed of absorption, and level of activity (CDC, 2013c).

Preventing ingestion and contact can decrease the risk of triggering an allergic response. Some schools ban certain food products (e.g., peanuts), something that would be necessary for Hector, and alternately, some designate allergen-free zones (e.g., specified area in the cafeteria). Preventive strategies recommended by the CDC (2013c) for the various areas and activities are described below:

• Classroom: Use designated seating to minimize exposure; and, refrain from using allergens in classroom celebrations, craftwork, science experiments, and as food reinforcers.

• Meals: Store foods in designated cubicles/lockers, discourage sharing, encourage handwashing prior to and after meals/snacks, provide information for substitute teachers.

• Cafeteria: Make meal accommodations for USDA’s Child Nutrition Programs by ob- taining a physician’s statement, specify a separate allergen-free zone for meal prep- aration, send home menus to parents, maintain records of foods served for a minimum of 24 hours in case of a reaction, check food labels frequently in case of changes in ingredients.

• Transportation: Prohibit food from being consumed on buses, train bus drivers and monitors for emergency responses.

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• Field trips, special events, etc.: Do NOT prevent students with allergies from par- ticipating, and do NOT require parents of students with allergies to attend, pack allergen-free meals/snacks.

Allergens are not restricted to foods, and some individuals may be allergic to prod- ucts that are used in the classroom, for example gloves. Some gloves are made of latex, which is secreted from rubber trees, and often is used in the production of gloves that we use as a part of universal precautions in food handling and care pro- viding. Individuals who have had repeated exposure (e.g., students who have had numerous surgeries, health workers who use latex gloves routinely, and individuals with spina bifida) are at higher risk of developing latex allergy (American Academy of Allergy, Asthma & Immunology, 2014; American Latex Allergy Association, 2014). It is important to remember that balloons, and in rare instances, rubber bands, erasers, and toys may contain latex and trigger a response. Furthermore, half of those indi- viduals with latex allergy are also allergic to certain foods such as bananas, kiwis, and avocados (American Latex Allergy Association, 2014). For students who require dia- pering, the use of latex-free gloves is recommended whether or not these students have a latex allergy, because it helps decrease the likelihood of an individual devel- oping one as a result of repeated exposure.

Basic care and emergency preparedness Another aspect of care is preparation for emergencies both big and small. A safe envi- ronment for all students is one in which school personnel are prepared to treat minor cuts and scrapes with basic first aid, and one in which school personnel recognize when the needs are beyond that which can be provided in school. Knowing when emergency support must be brought or when a student must be transported to more extensive care is key.

Basic First Aid and Seizure Management. Knowing how to stop bleeding, clean wounds, apply antibiotics, and cover a wound are all standard first-aid procedures that the school personnel should know. And having available the necessary supplies is part of being prepared. Knowing basic first aid for seizures, too, is key. The popu- lation of students who is the focus of this book is at higher risk for having seizure disorders than the general population. It is estimated that less than 1% of the general population have epilepsy (Epilepsy Foundation, n.d.), while, 30% of students diag- nosed with autism are also diagnosed with a seizures disorder. It is estimated by the National Institute of Neurological Disorders and Stroke (2014b) that as many as half of the students diagnosed with cerebral palsy also have a seizure disorder. Thus the need to know what to do in case of a seizure is higher for school personnel working with students with special health care needs.

Students such as Hector who have a known seizure disorder can be kept safe by tailoring the responses, during and after the seizure, to the type of seizure (Schachter, Shafer, & Sirven, 2013). For seizures that do not affect the students’ awareness, such as simple partial seizures, it may only be necessary to comfort the students during and after the seizure. When students have seizures that affect awareness such as is the case for some types of seizures (e.g., complex partial seizures and absence sei- zures), it may be necessary to guide them to or keep them in a location where they can be safe, to prevent wandering, to remove dangerous objects (e.g., sharp scissors), and to remember that they may not be able to follow verbal directions. Critical do’s and don’ts as a response to students’ seizures that result in the loss of awareness or consciousness—as in the case of generalized seizures—are summarized in Figure 8–1. Generally, the recommended actions include 1) the provision of care to the student having the seizure, 2) the assessment of the condition, measurement of the duration, monitoring respiration, 3) deciding whether or not to activate plans for calling emer- gency personnel, 4) supervising other students, and 5) communicating with parents.

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271Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

Because some of these actions may need to occur simultaneously, it is important to designate the individuals who will be responsible for each.

It is important to note that there is a misconception that the student will swallow the tongue during a seizure. Ill-informed individuals will attempt to insert objects into the mouth or to hold onto the tongue. These procedures should never be imple- mented as the objects used can break in the mouth and cause oral injury. Instead, the individual should be rolled to his or her side to prevent aspiration, as there is likely to be increased production of saliva during the seizure.

If a student has no history of seizures or his or her history is unknown, it is critical to call 911 without delay when the seizure occurs. For students who have had a his- tory of seizures, there should be pre-established lists of conditions for which 911 should be called; all other seizures should be considered routine, and require seizure first aid, but not emergency care. The following recommendations from Schachter (n.d.) and the CDC (2011a) should serve as a guide for determining when a seizure should be considered an emergency:

• Duration exceeds five minutes. • Duration is longer than what is observed typically. • Difficulty with respiration is observed. • Consciousness is not regained after the seizure. • Seizures occur in close succession, especially without regaining consciousness in

between. • Injury occurs during the seizure. • Seizures occur in the water (need to be checked for possibility of swallowing

water). • Additional health condition such as diabetes or heart disease is present.

Preparation for the possibility of choking includes knowledge of signs of chok- ing and knowledge of how to use the back blow and the Heimlich maneuver. Signs indicating the need for such procedures include difficulty breathing; skin, lips, and nails turning blue; and loss of consciousness. Back blows are given in an attempt to dislodge whatever is obstructing the airway. Back blows are given by bending the student at the waist, and then with the heel of the hand, giving five blows to the student between his or her shoulder blades. An alternative is abdomi- nal thrusts, known as the Heimlich maneuver. This is provided by standing behind

FIGURE 8–1 Responding to Generalized Seizures

Do Don’t

• Stay with the student. • Note the time to measure duration of the seizure. • Reassure the student. • Block sudden falls by providing support as the student falls to the fl oor. • Minimize risk of injury. • Remove hard and sharp objects that may cause injury. • Cushion head. • Remove glasses.

• Check respiration. • Turn student to the side to minimize risk of aspiration. • Mouth should be directed downward to allow saliva to drain

out rather than into the airway. • Remove scarves and ties that may restrict breathing.

• Provide privacy by keeping other students away.

• Leave the student unattended. • Move the student unless in hazardous situation (e.g., stairs,

pool). • Restrict movements. • Forcibly attempt to open the mouth. • Place any object inside the mouth. • Attempt to grab the tongue. • Provide any drink or food until fully conscious and alert.

(Schachter, 2014; CDC, 2011)

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the individual, wrapping your arms around the individual, making a fist with one hand and placing it slightly above the individual’s navel and below the breastbone, and then grabbing that fist with your other hand. Pull inward and upward and repeat five times or until the object is dislodged. While it is best to receive training in how to use abdominal thrusts effectively, there is no certification required for its use and many, including children, have used it successfully without formal training.

Medication Administration. Many children with special health care needs are likely to need to take medication while at school. As part of a comprehensive medical his- tory, a list of all currently used medications should be obtained prior to a student coming to school. The medications may be those often taken by the general popula- tion of school-aged children, including antibiotics for colds, ear infections, etc., but may also be more unusual, requiring that school personnel have a more extensive in- formation of both the precautions regarding and specialized procedures for their administration.

A good source of information about specific medications is the National Institute of Health’s U.S. National Library of Medicine (www.nlm.nih.gov/medlineplus/ druginformation.html). For example, when one looks up Tegretol, the viewer is redirected to a webpage with the generic term for the drug, carbamazepine. On that page is information about (a) why it might be prescribed (an anticonvulsant used to control seizures); (b) how it should be used; (c) special precautions to be followed for its use; and (d) potential side effects, both mild (drowsiness, dizziness, etc.) and serious (chest pain, vision problems, among others). Other information is provided about safe storage of the medication and what to do in the case of an extreme reac- tion to its use.

The American Academy of Pediatrics (2009) developed a statement designed to serve as guidance to state departments of education and school districts in developing policies for safe administration of medication. The recommendation is that first dis- tricts be sure to comply with federal, state, and local laws and regulations regarding medication administration in schools. Many states have clear laws, and state depart- ments of education have translated those laws into practice recommendations for schools in that state. Knowing what those specific recommendations are will help assure that the students receive their medication in a safe fashion and that procedures are consistent with local policies. The National Association of State Board of Educa- tion (n.d.) provides state-by-state policies regarding medication administration in schools (www.nasbe.org/healthy_schools/hs/bytopics.php?topicid=4110).

Generally, states have similar goals as that which is stated in the Massachusetts statute:

The aim of 105 CMR 2I0.000 is to ensure that students requiring prescription medica- tion administration during the school day will be able to attend school and to ensure that prescription medications are safely administered in schools. 105 CMR 210.000 en- courages collaboration between parents or guardians and the school in this effort. (105 CMR 210.000 sec 105 CMR 210.000)

For Massachusetts, the recommendation is that policies include

1. designation of the school nurse as supervisor of the prescription medication pro- gram in schools

2. documentation of the administration of prescription medications 3. responses to a medication emergency 4. storage of prescription medications 5. reporting and documentation of medication errors 6. dissemination of information to parents and guardians. Such information should

include an outline of a school’s medication policies and shall be available to par- ents upon request.

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273Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

7. procedures for resolving questions between the school and a parent or guardian regarding administration of medications. Such procedures shall provide for and encourage the participation of the parent or guardian. Existing procedures for res- olution of differences may be used whenever appropriate. (105 CMR 210.000 sec 105 CMR 210.000)

Ideally, medication is administered by a full-time school nurse. The American Acad- emy of Pediatrics (AAP) as well as the National Association of School Nurses and American School Health Association recommend that, if a nurse is unavailable, unli- censed assistive personnel such as a health aide, and less preferably, a school staff member, can be trained and supervised to administer medications.

The AAP (2009) recommends prescription medication should only be accepted when it is in its original container. The label of the container should contain the stu- dent’s name, dosage, and frequency, name and contact information of the prescribing physician, pharmacy, and expiration date. They further recommend use of a form that includes the student’s name, the name of the medication, required dosage, frequency, and rationale for administration at school and that both the prescribing physician, and parent/guardian sign the form.

Medication must be stored securely. For medications that must be refrigerated, it should be done so in a locked refrigerator that is not used by students and other school staff and not used to also store food. Controlled medication must be in a locked cabinet in a locked room (American Academy of Pediatrics, 2009). Additional requirements may include inventorying of each tablet/capsule to detect any difference between the original count and the log of administered quantity.

emergency responses Being prepared for an emergency means more than knowing to call the school nurse or 911. The American Academy of Pediatrics (AAP) (2008) acknowledged that the rise in the number of students with special health care needs and students with chronic illnesses has increased the likelihood of medical emergencies at schools. The policy statement also acknowledges the fact that many schools lack onsite health care professionals. Consequently, the AAP emphasizes the importance of the development of clearly articulated emergency plans, and the importance of them being developed by both school personnel and individual students’ clinicians, tailored to the needs of each individual student. The policy includes many other recommendations for the development of emergency plans, among them the following:

• Emergency plans should cover all locations, including the classroom and play- ground, and before- and after-school activities.

• Emergency information should be on hand for each student and include contact information for the parents/guardians and health care providers.

• Descriptions should include information about what constitutes an emergency as contrasted with minor illnesses or injuries.

• A clear description of procedures to be followed when emergency medical services (EMS) are called must be developed.

• Routes of access in the building should be identified. • Roles and responsibilities should be clarified in the event of an emergency. While

it may be the school nurse who has primary responsibility, it is recognized that there may not be a school nurse present in the building, in which case a responsi- ble designee must be identified.

• Campus-wide communication systems must be developed for use in the case of an emergency.

• Practice drills should be conducted with EMS.

The AAP noted additional types of preparation necessary for students with special health care needs. First, they recommend that each student have an individualized

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health care plan and that specific emergency procedures be articulated as a part of that plan. The AAP further recommends that copies of that plan be available for trans- port to the hospital with the student in case of an emergency.

CPR Training. Knowledge of CPR training is important for school personnel working with all children, and even more so for those working with students with special health care needs. Some states (e.g., California, Michigan) require both CPR and first-aid train- ing for teaching certifications; other districts and states encourage it by providing train- ing through professional development offerings. While a general description of CPR procedures is described below, reading about CPR is insufficient for competent imple- mentation of CPR. Training is readily available in most communities offered by the American Red Cross or the American Heart Association chapters. However, the Ameri- can Red Cross and the American Heart Association also suggest that a simplified form of emergency response that requires no training can be used. They recommend un- trained individuals follow a simple two-step process: Call 911 and “push hard and fast at the center of the chest” as an alternative to conventional CPR that includes 30 com- pressions to 2 mouth-to-mouth breaths, a procedure which requires a higher level of skill and practice. While, again, comprehensive competency training in CPR is preferred, knowing the simple two-step process can also save lives.

Anaphylaxis Emergency Responses. For children such as Hector, who experience anaphylaxis (i.e., severe life-threatening allergic reaction that includes symptoms such as hives, swelling of the lips and/or tongue, and difficulty with respiration), school staff should be trained on the use of epinephrine autoinjectors, including its safe and accessible storage, and emergency medical services following its use. Epinephrine autoinjectors include a single dose that can be injected directly into the outer portion of the thigh without the need to remove clothing. EpiPen® is a well-known brand name of an autoinjector, and Auvi-Q® (Sanofi-Aventis, 2013) provides step-by-step spoken directions on the administration of the autoinjector.

In preparation for anaphylactic emergencies, epinephrine autoinjectors must be kept in a location that would allow quick access. The storage location should be determined based on several factors. It is necessary to follow state and local regula- tions that may mandate medication to be stored in a locked area. The size of the school building, presence of a full-time nurse, availability of staff to communicate between different locations within the school grounds, etc. may impact storage loca- tion as well. The proximity of the health office from various locations such as the classroom, playground, cafeteria, etc. will also need to be considered (Center for Dis- ease Control and Prevention, 2013c). It is also critical that the epinephrine autoinjec- tor be taken on field trips and to other events occurring outside of the school property. Also, because some students will have their first anaphylactic episode while at school, the National Association of School Nurses (2012) supports the practice of maintaining a stock of epinephrine autoinjectors for non-specific students in states and localities that permit it.

Non-health workers who are permitted by state and local regulations to administer the autoinjector must be identified. Then, the designated staff should receive training that includes the recognition of the signs of anaphylaxis and the use of the autoinjec- tor. EpiPen training devices without the needle and an iPhone app—My EpiPlanTM (Mylan Specialty, 2014)—with step-by-step directions and videos are available. Staff who will be responsible for contacting the emergency medical services, the main office, and the parents as well as those who will be charged with supervising the other students should be predetermined.

When a student is showing signs of anaphylaxis, it is imperative to react quickly. However, it is also important to reassure the student and to communicate to the stu- dent that he/she is about to be injected. The student may also need to be reminded to remain still until the injector can be removed, and reassured as the side effects

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275Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

(e.g., rapid heart rate, sweating, dizziness, weakness, etc.) can be startling and anxiety- provoking. Once the epinephrine injector is used, a designated individual must call emergency medical services for transport to an emergency room without exception.

Following the use of the epinephrine autoinjector, the used autoinjector should be taken along with the student to the emergency room where it will be disposed of safely. Then, the episode should be documented. Documentation should include at least the following information: date and location, allergen that caused the anaphy- laxis, time that the autoinjector was administered, contact with parents and emer- gency medical services, professionals who responded, and any other side effects (Center for Disease Control and Prevention, 2013c).

underStandInG SpecIalIzed health care procedureS

Knowledge and training levels

While in school, students with special health care needs, who are integrated in the daily routine of the day, are likely to have contact with many individuals. In these schools three types of training are recommended: (1) training that is needed by all school personnel likely to have any contact with the students, (2) child-specific train- ing for those implementing procedures with students, and (3) training of the student him- or herself. General training, designed to increase understanding of health care procedures and their need, is necessary for all members of the school community. Understanding Ahn needs suctioning, and providing general information about that need and how the procedure is implemented can go far in alleviating fear and con- cern among school personnel around Ahn (Lehr & McDaid, 1993). Much more in- depth training, child-specific competency-based training, about specialized procedures is necessary for those school personnel who have direct responsibility for implement- ing the specific health care procedures. As Lehr (2014) pointed out

While it is possible that some charged with responsibilities for implementing proce- dures with specific students have had training regarding the protocols to be used for particular health care procedures, child specific training is aimed at assuring that the health care provider is competent in administering the particular procedures for each specific child, and addressing each child’s unique needs. Training is best provided by highly skilled health care educators, but including parents in on the training provides an opportunity for the parent/guardian to receive a “refresher course” in procedure ad- ministration and for the parent/guardian to explain specific techniques found to be ef- fective for the individual child. (p. 245)

Porter, Haynie, Bierle, Caldwell, and Palfrey (1997) emphasized the insufficiency of one-time-only training. To assure that procedures that are being implemented are correct, ongoing monitoring should be a part of comprehensive service delivery. Fidelity of implementation of procedures as initially designed is crucial, and as the health care needs of the students change, plans should change as well.

A third important type of training should be directed at the student. Child-specific training is designed to teach students how to provide, to the greatest extent possible, his or her own care, or to direct it (Porter et al. 1997). Examples of student-centered objectives are provided on pages 286–287 in this chapter.

What is presented in the following sections is information about specific proce- dures that some students require at school, and information about who should be providing it. It must be emphasized that this information is designed to inform the reader, generally, about the need for the procedures and about the administration of the procedures themselves. The information, however, is insufficient to result in com- petent administration of the procedures. Competency comes only with training by experts. An additional source of general background information is the internet, rec- ommended however, with caution. Care should be taken to seek information from

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credible sites, and it should also be understood that individual differences necessitate modifications to standard protocols and that the information presented should be used as a guide, not a prescription.

responsible personnel

Knowledge and even demonstrated competence in implementing a procedure do not mean that a procedure should be implemented by some school personnel. The ques- tion of who should provide what services in schools continues to be somewhat unclear (Lehr, 2014). It may be logical to assume that the health care procedures described below should be administered exclusively by school nurses, however, school nurses are not available in every school (Bergren & Monsalve, 2012). To have one in each school would prove costly, and to place students in schools where there are nurses would likely result in the more restrictive placements for students (Lehr, 2014). In response to the increased presence of students with special health care needs in schools in the 80s, a number of organizations (American Federation of Teachers, the Council for Exceptional Children, the National Association of School Nurses) developed guidelines regarding roles and responsibilities related to the provi- sion of special health care needs services in school (Council for Exceptional Children, 1990). Additionally, states clarified their Nurse Practice Acts regarding the delineation of care as related to school-based practice. Specified in such acts is information regarding which special health care must be provided by nurses and which can be delegated to others who work under nursing supervision (Palfrey, Haynie, Porter, Bierle, Cooperman, & Lowcock, 1992). While each state has a Nurse Practice Act and many states have developed manuals that describe guidelines regarding provision of special health care services in schools (e.g., Utah State Office of Education, 2005; Oregon Department of Education, 2012), there continues to be considerable variabil- ity regarding who provides what services to students (Lehr, 2014).

Specialized health care procedures

Some of the more frequently needed care procedures among students are described in the following sections. Information is included on clean intermittent catheteriza- tion, shunt monitoring, nebulizer treatments, tube feeding, tracheostomy care, and ventilator monitoring. Again, this information is designed to provide the reader with general information about the procedures and should not be considered sufficient to enable implementation of the procedures.

clean Intermittent catheterization Clean intermittent catheterization (CIC) is a procedure that is used to empty the blad- der by inserting a catheter from the urethra into the bladder to allow the urine to flow out of the bladder. Students with spina bifida account for the majority of those stu- dents who require CIC. Properly administered CIC and complete emptying are neces- sary to prevent kidney failure and urinary tract infection (Katrancha, 2008).

It is critical to determine the CIC schedule, location where the procedure will take place as well as where the materials will be stored, positioning of the student, and level of student participation. The family and urologist may recommend that the CIC be performed at a predetermined frequency level. The CIC should be performed in a location where privacy can be assured. Materials such as catheters, water-based lubri- cants (unless self-lubricated), wipes for cleansing the genitalia prior to CIC, mirror for female students who are learning to self-catheterize, syringe for flushing out the cath- eter, and gloves must be stored. Because students with spina bifida often develop a latex allergy, non-latex gloves should be used. Some students may need to lie face up, sit on the toilet, or squat depending on orthopedic abilities (Katrancha, 2008). After the CIC procedure has been completed, the catheter should be flushed out using a

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277Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

syringe. For some students, to prevent complications, it may be necessary to monitor the coloration and odor of the urine as well as its quantity (Katrancha, 2008).

The gender-specific CIC procedures are described in Figure 8–2. CIC should begin and conclude with handwashing, and each step should be clearly communicated to the student during the process. It is important to remember that some students may be able to learn to self-catheterize or at least perform some steps in the process. (See page 275 for more information about child-specific training regarding specialized health care procedures.)

Shunt Monitoring Hydrocephalus is a condition in which the cerebrospinal fluid (CSF) in the ventricles of the brain accumulates, widening the ventricles, increasing intracranial pressure, and leading to neurological problems. It may be useful to remember that, in Greek, “hydro” means water and “cephalus” refers to the head. The human body can pro- duce approximately one pint of CSF per day to serve as a conduit for sending nutri- ents and taking away waste from the brain. Typically, the CSF flows through the ventricles, base of the brain, the spinal cord, and is absorbed into the bloodstream. When there is a blockage in the ventricles that disrupts the drainage, CSF will accu- mulate in the brain (National Hydrocephalus Foundation, 2012a; National Institute of Neurological Disorders and Stroke, 2014a).

Most individuals who have hydrocephalus have a surgically implanted shunt to drain the CSF through another pathway. As illustrated in Figure 8–3, a catheter is

placed into the ventricle above the blockage. That catheter is connected to a valve that regulates the flow, and another catheter runs down the neck to the site of drainage. A ventriculo- peritoneal shunt drains into the stomach and a ventriculo-atrial (VA) shunt drains into the heart.

Because the shunt does not keep functioning indefinitely, it is critical to know the warning signs of a shunt malfunction. National Hydrocephalus Foundation (2012b) describes the following symptoms of a malfunctioning shunt:

• headache or pressure within the skull • digestive (e.g., lack of appetite, nausea, vomiting, incontinence) • cognitive (e.g., diminished functioning) • motoric (e.g., impaired gait) • vision (e.g., blurring, double vision) • mood (e.g., irritability)

FIGURE 8–2 Gender-Specific CIC Procedures

Watch “Pediatric Playbook – Hydrocephalus” at www.youtube.com /watch?v=bHD8zYImKqA.

Females Males

• Position the student so that the urethra can be visually observed.

• Use disposable wipes to cleanse the genitalia including between the labia making sure to wipe backwards.

• Apply lubricant to the end of the catheter with openings. • Put the other end into the toilet or other container. • Place the lubricated end of the catheter into the urethra

(2–3 inches). Observe urine begin to be drained out. • Keep catheter in place until the flow stops. • Apply gentle pressure to abdomen or have student lean forward

to drain any remaining urine in the bladder. • Remove the catheter in a manner that prevents drainage of the

urine back into the bladder.

• Position the student. • Use disposable wipes to cleanse the genitalia making sure to

wipe outwards from the tip of the penis. • Apply lubricant to the end of the catheter with openings. • Put the other end into the toilet or other container. • Position the penis so it points upward. • Place the lubricated end of the catheter into the urethra

(4–6 inches) and lower penis gradually. Observe urine begin to be drained out.

• Keep catheter in place until the flow stops. • Apply gentle pressure to abdomen or have student lean forward

to drain any remaining urine in the bladder. • Remove the catheter in a manner that prevents dripping.

(Based on American Academy of Pediatrics, 2003, updated 2013.)

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278 Chapter 8

If emergency care is not sought, individuals may experience seizures and suffer neu- rological damage (National Hydrocephalus Foundation, 2012c). Therefore, it is critical to be observant, especially because some of these symptoms may be difficult to dis- tinguish from common colds and flu as well as from characteristics of some students with severe disabilities who may already have fluctuating abilities including difficulty with balance.

nebulizer treatment A nebulizer is used for young children and for those who cannot use an asthma inhaler due to their difficulty simultaneously activating the inhaler and breathing in of the released medication. A nebulizer turns the liquefied asthma medication into a mist that can be breathed in, and children can breathe in the medication using a mouth- piece or a mask. The mask may be useful for students who do not have adequate lip closure on the mouthpiece. The materials needed include the air compressor, medi- cine cup, tubing, medication, and a mouthpiece or a mask. Students who may need to have the nebulizer in multiple settings may benefit from portable, battery-operated compressors. The procedures are as follows (Pediatric/Adult Asthma Coalition of New Jersey, n.d.; WebMD, 2014):

• Put the compressor on a table or other sturdy surface (never the floor). • Connect the compressor and the bottom end of the nebulizer. • Connect the medicine cup of the nebulizer and the mouthpiece or mask. • Place the medication into the medicine cup. • Activate the compressor to allow the mist to come out. • Position the student upright. • Place the mouthpiece in the mouth or mask over the mouth and nose. • Allow student to breathe in the medication until the medicine cup is empty (5–10

minutes). • If possible, instruct the student to hold his/her breath for a few seconds before

exhaling.

tube feeding Tube feeding is a method of providing nutrition, hydration, and medication through non-oral routes for students like Ahn. The conditions that may necessitate tube feed- ing include gastroesophageal reflux, cleft lip/palate, jaw and tongue thrusts and other oral motor reflexes that may make sucking and chewing difficult, and neurological

FIGURE 8–3 Shunt for Hydrocephalus

Ventricle

Catheter

Entry site for shunt

Skin flap

CSF flow

Peritoneal cavity

(Used with permission of National Hydrocephalus Foundation.)

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279Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

disorders that may make coordination of breathing and swallow- ing challenging resulting in heightened risk of aspiration or choking. Students may rely on tube feeding for all of their caloric intake or use tube feeding to supplement eating by mouth ( Ferguson, 2004). Students may have an NG-tube (nasogastric—

nose to stomach), G-tube (gastric—stomach), or J-tube (jejunum), depending on fac- tors such as duration of need. NG-tube is typically for short-term use, while a G-tube and J-tube are for the long term. The G-tubes can be placed through endoscopic or surgical procedures. Regardless of the procedure used, the tube has a disc, bulb, or balloon that secures the tube within the stomach wall.

The method of feeding may be pump controlled, gravity drip, and bolus. When a pump is used, the rate of infusion can be regulated with the mechanical pump. In the gravity-drip method, the feeding bag is placed at an elevated height to allow gravity and a clamp is provided to regulate the rate of infusion. The bolus method relies on someone using a syringe to inject food into the tube and the rate is controlled by the individual using the syringe (Mahnke, 2013).

Tube-feed schedules can be continuous (i.e., 24 hours a day), intermittent (i.e., predetermined periods), or bolus (i.e., rapid infusion) (Nutrition Support Interest Group, 2011). The advantages and disadvantages of each schedule are presented in Figure 8–4. The decision should be made in consultation with the child’s gastroenter- ologist to select the schedule that meets the child’s nutrition and hydration needs but also increases opportunities to participate in academic tasks. It is also important to consider the location of the feedings and to allow peer socialization during meal- times. If appropriate, students can still taste food or put small amounts of food in their mouth as tolerated and without risk of choking or aspiration in order to prevent the development of oral hypersensitivity and an overactive gag reflex.

The student should be positioned in a sitting position so the student’s head is ele- vated relative to the stomach or at a 30-degree angle. This is also known as a semi- Fowler position. Lying down flat is discouraged during and for at least one hour after the feeding to prevent reflux (Ferguson, 2004).

Complications can arise when children are fed using a G-tube. Infection of the gas- trostomy site can occur and children with diabetes and those receiving therapy to suppress the immune system can be at risk. Leakage may occur due to gastrostomy site infection, aggressive cleaning, insufficient space between the internal and exter- nal bolsters, or gastric acid increase. Buried bumper syndrome, a condition in which the mucous membrane of the stomach grows to cover the internal bolster, may occur if the internal and external bolsters do not have sufficient space between them or

FIGURE 8–4 Advantages and Disadvantages of Tube-Feeding Schedules

“Gastrostomy Tube: Feeding and Taping the Tube | St. Louis” at www.youtube .com/watch?v=HG5UE9YA10o.

Advantages Disadvantages

Continuous

Intermittent

Bolus

Provides the slowest rate of infusion to those who cannot tolerate higher rates

Maximizes opportunities for other activities

Provides a transitional feeding schedule (i.e., continuous to bolus or tube to oral)

Resembles eating pattern

Provides a transitional feeding schedule (tube to oral)

Necessitates continuous attachment to the equipment

Increases possibility of re� ux, discomfort, and nausea due to the higher rate of infusion

Requires more hands-on time for the procedure than continuous feeding

Introduces higher risk of re� ux, discomfort, and nausea

(Based on Nutrition Support Interest Group. (2011). Enteral nutrition manual for adults in health care facilities. Dietitians Association of Australia. Retrieved from: http://daa.asn.au/wp-content/uploads/2011/11/ Enteral-nutrition-manual-Oct-2011.pdf)

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there is weight gain that reduces the existing space between the bolsters. This may result in leakage, infection, decreased flow of the formula, G-tube that is difficult to move, and associated pain. The gastrostomy tube can also be accidentally removed or pulled out by the child (Itkin et al, 2011). Therefore, care must be taken to minimize the risk of complications.

Children may begin the process of transition from tube feeding to oral feeding based on input from members of the multidisciplinary team. The student should pos- sess adequate oral motor coordination in order to swallow the food, and also be able to coordinate swallowing with breathing to minimize the risk of aspiration. The need for oral stimulation that can minimize hypersensitivity may need to be considered as well as the texture and thinness/thickness of the foods. The quantity of food eaten by mouth should be monitored to ensure adequate nutrition if tube feeding is reduced (Gottrand & Sullivan, 2010).

tracheostomy care Students, like Ahn, who cannot inhale sufficient oxygen through their nose or mouth may receive surgery to create a hole (i.e., the stoma) in the trachea. A tracheostomy tube has three parts: (a) an outer cannula that maintains the opening, (b) a neckplate that anchors the ties around the neck, and (c) the inner cannula that is inside the outer cannula. Students who have a tracheostomy (trach) may require stoma care, humidification, and suctioning. In addition, the student will be unable to speak with- out the aid of a device such as a Passy-Muir valve ( Johns Hopkins University, n.d.a&b).

While the trach may supply sufficient oxygen, it results in mucous production because the air that is breathed in through the trach tube has not passed through the

nose and upper airway that serve the function of regulating the temperature, moisture level, and cleanliness of the air. This excess mucus can be expelled through the trach tube through coughing and suctioning. When using the coughing method, the student should be moved forward from an upright position and cough to expel the mucus. A small quantity of sterile saline solu- tions can be placed in the trach tube to make it easier for the

mucus to be expelled. However, suctioning of the mucus is necessary before and after sleeping, before eating and outdoor activities, and when the student experiences increased effort in respiration or sensation and sounds of the mucus in the airway and trach tube ( Johns Hopkins University, n.d.c).

The materials necessary for suctioning include the following ( Johns Hopkins Uni- versity, n.d.c):

• Clean suction catheter (correct size) • Distilled or sterile water • Normal saline • Suction machine in working order • Suction connection tubing • Jar to soak inner cannula (if applicable) • Tracheostomy brushes (to clean tracheostomy tube) • Extra tracheostomy tube

After all materials have been gathered, the first step prior to beginning the suctioning procedures is thorough handwashing. Following are the next steps (Johns Hopkins Hospital, n.d.b):

1. The students can be suctioned either as they are seated or they can be laid flat with a roll under their shoulders.

2. The suctioning machine should be turned on and the tubing should be connected to the machine.

3. Connect the catheter to the suction connection tubing.

Watch “Suction – Breath of Life – A Caregiver’s Guide to Pediatric Tracheostomy Care” at www.youtube .com/watch?v=u6v-b7P23Vk.

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281Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

4. Wet the catheter with sterile/distilled water for lubrication and to test the suction machine and circuit.

5. Remove the inner cannula from the tracheostomy tube (if applicable). 6. Insert the catheter into the tracheostomy tube with your finger off the suction

vent. 7. Cover the suction vent and suction for no more than 5–10 seconds, as breathing is

not possible during suctioning. 8. Remove the catheter by rotating and using a slow, even motion, and intermit-

tently placing your thumb over the suction vent. 9. Allow the patient to recover from the suctioning and to catch his/her breath. Wait

for at least 10 seconds. 10. Repeat suctioning as necessary. 11. When finished, suction a small amount of distilled/sterile water with the suction

catheter to clear any residual debris/secretions. 12. Reinsert the inner cannula from extra tracheostomy tube (if applicable). 13. Turn off suction machine and discard or clean catheter if it is to be reused.

Mechanical Ventilation Mechanical ventilation is necessary when an individual has difficulty breathing inde- pendently. The difficulty may be due to damage to the nervous system, muscular sys- tem, or due to pulmonary disease that controls the lungs. D’Shawn experienced hypoxemia (lack of oxygen) during his near-drowning and damage to the nervous system that regulate his breathing. Consequently, he is dependent on a ventilator to control his breathing.

Ventilators (sometimes called respirators) may be used to provide oxygen should the individual be unable to obtain a sufficient amount independently or to eliminate carbon dioxide or to push air in and out of lungs. The ventilator can provide the primary means for respiratory support and for other students the ventilators is a supplement. The sup- port may be continuous or intermittent, depending on the needs of the student.

The individual receives the breathing support through an endotracheal tube, inserted into the stoma in the windpipe and a machine moves the air into and out of the lungs. There are various types of ventilators used with students, but the most common type is a positive pressure ventilator, which pushes air or oxygen-rich gas into the lungs. Positive pressure ventilators are small, can be battery operated, and therefore portable, which makes education in a school setting possible. By contrast, a negative pressure machine (often referred to as an iron lung) uses vacuum-like pres- sure to expand the individual’s chest, allowing air to flow in. This type of equipment is not portable, and, therefore, is not seen in schools.

Students assisted with breathing by ventilators must be monitored continuously to make sure they are breathing properly, and their equipment must be checked regularly to assure proper functioning. It is critical that students using ventilators be attended to by individuals who have demonstrated competence in ventilator care and in CPR.

A comprehensive care plan for these students includes consideration of school attend- ance if only one person is trained to provide the care and that person is absent. Ideally, more than one person have the necessary competence; alternately, arrangements are made with parents for students to not attend school on days where their health care needs cannot be met. Also, arrangements must be made for bus transportation that includes someone to monitor the student and the equipment during transportation.

care coordInatIon throuGh coMMunIcatIon

Coordination of care for students with special health care needs is critical. This includes between home and school, and among care providers at school. Developing plans for all procedures helps assure consistency of implementation. Further,

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documentation of health care events and sharing those records between home and school enables those caring for the student to have an ongoing and comprehensive knowledge of the student’s health care status. The individualized health care plan, described below, is used to facilitate communication across care providers.

Individualized health care plans

It has become common practice for school districts to develop individualized health care plans (IHCPs) for students with special health care needs. This is sometimes included as a part of an IEP, and developed as part of the IEP process. At other times, it is developed as an independent document that focuses specifically on the health care needs of the stu- dents. While the format of health care plans often differ, most follow the model first rec- ommended by Porter et al. (1997). The components of the recommended IHCP include

• a description of the student’s health history • a description of the specific health care needs of the child • a description of the child’s current health status • a description of the medications used at home and school, possible side effects of

the medications taken, and a clear specification of which school personnel will be responsible for administering the medicine while the students is at school

• a description of any special dietary and nutritional needs of the student • specialized transportation needs (types of supports and equipment needed, includ-

ing on bus supervisions) • a listing of specialized equipment needed for administration of special health care

procedures, if needed • descriptions of what constitutes an emergency and specific procedures for respond-

ing to them • child-specific emergency plans

Plans are developed through collaboration between school personnel, parents/guard- ians, and the child’s physician. Due to the students’ complexity of needs, it is impor- tant that all who know about the needs of the students be involved in the development of the IHCP. To assure that there is agreement among the members of the team, Porter et al. (1997) recommended that the IHCP be signed by all members of the team. Some districts include the IHCP development as a part of IEP planning and include the IHCP as an appendix to the IEP.

A comprehensive individualized health care plan should address transportation as well. The Committee on Injury and Poison Prevention of the American Academy of Pediatrics, (2001, reaffirmed 2013) has provided a set of recommendations:

• Specialized seating and wheelchairs must be secured taking student’s weight, man- ufacturer guidelines based on impact tests, etc. into consideration (see full list for more detailed information).

• Wheelchair trays must be detached prior to boarding and must be secured (not resting or propped up next to the wheelchair).

• Liquid oxygen must also be secured and signage displayed on the exterior of the school bus.

• Training for bus monitors and drivers, as well as back-up/substitute transportation staff, should be provided.

• Bus evacuation drills should include students with special health care needs.

An individual transportation plan should address transport duration, equipment and securing, evacuation, emergency plan, and training of transportation staff. The training provided to transportation staff should include confidentiality of student health information, recognition of emergency situations, appropriate responses (e.g., procedures for the student, communication with dispatcher/emergency medical ser- vices, etc.), and evacuation procedures. Such training should be documented, and

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283Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

information reviewed periodically. The bus route should be evaluated to determine the location of hospitals (Utah State Department of Education, 2005). A sample trans- portation plan can be viewed in Figure 8–5.

record Keeping

It is important for school personnel and parents to know students’ health status when they are not under their care. Knowing that a student did not sleep the night before or knowing that a student had seizure activity while at school helps school personnel and parents/guardians understand the behavior of students. More importantly, records of

FIGURE 8–5 Transportation Plan for Students with Special Needs

(Continued)

154 Maple Street

Sam Jones

D’Shawn Jackson

Pine Street

Address

School

Darren Jackson

wheelchair

Parent/Guardian Name

789 Oak Street 123 789-1234 Address

wheelchair positioning Describe:

ventilator

Identify equipment that must be transported on the bus and method of securing (including oxygen; life- sustaining equipment, wheelchair equipment, communication device).

Describe:

Method of Mobility

Childcare Provider

Receives Medication

123 456-7890

4

Home Phone

(Student’s Picture)

Grade

123 567-8910

Dynavox

Work Phone (Father) 123 109-8765 Work Phone (Mother)

drowsiness

nurse on bus with student

Phone

I. Adaptations/Accommodations Required

II. Positioning or Handling Requirements

Bus Driver:

Transportation Plan for Students with Special Health Care Needs

Student:

Yes No

Method of Communication

aunt Emergency Drop-off Site

Possible Side EffectsYes No

Yes Bus Lift

Seat Belt No

Wheelchair Tie-Downs

Chest Harness

Booster Seat

Other

Yes

Walks to and from bus

Walks up and down stairs

No

Yes No

III. Behavior Considerations Yes No

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seizure activity can be helpful to students’ physicians as they work to adjust medications to control the students’ seizures. A seizure record- keeping form such as the one shown in Figure 8–6 makes record keeping straightforward. An app called Seizure Tracker (seizuretracker.com) makes record keeping and report writing an easy process.

FIGURE 8–6 Seizure Event Recording Form

(Transportation plan for students with special needs. Utah State Office of Education. Used with permission.)

FIGURE 8–5 Transportation Plan for Students with Special Needs (continued)

Nurse

ventilator monitoring CPR First aid

Names of Individuals Trained Signature Date

Describe training:

A copy of student’s emergency information/plan must be attached.

IV. Transportation Staff Training

V. Student-Specific Emergency Procedure

Seizure Record

Date Time Duration Description Other Information

1-20 2:15 pm 3 min Typical

2-15 1:05 pm 4 min Typical

3-9 10:45 am 2 min Nothing unusual

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285Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

Records of medication administration are also critical. Many states have specific regulations regarding the administration of and record keeping as related to medication (www.nasbe.org/healthy_schools/hs/bytopics.php?topicid=4110). While there are variations, below is the Massachusetts regulation as a sample:

210.009: Documentation and Record-Keeping

(A) Each school where prescription medications are administered by school personnel shall maintain a medication administration record for each student who receives prescription medication during school hours.

(1) Such record at a minimum shall include a daily log and a medication administra- tion plan, including the medication order and parent/guardian authorization.

(2) The medication administration plan shall include the information as described in 105 CMR 210.005(E).

(3) The daily log shall contain:

(a) the dose or amount of prescription medication administered; (b) the date and time of administration or omission of administration, including

the reason for omission; (c) the full signature of the nurse or designated unlicensed school personnel ad-

ministering the prescription medication. If the prescription medication is given more than once by the same person, he/she may initial the record, subsequent to signing a full signature.

(4) The school nurse shall document in the medication administration record signifi- cant observations of the prescription medication’s effectiveness, as appropriate, and any adverse reactions or other harmful effects, as well as any action taken.

(5) All documentation shall be recorded in ink and shall not be altered. (6) With the consent of the parent, guardian, or student where appropriate, the com-

pleted prescription medication administration record and records pertinent to self- administration shall be filed in the student’s cumulative health record. When the parent, guardian or student, where appropriate, objects, these records shall be regarded as confidential medical notes and shall be kept confidential, except as provided in 105 CMR 210.000.

IncluSIon In the General educatIon SettInG

Increasingly, students with special health care needs are being educated alongside their peers without disabilities. As with all students with severe disabilities, mere placement in the general education setting will not guarantee acceptance. Included in the following sections are considerations for program planning that will help facilitate students’ full inclusion in general education settings as students.

acceptance by peers

As mentioned previously, inclusion of students with special health care needs is increasing (AAP, 2008). It is still, however, not yet commonplace for school personnel to have had experience with students with special health care needs, particularly those with complex health care needs. The first step that must be taken, as described previously, is that of assuring that the student is entering a school setting where rou- tine practice includes use of universal precautions and hygienic care providing prac- tices, and where emergency plans are in place for all students. Further, general information about the special health care needs for specific students must be made available to all, and extensive student-specific training must be provided to those implementing the care. All this serves to make sure students are safe, but this is

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insufficient to make sure the students’ educational needs are being met as well. Con- sidering these students as a student and not just a patient is crucial (Lehr, 1990; 2014). As mentioned previously in this chapter, terminology used to describe students with special health care needs is important. Referring to a student as medically fragile places the focus on the health care needs of the student and not on the student as a student. And the term can be as off-putting to a classmate as it is to school personnel.

Students with special health care needs may also have some unique educational needs that must be addressed. They may miss more school than their peers, and they may not be as available for learning as their peers. Rest after a routine seizure decreases instructional time. Accommodating these needs requires careful planning and support such that the student can continue to be able to be a part of the classroom, despite these interruptions to presence in the classroom.

Lehr (2014) pointed out that students’ interactions with peers may be influenced by their teachers’ reactions to their medical needs. For example, consider how different peers’ reactions may be when suctioning is treated as routine as contrasted with that of a medical emergency. Consider the difference in peer interactions if students are considered sick and in need of tube feeding versus healthy because they are being tube fed (Lehr, Greene, & Powers, 2003). Parents and educators can be helpful in increasing peers’ understanding of students with special health care needs. Consider the training one parent provided to a class of students prior to his son’s joining the group after having had a tube inserted for feeding. A Curious George-like stuffed ani- mal, who happened to eat via tube rather than by mouth, visited the class during which time procedures were explained and the first grade students could ask what- ever questions they had.

Specialized education content

Students with special health care needs should have access to the general education curriculum as should all students. But in addition, there are some unique goals that should be included in these students’ programs. Their IEPs should include goals and objectives related to their learning to either implement their own health care proce- dures or at least direct their care. Developing appropriate habits related to handwash- ing is a good place to start (Lehr, 2014), but further, students can learn, for example, to perform their own clean intermittent catheterization or understand why they need a particular procedure or when they need it. Consider the independence of a student who, while unable to assemble the needed equipment necessary for feeding, was able to explain to another how to do so. Independence, in this case, was not assembling the equipment by himself, but independence was in his ability to explain what his needs were.

Consider a student who requires suctioning. While self-suctioning is difficult even for skilled adults and may not be a realistic goal for a student with special health care needs, a student could be taught to demonstrate some steps in the process even if he or she cannot do all the steps in the process, thus embodying the principle of partial participation (Baumgart et al., 1982). Consider these possible student-centered objec- tives for suctioning:

• Anh will signal need for suctioning. • Anh will describe the equipment needed for suctioning. • Anh will describe the steps necessary to perform suctioning.

For G-tube feeding, the learning objectives could be the following (Lehr, 2014; modi- fied from Lehr & Macurdy, 1994):

• Student will explain the reason for the alternative eating method. • Student will describe the steps necessary to implement the procedure. • Student will indicate the desire to eat/be fed.

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287Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

• Student will measure feeding liquid to be placed in feeding bag or syringe. • Student will pour food into feeding container. • Student will clean or direct cleaning of feeding equipment. • Student will feed self though a G-tube.

Maximizing educational opportunities

It is true that at times the implementation of health care procedures can be time consuming. But, with thoughtful planning, it does not have to significantly decrease instructional time. Consider these descriptions and how the environment can be arranged to maximize educational opportunities:

Diaper-changing while working on communication skills, versus changing diapers in silence

Tube feeding the student in the cafeteria while other students are eating and where there are opportunities for social interaction, versus tube feeding a student in the nurse’s office, in isolation, with no other students around

Having the student participate in the process of collecting the needed materials by following a picture checklist of what is needed for tube feeding, versus having the teacher get the materials before feeding the student. Consider this food preparation much in the same way as you would think about other students learning to set the table and prepare the food.

other conSIderatIonS related to the educatIon of StudentS wIth SpecIal health care needS

While the focus thus far has been on the specific health care needs of students and strategies to integrate them into schools so that their health care needs and educa- tional needs are met, there are some other issues that should be discussed to best understand this population of students. Among the issues addressed in this section of this chapter are discriminatory access to treatment and to least intrusive treatments, do-not-resuscitate orders, and preparation for death and dying.

Medical discrimination

There is a long history of medical discrimination against students with special health care needs (Crossley, 1996; Lehr, 2014). In one highly publicized case in 1982, so- called Baby Doe was denied corrective surgery for her defective esophagus, and denied hydration and nutrition on the basis of her having been born with Down syn- drome. The following year, Baby Jane Doe, who was born with spina bifida along with the related disabilities of hydrocephaly and microencephaly, was not provided with life-saving surgery to repair the opening in her spine, a procedure that would have been provided had the baby not presented with other disabilities (Crossley, 1996; Lehr, 2014). The decision to withhold treatment was reported to be based on the assumption that because the baby also would have had an intellectual impair- ment, the baby would also have had a poorer quality of life (Lehr, 2014). Media atten- tion to these cases raised questions in light of 1978 regulations for the Rehabilitation Act of 1973, that stated

No otherwise qualified individual with a disability in the United States, as defined in section 7(20) shall, solely by reason of her or his disability, be excluded from the partici- pation in, be denied the benefits of, or be subjected to discrimination under any

Watch “Gastrostomy Tube: Feeding and Taping the Tube | St. Louis Children’s Hospital” at www.youtube.com /watch?v=HG5UE9YA10o.

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program or activity receiving Federal financial assistance or under any program or ac- tivity conducted by any Executive agency or by the United States Postal Service. (Section 504, Rehabilitation Act of 1973)

Subsequent regulations issued by the U.S. Department of Health and Human Services required the posting of notices reminding medical personnel that discrimination on the basis of a disability was illegal based on Section 504 of the Rehabilitation Act. Fur- thermore, it stated that medical discrimination such as those that were demonstrated in the Baby Doe case were to be reported. This requirement was challenged, as it was the parents who made the decision to deny treatment and not the medical personnel. Crossley (1996) pointed out that a subsequent attempt to decrease medical discrimi- nation was accomplished through the Child Abuse Amendments of 1984, which speci- fied that states receiving federal funds had to have in place procedures for reporting instance of medical discrimination and neglect (42 U.S.C.A. section 5106a(b)(10) (West 1983 & Supp. 1995). Crossley (1996) noted that those regulations remain in place although their effectiveness is questioned.

Two other highly publicized cases pointed out other forms of medical discrimina- tion, one involving a young man with Down syndrome who had a life-threatening heart condition and another involving keeping alive anencephalic children for the purpose of organ harvesting. Phillip Becker, physically, was considered a good candi- date for corrective heart surgery. Advocates who befriended him when they volun- teered at the facility where he resided strongly supported the surgery, however, his parents, who retained legal custody, refused permission for the surgery. The parents eventually gave up parental rights and the advocates adopted Phillip clearing the way for his successful surgery. This occurred, however, as Lehr (2014) pointed out

… only after a long battle which put front and center in the media the issues of parental rights and quality of life decisions. The parents’ reason for denying treatment was their concern for the quality of Phillip’s life as an adult with an intellectual impairment after they passed. They preferred he die rather than live a long life with a disability. In this case, the state decided to sever parental rights, making way for the successful surgery for Phillip. (p. 238)

Anencephaly is a neural tube defect in which the baby is born without parts of the brain and skull. Babies with anencephaly typically die a few days after birth. Given their prognosis, they are considered by some to be good candidates for organ harvesting which raise many legal and ethical questions (American Academy of Pediatrics, 1992; Crossley, 1996; Fost, 1986). Standard practice for organ harvesting includes harvesting only after the patient is considered brain-dead. Babies with anencephaly are not brain-dead; they have minimal brain functioning. In 1987 an infant with anencephaly was transported to a California hospital so that it could be used as a live donor for organ transplant. The transplantation was challenged on the basis of the legal standard of “brain-dead” and on the basis of the ethical con- cern about the slippery slope of lowered standards on the basis of the baby’s intel- lectual disability (Crossley, 1996). Crossley (1997) noted the ethical discussions continue, although the practice of transplantation from newborns with anencephaly does not.

The question of unnecessary treatment was raised with the so-called “Pillow Angel.” Ashley X has encephalopathy and little volitional control of body functioning, and requires tube feeding (Ouellettee, 2008). In an effect to slow puberty, which she was demonstrating prematurely, and slow her growth so as to enable her to be more easily positioned and handled by her parents, she was prescribed growth attenuating hormones. Arguments were made both for and against the treatment (Lehr, 2014). Some argued this was a treatment that would not have been used had the child not had a disability and thus was an intrusive and unnecessary treatment. Others argued that the treatment could result in a better quality of life as it would allow the parents to care for Ashley at home longer than would otherwise be possible. And yet others

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289Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

argued the focus was on the wrong issue: It should instead have been on the lack of supports for families that would make home care easier (Ouellette, 2008).

Ireys, Wehr, and Cooke (1999) noted “many current definitions of medical neces- sity require evidence that a service will significantly improve a person’s health status” (p. 2). However, according to Ireys et al.,

Many children and adults with disabilities frequently need health or medical services that will maintain [emphasis added] their functional capacity. Defining as medically necessary only services that improve their health status means that they will be denied many services vital to their day-to-day lives. (p. 2)

do not resuscitate

Schools now have students in attendance who may succumb to their chronic illnesses (Adelman, 2010). In some cases, despite aggressive care, their chances of survival are unlikely. In some cases, parents express wishes that their children not be provided with life-sustaining treatment at school, and request do-not-resuscitate (DNR) orders be honored. DNR orders are commonplace in hospital settings, whereby patients can express wishes as related to their end-of-life care. Schools, however, are not medical facilities, and parents are making decisions not for themselves but instead for their children. This dilemma and the differences have resulted in some states developing policy guidelines for schools to follow when such requests are made. Adelman (2010) found, however, that most districts do not have a policy in place regarding DNR orders and there continues to be concern about the legal and moral implications of practices (Zacharski, Minchella, Gomez, Grogan, Porter, & Robarge, 2013).

Zacharski et al. (2013) noted that the DNR process typically begins with a request from parents. Then, it is a school nurse who leads the process of determining state and local policies and clarifies those policies with school administrators, by communi- cating with the hospital care team, and conducting team meetings with school per- sonnel and the family to discuss the plan. Zacharski et al, recommended attention to many factors including the consideration of the composition of the planning team, consultation with hospital personnel, identification of key personnel who must be informed of the plan, identification of key staff who must be trained, articulating the difference between acute care needs and end of life needs, and transportation in the event of death.

Additionally, the checklist notes important attention to the staff’s moral cultural and ethical issues (p. 73) and the needs of other students and staff. Heller et al. (2009) argue

The death of a child is one of the most traumatic experiences that can occur within a family. It is also traumatic for teachers and other educational professionals when a student dies. (p. 291)

Teacher preparation programs focused on the education of students with special health care needs should incorporate training on dealing with DNR orders, death, and dying. School personnel may struggle with DNR orders based on personal and ethical beliefs and with the seemingly contradictory request to honor a DNR order to end a life while at the same time implementing an IEP designed to improve a life. Helping school personnel understand differing perspectives, both personal and legal, may aid them in dealing with this complex situation. Death and dying are topics that are rarely discussed in schools. While some advocate that it be a general part of the school curriculum, at the minimum, it should be a part of training for school person- nel working with students who have a high likelihood of dying due to terminal ill- nesses or those with complex health care needs. And some of that training should focus on helping teachers understand how to explain death and dying to students. Heller et al. recommend that students be provided with factual information and the opportunity to communicate about the death.

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Often families will turn to the school for emotional support and, as Heller et al. (2009) note, at times school personnel assume a position of strength for the family and ignore their own feeling of grief. Counseling for school personnel is an important support under these circumstances.

learnInG outcoMe SuMMarIeS

8.01 Students with Special Health Care Needs Defined Learning Outcome Identify the types of health care conditions likely to be present in students with complex health care needs that require specialized knowledge to assure their inclusion in school settings.

Students with special health care needs include those who may have asthma, seizure disor- ders, tracheostomy, hydrocephalus, and various other conditions. While the incidence of children with special health care needs and intellectual disabilities is unknown, what is known is that the overall incidence of students with special health care needs is increasing. There- fore, schools must be prepared to maintain a safe and healthy learning environment and meet the educational needs of these students.

8.02 General Knowledge of Health Care Procedures Learning Outcome Describe methods to help school personnel develop the essential general knowl- edge to assure safe care of students with complex health care needs in school settings.

Basic knowledge of preventive practices and first-aid training are necessary. Proper hand- washing; cleaning, sanitizing, and disinfecting the environment; proper waste disposal; and allergen control help maintain a clean and safe learning environment for all students. Train- ing in seizure management and first aid, compliance with regulations for medication dispen- sation at school, plans for emergency responses, training in responding to anaphylaxis, and CPR should be provided.

8.03 Understanding Specialized Health Care Procedures Learning Outcomes 1. Describe specialized roles and responsibilities of school personnel as related to the provision of health care to students with complex health care needs. 2. Describe methods to help school personnel develop the essential specialized skills to assure safe care of students with complex health care needs in school settings.

Knowledge, skill, and training levels of special health care procedures should be differentiated for three groups of individuals: all individuals within the school, individuals who are implement- ing the special health care procedures, and the student him-/herself. There are various special- ized health care procedures that may be necessary depending on the needs of the student. Clean intermittent catheterization is a method for emptying the bladder that requires gender- specific procedures to be followed. Students with hydrocephalus require close monitoring for signs of shunt malfunction. A nebulizer that turns liquid asthma medication into a mist that can be breathed in must be used for children who cannot use an asthma inhaler. Tube feeding is a method for providing not only nutrients but also hydration and medication to students who can- not eat by mouth. Students with a tracheostomy tube will require suctioning of the mucus to clear the airway. Finally, students who require mechanical ventilation will need to have close monitoring of their respiration and the functioning of their equipment.

8.04 Care Coordination Through Communication Learning Outcome Describe communication processes necessary to assure health, safety, and inclu- sion of students with complex health care needs in school settings.

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291Understanding and Meeting the Health Care Needs of Students with Severe Disabilities

Collaboration of family members and care providers at school is critical to maintaining the health and safety of students with special health care needs. An individualized health care plan that outlines the student’s special health care needs, medication, special dietary/ nutritional needs, transportation needs, description of routine health care procedures and necessary equipment, and emergency plans allow the team to preplan and coordinate care. Meticulous record keeping and communication of health status and medication administra- tion are also essential.

8.05 Inclusion in the General Education Setting Learning Outcomes 1. Describe procedures to ensure that students with special health care needs are included successfully and accepted by peers.

Successful inclusion and peer acceptance of students with special health care needs can be facilitated through several methods. Sensitive language use can help students with special health care needs be viewed as students and not patients. When done with sensitivity, explanation of health care procedures to the classmates help de-mystify them without stigmatizing the student.

2. Describe methods for teaching students with special health care needs so that they can participate in performing the routine health care procedures; and describe methods to embed other instructional goals into health care procedures.

The principle of partial participation should apply to health care procedures, with students participating in their own care to the extent possible. Furthermore, it is possible to embed other instructional goals related to communication, socialization, and fine- and gross-motor skills into the implementation of the special health care procedures.

8.06 Other Considerations Related to the Education of Students with Special Health Care Needs Learning Outcome Identify other issues and practices essential for the safe care and effective educa- tion of students with complex health care needs.

Children with special health care needs have been subjected to medical discrimination and denied care due to the presence of a disability. Some students may have do-not-resuscitate orders, and schools must be prepared to address them within the context of state and local policies while also being considerate to the emotional responses of family members and school staff.

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9 Key Concepts in Understanding

Motor Disabilities Mary Jane Rapport

University of Colorado, Anschutz Medical Campus Amy Barr

Cherry Creek School District Maria Jones

University of Oklahoma Health Sciences Center

9.01 Impact on Education and Participation Learning Outcome Understand the impact of motor disabilities on participation of students in school and on learning.

9.02 Team Support for Students Learning Outcome Comprehend the role of the IEP team and related service providers in supporting students with motor abilities and their participation in school.

9.03 Meeting Students’ Needs Learning Outcome Describe strategies for meeting the physical assistance and management needs of students with motor disabilities in daily routines and school-related activities.

Introducing … Sophie

Age: 7-Year-Old First Grade Student Diagnosis: Genetic Syndrome with Visual Impairment Sophie is a seven-year-old first grade student who lives with her parents, Janelle and Sarah. Sophie is Janelle’s biological daughter. Both parents are involved with Sophie’s care and edu- cation, and they maintain frequent communication with her teachers. Sophie was observed to have atypical development soon after birth when she had difficulty feeding and significant low muscle tone. Her parents have been told she likely has a genetic syndrome, and they have elected not to pursue any detailed genetic testing at this time. She began receiving physical therapy, occupational therapy, and speech therapy through an early intervention program at age two months. At three years of age, Sophie began receiving these services through her school district as an eligible child with disabilities under IDEA Part B. Her motor skills have im- proved slowly. Sophie holds her head against gravity for several minutes when given physical

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293Key Concepts in Understanding Motor Disabilities

support at her trunk and shoulders, and she rolls on the floor with help once or twice using a poorly coordinated pattern.

Sophie attends her neighborhood elementary school and participates in the general educa- tion classroom during the morning routine, circle time, specials classes, lunch, and recess. In the first grade classroom, Sophie has support from a paraprofessional who assists her with mobility, communication, and modified academic tasks. Sophie receives special education instruction for language arts and math in a classroom with three other special education stu- dents. She wears glasses and visually attends best when toys and materials have high contrast or are lighted. She inconsistently communicates her needs and preferences by smiling and, more frequently, by crying when she is unhappy. Sophie uses a manual wheelchair for mobility at school and is dependent on others to lift her out of her chair or to change her position. Sophie’s decreased muscle strength and endurance limit her ability to control her head and body during functional tasks. Sophie wears ankle-foot orthoses due to decreased muscle tone and joint stability in her foot and ankle. She spends 30 minutes out of her wheelchair during the school day, either on a floor mat or in a supine stander. When on the mat, Sophie moves her arms and legs against gravity but her movements are poorly coordinated, and she fatigues quickly. Sophie has a gastric feeding tube (G-tube) in place for nutrition and does not take food by mouth. She relies upon teachers and other school staff for hygiene and self-care tasks such as diapering and handwashing.

Sophie’s team has identified these primary goals for her: helping her improve her communi- cation with peers and adults, and increase her participation in group activities in the classroom, such as completing the sign-in routine and placing completed work in the teacher’s basket. Identified steps to achieve these goals include developing a predictable and consistent yes/no response with Sophie, improving her head and trunk control while seated, and improving consistency of hand grasp and release skills.

Introducing … Teo

Age: 16-Year-Old High School Student Diagnosis: Cerebral Palsy, Seizure Disorder GMFCS Level: III Teo is a 16-year-old high school student who lives with his parents, grandmother, and 2 sib- lings. Spanish is the primary language spoken at home. During meetings between Teo’s family and school staff, an interpreter is present to translate between English and Spanish. In order to facilitate more frequent communication between the family and school staff, a Spanish- speaking staff member records and translates messages on a switch-activated device that Teo brings to school each day. Teo was diagnosed with cerebral palsy and a seizure disorder at five months of age and rated at a Level III on the Gross Motor Function Classification System (GMFCS). (Level III is similar to moderate impairment and will be described more fully in this chapter.) He received comprehensive early intervention services and had surgery to increase the stability of his hip joints when he was four years old. Teo has received physical, occupational, and speech therapy at school since preschool. As Teo’s motor skills developed and became commensurate with his GMFCS level III rating, physical and occupational ther- apy services prioritized consultation services focused on practice and generalization of acquired skills, development of accommodations and modifications to school activities and routines, and staff training.

Teo is enrolled in his local high school and attends general education classes with a modi- fied curriculum and support from a paraprofessional who works with two other students. He also participates in special education instruction including functional academic courses in math and language arts and a life skills class. As part of his transition plan, Teo has begun a job- shadowing program in order to explore his interests and preferences. Teo initiates communica- tion primarily with familiar adults, and this is accomplished using gestures or his high-tech voice output communication device. He requires adult facilitation to initiate communication with peers and to use more than one- or two-word responses. Teo walks between adjoining class- rooms and within his home using a four-wheeled rear walker with forearm supports. At school, he leaves each class several minutes early in order to walk between classrooms in a less crowded hallway. He uses a manual wheelchair when moving between hallways or buildings in his school and when in the community. Teo has difficulty sidestepping or walking backwards

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due to decreased balance, muscle stiffness, and weakness in his legs. Therefore, Teo requires physical assistance from adults for transfers in and out of a chair or seated position and when moving from one stable surface to another. He has a gastric feeding tube (G-tube) for supple- mental nutrition but has been increasing his oral food intake. Teo enjoys eating lunch with peers in the cafeteria and is beginning to use an adapted spoon to feed himself pureed foods. Teo uses a modified toilet seat with armrests and requires physical assistance for transfers on and off the toilet and for personal hygiene.

Teo’s team would like to increase his independence with completing assignments and tasks in general education and facilitate improved social interactions with peers in preparation for a successful transition to adult life. Identified steps to achieve this goal include improving self- advocacy skills, expanding his communication skills using a technology device, and providing additional supports to facilitate his independence at school and in the community.

Impact on EducatIon and partIcIpatIon

Students with physical disabilities and motor impairments attend schools and partici- pate actively in the educational setting despite challenges in accessing all the areas of the school or managing the necessary tools and equipment that may be essential to support or enhance learning. Quality education programs for individuals with motor disabilities include instruction as part of an academic and/or life skills curriculum and physical management routines. In addition, these students are most likely to benefit from therapy services, provided as related services under IDEA, designed around developing specific skill and abilities, and addressing specific impairments, to assist the students to benefit from their education through active participation. The intended result of any education program involves the ability to participate and produce func- tional outcomes in communication, mobility, socialization, work, and learning. For example, teaching a student to stand and move with assistance from a wheelchair to a toilet, a desk in the classroom, or onto the floor requires an instructional program or plan. Students with motor disabilities also require conscientious management of their physical needs in all settings—home, school, work, and community environments— and without this focus on their physical impairments, the ability to perform activities and to fully participate may be limited.

Caregivers and school teams must manage lifting, carrying, positioning, feeding, toileting, dressing, and other similar routines when a student with motor disabilities is unable to perform the routine independently, or is unable to fully complete the necessary steps in all settings. Physical management routines allow adults (or peers) to use procedures, equipment, or alternative strategies to (1) remediate, or (2) com- pensate for the absence or loss of function. Remediation is useful for building upon existing skills or intervening to improve upon an existing impairment. Compensation suggests that alterations in the routine can be made to allow for greater participation. A third strategy for physical management involves modification of the environment or personal factors (directly related to the individual) in an effort to (3) prevent further impairment or harm.

Lifting a student to move him/her from one location, or surface, to another, or positioning the student in an adaptive chair can be done in ways that promote relaxa- tion or in ways that make a student stiff, uncomfortable, or fearful. Proper positioning can provide the support and comfort necessary for a student to engage in active learning and communication during the school day. Occupational therapists and physical therapists, together with family members, teachers, and other adults, can ensure that they use the most effective and most efficient ways to manage a student’s physical needs in all settings. Addressing students’ needs will depend on their age and size, the degree and type of motor disability, the setting, and the person who will be carrying out or performing the routine. In addition to the resources available from the student’s IEP team and related service providers in school, many useful internet resources, including such websites as the American Academy for Cerebral Palsy and

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295Key Concepts in Understanding Motor Disabilities

Developmental Medicine (www.aacpdm.org), United Cerebral Palsy www.ucp.org), along with a variety of useful videos (www.youtube.com) are available.

This chapter provides an overview of students with motor disabilities, beginning with the need to understand how physical impairments can impact access to educa- tional settings, services, and supports, while focusing on how participation can be influenced by implementation of an IEP that offers the student opportunities for reme- diation, compensation, and prevention. Furthermore, related service providers can address quality of movement and offer other members of the IEP team strategies to accommodate the physical needs of these students so that they will participate as fully as possible in school and other activities and daily routines in everyday settings. Throughout the chapter, you will become acquainted with two students: Sophie, a seven-year-old first grader, and Teo, a 16-year-old high school student. Both of these students are introduced to you in the chapter-opening vignettes. These students share characteristics with many other students you may encounter in schools and they will illustrate the variety of ways in which IEP teams address students’ physical needs in school. We know that students with motor disabilities will need to receive some sup- port or services to address their access to education and daily routines that occur dur- ing school.

International classification on Function (IcF)

The International Classification of Function (ICF) is a framework used across many disciplines to describe an individual’s functional status related to a health condition. The framework focuses on what a person is able to do, rather than what a person is unable to do. The approach defines three perspectives: body structure and function, the person as an individual, and the relationship between personal and environmen- tal factors that contribute to the health condition. Introduced by the World Health Organization in 2001, the ICF framework describes changes to health as the dynamic interaction between the health condition and contextual factors (see Figure 9–1). Important to note is that this was the first time that “health” was considered as a pri- mary element in a model describing disability and was considered to be a radical philosophical change when compared to earlier models used to understand the impact of disability on participation and function within daily routines.

The ICF approach allows for health conditions to be used as the construct or framework upon which to describe or define the diseases, disorders, injuries, or trau- mas affecting the individual, while the body function and structure identify which physiological functions or anatomic parts of the body are most impacted by the health

FIGurE 9–1 ICF Framework

Personal Factors

Participation Restrictions

Activities Limitations

Health Conditions

Body Function and Structure Impairments

Environmental Factors

(Reproduced, with permission of the publisher, from International Classification of Functioning, Disability and Health: ICF, page 9, World Health Organization, 2001.)

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FIGurE 9–2 CF Terminology

ICF Domains of “Functioning” ICF Descriptions of “Disability” Application of ICF terms to Sophie

Body Functions

Physiological and

Definitions of ICF Domains of Functioning and Associated Disability

psychological functions of body systems

Impairments Problems in body function or structure (such as significant deviation or loss)

Sophie has decreased muscle strength and limited endurance for performing movement or holding her head and trunk erect against gravity.

Body Structures

Anatomical parts of the body (including organs, limbs, and their components)

Activity The execution of a task or action by an individual

Limitations Difficulties an individual may have in executing activities

Sophie holds her head against gravity for several minutes when given physi- cal support at her trunk and shoulders.

Participation Involvement in a life situation

Restriction Problems an individual may experience in involvement in life situations

Sophie has support from a paraprofessional who assists her with mobility, communication, and modified academic tasks in the classroom.

(Adapted from Leimkuehler and the American Academy of Orthotists & Prosthetists Online Learning Center. Retrieved from http://www.oandp.org/olc/lessons/html/SSC_09/module2.asp?frmCourseSectionId=7CC1D52A-9E9D-4A03-A2F0-78AE7DB64977)

condition. The impairments are the specific deviations or problems as a result of body structure and function. Activity limitations are recognized as difficulties that result when impairments interfere with the ability of the individual to perform a task or action. Ultimately, participation is the connection to function, and participation restrictions are the problems an individual may experience as his or her activity limi- tations restrict involvement in life situations. (Additional clarification of these terms using examples linked to Sophie can be found in Figure 9–2.) Key environmental fac- tors include the physical, social, and attitudinal environments in which people live and conduct their lives; personal factors are the many other aspects of life that create variability in living. These include the psychosocial factors, executive function, socio- economic status, healthcare access, and the like.

Related service providers can use the ICF framework when working with students with motor disabilities in schools to better understand the students’ ability to partici- pate in their school day. The ICF framework allows us to organize the consideration of physical management routines for students with motor disabilities. An example of this application for our student Teo is provided later in this chapter (see example in the section Meeting Students’ Needs). Although physical therapists and occupa- tional therapists address a student’s impairments through specific therapeutic inter- ventions that focus on compensation and remediation, the goal of such interventions is to allow the student to become better able to perform simple functional actions toward achieving the larger goal of performing an activity. For example, buttoning a shirt is one functional action related to the larger goal of dressing. Partial participa- tion, as described in Chapter 1, is a step toward achieving independence, whereby adjustments in personal and environmental factors may allow a student with severe disabilities the opportunity to engage in a level of participation in the classroom that was previously not possible. For example, Teo partially participates in eating lunch while continuing to receive nutritional support via the G-tube and the use of an adapted spoon and pureed foods during self-feeding.

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The ICF framework may be a beneficial one for the IEP team to use in organizing the student’s priorities for participation while noting the activity limitations and impairments in body structure and function that IEP goals could address. In addition, identification of appropriate special education and related services necessary to achieve the goals should become apparent as the team recognizes how they can respond to the student’s limitations in body structure, environmental, and personal factors. The ability to measure participation, and to distinguish this from activity—as elements of participation—have been recognized as barriers to fully understanding the extent to which a child, or student, is able to engage in common routines in typical settings (Coster & Khetani, 2008).

Gross motor Function classification System (GmFcS)

Students with significant physical, intellectual, sensory, and behavioral impairments have long been referred to as having severe disabilities. Recognizing that this term is often used to describe the presence of one or more conditions that are substantially limiting, or the absence of functional skills necessary for participation in daily rou- tines and activities, the diverse and heterogeneous nature of characteristics associated with severe disabilities suggests that other classification systems may be useful for members of the school team. The Gross Motor Function Classification System (GMFCS) was introduced in 1997 by CanChild (www.canchild.ca) as a measure of the perfor- mance in home, school, and community settings (Palisano, Rosenbaum, Bartlett, & Livingston, 2008; Palisano, Rosenbaum, Walter, Russell, Wood, & Galuppi, 1997; Rosenbaum et al., 2002; Rosenbaum, Palisano, Bartlett, Galuppi, & Russell, 2008).

The GMFCS is based on the student’s usual, or most common, ability and not on his or her peak or optimal performance, thereby capturing what is described as a cur- rent level of function. Using an ordinal scale for a five-level classification system, the gross motor function of children and youth with cerebral palsy is described according to the ability of the child to perform functional activities while reflecting the impact of personal and environmental factors. Judgments on quality of movement should not impede a measure of how the child functions using self-initiated movements associ- ated with sitting, walking, and wheeled mobility. Age bands (incremental differentia- tion by specific ages) measure performance of the child before age 2, between 2 to 4 years, 4 to 6 years, 6 to 12 years, and 12 to 18 years; these age bands distinguish between functional abilities that change over time and may be dependent on the child’s varying needs for assistive technology that include mobility devices (walkers, crutches or canes, or wheeled mobility) with limited influence on the quality of move- ment. When the GMFCS level is appropriately determined, the child’s performance can be understood as a measure of their function. Children do not generally change GMFCS levels as they develop (Palisano, Cameron, Rosenbaum, Walter, & Russell, 2006). Therefore, the GMFCS can also be used as a prognostic tool to determine the ability a child will likely have as he or she ages (McCormick, Brien, Plourde, Wood, Rosenbaum, & McLean, 2007). Figure 9–3 describes GMFCS Levels I–V for the age band of children 6 to 12 years of age. Descriptions of functional abilities, or perfor- mance at each level, are slightly different for each age band.

Teo is at GMFCS Level III using the 12–18 year old band. At this level, he is able to walk using a four-wheeled rear walker with forearm supports to assist with mobility. He uses a manual wheelchair for longer distances in school and when in the community. He can climb stairs slowly by holding onto a railing or with moderate assistance. Although Teo may work on some skills that are described in Level II, it is unlikely his performance will change to the extent he would move to a different level. He may learn to walk short distances using forearm crutches or may need slightly less assistance when ascending or descending stairs, but according to the prognostic abilities of the GMFCS, he won’t move from Level III to Level II.

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The GMFCS levels are useful in generating an overall prognosis for students with cerebral palsy and in the development of appropriate IEP goals. By knowing what skills or abilities are expected of a student at his or her current level and the next age band up on the GMFCS, the IEP team can carefully consider appropriate goals for the student and use it to guide decision-making. The IEP team should discuss which related service providers would be best able to assist the student in meeting these goals and have a guide for whether or not the student will be likely to reach more independent levels of function over an identified period of time (e.g., within one academic or calen- dar year). The IEP team should also not make unreasonable assumptions about a significant change in motor performance in a child who is at Level IV or V.

Quality of movement

Many students with motor disabilities have diagnoses that involve a loss of motor con- trol and difficulties with motor learning, or the ability to learn new skills that involve initiation or sustained movement. Without going into great detail regarding the neuro- science necessary to more fully understand these concepts, we need to recognize that related service providers who have specialized training and expertise in these areas

FIGurE 9–3 GMFCS Levels I–V for 6–12 Year Olds

Level I

Children walk at home, school, outdoors, and in the community. Children are able to walk up and down curbs without physical assistance and stairs without the use of a railing. Children perform gross motor skills such as running and jumping but speed, balance, and coordination are limited. Children may participate in physical activities and sports depending on personal choices and environmental factors.

Level II

Children walk in most settings. Children may experience difficulty walking long distances and balancing on uneven terrain, inclines, in

assistance if there is no railing. Outdoors and in the community, children may walk with physical assistance, a handheld mobility crowded areas, confined spaces, or when carrying objects. Children walk up and down stairs holding onto a railing or with physical

device, or use wheeled mobility when traveling long distances. Children have at best only minimal ability to perform gross motor skills such as running and jumping. Limitations in performance of gross motor skills may necessitate adaptations to enable participation in physical activities and sports.

Level III

Children walk using a handheld mobility device in most indoor settings. When seated, children may require a seat belt for pelvic alignment and balance. Sit-to-stand and floor-to-stand transfers require physical assistance of a person or support surface. When

seating for trunk and pelvic control and physical assistance for most transfers. At home, children use floor mobility (roll, creep, or

traveling long distances, children use some form of wheeled mobility. Children may walk up and down stairs holding onto a railing with supervision or physical assistance. Limitations in walking may necessitate adaptations to enable participation in physical activities and sports including a self-propelling manual wheelchair or powered mobility.

Level IV

Children use methods of mobility that require physical assistance or powered mobility in most settings. Children require adaptive

crawl), walk short distances with physical assistance, or use powered mobility. When positioned, children may use a body support walker at home or school. At school, outdoors, and in the community, children are transported in a manual wheelchair or use powered mobility. Limitations in mobility necessitate adaptations to enable participation in physical activities and sports, including physical assistance and/or powered mobility.

Level V

Children are transported in a manual wheelchair in all settings. Children are limited in their ability to maintain antigravity head and trunk postures and control arm and leg movements. Assistive technology is used to improve head alignment, seating, standing, and and/or mobility but limitations are not fully compensated for by equipment. Transfers require complete physical assistance of an adult. At home, children may move short distances on the floor or may be carried by an adult. Children may achieve self-mobility using powered mobility with extensive adaptations for seating and control access. Limitations in mobility necessitate adaptations to enable participation in physical activities and sports including physical assistance and using powered mobility.

(Republished with permission of John Wiley & Sons, Inc, from “Development of the gross motor function classification system for cerebral palsy,” Developmental medicine and child neurology, 50(4) by Rosenbaum et al, 1962; permission conveyed through Copyright Clearance Center, Inc.)

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299Key Concepts in Understanding Motor Disabilities

(primarily physical therapists and occupational therapists) should be consulted as part of the IEP team for students who may face challenges in their abilities to move smoothly and effortlessly and for whom motor control and motor learning may impact their ability to fully access their education. Specifically, a student’s ability to move against gravity and maintain postural muscle tone or control will require some type of intervention to ensure the student is ready and able to access the educational environ- ment. Postural tone describes an increased activity level in the muscles we use to stand upright and move our limbs against gravity (Shumway-Cook & Woollacott, 2001). To achieve independent movement, we must have sufficient muscle power to avoid forces of gravity while initiating active movement in a specific direction. Our postural tone may decrease, or be lower, when we are fully supported by a comforta- ble chair and will increase, or be higher, when we are sitting on an unstable surface without back support, such as a rock. Our muscles will have to become actively engaged to support us in an upright position in sitting or standing, and then any effort to move an arm or leg in a specific direction or position will add further difficulty in maintaining postural control. A cycle that illustrates the ways in which posture and movement may become more abnormal over time is illustrated in Figure 9–4.

Think about the effort that Teo may require as he attempts to use an adapted spoon to feed himself or use isolated finger control to communicate using his assistive technol- ogy device. In either situation, Teo must rely on adaptive equipment for external trunk support so that his postural control is sufficient to keep his trunk upright and allow for controlled movement at the shoulder in an antigravity position. Each time Teo at- tempts these movements, he must exert effort, and the impact of this effort is first no- ticed by an increase in his postural tone. This increased muscle tone, sometimes referred to as hypertonicity, can reduce movement at the extremities, thereby reducing overall function.

The next section will describe the impact of abnormal muscle tone on movement and function. Many students with motor disabilities will require assistance to achieve proper positioning and facilitate movement for function. Multiple opportunities for practice and repetition will be necessary to learn new skills and achieve goals related to movement and functional outcomes.

Spasticity and muscle tone Figure 9–4 shows the process that occurs when infants are born with abnormal tone or when atypical muscle tone is acquired through an accident or injury that damages the neurological system. Beyond postural control, discussed above, an understanding of muscle tone, and its impact on movement is important in identifying how to best address what students with motor disabilities may need to optimize their participation. Many children who have low muscle tone, or hypotonicity, were born

FIGurE 9–4 Cycle illustrating effect of increased muscle tone on posture and movement

Reduced movement potential

Reduced functional ability

Increased postural tone

EFFORT

Increased effort

(Scottish Sensory Centre – Marianna Buultgens & Heather McLean (2003) Cerebral Palsy and Visual Impairment (CPVI) in Children: Experience of Collaborative Practice in Scotland. Reprinted with permission.)

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prematurely, although this is not the only cause of this type of muscle tone. And many of these same infants actually develop increased tone in the extremities and, to a lesser extent, in the head and trunk over time. As a result, you may see children who started out in life with extreme hypotonicity (low muscle tone), but by school age they may have muscle tone that is described as hypertonic or spastic (high or tight muscle tone or stiffness). In addition, many children also have a combination of muscle tone with lower tone in the trunk and higher tone, or hypertonicity, in the extremities. Figure 9–5 provides additional definitions and descriptions of abnormal muscle tone.

Furthermore, the cycle of abnormal movement, coupled with adjustments in body position to support antigravity movement or postures, often leads to secondary motor disabilities over time. Physical changes in the muscles and joint structures may result in orthopedic deformities, which induce further development of compensatory pat- terns, and perhaps more orthopedic deformities. By the time many children with motor disabilities reach school age, they may have secondary motor disabilities and orthopedic deformities in addition to the original motor disability that was present during their infant and early childhood years. You may see students who have hypotonicity, or low muscle tone, in their trunk and head and who rely on numerous supports used in their wheelchair to maintain upright posture. The same student may have hypertonicity, or high muscle tone, in their arms and legs making voluntary movement, such as extending the elbow or knee, very difficult. Over time, the stu- dent may develop scoliosis or curvature of the spine requiring additional support of the trunk when seated. In addition, the pelvis, or hips, may be shifted to the right or left (depending on the direction of increased muscle tone) making it increasingly difficult for the student to sit with an even distribution of weight on both the right and left buttocks.

position and restriction Many students with motor disabilities will exhibit abnormal muscle tone and will require assistance to achieve proper positioning and facilitate movement for func- tion. Use of adaptive equipment, described in detail later in this chapter, may be necessary to provide the support necessary for trunk stability upon which voluntary movement of the extremities may occur. In addition, equipment may also be neces- sary to restrict extraneous involuntary movement, as in the case of a child with athe- tosis (see definition in Figure 9–5), for safety of the child or for the potential of facilitating more purposeful movement. Safety is a concern when the involuntary movements of arms or legs could lead the child to knock into walls or other immov- able objects with great force.

FIGurE 9–5 Definitions and Descriptions of Abnormal Muscle Tone

Hypotonia: ing to maintain a position or move against gravity

Hypertonia: increased muscle tone; usually observed in stiff arms and/or legs, especially when

decreased muscle tone; usually observed in floppy limbs or trunk, especially when attempt-

attempting controlled intentional movements

contracted; identifies damage in the pyramidal tract of the brain responsible for voluntary movement Spasticity: generally used in conjunction with hypertonia to describe stiff muscles that are strongly

Ataxia: affects muscle control and coordination of movement; results in poor balance and wide-based gait

Athetosis: represented by involuntary movements of trunk and extremities; most noticeable as slow, writhing movements that cannot be controlled

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301Key Concepts in Understanding Motor Disabilities

adequate opportunities for Learning and practice Sufficient opportunity for students to perform motor skills within a context is necessary for learning new motor skills and for practicing acquired movements. This means that a particular motor skill must be practiced often enough to become firmly established as “automatic.” When a child is first learning to go up and down stairs, for example, the required movements are made carefully and slowly with deliberate concentration and effort. As the child goes up and down the same stairs again and again, greater skill and precision result from the practice of repeating these movements, and the effort that is required appears to diminish. After much practice, going up and down stairs becomes automatic—a motor skill that is performed without even thinking.

Teo is able to ambulate up and down a small ramp to get from one area of the school building to another. Teo prefers walking so that he can enter the cafeteria without hav- ing to return to classroom after science to get his wheelchair. In order for Teo to accom- plish this without taking too much time out of the lunch period, he has had to practice this skill many times.

Many functional motor skills become automatic or are performed without con- scious thought: walking, drinking from a glass, feeding oneself, riding a bike, reach- ing for objects, washing dishes, or communicating through verbal language or non-verbal cues. In addition to the automaticity, children must learn to generalize the newly acquired motor skill to other situations or settings. Going back to the same example from above of going up and down stairs, we know that the motor skill has indeed been mastered when the child ascends or descends stairs that are slightly different in height, surface, or number from those that were initially used to acquire the skill.

Individuals with motor disabilities can best learn new skills through practice. Opportunities for practice are achieved through repetition and are enhanced through integrating therapy into common routines that occur both regularly and frequently throughout the day. This is known as integrated therapy. Team members can all assist by providing opportunities for practice as they create situations throughout the day where a child performs a specific motor skill. These practice opportunities may be incorporated into both physical management routines and participation in typical classroom activities. Children may, for example, lift their arms up before classroom staff put on or take off the tray on the wheelchair, as part of the routine of putting their coat on or taking it off, or reach forward to grab a stationary support bar in the bathroom before being moved out of a wheelchair as part of an assisted toilet trans- fer. By incorporating movement of the arms into many physical routines, an individ- ual not only partially participates in the care routine but also uses the same motor skill (in this case, lifting the arms up) across routines, thereby practicing this move- ment numerous times throughout the day.

Sophie’s first grade teacher has created many additional practice opportunities for her to practice the skills she is working on with her physical therapist. For example, she has all of the children lift their arms up many times during morning circle songs and ac- tivities, has incorporated this movement into hourly stretches for all children in the class, and requires Sophie to lift her arms up before moving in and out of her wheel- chair, putting on her coat for recess, and putting her completed work into the basket on her teacher’s desk. These natural opportunities for Sophie to use her arms allow her to learn and practice functional arm use across a variety of situations. Because Sophie’s parents, teachers, and therapists all incorporate this arm movement into everything they do with Sophie, they provide more than 100 opportunities a day to practice lifting her arms! This approach means that she will learn to lift her arms up much more quickly than if she practiced this movement only during weekly therapy sessions, and she is also less likely to develop muscle tightness and secondary disabilities in her arms and shoulders as a result.

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As you move through this chapter, we will revisit a number of the concepts intro- duced in this section to help improve your understanding and acquisition of them, and application of these concepts to students with motor disabilities.

tEam Support For StudEntS

Professionals from many different disciplines may be involved in working with and assisting students with motor disabilities throughout the school day both in the school building and in the community. Physical therapists (PT) and occupational therapists (OT), speech language pathologists (SLP), assistive technology specialists, adaptive physical educators, vision or hearing specialists, school nurses, or recreation thera- pists are some of the related service providers who may be involved with these stu- dents. These professionals will be part of the team in addition to regular and special education teachers, paraeducators/paraprofessionals, bus drivers, and child care pro- viders, among others. One of the primary challenges for the families of students with motor disabilities is coordination of the many services and supports, especially since the constellation of service providers may reach beyond school and involve a variety of separate agencies in addition to school, including child care programs, home health agencies, outpatient clinics, and respite care. Although these families may have been involved in early childhood programs under Part C of IDEA, and may be expecting the same level of service coordination available in those settings as their child gets older, Part B of IDEA does not include this type of case management. Service coordinators, who were available to help families locate and use a variety of services and supports and to coordinate those services so that they are provided in ways that help promote the progress of infants and toddlers within early intervention, are no longer available after children are in school, leaving the family responsible for service coordination.

team collaboration and communication

All members of the educational team, including related service providers working with the student, are expected to coalesce as a team and meet at least annually to dis- cuss and develop the student’s IEP. Parents are also members of the IEP team, and they are expected to participate actively in the IEP process in an equal capacity. At times, conflicts arise because each professional discipline may view a student’s disa- bilities and the impact on education, as well as the possibilities for intervention that might be necessary to assist the student to benefit from his or her special education, from a different perspective; and sometimes these underlying perspectives result in different priorities or goals when the intent is to have a single IEP developed by the team. For example, an occupational therapist (OT) may determine that a child could produce written work much faster using a computer (keyboard) rather than handwrit- ing in the classroom. Consequently, the OT may propose that the student would most benefit from keyboarding instructions and full access to a computer for all written work. The OT in such a situation would likely want the team to establish goals to improve the child’s use of a keyboard as a means of enhancing a child’s access to their education. However, the classroom teacher for this same student may see the priorities more aligned with isolated hand movements necessary for developing hand- writing. In this example, both the OT and the teacher want to improve the student’s performance in the classroom, but they have different approaches as to how they think these goals can best be met. Both professionals recognize the limitation in fine motor skills and the effect of this limitation on activities such as writing, but the occu- pational therapist is using a compensatory approach to “bypass” handwriting and prepare the child to use an alternative method to achieve competence in producing written work. In the meantime, the teacher wants to use remediation and encourage the child to learn to write using a pencil. Hopefully, the OT and the teacher would

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303Key Concepts in Understanding Motor Disabilities

discuss their ideas and approaches with each other and with the rest of the IEP team, and together the team would come to consensus about the student’s greatest priori- ties that should be addressed in the IEP. Perhaps, both can become part of the plan, but if not, other resources for the child to access outside of school may be suggested to the parents. Different perspectives and approaches can coexist when professionals and families work together. After all, the goal is the same under IDEA—assist the child to achieve educational benefits.

Related service providers who have specialized education and training have knowl- edge and expertise about interventions to address impairments, ways to adapt envi- ronments or settings, as well as ideas about compensatory movements or positions that may work best for students with motor disabilities in a particular circumstance. They also know how to adapt materials or change the sequence of steps in a routine to alter requirements or demands of the task. Teachers, family members, and other adults who interact with students with motor disabilities may see these related service providers as sources of information and ideas that can assist them with managing the student’s physical needs more easily and with less effort. Sometimes related service providers forget to share this knowledge, and sometimes the teachers or paraprofes- sionals forget to relay how challenging a physical routine is to accomplish with the student during the day. By engaging in a system of frequent, consistent, and open communication, all members of the team can benefit from sharing information and updates with each other toward achieving common goals.

IDEA regulations define the role of each related service provider and the criteria or qualifications of each. Some of these are very simple; for example, in 34 CFR section 300.34(c)(9), we learn that “Physical therapy means services provided by a qualified physical therapist.” While others are more detailed; for example, in 34 CFR section 300.34(c)(6), we learn that “Occupational therapy—(i) means services provided by a qualified occupational therapist; and (ii) includes—(A) improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation; (B) improv- ing ability to perform tasks for independent functioning if functions are impaired or lost; and (C) preventing, through early intervention, initial or further impairment or loss of function” (IDEA, 2004).

Physical therapists and occupational therapists are expected to deliver their serv- ices along a continuum that includes not only direct intervention/instruction with the student, but also consultation with other team members to ensure that students have the opportunities to practice prioritized activities and skills regularly. As a result, many therapists have had to learn how to change their role from one of a sole direct service provider to a collaborative consultant who considers how to effectively deliver service both directly and indirectly. As consultants, therapists are collaborating with teachers, paraprofessionals, and family members to address students’ physical needs throughout the school day. For example, in planning for an upcoming field trip in the community, the classroom teacher may ask the physical therapist for suggestions to assist a student who uses a walker and struggles to keep up with the class. Similarly, the teacher may ask the occupational therapist for suggestions to assist a student who spends a significant amount of time during recess attempting to don their coat while the rest of the class has already gone outside to the playground.

When therapists help families determine how their children can participate in the activities on the playground or in the local park, suggest ways to engage in commu- nity recreation programs, or determine how a young adult can work at a local busi- ness, students’ social and environmental experiences are broadened, as are their opportunities for learning. Similarly, when general education teachers identify what is difficult within the context of their classrooms, therapists may contribute suggestions or offer strategies that are likely to make the student successful in the situation, reduc- ing the stress on both the student and the teacher. Problem solving by team members with various backgrounds and expertise is important. Many of the challenges that teams need to address do not have known solutions. Instead, the team may have to

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engage in collaborative problem solving and think creatively to generate what seems to be an optimal solution (Utley & Rapport, 2002).

Many of the professionals who interact with individuals with motor disabilities do so for only short periods of time in that individual’s life. One set of therapists and teachers may be replaced by a new set when a student moves from early intervention to pre- school or from one school year to the next. Professionals may shift again each time a student moves within the educational system to a new school building—from elemen- tary to middle to high school and then to postsecondary education or work. Families are the constant in their children’s lives and are often the historical memory of what has occurred and been successful in their children’s life (Salisbury & Dunst, 1997). Thus, parents play a vital role as members of the team and should be regarded as “experts.” Figure 9–6 provides options for communication with parents and team members.

Most motor disabilities cross the life span; they often do not go away or decrease with age or as the result of a particular service delivery period. In many instances, motor disabilities become more limiting as the child ages due to secondary changes in body structure that result from poor physical management, insufficient use of adaptive equipment or assistive devices, or over-emphasis on performance of specific motor skills. By working as a team, communicating regularly, and collaborating within and across agencies, we can avoid negative outcomes and work together to obtain posi- tive, if not life-changing, outcomes for students.

Service delivery by the team

In addition to the required components of the IEP where teams provide projected dates for beginning services, anticipated frequency, location, and duration of services and modifications, the IEP should also specify the service delivery model selected to best meet the needs of the student. As an example, we will consider different models of the integration of related services, primarily OT, PT, and SLP, into the student’s school day. These related service delivery models include full integration of therapy by the team throughout the school day, partial integration of services, and delivery of services through a direct intervention model. In the fully integrated model, the stu- dent with motor disabilities would receive all special education and related services within the classroom. An instructional assistant, or paraprofessional, may be with the student all or part of the day, and extensive collaboration with any related service providers on the student’s IEP would be expected in the model. In the partially inte- grated model, the student with motor disabilities would receive most instruction in the classroom as appropriate for the individual student. This is a variable model dependent upon the needs of the student; specific related service providers may incorporate their interventions with the student into the routines of the classroom or may determine that they need to address some of the student’s needs outside the classroom. The direct intervention model may be used when the provider determines

FIGurE 9–6

Options for Communicating with Parents and Other Team Members

✓ Face-to-face scheduled meetings

✓ Face-to-face informal communications (hallway “chats”)

✓ Written notes in a notebook that “lives” in the student’s backpack or bag

✓ Email

✓ Text message

✓ Phone or conference calls

✓ Video calls (e.g., Skype, FaceTime, iChat)

✓ Facebook message

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305Key Concepts in Understanding Motor Disabilities

student needs can best be met through individualized intervention reliant on having greater focus on communication, socialization, adaptive behavior, mobility, or life skills. These related services may be provided both within and outside the classroom, and collaboration with the teacher is often needed to ensure that modifications and adaptations necessary for the student are available to facilitate optimal levels of par- ticipation (Best, Heller, & Bigge, 2005).

Another way to describe service delivery models would be along the following continuum from most to least direct:

• Individual pull-out • Small group pull-out • One-on-one in the classroom • Group activity in the classroom • Whole class instruction • Consultation

Figure 9–7 provides descriptions of what these service delivery models look like in a typical school setting.

FIGurE 9–7 Descriptions of Service Delivery Models

Individual pull-out Therapists take an individual student out of the classroom to another room or location in the school building or on the playground. The student receives intervention focused on specific needs identified in his/her IEP for approximately 30–45 minutes (time varies) and then the student returns to the

distractible or distracts peers around him/her; or when the intervention requires equipment, space, or other unique environmental features.

classroom setting. This approach may be essential when the student has very specific needs; is

Small group pull-out Therapists take a small group of students with disabilities, who all have similar needs for intervention as identified on their IEP, out of the classroom to another room or location in the school building or on the playground. The students receive intervention focused on specific needs for approximately 30–60 minutes (time varies) and then return to the classroom setting. These students may all be from the same classroom, or they may spend most of their day in several different classrooms, but they come together for this therapy session outside the classroom, which functions as their “academic home.”

One-on-one in the classroom her IEP within the classroom setting. At times, the intervention may be directly linked to activities or

An individual student receives intervention focused on specific needs that have been identified in his/

instruction occurring in the classroom at that time (as a parallel), or the student may be involved in activities that are different than what the rest of the class is doing (as an alternative). The primary point here is that the student does not leave the classroom, and the therapist works directly with one student in that setting.

Group activity in the classroom

A small group of students with disabilities, who all have similar needs for intervention from a

classroom setting. At times, the intervention may be directly linked to activities or instruction therapist as identified on their IEP, receive intervention focused on their collective needs within the

occurring in the classroom at that time through co-teaching or parallel instruction, or the group of students may be involved in an alternative activity or instruction from the rest of the class (Friend & Bursuck, 2009). The primary point here is that the students do not leave the classroom, and the therapist works directly with the group of students in that setting.

Whole class instruction The therapist or other related service provider engages the whole class in an activity that has been designed to meet the specific needs of one or more identified students, but in which all students participate. The therapist may co-teach the whole class, or the therapist and the teacher may work together to best manage the classroom, while they are both focused on the same activity, lesson, and outcome for individual students and the collective whole. (Bauwens & Hourcade, 1997; Magiera & Zigmond, 2005; Zigmond, 2001; Wilson, 2005; Friend & Cook, 2007; Friend & Bursuck, 2009).

Consultation The therapist or other related service provider is considered as an expert of their discipline able to assist the classroom teacher in identifying or solving problems as a component of addressing the needs of the individual student. The teacher and related service provider may interact in a collabora- tive relationship; however, this is not always the situation. Regardless, success in delivery of serv- ices through consultation will be dependent on the ability of the collective expertise to address problems (West & Idol, 1987; McWilliam, 1995).

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Not only do we need to consider the setting and model of service delivery, but we must also be cognizant of the extent to which IEP goals are developed by a team, including parents, written in a manner that addresses a skill necessary (in both aca- demic and functional areas) and appropriate for the student. Goals should be posi- tive; emphasizing what the student will do, the conditions under which the student will perform the skills, and be both measurable and observable in order to know when the student achieves the goal.

Here are some examples of an IEP goal written for Sophie and Teo:

Sophie Teo

During playtime, Sophie will communicate her continued interest in an activity by reaching and touching a switch that activates a recorded voice.

When in the bathroom, Teo will independently come to stand and transfer to the toilet.

mEEtInG StudEntS’ nEEdS

Physical assistance and management is an important component of educating stu- dents with severe disabilities. It refers to the physical support, techniques, and strate- gies that facilitate student safety, inclusion, and participation in typical school activities and routines. Developing strategies for safe and efficient physical assistance and management should be a collaborative process that can potentially include the student, family, teacher, paraprofessional, physical therapist, occupational therapist, school nurse, and other relevant team members. The strategies developed can be described as physical management routines. Figure 9–8 outlines the goals of physical assistance and management at school. In educating students who have motor impair- ments, it is important to consistently implement physical management routines. Writ- ten or pictorial instructions may be created to facilitate use of the routine in multiple environments and with a variety of staff members.

Sophie has a laminated set of cards with pictorial representations of each part of her school day. These are held together using a ring clip and cards can be added or elimi- nated from the set as needed. The cards are used by all team members and Sophie’s peers to not only tell her what is coming next, but also to show her a simple visual of the next activity or task. Additionally, the cards can be used to allow Sophie to select between two cards at appropriate opportunities that allow for her to make choices and commu- nicate her selection to adults or peers around her.

Repeated practice of specific skills in a variety of contexts has shown to be a fun- damental requirement of motor learning (Valvano, 2004). At school, students have frequent opportunities to practice skills that facilitate their participation in meaningful daily activities such as self-care, transfers, learning, and play. These important learn- ing opportunities can be maximized through the consistent use of physical assistance and management routines.

As described in the first section of this chapter, the ICF framework provides a helpful guide to understand the relationships between the student, the environment,

FIGurE 9–8 Goals of Physical Assistance and Management

Safety of student and staff

Increase student participation in school activities

Provide opportunities to learn skills that improve proficiency with daily routines

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307Key Concepts in Understanding Motor Disabilities

and the task. This is critical information necessary in designing a physical manage- ment routine. The body structure and function component identify activity limita- tions and participation restrictions that require development of a physical management routine. Activities the student is able to perform successfully can also be identified and incorporated to increase their independence with the routine. Environmental and personal factors important in physical management routine development are also identified using the ICF. For example, the physical layout of a bathroom will impose both opportunities and limitations on the methods used dur- ing a toileting routine. Personal factors, such as how meaningful the activity is to the student, may affect the student’s level of interest and consistency of participation. Figure 9–9 shows the use of the ICF model for evaluating a toileting routine for Teo.

daily routines

Students with motor disabilities often receive direct and/or indirect physical and occupational therapy services at school to help develop physical management rou- tines. The most appropriate service delivery model based on the student’s needs, goals, and prognosis is important to consider. Direct services are most often pro- vided when gains in functional skills can be expected based on the student’s prog- nosis and developmental progression. Indirect services, as described earlier in this chapter, are provided on behalf of the student in the form of consultation with school and community-based teams, development of accommodations and modifica- tions, obtaining necessary adaptive equipment, and improving student self-advocacy. Indirect services may be provided to facilitate access to school environments and curriculum after no further gains in student skill levels are anticipated. Figure 9–10 provides examples of how information on prognosis can help guide goal develop- ment and the interventions that will help the student reach those levels of independ- ence. Student needs and use of appropriate service delivery models may change over time. In fact, ensuring that a student has sufficient opportunities and practice to learn a new skill may necessitate a flow between direct and indirect, or a combina- tion of, services during an IEP period as well as from one IEP period to the next.

Students with motor impairments often have many skills and goals that they must work on simultaneously. In order for the student to accomplish goals and achieve

FIGurE 9–9 Using the ICF Model to Evaluate the Toileting Routine for Teo Teo is rated at GMFCS Level III and, based on evaluation data, his functional skill level is commensurate with other students his age at this GMFCS level. It is likely that Teo’s gross motor skills will not significantly improve.

Teo has muscle stiffness in his legs and decreased balance. Teo has fairly consistent bowel and bladder control with rare

accidents.

Body Systems

Teo is unable to stand and transfer to the toilet

independently. Once seated on the toilet he occasionally

loses his balance.

Activities

There is a large accessible bathroom in the nurse’s office with grab bars.

Environmental Factors

Teo is motivated to use the toilet at school and is

beginning to request using the bathroom.

Personal Factors

Teo is restricted in his ability to participate in toileting at

school.

Participation

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success in and out of the classroom, the IEP team will need to work collaboratively to carefully integrate goals and the strategies to achieve these outcomes across multiple situations and settings throughout the school day. Students will be more motivated when they have opportunities to make choices. Therefore, the team should attempt to provide options for the student when possible and reasonable.

Teo prefers to walk into the cafeteria and sit in a regular chair at a table to socialize during his lunch period. In order to have this choice, he must commit himself to packing up all his materials before the end of the class and moving quickly to the cafeteria when the bell sounds.

Self-care Self-care involves routines that are part of our daily lives. These routines are generally managed independently beginning at rela- tively young ages. However, for students with motor disabilities, many of these routines require special equipment or assistance. Figures 9–11 and 9–12 are examples of such equipment. As students

FIGurE 9–10 Using Prognosis to Guide Goal Development and Service Delivery

Current Level of Performance Functional Goal Service Delivery Rationale

Teo feeds himself ½ serving of pureed food by accepting adapted spoon from staff and bringing it to his mouth after food has been placed on the spoon. He eats in a quiet classroom environment.

Teo will scoop food and feed himself one serving of pureed food using an adapted spoon while in the cafeteria with his peers.

Minimal direct service provided for evaluation of required adapted utensils. Indirect serv- ice provided to develop plan to increase Teo’s endurance for self-feeding in the distracting cafeteria environment, train staff, and provide ongoing consultation.

Teo is motivated to be in the cafeteria with peers and has been increasing his oral intake.

Teo requires physical assis- tance when transferring from his wheelchair to his walker. The staff provides verbal instructions to Teo for each step of the transfer routine.

Teo will use his communica- tion device to request moving to his walker and choose two specific instructions to give to staff. Teo will continue to require physical assistance.

Indirect service provided for adding needed options to com- munication device and staff training and consultation

Based on Teo’s GMFCS level, prior physical therapy interventions, and his age, he will likely continue to require physical assistance for transfers. However, improving his self-advocacy is a reasonable goal based on his current communication skills and anticipated needs for community living.

FIGurE 9–11

Rifton Blue Wave Toileting System

FIGurE 9–12

Snug Seat Manatee

P ho

to : A

m y

B ar

r

P ho

to : M

ar ia

J on

es

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309Key Concepts in Understanding Motor Disabilities

get older and they mature physically, many of these routines may become more com- plex and personal. Team members will work together to make modifications to address any concerns that may arise during the performance of such routines.

For example, now that Teo is 16 years of age, it has become less desirable for him to have adult females assist with his toileting needs during the school day. Teo is working hard to manage the most personal aspects of the toileting skills independently and to rely on assistance for the transfers and more difficult aspects of securing his clothing at the end.

toileting/diapering Toileting and diapering routines are an essential part of a student’s day. Proper posi- tioning can promote alignment while providing postural support necessary for toilet- ing. The student and family play an important role in sharing information regarding toileting and diapering frequency and methods used at home and in the community. This information is an important starting place in developing routines at school that will meet the students’ needs and facilitate their comfort. Students with motor disa- bilities often achieve bladder and/or bowel control at a later age than their typically developing peers and excessive degrees of muscle tone can influence and sometime prevent elimination. Therefore, ensuring that students have adequate postural sup- port to facilitate elimination and developing routines that are age-appropriate and that respect the privacy of the student are important. Students using a toilet typically require an accessible bathroom and may require specialized seating systems designed for bathroom use. These seating systems provide postural support so the student can sit safely and comfortably over the toilet. Grab bars or other equipment may also be required for the student to move safely to the seat.

Students who are diapered need access to a clean surface where they can lie on their backs to be changed. Surfaces, such as a changing table or other type of plinth, are often used because changes cannot be accomplished well from a sitting position. Students who become stiffer when lying on their backs will often need a small pillow under their head to prevent excessive extension and to make managing the diaper easier. For students who are diapered, their routine should include any components of the task they can perform themselves, such as rolling or lifting their hips to assist in their care. Handwashing is an important life skill and including it in the toileting and diapering routine is not only a good way to reinforce personal hygiene, it also provides repeated practice opportunities for learning the skill.

Eating Sharing a meal or snack with peers is a social experience as well as a nutritional one, so ensuring the location and method of eating facilitates this social interaction and is an important consideration in developing mealtime routines. Many students with motor disabilities eat orally but may have difficulty controlling and coordinat- ing the muscles of their face, mouth, and throat. This can cause challenges for the student when manipulating and swallowing food. Positioning the student in good alignment and with appropriate support for eating is important. Ideally, the stu- dent’s head should be in the center of his or her shoulders, neither falling forward or backward, and his or her shoulders and trunk should be centered above the hips. Back support and/or head support, either from the student’s wheelchair or other adaptive chair, will likely be required. Adapted utensils or dishes may also be neces- sary to facilitate successful participation of the student in scooping food and bring- ing it to his or her mouth. These adaptations are often designed and monitored by the occupational therapist, physical therapist, and/or speech therapist working with the student.

For other students with severe motor disabilities, eating food orally may result in excessive choking, coughing, or biting (as a reflex) making this an ineffective or

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even dangerous way to ingest daily calories and nutrition. In those situations, the student may require feeding through a tube that delivers adequate nutrition directly to their digestive system. When a student is tube-fed, staff members are typically trained by the school nurse and/or family to perform this task safely and within physician-specified guidelines to ensure the student’s medical and nutritional needs have been met.

dressing Dressing activities at school can take on many forms including taking on and off a coat or hat, raising and lowering clothing during toileting, and applying or removing orthotics or shoes. Developing physical management routines to support dressing provides opportunities for students to learn important life skills through repeated practice in the their natural environment. Most school-aged children perform dressing activities either sitting or standing. For students with motor disabilities, sitting pro- vides the additional stability they need to more freely move their arms and trunk in ways necessary to participate in dressing routines and is a more active position than lying on their backs (where students are often more passive). As with other daily rou- tines, development of dressing routines should incorporate the portions of the task the student can perform with some level of proficiency.

Lifting, transferring, moving

Students with motor disabilities may be unable to independently stand, move, and transfer from one surface to another and will often require some form of assistance. This assistance may be physical support from staff and/or equipment designed to help lift or move a student. Although the best method to lift or transfer a student is dependent upon the student’s specific abilities and the contextual factors of time and the environment, caregivers should apply basic principles in every situation to maxi- mize the safety and comfort of both the student and caregiver. Adequate planning is the most important step to ensure that moving a student will be safe and comfortable for all involved. The time to find out if the wheelchair brakes are locked is not in the middle of a transfer but rather before any movement has begun. Methods for moving students should be developed collaboratively by the education team. Staff-training by the physical therapist and written or pictorial instructions are often required to increase consistency of implementation.

preparation for movement When the student has not initiated or requested being moved, but they need to be moved, it is important to first gain the student’s attention. This is often accomplished by saying the student’s name, making eye contact, and/or establishing physical con- tact. The student should be informed of what is about to take place such as “It’s time for our class to go to the gym for physical education, so I will help you into your gait trainer.” This is the time to make sure that all equipment is in the best location for the transfer to take place. In general, when transferring, lifting, or otherwise moving a student, it is best to minimize the distance that the student must travel or be carried. It is also helpful to minimize the height difference a student must travel between two surfaces or pieces of equipment. For example, when assisting a student onto a chang- ing table, lowering the table height to that of the student’s wheelchair so that the adult does not have to lift the student against gravity is ideal. Once the student is positioned on the changing table, staff can adjust (assuming this is an available option) or raise the table surface to a level where the staff can help complete the self- care routine at a comfortable height without back strain. If the table has rails or any other features to increase the safety of the student, these should always be available and used.

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Wheelchairs, standing tables, or other positioning equipment with wheels should always be locked prior to moving a student. Some students who have increased mus- cle tone (hypertonicity) or stiffness (spasticity) may benefit from verbal reminders to relax their body in preparation for movement and may require a few additional seconds to allow their body to respond as they attempt to accomplish this task. When requested to complete certain components of the transfer, the student may also require increased time to respond with the appropriate action. Classroom staff may use specific preparatory physical movements designated in the physical management routine to help decrease a student’s muscle stiffness and increase their participation in the lift or transfer. For example, prior to lifting Sophie, the paraprofessional has learned to gently bend both of Sophie’s legs at the same time, and slowly rock her hips from side to side.

Lifting and transferring When assisting students with lifts and transfers, applying some basic principles can serve to keep both students and staff safe. It is best for any adult who is assisting to be at the same height as the student. For example, when lifting a student from the floor, the paraprofessional should bend their knees and move their body down and as close to the level of the student as possible. Using their arms to provide support and securely cradle the student’s trunk and legs is the next step before rising up to standing by using strength in the powerful leg muscles to push up into a full stand- ing position. This method decreases the amount of stress on the adult’s lower back. It is also important to keep the student’s center of gravity (located around their navel) reasonably close to the body of the staff member. This allows increased con- trol of the student’s body, improves the student’s comfort, and decreases the effort of the person responsible for the lift. For example, while it may be possible to trans- fer a young student with outstretched arms, this can make the student less stable during the transfer and cause repetitive strain on the lower back muscles of an adult attempting to lift or carry weight that is too far out in front of their own center of support. Moving a student by grasping, holding, or lifting them from their elbows, wrists, or under the shoulders should be avoided, as this can lead to damage of these smaller and more vulnerable joints. Students with muscle weakness or low muscle tone (hypotonicity) are at particular risk for injury. Communication with stu- dents throughout the lifting and transferring process is beneficial to assure the stu- dent can anticipate the next steps or movements as well as participate to the maximum extent possible.

completing the movement After completing the transfer or lift, the student must be positioned comfortably and securely on the new surface or in the equipment. Seatbelts or other safety measures, including supporting straps and wheelchair foot rests, should be fastened as needed with the student participating in these activities based on their abilities.

positioning

Positioning refers to supporting the student’s posture as he or she sits, stands, or lies down. This support, called positioning, can be defined by the need for external control of the body’s alignment in relationship to gravity within the environment to complete the task at hand. Appropriate positioning allows students to better engage in academic, functional, and communicative tasks (Cheng et al., 2013; McEwen, 1992). Teams should evaluate positioning within these routines and use equipment that supports students with motor disabilities so they can easily per- form movements necessary for the routine. For example, Teo uses his communica- tion device most efficiently when positioned in his wheelchair, which provides

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good trunk support, enabling his arms and hands to more freely access his device. Positioning allows the student to maintain better alignment with less muscle fatigue than would be possible without support; this may avoid or minimize the develop- ment of secondary conditions such as joint stiffness or deformity. For students who have already developed secondary conditions, such as a structural scoliosis (curva- ture of the spine), appropriate positioning of their trunk accommodates for these changes and provides support and comfort. You may have seen a student in a wheelchair who has a plastic and foam brace (orthotic) around his or her trunk, or a student with a complex series of pads and support straps built in to the back sup- port of the wheelchair, who requires this trunk support as an important part of his or her seated position. By having a well-supported trunk, the students can use their arms, avoid fatigue and further leaning to the right or left, and maintain an upright position to facilitate talking, swallowing, and chewing among other move- ments. Skin health is another important consideration in positioning, as students with motor disabilities and secondary musculoskeletal deformities are at risk for skin breakdown caused by prolonged pressure over bony areas. Figure 9–13 describes the goals of appropriate positioning.

To accomplish the goals described above, positioning systems are typically used to provide the support that stu- dents need. Many students with motor disabilities have a wheelchair with a positioning system that they use at home, in the community, and at school. However, just as a typi- cally developing student does not sit in one position all day, a student with motor disabilities also requires the opportu- nity to change positions. These position changes should be based on the student’s schedule and typical school activi- ties. Position changes may be related to self-care tasks per- formed during the day, or be required for the student to participate in a specific environment such as completing a modified warm-up exercise program in physical education class. A written physical management plan related to posi- tioning is often helpful for the team in understanding the student’s needs for position change, the types of positions that can be used throughout the day, and the timing with which change should occur.

Students may use adaptive chairs (Figure 9–14), stand- ing systems (Figure 9–15), or be positioned on the floor (Figure 9–16) during specified periods of the day and/or to complete certain academic, learning, or functional tasks as appropriate. Working together as a team to cre- ate a schedule that is reasonable for the adults who will be moving the child and appropriate for the student’s learning needs in different classroom settings is benefi- cial. For example, taking a student out of the wheelchair and positioning him or her in a resting position on a mat may be necessary for pressure relief to his or her bottom at least twice during the school day. If this student is

FIGurE 9–13 Goals for Positioning

FIGurE 9–14 Leckey Easy Seat

✓ Promote good postural alignment

✓ Provide access to educational environments and tasks

✓

✓ Protect skin integrity

Accommodate fixed deformities

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313Key Concepts in Understanding Motor Disabilities

participating in several academically based high school courses, creating a schedule that does not conflict with the academic courses but occurs at a time when the student might have an “off ” period is important.

Sophie requires opportunities to be out of her wheelchair each day. One option is for Sophie to stand in a supine stander that provides support from behind her head, trunk, legs, and feet and that is placed at an angle of 90 degrees or less to the floor. The stander facilitates social interactions with peers for Sophie as she is at the same height and her friends are drawn to interacting with her when she is standing. Physiological benefits to a standing program such as maintaining or increasing bone mineral density have been documented (Pin, 2007). The physical

therapist established a physical management routine in collaboration with the educa- tion team and provided training on moving Sophie in and out of the stander and posi- tioning her correctly. The team determined that the most appropriate times for Sophie to use the stander are during physical education class or when working on activities devel- oped by the vision specialist. Sophie’s physical management routine for standing is de- scribed in Figure 9–17.

Learning

The majority of a student’s school day is spent in the classroom learning and therefore many physical management routines are completed in this setting. When planning the

physical management of a student with motor disabilities in the classroom setting, keep in mind the two primary roles of all students: They are both learners and classmates. Physical management routines should promote the student’s participa- tion in learning activities and social interactions. Students with disabilities should have eye contact with their peers and teach- ers and be able to see, hear, and interact with learning materi- als in a similar fashion as other students in the classroom. The instructional requirements and adaptations necessary for learning are covered in other chapters in this book. The physi- cal adjustments and modifications that a student may require to promote learning and social interaction throughout the day are important considerations.

In the early primary grades where instruction and shar- ing are often done on a carpet in the classroom, seating students with disabilities on or near the floor to facilitate their participation in these activities is beneficial. This often requires positioning equipment designed especially for floor-sitting (Figure 9–16). Similarly, a student who uses a wheelchair for academic activities at a desk must be able to access the supporting surface of the desk from his or her wheelchair. The classroom desk may need to be raised or lowered to enable the student to access the desk surface. In some situations, the student may require an adaptive desk to complete academic tasks. Occupational therapists and physical therapists, in collaboration with other team members, can recommend and provide training on specific equipment.

FIGurE 9–15 Bantam Stander with Tray

FIGurE9–16 Special Tomato Floor Sitter

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When considering physical management routines, strategies that promote the stu- dents’ participation in the same activities and environments as their peers are a prior- ity. Figure 9–18 presents a hierarchy of adaptations and modifications to activities and routines. Strategies at the top of the list promote full inclusion in activities and envi- ronments with peers, and those lower on the list address adaptations or modifications that provide alternate activities or environments to the student with disabilities. Using a hierarchy of strategies is helpful to educators and specialists as they collaborate on physical management strategies. Many students with motor disabilities require exten- sive modifications and adaptations to the general education curriculum; therefore, adults may begin at the bottom of the hierarchy without giving adequate considera- tion to simpler strategies that will still maintain learning and social opportunities with peers in the least restrictive environment (Campbell, 2010). Although the educational team may determine that alternative activities and environments are the most appro- priate, they should make such a determination only after thoughtful consideration of a range of options (McEwen, 2009).

Ecological Inventory

An ecological inventory is a flexible tool that can be completed for any school activ- ity or routine (Brown, 1979). The inventory consists of structured observations of the student, his or her environment, and the tasks he or she needs to perform during the school day. These observations help determine what skills, modifications, or adapta- tions the student needs to improve his or her participation. The information gath- ered using this type of inventory is invaluable for designing management routines that are student specific and facilitate active participation in a variety of settings. Ecological inventories can be completed by a teacher or a specialist who is familiar

FIGurE 9–17 Sophie’s Physical Management Routine for Preparing Her to Stand

Staff Tasks Sophie’s Tasks

Transfer to Stander

• Lock wheelchair and stander brakes. • Inform Sophie of plan to move her to stander. • Remove seat belt and chest harness. • Lift Sophie from wheelchair and position her

supine on stander. • Secure pelvic and chest straps. • Secure knee supports. • Secure foot straps. • Raise stander to 80 degrees.

• Flex head forward to allow staff to place arm behind head and upper back.

• Keep arms in middle of body during lift. • Indicate by smiling if she is comfortable once in

stander.

While Standing for 30 Minutes

• Monitor Sophie’s position and comfort. • Present activities for Sophie to complete.

Complete activities such as visually tracking lighted toys, attending to language arts activities when used with a light box, and grasp and release tasks.

Transfer to Wheelchair

• Inform Sophie of plan to lower her down. • Lower stander to horizontal position. • Remove foot straps. • Remove knee supports. • Remove pelvic and chest straps. • Lift Sophie from stander and position her in

wheelchair. • Secure seat belt and chest harness. • Remove ankle foot orthoses and check skin

condition.

• Keep arms in middle of body during lift. • Indicate by smiling if she is comfortable in wheel-

chair once positioned.

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with the—student’s abilities and typical skill performance. They can also be com- pleted collaboratively by several team members who all know the abilities of a stu- dent, such as the classroom teacher, physical therapist, and paraprofessional. An ecological inventory completed the first week of school for Sophie’s sign-in routine is shown in Figure 9–19.

playground and recreation

Play and recreation are important activities of childhood and provide opportunities to develop both social and motor skills (Mancini & Coster, 2004). You may not be surprised to learn that students with multiple disabilities have the lowest rates of participation in a wide variety of school activities, including playground and recrea- tion activities (Simeonsson, Carlson, Huntington, McMillen, & Brent, 2001). For pre- school and elementary school children, playground activities often include climbing, sliding, playing running games, and riding tricycles. For middle and high school students, recreational activities typically become less oriented around physical games and more focused on social relationships. Students may also participate in unified or adapted sports, physical education classes, and community sports and recreation programs.

When promoting playground and recreational participation, teams must consider the student’s goals. Typical goals include increasing motor skill proficiency, increas- ing general physical fitness, and socialization with peers. Balancing these priorities with other student goals related to academics and functional life skills is important for the IEP team to consider in their decision-making and goal-setting. As in other school settings, teams can modify the activity or the environment to promote increased par- ticipation in recreation and play. The student can also be taught physical skills and game rules—a strategy we do not always think to incorporate, but one that can be beneficial to increasing participation and positive peer interaction. Modifications may include the student using a particular piece of equipment during a game, such as a dynamic stander, or modifying the structure, format, or rules of the game itself. For example, using a baseball tee instead of having the student hit a pitched ball or using bumpers in the gutters at a bowling alley are equipment and rule modifications that may help a student participate alongside peers. Even when students require adult assistance to participate in playground and recreation skills, the social component of play should be integrated as much as possible, allowing students to interact and have fun with their peers.

FIGurE 9–18 Accommodations and Modifications in the Classroom

Provide environmental accommodations.

Hierarchy of Accommodations and Modifications

• Adapt setup. • Adapt tools or equipment. • Provide positioning equipment or adaptations.

(Modified from Accommodation and Adaptation Framework [Campbell, 2010]).

Modify schedule. Select or adapt activity. Modify requirements or instruction. Provide peer assistance/helper. Have individual child do a different activity in the typical environment/context. Provide adult assistance. Have individual child do something outside the typical context with an adult.

Least Restrictive

Most Restrictive

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transition to Employment or other postsecondary Settings

A transition plan must be part of a student’s IEP when they turn 16 years old but may begin earlier (IDEA, 2004). The plan identifies students’ postsecondary goals as well as their strengths, interests, and needs. Postsecondary goals may include employ- ment, adult living environments, or academic settings. School coursework, skills taught, and IEP goals should be clearly related to postsecondary outcomes. Physical

FIGurE 9–19 Ecological Inventory for Sophie’s Sign-In Routine

Completed by classroom teacher, physical therapist, vision teacher, special educator

Task Environment Sophie’s Current

Participation Plan

Identify laminated index card with her name.

Cards are secured to wall with Velcro. There is a small table next to area, which limits usable space in front of wall.

Sophie cannot identify her written name but is begin- ning to smile at pictures of familiar people.

Sophie’s name card and font size will be enlarged and her picture will be added next to her written name to help her identify it. The table will be moved away from the area to allow Sophie to get close to the wall in her wheelchair.

Move card from “home” column to “school” column.

Sophie requires hand- over-hand assistance to pull card from wall and move it to school column.

A small foam ball will be adhered to the back of the name card so that Sophie can grasp it easier and pull it from the wall. The classroom teacher will remove the school column and make a school basket for the stu- dents to put their names into. So- phie’s will likely continue to require physical assistance provided by the paraprofessional.

Make lunch choice by placing a tally mark on the whiteboard under the written choice.

Whiteboard area is large and wheelchair accessible.

Sophie requires hand- over-hand assistance to remove cap from pen, make tally mark, and replace cap.

This task was eliminated from Sophie’s sign-in routine as she does not eat food by mouth and therefore a lunch choice is not meaningful to her. She also requires increased time to complete the bell starter worksheet and to be positioned appropriately for circle time so the extra time is used for these activities.

Sit at desk and complete bell starter worksheet.

First grade desks have storage compartment under tabletop, which prevents Sophie’s from sitting at her desk with good positioning.

Sophie sits at instructional table near back of class- room so her wheelchair can fit underneath.

A wheelchair desk with side storage compartment will be provided. Sophie will sit at a desk next to her peers to complete bell starter worksheet modified by special educator.

Place worksheet in teacher’s basket when complete.

Basket is on edge of teacher’s desk. Aisle is too narrow for Sophie to approach it in her wheelchair.

Paraprofessional is placing completed work in teacher’s basket.

Classroom desks rearranged to provide two larger aisles that are wheelchair accessible. One leads to the teacher’s desk and one to the carpet circle area.

An adaptive chair that sits on the floorSit on carpet for circle time. Sophie is unable to sit on the carpet safely due to de- creased muscle strength and balance.

Sophie is sitting in her wheelchair at the back of the carpet area.

and provides head and trunk support for Sophie will be provided. She will be positioned in this chair by the paraprofessional during circle time. Sophie will sit at the end of a row allowing the paraprofessional to sit nearby and facilitate her participation as needed.

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317Key Concepts in Understanding Motor Disabilities

therapists and occupational therapists may be involved in assessment of the student’s motor, mobility, and self-care skills. Additionally, they help determine the need for and are able to obtain necessary adaptive equipment and/or environmental modifica- tions for achievement of the student’s postsecondary goals. Therapists should per- form assessment and interventions in the community, on the job, or in academic settings to determine the students’ needs in the environments where they will likely be living and working.

Teo and his family have identified two postsecondary goals. Teo would like to live in a group home with other adults with disabilities, and he would like to find meaningful work, either as a volunteer or paid employee, in his community. Teo started a job-shad- owing program several hours per week to explore his interests. Teo also needs to learn community living skills to live in a group home and travel by public transportation. To identify needed skills, the special educator, physical therapist, and occupational thera- pist completed a functional skills assessment. The assessment data indicated that sorting clothes and loading clothes into washing machine, carrying items on a tray, and wheel- ing himself on and off a bus lift are needed skills to meet his postsecondary goals. These skills were discussed with the family, student, and school team and integrated into his transition plan and goals on his IEP.

use of Equipment to Enhance participation

Earlier in the chapter, you read about some pieces of adaptive equipment that teams use to promote the student’s participation in self-care routines or in learning. In this section, we will continue to describe types of equipment and the ways students use this equipment, including assistive technology devices, in schools.

Students with disabilities often use adaptive equipment, also known as assistive technology, to address their unique needs and allow them to participate in daily activ- ities and routines. Adaptive equipment has three major purposes:

1. Prevention of secondary problems and conditions, including postural deformities 2. Increasing use of motor skills 3. Improving participation in activities and routines in home, school, and community

settings

Sometimes, conflict may occur between these purposes. For example, many students with severe motor disabilities can perform functional arm and hand skills best when in a sitting position, resulting in their being seated most of the time they are in school. Also, sitting may be the easiest position in which to manage a student with motor dis- abilities across different environments. When Sophie first enrolled in preschool, she had difficulty sitting on the floor during “circle time” or play. The school obtained a special adapted chair for Sophie’s functional positioning at school (Figure 9–20)

Even though sitting may be the ideal position for most activities, when students spend most of the time in only one position, secondary impairments, such as muscle tightness or a permanent shortening in the length of hip and knee muscles (contractures), may develop (even when equipment is well fitted and used appropriately). Such secondary problems cause the hips and knees to remain in a flexed (or bent) position and prevent them from extending (or straightening), which can then lead to problems for students when trying to stand or lie on their back or stomach. To prevent students from spending all their time in one position, teams will often incorporate alternate positions and types of equipment into the classroom to position students throughout the day. Alternate posi- tions for sitting are those that place, or position, joints of the body in opposite alignment or with opposing forces of gravity. Standing or lying on one’s side, stomach, or back straightens the hips and knees and extends muscles in the opposite direction.

Teams must consider the appropriateness of a position in the setting and activity in which the student will use the position. They should also consider the effect the

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position may have on adult and peer interaction with the child (McEwen, 1992). Young students, especially, should be at the same level as their peers so that they can play and learn with students who do not have physical disabilities in child-care, preschool, or commu- nity settings. Older students, on the other hand, may benefit from being out of their wheelchair; however, positions lying on the floor may not be conducive to their interaction with peers and participation in an aca- demic high school classroom in addition to being inap- propriate, embarrassing, and stigmatizing for a student at this age.

Positioning Teo, a high school student, in a side-lying posi- tion during art class is not socially appropriate, even though the position may work well for him and the equipment is available. Side-lying is a good position to use for watching TV at home, for sleeping, or for just relaxing. Standing is the best alternative to sitting for a majority of settings.

Most students with severe motor disabilities require different types of positioning equipment at home and as they begin child care or school. For example, they may need positioning support when sitting on the floor, sitting in a chair, standing, moving about, or toileting. A variety of equipment is availa- ble for positioning with new products being introduced each year. Related service providers, such as physical therapists and occupational therapists, should be called upon to assist school personnel, IEP teams, and families in identifying and selecting the most appropriate equipment for a student (Fig- ures 9–11, 9–12, 9–14, 9–15, 9–16, 9–20, and 9–21).

Students with motor disabilities may require equipment to support their participation in activities with their families, friends and alongside their peers in the community. Although the Americans with Disabilities Act led to major improve- ments in accessibility, not all environments and settings are accessible and students may need adaptations to enhance their participation.

Teo can get to any bathroom independently in his manual wheelchair but often cannot get through a standard doorway, which is likely to be too narrow to accommodate his chair. Some- times when visiting a museum or another community building, he is unable to get in the building unassisted because of steps or ramps that are too narrow for his chair, so he uses his four- wheeled rear walker to access those environments.

All settings are not fully accessible or don’t accommodate all types of equipment. Physical therapists, occupational therapists, and other specialists need to design alter- nate strategies to overcome architectural barriers when those situations arise. Lifting and carrying may be needed in some environments even when individuals are independent in others. As discussed earlier in the chapter, partial or full independ- ence in self-care routines such as toileting, eating, bathing, etc. may be possible only through environmental accommodations, use of adaptive equipment for positioning (e.g., wheelchairs, toileting chairs, bathing chairs), assistive devices (e.g., grab bars around the toilet, adapted handles on the sink faucets, special plates and utensils, bars around a person’s bed, a washcloth mitt), or other such aids. Students may be

FIGurE 9–20 (a) R82 Hi-low Base with Lecky Seating and (b) R82 Hi-low Base with Leckey Seating (elevated)

(a)

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319Key Concepts in Understanding Motor Disabilities

more dependent in a routine when the environment has not been designed or fully modified for accessibility by individuals with physical disabilities or when needed equipment and devices are not available. When the environment or circumstances are less than ideal for a student, the team should collaborate to find solutions.

When Teo needs to use a restroom in the community, his toileting routine is more diffi- cult than when he is at home or at school where he has a modified toilet seat readily available. In the community, he can still communicate his needs using his communica- tion device, and he can use his wheelchair or his walker to get into the bathroom inde- pendently. Once on the toilet, however, someone has to support him; this is unnecessary at home or in school where he is more familiar with the setting and has equipment in place.

determining appropriate Equipment The use of equipment for proper positioning is essential for most students with severe motor disabilities. Therapists often recommend positioning systems to ensure proper alignment to promote improved function, movement, and participa- tion in routines. Well-aligned posture results from control of muscles that maintain the body in positions against gravity. The positioning supports that students require depend on the severity of their motor impairments; some will need few supports that can be easily made or purchased, and others will require extensive and highly specialized equipment that has to be custom-ordered (Breath, DeMauro, & Snyder, 1997; Rainforth & York-Barr, 1997; Trefler, Hobson, Taylor, Monahan, & Shaw, 1996).

When using adaptive equipment, teams should understand the following principles to ensure appropriate use of the equipment:

1. Well-selected and well-fitted equipment can only support postural control and maintain body alignment, not normalize tone or provide corrective forces.

2. Adaptive equipment maintains body alignment only when it fits appropriately and when the student is properly positioned in it.

3. Adaptive equipment may not produce the specific results desired for each student, so teachers, parents, and therapists must carefully observe the student using the equipment over time and in a variety of situations to determine whether the desired function is being achieved.

4. Because many students with motor disabilities may lack the postural control neces- sary to adjust their body position, the length of time that students use any single piece of equipment will vary on an individual basis.

5. Limiting students to one position (even when using equipment that fits well and is otherwise comfortable) can produce secondary problems, such as poor circulation or skin ulcerations, or secondary motor disabilities, such as muscle tightness or contractures that can lead to permanent deformity.

Teams should discuss the length of time that individual students should use vari- ous pieces of equipment. Some students can stand or sit comfortably for long periods of time (two to three hours or more). Other students require repositioning more fre- quently (every 30 minutes to 1 hour).

mobility Mobility allows students to move from one place to another. Students with motor dis- abilities often require equipment to support their movement about their environment. When selecting equipment to support mobility, teams must consider the amount of time it takes for the student to get from one location to another and the energy expended. Because mobility equipment enhances the ability of students to move and socialize, teams should use caution when using equipment that results in the isolation of an infant or child from peers. Several mobility aids are available to promote

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students’ independence. These include canes, crutches, walkers (Figure 9–21), as well as power ride-on toys, manual wheelchairs (Figure 9–22 & 9–23), and power wheel- chairs (Figure 9–24). Students may use a combination of mobility aids depending on environmental demands. Physical therapists and occupational therapists have an important role in determining the type of mobility aids students need to be as inde- pendent and functional as possible.

Teo uses a four-wheeled walker to walk within classrooms and his home and then he uses a manual wheelchair in the school hallways, when outdoors, or in the community.

FIGurE 9–21 Kaye Reverse Posture Walker

FIGurE 9–22 TiLite Aero T Manual Wheelchair with ROHO Seat Cushion

FIGurE 9–23 Quickie IRIS Tilt-in-Space Manual Wheelchair

FIGurE 9–24 Permobil C300 Power Wheelchair

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communication Students with motor disabilities often have accompanying limitations in communication that prevent verbal speech. To overcome these limitations, augmentative and alternative communication (AAC) is often recommended as a means other than speech to assist students in communication (see Chapter 12). We all use different strategies to augment our messages with facial expressions and gestures, or by pointing to visual supports in the environment in an effort to make sure our message is understood, but for students with motor disabilities, such strategies may be their only form of communication.

Making decisions about AAC for any student requires a team that is often com- prised of the child, family, and professionals from two or three disciplines (Gierach, 2009). Each member of the team provides important information to the process allowing for a better decision. For example, the child identifies his or her abilities, limitations, needs, and desires. Family members provide information about any per- tinent medical and educational history; day-to-day communication needs; family dynamics, strengths, and needs; family resources; and environmental considerations. Educators discuss current and projected educational abilities, learning needs and potential, and use of materials in the classroom. Speech-language pathologists dis- cuss current receptive and expressive communication abilities, current and future communication abilities, needs, opportunities, and barriers and provide communica- tion intervention. When students who use AAC, or may potentially use AAC, also have motor disabilities, physical therapists or occupational therapists contribute by (1) assessing motor control, (2) identifying body part(s) and movement(s) that the child may use to control AAC devices, (3) assessing positioning and ensuring that positioning systems promote optimal motor control and use of devices, (4) design- ing a system that best matches the motor abilities of the child, and (5) designing intervention strategies to promote functional use of the AAC system (McEwen, 1997).

adaptive Equipment/assistive technology Physical therapists and occupational therapists are often involved in identifying and recommending appropriate equipment/technology for students to use. Figure 9–25 provides a list of important considerations that should be taken into account by the team. The purpose of equipment is often tied to the activity for which the student will use it. For example, a bath seat will get wet repetitively and is designed to provide support even when used in water.

Sophie requires support to sit, so she will need equipment to support her trunk and hips while sitting for bathing, toileting, eating, and during classroom and home activities. Although we might be able to select a single piece of equipment to support her in sitting, some routines require equipment with special functions or features.

Many students with motor disabilities will require equipment throughout their lives; although, some may only require it temporarily. For those whose needs are per- manent, ease of use, durability, and adjustability become crucial to ensure the equip- ment will last for several years and can be adjusted and modified as the students grow or as their abilities change. Most insurance companies and third-party payment sources expect equipment to last a minimum of five years before they will consider

FIGurE 9–25 Important Considerations When Recommending and Ordering Equipment

1) purpose of equipment related to function

2) ease of use of equipment

3) durability of equipment

4) adjustability of equipment for growth or changing condition

5) environments in which equipment will be used

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replacement, unless the child has a change in medical status. Because young students with motor disabilities grow rapidly just as their peers do, therapists should consider low-cost alternatives that can be easily replaced. “Homemade” seat inserts can be used to provide support as a child grows and needs change. Using a seat insert fabri- cated from Tri-wall packaging (i.e., cardboard used for an appliance carton that is three layers thick) and glue and covered with washable contact paper can be built and provide additional support in a chair. A wedge of upholstery foam can be cut to support and position an infant in alignment in a high chair. These options offer alter- natives to ordering a specialized high chair or booster chair for mealtimes and would be appropriate based on the size and needs of the child. As an infant grows and tran- sitions into preschool, a more customized seating support may be needed for sitting at the table during snack time. Because students will often use equipment across environments, therapists must consider the needs of all environments or settings in which the student participates on a regular basis when making recommendations. Different options may be available to appropriately position a student, but only one system may be suited to a school environment, be transportable in the family’s car or van, and support the child’s participation in family routines and in other settings where a family spends time. Determining that a recommended piece of equipment won’t fit in the bathroom of the school or in the family car after it is purchased is a waste of limited resources available to the student and often results in the unneces- sary purchase of similar equipment for different environments. Many pieces of equip- ment are quite costly, and their purchase may not be fully covered by insurance or other health care programs. Therapists and school teams must consider environmen- tal factors before recommending and ordering equipment.

Students with severe motor disabilities may receive equipment through a number of sources. Physical therapists and occupational therapists who work with the stu- dents in school settings should be involved in suggesting particular pieces of equip- ment and with securing and fitting equipment. Alternately, students may be referred by a physician or a therapist to specialized seating clinics that are operated by hospi- tals, rehabilitation centers, or state agencies to recommend equipment. In other instances, families, therapists, or teachers may purchase equipment directly after reviewing product information in catalogs. Equipment paid for through insurance, medical health care plans, or federal medical programs (such as Medicaid) often requires a physician’s prescription.

Equipment vendors assist families and professionals to secure the appropriate prescription and complete the necessary paperwork correctly. Most equipment used by students with severe motor disabilities requires adaptation and modification. Par- ents may experiment with adaptations or may return to clinics or local vendors to fit and adjust equipment, but physical therapists and occupational therapists are most often involved with the fitting and adjustment of equipment used for positioning and/or mobility. Following up is important when the equipment does not adequately hold the desired position or when the body seems to be misaligned. Family, teach- ers, and other adults responsible for the care of a student should not hesitate to contact the professionals who have been involved with ordering equipment. Figure 9–26 offers valuable suggestions for considering equipment options for a student.

The use of poorly fitting adaptive equipment may result in secondary motor disa- bilities, such as changes in muscle length or development of skeletal deformities. When equipment does not fit appropriately—whether too big or too small—maintain- ing proper alignment of the trunk or extremities becomes challenging. Improper alignment may be uncomfortable and make it more difficult for students to participate in typical daily routines and engage in learning at school. The most common second- ary deformities caused by equipment that does not support the trunk and hips in sit- ting are those that involve the spine. Improper positioning may contribute to scoliosis (e.g., a “C” curve in the spine), kyphosis (i.e., a rounding of the shoulders), or lordo- sis (i.e., positioning of the pelvis in a tipped-forward position with a sway back).

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use of other technologies and Equipment in the classroom

Students with motor impairments may use other types of technology, including but not limited to switch interface devices, computers, communication aids, writing devices, adapted feeding equipment, or environmental control units to participate in specific activities. Most assistive technology devices are designed as an alternate means of per- forming a functional task. Power wheelchairs, augmentative and alternative communi- cation devices, learning and communication apps, environmental control units, tablets and computers are examples of devices that use advanced technology to enable people with motor disabilities to participate in many different settings. High-tech electronic devices are often not easily used without training, instruction, or practice in their use. In other words, students do not just begin “talking” because we put a voice-output com- munication device in front of them. Low-tech devices (or adaptations) are as important as complex high-tech devices, and they may be easier for a student to use, less expen- sive, and more useful across settings and activities. A power wheelchair, for example, is useful in many settings but will not fit onto an airplane or in many cars. Because of the limitations of high-tech devices, most individuals need a combination of high- and low- tech devices to participate in activities and routines across environments.

Sophie uses a variety of communication aids, such as high-contrast pictures and a sin- gle-switch device, when on a class trip to the zoo. Sophie also uses a switch interface on the computer that allows her to advance pages of electronic books and make choices about other activities. During the afternoons, she tends to fall forward a lot in sitting, so when she is doing a painting activity, her teacher positions her in a stander to paint at an easel positioned in front of her.

Teachers and other professionals who work with students with severe motor dis- abilities often have difficulty including opportunities for practice with motor skills and using a variety of equipment to support movement during the school day. One commercially available curriculum designed to promote movement and functional

FIGurE 9–26 Suggested Activities to Guide Teams in Securing Appropriate Equipment

At the beginning of each school year, work with therapists to assess whether each student’s adaptive equipment is appropriate for the student and is used properly. To determine this, the team should decide on the following:

• Does the equipment � t the student?

• Do the staff members position the student properly in the equipment?

• Has the equipment produced the desired function over time and across activities?

• How long should the student remain in the piece of equipment before being repositioned?

• Is the equipment appropriate for the student’s chronological age?

• Does the equipment allow the student to participate in activities in the same manner as peers?

• Does the equipment isolate or prevent the student from participating in an activity because of its size, height, or purpose?

Observe the students’ typical activities during their school day (e.g., arrival and departure on a bus, move- ment to and from scheduled activities in other locations, use of the restroom, change of diapers, change of clothing for physical education class, or use of the library). For students who require assistance with their movements or communication, check to see if the following four activities occur during these routines:

1 The adult or peer makes physical contact with the student.

2 The adult or peer prepares the student for what is going to happen by communicating in a way the student can understand.

3 The adult or peer prepares the student physically for the routine.

4 The adult or peer performs the steps of the routine in ways that allow the student to have choices and requires the student to perform as much of the routine as possible.

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motor skills is the MOVE (Mobility Opportunities via Education/Experience) Curric- ulum (www.move-international.org/) described in Figure 9–27. Based on a phi- losophy of promoting function and improving quality of life in individuals with even the most severe physical impairments, teachers and therapists use the curriculum to teach and promote independence through the development of basic motor skills such as sitting, standing, and walking. By including principles of basic body mechan- ics with instructional processes to assist students in achieving greater levels of inde- pendence with motor skills, the curriculum has been used in over 20 countries.

transportation

Transportation is an integral part of the school services for many students with motor disabilities. Transportation is included as a related service that must be provided by school districts when an IEP team determines that a student with motor disabilities needs this support to access his or her education at school. IDEA (P.L. 108-446) does not provide specific guidance about transportation requirements, and although schools have to comply with IDEA, they must also consider Section 504 of the Reha- bilitation Act (P.L 93-112), the Americans with Disabilities Act (P.L 101-336), and the federal Motor Vehicle Safety Standards and Regulations (Lake, 2005) when determin- ing students’ transportation needs.

Buses are the primary mode of school transportation. Students with motor disabili- ties may require assistance getting on and off the bus, as well as maintaining a seated position as the bus moves. Although bus seats are designed to provide protection dur- ing transport, young students, or any child weighing less than 50 pounds, are required to wear an appropriate child restraint or safety vest as shown in Figure 9–28.

Although safety requirements for securing wheelchairs and wheelchair occu- pants on school buses exist, students who use wheelchairs as their primary means of mobility should be transferred out of the wheelchair and positioned on a bus seat or car seat that meets safety standards whenever possible. Considerations around the feasibility of transfers include how much assistance the student requires, and whether or not the student can maintain a sitting position without wheelchair supports. If a student has to remain positioned in the wheelchair, safe transportation requires the use of a four-point wheelchair securement system to anchor the wheelchair to the bus/vehicle, and a separate occupant restraint to securing the student to the wheelchair. Occupant restraints are not part of the stu- dent’s wheelchair, but are separate three-point harnesses that attach to the frame of the bus and positioned around the student. Postural supports used for

FIGurE 9–27 Six-Step Process of the MOVE Program

The MOVE Program is designed to a use six-step process to help the learners (term used by MOVE to describe a student) or family and/or care providers in helping the learner advance in their gross motor skills.

• Step One determines the learner’s present skill level through an interview assessment.

• Step Two uses the learner’s MOVE team (including the learner, family, care providers, and profes- sional staff) to determine the functional goals needed to work toward promoting independence.

• Step Three creates meaningful, functional activities and embeds appropriate skills into the activity for the learners to be successful in reaching their goals.

• Step Four looks at the supports the learner currently needs.

• Step Five reduces the prompts the learner currently needs.

defines and schedules teaching of the skills throughout the learner’s typical day.• Step Six

NOTE: When the learner presents with a medical diagnosis that requires restriction of time spent in sitting, standing or walking, use of partial participation or the option to refrain from participation may be necessary to avoid damage or harm.

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positioning in a student’s wheelchair are not intended, designed, or tested as occupant restraints approved for transportation. These postural supports should never be used to replace the occupant restraint attached to the bus/vehicle.

Many newer wheelchair models are designed with transit options and come equipped with specific attachment points for securing the wheelchair during transportation. Older wheelchair and some contemporary models do not have transit options, so team mem- bers must anchor securement straps to the frame of the chair and should avoid securing them to any moving part of the wheelchair, such as the wheels, armrests, or footrests.

Safety To ensure safety of all students during transportation, effective communication between schools and transportation providers is essential, including communica- tion about transportation needs and potential problems. School districts are respon- sible for ensuring that school bus drivers or other transportation providers understand (1) the special needs of individual students with motor disabilities who ride on school buses; and, (2) possible strategies and assistance that may be avail- able, including use of aides and equipment on and off the bus. In addition, the IEP team must develop a plan that outlines the supports and equipment required by the student, including how to address any medical, physical, or behavioral concerns and how to safely secure all equipment during transport. Education and transporta- tion staff may request assistance from others professionals, including occupational therapists, physical therapists, durable medical equipment providers, and other specialists to assist in the complex and potentially life-saving decision-making pro- cess for each student who will be transported to and from school each day.

FIGurE 9–28 (a) E-Z On Vest (back view) and (b) E_Z On Vest (side view)

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LEarnInG outcomE SummarIES

9.01 Impact on Education and Participation Learning Outcome Understand the impact of motor disabilities on participation of students in school and on learning.

Students with motor disabilities often experience barriers to participation with peers in typical school classrooms, activities, and routines due to limitations with posture, movement, com- munication, and self-care. Educating these students requires identifying how they can par- ticipate in their roles as students and as classroom/school peers and then designing specialized instruction to facilitate their participation to the greatest extent possible.

9.02 Team Support for Students Learning Outcome Comprehend the role of the IEP team and related service providers in supporting students with motor abilities and their participation in school.

The IEP team, including families, teachers, and related service providers, collaborates to support and enhance the students’ ability to benefit from their education. Physical therapists and occupational therapists contribute their specific knowledge and expertise as part of the IEP team to facilitate student participation in meaningful activities. Building a strong and col- laborative team is critical for developing goals, providing services, designing physical man- agement routines, and selecting assistive technology that will meet the students’ needs over time and across environments.

9.03 Meeting Students’ Needs Learning Outcome Describe strategies for meeting the physical assistance and management needs of students with motor disabilities in daily routines and school-related activities.

Educating students with motor disabilities includes instruction in both academic and func- tional skills organized through their daily school activities. Using physical management rou- tines that promote student participation in the classroom and other school environments, while also embedding skill practice, is an important strategy that requires collaboration, plan- ning, and ongoing monitoring. A quality education program for students with motor disabili- ties addresses important functional skills that will promote the students’ independence and participation in their community both as youth and adults.

SuGGEStEd actIvItIES

1. Create a chart using the ICF framework that represents one area of participation that is restricted, limited, or otherwise significantly challenging for a student with motor disabilities.

2. Use the chart developed in #1 above to write an appropriate IEP goal for this student. 3. Write a paragraph that describes how the ICF framework and the GMFCS are simi-

lar and can both be used to help portray the functional capacity of a student with cerebral palsy.

4. Read the description of Sophie and Teo at the beginning of the chapter. What other equipment do you think might be helpful to assist each of them in learning with their peers? Explain what the equipment is and why you selected it.

5. Read the description of Sophie and Teo at the beginning of the chapter. What other equipment do you think might be helpful to assist each of them in a self-care activity that they perform during the school day? Explain what the equipment is and why you selected it.

6. Describe the team composition for Sophie and for Teo. Explain what expertise each team member can bring to an IEP meeting about each student’s performance and goals.

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10 Teaching Self-Care Skills

Martha E. Snell Curry School of Education, University of Virginia, Emeritus

Monica E. Delano University of Louisville

Virginia L. Walker Illinois State University

10.01 General Teaching Considerations Learning Outcome Describe general strategies that can be used to identify what to teach across multiple self-care skill areas.

10.02 Special Considerations for Toileting Learning Outcome Describe specific strategies that can be used to identify what to teach, plan how to teach, and evaluate learning in the area of toileting skills.

10.03 Special Considerations for Eating and Mealtimes Learning Outcome Describe specific strategies that can be used to identify what to teach, plan how to teach, and evaluate learning in the area of eating and mealtime skills.

10.04 Special Considerations for Dressing and Grooming Learning Outcome Describe specific strategies that can be used to identify what to teach, plan how to teach, and evaluate learning in the area of dressing and grooming skills.

One of the first glimpses of personal independence comes when children start to participate in dressing and eating routines. When children learn to com-plete self-care routines, like using the toilet or getting dressed “all by them- selves,” there is often family celebration. For children and young adults with severe disabilities, the ability to manage personal care is also of paramount significance, even if there continues to be some reliance on others. A range of challenges, such as intellectual, physical, or behavioral disabilities, may slow, limit, or indefinitely post- pone the development of basic adaptive skills. Sometimes lowered environmental ex- pectations or poor instruction contribute to a lack of competence in self-care skills. Self-care skills can be more difficult to teach when students are older because of

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privacy concerns, social expectations, and competition with other learning objectives. Still, learning to be independent, or simply less dependent, in the basic daily routines is a priority for all individuals with severe disabilities whether children or adults. There is clear evidence that, with instruction, students with disabilities can make prog - ress in self-care skills and learn to demonstrate some level of independence from par- ents and other support providers. This chapter builds on Chapters 4 through 6, but more specifically describes proven and socially acceptable methods specific to assess- ing and teaching the basic tasks of maintaining personal hygiene—dressing, eating, toileting, and grooming.

Before we begin, we’d like to introduce three students: Adrian, a kindergartener with autism; Toby, a third grader with an intellectual disability; and Patrick, a young adult with cerebral palsy who attends high school. Within the chapter sections on dressing, mealtime, toileting, and grooming, we will share the related issues faced by these three students and their educational teams.

Adrian

Adrian is a five-year-old active kindergartner who has a love for computers and a diagnosis of autism. His early history of being a “failure-to-thrive” baby meant that he often refused to eat much and was overly picky with his foods through last year. Last summer, his parents enrolled him in an intensive feeding program that greatly improved the amount and variety of foods he now eats. Adrian uses a daily schedule to structure his day and has learned to follow lists of steps that guide him through activities. He now participates actively in kindergarten activities, spending more than half of the day there. Like some of his peers, he struggles with handwriting. His special education teacher made a video to help him learn to sit on the rug with his peers dur- ing circle in kindergarten; he has now learned this skill. He used to be anxious about changes in the daily schedule until his team began posting pictures of who will be there that day (e.g., the occupational therapist, the physical therapist, the speech language therapist) and what the lunch menu will be. Adrian checks this schedule several times a day, saying out loud who will be there and what is for lunch. He also eats lunch and attends library and P.E. with his classmates. Adrian spends part of each day in a resource classroom learning academic skills through a structured work procedure before using them in kindergarten. He is making progress in hand- washing; following the kindergarten schedule; and using crayons and pencils to color, draw, and print. Toilet training is targeted for summer school.

Toby

Toby is a bright-eyed, active third grader. At nine years old, Toby is diagnosed with an intellec- tual disability that resulted from seizures early in his life. He also has a primary diagnosis of autism and speech and language impairment. This is Toby’s third year in an elementary school, where he spends a lot of his day in a classroom with other children who have severe disabilities. Toby uses the cafeteria line with peers, but all special activities (P.E., art, and music) are taught separately from his peers. He is included with his peers without disabilities during recess, field trips, and assemblies. His weekly T’ai Chi classes include peers without disabilities as well. Toby independently uses an object schedule to guide his day. He rides a bike around the school for daily exercise and gets and eats his lunch with minimal assistance. He does not communicate vocally, but he is learning to choose tangible symbols to request preferred activities and to com- plete academic work using a structured work approach. He is making gradual progress toileting, washing his hands with sanitizer, and removing and hanging up his coat. Once a week, Toby walks with another classmate and a teacher to a local grocery store for community-based in- struction. He has learned to walk to and from the store without sitting down on the way and to help push a cart. His mother now takes him shopping at the same store because she feels ac- cepted there and the employees are accustomed to Toby. Toby will be moving in the summer and will attend another school in a different state. His educational team is working to make this transition smooth.

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329Teaching Self-Care Skills

Patrick

Patrick is in his second year in a post–high school program located on a university campus. At age 20, Patrick is tall with long arms and a big interest in others his age. Due to his cerebral palsy, he uses a wheelchair and communicates through a laptop computer with PixWriter™ and Speaking Dynamically™ Pro. Patrick attends several college classes, has a job delivering the college newspaper, and loves sports. He uses an adapted spoon and bowl at mealtimes and is learning to use a microwave oven to prepare his lunch. Patrick is in the maintenance stage of learning for several self-care skills, including washing his hands, washing his face, and using a napkin. He lets his teachers know when he needs to use the toilet and does the transfer with assistance. His jacket hangs on a hook that he can reach and he is able to put his arms through the sleeves and flip the jacket over his head to get it on independently. His instructors support the maintenance of these skills by observing Patrick from a distance, providing him with natural opportunities to perform the skills, and using non-specific verbal prompts as necessary.

General TeachinG consideraTions

This chapter is organized into five main sections: general teaching considerations and teaching the skills of toileting, eating, dressing, and grooming. In this first section, we briefly address basic practices for identifying what to teach across all skill areas. In the remaining sections, we address special considerations specific to toileting, eating and mealtimes, and dressing and grooming including (a) identifying what to teach, (b) planning how to teach, and (c) evaluating learning.

identifying What to Teach

Self-care routines are part of all individuals’ daily activities, and they have strong, life- long influences on health and positive self-image. Family members often designate the activities of daily living as priorities for their children. If not performed by the student, these routines must be completed by someone else or medically managed if the person is to remain healthy. Progress in self-care skills provides a sense of self- control and accomplishment for students with disabilities. The attainment of profi- ciency in basic self-care skills (even with some necessary accommodation) allows students to be more independent and to meet their own personal needs.

Starting during the adolescent years, appropriate dressing and grooming skills are often necessary for acceptance in a peer group. The accommodations that are allowed and available during the school years often change when students leave school. Young adults who lack a high degree of independence in their daily hygiene may be excluded from many community, work, and living environments as a result. All of these facts point to teaching basic self-care skills during the early years. Identifying what to teach is the first step.

Team input and consensus If you were Toby’s new teacher, how would you identify what he needed to learn? His team members (including, of course, his family) and his current individualized education program (IEP) are the logical places to start. If his IEP happens to be one that the current team did not develop but instead “inherited” from another team or school, then its goals and objectives may need to be revisited by the current team. Skill selection is based on an inventory of the student’s daily environments to deter- mine which self-care routines and skills are the most important for the student to master and what the best schedule and settings are for instruction. The ecological inventory, described in Chapter 3, is the basic tool that teachers, in collaboration with family members, related service personnel, general educators, paraprofessionals, and the student, use to identify needed skills and to select teaching methods. The

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collaborative team must pay close attention to the social, cultural, and age character- istics of the teaching procedures and the perspective of peers. The team makes many decisions about what to teach, how to teach, and how to improve teaching (Snell & Janney, 2005). A section of Toby’s ecological inventory for self-care skills is shown in Figure 10–1.

Toby’s teacher reviewed his ecological inventory with the team to identify priority skills. They discussed and then reached agreement on several self-care skills. Because toilet training had not been successful in the prior year and Toby would be moving at the end of the school year, the team was intent on achieving this skill, along with pulling his pants up and down (Figure 10–2), and making progress on handwashing. These skills met the team’s criteria for being high-priority skills (bottom of Figure 10–1).

Teachers. Special educators typically take the lead contacting parents and other team members to collaborate with them on the student’s self-care priorities and cur- rent performance, writing task analyses, and measuring and keeping records of stu- dent progress on IEP objectives. Special education teachers also play a dominant role in providing training and oversight of the paraprofessionals who help implement self- care instruction. General education teachers must be involved as core members, too, because (a) their classroom activities and teaching schedule provide the context for assessment and teaching, and (b) classmates may be included as informal or formal models for engaging in self-care routines.

Family Members. Family members can give the team perspectives that professional members typically do not have, especially in the self-care domain. Involvement of the family or other support providers in instructional plans can encourage the student’s use of the self-care routines where they are especially needed—in the home and the community—and thus facilitate skill generalization from the school to the home envi- ronment. Listening to the family as valued team members gives others on the team an opportunity to learn about cultural preferences that the family may have, methods that have worked or failed, and difficulties that the family has experienced. Skills se- lected for teaching should meet culturally appropriate criteria (i.e., skills that family members value that are related to heritage, religious practices, and beliefs). These family preferences may influence the selection and performance of some self-care skills, particularly dressing and diet.

Adrian’s parents were particularly concerned about his limited food choices. In pre- school, he would eat only a narrow range of foods that his mother prepared or bought (e.g., Chicken McNuggets®); he refused to eat the snacks or lunches served at school. When the team understood the extent of the problem and its potential impact on his health, they identified an intensive feeding program at an area university outpatient clinic that he could attend to expand his food options. After two weeks at the clinic dur- ing the summer, Adrian made significant progress. Teachers followed the clinic’s sug- gestions for expanding the foods that he would eat at school. By November, he was eating school lunches.

Related Support Providers. When self-care skills are a priority, related services professionals make essential contributions for many students. Occupational therapists (OTs) have expertise in the activities of daily living and the fine motor movements required. OTs also can provide helpful assessment and input when students exhibit increased sensitivity to tactile or oral stimuli. Physical therapists (PTs) are sources of knowledge on adaptive equipment and positioning, which both influence skill perfor- mance. Speech and language therapists (SLTs) have expertise in oral musculature that may be useful in the evaluation of eating and oral hygiene activities. School nurses may confer with families or directly assess nutrition, bowel and bladder characteris- tics, and health concerns (e.g., seizure disorders, urinary tract infections, sensory limi- tations); they also may consult with the student’s physician.

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M11_SNEL7163_08_SE_C10.indd 331 09/04/15 4:48 PM

332 Chapter 10

Most teams agree that related support services are best pro- vided within the context of an integrated, transdisciplinary model. Transdisciplinary services mean that decision-making and teaching roles are shared across a variety of relevant team members, instead of having just one team member (e.g., speech therapist) take on these roles. An integrated approach supports the assessment and implementation of therapy dur- ing natural self-care opportunities throughout the day (Clon- inger, 2004). The integrated therapy model (a) has been shown to be effective for student learning, (b) may facilitate better skill generalization, and (c) is preferred by teachers and related services staff (Paul-Brown & Caperton, 2001; Scott, McWilliam, & Mayhew, 1999).

Patrick’s OT, PT, and family work together to determine the best way for him to use the restroom within community environ- ments, including his job site, the football stadium, and the two restaurants on campus that he frequents. They have advised building owners of ways to modify the bathrooms so that Pat- rick and other wheelchair users can access the toilets and sinks.

Paraprofessionals. Paraprofessionals, also referred to as teaching assistants, are crucial members of the student’s edu- cational team. Their role as instructors has continued to in- crease. Students who are not independent in self-care routines require assistance during the day that often is pro- vided by paraprofessionals. While paraprofessionals with in- structional experience can contribute to student progress, problems can also result from relying too much on them for instruction. For example, some studies have found that (a) paraprofessionals often lack the skills needed to be effective instructors; (b) students may become too reliant on parapro- fessionals; and (c) students may be separated from their peers, have fewer opportunities to make choices, and have reduced personal control (Giangreco, Edelman, Luiselli, & MacFarland, 1997; Giangreco, Suter, & Doyle, 2010). These difficulties are perhaps more likely when self-care skills are being taught than when academic, communication, or social skills are being taught because so many self-care skills must be taught in private. Thus, paraprofessionals are less easily supervised. There is agreement that the use of several team practices can reduce these problems (Giangreco et al., 2010). First, paraprofessionals need training in order to be effective instructors, including in such areas as general instructional principles, how to teach and support specific students, how to work on the team, and confidentiality (Doyle, 2008). Sec- ond, paraprofessionals can benefit from learning to respect students’ preferences and to maximize students’ personal control during self-care routines. This means teaching self- care routines while being mindful of the individual student rather than “doing” self-care for the student. Improving para- professionals’ involvement as team members allows them to contribute to program development, may improve their moti- vation for using teaching plans, and can provide information that is meaningful for team decisions (Doyle, 2008; Gian- greco et al., 2010; Riggs, 2004). Finally, paraprofessionals

FiGurE 10–2 When Toby hooks his thumbs inside his waistband, he successfully pushes down and pulls up his pants.

(a)

(b) Photos: Martha Snell

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333Teaching Self-Care Skills

need and deserve regular supervision and feedback from teachers on their work with students; because self-care skill instruction does not take place in the open class- room, observation times must be arranged. Sometimes, as a supplement to less fre- quent direct supervision, teachers can rotate their schedules so that they cycle through the schedules of their teaching assistants; this practice allows teachers to get another perspective on the teaching assistant’s work, but does not create the sched- uling difficulties caused by direct instruction.

criteria for selecting self-care skills Like all other domains of learning, the self-care skills that the team selects as IEP objectives for students must meet five criteria. Targeted self-care skills should be (a) judged as functional for a student; (b) valued by the team; (c) suited to the teaching setting; (d) appropriate for the student’s chronological age, peer standards, and cul- ture; and (e) possible to acquire within a year.

Select Self-Help Skills That Are Functional for the Student. It is important that the assessment process (see Chapter 4) identifies those skills that a student needs. For example, the scope and sequence charts in the Syracuse Curriculum break down self-care skills by typical age and location of performance, with shaded sections of the curriculum listing skills performed during non-school hours (Ford, Schnorr, Meyer, Davern, Black, & Dempsey, 1989, pp. 324–340); this organizational approach helps pinpoint relevant self-care skill clusters. (The charts for hygiene and toileting are shown in Figure 10–3.) Needed skills are further defined through an ecological inventory as being important for a student to learn now or soon (see Figure 10–1). If too many skills are identified by the team as being needed, then team members must work together to prioritize them by necessity, asking a series of questions about each skill under consideration and then selecting those ranked more highly. Questions can include the following: Is this skill needed now? Will this skill be needed in the future? Can this skill be used across environments and activities? Will having this skill contribute to independence? Will this skill contrib- ute to acceptance by peers? Will the absence of this skill contribute to being less accepted by peers? Is this a skill that the family rates as a top priority? Does this skill meet a medical need? Does the student have a positive attitude toward learn- ing this skill?

Adrian’s team discussed and together completed a set of five questions on self-care skills that they thought would be functional to teach at school. His profile gave the team confi- dence that these skills were crucial.

Select Self-Help Skills That Are Valued by the Team. The self-care priorities that are written into a student’s IEP are those that are valued by all members, including the family; team members agree that the student would benefit from learning a par- ticular skill over another. Anderson and his colleagues developed a self-help skills inventory that provides a useful structure for teams to survey students’ current perfor- mance of self-care skills (Anderson, Jablonski, Thomeer, & Knapp, 2007). A version of this inventory was used by Adrian’s team (see Figure 10–4).

Select Self-Help Skills That Are Suited to the Teaching Setting. Teams should select skills that are suited to the teaching setting so that there will be adequate op- portunities for instruction. Sometimes teaching opportunities can be expanded, or created, so that teaching is more frequent and is integrated into ongoing routines. For example, Sewell and her colleagues taught preschoolers to dress and undress in the context of natural opportunities such as putting on and taking off smocks for paint- ing, jackets for recess and arrival, and dress-up clothes at centers time (Sewell, Col- lins, Hemmeter, & Schuster, 1998). Dressing, showering, and hair care, if priority skills, can be taught in middle or high school following P.E. Certain self-care skills,

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334 Chapter 10

FiGurE 10–3 Scope and Sequence for the Self-Management Home/Living Goal Area, Section on Hygiene and Toileting

such as toileting and brushing teeth, are best taught during the preschool years when natural teaching opportunities are easily arranged.

Select Self-Help Skills That Are Chronologically Age Appropriate. Self-care rou- tines targeted for instruction, as well as the procedures for instruction and monitoring progress, should be age and culturally appropriate. Skills are chronologically age ap- propriate for a student if they are performed by others of the same age. The specific ways that skills are accomplished, as well as the materials and settings used, also can be influenced by a student’s age. Using the flip-over-the-head method to put on a jacket might be appropriate for preschoolers but is less so for older students; thus, teams need to decide if an “age-bound” method should be selected temporarily or simply avoided. Whether a particular skill becomes a priority may also be determined by a student’s chronological age. For example, completely independent toileting is not an appropriate goal for a preschool or kindergarten-aged child since typical children

Elementary School

Goal Areas Kindergarten

(Age 5) Primary Grades

(Ages 6–8) Intermediate Grades

(Ages 9–11) Middle School (Ages 12–14)

High School (Ages 15–18)

Transition (Ages 19–21)

Hygiene and toileting

(Instruction during school hours)

Use private and public toilets

Wash hands and face with reminders

Blow nose and dispose of tissue with reminders

Use private and public toilets

Wash hands and face: routine time (e.g., after toilet, before eating)

Blow nose and dispose of tissue as needed

Use private and public toilets

Wash hands and face: routine times

activities (e.g., food and for specific

preparation)

Follow acceptable hygiene practices

Use private and public toilets

Wash hands and face: routine times and for

(e.g., food specific activities

preparation)

Follow acceptable hygiene practices

Use private and public toilets

Wash hands and face: routine times and for

activities (e.g., food preparation)

Follow

specific

acceptable hygiene practices

Use private and public toilets

Wash hands and face

Follow acceptable hygiene practices

(Instruction during non- school hours)

Brush teeth

Bathe

Shampoo hair

Brush teeth

Shower/bathe

Shampoo hair

Shower/bathe

Brush and floss teeth

Shampoo hair

Clean and clip nails

Manage menstrual care

teeth

Shower/bathe

Brush and floss Brush and floss Brush and floss

Shampoo hair

Clean and clip nails

Wear deodorant

Shave

Manage menstrual care

teeth

Shower/bathe

Shampoo hair

Clean and clip nails

Wear deodorant

Shave

Manage menstrual care

teeth

Shower/bathe

Shampoo hair

Clean and clip nails

Wear deodorant

Shave

(Republished with permission of Paul H. Brookes Publishing Company, from The Syracuse community-referenced curriculum guide for students with moderate and severe disabilities by Ford, A., Schnorr, R., Meyer, L., Davern, L., Black, J., & Dempsey, P., 1989; permission conveyed through Copyright Clearance Center, Inc.)

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335Teaching Self-Care Skills

FiGurE 10–4 Questions That Help Teams Identify Functional Skills to Be Taught

of this age receive assistance from parents or siblings in public toilets, with soap and towel dispensers, and even with getting on and off the toilet and manipulating doors because of the height, size, and novelty of the equipment. However, when students in elementary and middle school are still dependent on others for toileting, eating, and grooming assistance, their differences may isolate them from their peers.

Select Self-Help Skills That Can Be Acquired in One Year. Predicting how long it will take for a student to learn a target skill relates both to the student’s learning his- tory and the student’s current level of performance or stage of learning (see Chapter 5). Thus, to select skills that are possible for a student to learn within a year, the team will identify IEP objectives that build on the student’s present level of academic and functional performance (PLAFP) and then adjust the criteria so that the objectives are feasible to attain before the next IEP is written.

Sometimes priority self-care skills are age appropriate but are too difficult for a student to learn, such as shoe tying for many younger elementary school students. In such cases, the team may choose a goal of partial participation (Baumgart et al., 1982) instead of total participation in an ordinary manner. Partial participation refers to the process of teaching the student to do as much of a task as he or she can inde- pendently, while getting support for some steps through adapted materials, auto- mated devices, changed sequences, or personal assistance. Partial participation goals should take less time to master, but still address active participation. For example, wearing shoes with VELCRO® fasteners instead of shoe strings allows a student to learn part of the task (putting on and taking off his or her shoes) without the need to learn shoe tying. Occupational and physical therapists often play an important role in the design of adaptations for partial participation. Common variations in partial par- ticipation include the following:

• Modified or adapted materials (e.g., toothbrushes, combs, forks, and cups that are designed for easier gripping; VELCRO® fasteners in place of buttons, hooks, or snaps)

Identifying Functional Skills for Adrian to Learn Now Coat on and off

Pants up and down

Blow Nose Toileting

Brush Teeth

1. Does the absence of the skill prevent Adrian from fully participating in activities with peers or siblings (e.g., inability to swim in public because not toilet trained)?

YES YES YES YES NO

2. Does not doing the skill for Adrian underscore his weaknesses and lead to his being less accepted by peers (e.g., requires help in the bathroom)?

YES YES YES YES NO

3. Is the skill necessary or important for teaching another skill (e.g., pulling pants up and down is important for toilet training)?

YES YES NO NO YES

4. Is this a skill that must be performed independently in public (e.g., when Adrian becomes too old to accompany his mother into a public bathroom)?

YES YES YES YES NO

5. Is this a skill that, when absent, may create embarrassment for Adrian or his family?

YES YES YES YES YES

6. Is this a skill that, when absent, may result in noticeable messiness, unsanitary conditions, or create health concerns (e.g., not knowing how to blow nose)?

YES YES YES YES YES

(Figure used with permission from Self-help skills for people with autism, 2007; Woodbine House.)

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336 Chapter 10

• Adaptive switches or automated appliances (e.g., hair dryers activated by a pres- sure switch; battery-powered toothbrushes that provide scrubbing action automatically)

• Changed sequences within an activity (e.g., allowing a student to put her bathing suit on under her clothes before going to a public pool; sitting on the toilet for bal- ance and then scooting underwear down)

• Personal assistance (e.g., giving a student with limited hand movement an electric brush with toothpaste already applied and letting her do the lateral motion up front, while the teacher completes the molars)

Brown, Evans, Weed, and Owen (1987) point out that if a student is participating partially in a routine, those steps chosen for participation should provide the student with as much control over the routine as possible. For example, a student has more control over having her hair brushed if she can initiate the routine (e.g., ask some- time to brush her hair at the time she wants), and choose a preferred hairstyle (e.g., choose to have a pony tail, versus pig tails), than if she partially participates in comb- ing her hair. When a team decides to use partial participation with a student on a given task, any adaptations should be individually designed. Adaptations should be “only as special as necessary” ( Janney & Snell, 2004) and should meet the criteria of being age appropriate, non-stigmatizing, and practical (Ferguson & Baumgart, 1991). The team should take care that student participation is active and is meaningful to the function of the activity. As with all instructional strategies, ongoing evaluation of par- tial participation is needed to determine whether assistance can be faded and to ensure that modifications result in satisfactory outcomes. The goal is to get the task done while also empowering students.

special consideraTions for ToileTinG

Learning to use the toilet is one of the most difficult self-care skills to teach because it requires a functional bladder (normal capacity, intact urethral sphincter, and mature nervous system), an awareness of internal stimuli (e.g., bladder fullness, bowel ten- sion), and a lengthy sequence of related skills (e.g., pulling up pants, flushing toilet) that must be learned in part or in its entirety for the skills to be useful. Although it varies by culture, studies of large samples of children in western countries found that attainment of daytime continence (“always dry”) increased with age: age two (44%) and age three (86%) (Bax, Hart, & Jenkins, 1990). In the United States and in Great Britain, the expectation is that “a child will begin toilet training at 12–18 months and will become clean and dry by the age of 3 years” (Harris, 2004, p. 773). But these norms for western cultures are later than those for some African, Iranian, and Bengali cultures, where babies may master daytime dryness by or even before a year old (Harris, 2004)! In western countries, boys tend to learn later (mean age 2.56 years) than girls (2.25 years) (Bloom, Seeley, Rathcey, & McGuire, 1993), while bowel con- trol is typically mastered first for most children regardless of gender or age. Most chil- dren master daytime before nighttime control. This general pattern is also typically true for individuals with disabilities.

These facts, along with developmental sequences, can serve as general guides for teaching toileting to most students with disabilities. However, intellectual disability may delay learning and neurological involvement (from cerebral palsy, brain injury, seizures, paralysis) may make daytime and nighttime control more difficult to attain. In a review of the toilet-training literature, Harris (2004) reported two frequent rea- sons for incontinence: bladder capacity that was too small for a child’s age and dys- functional voiding (i.e., an interrupted flow of urine that results from overactive pelvic floor muscles). Medical research informs us that “normal acquisition” of toileting skills by ages three to four years can be expanded to age five and beyond for children with disabilities of these types. At the same time, incontinence can have a damaging effect

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337Teaching Self-Care Skills

on the individual and lead to more personal stress and inconvenience in families (Macias, Roberts, Saylor, & Fussell, 2006). (See Chapter 8 for information on students who require specialized elimination procedures.)

If the student is ready for toilet training, instructional plans should be balanced with the student’s age and teaching setting. Ideally, students are taught these skills during the preschool years or at home. Toilet training gets more problematic when students move into the upper elementary grades and beyond. Teams should empha- size toilet training at younger ages when schedules are more flexible and social stigma is less likely. However, when older students still lack bladder control, teachers will want to work closely with team members to explore solutions for training the student using systematic methods and perhaps a more intensive approach. On the practical side, both time and money are saved when students are independent or, at the very least, when they are regulated in their bowel and bladder elimination. In this section, we discuss the process for (a) identifying what toileting skills to teach, (b) planning how to teach them, and (c) monitoring learning progress.

identify What to Teach

For students who have toileting priorities, teams are likely to select objectives for elimination and related skills (e.g., getting to the toilet, pants up and down, hand- washing). Elimination objectives span from (a) bowel or bladder regulation (habit trained: student goes when taken and remains dry), to (b) self-initiated bowel/blad- der, to (c) independent bowel/bladder. Objectives are selected based on elimination records and related skill performance data.

record Keeping on elimination The first step in identifying what toileting skills to teach involves assessment. Team members need to determine if the student meets three prerequisites for toilet training: (a) a stable pattern of elimination, (b) daily one- to two-hour period of dryness, and (c) a chronological age of two years or older. These characteristics are interdependent and are related to the maturity of the central nervous system and the muscle sphinc- ters involved in elimination. Generally, students who are ready for training have one bowel movement daily and urinate three to five times per day occurring within pre- dictable time periods, but many will differ from this pattern. Bowel responses and some urination responses should occur within predictable daily time periods, not randomly.

Efforts to teach Toby over the past six years had not been successful. His parents were hopeful that he could learn, but they worried that his brain damage at infancy from seizures was the explanation for his lack of progress. Toby also has a history of learning skills “slowly but eventually” when systematic teaching methods are used. His team de- cided that they would work together to carry out an extended baseline on his elimina- tion patterns to confirm whether he met the first and second prerequisites. The OT, SLT, teacher, teaching assistants, and practicum students all worked in tandem to collect data on his elimination every 30 minutes throughout the school day.

A toileting record should be kept on a grid of days by time intervals. We recom- mend the use of 15- or 30-minute intervals. While these shorter intervals demand more staff time, they provide a more accurate picture of the student’s elimination pat- tern. This information helps determine if students have prerequisites 1 and 2, and is crucial if a traditional toileting method is selected. Other considerations for the assess- ment of toileting include whether data will be collected across environments (e.g., at home, in the community, school environments), the length of the day (e.g., an interval of the school day, the whole school day, all waking hours), and who collects the data.

To determine the natural pattern of elimination, check the student at the end of each time interval and record dryness, urination, or bowel movement. Figure 10–5

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338 Chapter 10

FiGurE 10–5 One of Eight Daily Data Sheets Used to Track Adrian’s Daily Bowel and Bladder Eliminations

Adrian was checked every 15 minutes and prompted to the toilet every hour.

Student: Adrian Date: 5/6/15 (Week 2 of baseline: 4/27–5/8)

Procedure: Dry-pants check every 15 minutes, prompt to the toilet every hour; he helps to change when wet, no comment

Key: U = Urination B = Bowel movement N = nothing

Time Dry-pants check (dry or accident)

Student was prompted to the toilet (success or non-elimination).

Student self-initiated sitting on toilet (success or non-elimination).

8:30 U B N U B N U B N

8:45 U B N U B N U B N

9:00 U B N U B N U B N

9:15 U B N U B N U B N

9:30 U B N U B N U B N

9:45 U B N U B N U B N

10:00 U B N U B N U B N

10:15 U B N U B N U B N

10:30 U B N U B N U B N

10:45 U B N U B N U B N

11:00 U B N U B N U B N

11:15 U B N U B N U B N

11:30 U B N U B N U B N

11:45 U B N U B N U B N

12:00 U B N U B N U B N

12:15 U B N U B N U B N

12:30 U B N U B N U B N

12:45 U B N U B N U B N

1:00 U B N U B N U B N

1:15 U B N U B N U B N

1:30 U B N U B N U B N

1:45 U B N U B N U B N

2:00 U B N U B N U B N