Case Study: Tracey Essay
Case Study: Tracey
Transitioning to adulthood can be stressful and challenging for all, but for those diagnosed with Autism Spectrum Disorder (ASD) and their caregivers transitioning to adulthood can provoke feeling of uncertainty or even fear. People with ASD function at different levels and require varying degrees of care. There should be an individualized educational plan (IEP) established by age 16 containing postsecondary goals related to training, education, employment, and independent living skills along with the transition services needed to assist in reaching those goals referred to as individualized transition plan (ITP) (Heward, 2013). Defining the needs of young adults with ASD should start with listening to the individual and helping him or her plan for the life he or she wants. When establishing an ITP, goals in education/training, employment and independent living; type of support needed on a job; residential alternatives; and interventions for any behavioral problems should be addressed.
Tracey is a twenty-one-year-old student diagnosed with ASD who can have difficulties with transitions and requires that her routine be predictable. Tracey’s goals are to attend college, work in an office and share an apartment with a school friend when she graduates. Tracey reads at a second grade level and will need extensive support from educators in order to achieve her goal of receiving a postsecondary education. Tracey’s educational curriculum should use a functional skills approach that will help her master critical skills for use in home, community, school, and work settings (Snell & Brown, 2006). Tracey will complete a technical training program that will include learning work behaviors and job skills that will be useful in an office work environment. It will be essential to coordinate communication between the school and community based service providers in order to identify potential employers. Tracey will sample different job tasks within an office environment taking advantage of her friendly disposition and ability to follow directions when they are paired with pictures to help her understand the steps in completing more complicated tasks.
Job tasks may include office maintenance, delivering messages, sorting and organizing material, and offering assistance to other personnel. Tracey is able to complete her daily living skills relatively independently but needs reminders to choose appropriate clothing and change her clothes on a regular basis. Her parents will provide positive reinforcement and implement a self-management intervention plan to encourage Tracey’s appropriate behaviors. Tracey is frequently impulsive which sometimes results in grabbing and even pushing another peer. An important aspect of transitioning is to address challenging behaviors through the use of behavioral strategies. Tracey will practice conflict resolution skills by learning to communicate her feelings and practicing relaxation techniques during stressful situations. In an effort to increase Tracey’s independence she will enter the workforce while receiving appropriate training. As Tracey enters the workforce she will require supported employment because she has never been employed. She will be receiving functional skills training that will prepare her with specific job skills required to work in an office as she desires.
Heward (2009) indicates “The individual placement model of supported employment consists of developing jobs with employers in the community, systematically assessing clients’ job preferences, carefully placing employees in jobs they want, implementing intensive job site training and advocacy, building systems of natural supports on the job site, monitoring client performance, and taking a systematic approach to long-term job retention” (p. 539). This type of supported employment is the best approach for Tracey because no two people with ASD are alike; employment should capitalize on Tracey’s strengths, abilities and interests. In this type of employment Tracey will receive ongoing support services while on the job from a job coach that will provide intensive on-site job training and support, which will be modified over time as she becomes more successful at completing her job tasks. It is important that the job coach gradually reduce the time spent providing direct training to Tracey in order to: avoid disruptions in the workplace, keep Tracey from interacting with coworkers without disabilities and have Tracey become too dependent on the job coach keeping her from developing problem solving skills and taking responsibility for her own actions (Heward, 2013).
Tracey’s training/support should focus on how to get to and from work, scheduling, following instructions (supported by pictures), interactions with coworkers, money management and self-advocacy. Tracey’s goal is to live in an apartment with a college friend. Supported living is designed to foster an individual’s integration to the community as he or she works toward his or her personal goals. A supported living model is suited for Tracey because she has established basic life skills and does not have significant levels of challenging behaviors but still requires assistance in some areas. An apartment cluster houses people with disabilities while having another nearby apartment for a support person or staff member (Heward, 2013). This type of living arrangement will offer Tracey flexibility in the amount of support she receives. Again, support will be adjusted as Tracey becomes more independent and fluent with her everyday living skills. A daily schedule will be provided for Tracey to remind her of things like hygiene routine, personal care (picking and changing her clothes), and household chores.
Heward (2013) suggests “to facilitate social integration, people without disabilities may also occupy some apartments in an apartment cluster” (p. 5450). Autism Living and Working (ALAW) provides supervised living with home ownership opportunities to adults with autism by focusing on each individual’s personal preferences, strengths, deficits, and sensory-motor requirements, ALAW works to provide the necessary residential accommodations and vocational supports to enable the person to participate more fully in work and life in the community (ALAW, 2014). All accommodations are specifically tailored to meet an individual’s needs and preferences across their lifetime. What is most beneficial of programs like that offered by ALAW is the help-to-do rather than the do-for attitude, where Tracey can continue to learn and develop new skills but most importantly she will find consistency, structure, and predictability. Tracey’s impulsivity must be addressed in order for her to be successful both in a professional and a personal setting. Behavior problems serve as a form of communication that has a function in the person who displays it. When Tracey grabs or pushes another peer she can be seeking attention in order to express her frustration when something is no longer predictable.
For example if Jane does not want to do what Tracey wants her to do she will push her getting the attention of others that will in turn interrupt or stop the activity that is frustrating Tracey (creating a predictable event for Tracey). This consequence also serves as reinforcement, making the unwanted behavior stronger. Tracey will learn new ways to communicate her frustrations. In order to have Tracey understand the consequences of her behavior (grabbing and pushing) she will need to understand and recognize what triggers the behaviors, known as antecedents. An intervention strategy to help prevent the behavior from occurring can include avoiding large crowds, avoiding exposure to long delays, and allowing Tracey to take frequent breaks during difficult tasks. Tracey will also learn replacement behaviors like organizational skills that will keep her from becoming frustrated when faced with multiple tasks and learn to control angry outbursts; instead of grabbing or pushing she will learn to say stop and request a break.
Those around Tracey will need to learn how to respond differently to Tracey’s behavior by redirecting her to another activity or prompting her to use an alternative skill, and providing corrective feedback. There will be a direct assessment used to collect behavior data in order to determine the effectiveness of the interventions. Tracey will be observed in her natural environment, including her work place, school and home. Antecedents, behaviors, and consequence patterns will be observed noting how frequent the behaviors occur, how long they last and the intensity of the behavior. Observations will be made with current strategies and with new strategies to determine effectiveness. Transitioning to adulthood for youth with ASD presents unique challenges but with the appropriate support a better quality of life can be achieved.
It is important to include Tracey in the planning of her daily activities in order to increase predictability, to be specific when setting expectations for her at the beginning of each activity and to use pictures instructions to make her daily routines understandable. Peers and coworkers without disabilities may have concerns regarding how to treat Tracey or how to communicate effectively with her; their concerns must be addresses with specific and clear instructions regarding Tracey’s communication system. Those near her will be taught how to appropriately respond to Tracey’s unwanted behaviors. Not only will having these skills make them feel more at ease around Tracey but it will also make them valuable assets in Tracey’s training and development. Keeping in mind Tracey’s personal goals in education/training, employment and living arrangements allows for an easier more successful transition into independent living specifically designed with her strengths and abilities in mind.
Autism Living and Working (ALAW). (2014). Self-determined housing. Retrieved from http://www.autismlivingworking.org/content/self-determined-housing Heward, W. L. (2013). Exceptional children: An introduction to special education (10th ed.). Upper Saddle River, NJ: Pearson Education Snell, M. E. & Brown, F. (2006). Instruction of Students with Severe Disabilities (6th ed.). Upper Saddle River, NJ: Prentice Hall