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Todd Harris, Ph.D.Director
Devereux Pennsylvania’s Division of Autism Services
Devereux’s Center for Autism Research and
Education Services (CARES)
Review issues related to familial stress
Describe what we believe to be the role of professionals with families going through the
transition process
Review strategies for supporting families
Research tells us that families with a child with an autism spectrum disorder (ASD) experience much higher stress levels than other families (including those with Down’s Syndrome and other developmental delays, chronic illnesses, and other types of disabilities).
Sources of stress include (but are not limited to): Financial demandsBehavioral challengesDecisions regarding treatment and placementIssues related to siblings and extended family
membersCo-morbid medical and psychiatric issuesSocial isolation with other familiesFrequent situations that are perceived as
unpredictable and uncontrollableFrustration and frequent contact with agencies
and service providersGeneral fatigue
In addition to the stressors mentioned previously, families may also experience additional sources of stress during the transition years including:
Puberty and related human sexuality issuesBehavioral issues that sometimes intensify and
are more difficult to manageGreater social isolation with same-age peersEmergence of co-morbid conditions (such as
anxiety disorders and other psychiatric conditions, seizure activity)
Uncertainty about the future as their child with autism enters adulthood:
Where will he (or she) live?Where will he work? Will he be able to hold a job?Will he be able to go to college?Who will be his friends?How will we fund needed supports?Who will care for him when we are no longer around?How can we ensure that he has a high quality of life
and is happy?
Research has illustrated that family stress can be reduced by:
The development of a comprehensive social support system
By receiving accurate information about services and systems
By acquiring skills that will enhance abilities to be effective instructors and to manage behavioral challenges
By targeting meaningful skills for adulthood across settings (including the community and employment sites)
By being knowledgeable about transition and adult issues:Best practices for transitionResources and funding streamsPost-21 program options in the area that you
workRelated legal and financial issues
By sharing your knowledge with families and discussing these issues with families at least annually once a child becomes 14 years old (or even earlier in many cases)
By organizing and routinely sharing resources with families (literature, web sites, presentations, etc.)
By assisting with action-oriented planning meetings (person-centered futures planning)
By teaching them to use interventions that work well with their child to enhance their ability to:Generalize previously acquired skillsTeach new skills that are specific to their home
environmentEnhance their child’s successful inclusion into
community settings.
Years 1 and 2: Enhance our transition program through staff training and developing specific tools including:PortfoliosSpecific lesson plan summariesPreference and skill assessment toolsSituational assessmentsPerson-centered futures planningA handbook for families on transition issues
Year 3: Partnering with Central Bucks School District and Lancaster-Lebanon IU 13, we demonstrated that our program could be replicated in regular education high school settings
Year 4: This past year was spent improving the mechanisms for better supporting CARES families with outreach across the region:
Completion of a needs survey and knowledge assessment
Development of a web-based wiki based upon our family handbook on transition issues A series of seminars for families on transition issues
Implementation of a structured parent education curriculum
Person-centered futures planning (PCFP) is an ongoing process that brings together a group of committed individuals to help an individual with special needs plan and create a life that is personally fulfilling and productive
This process can start at any time, but should begin minimally at 14 years
The initial PCFP meeting at CARES typically takes two to three hours; subsequent annual meetings usually last between one and two hours
We try to have this meeting about one month before the IEP; we have found that this process can help plan transitions IEPs
Should the student attend the meeting?
This depends on many variables, including the students communication abilities (receptive and expressive) and their comfort level with sitting in a meeting
Whenever appropriate, we encourage the student to participate as much as possible
Ultimately, this decision rests with the family and the student
If the student does not attend the meeting, it is critical that participants are thoroughly familiar with the student’s strengths, interests, and likes and dislikes
In addition to parents and the school team, other attendees can include siblings, extended family, friends, involved agency personnel, and others that the family invites
The following will be identified by the end of the meeting:
Important relationships that the student has developed across settings
Likes and dislikes related to social interactions, recreation and leisure, employment settings, community inclusion, sensory input, and environmental variables
Skills and supports needed for communication, social skills, and behavior
Meeting outcomes will also include:
A description of medical and physical needsThe student’s and family’s vision for post-
21 living, employment, social interactions, and community inclusion
Goals and objectives for employment education
An action plan for the upcoming year
See our wiki for our format
Who Responded209 families across the state (31 % had
a child between 14 and 17 years)15% had more than one child with an
ASD40% of families had a child with autism;
30% had a child with PPD-NOS; 15% had a child with Asperger Syndrome
45% had a child who was placed in their school district; 28% were placed in a private school; 12% in an IU classroom
Areas of reported confidence
Respondents were most confident in:Including their child into community settingsManaging behavioral issuesEffectively teaching new skills
Respondents were least confident in:Identifying and planning employment optionsIdentifying and planning housing optionsIdentifying and planning adult program and
college options
Topic areas that families were most interested in learning more about (in order of interest)
Post-21 employment optionsTeaching social skillsOptions for housingFinding and securing the right funding stream(s)
Results from our knowledge assessment
There were no real differences in knowledge based upon the age of the child with an ASD, child placement, or geographic location
Results from our knowledge assessment
Areas that parent were most informed included:Termination of wraparound services
in the post-21 years (77% correct)No IQ requirements with the autism
waiver (75% correct)Legally required action to maintain
guardianship at 18 years (66% correct)
Results from our knowledge assessment
Areas that parent were least informed included:Typical duration of OVR services
(32% correct)Age eligibility for the PFDS waiver
(36% correct)Absence of entitled services in the
post-21 years (39% correct)
As our students became 10 years and older, we quickly realized that critical information on transition:
Was not organized in one document, but rather required searching many different sources
Was not written in a manner that was easily understood
Based upon this finding, we created a Family Handbook on Transition Issues and Services
Within 3 months of publication, our handbook was already out of date due to changes in services and funding
We to decided develop a web-based “wiki” on transition service that can be updated as needed
Program Goals:
To give families the necessary knowledge and skills to be more effective instructors with their child with an ASD
To enhance the skills of our students across home and community settings
Program Components:
Monthly Workshops and MeetingsMonthly Assignments Related to Skill
BuildingHome Visits From Program Staff
Review assignmentsAnswer questions and concernsObserve teaching sessions and give
structured feedback
Establishing behavioral objectives and measuring progress
Arranging effective lessons
Using reinforcement
Prompting strategies
Teaching communication skills
Teaching social skills
Planning and teaching community skills
Addressing unwanted behaviors
Performance Feedback Component
Why is this component critical?Based upon the work of Aubrey Daniels
and others, staff were trained on how to deliver feedback effectively emphasizing:Be positive (using the 3 to 1 praise to
corrective feedback ratio)Be immediateUse specific examples
Let’s look at our performance feedback tool