Transition is broadly considered to be a process or period of change. Transitions can vary in scope on several dimensions such as small to large, quick to prolonged, easy to difficult, and from the perspective of those impacted, minor to life changing. Transitions are an inherent part of life and are challenging to varying degrees for everyone, but can be particularly difficult for individuals with disabilities such as autism. One of the largest transitions a child with disabilities will experience is the transition from student to adult, marked by a shift in services provided by the education system to those provided by adult service providers. This transition is so notable because it consists of a change in almost every aspect of the individual’s life. The school, the bus ride, teachers, fellow students, and curriculum that have been the center of the weekday routine for years will end. For some this will also mean a change in living arrangements. The place they have called home, whether with family or in a residential school, may change to a home managed and staffed by a community-based residential provider.
Laurel Ciavarri, PhD, BCBA, LABA
There are a variety of services available to students entering adult services, with models designed to address a range of needs. In terms of day services, two primary areas of focus include habilitative and employment supports, and can be provided independently or in combination. Day habilitation programs provide support and training focused on skills necessary for adult daily living and target skill deficits that create barriers for more independent completion of tasks or participation in activities. Day habilitation services are provided using a team approach and includes input from disciplines such as occupational, physical, speech and language therapy, nursing and behavioral supports. Participation in goal development by family/guardians as well as the service recipient is encouraged to ensure a focus that is consistent with a personalized vision of the future.
Residential options vary greatly as well, and range from group homes equipped with 24/7 staffing to targeted supports for a minimal number of hours in an unmanaged/independent residence. A group home model in and of itself has a range of possible features such as the number of residents that share the home, the staff ratio and staff expertise (i.e., training/certification in specialized areas such as medical issues, aging, behavioral interventions, etc.). Individualized home supports, in comparison, may include staff support around specific skill areas or needs at specified times during a day/week. For example, in cases where an apartment is rented independently or within a building managed by a service agency, staffing is provided to assist with a selected goal (i.e., community access) for two hours each weekday.
Given the magnitude of this transition, it is no surprise that there has been a considerable amount of focus on the process for ensuring that students are prepared effectively. A formal transition process is mandated by the Individuals with Disabilities Education Act (IDEA) with the intent of establishing a plan for the transition within the Individual Education Plan (IEP) to post-school activities/programs that target individualized needs, interests, strengths and preferences.
One step of the transition process that has received less focus is that of the logistics of the final component of the transition. That is, the process by which the student is introduced to and begins attending a new program. It is not uncommon for students to have support strategies for transitions of daily life. These strategies may include use of pictorial cues and schedules (Dettmer, Simpson, Myles & Ganz, 2000), prompting sequences, timers, transition cards and activity sequencing (Hume, 2008). Yet, for perhaps the largest transition into day habilitation or residential home services, there is little available to providers to guide the entry process, demonstrate efficacy of transition strategies or contribute to a discussion of factors that may influence the success of a transition style.
A key to remedying this centers on one of the existing recommendations of the IDEA, 2004. Specifically, the inclusion of all relevant members of a child’s treatment team in the development and ongoing evolution of the transition plan. In a review of publications pertaining to transition planning for students with autism from 1996-2008, Hendricks (2012) found that participation in IEP meetings included external support agencies in just 30 percent of IEP meetings. An inclusive meeting ensures that the perspectives of adult service providers and caregivers that work with or see the child in varied contexts and settings can contribute to goal development. In light of this, an initial recommendation for effective transition planning is to remedy the barriers to participation in the IEP meetings by external providers and/or identify alternative methods for their contribution to the IEP process.
A second recommendation is to consider whether the requirement for an inclusive IEP can be extended to include the future provider. There are several important contributions a future provider can make to ensure an effective transition plan. A primary contribution is a familiarity with the adult service models available and the skills necessary to be successful within those settings. As described, there are several service models, and there are notable differences in their structure compared to school-based services, including lower staff-to-student ratio, staff credentialing, classroom/work-group size, instructional style and curriculum content. If, for example, postsecondary plans include placement into a habilitative or residential program with a lower staff-to-student ratio or a specific job type, incorporating strategies to establish the skills to work within the projected future ratio or the identified work skills can be incredibly helpful to the student’s success. Similarly, other goals specific to the future placement environment could be identified and incorporated into the transition plan.
Certo, et.al. (2003) presented the Transition Service Integration Model, in which the receiving nonprofit adult provider worked closely with the school, rehabilitation and developmental disability systems for the year prior to exiting the school system for students with disabilities and employment goals. The results describe a high rate of success in that 63 percent were matched to an employment position that was able to be maintained post-graduation through the provider, 88 percent of the transitions occurred with no break in services, and 71 percent were still employed after three years. While more research is necessary for those receiving employment services and research is needed for those receiving day habilitation services, these results demonstrate the benefits of a greater level of involvement from the adult service provider early in the transition process.
A third recommendation centers on the logistics of the entry to the new adult program. Adult service providers often have a default process for referral review and entry to the program. However, the default process may not be conducive for many individuals with autism with specialized or individual needs around transitions. Creating an individualized entry to a new program should include questions such as: How many visits should occur, by whom, in what locations (existing program/school/home or, in the future program/home) and for what duration? At what point should this process begin – has the student historically fared better with short/rapid implementation of new routines, or with a more gradual/slow introduction of change? Would the use of a social story to introduce the new routine, people and places be helpful? What types of activities would be most helpful during the introductory visits? If initial visits target more preferred and low-demand contexts, what process for introducing task requirements typical of the environment would be best?
Enormous strides have been made in ensuring effective and appropriate services within children’s programming. Similar advances are underway within adult services, and creating a more cohesive effort between the two during the transition process may set the stage for an enhanced transition experience for providers, family/parents, and students receiving services.
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References
Certo, N.J., Mautz, D., Smalley, K., Wade, H., Luecking, R., Pumpian, I., Sax, C., Noyes, D., Wechsler, J., & Batterman, N. (2003). Review and discussion of a model for seamless transition to adulthood. Education and Training in Developmental Disabilities, 38(1), 3-17.
Dettmer, S., Simpson, R.L., Myles, B., & Ganz, J.B. (2000). The use of visual supports to facilitate transitions of students with autism. Focus on Autism and Other Developmental Disabilities, 15(3), 163-169.
Hendricks, D. R., & Wehman, P. (2009). Transition from school to adulthood for youth with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities 24(2), 77-88.
Hume, K. (2008). Transition time: Helping individuals on the autism spectrum move successfully from one activity to another. The Reporter 13(2), 6-10.
Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400 et. seq. (2004).
