Presentation on theme: "Brittany Schmidt, MA-CCC/SLP-L 605-351-1002 Social Thinking Case Studies Impressions and Ideas."— Presentation transcript:
Brittany Schmidt, MA-CCC/SLP-L Social Thinking Case Studies Impressions and Ideas
Why this topic? Thinking about what skills point towards the best outcome What are the “red flags”?
What are the greatest predictors of vocational success?
Poor outcomes for job placement for youth with ASD Rates vary from 80-95% Project Search Data:www.vcu-autism.org/about/index.cfmwww.vcu-autism.org/about/index.cfm 87.5% in treatment group acquired employment while 6.25% in the control group did.
Social Thinking at Work (Michelle Garcia Winner and Pamela Crooke) Social Mind at Work Social Memory Strategies for Adult Communication Emotions Perspective Taking (7 core tenets) Four Steps of Communication What People Mean by What they say and How they say it The Importance of Conformity, Teamwork, and Networking Relating at work Tips and Strategies
Book designed to be used independently or as a “workbook” of sorts to guide instruction for ST on the job
Case Studies Overview All of the following case studies were adults that were VR funded to receive Social Thinking therapy between the years 2010 and 2014 Ages: 19 (A), 27 (AS), 33 (N)
Case Study #1 19 year old male: “A” Graduated in 2010 Plan for transition fell apart due to school district realizing he wasn’t qualified for the support they had intended – 2 weeks before graduation. Had worked at HyVee for about 1 year. Evaluated ”A” and goals established. Significant concerns for progress. Communicated that to VR.
Positives Wanted to do well and cared about thoughts of others. Liked his job (mostly). Had a low average IQ and could reason and understand directions. Very nice and kind. Learned quickly – at work.
Challenges Hygiene Time Management and Organization Concrete Thinking (“all clocks are a few minutes off”) Initiation of communication – Expression in general. Very limited understanding about thoughts of others and E/UE behaviors. Becoming overwhelmed when social interactions impacted job completion Mild depression and anxiety.
Treatment Plan 1. “A” will demonstrate a use and understanding of the core Social Thinking vocabulary as it pertains to himself and his perspective taking abilities. 2. “A” will demonstrate an understanding of the hidden curriculum as it applies to various situations he encounter both in the community, at home, and at school by being able to relate his observations to the therapist with 1-2 examples per week. 3. “A” will increase his emotional vocabulary to include at least 5 picture and vocabulary words for 5 key emotions including examples of what may cause those emotions. 4. “A” will be able to monitor his facial expressions and tone of voice to reflect or mirror both his message and that of the message of the speaker as evidenced by self monitoring on video tape or through parent report
Progression 1 st week – 15 minutes late. Noted significant challenge with expression and emotional vocabulary. Introduction of ST vocabulary. The next week – did not show up or contact SLP. 2 nd Week: 15 minutes late. E/UE with time management. The next week: Came to the office much later and told receptionist he had a meeting but couldn’t remember when. 3 rd week – 20 minutes late. Started to work on strategies for organization and time management.
Continued….. 4 th week – I called a meeting with parent, “A”, and VR. Good discussion about extent of needs and possibility of ST not being the appropriate support for meeting those needs. Decided to increase communications with HyVee supervisor and provide a plan for organizational supports (with parent assistance) within his home.
Continued…. 5 th week: 30 minutes late – couldn’t find phone and didn’t have much money to put gas in his vehicle to return home. 6 th week: Arrived on time and clean shaven. Good session with progress noted in insight and E/UE behaviors. 7 th week: Arrived 10 minutes early but was not clean and was quite messy. Could not find his phone and was worried he would be late so did not shower.
8 th week: 5 minutes early. Unclean. SBM being in a group. Did well with most columns. Most difficulty with thoughts of others.
Week 9 Progress Note I am seeing some gains in “A’s abilities to use social thinking skills. He was on time and said he showered last night. His phone wasn’t charged so we discussed making sure that he follows through with keeping his phone on the kitchen counter (to charge it there) so he can have it with him at all times. Had people file information about one person at work. Watched a video about bagging groceries and also printed off a list of bagging techniques. He said his primary challenge with bagging is knowing how to bag items when they are not grouped correctly so the two videos we watched showed how to group things into categories and then how to bag according to weight and height (also fragility).
Next Week – “A” texted me saying he couldn’t get out of his street due to road construction. Mom confirmed this. 10 th – Final – Week: Arrived at 12:50. Appointment was at 3:00. I offered to see him with a group of boys that I had at 1:00, he declined and returned on time at 3:00. Good session with higher level concepts covered.
Progress 1. “A” will demonstrate a use and understanding of the core Social Thinking vocabulary as it pertains to himself and his perspective taking abilities. Progress: “A” understands the concepts of expected and unexpected behavior and resultant good or uncomfortable/thoughts in others. He also understands social wonder questions, 4 parts of communication and people files. He does not recognize UE behavior in himself without a prompt. He can recognize it in others via homework assignments and scenarios used during STG. 2. “A” will demonstrate an understanding of the hidden curriculum as it applies to various situations he encounter both in the community, at home, and at school by being able to relate his observations to the therapist with 1-2 examples per week. Progress: goal not met. 3. “A” will increase his emotional vocabulary to include at least 5 picture and vocabulary words for 5 key emotions including examples of what may cause those emotions. Progress: Part met for simple emotions such as mad, happy, and joyful. 4. “A” will be able to monitor his facial expressions and tone of voice to reflect or mirror both his message and that of the message of the speaker as evidenced by self monitoring on video tape or through Parent report. Progress: Goal not addressed.
Outcome Slight improvement in time management and organization. Maximum supports at home required. Slight improvement in understanding E/UE behavior in others and thoughts of others. Parent sought guardianship and SSI supports. Still on VR caseload.
Case Study #2 “AS” 27 year old male. Graduate HS Attended vocational school Expelled due to aggression (bullied and handled it very poorly). Used a PASS plan to establish a business (lawn care and snow removal) Business expanded to Christmas light displays.
Challenges Limited perspective taking. Time management. Fiscal management. Very little social activities besides sister and her son. Rigid thinking.
Strengths LOVED his work. Used his area(s) of interest for job development. Has a very supportive family. Has very little to no mental health concerns.
Progress Saw for 10 weeks in his home town in 1:1 session. No challenges with timeliness or scheduling. Good understanding of concepts (E/UE, ToY vs. JM, BIG, PF, etc….) Very little carryover at home with support system. Discontinued after the 10 weeks funded by VR.
Outcome Good understanding but little usage of ST concepts. Did develop some business ideas based on thinking of you concepts that he liked and incorporated into his business plan. (surveys of satisfaction, quarterly letters to communicate thank you) Parent and AS report of greater understanding of thoughts of others.
Case Study #3 (N) 33 year old male. Late diagnosis of ASD. Long history of being fired due to explosive behavior on the job. Varied jobs but mostly retail and food industry Long history of anxiety and depression, questioned PTSD in himself. Average IQ (last IQ was in High School.)
Challenges Cycles of mood. Concrete thinking. Limited by present understanding about thoughts of others. Emotional regulation. Hygiene Body language and affect No job (lost it the 2 nd week of our therapy), no insurance, debt
Strengths VERY motivated for change. Recognizes need areas. Needs little assistance to grasp concepts. Support of VR and family (west river) Stabile mood most of the time.
Communication with VR I told VR counselor that I felt “N” was going to do well and was excited to see what he could do with ST therapy. By week 5 I was communicating that I would really love to see him for an additional 10 weeks due to progress. VR approved 2 nd 10 weeks due to documented progress. Completed last week on 9/24/14.
Beginning Weeks Very limited affect. Scared/Worried. Introduction of concepts and established rapport/trust. Got fired from a job due to rigid thinking, ER, and lack of POV. Saw great gains in ability to manage emotional regulation. Note strong understanding about how others may be feeling. Realizes he was fired due to his own UE behaviors.
Middle Weeks Requested and obtained second 10 weeks. Incredible increase in ability to apply concepts learned in therapy to his real life situations. Met with his mom and he when she was visiting. communications with mom also occurred. Moving towards August which is usually a month of stress/anxiety due to school history.
Ending Weeks Moved to an every other week schedule. Wanted to be able to extend our sessions and also felt he was doing well enough to do so. Increased anxiety in August results in UE behaviors at work however did not get fired and really handled the stress nicely. Announced moving back west river in mid-October.
Progress Understanding and application of all ST concepts introduced including use during times of emotional distress. Got insurance Got a job (held this for over 6 months) Arranged for doctor appointment(s) to start medication. Did all communications with work as it pertained to needed days off. Disclosed his disability first with VR present and then advocated for himself on 3 more occasions. Arranged for a transfer west river independently.
Why this topic? Thinking about what skills point towards the best outcome Perspective taking level Lack of mental health concerns Ability to think about thinking (CBT) Support network What are the “red flags”? Mental health Low perspective taking level Rigid thinking predominates Poor or no support network