S ETTING T RANSITION G OALS FOR S TUDENTS WITH S IGNIFICANT D ISABILITIES April 27, 2011 Transition Center at West Bay Warwick, Rhode Island John Kregel Virginia Commonwealth University

My Background  Teacher in the first classroom for students with Severe Disabilities in Lawrence Kansas  Eight years classroom teaching experience for students with severe disabilities  Professor in VCU’s intellectual and development disabilities programs teaching transition and behavior management  Research Director at VCU-RRTC since 1984

What are your expectations for this morning’s discussion?

Our Learning Objectives Carefully review the expectations we have for our students Reflect on our current curriculum decisions based on our experiences and expectations Examine our formal transition planning process Share current approaches to teaching functional skills and making employment a reality for our students

What are our expectations for our students? Health and Safety Independence and Self Esteem Residential Education Employment Financial literacy Community Participation Social Relationships

Health and Safety 1. Our expectations for our students include: 1. Life Expectancy 2. Treatment for Chronic Conditions 3. Access to Health Care 4. Need for Assistive Technology 5. What Else?

Independence and Self-Esteem 1. Our expectations for our students include: 1. Family Member 2. Friend 3. Neighbor 4. Helper 5. Member 6. What Else?

Residential 1. Our expectations for our students include: 1. Avoiding medically based congregate care facilities 2. Living with families or relatives 3. Stability of living arrangements 4. Access to necessary supports

Education 1. Our expectations for our students include: 1. Dual Enrollment Models 2. Supported Education Models 3. When are these models appropriate?

DUAL ENROLLMENT

Mixed/Hybrid Model Students involved in social activities and/or academic classes with students without disabilities (for audit or credit) Participate in classes with other students with disabilities—such classes as life skills or transition programs Employment experiences are offered both on and off campus (Hart et al 2005) Hart et al., 2006

Substantially Separate Students are on campus, but are in classes only with other students with disabilities Access to socializing with students without disabilities is part of the model Employment experiences typically in pre- established employment settings on and off campus Hart et al., 2006

Inclusive Individual Support Model Students receive individualized services— educational coach, tutor, technology-in college classes, certificate programs and/or degree programs (for credit or audit) Not program based: courses are selected on students’ career goals and employment experiences (internships, apprenticeships, work- based learning) Interagency team w/student and family identify range of services and share costs Hart et al., 2006

Higher Education Opportunity Act (PL )  Enacted in 2008  Has provisions to improve access to postsecondary ed for students with ID  Language in legislation covers:  -Financial aid provisions  -Creation of model demonstration program  -Creation of coordinating center

George Mason University’s LIFE Program: Started in 2000  Provides inclusive university experience to further literacy skills and prepare for employment and independent living  Students commute or live on campus; Two-thirds attending LIFE Program are on campus  Receive certificate upon completion (4 yr program)  Program developed for students with intellectual and developmental disabilities

SUPPORTED EDUCATION

VCU ACE IT in COLLEGE  5 yr demo grant through US Dept of Education  Provides college education for students with intellectual disabilities (18-26 yrs)  21 credit, 30 month certificate program through School of Education  “Program of one” with inclusive core courses, electives and work experience

KATIE

 Learns through discussion and small group activities in UNIV 101 class (i.e. volunteered to write group responses on the board for class)  With initial prompts from education coach, expresses thoughts and ideas about class readings (i.e. Book: Letters to a Young Teacher)

 Expands her experiences through prompts from coach (i.e. participates in service learning, reads a story to children at her job in the university child development center).  Explores Google docs to get comments from education coach on assignments

Employment 1. Our expectations for our students include: 1. Competitive Employment First 2. Employment Retention 3. Employment Satisfaction 4. Access to Employment Supports

Financial Literacy 1. Our expectations for our students include: 1. Money of my own 2. Purchasing 3. Saving 4. Banking 5. Financial Education 6. Credit

TRANSITION ACTIVITIES LEADING TO FINANCIAL STABILITY

Individuals with disabilities often have very limited income and few, if any, assets. As of March 2011, 13.4 million individuals were receiving disability benefits. Of those: 7.5 million received Title II benefits only, 4.4 million received Supplemental Security Income (SSI) only, and 1.5 million received both SSI and Title II benefits (SSA, March 31, 2011).

People with disabilities are considerably more likely to experience poverty relative to those without disabilities: Poverty Status among SSA Beneficiaries Type of Benefit Percentage in Poverty Number in Poverty SSI72%3,175,000 SSDI31%2,825,000 26

Current Federal Poverty Level Federal Poverty Level (family of 1) $10,890 Two Times Federal Poverty Level$21,780 Federal Poverty Level (family of 4) $22,350

SSI and SSDI Benefits The average SSI benefit of $533/month (January 2012) is only 59% of the federal poverty level for a family of one. The average monthly SSDI payment is $1070 (2011) – only 118% of the federal poverty level for a family of one.

Material Hardship Indicators Hardship with respect to consumption of material items necessary to meet basic needs Unable to meet expenses  Unable to pay rent or mortgage  Unable to pay utility bills  Unable to get needed medical care  Unable to get needed dental care  Food insecurity (with or without hunger)

Hardship Prevalence Age Income Below the Poverty Level Hardship Indicator No Work Limitation Work Limitation Didn’t Get Medical Care 12%21% Food Insecurity with Hunger 8%20% Any of Six Hardships45%62%

50% of Individuals with Disabilities are “Unbanked” Individuals who are unbanked have no access to financial services (services that include savings, credit, money transfer, insurance, or pensions) through any type of financial sector agency such as banks, non-bank financial institutions, financial cooperatives and credit unions, finance companies. 31

Defining Financial Stability A concept that reflects each person’s employment and economic independence goals and takes into account his or her unique life circumstances and family situation. Financial stability encompasses:  An individual’s income and wealth in relation to his or her financial expenses, responsibilities, and desires;  An individual’s ability to manage his or her finances, and access the information and supports needed to make sound financial decisions and long-term financial plans; and  An individual’s ability to avoid lifelong poverty and dependence on disability benefits.

Community Participation 1. Our expectations for our students include: 1. Consumer 2. Citizen 3. Volunteer 4. How do I get there?

Social Relationships 1. Our expectations for our students include: 1. Building friendships with individuals who are not caregivers 2. Residential stability to allow individuals to maintain friendships

Promising Practices and Service Delivery Models with Businesses

Walgreens

Program Design  15 Distribution Centers  Two new ones are in Anderson, S.C. ( 700 employees) and Windsor Conn. (300 employees)  Individuals with disabilities work at same productivity rate, receive same pay, and work side by side with other workers Commitment to hire at least 10% of employees with disabilities in distributions center

Walmart

ARC of US & Walmart Foundation: School to Community Transition Project  ARC received 3year, 3 million dollar grant  Purpose of funding to identify & fund innovative & best practices in school-to- community transition services  Grants funded nationwide

Marriott: The Bridges Program

Bank of America

Bank of America- Card Center, Wilmington DE.  Has long history of employing individuals with cognitive disabilities  Has hired over 300 individuals with disabilities in Wilmington, DE and Bangor, ME

Bon Secours Supported by NIDRR, US Dept of Education V.C.U. Project Search Replication

Key Concepts  Collaboration with business, education, rehabilitation (VR) & DD  Braided funding  Immersion & impact  Training in real work settings  Low risk, low cost for business  Hiring students who are “good fit”  Goal of employment

School Day: Business Based 8:00 Employability Skills 9:00 Worksites 11:30 Lunch 12:15 Worksites 2:00 Review, Plan, Journaling 2:30 Depart 8:00 Employability Skills 9:00 Worksites 11:30 Lunch 12:15 Worksites 2:00 Review, Plan, Journaling 2:30 Depart

P.J. Coronary Unit

P.J.: Coronary Care Unit Duties Stock drawers & cabinets in patient rooms Take out laundry baskets Prepare rooms for next patient Remove needle boxes when they are full Make flow charts for each patient Stock lab trays Check refrigerator temperatures

Dan: Dietary & Nutrition

Dan: Dietary & Nutrition Duties Refill soda syrup Break down boxes Stock water bottles & soda Wipe down tables Take trash to dumpster

J.K.: Radiology

JK: Radiology Duties Clean & sterilize X-ray cassettes Stock patient areas with linens Travel to Radiology, ER, & Outpatient Units to complete these duties

Alice: Pediatrics

Alice: Pediatrics Duties Make new patient packets Stock supplies Clean toys Play with children Deliver blankets, books & toys Make name signs for patient doors & printing pages to color Help children with crafts

Kalyn Ambulatory Surgery

Kalyn: Ambulatory Surgery Duties Remove instruments from clean baskets Sort items Identify instruments & place correct items on tray

Internships  Employee Wellness  Scanning employee’s documents into the computer system  Assembling masks for employees  Filing Supports  Incredible 5 point scale card for noise  5 minute scheduled break in morning and afternoon  Visual cue cards: “what to do with your hands at work” “I’m feeling sleepy” “I’m feeling sad I should…” “I need a break”

Internships Diabetes Treatment Center  Creating invitations/mailings for “Sugar Fest”  Data entry  Bulletin Board prep and design for “Sugar Fest”

Internship Supports  5 minute break  “I’m feeling sleepy” visual cue card

Internships General Surgery  Stocking medical supplies, and linen in patient rooms  Refilling water for patients  Removing soiled linen from rooms

Internship Supports  Behavior plan with incentives – reviewed before & after each shift  Supply list with par levels

TRANSITION FROM SCHOOL TO ADULT EMPLOYMENT FOR YOUTH WITH DISABILITIES: WHERE ARE WE IN 2012?

Seamless Transition from School to Adulthood : Is There Such a Thing?

Pervasive Unemployment and Underemployment

Need for Renewed Emphasis on Work Since 80’s research has shown youth with disabilities who participated in work experiences, especially paid work, while in secondary school are significantly more likely to hold jobs after they exit school than those who do not (regardless of disability, or need for accommodation or support) Hazazi, Gordon and Roe, 1985,Benz, Yovanoff, & Doren, 1997,NLTS

Transition and IDEA Amendments of 1997 IDEA eliminated separation between Individual Transition Plan and IEP "Implicit in this requirement is the national policy.....that publically supported education for students with disabilities should culminate in postschool employment and independent living” Amendments of 1997 IDEA eliminated separation between Individual Transition Plan and IEP "Implicit in this requirement is the national policy.....that publically supported education for students with disabilities should culminate in postschool employment and independent living”

When Will Competitive Employment Be the First Choice? Wehman 2012

EFFICACY OF TRANSITION PLANNING: WHAT DOES THE RESEARCH TELL US? 31 studies reviewed involving 859 youth Not enough studies have sufficient methodological design (Cobb and Alwell 2009) Cobb & Alwell, 2009

Findings Too little, too late Lack of active participation by students/families Perception of poor post 21 outcomes by families and teachers Too little, too late Lack of active participation by students/families Perception of poor post 21 outcomes by families and teachers

Findings from Qualitative Metasynthesis of Transition Planning  Transition more of a promise than reality  Uneven transition expertise, low levels of parent/student involvement  Influence of families and extended families on career choices and job acquisition  Restrictive views on post-school outcomes  Lack of cognitive clarity and systematic instruction  Lack of respect and understanding by some teachers Source: NSTTAC

Lack of Career Goals Review 399 IEP’s (16 to 22 yrs) revealed two thirds did not address or provided inadequate detail for mandated transition goal areas Most lacked career planning and indicated disconnect between an individual’s career interests and type of work experiences they participated in Powers et al., 2005

EFFICACY OF LIFE SKILLS 50 studies reviewed involving 482 youth Alwell & Cobb, 2009

Findings Strong support for life skills training and positive transition related outcomes

Importance of Transition  Need to understand how transition relates to a whole life: living, working, and participating in the community  Great challenge when leave school and face adult service systems and programs  Planning through a transition IEP is essential

Types of Transitions that Lead to a Whole Life  No perfect way to perfect life; are ways to help get there  Family and culture  Appetite to grow  Plan and supports  Many require more supports than those without disability

MAKING TRANSITION A REALITY

COMMUNITY-BASED TRAINING AND EMPLOYMENT

WHAT skills should be taught in the community? What should be on the IEP?

Transition IEPs 1. Employment Goal (may include integrated employment and supported employment) 2. Vocational/Technical Training Goal (may include apprenticeship, work-force training) 3. Higher Education Goal

Transition IEPs (continued) 4. Continuing and Adult Education, Career/Technical Education Goal (may include public or private technical school) 5. Residential Goal

Transition IEPs (continued) 6. Transportation/Mobility Goal 7. Financial/Income Needs Goal 8. Self-Determination Goal 9. Social Competence Goal 10. Health/Safety Goal (Transition IEPs Wehman & Wittig, 2009, PRO-ED)

Life Skills Training Works! ( Alwell & Cobb, 2009)

HOW should these skills be taught?

Applied Behavior Analysis (ABA) in a portfolio of skills context (Wehman, Schall & Smith, 2009)

Discrete Trials vs. Portfolio Based Activity Training

I. Person Centered Planning to Inform IEP Development and Transition Planning Transition Planning

II. Implementation of Communication, Social Skill, and Self Determination Curriculum and Interventions across the Curriculum Transition Planning

III. Implementation of Organizational and Academic Supports to Achieve desired Transition Outcomes Transition Planning

IV. Implementation of Self Monitoring and Behavioral Supports to Mitigate Barriers to Desired Transition Outcomes Transition Planning

V. Implementation of Family Support to Increase Consistency of Supports Across Home to School Transition Planning

VI. Implementation of Community Based Career Development Curriculum to Increase Career Planning and Development Transition Planning

Cutting Edge Transition Issues

Employment Before Exit Policy (Rusch & Braddock, 2004) (Wehman et al, 2002; 2006b, 2012)

No More Subminimum Wages! APSE Board Statement, July, 2009

Access to Benefits Social Security and Other Benefits Age 18 Redetermination Student Earned Income Exclusion Section 301 Medicaid/Waiver Eligibility Wehman, 2006a

Functional Curriculum vs Literacy Based Curriculum (Wehman and Kregel 2011; Bouck, 2008)

Long Term Support: Who Will Pay? Long Term Funding: The Bane of Transition

Long Term Funding Policy for Extended Employment and Independent Living (see Certo et al., 2008)

Greater Early On Transition Planning with Student, Family and Self- Determination

Transition Research: What Do We Need to Know?

School Based  We need to know the EFFECTS (not relationships) of different service delivery models on post school employment/education outcomes. Specifically:  Does inclusive education in high school lead to greater likelihood of successful postsecondary education?  Do functional curriculum/life skills taught in "community immersion" settings lead to successful postsecondary employment?

Virginia Commonwealth University

Reference List Agran, M. and Hughes, C. (2008). Students' opinions regarding their Individualized Education Program involvement. Career Development for Exceptional Individuals, 31(2), Alwell, M. and Cobb, B. (2009). Functional life skills curricular interventions for youth with disabilities: A systematic review. Career Development for Exceptional Individuals, Aug 32, Analysis of state annual performance reports for indicator 13. National Secondary Transition Technical Assistance Center. Retrieved October 22, 2009, from APSE statement on subminimum wage. (July, 2009). Available from Benz, R.B., Yovanoff, P., and Doren, B. (1997). School-to-work components that predict post-school success for students with and without disabilities. Exceptional Children, 63, Bond, G.R. (2004). Supported employment: evidence for an evidence-based practice. Psychiatr Rehabil J 27, 345–359. Bond, G., McHugo, G., Becker, D, Rapp, C. and Whitley, R. (2008). Fidelity of supported employment: Lessons learned from the National Evidence-Based Practice project. Psychiatr Rehabil J, 31(4), Bouck, E. C. (2008). Factors impacting the enactment of functional curriculum in self contained cross categorical programs. Education and Training in Developmental Disabilities, 43(3), Braddock, D., Hemp, R., and Rizzolo, M.C. (2008). The state of the states in developmental disabilities, seventh edition, Washington, DC: American Association on Intellectual and Developmental Disabilities.

Reference List Certo, N. J., Luecking, R., Murphy, S., Courey, S. and Belanger, D. (2008). Seamless transition and long-term support for individuals with severe intellectual disabilities. Research and Practice for Persons with Severe Disabilities, 33(3), Clark, H. B., and Unruh, D. K. (2009). Transition of youth and young adult with emotional or behavioral difficulties: An evidence-supported handbook. Baltimore: Brookes Publishing. Cobb, B. R and Alwell, M. (2009). Transition planning/coordinating interventions for youth with disabilities: A Systematic Review. Career Development for Exceptional Individuals, 32(2) Flannery, K.B., Slovic, R., Benz, M.R., and Levine, E. (2007). Priorities and changing practices: Vocational rehabilitation and community colleges improving workforce development programs for people with disabilities. Journal of Vocational Rehabilitation, 27, Hart, D., Grigal, M., Sax, C., Martinez, D., & Will, M. (2006). Postsecondary education options for students with intellectual disabilities. Research to Practice, 45, Hartwig, R. and Sitlington, P.L. (2008). Employer perspectives on high school diploma options for adolescents with disabilities. Journal of Disability Policy Studies, 19(1), Hughes, C., Washington, B. H., and Brown, G. L. (2008). Supporting students in the transition from school to adult life. In Rusch, F. R. (Ed.). Beyond high school: Preparing Adolescents for Tomorrow’s Challenges (2 nd Ed.). Upper Saddle River, New Jersey, Pearson. Institute for Community Inclusion: Supported employment closures. Retrieved October 22, 2009, from

Reference List National Longitudinal Transition Study 2. Retrieved October 22, 2009, from Ottomanelli, L.,Bradshaw, L.D., and Cipher, D.J. (2009). Employment and Vocational Rehabilitation Services use among veterans with Spinal Cord Injury. Journal of Vocational Rehabilitation, 31(1), Powers, K. M., Gil-Kashiwabara, E., Greenen, S. J., Powers, L. E., Balandran, J., and Palmer, C. (2005). Mandates and effective transition planning practices reflected in IEPs. Career Development for Exceptional Individuals, 28(1), Revell, G., Smith, F., and Inge, K. (2009). Report: An analysis of self-employment outcomes within the Federal/State Vocational Rehabilitation System. Journal of Vocational Rehabilitation, 31(1), Rusch, F.R. & Braddock, D. (2004). Adult day programs versus supported employment ( ): Spending and service practices of mental retardation and developmental disabilities state agencies. Research and Practice for Persons with Severe Disabilities, 29, Test, D. W., Fowler, C.H., Richter, S.M., White, J., Mazzotti, V., Walker, A.R., Kohler, P. and Kortering (2009). Evidence- based practices in secondary transition. Career Development for Exceptional Individuals, 32(2), The young and the jobless. (2009). The Wall Street Journal, October 3, page A12. What works transition research synthesis National Secondary Transition Technical Assistance Center. Retrieved October 22, 2009, from

Reference List Wehman, P. (1981). Competitive employment: New horizons for severely disabled individuals. Baltimore: Paul H. Brookes Publishing Co. Wehman, P. (2002). A new era: Revitalizing Special Education for children and their families. Focus on Autism and Other Developmental Disabilities, 17(4), Wehman, P. (2006a). Integrated employment: If not now, when? If not us, who? Research and Practice for Persons with Severe Intellectual Disabilities, 31, Wehman, P. (2006b). Life Beyond the Classroom: Transition Strategies for Young People With Disabilities. Baltimore, Md.: Paul H. Brookes Publishing Co. Wehman, P., Revell,G., and Brooke, V. (2003). Competitive employment: Has it become the "First Choice" Yet? Journal of Disability Policy Studies, 14(3), Wehman, P., Targett, P., West, M., & Kregel, J. (2005). Productive work and employment for persons with Traumatic Brain Injury: What have we learned after 20 years? Journal of Head Trauma Rehabilitation, 20(2), Wehmeyer, M.L., Parent, W., Lattimore, J., Obremski, S., Poston, D., & Rousso, H. (in press). Promoting self- determination and self-directed employment planning for people with disabilities. Journal of Social Work in Disability and Rehabilitation.