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A Closer Look at Skills Training

Written by: Michael S. True, M.Ed

This article is copy protected and should only be reproduced by permission of the author. For information contact me at: mstrue1@hotmail.com .



     Remember when it all started? Parents, teachers, care-providers, each beginning the journey at some point. The "journey", being a commitment to providing guidance, assistance, and support to a boy, girl, man, or woman with exceptional needs. When the task ahead was being taken one step-at-a-time, we all took a deep breath and set our sites on a select number of skills we believed those in our care could learn. And then we set out to make a difference.

     Especially for those of us who have chosen this as an occupation, our expectation was not of overnight transformations. Even the most idealistic, after a few weeks, gave up on the idea of a "quick fix", (although miracles are always in our prayers). Perseverance was to become a byword. "Keep at it, allow plenty of time for the trial and error approach to learning, patience, patience, patience, that's the key to success!"

     We, who have spent more than 10 years in this business of helping others, have seen many would-be helping hands come and go. In the mid-1990's, I heard that the average length of time a "direct-care" provider stayed employed in one setting was six months. In many cases, caregivers and training staff would leave within the first month. Why? Because of the extreme demand involved in providing both personal care and active treatment. You see, for those working with persons with more involved disabilities, training actually takes place almost every minute of every "waking" day.

     As caregivers, even parents and highly trained professionals have limits! We are told, and tell ourselves over and over again, "There's no hurry. Slow and steady wins the race. There's always tomorrow, Patience, patience, patience, patience!"

     But the truth of the matter is that a road of limited progress, (tiny steps in skill acquisition and/or slow gains in emotional connectedness), is long and frustrating for any who are attempting to give support. Often it seems as if there is no end in sight. The question becomes, "Why bother teaching at all?"

     It is at this point that we must remind ourselves, (and stick that post-it on our mirror), of the two most important aspects of this process of teaching those with severe developmental delays:

     1) Learning is always happening. If a person is alive, learning is occuring! The human body and mind are constantly acting and reacting to the environment in which they are placed. This is the true essence of learning. Every day adjustments are made to the conditions to which we find ourselves exposed. We adapt to those conditions, as an element of our survival. We "move" towards things which provide comfort and away from those things that bring discomfort.

     This is why choosing functional skills in real-life settings is critical. For the severely handicapped, this may be the only way to approach the learning process. Learning how best to "fit in" becomes the priority of our goal setting. Routines which do not include opportunities to engage in real-life settings/situations often lead to outcomes that do not match what must be learned to adapt to the real world. The time spent teaching our wards how to sit in a desk at school does not necessarily reflect the experience of sitting at a table in a crowded fast food restaurant. Even though "desk sitting" could be considered "appropriate social behavior", how useful will it be in the long run?

     Constantly be aware of how your "student's" goals relate to normal family, school, or special program activities. Because we know how much time it will take to teach these basic life skills, it is paramount that we focus on them early on in the training process. How and where we spend our time teaching is actually more important than what we choose to teach.

      2) Even though it seems like every day is pretty much the same as the day before, small changes are taking place. A better grip on a spoon, less resistance to hand-over-hand activities, a word or signal to communicate some need or desire, whatever it is, something will be different! If we focus on the sameness of the routine, it may always appear the same.

     The insistant need for significant visible changes to take place in our day-to-day training program can sometimes work against us. We want so badly for things to progress from point A to point D, that we loose sight of getting to and beyond points B and C.

     I have seen so many individualized plans that put "monstrous" expectations on a student, (or the adult teaching them, for that matter). The person providing training or therapy can only become frustrated and disillusioned when nothing "new" happens in a relatively short period of time. In the eyes of certain family members and school administrators, for instance, this visible "proof of progress" must be significant enough to credit the "teacher" and/or the "system" with some level of accomplishment. Otherwise, someone may or may not be doing their job, heaven forbid!

     A classic example is the "student" who requires the caregiver to feed him or her at an age when this skill should have been mastered. It may be due to resistiveness, tactile defensiveness, or impaired motor coordination. This same goal: "To eat independently", has been un-met for two, maybe three years with little or no progress noted. Why? Perhaps it is the way this goal has been written and/or documented.

     Here is a specific example:

     Annual goal: "student" will use a spoon to eat at least one meal every day.

     Short term objectives (by quarters):

First quarter - will use spoon 2 of 10 trials.

Second quarter - will use spoon 4 of 10 trials.

Third quarter - will use spoon 6 of 10 trials.

Fourth quarter - will use spoon 8 of 10 trials.

     If at the end of the year the student is only using a spoon on 3 of 10 occasions, everyone shakes their head and looks for someone or something to blame for the lack of progress. Even the parent who has set or been "given" unrealistic goals can be criticizes by friends or other family members when outcomes don't match expectations.

     It is very important to carefully judge the goal and the distance to it. For instance, if you were driving from San Fransisco, California to New York, New York, your first thought may be that it doesn't look that far on the map. One could easily say that driving 1000 miles per day may be a reasonable objective with a goal of getting there in three days. Especially if you had a second person to help drive. Of course, being somewhat practical, you would probably add at least one day for emergencies or unforeseen traffic problems. Before you leave you tell the people you are going to visit in New York that you'll be there in four days. Then begins the journey.

     Of course, any number of things can cause travel delays, flat tires, more rest stops than originally estimated, road work, detours, missing a turn, and so on it goes. At the end of the first day you realize that 600 miles per day is going to be a much more realistic expectation for your daily objective. This means that the drive will take six days instead of four. Naturally, you will want to call your friends right away and let them know that it will take the extra days to get there. In most cases, you would not wait until the end of the fourth day to make the call.

     Parents and teachers often see the actual rate of progress long before the clock runs out. Despite the differences between real progress and the hoped for progress, it seems that there is a strong tendency to stick with the original goal's timeline. Perhaps it is hoping for the best. However, the pressure then begins to build on the teacher and student. Stress becomes an added obstacle heaped on top of an already overwhelming agenda.

     If the focus were turned more to the "levels of assistance" required to accomplish the task, the "invisible" milestones would become visible. This is not a new concept. But sometimes it is overlooked as a better way of viewing and documenting progress.

      First, of course, the task must be broken down into steps which can easily be observed and reinforced. I'll go back to the example of "eating with a spoon".

     Task analysis of steps to "eats with spoon":

     1)student will show awareness of mealtime

     2)...sits upright in chair with feet on floor

     3)...reaches for and grasps spoon

     4)...holds spoon correctly to scoop

     5)...scoops food from a bowl

     6)...brings food to mouth

     7)...gets most of food into mouth

     8)... removes spoon from mouth with little or no spillege

     Depending on the special needs of each student, these steps can be adjusted to include special conditions which must be met in order to succeed in the process of self feeding. Each of the steps may even be used as annual goals if there are multiple sub-steps between them. Examples include: positioning issues, lip closure and swallowing processes, etc.

     The rate of progress will be determined the easiest by noting the level of assistance on each separate step. Typical ratings for observation/documentation may include:

     - or U = unable to do without full assist

     HoH = Hand-over-Hand assistance required

     PP = (light) Physical Prompts required

     VP = Verbal Prompts required

     VC = Visual, (or Verbal), Cues required

     + or I = Independent - able to do without assistance  

     In cases of tactile defensiveness or aversion to intervention, it may take months for a student to allow you to fully place a spoon in their hand and do a hand-over-hand scoop. Other objects and parallel activities may be found to be useful in desensitization therapies. Hypersensitive areas could include the hands, face, lips, and tongue. The first year's goal may simply be: "to tolerate physical assistance, (hand-over-hand), on all steps of the task". The quarterly objectives might be: "...will allow/tolerate physical assistance (HoH) on two steps of the task", adding two more steps per quarter. Also, it is not essential that the two steps tolerated are the first two in the sequence.

     This brings us full circle to reminder #2, if our efforts are focused, we will see the progress that our students are making. If we are encouraging a greater level of self-reliance we will plant the seeds of independence. We will note things like less resistiveness, a smile of accomplishment, and eventually a new skill will emerge!

     Frame these affirmations:

     "The person I am teaching is learning!"

     and

     "If I look close enough, I will see the progress as it happens!"

     ...Then take it to heart.





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