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Interdisciplinary, Interagency Collaboration for Transition From Adolescence to Adulthood

Interdisciplinary, Interagency Collaboration for Transition From Adolescence to Adulthood

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  • Interdisciplinary, Interagency Collaboration for Transition From Adolescence to Adulthood
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  • Panelists Tony Antosh, Ed.D.; Director, Sherlock Center, Rhode Island College Ilka Riddle, Ph.D; Associate Director, University of Cincinnati UCEDD Margo Izzo, Ph.D.; Associate Director, Nisonger Center, Ohio State University Olivia Raynor, Ph.D.; Director. Tarjan Center, UCLA
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  • Agenda Introduction, Agenda, Objectives, Issue (Antosh) Perspectives on Transition Healthcare (Riddle) Youth and Families (Antosh, videoclips) Education, Employment, Postsecondary (Izzo) Community Living (Antosh) Strategies for Interagency Collaboration (Raynor) Small Group Discussion Large Group Discussion Wrap up and Resources
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  • Transition Listening Session Sue Swenson Deputy Assistant Secretary OSERS US Department of Education Tuesday, December 4 3:00-4:15 Gunston East
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  • Genesis of the Symposium AUCD Board of Directors wanted to select one issue and use the breadth and depth of the network to create a national focus on that issue. Interdisciplinary Practice is one of the foundation concepts of the AUCD network. After significant discussion, the Board focused on applying the concepts of interdisciplinary, interagency collaboration to transition
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  • The Issue Youth with IDD should be able to expect self-determined transitions with coordinated support from family, community, professionals, and agencies. But they and their families often experience very little coordination and collaboration from the myriad of systems involved in the transition process
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  • Why Failure to support self-determination as a central element of the person-centered process of transition
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  • Why Insufficient understanding of the role of culture in an individual or familys concept or approach to transition
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  • Why The tendency for professionals within each realm of transition (education, health, community living, employment, and others) to use language that is not easily understood by other professionals, youth with IDD, families, or other community partners
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  • Why Neglecting to specifically explore how transition in the different realms could/should be linked for maximizing success
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  • Self Determined Life Youth and Family Culture Perspectives Education Health Employment Postsecondary Adult Supports Providers Outcomes Competence Healthy Life Place to Live Paying Job SocialNetwork Community
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  • Goals Promote an interdisciplinary, interagency approach to transition Understand the language, methodology and practices inherent in the different disciplines and perspectives Understand the role of culture in transition Develop strategies for linking disciplines and agencies Increased awareness of network resources
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  • Perspectives on Transition
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  • Youth and Families
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  • I would like to live with my aunt who has provided me with the care that no one else has been able to do. I plan to find a part-time paying job. I would like to spend the rest of my days going to the gym to keep up my health, doing recreational activities in the community and being part of my social community. I can only do these things if I have wheelchair transportation, a job coach and a nurse to meet my medical needs. Quote from a letter from a youth with IDD to an agency administrator
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  • I expected assistance in planning ways that my daughter could function with support in various adult roles.I expected that the various entities that were involved with her supportwould collaborate together to design supports that would help her reach her unique adult goals. I expected to have good, complete and understandable information.I expected that supports would be available in her own community in places of her choosing. What I needed most was a guide. Quote from a mother
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  • Families want information and planning processes that are clear, simple and individualized. Families and individuals want choice and control their own voices primary in design of services rather than decisions made arbitrarily by others.. want what any family wants for their young adult. looking for the ways and means. Quote from a community supports navigator
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  • Two Videos The Good and the Bad of Transition Kristen Michael
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  • Youth and Family Practices Good, complete, understandable information Focused transition planning Person-centered transition planning Family/Community Support Navigators Self-Determination Curriculum
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  • Healthcare Transition Ilka Riddle
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  • Health Care Transition is the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child- centered to adult-oriented health care systems. Blum et al.,1993
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  • Health Care Transition is: patient-centered flexible responsive continuous comprehensive coordinated AAP, AAFP, ACP, 2002
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  • Guidelines & Best Practices AAP, AAFP and ACP 2002 Consensus Statement: 6 First Steps to Successful Transition AAP, AAFP and ACP 2011 Clinical Report: Health Care Transition Planning Algorithm
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  • Best Practice: Learning Collaboratives Pilots Got Transition Learning Collaboratives (www.gottransition.org)www.gottransition.org Transition Collaborations of Pediatric and Adult Practices/Systems
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  • Shared Management Approach to Transition Team/Partnership Approach Active Participation Empowerment Self-Determination
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  • StageProfessionalParent Child/ Young Adult 1 (Child 6-11) Lead responsibility Participates & Provides care Receives care 2 (Young Adolescent 12-14) Partner gives guidance & support Partner guides & manages Participates in care & decision making 3 (Adolescent 15-17) Consultant Supervisor shared decision making Manager shared decision making 4 (Young Adult 18+) ResourceConsultant Lead manages & supervises
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  • Data tell us that 40.0 % of all youth 12-17 years with special health care needs receive the services necessary to make appropriate transition to health care, work, independence National Survey of Children with Special Health Care Needs, 2009/2010 Data
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  • Considerations People involved: Youth/Young Adults Family Members/Guardians Pediatric care provider & specialists Adult care provider & specialists (Others)
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  • Considerations Systems involved: Pediatric health care system Adult health care system (Others (e.g. service system, education system, etc.))
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  • Barriers/Issues: Youth/Young Adult Little involvement in transition process Little knowledge about condition, health, health issues, health management Late start to transition planning
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  • Barriers/Issues: Family Members Late start to transition preparation Little knowledge about how to navigate the adult health care system Little information about changes regarding eligibility for services, changes to health care coverage and guardianship issues
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  • Barriers/Issues: Pediatric Providers Little time for transition care/coordination Lack of reimbursement for transition support Difficulty letting go Difficulty identifying adult care providers and specialists Little knowledge about community resources
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  • Barriers/Issues: Adult Providers Lack of training in congenital and childhood onset medical conditions Lack of training in working with patients with disabilities Lack of communication from pediatric provider Low reimbursement rates for comprehensive care/ care coordination
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  • Strategies: Youth/Young Adult Active participation in health care and transition preparation Making use of transition resources and tools specific to youth Active participation in finding adult health care provider and specialists
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  • Strategies: Family Members Early transition planning Encourage/empower youth to participate Utilize transition resources, tools and information specific to families Initiate identification of adult providers Ask for portable and accessible medical summary
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  • Strategies: Pediatric Providers Transition Policies & Processes Transition Plan at age 12-14 and updates Provide transition resources Initiate contact with adult providers Communicate with adult providers Provide medical summary
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  • Strategies: Adult Providers Engage in transition process Learn from young adult & family members Learn about congenital & childhood onset medical conditions Communicate with pediatric providers
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  • Recommendations Improved Health Care Provider Training Inclusion of disability training in medical school curricula Education about congenital/childhood onset medical conditions Inclusion of practical experience/ transition care rotations, etc.
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  • Recommendations Improved Collaboration and Dissemination of Information Inter-agency/multi-agency/integrated collaborative transition approach One comprehensive transition resource guide that addresses all types of transition, distributed in all systems
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  • Recommendations Increased evidence-base for successful health care transition: Health outcomes data
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  • Resources Got Transition National Health Care Transition Center www.gottransition.org www.gottransition.org Florida HATS www.floridahats.org www.floridahats.org
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  • Transition to College and Careers Margo Vreeburg Izzo, PhD Program Director of Transition Services Ohio State University Nisonger Center [email protected]
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  • College & Career Ready Higher expectations of all stakeholders 21 st Century Skills (CCS leading to CCR) Grades 8 12: Transition-focused Curricula Grades 13 16: PSE Programs Technology utilization Continue evidence-based policies/practices National Secondary Transition TA Center Think College What Works Clearinghouse 44
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  • Transition Requires Interagency Collaboration IDEA of 2004 requires schools to coordinate with other service systems (i.e. VR, DD): IEP must include AATA, measurable postsecondary goals, projected date for services (i.e. travel training, work experience) If participating agencies fail to provide transition services, LEA shall reconvene the IEP team to identify strategies to meet the transition objectives (IDEA of 2004, (D)(1 - 6)
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  • Transition Requires Interdisciplinary Approaches Age Appropriate Transition Assessments (AATA) Transition to Career/Employment Transition to College/Postsecondary Education Focus Common Core Standards on College and Career Readiness
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  • Transition Requires Interdisciplinary Approaches Special Ed, Voc Ed, Gen Ed & Rehab/DD counselors collaborate to provide: Career development & exploration Soft skills and employability development Self-determination/self advocacy training Summer work experiences Job training and placement Carter, Austin & Trainer, 2011, Predictor of Postschool Employment Outcomes for Young Adults with Severe Disabilities, Journal of Disability Policy Studies, 1-14.
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  • Transition Requires Interdisciplinary Approaches Special educators, OT & VR provide: Transition assessments Assistive technology assessment/training Worksite analysis & job match Job development & placement Worksite Jigs, Ergonomic assessments, etc.
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  • Teach SD Transition Planning* The Model has 3 phases & supports AATA Phase 1. What is my goal? What career do I want? Phase 2. What is my plan? What action can I do today to prepare for chosen career? Phase 3. What have I learned? Revise goals & plans, as needed Model Developed by M. Wehmeyer & Palmer, 2003
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  • 50 Age Appropriate Transition Assessment Interdisciplinary IEP teams use AATA to: Develop realistic and meaningful goals Provide information for present levels of academic achievement and functional performance Learn about the individual student, his/her strengths, needs, interests, preferences (SPIN) Connect IEP with future plans Inform the Summary of Performance
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  • Curriculum-based AATA Begins in the classroom Facilitated by special, general & CTE teachers Integrate AATA into core courses - ELA Examples: Self-determination assessments/curricula EnvisionIT 21 st century curriculum
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  • 52 21 st Century Curricula EnvisionIT teaches students: Common Core Standards (CCS) Information Tech Literacy How to build a self-directed Transition Portfolio by matching their interests, abilities, and personality to career goals. Izzo, M.V., Yurick, A, Nagaraja, H.N. & Novak, J.A. (2010). Effects of a 21st century curriculum on students information technology and transition skills. Career Development for Exceptional Individuals, 33(2), 95-105
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  • 53 Online Assessments The VARK Questionnaire http://www.vark-learn.com/english/page.asp The Myers-Briggs Personality Test http://www.personalitypathways.com/type_inventory. htmlhttp://www.personalitypathways.com/type_inventory. html The Princeton Review http://princetonreview.com/Careers.aspx
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  • Common Core Standards (CCS) & Transition Assessment Princeton Review: After completing the Princeton Review students will be able to analyze their Interest Color and list 4 occupations to explore Core Standard: Reading Strand: Cite strong and thorough textual evidence to support analysis of what the text says explicitly as well as inferences drawn from the text, including determining where the text leaves matters uncertain
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  • CCS and Transition Planning EnvisionIT Activities Students develop and present their assessment results and transition plans Students write an essay to describe their Princeton Review, personality and VARK assessment results Common Core Standards (CCS) Writing Strand 4 Produce clear and coherent writing in which the development, organization, and style are appropriate to task, purpose, and audience. Speaking and Listening Strand 2 & 5 Integrate multiple sources of information presented in diverse formats and media.
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  • Transition Knowledge (TK) Gains Conclusion: Students in the experimental group increased their performance significantly on the Transition Knowledge test, as compared to the control group. 56
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  • Recommendations Plan self-directed PCP meetings (IEP, IPE, ISP) that include college and career goals Raise expectations of service providers & parents through cross-agency trainings Coordinate variety of work experiences from age 14 (or earlier) until paid employment is achieved
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  • Recommendation Using the Self-Directed IEP Research-to-Practice Lesson Plan Starters To teach the Self-Directed IEP to students with cognitive disabilities http://www.nsttac.org/LessonPlanLibrary/ 1_and_8.pdf http://www.nsttac.org/LessonPlanLibrary/ 1_and_8.pdf
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  • Recommendation TEACH SELF-ADVOCACY SKILLS Self-advocacy is letting people (professors, teachers, employers) know what you need to be successful Important skill for anybody (especially those with disabilities) Critical for college and career success
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  • Recommendations Jointly plan with education, rehab and DD personnel Establish paid integrated job and community activities during the last years of school services Adopt Employment First Policies Washington State Legislature passed Jobs by 21 Partnership Project in 2007 Winsor, Burrterworth & Boone, 2011, Intellectual and Developmental Disabilities, 49, 274- 284.
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  • State Success in Integrated Employment National Survey of State IDD Agency Day and Employment Services 2010
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  • Transition to College 27 Projects implement: Interdisciplinary approaches VR and DD coordination Enrollment in college classes Employment experiences Self-determination Inclusive age-appropriate settings Go to www.ThinkCollege.netwww.ThinkCollege.net
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  • Who Should Go To College? http://www.youtube.com/watch?feature=pl ayer_embedded&v=auIYOb_rptQhttp://www.youtube.com/watch?feature=pl ayer_embedded&v=auIYOb_rptQ Over 200 colleges in over 30 states are enrolling students with IDD See www.thinkcollege.net for more infowww.thinkcollege.net
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  • OSUs TOPS Model Interdisciplinary Team Special Educators, Occupational Therapists, Physical Therapists, Rehab Counselors, Speech Language Therapists, Social Workers, Assistive Tech. Specialist Pilot Sites Ohio State UniversityUniversity of ToledoThree Replication Sites Services Planned Through Transition AssessmentPerson-Centered PlanningAcademic Advising
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  • TOPS: Student Experiences Inclusive Postsecondary Campus Experience Self- Determination Health, Wellness Independent Living skills Enroll/Audit College Courses Project SEARCH Internships Residential Campus Experiences Individualized Supports Peer SupportMentoringFamily SupportEducational/Job Coaching E-Portfolio Each student exits the program with an e-portfolio that documents academic employment and independent living skills through digital pictures, video and documents.
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  • Project SEARCH Internships Provides internships leading to employment Engages employers, community partners, employment service providers to meet workforce needs of businesses and job seekers Youth learn job tasks at no expense to employer Goal is EMPLOYMENT! For more information: http://www.projectsearch.us/ 66
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  • Dental Clinic Assistant
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  • Mentoring on OSUs Campus
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  • Technology Recommendations Promotes age appropriate supports Navigation around work/college setting Organization and schedule prompts Provides a means to express interests/skills using digital resumes and application materials Promotes access to academic and work content Sample digital story
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  • Transition: A Bridge to Inclusion in Society
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  • Community Living
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  • A Place to Live 599,152 (58%) people with ID/DD received publicly funded supports while living in the home of a family member 122,088 (12%) while living in homes of their own 40,967 (4) while living in host family or foster care setting 276,460 (26%) people with ID/DD lived in congregate care settings 57% of those lived with six or fewer people. Most of the growth in services in the last half century has been to support people living in their own or a family home. Family and Individual Needs for Disability Supports
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  • A Place to Live
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  • More than half of the family caregivers thought the ideal residential setting was somewhere other than these family home Family and Individual Needs for Disability Supports
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  • Time in the Community 80-90% have participated in community activities in the past month 50% have exercised 50% participated in a religious service, 40% usually feel lonely 30% have ever gone to a self-advocacy meeting NCI Consumer Report
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  • Time with Others How Time Was Spent During Three Days Individual Only 56.0% Housemate 21.2% Agency Staff 19.5% Day/Workmate 2.4% Family Community Friend 0.8% Someone else 0.1% Community Acquaintance 0.1%
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  • Getting There
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  • Transportation Resources http://www.projectaction.org/Initiatives/YouthTransportation.aspx Mobility Options in Your Community. A resource mapping tool to help you analyze the accessible transportation resources in your community Building a Transportation Education Continuum. An activity to assist educators to build transportation education activities across multiple tiers. Building Awareness in Accessible Transportation: Transit Assessment Guide for Students, Families and Educators. A tool for students, families, and educators who would like to increase their understanding of transit systems and how people with disabilities use public transportation.Building Awareness in Accessible Transportation: Transit Assessment Guide for Students, Families and Educators
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  • Initiating Activities Who Initiated Activities During Three Days Individual 71.6% Agency Staff 27.4% Family Community Friend 0.4% Housemate 0.4% Someone else 0.1% Day/Workmate 0.1%
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  • Making Decisions
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  • Summary Transition Planning should include: Where to Live How to Get There Community Activity Leisure and Recreation Building a Social Network Making Decisions
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  • Interagency Collaboration and Coordination Interagency Collaboration and Coordination
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  • IDEA Transition Planning The IEP must include for each student beginning at age 16 (or younger, if determined appropriate by the IEP team) a statement of needed transition services for the student, including, if appropriate a statement of interagency responsibilities or any needed linkages. 34 CFR 300.347(b)(2)
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  • Transition Barriers for Students and Families Accessing needed services Navigating adult services No coordination amongst multiple agencies Lack of sufficient information/awareness Insufficient preparation of students for work US Government Accountability Office (2012), Better federal coordination could lessen challenges in the transition from high school
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  • Interagency Teams Three groups typically served by interagency teams that vary by setting, roles and responsibilities (State level agencies) Developing cross- agency policies to facilitate transition (Regional/local district personnel)Developing procedures and guidelines at district level (Individual level) Working with individual students at IEP meeting or other interagency meetings
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  • The CA Postsecondary Education Interagency Workgroup The Tarjan Center, a University Center for Excellence in Developmental Disabilities established a workgroup consisting of public agencies representing rehabilitation, developmental disabilities services, education, and community colleges in partnership with the State Council on Developmental Disabilities and the California Health Incentives Improvement Project to address needed changes to improve access and participation in postsecondary education.
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  • CA Postsecondary Education Interagency Workgroup Participants John Kimura, Jeff Reil and Susan Mathers, California Department of Rehabilitation Denyse Curtright, Don Braeger, Rick Ingram, Victoria King, Department of Developmental Services Carol Risley, State Council on Developmental Disabilities Scott Berenson,& Scott Valverde, California Community Colleges Chancellors Office Dr. Catherine Campisi & Rachel Stewart, California Health Incentives and Improvement Project* Jill Larson, Dr. Dan Boomer, California Department of Education Carolyn Nunes, Director of Special Education, San Diego Office of Education Dr. Olivia Raynor & Wilbert Francis, Tarjan Center at UCLA Dr. Kathleen Rice, Facilitator *Funder
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  • How We Created an Engaged and Committed Group Developed relationships, mutual understanding and trust among diverse partners; Assessed the environment for change; Attended to the priorities and context under which each agency operated Identified assets and barriers and developed an actionable plan for our work Affirmed individual and agencys commitment to improve outcomes for youth with developmental disabilities Built a sense of purpose, hopefulness and commitment to the work
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  • Step 1: Map Each Agencys Initiatives that Support Students with ID and ASD Raynor, O., Campisi, C & Francis, W. (2012), Pathways to PSE for Students with ID & Autism
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  • Raynor et al., 2012
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  • Step 2: Create an Interagency Matrix ( Raynor et al, 2012)
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  • Step 3: Utilize Case Studies to Identify Supports, Strengths & Gaps Identified key issues and unmet needs Services each agency provided in response to student needs Regulations policies or local practices that created available services, prevented them from being provided or could have been employed but were not Who else needed to be involved? If the system worked well, what would have happened?
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  • Example: Reflection Discussions What are you pleased to see? What is most surprising? What is concerning to you? What else is possible? For your agency? For collaboration between agencies? What is the collective meaning of this work for students with intellectual disabilities or autism? What needs to happen with this information? What does this mean for this group What needs to happen next? Who else needs to be involved? How?
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  • Step 4: Deepen the Learning of Each Agency About One Another What are the top 3 priorities of your agency? What receives the most attention, resources, etc.? What is your agency held accountable for? Where does this accountability originate (e.g. legislation, funding sources)? Where does attention to people with ID and ASD in pursuing PSE fit in with those priorities and accountability expectations? Which of your agencys programmatic efforts or initiatives are truly working to specifically support people with ID and ASD in pursuing PSE? How many people with ID and ASD are utilizing these services? Are these numbers representative of the ID and ASD population? How do you know they are successful? Looking at the Chart mapping the current legislative authority and core functions (Step 1 above) or the Agency Interaction Matrix (Step 2 above), what other questions would help you learn about the work of this agency?
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  • Reviewing the Steps Deciding to Collaborate The Invitation Creating a Shared Understanding of Each of the Partners, their Individual Roles and Responsibilities Creating a Shared Understanding of How Each Agency Might Work Together Utilize Case Examples to Surface Barriers and Unmet Needs Deepening Understanding of Systems Barriers through Learning Conversations
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  • Pathways to PSE for Students with ID and Autism: An Interagency Guide 23 + 16-22 6-15 Birth - 5 Knowledge and Skills Required Information Provided to or by Individuals with ID & Families Primary Actions Primary Role Agency Plans
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  • Youth Ages 6-15 Raynor et al., 2012
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  • Key Learning It is critical to start early to lay the foundation (life experiences, role models, mentors, examples of success) for college and a career. There is a need to raise expectations across the board i.e., parents, self advocates, agencies, and schools, that individuals with ID/ASD will achieve success in their lives and careers. Perceived authority and decision making influences the interpretation of policies, planning and service provision at a state and local level. Context is critical. During the course of our work, new barriers and opportunities for collaboration emerged.
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  • Group Exercise
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  • Question to Consider: If the system worked well, what could/should happen to support this students self-determination and success? What could education do? What could the DD system do? What could VR do? Which agency is responsible for coordinating the health care needs? What could they do? Who else needed to be involved?
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  • Discuss the Following Record Your Best Ideas: What are the key transition issues? In your experience with transition, what needs are typically not met? What are the barriers to meeting those needs? What surprised you about your discussion? What was new information? What recommendations would you suggest to make transition a more collaborative process? What strategies would you use?
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  • Discussion Questions