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Supporting Adults with ASD in the Workplace Using Positive Behavior

Support

How to Put the Pieces to the Puzzle Together

Presented by: Emily Helmboldt, LPC, Virginia Department of Behavioral Health and

Developmental Services

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Our Session’s Agenda:I. Housekeeping-Cells on vibe,

breaks, etcII. A little about meIII. A LOT about ya’llIV. Autism Disorder primerV. Intro to VCU Career LinksVI. Positive Behavior Supports in the

workplace

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“If you’ve met 1 person with Autism…

You’ve met 1 person with Autism”

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A Snapshot of Autism Spectrum Disorder

A Neurobiological Disorder-

-prenatal brain dysfunctionneural pathwayschemical structure/balancesuneven growth patterns

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Causes of ASD??Complex, much is unknown

Genetic components (several genes involved)Physiological components (gastointestinal disorders, sensory)Environmental components (teratagens)Note: NO factors in the psychological environment cause ASD!

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It’s time to play…

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RulesTake out sheet of paper- Take out penTake 1 minute to notice all the types of stimuli you are aware ofWrite down a list of what you sensed

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Areas of focus-Severe delays in language development Severe delays in understanding social relationships Inconsistent Patterns of sensory responses Uneven patterns of intellectual functioning Marked restriction of activity and interests.

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To Do List:Learn normal patterns of speechLearn to communicateLearn how to relate to people, objects & events

“Similar to persons who have had a stroke”

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Prioritycommunication and socialization

communication and socialization

communication and socialization !!

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Behavioral SymptomsSocial Interaction• Non-verbal social

communication• Peer Relationships• Social Reciprocity

Patterns of Behavior• Activities• Interests• Rituals

Communication• Ability to Speak• Symbolic

Language• Pragmatic

Communication

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Secondary Characteristics

Behavior Challenges and Mental Health

Diagnoses Sensory Sensitivities

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“That’s a lot of negatives…Where’s the light at the end of

the tunnel?”Loyal employeesA lot of Persons w/ASD like repetitionAttentive to detailOrganizedBenefit from the SAME positive outcomes from employment that you and I benefit from…

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ASD Career Links

Purpose of the study:Conduct evidence-based research on vocational rehabilitation service models for individuals with Autism Spectrum DisordersExamine the impact of intensive community-based work experiences on the employment outcomes of young adults with ASD

Project SearchRandomized Controlled Trial

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ASD Career LinksNational Institute on Disability and Rehabilitation Research (NIDRR) VCU – Rehabilitation Research & Training CenterResearch related to Vocational Rehabilitation Models for Individuals with ASDPartners:

Virginia Department of Rehabilitative Services (DRS)Henrico County Public SchoolsThe Faison School for AutismBon Secours Richmond Health SystemCincinnati Children’s Hospital

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Credit goes to…Dr. Carol Schall, VARC, Va Commonwealth UniversityJennifer McDonough, RRTC/VCUDr. Paul Wehman, RRTC/VCURichard Kriner, Dept of Rehab Services

** Erin Reihle, Project SEARCHFor more information about Project SEARCH at Cincinnati Children's, please contact projectSEARCH@cchmc.org or call 513-636-2516.

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Project SearchSenior year transition programIn large business – microcosm community

HospitalLarge bank centerGovernment center

Classroom time, 1 hour in am, 45 minutes in pmRest of day – internships in business

3 rotations across year, ~10 wks each

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Business ModelSingle point contracts and contactsInterns, not volunteersCreate need in businessTalk about potential employment at every evaluationWork on match between intern and internship

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CollaborationRehabilitative Services – Provides job coachingSchool – Provides teacher and instructional assistantFamily – Provides information and receives support during transitionUniversity – Provides consultation in best practice and behavior support

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Schall, C. M. (2010). Positive behavior support: Supporting adults with autism spectrum disorders in

the workplace. Journal of Vocational Rehabilitation, 32.

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Challenges of PBS at Work

Visible and public contextSupports are co-workers and supervisorPressure to performFewer trained staffLack of access to PBS servicesContextual fit

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The PBS ProcessFBA

Person Centered PlanningIndirect Assessment

Identify and Define the BehaviorInterview TeamReview History

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The PBS ProcessDirect Assessment

Observe in Environment where Behavior Occur and Do not Occur

Hypothesis DevelopmentWhen (Antecedent)Intern will (behavior)In Order to (function)

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The Competing Behavior Model

Antecedent

Problem Behavior

Function of Behavior Achieved

Replacement Behavior

Function of Behavior Achieved

Desired Behavior

Enhanced and Natural

Reinforcement

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Example:Intern touches women while talking to them, either on shoulders or tries to hug them.List problem behavior?List replacement behavior?List desired behavior?

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Behavior InterventionPrevent Behavior • Alter the antecedents to prevent the problem

behavior from occurring

Teach• Teach replacement behaviors that serve the

same function as the problem behavior

Respond• Respond differently to the problem behavior by

removing the reinforcer and reinforce the replacement behavior

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From Student to Employee…Andrew: Goals:• Increase Independence :Computer, Agenda, Schedule• Writing: draft a letter, subject-verb agreement, vocabulary and sentence

development• Reading Comprehension: use of best words, comprehension to 4th grade

level, understand simple sentences• Message Delivery: remember a verbal message and relay it with

accuracy (without getting distracted)• Phone Calls: Introduce himself, state purpose of the call, ask a question

Fred: Goals:• Practical Math: visual recognition and identification of

fractions, counting mixed money• Functional Reading: identify information presented in real-life

materials• Vocational Skills: sorting, matching, work speed, following a

task list to completion

Environment: School, CBI, community based employment sites (7 hours per week)

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AndrewAutism

Communication challengesSocial interaction patternsPatterns of behaviorSensory sensitivities

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Andrew: Materials ManagementDuties:

Use computer board & wandCount the white labeled items Pull materials from the stockroomLoad his cartDeliver stock to assigned departments

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Andrew’s FBAIdentify and Define Behavior Challenges

DartingPushing through peopleLaying on ground (in parking lot)

Interview previous school teamChanges in routine

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Andrew’s FBAObserve behavior using ABC recording

Rushed through transition from computer or other desired activity to an unexpected activityForgetting important items at home

Employee orientation pinAcademy Awards Book

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Andrew’s FBADevelop Hypothesis

When Andrew forgets items that are important to him, he will pace flapping his hands, dart away from his area, plop on the ground and refuse to move in order to express his distress and anxietyWhen Andrew is rushed to change activities from a desired activity to a less desired activity he will pace, flap, and dart in order to escape being rushed and transitioningWhen corrected, Andrew will pace and walk away in order to avoid correction

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Andrew’s PBS PlanPrevent

Work on match between job and Andrew’s strengthsDesign visual supports to assist Andrew in understanding schedule for the day-iTouchProvide warnings before transitionsHave double sets of important objects

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Andrew’s PBS PlanTeach

Teach accepting correctionRespond

Train co-workers and supervisor about Andrew’s disability

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Andrew: Central Sterilization

Identify instruments using scannerPrint labels and place on packsPackage instruments in correct packs Peel packaging instruments in heat sealers

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Adam“High Functioning” Autism

Requires structured work dayWorks best with guysA few behavior challenges related to social interaction errorsSensory Issues

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Adam: RadiologyDuties:

Clean & sterilize X-ray cassettesStock patient areas with linensTravel to Radiology, ER, and Outpatient Units to complete these duties

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Adam’s FBAIdentify and Define Behavior Challenges

Touching OthersRubbing Others

Interview previous school teamHe likes to hug and rub shoulders, it’s so sweet!

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Adam’s FBAObserve behavior using ABC recording

When in close proximity to preferred female staffWhen attempting to interact with others and ‘at a loss for words’

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Adam’s FBADevelop Hypothesis

When Adam is in close proximity to preferred female staff, Adam will rub their shoulders and offer to rub their feet, in order to gain positive attention and sensory feedbackWhen Adam wants to maintain interaction with others, but has run out of things to say, he will put his hands on his co-workers shoulder in order to maintain contact

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Adam’s PBS PlanPrevent

Work on match between job and Adam’s desire for positive interaction

TeachTeach Adam to ‘be professional’

Hands to selfNo touching or rubbing others

Teach communication starters

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Adam’s PBS PlanRespond

Teach co-workers and supervisor about Adam’s disabilityTeach co-workers to say “be professional”

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Adam: EngineeringTeam assignmentsAssist with repairs/maintenance across campus

Remove pipesAssemble equipment

Identify and change light bulbsChange ceiling tilesClean air vents

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Adam – Infection Control

Clean, restock, and collect ‘not needed items’ from isolation carts on every floor of the hospital

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ASD Supports At WorkMatch – Capitalize on StrengthsCommunication Supports

Direct, Clear, Concise, WrittenSocial Skills Instruction

Social Skills Important in that EnvironmentLook out for work place bullies

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ASD Supports At WorkEnvironmental Design and Supports

Build routineDevelop distraction limited work stationProvide visual cues and information

Behavior ChallengesSort through the details to try to get the person’s perspectivePrevent the problemTeach new skillsSelf Management

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For more information…http://www.vcu-autism.org/

or cmschall@vcu.edu

Or Emily.helmboldt@dbhds.virginia.gov

PBS info: www.apbs.org www.AAIDD.org