Terry is an 18-year-old woman with a diagnosis of moderate-to-severe intellectual impairment of unknown etiology. Her hearing is within normal limits and her vision is mildly impaired (myopic) but corrected with glasses. Terry exhibits subtle motor planning problems evidenced during classroom tasks and activities of daily living. Her communication abilities include the use of natural gestures (e.g., leading, pointing, showing), facial expressions, body orientation, and behavioral responses such as physically withdrawing from people who make unwanted demands. Terry speaks in phrases of one to three words that are intelligible to familiar listeners. She uses five words in sign language. Terry comprehends context-based one- and two-step directions related to familiar routines. She is regarded as an intentional communicator who expresses requests for favorite items, events, and people. Terry protests and reports when peers have broken a class rule. A picture schedule is currently used to help Terry understand the steps associated with daily class routines.
by Paul W. Cascella and Kevin M. McNamara
Although students like Terry comprise a small percentage of the high school population, the American Association on Mental Retardation suggests that these students need an extensive amount of support to fully participate in everyday learning situations, community events, and social relationships. Supports are deliberate actions and incidental strategies used by teachers, paraprofessionals, and family members that enable students like Terry to fully access the same high school experience as her peers without disabilities.
Terry's Individualized Education Program (IEP) includes goals and objectives specifically designed for her transition to post-high school experiences. Terry is already 18 years old and her high school planning and placement team (PPT) has begun the process of thinking about how to prepare her for adult living and work. The Individuals with Disabilities Education Act (IDEA) requires the PPT to include a transition statement when a student is 14 years old, and address transition needs by the age of 16. In earlier years, Terry's speech-language programs focused on her academic and social success. With the transition to adult services, Terry's program will gradually shift to communication for life success. This is consistent with the concept of skill actualization highlighting the importance of assisting students to use their existing communication skills across a broad array of life contexts.
As part of her IEP, the PPT had discussions about Terry's post-high school experience. Her IEP includes a statement about where and how Terry will likely live, work, and recreate after she leaves high school. This plan includes input from all of Terry's high school teachers (i.e., special and regular education teachers, paraprofessional, speech-language pathologist, school psychologist, etc.), along with Terry, her parents, and siblings. Although Terry has cognitive and communication deficits that make it difficult for her to make life decisions, team members try to embed Terry's viewpoint into team discussions.
As she gets older and leaves high school, the team envisions Terry living in the local community (near public transportation), doing some type of daily volunteer or wage-earning work, and being able to access local community events and recreation. They also see Terry having opportunities to participate in her favorite recreational activities (e.g., going to the beach, taking hikes, eating out). At PPT meetings, her family and teachers discuss Terry's need for considerable support in order to participate in community living, work, and recreation. The team is especially concerned about Terry's communication and how she will fare and has discussed the supports Terry will need initially, as she is learning about work and independent living, and later, after she leaves high school.
The Role of the SLP
The SLP's role as part of the planning and placement team is to address the nature and type of communication services needed as Terry's curriculum focuses on her transition to adult living. Although all programs are individualized, a focus on specific goals and objectives related to functional communication will help facilitate Terry's transition into post-high school experiences. To begin the process, the SLP should:
- Help the Team Understand Functional Communication. Functional skills are those behaviors that are meaningful and salient to everyday communication events and enable the student to affect the environment and participate in communication exchanges. For someone like Terry, assessment and programming must address how she can communicate, make decisions, and exercise choices concerning her participation in daily routines. A functional communication model relies on communication partners who interpret and respect the student's communication and enable it to shape daily situations. This model encourages Terry to make choices within daily routines and requires her team to respect her preferences.
- Document How and Why the Student Communicates. As high school students with severe disabilities transition from school to adult-based services, few retain direct access to an SLP. Very few adult service agencies have the financial resources to afford ongoing speech-language pathology support. It might also be the case that the student does not automatically receive adult services upon completing high school. Therefore, documenting the student's existing communication skills and the strategies supporting these abilities can be beneficial to future service delivery. The SLP can develop a communication profile (see Communication Profile sidebar) identifying the student's context-specific receptive communication skills and methods of communicating (e.g., forms) and the reasons why the student communicates (e.g., functions).
We ask several people, including parents, teachers, paraprofessionals, and the SLP, to report on the student's communication at home and at school. We ask family members and teachers to report on the natural supports that facilitate the student's communication abilities. For example, communication supports might include the type of prompts that elicit the skill (e.g., verbal, gestural, pictorial, written) and/or how prompts are given (e.g., "she does better with slow repetitive prompts"). Comments on the behavior of the communication partner (e.g., "she needs extra time to tell you what she wants;" "she responds better if your body language conveys that you expect her to communicate back to you") and/or suggestions on how the environment can elicit the skill (e.g., "to help her make a choice, lay out three different outfits on her bed in the morning") might be included in the support column.
The subsequent record the high school team creates serves as a baseline for future person-centered communication programming in the student's ongoing habilitation plan and as a resource for people directly interacting with the individual.
- Document the Communication Skills Needed in Living and Vocational Tasks. For older adolescents like Terry, it is critical for the clinician to help the team highlight the importance of situation-specific communication in daily living and vocational tasks. As Terry's education shifts to include adult living and work, the SLP can encourage the team to identify the communication demands of job and living tasks and help the team develop and use specific strategies to assist Terry in meeting those demands.
In Terry's case, the nature of communication supports will vary depending on the routines, environments, and partners with whom she interacts. For example, if Terry participates in a landscaping crew, the SLP can help her foreman (vocational instructor) determine which lawn and flower vocabulary Terry already knows and which words she needs to learn to function effectively on the crew. If Terry is participating in cooking activities, the clinician might help the consumer science teacher use picture-based recipes to discover whether they help Terry master the sequence of cooking steps. If a student's transition plan includes volunteer work, then the team needs to consider how and what the student might communicate with the boss and co-workers, especially if these communication partners are unfamiliar listeners. As Terry transitions from high school to adult services, this context-specific model can be taught to her adult services team and incorporated into her ongoing habilitation plan.
- Use Professional References. Over the past 15 years, there have been several valuable professional reports that can be applied to students like Terry. Although not exhaustive or written solely for high school students, four journal articles listed in the references may be particularly helpful in working with students with severe disabilities. Mar and Sall provide a useful categorization chart to help the SLP document a student's degree of symbolic and intentional communication. Ogletree and colleagues specifically identify non-standardized and descriptive assessment for individuals with severe disabilities. The National Joint Committee for the Communication Needs of Persons With Severe Disabilities outlines eligibility criteria within an individualized and functional communication service delivery framework. Finally, McLean and McLean outline communication skill actualization within daily routines. There is also a variety of useful published assessment materials that the high school clinician can adapt to older students transitioning to adult habilitation programs (see Professional Resources sidebar).
Meeting the Challenges
Clinicians are challenged to identify and support functional communication for high school students with severe disabilities. They can participate in transition planning by documenting the supports and strategies that enable the student to communicate across multiple situations. The SLP can also assist students with severe disabilities by highlighting the communication expectations of specific daily living and work experiences and incorporating them into the student's curriculum. As planning and placement team members strategize educational programming, SLPs can actively lend their expertise so that functional communication programming becomes embedded into the high school curriculum and transition planning.
Paul W. Cascella is an associate professor and Kevin M. McNamara is the clinic director in the Department of Communication Disorders at Southern Connecticut State University. Paul and Kevin are particularly interested in functional communication services for children and adults with severe disabilities. They can be reached at cascellap1@southernct.edu and mcnamarak2@southernct.edu, respectively.