Interdisciplinary, Interagency
Collaboration for Transition
From Adolescence to Adulthood
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
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
Transition Listening Session
Sue Swenson
Deputy Assistant Secretary – OSERS
US Department of Education
Tuesday, December 4 3:00-4:15
Gunston East
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
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
Why
Failure to support self-determination as a
central element of the person-centered
process of transition
Why
Insufficient understanding of the role of
culture in an individual or family’s
concept or approach to transition
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
Why
Neglecting to specifically explore how
transition in the different realms could/should
be linked for maximizing success
Self Determined Life
Perspectives
Outcomes
Education
Health
Employment
Postsecondary
Adult Supports
Providers
Competence
Healthy Life
Place to Live
Paying Job
SocialNetwork
Community
Youth and Family
Culture
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
Perspectives on Transition
Youth and Families
“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
“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 support…would
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
“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
Two Videos
The Good and the Bad of Transition
Kristen
Michael
Youth and Family Practices
• Good, complete, understandable
information
• Focused transition planning
• Person-centered transition planning
• Family/Community Support Navigators
• Self-Determination Curriculum
Healthcare Transition
Ilka Riddle
Health Care Transition is…
• …the purposeful, planned
movement of adolescents and
young adults with chronic physical
and medical conditions from childcentered to adult-oriented health
care systems.
Blum et al.,1993
Health Care Transition is:
•
•
•
•
•
•
patient-centered
flexible
responsive
continuous
comprehensive
coordinated
AAP, AAFP, ACP, 2002
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
Best Practice: Learning
Collaboratives Pilots
• Got Transition Learning Collaboratives
(www.gottransition.org)
• Transition Collaborations of Pediatric
and Adult Practices/Systems
Shared Management Approach to
Transition
• Team/Partnership Approach
• Active Participation
• Empowerment
• Self-Determination
Stage
1
(Child
6-11)
2
(Young
Adolescent
12-14)
Professional
Lead
Participates &
responsibility Provides care
Partner
guides &
manages
Participates in care
& decision making
Consultant
Supervisor
shared
decision
making
Manager
shared
decision making
Consultant
Lead
manages &
supervises
4
(Young Adult
18+)
Receives care
Partner
gives
guidance &
support
3
(Adolescent
15-17)
Parent
Child/
Young Adult
Resource
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
Considerations
• People involved:
• Youth/Young Adults
• Family Members/Guardians
• Pediatric care provider &
specialists
• Adult care provider & specialists
• (Others)
Considerations
• Systems involved:
• Pediatric health care system
• Adult health care system
• (Others (e.g. service system,
education system, etc.))
Barriers/Issues: Youth/Young Adult
• Little involvement in transition process
• Little knowledge about condition, health,
health issues, health management
• Late start to transition planning
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
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
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
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
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
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
Strategies: Adult Providers
• Engage in transition process
• Learn from young adult & family
members
• Learn about congenital & childhood
onset medical conditions
• Communicate with pediatric providers
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.
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
Recommendations
• Increased evidence-base for
successful health care transition:
•
Health outcomes data
Resources
• Got Transition National Health Care
Transition Center
www.gottransition.org
• Florida HATS
www.floridahats.org
Transition to College and
Careers
Margo Vreeburg Izzo, PhD
Program Director of Transition
Services
Ohio State University Nisonger
Center
Izzo.1@osu.edu
College & Career Ready
• Higher expectations of all stakeholders
• 21st 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
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)
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
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.
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.
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
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
50
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 21st century curriculum
st
21
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
52
Online Assessments
• The VARK Questionnaire
• http://www.vark-learn.com/english/page.asp
• The Myers-Briggs Personality Test
• http://www.personalitypathways.com/type_inventory.
html
• The Princeton Review
• http://princetonreview.com/Careers.aspx
53
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
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.
Transition Knowledge
(TK) Gains
16
14
12
10
EXP
CONT
8
6
4
2
0
TK PRE
TK POST
Conclusion: Students in the experimental group increased
their performance significantly on the Transition Knowledge
test, as compared to the control group.
56
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
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
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
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, 274284.
State Success in Integrated
Employment
National Survey of State IDD Agency Day and Employment
Services 2010
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.net
Who Should Go To College?
• http://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 info
OSU’s TOPS Model
Pilot Sites
Ohio State University
University of Toledo
Three Replication Sites
Interdisciplinary Team
Special Educators, Occupational Therapists, Physical
Therapists, Rehab Counselors, Speech Language
Therapists, Social Workers, Assistive Tech. Specialist
Services Planned Through
Transition Assessment
Person-Centered Planning
Academic Advising
TOPS: Student Experiences
Individualized Supports
Peer Support
Mentoring
Family Support
Educational/Job
Coaching
Inclusive Postsecondary Campus Experience
Enroll/Audit
College
Courses
Project SEARCH
Internships
SelfDetermination
Residential
Campus
Experiences
Health,
Wellness
Independent
Living skills
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.
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
Dental Clinic Assistant
Mentoring on OSU’s Campus
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
Transition: A Bridge to…
Inclusion in Society
Community Living
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
A Place to Live
A Place to Live
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
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
Time with Others
How Time Was Spent During Three Days
•
•
•
•
•
•
•
Individual Only
Housemate
Agency Staff
Day/Workmate
Family Community Friend
Someone else
Community Acquaintance
56.0%
21.2%
19.5%
2.4%
0.8%
0.1%
0.1%
Getting There
Getting There
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.
Initiating Activities
Who Initiated Activities During Three Days
•
•
•
•
•
•
Individual
Agency Staff
Family Community Friend
Housemate
Someone else
Day/Workmate
71.6%
27.4%
0.4%
0.4%
0.1%
0.1%
Making Decisions
Making Decisions
Summary
Transition Planning should include:
•
•
•
•
•
•
Where to Live
How to Get There
Community Activity
Leisure and Recreation
Building a Social Network
Making Decisions
Interagency Collaboration and
Interagency
Collaboration
Coordination
and Coordination
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)
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
Interagency Teams
Three groups typically served by
interagency teams that vary by setting, roles
and responsibilities
– (State level agencies) Developing crossagency 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
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.
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
Chancellor’s 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
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 agency’s commitment to
improve outcomes for youth with developmental
disabilities
• Built a sense of purpose, hopefulness and
commitment to the work
Step 1: Map Each Agency’s Initiatives
that Support Students with ID and
ASD
YOUR AGENCY:
Local/State/
Federal
Policies Your
Organization
Implements
Regulations
You
Implement
Advocacy You
Provide
Information You
Provide
Services You
Provide
Name/Title of the Policy,
Regulation, Advocacy
Initiative, Information
Service, or Other Service
A phrase or one
sentence that describes
the purpose and primary
outcome of this initiative
What age group is this
focused on:
· Elementary School
· Middle School
· High School to age 21
· 21 and over or in
College?
Raynor, O., Campisi, C & Francis, W. (2012), Pathways to PSE for Students with ID & Autism
Their responses were written on half-sheets (5.5 x 8.5) and posted on
the wall, mirroring this chart with the names of all the agencies and
organizations down the left side. They posted their initiatives on the
timeline below as well:
Initiative
Initiative
Initiative
Initiative
Initiative
Initiative
Elementary School
Initiative
Middle School
Initiative
Initiative
High School to Age 21
Initiative
Age 21 and + or in College
Raynor et al., 2012
Step 2: Create an
Interagency
Matrix
CA Department Department of Department of
of Education Developmental Rehabilitation
Services
California
Community
Colleges
How We Link
Together
How We Relate
Expectations
Referral Process
Joint
Funding/Planning
( Raynor et al, 2012)
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?
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?
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 agency’s 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?
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
Pathways to PSE for Students with ID
and Autism: An Interagency Guide
Knowledge and Skills
Required
23 +
Agency Plans
Information
Provided
to or by Individuals
with ID & Families
16-22
Primary Actions
6-15
Primary Role
Birth - 5
Youth Ages 6-15
Raynor et al., 2012
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.
Group Exercise
Question to Consider:
If the system worked well, what could/should
happen to support this student’s 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?
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?
Discussion
Questions