1. SART: Strategy Assessment and Revision Tool A Tool for Evaluating, Revising, or Creating Plans PART FIVE A division of the ESC of Central Ohio linking research to real life. Co-Developers Wendy Szakacs OCALI Regional Consultant Chris Filler OCALI Program Director Lifespan Transitions Center

2. Consideration of Response Cost Individual T.J. Environment Workshop Enclave Behavior Assessment Talking out very loudly. Frequently. For Attention. For Help. For Avoidance Earning tokens for raising hand

3. Behavior Specialist: “Let’s Try Adding a Response Cost Strategy” A penalty is assessed for ‘inappropriate’ behavior Results in Loss of: points, tokens, recess, computer time, etc. Could include a process of losing more points for each incidence of the inappropriate behavior

4. T.J.’s Response Cost Plan Staff reports that T. J. yells out for help. Yells out for attention. And sometimes seems to yell out for no particular reason. The plan is to reduce the yelling by using a response cost system. Currently: T.J. earns TV time for working. He earns 30 minutes of time in the morning and 30 in the afternoon. New Plan: T.J. will lose five minutes of his TV time each time he yells out during work. Staff will track each time he yells out and will reduce his TV time accordingly

5. Respon se Cost Visual/Tactile : Not necessarily. Sometimes a visual is added Sensory: Not considered Positive Reinforcemen t: Nope Individualized, Motivating: May be individualized, but generally not building intrinsic motivation Teaches What To Do: Not the Focus. Focus is on what NOT to do Predictable and Consistent: Can be Implemented with Consistency Should be used in a consistent manner

6. T.J.’s SART YES?NO?MAYBE? Response Cost

7. Uses for SART HELP PREDICT OUTCOME: To help decide if an intervention will have positive outcomes for an individual REVISE: To help revise an intervention that doesn’t seem to be working FACILITATE DISCUSSION. To aide discussion with staff and family members about an intervention/strategy DETERMINE WHAT IS MISSING. To assist professionals and family members in processing what s/he might be missing in making a strategy successful

8. Try It Yourself using the SART Worksheet Read about “Rose” and the team’s plans OR Choose a Person you are working with and a strategy being used or considered. Determine if the strategy includes each element using the guiding questions sheet In Column 2, decide if the strategy reflects the element (“Yes”, “No”, or “Maybe”) In Column 3, describe how factor is, is not, or is somewhat included. In Column 4, describe what you might be able to do to include or improve the element if necessary

9. Rose and Personal Space Rose is 35 years old. She participates in a day program where she spends most of the time at the facility with an occasional day trip. The program is expanding it’s community based services and structure over the next several months. Rose likes ‘girly’ things. Nail polish, lace and ribbons on her clothing, and especially lotions with a flowery smell. Can’t seem to get enough. She enjoys being in the kitchen and tries to help with cooking and other activities. However, she is quite a picky eater. She likes taking walks and car rides. Some staff say that they think she watches to see who might possibly be going out for a walk or ride in hopes that she can tag along. She loves looking at photographs and will thumb through magazines and point to pictures. Sometimes repeatedly. Rose, like so many at the day program, struggles with communication. She uses one or maybe two word phrases to request or comment or sometimes it is not clear what it means. Rose is a sweet gal. She seems to be quite accustomed to the routine of the day program and goes along with the flow generally. The only real issue of concern is her lack of ‘respect’ for other’s personal space. She will come and stand very close, sit close and will touch others arms and face. She does this in her group home as well as the day program. It is hard to know how to redirect her or to make her understand that this is not OK with other people. Behavior specialists say she does this to gain attention, to communicate or maybe for other random reasons (boredom?). Due to the expansion of the day program into the community, there is a plan to help Rose learn that she really should not get into people’s personal space. The plan is simple. When Rose touches a person’s arm, face or other body part (and was not ‘invited’ to do so), the person will tell Rose, “I do not like that.”, will step away, out of her reach, and give her no further attention. The idea is that Rose will soon learn that touching people without their permission will push people away and will not get their attention. This strategy should result in a decrease in the touching behaviors. What do you think of the plan? Use SART to examine the plan and to revise it for improvement.

10. SART Guiding Questions for Use of the Worksheet Use the Guiding Questions sheet to help determine how each element of the SART is included in your chosen strategy.

11. SART Global Thinking Using SART to Develop Problem Solving Plans

12. SART Support Plans SART elements can also be used to create plans Instead of evaluating a specific strategy with SART: Start with the person, their strengths and their interests Include an issue of concern Use the SART factors to identify a variety of supports and strategies

13. Support Plans and SART Using SART Factors to Develop a Supportive Environment PERSON Strengths Interests Concern Visual/Tactil e Sensory Sensitive Positive Reinforcement Individualized & Motivating Teaches ‘What To Do’ Predictable and Consistent Reliable Implementation

14. Support Plans and SART Using SART Factors to Develop a Supportive Environment PERSON Strengths Interests Concern Visual/Tactile: How can we add more visual information to support the person to understand, to communicate with us, to predict? Sensory Sensitive: How can we make the person’s world (not just one special room) more sensory sensitive to their particular needs and desires? Positive Reinforcement: What specific reinforcement can we add to the person’s supports that helps them through tough times AND to learn new skills? Individualized & Motivating: What does the person have in his/her life that improves quality of life and is specific to their preferences and interests? Does not need to earn! Teaches ‘What To Do’: What specific new skills can we help the person learn to replace difficult behaviors and to expand opportunities in the community? How will we teach? Predictable and Consistent: Are the supports we use and the daily routines/schedules predictable for the person? If not how can we improve the predictability? Reliable Implementation: Are the support staff in all environments (including natural supports) supporting the person in a similar manner? Or does the person end up adjusting to our style? How to improve?

15. Darrin Screams Darrin is 32 years old. He participates in a Combo Day program and Workshop where he spends time working on piece work part of the day and in leisure activities for part of the day. The program is expanding it’s community based services and structure over the next several months so that Darrin will be having more opportunity to explore the community. Darrin likes sports…especially the Ohio Teams. He is drawn to anything that has the logos or colors that represent the Browns, Cavs, Indians, OSU, etc. He also loves music. He lights up when music is played, instruments are around, or the music therapist is visiting. He enjoys ‘helping out’ the handy man at the facility. He wants to hold the tools and tries to find a way to help. However, when there is lots of noise involved he will back off and leave the room holding his ears. Some staff report that noise, crowds, and confusion can be very difficult for Darrin. Several explain that he walks in circles, paces, and scans the environment for someone he knows. Darrin, like many people with autism, has difficulty communicating. He uses very few words. But most of the time seems to understand much of what is being said. Although the records indicate that Darrin never learned to read, staff observes him intently looking at the calendar, looking at staff notes, going through magazine articles, and other written text. Darrin is a described as a ‘nice guy’ by most people. Generally Darrin is not even noticed. He just goes with the flow of the day. However, in the last several months, something has been changing. Darrin has started screaming, which is quite upsetting. It is happening more often. Sometimes he walks into the workshop or the day program and starts screaming as soon he arrives. Sometimes when he is working he might start screaming. Sometimes during transition. Staff generally goes to him quickly when this starts and try to help. They may move him to new location, they may try to help him finish what he is doing or they may try to distract him by offering a snack or having him go into the sensory break area. Sometimes he calms quickly, sometimes not. Behavior specialists have been consulted and say that Darrin screams to gain attention, to get help, to avoid work or to communicate something else. Basically, they are not sure. What do you think could be done? Use SART to develop supports.

16. Darrin Ohio Sports, Music, Tools, Perhaps a reader, Follows routines. Screaming- more frequent and concerning Visual/Tactile: Visual Schedules of daily routines. Pictures and Words. Is he a reader? Sensory Sensitive: Avoid loud overwhelming environments. Opportunities to proactively move to quiet locations. Job in quiet office area. Build in movement activities. Positive Reinforcement: Have visual choice options of music and sports magazines and sensory room available. Offer the options at high risk times BEFORE screaming starts (at arrival, when transitioning). When he makes a choice, honor it immediately. Individualized & Motivating: Develop a daily schedule that Darrin helps create. Add music and choices of types of music throughout the day. Include tasks that involve tools. Teach him to use. Can he learn to build something to sell? Teaches ‘What To Do’: Teach Darrin to use choice board for a break, a different option or help instead of screaming. Present it to him frequently. Lots of opportunities. Provide option for telling us “no” Predictable and Consistent: Choice Board should look the same in all locations Darrin can predict what will happen when he uses this board. A schedule that is consistent and similar each day adds predictability. Reliable Implementation: Train Staff on Visual Schedule, Choice Board, Supporting Darrin in Job, Data Collection Support Plans and SART Using SART Factors to Develop a Supportive Environment

19. YOUR TURN DEVELOP a SART Global Thinking Plan for someone you know. Use SART Global Worksheet to begin identifying ideas to support a person that struggles with challenges that impact his/her ability to access new opportunities

20. References Bremer, C.D. & Morocco, C.C. (2003). Teaching for understanding. Research to Practice Brief, 2(4). http://www.ncset.org/publications/viewdesc.asp?id=1309 Browder, D. & Cooper-Duffy, K. (2003). Evidence-based practices for students with severe disabilities and the requirement for accountability in “no child left behind”. The Journal of Special Education, vol. 37, pp. 157-163. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007, November). A conceptual framework for implementation fidelity. Implementation Science, 2(40). http://www.implementationscience.com/content/2/1/40 Flores, M. M., & Ganz, J. B. (2007). Effectiveness of direct instruction for teaching statement inference, use of facts, and analogies to students with developmental disabilities and reading delays. Focus on Autism and Other Developmental Disabilities, 22, 244-251. Kranowitz, C. S. (1998). The out-of-sync child: Recognizing and coping with sensory integration dysfunction. New York: Perigee Book. May-Benson, T.A. & Koomar, J.A. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy, 64, 403-413. Mechling, L. (2007). Assistive technology as a self-management tool for prompting students with intellectual disabilities to initiate and complete daily tasks: A literature review. Education and Training in Developmental Disabilities, 42(3), pp. 252-269. Simonsen, B., Fairbanks, S., Briesch, A., & Myers, D. (2008). Evidence-based practices in classroom management: Considerations for research to practice. Education and Treatment of Children, Vol. 31, pp. 351-380. Simpson, R.L. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 20, 3, p. 140.

21. linking research to real life. A division of the ESC of Central Ohio