Routine Section Contents:
ROUTINES:
Essential for a Learner with Deafblindness
By Gerald Harris, Deafblind Specialist
A child with deafblindness depends on routines for learning and for living. Here are some ideas about routines in the educational program.
What we mean by the word “routines”:
A routine is any activity that occurs regularly and frequently, with the same sequence of physical actions by the child, with the same people, materials, locations and routes.
Active physical participation from set-up through cleanup is also part of the educational concept of “routines”.
For a child at school, any activity that occurs a few times per day or per week, or even once a week for sure, may become a routine.
Routines are essential to our children because:
• They learn by doing. They need to be body learners, through motion and touch. They need to organize their world not so much by visual images, sounds or words, as by the physical feel of the motions, positions, shapes and textures of the things and people they interact with. Routines allow learning by doing.
• Repetition is the only way to learn by doing, motion and touch. To learn an activity with your body requires many, many repetitions. Routines build the repetitions naturally into the school program.
• Physically interacting with their world is the only way our children can begin to understand it. Not seeing or hearing the world well enough to figure out how it works, the child with deafblindness builds understanding of the world and how it operates by physically moving in it, using objects and interacting with people. The child learns that the world out there makes sense. For example: things stay where you put them, so you know where to find them; things come from places and go back to those places, they don’t just magically appear and disappear. Routines increase the child’s understanding of the world naturally as part of the school program.
• Competence and a sense of being in control of their own life comes from routine. With routine, the child is able to predict, to anticipate what will happen next. The world is no longer random and scary. The child can learn specific actions and responses that make the child a doer, mover and initiator in the routine. Routines allow our children to become active participants and self determiners in their own lives.
• The natural way of organizing time for our children is as a sequence of routines. Clock time and calendar time are abstract; they are no use unless we first understand the concrete cycles of activities. For example: “Ten o’clock” is a totally abstract concept, but time for “Snack” or “Gym” or “Toilet” or “Swimming” is concrete. Or “Morning” is a semi-abstract concept, so the child might understand the morning as: “Arrival” then “Delivering Attendance” then “Book Time” then “Toilet” then “Gym” then “Lunch”. Or “Tuesday” is an
abstract concept, but “Swimming” day is concrete. Routines allow the child to make sense of time. Routines are the child’s way of understanding the day and week.
• Consistent feedback is the key to learning for children with deafblindness. A big problem in learning for our children is that they often don’t see or hear the results of their actions. So they don’t know if it produced a good or bad result. So they lack information for choosing successful action in the future. That’s how all learning occurs: act - assess the feedback - adjust the next action. Routines allow for consistent feedback. Routines are set up so that the child uses the same cue for the same action, giving the same result, day after
day.
Frame the day and week as a sequence of routines:
• Routines provide the basis of organizing curriculum for the child with deafblindness. From the child’s point of view, the school day is a series of routines in which the child is becoming competent.
• Identify the routines that comprise each school day. A routine is an identifiable main activity that has a distinct start, middle and end.
• Assign an object cue for each routine (as well as its verbal name and sign). These object cues form the calendar system that allows the child to make sense of the day.
• Identify a routine that signifies each day of the school week. Here is the basis of a calendar that will allow the child to make sense of the week.
• Increasingly complex and increasingly abstract representation of the day and week will grow over the years, but it needs to start with object cues for routines.
Functional Routines (Or Therapeutic Activities):
• The concept of “Functional Routines” is important for learners who have little formal language and/or have deafblindness with multiple disabilities.
• “Functional” routines have a reason or purpose beyond a single “therapeutic” or “academic” goal area. They are a piece of everyday life in which the child is becoming and active participant. Functional routines form the basis of curriculum for most learners who are deafblind.
• The child can make sense of a functional routine as an activity of daily life, such as self care (e.g. Lunch), or recreation (e.g. Swimming), or helping out in the classroom (e.g. Reporting the Weather), or being with the other kids (e.g. Band). And the child can increase his level of participation or competence within the activity.
• “Learn it where you need to use it” is the philosophy behind functional learning. Activities that are “therapeutic” or “academic” may work on skills without context, so the child does not know how they fit into life, or how they increase one’s competence in life, or how they make life more rich and enjoyable. The child may not understand why the skills are useful or necessary, and may never apply the skills where they are needed. Real life and therapy may be separate worlds that the child does not connect.
• Functional routines begin with the “real activity” then develop the skills needed within it. The skills may be the same as the “therapeutic” or “academic” ones, but they immediately make the child a more active participant in the real activity. The skills are immediately “functional” for the child. For example, counting to three is functional for the child when his or her job is to take three blackboard brushes for cleaning, and bring back three clean ones.
• Functional routines are a powerful “therapy” tool. Instead of drilling skills in one or a two sessions per week, the therapist can build the skills into the child’s functional routines, where they may be worked on many times a day. For example, the vision teacher, working on shifting gaze between two objects, can build the shifting skill into a method for making choices that the child uses several times per day in various routines.
Routines and Educational Goals, how do they fit together?
• Any routine can work on most educational goal areas. Typically, the children have goals in areas such as Communication, Fine Motor, Gross Motor, Social Development, Hearing and Vision. Functional routines require every one of those functions.
• Choose the routine first, then plan how to work on goals within it. Look for possible opportunities to work on all of the goals. For example: if there is a Fine Motor goal for developing grasp and release, one would look in all the routines of the day and week for situations in which the student might need to pick things up and put them down. There are hundreds of such opportunities.
Sub-routines
Many sub-routines occur within the main routines of the day. The sub-routines do not have their own object cues and spots in the calendar. For example, a child may be working on a sub-routine for “greeting”. So opportunities for greeting may occur in several of the day’s routines throughout the day and week. Essentially the same greeting script would be used with different people in different contexts.
Consistency and organization count:
Routines help the child learn that the world actually is predictable, that a person really can exercise some control through one’s own actions. So the routine needs to unfold as the child expects; things and people need to be where they are expected to be and to do what they are expected to do; switches need to work. To provide a routine, a little part of the day that makes sense to the child, takes dedication to consistency and organization by the educator.
Same Routines All Year:
Variety is not the spice of life for children with deafblindness. Routine is. Over the school year, a child comes to understand a routine, to anticipate and become competent. Within a routine, children can attain educational objectives and move on to new ones. Same routine, but the Intervenor can increase the expectations, or introduce variations and expansions. So the ideal is to establish a good set of routines and to stick with them.
Some Finer Points of Routines:
• Gradually pass responsibility to the child: In the beginning, the child may need to be entirely shaped through the routine. But gradually, the Intervenor passes little bits of responsibility to the child. Strategies are to slightly decrease the prompt level, or to wait and see if the student will initiate the action.
• Allow TIME for the student’s pace: Routines would be quick and efficient if you just did everything yourself or if you zipped the child speedily through everything, but the child would not learn. Allow twice as much time for the routine as it “should” take.
• Take time to follow the child’s interests: Even though consistency is very important, be aware of the child’s interests. Where is the child’s attention, gaze, hands? Follow it and give it language. Take the teachable moment.
• Expand the Routines: The same routine looks different for five year old than it does for the same student at 17. Expanding routines over the years expands the scope and complexity of the student’s world. The five year old, for example may just be learning to sit down for snack, while the 17 year old may be shopping, cooking and growing vegetables.
• Therapists and specialists think in a new way: We no longer own our little piece of the child’s program. We give objectives and strategies for use throughout the child’s school day. The teacher may use us more as consultants, to solve problems and offer suggestions for specific parts of the school day. We think across disciplines, making our suggestions with awareness of the child’s whole program.
• No slavish application: No educational model applies in all situations or for all students equally. Functional routines, like any model, needs to be individually tailored to each of our unique children. So please don’t feel burdened by the model in situations where it does not make sense.
Elements of a Good Routine at School
• A “Functional Purpose” - The routine, from the point of view of the child should “make sense” in one of the following four ways: It may fulfill some Self Care need such as eating, toilet or grooming. It may be Recreational fun such as swimming, hand massage, Snoezelen Room. It may be Helping someone such as by doing jobs that support the classroom, school, home or community. It may provide Inclusion with classmates or other children in a situation in which the student is participating in the same activity as the other children,
such as recess, circle time, buddy reading.
• An Object Cue - Along with a verbal name and a sign, the object cue identifies the routine to the child. It is a concrete word standing for a specific routine. Use of the object cue initiates and concludes the routine, and gives the routine a place in the daily calendar. It also serves to prompt during the routine to keep the child on task. With most students, the object cue is eventually replaced by symbols that are progressively more abstract.
• Participation from Set-up to Clean-up - The child does not sit and wait while the Good Fairy makes things appear and disappear. The child is physically involved in the getting and organizing of materials, and in the putting away and cleaning up. Many of the best opportunities for working on educational goals occur in the set-up and clean-up portion of routines.
• Need for Expressive Communication - Every routine of the day should develop the child’s disposition to communicate expressively, and should give the child clear means of doing so. The child needs opportunities for the most basic functions of communication: calling for attention, protesting or requesting that something stop (finish), requesting that something continue or resume (more), choosing between two activities or objects. Communication in routines may advance to later functions: social greeting, give and take of objects,
repeating, answering questions, naming or labeling, commenting, and others.
• Need for Receptive Language Input - Children normally learn to understand language as a result of hearing words and sentences used frequently and interactively, in context. Daily routines are ideal contexts for language learning. Appropriate verbal, object, and sign labels, along with brief verbal descriptions, should be paired in a consistent, predictable manner with what is happening in the routine. This input, repeated over and over, helps the child develop comprehension skills. General Guidelines: Use primarily single words and short grammatically correct
phrases to talk about what the child is hearing, seeing, doing, and feeling. Speak slowly, inserting numerous pauses into the conversational flow. Use lots of repetition as you describe on-going events. Expect specific responses to cue words, signs, symbols.
• Interaction with Others Besides the Intervenor - Social and communication skills develop with interaction with the Intervenor, but also with other members of the class, school and community. The interactions may be scripted, so the roles are clear for each party; or they may be facilitated by the Intervenor, who creates a topic, opportunity and skills. Interactions include giving and taking, greeting and parting, mutually helping, play, and other basic forms of interaction common in daily life.
• Purposeful Use of Hands (or feet or head) - The child’s own hands make things happen in the routine. They do the taking and putting, opening and closing, and using of objects. Fine Motor goals may all be addressed in the functional routines. For the child with deafblindness, getting the hands out and doing things purposefully in the world is key.
• Purposeful Use of Vision - What visual function does the child need to develop to become a more active participant in the routines of the school day? The routines offer dozens of opportunities every day to develop the child’s use of vision.
• Purposeful Use of Hearing - What auditory function does the child need to develop to become a more active participant in the routines of the day? The routines offer dozens of opportunities every day to develop the child’s use of hearing.
• Purposeful Use of Other Senses - Touch, smell, taste, proprioception and balance may all be important in helping the child make sense and participate actively in the routines of the day. What does the child need to develop in these areas, and where are opportunities.
• Purposeful use of Large Muscles - The opportunity here is to work on Gross Motor goals in the context of all the functional routines of the day. These may include work on sitting, standing, walking, bending, reaching and stretching, other positions and motions.
• Purposeful Use of Mobility - The child does not stay in one place during the routine, but has reasons to move in the environment. For children with no independent mobility, the movement is important in making the child a more aware user of the environment. For children who are developing independent mobility, the routine gives it pupose.
• Motivation for the Student - Motivation is the magic ingredient. The children will do amazing feats of learning and developing if their motivation is high. What aspects of the routine does the child love? Does it make use of known likes of the child and sugar-coat known dislikes? Does it make sense to the child? Is there a concrete purpose or product the child can understand and value? Is it fun?
Routine Checklist
Student: ___________________ Year: __________ Routine: _______________________
An excellent educational routine for the student will score high on this checklist. Rate the routine from 0 to 4 on each item. A “0” means “not at all”. A “4” means “amazing”.
This routine develops the student as an informed, active participant by providing:
• 0 1 2 3 4 - a functional purpose that makes sense to the child.
• 0 1 2 3 4 - strong motivation for the child.
• 0 1 2 3 4 - consistent use of object cue, verbal and sign name for the routine.
• 0 1 2 3 4 - active participation from set-up to clean-up.
• 0 1 2 3 4 - need for expressive communication.
• 0 1 2 3 4 - interaction with others besides the Intervenor.
• 0 1 2 3 4 - purposeful use of mobility.
• 0 1 2 3 4 - purposeful use of large muscles.
• 0 1 2 3 4 - purposeful use of hands.
• 0 1 2 3 4 - purposeful use of vision.
• 0 1 2 3 4 - purposeful use of hearing.
• 0 1 2 3 4 - purposeful use of other senses.
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Total/48
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If the score is over 30: this is already a very well developed routine.
Between 25 and 30: do some brainstorming to see what aspects you can develop.
Below 25: with some creative thinking, you can make this routine work better for the student.
Brainstorm Ideas for Excellence:
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Functional Routine Planning Chart
Theory Into Practice
POPDB Consultant's Suggestions for Mary
Consultant - Gerald Harris
1. Routines for Mary
a) Learning by Doing
Mary’s learning style works best in routines. When she can go through the same sequence of actions with the same objects and people many times she can learn them with her body and also learn to see and hear the visual and auditory cues. In this routine situation, when she can anticipate what comes next she can learn to do things herself.
She is not very good at transferring skills from one setting to the next, so “learning by doing” also means that mainly she will learn skills and communication while engaged in the functional activities of life, rather than in separate skill or therapy sessions.
Thus the ideal school curriculum for Mary is a series of functional routines. “Functional Routines” refers to routines that have a practical purpose beyond skill development. The purpose may be: self-care / service to the classroom, school or community / service to the classroom, school or community/ recreation / or participation in a class or school activity.
b) Classroom Interaction
What we look for in terms of Classroom Interaction for Mary are a few points of Purposeful Interaction between her and classmates or teacher. Since her curriculum and goals are so radically different from those of her classmates, our best route to inclusion is to look for a few points in the day and week in which her program can intersect with that of a classmate or the teacher in a way that works for both parties. Here are a few examples I have seen:
Greeting the Teacher: Student has responsibility for greeting the teacher at some routine time each day. He signs, “Hi Mary, it’s Teacher” (and says it.) She replies (sign) “ Hi Teacher” and then they have a brief interaction.
Feeding the fish: The student brings an object symbol or functional object to the teacher or to a specific student and hands it to that person to request some sort of help or materials for feeding the fish. The person gives Mary the help she needs, and Mary carries on with her job. At the end, she comes back and gives the object (e.g. The fish food) back to the person. The person says, “thanks Mary” (signs) and gives her back the object cue.
Returning Journals: The student has responsibility for routinely returning a journal to a specific student. There is a scripted greeting and giving and thanks.
Delivery Jobs: The teacher or class may have a regular need for something to be taken to another art of the school or got from another part of the school, such as attendance, library books, photo copying, bar codes for charity. Any of these jobs might include scripted purposeful interactions to initiate the job in the classroom, at the distant spot (like giving something to the school secretary) and in closing the job back in the classroom.
Data Gathering: The student can gather data for some on-going math work in the classroom, statistics for graphing and analysis, such as weather data, attendance, any strange thing you choose. Then the student can deliver that data to another student to record or post.
Non-Scripted: All the scripted ideas above are not intended to replace or distract you from taking opportunities to simply include Mary in the enjoyable buzz of classmate energy in enjoyable activities.
c) Art Activities: to make Art period work for Mary we can look for projects with the following characteristics:
- Parts of it are simple enough for Mary to become independent
- The final product is in some way interesting to Mary, and has some use or value to somebody
- the project relates her in some way to the classmates.
- it can be repeated several times so she becomes more able in it.
An Example: Student Name Cards
If letters from a student’s name were on a piece of paper, with her choice of colours Mary and the Intervenor could then cut out the letters and paste then on card stock. Mary could then decorate the card in some way, such as with glue and glitter, with stamp or sticker. The student could choose what decoration he or she wants. The finished product could go up around the wall of the classroom. Mary could tape it there.
A variation would be cards to go with a project of the class, such as Egypt.
d) Walker Ideas: Think of the walker not as an activity in itself, but rather as part of a purposeful routine, such as a delivery task in the school. It is a way to get where she is going.
2. Hello and Goodbye with a peer:
H______ is a fellow student who loves to push Mary to the cafeteria for snack time. Here are some ideas for turning that time into social interaction that benefits both students.
- script a greeting and parting for the two girls
- H______ gets close and in Mary’s visual field and stays still
- say and sign, “Hi Mary, it’s H______”
- Mary signs “Hi”
H______ waits for Mary to initiate some touch and also touches Mary in some way.
The Intervenor also greets and parts with Mary to provide a model to the peer (and also because it is important that people who work with a deafblind student take the time for greeting and parting.)
3) Choices
Making choices using object cues will help Mary move toward communicating with symbols. These are not the object cues for her routines, because those routines are not a choice. This is a separate set of object cues for choices within her routines.
Consider use of a “choice-board” for choices, to help Mary recognize a choice. A small board with two Velcro patches would work.
Look for possible motivating choices in her routines. She is most likely to learn to use the system if one of the choices is something she really likes. Possibilities: 1) a small snack (maybe something from lunch, or maybe make the PM snack time optional for her, 2) the favorite lights in the sensory room, 3) playing at the water fountain.
A choice such as water fountain play could occur as part of her delivery routine.
4) Goals and Continuous Progress
State most of Mary’s goals in a way that lets her work on them in her various routines. The routines are the domains in which goals are worked on. For example, gross motor work can occur in almost all of the routines of the day.
A FUNCTIONAL ROUTINE PLANNING CHECKLIST FOR MARY
Using this checklist can help in developing any of her routines into an excellent educational routine. By using the checklist in planning and reviewing the routines, you can make sure she is working on her educational goals.
Name of Routine: _____________________________
This routine works well educationally for Mary because it is strong in most of the following characteristics:
____ FUNCTIONAL PURPOSE: It serves some practical purpose beyond therapy or skill development, such as: Self Care / Service or Work that contributes to classroom, school or community / Recreation / Participation with classmates in some class or school activity.
____ INCREASING RESPONSIBILITIES THROUGHOUT THE ACTIVITY
Setup: ______________________________________________________________
Middle: _____________________________________________________________
Cleanup: ____________________________________________________________
____ USE OF AN OBJECT CUE FOR ANTICIPATION AND CLOSURE: She takes the cue out of the cue box to initiate the activity and puts it in the finished bag to close the activity. The object cue is accompanied by a verbal label and a sign.
____ MOTIVATION: There are one or more things built in to the routine that she really likes
____ CHOICE: There are choices offered within the routine, preferably a highly motivating choice, and preferably offered with object cues.
____ GROSS MOTOR CONTENT: She has need to walk, transfer, stretch or move on the mat, preferably in ways that work on her Gross Motor Goals.
____ PURPOSEFUL HAND USE: She is using her hands to do the practical activities of the routines, such as opening and closing things, taking and giving things, turning things on and off, as well as using objects appropriately.
____ INTERACTION: She comes into purposeful contact with at least one person besides her Intervenor, in an interaction that is scripted so she can learn her part and the other person can learn his or her part. It may involve greeting, parting, giving, taking or some for of play.
____ RECEPTIVE COMMUNICATION: There are cues of sign and word, and preferably also object symbols to which she is expected to respond.
____ EXPRESSIVE COMMUNICATION: There are uses of object cue, sign or gesture that she is expected to use in order to make something happen.
Continuous Improvement Log Sheet for Assessment and Planning
The Continuous Progress recording sheet below is a way of tracking progress in her goals. If her Intervenor uses it to record all the little bits of progress in the various routines, then the teacher and case manager will have a basis for reporting and father planning.
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IDEAS FOR UPPING THE ANTE |
DATE: |
Details/Context where advance occurred/ Related IEP goal |
Establishing the behaviour/Generalizing/ Decreasing prompt/ Next Step |
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STUDENT: SCHOOL YEAR: OBSERVED BY:
Next Visit - Updates on Routines:
Swim Routine Ideas
Getting Ready:
a) Swim suit as an object cue
b) Mary goes and gets her “swim bag” from her locker
c) She gets her towel from its proper place
d) She puts the towel in her bag
e) She gets her coat and puts it on
f) She takes her swim bag in her lap
After Swimming:
a) Takes off coat and puts it away
b) Goes for lunch because she is hungry
c) Takes towel and suit out of bag and gives it to the Intervenor
d) Puts swim bag back in locker
The idea is that she is a responsible participant in getting ready for each routine, and in putting things away after the activity.
Life Skills Ideas
The Life Skills block needs routine to make Mary’s time there purposeful and productive. Here are some ideas for 2 kinds of routines alternate days:
a) A Learning Game with Two Classmates – Safety Signs Bingo or Board Game
Mary takes a children’s building block out of a bin and hands it to a classmate. Each block has a safety symbol on it.
If the game is Bingo then Mary hands it to the peer who announces it.
If it is a Board game then she hands it to the peer whose turn it is.
The purposeful interaction with her classmates is the main point of the game for Mary. The classmates learn turn-taking, social scripts and also get practice with the safety signs.
b) Making a Blender Drink for Classmates
Mary makes a blender drink, choosing between 2 flavours. This can be done with a frozen drink mix, or with flavour crystals and ice. She then serves the drink to each classmate in very small cups.
Again, there is a brief purposeful interaction with her classmates, who can use a social script to practice interacting with her.
Shopping - A Sample Routine
Karen Froess - Intervenor
This sample routine gives an excellent example of all the things that need to be considered when supporting someone with deafblindness.
The groceries and amounts of each that we will purchase are preset. We will buy 2 seperate items or sets of items. They are: 10 carrots, 1 bag of almonds, 4 apples, 3 beets, 10 celery stalks, and 1 piece of ginger. These numbers will always be the same. Carrots are the consistent item that we purchase every time. We will purchase one set of the others along with the carrots. For example: 10 carrots and 4 apples. Because carrots are the consistent item they are always considered and dealt with first before the other items.
This routine starts before school, at home, with Mom. She will give the student a $5 bill to put into his wallet and they will put the carrot cue and other cue into the cue bag (Ziplock bag) so we know what to purchase.
Remember to always include the student as much as possible. Constantly sign and say to him what you're doing, what's happening around him, what he's doing, and what's happening to him. Go at his pace. Do with, not for. This routine is written up to show him as an active participant (tactilely) in all parts. Because this routine is still very new to him he is unable to participate actively throughout. He will need break times between doing activities. He will need a lot of waiting time during activities to assimilate all the information he is receiving. So I give him opportunities to participate and allow him to communicate to me by his actions, how much he wants to participate. If he pulls away at first I gently guide his hand back again (hand under hand) but I also watch his
reactions and assess how much he is willing to do. If he chooses not to touch the items himself I try to keep him involved by doing the activities with hand under hand movements. If he is still not interested in this (it may be a good time to take a break depending on what type of day he is having). I make sure to keep his vision on track so that he watches me do the activities while I constantly sign and say to him what is happening. I also watch him for opportunities in which to include him again.
School:
Greet the student, go through the locker routine and tell him he's going shopping. Get him ready to do the calendar routine. Have him put the store cue into the small yellow basket, then take the wallet off the wheelchair and put it into the basket. Take the object cue bag off the wheelchair and put it into the basket. Then put in the school cue. Put his tray on the wheelchair and put the basket on the tray. Have him attach the object cues to the wall calendar in the order above. Then go through the calendar system starting with the store cue. Tell him he's going to the store to go shopping. Have him take down the store cue and attach it to the tray. Next go to the wallet and have him take it down, telling him the wallet has money in it to take shopping. Have him open the
wallet and take out the $5 bill. Tell him he's going shopping at the store to buy some carrots and apples with the money. Help him put it back into the wallet, close it and attach it to the tray. Next go to the cue bag on the calendar and have him take it down. Tell him there’s a carrot and an apple in the bag and that we are going to buy some more of each at the store. Take out the carrot, tell him what it is and allow him to explore it. Explain to him that he's going to buy 10 more carrots at the store with the $5 in his wallet. Then have him put the carrot back into the bag and take out the apple cue and follow the same procedure telling him he’s going to buy 4 more apples. Attach the bag to the tray. Have him take down the school cue and tell him he's coming back to school after shopping is finished. Attach the school cue to the tray. Grab the finished bag to take with you and leave for
store. You may want to take his arm splint with you if he's constantly mouthing.
Much of this is very repetitious. The repetition helps to reinforce all the components of the routine and shows him how what happens at home preludes and then links with what happens at school, store and then at home again.
The student may wish to explore fences, trees, shrubs, etc., on the way to store. He will show this interest with his eyes and hands. Allow him to explore for short periods of time if he wants to, but don't overdo it or initiate it because you don’t want him to get 'burned out' before he gets to store. You don't want him to be too tired to concentrate when he gets there.
Store:
There is a long row of shopping carts outside store beside the 2 pop machines. Have the student touch the end one that is the furthest away from the pop machines. Tell him he is at store and give him time to explore the shopping cart. When he's done, wheel him down along the row allowing him to touch the carts as he goes by. You need to go very slow, give him lots of time and watch his hand so that it doesn't bend back or get caught. Help him grasp the store cue and tell him he's at store and he's going to go into the store.
Once inside wheel him up so he's beside the end of the closest checkout counter where the grocery bags are. Give him time to take in the new environment – smells, lights, sounds, etc. Let him know you're there, but hive him some space so he can see, smell and hear this new environment. When he's ready have him feel one of the store bag along with the store cue. Tell him he's in store and he's going to do some shopping. Then reattach the store cue to the tray. Wheel him through to the end of the produce section (to the far wall where the fruit is) to where there is a roll of plastic bags at his height. Tell him what they are and that he's going to pull one off to put 10 carrots in. Have him touch the bag and help him pull one off. Go very slow and observe him while doing this because
he really enjoys it and will be an avid participant if given time. Grab a twist tie, show it to him and tell him what it's for.
Put the bag on the tray and then have him grab the cue bag, open it and take out the carrot cue. Tell him he's going to get 10 more carrots and will put them into the produce bag. Leave the carrot cue out, watching that he doesn't try to bite it.
Wheel him over to the bulk carrots making sure his left side is toward them. Give him time to get used to the different lighting and temperature. Help him to feel the cold, white edge of the shelf. Go slow as the temperature is cooler on his fingers and he may startle. When he's ready help him to reach up and grasp a carrot. You may need to place it on the pile so it is more accessible for him. He will grab the carrot and pull it towards him. Let him explore the carrot. Tell him what it is and that he has 1 carrot and needs to get 9 more. Help him to touch the carrot cue at the same time to reinforce its meaning. Don't let him mouth the carrot. When he's done exploring it tell him to put it into the produce bag. Have him open the bag and help him put the carrot in. Repeat with 4 more carrots. If he's lost interest at this time then try hand under hand having him feel and watch you grab and bag the next carrots. Ensure this is a visual and audio experience for him by
showing and explaining to him what you are doing. Watch him closely in case he shows interest in participating again so that you can include him immediately. When all the carrots are in the bag tell him that he has 10 carrots in the bag and that's all that we need. Help him to close the produce bag and put the twist tie on. Put the carrot cue back into cue bag telling him carrots are finished.
** If you're purchasing almonds next:
Have him take the cue out of the cue bag and tell him you're going to a different part of the store to buy a bag of almonds. Then take him to that area of the store (baking items) explaining to him where you are going and what's going on around him. Have him feel the shelf (you may need to make the bag accessible) take them off the shelf and put them onto his tray. Compare the cue bag (empty almond bag) with the full bag. Put the empty almond bag back into the cue bag and tell him almonds are finished. Show him the cue bag and tell him that we have all the items we came to buy and that now we need to go to the checkout to pay the cashier for the groceries with his $5 bill.
** If you are buying more produce instead of almonds:
After finishing with the carrots, take him back to the roll of produce bags and have him take another one off following the same procedure as before. Take the cue out of the cue bag and follow procedure same as for carrots. You may need to move items to make them more accessible to him. I put the ginger basket on the shelf at his level so he can pull the ginger out himself. Then show him the cue bag and the items inside and the bags of carrots and apples and tell him we have all of the items that we came to buy and now we need to go to the checkout to pay the cashier for the groceries with his $5 bill.
Wheel him up beside the end of the checkout counter where groceries are loaded onto the belt. Help him feel the rail running along the back side using this as an environmental cue to tell him where he is. Explain to the cashier what you are doing and ask her if it's okay that you take some extra time. Tell her you'll bag the groceries yourselves.
Then have him reach up to feel the belt and ask the cashier to make it move for him. He likes feeling this movement. When he's done tell him he's going to put the carrots and apples up onto the belt. Ask the cashier to stop the belt from moving. Help him grasp the carrots and put them up onto the belt and do the same with the apples. Have the cashier start the belt and allow him to feel the items move away. He's a little too short to follow them along right now so I have him feel them move away and he runs his hands along the rail as I wheel him down to the debit machine. Have him touch the counter and tell him that the cashier is there and that he's going to pay for the carrots and apples with his $5 bill. If the cashier is willing have him touch her hand and explain
to him who she is. Then tell him we are going to get out his $5 bill and pay her for the groceries. Get him to grab the wallet, open it up and take out the money. Reinforce its purpose and have him hand it to the cashier saying, "Let's give the $5 bill to the cashier to pay for the carrots and apples." Then tell him she will give us back some change as the groceries cost less than $5. Help him to receive the change and tell him how much it is showing him the different coins. You may need to move down to the end of the checkout counter to look at the money if there are people in line behind you. Then have him put the change into the wallet, close it and shake it telling him the change is shaking in the wallet. Attach it to the tray. Remember to sign and say what you are doing. Tell him the cashier is finished. Wheel him up to where the grocery bags are hanging and let him feel the bags. Have him
touch the store cue and the grocery bags to reinforce the cue. Help him to pull one off telling him that we are going to put his carrots and apples into the bag. Help him to take the carrots and apples from the counter and put them into the bag. Have him put the cue bag into the shopping bag as well telling him he's finished buying carrots and apples. Help him tie up the bag so the groceries can't fall out and then leave it on the tray. Grab the finished bag and have him put the store cue into it. Tell him store is finished. Help him to grasp the school cue and have him feel it while you tell him he is going back to school. Attach the school cue to the tray.
Allow him to explore trees, fences, etc. as much as he wants. He may be too tired but give him the opportunity. Watch him for any signs of interest.
School:
Feel the brick wall and the school cue at the same time and tell him he's back at school. Take him inside and allow him to feel the 'shoe' sign. Take the groceries to the student's room and help him to put them onto the round table telling him that he's going to put them into the home bag at the end of the day to take them home to make juice with mom. Put the wallet onto the table as well. Tell him shopping is finished.
End of Day:
Cue home on the wall calendar. Take the home bag to the table. Reinforce shopping day and the continuation of it with juicing at home by having him remove the carrots and apples from the shopping bag and then feeling them. Remind the student where he got them and that he's going to take them home to make juice. Put them back into the shopping bag and then put it into the home bag. Have him grab the wallet off the table, shake it and tell him the change from the $5 bill is shaking in the wallet and that he's going to give the change to his mom when he gets home. Put the wallet into the home bag. Tell him shopping is finished and that he's going home to make juice with mom.
Communication Within Routines
Michele Kohut-Jones - Consultant
Assisting with taking her cape off
- The student has her bag on her lap, she grabs the beads on the zipper and pulls open her bag. Her Intervenor offers minimal assistance (holding the bag still and pulling somewhat)
- The student has 3 items to take out of her bag. 1. Lunch bag 2. Communication book 3. Red Big Mac switch. The student chooses the order and places the items in her Intervenor’s hand.
- Lunch bag goes on table
- Big Mac switch – The student pushes her switch to hear the message from home.
- She closes the bag and places it under the table.
- Her Intervenor presents the student with her calendar pics for lunch bag and eat. The student looks for her lunch bag and reaches for it.
- The student puts her lunch bag in the fridge
- Her Intervenor presents the student with her choice board. The student chooses between cranberry juice and apple juice. The student used a nice long gaze to make her choice of cranberry juice.
This is a beautiful routine. The student is motivated and enjoys the social aspects of the “Good morning” routine. She is able to anticipate what is happening and has immediate feedback about the steps as they are completed. This seems to be a solid routine that the student enjoys. She is smiling and having a great conversation with her Intervenor.
Receptively, the student is able to use her vision and hearing to complete her routine. Her Intervenor uses her voice, signs, and cues (both object and picture cues) throughout the activity.
Expressively, the student signs finished, reaches for her zipper and lunch bag. She uses her Big Mac switch to share a message from home – she chose to listen to it several times. She vocalizes and uses facial expressions to converse with her Intervenor. She used her eye gaze to make a choice.
When the student seems to be unhappy, her Intervenor has been consistently introducing picture symbols for feelings and support. These have been in place for a while and are paired with any feelings the student is expressing. The symbols used are hot, hurt, get out of my chair, toilet, help, and come here. Again, the student held a long gaze and was really looking at her choices. Well done!
Her Intervenor ensures that the student is always an active and informed participant in all of her routines. Her Intervenor never does anything for the student that she can do for herself. She is always there to support her in her more difficult or new routines. This is true Intervention!
ROUTINES
An Intervenor's Perspective
by Lee Grant - Intervenor
What is a routine? The dictionary definition is: ‘A fixed, regular method of doing things; habitual doing of the same things in the same way.” The purpose of using routines throughout the day, gives the individual a chance to anticipate what is going to happen. A routine to begin the day becomes very familiar when used in a habitual manner every day. The individual is given access to the information that will help structure his day or an event during the day. Routines will help provide a predictable, secure understanding of events as they happen. An individual must be encouraged to actively take part in preparing or being part of a routine. By being an active participant, the individual gains the knowledge that this routine will happen the same way each time for a specific routine,
like a morning greeting, preparing for the day and leaving to go home. As a routine becomes a consistent part of an activity, it also brings pleasure to the individual, as they begin to know their part and the activity becomes non-threatening to them. Routines give an individual an opportunity for patterning behaviours after the consistent routine has been established. This gives guidance to the individual to have a specific role and share the responsibilities of the routine. The routine must be designed for a learning experience to happen each day and being organized with a prepared plan, will give a positive learning experience. To implement a morning greeting routine, start as follows:
APPROACH - Greeting Routine
• Approach from the front and speaking in a normal voice say/sign individuals name.
• Introduce yourself verbally and with your sign.
• If possible, gently touch back of individuals hand, then wait for a response.
• Say “Hello” and use individuals name sign.
• Respond to all communication and make small talk.
• Proceed to sign about upcoming activity or what is going to happen next in the routine.
Using the approach method for a greeting routine is a simple but structured technique to help develop a supportive environment that is reactive to the individual. All people involved with the individual can use this routine’s simplicity with ease. Why a routine works, is it provides anticipation, security, ability to predict and to know what happens next as well as it helps to provide an environment to enable an individual to develop the awareness, skills and emotional stability to be successful. Routines will help support learning and skill development during planned activities and recreational activities. This requires the intervenor to supply support to the individual by providing all the information necessary for the individual to make informed decisions when choices are offered. From this, we can also
build flexibility into our routines. Daily situations and surprise events are an opportunity to use a “teachable moment” inside a routine. We must try to continually expand our routine, even if by a small amount, so as not to adhere to tightly to a rigid set of rules. We can have many chances of spontaneity and adapt our strategies to accommodate individual needs and styles. The approach method stays the same until you start the small talk. At this time the routine becomes flexible to be able to share relevant information about the coming day.
STRATEGIES: Everyday activities are natural opportunities for developing early routines. Interactive routines that support communication can be simple and effective. The routine should consist of a beginning, middle and end.
• Identify a routine -- greeting.
• Identify the steps in the routine in their natural order.
• Identify cues that occur during each step of the routine.
• Identify the communication system used.
• Identify the individuals participation during each step of the routine.
• Identify times during the routine for flexibility and spontaneity.
• Identify the individuals personal needs and styles of learning.
Routines will help you encourage an individual to interact with their environment in a safe and familiar way. The step by step sequence of a routine will become familiar and anticipated in a pleasurable way for the individual.
By: Lee Grant
Bibliography
The Gage Canadian Dictionary (1973), Gage Educational Publishing Limited, Toronto
Deaf-Blind Infants and Children, A Developmental Guide (1982) J.M. McInness -- J.A. Treffy, University of Toronto Press, Toronto
Hand in Hand Essentials of Communication and Orientation and Mobility for Your Students Who are Deaf-Blind (1995), Volume 1, Kathleen Mary Huebner, Jeanne Glidden Prickett, Therese Rafalowski Welch, Elga Joffer -- Editors. AFB Press New York, New York
Remarkable Conversations (1999) Barbara Miles, Marianne Riggio -- Editors, Published by Perkins School for the Blind, Boston
A Guide to Planning and Support for Individuals Who Are Deafblind (1999), Edited by John M. McInness, University of Toronto Press, Toronto
For More Information:
Incorporating Active Learning Theory Into Activity Routines
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