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Importance of Survival Skills

Introduction to Essential For Living | Dr. Vincent Carbone

Introduction to Essential For Living | Dr. Vincent Carbone

“Essential For Living”. It’s about a method of speaking,
how do we teach children to speak – that may be through signs, it may be through speech generating devices,
it may be through gestures – lots of different ways. It’s about essential eight skills that will get you to a
happier and fulfilling adult life. So there are eight basic skills that McGreevy outlines that says you will have
a happier, more productive life if you can learn to do these things, or not do some of the things that are involved
in these. We will take a look at these eight essential skills. It scores small steps of incremental progress. In other words, on the VB-MAPP you might never see anything
kind of colored in with some of the individuals who we are talking
about. You might hardly see any progress at all. He (McGreevy) has got it broken down in a way that you are going
to see progress – which encourages parents, and encourages people who provide the service, to continue to provide the service.
You could go a couple of years, on the VB-MAPP, for example, and not see certain areas filled in – despite the fact that in the
Essential For Living, in those same areas, you might see progress, which is an important issue. That is what we mean by an “incremental
scoring”. More on that later. It’s designed for both adults and children with moderate to severe
disabilities. It’s based on the basic principles of Applied Behaviour Analysis, so it is more behavioural analysis, and of course including
Skinner’s analysis of verbal behaviour – more overview of that in a minute. There are other good assessments, these are ones that are
available in the United States: The Syracuse, and a Functional Curriculum for Teaching Children with Disabilities – there are
several curriculum materials. But what is different about this is that it is based on Applied Behaviour Analysis principles – that are
throughout the manual – and is based upon an analysis of language which is a key component for development in persons with
moderate to severe disabilities. That is what is different about this particular curriculum. It’s the only instrument that is
based on the concepts and principles of ABA, and speaking and listening skills. It is both an assessment and a curriculum. Within it
is the assessment, and also how to go about teaching certain things and in what order. It identifies current level of performance
and leads to the development of goals and objectives for Individual Education Plans (IEP’s), and can track skills over time –
similar to the ABLLS and the VB-MAPP. What it isn’t? It is not a developmental assessment.
It is not based upon grade levels, or ages, or any of those sorts of things.
It is a functional curriculum of skills – one skill builds on the other; so it is not developmentally normed.
It doesn’t tell you what age level or what grade level in school somebody might be, or any of that. It doesn’t
compare children to other children in a normative sort of way. It is criterion-referenced, it is just “do you do these skills?”,
“do you do this?” – “do you do this?” – “do you do this?” It basically looks at measuring repertoires over time, not
comparing to anybody else, and you will not see age levels or any of those sort of things. And skills are not necessarily
in order of development, either. It may not include, for example, some of the early sort of labels
that somebody might develop or of the early sort of mands (requests) that somebody may develop. That may not be
relevant, at all, because what needs to be done is what is functional to this individual, and not based on what the typical
child develops – and in what order they develop them. In other words, there is usually a first list of words that children
develop as mands and tacts. Certainly not mands as much as tacts (labels). There is clearly nouns and verbs, and so on, it is
a clear developmental progression. This may not follow that at all, you may be teaching somebody to mand for an action on the
part of somebody, which might not come until somebody is 2, 2.5 years old. You might have the mand for something as an
adjective, a color, a size, or something like that – an attribute – when that may not be relevant until 3, 3.5 years old; you might do it
because it is functional for this particular individual. That is what I mean by it is not in any kind of developmental sort of order. The VB-MAPP is composed of skills arranged in a sequence.
Skills from the VB-MAPP are not functional – they are developmental. I mean they are functional in the sense that they are useful to the
person, but they are presented in a developmental order. And of course I make good use of the VB-MAPP, as does Patrick
with the children he serves, but are not relevant to the Essential For Living. They (VB-MAPP) are not designed to be functional,
they are designed to be developmental. They are designed to develop an intellectual repertoire that is necessary to do well in
school, for example, and may not be terribly functional. Think about some of the facts that you know about things.
Were they ever functional to you? When you think about some things you have learned. How many of you may have had an Art History course,
how many of you make use of that, other than when you go to Italy occasionaly, and you know where to find David. But other
than that, it is just not functional necessarily, it may be interesting and useful, and it is important knowledge to have, but it is not functional to
your life, if you never saw a picture of David or knew who chiseled him, that you would not be able to carry on your day, you would
do just fine, and maybe some of you don’t and it doesn’t matter. But you get the idea? It is not those sorts of things. A developmental
curriculum teaches you those sorts of things, which are relevant to a broader life, but not necessarily functional, in any sort of way.
And that is the distinction that McGreevy is making there. It is composed of functional skills and behaviours, which are essential
for effective daily living, which result in improved quality of life. Skills and behaviours which are required in other settings; skills and
behaviors which are taught; in the absence of which learners would require the assistance of other persons. That is a really important
issue when you teach somebody. There have been some examples of this in the United States – some classic sort of
examples of this – but in the absence of which, if you didn’t teach these skills, the learner would require the assistance of other
persons. In other words, would it be more relevant to teach somebody to tie their shoes, or to work on puzzles? I mean, who is
going to do your puzzles for you if you can’t do them? You better learn to do puzzles, because who knows when
you will need to do a puzzle. On what do we spend more time? We spend more time on puzzles than we spend on shoe tying.
Why? Shoe tying is hard to teach. Puzzles are fairly easy. But, who is going to do your puzzles if you are an adult and you
can’t do it? Well, you get the idea. “Who is going to tie your shoes?” – should really be the question.
It is really asking yourself: “if I don’t teach this person to do this, will somebody else have to do it for them.” That is a key question
throughout this curriculum: will somebody else have to do it for them, and if somebody else would have to do it for them,
then I think you ought to teach it. That is the way to make a broad judgment on what should be taught. And results in
increased access to preferred items, activities, places and people. Here is an example of the differences between a developmental
model, the VB-MAPP in particular, and the Essential For Living. For example, this is a developmental model from the ABLLS-R
or the VB-MAPP, and this is the functional skills from the Essential For Living. So you make requests with three different carrier
phrases. “I would like”, “can I have”, “make would you give me” – carrier phrases, autoclitic frames. Makes a request for assistance,
for example, with menstruation or locating a restroom (in a young woman) – that idea. The idea that it is something functional
and useful. Looks for an item that has fallen out of sight. Retrieves a wash cloth from a linen closet. Get the difference
between these? Matches identical pictures in a neat array of three. Takes clothes out of a dryer, matches socks and folds
socks. That is the differences between the two curricula. Touches one of two body parts when directed. Retrieves items
and participates in activities that are part of a snack or break – plate, napkin, pouring juice; touches one of two body parts when
directed to do so – that is listener behavior. Touch your nose, where are your eyes, show me your mouth. But retrieves items, and
participates in activities that are part of a snack, in other words, the person can identify, or select, the plate, the napkin, the juice,
the table, the trash can, and throwing away trash and can engage in those sorts of things. In other words, can follow directions
related to these sorts of things. Completes out of context fill-in phrases. Provides name and address when asked to do so.
May be important, specially if you get lost. Uses irregular plurals correctly. Makes requests that include two
items, the same item, two items, or an item with a feature. “I want two cookies.” “I would like strawberry yogurt.” “I would like
juice and cookie.” Rather than increasing the length of uterrance to: “I would like some juice”, it might be – the person will just say:
“juice and cookie”, or they will say: “strawberry yoghurt”. You generally don’t start to teach these modifiers like “strawberry”,
for example, on “yoghurt” until you are in a developmental sort of model – until way into it. But that doesn’t matter, because
this person likes strawberry yoghurt. Teach the adjective, if you will, early on – that is the difference in the way of thinking
about these sorts of things. So these are kinds of examples of the kind of functional needs and how they relate to ABLLS and
VB-MAPP stuff, where a lot of this might be taught during discrete trial instruction sitting down, this stuff (the EFL) will all
be taught in this sort of way. Which assessment to choose? Take a look at this here – which
assessment to choose? When will you choose a developmental – VB-MAPP, ABLLS – and most of you are familiar
with the VB-MAPP and the ABLLS, right? I will assume that most are somewhat familiar with that. Children ages 2 – 6; let’s look
at those: development delays, delays primarily with social and language skills – 2 to 6 years old. Well, you ought to probably
choose the VB-MAPP; 2 -6 years old, with developmental delays, maybe a development disorder as well, meaning autism, or delays
primarily with social and language sort of skills. In other words, some of the children are fairly friendly, in the sense that social
attention matters to them; they have good matching skills already, they make eye contact, you know the type of child that I am kind
of talking about. It has all these relevant sort of skills and “if I could just teach him for a few years, I am going to catch them up”. They guy likes to
be around people, all those kinds of things. But let’s take a look at children ages 2 – 6 with significant global delays. These are children
with kind of motor sort of problems, possibly didn’t learn to walk until they were 5 years-old. They tend to have low tone, like drool
quite a bit as well, very low tone sort of guys. Poor motor skills, kind of significant global delays, were they don’t have language,
they have all these motor skills that I talking about, social awareness, lots of stereotypies, and you get the idea. And it may not be a child
with autism necessarily, keep in mind. Specific syndromes, types of syndromes that are associated with long-term difficult outcomes.
You know what I talking about, Lesch-Nyhan for example, severe kinds of syndromes. That might be somebody who would go right
into the EFL, the Essential For Living. Limited language, were there is almost no language development whatsoever. No social
development, no social awareness; hearing, vision or orthopaedic impairments, and medical conditions. With all kinds of cognitive
issues, might have a trait for example, might have a G-tube – there are kids with G-tubes who could be on a
developmental sort of approach as well, but I am talking about those kind of severe sort of medical problems. These are kids with medical
problems, that are usually, unfortunately, a large percentage of the children who fit in this category, who have medical problems, hearing
and vision impairments, are unfortunately, perinatal sort of accidents that occur around the time of birth or prematurity is one of
biggest issues related to kids who would fit into this sort of category. They are not ambulatory potentially, you know the types of
individuals I am talking about. Who almost need assistance with nursing care. People with severe, profound disabilities.
Certainly it will be the EFL, 2 – 6. Children ages 7 – 8 who are making steady progress. They are doing
OK. Then continue on the VB-MAPP. Childrens ages 7 – 8 who are making very little progress or no
progress, well what McGreevy says is find somebody skilled and just check out whether you got them in the right program – you’re
programming the right way. But a lot of these kids here probably you should consider the Essential For Living for a lots of these
guys. These are guys that have had 4, 5, or 6 years of pretty good treatment, and they are making hardly no progress. These are kids
that have had 4 or 5 years of pretty good treatment and, are still in level 1 for example, and are moving very, very slowly on
the VB-MAPP. They are 7 years old, and they are about at an 18-month old level. You should consider – unless they just have
not had very good teaching, and you say “well, they have hardly had any training”, maybe that accounts for it, but if not then maybe
you should consider the Essential For Living. It is a difficult discussion with parents on these issues. Some of these children here
with syndromes and with some of these medical hearing issues, related to prematurity, and brain bleeds, many of the individuals
here have had significant brain bleeds just after birth or at birth, due to prematurity. And they will fit in into this sort of category
here. So this assessment treats – suggests treatment methods for persons who have these kinds of severe sorts of disabilities
that are the result of brain trauma that may have occurred after birth – acquired brain trauma – or brain trauma that occurred like
an accident or brain trauma that may have occurred at birth or before. Individuals potentially with cognitive impairments and
severe cerebral palsy, for example, might be individuals in these. So this curriculum treats all of those types of issues.
Children ages 9 – 10 having difficulty answering questions or participating in conversations; have not acquired academic skills
of at least a first grade or second grade level, then consider the Essential For Living. These guys are a kind of a toss-up here.
McGreevy refers to these guys who are 7, 8, 9, 10 that are “stuck in level two”. He calls them “stuck in level two”. Some of you
who have a lot of experience with children with autism with the VB-MAPP know what we mean – kind of “stuck in level two” – just not making much
progress in level two, which is 18-30 months, and they may be 8, 9, 10, 11 years-old, and they are still operating at
about a two-year-old sort of level, after many years of good treatment. It may mean that the Essential For Living might be the
thing to consider. So these are some broad guidelines on which to think about
this. The important thing about this chart is don’t consider this only for children who are 15, 16, 17 or adults – that may be too
late. You may consider it between ages 2 – 6 as well, if there is some relevant reason to do so. In addition, I have found that
if you make the decision too early, in some of these children, that it is self-correcting, because suddenly these guys start to
make progress in areas that you are not teaching. You did it too early, and know they have an enriched environment,
and they start picking up things on their own, then maybe it is time to switch back to the VB-MAPP – but you will see it.
These will be guys who will start learning on their own. You will say “my gosh, we did not teach any of that stuff, and know they
are learning it,” maybe we ought to consider going back to a developmental approach – you will be able to see it if it happens.
You have to be careful about it, but is almost as if it is self-correcting, you will see the differences.

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