Working the Transition Plan

Late in 2007, Jess had been approved to volunteer at a nursing home. Because of Christmas Break, it was January 2008, before we learned more about her upcoming assignments at the nursing home.

At School

Because it was part of the Community Based Vocational Instruction (CBVI), her ‘work’ would only take up a small portion of her school day. Her schedule needed to coordinate with the bus that took her classmates out for CBVI. In addition, there also needed to be time allotted in her day to work on her IEP goals and transition plan.

• Increase communication skills – One of the ways they worked on this was through journaling. At times Jess did this with her parapro by telling her what to write. 
• Maintain and increase Braille reading and writing skills – Other times, the journaling was done with the VI teacher while practicing Braille.
• Increase ability to use numbers and money – Jess  worked on this by learning to fold money for identification, counting by 5’s & 10’s, and doing math.
• Increase assistive technology skills – Jess worked on learning to email as a form of social communication. 

One of the services Jess received through Voc Rehab was Blind Services. Someone went to the school to work with Jess on independent living skills as they related to adaptations needed for blind people. Jess  worked on learning things like:

• making up a bed
• filling up a cup and how to know when it is full
• how to use measuring cups
• using microwave to cook/heat up lunch
• putting toothpaste on a tooth-brush and brushing teeth

Defining Caregiving

For her assignment at the nursing home, we found out that Jess would be trying a variety of things like pushing an activity cart from room to room to hand out books, playing games (bingo) with patients, or just sitting and talking with those who were lonely. While Jess was learning her environment and the routine, she would always have her teacher or a parapro with her either assisting or observing.

In the beginning, she went to bingo a lot. Eventually, she helped put someone’s bingo chips on their board. She made a friend at work who was letting her help with passing towels and ice to patient rooms. A plan was developed for her to help with that task and that was something she really looked forward to doing.

The next progression of Jessica’s work was for her to learn to visit with the patients. At first, she did not realize that talking with them was part of her job. She just wanted to walk in, say hi, then walk back out even though several of them wanted to talk to her. Jessica’s teacher, parapro and I all had discussions with Jess to help her understand that visiting and talking was a part of caregiving.

By end of January, she grasped the concept and would go into patients’ rooms and start up conversations and not walk away until the conversation was over. In February, with supervision, Jess got to push someone in their wheelchair to ‘activities’ and Jess was really excited about it.

By the beginning of April, Jess could walk into the building and independently find her way to a patient’s room. A couple of weeks later, she was helping make beds, helping patients play bingo, and she was able to walk with a patient from the patient’s room all the way to the cafeteria by herself (with teacher observation). Walking patients to activities became one of her regular responsibilities. She loved it.

In May, she added a new skill to her resume, and that was massaging patients’ hands while she visited with them. My mother discovered Jess had this skill. Jess is really gentle with it and it is comforting and relaxing.

Overall

Many things went well that second half of the school year, but, other things were going on that continued to interfere with maximum progress. One of those things was fatigue related to starting (and changing) seizure medication. Other issues were moodiness, aggression, and ongoing anxiety.

The second week she was working at the nursing home, she got upset about something but was unable to tell the parapro what it was. The next week, she fell asleep on the bus  (which is very unusual) while riding to work, then, got upset while at work and cried. That same day, once she was back at school she mentioned biting and pinching several times but never did.

The next week, as she arrived at school in the morning, the first thing she did as she was exiting the bus was whack one of the parapros with her cane. She knew she was going to have a substitute teacher that day and was upset about it. All day long she kept saying she might hit or bite. Understandably, on days like that, she was held back at school and not allowed to go to work.

Another thing that was continuing to happen was Jess being upset about her friend being absent from school, and her friend was absent frequently. Many of those days, Jess would be upset for the entire day.

It was that same kind of attachment/anxiety connection that began to cause wrinkles in the nursing home plan. One day, Jess came home upset because someone’s mother passed away. Because of Jessica’s communication disorder, she was not able to tell me if it was a patient, or if a patient talked about her own mother passing, or if it was a worker’s mother, etc. Another day, Jess became upset because a lady she liked to visit was gone out of the facility for the day.

As the school year wound down, we needed to reconvene, strategize about how to address this anxiety in the workplace, and develop a plan for the next school year. Jessica’s last year of high school.