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Article 2. The story:
Doing meaningful things at adult day programs.

You tell me and I forget.

You teach me and I remember.

You involve me and I learn.

(Benjamin Franklin)

This is not just a great quote. It's true. Studies on adult learning support it unequivocally. This quote is the theme of the story. Group processes and AAC techniques described are far from unique. Many other people in many other programs are probably doing similar things. We sat around a table or in a semi-circle. Between 8 and 22 people attended the two group sessions at each of the five programs. We had flip charts, magic markers, erasable writing boards, and communication symbols, digitized speech devices, colored dots, paper, pencils and courage. A feeling of nervous anticipation was easy to discern.

We were all adults associated with the Skills Center programs. Beyond that, we were a motley crew. Our ages spanned nearly five decades. Our capabilities, skills and interests were just as varied. "Clients" outnumbered staff–that was a requirement–and were certifiably persons with disabilities. (Mental retardation, traumatic brain injury, communication problems and behavioral disturbances topped the list.) Most were ambulatory although many had motor problems. Staff understood almost everyone; but as an unfamiliar partner, I found the speech of more than half difficult to interpret. Bilingual issues were pervasive. Some people used signs, communication wallets or communication boards, but rarely away from their structured communication groups. Electronic communication devices had not been tried.

Staff attending the sessions understood the administration's commitment to change. Most–not all–were interested in making changes. While some had worked at the Center for years; others were new employees.

Brainstorming

Brainstorming was the first activity. Just for the record . . . nearly everyone could point to his/her brain. Of course that was not the point! Brainstorming requires that people communicate and participate. Staff plays supportive, never directive roles. After reviewing the rules in Table 1 (not included), after contributing ideas and supporting anyone who seemed to need it or requested it. Support could mean:

• Enabling someone to be a recorder (write and/or draw), keep time or give a report.
• Making appropriate symbols available for an activity.
• Translating Spanish to English and English to Spanish.
• Interpreting difficult to understand speech.
• Encouraging participation by modeling, offering choices and coaching.

First, we practiced. I asked, "What kind of foods can you think of?" Recorders wrote down words and drew icons next to each word on a flip chart or white board. In some cases, two recorders worked in tandem–a staff member printed and a client drew, or visa versa. Within five minutes at each site, we had a list of more than 15 foods. We were even having fun. Participants who were not literate could attach meaning to our hand-drawn icons. That was exciting! I took a deep breath, looked around, and thought, so far . . . so good. Nothing ventured; nothing gained.

Next, people in the group brainstormed "Reasons I come to the program are____." People volunteered to be recorder(s), timekeeper, and reporter. Every- one was offered support. Despite the more abstract nature of this task, more than 20 reasons were generated at each site in just 10 minutes. Then, we were ready to prioritize. Table II (not included) is an example of one program's list.

Setting Priorities

Prioritizing is a process allowing groups to find out how people feel, reach consensus and/or make decisions. All participants were given three colored dots to cast as votes. During a break, each person placed his/her dots on the list next to three primary reasons for attending the program. Some people did not understand the task and put dots in places they could reach or where they saw other dots. However, for our purposes that didn't matter. There are no "right" answers. People learn the value of their opinions over time and through experience.

Primary reasons people in the five programs attended the Skills Center were to:

• Go places (downtown, library, movies, Taco Bell) (44 votes).
• See their friends (41 votes)
• Make money (39 votes)
• Have fun (38 votes)

Brainstorming and prioritizing can help programs ask and answer a very important question–Does our program's current schedule of activities reflect the preferences of our consumers? According to these group sessions, time should be focused on doing things in the community, building friendships, making money and having fun.

Solving Interaction Problems

Another emphasis was to provide opportunities for clients to solve communication problems and learn from each other. For this activity, clients enacted solutions to communication situations. Role playing, problem solving, modeling and AAC communication strategies gave everyone opportunities to observe multiple ways of communicating. Each group selected one situation that was causing problems at their site:

• Grabbing to get attention.
• Taking too long in the bathroom to wash your hands.
• Refusing to participate during group activities.
• Refusing to respond.
• Acting "mean" for no apparent reason.

Table 111 (not included) illustrates solutions one group generated and role-played

Planning a Project

An adult's life is full of projects (making dinner, cleaning house, balancing the checkbook, shopping). Group projects allow people to plan, work toward a common goal and do something that has a tangible result. Projects have identifiable beginnings and endings. The goal of this activity was for each group to select a project using brainstorming and prioritizing and then plan it. See Table 1V (not included) for one program’s list. The five programs selected these projects:

• Solve the mud problem in the front of the Center.
• Make cookies.
• Make a video.
• Find new ways to make money.
• Have an art show.

Staff supported, but did not direct, project teams. Teams developed an Action Plan with tasks to accomplish, people responsible for accomplishing each task and a timeline. Table V (not included) is one example.

Projects often don't come out exactly the way they are planned. Timelines seemed to be particularly elusive. Coping with reality is among the many things to be learned during a project.

Solving Communication Problems: Shopping

Next, we set up a mock store. Merchandise depended upon what happened to be available–we had three plant stores, a candy store and an office supply store. Only clients were storekeepers, but everyone took turns being customers. Speech, gestures, facial expressions, written messages, an interpreter, a communication board/wallet, and voice output devices were options for communication.

How exciting! Learning was incremental as each person learned from the last. Clients were sensitive, patient and supportive of each other. They demonstrated skills staff didn't know they had. We all agreed that intelligible voice output was more effective than symbol displays in our stores. And yes, it was lots of fun.

Expanding Horizons

The purpose of the final activity was to develop course-work that would interest adults who attend day programs. Many clients had limited experience and world knowledge. Thus, we were required to find ways to expand their information-base in order to fulfill the mission statement. Also, courses and curricula developed by one group could be useful to others. At each site we broke into smaller groups. Each group brainstormed "I would like to know more about____" and prioritized their lists. Then we reconvened. Reporters read the ideas generated in their small groups. After discussion, each program selected one course. They talked about how to approach the learning process, costs and skills people would need. Table V1 (not included) gives two examples (Making ice cream and landscaping.) Then, groups decided how to pursue the information they needed. After a course is completed, they provide the Center with something others can use to guide their learning.

In Retrospect

Approximately six months following the last session, I asked program supervisors^2,3 to rank the impact of the following processes and techniques. A scale of 1=least important to 5=most important was used:

Brainstorming 4.75

Project teams 4.25

Action plans 5.00

Role playing 5.00

AAC Techniques 5.00

Coursework 5.00

All are perceived very positively. In addition, supervisors said the experiences of consumers and staff, as well as characteristics of the program have changed:

Consumers

• Individuals who never came to groups are more involved.
• The interaction among clients has increased.
• Boundaries seem to have been crossed. Spanish speaking clients now interact with symbol communication users because symbol use is being modeled.
• People are more willing to voice opinions and preferences.
• Everyone seems to be having more fun.
• Clients seem to have found a value in each other we didn't see before. Now they have a method of communication–symbols.
• On the negative side, the range of skill levels is wide so projects take more time than one might think.

Staff

• Staff listens to clients more.
• The quality of services has improved.
• Staff now know how limited some client's experiences are.
• Staff sees how proud clients are when they accomplish something that was their idea.
• Brainstorming can be frustrating because sometimes clients can think of only a few options.
• Staff needs to plan things out and that takes time; however, planning can occur during group meetings.

Program

• It's a lot more client-driven.
• Now when we need to send something home, clients type or write the notes, make copies for everyone, find the paper and so on. Before, notes just magically appeared.
• Scheduling is more difficult. Some aspects of the program remain unchanged. Because this approach requires more flexibility, it's tricky.

Some Hints

1. Living and learning should be fun. We've developed a Fun Index for staff and clients to use to measure the effects of activities.

< No fun 1 2 3 4 5 lots of fun>

2. It's best to start with simple, specific projects like making a salad. Making a video was a bit ambitious!
3. Make a log (pictures or drawings) of completed projects. You'll have an outcome measure and something to help others during brainstorming activities. It can be a menu of ideas.
4. Schedule at least two-hour blocks of time for project work.

Summary

There is no end to this story–just a snapshot of its beginning. In a Top Down approach, staff know what's best and put clients through their paces. Our approach gives people with few choices a voice. It is not necessarily easier, but it is more fun and more motivating. The Skills Center's mission statement is beginning to be realized and the field of AAC is playing a crucial role.

This article appears in ACN Volume 7, # 3.

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