Adapting and Evaluating COMPASS for Transition-Age Youth for Improving School Outcomes

Abstract

When an intervention is deemed effective for a particular population, it cannot be assumed that it will work equally well with a different population and often must be adapted. COMPASS was originally developed for young children. Because of the need for interventions that improve the transition planning process and outcomes of adolescents and young adults with autism, it was necessary to modify COMPASS for this age group. In this chapter, we provide background information on transition Individual Education Programs, including the laws and services that must be considered. Next, we summarize results from stakeholder focus groups combined of caregivers, educators, and autistic adults about transition services. Next, we describe the specific adaptations made to COMPASS based on the focus groups, including the COMPASS profile, the priority of discussion areas such as postsecondary goals, and informational handouts. We conclude with a detailed case study that features the steps in completing COMPASS with a high school student.

FormalPara Overview

The goal of this chapter is to describe the process for adapting COMPASS for transition-age youth and the outcomes. A case study details the steps in completing COMPASS with a high school student.

“Begin with the end in mind.”

This was a quote from a parent of a high school student with autism when asked what good transition planning looks like (it also comes from The 7 Habits of Highly Effective People by Steven Covey). The goal of beginning with the end in mind was very insightful and could not be more on target. It is what the federal law of the Individuals with Disabilities Education Improvement Act of 2004 (IDEA; PL 08–446) means when it requires Individual Education Programs (IEPs) to include transition services as

‘a coordinated set of activities for a child with a disability’ (Sec. 300.43 Transition services) and ‘designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation.’

Schools, caregivers, and students rely on the transition IEP as the roadmap that articulates and lays out the results-oriented process described in IDEA. It is a promise to students and caregivers outlining what will happen to ensure a successful transition from school to post-school activities. The transition IEP is

based on the individual child’s needs, taking into account the child’s strengths, preferences, and interests; and includes—(i) Instruction; (ii) Related services; (iii) Community experiences; (iv) The development of employment and other post-school adult living objectives; and (v) If appropriate, acquisition of daily living skills and provision of a functional vocational evaluation.

However, a promise is not enough. Laws can establish goals but cannot guarantee outcomes. For positive transition outcomes, evidence-based approaches, including careful planning, are necessary to ensure good outcomes. IEPs must prioritize employment or enrollment in internship or volunteer experiences, structured day programs, training programs, community college, or universities and have clear strategies to meet these future outcomes by including carefully thought-out activities that can be implemented during high school as part of the transition plan. Just merely identifying a goal of employment is insufficient for ensuring the person will be employed or be involved in activities following high school. We will reflect on some reasons behind why transition plans are not enough, and other strategies such as clear intervention plans, outcome monitoring, and most importantly, parent/caregiver and student input are critical. We also review more in-depth about the transition IEP in Chap. 3 and specific areas of improvement based on our research.

Although there are an abundance of interventions for students with autism that claim to be evidence-based, surprisingly few are research supported. IDEA does not stipulate what “results-oriented process” should be used or what plans lead to good outcomes. It falls on educators to determine the best approaches (Findley et al., 2022). The promise that transition planning should facilitate families’ abilities to access services so that a personalized and seamless plan based on the needs, preferences, and strengths of the whole person with autism is maximized to the fullest extent possible is far from being realized.

But this gap is not solely the fault of school programs. COMPASS is one of the few interventions with research support that helps address this gap. With funding from the National Institute of Mental Health, we adapted COMPASS for high school students. Our initial work, which is highlighted in our first manual on COMPASS (Ruble et al., 2012), focused on preschool and elementary school-age children with strong results and superior IEP outcomes compared to children whose teachers did not receive COMPASS. In the following section, we will describe the COMPASS intervention and our work in adapting, making, and testing COMPASS and its effectiveness for older, transition-age autistic youth.

COMPASS Adaptation for Transition Youth

Consistent with IDEA and COMPASS is that all goals and plans or teaching strategies to achieve the goals are individualized and personalized to the student. For special education programs to produce successful transition outcomes, IDEA ensures

…that all children with disabilities have available to them a free appropriate education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living.

Thus, by definition, the ultimate outcome of special education services is a seamless and smooth transition from high school to postsecondary opportunities. By the age of 16, well before the time students with autism reach their final year of school, postsecondary goals for what they will be doing for employment, training, or college and where they will be living should be identified in the IEP, along with plans for achieving them. But even more importantly, not only should goals be identified, they should also be obtained.

Wong et al. (2021) identified the supports that should be prioritized for facilitating employment outcomes for students with autism. Researchers found that parent participation was critical for employment. In addition, important school-based transition supports should include (a) vocational-related services, (b) supports for transition planning, and (c) work experience. Vocational-related services included participation in classes related to job readiness/prevocational training, job shadowing and work exploration, internships, specific job skills training, job search training, and a job coach. Supports for transition planning included having a transition plan, receiving teacher implemented instruction on transition planning, and identifying service needs in the IEP. Lastly, work experience includes volunteer or community service during high school, community-based work, and participation in a school-sponsored work activity.

There are also services outside the school system that should be considered for the transition IEP. The Rehabilitation Act of 1973 is a federal law that authorizes grants to states for vocational rehabilitation services, with emphasis on those with the most severe disabilities. Several researchers have identified the use of vocational rehabilitation services as a predictor of positive employment outcomes (Hatfield et al., 2018; Rast et al., 2020; Burgess & Cimera, 2014). Burgess and Cimera (2014) found that when individuals with autism received VR services, they were more likely to be successfully employed compared to the overall population of adults served by VR. These findings point to the importance of having a VR counselor at the table during transition planning. Yet Shogren and Plotner (2012) reported that few agencies, including VR, participated in transition planning, a finding that goes against best practices and also the needs of individuals with autism who often require more postsecondary support services compared to students with other disabilities. We will revisit the different players, such as VR, important for transition planning later and provide an example of the different services and a suggested timeline for transition planning on our website compassforautism.org.

While high-quality and personalized IEP goals are necessary to ensure we are headed in the right direction, implementing the strategies related to the goals is where the rubber meets the road. Clear and effective transition plans are the glue to ensure goals are put into actions. In other words, IEP goals should be related to and linked to postsecondary goals to ensure the student is meeting the milestones and benchmarks necessary for a successful transition. In Chap. 3, Findley discusses these issues in more detail and a measurement tool that can help bridge the gap between postsecondary goals and IEP goals.

Overview of COMPASS

Up to this point, we have identified several factors important for positive transition outcomes—individualized assessment, goal setting, and intervention planning that includes VR-related services, work experiences, community college and college readiness experience, etc. But what about other outcomes—those that we often consider as essential for a good quality of life—outcomes such as independent living skills, friendships, and participation in leisure activities? What do we know about these types of outcomes and how can we improve them?

With supports, autistic individuals can achieve a good quality of life that includes a productive, satisfying, and meaningful life, integrated into their communities. More than 25 years ago, we proposed an alternative framework for a personalized perspective for conceptualizing, assessing, and intervening to support and improve adult outcomes in autism that was based on a transactional approach (Ruble & Dalrymple, 1996). Because people do not live in isolation, we needed a framework that considers the complex interplay between the individual, family, school, social, community, and economic resources, i.e., the critical proximal and distal influences and interactions between individuals with autism and their environments. Proximal interactions are those most closely connected with the individual and include families, friends, and teachers, for example. Distal influences affect the individual less directly and can include availability of social and community resources such as vocational rehabilitation services, training experiences, and Medicaid waiver services.

We believe that traditional outcome definitions for autism of normal social development and independence articulated decades ago tend to misrepresent and underestimate the competencies and critical gains in ability that meaningfully impact the quality of life of those with autism. The COMPASS model is based on the developmental theory that competency, which serves as a buffer against failure, is the result of reciprocal and dynamic interactions between individuals and their environments (transactional). If we can examine carefully and identify the contribution that the environment makes toward reducing individual risk factors and enhancing protective factors, then we can influence the development of important quality of life skills (see Fig. 5.1). In other words, all people have personal challenges that when met with environmental challenges sets the stage for failure. But when personal and environmental challenges are countered with personal and environmental supports and protective factors, competence and success can be achieved.

Fig. 5.1

COMPASS balance

Competence looks different across the lifespan of the individual and is also person-specific. Transition to adulthood brings with it vocational decisions as well as demands for more independent living skills. The individual no longer is faced with the school routine but must now learn social and leisure activities on his/her own initiative. The social, communication, self-awareness, and emotional competencies continue to be refined and utilized throughout adult life. The extreme heterogeneity in autism requires a framework, such as COMPASS, that can be helpful for individuals independent of language, cognitive, or social abilities (Ruble & McGrew, 2013).

COMPASS was first described in 2002 (Ruble & Dalrymple, 2002) and manualized in 2012 (Ruble et al.). The original randomized controlled studies of COMPASS focused on young children ages 3–8 (Ruble et al., 2010, 2012). Two randomized controlled trials demonstrated that IEP outcomes in the critical areas of social, communication, and learning skills are essentially doubled in COMPASS. Further, the second study compared a web-based coaching approach with traditional face-to-face coaching with teachers and resulted in similar outcomes. The success of COMPASS for young children then led to NIH research funding for adapting COMPASS for transition-age youth (2018). NIH had a special request for applications in areas understudied, which included research on interventions to improve transition outcomes. Thus, this chapter will focus on our approach for adapting and implementing COMPASS with high school students. For the details of implementing COMPASS, the 2012 manual provides step-by-step instructions and protocols for the initial consultation and coaching sessions.

Approach

Because COMPASS was originally intended for young children, it was necessary to adapt it for transition-age students. This was because transition brought about a different way of thinking of IEPs and how we make decisions. For young children, we assess the needs across developmental areas and use our assessment results to determine IEP objectives. For transition-age youth, we identify postsecondary outcomes and use this information to develop IEP objectives that are designed to reach these outcomes. For effective transition planning, postsecondary outcomes and the strategies to meet them must be clear, measurable, and consistently revisited over time, based on careful monitoring of progress or lack thereof.

To ensure that the adaptations made for COMPASS reflected student, parent, and teacher observations of effective transition planning, we conducted a series of focus groups (Snell-Rood et al., 2018) to help identify our adaptations. In the following section, we summarize the results.

Focus Groups

Before we adapted COMPASS for transition-age youth, we wanted stakeholder perspectives ahead of time. When adapting an intervention, obtaining information from the people impacted by the intervention is important because we wanted to confirm what aspects of good transition were embedded in COMPASS and what needed to be added. We sought to understand the facilitators and barriers of positive, thoughtful, and thorough transition planning through the lens of stakeholders. We asked stakeholders about (1) implementation practices (i.e., critical players, services, processes, and outcomes); (2) barriers and facilitators to good transition planning and transition interventions; (3) the role of collaborative relationships (i.e., interagency, intra-organization, and family-practitioner) and policies (i.e., federal, state, and school); and (4) what additional measures should be used to evaluate outcomes.

1. What are the critical elements of good IEP transition planning? What would we see as a result of good transition planning? Who should be involved? Who are the critical players? And what are the key services that we should be described in the transition plan?

2. What are the main barriers or challenges that make it difficult to achieve good IEP transition planning and what are potential solutions to these challenges?

3. What are the critical elements of a good transition intervention? What would we be able to observe with a good transition intervention? What services, agencies, organizations, federal, state, and local that could/should be accessed and included?

4. What are the main barriers or challenges for good transition intervention and what are potential solutions to these challenges?

5. How will we know if transition planning has been successful (what intervention outcomes should we expect), and how could we best observe this or know it has been achieved?

We met with 40 stakeholders who represented individuals with autism, parents, classroom teachers, school administrators, adult service providers, and state policymakers and asked the groups to consider the questions detailed in the box. We analyzed their responses and identified three major themes related to good transition planning and implementation of transition plans: (a) the planning process that takes place in schools to help students prepare for transition; (b) the struggle to initiate life beyond school; and (c) efforts to gain and maintain employment. The first theme was most relevant for school-based interventions, such as COMPASS. The other themes highlight the importance of context and collaboration and input from key players, including adult service agencies.

For the first theme concerning the transition planning process, stakeholders described several limitations of the current process such as inappropriate assessment for goal-setting and skill development, and poor communication, including insufficient involvement of all key players responsible for decision-making needed for good planning. Underlying all their concerns, one consistent theme was the crucial need for collaborative relationships between school, home, and community agencies. Another common concern was the lack of an adequate planning approach that accounted for the full continuum across the autism spectrum. Families lamented that overall the responsibility for transition planning and the implementation of the plans shifted from the schools to them. We will talk more about this finding and its implications in a later section.

Steps to improve implementation of transition planning. Participants of all backgrounds suggested that IEP meetings could be improved by holding planning sessions beforehand to prepare participants to make decisions at the actual meeting. Direct, continued communication between schools, families, individuals with autism, and community providers is necessary for understanding and informed decision-making. Moreover, the use of collaborative, accessible language that parents understand would facilitate more equitable involvement. Many recommended that the key players (e.g., employer and service providers) needed for effective transition planning might vary depending on student needs.

For the second and third themes: (a) struggle to initiate life beyond school and (b) efforts to gain and maintain employment, stakeholders likened the experience of transition to walking off a precipice. They noted a lack of services for young adults post-transition despite policy mandates, inadequate oversight and accountability of implementation of adult services, and little training for adult service providers to work with adults with autism. Policies that emphasized differentiating between children and adults were viewed as limiting access to adult services. They repeated the need for collaborative community relationships, with shared understanding of each other’s roles and how best to work together to create a more seamless experience to enhance best practices, and a long-term approach to the measurement of transition outcomes. They also observed that transition plans do not address educational benchmarks necessary for employment and that insufficient assessment of employment abilities and opportunities created barriers. They noted that job and individual-specific support were essential and that ongoing assessment of employment needs was necessary. Lastly, they returned to collaboration, noting that collaborative community relationships are critical to support employment of young adults with autism.

COMPASS Adaptations

Based on the focus groups, we adapted COMPASS accordingly. We made four key changes to COMPASS for transition youth: (1) We revised the process of the consultation to include a discussion of future plans for the next 5 years. (2) To include the voice of the students, we updated the COMPASS Profile Assessment for Middle/High School Autistic Youth and Adults to include more age-appropriate skills and a self-report version; this activity led to different forms being used during the consultation. And (3) we developed a top ten list of critical activities to be completed by parents and youth and (4) a transition process resource guide that helps explain what transition planning is, who the key players are and their primary responsibilities, and a timeline for planned activities. We review each of the changes briefly and provide the forms on our website www.compassforautism.org.

Updating the COMPASS Process

In our first book, we describe the COMPASS intervention and the activities associated with the two parts of the intervention (initial consultation and teacher coaching sessions) and provide the forms and handouts used for the program. The basic structure for COMPASS for young children was retained for the transition-age youth. The main difference is that the original COMPASS program was developed for children between preschool and elementary school age. COMPASS for transition, like COMPASS for the younger children, consists of the same two primary activities, the initial consultation and coaching sessions, that are distinct but related.

The original framework for the COMPASS intervention is illustrated below (Fig. 5.2) with the white boxes. It consists of two action steps: first, the initial consultation where goal setting and intervention planning happens with the caregiver, student, and teacher, and second, the coaching sessions that involve activities of monitoring student progress, monitoring teacher adherence to the implementation of intervention plans, and problem-solving or modifying intervention plans as necessary.

Fig. 5.2

COMPASS activities. (Copyright © 2018 by the American Psychological Association. Reproduced with permission. Ruble et al. (2019)

The changes are represented by the dark arrows on the right in Fig. 5.2. The first arrow refers to an added and necessary discussion of the student’s postsecondary goals (future planning; see box) following high school. To identify post-school goals, a training packet (available online compassforautism.org) was created and provided to all the participants that included, in addition to discussion of future planning, an overview of COMPASS, best practices for transition, and the outline for the session.

Future planning

1. What will she/he do during the day? (employment, postsecondary education, community participation)

2. Where he she/he live?

3. How will she/he move about in the community?

4. How will she/he make decisions about finances?

5. What will she/he do for recreation and leisure?

6. How will she/he develop and maintain friendships and relationships?

After discussion of each of the goal areas, including the postsecondary goals, intervention plans were made. This plan was revisited during each of the follow-up coaching sessions. Most importantly progress toward implementation of the plans was discussed, and, when necessary, problem-solving occurred when progress was not made and plans were changed accordingly.

Profile Assessment for Middle/High School Youth with Autism

Similar to COMPASS for young children, for transition-age youth, parents, teachers, and students (when possible) are asked to complete a profile. The profile identifies the student’s preferences, strengths, frustrations, and dislikes as well as self-management, behavior, social, communication, and learning skills strengths and challenges. The profile is reviewed during the initial consultation so that common strengths and challenges are identified at home and school, as well as differences. Further, the profile pinpoints critical self-determination skills of social, emotional, and learning goals necessary for and linked to positive post-school goals and aspirations. After the skills are identified and turned into measurable goals, individualized interventions are developed for each goal with consideration of the student’s personal/environmental challenges and supports. We provide a detailed case study later in the chapter that illustrates the full process, including the intervention plans.

In our first book, we referred to the profile as the COMPASS Challenges and Supports form or the joint summary form, aka the COMPASS Profile. For transition youth, the profile was adapted in two primary ways. First, a self-report version of the assessment was developed. To the greatest extent possible, the voice of autistic students must be part of the transition planning process. In our test of COMPASS for transition youth, about 1/3 of the consultations involved students who were able and desired to complete the self-report. A self-report version of the COMPASS Profile is available online on our website compassforautism.org. Second, the profile was updated based on age-appropriateness for autistic youth.

Caregivers and teachers completed the COMPASS profiles separately which were then aggregated into a single report allowing for ratings to be viewed side-by-side. As a side, teacher feedback about the usefulness of the profile of the student at home, school, and in the community was that it was extremely helpful (see Chap. 4 for more details on caregiver and teacher perceptions of COMPASS and especially the profile). The COMPASS Profile (for adolescents and adults) assessment for autistic youth is available as a .pdf online at compassforautism.org. There is also an electronic version available on the website that is part of the electronic consultation and coaching platform. Both the caregiver and teacher forms are freely available at no charge.

For students who were unable to complete the profile due to difficulties with reading and comprehension skills, we met with the students in advance of the consultation and conducted an interest assessment of likes and dislikes. This assessment also included activities designed to elicit work skills (starting and completing a task independently, asking for help, making a request). Common to these students were the need for augmentative and alternative communication approaches to facilitate comprehension and expression as they were generally nonverbal and also had intellectual disability. Thus, we also assessed ability to understand visual supports and identified those which were most comprehensible. This allowed us direct knowledge of the student that helped generate ideas for goals and intervention strategies during the first consultation.

Top Ten Resource List

As mentioned, our focus group members discussed a need for information that was accessible and understandable by all key players, especially parents when it comes to important areas related to transition planning. They also reported a need for information on a variety of areas such as guardianship, employment, etc. and where to go for help. As a result, we generated a resource list that was shared with parents prior to the initial consultation. We provide an example of our list for one state, Kentucky, on our website compassforautism.org. We hope that this can serve as a template for providers to use from other states. It is necessary for consultants located in different states to update this information to reflect their own state agencies and services as they change over time.

Transition Handout Reference Guide

Closely related to the top ten list is another reference guide that focuses on transition specifically and to important related players. In our reference guide, we describe what the transition process is, who the important people are that make up the process and what their roles are, employment, supported employment, educational opportunities after high school, and a transition planning timeline. We also provide the federal and state education law related to transition. The example we provide is for the State of Indiana. Like the top ten list, the reference guide would need to be adapted for the consultant’s specific state and updated as laws, agencies, and services change.

COMPASS Effectiveness

To test COMPASS for transition youth with the modifications, we conducted a randomized control trial (RCT). Research using RCT designs are the strongest because participants are randomly assigned (such as with a flip of a coin) to a group. One group receives the intervention, and the comparison group receives services as usual. This design ensures that group differences that might account for superior outcomes within the COMPASS group (e.g., fewer individuals with intellectual disabilities) are equally distributed across the two groups. Making sure the students in the groups are similar is important because research on early intervention for young children did not always use RCT designs. The Lovaas study, as an example, was limited because the researchers failed to randomize group assignment. As a result, children who were in the intervention had fewer autism symptoms than the comparison group who did not get the intervention (Schopler et al., 1989); thus, superior outcomes could have been due to intervening with less severely impacted individuals. We know from other studies on early intervention that the children who start an intervention with better cognitive, language, or adaptive behavior skills and less autism severity achieve higher outcomes compared to children with lower scores in those areas (Ben-Itzchak & Zachor, 2007) as the Lovaas study found.

For our RCT of COMPASS with transition youth, we report details of the study in our published paper (Ruble et al., 2018) and summarize it briefly here. We recruited 20 participants including the student, caregiver, and the special education teacher. Eleven students were randomized into the COMPASS group. The comparison group teachers received online professional development on three evidence-based practices of their choosing in transition planning. The activities reported in Fig. 5.2 were also completed. After the initial consultation, the COMPASS participants identified goals that were updated and included in the IEP and then used to create a goal attainment scale (GAS) for each goal. For the comparison group, goals from the student IEPs were used to create a GAS. This allowed for direct comparison on goal progress and type of goals at the end of the school year. We describe the goal attainment scale process in our first book in detail (Ruble et al., 2012). At the end of the school year, a researcher who was not part of the COMPASS intervention and who was unaware of what group the teacher or student were assigned conducted teacher interviews and observed videos of the student’s skill level for the goals. Having a rater who was blind to group assignment helps reduce bias in the findings and provides additional confidence in the results. The final GAS scores were averaged, and a mean score of 3.6 was obtained for COMPASS and 1.9 for the comparison group. This was a significant result that would be observed by chance in less than 1/1000 replications. A very large effect size of 2 was obtained meaning outcomes were more than 2 standard deviations higher for the COMPASS group compared to the services as usual group. To help illustrate the COMPASS process, below, we provide a detailed case study.

Case Study of Tony

Tony is an 18-year-old senior in high school. He attends both a resource room and general education classroom. He spends about 5 hours a day in general education and receives special education services from his IEP under the eligibility of autism and intellectual disability. His IQ, based on the Kaufman Brief Intelligence Test, is 57, and his language skills, based on the Oral and Written Language Test is 77. Assessment based on the Behavior Assessment Scale for Children (BASC) revealed parent-reported standard scores that fell within the average range for externalizing, internalizing, and aggression (mean scores between 53 and 59). Ratings from the behavioral symptoms index were elevated (72), and adaptive skills were low (32). Teacher-reported scores from the BASC were consistent with parent report of externalizing and aggression subscales, but internalizing behaviors were elevated (73) along with scores for the behavioral symptoms index (68); further adaptive behavior was low (37). The Vineland adaptive behavior composite was 77 based on teacher report.

For services, Tony received Medicaid waiver services. He has a Community Living Supports (CLS) worker (who is not always available because she is in school) and a case manager. He receives behavioral therapy about twice a week for about 2 hours. Tony says that he vents his frustrations with her, works on making greetings and eye contact and social skills. He also receives occupational and speech therapy. There are more comprehensive services provided through a different waiver program, but he is on a waiting list. This program would fund residential services.

Although Tony has intellectual disability in addition to autism, he and his mother decided that he would leave school after he turned 18 rather than continue his public-school program. When asked about this decision, his mother explained that she was ready for Tony to move on because school has not been helpful. She said he has had the same goals year-after-year, and she does not see any benefit. She shared Tony’s history of hospitalizations for anxiety and externalizing behaviors and felt that school was the primary reason for his mental and behavioral health challenges. A year ago, Tony was hospitalized for aggression. Although he was allowed through IDEA to continue his education and despite not having any postsecondary services planned, his mother was fed up. A review of his IEP revealed that Tony had five IEP goals, including a goal for communication and the rest for academic skills. However, he had no social emotional learning skill goals. For postsecondary goals, Tony had goals related to employment, education/training, and independent living. But they were written as one goal rather than separate goals making specific plans almost impossible to follow (see Chap. 3 for more detailed discussion of transition IEPs).

COMPASS Consultation

Prior to the consultation, Tony, his mother, Ms. Blair, and his teacher, Mr. Schall, completed the COMPASS Profile provided in the appendix. The consultant took copies of the aggregated parent and teacher ratings represented in the joint summary report of the COMPASS profile to the consultation. Tony’s self-report was also included. Both the vocational rehabilitation counselor and his case manager were invited but unable to attend.

The Initial Consultation: Setting Goals and Developing Intervention Plans

Future planning. For the initial consultation, the consultant began by discussing Tony’s future plans for where he would live, what he would be doing, and how he would spend his leisure time. Projecting out 5 years, Tony said that he could see himself living on his own, perhaps with a roommate, at which point his mother reported that he did not have the supports for community living (SCL) waiver that would help fund residential services and was on a waitlist. He and his mom discussed a meeting they attended the day before on housing and that, so far, the options available are based on having SCL services that he does not have access to yet. His mother went on and said

Parents have set up for their children to be independent. And um, kind of emphasizing too that you want to get your child as independent as possible. Because if anything does happen to you, you want it to be a smooth transition and they already know what they’re supposed to be doing, and they already have their supports in place.

She went on further “And that kind of thing, so you know it’s not a good thing to think about, but you don’t want them be living with you and then all of the sudden something happens and it’s just a complete upheaval for them.” Tony does receive a different Medicaid waiver and has a case manager and community living skills (CLS) worker. The consultant discussed his current waiver and how it could be used to teach some of the daily living skills such as cooking and transportation that would relate to Tony’s long-term goals of living on his own and asked if the CLS worker could attend the follow-up COMPASS sessions.

When discussing future employment, Tony reported that he was interested in being a tour guide. He was especially interested in the paranormal and wants to work in a haunted house as a tour guide for one located in a different state. When education or training was discussed, Tony and his mom expressed concern that there was a training program he wanted to attend but that it was in a different town. If he moved away to this residential training program, he would lose his waver services because the CSL services required Tony to receive services at least monthly. She also mentioned another program with mixed feelings—a college-based experience for students with intellectual disability located in his town as an option. His mother concluded

Because I see him struggling here [at school], I don’t understand why he wants to continue with college. But that’s not his perspective. So, you know I’ve kind of…Part of me says, I just need to step back and let him do what he wants to do and make his own conclusion. I think and I’ve told him that.

For leisure activities, Tony’s mom reported that he is part of the Special Olympics. He also enjoys sporting events and horse racing. He described that he wants to be able to make the same choices as anybody else his age and have survival skills. For transportation, Tony’s mom wants to work on getting him around independently in the community because she drives him everywhere. His mom says he will walk or ride his bike, but he cannot do that where they live.

COMPASS Profile

Next, the consultant turned their attention to review the COMPASS profile (see Appendix). Tony has several preferences and interests such as horse racing, spy movies, paranormal, sports, and certain foods. He has a great memory and knowledge of certain topics such as horse racing. Both his teacher and mother reported independently that he is a kind and caring person. For frustrations, his mom reported concern of Tony “mirroring behavior” of others if he is confronted. She explained that if Tony interacts with the police and they confront him, he will mirror their behavior and things may escalate. His mom described a situation that happened once with a female police officer who remained calm. Because she was calm, he remained calm. Mom states that Tony will be aggressive if the person who confronts him is also aggressive. Tony confirmed that “If my boss yells at me I will say, ‘If you talk to me like that one more time, I’m quitting.’” Thus, the tone of voice when being corrected is a trigger for Tony. His fears are being wrongly accused or spoken to in a stern voice. His mother reported that she worries that he will yell back at the wrong person and end up hurt or in jail. She doesn’t want others to take advantage of him. His teacher also reported that Tony ruminates about disappointments, such as not being in the marching band.

For adaptive skills, more strengths than weaknesses were noted. Of the challenges, concerns about sleeping, following directions, accepting correction, participation with a group, and managing transportation were reported. Tony works from 4 to 9 pm at Goodwill, about 17–18 hours/week. Tony explained that he does not get home until 9 at night. When he gets home, he eats. His mother said that he sometimes goes to bed late or in middle of the day and does not get enough sleep, even though he seems like he is not tired. He chooses not to get dinner while at work but may get a snack at the grocery store. When asked about his job, Tony said he does not like it sometimes because it is kind of boring. At school, he received job training from an instructor who works with him during his academic internship. Mom asked if this trainer could go to Goodwill and help Tony. He is supposed to receive job coaching at Goodwill but does not. Both his mom and classroom teacher agreed that the job trainer was a good resource and could help him work on skills that could generalize to other jobs as well as different jobs at Goodwill. Mom says Tony has mentioned that he may zone out sometimes, especially while working.

For behaviors, Tony’s mom notes challenges with being overly quiet or withdrawn, engaging in behaviors that may be distasteful to others, and walking away from others during interactions. His teacher noted several of the same behaviors. His mom expressed concern that Tony’s unusual mannerisms or compulsive behavior may get in the way during the work by bringing attention to him.

For social interactions, several strengths were noted in the areas of responding to initiations. The greatest challenges fell within initiations with peers and understanding friendships. Tony does not initiate greetings to others or use the names of people. Tony clarified that he knows the names of people, but he does not like giving someone’s name to another person. He says he thinks it feels strange if a random person knows your name. He said “that would be weird” because “it feels like the name is private information.”

With communication, Tony readily initiates for personal needs such as using the toilet, but he rarely initiates for asking for information, making a choice, or asking for help. He also does not initiate with others or directly express his feelings such as when he is angry or frustrated or experiences pain. For expressing himself when his feelings get hurt, Tony said he tells people when they hurt his feelings, but sometimes he does not tell unless if it is bad; then he will report it to a teacher. Sometimes it is hard to tell the person directly who hurt his feelings, and he just ignores it. To let others know when he feels sad, he puts his head down and makes a face, not verbalizing or expressing his feelings directly. Mom notices that at home when he gets frustrated, he will move around more and make noises.

Sensory challenges and supports were also reviewed and revealed that Tony has difficulty listening or paying attention, makes self-induced noises, eats a small variety of things, does not make much eye contact, has trouble with using tools, understanding time perception and doing paper/pencil activities, and has sensitivity to some smells. Tony says he is sensitive to smells of food he does not like. Mom says the cafeteria is difficult for him. The cafeteria would not be a good job placement because of food smells and people and crowds. Tony says he likes the smells of horses. For sensory supports, he needs to move his body a great deal, likes music, the TV, videos, and the computer. Tony says he likes all music except rap. He listens to music on the computer and does research (getting information). He was on the cross country team freshman year. Running may be a good recreational activity.

For learning skills, Tony has difficulty with distractions and ability to refocus on the task at hand, starting a new task once the old one is completed, and organizing himself to perform tasks when multiple materials are in front of him.

As the consultant went through the profile, several ideas emerged for social communication skills important to help at work and school and with interactions with others. With much discussion among the team, the following three goals were selected: (i) When Tony is greeted by or sees someone, he will respond to or initiate a greeting and will follow up with a question at least twice per day with at least 90% accuracy. (ii) When feeling that he is being confronted or corrected, Tony will stay calm, acknowledge the person, and return to his work/task with 100% accuracy. And (iii) when assigned an activity, Tony will start and complete the task independently within the required timeframe with at least 80% accuracy. Table 5.1 summarizes the goals, personal and environmental challenges, and supports related to the goals, including the intervention plans for each goal. A template that can be used for creating teaching plans is available in Chap. 2 and also on our website compassforautism.org. Following the intervention plans are the postsecondary goals for Tony and the plans to reach them.

Table 5.1 Tony’s COMPASS goals and intervention plans

After the initial consultation, specific recommendations were made and activities discussed in preparation for the first coaching session (see box).

Coaching Sessions

Prior to the first coaching session, the consultant prepared a goal attainment scale (GAS) for each of Tony’s three goals (see Fig. 5.3) The GAS was used for progress monitoring and decision-making. The bolded wording reflects adjusted criterion descriptions that if met, would represent progress at that level. Tony, his teacher, and his mother participated in four follow-up coaching sessions that focused on the implementation of the intervention plans related to the IEP and to his postsecondary goals, assessment of Tony’s progress toward his goals, and problem-solving. A summary of the first coaching session and the fourth (last) coaching session is provided.

Fig. 5.3

Tony’s goal attainment scale

Coaching 1

The consultant was delighted that several of Tony’s team members attended the first coaching session including his Medicaid waiver case manager, Ms. Hirn, and OVR counselor. The team is also pleased that Tony decided to join the session. Each person participated and contributed valuable information throughout the hour and a half-long first coaching session. The team discussed the progress of each goal for Tony that was being followed throughout the school year. The team also reviewed the progress made toward each of Tony’s postsecondary goals.

Observation and Discussion for Goal 1

For each skill, the team observed a video of Tony’s most current level of performance. The first skill is when Tony is greeted by or sees someone, he will respond to or initiate a greeting and will follow up with a question at least twice per day with at least 90% accuracy. For this skill, the team observed Tony and Mr. Schall practicing how to respond to a greeting. Tony and Mr. Schall role-played a greeting and response with Mr. Schall explaining different ways Tony could possibly respond. Mr. Schall and Tony also began discussing what is okay to say to people depending on who they are such as teachers, bosses, classmates, etc. The next step is to involve Tony’s academic internship teacher, Ms. Duncan, and learning strategies teacher, Mr. Hirn, and peers to help Tony practice in a variety of situations. It was suggested that Mr. Jenkins, the speech language pathologist, may also be able to help Tony practice this skill. Mrs. Blair suggested that Dr. Henry’s “Lunch Bunch” group could be a great opportunity for Tony to practice this skill with his peers.

The team reviewed the teaching plan, and Mr. Schall stated he has not yet worked on social stories with Tony but will begin creating some samples. The skill is worked on at least once a week and data are being kept. Tony has worked on this goal with Mr. Schall. A review of progress using the goal attainment scale (GAS) form showed that Tony is making progress. Based on the video, he received a score of −1.5 because he has role-played greetings.

Observation and Discussion for Goal 2

For the second goal of staying calm, acknowledging the person, and returning to his work/task with 100% accuracy when Tony feels that he is being confronted or corrected, the team observed a video of Tony and Mr. Schall discussing emotions and his response to a recent instance when he was corrected at work. In the video, Tony stated his boss used a firm voice and corrected Tony to put clothes in the right bin. Tony said that he did not verbally respond to his boss, but did remain calm and did what his boss said because his boss did not yell at him. Tony also talked about how he did not stay calm while watching a movie at school because it made him upset. Tony provided another example when he did not stay calm when his teacher said he would have to get off the computer, if he did not stay calm. He explained that he did not yell at her or say anything inappropriate. The consultant reviewed some handouts on social autopsies, relaxation strategies, and maintaining control. At a couple of different points during the conversation related to this goal, Tony became visibly upset (rubbing his hands on his pants and breathing heavily). It was difficult for him to listen to this conversation, but he did remain calm overall. He left the room a few times. His mom asked him to explain where he was going, and he did. But on his own, he came back to join the conversation each time.

The teaching plan was reviewed, and the consultant discussed involving Dr. Henry (school psychologist) to talk to Tony about the importance of staying calm and different calming strategies. The consultant also discussed possibly allowing Tony, when he is upset, the opportunity to state he needs a break, then to step away, calm down, and then come back when calm as he demonstrated today. Tony’s other teachers would have to agree to this as well. Tony has worked on this skill one time and data are not being kept. The consultant discussed tracking data by having Tony report to Mr. Schall at the end of English class any instances he stayed calm. The following sentence was developed for Tony to use for his self-report: When I was upset (write number of times you were upset), I stayed calm (write number of times you stayed calm). Tony has worked on this skill with Mr. Schall and peers. A review of progress using the GAS form showed that Tony is making progress. Based on the video, he received a score of −1 because he was able to stay calm and return to his work when he was corrected. He also stayed calm during the conversation of this goal and returned to the discussion. The team praised Tony for his efforts of staying calm and returning to the session, and reminded him how important his input was for his program. 

Observation and Discussion for Goal 3

For the last goal of starting and completing the task independently within the required timeframe with at least 80% accuracy, a video of Tony demonstrating the skill was not made. The team reviewed a sample of Tony’s English assignment given by Mr. Schall. Mr. Schall said he gave the assignment to Tony, walked away, returned, and saw that Tony had stopped working. Tony explained he will sometimes “zone out” while sorting clothes at work and he has been asked to not do this by his employers. Tony also indicated he sometimes chews clothes when he zones out and says his counselor at work has told him to not chew on the clothes. He is aware of his chewing and more problem-solving about this would be helpful (such as why he chews, what can he do to replace this skill with something more appropriate).

The consultant reviewed the teaching plan and clarified the goal for this skill is to occur once per week. The new goal reads: When assigned an activity, Tony will start and complete the task independently within the required timeframe with at least 80% accuracy once per week. The consultant suggested that he work on this skill daily, even though data might be collected only once a week. The skill has been worked on once and data are not being kept. The GAS form was reviewed; however, because no video was available for review, the consultant did not assign a GAS score.

Review of Postsecondary Goals

Next, the consultant reviewed the progress toward each of Tony’s postsecondary goals. See the attached table for progress toward the goal using the three-point scale (1 = no progress; 2 = some progress; 3 = completed). Table 5.2 shows the ratings of progress toward postsecondary goals. Ratings of 2, some progress, were given at the first coaching session. Some plans had not been implemented and received no score.

Table 5.2 Tony’s postsecondary goals and plans

Next Steps

The team made the following recommendations for the next coaching session, including adding the goals into Tony’s IEP and obtaining more involvement from his team.

• 1. Adding the goals to the IEP, both the personal goals and the postsecondary goals

• 2. Getting Ms. Duncan, Mr. Hirn, and Mr. Jenkins involved with goal one

• 3. Getting Dr. Henry involved with goal two

This coaching session should take about 1 hour. The consultant hoped that Tony, Mr. Schall, Mrs. Blair, Ms. Hirn, Ms. Prater, and Tony’s behavior specialist might attend.

• 1. To make this time as efficient as possible, please have the following done:

  • Make a short video of Tony working on each of the goals.

  • Collect the most recent data regarding each of the three goals.

  • Be ready to discuss ideas for the teaching plan and any tweaking of the plan that needs to be done.

• 2. In addition to discussing the progress on the individual goals, the consultant will also talk about the action plans for and progress with the postsecondary goals described below for Tony (Table 5.2).

Coaching 4

The consultant met with Tony, Mrs. Blair, Mr. Schall, the VR counselor, and his CLS worker for the final coaching session. Tony’s behavior specialist was also able to join us by phone. The team discussed the progress of each goal for Tony. The team also reviewed the progress made toward each of Tony’s postsecondary goals.

Observation and Discussion for Goal 1

For the first skill When Tony is greeted by or sees someone, he will respond to or initiate a greeting and will follow up with a question at least twice per day with at least 90% accuracy, the team watched a video of Tony and Mr. Schall practicing how to greet someone or respond to a greeting. Tony and Mr. Schall role-played a brief conversation consisting of a greeting, response, and at least one follow-up question. Mr. Schall initiated the first greeting and then let Tony practice initiating. At this first attempt, Tony’s voice was too low for Mr. Schall to hear. Mr. Schall discussed appropriate volume and different forms of greetings and let Tony try again. At this next attempt, Tony’s volume was more appropriate. Throughout the role-play, Tony asked appropriate follow-up questions. The team reviewed the teaching plan. The skill is worked on at least once a day, and data are being kept with Google Docs. Tony has worked on this goal with Mr. Schall and other teachers. A review of progress using the goal attainment scale (GAS) form showed that Tony has exceeded his goal. Based on the video, he received a score of +1 because he can respond to a greeting and will follow-up with more than one question. To achieve a higher score, Tony can begin to ask more questions and will respond to or initiate greetings with different people, such as peers.

Observation and Discussion for Goal 2

For the second goal of staying calm, acknowledging the person, and returning to his work/task with 100% accuracy when Tony feels that he is being confronted or corrected, the team observed a video of Tony and Mr. Schall role-playing a work situation in which Tony’s boss is correcting Tony in a stern voice. Tony remained calm when being corrected in the role-play and in the discussion about the goal. Mr. Schall and Tony discussed ways Tony could respond assertively in such a situation. Tony and Mr. Schall also discussed different strategies for staying calm including taking a time out to take a deep breath and picturing oneself as the eye of a storm to stay calm. Tony shared an instance in which, while working on the tech crew of a school play, Tony was given tasks to complete by his teacher in a stern voice. Tony states he stayed calm because he remembered that doing those tasks are part of his job and that is why he is there. Tony also shared an instance in which he felt a lot of pressure to do well during a softball game and states he gave himself a time out, took a deep breath, and then resumed playing. The teaching plan was reviewed. This skill is worked on daily with Mr. Schall, and other teachers and data are not being kept. A review of progress using the GAS form showed that Tony has met and exceeded his goal and received a score of +1.

Observation and Discussion for Goal 3

For the last goal of starting and completing the task independently within the required timeframe with at least 80% accuracy once per week, the team watched a video of Tony starting and completing a reading task given by Mr. Schall. Tony was instructed to read a passage and then answer three questions. Mr. Schall and Tony report he took 15 minutes to complete the task. Tony reports he “zoned out” at one point during the task but states he was able to bring himself back on task. The team discussed different ways to help Tony stay on task such as using a wrist watch with a timer set to vibrate every 5–10 minutes (depending on the task) or using a printout that Tony can use to self-monitor every 5 minutes by making a checkmark if he has stayed on task or an “X” if he has zoned out. The team also discussed possibly giving a reward if Tony is able to stay on task 100% of the time. This will be further discussed by Tony and his mom. The team reviewed the teaching plan. This skill is worked on daily and data are being kept. This skill is worked on with Mr. Schall and other teachers. Based on teacher report and the video, the team determined that Tony is at the −0.5 level on the GAS form.

Postsecondary Goals for Tony

Next, the team reviewed the progress toward each of Tony’s postsecondary goals. See Table 5.2 for the last coaching session ratings. Unlike the first coaching session where many plans were not yet initiated, all plans were in process during the final session. Almost half of the goals were achieved. For those areas that were in progress, the team talked about Tony learning how to contact the local transportation services to set up rides. The consultant also talked briefly about budgeting and spending. His vocational rehabilitation counselor will search for resources on teaching budgeting. These would be good goals to target at school, home, and out in the community.

After the coaching sessions, the following next steps were planned:

• 1. Make video of progress on each goal for final evaluation.

• 2. Continue to work on responding at an appropriate volume, asking more follow-up questions, and initiating greetings with different people.

• 3. Continue to practice calming strategies and teaching the difference between assertiveness and aggressiveness.

For the final assessment of Tony’s progress, the consultant will make plans to call Mrs. Blair so she can join by phone conference to discuss the postsecondary goals and their accomplishment. The consultant also planned to take a few minutes to talk with Tony.

To make this time as efficient as possible, the consultant asked that the following be done:

• Make a short video of Tony working on each of the goals. If possible, email the videos ahead of time for a more efficient meeting.

• Collect the most recent data regarding each of the three goals and provide an example of each.

In conclusion, in this chapter, we described our process for adapting COMPASS for transition-age autistic youth. We also reported the success of COMPASS for achieving IEP goals and postsecondary goals. We concluded with a detailed case study of a student, Tony, and his outcomes. The case study illustrates that complex decision-making in all areas of life that need to be addressed during transition. Many individuals are often involved—teachers, pre-employment specialists, vocational rehabilitation counselors, Medicaid wavier personnel, case managers, and more. But the most important individuals are the autistic youth and young adults and their family members. We learned that the postsecondary goals for community living, employment, leisure, transportation, budgeting, etc. require specific planning and strategies that fall on the autistic student and/or caregiver to implement. Often these plans generated ideas and discussion that involved a network of services and people that required organization, communication, and follow-up.

COMPASS Profile

COMPASS Consultation

Download print-ready, use-ready Versions of many helpful forms at https://compassforautism.org/blank-forms/