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How to Implement Natural Support Strategies in Employment and Community Settings

Keith Storey, Ph.D., BCBA-DTouro University, Graduate School of Education

Keith.Storey@tu.edu

What Are Natural Supports?

Goetz, Certo, Doering, and Lee (1996) define natural supports as:

Natural supports refers to a person (or people) who agree(s) to provide assistance or feedback, or provide companionship to facilitate independent or partially independent performance in employment settings, for or with an individual with severe disabilities, and for whom the provision of such assistance, feedback, contact, or companionship is not their primary responsibility, regardless of whether or not they are compensated. (p. 290)

In the workplace, natural supports involves work-site personnel and others providing support to employees with ASD with a special emphasis on enhancing social integration.

Natural supports can be important both for job skill development and social integration.

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Can involve techniques such as “hanging out” during social functions, building trust, reassuring people (co-workers), encouraging a multitude of formal and informal interactions, and “fine-tuning” new and existing social networks.

There appears to be a logical connection between natural supports in the workplace and in the community. If a person with ASD is integrated in a job with good pay then they are more likely (but not guaranteed) to have skills and supports for integration in the community.

Why Are Natural Supports Important?

It has been suggested, though only minimally empirically validated, that the presence of job coaches and other human service professionals inhibits interactions between the person with ASD and others.

Social integration is one of the most important reasons for supported employment services for individuals with ASD.

A worker may be physically integrated, but socially segregated in a work setting.

Natural supports are a way of developing appropriate supports and increasing social integration.

Each worker needs to be considered individually and supports then built around their needs, rather than arbitrarily deciding that any one method is always best for all individuals.

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Co-workers have been able to provide verbal instructions, modeling, prompts, feedback, and praise to SE workers. In addition, they already know the job. They may be able to provide very much the same instruction that a job coach might, but need to be taught the instructional skills.

Overview Study

Researching social interaction patterns related to the type of training workers with disabilities received while on the job. The use of a job coach who directly provides training to the employee with a disability or the use of a “mentor,” a co-worker that provided training (with support from an outside agency).

Ten employees with severe disabilities in each of the two categories.

Measurement

The number and type of reciprocal interactions that occurred between supported employees and non-disabled co-workers.

Each employee was observed on two different occasions during 30 minute sessions.

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Applied Example 1

Cassie was a 27-year-old woman with a developmental disability.

Her labels included emotional and mental disturbances, moderate mental retardation, and sensory integration problems.

For 13 months prior to the start of the study she had been employed at a restaurant where her job duties were to set and bus tables and set silverware.

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Measurement

Direct observation of frequency of type of interaction (initiating, continuing, terminating).

Where the interaction occurred.

With whom the interaction occurred.

The topic of conversation.

Was it the appropriate social occasion and the right time.

The task in which the person was engaged.

Was it with an appropriate person.

Intervention

TEACHING CO-WORKER TO TEACH 2 NEW JOB TASKS

One non-disabled co-worker (who was a waitress and also the shift supervisor) was how to use instructional strategies of verbal instructions, modeling, practicing the next step with corrective feedback, praise, and quality-control checking.

The co-worker was taught the skills during 20-minute training sessions. After modeling the teaching of the job task, the co-worker then “taught” the job task to the researcher and the researcher provided feedback to her.

INTERVENTION 1: CO-WORKER TEACHING CASSIE 2 NEW TASKS (wiping down seats and asking customers if she could “take their plate”:

The training sequence involved:

1. The co-worker providing a verbal description,

2. Modeling the steps,

3. Having Cassie practice the steps,

4. Providing corrective feedback as necessary,

5. Praising correct responses.

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Interactions

INTERVENTION 2: ENCOURAGING CASSIE AND CO-WORKERS TO INTERACT:

1. The researcher talked with the co-worker who had provided training in Intervention 1 about the importance of involving Cassie in social interactions.

2. The co-worker talked with Cassie about it being okay to spend more time interacting with co-workers and that they enjoyed talking with her.

3. The co-worker talked with each of the co-workers about the importance of including Cassie in their social interactions. She suggested that when Cassie passed by that they make a comment that would illicit per participation in a current conversation.

Interactions

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Initiations

INTERVENTION 3: QUESTION ASKING INSTRUCTION:

1. Involved role-playing a series of question-asking conversational exchanges appropriate to conversational context.

2. Question-asking was taught by: A. Giving a rationale for asking questions.

B. Modeling examples of different questions using socially validated topics.

C. Practicing asking questions by role-playing and corrective feedback.

D. prompting question asking during training conversations.

E. Reinforcing appropriate behavior.

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3. Expansion Training:

A. Training involved producing a response which expanded upon the statement which just occurred.

B. Cassie was prompted to ask questions which would initiate a new topic or expand the current topic.

C. Conversational topics were selected by having workers fill out a questionnaire to determine topics of conversation they preferred to having with their co-workers.

Interactions

Initiations

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Conclusions

Initial co-worker instruction did not adequately increase Cassie’s social interactions. Cassie would pass by co-workers but seldom initiated interactions during Intervention I and if coworkers did not initiate towards her then no interaction occurred.

By directly teaching Cassie social initiation skills, she was less dependent upon the initiations of others for social interactions.

Applied Example 2

The purpose of this study was to assess whether an individualized “package” of social supports and instruction would increase the social integration of a supported employee with very significant disabilities.

Jake was a 40-year-old, basically nonverbal man whose labels included cerebral palsy and severe intellectual disability. He had 1:2 support from a job coach.

He was working as a Stocker’s Helper at a large discount store 3 days a week, 2 hours per day. He partially participated in the processing of shipment in the receiving area, light stock work, and returning of fitting room itensto the floor racks.

Phase B: Change of Job Duties:

Jake’s duties were changed to allow him to work in various departments on the store floor where more social interactions occurred among non-disabled workers.

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Phase C1: Natural Supports Intervention During Work:

This intervention consisted of training a non-disabled co-worker from the receiving area to directly support Jake for this first half hour of his shift.

Phase C2: Natural Supports Intervention During A.M. Break:

During this intervention, a non-disabled co-workers (food court casher and meal preparation employee) was trained to support Jake in ordering and preparing his morning coffee.

Phase C3: Natural Supports Intervention During P. M. Break:

This intervention consisted of training a non-disabled co-worker who worked as a cashier and food preparation employee in the food court (but different than the A. M. break natural support co-worker), to take Jake’s order and bring the order to Jake’s table instead of having Jake go up to the counter to get it (which required support from jake’sjob coach).

Frequency of ND Interactions

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Phase D: Introduction of Adaptive Equipment.

This intervention consisted of introducing a hand held, touch activated, voice output communication device, which Jake carried next to him on his wheelchair. No instruction was given to Jake, his job coach, or non-disabled co-workers.

Phase E: Intervention Package:

1. The co-workers who had provided natural supports were asked to continue to provide support and to involve Jake in their social interactions throughout the store.

2. Jake, his job coach, and non-disabled co-workers were trained to use the communication device to facilitate Jake’s participation in conversations.

3. Jake’s job coach was given training in facilitating social interactions (how to physically support Jake to use his device to ask questions of co-workers, how to help Jake initiate and continue conversations, and how to informally educate co-workers about Jake.

Frequency of ND Interactions

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Conclusions

No one intervention proved successful in and of itself. Package of individualized supports was necessary.

Social interactions heavily dependent upon job coach.

Important that SE staff be well trained and able to provide a variety of supports. They can make or break a situation (facilitate or be barriers to social inclusion).

Jake had skill deficits which made social interactions difficult (lack of eye contact, basically nonverbal, did not attend to others well, needed help maneuvering wheelchair).

Applied Example 3

3 Job Coaches with 16 months, 4 years, and 13 years working as job coaches.

3 Participants: Nancy was 32 years old with diagnoses of

cerebral palsy, epilepsy, depression, and intellectual disability.

Luke was 31 years old with diagnosis of intellectual disability.

Joanne was 21 years old with diagnosis of intellectual disability.

Measurement

The Job Coach/Natural Supports Record with 43 factors divided into 2 categories: The job coaches' rapport with the supported

employee.

The rapport of the supported employee with her/his co-workers and supervisors.

The checklist served as both a data collection form and a feedback form.

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Intervention

The intervention consisted of two training sessions. In the first session the researcher met privately with each job coach for 1.5 hours to: Review the purpose of the study.

Discuss the Job Coach/natural Supports Record.

Assign two articles to read related to natural supports.

Answer any questions/concerns.

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The researcher explained and provided examples for each of the 43 natural support strategies.

The baseline data from the researcher's observations were presented and discussed.

Roleplaying regarding how to implement natural support strategies.

In the second session (a half hour) the two articles were discussed and any questions/concerns were addressed.

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Conclusions

When the job coaches utilized the natural supports checklist, they in- creased and varied the natural support strategies over a 6-week to 8-week period of time.

All job coaches included co-workers more often in discussing issues with the sup-ported employee, and they all encouraged the supported employee to start conversations with co-workers based on common interests.

The Job Coach/Natural Supports Record served to acquaint job coaches with a wide repertoire of strategies while working. However, two hours of instruction and reading academic material based on the subject, may not constitute sufficient training to ensure competent use of natural support strategies by job coaches.

The challenge continues to redefine the role and approach of job coaches so that their behavior facilitates the involvement of work-site personnel (i.e., natural supports), while remaining active and supportive when needed; that is, to act as a facilitator or consultant to the business, identifying, engaging and maintaining supports internal to the workplace

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Applied Example 4

Four high school students with diagnoses including Learning Disabilities, Severe Emotional Disturbance, and Language Delays.

They were working in one of two rooms at a state social services agency. They worked either by themselves or with a job coach provided by the school district.

Their job task was to put together social service client packets which were distributed to social service workers.

Measurement

The frequency and type of interaction (initiating, continuing, terminating)

With whom the interaction occurred.

The topic of conversation.

Intervention:

1: Teaching non-disabled co-workers instructional skills using the “Tell-Show-Watch-Coach” teaching sequence.

2: Changing student job tasks (computer work and copying, form processing, and sorting mail)

3: Having the non-disabled co-workers teach the new job tasks.

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Guidelines for Implementing Natural Support Strategies Use Wellness programs already in place at job sites.

Hanley-Maxwell & Millington, 1992.

Use existing employee assistance programs.

Hanley-Maxwell & Millington, 1992.

Use existing Basic Skills Training programs.

Hanley-Maxwell & Millington, 1992.

Use mentoring programs. Hanley-Maxwell & Millington, 1992.

Use apprenticeships. Hanley-Maxwell & Millington, 1992.

Use mentor after initial job development, analysis, and training. Nisbet & Hagner, 1988.

Use job sharing options Nisbet & Hagner, 1988.

Attendant hired by worker with disability. Nisbet & Hagner, 1988.

Use mentors for initial training. Lee, Storey, Anderson, J., Goetz, L., & Zivolich, 1997

Anticipate personnel changes. Woolcock, 1995.

Ongoing dialog and regular meetings between all persons involved is critical. Woolcock, 1995.

Base instructional plans on methods co-workers naturally use. Woolcock, 1995.

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Training program should emphasize behavioral rehearsal, and discussions and modeling with verbal descriptions.

Shafer, 1986.

Model appropriate social responses. Certo et al., 1995.

Be present during social functions (e.g., holiday party) to capitalize on potential interactions. Certo et al., 1995.

How to (and how not to) Facilitate Natural Supports + Encourage SE to greet and say goodbye to co-workers as

part of the work routine

- Allow SE to slip in and out of work relatively unnoticed.

+ Encourage co-workers/supervisors to address the SE directly. Be a consultant rather than a surrogate supervisor

- When a co-worker/supervisor has a problem with a SE say “I’ll take care of it.”

+ In addition to checking in, ask specific questions such as “How are you giving _____ feedback? Do you need any advice?

- When checking in, only as vague questions such as “Is everything okay with _____?”

+ Assist the SE to share with co-workers/supervisors (i.e., holiday cards, birthday gifts, donuts, etc.)

- Allow SE to receive friendly gestures and/or gifts without reciprocity.

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+ Act as a support to the SE and make sure that everyone understands that you are NOT the SE’s supervisor. Be as unobtrusive as possible.

- Act authoritative with the SE so that others see that you are their supervisor and in charge.

+ Proactively plan for SE to attend any social activity and facilitate support for SE to attend.

- Assume that SE cannot attend work parties for after work events because of group home hours, lack of transportation, etc.

+Act natural, blend in. Let co-workers/supervisors know that you’re there to help but that you are only one member of the team.

- Assume a highly professional role as the expert on the job and the SE. Try to stand out from the others.

+ Assist the SE to initiate interactions, having lunch, or after work activities. Help to facilitate interactions and to help everyone feel at ease.

- Wait for the co-workers to invite the SE to socialize at breaks, lunch, or after work.

+ Assess who has good social skills and a good social network at the job site. Help the SE to fit in with that worker/group.

- Assume that all co-workers are equal in their social skills and social network.

+ Learn the workplace. Work on getting to know supervisors and co-workers as people. Help the SE learn the workplace as well as the job.

- Just learn the job tasks. Just teach the job tasks.

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+ Play close attention to the social skills, mannerisms, and appearance of the SE and how they may effect the willingness of co-workers and supervisors to get involved. Teach skills and develop supports as necessary.

- Let the SE dress and act as they like (call this “empowerment”).

VERY IMPORTANT POINTS

Think carefully on a person by person, job by job basis about how to develop natural supports. Every person and every job site is different.

The focus on natural supports needs to be on the outcomes of social integration and employment success.

ROLES OF SUPPORT STAFF

Are natural supports “all or nothing?”

Can be combined with other support strategies such as systematic instruction of skills, self-management strategies, etc.

Do job coaches, teachers, and other support providers become facilitators in addition to directly teaching skills?

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References

Duggan, C., & Linehan, C. (2013). The role of 'natural supports' in promoting independent living for people with disabilities; a review of existing literature. British Journal of Learning Disabilities, 41, 199-207.

Goetz, L., Certo, N. J., Doering, K., & Lee, M. (1996). Meaningful work and people who are deaf-blind. In D. Lehr & F. Brown (Eds.), (pp. 283-305). Baltimore, MD: Paul Brookes. Individuals with disabilities who challenge the system

Lee, M., Storey, K., Anderson, J., Goetz, L., & Zivolich, S. (1997). The effect of mentoring versus job coach instruction on integration in supported employment settings. Journal of the Association for Persons with Severe Handicaps, 22(3), 151-158.

McHugh, S. A., Storey, K., & Certo, N. J. (2002). Training job

coaches to use natural support strategies. Journal of Vocational

Rehabilitation, 17(3), 155-163.

Mautz, D., Storey, K., & Certo, N. J. (2001). Increasing integrated workplace social interactions: The effects of job modification, natural supports, adaptive communication instruction, and job coach training. Journal of the Association for Persons with Severe Handicaps, 26(4), 257-269.

Nisbet, J. (1992). Natural supports in school, at work, and in the community for people with severe disabilities. Baltimore, MD: Paul Brookes.

Nisbet, J., & Hagner, D. (1988). Natural supports in the workplace: A reexamination of supported employment. Journal of the Association for Persons with Severe Handicaps, 13, 260-267.

Rogan, P., Hagner, D., & Murphy, S. (1993). Natural supports: Reconceptualizing job coach roles. Journal of the Association for Persons with Severe Handicaps, 18, 275-281.

Storey, K. (2002). Strategies for increasing interactions in supported employment settings: An updated review. Journal of Vocational Rehabilitation, 17(4), 231-237.

Storey, K. (2003). A review of research on natural support interventions in the workplace for people with disabilities. International Journal of Rehabilitation Research, 26(2), 79-84.

Storey, K., & Certo, N. J. (1996). Natural supports for increasing integration in the workplace for people with disabilities: A review of the literature and guidelines for implementation. Rehabilitation Counseling Bulletin, 40(1), 62-76.

Storey, K., & Garff, J. T. (1997). The cumulative effect of natural support strategies and social skills instruction on the integration of a worker in supported employment. Journal of Vocational Rehabilitation, 9(2), 143-152.

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Storey, K., & Garff, J. T. (1999). The effect of co-worker instruction on the integration of youth in transition in competitive employment. Career Development for Exceptional Individuals, 22(1), 69-84.

Test, D. W., & Wood, W. M. (1996). Natural supports in the workplace: The jury is still out. Journal of the Association for Persons with Severe Handicaps, 21, 155-173.

Warning:

Shameless Self Promotion is next!

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