Handheld Technology Supports and Transition to Employment

Finding a job is hard enough, but what happens once you have one? Young adults with disabilities often have difficulty with learning job responsibilities and expectations. However, smartphones can be used to support work skills! This webinar, presented by Carrie Clawson, OTR/L, ATP, and AT Specialist for Virginia's Department for Aging and Rehab Services, teaches techniques on how handheld technology can help when navigating the transition to employment. (Get the PowerPoint and the iPod Issue Checklist in the Download Here box).
 

Transcript: 

- [Presenter] Welcome, everybody, thanks for joining us for our CTD webinar, Handheld Technology Supports and Transition to Employment. We're pleased to welcome Carrie Clawson, OTR, ATP and AT Specialist for Virginia's Department for Aging and Rehab Services. She has 20 years of experience and will be joining us to share her insights on some advantageous tech tools, as well as strategies for supporting a successful transition to work.

- Thank you so much--

- I will go ahead and her on. Carrie, go ahead.

- [Carrie] All right, thank you. Thank you so much. I just wanna thank everyone for logging in to listen at the beginning of their short week after hopefully a nice relaxing weekend. I'm gonna get started. Sorry, took me a little bit to get into it. So I work with the Virginia Division for Rehab Services. And I first wanted to take a few minutes and just give a brief overview of VR services. I know we have a wide range of participants. So we are a vocational rehab agency. We are tasked with helping people with disabilities in employment, and every state has an agency like ours. They're are different names for each state. And just kind of need to be a little bit of the history of how we came to be. We were established, or vocational rehab was established as part of the rehab act in '73, which established the RSA, the Rehab Services Administration. And then there were amendments in '92. But if you're looking for your state's VR agency, you can find it at the link provided here at soar.askjan.org/IssueConcern/214. Or you can just search for that at askjan.org, you know, do the Google search.

 

And when we're talking about transition, so we're talking about transition to employment. And we're talking about handheld technology. But transition is really that transition from high school to college or high school to work. And, again, a lot of you might know this already, but we just wanna make sure everyone's on the same level. And usually that transition refers to people that are ages around 14 to around 24, although there's definitely a plus or minus there, depending on the situation and the state. And obviously vocational rehab is going to work with this age group. But that might, for vocational rehab, that might include training, like training in being able to do a job. It might include college. For many of us, that was how we were able to be prepared vocationally. And, again, assistive technology may be part of the picture as part of vocational rehab. And then big news in the past couple of years, and maybe many of you have heard this and you're having some flashbacks now of uncomfortable things, but WIOA, the Workforce Innovation Opportunity Act is big news for us in vocational rehab as it is I'm sure for everyone who works with transition. It's really designed to provide some workforce development and some opportunities for people to be more employable and obviously to help society overall. That's the hope.

 

But as part of that, we're looking, again, at training, and education, and employment-related services. And the big focus for WIOA is that it really expanded the reach of vocational rehab agencies. And for schools to target younger students, particularly younger students with disabilities to help them be more prepared for employment at graduation. And for us in vocational rehab, the huge thing is that 15% of each state's agency fund are to be spent towards this pre-employment transition services. So this means not people that are clients, but who are sort of getting ready to be addressing employment. 15%, that's a lot. And there's lots of regulations about how you're tracking that. And if you are interested in seeing how your state is managing this WIOA, you can look at that at the link provided. So exciting to read all these government documents, I know. And then I wanted to spend a little bit talking about supported employment, because that's really integral to our success with handheld technology. Which I promise I will be talking about after all this boring stuff.

 

So supported employment is something that will help people with more significant disabilities gain and maintain employment, who maybe would not have been able to be employed without it. So what we found is that, as you know, probably most of you, a lot of times we just need to support someone in learning the task of the job. And then they're able to do the job independently. But if we aren't providing that really intensive support at the beginning, the person may not be, quote/unquote, employable. So it's really expanding our opportunities for people with disabilities. So employment service organizations, or ESOs, are providing the supported employment. And, again, that might include situational assessments for trying out a job, might include job development, it might include helping someone with finding the right fit for them, obviously training in that. And then some follow along just to make sure things are continuing to go well. And Virginia is a huge user of supported employment services. So this is just a little snapshot from where we have spent our money so far this year, from what I could tell, looking online at our report. And 66% of our expenditures are in supported employment. So that's the yellow. And, let's see, we have technology is the sort of brighter green. Our home and vehicle modifications, we have that now, that'll be me in all the stuff we do. You can't see it's such a tiny sliver of the pie. And training and tuition, again, a very tiny sliver of the pie. It's really all about supported employment. You can imagine that's a lot of our funds. I'm gonna come back to that one.

 

So we started using handheld technology to augment these employment reports in Virginia back in 2010. And we were collaborating with our job coaches in supported employment, obviously with the clients, and it's just the technology specialist. So in Virginia we're kind of unique in that assistive technology services are provided by occupational therapists who specialize in AT, who also are... Who also work for vocational rehab agency. So that's a little unusual that we are actually employees of the state, of the commonwealth, rather than being hired for these specific jobs. So I guess we have more of a buy-in, 'cause it's funds, right? So Tony Gentry and Richard Kriner, and a couple of others, have been studying this, particularly Tony Gentry, he is one of the professors at the Virginia Commonwealth University Occupational Therapy Program there. And he's been studying handheld technology as a cognitive support for a long time. And it's a particular interest of his. And he has been studying handheld technology as it relates to people with autism for employment support. So we kinda looked at what he was doing and thought, well, hey, we're working in employment, maybe we shouldbe checking this out. So I cited here the first article that he published based on some of his findings. So you can look for it there. And the major findings are great for us, that there was a significant cost, I'm sorry, significant reduction in the cost of employment support. That supported employment cost was significantly reduced. And here we're looking at not just handheld technology versus no handheld technology. He was really studying handheld technology at the beginning of employment, or handheld technology starting a few weeks after employment. So they were finding an average cost savings of over $2,000 per person in supported employment cost over the course of 24 weeks. So that, again, for each person that we're seeing, that's huge. And you look at that huge pie, over 60% of our services. That's a huge cost savings for us. And Virginia, like many other agencies across the state, we're not that fresh these days and some cost savings can always come in handy. So we're really excited about this. And, more importantly, we're really seeing some success with that.

 

Two other things that we found were interesting, Dr. Gentry really felt that having an experienced assistive technology specialist, and he's an occupational therapist, so both of those determine the need of the person, was integral to the success of this program. So he felt really strongly about that. And he also indicated that the average number of hours that he spent with each person was 9.2 hours, which is actually a lot for us, considering how many people we're serving. Course back in 2010, 2011, 2012, most people hadn't seen handheld technology, so there's a lot more education than just turning something on and what is an app, you know all those things that we already know if you think about how many of us are using our calendars on our phones. So what we're using is an iPod Touch in most cases. If we are working with someone who already has their own phone, we obviously will use that. It doesn't make sense to have a separate device for someone to keep track of. So that means we might be using Android phones, we might be using Apple phones. And in some cases we might be using Windows phones, depending on what the person has. We are starting to use fitness trackers off and on, things like the job or often the Fitbit as it can give some reminders, some tactile reminders. And, obviously, we have all seen news about the Apple Watch. We have used the Apple Watch a few times. We're also using things like timer watch, we're getting ready to use the RE-vibe. So we're kind of branching out. But I wanted to make a point here. For us, the iPod Touch is the only device that is a handheld size that doesn't require a service fee to continue using it. So like if you wanna buy apps, sure. You have to buy an iTunes card. But it's not like a phone having that $70 bill that you have to pay every month. So an agency, we can purchase devices, but we cannot pay a monthly service fee. So that's true for us. We do have the ability to provide an iPod Touch for someone if they meet our eligibility requirements or financial requirements. And, of course, we don't wanna saddle anyone with a huge fee. So some of the things that we have found that we can address through handheld technology. These are some of the issues that we see in employment, and there's just some of the issues that we can impact. So, I think you guys knows this, but it's really the soft skills that are a huge issue, it's not really knowing how to do the job, it's all the other stuff that isn't really the job, right?

- [Woman] That's really annoying.

- [Carrie] I'm sorry, are you having difficulty hearing? Are we good?

- [Woman] We're good.

- Okay. So there are social and emotional issues that can impact employment. And a lot of times we're working with people who have anxiety. And, in fact, I feel like every person that I see has anxiety because they're starting a new job. How is that not anxiety-provoking, right? So speaking with coworkers, talking to the supervisor, talking to customers, a lot of times working with people who are uncomfortable talking to strangers. And you know what? At work, pretty much everyone is a stranger if you're working in a retail situation. That can be anxiety provoking. We also might have people who are having some anxiety specific to a task. Like I worked with someone who was uncomfortable being around the stove. So working in a fast food place, he was able to work in the front, but if he had to go through the back by the area where things are being fried, or things are being cooked, that was really anxiety provoking for him. So we're gonna see some things like that. I just put behaviors in quotations there, because you'll sometimes get called in for behaviors but it's for issues that people are having and how they're acting out based on some of the needs they have. And then a huge one, would be a professional appearance. And along with that is maintaining good hygiene. Those are things that they'll making a difference in keeping your job. Maybe some of you have more experience with another. And then different terms of the work itself. A lot of times we're working with people who have some difficulty, as I said, with learning the job, with following the procedures, following the routine, just kind of getting in the swing of things, getting a lot more support with that, getting things done, keeping track of what they need to do. A huge issue for us is work pace, and getting people to work at the pace that is expected by the supervisor. Another huge issue are breaks, so taking your break at the right time, but more importantly, coming back from your break when you're supposed to. And I can't tell you how many times we've had people who've lost their job with that issue, before we were involved. And then another issue that a lot of people have would be remembering all of the things that are spoken to them to do. It can be very disorganizing for people that we're working with who have auditory processing issues. So these are all things that we can address.

 

So we're gonna talk about some of the standard apps that are available. And here specifically we're talking about the Apple iPod Touch. But, obviously, many of these are also available on Android phones and on other phones. So the calendar, now I wanna remind you, in 2010, we were kind of at the forefront of using the calendar for things like reminders to leave for work. Now this is sort of passe to you guys. Of course you would just set a reminder. But seven years ago, that was sort of groundbreaking. You can use an iPod Touch to do that. So a lot of times we can set a reminder on the calendar when it's time to leave for work to make sure that the person is on time. A huge thing that we have an issue with is people getting up in time to go to work. And I like to say getting up on time is not really an issue of getting up as much as it is an issue of going to bed. And maybe some of you who work in schools are experiencing this every day. There's people that are trudging in in the morning. But we might set a reminder to get to bed at the time that the person feels is appropriate for them to be able to do their job well the next day. And then, again, that leaving and returning from break. That's a great thing to put on the calendar. Some other things that we might put are just kind of getting ready for the day, you know, packing lunch for the next day or getting the uniform ready. And the nice thing about the calendar, and having things kind of all laid out on the calendar, is that visual layout can really have an appeal for our visual learners. And, again, for people that have difficulty with that passage of time, it can be a lot easier for them to see that on the calendar app.

 

And then reminders, one of my favorites. This is obviously standard just on iOS, but there are similar apps that you can use. Any.do is one that I'm thinking of right now for Android. And, again, having a task list of things that people need to do at work. So you see here, check the schedule, check the cart to stock the missing supplies, packing their lunch, taking their meds, kind of a range of things that this person is getting reminders for. Hygiene, I mentioned before, it's huge, but just having a reminder to put on deodorant or take a shower, or brush your teeth, whatever it is that might need to be reminded, the Reminders app is a good place to put that, and then taking medication as well. It's wide open here how you could use that.

 

Notes, I don't use this as much. But for a long time it was the only thing we had like this. But I do have people sometimes put their login or clock-in procedures. Sometimes it can be really complicated. Like you have to get to the computer and you have to remember your passcode, and that can be really challenging, so kinda putting that in.

 

Another thing that we have issues with is people who will ask their supervisor over and over, "Okay, I did that. "What do I need to do next? "Okay, I've done that. "Now what do I need to do? "Okay, now what do I need to do?" But, you know, over the course of eight hours, that really interrupts the workflow for the supervisor. And it's not really the kind of behavior that we want our employees modeling. So if we can encourage them to write down their list of questions. Now obviously the checking, "What do I do?" we wanna have a task like this with the pallets, to keep orienting what they need to do. But if they have questions like, "Oh, I need to remember "that I need to take off in December. "Ooh, I wanted to ask you if I can have a new uniform. "Ooh, I needed to get a new pair of shoes." Whatever, all of those things, let's collect those in notes and then present them all at one time, preferably at a meeting that's already been established. But then here I have a picture of an example, someone who was working in a diary case, and the dairy area. And then this is just a list of the things that you needed to do. You can see that it's kind of old, because it's a older note.

 

The camera and video, that was really such a game changer for us, because when the iPod Touch 4 came out, we could suddenly take video right on the iPod. We can manipulate it, we can do some editing, and then it could be available for you immediately. We didn't have to go back to our computers in our office. So this was huge. And one of the things that we used it the most would be video modeling. That's all we talk about in a few minutes. I often will take a picture of, okay, here's what the shelf is supposed to look like, after you have the display finished. And then a lot of times people have difficulty with facial recognition. So we might take a picture, with permission, of coworkers. And you know you can edit pictures now and you can write on them, which is kinda nice. And so you could write, okay, that's Sally, that's Megan, that's Carrie. And it makes it easier to recognize people's faces.

 

Also, another favorite thing that I do with the camera is put a picture up of some sort of cue that someone might need as their lock screen. So like if we have someone who's displaying some inappropriate behavior, you might have a picture of a badge, like, you know, this kind of behavior could get you in trouble, so you wanna curb that behavior. Not the best example there. You might also provide a reminder like: This phone is to be used only during your break time. So that could be your lock screen. So as the phone gets turned on, you can see oh, right, I'm not supposed to use it. Just as a reminder. Not foolproof, but it's something that you can use.

 

FaceTime, again, that's obviously just on iOS. But this is something that a lot of our job coaches really benefit from. I'm in the Northern Virginia area, so traffic can really increase our cost. We might have someone going just five or even 10 miles away. And it can be 45 minutes for our job coach to get onsite with that client. So if they can FaceTime, if the client has an iPod, they have wi-fi, the job coach can do that, then we're talking about a five minute meeting over FaceTime, instead of an hour or two hours, you know, with the travel. That's kind of nice. They also find that sometimes just having the ability to have that face-to-face, I'm doing that air quotes, but face-to-face interaction using FaceTime, kind of like an insurance plan, that maybe you don't need to check in with a job coach, but just knowing that you can, if you really get into trouble, that you have that option, can be very reassuring. And we've had some examples where that has really decreased some of that repetitive sort of checking in behavior, just by having that as an option. Not that it got used, just that it was there. That's nice to have.

 

Okay, now we're getting to talking a little bit more about some of the apps. And I'll take some questions in a minute. So I just wanted to give a little case study with someone that I was working with. This is a young lady who was working in a hotel position. She was doing some custodial and setting up the room kinds of things. And she was really having difficulty with learning how to make the bed. So we had a couple of options here. We could take a video of how to make the bed. But you know if you're watching the video at the time you're making the bed, it's difficult, right? You're looking at the video and not at the bed. And she really needed sort of one-to-one cues, "Okay, now go to the head of the bed. "Okay, so put your sheet that's fitted "that's starting at the top right corner. "Okay, now that you have that, "move down to the bottom right corner and put that on." She really kinda needed the cues at that level. So what we did is a voice memo, actually. So we recorded me giving her the cues in time so that she could kinda follow along. She could play it, she didn't have to look at it, and it would provide those cues. So you can see how augmenting the supports that you would have in place.

 

And then another thing that was going on with her is that they said, "You know, she's great, she really works hard. "I can tell she's very motivated. "And usually she does things without needing "a whole lot of help. "But there are days that she comes in "and she says, 'I'm tired.' "And I know on those days," this is the job coach on site. "I know on those days that I'm gonna have to be with her "the whole time, 'cause she's just not gonna be with it." So for her we had a little of a session about what was going on. You know, it's really a sleep issue that she was having difficulty getting to bed at a reasonable time. So we set a reminder for that. But we also set a reminder for her to set out her clothes the night before, because what was going on is that she would take forever to figure out what she was gonna wear in the morning. And that would sometimes make her late, in addition to the not sleeping. So we figured out how long she needed to get ready for bed, how long she needed to sleep. She figured that out with us and then we set the alarms with her. And so she actually was much more consistent with that. She did well with the bed-making. And then I get a call about two months later saying, "You know, she's done really well, but she just came in "and she had one of those days again. "She said she was tired." And you know, this was two months. And I thought to myself, yeah, well, you know, getting to bed at 8:30 probably finally got old after two months. But they had gone on vacation. So once she got back in the routine, they'd got back really late the night before when she got back in her routine, getting to bed at 8:30, she was, once again, much more consistent.

 

So I wanted to pause for a minute and see if you have any questions. I see there's a couple of things about the Powerpoint. If you have any questions you can put it in the chat now. Works for non-readers. I think Val's asking about lists for non-readers. If you're asking about particular apps, I'll show those in a little bit. If you're asking about the slides, I'm pretty sure you'll be able to use a screen reader on that. But we can check with it. And, more importantly, now you have a chance to not listen to me talk for a few seconds, because I know speak really quickly.

 

I'm super excited about this task. So back into it, you know, I'll pause for questions again in a little bit. So learning new tasks. My four favorite things to do for people that are having difficulty with learning new things would be video modeling, again, I'll show that in a second, creating an album of the pictures. So if you already are an iOS person, you know you can take a picture, and then another picture, and another picture, so, okay, here's step one of the task, here's step two of the task, here's step three of the task. So you can put those into an album, just like you would put your pictures from Hawaii or your Christmas vacation into an album. You can put those pictures into an album and call it washing the dishes, or mopping the floor, whatever the task is. And then the person's able to flip through each of those pictures to see the next step. The book becomes the support. And then the CanPlan app and then First Then Visual Schedule app, I'm gonna show you. So video modeling, again, we are so excited about this being right on a device, that you can do all this editing, new recordings, without having any other devices. And we know video modeling is the standard of practice for individuals with autism, because they really benefit from having that visual interaction. And it will help for people that are learning new tasks like we've talked about. And sometimes we find that people do really well with knowing their job, say, Tuesday to Friday, but then after the week when they come back on Monday, they've lost a lot of what they had already kind of reinforced through the week. And this is particular so over a vacation, like over the holidays, or if they go away with their family or if they take their own vacation. And then coming again, we again have lost a lot of things that we've learned. So having a video of that procedure can really help reinforce some of the things that people either already know or that are learning. So I'll use just the camera that's already on there most of the time. I find that to be really effective. And then you can do a lot of the editing right in the camera app. But if we wanted to put a couple of videos together, and I have an example to show you, I like to use iMovie. And that's something that you can get on your Apple devices as well. So we've got the video. I lost my slide for that. Yeah, and 30hands is a great video modeling. That's a good point, Mary. So this is a video of just mopping. You're gonna see the cues. I'm sorry, you're gonna hear the cues and see that we're actually showing the entire procedure. And sorta halfway through you're gonna see that really speed up, 'cause we wanna show the entire process without it taking 15 minutes, right? So let's see how that works.

- [Coach] The bucket, put it in the sink. Turn the water on. Get some hot water. All right, and you also need to put a little soap in there. All right, now get your rinser, I mean your ringer, stick it in the bucket.

- [Woman With Pink Top]There we go.

- [Coach] And take your mop, put your mop down in the bucket, get it good and wet. Now move your bucket over to the area that you're going to mop. All right, take your mop out of the bucket, put it in the ringer. And squeeze the water out. Take your mop out of the ringer, place it on the floor, and then swing your mop as far as you can from left to right that's comfortable. Don't overstretch yourself too much, just gotta be comfortable in your swing. You can always move over. Kinda keep your little line so you can see what you've mopped. When you move over, you'll see your line that's still wet so you know where to start over. Now I think it would be a good idea to change your water. You've done a lot of mopping. Your water's probably pretty dirty. So you wanna take it to the sink, pour the water out, and get some fresh water.

- [Carrie] So the sound was a little off on there. I think you guys probably all figured that out. But you could see that was four or five different videos that we put together so that it showed the entire process. And then in the middle, did you see that part with the super fast movement? That's using the time lapse feature on the iPhone, or the iPod Touch so that you, again, can show that whole procedure without it taking forever. We have learned that we want it be like less than five minutes ideally. Two minutes is even better. Okay, and then, again, video modeling can be used for a whole variety of things. It can reinforce social skills. You guys have all seen the social stories and it can reinforce some anxiety management strategies. But that was just one example of how it could support work tasks.

 

So here's CanPlan. CanPlan is a nice app that offers you a task list. So here you can see on the left, charge phone, collect cart, make coffee, wash clothes. These are things that need to be done. You can time those so that an alarm will go off. So here it says at 1:30 you're supposed to collect the carts. At nine a.m., make the coffee. And 11:30 wash the clothes. Obviously that's a weird mismatch, hodgepodge of tasks, but just kinda demonstrating that you can do that. And you have step-by-step instructions within this video. I'm sorry, within the app. So you can see the wash clothes screenshot down on the bottom left. And the next slide would be separate the whites and colors. And then the next one over would be place laundry into the machine. And the really cool thing about this is if you look at the bottom of each of those, you see the little green Speak button. And that's actually giving you some text to speech for whatever you have typed in. So it will read those things out loud, separate whites and colors, place laundry into machine. So this is has a lot of options. You can also put some video in to follow along instead of these step-by-step pictures. So it really offers a lot. The cool thing about CanPlan, besides all that is that you can try it out for free. You can put up to three tasks in there for free. And then if you decide that it's working for the situation that you have, it's 14.99. That's like the magic number for all of these. You'll hear this throughout, 14.99. Unfortunately, there's no Android comparison for CanPlan. Although 30hands is pretty close, isn't it?
 

And then First Then Visual Schedule, the next one I wanna show you. Great thing about First Then Visual Schedule is it is available on Android, woo-hoo! We can't say that very often. It's 14.99 on iOS, but 4.99 on Android. Interesting. And what is here is more of a pictorial checklist. And it's great that you can kind of have your checklist into different groups. So you can see here, the Get Dressed group, and Morning School Routine group, Saturday Chores group, and that's what I've kind of broken out. And the Saturday chores, this right-hand picture, empty the trash, sweep, mop, empty the dishwasher. This is a busy person, right? You can check off each of those. And you get the little green check mark. You know that it's done. So that is the, that screen, all the way on the right shows you the entire list. You can also modify that so that you see here in the middle that it's just one task. And once you check that off, you can swipe and it'll show you the next task. Or you can have it show you just two. So just depending on how much you need to kind of modify How much a person is looking at it one time. One thing that I don't like about First Then Visual Schedule is that it does look, to me, pretty childish, and we're really trying to use things that are more adult looking. But we can put our own pictures in. So while this does have a kind of kiddie look, with the sunshine and things like that, we can put our own pictures in of a cart, or of the shelves that are being stocked. As you can see some of these other pictures over here. So we can affect that somewhat. And, again, that visual representation can be really helpful. A lot of times people are able to read, but they still benefit from having pictures to help keep them oriented, particularly if their reading isn't as strong, or they just really benefit from that visual of pictures. So it's worth picking up.

 

And then 30/30, honestly, this, I'm sorry. These are apps for following a routine. So I have four to show you here, 30/30, Visual Planner, or Visual Schedule Planner, Actually, ChoiceWorks and good old voice memo. So 30/30, I think I probably use this more than any of the other apps I do, just for the type of people that I tend to see, I think, are able to benefit from this more than some of the others. It's free. I love that. It's a right price. You can't make a case againstthat with the price. It is available only on iOS, which is so unfortunate, 'cause it's a great app. And 30/30 is a cross between a timer and a task list. So the top sort of wheel, the circle that you see, that's the timer. And you can see in both of those that there's an area where the color is darker and an area where the color is lighter. And that moves to show you the passage of time. And, again, remember when I said work pace was a big issue? This is a way that we can kind of orient a person, like 20 minutes, you have 20 minutes to finish working on this, or you have five minutes to check the dining room. And then you can see, oh, the time is half up, so I should be about half done with what I'm doing. So we love that. It is very easily customizable. You can see over here on the right, there's a pretty long checklist there of all the things you do. It automatically will advance to the next thing on the list once the time has elapsed, which is a nice feature. You can pause it. If you're finished with something and the time is still going, you can click the check button and, again, it will advance to the next thing. So I have a lot of people who benefit from sort of orienting their day, their routine, by looking at that. So that's worth checking out.

 

And another app for following a schedule is the visual schedule planner. I'll be honest, it's complicated. That part of it is not my favorite. But there are some clients for whom this really meets the needs that they have. So it's kind of a planner, but it has that pictorial representation. So, again, for someone who's really visual, this would be a benefit. So you can see the little pictures of the breakfast, there's a picture of sitting in class. I feel that this is also probably more appropriate in a shool environment, although not inappropriate for work. But the first slide, I have another picture. Here are some of the time things. You can repeat the breakfast, you can have a reminder or it will beep to give you an alert. Like, hey, it's time for you to go to your class or it's time for you to go get the carts, or it's time for you to pick up the trash then, whatever that is. You can add your own pictures, your own sound, and then you can click Link to Video. And it is, guess what? 14.99, and also available only on Apple. See, there's a theme, right? Apple, unfortunately.

 

And then ChoiceWorks is a great app that I just found out about. One of my coworkers is a huge fan of this. It also looks very childish. And, once again, we can change that by the pictures that we choose. And I guess like some of the other apps you have different groupings of lists. They're very visual. So here we're looking at the night time schedule. And what you do is slide over the app. I'm sorry, slide over the picture when you're done. So you eat dinner, you can slide it over. You take a bath, slide it over. Put on pajamas, slide it over. Now, okay, brush teeth and go to the bathroom is what I have left. So in terms of a task list, that's great. What's really cool about this are these two that you see, Worried and Upset, and also the Waiting. And what those do is they provide different strategies or a way to remind people of different strategies and activities for self-regulation and for emotional control, and also for waiting, like these are the things you can do while you're waiting. You can read a book, you can listen to some music. You can talk to a friend. But this kind of help people through some of the things that cause some stress. But that's a really nice feature, the self-regulation aspect. I forgot to say ChoiceWorks is 6.99 and only on iOS.

 

And visual timers. For the people that work in schools, this is nothing new for you. Visual timers are a great way to provide that visual representation of time. And it seems like so many people that we're working with don't really have that integral in their minds. Like you can say 15 minutes, but that doesn't really have a meaning to them, which makes it difficult in a job to knowhow fast you need to work. So some of our favorites are Time Timer. That's just like the Time Timer that you use in schools, but it's an app. VisTimer is another one that's similar. I think it's a little cheaper. And then another one to check out is 360 Thinking. And it's a little more complicated, but it gives you like a ramp up to better preparation for the time. It shows you the time and then it allows you to the kind of finishing up. So it's complicated, but it has nice options. Time Timer is available on Android for 99 cents, and for iOS for 2.99. VisTimer is 1.99, only on iOS. And then 360 Thinking is also only on iOS and it's 2.99. But, you know, there are tons and tons of these visual timers. So I'm not saying these are the three best in the entire app store and Google Play Store. You probably have your own favorites.

 

All right, apps for anxiety. We're moving right along. So it seems like anxiety is my wheelhouse these days, 'cause most of the people that I work with really struggle with it, as I said. So here's some of the apps that I found to be very helpful. MyCalmBeat, this is a free app on Apple and on Android, nice price, and available on all the devices. And it just trains people in a slower breathing pattern. And so it's pretty simple to use. It will cue people to do a minute or two minutes, you can choose, of breathing. Proved effective for right in the moment strategies to reduce stress for people that are able to follow that cue. SAM, Self-Help Anxiety Mgmt, is another free app also available on Apple and Android. I actually just worked with a young man today who loved this one and downloaded it right away. They have a ton of stuff in the app. And that first screen on the left is all the things that it has on there. And if you click on the Life Preserver to help now. You get the second screen, read this twice slowly. And then that brings you to the thing that everyone loves in this app, Picture Peace, which is this screen with all the pictures. You pick a picture in that screen and then the next slide, which is marigold, it shows you the picture, but covered up. And you uncover it with your finger. And I cannot explain to you why uncovering a picture with your finger is so relaxing, but it just is. I don't understand, but I experienced it myself. There is not a person that I've worked with who hasn't loved it and hasn't had to uncover the entire picture while they're waiting with me. So that is a nice one, again, to have in your pocket, right in the moment when you're stressed about something. And it also has this nice little anxiety tracker.

 

Okay, moving quickly now. Breate2Relax, another great app for managing a slower breathing pattern to bring out about more stress release. And this one will show you on the left-hand side, that's the breathing in and breathing out. Cool thing about this one is that it shows you this really relaxing natural scenery. So you've got like jungle and forest pictures. And those change with each inhale and exhale. Very calming, and of course they have the very calming music playing as well. This is another free app also available on Apple and Android. I love the anxiety apps, they're so accessible to people, not dependent on their platform.

 

Calm and Meditation Studio, are my two, at the moment, favorite meditation apps. We all know meditation is good for us, right? And we probably feel like we should do it, just like exercise, but it's hard to get there. And Calm is a nice app, it's free. It's available on Apple and Android. It does teach you how to meditate. But it's a guided mediation, so you put it on and you listen to it, and it kind of brings you around to what you should be thinking. So it's a little easier than, say, sitting quietly and emptying your mind. I think most of the folks with anxiety would have difficulty with that. Lately Calm has really gotten rid of a lot of the free content. So I'm not loving that so much. Their free content was great when they had it. So Meditation Studio is my next favorite. It is not free, unfortunately, it's 3.99. Both of these are available on iOS and on Android. But the nice thing about Meditation Studio is that once you pay that 3.99, there's a ton of information in that app. So you can see there's different collections like Stress or Sleep, or Anxiety, Pain, and there are different meditations within that. There are courses. There's a lot of information in there for the four dollars. And let's see, I thought I was gonna say one more thing about the Calm. Yeah, Calm is also a subscription and not just a pay at one time kinda thing. So it's unfortunate that they've gotten rid of so much of the free stuff.

 

Okay, so we're getting to the end of the anxiety stuff. So Calm Counter is a great app for people that are having difficulty with following the breathing, like MyCalmBeat, or the Breathe2Relax apps. Sometimes that can be a little bit too abstract for people. Calm Counter is basically just a countdown from 10. So you start at this I need a break, and it actually says it out loud. Every time you tap on the screen, you get a new number counting down, nine, eight, seven, six. And this face changes. So you can see the colors change and the face changes just slowly relaxed and be in a smile instead of this worried face. And then the last thing it does is it cue you to take a deep breath. And that is also an auditory cue, with a And if you look at that, you'll see that was a spot-on impression of Calm Counter. And I'm psyching myself up here, people. 2.99 for that, and it's also on iOS, not Android, unfortunately.

 

All right, I'm gonna stop talking for a minute and ask if you have questions. I see people have been talking a lot. Yeah, someone said that First Then Visual Schedule is difficult, yeah. CanPlan, I think, is easier. I do prefer that. They are both a little complicated. And once you get used to either of them, it makes a little more sense. But I do think CanPlan is a little easier. Yeah, you do wanna make sure, I don't think you would just hand that over to just any person and have them going. I think it's needs to be someone who's used it a couple of times, or have familiarized themselves with it. And the SAM app was free, right? Also on Apple and Android.

 

Any other questions? We're moving right along? I'm glad to see that everyone is still awake, good. Okay, so I just have to get on my soapbox here, 'cause I see a lot of folks who've transitioned, and I see a lot of the same issues. And I'm sure that none of this is new to any of you. But the four things that I see, the, I think the big issue that impact employment aren't following the list of things, it's a lack of sleep, not eating, or skipping meals, having too much leisure and not enough work time, maybe that's the best way to say that. And then not having some limits on their electronics. This is not parenttalk. I'm a parent of a teenager. I know how hard that electronic thing is. I'm not the best at managing that either. But we see a lot of people who had difficulty turning off their enthusiasm for their electronics, and that will impact their ability to participate in work tasks.

 

So, okay, soapbox off. Here's what I found. What you want to do is you wanna just tell people, "Okay, you need to stop looking at your phone." or "You need to start going to bed at 8:30." But that does not really lead to behavior change. For those of you who work with teenagers, now I'm preaching to the choir, you know this. But I found a solution. The motivational interviewing can help you guide the person in, oh, I'm sorry. So motivational interviewing is one of the keys to behavior change, and I'll talk about that in a minute. You also wanna help guide that person into talking about what their obstacles are. Saying, "Now what is it that's keeping you "from getting to bed earlier?" or "What is it that makes it hard for you "to get a shower every day?" So having them answer those questions and think about that and reflect on that. And then you can provide information, like, well, most people need between seven and nine hours of sleep. Or there are a lot of studies that have shown looking at your phone before you go to bed can impact how restful your sleep is. But that one is maybe a stretch, but in terms of getting people to buy in. So having that goal identification is key. Having a plan for accomplishing those goals. You guys know all these, right? And then being accountable. So that's the key to behavior change.

 

So motivational interviewing, if you don't know about this, I went to a conference and learned about it. It's something that's been used for people that have substance abuse. And the spirit motivational interviewing is that you have respect for the individual. Instead of telling them what they need to do, you're collaborating with them. And you're basically you're kinda sending the message that, "I know that you know what it is ihat you need. "I'm just gonna help you get there." Not because I'm like smarter than you, or because I have all the answers, but the two of us could probably figure this out together. So as much as we want to lecture, that doesn't really work. And I have found this to be so successful with the transition population, and also for some of the habit change for anxiety management. And, Mary, I see your point. Yes, if a person is using a device that works and it's impacting them, yeah, we would not have them use a device if they're not able to turn it off and participate in work. And I said I would answer questions later, but I just saw that and I had to sayit. 'Cause that was in the back of my mind.

 

A lot of times we might look at using a separate device for work. So this is the work iPod Touch that only has CanPlan on it. It doesn't have Safari on it. It doesn't have messages on it. It doesn't have access to wi-fi. This is all it's gonna do. And sometimes you can't have technology, because it's not gonna be appropriate for that individual, unfortunately. So motivational interviewing in five seconds, right? There are the things that you wanna say: What needs to happen for you to get to bed early? What needs to happen for you to have your lunch packed? What is the barrier for taking a shower every day? What is the barrier for getting back from break on time? What do you need in order to have your clothes laid out? What do you need in order to know what you're supposed to do at work. Asking these questions, you just can't imagine that people have these wonderful insightful answers and ideas. They know. We just haven't asked them necessarily. And I love, "What would happen if you "set an alarm across the room?" Or "What would happen if you laid out your clothes "the night before?" Sometimes there's a little bit of leading, right? And then I'll also do some reflecting, "I hear you saying that you need more sleep, "but I also hear that" you know,things. And then what we also want to do is we wanna say, "What you need to do "is set your alarm for 8:30." 'cause that does not inviteparticipation. We all know that, that have teenagers in our lives, right? "Here's what needs to happen, you need." We can't do that either. "Why can't you just get up at seven?" So these are the things that we want to avoid. "Let me help you figure this out." Again, that's kinda setting you up as the authority figure, so you kinda wanna shy away from that.

 

And I'm just gonna put out, this is extremely difficult. I'm gonna recognize it. But if you were interested in more about that, do some Google searches on motivational interviewing. The Good Day Plan from I'm Determined, that's a Virginia Department of Education Program. I love using that to help figure out what their goals are. And guess what? If you're doing a Good Day Plan with someone, you'll have to do one yourself, because you have to be able to show, "Here's what my plan for a good day looks like." It starts with coffee and it means that I've had eight hours of sleep. And I've had some exercise. And I have something fun to do. And then here's my plan. That Action category means I'm making a coffee in the morning. I need to get ready for bed by 9:30, Need to get up at 5:30 if I'm gonna exercise. That action plan, I'm pointing at it in case you can't see it, that action plan goes in your calendar. And that's your plant for doing what it is that you need to do. So I do love that, too. Going quickly. Obviously we wanna make sure we're doing a good evaluation of the needs. Yeah, I do love the Good Day Plan, Mona, thank you. The evaluation of needs, looking at the environment, looking at their skills. I think sometimes it just looks like we're, oh, you know, just use this app and everything's gonna be great. There's a whole lot behind the scenes. Hopefully you guys know that, right? We do use restrictions liberally to block content, to block apps, to block access to things that we feel are gonna be inappropriate, specifically for each person. We do like to enable a back up, particularly if it's a person's device that we're setting up for them.

 

And then we like putting in some of those emergency contacts. So in case you didn't know about the emergency contacts, check out the health app on the iPhone. You can put your emergency contacts in. And here you see Mark Rogowsky, he wrote this article. If you put your information in, then if something happens to you or the person that you're working with, and their phone is locked, medical personnel can still click the emergency button and then they have access to just the medical ID, just the person that you need to call in case of emergency, just putting that shout out there. That's kind of a neat thing.

 

All right, and I'm sharing this. You guys also have access to this separately as its own document. But this is just kind of a checklist of what we go through when we are issuing iPod Touch for someone, the things that we wanna make sure we're doing. So I'll let you kinda look through that. I'm just going to really quickly, you have a lot to do. And then this is just a short description of what our eval kit is when we are working with someone. We're gonna show up with the device, charging cable, the plug. We love the protective cases, like the Griffin Survivor, you see that orange one there, the Otterbox Defender is great, the LifeProof is great, but a little pricey. And we also the cases with the belt clip so they don't have to go in pockets necessarily. We like to have some different stylus options just in case there's some fine motor issues. I've got an example of an Incase sleeve case. Sometimes people need to have their hands free. So having something on a sleeves can be helpful. And then this lanyard, the bottom right, that's a lanyard case. This is crazy, but sometimes employers don't want to allow someone to use an iPod because it looks like a phone. And phones aren't allowed to be used by employees at work. But, somehow, magically, that phone or iPod is transformed into a work tool. This fits in a lanyard around someone's neck. I'm not gonna complain, it works for our client. So that is an option sometimes to have that. And that is the Lanskin, Lanskin.com, lanyard case. We do have backup batteries, too, because you never know what's gonna happen. And then, very quickly, things that we feel like have been really helpful are that comprehensive assessment, providing education to the employer, providing education to coworkers, like, "No, he's not gonna be on Facebook. "He's not gonna be checking emails." And also providing that same information to the client, right? "You can't check email, you can't check Facebook "while you'reat work." And we wanna do some training on those use and expectations of the device to the person, to the employer, to the family. We will provide training and support to that employee. And, again, making sure that the family is on board and understands how and why it's being used. Whew! We did it! What questions do you have? As we're right at the tail end. Thanks for part of that checklist, thank you. And, yes, I do love I'm Determined. And it's great for community college students, it's great for students who are working, it's great for adults.

- [Todd] Carrie, can you hear me? It's Todd.

- [Carrie] Yes, yes.

- [Todd] Hey, we just had a couple of questions in the very early beginning that I think got missed.

- [Carrie] Oh, okay, thanks, let me scroll up and look.

- [Todd] There was one from Anna asking about if other states were prepared, I think she was talking about the study.

- [Carrie] Yes, you know, I've been to a lot of conferences and I'm talking about handheld technology. And I'm not seeing a lot of other states talking about this. That doesn't mean it's not happening. I think when we think about the iPod Touch, it's relatively new. And smartphones in general are relatively new. So I think getting those into the AT sort of mindset is taking us awhile to get there. And I think we're all kind of just figuring it out. I know that when our job coaches go to their national conferences, they're not hearing a lot of other people talking about that either. But I also think things like using the calendar to remind you to get back from break is not rocket science, right? So I think that's happening a lot more and people are just not talking about it. That's probably the worst answer ever. But hopefullythat's helpful. And if you're in New York, and you wanna know what's available in terms of voc rehab, go back and look at that slide to see what your voc rehab agency is called and find out how you can apply for them. Let's see, did I miss anything else? I think that's it. Does anyone else have a question? Now, Todd, there's really the answer for the Powerpoint. I think that's gonna be available to download tomorrow. And thanks for the feedback.

- And we'll have the recording and all the materials posted on our website tomorrow. That's ctdinstitute.org.

- [Carrie] Excellent. Well, thanks very much for listening everyone. And I think we got out just in time. Have a great day.

- [Presenter] Thank you very much, that was great.

- [Carrie] Thanks.