Case Study NB (Handwashing, Face Washing, Showering, Food Preparation, Kitchen Safety, Shopping)
NB is fifteen years old and lives with his parents and two older siblings both of whom also have a diagnosis of autism.
NB is fifteen year’s old and lives with his parents and two older siblings both of whom also have a diagnosis of autism. NB attends Special School and was allocated a 1:1 teacher. Three members of staff within the school setting also support NB throughout the day.
Home support is provided each week day and on Saturday mornings for NB and his family. Two members of staff are present within the home setting to provide this. NB also receives respite services, (which he attends on a monthly basis) again two members of staff are required to ensure health and safety for both NB and staff.
NB is dependent on adults across all environments for many of his life skills and personal care needs. For the remainder of his school life it was agreed by parents and Educational Professionals that development of skills in this area was a priority. During the period of observation and assessment an Assessment of Functional Living Skills (AFILS) was completed.
Main areas of concern:
Areas highlighted as priority by NB’s parents and carers following completion of the Assessment of Functional Living Skills were as follows:
NB can apply hand soap and has an emerging skill to wash his hands but requires full supervision and prompting to complete the task effectively, for example, to rinse all soap off and his dry hands.
NB can turn on the tap and wet a face cloth but requires both verbal and physical prompting to squeeze the excess water from the face cloth and wipe and dry his face.
NB’s father completes the self-care routine with NB daily, NB fully co-operates and enjoys the process. NB’s father was encouraging NB to participate in the process by washing specific body parts on verbal directions and with prompts.
NB helps prepare breakfast in school each morning, staff encourage NB to be involved in the process. At home NB initiates putting food in the oven for himself, he will organise required utensils such as oven tray and operate the oven timer with assistance from an adult- by leading their hand to the control.
NB is unaware of the aspects of safety in the kitchen. For example, he had the potential to touch hot surfaces during times of food preparation.
When NB has access to his local shop he has a strong preference for carbonated drinks with a high sugar content and certain items suitable for small infants.
The following strategies were used:
Hand/ Face washing
- An individualised task analysis using photographs was created. Photos of each stage of hand washing and face washing were taken and these were mounted on the wall at the sink area within the school setting.
- NB was visually and verbally prompted to reference each photograph and complete each step in the sequence. Foam soap was used to provide an enhanced visual cue for NB to clearly see the soap.
- NB was supported by school staff to practice this routine within the school setting. When NB became proficient with this skill it was then generalised to the home and respite setting respectively. The photograph task analysis was used in each setting.
- Video footage of NB engaging in this task was filmed and shared with all supporting adults.
- Visual support which depicts parts of the body in sequence of washing. Displayed within the showering area. The use of crazy foam soap again to ensure process is visually obvious for NB and he can see where he has put soap. Initial use of verbal and physical prompting at the required level. As the routine becomes familiar and visual supports recognised, prompting was gradually reduced promoting increased independence with the task.
- Task analysis using photographs of the sequence of getting bread and buttering it. This was displayed within the food preparation area at school. Initial prompting at the required level was given to support NB in completion of this task. As the routine became familiar and visual supports were referenced by NB as prompts, then verbal prompting was gradually reduced. NB gained independence with this task requiring only minimal verbal prompts at the beginning.
- Hot surfaces were labelled with the universal NO Sign. Adults were advised to spend time orientating NB away from hot areas prior to beginning cooking task using universal NO Sign. Adults were advised to remind NB throughout task of hot surfaces.
- NB was provided with opportunities to access his local shop and purchase motivating items using a visual photo schedule which includes photos of choices between items he may purchase. The choice of zero sugar carbonated drinks replaces those with a high sugar content. The schedule also includes reference to items which are not available for NB. For example, those items suitable for young infants.
- An individualised choice board was created using photographs to represent the range of food items available to NB at snack and meal times. This provided an opportunity for NB to control choice throughout the day for food. A choice board was also introduced for certain activities.
Information for Supporting Adults
- In addition to his parents, there were a number of adults who supported NB at home and in the respite setting. A list of ways to support NB to increase independence was provided. This was to be shared with support workers within the home and the respite staff. And displayed in the both settings.
Sharing of information
- Video footage of NB engaging in tasks was filmed in the school setting and shared with all supporting adults across all other settings. This facilitated effective accessible communication AND promoted a consistent approach from all adults supporting NB. It was important to ensure expectations.