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Biographical data
Sini te Winkel was trained
academically as a clinical psychologist. Since 1984 she has been working
in several positions on Bartiméushage, a centre in The Netherlands,
which houses about 350 people with a visual and intellectual disability.
The last few years she has been directly involved as a manager in resettling
part of its residents from the institute grounds to the community. She
introduced an adapted training programme in social skills for adults with
a visual and mildly intellectual disability.
Her presentation will be
on this training programme.
Getting to know a person, starting a conversation, listening to someone, asking something: a few social skills which you as a conference participant will practise several times this week. You will probably find it enriching and instructive to trace the cultural differences in opinions, standards, values and experiences among all the varied contacts you have. Sometimes you might notice, owing to often non-verbal reactions of your partner, that your behaviour is not up to expectations. How will you react then? Will it cross your mind that it might have to do with cultural differences?
Adequate social behaviour is very important. The basis of our human existence lies in contact with other people. Knowing how to behave in all kinds of social situations enables us to contact others and to maintain contact. Adequately applying social skills is regularly trained in a natural way from an early age; these skills are learned automatically in contacts with other people and by getting verbal and non-verbal feedback in differing situations and circumstances.
For people who have a visual and intellectual disability this learning process is much harder. The number of social skills that is learned is limited. It is much more difficult for these people to learn through observation and imitation, to apply learned behaviour (generalisation) in everyday situations, to test own behaviour against the (often non-verbal) reactions of the surroundings and to gain experience in various situations.
The nature of the multiple
disability determines the learning process to a great extent. Development
is much slower in every way. The ability to explore things is limited and
it is much more difficult to obtain and interpret information.
The ability to learn through
imitation in order to compensate for the intellectual disability is restricted
because of the visual impairment. The same applies for the compensation
of the visual impairment; compensating use of other senses is needed, e.g.
hearing. And in order to understand, interpret and remember it takes a
lot more effort of the limited cognitive abilities.
Learning to apply effective
social behaviour requires the learning process to be adapted for these
people and it asks for an adequate support from the environment.
This learning process will
be the subject of my presentation. I will tell why and in what way we offer
adults with both a visual and intellectual disability an adapted Goldsteintraining
in social skills.
To give an idea of what
level of intellectual disability I am talking about: the terms 'mildly
mentally handicapped' or 'mildly mentally retarded' were used in former
days.
Whenever I talk about 'he', please understand that I also mean 'she'.
The Dutch situation
In the centre where I work,
Bartiméushage, we house people with a visual and intellectual disability.
In the daytime they go to school, visit a daycarecentre or work in one
of the workshops of Bartiméushage. The intellectual disability ranges
from mild to profound.
The current policy is to enable people with a disability to lead a normal life among other, non-disabled, people. In The Netherlands many disabled people still live in an institute. A lot of these institutes were built or rebuilt about 20 to 25 years ago. The policy was then to let the people lead a life as normal as possible but with special care and support. We are now catching up with recent developments. Everywhere resettlement is taking place in order to get integration and inclusion. It has become the practice now for disabled children to stay with their parents as long as possible. The educational programme for children is being more and more adapted to the current policy: future oriented by means of a functional curriculum. A functional curriculum is a well-planned and longterm programme that will develop in children the skills needed to live and function adequately as an adult. These skills have to be adapted to and be relevant for the social, vocational and economic environment in which these children live (1).
Why training adults?
Today I am talking about
the growing number of adults who are being resettled in the community.
They have a mild learning disability and they are blind or partially sighted.
Their ages range between 21 and 50 years.
They have moved from the
institute grounds to nearby villages and live alone, with a partner or
with friends, just like other people. Some of them have moved from the
workshops in the centre to a regular job in the free labour market. They
get support according to the Supported Employment method.
It is important for these people to experience that also in new situations other non-disabled people see their behaviour as adequate. It is striking that in their new housing or working situation others often interpret their social behaviour as inadequate. The cause is usually a lack in common social skills, because these skills differ in some ways from those of the (highly) tolerant and accepting subculture of the centre in which they have grown up.
There is a risk of being avoided, of isolation or stigmatization and to prevent this they need to have knowledge of common social skills. But also support in how to apply these skills in various situations according to their own values. A training that is adapted to the visual and intellectual disability can therefore be of great help.
The Goldsteintraining
The training we offer is
based on the structured learning therapy developed by the American psychologist
Goldstein for people from socially deprived areas. Goldstein's concept
has been adapted in The Netherlands for people with a mildly intellectual
disability (2). We further adapted the training for adults with both a
visual and mildly intellectual disability.
The aims of the training
are:
-acquiring knowledge; knowing
how to handle (difficult) situations
-changing behaviour; developing
skills to really behave adequately
-alteration of perception;
getting more self-confidence and thus more courage to act.
Which skills are included
in the training? Every culture or subculture has its own prevalent social
skills. To determine the basic social skills for a training it is essential
to first make a list of the current social skills and then to analyse where
people have a lack of knowledge and which skills are not or inadequately
used.
In the Dutch programme the
following skills are included: getting to know a person, listening to others,
asking something, starting a conversation, refusing something, discussing
something, being criticised and giving criticism, showing feelings and
emotions. They are mentioned in order of complexity.
Further the skills to be
learned have to be familiar to people and it should be possible to break
them down in small steps in order to fit in with the learning capacities.
Important parts in the training
programme are:
-making a skill concrete
in order to show the importance and the aim; breaking down the skill in
small steps
-demonstrating familiar
situations in order to show which steps should be made to apply a skill
adequately
-roleplays in which the
skill to be learned and own situations are practised
-assignments to practise
the skill to be learned in all kinds of everyday situations.
Training programme
Recurring fixed parts in
the programme and a guiding attitude of the trainer create a clear structure.
Depending on the difficulty
of the skill to be learned two to four meetings are generally needed; a
meeting lasts for 1 1/2 hours at the most. Recurring fixed parts in the
programme create a clear structure in the training.
A training group consists
of five to seven participants and is led by two trainers preferably who
can lead the different parts in the programme alternately.
How is the programme built up and what are the important didactic elements?
1. Introduction of a skill
Especially when the participants
are not familiar with current social skills, the trainer will have to pay
extra attention to the importance and the effect of adequately applying
a skill. He discusses with the participants if there has been a proper
introduction you know the other person's name, you can call the person
by his name and you know who you have spoken to. You then know which people
are present and where they are in the room. This enables you to start a
conversation with someone you prefer.
To make the skill concrete
and to increase participation he asks the participants to tell about a
real situation in which it was difficult to apply the skill. In this way
a link is made between their own experiences and the aim of the skill to
be learned.
2. Breaking down the skill
in steps
The skill is broken down
in small steps. To be able to apply the skill 'getting to know a person'
adequately, it can be broken in the following steps (also called learning
points):
* say that you would like
to get to know the person
* tell the person you are
blind
* stretch your right arm
(and shake hands)
* say your name loudly and
clearly
* listen carefully to the
other person's name
* look in the direction
of that other person
For these learning points to be 'drilled in' they are regularly repeated at several parts in the programme.
3. Demonstration
On video you show a wrong
example of the skill to be learned. In the discussion afterwards you check
if the participants have understood what the effect is if a step is applied
wrongly. Subsequently one or two situations are demonstrated in which the
steps (learning points) are applied effectively. In the discussion afterwards
the participants tell which learning points they have discovered in order
to check if they have understood the effect of adequately applying the
steps.
In this part of the programme
use is made of the behavioural therapy component called 'modelling'. Modelling
can be described as learning through watching examples. Watching, however,
should not be taken too literally. Modelling includes everything that is
perceived. Blind and partially sighted people of course have to make extra
use of other senses. Especially hearing can be an important compensation.
Apart from that the trainer
has to verbalise as clearly as possible relevant behaviour the participant
cannot see so that everything is understood. Instead of videotapes audiotapes
could be used. The trainers can also choose to demonstrate familiar situations
in a roleplay themselves. In these cases irrelevant behaviour and background
noises are always minimized.
4. Practice
In roleplays the participants
practise the skill. First by imitating in a roleplay one of the good examples
that have been shown. In follow-up meetings situations are practised the
participants choose themselves. These can be situations that have occurred
and in which the participant was not satisfied with his own behaviour.
But these can also be situations that are expected to occur and which are
practised in an anticipating roleplay with the help of the learning points
(steps). The instruction on the roles to be played should be very clear.
It is important to check if the instruction is understood by everyone.
When practising effective
behaviour it might be necessary to take the participant literally by the
hand. To give an example, I mention the example of a blind young man who,
before he started the training, always waited for someone else to take
his hand. He had never learned that you can take initiative yourself in
introductions, that you can shake hands yourself and that other people
appreciate you to look at them when you introduce and talk to them. By
helping him every time to stretch his right arm and to tell him to look
at the other person he has learned to introduce himself in a different,
more adequate way.
After the roleplay positive feedback is given by indicating the learning points. The stress is on the adequately applied steps and on their effects. Mistakes are discussed in a way without setting the standard. The aim is to give the person more insight into his own behaviour and into the way he himself wants to reach things. The trainer functions as model for the other participants who also give their feedback.
The room in which the roleplays are practised should be furnished plainly without any obstacles so that the participants can move around freely. The place of participants who are partially sighted should be such that they can see as much as possible and lighting must be accordingly.
5. Assignments
Adequately applying the
skill in differing situations and circumstances (generalisation) asks for
a lot of practice. Therefore separate arrangements are made with every
individual participant to apply the skill in daily life during the following
week. The participant suggests possible situations himself. This can be
a situation at home, at work or a recreational situation. Sometimes
the trainer has to help in thinking of possible situations in which the
skill can be practised. The assignment is formulated as clearly as possible:
when and where the skill is practised and which persons are involved. The
situations must always be connected to the individual situation. They are
written down in big letters, in braille or put on a tape. During the next
meeting the assignments are discussed: how did it go, what was good, what
went wrong, what was the effect. Afterwards the participant can reconstruct
the situation in a roleplay or let other participants do it the same situation.
Effectively applying the
skill to be learned in everyday situations appears to be one of the most
difficult parts of the training. It is therefore essential that people
who are close to the participant are well-informed about the way in which
the several skills have to be practised. In that way they will be able
to give adequate feedback and support.
The following example illustrates
this. In a situation at work a staffmember who is carrying a lot of packets
friendly asks a partially sighted woman: " Would you please open the door
?" The woman answers: "No, I don't like doing it." The staffmember is very
surprised about this inadequate and unexpected reaction; he does not understand
it at all. What the staffmember did not know, however, was that the woman
was practising the skill 'refusing to do something'. For the woman it is
still difficult to distinguish between several situations; refusing to
do something according to the learning points is not an adequate reaction
in every situation. If the staffmember had been well-informed he could
have given adequate support and feedback immediately to stimulate generalisation.
Attitude of the trainer
It is important for the
participants to feel safe and to gain positive experiences in the training
situation. So the attitude of the trainer always has to be accepting and
confirming in a positive way. He shows understanding whenever a person
finds it hard to participate actively, stimulates this person to at least
try by starting with an easy exercise. In the feedback he stresses the
things that were good and is alert on giving observable positive feedback,
in words or in giving a pat on the back. Non-verbal feedback in the way
of facial expressions are not or hardly perceived after all. The language
used should be clear and should fit in with the language and understanding
of the participant, with his situation and perception.
The results of the adapted Goldsteintraining for our target group, adults with both a visual and intellectual disability, can be positively interpreted. This can be concluded from tests before and after the training, from reactions of participants and of people around them. They indicate that after the training the social behaviour has become more effective and that the social skills have improved. The motivation and enthusiasm of the participants has generally been great. Undoubtedly this has positively effected the results.
Summary
In contacts with other people
adequate social behaviour is essential. In my presentation I have lined
out how the Goldsteintraining in social skills can be adapted for adults
with both a visual and mildly intellectual disability. The training provides
the participants with knowledge about prevalent social skills and with
support in the way they could use them adequately, according to their own
values.
Bibliography
1. Raemaekers, Marlies,
Lecture Early Intervention Conference (European Blind Union), Bad Berleberg,
1995
2. Van der Zee, Van der Molen
and Van der Beek, 1989, Sociale vaardigheden voor zwakbegaafde jongeren,
Praktijkboek Goldsteintraining, Van Loghum Slaterus Deventerv