In-Home Services!

Today began with a trip to a different part of Nairobi for Kaizora's first in-home session ever!!!  Addressing this need has been a challenge in the past, as staffing and transportation have not made this possible.  However, it is clear that there are more and more families asking for such services, so this is a gap Kaizora would love to fill.  This particular case is a 4 year old kiddo from the Phillipines who just moved here with his family.  Given his location relative to Kaizora, the family was unable to come daily, despite their desire for him to receive daily ABA.  As a sort of pilot opportunity, Kaizora has agreed to provide in-home services 2x/week.

When taking into account the advantages, this could be a good opportunity for generalization of skills taught in the center, an opportunity to include self-help and toilet training programs, and provide the father, who cares for the boy at home during the day, with some modeling and coaching, as this is an area he felt as if he wasn't as skilled in.  This session consisted primarily of observing him in the home, getting a feel for his routine, and getting him comfortable with trainers being in his environment.  Things went really well, and what is clear is that the boy seems eager to learn, and the father is very receptive to feedback.  I became inspired that things could work well when the boy grabbed his father's hand and led him into the kitchen towards the fridge, we prompted the father to ask the boy to say "open please", which he did, and when the father did so, the boy grabbed a bottle of coke and handed it to his father.  The father said "no coke" and closed the door.  The boy instantly tantrummed, throwing himself on the floor screaming and crying.  The father tried to redirect the behavior by looking at the boy and saying "it's ok, come on, let's leave, it's ok, it's ok, it's ok".  I asked the father "what would happen if he just walked out of the kitchen?", and the father said he had never tried it before.  I said "let's try and see?".  He walked out of the kitchen, and approximately 1 minute later the boy came out of the kitchen, plopped on the floor, looked around, walked to a roll of paper towels, ripped one off, wiped his own tears, threw the paper towel in the trash, and climbed on the chair and got his cup of water and had a few sips.  We of course gave the father lots of praise and he seemed content.  The father is apprehensive about his English skills, especially given we have talked to the family about only using one language to facilitate language acquisition.  Nonetheless, the father seemed content with the day's session, and after leaving the team from Kaizora was thrilled about the prospects of subsequent sessions.

Upon returning to Kaizora, we met with a family from Zimbabwe who has a 6 year old son with Cerebral Palsy with severe physical limitations on the left side of his body.  His leg has virtually no muscle structure, and his mother is taking him to South Africa in a month to receive a botox injection in his leg.  There was a lot of clinical problem solving around how to increase functioning on the left side of his body, including me contacting a Doctorate-level Physical Therapist in the United States with extensive background in working with children.  She offered many helpful suggestions based on the most current research in Physical Therapy with regard to complete vs. incomplete hemiplegia, motor planning abilities and spastic vs. flaccid CP.  She informed us of a growing body of evidence in support of "constraint-induced therapy", which basically entails putting the unaffected side of the body into a position to essentially make it non-functional, and incorporating fun activities into tasks such as pulling a rope, pouring water back and forth between cups, riding a bike with straps to keep his foot on the pedal, stacking blocks and pushing magnets all over a wall.  Hopefully as the kiddo is able to make more use out of the left side of his body, he will be able to participate in more activities with his peers, and subsequently gain more self confidence.  A program will be put in place incorporating ABA tasks and programs and prompting more use out of the left side of his body.  Ultimately, of course, the parents would like to see him go to a mainstream school with the rest of his peers, while still being able to receive the most out of his schooling environment.  We also agreed to meet with the school teachers and his aya (aide) in order to replicate tasks like those at school in the center so the goal can continue to be mainstream placement.  We were able to run many sessions with this kiddo later as a team, and what was also evident is the desire for him to compensate the best he can given restrictions on his left side.  We ran Precision Teaching sessions, and prompted lots of motor imitation in the context of his preferred activities, such as peek-a-boo, high fives, raising arms above the head and cheering and manipulating objects with his hands.  His left side upper body is much more functional than his left leg, and his mother indicated that when he had botox previously on his leg, his stance and walk was much better.  The team is excited to see how this round of botox affects his muscles in his legs.

Overall the day was very good, and there was lots of opportunities for in situ clinical problem solving and development.  We had the chance to record some sessions so we can review later and provide feedback later and review with Molly back in New York on Skype.  Pooja was hard at work trying to ascertain a large selection of reinforcers for the kiddos, and pairing these reinforcers with pictures she made on cards so they can have some meaning as we implement "First, Then" boards.  Way to go team!!
- Emily

Back to School

As the air cools and leaves begin to change their color in the US, the sun begins to burn brighter here in Ghana. Similar to the US, September not only begins a change in weather, it also signifies the reopening of a new school year. During the summer months, AACT had about 15 students who regularly attended the center with just about one caregiver for every child. Many of the other students traveled with their families or stayed home with other siblings on vacation. Over the past few weeks, all of these students have returned. Now a typical day at AACT has about 25 students, being taught by 12 caregivers, 3 directors, and a few volunteers. Not including the daily visitors, there are over 40 moving bodies in the center on a regular basis, at least half of whom have autism.



Due to increased attendance, it became necessary to find more effective ways to keep groups of students engaged. With support from Auntie Baaba and help from two new volunteers, we put together a more structured morning routine for the middle classroom. We choose this room to focus on first, because they typically have the most students with the least amount of caregivers. The routine involves the students identifying “who is here today” by moving pictures of themselves to the appropriate area, going through the day of the week, month, year, and then identifying the weather. So far, it seems to be working well!



There has been a lot of other excitement over the past few weeks. On September 8th, a television series called Impact Africa came to film an episode at AACT. This included footage of the students activities and interviews with Auntie Serwah and I. Last week, the Rotary Club came to present a donation to the center. There were over 25 members who came for the ceremony. It was a great opportunity for them to learn more about children with autism and the services provided at AACT.



On top of all of this, I have been continuing correspondence with a variety of others. Caroline Pongo, the creator of a local educational puppet theater, came to the center last Thursday. Her and I discussed getting the students involved with a puppet making workshop, as well as planning a performance at the center. Stacey Reynolds, an Occupational Therapy professor at Virginia Commonwealth University has agreed to include AACT on their annual service trip next May. This is especially exciting because there are currently no Occupational Therapists in Ghana. This coming Monday, I have a meeting with Nana Ocran, the Director of Education at the Ghana National Museum, to begin setting up educational programs at the museum modified for children with autism.

In regards to administrative tasks, I have been involved with developing job descriptions and creating an employee code of conduct. These will be compiled into an employee handbook and be available in the future for new employees. As volunteers come and go, we have been asking for their feedback as well, in order to continuously improve the current volunteer handbook. The point of all of this is documentation. Keeping records, putting job rules and regulations on paper, tracking the number of volunteers in a given time period, etc. It all helps to strengthen an organization’s permanence.


Last but not least, the Caregiver Challenge, a fundraiser started about a week and a half ago, has already raise 130GHc (about equal to about $90 US Dollars)! Auntie Serwah has created a bank account that is specifically for donations. The goal is to not touch this money until there is enough to build, buy, or rent an additional, desperately needed, facility.

All in all, things are progressing! And as much as I miss the beautiful fall weather, the warm sun doesn’t feel too bad. Thanks again for reading.

Until next time,
Casey

Saturday August 1, '09

Last weekend Lori, Brad and Alicia all flew back to the US. It was sad to see them go, but know they accomplished an incredible amount over the course of their three weeks in Ghana.

Work started with the development and implementation of preference assessments. These will be used to determine potential reinforcers for communication opportunities and academic work. In collaboration with Baaba, we helped to create an afternoon activity schedule. This not only gives the students more structure, it also puts selected staff in leadership positions, increasing overall accountability.

Throughout the trip, Lori and Brad put together workshops for the staff. These included trainings on the Picture Exchange Communication System (PECS), Pivotal Response Treatment (PRT), and Functional Behavior Assessments. Along with the workshops, we all helped to make the necessary PECS pictures cards and provided consultation on their use. The BI Capture was also set up. The AACT staff was taught how to use it when evaluating problem behavior or modeling effective techniques.

Last, but certainly not least, Alicia built four specially modified workstations. The materials used were all locally acquired, in order for more of them to be created by AACT staff in the future. Needless to say, Lori, Brad and Alicia were fantastic on many levels. They will certainly be missed here in Ghana.

As for the past week...

Baaba came into work Monday morning with a mission to clean. Every day we choose one room or space to tackle. Broken, chewed, unuseful toys were thrown away. Selected toys and teaching tools, including all stuffed animals, were washed. Once inventory was taken, we were able to make every child there own set of supplies. Each pouch included a new box of crayons, colored pencils, a pen, a pencil, sharpener, and eraser. The individual classrooms were also given the appropriate toys and teaching materials according to the needs of the students.

Once again, a personal thank you to Lori, Brad and Alicia for being excellent volunteers. Can't wait to work with you again next summer in India!

Going now to enjoy some delicious grilled plantain.
Casey

Friday, July 24

Greetings!

This is Lori again. We had a very exciting day today at the centre! In the morning Brad helped the centre with evaluating a new potential student. I went with the Casey to print out all of our training summaries as well as the graph showing the number of functional communication statements made by students during snack before we started training and after we started training. The data was very impressive! Casey will be taking data a week or so after we leave so we can measure if this change in staff behavior (increased opportunities for communication) is maintained. Considering the enthusiasm by the staff over the impact this has had on the students, I believe that this change will be maintained after we are gone.

In the afternoon, Brad and I did our third Functional Behavior Assessment (FBA) workshop with the staff. The response from the staff was amazing! In all three workshops the staff had excellent questions and were really beginning to understand the functions of behavior. After one of the workshops, two staff members came up to Brad and I to tell us this was the best training they had received in five years working with kids with Autism. They told us that often times people in the community turn to them for answers about what is Autism and how can Autism be treated and they are often unsure of the answer. They said the workshops from this training trip helped them understand Autism and Applied Behavior Analysis so that they could answer the questions of people in their community. One of the staff members even told us that every day since the beginning of our visit she has gone home and shared with her family what she had learned from us that day. All of the comments from the workshops were incredibly powerful, but these in particular were very touching and meaningful to us. It is such an honor to be able to provide knowledge and information to individuals who are so dedicated to their work and hungry to learn more.

During the FBA workshops we also showed the staff how to use the BI Capture. In the morning, the staff set up the BI Capture (with a little guidance from us) and used the BI Capture to get videos of a student’s biting behavior. The supervisor at the centre will review these videos with the staff to determine the function of the behavior and be able to come up with an effective intervention plan.

Alicia finished modifying the desks today! They look absolutely amazing and are the best desks I have seen for Autism intervention. The pull-out drawer leaves space for data taking and lesson plans without placing too much onto the desktop. The beads make data collection easy which allows for faster teaching. There is even a spot on the desk where the reinforcer is placed so that staff does not forget to determine what the child will be working for before beginning teaching. The staff was very excited about these new desks and we look forward to their feedback as they begin using them.

After our day at the centre, Brad and I had a drum workshop with a local drummer. This was a truly remarkable experience! We sat in his drum workshop (where you can watch cattle passing by) and played our African drums together! Then we had a traditional ceremony where liquor is poured on the floor (and a little on the drums) as a blessing. I have to say, I have never had an experience quite like it!

Alicia and Casey went to the market and then met us for dinner at the vegan restaurant (again) where we had some delicious veggie stir fry, pasta and yam fries. I am very sad to say goodbye! I look forward to keeping in touch with the staff at the centre as many of them want to continue to learn more about Autism and ABA. I cannot express how meaningful this trip has been to me. Being able to see an Autism centre in another part of the world and collaborate with the staff there has been a great pleasure and wonderful learning experience.

As always, thanks for reading! I look forward to sharing future trips with you!

Afua (this is my Ghanian name!)

Day 8: July 14

Greetings from Brad,

We had another busy day at the centre, working with the staff to develop and implement a preference assessment for all of the students. The preference assessment will be used to gain some insight into what motivates each student. We will then use these "motivators" as reinforces for appropriate communication and academic demands.

Lori and I also continued with the PECS and PRT trainings that we had started on Monday. The staff responded amazingly, jumping into the demonstration and showing that these skills are like many that they are already using. We are confident that the staff will be able to apply these approaches to their interactions with the students.

Alicia continues to make progress with her project by having completed all of the sanding. In addition, she started painting (with a color scheme of grey for the legs and blue for the tops) the desks.

After handing out the certificates of achievement to the local staff we headed back to our village to prepare for our personally cooked meal. Before the meal we worked up an appetite by taking a walk to Independence Square. We took in all of the sights, the memorial arch and the conference centre, which are really stunning. Back to the meal, through a mutual friend we had an amazing typical Ghanaian meal that consisted of a pasta with seasonings, jolof rice (similar to spanish rice), and a salad of cabbage, potatoes, and salad cream. This was all topped off with an amazing orange crepe dessert that I hear was incredibly delicious (there was no vegan option, so I had more jolof).

Tomorrow we are heading out on an excursion to the botanical gardens. Lewis, the official drummer of the Global Autism Project will be joining us to provide a drumming workshop for the students. This is going to be great!

Respect,

brad "kofi" herron