Slide 1:
Hello. Thanks for joining us today. My name is Susan Bachinski and I've been invited by the staff of the Kansas State Deaf-Blind Project to talk with you for a while today about utilizing routines. Routines are really a cornerstone of effective instruction for learners with significant challenges, including deaf-blindness. So we're going to take a look today at what constitutes a routine. How you might implement them in your home with your own child, in your classroom with learners who have deaf-blindness and/or other significant multiple disabilities, and how you can take some data about the routines you're implementing to see if there're improving your effectiveness and if the kids with whom you're utilizing routines are indeed making gains. So let's get started.

Slide 2:
I think it's important to start out with some basic definitions and the rationale behind why we choose to use them. And I believe that a routine that is structured in a consistent way and is targeted for instruction, provides a learner with necessary supports for learning. So this is the why behind why the folks with the Kansas Deaf-Blind Project would encourage you to build your classroom time, to build your school day, to build time in the evenings at your homes with your children, in routines. So let's take a look at what we mean by that.

Slide 3:
To define routine we'd say it is a related series of activities that are organized into a predictable format. And with the highlight, you see the keyword is predictable. Kids with deaf-blindness, particularly children who are born with hearing loss and vision loss, really have no conceptual impression of the world as an organized, safe place to be. And if you will consistently implement routines with your child or with a learner in your classroom, one of the main gains you will see is that those routines will help to organize the learners' activities, but in a bigger sense, they will help organize the learner's world.

Slide 4:
It will help kids learn to anticipate. Anticipate what is going to happen to them when they're physically picked up to be set on a toilet, to have a diaper changed, to have the learner anticipate what's going to happen when you tell them you're taking your brakes off their wheelchair and you're going to start moving them. Anticipate what is going to happen when they move into a session with a physical therapist. Literally anything, everything. The world really is-- despite the chaos we sometimes feel in it, the world really is predictable in many, many ways. And if we can organize that, we can help children with deaf-blindness learn cause and effect, learn to predict if this happens then that is going to happen next. And if they can gain that prediction skill, that child will learn to anticipate what is going to be happening, what is going to be coming. And anticipation is really a key that unlocks the ability to communicate.

Slide 5:
I would suggest that you might develop routines for a whole variety of different types of activities. Routines in your home may be developed for any home chores or home responsibilities. If it's a matter of how you load a dishwasher in the kitchen, what the steps are you need to take. That you take all the dishes from the table, put them on the cabinet. Next step is take the dishes, rinse them off, put them on the other side of the sink. Next step take the biggest things, put them on the bottom of the dishwasher. Next step take the small things and the glasses, put them on the top of the dishwasher. So on and so forth. It may be that when you change your clothes you throw all your clothes that are dirty into a laundry hamper or dirty clothes basket. It may be that you put your shoes in your closet at the end of the day. Routines may be developed for child care activities either at home or at school. This would be things like helping a learner brush her teeth, giving your toddler a bath at home in the evening, diapering routines, diaper changing is a very big one.

Slide 6:
Routines may be developed for daily school events or activities. Kinds of things that very naturally invite the development of routines are those things that happen at school every single day. A child gets off the school bus and has to enter the school building the same way every school day. The same thing happens at the end. At the other end of the school day, there's a pretty standard time and procedure for loading a school bus to go home. If your child doesn't ride in a school bus-- if you pick up your child I would imagine you pick her up at the same place, at the same time most school days that you don't have to go to a special doctors appointment or something. Other daily school activities, kids eat lunch at the same time every school day. Even if your child is tube fed there's a schedule with which the tube feeding should occur and it typically happens in the same general location and the steps to prepare for that are the same every day. Those are the kinds of things that I'm saying are daily school events or activities.

Slide 7:
Routines may also be developed for academic tasks. Let's say your elementary school age student-- or you as teachers you do writers workshop in your classroom. And Sally, who is a learner with deaf-blindness in your classroom, is going to help out with writers workshop. She may help with distribution of materials to her classmates. There could be a routine for that. She may indeed help-- not help, I'm sorry. She may indeed engage in a writing task on a computer by using Writing with Symbols or by using main stamp and other types of pre-prepared materials that have to do with academics. It could be a lab assignment in a high school science classroom, and the student with deaf-blindness could be responsible for being the materials gatherer for a cooperative learning group. Or the student could be responsible for cleaning up the lab equipment that was used at the conclusion of a biology experiment. Any type of academic task invites a routine. And finally, routines may and probably should be developed around each of the learners specifically targeted IEP goals.

Slide 8:
There are other types of skills that should be embedded within routines. And I really had a little bit of a difficult time trying to decide how to describe this to you. So let me share a disclaimer with you before you go on. I'm not suggesting to you that you would never build a routine about any of the six content points listed on your screen right now. Certainly, you might develop a routine to help a learner greet other people or say goodbye to other people when he is departing their company, which would be a communicating and a socializing kind of goal. You certainly might develop a routine for listening. If you have a learner with a cochlear implant and you're trying to teach auditory awareness or auditory discrimination there would be a definite routine for teaching use of that particular sensory ability. So I'm not saying that with the six topics listed on your screen right now they would never be developed as a routine in and of themselves. That is a possibility. The point that I think is important to be made in regard to these skills of communication, socialization, utilizing remaining vision, remaining hearing skills, getting around, using hands and arms, and general problem-solving. These are the kind of skills that should be embedded within any routine that you develop.

Slide 9:
Some of the examples we've talked about today. If you're developing a routine to help your child know how to load the dishwasher after dinner, you certainly would want to consider and need to consider, using hands and arms and what type of adaptations or supports might be required for that. If you had a big family dinner and you've got way too many dishes to load in the dishwasher at one single time, problem-solving would be involved. How do you figure that out? With the notion of classroom and getting to the cafeteria on time for lunch, socialization would be very important. How you're going to be friendly with the other students you encounter in the hall. Communicating would be important. How you're going to place your order or tell the ladies who work the cafeteria line what you want for lunch. Getting around, mobility. How you can get to the cafeteria. How are you going to carry your stuff? That involves using your arms and hands. So these kinds of six considerations should always be considered within any routine that you might develop for your own child or a learner in your classroom.

Slide 10:
What makes up a routine? Every single routine that you might develop-- every single routine that an IEP team might develop for a learner --should have a same number of steps that will be implemented in the same order and used consistently each and every single time the learner is engaged in that activity. Now, I'm not saying that if you develop a load the dishwasher routine and a writers workshop routine and a wash the toys in the toddler room where you go work as part of your vocational training program, that every single one of those routines must have the same number of steps across one another. That's not what I'm saying. But if you're going to develop a writer's workshop routine, then every time you implement the writers workshop routine, it should have the same number of steps. If it has seven steps when you write it then every day you implement seven steps in the writer's workshop routine, in the same order.

Slide 11:
Maybe the cleaning up the toys, to disinfect them in a toddler room if you, as a secondary student, go there as part of a job skill training program, maybe the routine only has three steps to clean the toys. You wipe the top, you wipe the bottom, you set it on a dish towel to dry. That's a little bit lame as an example, but I'm trying to keep it simple. But then you do that over and over and over. Wipe the top, wipe the bottom, set it on the towel. Wipe the top, wipe the bottom, set it on the towel. Same number of steps, implemented in the same order and implemented consistently every single time the learner engages in a particular activity. And hopefully, you're thinking now-- if we were face-to-face I would say to you, "And why is this important?" What is the main point we're trying to help children and young adults learn when we implement routines? Oh, predictability. The world is predictable. I can anticipate what's going to happen to me. I can anticipate what I am going to be doing next. The world's organized. The world's predictable. And that's why consistency in routines is so very important.

Slide 12:
Other features of a routine, it is a sequence of experiences. So if you want to say, "How do we sequence the experience? How do we write the routine?" I'm okay with that. Most effective routines occur in a natural environment, a natural context. They happen at a time that corresponds with when we might engage in that activity during the course of our regular lives. We're going to practice loading the dishwasher after your family has eaten a meal. In the evening, on the weekends, after Sunday dinner. You don't practice loading the dishwasher at 10:30 in the morning when nobody's had any food and there really aren't any dirty dishes. You don't practice over and over again how you pass out materials for a science lab experiment, except when you're in the science classroom and it's time to do a laboratory experiment.

Slide 13:
There is a central or shared focus to each routine. Some of the literature in our field talks about central focus. I really prefer to talk about a shared focus. What that means is that you and your child-- you and the learner with whom you're working --are paying attention to the same task. You're paying attention to the same shared set of materials. The same shared demands of the task. Some of the literature will refer to this shared focus as joint attention. You and the learner who has deaf-blindness are both jointly attending to the same tasks, same materials, same requirements. For kids who are blind-- in literature that deals with this notion of joint attention with kids who are blind, you will hear about joint tactile attention. And it's the same thing. You're going to be touching, exploring, handling, manipulating the same objects, the same cues for a task, the same sequence markers that communicate to the learner what is going to happen next. So the shared focus could be visual, auditory, tactile, or all of the above.

Slide 14:
To really be a routine in the true sense of the word as the professional literature describes it, a routine will involve turn-taking opportunities. Does not have to necessarily be an equal number of turns, but there will be turn taking. To go back to a learner who is distributing materials for writers workshop in a classroom, the learner with deaf-blindness would extend a certain material to a peer who will then take a turn, receive it from her, thank her or respond in some way, then the learner with deaf-blindness will move on to the next peer, take a turn to hand over the materials, the receiver will respond in some sort of way. If you at home are doing some kind of bathing routine with your child-- or showering routine --it might be that your child wants support in getting the soap on the wash rag or the sponge or whatever the bath glove that you use. And so you take a turn to prepare the materials, but then your child takes a turn to wipe her face or hand or foot with that soaped up bath glove or whatever. And then when she's finished that part, she'll hand the glove back to you for more soap or something like that.

Slide 15:
So the turn taking opportunities do not have to be equal in number nor do they need to be equal in magnitude in terms of what each person's contributions make to the accomplishment of the whole task, but it does involve turn taking. And as such, it involves reciprocal roles. The learner will receive information from you, will express or send information to you. If you've had the opportunity to listen to any of the other communication webinars that we've done for the Kansas Deaf-Blind Project, it goes into a lot more detail to discuss this notion that communication involves both receptive understanding or comprehension of information and sending or expressing of information. And that's a communication loop, is what we've called it, but it's reciprocal. I talk, you listen. You talk, I listen. And back and forth, and back and forth, which reinforces turn-taking.

Slide 16:
Repetition. Predictability. Hopefully, you could already have listed those features of routines on the basis of what we've discussed today. Repeat, repeat, repeat. Be consistent. Do it the same way in the same order. Predictability is the purpose. Most routines that are most effective have a small number of steps. As I say, if you're going to be washing materials, you wipe the top, you wipe the bottom, you set it on the towel to drain. You wipe the top, you wipe the bottom, set it on the towel to drain. Three steps. Do it several times. Three steps. Load the dishwasher with the example I gave we had four steps. I'm not sure we were quite finished, but you want to keep the number-- I would say definitely --under ten. I personally think the number of steps should be under six or seven because you're going to be requiring, hopefully, your child or the learner to hold those steps in mind eventually. The learner might need visual supports as the routine is new, but the whole point is to be able to commit it to memory, to develop automaticity is what we call it. But to develop the skill that automatically-- once I start to load the dishwasher - bang - I know what to do because I practiced those steps in the same order so many times I just automatically do it. And routine should have a very clear beginning, very clear middle, and a very, very clear ending. And we'll talk about that more in just a few minutes.

Slide 17:
What are the primary components of any routine? What we've talked about until this point in time are features or characteristics of routines. When I say now, what are the primary components, what I'm really meaning are what are the primary parts? And this is where we get into an expansion of that last notion from the last slide that routines need to have a very clear beginning, middle, and end. That's what we'll develop with these components of initiation, preparation, performance, and termination. So I think we want to take a look at each one of these individually and expand on them just a little bit.

Slide 18:
First component of implementing any routine is the initiation. How does the learner know that it's time to begin a particular activity? How does the learner know that it's time to take her medication at school? That's a goal on her IEP that she's been trying to learn. Maybe a timer goes off. Maybe she has time cue voice output communication device and the alarm goes off at 11:30 and that cues the learner to have the device-- take it to one of her classroom staff members, activate the recorded cue that says, "I need to take my medicine now, please." So maybe the timer signals that. Maybe a way that a learner knows it's time to begin a particular activity is because you as a teacher would take her to the calendar box in the classroom and cue her to say, "What are you supposed to do now?" And the Kansas Deaf-Blind Project does have another webinar on calendar boxes if you're interested in pursuing that topic.

Slide 19:
Maybe it's something as simple and direct as when your family finishes a meal-- finishes Sunday dinner --you might say, "Okay, Tommy. Your turn to do your job. You need to load the dishwasher for us." It may be direct such as that. It may be visual. It may be an auditory cue. It may be context. It may be that when every other child in the classroom is packing up at the end of the school day, the cue to which you're trying to help the learner respond is, "Oh. When you hear and/or see everybody else putting their materials away and getting their backpack to get ready to go home-- to get ready to load the bus --it's time for you to do that too." So the choices are wide open, but when you're writing out-- and we'll talk about how you might do that. When you're writing out and developing a written routine that you hope to utilize in your home or in the classroom, the first thing that you need to settle on is how are we going to choose a learner? It's time to initiate a particular routine sequence.

Slide 20:
After that, you're concerned with preparation. What does the learner need to do in order to be ready for this activity? Let's say for example that you're getting ready to have a child participate in a therapy session-- occupational therapy or physical therapy --in your classroom. The initiation might be if the child can see or hear the therapist enter the classroom. If he or she can't see or hear that person coming in, when the therapist comes, hopefully, she would introduce herself with an object cue, a tactile cue to say, "Hi, Jimmy. I'm here. It's time for therapy." So then in terms of preparation, what does Jimmy need to do? Maybe he needs to wheel his wheelchair-- if he's learning to do that independently --over to a section of the room where there's a mat. Maybe if he walks, he needs to walk over to that particular section of the mat, get down on the floor, and take off or begin to initiate the process of taking off his AFOs or taking off his shoes and socks so that he can be ready.

Slide 21:
If it's an academic task to get ready for a math activity, maybe the learner needs to gather manipulatives or the learner needs to gather specially lined paper and a calculator and some manipulatives and move to a certain table in the classroom. Whatever the learner needs in order to participate, it's the collection of materials, movement to the proper location or setting in which the activity will be completed. Whatever contributes to being prepared and it's a part of get on your mark, get set. Get ready to do the activity.

Slide 22:
The third step-- after we did get on your mark, get set with preparation --go is actually to perform the core. In some of the professional literature, this will only be listed as core. But I think it makes it a little bit clearer if we say you actually perform the core. What will the learner actually do to participate in the activity? And this is where the majority of your steps of your written sequenced routine come in. The performance of the core would be the steps that we enumerated a while ago for clearing the table, putting the dishes on the cabinet, rinsing the dishes on one side of the sink, setting the rinsed dishes on the other side of the sink, taking the large things putting them on the bottom shelf of the dishwasher, so on and so forth. That's the performance of the core of the routine.

Slide 23:
And then finally, after the core has been completed-- that is however many steps make up the actual activity itself --you need a marker of some sort that says, "We're done now", or, "You are done now." And it really needs to be more than a reinforcement of, "Great work, Tommy. I like the way you loaded that dishwasher." I'm not saying it's not important. Sure, reinforcement is important, but sometimes we reinforce our children, the learners who we teach, while they're in the process of completing the core of the routine. So the termination needs to be a marker that more clear than just, "Oh, you did a good job with that." The termination might be with the loading the dishwasher that an older sibling or a parent comes to check after the soap's been put in and checks it out and says, "Okay. Great job Tommy. Let's lock it up and start it and then you're done."

Slide 24:
With an academic activity-- the mathematics activity --maybe the termination would be when the bell rings. If it's a school where students in the school move from class to class, there will be bells that signal the end of classes. So even if your child or this particular learner doesn't move from class to classroom, maybe when the bell rings that's the signal that math time is over, you need to stop now. Put your calculator away. Put your paper in a particular assigned location for "turning in work", by the teachers' desk or by the door or by the teacher assistants desk. And replace the calculator in your cubby so it'll be there when you need it next time.

Slide 25:
If you're using a calendar box it may be putting the object's symbol that represented that particular activity, math or assembling or pre-literacy with picture matching, whatever it is, put the symbol for that into the finished box. Or go back to the calendar box and turn down the flap that says, "This activity is over now." Turn it down, finished. And we're going to move on to the next one. Very clear termination marker, this thing is done now. And then you're going to move back up to the top to initiate another routine to help the learner begin to predict, well, when I finish math, that's when, thank goodness, I get to take a free time break. If math is done, then I get free time. Predict what's going to happen. The world is an organized place.

Slide 26:
In the literature, you will also hear or read, about a scripted routine. And I'm not sure that the actual importance of the difference between a routine that is just called, "Oh, is this a routine?" and a routine that is described as a scripted routine, is truly all that significant for our purposes. But I did want to mention to you that some authors-- some folks --will write only about scripted routines. Particularly when a lot of the focus of a learners instructional program in on development of communication skills, I tend to see the word scripted routine used more commonly. The forms and the process I'm going to share with you in just a few minutes have to do with development of scripted routines. And these have the features that we've discussed to this point in time. Scripted routines should always occur in the natural context and should always incorporate reciprocal roles.

Slide 27:
There are four main elements that you will specify in a scripted routine. One would be a touch or an object cue that you would use to signify the initiation stage of the routine-- the initiation component of the routine. If you're working with a learner who has advanced communication skills-- more what we call symbolic communication skills --this touch or object cue could convert to a verbal request or it could simply be left out and the verbal cue would take over. When we're working with learners who haven't yet developed more advanced communication skills-- who haven't yet developed symbolic communication skills --we really recommend starting with a touch or object cue and then pairing it with a verbal cue. With learners with more advanced communication, the verbal cue really should be more lengthy, more sophisticated, and then possibly reduced to just a single cue word.

Slide 28:
It's also going to involve time delay-- which we'll look at that in just a moment --and specification of the learner,s anticipated response. And then whatever action it is the partner is going to take. Because we have to talk about the interaction partners roles too. Because scripted routines are reciprocal. But before we look at the actual forms and talk about how you might go about writing a scripted routine for the first time, some of you may not be familiar with the notion of wait time or time delay. I believe some of you may be well familiar with this and you use time delay, but I didn't want to take a risk that this might be new to somebody and we didn't take time to define it.

Slide 29:
A definition of time delay involves the use of wait time to encourage a learner to initiate some action or to initiate communication. If I'm going to ask you a question, I need to then wait and wait and wait. Sometimes wait a fairly long period of time to allow you the opportunity to do the motor planning involved. If I'm going to say, "It's time to stand up," and that's just a skill that the learner is just developing right now, it might take that learner 25 seconds to begin to shift her weight forward, scoot her bottom forward in the seat, position her left foot under her body in a secure way, position her right foot under her body in a secure way, shift her weight more to her feet, put her hands on the sides of the chair with which to push up-- maybe on the arms of the chair, the seat of the chair to push herself up, to start to increase muscle tone in her lower limbs to push herself to vertical, then to gain balance to be able to stand up.

Slide 30:
Well that doesn't happen really quickly when you're first learning how to do it. So if you say, "Stand up Janie. It's time to go." So the kid starts the plan. Okay, I'm going to move my bottom forward. I'm going to put my foot here. And then if you go, "Come on Janie. It's time to stand up." She has to start over. She has to go back to, okay, I'm going to scoot my bottom forward, I'm going to put my leg here, I'm going to put my other leg here. We have to wait because sometimes when partners don't wait long enough to allow kids to independently respond or to initiate a response on their own, we as caring adults, we jump in and help. We jump in with supports the kid might not need. We jump in with prompting. And the whole idea of wait time is to begin to wean the learners away from reliance on prompting.

Slide 31:
So with time delay we can use as many pauses as we need, of any length of time we need. And that's the tricky part. Learners are very individual. Your children are very individual in terms of how much time they need to respond. And this length of time they need to respond is not necessarily correlated at all with their ages. It's not that children who are three years old need longer to respond than a young adult who is sixteen years old. That might be true, but it might not be true. It has more to do with cognitive ability, with motor control and motor skill, with sensory ability, to actually hear if the request is auditory or to interpret a tactile request if it's tactile sign language or touch cues to let the learner know what she's supposed to do. It's very, very individualized and it's very linked to the level of a child or young adults communication skill. So we wait as long as we need to wait. Lance might need you to wait 25 seconds whereas Janie might only need you to wait an average of 6 or 7 seconds to allow her to respond. So you need to do watching and observing and taking notes to know how long to wait.

Slide 32:
But waiting, or using time delay, is very, very important for the final point on your screen right now. It allows opportunity. It offers opportunity for a learner to use behaviors that are already existent in her skill repertoire. If you're trying to teach a brand spanking new skill to a learner, time delay is not a tool you need to implement. You can wait forever because that learner doesn't have that skill and isn't going to be able to perform it independently. But when you have been working on instructing a learner in a particular skill, and it's coming along, coming along, you're trying to get rid of the prompts and fade the prompts out. You're trying to get a learner to jump over that bridge, that hurdle of initiating skill performance, time delay is a really powerful, effective tool to use.

Slide 33:
So with that said, let's take a look at a format that you might use to develop a scripted routine. And this just takes those four elements that we just listed a couple slides ago and puts them in a chart format. The touch or object cue, what the verbal cue is going to be, the time-delay for Janie's anticipated response-- how long are you going to wait --and what action do you expect to be taken. So here's an example with a couple of steps. This is from an actual routine I wrote one time for a high school learner who one of her job exploration assignments was to work in the laundry room of the high school. She helped launder all of the uniforms for the football and basketball and track teams, and the cheerleaders and those kinds of things. This particular routine was developed to help her learn to remove stuff from the dryer when it was finished and to begin to fold it as best she could. And Linda did have very, very, very little vision, so we built in tactile cues. She had a very significant hearing loss as well, so we needed to rely on tactile cues.

Slide 34:
So to try to cue her that it was time to get the stuff out of the dryer-- that the load of laundry had indeed finished drying --the person working with Linda would place her hand on top of the dryer while it was still tumbling to feel the vibrations. And then when the dryer stopped, they would put her hand on there when it was no longer tumbling. You had to have the contrast. And the verbal cue would be, "Dryer stopped." So we're going to wait for 20 seconds, that's time delay. Wait 20 seconds. Does Linda attempt to feel the dryer again? That's what you want to see if she's going to check to see if the dryer has stopped. Or is she going to go ahead and make the connection automatically in her mind that, "Oh, this thing stopped? I'm going to find a handle on the door now and open the dryer door to begin to remove the contents inside." If she doesn't attempt to check on the dryer or move for the handle of the dryer then the action you as the partner would take would be to assist her to tactilely search the dryer and find the handle and move on from there.

Slide 35:
So the cue for the next step would be to tap on her right hand and say to her-- it might be sign, it might be spoken, it might be tactile sign, it might be through pictures --"Open the dryer door." The time delay again is going to be 20 seconds. Does she try to find the latch and open it? The action you are going to take is assist as needed to open the latch on the door to the dryer.

Slide 36:
I realize these are only a couple steps of what we actually wrote as a six-step routine. Part of it is a space restriction in the PowerPoint. Part of it is a time and attention restriction because you get tired of listening to me read to you what's on your computer screens. But the next steps would be things such as, to slightly prompt her if necessary, to put her right hand-- because she's right-handed --into the dryer to pull out a piece of the laundry. And you're going to check to see if she grasps it. Assist her to grasp and drop it in the laundry basket. And whatever she's pulled out is actually the cue for put it in the laundry cart, put it in the laundry basket.
Then you can write in a scripted routine, repeat until all of the contents are removed from the dryer. So it's a loop. It's a loop between steps two and three and four, and then you do two and three and four, two and three and four, two and three and four, where you're tapping on her hand, pushing her hand inside the dryer. She's grabbing something from the dryer, throwing it into the laundry basket or dropping it into the laundry basket or the laundry cart. So you're looping, and that is the performance of the core of the routine until the dryer is completely empty.

Slide 37:
And then the conclusion of this routine would be to help Linda get her hands onto the two handles of the laundry basket if it's a portable basket that's carried. Or if it's a laundry cart on wheels to put her hands on that cart and start to push that cart over to the folding table where then you would pick up on a second routine of folding whatever it was. If it were a load of towels from the athletic department, you'd have one routine for folding the towels. It might be a sorting routine where you're going to sort out the towels from whatever else might be in there, the socks and the shirts and the whatever. But you would follow this through with these kinds of specifications.

Slide 38:
You might wonder why do we need this level of detail and this level of specification. It goes back to what we started with today, to say that a routine is a collection of a set number of steps that are completed in the same order every time the routine is completed with the learner. It's performed consistently with the same cues, the same words. It's very repetitive. It's very predictable. And that's the whole point, right? We implement routines. We utilize routines to help learners with deaf-blindness develop an understanding, the world is an organized place. The world is a predictable place, and I can anticipate what I'm expected to do next by what I've just finished doing.

Slide 39:
When you are implementing routines with your children or with learners in your class, you should be collecting data to see is it effective? Is each of the individual steps of a routine effective? Are four effective and three of them seem to bomb? What is going on with the actual learner performance in the routine? You may collect data on a totally separate sheet and any other way that you want to make notes. Or you may add a data collection capacity to the actual routine form that we just examined. And here's an example of what that might look like.

Slide 40:
You could have this be a sheet that you would use to fill out every time Linda worked in the laundry room at the high school. This could be for three days because that's all the room I have on this slide. You would put today's date and then under it you would put a plus if Linda completed that step-- that component of the routine independently. You put a minus if she didn't complete it at all or if she needed support and prompting from you to complete it. In the middle set of boxes that is empty you'd enter the date for the second date she tried this. Plus or minus. Was she successful or not? Far right-hand column would be the third date that she tried this. Plus or minus. Did she complete that step successfully or not? And you would, if you chose to embed your data collection within the scripted routine itself, you would create a box, something like this, after each of the three, four, five, six steps in the routine.

Slide 41:
I think an aspect that is really important as you school personnel-- educational team members --work with families to develop routines for their children, it's really important to support their efforts to implement routines at home. And I would suggest that you ask the family to rate their child's participation in those child care routines at home. Bath time, brushing your teeth, putting your clothes in the laundry basket when they're dirty, loading the dishwasher, home chores, home responsibilities. Ask the family in terms of their own expectations for their child's performance, does what their child is doing exceed their expectations, meet their expectations, occasionally meet them, or not meet their expectations at all?

Slide 42:
Another way to get around this is to ask the family about their level of satisfaction with how their child's performance in a particular routine is going. By talking with families, particularly early interventionists, early childhood educators who work in the homes, these aspects of implementing routines are absolutely critical because the routines that you even implement with the child and his or her parents are going to be done in that family home. And the family will then replicate them in your absence. So getting the family's feedback about how their expectations are being met and how satisfied they are or are not with their child's learning and demonstration of skill, that is critically important.

Slide 43:
This slide and the one that immediately follows it, provide you with what I would suggest are seven basic core steps for development of a scripted routine. These are steps you might follow to write your very first scripted routine. You want to start first by identifying activities that you, a partner, predictably completes with the learner every day. Going into school. Going out of school. Going to the cafeteria. Sitting down for dinner. Getting ready to be tube fed. Taking a shower. Those kinds of things. Choose one. You're going to start with one activity. You don't need to write seventeen routines all at the same time.

Slide 44:
Number three. Write out each step of the selected activity bearing in mind to not break it into every single teeny, tiny part that is possible. Chunk the parts. Chunk the elements so that you can keep the routine to somewhere between four and seven or eight steps.

Slide 45:
Number four. To incorporate touch cues, object cues. If you have discovered, developed ways that you as a team are going to augment input to the learner. How you're going to talk to her more than with your voice. With your hands. With objects. With touches. Incorporate those kinds of things as cues for initiation of a scripted routine.

Slide 46:
Step number five. Identify the response the learner will be expected to make at each step of the routine to be an active participant. For a diapering routine you might say, "Well, Christopher can't diaper himself because if he could diaper himself he could use the restroom, use the toilet independently. That's a silly thing to even think of." But we have to challenge ourselves to find ways that for an activity that would seem to be even pretty passive, such as having your diaper changed, that there would be ways for the learner to take some active role in at least a small part of the routine. And that's what you're trying to do in number five is identify the way the learner can actively participate at least partially in the routine.

Slide 47:
Maybe it's a matter of when you first help Christopher to lie on the changing table or the bed, he could put his hand on the tape that needs to be pulled off to loosen the diaper. Maybe he doesn't have the strength to open that tape himself, but he could touch the tape and that's a way to build awareness and communication. He knows that tape's got to be pulled off. Then you pull off the tape. And then maybe when you give a touch cue or touch his hip to say raise your bottom, maybe he can help. Maybe he can't fully raise his bottom, but maybe he can. If he can't fully raise his bottom, maybe he can relax his muscles to allow you to more easily lift his bottom. Maybe he can hold the diaper for you and not let it fall to the floor. To hang onto the diaper or press his hand so it holds the diaper on his abdomen while you're getting him ready to be changed. Whatever is going on at each step of a routine, there needs to be some tiny to small to significant part of the routine in which the learner can be actively engaged.

Slide 48:
Number six. Anticipate the amount of time the learner needs to make the response. Set the time delay or what we've also called set the wait time, specify that on your scripted routine chart. And determine what the partner's going to say and going to do. Again, you might think there's so much detail, that's just nuts. But it's really important. Especially for learners who don't have solidly developed conventional communication systems. They need to learn the world's predictable, the world's safe, the world's consistent, and partners need to implement this diaper changing routine exactly the same way. They need to say the same things. They need to do the same things in the same order every single time.

Slide 49:
Key to the whole thing about routines, we're trying to create predictability. We're trying to teach the learner the skills of anticipation. Teach the learner the foundations for cause and effect. Means/ends behavior, which all converts into problem-solving at a more abstract, more sophisticated level. And remember that routines need to have a very clear beginning. A very clear middle. And a very definitive end that needs to mark, "We're done now. This is over." And so my very clear signal to you that we have come to the end of our webinar on utilizing routines, is to say we're finished. And I thank you very much for your attention to this content that the Kansas State Deaf-Blind Project staff believes is very important as you work with your children, as you work with learners who experience deaf-blindness. If you have questions, feel free to contact them. If you have questions for me, they can surely put you in touch with me. I'd be happy to do my best to answer your questions. I thank you very much for your kind attention.