Challenges
There are a variety of challenges for individuals with autism and low-incidence disabilities that are presented by the new safety procedure requirements within schools and public places.
Consistent ExpectationsThe first step in establishing a plan for teaching safety procedures is considering each student’s individualized needs and abilities. Determine what the student’s specific expectations in relation to each safety procedure will be and explicitly state the expectation. Set expectations that are reasonable and will be consistently presented across environments.
5-Step Process for Skill BuildingOnce the expectation is determined, develop a plan for teaching the skills necessary to reach this goal. Determine how you will provide direct instruction and when you will allow time for the student to practice. Decide which supports will be used to assist the student and in reminding them of the expectation. Don’t forget to plan for praising and reinforcing the student. Reinforcement is an evidence-based practice and it is essential to successful skill acquisition. Below, you can find a variety of ideas and resources for developing each student’s individual plan when working on wearing a mask, social distancing, and washing hands. Use the planning template at the bottom of this post to record your plan for each student.
Masks
1. Direct Instruction- Direct instruction for wearing a mask should include reasons why masks are important as well as the logistics of how to put on a mask. Use modeling and visual supports to show the student what to expect. For more information check out this great caregiver tutorial from Cincinnati Children’s Medical Center and accompanying social story.
2. Practice- Allow the student to trial different types of masks to see which texture is most tolerable for their sensory needs. Allow them to provide feedback. Determine if the student prefers masks that tie or those with ear loops. Also consider specialized adaptations that may help the mask be more tolerable such as buttons on a hat or headband or using mask extenders.
Once you find a mask that works best, schedule times for the student to practice wearing their mask. Determine what length of time is comfortable for the student and slowly lengthen the time expected. Some students do well with wearing masks when they are distracted by completing a preferred or reinforcing activity.
3. Priming- Once the student has had the opportunity to practice wearing their mask in a structured setting, determine how you will prime them for meeting this expectation in other locations. Use visual supports such as a schedule to let them know when to wear a mask, a social story for reminding them why masks are important, and a visual timer or countdown to let them see when they can remove their mask.
4. Prompting- If the student forgets to wear their mask, use a visual support to remind them of the expectation.
Consider the use of a power card which incorporates a special interest character and the concept you are trying to emphasize. The expectation can be reviewed during the priming time and a simple visual cue such as a picture illustrating the expectation can be used to prompt the student in the moment.
5. Reinforcement- Reinforcement can be embedded into wearing a mask by finding masks that feature the student’s special interest such as Thomas the Train or Minecraft. You can also incorporate a favorite stuffed animal and the student can practice putting the mask on their stuffed animal as well. As mentioned above, you can also incorporate using a preferred or reinforcing activity either while the student is wearing the mask or immediately following to reinforce them. For some students, having time without the mask may be the most rewarding reinforcer, therefore determine a plan for where they can safely take a mask break such as visiting a separate location such as a calming corner or taking a walk outside.
For some more tips on teaching mask wearing check out this helpful video from Autism Speaks:
Social Distancing
1. Direct Instruction- Start with teaching students why social distancing is important and then teach the social distancing procedures that will be in different environments (i.e. working 1:1 with staff, in class, in the hallway, on the bus, etc). These expectations can be taught through social stories or video modeling. Click the image below for a great social story from Autism Little Learners.
2. Practice- Provide the student with plenty of opportunities to practice the social distancing procedures. For instance, if there are specific rules for walking in the class line, take them into the hall to model and practice. Use peer models to demonstrate and act as practice partners.
3. Priming- When entering a new environment, prime the student on what the distancing requirement will be. Highlight any physical or visual cues within the new environment. Review social stories or video priming tools as needed. Cartooning is also a popular strategy to help walk students through different scenarios and the social expectations.
4. Prompting- If the student is struggling with remembering to socially distance, use visual cues to remind them of the expectation. The pack from Pocket of Preschool featured above also has some distacing cues.
5. Reinforcement- Use special interests to draw the student’s attention to social distancing expectations. When using tape to create visual boundaries, look for their favorite color or duct tape with their favorite character. Or place the color or character on a specific spot where you would like for them to stand or sit. Don’t forget to provide frequent, specific praise for following social distancing rules.
Handwashing
1. Direct Instruction- Luckily, most students have some preliminary knowledge of basic handwashing. However, new procedures may require them to wash their hands longer or in a different way. As we discussed earlier, this change may be a challenge. For some students, you may need to approach this as an entirely new skill by switching up several variables at once to decrease the anxiety (and resistance) related to changes. Use different soap, introduce new visuals, and/or find a fun song to incorporate. Other students may respond well to a simple rationale as to why the expectation is changing.
2. Practice- There are many natural opportunities to practice handwashing throughout the day so hopefully this is a skill that can be obtained rather quickly. During practice times, be consistent in providing any new visual or verbal cues.
3. Priming- Prime students of when you would like for them to wash their hands (after restrooming, before eating, after recess, etc.) using visual supports such as a visual cue card or poster in the location. For some students you may need to also provide a visual task list which details the steps to handwashing or provide a visual countdown for how long they need to continue washing. STAR Autism Support has some excellent resources including a video model, handwashing steps visual, and a 20 second timer visual.
4. Prompting- Monitor students to ensure they wash hands properly and for the required amount of time. Use visual and verbal cues to remind them of the expectations.
5. Reinforcement- Make handwashing fun by allowing the student to trial different types of soap to see which textures and scents they prefer and use a catchy song to help with timing. Search online to find popular songs for kids or pop songs to incorporate.
Back Up Plan
While students are still learning these skills or if you determine a student is unable to follow a certain procedure, you will need to determine a plan for keeping them and others safest.
Also, keep in mind that some students seek proprioceptive input so they may seek out others for hugs, try to sit on the lap of a staff member, or lean in to others. It is important that they still receive this sensory input so that they can remain focused and regulated. Work with the student’s OT to find alternative activities such as wearing a weighted vest, teaching a self-squeeze, or using tools such as a steamroller or body sock.
To assist with planning for teaching students these important safety procedures, we have created a planning template for teams to use.
For more COVID-19 Resources check out these great sites:
- Difficulty with Change: Students with autism and low-incidence disabilities struggle with change. They thrive on routine and predictability. Students may resist safety procedures because they are a new expectation and they may feel unpredictable because expectations vary in different environments or they may have a “fear of the unknown” because they don’t understand why the procedures are in place.
- Differences with Sensory Processing: Individuals with autism in particular may struggle with some of the sensory demands presented by the new safety procedures. They may not like the feel of masks on their face or struggle with providing personal space necessary for social distancing.
- Difficulty Obtaining and Generalizing New Skills: Many individuals with disabilities struggle to quickly pick up new skills. They need ample opportunities to practice and many need reminders along the way. Additionally, once these new skills are obtained, it can be challenging for them to generalize them across settings especially when the expectations have been different previously.
Consistent ExpectationsThe first step in establishing a plan for teaching safety procedures is considering each student’s individualized needs and abilities. Determine what the student’s specific expectations in relation to each safety procedure will be and explicitly state the expectation. Set expectations that are reasonable and will be consistently presented across environments.
5-Step Process for Skill BuildingOnce the expectation is determined, develop a plan for teaching the skills necessary to reach this goal. Determine how you will provide direct instruction and when you will allow time for the student to practice. Decide which supports will be used to assist the student and in reminding them of the expectation. Don’t forget to plan for praising and reinforcing the student. Reinforcement is an evidence-based practice and it is essential to successful skill acquisition. Below, you can find a variety of ideas and resources for developing each student’s individual plan when working on wearing a mask, social distancing, and washing hands. Use the planning template at the bottom of this post to record your plan for each student.
Masks
1. Direct Instruction- Direct instruction for wearing a mask should include reasons why masks are important as well as the logistics of how to put on a mask. Use modeling and visual supports to show the student what to expect. For more information check out this great caregiver tutorial from Cincinnati Children’s Medical Center and accompanying social story.
Wearing Masks Tutorial Video from CCMC
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| I Can Wear a Mask Social Story from CCMC (Click image to access) |
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| STAR Autism Support Mask Video Models (Click image to access) |
2. Practice- Allow the student to trial different types of masks to see which texture is most tolerable for their sensory needs. Allow them to provide feedback. Determine if the student prefers masks that tie or those with ear loops. Also consider specialized adaptations that may help the mask be more tolerable such as buttons on a hat or headband or using mask extenders.
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4. Prompting- If the student forgets to wear their mask, use a visual support to remind them of the expectation.
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| COVID Healthy Habits Posters and Visuals from Pocket of Preschool (Click to access) |
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For some more tips on teaching mask wearing check out this helpful video from Autism Speaks:
Caregiver tips to make mask-wearing easier for people with autism from Autism Speaks
Social Distancing
1. Direct Instruction- Start with teaching students why social distancing is important and then teach the social distancing procedures that will be in different environments (i.e. working 1:1 with staff, in class, in the hallway, on the bus, etc). These expectations can be taught through social stories or video modeling. Click the image below for a great social story from Autism Little Learners.
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| Social Distancing Social Story from Autism Little Learners (Click to access) |
Consider how specific visual supports or verbal cues will be used to directly teach what they are and what they mean. For instance, if the student is expected to stay within a taped boundary within the classroom, show them the boundary and explain the purpose. Also, teach alternatives to previous social interactions. For instance, find alternative morning greetings that students can do while distancing. We love this video from Jack Hartmann:
Greet from 6 Feet Rap from Jack Hartmann
2. Practice- Provide the student with plenty of opportunities to practice the social distancing procedures. For instance, if there are specific rules for walking in the class line, take them into the hall to model and practice. Use peer models to demonstrate and act as practice partners.
5. Reinforcement- Use special interests to draw the student’s attention to social distancing expectations. When using tape to create visual boundaries, look for their favorite color or duct tape with their favorite character. Or place the color or character on a specific spot where you would like for them to stand or sit. Don’t forget to provide frequent, specific praise for following social distancing rules.
Handwashing
1. Direct Instruction- Luckily, most students have some preliminary knowledge of basic handwashing. However, new procedures may require them to wash their hands longer or in a different way. As we discussed earlier, this change may be a challenge. For some students, you may need to approach this as an entirely new skill by switching up several variables at once to decrease the anxiety (and resistance) related to changes. Use different soap, introduce new visuals, and/or find a fun song to incorporate. Other students may respond well to a simple rationale as to why the expectation is changing.
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| Handwashing Songs for Kids from Teaching Mama (Click image to access) |
2. Practice- There are many natural opportunities to practice handwashing throughout the day so hopefully this is a skill that can be obtained rather quickly. During practice times, be consistent in providing any new visual or verbal cues.
3. Priming- Prime students of when you would like for them to wash their hands (after restrooming, before eating, after recess, etc.) using visual supports such as a visual cue card or poster in the location. For some students you may need to also provide a visual task list which details the steps to handwashing or provide a visual countdown for how long they need to continue washing. STAR Autism Support has some excellent resources including a video model, handwashing steps visual, and a 20 second timer visual.
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| STAR Autism Support Handwashing Resources (Click image to access) |
5. Reinforcement- Make handwashing fun by allowing the student to trial different types of soap to see which textures and scents they prefer and use a catchy song to help with timing. Search online to find popular songs for kids or pop songs to incorporate.
Wash Your Hands with Baby Shark video
Back Up Plan
While students are still learning these skills or if you determine a student is unable to follow a certain procedure, you will need to determine a plan for keeping them and others safest.
- Masks- If a student is unable to wear a mask, consider seating them in a location within the classroom that allows for increased social distancing. When staff needs to work closely with the student, they can use a sneeze shield or another physical barrier in addition to their own PPE.
- Social Distancing- Physical boundaries can also be used to help students with social distancing such as dividers.
- Handwashing- If you have already tried to make handwashing fun through trialing soaps and incorporating music, consider what other variables may be impacting the student’s success. For instance, many of our students are sensitive to temperature so consider the water temperature when they are washing their hands. Also, be sure to stock up on compliant hand sanitizer and establish a regular surface cleaning routine.
To assist with planning for teaching students these important safety procedures, we have created a planning template for teams to use.
ACT COVID-19 Safety Procedure Teaching Plan (Click image to access)
For more COVID-19 Resources check out these great sites:
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