Monday, April 12, 2021

The Dreaded Dead Man's Goal

There I was,  sitting in a very long IEP for Lily a student with multiple impairments including but not limited to quadriplegia, vision impairment, seizure disorder, as well as numerous other medical conditions. When we came to the goals and objectives section,  the teacher read off her carefully crafted goal, " By the designated date, Lily will respond questions using alternate means (pictures, symbols, etc) given maximum verbal, visual, and physical prompts 30% of the time as measured by documented observation."  As I listened to the reading of this goal, something that I had been wrestling with for a while finally clicked into place.  I realized that this goal, which had seemed so reasonable and typical in the past now seemed like complete bullsh-t. 

So, what's wrong with this goal?  Lily has a complex body.  She has difficulty with movement and she doesn't speak so isn't this goal perfectly reasonable?  The answer is no, it's not.  When I listened to the teacher reading this goal, I was transported back to a training on IEP goal writing that I had attended sometime before.  I remember being warned to avoid writing "dead man's goals"  meaning goals that a dead man could still achieve.  At the time I thought it was ridiculous, who would actually write a goal like this?  Who would be that stupid?  And now, sitting here, I realized that not only was the teacher sitting next to me that stupid, but I had been as well.

What I realized as I heard this goal read aloud was that, when you add physical prompting as an acceptable prompt to use in achievement of a goal, you have just written a dead man's goal.  You see, Lily doesn't actually have to be conscious or even breathing and she could still achieve this goal.  The teacher could ask Lily a question, place the symbol system in front of her and then take her hand (or other body part) and physically prompt her to select a symbol to answer the question.  Lily doesn't have to do a thing and even if she, God forbid, expired during the lesson, we can all rest easy that she could continue to meet her IEP goals posthumously.  

There is a LOT wrong with this entire scenario.  Think about it. This is a goal to, presumably, further Lily's communication and use of symbols but it is padded with so much prompting that she doesn't actually have to DO anything.  This goal can be achieved if someone moves her hand for her and, they only have to do it 30% of the time.  I mean, if it's OK to move her body for her, why is the measurement so low?  Is the teacher so busy that there is only time to physically prompt 30% of the time?  Are we measuring Lily's performance or the teacher's?  

And don't get me started on figuring out what 30% of the time means because I have no clue.  When it comes to communication, percentages are problematic.  By 30% of the time, we really mean 30% of the times WE wanted her to respond.  It measures her compliance with our request that she select from the choices that WE put in front of her.  And, last time I checked, communication was NOT a compliance task that could be measured in percentages.  Communication is an exchange of information between partners and when you are a person with a complex body, sometimes the only power you have is to NOT respond.

So, why do these goals get written in the first place? Why do administrators and compliance consultants allow these goals to continue to be written? These types of goals hint at a dirty little secret...we don't believe in ourselves as teachers.  Students like Lily are challenging.  With her limited movement, it's hard to find things that she actually CAN do.  And then she's absent for months with her medical issues so its difficult to write a goal that she can actually achieve.  And truthfully, students like her scare us.  As teachers, we develop a set carefully honed tools that work for most students.  The Lily's of the world remind us that we don't know everything.  They challenge us to reevaluate our methods and dig deep to look for strategies for those students who are the outliers in a group of outliers.  Some of us choose to rise to that challenge while others are consumed by the fear that we might fail.  So instead of rolling up our sleeves and trying something, anything to teach the student, we simply blame the student for our own failings.  We say things like, "well, she's too low to..."  or "she's to medically fragile to be expected to.." 

When we take this approach, we rarely get any pushback from our administrators.  They are afraid too.  They are just glad it's not them on the hook for teaching this student.  We, more times than not, don't even get pushback from the parents.  They have bigger fish to fry as it can be a full time job just keeping the Lily's of the world breathing let alone ensuring that they are properly educated.  And they've had years of professionals telling them what their children can't do.  Many of them have had to lock away the pain of those statements just so that they can continue with the business of loving and caring for their child.  

So what do we do instead?  Well, every child is different but I can tell you what I did.  First, I looked at Lily with a fresh set of eyes.  Instead of looking and all of the things she couldn't do, I focused on the things that she could do.  While she had limited independent movement of her limbs, she could control the movement of her head.  I also learned from her family that she had definite likes and dislikes.  She loved hearing the voices of her family members and familiar caregivers.  She loved swing and rock.  She disliked cold sensations.  Using these few motivating activities, we were able to start building her ability to use a single switch placed near her head.  She was quickly able to learn to activate the switch to hear her sister recite poems and stories that we recorded on a simple communication device.  She was able to use her switch to request a push on the school's wheelchair swing when it stopped swinging.  From there, she was able to begin to use her simple communication device to call for attention during down time in the classroom.  The reward of getting someone to come over and pay attention to her or simply call out to her increased this behavior. She was eventually able to start to use partner assisted scanning to access more vocabulary.  

Instead of writing goals that Lily was already able to achieve or writing goals with low expectations, We were able to collect data and write meaningful goals that would move her forward.  Before her next IEP we measured how many times she used her device to make a comment during a classroom activity.  It was about 2 times on average.  We wrote a goal that given the use of a symbol based communication book and partner assisted scanning, she would independently make a comment 6 times during a classroom activity.  In order to achieve this goal, we modeled commenting using her system so that she would understand what to do.  We tried to incorporate sensory experiences and activities that were motivating for her into our lessons.  Did she meet her goal? No, she didn't.  She only averaged 5 comments per session by the end of the year but, despite not achieving her goal, she improved.  She was starting to use symbolic communication. She went from working on a goal where she didn't have to do anything to one where she did.  And, did anything bad happen as a result of us having slightly missed the mark on goal achievement? No!  Nothing bad happened.  We just reviewed our data, adjusted our goals for the following year and moved forward.

Not only did we feel good about Lily's progress, we stopped having that weird sinking feeling in the pit of our stomachs knowing that we had just written a bullsh-t goal.  There was another difference as well, Lily's mom started to listen to our progress report with interest rather than checking out like she normally did.  We were now writing goals that made sense, that she knew that Lily was likely to achieve.  She could see a slow and steady path ahead.  There was hope.



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