Transitions
"Only a few decades ago,
many youngsters with Down syndrome were viewed as eternal children. They were
kept [in] sheltered independent positions and were not provided with the opportunity
to become responsible citizens in an accepting society" (Pueschel, 2001).
Today, adolescents with
Down syndrome face a series of transitions as they emerge from childhood and
prepare for adulthood. Indeed, transition is one of the top priorities for teens
with Down syndrome today. Individuals with Down syndrome are eligible for special
education services through the public school system through their 22nd birthday.
Within the special education system, transition is a specific process that begins
at age 14 and continues through age 21, designed to prepare the individual to
leave school and prepare to enter the work force.
In reality, however, transition
is a lifelong process that begins in childhood and extends through adulthood.
Pueschel describes transition as "...a bridge between the security and
structure offered by school and home and the risks of a more independent adult
life" (Pueschel, 2001). Within this definition, there are clearly roles
for the adolescent with Down syndrome, his parents and other family members,
teachers, health care professionals, and representatives from public and private
agencies that serve individuals with developmental disabilities.
The National Down Syndrome
Society (NDSS) outlines a specific transition time line that includes specific
recommendations for transition activities from elementary school age through age
22. Some highlights of this time line include:
Elementary School Age:
- Introduce the concept
of work into everyday life, including chores and an allowance
- Learn about various careers
and vocational opportunities
- Develop self-care, daily
living, and social skills at home and school
Middle School Age:
- Explore options for careers,
vocational paths, and job training
- Do volunteer work and
community service
14 Years Old
- This is the time for
the formal Transition Planning Committee meeting
- Incorporate vocational
and transition goals into the Individualized Educational Plan (IEP)
- Explore recreation and
leisure interests
- Explore funding sources
15 Years Old
- Gather information about
life planning options for job training, living arrangements, employment, recreation,
and guardianship
- Continue writing transition
goals into the IEP
16 Years Old
- Find and hold a part-time
job
- Discuss how long students
will attend high school (4 years or until age 21)
- Make referral to vocational
education agencies as appropriate
17 Years Old
- Enroll in vocational
education
- Establish a graduation
date
- Make decisions about
guardianship
18 Years Old
- Apply for SSI and Medicaid
- Establish living arrangements,
contract with adult service provider or case manager, and guardianship as
appropriate
- Attend a job fair and
schedule a vocational evaluation
19-21 Years Old
- Schedule vocational education
- Find a suitable job,
generally in a supported employment environment
- Ensure coordination from
all support services; make sure they’re ready to go following graduation
- Introduce budgeting and
other life skills
A nurse's
involvement of in each of the transition activities outlined above, depends on
training, experience, and practice setting. A nurse case manager working
closely with the teen, for example, may attend a variety of educational, vocational,
and other planning meetings. Nurses in a clinic setting may be involved in establishing
job restrictions secondary to health issues of the adolescent. Home health nurses
can play a valuable role in supporting employment decisions, guardianship recommendations,
and explorations of living arrangements. With good assessment skills and a genuine
interest in the adolescent with Down syndrome, professional nurses can help the
family achieve optimal outcomes in almost every aspect of the transition process.
INSTANT
FEEDBACK:
Nurses
should stick with health care issues and not involve themselves in the educational,
developmental, or employment decisions.