Hersher Institute: Module on Ethical Reasoning in Developmental Disabilities

Young Adult: Case Scenario

John is a 19 year old young man with an intellectual and developmental disability. John is a friendly person, and always smiling. He is significantly over-weight, and he presents with a slow and steady gait. He lives at home with his parents, and he requires full assistance with all his ADL’s (activities of daily living) and IADL’s (instrumental activities of daily living). His parents have employed a personal-care assistant to assist him with after-school and evening routines, Mondays through Fridays. His family assists with all his morning routines before school, and meet all his personal care needs on the weekends. John has no friends outside of his family circle, and he wishes he had a friend. Other than friendships, John is relatively content in his life. He hopes and dreams to some day to live on his own, in an apartment; he’d love to be able to go to work; and he’d like more opportunities to participate in leisure activities and make friends.

John attends a full-time special education program at his local high school. John likes going to school. He wants to go to school, because he believes school is going to help him get a job. He is put on the school bus everyday by his mom, and has a full-time paraprofessional during the school day to facilitate his participation in school activities.

The school program offers John daily instruction in literacy (reading, writing and communication), basic math and science. All instruction is delivered in a special education classroom, with five other students. He does not have friends outside of school. John is also involved in a pre-vocational and life skills program. His pre-vocational and life skills are moderately poor – he requires continuous assistance, but some skills are developing. Over all John participates successfully in school with supports, however, some days he presents with behavioral outbursts (yelling and cursing in frustration). Instructional materials for John are at a third-grade level. John receives related student support services of occupational therapy, physical therapy and speech, to address ADL’s, IADL’s, mobility, and communication skills.

The school program offers John daily instruction in literacy (reading, writing and communication), basic math and science. All instruction is delivered in a special education classroom, with five other students. John is also involved in a pre-vocational, life skills and social skills program. His pre-vocational abilities and life skills are moderately poor due to his difficulties processing directions and problem solving. He requires assistance in most activities; however, he is making progress in some areas of skill development. Over all John participates successfully in school with supports. There are some days he presents with behavioral outbursts (yelling and cursing in frustration). Instructional materials for John are at a third-grade level. John receives related student support services of occupational therapy, physical therapy and speech, to address ADL’s, IADL’s, mobility, and communication skills.

John goes to a community work site every Friday. He has been going to this site for the past 8 months. His job is at the Town Hall Community Shop. John’s paraprofessional teacher is with him for support at his work site. John has to work with the store-owner, and his primary responsibilities are to deliver and sell newspapers to all the offices within the town hall. His job requires him to handle and carry the newspapers, organize the papers for delivery in the building, deliver them to thirty different offices within the building, and collect the money from the customers. John is managing most aspects of his job, with the exception of handling and dealing with money.

There is a transition IEP meeting planned for four weeks from now. The team has been instructed to provide an update on John’s academic, school, work and social performance, research possible options for John post school, and they are to prepare some suggested postsecondary goals for John, transitioning from school to work. John’s classroom teacher and paraprofessional do not expect that John will ever be able to live and work in the community independently. The teachers have been working with John closely over the past three years, and really believe there are too many barriers for John to overcome, in becoming independent. The teacher believes that John has reached his maximum potential in the high school setting, and wants to prepare the family for John’s graduation from High School. The teacher believes that John has the capability to further develop his independence/life skills, however, the teacher feels strongly that this is an area for the family to continue to address with John, and that he should be exited from the educational setting. The family believes that John has not yet reached his full potential, and wants for him to continue further education at the High School until he is 21 years. They believe that with additional educational programming, John will be better prepared for possible future employment and independent living.

Other members of the team are thinking about John and his future, and how best to plan for his future. The OT, PT and SLP have decided that they would like to gather information for the team about what future supports might be available to John within the community – they are researching agencies of support, employment supports, independent living and social supports, that might be available to John once he leaves school. The OT and SLP believe John should continue at the High School for at least one more year of education, in order for him to achieve greater success in transitioning. 

John just dictated his wishes to his paraprofessional. His wants include the following:

    1. He wants to be able to speak for himself, and not have everybody “bossing him around”
    2. He wants to find a real friend to “go bowling with”.
    3. He wants to “eat any kind of food I want, when I want”
    4. He wants to live in an apartment, and go to work to make money.

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