Evaluating Self-directed Support Services


When the Administrative Rules that govern quality assurance are applied in a relationship of advocacy between the service provider and the client, the evaluation tool should be client-friendly. Most service contracts are aleatory contracts which impose a greater duty on the maker/designer of the contract than on other parties to the contract. Surveys and other tools that attempt to measure client satisfaction in the case of clients with developmentally altered abilities, should furthermore be designed to consider the developmental characteristics of those very clients. Tool design consideration should be given to orthopedic, cognitive or any other existing factors that impact those clients’ abilities to experience and to enjoy admirable lives.


In any case, the clients of such agencies deserve a tool which speaks to each client’s needs while communicating on a level that the average person with developmentally altered abilities can comprehend. There it is again; that old “c” word.



To summarize briefly if not concisely, a wealth of research exists on the use of visual supports with all ages of readers and with all ability levels to increase literacy levels. It started shortly after the printing press was invented. In England, these supports were called emblem books. They were, by our current standards, similar to what we would call comic books.


These emblem books consisted of woodcut prints containing a symbol or drawing that was matched with a more abstract verbal concept that was usually intended to convey some religious or moral standard. In America, we had the classic “In Adam’s fall, we sinned all” in the lesson materials of the New England school masters. The phrase was paired with a woodcut of Adam and Eve being ejected from the Garden of Eden.


In special education, we call these “paired associates”. In one theory that addresses acquisition of literacy skills, paired associates are presented to persons learning to read. The matching pictures are gradually faded until the student recognizes the text without the picture support.


We know in the case of individuals on the Autism Spectrum Disorder, language development is a key component of any educational intervention. Writers like Temple Grandin, a person with Autism who designed animal confinement systems, report from personal experience that individuals with Autism tend to think in pictures.


The interesting aspect of Temple Grandin’s case is that her developmentally altered abilities include the meta-cognitive skill that allows her to reflect on her own thinking processes and to share those reflections with the greater community.


How many other disorders and syndromes include criteria that would suggest an affected person would naturally think in pictures? How many of those other disorders and syndromes include individuals who can communicate about the ways in which their brains work?


In designing tools therefore, that are intended to communicate with (and not to) persons with developmentally altered abilities, the quality assurance component needs to be based on some common communication aspect that is experienced by the entire community of involved persons.


I suggest that common ground is a picture support system for communicating abstract concepts and the reduction of abstract concepts being communicated to a common level of understanding. That common level of understanding is language reduced to the least complex and unambiguous word choice.


Many of you special educators reading this will respond that these ideas being discussed in this paper are a restatement of the obvious. My personal experience suggests that the level of understanding of persons with developmentally altered abilities tends to be more greatly appreciated in the educational arena that in other federally funded service delivery systems.


My intent here is not to indict those other agencies. My intent is to include them in a collaborative effort to improve communication with our mutual clients.


I was recently asked to review a form used by one federally-funded agency to measure the satisfaction of its clients with the services the agency was delivering. I suggested to the group that clients might benefit from picture supports for each question on the survey.


I was told that the agency had discussed that possibility, and concluded that picture supports were believed to be insulting to the clients. The picture supports being considered were “smiley” faces and “sad” faces.

I cannot evaluate if these would have been insulting to the clients. I can conclude that this specific picture support has been overused to the point of becoming trite and ineffective (if not down right silly at times as in the case of the emoticons so frequently used in email communication).


I submit that the common level of understanding is in fact a level at which written language is secondary to the processing of concepts conveyed in pictures. I will avoid the cliché that measures their worth in the thousands of words.


I submit that the resulting language is an experiential language, much like American Sign Language. It is based in common gestures and iconic images that surround us in our daily life activities.


I submit that I am describing a community-based language that we all speak out on the streets of our communities. At its worst, it is a language that caters to our basic instincts. At its best, it is a language composed of signs and standards that keep us safe.


I conclude that a tool designed to measure the satisfaction of a client with a developmentally altered ability level is useless unless it allows the client to communicate about the most significant of client concerns – happiness.


In my humble opinion, every survey that was designed to measure client satisfaction and the quality of service delivery, is useless unless the clients can communicate whether they enjoy the homes in which they reside, or whether they do not.


Can you imagine a picture that you can use with your client to communicate about your client’s happiness? I will bet that you can. In fact, you may just have found the first grapheme in your own developmentally appropriate language.