Stakeholder perceptions of the impact of individualized electronic “Communication Stories” on workplace communication

Abstract

BACKGROUND:

“Communication Stories” provide individualized, electronic examples of how transition-aged students communicate. Intended to promote self-advocacy and improved workplace interactions, they are created and shared by students with supervisors about the specific communication strategies they use.

OBJECTIVE:

This pilot study evaluated the perceived impact of Communication Stories on participants, their job coaches, and workplace supervisors using a combination of quantitative/qualitative methods.

METHODS:

Using their personal iDevices, stories were created with input from nine participants with intellectual disabilities and/or autism and concomitant language impairments. Job coaches self-assessed their knowledge of participants’ communication strategies before and after viewing the stories, and job coaches and workplace supervisors were interviewed about the perceived impact of the stories on workplace interactions.

RESULTS:

Following viewing of stories, job coaches reported significant increases in knowledge of participants’ communication strategies and confidence supporting their workplace communication. Stakeholder feedback also revealed themes including: (1) participants’ “taking charge” of sharing their stories appeared to strengthen their self-esteem and relationships with their supervisors, and (2) viewing stories appeared to have a positive impact on the communication behaviors of job coaches and workplace supervisors.

CONCLUSIONS:

Stakeholders, including participants and their families, were very enthusiastic about Communication Stories and recommended their expanded use across settings and conversation partners.

Keywords

Communication transition employment assistive technology intellectual disabilities autism self-advocacy

1 Introduction

Outcomes literature strongly supports the claim that quality of life for young adults with disabilities is correlated with successful employment, and even more so with social integration in the workplace (Jahoda, Kemp, Riddell, & Banks, 2008; Kober, & Eggleton, 2005; Kraemer, McIntyre, & Blacher, 2003). Finding and maintaining jobs continues to pose a significant challenge for this population, however, especially for young adults with intellectual disabilities (ID) and/or autism spectrum disorders (ASD), the vast majority of whom remain unemployed or underemployed (Hendricks, 2010; Newman et al., 2011).

When asked what they look for when hiring employees with disabilities, studies indicate that employers are especially concerned about their employees’ abilities to communicate effectively. Many individuals with ID and ASD struggle with concomitant expressive, receptive, and/or social and pragmatic language impairments (Hendricks, 2010; Schalock, Westbrook, & Young, 2012), which means that functional communication difficulties can pose a significant obstacle to workplace success. For example, a study by Riches and Green (2003) found that employers of individuals with disabilities especially valued their employees’ abilities to participate in conversation (78.9%), use greetings and partings (67.6%), discuss general topics (47.9%), and be assertive (46.5%). A second study focusing on employment of adults with ASD found that factors influencing employers’ hiring decisions included job applicants’ abilities to make eye contact, ask and answer questions, request help, and interact appropriately with supervisors and coworkers (Nesbitt, 2000). Several recent studies have also found that effective social skills—including communication skills—appear to predict higher rates of post-school employment for individuals with disabilities (Mazzotti et al., 2015; Test, Mazzotti, Mustian, Fowler, Kortering, & Kohler, 2009), reinforcing the idea that the ability to engage in successful workplace interactions is extremely important to employers.

Deficits in communication skills have also been cited as reasons why adults with ID and/or ASD have difficulty maintaining employment and employers are more likely to fire them. For example, a study of adults with ASD conducted by Müller et al. found that the majority of participants reported receiving poor work evaluations and/or being fired from their jobs as a result of communication difficulties (Müller, Schuler, Burton, & Yates, 2003).

Evidence shows that when given access to appropriate supports, individuals with ID or ASD and language impairments can achieve success in competitive work environments (Brown, Shiraga, & Kessler, 2006; Hillier et al., 2007). Even more importantly, when given appropriate communication supports, the number of workplace interactions of employees with language impairments goes up, and employers are more likely to report satisfaction with their employees’ workplace performance (e.g., Mautz, Storey, & Certo, 2001; Purcell, McConkey, & Morris, 2000; Storey, 2002).

We argue that ensuring successful workplace communication for individuals with ID and ASD may require thoughtful intervention, and recommend consideration of the following when developing individualized workplace communication supports: (a) focusing not just on the communication skills of employees with ID and ASD, but also on the communication skills of employees’ communication partners; (b) fostering self-determination in employees with ID and ASD by including them as active participants in identifying their primary communication strategies; (c) increasing workplace supervisors’ disability awareness levels and knowledge of their employees with disabilities’ communication support needs; and (d) designing interventions utilizing assistive technologies that minimize the possibility of social stigma.

Recent literature on communication interventions frequently builds on the assumption that communication is a dynamic and transactional process involving at least two parties, and that the success of interactions is dependent on the communication skills of everyone involved. These studies are based on the idea that targeting communication partners can be as effective—and sometimes more effective—than only targeting individuals with language impairments (Foreman, Arthur-Kelly, & Pascoe, 2007; Kent-Walsh & McNaughton, 2005; Purcell, McConkey, & Morris, 2000). Although intervention research specifically examining communication in the workplace is extremely limited, much of it has been based on a transactional approach. For example, an older study by Storey and Garff (1999) focused on supervisors/coworkers, and found that when given appropriate instruction on how to interact with employees with ID and language impairments, supervisors/coworkers were able to function as effective “natural” supports, resulting in increased quality and quantity of workplace interactions involving their employees with disabilities. A review of the literature by Storey (2002) on strategies for increasing interactions in employment settings also identified several studies (all published prior to 2000) indicating that training of supervisors and co-workers could lead to increased social interactions, self-advocacy and workplace social integration. Demchak & Greenfield (2000) recommended use of transition portfolios, which enable transition-aged students to share information with their workplace supervisors about how they learn and communicate (e.g., via a gesture dictionary or list of receptive/expressive language strategies), but there is clearly need for additional research on communication interventions in the workplace.

Studies suggest that self-determination is one of the key indicators of post-school success, including higher rates of employment (Mazzotti, Rowe, Sinclair, Poppen, Woods, & Shearer, 2015; Test, Mazzotti, Mustian, Fowler, Kortering, & Kohler, 2009). For example, Wehmeyer and Palmer (2003) found that self-determined young adults with ID were more likely to hold jobs three years after leaving high school than their less self-determined peers. Further, the National Technical Assistance Center on Transition recommended that opportunities for self-determination (including teaching self-advocacy skills and adopting student-driven IEPs) be built into transition planning whenever possible (NTACT, 2015) in order to improve post-school outcomes.

Another factor influencing workplace success has to do with supervisors’ feeling competent interacting with their employees with disabilities. Workplace supervisors often report lacking a basic awareness of disability issues, as well as knowledge of how to interact effectively with employees with disabilities (Kaye, Jans, & Jones, 2011). One study found that employers willing to hire employees with disabilities were more likely to report understanding how to accommodate their employees with disabilities (Gilbride, Stensrud, Vandergoot, & Golden, 2003). Another study found that 60.9% of employers reported that consultation with job coaches or employees themselves was “important” or “very important” to them (Graffam, Shinkfeld, Smith, & Polzin, 2002). These findings suggest that including supervisors in workplace communication interventions for employees with language impairments not only increases opportunities for employees to interact directly with their supervisors (as opposed to always having their interactions mediated by job coaches), but also provides supervisors with specific information about their employees’ disabilities and communication strategies, and improves supervisors’ confidence interacting with them.

Finally, research indicates that while assistive technologies (AT) have been shown to positively impact workplace performance (Sauer, Parks, & Heyn, 2010), traditional AT devices are often abandoned because they lack consideration of individuals with disabilities’ needs, draw unnecessary attention, and/or lack portability (Alper & Raharinirina, 2006). A study by Shinohara and Wobbrock (2011) involved interviews with a group of AT users and found that users valued AT devices that allowed them to look like everyone else. In response to this, Shinohara and Wobbrock recommended that mainstream technologies (e.g., iPads and iPods) be used whenever possible in order to eliminate the social stigma often associated with AT.

Given the clear need within the field for supporting successful workplace interactions of employees with ID and/or ASD and concomitant language impairments, there is surprisingly little research on tools designed expressly for this purpose (exceptions to this include the work by Demchak & Greenfield, 2000). In response to this need, the second author (a speech-language pathologist/SLP at Ivymount School) developed “Communication Stories,” individualized self-advocacy tools designed to help transition-aged students with ID and/or ASD teach others about how they communicate. Communication Stories address the four intervention considerations described above by (a) providing explicit information on how communication partners (in this case, job coaches and workplace supervisors) can modify their own communication styles to better facilitate successful workplace interactions; (b) fostering self-determination by actively involving students in all phases of the intervention—from selecting content, through sharing stories with workplace supervisors; (c) increasing workplace supervisors’ knowledge of students’ communication support needs and confidence meeting those needs; and (d) using students’ iDevices for sharing Communication Stories to both maximize portability and eliminate any possible social stigma associated with AT.

The purpose of this pilot study was to evaluate the perceived impact of Communication Stories. A combination of quantitative and qualitative data were used to answer the following question: What were stakeholders’—specifically job coaches’ and workplace supervisors’—perceptions of (a) the impact on transition-aged participants with ID and/or autism and concomitant language impairments of sharing their Communication Stories; (b) the impact on job coaches and workplace supervisors of viewing participants’ Communication Stories; and (c) the overall value of Communication Stories as a self-advocacy tool designed to support workplace interactions?

2 Methods

2.1 Participants

Participants were selected via a purposive sampling procedure. Program administrators from a single post-high school program serving students with disabilities identified 11 students who met inclusion criteria. These criteria included the following: (1) diagnosis of mild to moderate ID and/or ASD; (2) transition-aged (i.e., 18–22); (3) identified to begin a Fall internship at one or more community-based jobsites; (4) informal evaluation by their SLP establishing functional expressive, receptive and/or social/pragmatic language impairments that would prohibit them from using spoken language to independently explain their communication strategies to others. Of the 11 eligible students, we were able to secure informed consent/assent from 10, but only nine of these were able to share their Communications Stories with workplace supervisors.

These nine participants ranged from 20 to 22 years of age at the time of the study (see Table 1). Six were male and three were female. Educational records documented an extensive history of special education and speech language therapy services for all nine, as well as diagnoses of ID for five, ASD for two, a combination of ID/ASD for one, and a combination of ID and other health impairment for one. In order to determine levels of cognitive functioning, reviews of participants’ educational files were conducted. Records indicated that three participants were classified as having mild ID (i.e., IQs of 70–55) and six were classified as having moderate ID (i.e., IQs of 35–54). Although all experienced language impairments, communication skills varied considerably across participants. For example, some communicated verbally using only one- to two-word phrases, and struggled with intelligibility, whereas others communicated quite clearly and were able to speak in longer sentences. Further, while some were motivated to initiate and maintain conversations on preferred topics, others required high levels of prompting and support in order to do so (see Table 1 for brief descriptions of participants’ communication levels).

Table 1
Participant Characteristics

Participant Age Sex Diagnosis IQ Communication Skills

P1 22 M Intellectual Disability/ Other Health Impairment Mild ID Understands 5–8 word, verbally presented directions and questions containing familiar vocabulary. Needs prompting to use self-advocacy strategies when a comprehension breakdown occurs. Verbally communicates using phrases and sentences. Intelligibility is impacted by lack of coordination of the articulators. Uses strategies to clarify speech production given natural cues. Will initiate interactions by asking questions about routine topics (e.g., the weekend). Needs prompting to comprehend nonverbal language of peers and staff.

P2 20 F Intellectual Disability Moderate ID Understands 3–5 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using 3–4 word phrases and some sentences. Responds to natural cues to repair communication breakdowns related to intelligibility. Will initiate interactions by making comments about preferred topics and sharing pictures.

P3 22 M Autism Spectrum Disorder Mild ID Requires initial prompts to attend to staff members and conversation partners. Understands 3–5 word, verbally presented directions containing familiar vocabulary. Processes questions and complex directions more successfully when written down. Verbally communicates using 1–7 word phrases and sentences. Initiates conversation related to preferred topics by asking a question or using a script related to the topic. Requires prompting to initiate interactions using social pleasantries (e.g., greetings) and respond to conversation partners across the day.

P4 22 M Autism Spectrum Disorder Moderate ID Requires initial prompts to attend to staff members and conversation partners. Understands 3–5 word, verbally presented directions containing familiar vocabulary. Processes questions and complex directions more successfully when written down. Verbally communicates using 1–3 word phrases. Requires prompting to initiate interactions using social pleasantries (e.g., greetings) and respond to conversation partners across the day.

P5 21 F Intellectual Disability Moderate ID Understands 3–5 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using 3–4 word phrases and some sentences. Intelligibility is impacted by dysfluent speech and articulation errors. Will use strategies to improve fluency of speech given natural cues. Will initiate interactions by making comments about preferred topics and sharing pictures.

P6 22 M Intellectual Disability Mild ID Understands 3–4 word, verbally presented directions. Discriminates between WH-questions with visual and written prompts. Verbally communicates using 1–3 word phrases. Intelligibility is impacted by articulation errors and low volume. Uses strategies to repair conversation breakdowns such as writing down words, showing a picture, or pointing with prompting. Will initiate interactions by making comments about things happening in the immediate environment.

P7 22 M Intellectual Disability Moderate ID Understands 1–2 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using phrases and sentences. Intelligibility is impacted by articulation errors, fast rate of speech and low volume. Will initiate interactions by asking questions about routine topics (e.g., the weekend).

P8 22 M Intellectual Disability/ Autism Spectrum Disorder Moderate ID Understands 1–3 word, verbally presented directions paired with gestures and pictures. Learns new tasks given faded physical prompting. Verbally communicates using 1–2 word phrases and scripts. Learns new vocabulary, phrases and scripts given visuals paired with audio cues. Perseverative speech related to behavior. Initiates greetings and farewells with familiar and novel staff members and peers.

P9 20 F Intellectual Disability Moderate ID Language development impacted y hearing impairment. Understands 2–5 word, verbally presented directions paired with visuals/gestures. Verbally communicates using 1–5 word phrases and sentences. Clarifies verbal communication using a Speech-Generating Device with prompting. Intelligibility impacted by difficulty coordinating articulators, fast rate of speech, and low volume. Initiates social interactions about preferred topics in familiar environments.

Participant	Age	Sex	Diagnosis	IQ	Communication Skills
P1	22	M	Intellectual Disability/ Other Health Impairment	Mild ID	Understands 5–8 word, verbally presented directions and questions containing familiar vocabulary. Needs prompting to use self-advocacy strategies when a comprehension breakdown occurs. Verbally communicates using phrases and sentences. Intelligibility is impacted by lack of coordination of the articulators. Uses strategies to clarify speech production given natural cues. Will initiate interactions by asking questions about routine topics (e.g., the weekend). Needs prompting to comprehend nonverbal language of peers and staff.
P2	20	F	Intellectual Disability	Moderate ID	Understands 3–5 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using 3–4 word phrases and some sentences. Responds to natural cues to repair communication breakdowns related to intelligibility. Will initiate interactions by making comments about preferred topics and sharing pictures.
P3	22	M	Autism Spectrum Disorder	Mild ID	Requires initial prompts to attend to staff members and conversation partners. Understands 3–5 word, verbally presented directions containing familiar vocabulary. Processes questions and complex directions more successfully when written down. Verbally communicates using 1–7 word phrases and sentences. Initiates conversation related to preferred topics by asking a question or using a script related to the topic. Requires prompting to initiate interactions using social pleasantries (e.g., greetings) and respond to conversation partners across the day.
P4	22	M	Autism Spectrum Disorder	Moderate ID	Requires initial prompts to attend to staff members and conversation partners. Understands 3–5 word, verbally presented directions containing familiar vocabulary. Processes questions and complex directions more successfully when written down. Verbally communicates using 1–3 word phrases. Requires prompting to initiate interactions using social pleasantries (e.g., greetings) and respond to conversation partners across the day.
P5	21	F	Intellectual Disability	Moderate ID	Understands 3–5 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using 3–4 word phrases and some sentences. Intelligibility is impacted by dysfluent speech and articulation errors. Will use strategies to improve fluency of speech given natural cues. Will initiate interactions by making comments about preferred topics and sharing pictures.
P6	22	M	Intellectual Disability	Mild ID	Understands 3–4 word, verbally presented directions. Discriminates between WH-questions with visual and written prompts. Verbally communicates using 1–3 word phrases. Intelligibility is impacted by articulation errors and low volume. Uses strategies to repair conversation breakdowns such as writing down words, showing a picture, or pointing with prompting. Will initiate interactions by making comments about things happening in the immediate environment.
P7	22	M	Intellectual Disability	Moderate ID	Understands 1–2 word, verbally presented directions and questions containing familiar vocabulary. Verbally communicates using phrases and sentences. Intelligibility is impacted by articulation errors, fast rate of speech and low volume. Will initiate interactions by asking questions about routine topics (e.g., the weekend).
P8	22	M	Intellectual Disability/ Autism Spectrum Disorder	Moderate ID	Understands 1–3 word, verbally presented directions paired with gestures and pictures. Learns new tasks given faded physical prompting. Verbally communicates using 1–2 word phrases and scripts. Learns new vocabulary, phrases and scripts given visuals paired with audio cues. Perseverative speech related to behavior. Initiates greetings and farewells with familiar and novel staff members and peers.
P9	20	F	Intellectual Disability	Moderate ID	Language development impacted y hearing impairment. Understands 2–5 word, verbally presented directions paired with visuals/gestures. Verbally communicates using 1–5 word phrases and sentences. Clarifies verbal communication using a Speech-Generating Device with prompting. Intelligibility impacted by difficulty coordinating articulators, fast rate of speech, and low volume. Initiates social interactions about preferred topics in familiar environments.

All participants attended a post-high school program for students with ID/ASD at a non-public school in Maryland. At the time of this study, and as part of their transition plans, all were starting entry-level internships at workplaces throughout the area. For the purposes of this study, each participant was paired with a job coach who helped them share their Communication Story with a workplace supervisor. In the event that a participant had more than one workplace supervisor, and in order to gather as much novel input on the effectiveness of Communication Stories as possible, we selected a workplace supervisor who was not already matched with another participant.

2.2 Description of intervention

The Communication Stories intervention involved (a) developing the stories in conjunction with participants; (b) training job coaches in the protocol for supporting participants to share their stories; and (c) sharing stories with workplace supervisors. Communication Stories were also sent home so that parents could review and comment on them.

2.2.1 Developing Communication Stories

The SLP (second author) created an initial list of communication strategy scripts used by each of the nine participants based on clinical observation and data collected during speech and language intervention sessions. Scripts were written in the first person from the perspective of the participant (e.g., “Sometimes it is hard for me to understand words. Here are ways to help me”) and included a combination of captioned photos and brief video clips. Each Communication Story included sections on strategies for supporting participants’ (a) receptive; (b) expressive; and (c) social/pragmatic language (including information on interests/preferences); (d) vocabulary acquisition; (e) self-advocacy; and (f) organization.

Receptive language strategies (i.e., strategies that support participants’ understanding) were based on language modeling strategies recommended in the literature, including encouraging communication partners to reduce their rate of speech, use visuals to support language, simplify language, and highlight important words (Grow & LeBlanc, 2013; Müller et al., 2003; Purcell et al., 2000). Other receptive language strategies included providing partners with the ideal number of words and/or pictures per step on a checklist for each student, and guidelines for the maximum number of words a conversation partner should use when giving directions and asking questions. The self-advocacy section included scripts for participants to explain how they advocate for their comprehension needs (e.g., “I am learning to say, ‘Please show me.”’). Expressive language strategies (i.e., strategies to support participants’ use of language) included information on each participant’s communication modality (e.g., vocal speech, alternative and augmentative communication [AAC], gestures), and included specific information on factors that might impact participants’ intelligibility (i.e., how well their vocal speech is understood by others). Social/pragmatic language strategies (i.e., strategies used for engaging in social communication) included how participants use language to initiate interactions, how participants’ respond using language, and topics of interest to each participant (see Fig. 1 for examples of scripts).

Fig.1

Examples of Strategies Included in Each Section of the Communication Story.

The SLP gathered feedback on these lists from members of participants’ transition teams (e.g., participant, behavior specialist, job coach, student employment coordinator, classroom teacher, transition specialist, and occupational therapist). The final list included communication strategies that supported participants across as wide a range of contexts as possible.

The SLP then shared an example of a Communication Story with each participant, and explained that she would be working with them to make their own Communication Stories. The SLP reviewed vocabulary with participants related to understanding what a Communication Story is (e.g., “Communication Story,” “strategy,” “self-advocacy”). A series of individual and small group lessons were conducted to help participants identify which communication strategies they wanted to include in their stories. With adult support, participants typed one communication strategy per page using the application MyPicturesTalk by Grembe Apps. For each video clip, the SLP modeled the selected strategy for the participant and video-recorded the participant using the strategy in different settings. Together, the participant and SLP selected photos and captions for the other pages of the story. Most stories were between 20–25 pages long.

2.2.2 Training

To ensure fidelity of implementation, job coaches were carefully trained on the purpose and content of each participant’s Communication Story. The SLP modeled the protocol to be used with each participant while sharing their story with their workplace supervisor (e.g., how much and what type of prompting to use). The SLP also modeled the reinforcement schedule for each participant, which included periodic social praise provided by the job coach while sharing the story. Structured role play was used to practice enacting the protocol. A systematic instructional protocol was also used to help participants prepare for sharing their stories with their workplace supervisors. The SLP worked individually with each participant, using a most-to-least prompting hierarchy, until all became fluent in sharing their stories with familiar partners (MacDuff, Krantz, & McClannahan, 2001).

2.2.3 Sharing with workplace supervisors

Times were scheduled for sharing each participant’s Communication Story with their workplace supervisors, and a quiet sharing location was identified in advance. Before arriving at the site, job coaches made sure participants had their iDevices with them, adjusted iDevice volume, read a social story created by the SLP that explained to participants how they would share their Communication Story at work, and helped participants navigate to the Communication Story within the MyPicturesTalk app. Job coaches then prompted participants to share their stories using the protocol outlined during the job coach training session. The sharing procedure took approximately 15–30 minutes.

2.3 Study design and instrumentation

We chose a mixed methods design in order to determine whether different forms of data pointed to the same conclusions regarding the perceived impact of Communication Stories on participants, job coaches and workplace supervisors. Three types of data were collected.

2.3.1 Job coach self-assessments

First, during the Summer, the SLP presented each of the nine participants’ Communication Stories during weekly job coach meetings. Prior to viewing each Communication Story, job coaches were asked to complete a baseline self-assessment regarding their knowledge of the participant’s receptive, expressive, and social/pragmatic language strategies, as well as their levels of confidence as job coaches in supporting the participant’s communication in the workplace. The assessment included a series of six questions (e.g., “How much do you know about this student’s expressive communication [i.e., his/her strategies for communicating with you and others]?”) using 4-point Likert-type scales (e.g., 0 = None at all, 1 = Not much, 2 = Some, 3 = A lot”). Immediately after viewing each Communication Story, job coaches completed an identical post-viewing self-assessment in order to help us determine whether job coaches’ believed their knowledge and confidence levels changed in any significant ways. Because cross-training of post-high school staff is encouraged, all job coaches completed pre/post-viewing self-assessments for each of the participants, resulting in a total of 64 sets of pre/post data.

2.3.2 Workplace supervisor interviews

Participants were then assigned to Fall internships at a variety of workplaces, and after at least three weeks on the job, shared their Communication Stories with their supervisors. Several weeks after viewing the stories, the first author conducted follow-up phone interviews with each supervisor and asked about their perceptions of the impact of the Communication Stories on their own knowledge and communication behaviors, as well as on participants’ workplace interactions (e.g., “How much do you currently know about your intern’s receptive communication and did your knowledge improve since viewing his/her Communication Story?” “How comfortable do you currently feel when interacting with your intern [e.g., talking about work-related issues, engaging in informal conversation]?”). They were also asked to evaluate the usefulness of the Communication Story as a tool for supporting work place interactions. Phone interviews took approximately 45 minutes each, and were transcribed verbatim at the time of the interview. In total, nine phone interviews with workplace supervisors were conducted.

2.3.3 Job coach interviews

Job coaches who supported participants to share their Communication Stories with workplace supervisors also participated in phone interviews several weeks after the viewing took place, and answered questions similar to those asked of workplace supervisors. Phone interviews took approximately 45 minutes each, and were transcribed verbatim at the time of the interview. In total, nine phone interviews with participants’ job coaches were conducted.

2.4 Data analysis

2.4.1 Quantitative analysis

In order to determine whether job coaches felt more knowledgeable/confident supporting participants’ communication in the workplace following viewing of their Communication Stories, we compared results of pre- and post- self-assessment data. Differences in mean scores for each survey item were calculated using a series of t-tests for paired samples. Differences were found to be significant at the 0.001 level. Effect sizes were calculated using Cohen’s d.

2.4.2 Qualitative analysis

In designing the qualitative portion of our study, we sought to meet all of the quality indicators for qualitative research identified by Brantlinger et al. (Brantlinger, Jimenez, Klingner, Pugach, & Richardson, 2005). Analysis of stakeholder responses took place in several phases and was conducted systematically using methods described by Miles and Huberman (1994). Initially, the first and second authors independently engaged in data reduction by reviewing surveys and interview transcripts, and labeling/coding all instances where stakeholders mentioned either (a) the perceived impact on participants of sharing their Communication Stories; (b) the perceived impact on workplace supervisors and job coaches of viewing participants’ Communication Stories; or (c) overall impressions of the effectiveness of Communication Stories as self-advocacy tools for supporting workplace interactions. Authors met to discuss and consolidate findings and establish a coding tree. Any differences of opinion were resolved by returning to the data and establishing, via consensus, what the data were actually “saying.” The first author then went back and coded all transcripts accordingly, making minor modifications to the coding tree as needed. In order to posit a more unified and comprehensive interpretation of study findings, authors met once more to integrate findings with ideas from the literature on the importance of (a) training communication partners; and (b) creating opportunities for self-determination.

In an effort to be transparent, authors felt it was important to self-disclose the following information about our roles and potential biases: Our team included the first author who served s Ivymount School’s Program Evaluator. The second author served as the post-high school SLP and conceived and designed Communication Stories in response to a perceived need for such a tool among her transition-aged students. The third through fifth authors served as the post-high school’s Student Employment Coordinator, Supervisor of Post-High School Programs, and Director of Speech and Language Services. The second and third authors played an active role in implementing the Communication Stories intervention, and our entire team was inclined to believe that Communication Stories would have a positive impact on workplace interactions. Those of us with backgrounds in language impairments were committed to a transactional approach to communication intervention, focusing not just on the individual with a language impairment, but also on his/her communication partners. To avoid overly subjective interpretations of findings, the five authors collaborated on each component of research design, data collection and analysis.

2.5 Social validation

We sought to establish the social validity of findings by soliciting feedback from participants and their parents on the perceived value of Communication Stories. All nine participating students completed brief interviews about whether they liked making their stories on their iPads, and whether they liked sharing their stories with their supervisors. We also shared participants’ Communication Stories with their parents, and asked parents to complete brief email surveys about how helpful they thought the stories were, and whether they would recommend sharing the stories with other important adults in participants’ lives. In total, seven parent surveys were received. Responses from both stakeholder groups were extremely enthusiastic, and confirmed the social value of Communication Stories.

3 Findings

3.1 Quantitative results

3.1.1 Job coach self-assessments

Based on self-assessment at baseline and again following viewing of participants’ Communication Stories, job coaches experienced statistically significant growth (p values of <0.001) in their knowledge of participants’ expressive communication, receptive communication, social/pragmatic communication, and self-advocacy skills following viewing of the stories (see Table 2). Based on a 4-point scale, mean scores increased by 0.55 points for expressive communication, 0.49 points for receptive communication, 0.61 points for social/pragmatic communication, and 0.6 points for self-advocacy. Job coaches also reported significant growth (p values of >0.001) in their ability to adapt checklists to match participants’ communication levels (mean growth of 0.47 points) and their confidence supporting participants’ communication in the workplace (mean growth of 0.39). Effect sizes based on Cohen’s d were above 0.80 for expressive, receptive, and social/pragmatic communication, as well as for self-advocacy, and were therefore classified as large (Cohen, 1992). Effect sizes ranged from 0.70 to 0.80 for ability to adapt checklists and confidence supporting participants’ workplace communication, and were therefore classified as medium.

Table 2
Summary of Job Coaches’ Baseline and Post-Viewing Survey Responses

Baseline scores Post-viewing scores Difference t stat Effect size

Mean SD Mean SD Mean SD

Knowledge of participant’s expressive communication 1.97 (0.79) 2.52 (0.53) 0.55 (0.80) 5.47* 0.99

Knowledge of participant’s receptive communication 2.02 (0.69) 2.51 (0.59) 0.49 (0.72) 5.48* 1.02

Knowledge of participant’s social/pragmatic communication 1.84 (0.81) 2.45 (0.46) 0.61 (0.70) 6.95* 1.07

Ability to adapt checklists to match participant’s communication level 2.17 (0.84) 2.64 (0.52) 0.47 (0.78) 4.81* 0.80

Knowledge of participant’s self-advocacy strategies 1.87 (0.82) 2.48 (0.56) 0.60 (0.71) 6.84* 1.05

Confidence supporting participant’s communication in the workplace 2.17 (0.86) 2.56 (0.54) 0.39 (0.56) 5.53* 0.70

	Baseline scores	Post-viewing scores	Difference	t stat	Effect size
Knowledge of participant’s expressive communication	1.97	(0.79)	2.52	(0.53)	0.55	(0.80)	5.47*	0.99
Knowledge of participant’s receptive communication	2.02	(0.69)	2.51	(0.59)	0.49	(0.72)	5.48*	1.02
Knowledge of participant’s social/pragmatic communication	1.84	(0.81)	2.45	(0.46)	0.61	(0.70)	6.95*	1.07
Ability to adapt checklists to match participant’s communication level	2.17	(0.84)	2.64	(0.52)	0.47	(0.78)	4.81*	0.80
Knowledge of participant’s self-advocacy strategies	1.87	(0.82)	2.48	(0.56)	0.60	(0.71)	6.84*	1.05
Confidence supporting participant’s communication in the workplace	2.17	(0.86)	2.56	(0.54)	0.39	(0.56)	5.53*	0.70

*p < 0.001.

3.2 Qualitative results

Due to the overlap between workplace supervisor and job coach interview questions, we aggregated findings in order to streamline analysis. Themes and subthemes were grouped into three major sections: (a) perceived impact of sharing Communication Stories on participants; (b) perceived impact of viewing Communication Stories on workplace supervisors and job coaches; and (c) overall impressions of the Communication Story as a self-advocacy tool for supporting successful workplace interactions (see Table 3 for summary of qualitative themes and subthemes).

Table 3
Summary of Interview Themes and Subthemes

Perceived impact of sharing Communication Stories on participants

Increased self-esteem, empowerment, and sense of pride

Minimal impact on participants’ expressive communication

Increased comfort interacting with workplace supervisors

Perceived impact of viewing Communication Stories on workplace supervisors and job coaches

Increased workplace supervisors’ confidence when communicating with participants

Increased job coach confidence when supporting participants’ workplace communication

Changes in workplace supervisor/job coaches’ communication behaviors to better support interactions with participants

Establishing participants’ attention/gaining eye contact

Allowing additional processing time

Simplifying language

Using written and/or visual checklists

Spending more time interacting with participants

Supporting self-advocacy

Workplace supervisors’ attitudes shift toward participants

Improved sense of connection to participants

Greater appreciation of participants’ complexity and multi-dimensionality

Overall impressions of Communication Stories (CS) as a tool to support self-advocacy and interactions

Enthusiasm for using CS in a wide range of post-school contexts

CS providing an excellent introduction to participants

Electronic format giving participants control over sharing process

Value of sharing CS with other important adults in participants’ lives

3.2.1 Perceived impact on participants

Three key themes emerged: (a) increased self-esteem, empowerment, and sense of pride; (b) minimal impact on participants’ expressive communication; and (c) increased comfort interacting with workplace supervisors.

3.2.1.1. Self-esteem, empowerment, and pride. Both supervisors and job coaches noted that participants seemed to feel empowered by the act of independently sharing their Communication Stories. They used terms like “proud,” “smiling,” “happy,” and “confident” to describe participants’ attitudes while clicking from one page to the next, and/or commenting on video clips illustrating their communication strategies. Typical comments included, “I think it was great for him: It was like, ‘This is who I am.’ And instead of having to explain it verbally, in a setting with no iPad, he was able to show … everything about him[self] right there, and it wasn’t hard to understand. Nothing in the way, no breakdowns in communication,” and “I think it impacted [participant] in that he was able to show off, and to finally have a moment where he can explain or show what helps in a way that his supervisor understands.”

3.2.1.2. Expressive communication. Interestingly, most job coaches and workplace supervisors felt that although the Communication Stories improved the overall quality of workplace interactions, they had minimal impact on participants’ expressive communication behaviors. While several supervisors noticed some improvements in participants’ social/pragmatic language (e.g., improved eye contact and initiation of conversations)—most were hesitant to attribute the changes to participants’ sharing of their Communication Stories.

3.2.1.3. Comfort interacting with workplace supervisors. For those who did draw a connection between the sharing of the Communication Story and improved independence, self-advocacy, and/or expressive communication, several hypothesized that in response to sharing their Communication Stories, participants developed closer, more trusting relationships with their supervisors, which in turn resulted in greater comfort and ease when interacting with them. In other words, positive relationships with their supervisors allowed participants to really open up. One job coach described a participant as experiencing a “sort of breakthrough,” and another described the shift in a participant’s focus during interactions away from the job coach (where it had always been in the past) and towards the supervisor: “He’s doing much better with communicating with his supervisor. He’s actually looking at her when he speaks to her, following her directions, and not always looking at me for help.”

3.2.2 Perceived impact on workplace supervisors and job coaches

Four key themes emerged: (a) increased workplace supervisor confidence when communicating with participants; (b) increased job coach confidence when supporting participants’ workplace communication; (c) changes in workplace supervisors/job coaches’ communication behaviors to better support interactions with participants; and (d) shifts in workplace supervisors’ attitudes toward participants.

3.2.2.1. Workplace supervisor confidence. After viewing participants’ Communication Stories, workplace supervisors reported feeling much more confident interacting with participants. Many described having at first felt anxious or unsure about interacting with them. Some were worried about the possibility of inappropriate behaviors or emotional outbursts, and appreciated learning from the Communication Stories what to expect and how to interpret participants’ behaviors. For example, one supervisor said, “At first I wondered if he had behavior issues that I had to maybe be concerned about, with his deep breathing, and seeing him get visibly upset. I am fine now. I understand how he interacts …. Now I know [his deep breathing] is a coping strategy, and I can help him.” Several supervisors referenced specific strategies they learned about while viewing the Communication Story that helped them feel more competent when interacting with participants.

3.2.2.2. Job coach confidence. Job coaches also described feeling more confident in their ability to facilitate participants’ interactions in the workplace. In many cases, this was the first time job coaches were working 1:1 with participants, so viewing the Communication Story served as a sort of orientation. In the words of one, “I understand him more. I think I was a little bit anxious with him in the beginning. But just giving him time to process I think helps … and it’s so nice to see what his abilities are, what he’s capable of.” Several job coaches also mentioned how viewing the Communication Story alongside the workplace supervisor helped create a shared perspective on the participant’s communication support needs. For example, “I think ever since the supervisor watched it, we’re on the same page. They are with me on what [participant] can do, so I don’t have to explain anything … we’re all together helping him.”

3.2.2.3. Changes in supervisors/job coaches’ communication behaviors. One of the key points made by several workplace supervisors was that viewing Communication Stories had a more significant impact on their roles as communication partners, than on the communication behaviors of participants themselves. They recognized that communication is an interactive process, and that by changing their own ways of communicating, the overall quality of interactions improved. For example, one supervisor said, “It’s a two-way street. What the Communication Story does is not that he changes, but that the process changes. I cannot say he changed, because that’s who he is, but it changed the interaction, because … in this case … I changed. The process changed.” Job coaches concurred with this, frequently pointing to ways in which supervisors modified their communication after viewing the stories to better match participants’ needs. In the words of one, “Ever since [viewing the story], [the workplace supervisor] takes his time, doesn’t rush by, engages with [participant] more, gives him more time to process. He’s more focused on [participant].”

Some of the key ways in which workplace supervisors described their communication behaviors changing related directly to what they learned from the Communication Stories about participants’ receptive language strategies—such as establishing participants’ attention/gaining eye contact prior to starting to talk, allowing additional processing time, simplifying language, using written and/or visual checklists, and spending more time interacting with participants. Typical comments included, “I know I need to say her name, get her to stop, try to get her to look at me,” “[The Communication Story] made me more aware when asking detailed questions. Did he understand? Am I asking too many questions? Bombarding him with information?” “[I learned] the time he needs for processing … it’s not because he didn’t hear, it’s that he needs that time to understand.” Several also noted strategies for supporting participants to be better self-advocates, instead of simply doing things for and/or speaking for them. For example: “I liked that [the Communication Story] talked about self-advocacy she’s supposed to be doing. She’s supposed to say ‘Please show me.’ I was made aware of what she should be asking me. I need to step back a little if she’s having trouble, and give her a chance to ask me instead of jumping in.”

3.2.2.4. Workplace supervisors’ attitudes toward participants. Finally, workplace supervisors frequently mentioned shifts in attitude following viewing of participants’ Communication Stories. For example, several mentioned feeling more connected to participants. In other words, sitting together and sharing the experience of going through the story deepened their sense of intimacy and closeness. Typical supervisor comments included, “I feel like I’ve seen him open up a little bit. I feel I saw a side of him that I didn’t know about. I saw how proud he was, and how happy. We shared something. Did it make him a better communicator? No. Did it make us closer? Yes. We shared a moment,” and “I could see the euphoria and excitement for her, about sharing something about herself with someone she knew—which made a huge difference for me.”

Supervisors also noted that viewing the Communication Stories made them realize how much more complex and multi-faceted participants were than they had originally believed. Typical comments included, “[The Communication Story] made me more aware of his interests. For example, he loves computers, is good at typing, he likes maps—[it] gives me more ideas of his person … what he likes to do outside of work. Like music. I had no idea he liked to do that. He does many more things than I would imagine he would do outside of work. It’s not as limited as I thought,” and “It made me see him in a different way that I wouldn’t have if I hadn’t sat with him and [viewed the story] … I love that he narrated his own story …. Obviously he was reading it, and I didn’t realize how good he was at that, because I didn’t know all his skill levels …. The Communication Story stepped up my impressions of what he’s capable of.” A few supervisors also admitted that they had had misperceptions about individuals with ID and/or ASD, and that viewing the Communication Story helped correct their views.

3.2.3 Overall impressions of Communication Stories as tools to support self-advocacy and interactions

Five key themes emerged: (a) enthusiasm for using Communication Stories in a wide range of post-school contexts; (b) Communication Stories providing an excellent introduction to participants; (c) electronic format giving participants control over the sharing process; (d) value of sharing Communication Stories with other important adults in participants’ lives; and (e) recommendations for improved impact of Communication Stories.

3.2.3.1. Enthusiasm for Communication Stories. Stakeholders unanimously agreed that Communication Stories were a useful, much-needed self-advocacy tool that provide a comprehensive, user-friendly introduction to participants. All recommended broad adoption of the tool as part of the transition process for students with functional language impairments. In other words, they wanted to share the story with other adults in participants’ lives, and expressed a desire to view Communication Stories for any employees with communication difficulties.

3.2.3.2. Communication Stories as “introduction” to participants. Several noted that Communication Stories also offered a highly time-efficient means of getting to know about participants’ communication needs. Typical comments included, “I think it’s wonderful. I see the benefits at the workplace of using Communication Stories. People know [participant] now. He’s not an unknown person that … takes months [to get to know]. They know him, and it’s not a mystery who he is and how to work with him,” and “I just see such benefit for supervisors and coworkers in seeing Communication Stories and having a better understanding of [participants]. And communication transition is so much smoother. Instead of taking months and months for supervisors to get to know them, the Communication Story helps them to get to know the intern right there. The transition period is much shorter.”

3.2.3.3. Electronic format gives participants control over sharing process. Job coaches and workplace supervisors were also enthusiastic about the electronic format of the Communication Story, not only because it was an innovative way of using new technologies, but also because it put participants in the driver’s seat in terms of teaching their supervisors about themselves and their communication strategies. For example, one supervisor said, “It was very helpful, because it was something that [participant] could participate in and share with me. If we had done it through ‘old school’ means, through the job coach coming in to share it with me, [participant] would not have been involved … this approach gives him control, with him sharing with me rather than an outside expert.” In other words, Communication Stories enabled participants to interact directly with their supervisors, taking the lead in teaching them about their communication needs, and bypassing the job coach as “middle man.”

3.2.3.4. Sharing with other adults in participants’ lives. All stakeholders recommended sharing the Communication Story with other people in participants’ lives. Workplace supervisors and job coaches recommended that other coworkers, especially those in a supervisory role or with regular contact with participants, view the story. Interviewees also suggested an even broader audience, frequently citing adult service providers and medical practitioners, but also mentioning extended family, community helpers, members of their religious communities, neighbors, and home support staff.

3.2.3.5. Recommendations for improved impact. In order to increase the impact of Communication Stories, stakeholders recommended that they be viewed multiple times to support comprehension/mastery, and that participants hand out “cheat sheets” for workplace supervisors to refer back to in order to help them remember useful communication strategies.

4 Discussion

Preliminary findings from this pilot study suggest that Communication Stories may be a beneficial means of supporting participants’ communication in the workplace. Not only do stakeholders report that viewing of Communication Stories increases job coaches and workplace supervisors’ knowledge of participants’ communication strategies, and the overall quality and quantity of workplace interactions, but also that sharing of Communication Stories appears to improve participants’ self-esteem and sense of comfort with/connection to their workplace supervisors.

First and perhaps foremost, input from both stakeholder groups pointed to the overall value of the Communication Story as a tool for improving communication in the workplace. Job coaches stressed how much they learned about participants’ communication strategies, and how much more confident they felt facilitating participants’ workplace interactions after viewing their stories. They also mentioned how time-efficient the Communication Stories were in terms of covering a lot of information in a very short time, and with minimal need for job coaches to conduct further workplace communication trainings. Workplace supervisors were enthusiastic about the Communication Stories, and stressed how much they learned about participants’ communication strategies, and how much more comfortable they felt interacting with them post-viewing. Many also noted that they felt closer and more connected to participants after viewing their stories, and had a better understanding of who they were as individuals. Stakeholders were unanimous in recommending continued development of Communication Stories for students who would likely benefit (i.e., any transition-aged students with functional language impairments), as well as sharing the stories with a broader audience (e.g., adult service providers and other members of the community with whom students are likely to interact directly).

One of this study’s most intriguing findings was that interviewees (i.e., job coaches and workplace supervisors) believed that participants’ behaviors were less impacted by sharing of the Communication Stories than were their own behaviors. Traditionally, communication interventions only targeted individuals with language impairments, with an emphasis on “fixing” their communication deficits. Over the last few decades, as we have come to understand communication as a dynamic and transactional process, researchers have turned their attention to providing instruction for communication partners as well (e.g., Kent-Walsh & McNaughton, 2005). Examples of this include work by Grow and LeBlanc (2013) which emphasizes greater responsiveness on the part of the conversation partner to the student’s needs. Researchers argue that when communication exchanges are viewed as partnerships, the communication that results is often more successful and satisfying for both parties (Bartlett & Bunning, 1997). Findings from the present study seem to support this claim, with stakeholders reporting that the quality of interactions improved as a result of their becoming more aware of participants’ receptive language strategies, and learning how to be better, more responsive communication partners.

Another important finding had to do with the active involvement of participants in the process of developing and sharing their Communication Stories. Participants helped select the strategies that were included in their stories, and by using the MyPicturesTalk app to create the stories and upload them to their personal iDevices, they were able to take charge of the sharing process. Although we did not initially ask specifically about the experience of “viewing” participants’ Communication Stories, so many workplace supervisors and job coaches mentioned the significance of this event during their interviews—especially the pride and pleasure participants’ took in sharing their stories—that we added a question about the viewing experience to make sure we fully captured its importance. Many job coaches and supervisors mentioned improvements in participants’ self-esteem following the sharing of their stories, and several believed that the stories resulted in greater comfort with their supervisors, and confidence asserting themselves/self-advocating. Again, this finding is consistent with research that has been done on self-determination, which finds that the more autonomous individuals with disabilities feel, and the more opportunities they have to take control of their lives, the more satisfied they are and the better their outcomes at work and in other contexts (Algozzine, Browder, Karvonen et al., 2001; Cobb, Lehman, Newman-Gonchar, & Alwell 2009).

Significantly, many supervisors mentioned changing their perceptions of participants’ abilities as a result of viewing their Communication Stories. Several gave examples of having viewed participants as more intellectually limited prior to seeing their stories, and having modified their views after learning about participants’ many skills and interests. They also described the sense of intimacy that resulted from sitting side-by-side with participants and getting to know them on a deeper level. Research shows that opportunities for positive interactions may help mitigate bias towards employees with disabilities, and that negative views about hiring/retaining workers with disabilities can be offset by building positive experiences (Hernandez, McDonald, Divilbiss et al., 2008). In light of these findings, it seems possible that the sharing of Communication Stories, and the opportunity this creates for building a sense of connection between participants and their supervisors, can play a critical role in helping form stronger, more positive workplace relationships, and may even facilitate job success/retention.

The findings from this pilot study should be interpreted with the following cautions in mind: The sample size was extremely small, and measures were all based on stakeholder perceptions, which were necessarily subjective. It is possible that job coaches and workplace supervisors may have over- or under-estimated the impact of Communication Stories on their behaviors (e.g., as described by Purcell, McConkey, & Morris, 2000). Second, job coaches may have over-estimated their pre-viewing knowledge levels, resulting in the artificial inflation of their baseline self-confidence ratings (a common phenomenon when measuring people’s sense of self-efficacy). Third, participants were all unpaid interns as opposed to paid employees, and it is unclear whether findings from this pilot study are generalizable to other workplace contexts and participant groups. Finally, because there was no control group, it was not possible to determine whether there was a causal relationship between the use of Communication Stories and the outcomes described in this study, or whether other unknown factors were responsible in whole or in part for the changes observed.

Since preliminary outcomes were so positive, however, we recommend future research on the impact of Communication Stories using a more rigorously controlled design and a larger participant sample (including adult participants who are not necessarily transition-aged), as well as actual observations of job coaches/workplace supervisors’ interactions with participants in addition to self-report. True workplace integration requires not just securing a job in an inclusive work environment, but also being able to communicate in a meaningful way with one’s supervisor and coworkers. The Communication Story is specifically designed to support this, and appears to have had a positive impact on participants’ relationships and interactions with their supervisors. Furthermore, the Communication Story takes advantage of new technologies, and maximizes participants’ control over the process of teaching others how to interact with them more successfully. In other words, it provides a promising new tool for supporting both self-advocacy and communication in young adults with ID/ASD and language impairments.

Conflict of interest

None to report.

Footnotes

Acknowledgments

Authors gratefully acknowledge the contributions of the Ivymount students, families, and workplace supervisors who participated in this study, as well as the following Ivymount post-high school job coaches: Kimberly Blocker, Neal Gertner, Gregg Price, Paula Radbod, Francess Songa, and Tiffany Stevenson, without whom this study would not have been possible.

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