This summer, Scotia Bank sponsored me to provide support to the Step-by-Step School for Autism in Guyana, South America. All of the ten children who attend the school, which officially opened in 2011, have an autism diagnosis and a majority are functionally non-speaking. The school sits on the top floor of a car dealership.

My talented colleague, Dr. Jim Ellis, PhD, BCBA-D, assesses the children as they come in, and writes up all of the ABA programs. As far as I know, he’s the only person in the city (more likely the country) that diagnoses children with autism. He visits several times a year, brings supplies, and supports the staff through Skype sessions and video.

I think I underestimated the cultural adjustment. While the primary language is English, the dialect is Guyanese Creole, a form of Creole influenced by African and East Indian languages. On several occasions, new families came in to meet with me at the school. Luckily one of the head tutors was there to gracefully interpret and mitigate any language difficulties. Everything was different from what I was used to: the roads, the livestock wandering the street, the weather, the sound of generators. There was not an ATM in site. I did love the mangoes I got to eat every day, and the neighbor next to the school had three beautiful (and loud) Macaw parrots for pets.

Most of the families do not have enough money to pay tuition. The cost per child is $4,800 USD per year, which pays for the tutors’ salaries. Assistance is also given for snacks and transportation costs.  That’s right, tutors make about $480 USD per month, which is considered relatively high for teachers. And don’t think the cost of living is much lower. I spent 300 Guyanese dollars on a bottle of soda, which was about $2 USD.

In Guyana, there are no speech-language pathologists per se. Rather there are trained “rehab techs” who, after 18 months of training, provide OT, PT, and SLP to children and adults. The pay is so low that qualified people simply leave, so there are no speech-language pathologists in the country.

Kudos to the tutoring staff there. Aside from a few that have children with autism, very few of the tutors have any teaching experience, let alone experience with autism, but they do remarkable work. They work around the power outages, flash floods getting to work, and that one morning where we didn’t have running water. The entire program is supported by donations from private citizens and businesses, so finding consistent financial support is a struggle. Despite these obstacles, the students are clearly benefitting.

I appreciated that the tutors welcomed me, a total stranger, into their school. In the mornings, I observed or worked with the students and tutors.  In the afternoons, I conducted trainings and workshops. A few of the rehab techs from the hospital came to the school, observed the tutors working with the students, and then stayed for trainings. The majority of my time was spent modeling how to use each student’s communication system, evaluating language, and coming up with communication and language goals.

First, the tutors needed a foundation. While I evaluated the students, I assessed the most practical things that the tutors needed to learn. It’s important to know why you are doing what you are doing so lecturing at them wouldn’t be helpful (let’s face it, none of us really learn that way). Every day, I divided the seven tutors into groups, one group per table. Each table had slightly different materials, whether it be games or books. Every day, the tutors made therapy materials, and then role-played with their partners using the materials to support the games or books on their tables. Then they swapped tables and partners. This was important so they could naturally provide feedback to one another. Over the course of ten days, the tutors focused on:

• How to create communication books and use pictures to communicate (we made 10 in 10 days!)
• Pre-literacy activities: How to modify and present books to enhance language
• How to use play to support language development
• How to use Boardmaker® software
• How to use an iPad to support language and social skills (iPads donated by the British High Commission)
• How to use pictures and language to support transitions
• How to use functional sign language to support language development
• Typical language development for grades K-1

A few statements have stuck with me: One tutor said that she loved the sense of teamwork that she felt that week, every tutor pulling together to make materials for all students. Another commented on how nice it was to play and to see how the students responded. The students were amazing and so responsive to intervention.

So, I’m hooked. In between visits, Dr. Jim and I consult with the school through data and video in Dropbox, and through frequent Skype sessions (barring any technology issues, which are plentiful).

Our next trip is scheduled for February. Dr. Ellis and I will be doing more evaluations, training staff, and educating families about autism, and developing tools to inform staff and families about how to support children with autism, one step at a time.

Kerry Davis, Ed.D,CCC/SLP
2013

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with autism, multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

This blog post was first posted on Ashasphere, August 15, 2013.

 

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The views expressed in this paper are those of the author(s) and do not necessarily represent the views of the NLM Family Foundation.