Meaning-centered Approach Research Articles

How healthcare team build Resilience to Stress

Introduction: This study explores how the interaction theory of stress and coping, the expansion and construction theory of positive emotions, and the conservation of resources theory can help healthcare teams resist stress. Community resilience has been overlooked in health research on individual resilience. This study examines the resilience of teams to overcome knowledge gaps. Methodology: A snowballing method was used to select 10 members of the oral and maxillofacial surgery team for the study. Zoom was used to conduct 10 semi-structured interviews with three study participants. What causes team stress? How is stress tolerance defined? What strategies does the team use to build resilience? Interviews were coded using thematic analysis. Results: Research has found that patient care, long working hours, conflicting work commitments and a lack of control contribute to employee stress. Transactional theories of stress and coping suggest that a problem- and meaning-centered approach can help people cope with a variety of stressors. Teams also leverage social capital, constructive criticism, and positive emotions. It turns out that people have different definitions of resilience. Resilience is defined as a quality, characteristic, or strategy for coping with stress. Conclusion: The paper concludes with recommendations for implementation. Research shows that unpleasant emotions are expressed in difficult, low-stress work situations. It supports the non-suppression of unpleasant feelings, their resolution, and solutions. Management needs to step in and teach team members to express uncomfortable feelings in a constructive way.

A Logotherapy Meaning-Centered Approach to Therapeutic Recreation Rooted in Centripetal Leisure

This paper describes a logotherapy meaning-centered therapeutic recreation model based on Viktor Frankl’s will to meaning theory and his centrifugal and centrip-etal leisure dichotomy.This manuscript introduces a therapeutic recreation meaning-centered intervention grounded in existentialism and logotherapy, with its focus on human suffering-meaning potentials and self-transcendence. Therapeutic recreation application begins with an assessment focused on understanding the client’s values and meaning potentials then links leisure as a way to discover or experience meaning. Primary intervention strategies are search for meaning and Socratic and ma-ieutic dialog linked to leisure interest finders to help cli-ents experience centripetal leisure. The paper presents an intervention applying these strategies. A concluding sec-tion offers recommendations for education and research.

The loss of a child, bereavement and the search for meaning: A systematic review of the most recent parental interventions.

The loss of a child is considered one of the most tragic experiences that parents can go through. The present systematic review aims to compile the most recently published interventions in bereavement support for these parents, being particularly interested in those made from a meaning-centered approach. The search for the units of analysis was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement and was entered in Web of Science, Scopus and EBSCO, obtaining a total of 485 papers of which 21 have been included in this article. The results found are heterogeneous in terms of the type of intervention used and results, but they all seem to have something in common: the lack of research and reliable interventions that exist for this population. With this systematic review we intend to achieve a better understanding of these parents' needs and to highlight the enormous work that still remains ahead in order to make their bereavement experience a little less devastating.

Life routinization and clandestine photo-taking behavior among young people in Hong Kong: Implications for social work practice

With a growing number of reported offenses, clandestine photo-taking has become an increasingly noticeable phenomenon in Hong Kong and other parts of the world. This behavior is usually seen as a selfish act as it invades people’s privacy and sexual autonomy to satisfy one’s own sex drive. However, the present study provides new and varying insights into the problem. This is the qualitative section of an impact assessment including three focus group interviews with 10 young sexual offenders aged between 18 and 25 years who were either arrested or under probation. The results suggest that more than being sexually driven, people engaged in clandestine photo-taking to eliminate their sense of loneliness and break through the routinization of their everyday lifestyle. Living in a fast-paced and highly demanding metropolitan city, they felt lost and occupied to the extent that they were unaware of their purpose and meaning in life. In contrast, clandestine photo-taking allowed them to have a sense of control and satisfaction that they were lacking in their everyday lives. Based on the young offenders’ experiences and responses in the present study, social and parental understanding with early and preventive measures such as curriculum-based sexual education, and sufficient sexual and counseling support will be more important than imposing strong legal sanctions or social control to handle their sexually offending behavior. To assist young people in their need to overcome their everyday life’s boredom, stress, and routine, in combination with existing treatments, a meaning-centered approach is suggested for future practices.

Meaning in life and resilience among teachers

Meaning in life is a significant resource in the resilience process, supporting the use of adaptive behaviors and enhancing the feeling of wellbeing. As such, it could be critical for teachers who encounter many stressors threatening their life quality and work productivity. This study aimed to investigate how teachers' levels of meaning in life relate to their resilience. Data were collected from 299 teachers using the Meaning in Life Questionnaire (assessing presence of and search for meaning) and the Multidimensional Teacher Resilience Scale (assessing protective factors related to motivational and professional, social, and emotional resilience). As predicted, presence of meaning had medium-sized positive correlations with the resilience factors, whereas search for meaning had low correlations with social resilience and professional-motivational resilience and no correlation with emotional resilience. Using K-means cluster analysis, teachers were grouped into three clusters according to their scores in the two meaning dimensions. The cluster of teachers reporting both high presence of and high search for meaning showed the highest scores on the resilience factors, followed by the cluster including teachers with high presence and low search. In conclusion, our results emphasized the important role of presence of meaning in strengthening resilient responses; also, searching for meaning, when combined with a high sense of meaning, relates to better use of the resilience protective factors and resources. As to the study implications, a meaning-centered approach to building resilience in teachers is suggested and discussed.

Logotherapy, existential analysis, music therapy: Theory and practice of meaning-oriented music therapy

Meaning is a distinct resource and indicator of human health and well-being. Meaning in life and the search for it predict subjective well-being. In logotherapy and existential analysis, the human will to meaning is considered the prime motivation in human life. Founded by Viktor Emil Frankl, this meaning-centered approach in psychotherapy is often called the Third Viennese School of Psychotherapy. Although there is evidence that meaning can be actualized through music, music therapy has hitherto hardly focused on the concepts and theory of logotherapy and existential analysis. This contribution closes this gap by introducing a meaning-oriented approach to music therapy and an adaption of Frankl’s model of meaning fulfillment to music therapy. A case example demonstrates the practical application in the clinical context of palliative care. Meaning-oriented music therapy is not a separate form of music therapy, but complements existing concepts and theories in modern music therapy. It is indicated when meaning-related topics take center stage in music-therapy sessions.

Addiction in existential positive psychology (EPP, PP2.0): from a critique of the brain disease model towards a meaning-centered approach

ABSTRACTAddiction is widely considered to be a chronic brain disease. Under this view, neuroscientists have spent lots of resources to study the brain and identify pharmacological targets to palliate addiction. However, the brain disease model presents serious epistemological and practical limitations. Firstly, this article collects important critiques to the medical model and calls for a more pluralistic approach to addiction. Secondly, we discuss the problematic self-regulation of people with addiction from an existential positive perspective (also termed PP2.0). People with addiction, whether it is related to substance abuse, gambling, internet surfing, shopping or eating, usually manifest existential struggles that could account for the development and maintenance of their addiction. Relational problems, evasion of guilt and responsibility, and a lack of meaning in life have been evidenced in the literature. At the base of this psychological problem, there are both an inability to cope with the dark side of life and a maladaptive search for positive emotions that cannot be naturally obtained from meaningful social interactions. Finally, the meaning-centered approach (MCA) is proposed for addiction recovery. MCA helps clients find a purpose in life and integrate into society. This existential positive approach can be a fundamental complement for mainstream addiction treatments.

“Women’s Three Bodies”: An Anthropological Perspective on Barriers to Safe Abortion Services in Kibera Informal Settlements, Nairobi, Kenya

Background : Abortion remains a critical determinant of maternal morbidity and mortality in Kenya. Recent studies on induced abortion estimated an annual abortion incidence of 48 abortions per 1,000 women of reproductive age, which is higher than other East African countries. In 2010, the Kenyan Constitution widened the provisions under which women qualified for safe abortions. However, majority of women still seek abortion services from unqualified providers. Using an interpretive, meaning-centered approach, this study aims to explore the barriers to safe abortion services in Kibera informal settlements, Nairobi Kenya. Subjects and Method: This was a cross-sectional study encompassing both qualitative and quantitative research methods. We used different sampling techniques (convenient, purposive and snow ball methods) to recruit our study participants (n=55). Quantitative data was collected using a survey questionnaire and data was analyzed by SPSS version 21. Qualitatively, data was collected using Focus Group Discussions (FGDs), Key Informant interviews and case study narratives. This involved note taking and audio recordings, which were transcribed verbatim and thematically analyzed using QSR Nvivo 21 software. Results: This study revealed that women’s decisions to procure abortion are influenced by a myriad of complex factors: a multiplicity of meanings regarding abortion, as provided by the law or as dictated by cultures or religion. Women’s access to safe abortion services were also determined by their ability to afford the procedure and to identify and reach a health care provider who offered the services. Conclusions: Legal access to abortion does not simultaneously ensure access to safe abortion services. Policy makers and health promoters need to work towards changing the socio-economic and religious forces that hamper access to safe abortions. Safe and affordable abortion services to women in Kenya including post abortion care need also be ensured. Keywords: barriers, access, safe abortion, Kenya Correspondence: Edna Nyanchama Bosire, MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 27 St Andrews Road, Parktown, Johannesburg, South Africa. Email: edna.bosire@wits.ac.za. Telephone: 011 717 2383. Journal of Maternal and Child Health (2019), 4(2): 97-109 https://doi.org/10.26911/thejmch.2019.04.02.05

Meaning-centered approach to research and therapy, second wave positive psychology, and the future of humanistic psychology.

Meaning-centered approach to research and therapy, second wave positive psychology, and the future of humanistic psychology.

Book Review: I-M-ABLE: Individualized Meaning-Centered Approach to Braille Literacy Education

I-M-ABLE: Individualized Meaning-Centered Approach to Braille Literacy Education, by Diane P. Wormsley. New York: AFB Press, 2016, 162 pp. Paperback, $49.95; e-book (ePUB or Kindle), $34.95; online, $29.95 Reviewed by Yue-Ting Siu I-M-ABLE: Individualized Meaning-Centered Approach to Braille Literacy Education, by Diane P. Wormsley, is a lightweight tutorial that breaks down complexities of instruction for teachers who are new to working with who are visually impaired, seasoned teachers who face challenges in achieving literacy goals with emerging braille readers, and parents who can unify a team to ensure equitable instruction and meaningful learning experiences for their children. Reading, inclusion, and resource specialists who support onsite instructional delivery might also benefit from conceptual knowledge included in this book to better understand learning needs of with visual impairments. FOCUS ON MOTIVATION, ENGAGEMENT, INDIVIDUALIZATION, AND SUCCESS Chapter 1, Introduction to I-M-ABLE, promptly summarizes foundations of learning and instruction for any student with differentiated learning needs. It embeds teaching in a student-centered approach that considers student's experiences and focuses on four key principles: motivation, engagement, individualization, and success. I most appreciated Dr. Wormsley's focus on independence of in their own learning process and importance of ensuring equitable access to learning experiences in order to promote literacy. The remaining chapters of book are organized according to segments of instruction that might be incorporated in a comprehensive lesson plan. These segments include: assessment, instructional design and planning, differentiated reading instruction, mechanics of braille reading, differentiated writing instruction, mechanics of braille writing, alignment to traditional literacy instruction, and next steps for future instruction. Although chapters are organized in a logical sequence that outlines a student's journey to literacy, chapters can also be read out of order and on-demand according to a student's instructional needs. This format successfully individualizes book for teachers with varied experiences in delivering braille instruction to different types of learners and, therefore, promotes individualized goals for ongoing professional development. STRATEGIES UPON STRATEGIES Diagnostic teaching, which is defined as the process of continuously trying a variety of instructional strategies and materials based on current needs of students on page 5 of Dr. Wormsley's book (a quote from sixth edition of Reading Diagnosis and Improvement: Assessment and Instruction, by Michael Opitz, Dorothy Rubin, and James Erekson), is a generalized theme throughout book. Each chapter highlights teachable moments and strategies to adjust instruction in response to students' strengths and weaknesses. Also within each chapter are student scenarios and lesson plans that exemplify author's teaching points and specific activities that can be carried out with peers, classroom staff members, and at home. …

Meaning Making in the Life Story, and Not Coherence or Vividness, Predicts Well-Being up to 3 Years Later: Evidence From High Point and Low Point Stories

This study investigated emotionally intense, identity-salient memories—high and low points from the life story—for vividness, meaning, and coherence. Three approaches of perennial interest to memory researchers were operationalized in terms of these memory characteristics: meaning centered, coherence focused, and valenced processing. The study tested which approach best accounted for concurrent and future subjective well-being (SWB), including development differences. Life story episodes were collected and analyzed from an emerging adult sample and a late-midlife sample, as were self-reports of SWB over a 3-year period. The meaning-centered approach received support in both samples, concurrently and longitudinally. Notably, the coherence and vividness codes did not relate to SWB. Developmental differences were found: negative meaning predicted SWB among emerging adults whereas positive meaning predicted SWB among late-midlife adults. These relationships held when controlling for neuroticism and extraversion.

Individualized Meaning-centered Approach to Braille Literacy Education (I-M-ABLE) Case Study: Ajay's Story

The following case study documents the strategies employed and successful results of implementing Diane Wormsley's Individualized Meaning-centered Approach to Braille Literacy Education (I-M-ABLE) with a student with multiple disabilities, including autism and attention deficit hyperactivity disorder (ADHD), who was also learning English as a second language. Ajay (a pseudonym), a 5-year-old boy, entered our public school system at the beginning of the school year shortly after moving to the United States from India during the summer. Ajay had significant language delays in English and Tegulu (the primary language spoken at home), and he communicated through incomplete sentences to express wants and needs. He had medical diagnoses of autism, sensory-integration disorder (SID), obsessive-compulsive disorder (OCD), and ADHD (Ajay was primarily hyperactive, with attention deficit). Ajay had progressive Leber's congenital amaurosis with approximately 20/1000 acuity. Ajay was placed in an enhanced autism classroom, which specialized in applied behavior analysis (ABA) strategies, with 10 hours per week of direct services from a teacher of students with visual impairments. INITIAL LITERACY SKILLS Ajay arrived at school with a few key literacy skills. He could read and write English upper and lower case letters and his first name in print, although he could not read his handwriting. Ajay understood that letters make up words and that words have meaning, and he could spell a few words in English. Given a book, he oriented it correctly and attempted to visually examine the pages, turning one to three pages at a time. Ajay's parents consented to braille instruction, but they requested that he also be instructed in print. The enhanced autism program implemented a literacy curriculum that paired picture symbols with words. Ajay participated for only two months, because he could not visually engage with the content. PURSUING I-M-ABLE When considering teaching Ajay braille, I wondered how to show him that braille had meaning, just like the print he already understood. I knew that Dr. Wormsley's I-MABLE would provide the best chance of success, given its ability to tailor instruction to his specific interests and needs. The combination of Ajay's disabilities meant he either perseverated or quickly disengaged from activities. To capture and maintain his attention, his literacy instruction had to be highly appealing. I was reluctant to implement I-M-ABLE, however, because although I know braille, I am not a reading specialist. With the encouragement of my mentors, I started I-M-ABLE, and soon became caught up in Ajay's rapid skill acquisition. Before I introduced any key words, we embarked on a series of emergent literacy and tactile skill activities. Ajay and I worked individually in a quiet room for 30 to 90 minutes a day, for an average of 60 minutes a day. We focused on activities such as scribbling on the braillewriter together, tracking a line of braille, sorting strips of lines and broken lines, and reading braille and tactile books together. These activities reinforced appropriate hand-finger placement and concepts including left, right, top, middle, and bottom, depending on where we placed different baskets along his braille mat for the sorting activities. INITIAL STRATEGIES--READING AND WRITING When considering initial key words to teach Ajay, I realized that he had already selected them. He knew his name could be written in print, so we explored his name. The next words were P.E. (physical education was his preferred school activity, written pe to teach him the letters without the extra braille characters) and tape measure a noisy object he became fixated with during his functional vision and learning media assessment. Because they were topographically unique in braille, Ajay soon mastered these words, and we slowly added more. One mistake I made in the first months was introducing two key words that were too similar in braille for Ajay to discriminate between them. …

Emotion, Relationship, and Meaning as Core Existential Practice: Evidence-Based Foundations

Existential therapy’s solid evidence-based foundation has not been adequately articulated to date. One challenge to this task is the lack of a singular or unified existential approach. Despite this, there remain shared themes that are common across the approaches to existential therapy. A second challenge is that many existential therapists resist Evidence-Based Practice in Psychology (EBPP), viewing it as excessively restrictive. However, EBPP is more inclusive than previous approaches to evaluating therapeutic effectiveness, such as the empirically supported treatment movement. We maintain that EBPP fits well with existential therapy and supports its practice. This paper identifies three pillars of existential psychology as its (1) relational focus, (2) emphasis on working with emotions and experience, and (3) meaning-centered approach. Each of these pillars have a strong foundation in empirical research, clinical competencies, and ability to be adapted to individual and cultural differences, which have been identified as the core of EBPP (American Psychological Association Presidential Task Force on Evidence-Based Practice in Psychology 2006). While few outcome studies specifically on existential psychotherapy exist, there is extensive research supporting the core practices that comprise existential therapy practice.

"Pensando mucho" ("thinking too much"): embodied distress among grandmothers in Nicaraguan transnational families.

In this paper, I describe an embodied form of emotional distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, "pensando mucho" ("thinking too much"). I draw on ethnographic fieldwork and semi-structured exploratory interviews about pensando mucho conducted with grandmother heads-of-household to show the cultural significance of this complaint within the context of women's social roles as caregivers in transnational families. Adopting an interpretive and meaning-centered approach, I analyze the cultural significance of pensando mucho as expressed through women's narratives about the impacts of mother outmigration on their personal and family lives. I show how women use pensando mucho to express the moral ambivalence of economic remittances and the uncertainty surrounding migration, particularly given cultural values for "unity" and "solidarity" in Nicaraguan family life. I also discuss the relationship between pensando mucho and dolor de cerebro ("brainache") as a way of documenting the relationship between body/mind, emotional distress, and somatic suffering. The findings presented here suggest that further research on "thinking too much" is needed to assess whether this idiom is used by women of the grandmother generation in other cultural contexts to express embodied distress in relation to broader social transformations.

Enhancing cognitive behavior therapy with logotherapy: Techniques for clinical practice.

Logotherapy is a meaning-centered approach to psychotherapy, which is compatible with cognitive behavior therapy. Its basic tenets have the potential to increase both the efficacy and effectiveness of the therapeutic process. This article describes the main techniques of logotherapy and provides specific and practical examples of how they may be incorporated into a cognitive behavior framework. The article concludes with a proposal for future research to validate integrative treatment protocols, and to provide an empirical base for logotherapy-enhanced cognitive behavior therapy.

Usability Testing for Mobile Input Method Interaction Design

The paper describes the interaction design for mobile input method. In order to further the interaction design, we proposed the usability testing to testify the design details in the two new input method interactive prototypes (T9 style keyboard and QT style keyboard). Quantitative data (accuracy rate of keystroke) was collected which was used to measure the effectiveness of different styles of buttons and related UI designs in the demos. And the users’ subjective attitudes and user experiences on the different design were collected through interactive demo. Finally the user research and usability testing results improve the validity of meaning-centered design approach for input method.

Sarah's Story: Using the Individualized Meaning-centered Approach to Braille Literacy Education (I-M-ABLE)

I began providing braille instruction to (a pseudonym) at a residential school for blind students when she was 11 years old and had been learning the braille alphabet and whole-word contractions for more than two years. Sara was born with retinopathy of prematurity and was totally blind; and, according to verbal comprehension and working memory testing results, she was intellectually deficient. Her ability to recognize letters was consistently minimal (see Figure 1). Furthermore, when I reviewed the assessments, I discovered that identified only eight letters with 100% accuracy across the seven assessments. displayed a general lack of interest in learning to read braille and exhibited poor braille-reading mechanics and retention. She typically scrubbed (that is, moved her fingers in a circular or vertical motion over a braille character to aid in recognition) individual braille letters and had difficulty tracking and locating new lines of braille. Therefore, I decided to restart Sarah's alphabet-recognition instruction using the Mangold curriculum, which would help with her tracking and perhaps improve her ability to recognize letters at the same time. [FIGURE 1 OMITTED] After 2-1/2 months of using a traditional method of teaching to read braille and seeing her twice a week for lessons, I measured her accuracy in identifying 12 letters at 67%. At that same time, I enrolled in a series of weekly I-M-ABLE training sessions given by Diane Wormsley at the residential school at which I worked. We were asked to select a student to use as a case study as part of this training, and since I was concerned about Sarah's continued lack of retention and reading inconsistencies, I selected her as a case study during the training. I-M-ABLE is an individualized instructional method for braille that uses meaningful, student-selected vocabulary. I knew that had interests of which I was unaware, since her hobbies were not something we had discussed during previous braille lessons. After completing an interest inventory by asking questions about her favorite books, music, and things to do during leisure time, I was able to help her create a list of meaningful words. Sarah's first selection of Key Vocabulary or student-chosen words were Chris Brown, SpongeBob, pizza, and music. When the initial list was complete, I reviewed each word with Sarah. Her immediate response was, Thank you for writing all those words! At this point, it seemed as though I had some buy-in from Sarah. I then chose to introduce the words pizza and Chris Brown first on individual braille word cards because these words were tactilely distinct. When she showed success with them, I introduced SpongeBob and music. While and I looked at these words and others on braille word cards, we discussed word cues (unique distinctions of individual words, such as the characters in the words appearing tall, clumpy, spaced apart, or at the top or bottom of the braille cell). became instantly successful at recognizing her new words. Whereas she had previously not been able to recognize letters, she now was able to learn the feel of the new words using the word cues we discussed. As she learned more words, I wanted to use them in stories, which required me to introduce her to some filler words (teacher-selected words, including high-frequency words). Sarah's first filler words were likes and eats. One of the filler words allowed her to read her first key vocabulary story Likes: Sarah likes pizza. likes music. likes Chris Brown. likes SpongeBob. likes it all. By the end of the two-month-long I-MABLE workshop that I was attending, was successfully reading eight words and was using more efficient hand movements while reading (that is, she was no longer scrubbing). In addition, I watched her become extremely motivated to learn to read braille using this new approach. …

A Theoretical Rationale for using the Individualized Meaning-centered Approach to Braille Literacy Education with Students who have Mild to Moderate Cognitive Disabilities

This article describes the components of the Individualized Meaning-centered Approach to Braille Literacy Education for teaching braille reading and writing to students who are blind and have additional cognitive impairments. A theoretical rationale is presented for the approach, along with some limited empirical evidence for using it with this population.

Putting Theory into Practice: Two Teachers’ Experiences with Wormsley's Meaning-centered Approach to Braille Literacy

Putting Theory into Practice: Two Teachers’ Experiences with Wormsley's Meaning-centered Approach to Braille Literacy

I-M-ABLE: A Pathway to Literacy

In planning a literacy program for 6-year-old Andrea (a pseudonym), teachers in the Vision Resource Department, of the Toronto Board of Education, had some significant hurdles to consider. A psychological assessment suggested that Andrea, who was blind, autistic, and had little grasp of the English language, responded like a 2 year old, rather than a 6 year old. Andrea was placed in a multiple exceptionality class of a regular public school where reading and writing were milestones that would not be achieved by all students. Whether Andrea would become a reader was yet to be determined. The school staff members focused on her language skills and teaching her to understand and trust the classroom environment, while her itinerant teacher of students with visual impairments considered Diane Wormsley's functional approach to braille literacy, the Individualized Meaning-centered Approach to Braille Literacy Education (I-M-ABLE), for Andrea. It was apparent that traditional methods were unlikely to work for this student. Andrea's autism and other special needs beyond her visual impairment meant that she had large gaps in concept development. Learning for Andrea would have to center on her life experiences and the meaning that could be derived from them with her. In the first year of her four-year program, the activities selected for Andrea included traditional prebraille skills, such as finger strengthening with play dough and clothespins, tactile discrimination games, and concept development kits with concrete objects. But Wormsley's functional approach to braille literacy provided the next steps. Following Wormsley's outline, Andrea's classroom was set up with braille labels in as many places as possible, creating a braille-rich environment. The words were meaningful to Andrea in the beginning only as a series of tactile markers around the classroom, but they gave her a consistent presence of braille signs, such as the sort of print signs that are available in most environments. Andrea's name was brailled on many items, such as her chair and table, and she was often referred to these signs by hand-over-hand touching. The Perkins Brailler was initially a toy to be explored and scribbled with. Understanding the concepts of left and right through games and play, and incorporating finger tracking left to right, were also specific skills for the first year. Andrea used a caddy with meaningful tactile symbols from which she could pick objects. She would feel the symbol, say what it meant, and then touch the object to see if she was correct, a precursor to the actual words. Understanding words was, of course, the staff's end goal. Guided by Wormsley's program, we placed Andrea's name on several word cards, and to challenge her discrimination skills, the shorter word Mom was brailled onto others. Andrea knew her own name and repeated it often, and she certainly knew who Mom was, because she had a strong attachment to her family. This was the start of her favorite form of reading over the next three years--her collection of word cards. One of Andrea's strengths was her tactile discrimination skills. Andrea would feel the dots on the double-spaced word cards and was soon able to distinguish that different cells had different combinations of dots. She was on her way to learning letters. Once Andrea memorized the alphabet song, it was broken down into the exploration of the various letters--first, of course, were the letters A and N, the first two letters in her name. These letters were followed by several other letters that were introduced one by one and then used as initial letters of words on word cards. Special words that we used in repeated conversations were sometimes chosen to become word cards. For example, Andrea enjoyed exploring necklaces and bracelets. Both were long words that contrasted well with shorter ones. Both were used in conversation by Andrea several times a day when she commented on her own necklace or bracelet or ones that were worn by others. …