“developing a collaborative team approach to treating autism” 1071 valley road, stirling, new...
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“Developing a Collaborative Team
Approach to Treating Autism”
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Presenters
Greg CarrFounder of The Uncommon Thread
and Scholastic Interventions
Katherine DeCotiis WiedemannBCBA
Agenda
Introduction Autism and the Rate of Growth The Why, What, When and How of ABA Parent/Family Dilemma From Evaluation to Diagnosis to Treatment The Collaborative Team Parent Role Pediatrician Role Specialist: Neuro Pediatrician/Child Psychiatrist School District Role Insurance Provider Role
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Commitment to Early Intervention
The Uncommon Thread offers behavior analytic services (ABA therapy) tailored to each child’s needs, educational materials, and parent training to help children dealing with learning, developmental, and behavioral disorders including Autism.
Our mission is to help families organize and manage effective plans.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Services Offered 1:1 ABA – offered in center & in home settings Group ABA and Social Skills Parent Training Community Training Shadow Services – school, camp, daycare Skill & Readiness Assessments Functional Behavioral Assessmentsoffering
BCBA supervision of all programs ensures oversight of all assessments and reporting, and approval of all programs and program materials. Programs are language based focusing on
acquisition and maintenance of new skills.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Dilemma: Nationwide Trends
Incidence of Autism on the rise 2000 - 1 in 150 Today - 1 in 88, 1 in 49 in New Jersey Increase in Special Education Expense Decrease in the costs covered by the state and
federal governments Limited Insurance Coverage Increasing number of stakeholders and systems
to navigate
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Defining the Increase
The apparent increase in prevalence may represent a combination of several factors.
The change in the criteria for diagnosis with the inclusion of milder forms on the spectrum of Autism
A higher public and professional recognition of the disorder
A true rise in prevalence
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Autism Spectrum Disorder (ASD)
ASDs are now the leading form of childhood developmental disorders
Parents are overwhelmed and confused
Families need their Primary Care Provider’s help to guide them through all the aspects of the management of this condition
1071 Valley Road, Stirling, New Jersey (908) 604-4500
The Why, What, When and How of ABA
Applied Behavior Analysis
Applied Behavior Analysis (ABA) is a science in which procedures are systematically applied to improve socially significant behavior to a meaningful degree. An ABA program is a systematic teaching approach that involves breaking skills down into small, easy-to-learn steps. Praise or other rewards are used to motivate the child, and progress is continuously measured so the teaching program can be adjusted as needed.
Why ABA? ABA is the only treatment for autism whose benefits have
been consistently validated by independent scientific research. In fact, ABA has been endorsed as an effective intervention for autism by the American Academy of Pediatrics, the United States Surgeon General, and 29 states with insurance mandates including NJ.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
ABA Methodology
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Why does Autism need Specialized Treatment?
Learning deficits rate of skill acquisition; maintenance and
generalization of skills Language disabilities
articulation; expressive; receptive; spontaneous; functional communication; non-contextual vocalizations
Behavioral disorders stereotypical behavior: motor, visual, tactile,
vocal; self-stimulatory behavior Compulsive behaviors
rigidity of routine, intolerance to change
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Why does Autism need Specialized Treatment?
Attention deficits lack of eye contact; unaware of danger in the
environment; poor attending skills Emotional impairments
inappropriate or non-contextual emotion; lack of self-concept; inability to identify others’ emotions
Social impairments lack of eye contact; gestures; facial expression,
greetings; awareness of other children, friendships
Play skills deficits lack of imaginative play; cooperative play; turn-
taking
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Why does Autism need Specialized Treatment?
Sleep disturbances going to sleep late; getting up early; getting up
during the night Toileting impairments
delayed toilet training; lack of awareness Eating disabilities
difficulty with textures and appearances; limited diet; inability to use utensils; food stuffing
1071 Valley Road, Stirling, New Jersey (908) 604-4500
What is ABA?
“ABA is the science in which tactics derived from the principles of behavior are applied systematically to improve socially significant behavior and experimentation is used to identify the variables responsible for meaningful behavior change”
-Cooper, Heron & Heward (2007)
1071 Valley Road, Stirling, New Jersey (908) 604-4500
What is ABA?
Research has shown Applied Behavior Analysis (ABA) has the most benefit when applied in early childhood development.
Beginning intensive behavioral interventions before the Age of 2 with a Minimum of 25 Hours and a low student to teacher ratio (1:1, 2:1)
ABA is recommended by the NY State Department of Health, American Academy of Pediatrics, US
Surgeon General, the Association for Science in Autism Treatment
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Defining ABA:6 Important Features of
Applied Behavioral Analysis
1. Applied behavior analysis is guided by science.2. Behavior change procedures are applied in a
systematic, technological way.3. Procedures are derived from basic principles of
behavior.4. The focus is on socially significant behavior.5. ABA seeks to make meaningful improvement.6. ABA seeks to demonstrate a functional, or causal
relationship.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Teaching Techniques in an ABA Program
Discrete trial instruction (DTI) Natural environment teaching (NET) Task Analysis Errorless learning Incidental teaching Prompting Shaping Chaining Small Group Instruction
1071 Valley Road, Stirling, New Jersey (908) 604-4500
What is Discrete Trial Instruction?
One of many teaching procedures utilized in ABA Highly structured teaching technique Often involves an instructor working one-to-one with
a student Involves learning trials which begin with a short
clear instruction; this is a highly researched teaching procedure, found to be effective in teaching various language, social, and academic skills
Is not aversive! Should be combined with other teaching procedures Discrete Trial Instruction is not synonymous with
ABA, it is only one procedure that uses ABA principles.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Role of BCBA
BCBA Responsibilities: Conducts behavioral assessments, such as
Functional Behavior Assessments (FBA) or a Functional Analysis (FA), and interprets the results
Conducts initial assessments (ABLLS, VB-MAP) Designs and supervises individualized programs Supervises BCaBAs and other staff Develops skill acquisition programs Develops and implements intervention plans
when necessary
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Applied Behavior Analysis Efficacy
“Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas model (see Rogers, 1998).”
U.S. Surgeon General David Satcher, M.D., Ph.D.
Efficacy
“All programs educating children with autism should include intensive behavioral interventions and year-round education”.
The US Dept. of Education and the National Research Council's Report
'Educating Children with Autism‘
“Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program”.
NYS Department of Health Early Intervention: Clinical Practice Guidelines
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Efficacy
Over 500 research articles have supported the use of applied behavior analysis in teaching skills to individuals with autism
Research has been published supporting the use of ABA in teaching fine/gross motor skills, academics, self help/care,
activities of daily living, pre-vocational, vocational, social skills, language, communication, independent activities
Efficacy Myers, et al. recommends intervention as
soon as a tentative diagnosis is made, rather than waiting for additional tests to make a definitive diagnosis (2007).*
Ideally, interventions should involve active engagement of the child for at least 25 hours per week year-round, and a low student-to-teacher ratio to allow for sufficient one-on-one time.
In addition to recommended hours and staff ratio, all programs require frequent supervision by a BCBA.
*Myers, et al. "Management of Children With Autism Spectrum Disorders" www.pediatrics.org/cgi/doi/10.1542/ peds.2007-2362
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Family Dilemma
Time is Crucial – Delays Effect Outcome
Basic Reasons for Delay:◦ Parental denial◦ General practice of wait-and-see◦ Limited awareness of available resources◦ Shortage of pediatric specialists◦ Emotional exhaustion◦ What to do next? ◦ Financial constraints
Insurance denials of support
Parents Juggle Interaction with Multiple Stakeholders
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Evaluation Diagnosis Treatment
Addressing “Hands Off” Issues Time is Crucial –delays effect outcomes Awareness, understanding and follow-
up Insurance and Financial Issues
Collaboration Model
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Parents’ Role
Advocate for your Child Find the best resources available Coordinate Services (build your team) Determine financial and logistical
implications Develop and execute child’s wellness
plan Time is of the essence
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Pediatrician’s Role
Screening Recommendations Early detection and early intervention leads
to better prognosis Autism specific screening should be done at
18 and 24 months using the M-CHAT Provisional diagnosis can be made before the age
of 2 ASD diagnosis at age 2 to 4
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Pediatrician’s Role
M-Chat 23 yes/no questions for parents Tested on children 16-30 months Available in 42 languages, free download and
scoring www.mchatscreen.com Follow up interview is necessary to reduce false
positives Appointing an ‘Autism Champion’ among office staff
can help make sure screening is done
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Pediatrician’s Role
Autism Suspected DON’T DELAY
Refer for Neuro Developmental Assessment for multidisciplinary testing
Refer for Audio screening Under age 3 years - Refer to Early
Intervention and ABA Provider Over age 3 years - Refer to local school
district and ABA Provider
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Awareness, Understanding, and Follow-Up
If the child is diagnosed: Ensure the proper follow-up to verify that parents
are seeking or have found ABA therapy Question if ABA Therapy is underway Look for feedback from an ABA Center and/or
professional to ensure progress
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Awareness, Understanding, and Follow-Up
If the child is NOT diagnosed: Does the child still need early intervention
services (behavior intervention, speech, etc.) to build on skills?
Question if therapy is underway Keep an eye for continual signs (Both from the
parent and you revisiting the M-CHAT) If applicable suggest a second visit with a
specialist
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Awareness, Understanding, and Follow-Up
Remind Parents that intensive early ABA intervention will give them the
best odds at mainstream outcomes - 25+ hours per week
Specialist Role
Specialists: Neurodevelopmental Pediatrician Child Psychologist
Specialist Testing Neurological Examination, Audiological
Evaluation, Neuroimaging studies and EEG when indicated, medical laboratory testing including metabolic screening tests and genetic testing
A diagnosis of Autism 299.00 is required for insurance purposes and to assist school districts in forming an Individual Education Plan (IEP)
1071 Valley Road, Stirling, New Jersey (908) 604-4500
School District’s Role
School-based Special Education Starts at 3 years of age with special preschool
education The child has an Individualized Educational Plan This should provide the child with structure and
methods to facilitate social skills, functional communication, learning, speech, OT and PT as needed
Does the District have ABA Classroom Supports? Typically developing peers as role models and
playmates are usually included
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Insurance Provider Role
States with Coverage
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Autism Bill Expanding Insurance
N.J. expands coverage for autism, developmental disability therapiesBy Katherine Santiago/The Star-Ledger August 13, 2009, 3:45PM NEW BRUNSWICK -- New Jersey became the 15th state today to
enact a law requiring insurance companies to cover the screening and therapeutic treatment for children up to age 21 who are diagnosed with autism and other developmental disabilities.
The legislation overcame the opposition of business associations and insurance companies, who've predicted the measure will make health coverage unaffordable. Insurers have denied coverage for speech, occupational, physical and behavioral therapies because they deemed it "educational," not medical in nature, or because the therapy would not restore a child's ability to speak if the child never could speak at all.
But as the evidence of autism's pervasiveness hit home for New Jersey, that has the highest rate of the disability in the nation, momentum for the bill grew. One in 94 children in New Jersey is diagnosed with autism, compared to the one in 150 children in the nation.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
What does the Autism Bill mean for New Jersey Families?
Currently we estimate about 1/3 of families in NJ are covered by the insurance bill
General Criteria for Coverage Insurance coverage must be a group plan that
was written by a NJ insurance provider. Generally, self-funded plans and federally
funded plans are not covered. If your insurance plan is written outside the
state of NJ, parents need to check if that state also has the Autism Bill
1071 Valley Road, Stirling, New Jersey (908) 604-4500
ABA Provider’s Role
What makes a good ABA Program? Dedicated and Energetic Therapists Trained Therapist in The Science of ABA Quality Lesson Plans and Curriculum Data Collection/Data Analysis/Progress
Reporting Parent Collaboration and Parent Training Generalization of skills in the home,
school, and public settings Qualified/Experienced BCBA
Founders and Staff
Founders - Greg & Aileen Carr Founded Center in 2006, doors opened in 2007 Have a son who was diagnosed with Autism in 2002 Currently, Aileen is a BCaBA and pursing her MA in
Special Education. Staff
Dr. Kimberly Vogt, Ph.D., BCBA, Special Education Teacher Has over 20 years of experience working with children with special needs
and extensive training in verbal behavior analysis. Katherine DeCotiis Wiedemann, MA, BCBA, Special Education
Teacher Katherine has taught as a special education teacher with children on the autism spectrum. She has consulted to agencies, school districts and families for the past 5 years.
Robin Mammone, MA, BCBA Has over 18 years of experience in special education, as well as working with children on the autism spectrum. Robin was previously a Lead Behaviorist at a North Jersey School District.
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Founders and Staff Staff
Melanie Roman White, BA Psychology, ABA Consultant, ABA Graduate Certificate, Penn State. Our staff director, has experience working with both children and adults on the autism spectrum, both in home and center-based.
Sacha Altadonna, BS Business Administration. Our director, has many years of experience managing diverse responsibilities in a fast-paced environment.
Additional Staff members: 3 have master’s degrees 3 are pursing master’s degrees 5 have education backgrounds 3 have backgrounds in psychology 1 is a BCBA Candidate
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Credentials of BCBA and BCaBA
Board Certified Behavior Analyst must have at least a master’s degree must have completed at least 225 hours of
graduate coursework in Behavior Analysis must have completed 1500 hours in the field must have completed supervision under a
BCBA must have passed the national board exam
Automated System- Sample Assessment
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Automated System- Sample Lessons
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Automated System- Sample Graph
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Automated System-Sample Progress Report
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Make a Referral
1071 Valley Road, Stirling, New Jersey (908) 604-4500
Thank You
1071 Valley Road, Stirling, New Jersey (908) 604-4500
DSMV Diagnostic Criteria 299.00
1. Qualitative impairment in social interaction as manifested by at least two of the following:
marked impairment in the use of non-verbal behaviors such as eye contact, facial expression, body posture, and gestures.
failure to develop peer relationships appropriate to developmental level.
lack of spontaneous seeking to share enjoyment , interest or achievement (JOINT ATTENTION)
lack of social or emotional reciprocity
1071 Valley Road, Stirling, New Jersey (908) 604-4500
DSMV Diagnostic Criteria 299.00
2. Qualitative impairment in communication as manifested by at least one of the following: Delay in development of spoken language, not
compensated with alternative means of communication
Impairment in ability to sustain conversation once speech is used (ex. Echolalia)
Stereotypical or repetitive use of language (video talk)
Lack of varied social imitative or pretend play
1071 Valley Road, Stirling, New Jersey (908) 604-4500
DSMV Diagnostic Criteria 299.00
3. Restricted, repetitive, or stereotypical patterns of behavior or range of interests as manifested by at least one of the following: Preoccupation with restricted pattern of interest
that is abnormal in intensity or focus Inflexible adherence to nonfunctional routines or
rituals Repetitive motor mannerisms (flapping, spinning) Preoccupation with the parts of things
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