“developing a collaborative team approach to treating autism” 1071 valley road, stirling, new...

“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


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.


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.


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



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


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


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.


ABA Methodology


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



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



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


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)


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


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.


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


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.


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


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


http://bob.nap.edu/books/0309072697/html/


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

http://www.pediatrics.com/






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



Evaluation Diagnosis Treatment

Addressing “Hands Off” Issues Time is Crucial –delays effect outcomes Awareness, understanding and follow-

up Insurance and Financial Issues

Collaboration Model


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


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



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

http://www.mchatscreen.com/



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


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



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



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)


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


Insurance Provider Role

States with Coverage



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.

http://connect.nj.com/user/ksantiag/index.html

http://www.nj.com/politics/index.ssf/2009/08/trenton_gov_jon_corzine_today.html

http://www.nj.com/politics/index.ssf/2009/08/trenton_gov_jon_corzine_today.html


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


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.


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



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


Automated System- Sample Lessons


Automated System- Sample Graph


Automated System-Sample Progress Report


Make a Referral


Thank You


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



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



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

“developing a collaborative team approach to treating autism” 1071 valley road, stirling, new...

Documents