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“Developing a Collaborative Team Approach to Treating Autism”

“Developing a Collaborative Team Approach to Treating Autism”. Presenters. Greg Carr Founder of The Uncommon Thread and Scholastic Interventions Katherine DeCotiis Wiedemann BCBA. Agenda. Introduction Autism and the Rate of Growth The Why, What, When and How of ABA Parent/Family Dilemma

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“Developing a Collaborative Team Approach to Treating Autism”

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  1. “Developing a Collaborative Team Approach to Treating Autism” 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  2. Presenters Greg Carr Founder of The Uncommon Thread and Scholastic Interventions Katherine DeCotiis Wiedemann BCBA

  3. 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

  4. 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

  5. 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 Assessments offering BCBA supervisionof 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

  6. 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

  7. 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

  8. 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

  9. The Why, What, When and How of ABA Applied Behavior Analysis 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  10. ABA Methodology • 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Defining ABA:6 Important Features of Applied Behavioral Analysis • Applied behavior analysis is guided by science. • Behavior change procedures are applied in a systematic,technologicalway. • Procedures are derived from basic principles of behavior. • The focus is on socially significantbehavior. • ABA seeks to make meaningfulimprovement. • ABA seeks to demonstrate a functional, or causal relationship. 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  17. 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

  18. 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 • DiscreteTrial Instruction is not synonymous with ABA, it is only one procedure that uses ABA principles. 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  19. 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

  20. 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. 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  21. 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

  22. 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 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  23. 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

  24. 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 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  25. Parents Juggle Interaction with Multiple Stakeholders 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  26. Evaluation  Diagnosis  Treatment • Addressing “Hands Off” Issues • Time is Crucial –delays effect outcomes • Awareness, understanding and follow-up • Insurance and Financial Issues 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  27. Collaboration Model

  28. 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

  29. 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

  30. 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

  31. Pediatrician’s Role Autism Suspected • DON’T DELAYRefer 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

  32. 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

  33. 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

  34. 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 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  35. 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

  36. 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

  37. Insurance Provider Role States with Coverage 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  38. Autism Bill Expanding Insurance N.J. expands coverage for autism, developmental disability therapies By 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

  39. 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

  40. 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 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  41. 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 TeacherKatherine 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

  42. 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

  43. 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 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  44. Automated System- Sample Assessment 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  45. Automated System- Sample Lessons 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  46. Automated System- Sample Graph 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  47. Automated System-Sample Progress Report 1071 Valley Road, Stirling, New Jersey (908) 604-4500

  48. 1071 Valley Road, Stirling, New Jersey (908) 604-4500

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  50. 1071 Valley Road, Stirling, New Jersey (908) 604-4500

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