First Steps_LS2 Phase II_Educational Approaches and

Educational Approaches and
Carol Hubbard MD PhD
• Applied behavior analysis is the process of
systematically applying interventions to improve
socially significant behaviors, and to
demonstrate that the interventions are
responsible for the improvement in behavior
• Behaviors are defined in observable and
measurable terms in order to assess change
over time.
• Direct observation, measurement, repetition,
and incentives are important components
• Advantages
– best data to support its use
– good for nonverbal or non-compliant
• Disadvantages:
– skills may lack generalization,
– does not take into account sensory
– can increase anxiety
– does not provide opportunity for
socialization (if done in its purest form)
Think Social: Michelle Garcia Winner
“Social thinking is required before the
development of social skills. Successful
social thinkers consider the points of
view, emotions, thoughts, beliefs, prior
knowledge and intentions of others
(perspective taking).”
• Four steps of communication:
1. Thinking about others and what they are thinking
about us
2. Establishing a physical presence
3. Thinking with our eyes
4. Using language to relate to others
Types of services to expect for a
child on the autism spectrum
– Academic instruction: mainstream, pull-out time,
special education classroom, specialized school
– Support in the classroom as needed (some need 1:1
or shared educational technician)
– Speech and language therapy in most cases
– Occupational therapy in some cases (for fine motor
and sensory issues)
– Social skills training (small groups, speech therapist
or social worker/guidance counselor), ideally using
some curriculum, and working on eye contact, body
language, reading facial expressions and nonverbal
cues, conversational skills, initiating and maintaining
– Support in unstructured settings (lunch and recess)
Teacher questionnaire
Call schools!
Ask for a school observation
Ask for team meetings to be held in your office
Learn how to read IEPs and
psychological/educational test reports
• Talk with Case Managers
• Make sure goals and objectives are appropriate,
specific and measurable, include social goals,
are being followed and that data is being
collected to track progress
Legal Aspects
• 504 Accommodation Plan
– Rehabilitation Act of 1973 – prohibits discrimination for recipients of
federal financial assistance
– Physical or mental impairment that affects ‘major life activities’
– ADHD, medical conditions, special health care
– Can include accommodations and modifications
– Does not require a written plan or prior notice to change
• Individual Educational Program (IEP)
IDEA 2004 (Individuals with Disabilities Education Act)
Includes concept of response to intervention
Must need “specially designed instruction”
Must fit into one of 13 categories of eligibility
Written plan, IEP meetings, triennual testing
Can add behavioral modifications for ADHD
Southern Maine Parent Awareness has excellent on-line guidebooks
The New Process: IDEA 2004
• Response to Intervention (RTI) Tier 1
– Basic education using best practices in
regular classroom setting, started June 2010
• Response to Intervention Tier 2
– Modified to meet students needs
• Response to Intervention Tier 3
– IEP written
Maine DHHS
Office of Child and Family Services
• Children’s Behavioral Health Services
– 207- 624-7900
– District 2: Cumberland County
– Districts 3, 4 & 5 (Formerly Region 2)
Kennebec, Somerset, Androscoggin, Franklin,
Oxford, Sagadahoc, Knox, Lincoln, and
Waldo Counties
Katie Beckett Waiver
• Apply for MaineCare based on income.
– When denied, ask to be processed for Katie Beckett
– The child’s own monthly income must be $1656 or less,
and assets $2000 or less.
• If rejected, must qualify based on disability:
– Must meet the Social Security rules for disability
– Physical or mental disability that will last at least 12
– Condition must be serious enough that the child is “not
able to do what other children of the same age can do”
Katie Beckett
documentation requirements
• Documentation of a mental health
diagnosis that has persisted for at least 6
months and can be expected to last a year
or longer- PCP can endorse specialist
– Must be dated within the last year
• There are now monthly charges for
Katie Beckett
– Based on income and if have primary
Case Management
Case management consists of an intake and assessment
for eligibility, an Individual Service Plan (ISP) detailing
the strengths and needs of the child and the services
necessary to address these needs. The case manager
will work with the family to assist with the coordination
and advocacy of services for the child.
• Different agencies for “mental health,” and “mental
• Families can self refer to an agency of their choosing
• Must have active needs that require case management
• Case Management Agencies: Woodfords, Sweetser,
Independence Association, Pinetree, more on DHHS
Services that case managers can
help to procure
• Flex funding – financial assistance to support
treatment goals in the child’s ISP i.e. training for
parents, weighted blankets, medical equipment,
etc. Very limited availability.
• Respite services – temporary planned relief for
caregivers i.e. babysitting
– Diagnosis, 0-5 is at risk, 6-18 sig. delays in 2 or more
areas of development. Must be renewed yearly
• In-home support
In home support
Section 28: MR or autism diagnoses along with ABAS or Vineland
with the overall score more than 2 standard deviations below the
mean, direct support for the child
“Specialized Section 28:” must have autism diagnosis
Section 65:
• Mental health diagnoses,
• Time-limited but can be renewed
• Model of working to support parents in managing their
• A Licensed Clinician writes the plan and does family
work and a bachelor level support worker helps
implement the plan
Adaptive function assessment
– Needed to qualify for in-home support
– Vineland: interview format
– ABAS II (Adaptive Behavior Assessment
Questionnaire for parents and teachers
Ages birth through 89
Daily living skills: conceptual, social and practical
Hand scoring takes 5 to 10 min, computer scoring
available (gives nice printouts)
• Kit is $199, or $349 with computer scoring
• Western Psychological Services
Community resources
STRIVE: S. Portland, social programming for teens/pre-teens
Special Olympics
Maine Handicapped skiing: Sugarloaf, Sunday River, Lost Valley
Therapeutic Recreation in Portland (through Easter Seals)
Central Maine Adaptive Sports Cindy Dubois 786-3062
Summer Camps
– Pine Tree
– Camp Sunshine
– Camp CaPella Orono 356 0207
– Autism Society: UMF Summer Camp Ages 5-15 1-800-2735200
• Hippotherapy –therapeutic horseback riding
– Riding to the Top, Windham
– Hearts and Horses
• Talk with Case Managers for other local resources
Transition to Adulthood
• Planning should start 4 to 5 years before leaving
school system (we start at 14)
• Need to be receiving children’s services and
have diagnosis of autism or MR before age 18 to
qualify for adult services
• Services much more restricted for adults:
changes from IDEA to ADA and 504, and from
‘entitlement’ to ‘eligibility,’
• DHHS Office of Adults with Cognitive and
Physical Disability
• Southern Maine Parent Awareness transition
Transition to adulthood (continued)
• The young person should be included in
IEP meetings, if possible, in high school
• Issues to consider (among others)
– Driving/transportation
– Future education/vocational training
– Guardianship
– Trust fund
– Day treatment vs employment
– Housing
Parent support groups
and resources
Autism Society of Maine
Asperger’s Association of New England
Maine Parent Federation
Southern Maine Parent Awareness (on-line guidebooks to special ed law)
Pine Tree Legal
Disability Rights Center
– 1-800-452-1948
Maine Developmental Disabilities Council
Future Horizons – excellent site for autism/Asperger books