Tag Archives: autism

Is my ABA provider effective?

Applied Behavior Analysis (ABA) therapy for children with autism has been proven to work over a period of time. However, as a parent you may not have the necessary experience or background to determine if the level of expertise of a practitioner is meeting your child’s goals and needs.

Beyond the obvious signs of whether or not your child is making progress, there are some other factors when assessing a provider that you can use to evaluate their potential effectiveness.  Here’s a tool-kit that you can use.

Didactic Children Therapy

How many children are on your BCBA/ BCaBA’s caseload?  Of course, you might also want to check if the individual overseeing your child’s program is credentialed (Board Certified).  The best way to find out is to ask directly.  If that doesn’t work then you can approximate this by comparing the total number of children in the program with the total number of BCBAs/ BCaBAs.  There is no ‘correct’ number of children per BCBA/ BCaBA (it depends on the complexity of each program, the experience of the staff, number of assistants etc).  In our experience a good approximation is no more than 10.  You can also think about it this way – if your BCBA/ BCaBA has, for example, 15 kids, then assuming they spend about 2 hours a week with each child, that adds up to 30 hours (assuming no travel time from one location to another).  Now each child’s care also involves programming time (writing reports, collecting data training with staff etc).  Conservatively allocating around 1 hour per child for programming time totals 15 additional hours for a total of 45 hours. Add in usual administrative time for meetings, emails and other non-clinical weekly activities and very soon you’re above 50 hours/ week.  This is not an effective setting for providing quality of care and leads to compromises and shortcuts.

How many individuals are assigned to your child’s team? An effective model involves more than just the BCBA/ BCaBA overseeing a child’s program – such as such as trainers, program managers (or people assisting BCBA/ BCaBAs etc).  Additional team members should be assisting with some of the tasks mentioned above.

Is your child’s team trained?  How effective a provider’s training program is can have a direct correlation with how good your child’s program will be.  You should inquire about your provider’s training program and methodology to ensure adequate attention is devoted to this.

Is parent training offered?  For a child’s program to be successful – you should be able to ask for and receive training to implement some of the principles at home that are being used with your child everyday.

Is the child actually receiving one on one therapy? – Or are multiple children overseen by a therapist?  For ABA services to be most beneficial – your child should be one on one with a therapist.  Your child’s therapist should not be paired with multiple kids at once.  This is important not only for the quality of care – but also for how billing is done (if services are being accessed through health insurance)

Are you allowed free and open access to your child’s team and to his/ her sessions?  If not, that is a red flag… it is your child, after all and you should be able to observe your child’s sessions.  (Incidentally this is also a good way to check the above points about one on one therapy).

Are you able to interact with your child’s team on a regular basis and develop a good working relationship?  The level of communication and involvement that you have with your child’s team is a good measure of how vested the provider is in your child’s program.

What is the general vibe and environment like at the place of service?  Schedule a visit or request and observation. You can tell a lot by observing and interacting with the team.

Does your child’s staff take proper data and clinical note? You should be able to get a summary of your child’s sessions – either upon request or as a regular part of the process.  This is a good way for you to stay up to speed with your child’s progress.

Creative Children Therapy

Since time is your most valuable resource, especially when your child’s progress is concerned – it is crucial to have a toolkit to assess the effectiveness of your provider. These questions should serve as a starting point for you.

Further reading: http://www.bacb.com/Downloadfiles/ABA_Guidelines_for_ASD.pdf

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7 tips to help kids with Autism prepare for Fireworks

fireworks

The Fourth of July is a day that often involves, fireworks, barbecues and, at least around here, lots of crowds. For families that have children with autism, everything about the holiday can be a recipe for a meltdown. These seven tips were compiled for families that would like to see the show together. The key is to know your child’s limits and have an escape plan in case he or she needs a break.

Prepare for the Show 

Letting your child know in advance what might happen in advance will give your child some sense of control and help reduce his level of anxiety. Talk about exactly what you will be doing: getting in the car, taking a picnic, eating, watching fireworks, walking back to the car, waiting in traffic and any other details you can think of. The more your child knows what to expect, the better he will be able to handle the situation.

Preview the Show

Sparklers may not have much sound, but they look like mini fireworks. You can also watch videos of fireworks displays online. Fireworks Blast-Off  is an app ($.99) that lets the user control the colors and size of fireworks on the screen. Programs like this are great at simulating actual sound but not at the intense level you would find at a real fireworks display but they can serve as a good introduction.

Watch from far away

Your best option may be a nearby parking lot, or the side of the road with the windows rolled up may provide a comfortable and safe distance for your kiddo to experience the show.

Have a solid Plan B

When you make the decision to try a live fireworks display, be prepared to leave if your child becomes overwhelmed. Despite the fact that you have spent time preparing your child and have a pair of headphones available, things may not work out as planned. Keep this in mind when parking the car so you can have an easy route out

Take comfort items

Be sure to pack items that help to calm your child, such as a weighted vest, blankets, snacks, iPad or fidget toy.

Create a Social Story

A social story may work to prepare your kiddo for any event that might be stressful throughout the evening. A great social story is up for free download here.

Headphones

If you haven’t already, invest in a good pair of noise canceling headphones or construction grade earplugs. You may be able to prepare your child for the crowds and change of surroundings, but they may be over stimulated by the noise! You can even play soothing or patriotic music through them.

Indy with Kids has laid out Fireworks in the Indianapolis Area here.

Fort Wayne area Firework displays are listed here.

Greater Boston area Fireworks are listed here.

Have fun!

Tips for grocery shopping with your child with Autism

grocery

Hey parents!  I know grocery shopping with a child on the spectrum can be challenging at times.  Here are a few helpful tips that may help you get your get in and out of the grocery store successfully!

  1. Keep little hands busy from grabbing items outside of the cart by giving your child something to hold onto while in the cart.  It can be a little bag of snacks or a fun toy to play with.

 

  1. Make shopping a game.  Share the list of items with your child.  You can even make a visual list if it will be more helpful for your child to see the pictures of the items you need to find.

 

  1. Set rules and stick to them.  If you don’t follow through with the rules you set, your child will learn your rules don’t need to be followed.

 

  1. Reward good behavior and don’t reward the bad!  If your child is being cooperative, praise your child and deliver other desirable items and activities while you shop.  If your child makes it through the entire shopping trip successfully, reward your child afterwards such as go to the park or get some ice cream.

 

Start with short trips and work up to keep your child successful if shopping trips have a history of being very difficult.  You may need to start with going to the store to purchase only 1 item so that you can get in and out quickly to begin teaching your child how to behave while in the store so that you can get a chance to reward your child for being successful.  Once your child begins to understand how to behave in the store and learns that being cooperative leads to other desirable and fun things, you can gradually begin to increase the number of items on your list and the length of your shopping trip.

Planning Ahead: Tips for Increasing Your Child’s Success when Dining out in a Restaurant

We know that sometimes as parents it can be very difficult to take a child with autism to a restaurant with you. You might be worried that people may judge you if your child misbehaves. Below are some tips on how to plan ahead before going out to help keep your child successful and your trip enjoyable!

dining

1.) Find places that are designated as autism friendly; that may not have as many people and are not as brightly lit or as loud.

2.) Keep your child with you at all times, this will make them feel safe knowing that you’re by them.

3.) Set the expectations ahead of time as to where you’re going and what they can or cannot do while you’re there.

4.) Let your child have a say in what you do, you can even show them pictures so they can help decide where you’re going.

5.) Use the bathroom before leaving the house so your child is comfortable.

6.) Bring an item for your child to play with that they enjoy while you wait for your food – this could be an iPad, sensory items, toys or even a snack.

7.) Look at the menu beforehand, make sure there is a food option for your child that they will eat.

8.) Make a reservation or call ahead so you don’t have to wait to be seated upon arrival.

9.) Ask for a seat in a quieter, less crowded section of the restaurant, this can be less over-stimulating for your child.

10.) Don’t be afraid to ask the server for help – if your child needs a lid for their cup, or a snack to come out quickly.

11.) Request the check as soon as your food arrives.  This way, you will not have to wait long after your child is done eating.

12.) When your child behaves desirably reinforce good behavior with a snack or preferred item to play with.  Make good behavior worthwhile so they will want to behave well in the future.

13.) Have your child keep a preferred item with them so they will be less likely to be upset if they cannot have something they want.

Post by Holli Novinger, BCaBA, Manager of our Indianapolis Area Locations

Can the ACA help my family?

HealthINFO

The period for open enrollment is drawing to a close.  The last day for open enrollment is March 31, 2014.  After this period, an individual (or family) wanting medical benefits must wait for a qualifying event (marriage, childbirth, loss of employment, etc.) or wait until the next open enrollment period to sign up for benefits.
Individuals or families wanting benefits to begin on March 1, 2014, must complete registration by February 15, 2014, to guarantee coverage.

Healthcare.gov is the federal website (often referred to as an exchange or marketplace).  Indiana elected to use this website so a family who qualifies for the premium subsidy must go through this website in order to qualify for the reduced rates.

The government has restrictions for who qualifies for the subsidy.  Below is a grid which shows the household size and maximum household income allowed.

Household Size    Maximum Household Income

1                              $45,960

2                              $62,040

3                              $78,120

4                              $94,200

5                              $110,280

6                              $126,360

7                              $142,440

8                              $158,520

If you meet these qualifications and are interested in purchasing a policy through the exchange, please know that there are other qualifications, too.  For more information, please call Eric at (317) 815-5501, ext. 2

Restrictions on Policies Available to Purchase

The policies available through the exchange are typically not available if the patient is already covered by Medicare, Medicaid, or Tricare.

For more information on this topic, please explore our previous Newsletters about the ACA Health Care Exchanges. 

Autism Specific ACA information
Information about how the ACA specifically will affect families with children on the Autism Spectrum.

General Information regarding ACA laws
Information compiled by our Insurance guru to help you to navigate the ACA myths and laws, especially how those may impact ABA coverage.

If an individual or family needs additional coverage beyond what is provided by Medicaid, Medicare, or Tricare please call Eric at (317) 815-5501, ext. 2, to discuss other options.

Affordable Care Act (ACA) – implications for our families

A lot of our families have asked us questions about the new Affordable Care Act.  Some of you have received letters in the mail from your insurance provider giving you a deadline if you wish to keep your existing plan.

Here are a few pointers that we’ve gathered together that might help.

Disclaimer:  Please note that most people out there including the experts are still trying to piece together the effects of this new legislation.  We are by no means close to being experts on insurance law… these are just pointers based on what we’ve gathered along the way and should only be used to supplement your own research and/ or advice from professionals.  

Is the government now providing health insurance?

  •   A common misunderstanding is that health insurance is now purchased through the government.  This isn’t true.
  •    The government has created online exchanges (healthcare.gov) for Indiana through which you can shop, compare and purchase insurance plans.  The plans themselves are still administered by insurance companies (Anthem and PHP are the major providers for Indiana)
  •    All plans must comply with new federal wide guidelines – such as not getting denied for pre-existing conditions, deductible levels etc.

What are the major changes in how this affects my child’s insurance?

  •    You can now put your dependent/ child on his or her own policy.  This is quite a big change in that now the child can have his or her own policy.  Depending on your individual circumstances, this could actually lower your out of pocket expenses.  This is a big benefit of ACA.
  •    There are no lifetime maximum limits to coverage; there are also caps on out of pocket maximum spend for covered individuals/ families.

How does the exchange work and why use it?

  •    Currently, it only works sometimes!  You have to log in and create an account and then get quotes.
  •    Depending on your individual circumstances (income, # dependents etc), you might be eligible for credits and tax subsidies.
  •    Individuals and families whose income falls at or below 250% FPL ($28,725 for an individual, $58,875 for a family of four) will be eligible for cost-sharing reductions.  http://www.cbpp.org/cms/index.cfm?fa=view&id=3190
  •    Those eligible for this subsidy can take advantage of it by purchasing a silver-rated (or higher) plan (there are different tiers of insurance available – platinum, silver, bronze.  Platinum pays for 90% of expenses, silver 80% and bronze 70%)
  •    If you intend to purchase insurance through the Exchange, you must do so during the open enrollment (ending March 2014)https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/
  •    Coverage starts Jan 1st, 2014

Do I have to use the exchange?

  •    If you expect to get a subsidy (based on income level) then generally you must use the exchange to purchase insurance
  •    You can buy insurance on or off the exchange (more on this below)
  •    If your employer provides coverage currently that qualifies under the ACA act then you are automatically disqualified for a subsidy

What other options exist?

  •    If you don’t expect to get a subsidy – either because of income level OR if you get insurance through your employer, then you can shop for insurance on private exchanges or directly through insurance companies
  •    One private marketplace is http://www.ehealthinsurance.com
  •    In Indiana – the major insurance companies you can go to directly are Anthem and PHP

So, what should I do?

  •    Regardless of your circumstances, we believe you should research and compare all your options.  Even if you receive employer provided coverage, you might still want to research the new options that have been created out there
  •    One of the carriers available in Indiana is PHP.  We are in network with PHP and generally they are easier to deal with than anyone else.  Also, they have not been known to automatically send all children getting 20hours or above to medical review.  We highly encourage you to check out PHP as an option – some of our families have got highly competitive quotes from PHP including quick responses from customer service.  o   .  Caveat: PHP is not available in certain zip codes. 
  •    If you think you are eligible for a subsidy (see table at:http://www.cbpp.org/cms/index.cfm?fa=view&id=3190); then create an account at healthcare.gov and shop around for rates; You can also call 800-318-2596

 

  •    If you are not going to qualify for a subsidy – check rates at http://www.ehealthinsurance.com
  • Sample comparative from ehealthinsurance.com
  •    Assess if it is cheaper to put your dependent on their own separate policy
  •    Make sure whatever you pick is an Indiana based plan (so the mandate applies).   Generally it should be – but doesn’t hurt to make sure!
  •    Before you sign up for anything – please get all the important policy information!  Make sure you look at not only the monthly premium but also the deductibles and out of pocket maximum on the policies you compare.
  •    Generally speaking policies with an office visit co-pay will be prohibitively expensive in the long run (since you incur a deductible as well as an office visit co-pay every day the child is getting service)
  •    If you are eligible for a cost-sharing subsidy, you need to pick a silver plan or above
  •    Finally – if you’ve received a letter from your insurance company about grand-fathering your existing plan, you definitely still want to evaluate the policy options available.  Many families are actually finding savings through these new plans (keeping in mind, that now you can put a dependent on their own policy).

Please feel free to call us with any questions (317-815-5501 ext- 2)
We intend to evolve the above guide as we get new information.

Additional recommended reading can be found at the links below:

Information from Autism Companion, a local publication.

http://www.autismcompanion.com/a-guide-to-purchasing-insurance-for-children-with-special-health-care-needs/

http://www.npr.org/2013/10/11/230916150/faq-all-about-health-insurance-exchanges-and-how-to-shop-for-coverage

https://www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace/

https://www.ehealthinsurance.com/affordable-care-act/faqs?fromRetail=true

Thanks for sticking with us!

Tips for Increasing Appropriate Play Skills

Children on the Autism Spectrum often do not engage in appropriate play.  Play may involve manipulating a toy inappropriately or playing with only one part of a preferred item (the wheels, for example).   They may explore toys but rarely play them according to their function. Pretend play and social play are often limited as well.

When teaching appropriate play, start with simple toys and/or activities. Be aware of the items or activities that the child already finds fun.  Pair new play skills with fun things!  For example, if the child loves a particular movie, play the movie in the background as they explore a new toy.  If they really love chips, give them chips intermittently as they look at the pictures of a new book or turn on their favorite song and give them praise as they explore a new play set.  Pairing new play skills with items or activities that are already fun will make new play behaviors fun as well.  It will then be more likely that the child will want to play appropriately again in the future.

Once they show interest in a new item and/or activity, model appropriate play.  Show them how to push the buttons, drive the car across a track, or turn the pages of a book.  If they spontaneously imitate any of these behaviors, make sure to reinforce with already established fun activities (such as edibles, praise, movies, etc.).

These tips are also beneficial for teaching social and pretend play.  Pair social and pretend play with fun things!  Model these behaviors and be sure to reinforce with established fun activities when the child emits any of these appropriate skills.    Siblings can be an essential part of the modeling process and can help deliver reinforcing items and activities as well.

Allow the child to naturally explore their environment.  Don’t force the child to engage in appropriate play behaviors as this may make new behaviors aversive. Remember to pair, model, and reinforce!

Laura Britton, BCBA

increasing appropriate play skills

increasing appropriate play skills