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Archive for November, 2012

We recently received the call for proposals for the upcoming conference in Dubai. If you will recall, we went last year and had a wonderful experience. The upcoming conference is going to focus on behavior analysis. We are super excited to submit something and we hope that our colleagues will as well. Here is the call for abstracts. Please share it with your colleagues! Due date extended to November 15th.

Abstract For Autism

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I love, love, love both of these. Thank you, thank you, thank you Ali Rowan for your brilliance.

Want to see more of her work? Check out her web page:

http://alisonrowan.com/

 

 

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled “Brief Report: Increasing Verbal Greeting Initiations for a Student with Autism Via a Social StoryTM Intervention”. Brian Reichow and Edward Sabornie authored the article and The Journal of Autism and Developmental Disorders published the article.

Study Purpose

It is a known fact that children with autism spectrum disorders have social deficits. One intervention that has been used is Social Stories. While social stories are widely used, the research on the effectiveness has been limited. Thus, the authors set out to determine if a Social Story could be used to increase appropriate verbal greeting initiations.

Study Methods

The authors enrolled an 11-year-old male with autism in the study. “George” as he was called, had an average IQ and he had above average grades on his report card. While he attended a social skills group at school, his social skills did not seem to be improving.

The authors developed a story according the guidelines recommended by Carol Gray. We discussed some of the differences between Social Stories TM and social stories or social narratives earlier this week.

The authors used a withdrawal design to demonstrate experimental control. Basically, in this design, an intervention is implemented. If the intervention is effected, it is removed to determine if the behavior would return to pre-treatment levels.

The authors merely counted the number (or frequency) of verbal greeting initiations. Waves and gestures did not count, only verbal greetings (e.g., hi, hello, good morning).

In baseline, George reported to his home room, picked up his schedule, and went about his day.

During intervention, George picked up his schedule (which included “read your Social Story”) and then read his social story before heading out to classes. The authors faded the social story and moved to a simple “cue card”.

Results

During baseline, George had zero verbal initiations. During intervention, George had an immediate increase in verbal greeting initiations. Specifically, he initiated greetings between 2 and 6 times a day; including greetings to peers! However, when the intervention was “withdrawn”, George stopped initiating greetings. When the intervention was reinstated, his initiations increased again to 2 to 4 initiations per day; including initiations to peers. When the social story was faded and the cue card was taught, the verbal initiations continued.

Conclusions

As we have discussed, this intervention is effective. Also as we have discussed, all interventions should be developed on an individualized basis. This is not a one size fits all approach. This individualization means that teachers, behavior analysts, and other practitioners will need to spend time developing the materials that will be used to teach the skill(s).

 

 

 

 

 

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Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files. We usually focus on the use of ABA and its effectiveness for our clients. Today, we are going to share a resource that works. The resource is the Office of the Health Care Advocate (OHA). We have one in Connecticut. Here is the website: http://www.ct.gov/oha/site/default.asp

Here is the contact information:

Mail To:
Office of the Healthcare Advocate
P.O.BOX 1543
Hartford CT,06144

Phone: Toll Free at: 1-866-HMO-4446

FAX:  (860) 297-3992

E-mail: Healthcare.advocate@ct.gov

On October 17th, the OHA held a public hearing on barriers to access to mental health and substance use services. I (Missy) went to testify. Here is my testimony:

Introduction

Hi and thank you for taking the time to listen to consumers, providers, and advocates. I am here today as a behavioral health provider. I am a Board Certified Behavior Analyst and my company, Applied Behavioral Strategies, LLC provides Applied Behavior Analysis (ABA) therapy services to children with autism under Public Act No. 09-115.

Autism Insurance Bill

Under Public Act No. 09-115, children under the age of 15 are eligible to receive ABA therapy if their parents have certain types of health insurance.

Success!

While I have only been in business 2 years, you will be pleased to know that all of the children on my caseload who receive services through mandated insurance coverage have made growth as a result of ABA therapy. For example:

  • “Matthew”
    • Learning to go on community outings without screaming when dogs pass
    • Learning to take a shower independently
    • Learning to shave
  • Casper
    • Used to request to avoid many school classes (specials), now participates in all instruction and specials
    • Before our therapy, he had no friends.  Now he has friends and makes play dates
    • Historically engaged in aggression with his parents and siblings, we haven’t seen aggression in many months
  • “Joanna”
    • After living off pureed food for 8 years, she learned to eat table food!
    • She is learning to wear different shoes, hats, gloves
  • “Sammy”
    • Learned to sit and relax by playing games on his iPad or watching music videos
    • Decreased self-injurious behaviors
    • Improving his spontaneous communication
  • “Charlie”
    • Decreased head banging
    • Learning to tolerate work at home
    • Learning to ride in the car without thrashing his head when his parents go a different route
  • “Clark”
    • After being restrained repeatedly in his public school, Clark attends a private school with support and only a few outbursts
    • In the past, cried because he didn’t want to do school work, now gets upset if he cannot finish his work

The “Unlucky” Ones

Those case studies illustrate how state policies improve the quality of lives for individuals with behavioral health challenges. But unfortunately, a group of clients exist who are not eligible for these services because they don’t have the right type of insurance, or their insurance originates from a different state, or even worse, they are too financially disadvantaged to have insurance and are covered by Husky.

It is for these clients, I am begging for your ear. These clients and their families will never share joys described to you previously because they will not receive the ABA therapy. They cannot afford to pay for it out of pocket so they do without.  Even as I write this, it feels like I’m writing about a different century or a third world country. How can this be? These clients and their families have just as many needs, if not more, than the clients who are receiving therapy. But as a result of not receiving therapy, their behavioral health needs worsen which only serves to exacerbate the mental health needs of their parents. And all of this costs more in the long run.

Provider Issues

But even worse than not having the appropriate insurance, are the clients who have the right insurance but cannot find a provider because there are not enough providers who accept insurance. Let me tell you why providers do not accept insurance:

  • The reimbursement rates are drastically reduced from fair market value
    • My highest rate of reimbursement is still 50% less than my billable rate
    • The insurance companies do not reimburse for services in a timely manner
      • Cigna currently owes me $18,000 on ONE client
      • The stress I experience at each payroll period is overwhelming because I am not sure if my cash flow is sufficient to pay my employees
      • The amount of administrative time that is needed to follow-up with insurance in order to get paid is almost a full-time position
  • The reimbursement for services does not cover my income and that of an administrative assistant (see rates above).

Amazing Resource

The Office of the Healthcare Advocate has been extremely helpful for me and my clients as staff (Vicki and Jody) have assisted my clients (and many others that are not my clients) in obtaining the coverage to which they are entitled. I am extremely grateful for their assistance over the past two years.

Summary

In closing, I feel fortunate that ABA services are available to children in this state. Thirty years ago, these services were not available to my brother. I cannot help but wonder where he would be today, had he received the services that my clients receive today.

Thank you for taking the time to listen to us today and please do not hesitate to contact me if you have questions regarding this testimony.

If you want to watch the entire hearing, you can do so here:

If you live in CT, be sure to use your OHA. If you do not live in CT, check your state’s resources to see if you have an OHA in your state.

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Today is election day in the United States.As you head out to the polls to vote, think about the issues that are important to you:

  • autism
  • disability issues
  • behavior analysis
  • children
  • vulnerable adults
  • special education
  • public education
  • (any others that matter to you and your family)

If we lived in Australia, we would be fined for not voting. In the U.S., people have died fighting for our right to vote. Exercise your right today (if you haven’t already). Just do it. Vote.

 

 

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is in response to multiple requests and questions about social stories and visual supports. Common questions include:

  1. I thought the story had to be written in first person? (e.g., “I like” versus “Charlie likes”)
  2. I thought the story had to be just like Dr. Gray says (A specifically defined style and format: sharing accurate social information and affirming something positive about the child)
  3. Is there any research to support social stories or visual supports?
  4. We do ABA.  Social stories aren’t behavioral.
  5. My child cannot read so why should we have a story?

Overview

Social stories and visual supports serve a specific purpose of providing visual information to individuals so that they can be successful in difficult situations. Some examples of difficult situations include:

  • Non-preferred but required activities (e.g., shopping, haircuts, blood draws)
  • Changes to routine (schedule is disrupted, substitute teacher, different bus route, school cancellations)
  • Novel situations (first time to hospital, first time on an airplane, first time to a play or show, storms)
  • Special but routine situations (dr. appointments, dentist appointments, hair cuts)

 

Individualized

Social stories and visual supports should be individualized to the user. While it may  not be convenient for a teacher to create 12-15 stories/visual supports, what works for one person may not be appropriate for another. When developing stories and visual supports keep the following considerations in mind:

  • age of the individual (resources must be age appropriate for the user)
  • reading ability (adjust the text of the visual depending on the reading level)
  • visual acuity (content should be selected based on the individual’s vision and ability, 3D versus 2D, color versus black and white)
  • attention span (the length and detail of the story or visual support)

Content

While Dr. Gray has created a trademark, there are many options beyond what she describes. Because social stories and visual supports should be individualized, the content should be determined based on the individual’s needs. For example, a mom here in CT created a social story for her child regarding Hurricane Sandy. The story included information about the storm, how it would affect trees and power, and how power could be restored. The story was developed for her son because the issue of losing power is important for him. He becomes upset if he cannot turn on lights or play on computers. However, another child may be scared of the wind or scared of the heavy rain. That child would need a story that focuses on the wind and the rain and how to make the noise go away. And then another child may not fully understand why she cannot go to school. Because she cannot read, her story may show a picture of wind and rain and a picture saying “no school”. The story would end with a picture of the little girl at home working with her ABA therapist.

Research

We have written about visual supports before: here, here, and here. We recommend only evidence-based strategies for our readers. So obviously there is ample research to support social stories and visual supports. A research group has developed a list of evidence-based practices for individuals with autism. Social narratives and visual supports are both on the list. For additional information on those practices and to read the research visit here.

ABA and Social Stories and Visual Supports

ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. For additional information on ABA, visit our website. Thus, the use of visual supports and social stories does not preclude someone from doing ABA. Similarly, implementing ABA does not preclude someone from using visual supports and social stories.

I hope this helps to answer the many questions about social stories and visual supports. If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 

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Many children in the New England area are happy today because schools are cancelled again. Teachers realize that we will be in school until the end of June. And what are parents left to do?

Here are some tips for entertaining your children so that you can work, clean, cook, do laundry, or any one of the other 99 things on your to-do list.

Organize

Anyone who has been following this blog for a while has learned that organization is the key to success.

Get out your whiteboard and markers and make a list of things the children should do before they get to play. Some common chores in our house include:

  • making the bed
  • preparing breakfast
  • cleaning up after breakfast
  • getting dressed

School Work

Yes, school is out but students still need to read every day. If your child is struggling in an area (e.g., math or spelling), then ask your child to complete some extra work in that area. We have written about some great spelling and math games previously. In addition to the chores above, children in our house will find the following:

  • read
  • math
  • spelling
  • clean out your backpack
  • finish your Veteran’s Day Project

Play Time

Once all the chores and school work have been completed, then it’s time for fun. Your children may need some direction or assistance in this area depending on their ages. We prefer to pick games the children can play on their own so that we can get our work done.

  • Wii (we prefer Wii Fit to keep kids moving)
  • Board Games (Yahtzee, Monopoly, Clue)
  • Card Games (Uno, GoldFish)
  • Art (our kids made “fall” cards for their grandmother in Florida including some hurricane thrown leaves)

Play Date

Once your kids have entertained themselves for the morning (and kept themselves out of trouble), then you can arrange for their friends to come over and play. While it may not seem like such a good idea to add more children to the mix, when children have friends around, they are more likely to play and stay out of your hair. If you have a friend for each child, even better.

Hopefully power will be restored soon and all of you can return to your regular routines. In the meantime, try to get as much done as you can while your kids are home.

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