Now Serving Flagler!

We are thrilled to announce that we will now be serving the Flagler Beach area of Florida!

We have immediate openings for ABA therapy in homes, communities, and schools. We are also available to contract with schools for a variety of services.

If you are interested in receiving services in our new catchment area, please call our toll free number: 844.854.7400

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New Data Collection Software! BIP Track

We are super excited to share with our followers the new data collection software program we have been utilizing.

BIP Track combines intuitive tools into one comprehensive portal. Our team of BCBAs, RBTs, and BTs are able to collect, analyze, and report on behavior and skill acquisition program data in real time.

One of our BCBAs, Sara Hult, worked with the developers, Gene & Dave, to help the software meet all of our needs. Our team has tried every data collection tool on the market, and none of those programs could meet our needs.

Here are some of the features that set BIP Track apart from “the others”

• live reporting available on any client at any time
• track multiple clients at one time
• graphs automatically update (insert your trend lines!)
• IOA data collection is built in
• track multiple types of data including frequency, duration, and interval recording
• student self-evaluations are available for your self-management plan
• supervisor notes may be submitted as they occur
• therapist SOAP notes are created as the session progresses
• link IEP goals to trackables and skill acquisition programs
• HIPAA compliant even when sharing SOAP and supervisor notes!
• dashboard and interface are user-friendly

We are so pleased with this product that in March of this year, our entire team moved over to BIP Track and we couldn’t be happier.

Disclaimer: we do not receive any income from BIP Track!

 

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Announcing ABS on Florida West Coast

We are pleased to announce the opening of our Florida West Coast (AKA Cultural Coast) office!

We have no wait for ABA services! We accept most forms of insurance. We provide services in your home, in your child’s school, in your child’s daycare, and other community locations.

 

Please contact our office if you are interested in obtaining services.

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Autism Awareness Day

You know, I like to be positive. But today on this International Autism Day (AKA Light It Up Blue #LIUB), I’m not getting the feeling that we have the “awareness” we need. And it makes me ANGRY.

Yes, I’m happy that thanks to Autism Speaks we have 45+ states with insurance mandates!

 

But I’m boiling red mad because “awareness” is not enough! 😡

We need:

1. Children identified EARLY. Pediatricians should lose their license when they send a family away and tell them to wait. REFER! A licensed clinician, with expertise in early identification, can determine if it’s autism.
2. When the child is diagnosed, early intervention happens IMMEDIATELY without waiting lists or delays.
3. Every child should be able to receive applied behavior analysis (ABA) therapy at the intensity recommended by the professional and based on assessment. This should be without regard to race, native language, socio-economic status, or type of insurance coverage. If you want to know more about ABA, read here.
4. Every child with symptoms should be screened for appropriate medical treatment of any GI problems such as reflux, constipation, diarrhea, or food allergies/insensitivities.
5. Every child should have access to quality behavioral feeding intervention if assessment indicates it is warranted.

Until these things happen, I will stay mad or “I mad” as one of my clients told me recently (when he found out he couldn’t have chocolate ice cream.) Go ahead, light it up blue but let’s turn awareness to ACTION!

 

Related Posts

• https://appliedbehavioralstrategies.wordpress.com/2015/04/01/updated-ipad-list-autism-awareness-month/
• https://appliedbehavioralstrategies.wordpress.com/2013/04/02/light-it-up-blue-for-autism-awareness/
• https://appliedbehavioralstrategies.wordpress.com/2015/04/30/recovery-from-autism/
• https://appliedbehavioralstrategies.wordpress.com/2011/12/22/recovery-from-autism-is-possible/

 

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Tribute to Stan Deno

The field of special education and behavior analysis lost a great man last week. Stan Deno, Ph.D. served on faculty in the College of Education and Human Development at The University of Minnesota (commonly referred to as The U) from 1970 (or so) until he retired in 2009. During that time, Stan developed a framework for monitoring student progress towards their academic goals. His work in Curriculum Based Measurement (CBM) is the foundation for DIBELS (Dynamic Indicators of Basic Early Literacy Skills; Good & Kiminski, 2002) which has been used in thousands of schools across the country.

Stan also trained many students including undergraduate, masters level, and doctoral level. Two of his students, Doug and Lynn Fuchs, have led the way in developing Response to Intervention (RTI) an evidence-based approach to identifying students with learning disabilities and behavior disorders.

If you don’t know Stan or haven’t read his work, you should make time to do so. Without a doubt, his work has influenced the way we monitor progress in schools and the way we address instruction for students with learning and behavioral needs.

I have many fond memories of Stan. I feel so lucky to have studied with him during my time at The U. He worked diligently to help me slow down when I spoke (I talk fast and southern and it was difficult for him to understand me). He also modeled for me the act of thinking carefully before speaking. If you know me, you know I still am working on this skill!

Stan trusted me to serve as his Teaching Assistant (TA) in the Intro to ABA class. He taught me how to teach adult learners and how to give meaningful feedback on their written work. During this time, he also taught me the importance of technology in the classroom to increase graduate student participation and responding. I am a much better teacher now because of Stan.

I took several classes from Stan. The most memorable included the course on Single Subject Design. In this course, Stan introduced me to the work of Alan Kazdin and he taught me to conduct experimentally sou
nd research studies as well as how to read research and interpret and apply it in my own work. His influence enabled me to write successful grants, publish my own science, and go on to teach my own students. Stan also served on my dissertation committee where he modeled for me how to help students improve their research ideas, study procedures, and how to interpret results accurately. I was so fortunate to learn so much from him.

In addition to our love of research, behavior analysis, and helping students learn, Stan and I both shared the diagnosis of cancer. I received my diagnosis in 2002 some time after he received his diagnosis and treatment. I stopped by the U to visit Stan while I was in town later that same year. We shared how hard living as a survivor can be and we shared how crushing the diagnosis can be. It was then that Stan shared with me the theory of the Sword of Damocles. It took some time for me to truly understand this concept as a new survivor. But oh do I understand it now, 14 years later.

My heart sank to my stomach last week when I learned of Stan’s passing. But, I have joy in knowing how much he taught me and how much he has taught the special education world. Stan will be missed.

The family asks that in lieu of flowers contributions be made in memory of Stanley Deno to: “Stan Deno CBM Research” fund #20003 at the University of Minnesota Foundation.

Online gifts can be made at:  www.give.umn.edu/giveto/standeno

Or mail this giving form to:

University of Minnesota Foundation
P.O. Box 860266
Minneapolis, MN 55486-0266

 

References

Good, R.H., & Kkaminski, R.A. (2002). Dynamic Indicators of Basic Early Literacy Skills (6th ed.). Eugene, OR: Institute for the Development of Educational Achievement. Available: http://dibels.uoregon.edu.

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Pill Swallowing Data Sheet

A shout out to Carmen who stopped by the blog yesterday asking questions about the types of data we collect when working on pill swallowing. I thought I would post a copy of one of our data sheets for reference. As with any area of work, please follow BACB Ethical Guidelines regarding scope of practice. Teaching children to swallow pills can be dangerous and should not be attempted without appropriate training and supervision. Additionally, a medical screening prior to intervention is essential.

pill swallowing datasheet

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Top Posts for 2012

2012 was a great year for the Applied Behavioral Strategies blog. We had almost 100,000 visitors in total. Here is a list of the most visited blog postings last year. The great news is that I wrote some of the most visited posts in 2011. I am pleased that my posts remain relevant for readers.

#5. Early Morning School Routines. Who doesn’t need help with this? Seriously, it is THE most stressful time of the day for my house.

#4 Just Say No. I can see why this one has staying power. Almost daily, I hear myself saying “Parents need to learn to say no.” You don’t even have to state a reason. Just know that your child needs to learn to accept being told no. (And despite how it may feel or sound, it will NOT be the end of the world.)

#3 Autism Awareness Apps. I really need to update this link. I will be sure to do so in time for April give aways. Keep in mind that I’m also presenting on this topic at SXSW in Austin, TX in March, 2013.

#2. Do You Use Visual Schedules? Wow. I am pleased that this topic is still a hit. If you aren’t using visual schedules, you should! In my home, we use a homework whiteboard every day and it makes our afternoons a BREEZE!

#1. Using ABA to Teach Math. I had no idea when I wrote this post that it would become so popular. The great news is that ABA may be used for a variety of skills!

I cannot thank you enough for your readership! Keep the reading, following, sharing, ideas, feedback, and questions for Ask Missy Monday coming!

Related articles

• Forget New Year’s Resolutions – Do a Year-End Review (gtdforcios.com)
• Vote For SendGrid In The 2013 SXSW Panel Picker (sendgrid.com)

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Reading Research

Hi! and welcome to What Works Wednesdays where historically a success story from clinical files is shared. With all the buzz about the latest “research” on getting the flu while pregnant and the supposed link to autism, it seems logical to help readers better understand research so they can interpret findings themselves. If readers know how to read research, then they are better able to know if an intervention works (or if the conclusions from a study are flawed or misinterpreted).

What is Research?

• “work undertaken systematically to increase the stock of knowledge” (Wikipedia.org)
• “diligent and systematic inquiry or investigation into a subject in order to discover or revise facts, theories, applications, etc.” (dictionary.com)

Most scientists conduct research by utilizing the scientific method. The scientific method requires the development of a hypothesis (which is usually formed from observation or reading other research), conducting the experiment, gathering results, and determining if the results support the original hypothesis.

Different Types of Research

Using the scientific method, scientists design different types of studies. These study types include:

1. Experiments. In experimental studies, researchers recruit participants and assign them to treatment groups. Researchers can study one or more treatments and participants may receive some treatments or they may receive a placebo or no treatment at all. Usually, researchers measure one or more important variables before the study and they measure the variable(s) again after the study.
2. Single Subject Experimental Studies. In these studies (most often conducted by behavior analysts), researchers recruit participants who are observed and measured carefully for a period of time before receiving treatment. Researchers then implement treatment while continuing to observe and measure carefully.
3. Correlational studies. In these studies, researchers use existing data sets (e.g., collected for some other purpose) or they recruit participants. Researchers gather a wide range of information on each participant (e.g., age, SES, education, health history). Participants do not generally receive treatments or interventions of any kind.
4. Qualitative studies. In qualitative studies, researchers occasional recruit participants but at times they enroll participants with whom they are already familiar. In qualitative studies, researchers study one or more individuals or one or more groups (e.g., one class). Researchers carefully study the participant and take copious notes. Researchers may interview the participants and they may use focus groups to better understand some of the issues. If a treatment is provided, the researcher continues to carefully study the participants to document the participants’ responses to the treatment.

Conclusions Based on Study Type

Researchers must use caution when drawing conclusions about their studies. Researchers who use well-designed experimental designs can draw cause-effect conclusions. For example, a researcher can enroll a bunch of smokers in a study. Some of the smokers receive a behavioral treatment, some of the smokers receive nicotine patches, and other participants receive both. At the end of the study (if the researchers have conducted the study carefully), the researchers will be able to say that one or more methods is successful at helping smokers quit.

Similarly, in a single subject experimental study, researchers can demonstrate if a treatment changes behavior. Again, the study must be carefully designed and conducted but it is possible to draw cause-effect conclusions. For example, a researcher could study 3 smokers. The researcher would observe the smokers and collect data. One smoker could receive treatment. While she is being studied, the other smokers would still be studied. After the first smoker quits successfully, the next smoker would receive treatment. He would continue to be studied as would the non-treated smoker. Finally, when the last smoker receives treatment, researchers continue to observe him. If the researchers successfully help all 3 participants quit smoking (and the study is carefully designed and carried out), they will be able to say that the treatment caused the behavior change.

Correlational versus Causal

Correlational studies are designed to determine if any relationships exist between variables. Researchers could gather data on 1,000 people from an existing data base. They could sort the data into smokers and non-smokers. They could run a simple data analysis to see if smokers have other tendencies (e.g., like to go to race car events, like to drink socially, and so forth). Researchers may not conclude causal relationships from their studies. They are only able to conclude that a relationship exists. Of more importance is the strength of the relationship. For example, if researchers ran an analysis on the relationship between giving birth to a child and gender, they would find a very strong (almost perfect) relationship between giving birth and being a female. If a weak relationship exists between variables it is more likely due to chance.

Go Forth and Read

In these days of social media, spin rooms, and media crazed talk shows, very poorly designed studies are being presented to the public without appropriate interpretation of the study or its results. If you are interested in reading a few examples of this, check previous posts here and here.

In summary, don’t believe everything you read about the “latest scientific study” unless you read the study itself. When you read the actual study, what you find may actually surprise you.

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More Research on Social Stories

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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Office of the HealthCare Advocate

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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