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Simple strategies to make recess more fun, social and independent for students

Admin 10/7/2014
Simple strategies to make recess more fun, social and independent for students
Author: Danielle Cotti, M.Ed., BCBA Social Skills Coordinator

Recess can typically be a troublesome time for many school-age children; there may be little structure, many options, and little adult guidance. For children diagnosed on the spectrum, the lack of structure can result in lack of initiation, making poor play choices, or a tendency to avoid socializing. Research indicates that the most effective way to target social skills during recess is to make the abstract concrete by utilizing visual schedules or checklist, defining appropriate behavior, and creating rules for interacting during the recess period (Krasny, et. al., 2003). A visual recess schedule can be utilized for those students that work well with a visual list of items that need to be completed. This schedule can be broken into increments of time and presented to the child prior to the recess period. McKinnon and Krempa (2002), the authors of Social Skills Solutions, have detailed effective strategies in utilizing visual schedules and lists to increase independence during recess. The book includes examples of how to structure the visual supports, how to implement this accommodation, and data collection systems to assess the effectiveness of the intervention.

A prerequisite to utilizing a schedule or checklist is the ability to self-monitor one’s own behavior. Self-monitoring is defined as the ability to observe one’s own behavior and collect data on the target behavior’s occurrence or nonoccurrence (Cooper, Heron, & Heward, 2007). This technique is especially effective for the increase of social skills, because it is a monitoring system that does not require prompting from another person; therefore, it is easier to fade intervention. Research has demonstrated that the use of self-monitoring interventions result in a reduction in adult intervention (Rock, 2005). These factors make it ideal for recess, given the lack of adult availability during recess times, and the need to utilize social skills. 

An intervention that requires no prerequisite skills is the use of a social narrative to define appropriate social behavior during recess. A social narrative can be composed either to describe how the learner should interact at recess or can be presented as a list of rules to follow during recess. Creating a concrete description of expected behavior increases the likelihood that a child diagnosed with autism will interact successfully during recess. Expected behaviors for recess should include ideas regarding what to play, how to join in play with others, and who the child can look to for assistance when needed. More information of the effectiveness of, and ways to implement social narrative, can be found at: http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/files/SocialNarratives_factsheet.pdf

Proactively planning for recess will result in an enjoyable social experience and increased independence for the learner; creating a concrete plan, with the input of the learner, will increase the likelihood of successful implementation of the recess plan. Resources are available to assist in this process, including http://autismpdc.fpg.unc.edu/, which provides clinicians and educators effective, research-based intervention and Social Skills Solutions (McKinnon & Krempa, 2002), a manual for teaching social skills for children on the autism spectrum.

Resources:
Cooper, J.O., Heron, T.E., Heward, W.L., (2007). Applied Behavior Analysis, Second Edition. Pearson Education, Inc: Saddle River, New Jersey. 

Krasny, L., Williams, B.J., Provencal, S., Ozonoff, S. (2003). Social skills interventions for the autism spectrum: essential ingredients and a model curriculum, Child and Adolescent Psychiatric Clinics, 12, 107-122.

McKinnon, J. & Krempa, K. (2002). Social skills checklist. Social Skills Solutions: A Hands-on Manual for Teaching Social Skills to Children with Autism. DRL Books, Inc: New York, NY.

Rock, M.L. (2005). Use of strategic self-monitoring to enhance academic engagement, productivity, and accuracy of students with and without exceptionalities. Journal of Positive Behavior Interventions. 7(1), 3-17.

New Health insurance options coming to NH's Healthcare Exchange in 2015

Admin 8/21/2014
Recent news releases from the NH Department of Insurance as well as others have announced several new options that have been recommend to CMS for next year's NH Healthcare Exchange.  The link below announces Assurant Health specifically but others that were just confirmed with the DOI are Anthem BCBS NH, Harvard Pilgrim, Minute Men, Assurant Health and Maine Community Health.  They are awaiting confirmation from CMS Federally for inclusion.  

I've seen announcements from Anthem that service limits for ABA Therapy have been removed but have not yet been able to access details surrounding the other plans.  I wrote to our Insurance Commissioner recently regarding Harvard Pilgrim's current dollar cap for ABA but was unable to identify the details of the plan that has already been recommended for inclusion.  You can see a copy of my letter below.  Note that Dan Unumb of Autism Speaks has been a great help in these efforts so be sure to get out on September 28th for the Northern New England Walk NOW for Autism at SNHU in Manchester.  Without their help we probably would not have seen the dramatic shift towards support for ABA in NH this year. ~Tim Heald

http://www.nh.gov/insurance/media/pr/2014/documents/060214-2.pdf 

Recent Updates on Autism Advocacy in NH

Admin 8/14/2014
Recent Updates on Autism Advocacy in NH
As part of my role in Constellations, I have taken on the responsibility of pushing forward awareness, understanding and support for those affected by autism.  NH had a wonderful group of dedicated parents and advocates who pushed through Connor’s Law (2010 HB 569) but we have seen a drop-off in advocacy efforts since then.  That said, I’m proud to say that the torch has been once again picked up and there is again a solid group of advocates that are steadfastly pushing for stronger support and knowledge throughout the State’s support system and beyond. 

This year alone has seen some dramatic developments with insurance reform at the state level.  I’ve bulleted out some of the highlights below and will continue to fight for funding and support for evidenced-based education and ABA therapy.  If you’d like to help or know of a contact or effort that I may not be aware, please contact me at tim@constellationsbehavioral.com .

·         Anthem BCBS NH was able to convert Connor’s Law’s $36,000 limit on ABA Therapy to a mere 360 hours for 2013 and the first half of 2014.  I’m excited to say that they have announced that annual caps on ABA will be eliminated for small group plans on 7/1/14 and on individual plans as of 1/1/15.  This is a monumental shift for them and we look forward to further improvements in their policies towards ABA and ABA providers. Read the notice to providers at: http://www.anthem.com/provider/nh/f5/s1/t0/pw_e218354.pdf?refer=ahpprovider&state=nh 

·         Harvard Pilgrim appears to still be issuing plans in 2014 with the annual cap to ABA benefits as prescribed by Connor’s Law but may not be in line with ACA.  An effort is currently underway to explore whether this is justified or not.

·         NH Medicaid is currently evaluating how to add ABA as a covered benefit for their members per advice from CMS at the Federal level to all states.  A working group has formed and is meeting soon to begin the discussions of this vitally important effort. http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdf The NH Disabilities Rights Council (DRC) has asked that families with Medicaid who have been denied coverage for ABA be aware of their rights of appeal as they are entitled to these benefits now.  If you have questions or would like assistance in the appeal process, you can reach the DRC at www.drcnh.org.

·         Mainecare has very recently opened up another Section of Medicaid (Section 32) which among other things provides for additional funds for consult, including consult by a BCBA.  The program will be limited to 40 families for this year.  Details of the selection process are not yet available.

·         Tricare announced in July that the three programs they had developed for active duty and non-active duty military families are being consolidated into one streamlined program, TRICARE Autism Care Demo (ACD).  There will not be an annual cap on the program.  Families currently enrolled in one of the existing programs will be converted to the new plan by 1/1/15.  You can read more on this at www.tricare.mil/ABAPilot072314.

·         ABA International (ABAI) proposed standardized billing codes for ABA Therapy to the American Medical Association (AMA) this year.  The AMA has published CPT codes specific to ABA providers thereby validating the service as medically necessary and negating the argument that ABA is an “experimental” therapy.  These new codes are considered temporary while the ABA field and insurance companies process the implications.  The main benefit to having standardized codes would be to eliminate the confusion and delay in forming new relationships with insurance companies and establishing pre-authorization for clients.  I am not aware of a NH insurance company that has adopted these codes but look forward to future developments.

As you can see, it’s been a very dynamic and positive year for the field of Behavior Analysis.  Many elements are still being evaluated but the conversation has shifted from “What’s best for children with autism?” to “How do we add ABA to our network quickly?”  I look forward to next year’s developments with great optimism but it is important to remember that awareness and implementation of ABA Therapy programs in NH continues to be vitally important. 

Our state and local officials need to hear from you regarding your concerns and needs.  They use the complaint and appeal processes to determine what needs attention so without complaints begin filed with the Department of Insurance and appeals being sent to your NH Medicaid Managed Care Organization (Wellsense/ NH Healthy Families) their thought is that there are no problems.  Reach out and make your voice be heard.  ~Tim Heald

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” ~ Margaret Mead

Preparing for Back to School: Ideas to help ease your child (and you!) into the new school year

Admin 8/12/2014
Preparing for Back to School: Ideas to help ease your child (and you!) into the new school year
Governor Maggie Hassan recently proclaimed August 4th-8th as ‘Back to School Preparedness Week’ in the state of New Hampshire.  In hearing this, the team at Constellations began to wonder;  “What is the best advice we could give parents for preparing their child with special needs for the upcoming school year?”

One of the most important things to consider is avoiding ‘guilt by association’.  In the world of Applied Behavior Analysis, we refer to this as ‘stimulus-stimulus pairing’.  This is when two stimuli (changes, events, items, actions) are presented at the same time- typically for repeated trials or presentations.  The end result is that one stimulus will typically acquire the function of the other stimulus. 

For a relevant example, think about your child on his or her first day of school.  All summer, you have been allowing him/her to wake up naturally, play or watch cartoons while you make breakfast.  Perhaps he or she is even able to lounge in their jammies for a while before getting dressed to go play outside.  Structure and routine have not been your priority this summer and it feels so nice! 

Before you know it, the morning of the first day of school arrives.  This morning feels different.  Your child is woken up by an alarm you set for him or her or perhaps by you, your spouse or even a rushed sibling.  You prompt your child to sit at the table and eat their breakfast- no time for TV or playing.  Breakfast is cold cereal- not the yummy pancakes you have been whipping up!  Now it is time to get dressed, out the door and onto the bus!  What a hectic, potentially stressful morning for your child!  (Stimulus number one).  Your child then arrives at school and is held to a routine and expectations which he or she was not prepared for.  There a lot of people, bright lights, loud noises, funny smells, and other sensory experiences that could also add to what your child now thinks of as ‘school’.  (Stimulus number two).  This occurs over and over.   A few weeks into school, you find yourself telling a friend that mornings in your house have become so tense and that your child is extremely difficult to get out of bed and to the breakfast table.  You wish you knew what to do.

To avoid this sort of scenario in your home and to promote a smoother transition for everyone involved, here are some things you can do ahead of time to make that first day of school more comfortable and perhaps even associated with familiar and fun things. 

1)         Begin practicing your morning routine now.  This does not have to be done all at once, but could be introduced gradually.  If your child has been eating the same breakfast every morning but you know it will not be an option on rushed mornings, introduce other things from time to time.  If you are going to require your child to be dressed before coming out of their room in the morning, help them by laying out their clothes at night.  If waking up much earlier is a concern, begin introducing the alarm you plan to use but at the time your child has been waking up naturally.  You can then slowly set the alarm for earlier and earlier times over the course of a week or two until you have helped your child adjust to waking at an earlier time. 

2)        Visit the school.  Part of your child’s comfort level in their new classroom could be directly related to a great experience you have with them there.  Contact your school to find out when it would be a good time for you and your child to go see their classroom.  Allow your child to look around and perhaps even help you take some pictures!  (These could be used later for a social story.)  If your child’s teacher is available, remember the pairing we talked about!  Ask the teacher if he or she would be willing to read a favorite book or even share a favorite snack with your child when they come in.

3)      Plan your routines.  Help your child feel more comfortable by providing predictable routines to the extent possible for the times right before and after school.  If your child benefits from picture activity schedules, written lists or calendars, provide those and help him or her use those tools until they become more independent and/or comfortable with the routine. 

4)      Organize and involve your child.  Your child will have an easier time finding things in their backpack and knowing where to put things away if you involve him or her in this process.  Have your child help you pack their backpack for school, now he or she will know what they have and where they can find it! 

5)      Brush up on the IEP.  Be familiar with your childs IEP so that you can be mindful and observant of their progress and/or any difficulty they might have.  Be sure to bring any questions to the team and communicate often.  Remember that you can call an IEP meeting at any time to discuss progress, ask questions, etc. 

Here are a few helpful links for preparing for school and communicating your childs needs with the school team:

http://featsacramento.org/Portals/0/Document%20Library/Teacher%20HandBook%20Downloadable%20Documents/2009TeacherHandbook.pdf 

A handbook for teachers which parents can print and fill out for their own reference as well as to send to school ahead of time to provide additional information to the teacher about their child.

http://specialchildren.about.com/od/specialeducation/ht/teacherpacket.htm

Step by step tips and resources for creating a back to school packet to send to your child’s teacher and team ahead of time.

Easy Way to Build Communication with Toys You Already Own

Admin 6/1/2014
Easy Way to Build Communication with Toys You Already Own
An effective way to increase many language and social skills, while putting a new spin on an old game or toy, are barrier games.  In a barrier game, the players sit with some sort of barrier between them and a directing player gives directions on how to complete a task or create a matching end product.  Common toys, such as Mr. Potato Head, Cootie bugs from the game Cooties, Legos, K’nex, a coloring page, or simply a piece of paper and some crayons can be used. 
To play a barrier game, the “it” person, or the directing player, creates a product.  For building games, it could be a structure using particular types of blocks or certain colors.  For Mr. Potato Head one player could draw a diagram of the final product that the other player is going to have to create.  Then, without being able to see what the other is doing, and just using words, the “it” player describes what the other player needs to do to accomplish the final product.  This requires the use of precise language, including adjectives and prepositions.

This spin on your typical toys targets skills such as receptive language, use of descriptive language, and perspective taking skills.  The “it” player will learn quickly that simply saying “put the piece on the side” is not sufficient enough to “win” the game.  Try it out yourself with a sibling or friend first to see how much fun it can be.  Even the attempts that don't work out can be as much fun as those that do!

Don't Forget About the Siblings!

Admin 4/1/2014
Don't Forget About the Siblings!
Siblings of people with autism experience joys and woes of being and having a sibling, just as anyone does.  Siblings of people with autism also face many different situations and emotions that parents, teachers, friends and other support people should be aware of.  In a Time Magazine article called ‘Autistic Kids: The Sibling Problem’, the author, Amy Lennard Goehner (a parent of a child with autism) wrote “The typically developing’ siblings of autistic children are, in fact, the furthest thing from typical.  Often they are wiser and more mature than their age would suggest.  And they have to be, given the myriad challenges they face: parental responsibility; a feeling of isolation from the rest of the family; confusion, fear, anger and embarrassment about their autistic sibling.  And on top of all of it, guilt for having these feelings.”  

Thankfully, there are many resources available to help involved support people .   Among the recommendations for siblings of children with autism are early education about autism and keeping the conversation open, finding support groups or helping your child to connect with other children who have siblings with autism and creating special time to spend with just them.  Below are sites and resources for this information as well as where additional ideas and supports can be found.

http://www.autism-society.org/get-involved/events/sensory-friendly-films/  AMC moving theaters offer ‘Sensory Friendly Films’ at 10:00am on Saturdays.  Tickets cost between $4 and $6 depending on location.    Go to the website for more information and to find a theater near you!

http://www.autismspeaks.org/family-services/tool-kits/family-support-tool-kits#siblings  Autism Speaks website has a section which celebrates and understands the joys and sorrows of loving a person with autism.  Entering your name and zip code will give you access to their tool kits for explaining autism to friends, grandparents and siblings.  The tools can be modified depending on the need of your audience. 

http://www.autismspeaks.org/family-services/resource-library/books#siblings This is an extensive book list which references books which can be used to explain autism as well as the feelings that come along with being a sibling of a person with autism. 

www.siblingsupport.org The Sibling Support Project is a national effort dedicated to the life-long concerns of siblings of people who have special health, developmental, or mental health needs.  ‘Sibshops’ are workshops and support groups existing in many locations to include the following New Hampshire towns; Lebanon, Nashua, Laconia, Concord. 

http://content.time.com/time/health/article/0,8599,1698128,00.html  This is the link to the article in Time magazine.  

Five Fun & Festive Ideas for a Happy Halloween!

Admin 10/28/2013
Five Fun & Festive Ideas for a Happy Halloween!
Social Skills
1. Create a simple social story to define and explain what is expected during trick or treating.

Ideas to include:
- People will be dressed in costumes that will cover their face- you may not know who people really are.
- People may try to scare you (scream, say boo, jump out at you), this is the "tricky" part of trick-or-treat
- When you ring the doorbell to trick-or-treat, you wait on the porch for the candy- you do not go into the person's home.
- You accept the candy, whether you like it or not. You can always trade for a preferred candy when you return home.
- Always say thank you when someone offers you candy
- Do not eat anything until it is checked by an adult
- Initiate imaginative play schemes involving "trick-or-treating" the weeks before as a practice (a good reason to try out the costume!)

2. Review safety rules before leaving the house and consider putting the rules on a cue card to reference throughout the night.
Stay with an adult
Stay in a lit area
Avoid cars and the street
Do not eat anything until it is checked by an adult

3. Trick-or-treating at the mall has several benefits. It keeps the distant short, removes the danger of darkness as well as the need for bulky clothes necessary to stay warm outside. It's also a good way to control any unexpected events that can be accompanied with trick-or-treating in the dark. Some towns have alternative options close by as well.

4. Remember, trick-or-treating may not be successful, but there are other fun Halloween options! Handing out the candy can be just as fun! Watching Halloween-themed movies is an option as well. Be positive and flexible!

5. Another alternative to trick-or-treating, try inviting a friend for a Halloween-themed play date, some options are:
Make and decorate Halloween cookies
Carve/Paint pumpkins
A hayride and hot chocolate!
Laser tag, roller skating or glow bowling
Host a Halloween party with bobbing for apples, pin the tail on the cat, or Guess-that-Goop!





 

Managing Sensory Differences With Little Ghouls and Goblins

Admin 10/7/2013
Managing Sensory Differences With Little Ghouls and Goblins
Occupational Therapy
Many children demonstrate challenges processing sensory information, such as sight, sound, taste, touch input and perception of position and movement in space.  Holidays can magnify these challenges.  Here are some tips to address these challenges:
  • Ensure costumes are not too scratchy, tight or stiff.  Make sure your child can move with ease or won't trip.  Consider whether they will be too hot or too cold in their costume.  Masks and face paint do not often work well with children with facial sensitivity.
  • Try trick-or-treating on a quiet street early in the evening with more light.
  • Practice the sequence of trick-or-treating and perhaps start with close family and friends.
  • If this is too hard, have your child pass out candy instead!