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1:1 ABA

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

08/21/2014

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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 

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

08/12/2014

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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.

Top 3 of the 10 Reasons to Hate ABA

05/1/2014

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1." It’s only for kids with autism"  This couldn't be further from the truth!  Let me ask you, “do you go to work every day to receive a paycheck?”  If the answer is yes, then the foundation ABA principles are working on YOU!  Applied Behavior Analysis is not aligned with a specific treatment or diagnosis.  Here are some common areas you know of where ABA has had an impact: ·         Decreasing addictions (smoking, alcohol, etc.) ·         Safety regulations (do you know about OSHA?) ·         Health/fitness ·         Criminology ·         Organizational behavior management ·         Speech & language ·         Learning or refining a sport 2. " That’s the therapy that creates robotic children!" Unfortunately, there is a lot of outdated and inaccurate information still lingering around the ABA field.  This information comes from the idea that most of ABA is implemented in a highly structured, adult-driven setting where rote or repetitive responses are trained.  This is not the case.  There are many methodologies that utilize ABA principles including incidental teaching, Verbal Behavior, natural environment training, functional communication training, and discrete trial teaching.  If a student sound “robotic” that often means they are struggling with intonation and inflection within their speech and that they probably need a more detailed generalization plan.  If you want to hear some of our kids communicating with staff, schedule an appointment to see the clinic and hear for yourself! 3. " I hear they bribe kids with food..." Behavior Analysts do sometimes use food as reinforcers (meaning, if a student engages in the behavior we are trying to teach, we will reinforce with an edible).  Why? For many young children, developmentally delayed students, or children with very limited play/social interests, food can be an effective reinforcer.  Food is a primary reinforcer, meaning, we don’t teach a child that food is good.  If we cannot find other reinforcers, we begin teaching by using edibles if the parents are comfortable.  Much of our approach would then center around shaping up new reinforcers through pairing for the purpose of enabling the student with natural reinforcers such as social engagement, positive attention and personal accomplishment.  What’s pairing?  Come find out!  

Don't Forget About the Siblings!

04/1/2014

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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.  

Safety Tips For A Not-So-Spooky Halloween

10/1/2013

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ABA Services Our staff utilize evidence-based methodologies when working with children.  This means that we ground our work in procedures that have already been proven time and time again.  We document and show a child's growth through data, but most importantly through daily evidence of their increased engagement, communication and participation.   Did you know that we can teach your child lifelong safety skills using the principles of ABA?  Let me give you an example: In 2004, Bridget Taylor and her colleagues demonstrated that they could teach three teenagers with autism to seek assistance when lost using ABA principles.  The teenagers were taught to respond to a pager by finding an adult and giving them a communication card with their name, a statement of being lost and instructions to call the parent or teacher.  This skill was taught using modeling, prompting and reinforcement in a teaching setting to practice how to respond when the pager went off.  Once the students learned how to respond in the teaching setting, a generalization plan included practice in the natural setting.  Prompts to execute this skill were faded until the students consistently demonstrated how to respond.  The teaching teams then helped the parents follow through in the community with successful results.  Prompting, prompt fading, modeling, and reinforcement are some of the basic foundations of ABA. Other safety tips on Halloween: If your child is nonverbal, put an ID bracelet on them as a precautionary step Practice and wear glow bracelets or necklaces Put reflective tape on costumes, bags or props Stay in smaller, familiar neighborhood