Autism Benefit Training Initiatives

Transcription

1 Krista Clancy, LLP, BCBA Director of Behavioral Services University Pediatricians Autism Center Nicole Dwyer, MALPC Autism Benefit Specialist Detroit Wayne Mental Health Authority 1

2 2 Detroit Wayne Mental Health Authority Agenda: Overview & History DWMHA & UPAC Autism Benefit Training Initiatives DWMHA Autism Benefit Training Outcomes Additional Resources Questions / Comments

3 3 Detroit Wayne Mental Health Authority History: Medicaid / MIChild ASD Benefit implementation April 1, 2013 Applied Behavior Analysis became a newly covered service by private and public insurance for treating individuals with Autism in the State of Michigan Within the first three months we are seeing significant progress in decreasing negative behaviors and increasing communication Medicaid / MIChild currently covers children ages 18 months to 6 th birthday with Autism Diagnosis Private Insurance covers children 0 to 18 years of age CDC Diagnosis Rate of 1:68 Children

4 4 Detroit Wayne Mental Health Authority Future: The Centers for Medicare and Medicaid Services (CMS) issued a memo in July 2014 to all States regarding the need to provide evidence-based EPSDT services to individuals ages 0-21 years with ASD Michigan is ramping up for expansion tentatively for 2016

5 5 Detroit Wayne Mental Health Authority Where we are at / Where we need to go: Current Medicaid / MIChild (18 months 6 years): Michigan: 1,400 Current Children Open Wayne County: 900 Total Served Children 375 Current Children Open 13 Child Average Monthly Growth Rate Ramp- Up Projections Medicaid / MIChild (0 21 years): Wayne County (Detroit Wayne Mental Health Authority 30mo): 4,000 Total to Serve Children 1,750 Open Cases 141 Child Average Monthly Growth Rate Anticipating 1,100 in the 1 st year

6 6 Detroit Wayne Mental Health Authority Staffing: Need to ramp up staffing on both the private and public side Ensuring that effective staffing development, practice improvement, and educational programs are in place is vital with a rapid ramp-up benefit MDHHS ASD Benefit Training Funding provided each year to each PIHP Detroit Wayne Mental Health Authority has taken an approach that focuses on each staffing level in the benefit to address the ASD Benefit training needs

7 7 University Pediatricians Autism Center Considerations for Adoption of Evidence- Based Treatment Adequate Resources for Implementation Adherence to protocol Training Close supervision Monitoring of fidelity Effectiveness Variables that effect treatment outcomes

8 University Pediatricians Autism Center Factors that Impact Effective Training Professionals with Limited Experience with ASD Limited exposure to populations Different backgrounds in training and in treatment Restricted system of policies and procedure Limited number of qualified Supervising BCBA s 8

9 University Pediatricians Autism Center Training Goal Use techniques based on Applied Behavior Analysis and learning theory to not only teach consumers but to educate and train the staff 9

10 University Pediatricians Autism Center Assessment of Treatment Provider Skills Learning Style Characteristics of ASD Typical child development Reinforcement Motivation 10

11 11 University Pediatricians Autism Center Training an ABA Workforce ABA uses a train the trainer model ABA is not just a specific treatment strategy but a set of concepts and principles that the strategies are based on This makes the train the trainer model more difficult

12 12 University Pediatricians Autism Center Train the Trainer Model Bridge the gap between research and clinical practice embed an expert into the system Build community support for the new intervention Establish rapport and buy in for all stakeholders Establish investment in the training and treatment system to help maintain the fidelity and effectiveness of the Evidence Based Intervention

13 13 Detroit Wayne Mental Health Authority Staffing: MDHHS ASD Benefit Training Funding provided each year to each PIHP Detroit Wayne Mental Health Authority has taken an approach that focuses on each staffing level in the benefit to address the ASD Benefit training needs

14 14 Detroit Wayne Mental Health Authority Board Certified Behavior Analysts & MA Level Qualified Behaviorists ABA Aides & Behavior Technicians Diagnostic Evaluators & Cognitive Evaluators Supports Coordinators & Case Managers Other Ancillary Network Providers Community Agencies, Educational Systems, Primary Care Providers, & Religious Institutions Natural Supports (Parents, Guardians, Siblings, Neighbors, Extended Family) Individuals with Autism

15 15 University Pediatricians Autism Center Who is on the ABA Direct Treatment Team? Parents BCBA BCaBA Registered Behavior Technician What are their roles, training, and supervision necessary for each treatment team member

16 16

17 Board Certified Behavior Analysts (BCBA), Masters Qualified Behaviorist, and Behavior Consultants 17

18 18 Detroit Wayne Mental Health Authority Board Certified Behavior Analysts (BCBAs): BCBA caseload sizes range from 6 24 cases depending on the level of support and severity of case Obtaining the BCBA credential is a lengthy process MA level coursework, Post-Master supervision Fieldwork, Board Certification Exam Temporary MA Level Behaviorists as exceptions until 2016

19 19 Detroit Wayne Mental Health Authority BCBAs Continued: History: 30 BCBAs in Michigan mainly worked in University Settings or with Traumatic Brain Injury Centers Current: 356 BCBAs in Michigan 40 BCBA/MA Qualified Behaviorists in DWMHA Network Future Need: 1,500 BCBAs in Michigan 250 in DWMHA Network

20 Detroit Wayne Mental Health Authority BCBAs Continued: DWMHA Behaviorist Consultation Group: With the new benefit, many BCBAs and Qualified Behaviorists are new professionals and/or are new to delivering ABA Services to individuals with ASD Facilitated by a Supervising BCBA from the Children s Center who is a Provider in network and the DWMHA ASD Benefit Specialist Held quarterly Location rotates so tours can be given at each provider location Not mandatory, but open only to individuals serving in the BCBA / or Qualified Behaviorist positions at the ASD providers on panel with DWMHA; normal attendance 5-20 people Topics cover case consultations, treatment ideas, sharing forms, treatment supplies, guideline clarifications, standardization, and training need identification, etc. 20

21 21 Detroit Wayne Mental Health Authority BCBAs Continued: DWMHA Behaviorist Parent Training : With the new benefit, many BCBAs and Qualified Behaviorists are new professionals and/or are new to delivering ABA Services to individuals with ASD In order for the behaviors and communication learned during treatment to generalize to times outside of treatment, parents / guardians and others involved in the child s life need to be trained to utilize the techniques and responses A 3-Day Early Intervention Parent Training delivered by MSU s Project Impact Consulting Team was provided to the Behaviorists in the DWMHA Network

22 Detroit Wayne Mental Health Authority BCBAs Continued: BCBA Education Programs: Approximately 2 years to complete History: only 2 Universities offered programs Current: 7 Universities in Michigan Offer BCBA Programs: Central Michigan University Eastern Michigan University Michigan State University Northern Michigan University Oakland University Wayne State University Western Michigan University 57 Universities or Colleges Offer Online BCBA Programs Bold indicates in the Metro-Detroit Area *Grand Valley Pending 22

23 Behavioral Consultant Skills Observation University Pediatricians Autism Center Proneness to personal stress Reaction to family's distress Reaction family s participation Ability to diffuse conflict Ability to apply principles of behavior & learning theory to the family unit 23

24 24 University Pediatricians Autism Center WSU BCBA Course Sequence Formal Training Wayne State University Adding more flexible class schedule Live classroom training in a cohort of students Addition of approved Accelerated practicum sites Additional course content focused on treating children 0-2 & over 6 and therapeutic rapport building and overcoming barriers to Tx

25 25 University Pediatricians Autism Center Grant Partnership with Integrated Care Alliance Learning Collaborative 10 week training offered to new Behavioral Consultants focused on implementation of skills once in the field trained 10 BC s (5 completed all trainings)

26 26 University Pediatricians Autism Center Grant partnership with Children s Hospital of Michigan Motivational Interviewing Training for Behavior Consultants 20 Behavioral consultants 2 day seminar Recorded feedback by motivational interviewing experts

27 27 University Pediatricians Autism Center Internal Monitoring and Supervision Behavior Review Team Group review by a team of behavior analysts, director of behavioral services and consultation from medical staff from Children s Hospital of Michigan as needed Case review and student supervision

28 Board Certified Assistant Behavior Analysts (BCaBA) 28

29 University Pediatricians Autism Center BCaBA Skills Observation Learning theory Child development Understanding of ASD Observe and provide feedback to family/staff Documentation skills 29

30 30 University Pediatricians Autism Center WSU BCaBA course sequence Formal Training Wayne State University Adding three semester sequence Live classroom training in a cohort of students Approved accelerated practicum sites

31 ABA Aides, Behavior Technicians, and Registered Behavior Technicians (RBT) 31

32 32 Detroit Wayne Mental Health Authority ABA Aides / Behavior Technicians: 5-20 hours per week per child of service delivery High School Degree Minimum Education Requirement Training requirement competence in service delivery is vital for effective treatment 10% Supervision/Direction/Observation Rate Requirement Aide/Tech caseload sizes range from 1-4 depending on the level of support and severity of cases

33 33 Detroit Wayne Mental Health Authority ABA Aides / Behavior Technicians Continued: History: CLS staff provided one-on-one support to individuals with no specific treatment modality or supervision prior to the ASD Benefit Current: 323 Behavior Technicians in DWMHA Network Future Need: 1,500 in DWMHA Network

34 34 Detroit Wayne Mental Health Authority ABA Aides / Behavior Technicians Continued: Behavior Technician Coursework: Krista Clancy, BCBA, Supervising BCBA at Children s Hospital / University Pediatricians Autism Center (UPAC) provided seven behavior technician training courses that cover the MDHHS required training topics Courses were recorded and uploaded along with a seven competency evaluations to the DWMHA Training Website ( These trainings are required for Behavior Technicians working in the DWMHA Network

35 35 Detroit Wayne Mental Health Authority ABA Aides / Behavior Technicians Continued: Behavior Technician Coursework: Beginning September 2015, DWMHA purchased the Relias Training Solutions Registered Behavior Technician (RBT) Coursework for network ASD Benefit Providers This coursework has 96-different ASD and ABA related trainings, and includes the BACB required 40-hour RBT Curriculum that individuals can take who are seeking to become registered with the BACB to deliver ABA services under supervision of a BCBA Providers can complete this 40-hour training in lieu of the vceonline.org behavior technician coursework

36 University Pediatricians Autism Center Behavior Technician Skills Observation Functions of behavior Task Analysis Reinforcement Motivation Implementation of a variety of treatment techniques 36

37 37 University Pediatricians Autism Center Partnership with Colleges and Universities WCCCD Baker College Wayne State University

38 38 University Pediatricians Autism Center Health Innovations Grant Modify college training curriculum to meet 40 hour training requirements for RBT Pair with hand-on practical training to demonstrate competency Recruitment from high schools, colleges and displaced workers Train the training mentorship program to train new instructors and supervisors

39 39 University Pediatricians Autism Center University Autism Program Grant Complete in house training for outside organizations Train on training protocol for RBT staff Train the trainer at each supervision level (Supervising BCBA, BCBA, Behavioral Consultant, BCaBA, Lead RBT, RBT) on the implementation of training system for sustained ability to do in-house training

40 Diagnostic / Cognitive / Adaptive Evaluators 40

41 41 Detroit Wayne Mental Health Authority Diagnostic / Cognitive / Adaptive Evaluators: LLP or MA Level Licensed CMHP evaluator required staffing level PhD, MD, or DO staff providing diagnosis verification Evaluation can take a minimum of 3 hours to complete Re-Evaluation must be completed on each child annually

42 42 Detroit Wayne Mental Health Authority Diagnostic / Cognitive / Adaptive Evaluators Continued: Evaluation Tools: Observation: Autism Diagnosis Observation Schedule 2 nd Edition (ADOS-2) Parent Interview: Autism Diagnosis Interview Revised (ADI-R) / Developmental Interview Many staff did not have prior experience with the ADOS-2 & ADI- R tools before the benefit rolled out, and it take a lengthy training, multiple observations, multiple administrations and supervision to be properly trained and competent to deliver these tools accurately The expertise of the evaluator more than the dependence on the tool Cognitive Test: Mullen, Differential Abilities Scale (DAS), or WPPSI-IV Adaptive Test: Vineland Adaptive Behavioral Schedule 2 nd Addition (VABS-2)

43 43 Detroit Wayne Mental Health Authority Diagnostic / Cognitive / Adaptive Evaluators Continued: History: Minimum evaluators in Michigan with competence in required tools administering evaluations on a consistent basis Current: Each PIHP must have a minimum of one evaluator 5 FTE evaluators in the DWMHA Network Future Need: Build to increased capacity demand 10 FTE evaluators in the DWMHA Network

44 44 Detroit Wayne Mental Health Authority Diagnostic / Cognitive Evaluators Continued: DWMHA Diagnostic Consultation Group: With the new benefit, many evaluators are new to delivering the ADOS-2 & ADI-R and may be the only ones at their agencies serving in this role Facilitated by Dr. Risi, one of the authors of the ADOS-2 Held quarterly Not mandatory, but open only to individuals serving in the Diagnostic and Cognitive Evaluation or Verification positions at the ASD providers on panel with DWMHA Topics cover case consultations, coding clarification, evaluation ideas, sharing forms, guideline clarifications, standardization, and training need identification, etc.

45 45 Detroit Wayne Mental Health Authority Diagnostic / Cognitive Evaluators Continued: ADOS-2 & ADI-R Trainings: Dr. Risi, a co-author if the ADOS-2, provides initial & refresher on an annual basis: 2-Day ADI-R Trainings 4-Day ADOS-2 Trainings

46 Supports Coordinators / Case Managers 46

47 47 Detroit Wayne Mental Health Authority Support Coordinators / Case Managers: SC/CMs play a vital and necessary role in the ASD Benefit, by serving as the conduit for the family in developing the Person-Centered-Plan (IPOS) and linking the family to any services and supports that may be medically necessary, including ABA. SC / CMs also assist in ensuring benefit coordination and linkage to other community-based supports. There are some specific SC/CM requirements that are different for the ASD benefit than they are for other service delivery. It is vital that all providers coordinate with the SC/CM on the case and that the SC/CM is familiar with the ASD Benefit requirements and process and ABA overall.

48 Detroit Wayne Mental Health Authority Support Coordinators / Case Managers: The DWMHA ASD Benefit Specialists attends staff meetings to provide overviews of the ASD Benefit and provide technical assistance to staff. DWMHA ASD Credential: DWMHA developing an ASD Credential specific to this provider staffing level to assist families in coordinating services and linking to resources. The credential curriculum includes: ASD Benefit 101 ASD 101 ABA 101 ASD Benefit Requirements (Roles and Responsibilities, requirements, navigation, parent training, technical assistance) 48

49 Network Providers 49

50 50 Detroit Wayne Mental Health Authority DWMHA Network Providers: The DWMHA ASD Benefit Specialists provide overviews of the ASD Benefit and provide technical assistance to providers and systems of care. offers a number of different ASD & ABA related content offers technical assistance guides, policy, and consumer resources

51 51 Detroit Wayne Mental Health Authority DWMHA Network Providers: DWMHA Children s Grand Rounds ( DWMHA offers monthly Children s Grand Rounds that provide 2-3 hours of training each month to the system that work to meet the CMHP Child Training Hour requirement as well as CEUs for many professional licensures. Grand Rounds are free and open to the whole network and community Grand Rounds are held live at one site and live-broadcasted to four other provider locations. They are recorded and uploaded to the website for future viewing 2015 Children s Grand Rounds Topics Included: ASD Diagnosis and Co-Morbid Conditions: Dr. Brooklier, a Neuropsychologist that provides diagnosis evaluations on ASD panel with DWMHA at The Children s Center, provided a network-wide training open to the entire system and community Externalizing Behaviors in Youth: Understanding Their Meaning; Developing Effective Interventions with Shaun Cooper, PhD

52 Parents, Guardians, and Other Natural Supports 52

53 53 University Pediatricians Autism Center Parent Education Seminars ASD diagnosis Family roles and responsibilities Effective communication between family members and providers Effective strategies for a parent child with ASD Community resources Data based decision making

54 Community Agencies, Educational Systems, Primary Care Providers, Parent Groups, Advocacy Groups & Religious Institutions, etc. 54

55 55 Detroit Wayne Mental Health Authority Community Agencies, Educational Systems, Primary Care Providers, Parent Groups, Advocacy Groups & Religious Institutions, etc.: The DWMHA ASD Benefit Specialists provide overviews of the ASD Benefit and provide technical assistance to providers and systems of care. DWMHA ASD Benefit Flyer & Brochure

56 Detroit Wayne Mental Health Authority Additional Training Initiatives: The DWMHA Training Website: offers a number of different ASD and ABA related trainings and resource pages / links offers technical assistance guides, policy, and consumer resources Relias Learning System was implemented that has 96 ABA Related Courses online to access, including toileting, ASD & sexuality, ABA supervision, feeding, ethics, etc. Western Michigan University offers a resource page through funding from MDHHS with ABA Videos for access at: Western Michigan University offers an tele practice Functional Behavioral Assessment (FBA) Consultation that providers are able to access through MDHHS Funding 56

57 57 University Pediatricians Autism Center Medical Professional Training Collaboration With AHEC University Autism Programs Grant In-house training with residents from nursing, pediatrics, psychiatry, family medicine, physicians assistant, neurology State wide community webinars

58 58 University Pediatricians Autism Center Referral Agencies Educate your referral source to help them describe ABA in a way that will motivate families to enroll How can the agencies work with each other? Why would they be motivated to refer to you? Do they get updates and results from your plans? Do you work on targets that make their job easier?

59 University Pediatricians Autism Center Considerations for Systems Change What is the investment? What is the supervision system? How are staff assessed? What are opportunities for ongoing training and boosters? Parent training and implementation of treatment changes? How do you evaluated the novel changes that staff will encounter and problem solve challenges? What is the sustainability plan? Will the system be run with fidelity? 59

60 ASD Benefit Outcomes 60

61 Rolled out Early Expansion Phase 1 and working towards Phase 2 to allow for gradual roll-out of services ahead of MDHHS mandate 61 Detroit Wayne Mental Health Authority Autism Benefit Training Outcomes Staffing: Developed a Collaborative ASD Workforce DWMHA Network has grown from 1 BCBA to 20 BCBAs with 20 additional MA Qualified Behaviorists since the implementation of the benefit in 2013 DWMHA has over 300 trained Behavior Technicians in the network providing services to children in the benefit DWMHA has developed an ASD Diagnosis Evaluation workforce to meet the needs of the system

62 62 Detroit Wayne Mental Health Authority Autism Benefit Training Outcomes Continued DWMHA Utilization Numbers: DWMHA has experienced a 58% growth in referrals in the previous 12 months DWMHA has served 900 children since the implementation of the benefit and currently has over 400 open active cases (ages 18 months to 6 years) 400 Chart 1. Number of Children Enrolled in the DWMHA ASD Benefit per Month (Discharged cases removed)

63 63 Detroit Wayne Mental Health Authority Autism Benefit Training Outcomes Continued DWMHA Access to Care Numbers: Decreased the average number of days from referral to evaluation by 72 days since 2013 Decreased the average number of days from evaluation to MDHHS approval by 14 days since 2013 Decreased the average number of days from MDHHS approval to IPOS completion by 110 days since 2013 Decreased the average number of days from MDHHS approval to ABA Direct Service start by 94 days since 2013

64 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep Detroit Wayne Mental Health Authority Autism Benefit Training Outcomes Continued Chart 2. Autism Benefit Timeline by Referral Cohort Referral to Evaluation 200 Referral to MDHHS Approval Referral to IPOS Completion Referral to ABA Direct Start

65 65 Detroit Wayne Mental Health Authority Autism Benefit Training Outcomes Continued Additional Challenges & Barriers: Rapid Ramp Up Building infrastructure and serving children at the same time System Restructure Where we were and where we are now Challenges managing the benefit in an integrated system of care while meeting the program mandates that are unique from other service mandates in our system

66 Additional Resources 66

67 67 Detroit Wayne Mental Health Authority Additional Resources State Resources: The Michigan s Autism Program: Michigan s State Autism Plan: pdf Medical Services Administration Bulletin: Federal Resources: The Centers for Disease Control Act Early Information: Evidence-Based Practice & Research Information: The National Autism Council s National Standards Project: The National Professional Development Center on Autism Spectrum Disorder: The Statewide Autism Resources and Training (START) Project:

68 68 Detroit Wayne Mental Health Authority Additional Resources Continued Navigation & Resource Guides: MI Navigator Neighborhood Directory by The Autism Alliance of Michigan: Day Kit for Newly Diagnosed Families of Young Children: The National Autism Council s Resource Guides: Navigating Services for Young Children with Autism Spectrum Disorder (ASD): Autism Speaks Tool Kits: Autism Speaks Resource Guide: Support Resources: Autism Speaks: The Autism Society: The Autism Society of Michigan: The Autism Alliance of Michigan:

69 69 Detroit Wayne Mental Health Authority Additional Resources Continued Training & Certification Resources: No Cost Autism Internet Modules: Behavior Analyst Certification Board (BACB): No Cost Parent Autism ADEPT ABA Training Module 1: No Cost Parent Autism ADEPT ABA Training Module 2: CDC Autism Case Training: The National Professional Development Center on Autism Spectrum Disorder Early Identification Training Module: Other Resources: Autism Apps: Ohio Center for Autism and Low Incidence (OCALI): Wayne State University Developmental Disabilities Institute: American Academy of Pediatrics/Bright Futures Recommendations for Preventative Pediatric Health Care:

70 70 Questions? Nicole Dwyer, MALPC Autism Spectrum Disorder Benefit Specialist Detroit Wayne Mental Health Authority (313) Krista Clancy, MS, LLP, BCBA Director of Behavioral Services University Pediatricians Autism Center (734)