NOW SERVING: DEVELOPMENTAL DISABILITIES DEMYSTIFYING A NEW POPULATION

Transcription

1 NOW SERVING: DEVELOPMENTAL DISABILITIES DEMYSTIFYING A NEW POPULATION A presentation for the Region 10 Autism Conference J u ly 3 0, Developed B y E m ily Helmboldt, L B A, B C B A, L P C VC U Au t ism Center for E xc ellenc e P r esented by J u stin Creech, P B S F a n d Darcy C r eech, P B S F

2 PARTICIPANT OBJECTIVES 1. Be familiar with the federal definition of developmental disabilities. 2. List at least 3 developmental disabilities 3. List the 3 most common developmental disabilities 4. Have a better understanding of required supports for various developmental disabilities

3 WHO S HERE?

4 LET S REVIEW SOME POINTS

5 BRIEF HISTORY OF WAIVERS Waiver services first began in early 1991 through what was known as the Mental Retardation Waiver. This was eventually renamed the Intellectual Disabilities (ID) Waiver. The Individual and Family Developmental Disability Waiver (IFSDD/DD) was established in 2000 to serve individuals with Developmental Disabilities not meeting the diagnostic criteria for the ID Waiver The Day Support Waiver was started in 2005 to allow individuals on the Statewide Waiver waiting list at least day support services while continuing to wait on the Statewide Waiting list for services.

6 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

7 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

8 WHAT IS THE OFFICIAL VIRGINIA APPROVED DEFINITION OF DD? Federal definition developed by the AAIDD: "Developmental disability" means a severe, chronic disability of an individual that (i) is attributable to a mental or physical impairment, or a combination of mental and physical impairments, other than a sole diagnosis of mental illness; (ii) is manifested before the individual reaches 22 years of age ; (iii) is likely to continue indefinitely; (iv) results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency; and (v) reflects the individual's need for a combination and sequence of special interdisciplinary or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.

9 DD DEFINITION CONTINUED An individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described in clauses (i) through (v) if the individual, without services and supports, has a high probability of meeting those criteria later in life. Also, Traumatic Brain Injury incurred up to age 22

10 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

11 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

12 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

13 SUPPORTS INTENSIT Y SCALE Supports Intensity Scale Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

14 SIS LEVELS LEVEL 1 Score 116 or more Less impact Level 2 Score Level 3 Score Level 4 Score 84 or less More impact

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16 Intermittent Limited Extensive Pervasive

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18 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016

19 FACTS ABOUT DEVELOPMENTAL DISABILITIES Over 6 million people have a developmental disability 15% of children in the US ages 5 to 17 have one or more developmental disabilities. Autism is a developmental disability Intellectual Disability is not necessarily a developmental disability (Look at areas of functioning )

20 TRENDS IN DD CDC and HRSA study of 119,367 children ages 3 17 found: Increased 17% over this period Prevalence of autism increased 289.5% Prevalence of ADHD increased 33.0% Prevalence of hearing loss decreased 30.9%.

21 EXAMPLES OF DEVELOPMENTAL DISABILITIES Cerebral Palsy Fragile X Fetal Alcohol Syndrome Learning disabilities Hearing loss Autism Visual impairment Attention Deficit Hyperactivity Disorder Spina bifida Intellectual Disability Downs Syndrome Brain Injury

22 MOST COMMON DEVELOPMENTAL DISABILITIES As of 2014, according to the Centers for Disease Control: Intellectual Disabilities 1 in 120 Cerebral Palsy 1 in 323 Autism Spectrum Disorder 1 in 68 children (1 in 42 boys and 1 in 189 girls) What about Down Syndrome?? 1 in 1000

23 THREE MAIN CRITERIA originated at birth or during childhood is expected to continue indefinitely substantially restricts the individual's functioning in several major life activities.

24 DD DETERMINATION ID- Psych Eval Cerebral Palsy- Medical Evaluation Autism- Pediatrician, Diagnostic Clinic, Developmental Ped, etc. Down Syndrome- Pediatrician, Geneticist, etc. How to determine: substantial functional limitations in three or more of the following areas? Vineland Adaptive Behavior Scales Other adaptive behavior scales

25 2 TYPES OF DD ELIGIBILITY NEEDED Diagnostic eligibility Disability diagnosis Adaptive Behavior Assessment Vineland DABS (in development) Adaptive Behavior Assessment System (ABAS) Adaptive Behavior Evaluation Scale (ABES) similar to the ABAS, but used only for children Scales of Independent Behavior-Revised (SIB-R) Functional eligibility Virginia Individual Dev Disability Eligibility Survey VIDES

26 ADAPTIVE BEHAVIOR ASSESSMENT Conceptual skills language and literacy; money, time, and number concepts; and self-direction Social skills interpersonal skills, social responsibility, self - esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules, obey laws, and avoid being victimized Practical skills activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone

27 VINELAND Covers the full spectrum of adaptive behavior Three domains Communication, Daily Living Skills, Socialization correspond to the three broad domains of adaptive functioning specified by the American Association on Intellectual and Developmental Disabilities and by DSM-5.

28 QUALIFICATIONS TO ADMINISTER VINELAND II QUALIFICATION LEVEL B: A master's degree in psychology, education, occupational therapy, social work, or in a field closely related to the intended use of the assessment, and formal training in the ethical administration, scoring, and interpretation of clinical assessments. OR Certification by or full active membership in a professional organization (such as ASHA, AOTA, AERA, ACA, AMA, CEC, AEA, AAA, EAA, NAEYC, NBCC) that requires training and experience in the relevant area of assessment. OR A degree or license to practice in the healthcare or allied healthcare field. OR Formal, supervised mental health, speech/language, and/or educational training specific to assessing children, or in infant and child development, and formal training in the ethical administration, scoring, and interpretation of clinical assessments.

29 DIAGNOSTIC ADAPTIVE BEHAVIOR SCALE DABS In development by AAIDD Comprehensive assessment of adaptive behavior

30 CLOSER LOOK AT THE TOP 3 Intellectual Disability Intellectual disability is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 18.

31 HOW IS ID DIAGNOSED? Measurement of IQ Measurement of Adaptive Behavior Stanford-Binet, Wechsler, Woodcock Johnson Vineland Adaptive Behavior Scale, Woodcock Johnson Scales of Ind Behavior, Diagnostic Adaptive Behavior Scale

32 AUTISM SPECTRUM DISORDER Characterized, in varying degrees, by dif ficulties: social interaction verbal and nonverbal communication repetitive behaviors. SPECTRUM- varying levels of impact, functioning, comorbidity

33 LEVEL OF AUTISM Level 1 Requiring support Level 2 Requiring substantial support Level 3 Requiring very substantial support

34 WHY ALL THE TALK OF AUTISM?? FASTEST growing developmental disability in world The cost of lifelong care for someone with Autism can be reduced by 2/3 with early diagnosis and intervention Persons with ASD have poorer community integration and employment outcomes than any other developmental disability.

35 HOW IS AUTISM DIAGNOSED? Developmental Screening Comprehensive Diagnostic Evaluation Multidisciplinary Developmental Pediatrician Pediatric Neurologist Geneticist Audiologist Developmental Psychologist Psychiatrist M C H A T ( M o d i f i e d C h e c k l i l s t f o r A u t i s m i n T o d d l e r s ) m o n t h s C A S T - ( C h i l d h o o d A u t i s m S p e c t r um T e s t ) y e a r s, A s p e r g e r s i d e n d i f i c a t i o n C A R S ( C h i l d h o o d A u t i s m R a t i n g S c a l e ) : F o r > 2 y r s. o l d ; i t e m, d i r e c t o b s e r v a t i o n ; 5-10 m i n u t e s A D O S ( A u t i s m D i a g n o s t i c O b s e r v a t i o n S c h e d u l e ) : F o r t o d d l e r s t o a d u l t s ; d i r e c t o b s e r v a t i o n, m i n u t e s A D I - R ( A u t i s m D i a g n o s t i c I n t e r v i e w ) : F o r m e n t a l a g e > 2 y r s. ; s t r u c t ured i n t e r v i e w ; h o u r s. B e s t f o r o l d e r a d o l e s c e n t s / a d ults. G A R S ( G i l l i a m A u t i s m R a t i n g S c a l e ) 3 t o 2 2 y e a r s o l d

36 THE PROCESS FOR SCREENING

37 CEREBRAL PALSY non-progressive brain injury or malformation occurs while the child s brain is under development primarily af fects body movement and muscle coordination before birth, during birth, or immediately after birth 65%will have mild cognitive impairment or ID 35% will NOT

38 SEVERIT Y LEVELS OF CEREBRAL PALSY Mild Mild Cerebral Palsy means a child can move without assistance; his or her daily activities are not limited. Moderate Moderate Cerebral Palsy means a child will need braces, medications, and adaptive technology to accomplish daily activities. Severe Severe Cerebral Palsy means a child will require a wheelchair and will have significant challenges in accomplishing daily activities. No CP No CP means the child has Cerebral Palsy signs, but the impairment was acquired after completion of brain development and is therefore classified under the incident that caused the Cerebral Palsy, such as traumatic brain injury or encephalopathy.

39 HOW IS CEREBRAL PALSY DIAGNOSED? No single test Sometimes can be dx at birth Majority diagnosed by age 2 Developmental Pediatrician, Neurologist, Pediatrician Reflexes, muscle tone, posture, coordination, etc. MRI, cranial ultrasound, CT Scan Multiple specialists can be involved

40 READY, SET, SUPPORT! In your group choose a scribe and a person to report out Read your case notes and review SIS scores List: What type of professional may have made the diagnosis? What type of assessment might they have used? Guess Any additional information needed to decide what services needed? At least 3 services to be requested (besides case management) EXTRA CREDIT: What Tier and level would you guess?

41 CASE STUDY-ELLEN Meet Ellen A ge 22 ASD Level 3 IQ 98 Last year of high school and has an internship at a local hospital Works with job coach, special education teacher, work super visor Lives at home with mom and dad Can do laundr y independently, needs super vision cooking Loves to color, has fits when things aren t right (wanted seafoam green crayon, staf f handed her a crayon and she screamed it s not seafoam green that s pine forest green! ) Screams when something unexpected happens (new job coach, substitute teacher) Needs repetition and visual presentation to learn new activities Requires high level of structure for social activities (things have to go as planned) Wants to move out eventually Sped ed 100% self contained Highly verbal yet monotonic Visual suppor ts: uses IPod for checklists, 2D checklists and task analysis, social stories, scripts, 5 point scale for emotional regulation, etc. Has great dif ficulty making friends and becoming par t of social groups

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43 CASE STUDY -CHRIS Meet Chris 20 years old Autism diagnosis level 3 (most impacted) IQ 78 In last year of high school and par ticipating in an internship at a hospital Suppor t persons: special education teacher, job coach, on site super visor Low verbal ability (poor expressive language) Episodic severe behavior consists of physical aggression (pushing/shoving), refusal to move (sitting down when upset) and has had numerous Functional Behavior Assessments and Behavior Inter vention Plans Gets ver y upset if routines are interrupted, something isn t right (a tear in a piece of clothing or crooked picture on wall), or there are unexpected transitions Lives at home with mother and father Home routinized, basic self- care, no cooking, does laundry Might want to live in an apartment or group home one day Difficulty learning new tasks at home Behavior is stable at home usually Involved in church Sunday school and other activities at church. Needs specialized suppor ts to learn new tasks Visual supports ( checklists, task analysis, schedules) Uses the 5 point scale for emotional regulation to identify when he may need a break Scripts for various conversations or social situations Narrow range of interests consisting of academy awards history (has a book with all the information in it)

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45 A STEP IN THE RIGHT DIRECTION

46 WAIVER CONTACTS AND INFORMATION Information about the Waiver Redesign, Forms, and frequently asked questions can be found at: -andfamilies/developmental-disabilities/my-life-my-community Contact any of the local Waiver Experts and or your local Community Resource consultant, information can be found at: -and-ser viceproviders/developmental-disability-ser vices-for-providers/providerdevelopment You may also send your to to receive periodic updates.

47 Emily Helmboldt, LBA, BCBA, LPC Technical Assistance Associate VCU- Autism Center for Excellence

48 POSITIVE BEHAVIOR CONSULTING, LLC Justin Creech, PBSF Darcy Creech, PBSF (804)