A presentation for the Region 10 Autism ConferenceJ u l y 3 0 , 2 016

Deve lo p ed B y E m i l y H e lm b o ld t , L B A , B C B A , L P C

VC U Au t i sm C en te r fo r E xc e l lenc e

P r esen ted by J u s t in C r eec h , P B S F a n d Da r c y C r eec h , P B S F

NOW SERVING:

DEVELOPMENTAL

DISABILITIESDEMYSTIFYING A NEW POPULATION

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

PARTICIPANT OBJECTIVES

WHO’S HERE?

LET’S REVIEW SOME POINTS

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.

BRIEF HISTORY OF WAIVERS

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

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 i l lness; (i i ) is manifested before the individual reaches 22 years of age ; (i i i ) is l ikely 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 l iving, 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 l ifelong or extended duration and are individually planned and coordinated.

WHAT IS THE OFFICIAL VIRGINIA

APPROVED DEFINITION OF DD?

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 l ife .

Also, Traumatic Brain Injury incurred up to age 22

DD DEFINITION CONTINUED

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

Supports Intensity Scale

SUPPORTS INTENSITY SCALE

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

LEVEL 1 Score 116 or more

Level 2 Score 100-115

Level 3 Score 85-99

Level 4 Score 84 or less

SIS LEVELS

Less impact

More impact

Intermittent

Limited

Extensive

Pervasive

Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers,

Presentation Powerpoint, 4/1/2016

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…)

FACTS ABOUT DEVELOPMENTAL DISABILITIES

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%.

TRENDS IN DD 1997-2008

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

EXAMPLES OF 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

MOST COMMON DEVELOPMENTAL

DISABILITIES

originated at birth or during childhood

is expected to continue indefinitely

substantially restricts the individual's functioning in several

major life activities.

THREE MAIN CRITERIA

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

DD DETERMINATION

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”

2 TYPES OF DD ELIGIBILITY NEEDED

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

ADAPTIVE BEHAVIOR ASSESSMENT

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.

VINELAND

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 cl inical assessments.

OR

Certification by or ful l 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 l icense to practice in the healthcare or al l ied healthcare field.

OR

Formal, supervised mental health, speech/language, and/or educational t raining specific to assessing chi ldren, or in infant and chi ld development, and formal training in the ethical administration, scoring, and interpretation of cl inical assessments.

QUALIFICATIONS TO ADMINISTER

VINELAND II

In development by AAIDD

Comprehensive assessment of adaptive behavior

DIAGNOSTIC ADAPTIVE BEHAVIOR SCALE

“DABS”

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.

CLOSER LOOK AT THE TOP 3

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

HOW IS ID DIAGNOSED?

Characterized, in varying degrees, by dif ficulties:

social interaction

verbal and nonverbal communication

repetitive behaviors.

SPECTRUM- varying levels of impact, functioning, comorbidity

AUTISM SPECTRUM DISORDER

Level 1

Requiring support

Level 2

Requiring substantial support

Level 3

Requiring very substantial support

LEVEL 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.

WHY ALL THE TALK OF AUTISM??

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 ) 1 6 - 3 0 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 ) - 4 - 1 1 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 ; 1 5 - i t e m , d i r e c t o b s e r v a t i o n ; 5 - 1 0 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 , 3 0 - 4 5 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 u r e d i n t e r v i e w ; 1 . 5 – 2 . 5 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 u l t s .

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

HOW IS AUTISM DIAGNOSED?

THE PROCESS FOR SCREENING

non-progressive brain injury or malformation

occurs while the child’s brain is under development

primarily affects body movement and muscle coordination

before birth, during birth, or immediately after birth

65%will have mild cognitive impairment or ID

35% will NOT

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.

SEVERITY LEVELS OF CEREBRAL PALSY

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

HOW IS CEREBRAL PALSY DIAGNOSED?

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?

READY, SET, SUPPORT!

Meet E l len

A ge 22

ASD Level 3

IQ 98

Last year of h igh school and has an internship at a local hospita l

Works wi th job coach, spec ial educat ion teacher, work super v isor

Lives at home wi th mom and dad

Can do laundr y independent ly, needs super vis ion cooking

Loves to co lor, has “ f i ts” when th ings aren’ t r ight (wanted seafoam green c rayon, s taf f handed her a c rayon and she screamed “ i t ’s not seafoam green that ’s p ine forest g reen!” )

Screams when something unexpected happens (new job coach, subst i tute teacher)

Needs repet i t ion and v isual presentat ion to learn new act iv i t ies

Requi res h igh level o f s t ructure for soc ia l act iv i t ies ( th ings have to go as p lanned)

Wants to move out eventual ly

Sped ed 100% sel f contained

Highly verbal yet monotonic

Visual suppor ts : uses IPod for checkl is ts , 2D checkl is ts and task analys is , soc ia l s tor ies , sc r ipts , 5 po int scale for emot ional regulat ion, etc .

Has great d i f f icul ty making f r iends and becoming par t o f soc ia l g roups

CASE STUDY-ELLEN

Meet Chr is

20 years o ld

Aut ism diagnos is leve l 3 (most impacted)

IQ 78

In last year of h igh school and par t ic ipat ing in an internsh ip at a hospi ta l

Suppor t persons : specia l educat ion teacher, job coach , on s i te super v isor

Low verbal abi l i t y (poor express ive language )

Episodic severe behav ior cons is ts of phys ical aggress ion (push ing/shov ing ) , re fusal to move (s i t t ing down when upset ) and has had numerous Funct iona l Behav ior Assessments and Behav ior Inter vent ion P lans

Gets ver y upset i f rout ines are inter rupted , someth ing isn’ t r ight (a tear in a p iece of c loth ing or crooked p icture on wal l ) , or there are unexpected t rans i t ions

Lives at home with mother and father Home routinized, basic self -care, no cooking, does laundry

Might want to l ive 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 activit ies at church.

Needs specia l i zed 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 al l the information in it )

CASE STUDY -CHRIS

A STEP IN THE RIGHT DIRECTION

Information about the Waiver Redesign, Forms, and frequently asked questions can be found at:

http://www.dbhds.virginia.gov/individuals -and-families/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:

http://www.dbhds.virginia.gov/professionals -and-service-providers/developmental -disability -services-for-providers/provider-development

You may also send your email to waiverupdates@DBHDS.virginia.gov to receive periodic email updates.

WAIVER CONTACTS AND INFORMATION

Emily Helmboldt, LBA, BCBA, LPC

Technical Assistance Associate

VCU-Autism Center for Excellence

ECHELMBOLDT@VCU.EDU

Justin Creech, PBSF

Darcy Creech, PBSF

www.positivebehaviorconsulting.com

positivebehaviorconsulting@gmail.com

(804) 221-8745

POSITIVE BEHAVIOR

CONSULTING, LLC