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 [email protected] to receive periodic email updates.
WAIVER CONTACTS AND INFORMATION
Emily Helmboldt, LBA, BCBA, LPC
Technical Assistance Associate
VCU-Autism Center for Excellence
Justin Creech, PBSF
Darcy Creech, PBSF
www.positivebehaviorconsulting.com
(804) 221-8745
POSITIVE BEHAVIOR
CONSULTING, LLC