THE WORLD OF THE “D’S”

ASD, ADHD, LD, DD & IDD Emily Boncek M.S., CRC & Lucy Gafford M.S., CRC Training Developed by Jennifer Kaut M.Ed.,BCBA Board Certified Behavior Analyst DARS-DRS Developmental Disorder Specialist

Looking at July 2014 TEA DATA:

 Our Total Numbers      Age Group with the Greatest Numbers Rate of Growth Percentage by Age, Grades and Severity Level Numbers Graduating in 3 -5yrs. & 10 -12 yrs. Possible Financial Effects Created by: Jennifer Kaut, M.Ed. BCBA Data obtained by TEA July 2014. Data reporting Levels of Severity are based on the DSM 5 definitions. Data for Levels of Severity nor financial costs are not validated.

Number of ASD Elementary School Age Students: 24,932

4 055 3 396 3 675 3 719 4 011 3 768 2 308 5 yrs 6 yrs 7 yrs 8 yrs 9 yrs 10 yrs

Number of ASD Middle School Age Students: 9,809

3 590 3 242 2 643 12 yrs 13 yrs

Number of ASD High School Age Students: 8,275

2 300 2 054 2 977 14 yrs 1 278 11 yrs 15 yrs 16 yrs 17 yrs 18 yrs 689 19 yrs

Number of ASD 18 + Age Students: 1,579

488 20 yrs 402 21 yrs

Percentange of ASD Students in Pre-K, Elem, Middle, High & 18 +

18 +(19-21) 3% Pre-K(3-4) 6% High School(15-18) 17% Middle (12-14) 21% Elem (6-11) 53%

Current Number of ASD Students Ages 3-21 broken down by the DSM Level of Severity

25 000 Data provided by TEA July 2014. The levels are estimates only. They are not reported numbers 20 000 15 000 10 000 5 000 0 Level 1 "Requiring Support" Level 2 "Requiring Substantial Support" Level 3 "Requiring Very Substantial Support" 3-5 yrs (4,986) 1 114 2 122 1 750 6-14 yrs (32,433) 14 296 5 938 12 199 15-18 yrs (8,259) 3 662 1 540 3 057 19-21 yrs (1,579) 87 114 1 378 In total: 47,527 broken down by level 19 159 9 714 18 384

DSM Definition of Level 1:

Social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

DSM Definition of Level 2:

Social communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and how has markedly odd nonverbal communication.

DSM Definition of Level 3: Social communication:

Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. Restricted, repetitive behaviors: Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

Restricted, repetitive behaviors: Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.

Restricted, repetitive behaviors: I nflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.

18 yrs: Total: 2,296 Level 1: 434 Level 2: 201 Level 3: 661 Percentage of Students with ASD by Level of Serverity

Level 3 39% Level 1 40% Level 2 21%

How Many Are We Sending for 18 + Services?

19 yrs Total: 688 (30%) 71

Percentage that go on to 18 + services: 16%

70

Percentage that go on to 18 + services:35%

547

Percentage that go on to 18 + services: 86%

20 yrs Total: 488(21%) 10

Percentage that go on to 18 + services:.02%

30

Percentage that go on to 18 + services:15%

448

Percentage that go on to 18 + services: 68%

21 yrs.

Total: 392(17%) 6

Percentage that go on to 18 + services:.01%

4

Percentage that go on to 18 + services:.02%

382

Percentage that go on to 18 + services: 58%

In the next 10-12 years… Texas will TRIPLE the numbers of students graduating with Autism

2017-2019, Texas will have 9,838 students with Autism graduating.

2024-2026, Texas will have 32,433 students with Autism graduating

Number of ASD Students Graduating

3 to 5 years 10 to 12 years 32 433 9 838 3 to 5 years 10 to 12 years Level 3 (very substantial supports) Level 2 (substantial supports) Level 1(needs supports)

Number of ASD Students Graduating by Level of Severity

10 to 12 years 3 to 5 years 1 654 4 435 5 938 3 789 12 199 14 296

What Supports Did These Graduates Need in School and How Will These Reflect Their Transition Needs?

(Predications based on the DSM 5 Levels of Severity) LEVEL 1’s (Need Supports)

In 3 to 5 years  3,749 students received their instruction in the least restrictive instructional setting. They were in their regular classroom approximately 80% of the time. They may need to stay in school 1 or 2 more years to further develop life and social skills, if their academics, were the primary focus during high school. They may need VR services in order to obtain/maintain employment or attend higher education

In 10 to 12 years

 14, 296 students

LEVEL 2’s (Substantial Supports)

In 3 to 5 years  1,654 students received their instruction in a moderate restrictive instructional setting. They were in their regular classroom approximately 40% - 79% of the time. They will most likely need 18 plus school services, as well as, VR services in order to obtain or maintain employment. These students are at a crossroad: there are 3 directions these students can take. 1) If provided, intense intervention with the expectation of independence, they could move up to a Level 1 2) They stay the same and will most likely never reach full independence 3) Or due to a lack of intervention and supports, this group is at risk for dropping to a Level 3, thus needing lifelong supports.

In 10 to 12 years

 5,938 students

LEVEL 3’s (Very Substantial Supports)

In 3 to 5 years  4,435 students received their instruction in the most restrictive instructional setting. They were in their regular classroom less than 40%. These students will require intense long term supports.

In 10 to 12 years

 12,199 students

2012’s Top 5 Reasons for ASD Unsuccessful closures…

1.

Making eligibility decisions largely based on a psychological report  People with ASD need time to transition to new people & places and struggle to generalize skills from one environment to another. In this contrived setting, with an unfamiliar person & place, it is not possible to get a valid snapshot of this person’s ability to work. 2.

Ignoring the validity of school assessments  Instead sending for a psychological even though the school assessment was recent and accurate. 3.

Problem behaviors that were identified but not treated  2 main types: Challenging behaviors or social skill deficits. 4.

Problem behaviors that were identified but treated with psychotherapy  Research tells us that traditional psychotherapy has little success at decreasing problem behaviors and increasing skill deficits. It is unlikely that an ASD individual can replicate a skill learned in a contrived setting and generalize it. Furthermore, the only way to decrease problem behavior is determine what factor/s are maintaining them, and address the environment in which it is occurring. 5.

Failure to recognize characteristics of ASD  63 year old consumer “failed to cooperate” when he would not work anywhere but the one county he has lived in his entire life . ASD causes rigid patterns of behaviors and inability to be flexible.  Consumer “refused services” after his 3 rd new counselor introduced herself. Inability to transition is part of ASD.  Consumer “failed to cooperate” when he missed several appointments. Social phobia & severe anxiety is a characteristic of ASD.  Consumer was closed because he was “happy” with his Whataburger job and did not want to change (he got it himself). ASD causes a person to resist change.  Consumer stopped showing up to DARS appointments after being fired. Closed as “ refused services ” . Once a negative event occurs, people with ASD will associate all involved with that negative experience. Created by: Jennifer Kaut M.Ed.,BCBA

What’s with all this Autism Stuff?? Why does it matter to me? I don’t have that many on my caseload!

WHY? Because

anything you do for ASD

, is best practice for ANY developmental disorder. They are the

largest disability

population and we are the least them….

successful with

OLD Way

Immediately sending for psychological Using the same psychological tools Traditional vocational assessment No other vocational assessment options

What WORKS

If they are not college bound, what will this tell you? If you need a diagnosis for Autism, use the ASD psychological battery Viewing these consumers in a contrived setting will not give you an accurate assessment of work abilities, many are not “generalists”

IN PROGRESS:

Environmental Work Assessment that measures HOW a work envirnoment either increases the disability characteristics or decreases.

Treating with psychotherapy Not treating social skill deficits and/or challenging behaviors Only use if the mental illness is barrier not the developmental delay Use Applied Behavior Analysis (ABA) providers to address these issues BEFORE work.

IN PROGRESS: Updated policy

Using CRP’s who have little experience with developmental disorders

IN PROGRESS:

Creating ASD/DD CRP specialists No choices if the consumer needed specialized support that was not therapy but outside the duties of a job coach

IN PROGRESS:

ASD/DD Supports

Simply put: ABA is a methodology whose goal is to socially significant behavior.

So what is “

socially significant behaviors”?

Any behavior that effects a person’s quality of life Communication Verbal Language Problem Behaviors Academics Self Help Skills Social Skills Vocational Skills

•

A

pplied: ABA takes what we know about behavior and uses it to bring about real-world, meaningful change

•

B

ehavior: Behaviors are defined in observable and measurable terms in order to assess change over time

•

A

nalysis: Behaviors are analyzed within the environment to determine what factors are influencing the behavior

3 levels:

• BCaBA : Bachelor’s + behavior classes +supervised hrs.+ board exam • BCBA: Master’s + behavior classes +supervised hrs +board exam • BCBA-D: Doctorate +board exam  All must have degree’s in Education, Sp. Education, Psychology , Social Work or Behavior Analysis.

What they can do:

• BCaBA/graduate student in a behavior analysis program • Cannot do assessments • Can only conduct intervention plans supervised by a BCBA & all reports on progress must be signed by a BCBA • BCBA: • Can do assessments • Can do all interventions • BCBA-D: • Can do assessments • Can do all interventions

How do I find one in my area?

2 ways: 1.

2.

Check Rehab Works www.bacb.com

certificates”) (click on the page that says “find

• Has a problem behavior that presents a barrier to employment • You need to

DECREASE

these behaviors • Has a deficit in social skills that present a barrier to employment.

• You need to

INCREASE

these behaviors

What if it looks like there is several problem behaviors and several deficits?

• • • • • • • • • • You can call in a behaviorist to assess: Skill level Social skill level Communication ability Environments that would support their autism Environments to avoid Determine the function of any problem behaviors Identify triggers Identify preferred interests & reinforcers Determine if they have natural supports IF needed, provide a treatment plan to address these behaviors

 Their parents are glued to them and speak for my consumer  Parents might sabotage what we are doing  Need more information to develop a plan  CCSA is a great pairing with a FBA A behaviorist would work with ALL environments- if the environment presents a barrier to employment then we can address it.

What is the work goal?

EX.

If your consumers work goal is to work at a gaming company that provides tele-work or cubicles, little interaction, low lighting, then what social skills does he need? If he can respond when spoken to, follow supervisor’s instructions, accept feedback, has transportation and shows up dressed appropriately, then does he have a barrier?

Autism DOES NOT = ABA

Challenging Behavior Skill Deficits •

Social Skills Support

(Consumer does not have challenging behavior but displays skill deficits) • • Social Skill Assessment (up to 4 hrs) Intervention (group or individual up to 30 hrs) •

Behavioral Intervention

(Consumer has challenging behaviors that need to be decreased) • • Functional Behavior Assessment(FBA) (up to 8 hrs) Behavior Intervention Plan(BIP) (group or individual up to 30 hrs) ***

Any combination of individual or group can be used but the total is not to exceed 30 hours ***

• ABA is short term • You should see progress • Receive frequent updates on the mastery of the consumer’s goal • A good therapist will redo the plan if progress is not shown quickly • You should see generalization of skills in all environments • People in the environment that is being treated should be trained in any plan or recommendations

RPM: Chapter 5 (5.3.7) • Located after Mental Restoration Services Rehab Works • Level 1- Evaluation Services • Level 2-Behavior Analysis (will be changed to APPLED Behavior Analysis)

DARS COMMON MYTHS REVIEWED

MYTH: YOU MUST BE AT LEAST 16 YEARS OLD TO APPLY FOR DARS SERVICES MYTH: HIGH SCHOOLS SHOULD REFER A STUDENT TO DARS ONLY WHEN THEY ARE A SENIOR MYTH: DARS IS A SCHOLARSHIP PROGRAM MYTH: DARS CAN’T ASSIST A TRANSITION AGED STUDENT WITH FINDING WORK, UNTIL THEY GRADUATE HIGH SCHOOL MYTH: DARS IS A LONG TERM SERVICE PROVIDER MYTH: DARS PROVIDES EMERGENCY SERVICES MYTH: DARS CAN’T WORK WITH A STUDENT IF THEY ARE RECEIVING 18+ SERVICES WITH THE HIGH SCHOOL MYTH: APPLIED BEHAVIOR ANALYSIS(ABA) SERVICES ARE RELEVANT ONLY TO INDIVIDUALS DIAGNOSED WITH AN AUTISM SPECTRUM DISORDER MYTH: ABA CAN ONLY BE APPLIED TO BEHAVIOR PROBLEMS MYTH: ABA SERVICES ARE ONLY EFFECTIVE FOR YOUNG CHILDREN

DD Regional Point of Contacts…

Region 1 Region 2 Region 3 Region 4 Region 5 Rick Bullard Gena Swett Dae Eun Marilyn Gilbreath Emily Boncek

2014 Statewide Developmental (ASD/DD/IDD/ADHD) Disorders Team

Team Lead: Jennifer Kaut M.Ed., BCBA Total ASD VR Counselors: 56 (updated 9/4/14) Total CRPs: 33(updated 9/4/14) Total: VR/CRP: 89

Region 1 TOTAL: 7 & 2 VACANT w/CRPs: 13 Region 2 TOTAL: 14 w/CRPs: 24 Region 3 TOTAL: 12 w/CRPs: 20 Region 4 TOTAL: 7 & 1 VACANT w/CRPs: 9 Region 5 TOTAL: 16 w/CRPs: 23 Ellen Dingus

Wichita Falls

Jonathan Perkin(UPS)

Abilene

Mary Ellen Pate

San Angelo

Della Moore & David Enrique

El Paso Central

Ashley Richardson

Lubbock South

Debbie Edwards

Lubbock West

VACANT

Odessa

VACANT

Amarillo

Regional Point Person:

Rick Bullard El Paso Area & Back up: David Enrique

Additional Regional staff:

Joe Morris, Mike Lawson Shannon Johnson (trainer)

Trinetta Powell

Plano

Tina Shaffer

Garland Diana Terry Ft. Worth South Lori Charlton Cleburne

Kelly Holloway

Lewisville

Mary Faltaous

Carrollton

Kellie Harrison/Lucy Gafford(AM)

Denton

Katharine Bowdre

Sherman

Deanna Layfield

Dallas Southeast

Angela Gonzalez

Dallas Northeast

Michael Marler

Round Rock

Elsa Perez/Stanley Bell

South Austin

Debbie Browne

East Austin

Patrice Rabalais

Beaumount

Teresa Frechette

Temple

Jennifer McCurley

Tyler

Lhea Homesley

Waco

Giovanne Bell

College Station

LeAnn Bolwerk

Longview

Jennifer Reynolds/Brian Loftus/Virginia Shutt

Arlington

Susan Payne

Paris/Texarkana

Jacklyn Meade

Fort Worth West

Regional Point Person:

Gena Swett Back up’s: Audra Ressel  & Lucy Gafford

Kelley Downey

Lufkin

Regional Point Person:

Dae Shin

Additional Regional staff:

Rosla Hocker, Betty Davis

Additional Regional staff:

Merry Straube, ,Frank Donaldson, Kelly Yarbrough

VACANT

Conroe

Veronica Comeaux

North Houston

Karen Williams

Southwest Houston

Eligio Hinojosa

Houston Central

Kristie Sekmistrz

South Houston

Catherine Guillory

Houston West

Solomon Ambani

Houston West

Nichole Rideux

Humble

Nick Boyko

Texas City

Salynda Bryson

Rosenberg

Regional Point Person:

Marilyn Gilbreath Back up’ s Nick Boyko

Additional Regional staff:

Stephanie Jenkins

Ruby Wilkins/ Cinda Alvarado

San A. Northeast

Erlinda Leal/Blanca Perez/Becky Ashton

San A North

Steven Martinez/Alma Alvarez

San A South

Debbie Rodriguez

San A West

Sherri Eddy

Harlingen

Gabby Martinez

McAllen

Leigh Ann Godinez

McAllen

Sasha Esparza/Michael Day

Corpus Christi

Jacqueline Gutierrez/Esmeralda Lopez

Laredo

Maricela Ponce

New Braunfels

Regional Point Person:

Emily Boncek Back up: Blanca Perez

Additional Regional Staff:

Ron Garza, David Dehoyos, Johnny Weddington

2014 Statewide Developmental (ASD/DD/IDD/ADHD) Disorders Team CRPs Region 1 ASD CRP TOTAL: 6

-Texas Employment Consultants -El Paso Helping People -Strassler Employment Services -After Mile Inc.

-Ability Solutions -Burkhart Center (pending CRP status)

Region 2 ASD CRP TOTAL: 10

-LauchAbility -Autism Treatment Center -Easter Seals-temple mays -UNT JobFit -Life Path Systems -Ability Solutions -Association for Independent Living -Bryant Guidry -Spectrum Services - Work Ready

Region 3 ASD CRP TOTAL: 8

-Client Services of East Texas -Dverse Solutions -Goodwill(Central) -Debby Puckette -Bruce Bloom -Ability Solutions -Opportunity Center -Austin Dog Alliance

Region 4 ASD CRP TOTAL: 2

-Easters Seals Greater Houston -University of Houston at Clearlake

Region 5 ASD CRP TOTAL: 7

-Job Adventures -Goodwill (South TX) -Compass Resource Group -Autism Treatment Center -Gatehouse Supportive Services -HELP -Business Resource Center