Developing and Implementing a County Wide Autism Program

1. Developing and Implementing a County Wide Autism Program American Educational Service Agencies Phoenix, Arizona December 6, 2008 Jocelyn M. Mills, MA CCC/SLP- PhD Candidate S.T.A.R.S. – Program Director Geauga County Educational Service Center Chardon, Ohio Specialized Teaching for Children with Autism and Resource Services

2. Geauga County Educational Service Center

3. Autism Spectrum Disorders • Autism:Life-long, non-progressive neuro-biological condition, which manifests in a unique triad of abnormalities in socialization, communication, and behavior. • 1 in every 150 births • Spectrum of communication, behavior, cognitive status • Some have average cognition • Most know a lot more than they can express • Cause is largely unknown • Look like typical kids

4. The Spectrum • Unique Triad Characteristics Including Abnormalities of: • social interactions and communication • severely restricted interests • highly repetitive behavior • 3 Main Forms of Autism Spectrum Disorders: • Autism • Asperger syndrome • PDD-NOS: (Pervasive Developmental Disorder- not otherwise specified)

5. Characteristics Associated with ASDs • Autism is Characterized by… • Qualitative Differences in Communication • Qualitative Differences in Social Interactions • Qualitative Differences in… • Behavioral Repertoire • Range of Interests • Stereotypies and other Disruptive Behavior Patterns • Peeks and Valleys in Performance within and across Academic, Behavioral and Social Skills Domains • These pervasive needs necessitate comprehensive assessment and individualized interventions in multiple domains

6. Difficulty relating to others and to the world Deficits in reciprocal responses to others Lack of joint attention Deficits in eye contact (not always!) Deficits in play skills Impaired imitation Delayed or atypical and/or language development Repetitive and stereotypic patterns of behaviors, interest, and activities Difficulties with transitions Sensory deficits (hyper/hypo sensitive) Stereo-typic behaviors Auditory processing Language comprehension Inappropriate social skills Aggressive behaviors Lacks understanding of social cues Avoids or uses eye-contact in odd ways Low motivation Inability to imitate Characteristics Associated with ASDs

7. Increase in Numbers • Nationally, 67 children are diagnosed with autism every day. • The disorder costs the nation $90 billion a year. The cost is expected to double in the next decade. • Autism is about 10 times as prevalent today as it was in the 1980's. • 4 to 6 children in 1,000 are on the spectrum. • 425,000 Americans under age 18 have some form of autism.

8. Autism Cumulative Growth

9. Autism Prevalence Trend, Ohio

10. What do these numbers mean to educational institutions? • Students with ASDs are in our schools and represent people across the spectrum • Sharp increases have prompted a nationwide media explosion • A plethora of treatments, therapies, and educational strategies have been promoted • Parents have become knowledgeable and are strong advocates for their children • Many due process cases nationwide involve children with ASDs • School budgets are not growing nearly as rapidly as the number of children classified as having special needs. • School districts face difficulty determining the most effective programming and often cobble a mishmash of methods that change with each new trend • Students with autism are more likely than other students to receive out-of-district placements.

11. Legislative Changes • Reauthorization IDEA – 2004(Individuals with Disabilities Act); Guarantees all school age child a “free and appropriate public education. • No Child Left Behind Act (NCLB):Emphasis on achievement (proficiency) for all students, accountability, student assessment, evidence based instruction, expanded parent options, highly qualified teachers. • Educational Classifications: IDEA requires that the disability adversely affect a child’s educational performance • Least Restrictive Environment (LRE): Defined according to student needs

12. Methodology Based Interventions • Applied Behavior Analysis:Science of applying “principles of behavior” to shape and change behavior in measurable ways. Strategies are used to teach skills in a specialized sequence to increase socialization, communication, and adaptive functioning. Focus is on intense training of small, discrete skills through multiple training and practice or trials. The science of “errorless learning” using shaping, prompting and reinforcement to increase appropriate behavior and reduce maladaptive behavior. • Developmental Intervention Model (Floor Time):Based upon the assumption that symptoms reflect biologically based processing difficulties involving affect, sensory modulation, and processing. Caregivers enter the child’s activities and follow the child’s lead. Through mutual, shared engagement, the caregiver uses techniques to engage the child into more complex interactions.

13. Methodology Based Interventions • LEAP (Learning Experiences Alternative Program):Program designed to educate children with autism with typical peers based on the premise that social isolation is a powerful predictor of adjustment problems. The curriculum blends a behavior approach with developmentally appropriate practices. Large parent training component • Verbal Behavior: Focused on language as a skill that can be analyzed and targeted according to behavioral principles. Language is influenced by reinforcement and maintained through motivation. Techniques are behaviorally based. Promotes language skills through intensive teaching and naturalistic environment training. The emphasis is on teaching the function of language through teaching procedures that focus on transferring the child’s ability to respond across all environments.

14. Other Methodological Strategies • Augmentative Alternative Communication • Person Centered Planning • Positive Behavioral Intervention and Support • Pivotal Response Training • Relationship Development Intervention (RDI) • Biomedical Interventions • Sensory Integration • Social Strategies • Inclusion/Reverse Mainstreaming

15. Case Law • Families have been granted reimbursement for home ABA programs • In cases where the district’s program could have or demonstrates progress that is beneficial to a privately placed child, the families are not reimbursed • Key: Have appropriate programming, trained staff, and related services • Cases in which no methodology with a student was used, is often won by the families. • Cases in which the school refuses to list a specific type of methodology in the IEP, but uses specific methodologies for students with autism are won by the district • Key: Be informed and trained in current literature and research related to autism and use such information accordingly to build a methodology based and individualized IEP, but avoid indicating any specific methodology on the IEP, rather have a discussion with the IEP about methodologies that may be appropriate for the child. • Cases in which a school district IEP does not include all the necessary elements of content can be viewed as compromising the students right to FARP. • Key: Assure that the team develops an appropriate, clear, and specific IEP • Cases in which a district indicates “finances” as a reason for not employing a specific intervention is lost. • Key: Districts should not enter a meeting with a predetermined plan, or that is basing programming/interventions on fiscal convenience • Deal ex. Rel. v. Hamilton County Bd. of Educa., 49 IDELR 123 (6th Cir. 2008)

16. Research Findings • Methodological treatment research is inconsistent • Applied Behavior Analysis (ABA) is the most extensively researched and proven • When schools make “good faith effort” to accommodate students with ASDs the courts act favorably towards their actions • Prior to 1995, parents were winning most methodological cases, now this has flip-flopped • While methodological wars continue, consensus regarding the essential components of a program for children with ASDs is emerging. • Comprehensive programs for students with ASDs ensures the capacity to individualize within the program • When programs are developed and implemented appropriately they can be cost effective

17. Geauga County Educational Service Center Initiative • 7 Districts in the county struggling trying to meet the individual needs of the most intensive needs students with ASDs • Districts were struggling to provide appropriate comprehensive programming • Staff and related personnel were not trained to work with this population • Components of a comprehensive program were missing (i.e. strong parental involvement, community based instruction, integrated therapies, intense program supervision) Solution = Consortium of the 7 districts initiated a site based county-wide program to support this population of students

18. Designing a Program Before designing and developing the program for children with autism, a solid understanding of the nature of autism is warranted including: • The full spectrum of disorders • The ways in which children within the spectrum may qualify for special education services under the IDEA • The wide range of educational challenges these children may present due to the heterogeneity of the disorders • The importance of EIBI and methodology based interventions

19. Early Intensive Intervention Family Involvement Strong Behavioral Understanding Comprehensive Methodological Understanding Cooperative Planning Systematic Instruction Ongoing Assessment Specifically Trained and Certified Personnel Multi-disciplinary Approach Imbedded Therapies Low student-to-staff ratio High Structure High Fidelity of Instruction Individualized Curriculum Functional Adaptive Skills Transition/Vocational Programming Recreation/Leisure Academic Instruction Peer Relationships Opportunities for Inclusion Developing Program FrameworkResearch/Literature Review to determine most effective programming:

20. S.T.A.R.S. ProgramSpecialized Teaching for Students with Autism & Resource ServicesGeauga County Educational Service Center • 30 Students (Grades K-Age 22) • Multi-Methodological and Individualized Approach • Students Grouped by age, communicative, and behavior status • Located in Public School Building • Districts Refer Students (Screening Process) • High Staff to Student Ratio (4:6) • Program Develops, Implements, and Maintains IEP’s • Follows School Calendar Year with Extended School Year Programming in the Summer

21. Multi-Methodological Approach • Comprehensive Programming • Must contain essential parts of a program specific for students with ASDs • Variety of sound methodologies can be individualized based on learner profile • Consider an array of methodologies to be utilized • Staff knows the research regarding the chosen methodologies and application to each student • Conduct appropriate levels of professional development so that staff is qualified to select, tailor, and implement an array of methodologies • Implement methodologies based on peer-reviewed research to the extent practicable

22. S.T.A.R.S. ProgramSpecialized Teaching for Students with Autism & Resource ServicesGeauga County Educational Service Center • Staff: • (1) Program Director • (5) Intervention Specialists • (14) Highly Trained Paraprofessionals • (2) Occupational Therapists • (1) Occupational Therapy Assistant • (2) Speech Language Pathologists • (1) Adaptive Physical Education Teacher • Consultants: • Certified Behavior Analyst • Assistive Technology Coordinator • Literacy Consultant

23. Program Components • Staffing Structure: • Daily Program Supervision • Highly Trained Staff(Methodology Based Instruction, Behavior and Communication) • Integrated Therapies • 1:1 in the Classroom • Consulting • Groups • Home Based • Team Approach • Methodological Fidelity and Data Collection

24. Program Components • Additional Program Supports: • Home Visits/Consultations • Parent Observation • Parent Training Series • Family Field Trips • Weekly Community Based Instruction • Pre-Vocational/Vocational Programming • Community Awareness • District Wide Training (staff/students) • Daily Parent Communication • High School Student Community Service Volunteers • Parent/Teacher Support Group

25. Program Components • Classroom Structure • Academic Content Standards • Activities of Daily Living • Pre-Vocational/Vocational Programming • Behavior Reduction Plans • Highly Structured (Student Schedules) • Individualized Programming (Methodology Based) • Focus on Building Student Independence • Inclusion/Mainstreaming • Reverse Mainstreaming

26. Allows for a comprehensive approach to the education and treatment of children and adolescents with ASD Most consistent and collaborative treatment Involves working together as a team, learning from one another, and sharing information about assessment and programming Allows for multiple, highly-specialized practitioners to work jointly in the interests of the individual with ASD Allows for multiple informants to provide context-specific information about assessment and programming Allows team members to gain new insight about the individual and treatment options Strong, supportive relationship between families and providers Increased family buy-in/accountability Services are more likely to reflect family values and differences More accurate early markers of treatment response Greater cumulative progress Greater team understanding of the range of treatment effects Greater understanding of issues related to the clinical integration of treatments Positive Outcomes of Comprehensive Program

27. Conclusions • Steps to ensure positive results with students with ASDs: • Build a solid understanding of the nature of ASDs among district members • Design and develop a comprehensive program that contains the essential components as established by the research, without regard to methodology • Make knowledgeable decisions about an array of instructional methodologies to be utilized within the framework of broad-based programming • Ensure appropriate levels of professional development • Conduct a full and individual evaluation of each child • Conduct IEP meetings that meet the procedural and substantive requirements of IDEA, including that of full parental participation • Use evaluation results to inform the development of individually tailored IEP to enable the child to receive meaningful educational benefit in the least restrictive environment

28. References