Behaviorally Speaking

Autism Insurance Passes Illinois Assembly

Sun, 23 Nov 2008 08:19:08 -0600

As folks who regularly pay attention to Autism news in the press will already be aware, the Illinois General Assembly finally passed the Autism Insurance Bill that has been moving back and forth for most of the past calendar year. On more than one occasion this bill has looked to be dead, at least for the current legislative session. Now all that remains is for Governor Blagojevich to sign the bill, which he has said that he will.

Some important components of the bill include:

Coverage for people with Autism Spectrum Disorders up to 21 years of age.
Diagnostic and treatment services are covered, including testing and assessment services.
“Autism Spectrum Disorders” refers to “pervasive developmental disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)”. The bill specifically identifies “autism, Asperger’s disorder, and [PDD-NOS]”. However, let me note here that Rett’s Disorder and Childhood Disintegrative Disorder are also identified within the Pervasive Developmental Disorders section of the most current version of the DSM, so one assumes, based on the language of the bill, that they will also be covered.
Applied Behavior Analysis (ABA) services are specifically identified as being covered in the bill.

It should be obvious in general terms that the passing of this bill provides an important advance in the provision of services for families that include children with Autism Spectrum Disorders in the state. In more specific terms it does some important things for the types of services that can now be available in our great state.

Without this type of coverage ABA services in Illinois were limited to either provision of services as private pay or through the Medicaid Waiver. This has had the net effect of severely limiting the opportunities for Board Certified Behavior Analysts (BCBA’s) in the state, thus making the Land of Lincoln relatively unattractive to those offering such services. For service provider groups like Forest City Behavior it provides a much needed diversification of funding sources, particularly given the State’s atrocious delays in payment to vendors.

This also has an impact for families who’s health insurance needs are covered by Illinois Public Aid, as it is my understanding that the bill requires coverage by that entity as well as by private health insurance providers. As with any other type of insurance coverage, virtually none of the behavioral treatment needs of a child with a disorder in the autism spectrum were covered by Public Aid. Now that will change.

According to the bill these provisions will go into effect “upon becoming law”. As a general rule we believe that means as soon as they are signed by the Governor. Of course, there will be some sorting out period as insurance providers determine who can offer services - what the credential qualifications will be - and providers, who haven’t been able to work through insurance companies before complete the process of credentialling with those providers. Still - the road has been opened and we can start our way down it!

Motiv-Aider in use - A Review

Sun, 27 Jul 2008 12:05:15 -0500

One of the more challenging things to administering reinforcement schedules is getting them to occur as written or designed. Parents and staff often have a lot more going on than just delivering a reinforcer on a schedule, and it can be easy to forget to get that bit of attention, edible, or what have you, delivered. Things get even more challenging when we look at high frequency and/or variable delivery schedules.

Several months ago we came across the MotivAider. This is a vibrating timer that provides an alert on a repeating schedule set by the user. For example, you can set it to a five minute schedule, and at the end of every five minutes it vibrates and starts counting down for the next interval. There is no need to manually re-set.

In addition, the MotiveAider also has an average rate setting, which lets the user set it at a given time, and it will repeat the schedule at a variable rate set around that average time. So, for that five minute interval it will first go off at five minutes, then at perhaps 4 minutes 30 seconds, and then at 6 minutes 15 seconds, and so on - perfect for a variable interval delivery.

This all looked pretty cool on paper, there was some time between discovery and the opportunity to put it into use. We recently started a consultation for a woman, living in a congregate setting, in which the indicated treatment plan included a relatively high frequency Non-Contingent Reinforcement (NCR) schedule of attention. It looked like the perfect opportunity to try the MotivAider out.

In this single application, at least, all reports are positive. The program is going well, the consultee is improving, and the staff and management at the agency appreciated the MotiveAider enough that they bought two of their own. The directions that come with the device are clear enough that we were able to make revisions in the NCR delivery schedule without needing to come in just to change the time setting on the device (a major plus when you are working in a primarily rural setting and “coming in” means driving a considerable distance.).

The next step for that particular program will be to adjust the NCR schedule by converting it to variable interval. This is something that is often challenging to do - it’s simply easier to remember to deliver a reinforcer at a fixed interval. However, with the staff relying on this little device, I’m a lot more comfortable that it will be done well. As of this first trial with it, the MotivAider gets a thumbs up!

Data Spreadsheet Pt 2 Understanding Relationships & Functions

Mon, 24 Mar 2008 16:16:41 -0500

Yesterday I posted a screencast introducing the Microsoft Excel data spreadsheet that Forest City often uses in different settings. That introduction covered what the different components of the sheet were.

This screencast goes into the relationships between the different worksheets within the spreadsheet. Specifically the template is designed to streamline data entry by allowing data entry in one location show up in multiple other settings. For example, when a case worker or data entry person puts in daily data counts, the other sheets keep running totals and daily averages, and plots that data on a graph. In the past these have often been individual activities.

However, for people who are not familiar with spreadsheets understanding how this all works together can be somewhat challenging. For this reason the process is outlined in this screencast.

At first posting the “Download Hi-Res Version Here” link will not be functional. The high-resolution versions take a little more time to export than the streaming versions. The page will be updated soon for those interested in downloading the training.

Some notes here about the screencast:

The screencast was composed with a new bit of software called Screenflow from Varasoft. This is Macintosh-only software that makes the process of generating and producing a screencast much, much simpler than it has been in the past.
These are the first screencasts we’ve put together for this or any other process - And this should be considered a rough draft. Your comments, critiques, and suggestions on how to improve this and future screencasts are encouraged.

Future plans for this space include some discussion about what goes into managing the business of behavioral consultation in a largely rural environment. These screencasts are a part of that - we do consultation and training for staff in a large geographic area. In-person training - which is ideal - can be very challenging when you are literally a hundred miles apart from one day to the next.

Introductory Spreadsheet Training Screencast

Sun, 23 Mar 2008 19:00:55 -0500

Applied Behavior Analysis (ABA) involves a lot of interaction with behavioral data. This can be a very time consuming part of the job, and it’s helpful to learn how to use spreadsheets to make this more efficient.

This can be a daunting task. Spreadsheets programs like Microsoft Excel are very powerful and useful tools, but they offer a staggering array of options that makes them intimidating for many new users. To this end when Forest City does consultation we often introduce a basic spreadsheet template for people to use. The screencast here is an introduction to that template.

Some notes here about the screencast:

The screencast was composed with a new bit of software called Screenflow from Varasoft. This is Macintosh-only software that makes the process of generating and producing a screencast much, much simpler than it has been in the past.
This is the first screencast we’ve put together for this or any other process - And this should be considered a rough draft. Your comments, critiques, and suggestions on how to improve this and future screencasts are encouraged.

Future plans for this space include some discussion about what goes into managing the business of behavioral consultation in a largely rural environment. These screencasts are a part of that - we do consultation and training for staff in a large geographic area. In-person training - which is ideal - can be very challenging when you are literally a hundred miles apart from one day to the next.

Behavioral Consultation in Illinois - Rural ABA

Sun, 23 Mar 2008 17:16:22 -0500

Attentive regular readers will already be aware that Forest City’s base of operations is in Illinois. People from outside of the state often seem to assume that the city of Chicago is essentially most of the state. On occasion it seems that people from the city of Chicago assume this as well.

This is, of course, not true. While Chicago does occupy a good portion of the Northeastern corner of Illinois the overwhelming majority of the state is rural in nature and thrives on an Agricultural economy - largely corn and soybeans. Outside of the greater Rockford area communities are small and typically separated by considerable expanses of farmland. Forest City is based in the Northwest Corner of Illinois in the state’s third largest city - Rockford. Despite being #3 in size the city of Rockford proper has a population of just over 150,000, and the greater Rockford area comes in at just over 300,000 people (compared to 9.7 million for the greater Chicago area).

What this means for ABA and Behavioral Consultation is that we serve people across a large geographic territory. Depending upon where we need to be on a given day consultation sessions can require nearly as much travel time as the session itself. Travel time is often not reimbursable, and the additional expense of transportation adds to overhead - making it challenging to offer services to more remote locations. This leads to people in these areas being significantly underserved, and it’s a problem that ABA services share with a number of other professions in rural locations.

In some ways Forest City Behavior has found ways to offer services to underserved areas, and in others we continue to struggle. Over the coming weeks and months I’ll occasionally write about the things that we do in order to spread services over a wider area. As a bit of a tease I’ll let you know now that some of the areas we’ve had to work into include:

Careful selection of vehicles for durability and economy.
Developing collaborative relationships with agencies in a variety of communities.
Extensive reliance on computer technology in a variety of ways.
Considerable research into the state’s funding structures for people with disabilities.

This won’t be our only topic over coming weeks, but it’ll show up on occasion. You’ll see today our first screencast posted on the website which is an example of this very topic.