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What's New with Autism in Early Childhood
2020 ASD State Conference Breakout session
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So thank you guys for joining me.
So now I'm just gonna take a moment
and kinda share a little bit about my background.
I coordinate the Early Childhood Special Education program
at the University of Nebraska-Lincoln.
It is a graduate training program
so we do work primarily with students
that are interested in working within early intervention,
or as early childhood special education teachers
within the public schools,
but our graduates end up in a lot of different settings.
We have a master's degree program
as well as offer initial teaching certification
for people that are interested in becoming teachers.
I myself have spent my entire education
learning about early intervention
with a specific focus on autism.
I am a Board Certified Behavior Analyst,
and I've worked in the field for about 20 years.
I like to say that I've had a lot of different hats.
So I have worked as a program manager
for an early intervention agency prior to coming here,
as well as worked as a behavior analyst for many years.
I've done a lot of training of graduate students
and people that work within the field.
And I've sort of worked with individuals
with autism across the lifespan.
However, focus has really always been on how
to support families, and children ages birth to five.
So today, I'm going to provide you an update on autism
as I see it in early childhood settings.
We'll focus specifically on children ages birth to five.
So there may be issues that occur outside of the age of five
and I'm happy to discuss those as well.
However, my focus will be really on that
under five population.
Now, I recognize that the way that we are perhaps
being asked to support children that have autism right now
is very different considering with the coronavirus outbreak.
And so I decided to keep this presentation focused on
how we would typically deliver services or supports
within the settings that we were in prior to this occurring.
However, I do want to encourage you to think about
how we might modify some of these things
as we start to deliver distance-based learning,
e-learning or even telepractice with children
that have autism and their families.
So today, before we get started,
I just wanna ask, just a request from me,
some of the things that I'll discuss today
I absolutely understand that we have
a variety of different people here joining us
that have different backgrounds, different training
and so I'm sort of sharing things from my perspective
and I want to encourage you to really have an open mind
and to think about how what I share relates to the work
that you're doing with children and families,
because it may be slightly different
than what you've heard before.
So, today, what we'll be covering first
is discussing the current prevalence of autism.
Then I'm going to provide you with information on
recommendations that were published
in the American Academy of Pediatrics,
and how I see that these recommendations
relate to Nebraska itself.
Then I'll be moving forward with providing you with a
what I think of as four high leverage practices
that we can engage in within early intervention
and early childhood special education
to best support families
and young children that have autism.
And finally, I'm hoping that we'll get an opportunity
where I can break you into groups,
and we're gonna try that out where you'll be in small groups
and get to discuss some of the things
that you've learned today.
Just to give you a little bit of information about autism,
I'm not going to go into the diagnostic criteria at length
but I recognize that there may be some people here
that don't have as much knowledge of what autism looks like.
And so I'm just gonna briefly touch on that.
So there are two areas
that when a child is diagnosed with autism,
we focus on looking at specific behaviors
in social communication and interaction.
So these are challenges that exist within those areas,
as well as the presence of repetitive
and restrictive behaviors.
And so those could be some of the behaviors that you see
such as hand flapping or maybe toe walking,
or it could be behaviors that occur pretty repetitively
and can cause some challenges when children are asked
to transition or move through their daily activities.
So a report was published a few days ago
and some of you may have seen this
that indicates that the current prevalence of autism
is now one in 54 children in the U.S..
And what we see is this is about a 10% increase from
where we were in 2018 at one in 59.
Now, this report documented data
from eight different monitoring sites.
So it's not looking at every single area
in the United States, but has been following
these different specific areas over time.
So that's important to know.
So autism now is considered a high-incidence disorder.
So it didn't use to occur or children weren't diagnosed
with that disorder many years ago, but now we're seeing
many more children that have this diagnosis.
What high incidence means is that it's very likely
that you would be working with a child
in the setting that you're in, that has autism,
or perhaps two or even more.
And so it's really important
that if you work in early childhood,
you have a sense of children that have autism
and how to best support them.
So there are a number of reasons for this increase
and so I'm just gonna share a few of those here.
First, there's now greater awareness of autism
so there is organizations like Autism Speaks
or also television shows that focus, or movies on autism.
Additionally, there have been changes
to the diagnostic criteria,
as well as the educational verification,
meaning that children may be were identified in the past
as having a different disorder,
and now they're being diagnosed as having autism.
Additionally, there are more access to services
and so one of the things we've seen in the last 20 years
is that laws have passed across all 50 states
with the last law passing this year in Tennessee,
saying that children can now access services and supports
for the autism diagnosis.
And this includes occupational therapy
or physical therapy or speech therapy,
but it also includes applied behavior analysis treatment.
So families are now seeking out that diagnosis
in order to access treatment in different ways.
Additionally, we now can diagnose children
before the age of two.
And that's a really critical, important point in that
we're not only able to see the signs and symptoms early
but we can also reliably diagnose children with autism
at a very early age.
And that early identification and diagnosis
is really critical for the best outcomes in young children.
The recent CDC monitoring showed that we are now seeing
that children are being diagnosed around 36 months of age
instead of where it used to be, which was 48 months of age.
However, in some areas, we still need to do a better job
of identifying and also diagnosing children.
Because what we know is that when they have this diagnosis,
and we do identify that they have autism,
we can then provide them with more appropriate services
which leads to better outcomes.
Some of the early markers for autism,
which some of you may be very familiar with
are limited social attention and communication,
repetitive or restrictive behaviors
that focus around objects.
One new finding recently is that children with autism
tend to have delays in motor development,
as well as the presence of challenging behavior.
When I was managing our early intervention program,
which was in Hawaii, we had a number of children
where we would see sort of global delays.
So they would be generally delayed in all areas,
and have a specific delay in motor development.
And a lot of those children were then
later on diagnosed for autism.
So it is a thing that we are recognizing now in our field.
These markers are evident as early as
12 to 24 months of age
and know that it's really critical for us to identify
these early markers in the first five years.
Because within those first five years
is when language and sensory pathways
and cognition and executive functioning skills
are really developing most rapidly.
And so when we identify autism early,
we can then provide that early intervention which allows us
to have the best in children.
So thinking about
the world we live in related to early childhood,
many of you are probably serving children
or supporting children that you think
may be developmentally delayed or perhaps there's a concern.
One of the things that we can do as a field
is to really make sure that we are setting up
monitoring as well as screening procedures
to identify if we think there's a concern there.
The other area is making sure that we're having
meaningful conversations with families.
And I know that throughout my work over the years,
one of the most challenging parts
is having those conversations with families.
And so I'm gonna talk about some resources in just a moment
that you might be able to utilize
as you think about how to have those conversations.
But often, I'm asked,
"What is the first thing that you can do?"
And I usually say that the first thing
that you can start doing is collecting a little bit of data.
So writing down those observations that you see,
so that when you have those conversations with families,
you're able to provide them with some information about
what you've observed and how it relates
to their child's development.
So what we know is when that child is then diagnosed
or verified, those assessment results themselves that report
often can help to guide intervention planning.
And one of the things that is really impactful for schools
is that if we're able to identify children earlier,
we can provide earlier intervention.
However, if we don't identify children earlier,
then the cost of providing services to these children
later on is much lower than it would have been
if we had worked with them earlier.
For example, the current, the cost in for example, in 2015
of Americans that had autism was about $268 billion,
and it's estimated that this would rise up to about
$461 billion in 2025.
And so for school children with autism often struggle
and need those specific autism interventions
to be in place to be successful.
In the state of Nebraska,
we're lucky to have an ambassador here
that represents the Center for Disease Control
Learn the Signs. Act Early initiative.
This initiative provides free materials to anyone
so that they can monitor children for developmental delay,
and also how they can talk to families about the things
that they might see in their child.
I highly recommend that you try to access these resources
as they are free, in addition to
the CDC's Milestone Tracker app.
This tracker app
is really helpful and actually, I use it with my own son.
He's four years old, but I am able to download the app
and look at what he should be doing developmentally.
And then I'm able to see sort of
what is the next step for him so that I can start to work on
some areas that are perhaps emerging.
However, for families, this can can be a really helpful tool
in just being able to see
how their child develops typically.
The tool itself has videos embedded
as well as other resources,
which can be really helpful to families.
So I just wanna throw up Kerry's information here.
Her email address is firstname.lastname@example.org,
and she's at the Munroe-Meyer Institute.
So if you have
team members or you are someone
that does work with young children,
she is happy to come talk to your team.
She also can get you access
to those resources that I discussed.
So now we're gonna shift towards focus on
discussing children specifically in Nebraska.
And so I'm going to share with you some data
that I have been able to find on children
with developmental delays or disabilities in Nebraska.
However, there may be other resources
that could potentially be helpful to you,
and know that this is really my interpretation
of what I've been able to find.
So the early childhood report
that came out last year in Nebraska,
it indicates that 45% of children in public schools,
and ESUs and Head Start,
that are served under the age of five
have an Individualized Family Service Plan
or an Individualized Education Program,
meaning they are receiving special education services.
So this report focuses on about 20,000 children,
and about 9,000 of those children have an IEP or an IFSP.
So we're looking at a lot of the children
that are being served in early childhood programs
do have delays or disabilities.
So it's very possible knowing the national prevalence
that many of these children do have autism.
So I wanna take a moment to look at the data that exists
related to the educational verification of children
that are receiving early intervention,
and also early childhood special education services.
So I can see that many of you are people
that are probably working within early intervention
or with children that receive Early Childhood
Special Education services.
And I think that as we move forward,
I'm going to focus specifically on that population
because I think it's likely that more children
in those settings are likely to have autism
and to receive support by the people
that are serving in EI or ECSE.
So if we first look at the educational verification
and you can see this graph here, on the y-axis
you can see it spans from zero to 1600 children.
Okay, so those are numbers of children.
And then on the x-axis we have the
years that have passed over the last,
let's say it's about nine years
that I was able to find data on.
Now, you can see there's a big gap in the middle,
and I wasn't able to find data
specifically on this period of time.
However, I'm showing you here what I was able to find,
and I think this data probably exists somewhere
I just wasn't able to locate it in the time that I had.
So what you can see here is I've identified
the red circles are children that are verified
with autism every year.
The triangles are children that are verified
with having developmental delay, and the,
the box are children that have,
that are verified as having a speech impairment.
And so one of the things that I really want you
to notice here is that there has been an increase
in children that are verified as having developmental delay
in early intervention over the past 10 years.
You can see that the speech impairment as well as,
speech language impairment as well as autism
have stayed relatively low.
And what we know within early intervention is that
children don't need to have a specific verification
other than developmental delay in order to access services.
And so many times children are not identified
as having a verification of autism
or a specific disability before three,
and they can still receive services and that's fine.
I'm gonna just take a moment
and break down autism a little bit more.
And please ignore the where it says, "Formula Bar."
Took a screenshot and didn't have time to redo this graph,
so I apologize there.
But what you can see here is that there has been
a slight increase with the autism verification.
So this is sort of, I just zoomed in on that autism piece.
Now, if you look at the child count,
we're only looking at zero to 40.
And so we're really seeing an increase of only about
20 or so children over the last 10 years.
And so, the reason that I'm sharing this data
is really because when we look at those national averages,
from the data that we have in Nebraska
and how we identify children under three,
we're not really able to clearly see
perhaps how many children do have autism.
And when you look at the speech language impairment,
what we could see is a decrease in children being identified
as having speech language impairment as a verification.
Which is just sort of an interesting finding,
it means that children are identified,
being identified more as having developmental delay,
less as having a speech language impairment,
and also just sort of relatively stable rates
of a child being identified as having autism.
So now we're gonna move on to looking at
the educational verification of children
that are in Pre-K settings.
So these are children that are ages three to five.
And what you can see here is similarly,
we've seen an increase in the number of children
that are verified in having developmental delay
in early intervention over the past 10 years.
You can see that the child count or how many children
has increased a lot from early intervention.
So we're now looking at around 3500 children
that were identified as having developmental delay
in those Pre-K settings.
What you can see with the speech language impairment is that
we actually saw sort of a crossover
where speech language impairment used to be higher,
and then decreased and you can see that developmental delay
increase at that time.
And when you look at autism, which is at the bottom,
it's sort of staying in a very stable rate,
maybe a little bit of an increase,
which we see even more blown up here.
So you can see here that really, we're seeing an increase
in autism, in Pre-K with verifications.
But that increase, you're looking at
about 150 children in 2010
to now being over 300 in 2019.
So it's still not as high
as maybe we would see if we were just looking at children
that were diagnosed with autism.
And we can continue to identify children in Pre-K settings
as having developmental delay, however, it's possible
that some of those children do have autism.
So let's take a look at if we were to compare it
with the national prevalence rates,
and we're looking at ages.
So I just sort of combined all the data.
So if we're looking at the number of children
that are verified
right now perhaps or last year as having autism
from ages birth to five,
we would see that there is about 387 children.
However, the national average would put us at about
over 2,000 kids being identified as having autism.
And so it's just I'm sharing this information
because I think it's helpful for people to know
and understand how we are verifying children
and more because I want you to
think about this a little bit.
So compared to the national prevalence
the children identified with autism is low.
And this could be due to the continuation
of speech language impairment
or developmental delay verifications.
But as I talked about throughout
the first part of this presentation,
that diagnosis or verification
really leads to better outcomes.
When we know that a child has autism,
then we can implement specific evidence-based practices
that focus on social communication.
And we can also work specifically on those behaviors
that occur knowing that there're specific practices
that are considered to be evidence-based for autism.
So I just want you to think about as a field, perhaps,
what changes we might need to make in early childhood.
And I think it's more that I'm just
giving you some things to ponder.
The second thing that I'm gonna have you ponder a little bit
is that we have another challenge in that
we need to make sure that the
educators and professionals in Nebraska
are very strong in their understanding
of evidence-based practices as it relates to autism.
Now, Mindy Chadwell and colleagues,
Mindy's at the Munroe-Meyer Institute,
examined some data that the Buffett Institute collected
from their early childhood needs surveys.
And these data showed that
19.6% of Nebraska early childhood educators
felt prepared to work with children with disabilities.
So it is reasonable that some teachers
might feel that they need more training
in these types of practices, and specifically,
how to support children that have autism.
Now, I just wanna say that I work in Nebraska
and I have been here now for several years.
And I work every single day
with people that are currently working in early intervention
and as early childhood special education teachers
And what I can tell you is that the teachers
and the professionals here are so dedicated to learning,
just as you all are here at this conference,
about how to support children in the best way possible.
Specifically, I see so many people
that are interested in learning about autism,
and that really want to be well-trained.
And so I'm gonna share with you
a few, what I would consider to be high leverage practices.
And those high leverage practices,
I think can be helpful for administrators,
educators, and professionals
that are wanting to learn more about autism.
There are so many different things that we can do.
And so it's hard to identify where to start.
And I'm hopeful that this will give you
a little bit of a foundation for thinking about
the key practices that you should be engaging in.
And the first is really to look at how all team members
are well-trained to use applied behavior analysis,
and also implement Naturalistic Developmental
Behavioral Interventions for children with autism.
And I'll share what that is in a minute.
Additionally, we wanna make sure that we have a strong focus
on supporting caregivers and families.
There are specific,
and there's a lot of research out there about this.
There are specific needs of parents
that have children with autism.
And we know that parent training is effective,
and that there are lots of ways that we can engage families.
Ultimately, we as providers see children
for just a period of time, and so our goal
should really always be to determine
how we best support the family in using those interventions
within their home and community setting with their child.
Additionally, we need to make sure that we are engaging
in teaming practices for young children with autism
that are collaborative, where we do two things,
one, use what we call a primary service provider approach,
and also that we have agreed upon practices
and interventions that we're using with those children.
Additionally, and recently, Nebraska has adopted
using a multi-tiered system of support,
and teaching teachers to engage in these practices.
And I would say that there are many ways
that this different tiered levels of support
can help us to best identify
the needs of children that have autism.
So let's start by just talking about team members
being well-trained in autism, and what we call NDBIs
or Naturalistic Developmental Behavioral Interventions.
First, I'm just going to discuss ABA, and I know that.
I'm sorry, first I'm going to discuss
the range of autism interventions.
And I know that there is a range, okay so, what we,
there are so many different interventions out there
for children that have autism.
And so this is how I conceptualize it
and capture the information,
but I'm sure that there's other ways
to think about this as well.
So the way that I think about interventions
is that there are interventions
that are based in applied behavior analysis,
or have a more functional perspective
versus those that do not have a functional perspective.
Interventions that tend to be more child-directed,
developmental, and naturalistic,
such as you may have heard of Floortime
or Relationship Development Intervention,
those approaches tend to be more child-directed,
developmental and naturalistic, and don't often include
components of behavioral interventions.
Then on the other end of the spectrum,
we have interventions that are more adult-directed,
that are structured and also behavioral.
And those approaches you may have heard of,
such as Lovaas Discrete Trial,
or using a Verbal Behavior approach.
And I've just put here
some years when these approaches came about.
Now in the middle, what we have are what's called
Naturalistic Developmental Behavioral Interventions.
And what these approaches do is that they combine
those more child-directed approaches
with more adult-directed approaches.
And these particular approaches in the middle here,
have developed comprehensive models for addressing
all of the skills or most of the skills
that young children need to learn in order to be successful.
Now, what we know about applied behavior analysis, which
is that we have a large body of research
that supports the use of applied behavior analysis
for children with autism, specifically what's called
Early Intensive Behavioral Intervention.
There are a number of studies that show that
intensive intervention is effective for young children.
Some of these studies look at the use of intervention that
focuses on 25 to 40 hours a week
of intervention for children.
So that's sort of the one end of the spectrum.
But we also know that there are a lot of
well-conducted studies now that show
that young children with autism,
while they benefit from behavioral approaches
they also benefit because they are younger
and they're learning within their natural environment
and within play, that they benefit from
more naturalistic developmental behavioral interventions
that are embedded within daily routines.
And so these types of approaches really blend ABA
and developmental science together,
and they use aspects of both types of those approaches.
As a behavior analyst I have worked in the field
for many years,
and initially I started out being trained in a
model Verbal Behavior classroom.
And so I was trained to use an approach
if you've heard of Carbone, Vincent Carbone,
he was part of this project in Pennsylvania
and I was trained in a patent classroom,
where we delivered a very strict Verbal Behavior program.
Through my work in the field, what I found was that
with young children that have autism that are with families,
and where we're teaching families
to engage with their children,
those VB approaches, while they are effective,
can be enhanced through the use of
these more naturalistic approaches,
and some of them include the Early Start Denver Model,
which is Sally Rogers and colleagues at the MIND Institute.
An approach that's called Project ImPACT
that was created by Brooke Ingersoll and Anna Dvortsak.
And then also Pivotal Response Treatment,
which some of you may have heard of before,
which was developed by the Koegels
and also Laura Schriebman.
So these are, I would say,
the three evidence-based approaches
that have been manualized in a way
that people can pick them up and deliver them.
I would say the first two, perhaps more than the last one,
but I think that they all are deliverable
by people being trained to learn how to use them.
So what we've seen then is that,
and what I've kinda come to the realization
over the years looking at the research,
but also looking at practice and how early interventionists
can work with families is that really we need to use
a combination of these approaches,
and within those Early Intensive
Behavioral Intervention programs we can embed
Naturalistic Developmental Behavioral Interventions.
I know it's a lot of acronyms.
And so an example of that is that prior to coming here,
as I mentioned, I did work as a program manager
for an early intervention agency.
And so we had
a number of behavioral consultants
that would work with some of our children.
They were not BCBAs,
but they would provide more direct services.
And then in combination with that, we would have our staff
who were occupational therapists or physical therapists
or speech language pathologists or teachers,
they would implement Project ImPACT with families
and I'm gonna share an example of that in just a minute.
And so there really are ways
to incorporate both types of interventions.
However, it does take a lot of training
and a lot of expertise in how to deliver
those types of services.
Now, in terms of Early Intervention,
and when you're looking at Behavioral Intervention, or EIBI
research-based approaches include the Lovaas,
which we do have here in Nebraska, where they're providing
Early Intensive Behavioral Intervention services,
as well as using a Verbal Behavior approach,
which may be based on the Verbal Behavior Milestones
and Placement Program Assessment.
Or even more recently now there has been some research
supporting what's called the PEAK Approach,
which is sort of an evolution of what's called
relational training or relational frame theory
and thinking about how we,
how we deliver these types of services
in a slightly different way than we had been before
and specifically, more specifically for children
that are higher functioning.
I wanted to share too, in case you are interested,
this textbook by Travis Thompson
at the University of Minnesota, it's called
"Individualized Autism Intervention for Young Children."
This book does a nice job of talking about
how you blend discrete trial or more structured approaches
with naturalistic strategies.
And more specifically, he talks about how you embed
those interventions within, to daily classroom routines.
And I think for many of us, we are in settings
that where we do have children
that are in those classroom settings.
And so we need to think about
how we're individualizing intervention
for the children that are there.
One of the things that the research has told us recently
is that we still need to do more research.
So we know that these approaches are effective.
We know that for young children, naturalistic developmental
behavioral approaches are effective.
But we still need more research to tell us about
the best intervention agents meaning the people
that are delivering these types of services.
We also need to know more about intensity of hours
and the number of hours.
And so there has been some recent research
that's come out that is looking at those components.
And so one of those is a research study
that's being done by Sally Rogers
at the UC Davis MIND Institute with a number of colleagues.
This research study is called Intervention Effects
of Intensity and Delivery Style for Toddlers With Autism.
And this particular study looked at comparing
Early Start Denver model with Lovaas Discrete Trial
in a randomized control trial.
And it had a number of children,
so was able to see over a lot of different children,
which approach maybe is the more effective.
And they were looking at these two approaches
and comparing them.
And what they found was that children that were using both
or that had interventions from both approaches
had similar outcomes, regardless of their level of need,
regardless of the hours of intervention.
And so what this tells us is that,
while we know that intensive intervention is effective,
we also have to look at,
could we deliver a lesser amount of hours
if we know that that person is very well-trained?
And so I want you to think a little bit about
your own practices related to children with autism
and how we learn.
So when you think about learning
and how we are training ourselves
to be effective supporters of children with autism
or their families, we know that there's a number
of different ways that we can learn.
So the first is that we might
complete some internet modules or read some documents,
or perhaps you go to a professional development opportunity
like this one.
You also could receive coaching on the job by experts,
which is a possibility as well as
what would be maybe
a more intense approach to learning about autism
is to pursue some sort of certification or degree.
And so I just wanna take a moment to talk just briefly about
what's called the Board Certification and Behavior Analysis,
or the BCBA.
So there are,
and I myself am a Board Certified Behavior Analyst.
And so these are training programs
that really focus on people understanding
the principles of behavior analysis,
but many of them focus specifically on autism.
There are four different credentials that are within
and offered at different levels depending on who you are.
However, I'm gonna focus specifically in
on that master's degree level.
So right now, in the United States,
we've seen a really drastic increase in the number of people
that are seeking out this type of certification.
So I was certified in 2007
and there 3,000 behavior analysts at that time.
Now there are almost 40,000 behavior analysts,
which is a pretty significant increase over time,
and a lot of that has been because now,
insurance is covering these services across states
and so people are able to provide the service
and seeing the benefit of becoming a BCBA.
So this is one method.
And when I think about the BCBA,
working within educational settings
it might look something like this.
You have your child with autism,
a direct service provider perhaps that's a paraprofessional,
but in the behavior analytic world
that could be a behavior technician,
or what's called a Registered Behavior Technician.
And then you have all your team members,
so everybody that's supporting this child.
And perhaps one of those team members
is a Board Certified Behavior Analyst.
And so she's or he is then able
to help support the team members.
And one of the things that's really helpful
is that they can also provide parent care
or caregiver support and training.
And so then that caregiver is able to work specifically
with their child through the support
of all of the team members and perhaps the BCBA.
Now in Nebraska, you have only one program
that exists at the master's level,
which is a joint program between the Munroe-Meyer Institute
at the University of Nebraska Medical Center,
and the University of Nebraska Omaha.
You also have a number of people that work
in the autism spectrum disorders network
that are behavior analysts or are currently seeking out
certification in behavior analysis.
Additionally, Midland has a training program
for people that are interested in getting their bachelor's
and becoming what's called a Board Certified
Assistant Behavior Analyst.
I wanna take a moment and I'm gonna pause
and I have been supervising
a teacher that is seeking
her board certification in behavior analysis.
And so I wanted her to take a moment to talk about her role,
but then also sort of how she got to
the decision of becoming a behavior analyst
and how that's been helpful for her within the schools.
So Lizzie, I'm gonna try to find you and unmute you.
Hi. Oh, there we go.
Yes, can you hear me? Yep, all right.
Okay, so my role currently is
a preschool special education teacher,
or an ECSE in a preschool classroom.
But I am also pursuing my master's degree
in applied behavior analysis and working toward becoming
a Board Certified Behavior Analyst.
I found this path after I had a class
in behavior management with John Maag at UNL.
I think a lot of us who went to UNL
got to sit in on his class and he gave a lot of information
just about behavior management,
and working with challenging behaviors,
but also working with students who have autism.
And when I left that class,
I was just wanting more training, I was wanting to know more
and I felt like we just got like a tiny little piece
of what working with students with autism was like.
And so I reached out to him, and I asked,
hey, how can I get more information on this topic,
it's something I'm really passionate about?
And he directed me to a master's program
in applied behavior analysis.
And so that is what I'm currently pursuing,
I will graduate in August, so pretty soon.
And I found this program just to give me
more information on the subject
but it also partnered me with a supervision experience.
So within that supervision experience
I have had the chance to connect with Johanna every month,
maybe even multiple times a month,
and I get advice and critique and we work together
on implementing interventions with my students,
and it just gives me an extra level of training
and a level of supervision where if I have questions
or if I'm not sure how to address
a problem behavior that's going on
I have someone to just lean on and ask
and get some great advice from.
So this training definitely led me to feel more prepared
working with my students, not only students with autism,
but the variety of students with developmental delays
that we work with.
All right, thank you, Lizzie.
Yeah, and I've supervised a number of people over my career,
but I've really enjoyed being able to work with Lizzie
and sort of see how
the knowledge that she's learning about autism
and behavior analysis then applies to
how she works with her students in her classroom.
And it's been a really fun experience.
So thank you, Lizzie for sharing about that.
So now I'm just gonna share just briefly,
a little bit about some legislative updates
that have happened that you might not be as familiar with.
So I mentioned that autism insurance
is now covered in all 50 states.
So this law went into effect
in the state of Nebraska in 2014.
And if you type in LB 254, you can look up that exact law.
And what that says is that children with autism
are able to receive behavioral interventions
and behavioral health services
specifically applied behavior analysis treatment,
as well as other interventions.
And so sometimes I think that often as providers,
we're not necessarily aware that this law has passed
because what it really means is that families
across the state of Nebraska can be accessing ABA,
which is a really critical component to
for families and children with autism to be successful.
Additionally, last year a law passed
which is LB 619 that said that mental health services
can be delivered in school settings.
So for administrators, it's just something to consider
in that we have the ability now to bill insurance
for these services and when we think about
and to also deliver them within school settings.
And so when we think about the support that children need,
it's possible that one idea may be to utilize
behavior analysts that are then billing insurance
in collaboration with teams
that are working within early childhood.
So just something to be aware of,
because these services now are accessible to families
and that support is available for others
that are working with those children.
So we get to our next point of thinking about teaming.
I mentioned what's called the primary provider approach,
and having purposeful collaboration
and an agreed upon intervention.
So one of the biggest challenges that I've seen
in early intervention and in Pre-K settings,
is that we all come from so many
different training backgrounds, okay so.
And when you think about all of our different philosophies
and how we deliver services, oftentimes they conflict.
And so for children with autism, it's really critical
and really for any child,
that we all come to an agreed upon intervention approach,
meaning we have conversations and talk about
how we're gonna be delivering those services,
and what types of approaches
we're all going to use together.
Additionally, we know in early intervention
that the primary service provider approach model
which is having one specific person work with the family
and with the support of all of the other providers.
This model can also be used in ECSC settings.
So for example, we have one primary person
that designs the plan that supports the child,
but then all of those other providers
help to support that person first as working individually.
And I truly believe that,
and I love this quote by Henry Ford
that if everyone's moving forward together,
then success takes care of itself.
And I would say that communication, collaboration
and teaming are things that we don't often make time for,
but they are the critical components that will help to move
our services forward.
Additionally, making sure that we are training
and educating families and supporting them.
And so we do this in early intervention
because we're already having access to the family.
But often in Pre-K settings,
we don't necessarily include the family
other than by maybe sharing what's happening,
during IEP meetings.
And so, I think that as a field,
we have the ability to better engage families
to create ways to communicate better with them,
but then also to set up training at any point
where they can learn more about the interventions
that we're implementing with our children.
One such approach that is evidence-based
is what's called Project ImPACT.
And this is an approach that I've studied within my career.
This approach just came out with a new manual last year.
And so it actually comes with materials,
and PowerPoint presentations and video examples
that are available.
And what I've been doing in my classes
is actually teaching my students to use this approach
and then to go use it with families.
And while there are obvious challenges with doing that,
I think that I found it to be an approach that
people can learn to use,
but it also incorporates a lot of interventions
that you might be familiar with already.
So I just wanted to mention that here.
Additionally, Early Start Denver Model
recently within the last couple of weeks
came out with some online modules that are available
for practitioners to use and also families,
and they're completely free.
And so I put the link here for you guys,
it's called Help Is In Your Hands.
And they focus specifically on
young children with autism or developmental disabilities
and how to engage using those naturalistic approaches.
So I wanna just take a moment to shift and share.
Actually, I think what I'll do is,
I'm gonna come back to this at the end if we have time
'cause I wanna make sure I give you a little bit of time
to talk to each other.
So I'm sharing some of these ideas with you of what are
more high leverage practices,
but I also want you to think about
how they apply in your own settings, okay.
So when we think about the last key component,
which would be multi-tiered systems of support.
We in Nebraska have now adopted the use of MTSS.
There are a number of different tiered systems of support,
one being the Pyramid Model,
which many of you are probably very familiar with.
Rooted in Relationships and the Department of Education
have done a really nice job of developing
and are working towards developing coaching systems
that can really support educators across the state.
So that's been really nice to see.
Additionally, just for all educators,
the Department of Education is promoting the use of
Nebraska MTSS Framework.
And one of those aspects is what's called
the Layered Continuum of Supports.
And so I'm gonna take a couple minutes here
to just think about how we might implement those
Layered Continuum of Supports within early intervention
and then also within early childhood special education.
And then I'm gonna try to break you into groups
for the last 10 minutes and then we'll come back together.
Okay, so when we think about early intervention
and I'll be honest with you,
I could do a whole presentation on how to deliver
these tiered supports within early intervention
and Early Childhood Special Ed, but I'll kinda,
what I've done here is I'm summing up a few key points
I think could be helpful to you.
So we have our first tier,
which is we are working with families,
we're starting to serve families,
and perhaps those families are in need of
simply developmental support.
So understanding their child's development.
For children with autism,
what we might do is focus more on parenting resources
that support families in understanding the,
and accessing resources within their community,
as well as trainings that they might participate in
or perhaps support groups.
Okay, so some families that's gonna be enough
because they will be able to
support their children independently on their own,
but for other families, we may need to take
a more autism-specific parent coaching approach,
meaning, we don't just use the strategies
that we know as effective, but we really look at
some of those more manualized approaches
to teaching parents very specific skills about autism.
And so those are some of the approaches
that I just talked about.
So perhaps, then we're delivering
this higher level of service
because parents need more specific information
about parent coaching as it relates to autism.
Now, there will be other families where
those children have more significant needs, and so
we may need to continue to do
that parent coaching specific to autism.
However, we may also need to include
possible direct intervention.
So that could be the provider
working directly with the child
which may mean that we're increasing the frequency
and intensity of services, or we're increasing
how frequently we do parent coaching.
So we're working more consistently with the family.
Or perhaps we're partnering with an ABA provider,
and we're looking at how we can collaboratively
provide services to children
that have more significant needs.
Now, when we look at early childhood classrooms,
while I know that there are a range of
different classrooms across the state of Nebraska,
and I don't know about the specifics
of all of those classrooms,
what I have seen in the larger districts is that
we often think that children,
there's sort of a 50-50 split in inclusive classrooms.
So we have 10, let's say it's 20 children,
10 of those children have developmental delay
or other disabilities, and then 10 of those children
don't qualify for services
so they're considered to be typically developing.
Now what I'm seeing is one of the challenges in Nebraska
is we have a large immigrant population.
And so we have a lot of children
whose families do not speak English.
And so in many cases, we're seeing what.
And I will just say, I don't have any data to support this
but what I observe is that we have these children
that have autism, and they require more specific supports.
And then we have children that are developmentally delayed,
as well as English language learners.
And so there are challenges there
with delivering support and services to those children.
And so what I see oftentimes
is that the educators have a difficult time
with providing support to all of the children
because they spend more time trying to figure out
how to support those children that have autism.
And oftentimes, they are doing their best
they're trying to use the knowledge they have.
However, without additional resources,
they may not be successful.
And so when we think about inclusive classroom environments,
we're really looking at that first tier
as being support that we provide to all children.
Okay, so responsive teacher child interactions,
high quality environment for children with autism,
that might mean also putting in modifications,
or adaptations that are specific to children with autism,
such as visual supports, or perhaps
transition tools that help throughout the day,
and those are gonna help all kids anyway.
And then our second tier might be having some brief plans
that focus very specifically on teaching skills
and creating more opportunities for children
to learn more specific skills within daily routines.
And I see as one of the critical pieces of this
is training our paraprofessionals to be able to embed
those interventions within the daily routine,
and really focusing on how every single team member
is involved in that process.
And additionally, the third tier would then be looking at
children that really need more intensive support.
Okay, so they need a more individualized program.
They need a comprehensive plan
as it relates to children with autism,
really in all developmental areas.
And for that to be successful, really, we need to look at
how we decrease staff to child ratio,
how we increase that one-on-one support throughout the day,
and how we train everybody to be part of the team
so that no matter who is supporting that child,
they know how to use the same exact interventions.
And I recognize that this is a challenge
specifically for administrators to look at
how to provide that additional level of support,
but really when we're implementing MTSS
we have to look at not only
what type of support that child needs,
but how do we create and provide the resources
to the educators in those settings.
Okay, so I know I've probably given you
a lot to think about, and what I'm gonna do here
is I'm just gonna share one more time for you,
and I actually will copy this
and I hope this saves into the; oh, no, I can't do that,
into the Chat function.
But what I'd like to do is try to break you into groups.
We have about 15 minutes left.
And so I want you to take about, let's say 10 minutes
to just talk in small groups and think about
how you are using the high leverage practices
that I discussed, so that's team members being well-trained,
autism-specific parent support, teaming practices,
as well as using the multi-tiered systems of support
specifically looking at the amount of support
that's provided and resources for each particular child.
And I want you to introduce yourselves,
and then talk about are you using these practices
or how could you work towards those practices?
So Jamie, can you see
if you can split everybody into groups,
from your end?
I've just split everybody into groups
and then I think I hit the button Open All Rooms--
Okay, so let me just say something before that,
so you should, so what's gonna happen is then
you'll be split into rooms and then Jamie will,
you stay here, can you do that?
I don't know if you can stay here specifically,
but then we'll bring you all back together.
And just take a few minutes to talk amongst yourselves
and have an opportunity to engage with one another
however you feel comfortable.
Looks like people are figuring it out
so that's good.
You usually have to press something
that puts you then into the group.
And there may be some people that--
Pause the recording right now Johanna.
You can if you want to.
I will start it back, okay.
All right, so thank you everyone
for making it back into the room.
Some of you are still coming back in.
I hope that you found that was a okay experience to kinda
take a listen to some of the other people
that are attending and how they're,
what their experiences are.
If possible, would a few of you be willing
to just share in the Chat function,
maybe one or two things that you talked about as a group.
I know it was just a very short period of time,
but I would love to hear anything.
We kinda talked about like our positions
and how the high level leverage practices
pertain to each of our different positions.
Okay, that's great, yeah, and I think it's a,
it definitely needs to be a team approach, right?
But everybody does play a different role,
specifically when you have younger children.
So yes, absolutely.
Okay, Mandy, you said teaming is time consuming
but highly beneficial.
It absolutely is, and that's one of the things that I found
in the, just in general in interdisciplinary work,
people often aren't getting paid to team,
to engage with one another,
but we definitely need that to happen
in order to be successful.
Okay, and Lizzie, "So we talked about
"providing parents support," yep,
"during home visit sessions or IEP meetings,"
that's really critical, awesome.
Yep, turnover of staff is a factor absolutely.
Why disparity of application of programs?
Yep, and getting everybody trained.
And I think, we're all working, the way that I see it
is we're all working together in the best way that we can
to support the kids that are in Nebraska.
And I think everybody's at different levels
of trying to figure this out.
Okay, we would love to increase verification
at the birth to three level.
Yeah, and I think that's sort of one of the things
I wanted you to think about,
is that we don't need to verify children with autism
under three because they can receive services
through that developmental delay verification.
However, if we want the family to access
any sort of outside service,
that verification is gonna be helpful
in terms of getting that diagnosis.
Yep, Katie, you're having a clear philosophy of program.
Yep, it absolutely makes handling pair training
and staffing, definitely but it's more challenging.
And I think that, my mention of having a clear philosophy
or program philosophy as it relates to intervention,
those are conversations that need to happen over time.
And it's not gonna happen in a week where we just decide
this is how we're gonna do things.
It's really a process that we come that we wanna go through
in order to determine as a team how do we all think
and how do we all support children.
And starting with children with autism can be helpful
because we at least know what evidence-based interventions
are available for that population?
Okay, so I'm gonna stop there,
thank you guys so much for sharing.
I'm just gonna take a moment
and if anybody has any questions,
I told Jamie, I am happy to stay afterwards.
Meaning we can just hang out here.
So if anybody has a question they wanna ask
and then you're also welcome to pop off
if you wanna head out.
Any questions at all?
Yeah, and thank you guys for being here.
It's been really fun to have you
and I hope I gave you lots to think about.
Oh, thanks, Brionne.
Oh, and feel to get in touch with me too.
I didn't actually do my summary statement, but that's okay.
My email is actually johanna.taylor,
'cause I just got married recently @unl.edu.
I'm always wanting to think about
all of the things I talked about today,
so happy to talk to anybody about it at any point.
Okay, so, Jamie, I think we can wrap up.
Oh, we have one question.
Could I offer a session how to do this in home visiting?
Absolutely, and I will keep that in mind
and submit next year.
I have a whole nother presentation
on how you would do this in a,
more specifically in home visiting.
"If you have a student with a DD..."
Pandora, that's a good question and
the answer would be yes, you should.
Johanna we're not able to see that on this side,
I don't think. Yeah, I know.
Yeah, so any child that, in order for children
to receive services through special education
they need to have an educational verification,
they can't just have a developmental delay diagnosis
or a diagnosis from a clinical psychologist
or someone like that.
So they would need to be evaluated, any child that,
in order to access special education services
they would need to be evaluated by the district or ESU,
in order to, and go through an evaluation
and provide that educational verification
as well as qualify the child for services.
Well, thank you very much, Johanna.
Yeah, thank you, lots of fun, good to see you.
Hear from you again at the next conference.
So thanks everybody for joining.
We will see you for the next sessions.
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