What's New with Autism in Early Childhood

Johanna Riggings Author

04/05/2020 Added

50 Plays

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2020 ASD State Conference Breakout session

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[00:00:00.500]So thank you guys for joining me.
[00:00:02.900]So now I'm just gonna take a moment
[00:00:05.780]and kinda share a little bit about my background.
[00:00:10.440]I coordinate the Early Childhood Special Education program
[00:00:14.660]at the University of Nebraska-Lincoln.
[00:00:17.520]It is a graduate training program
[00:00:19.750]so we do work primarily with students
[00:00:22.470]that are interested in working within early intervention,
[00:00:26.260]or as early childhood special education teachers
[00:00:29.370]within the public schools,
[00:00:31.540]but our graduates end up in a lot of different settings.
[00:00:35.460]We have a master's degree program
[00:00:37.010]as well as offer initial teaching certification
[00:00:40.610]for people that are interested in becoming teachers.
[00:00:44.780]I myself have spent my entire education
[00:00:49.590]learning about early intervention
[00:00:52.010]with a specific focus on autism.
[00:00:54.780]I am a Board Certified Behavior Analyst,
[00:00:57.647]and I've worked in the field for about 20 years.
[00:01:00.260]I like to say that I've had a lot of different hats.
[00:01:03.540]So I have worked as a program manager
[00:01:08.380]for an early intervention agency prior to coming here,
[00:01:12.150]as well as worked as a behavior analyst for many years.
[00:01:15.980]I've done a lot of training of graduate students
[00:01:18.650]and people that work within the field.
[00:01:20.950]And I've sort of worked with individuals
[00:01:23.010]with autism across the lifespan.
[00:01:25.720]However, focus has really always been on how
[00:01:29.340]to support families, and children ages birth to five.
[00:01:34.380]So today, I'm going to provide you an update on autism
[00:01:39.870]as I see it in early childhood settings.
[00:01:42.810]We'll focus specifically on children ages birth to five.
[00:01:48.670]So there may be issues that occur outside of the age of five
[00:01:52.320]and I'm happy to discuss those as well.
[00:01:55.260]However, my focus will be really on that
[00:01:57.970]under five population.
[00:01:59.800]Now, I recognize that the way that we are perhaps
[00:02:04.740]being asked to support children that have autism right now
[00:02:08.650]is very different considering with the coronavirus outbreak.
[00:02:14.770]And so I decided to keep this presentation focused on
[00:02:20.630]how we would typically deliver services or supports
[00:02:24.640]within the settings that we were in prior to this occurring.
[00:02:28.240]However, I do want to encourage you to think about
[00:02:31.530]how we might modify some of these things
[00:02:34.920]as we start to deliver distance-based learning,
[00:02:39.130]e-learning or even telepractice with children
[00:02:43.410]that have autism and their families.
[00:02:45.620]So today, before we get started,
[00:02:48.430]I just wanna ask, just a request from me,
[00:02:51.600]some of the things that I'll discuss today
[00:02:54.000]I absolutely understand that we have
[00:02:56.530]a variety of different people here joining us
[00:02:59.750]that have different backgrounds, different training
[00:03:02.610]and so I'm sort of sharing things from my perspective
[00:03:06.400]and I want to encourage you to really have an open mind
[00:03:09.370]and to think about how what I share relates to the work
[00:03:13.540]that you're doing with children and families,
[00:03:17.660]because it may be slightly different
[00:03:19.460]than what you've heard before.
[00:03:21.310]So, today, what we'll be covering first
[00:03:24.290]is discussing the current prevalence of autism.
[00:03:28.120]Then I'm going to provide you with information on
[00:03:32.090]recommendations that were published
[00:03:34.480]in the American Academy of Pediatrics,
[00:03:36.930]and how I see that these recommendations
[00:03:39.810]relate to Nebraska itself.
[00:03:43.090]Then I'll be moving forward with providing you with a
[00:03:47.380]what I think of as four high leverage practices
[00:03:51.430]that we can engage in within early intervention
[00:03:54.730]and early childhood special education
[00:03:58.130]to best support families
[00:04:00.040]and young children that have autism.
[00:04:02.470]And finally, I'm hoping that we'll get an opportunity
[00:04:05.820]where I can break you into groups,
[00:04:07.747]and we're gonna try that out where you'll be in small groups
[00:04:11.150]and get to discuss some of the things
[00:04:12.960]that you've learned today.
[00:04:17.340]Just to give you a little bit of information about autism,
[00:04:21.110]I'm not going to go into the diagnostic criteria at length
[00:04:25.680]but I recognize that there may be some people here
[00:04:28.570]that don't have as much knowledge of what autism looks like.
[00:04:33.210]And so I'm just gonna briefly touch on that.
[00:04:35.810]So there are two areas
[00:04:37.620]that when a child is diagnosed with autism,
[00:04:41.640]we focus on looking at specific behaviors
[00:04:44.730]in social communication and interaction.
[00:04:47.720]So these are challenges that exist within those areas,
[00:04:51.230]as well as the presence of repetitive
[00:04:53.720]and restrictive behaviors.
[00:04:55.490]And so those could be some of the behaviors that you see
[00:05:00.090]such as hand flapping or maybe toe walking,
[00:05:04.550]or it could be behaviors that occur pretty repetitively
[00:05:08.120]and can cause some challenges when children are asked
[00:05:11.160]to transition or move through their daily activities.
[00:05:15.920]So a report was published a few days ago
[00:05:18.510]and some of you may have seen this
[00:05:20.210]that indicates that the current prevalence of autism
[00:05:23.090]is now one in 54 children in the U.S..
[00:05:28.010]And what we see is this is about a 10% increase from
[00:05:32.560]where we were in 2018 at one in 59.
[00:05:37.980]Now, this report documented data
[00:05:41.640]from eight different monitoring sites.
[00:05:44.500]So it's not looking at every single area
[00:05:46.990]in the United States, but has been following
[00:05:50.370]these different specific areas over time.
[00:05:53.170]So that's important to know.
[00:05:55.290]So autism now is considered a high-incidence disorder.
[00:05:59.780]So it didn't use to occur or children weren't diagnosed
[00:06:03.210]with that disorder many years ago, but now we're seeing
[00:06:06.880]many more children that have this diagnosis.
[00:06:10.450]What high incidence means is that it's very likely
[00:06:13.700]that you would be working with a child
[00:06:16.550]in the setting that you're in, that has autism,
[00:06:20.050]or perhaps two or even more.
[00:06:22.500]And so it's really important
[00:06:23.650]that if you work in early childhood,
[00:06:25.830]you have a sense of children that have autism
[00:06:29.790]and how to best support them.
[00:06:32.070]So there are a number of reasons for this increase
[00:06:36.610]and so I'm just gonna share a few of those here.
[00:06:38.680]First, there's now greater awareness of autism
[00:06:42.160]so there is organizations like Autism Speaks
[00:06:45.220]or also television shows that focus, or movies on autism.
[00:06:50.390]Additionally, there have been changes
[00:06:52.550]to the diagnostic criteria,
[00:06:54.790]as well as the educational verification,
[00:06:58.000]meaning that children may be were identified in the past
[00:07:02.070]as having a different disorder,
[00:07:04.550]and now they're being diagnosed as having autism.
[00:07:07.880]Additionally, there are more access to services
[00:07:12.250]and so one of the things we've seen in the last 20 years
[00:07:15.990]is that laws have passed across all 50 states
[00:07:19.400]with the last law passing this year in Tennessee,
[00:07:22.530]saying that children can now access services and supports
[00:07:26.660]for the autism diagnosis.
[00:07:29.730]And this includes occupational therapy
[00:07:32.840]or physical therapy or speech therapy,
[00:07:34.940]but it also includes applied behavior analysis treatment.
[00:07:39.870]So families are now seeking out that diagnosis
[00:07:42.610]in order to access treatment in different ways.
[00:07:46.380]Additionally, we now can diagnose children
[00:07:50.470]before the age of two.
[00:07:52.500]And that's a really critical, important point in that
[00:07:56.360]we're not only able to see the signs and symptoms early
[00:07:59.890]but we can also reliably diagnose children with autism
[00:08:04.080]at a very early age.
[00:08:06.360]And that early identification and diagnosis
[00:08:09.740]is really critical for the best outcomes in young children.
[00:08:14.090]The recent CDC monitoring showed that we are now seeing
[00:08:20.500]that children are being diagnosed around 36 months of age
[00:08:24.360]instead of where it used to be, which was 48 months of age.
[00:08:28.270]However, in some areas, we still need to do a better job
[00:08:32.000]of identifying and also diagnosing children.
[00:08:35.220]Because what we know is that when they have this diagnosis,
[00:08:40.270]and we do identify that they have autism,
[00:08:43.260]we can then provide them with more appropriate services
[00:08:47.080]which leads to better outcomes.
[00:08:49.420]Some of the early markers for autism,
[00:08:52.720]which some of you may be very familiar with
[00:08:55.270]are limited social attention and communication,
[00:08:59.070]repetitive or restrictive behaviors
[00:09:01.930]that focus around objects.
[00:09:04.460]One new finding recently is that children with autism
[00:09:09.728]tend to have delays in motor development,
[00:09:13.130]as well as the presence of challenging behavior.
[00:09:17.670]When I was managing our early intervention program,
[00:09:21.820]which was in Hawaii, we had a number of children
[00:09:27.370]where we would see sort of global delays.
[00:09:30.340]So they would be generally delayed in all areas,
[00:09:34.090]and have a specific delay in motor development.
[00:09:36.650]And a lot of those children were then
[00:09:39.270]later on diagnosed for autism.
[00:09:42.050]So it is a thing that we are recognizing now in our field.
[00:09:46.130]These markers are evident as early as
[00:09:50.610]12 to 24 months of age
[00:09:52.990]and know that it's really critical for us to identify
[00:09:56.310]these early markers in the first five years.
[00:10:00.180]Because within those first five years
[00:10:02.670]is when language and sensory pathways
[00:10:05.530]and cognition and executive functioning skills
[00:10:08.180]are really developing most rapidly.
[00:10:10.670]And so when we identify autism early,
[00:10:12.780]we can then provide that early intervention which allows us
[00:10:16.140]to have the best in children.
[00:10:20.520]So thinking about
[00:10:23.510]the world we live in related to early childhood,
[00:10:26.890]many of you are probably serving children
[00:10:29.270]or supporting children that you think
[00:10:31.870]may be developmentally delayed or perhaps there's a concern.
[00:10:36.730]One of the things that we can do as a field
[00:10:39.250]is to really make sure that we are setting up
[00:10:43.280]monitoring as well as screening procedures
[00:10:46.190]to identify if we think there's a concern there.
[00:10:49.920]The other area is making sure that we're having
[00:10:53.590]meaningful conversations with families.
[00:10:57.140]And I know that throughout my work over the years,
[00:11:00.660]one of the most challenging parts
[00:11:02.400]is having those conversations with families.
[00:11:05.260]And so I'm gonna talk about some resources in just a moment
[00:11:10.020]that you might be able to utilize
[00:11:12.100]as you think about how to have those conversations.
[00:11:15.800]But often, I'm asked,
[00:11:17.287]"What is the first thing that you can do?"
[00:11:19.510]And I usually say that the first thing
[00:11:21.700]that you can start doing is collecting a little bit of data.
[00:11:25.480]So writing down those observations that you see,
[00:11:29.920]so that when you have those conversations with families,
[00:11:33.610]you're able to provide them with some information about
[00:11:39.050]what you've observed and how it relates
[00:11:41.520]to their child's development.
[00:11:43.720]So what we know is when that child is then diagnosed
[00:11:47.840]or verified, those assessment results themselves that report
[00:11:53.440]often can help to guide intervention planning.
[00:11:57.000]And one of the things that is really impactful for schools
[00:12:01.600]is that if we're able to identify children earlier,
[00:12:05.210]we can provide earlier intervention.
[00:12:07.340]However, if we don't identify children earlier,
[00:12:10.340]then the cost of providing services to these children
[00:12:13.880]later on is much lower than it would have been
[00:12:16.680]if we had worked with them earlier.
[00:12:18.480]For example, the current, the cost in for example, in 2015
[00:12:24.840]of Americans that had autism was about $268 billion,
[00:12:30.950]and it's estimated that this would rise up to about
[00:12:34.077]$461 billion in 2025.
[00:12:38.350]And so for school children with autism often struggle
[00:12:44.790]and need those specific autism interventions
[00:12:48.420]to be in place to be successful.
[00:12:51.880]In the state of Nebraska,
[00:12:53.190]we're lucky to have an ambassador here
[00:12:55.770]that represents the Center for Disease Control
[00:12:59.550]Learn the Signs. Act Early initiative.
[00:13:02.290]This initiative provides free materials to anyone
[00:13:06.320]so that they can monitor children for developmental delay,
[00:13:11.010]and also how they can talk to families about the things
[00:13:16.260]that they might see in their child.
[00:13:20.300]I highly recommend that you try to access these resources
[00:13:24.740]as they are free, in addition to
[00:13:29.420]the CDC's Milestone Tracker app.
[00:13:33.121]This tracker app
[00:13:36.300]is really helpful and actually, I use it with my own son.
[00:13:40.500]He's four years old, but I am able to download the app
[00:13:44.940]and look at what he should be doing developmentally.
[00:13:49.800]And then I'm able to see sort of
[00:13:51.710]what is the next step for him so that I can start to work on
[00:13:55.100]some areas that are perhaps emerging.
[00:13:58.070]However, for families, this can can be a really helpful tool
[00:14:01.870]in just being able to see
[00:14:03.210]how their child develops typically.
[00:14:06.120]The tool itself has videos embedded
[00:14:08.510]as well as other resources,
[00:14:10.400]which can be really helpful to families.
[00:14:13.760]So I just wanna throw up Kerry's information here.
[00:14:18.840]Her email address is kerry.miller@unmc.edu,
[00:14:23.150]and she's at the Munroe-Meyer Institute.
[00:14:25.970]So if you have
[00:14:28.300]team members or you are someone
[00:14:31.400]that does work with young children,
[00:14:33.790]she is happy to come talk to your team.
[00:14:36.280]She also can get you access
[00:14:38.900]to those resources that I discussed.
[00:14:42.200]So now we're gonna shift towards focus on
[00:14:46.600]discussing children specifically in Nebraska.
[00:14:51.100]And so I'm going to share with you some data
[00:14:54.850]that I have been able to find on children
[00:14:58.750]with developmental delays or disabilities in Nebraska.
[00:15:02.520]However, there may be other resources
[00:15:04.640]that could potentially be helpful to you,
[00:15:07.090]and know that this is really my interpretation
[00:15:09.330]of what I've been able to find.
[00:15:13.360]So the early childhood report
[00:15:16.080]that came out last year in Nebraska,
[00:15:18.870]it indicates that 45% of children in public schools,
[00:15:24.030]and ESUs and Head Start,
[00:15:26.690]that are served under the age of five
[00:15:30.170]have an Individualized Family Service Plan
[00:15:33.300]or an Individualized Education Program,
[00:15:36.370]meaning they are receiving special education services.
[00:15:39.730]So this report focuses on about 20,000 children,
[00:15:43.530]and about 9,000 of those children have an IEP or an IFSP.
[00:15:49.960]So we're looking at a lot of the children
[00:15:53.300]that are being served in early childhood programs
[00:15:57.330]do have delays or disabilities.
[00:15:59.370]So it's very possible knowing the national prevalence
[00:16:03.230]that many of these children do have autism.
[00:16:06.920]So I wanna take a moment to look at the data that exists
[00:16:11.390]related to the educational verification of children
[00:16:15.870]that are receiving early intervention,
[00:16:18.760]and also early childhood special education services.
[00:16:22.240]So I can see that many of you are people
[00:16:26.040]that are probably working within early intervention
[00:16:29.950]or with children that receive Early Childhood
[00:16:34.110]Special Education services.
[00:16:36.410]And I think that as we move forward,
[00:16:40.030]I'm going to focus specifically on that population
[00:16:42.930]because I think it's likely that more children
[00:16:46.880]in those settings are likely to have autism
[00:16:51.530]and to receive support by the people
[00:16:54.130]that are serving in EI or ECSE.
[00:16:59.210]So if we first look at the educational verification
[00:17:02.260]and you can see this graph here, on the y-axis
[00:17:06.500]you can see it spans from zero to 1600 children.
[00:17:10.380]Okay, so those are numbers of children.
[00:17:12.720]And then on the x-axis we have the
[00:17:16.560]years that have passed over the last,
[00:17:20.440]let's say it's about nine years
[00:17:22.300]that I was able to find data on.
[00:17:24.100]Now, you can see there's a big gap in the middle,
[00:17:26.170]and I wasn't able to find data
[00:17:27.950]specifically on this period of time.
[00:17:29.900]However, I'm showing you here what I was able to find,
[00:17:33.210]and I think this data probably exists somewhere
[00:17:35.400]I just wasn't able to locate it in the time that I had.
[00:17:40.390]So what you can see here is I've identified
[00:17:44.500]the red circles are children that are verified
[00:17:47.610]with autism every year.
[00:17:50.190]The triangles are children that are verified
[00:17:53.850]with having developmental delay, and the,
[00:17:59.170]the box are children that have,
[00:18:02.650]that are verified as having a speech impairment.
[00:18:05.350]And so one of the things that I really want you
[00:18:07.700]to notice here is that there has been an increase
[00:18:12.300]in children that are verified as having developmental delay
[00:18:17.110]in early intervention over the past 10 years.
[00:18:20.780]You can see that the speech impairment as well as,
[00:18:24.500]speech language impairment as well as autism
[00:18:27.610]have stayed relatively low.
[00:18:29.730]And what we know within early intervention is that
[00:18:33.520]children don't need to have a specific verification
[00:18:37.650]other than developmental delay in order to access services.
[00:18:41.540]And so many times children are not identified
[00:18:45.450]as having a verification of autism
[00:18:48.010]or a specific disability before three,
[00:18:52.290]and they can still receive services and that's fine.
[00:18:55.700]I'm gonna just take a moment
[00:18:57.860]and break down autism a little bit more.
[00:19:00.250]And please ignore the where it says, "Formula Bar."
[00:19:03.770]Took a screenshot and didn't have time to redo this graph,
[00:19:06.310]so I apologize there.
[00:19:07.720]But what you can see here is that there has been
[00:19:11.450]a slight increase with the autism verification.
[00:19:14.850]So this is sort of, I just zoomed in on that autism piece.
[00:19:18.750]Now, if you look at the child count,
[00:19:20.750]we're only looking at zero to 40.
[00:19:23.460]And so we're really seeing an increase of only about
[00:19:26.370]20 or so children over the last 10 years.
[00:19:31.210]And so, the reason that I'm sharing this data
[00:19:34.380]is really because when we look at those national averages,
[00:19:38.980]from the data that we have in Nebraska
[00:19:41.180]and how we identify children under three,
[00:19:43.710]we're not really able to clearly see
[00:19:45.870]perhaps how many children do have autism.
[00:19:49.940]And when you look at the speech language impairment,
[00:19:53.620]what we could see is a decrease in children being identified
[00:19:57.680]as having speech language impairment as a verification.
[00:20:03.030]Which is just sort of an interesting finding,
[00:20:04.740]it means that children are identified,
[00:20:07.790]being identified more as having developmental delay,
[00:20:12.130]less as having a speech language impairment,
[00:20:15.380]and also just sort of relatively stable rates
[00:20:19.610]of a child being identified as having autism.
[00:20:23.420]So now we're gonna move on to looking at
[00:20:26.830]the educational verification of children
[00:20:29.500]that are in Pre-K settings.
[00:20:31.830]So these are children that are ages three to five.
[00:20:34.730]And what you can see here is similarly,
[00:20:38.730]we've seen an increase in the number of children
[00:20:41.560]that are verified in having developmental delay
[00:20:44.500]in early intervention over the past 10 years.
[00:20:48.420]You can see that the child count or how many children
[00:20:52.270]has increased a lot from early intervention.
[00:20:55.760]So we're now looking at around 3500 children
[00:21:01.210]that were identified as having developmental delay
[00:21:03.600]in those Pre-K settings.
[00:21:05.930]What you can see with the speech language impairment is that
[00:21:10.920]we actually saw sort of a crossover
[00:21:13.460]where speech language impairment used to be higher,
[00:21:16.530]and then decreased and you can see that developmental delay
[00:21:20.850]increase at that time.
[00:21:22.170]And when you look at autism, which is at the bottom,
[00:21:24.850]it's sort of staying in a very stable rate,
[00:21:27.960]maybe a little bit of an increase,
[00:21:30.800]which we see even more blown up here.
[00:21:34.270]So you can see here that really, we're seeing an increase
[00:21:37.970]in autism, in Pre-K with verifications.
[00:21:42.610]But that increase, you're looking at
[00:21:46.930]about 150 children in 2010
[00:21:50.560]to now being over 300 in 2019.
[00:21:55.420]So it's still not as high
[00:21:58.680]as maybe we would see if we were just looking at children
[00:22:01.670]that were diagnosed with autism.
[00:22:03.500]And we can continue to identify children in Pre-K settings
[00:22:07.350]as having developmental delay, however, it's possible
[00:22:10.830]that some of those children do have autism.
[00:22:14.490]So let's take a look at if we were to compare it
[00:22:17.130]with the national prevalence rates,
[00:22:20.340]and we're looking at ages.
[00:22:22.520]So I just sort of combined all the data.
[00:22:24.340]So if we're looking at the number of children
[00:22:27.000]that are verified
[00:22:29.310]right now perhaps or last year as having autism
[00:22:34.090]from ages birth to five,
[00:22:35.970]we would see that there is about 387 children.
[00:22:40.180]However, the national average would put us at about
[00:22:43.750]over 2,000 kids being identified as having autism.
[00:22:49.500]And so it's just I'm sharing this information
[00:22:52.110]because I think it's helpful for people to know
[00:22:54.970]and understand how we are verifying children
[00:22:58.610]and more because I want you to
[00:23:00.350]think about this a little bit.
[00:23:02.010]So compared to the national prevalence
[00:23:05.250]the children identified with autism is low.
[00:23:08.130]And this could be due to the continuation
[00:23:12.060]of speech language impairment
[00:23:13.890]or developmental delay verifications.
[00:23:17.630]But as I talked about throughout
[00:23:20.070]the first part of this presentation,
[00:23:22.140]that diagnosis or verification
[00:23:25.190]really leads to better outcomes.
[00:23:28.110]When we know that a child has autism,
[00:23:31.050]then we can implement specific evidence-based practices
[00:23:35.750]that focus on social communication.
[00:23:39.370]And we can also work specifically on those behaviors
[00:23:43.860]that occur knowing that there're specific practices
[00:23:46.920]that are considered to be evidence-based for autism.
[00:23:50.360]So I just want you to think about as a field, perhaps,
[00:23:53.850]what changes we might need to make in early childhood.
[00:23:57.320]And I think it's more that I'm just
[00:24:00.130]giving you some things to ponder.
[00:24:03.680]The second thing that I'm gonna have you ponder a little bit
[00:24:06.550]is that we have another challenge in that
[00:24:10.290]we need to make sure that the
[00:24:14.180]educators and professionals in Nebraska
[00:24:18.920]are very strong in their understanding
[00:24:22.140]of evidence-based practices as it relates to autism.
[00:24:26.200]Now, Mindy Chadwell and colleagues,
[00:24:30.710]Mindy's at the Munroe-Meyer Institute,
[00:24:33.250]examined some data that the Buffett Institute collected
[00:24:37.130]from their early childhood needs surveys.
[00:24:39.780]And these data showed that
[00:24:42.964]19.6% of Nebraska early childhood educators
[00:24:47.650]felt prepared to work with children with disabilities.
[00:24:50.740]So it is reasonable that some teachers
[00:24:54.200]might feel that they need more training
[00:24:56.680]in these types of practices, and specifically,
[00:24:59.620]how to support children that have autism.
[00:25:05.420]Now, I just wanna say that I work in Nebraska
[00:25:10.870]and I have been here now for several years.
[00:25:15.750]And I work every single day
[00:25:18.980]with people that are currently working in early intervention
[00:25:22.790]and as early childhood special education teachers
[00:25:26.010]in Nebraska.
[00:25:27.410]And what I can tell you is that the teachers
[00:25:30.970]and the professionals here are so dedicated to learning,
[00:25:36.360]just as you all are here at this conference,
[00:25:39.270]about how to support children in the best way possible.
[00:25:44.360]Specifically, I see so many people
[00:25:47.080]that are interested in learning about autism,
[00:25:50.090]and that really want to be well-trained.
[00:25:52.910]And so I'm gonna share with you
[00:25:57.070]a few, what I would consider to be high leverage practices.
[00:26:02.700]And those high leverage practices,
[00:26:05.330]I think can be helpful for administrators,
[00:26:09.400]educators, and professionals
[00:26:11.440]that are wanting to learn more about autism.
[00:26:14.700]There are so many different things that we can do.
[00:26:18.980]And so it's hard to identify where to start.
[00:26:23.000]And I'm hopeful that this will give you
[00:26:25.140]a little bit of a foundation for thinking about
[00:26:28.410]the key practices that you should be engaging in.
[00:26:31.370]And the first is really to look at how all team members
[00:26:36.300]are well-trained to use applied behavior analysis,
[00:26:40.530]and also implement Naturalistic Developmental
[00:26:44.600]Behavioral Interventions for children with autism.
[00:26:47.527]And I'll share what that is in a minute.
[00:26:50.270]Additionally, we wanna make sure that we have a strong focus
[00:26:55.310]on supporting caregivers and families.
[00:26:59.210]There are specific,
[00:27:00.460]and there's a lot of research out there about this.
[00:27:02.730]There are specific needs of parents
[00:27:04.750]that have children with autism.
[00:27:07.040]And we know that parent training is effective,
[00:27:10.810]and that there are lots of ways that we can engage families.
[00:27:14.800]Ultimately, we as providers see children
[00:27:19.060]for just a period of time, and so our goal
[00:27:22.270]should really always be to determine
[00:27:24.840]how we best support the family in using those interventions
[00:27:29.440]within their home and community setting with their child.
[00:27:33.240]Additionally, we need to make sure that we are engaging
[00:27:37.280]in teaming practices for young children with autism
[00:27:41.610]that are collaborative, where we do two things,
[00:27:45.670]one, use what we call a primary service provider approach,
[00:27:50.600]and also that we have agreed upon practices
[00:27:54.020]and interventions that we're using with those children.
[00:27:58.090]Additionally, and recently, Nebraska has adopted
[00:28:03.370]using a multi-tiered system of support,
[00:28:06.100]and teaching teachers to engage in these practices.
[00:28:09.740]And I would say that there are many ways
[00:28:12.690]that this different tiered levels of support
[00:28:16.430]can help us to best identify
[00:28:19.290]the needs of children that have autism.
[00:28:22.310]So let's start by just talking about team members
[00:28:25.540]being well-trained in autism, and what we call NDBIs
[00:28:31.550]or Naturalistic Developmental Behavioral Interventions.
[00:28:35.280]First, I'm just going to discuss ABA, and I know that.
[00:28:38.540]I'm sorry, first I'm going to discuss
[00:28:40.110]the range of autism interventions.
[00:28:42.660]And I know that there is a range, okay so, what we,
[00:28:47.610]there are so many different interventions out there
[00:28:51.150]for children that have autism.
[00:28:53.660]And so this is how I conceptualize it
[00:28:56.070]and capture the information,
[00:28:57.960]but I'm sure that there's other ways
[00:28:59.710]to think about this as well.
[00:29:02.200]So the way that I think about interventions
[00:29:05.190]is that there are interventions
[00:29:06.880]that are based in applied behavior analysis,
[00:29:10.150]or have a more functional perspective
[00:29:12.660]versus those that do not have a functional perspective.
[00:29:17.060]Interventions that tend to be more child-directed,
[00:29:20.930]developmental, and naturalistic,
[00:29:23.380]such as you may have heard of Floortime
[00:29:26.540]or Relationship Development Intervention,
[00:29:29.260]those approaches tend to be more child-directed,
[00:29:33.280]developmental and naturalistic, and don't often include
[00:29:37.390]components of behavioral interventions.
[00:29:40.830]Then on the other end of the spectrum,
[00:29:42.560]we have interventions that are more adult-directed,
[00:29:45.960]that are structured and also behavioral.
[00:29:49.160]And those approaches you may have heard of,
[00:29:51.940]such as Lovaas Discrete Trial,
[00:29:54.490]or using a Verbal Behavior approach.
[00:29:57.890]And I've just put here
[00:30:00.280]some years when these approaches came about.
[00:30:03.590]Now in the middle, what we have are what's called
[00:30:06.970]Naturalistic Developmental Behavioral Interventions.
[00:30:10.680]And what these approaches do is that they combine
[00:30:14.090]those more child-directed approaches
[00:30:16.140]with more adult-directed approaches.
[00:30:18.350]And these particular approaches in the middle here,
[00:30:23.350]have developed comprehensive models for addressing
[00:30:26.680]all of the skills or most of the skills
[00:30:29.210]that young children need to learn in order to be successful.
[00:30:34.310]Now, what we know about applied behavior analysis, which
[00:30:39.870]is that we have a large body of research
[00:30:44.390]that supports the use of applied behavior analysis
[00:30:47.570]for children with autism, specifically what's called
[00:30:50.640]Early Intensive Behavioral Intervention.
[00:30:54.870]There are a number of studies that show that
[00:30:57.850]intensive intervention is effective for young children.
[00:31:02.480]Some of these studies look at the use of intervention that
[00:31:08.690]focuses on 25 to 40 hours a week
[00:31:11.940]of intervention for children.
[00:31:15.460]So that's sort of the one end of the spectrum.
[00:31:18.260]But we also know that there are a lot of
[00:31:21.740]well-conducted studies now that show
[00:31:24.330]that young children with autism,
[00:31:27.040]while they benefit from behavioral approaches
[00:31:30.250]they also benefit because they are younger
[00:31:35.000]and they're learning within their natural environment
[00:31:37.280]and within play, that they benefit from
[00:31:40.020]more naturalistic developmental behavioral interventions
[00:31:44.180]that are embedded within daily routines.
[00:31:47.400]And so these types of approaches really blend ABA
[00:31:52.050]and developmental science together,
[00:31:55.530]and they use aspects of both types of those approaches.
[00:32:00.010]As a behavior analyst I have worked in the field
[00:32:03.430]for many years,
[00:32:05.890]and initially I started out being trained in a
[00:32:11.200]model Verbal Behavior classroom.
[00:32:14.010]And so I was trained to use an approach
[00:32:16.370]if you've heard of Carbone, Vincent Carbone,
[00:32:19.300]he was part of this project in Pennsylvania
[00:32:22.350]and I was trained in a patent classroom,
[00:32:25.240]where we delivered a very strict Verbal Behavior program.
[00:32:30.930]Through my work in the field, what I found was that
[00:32:34.110]with young children that have autism that are with families,
[00:32:39.500]and where we're teaching families
[00:32:41.260]to engage with their children,
[00:32:43.410]those VB approaches, while they are effective,
[00:32:48.220]can be enhanced through the use of
[00:32:51.360]these more naturalistic approaches,
[00:32:53.370]and some of them include the Early Start Denver Model,
[00:32:58.680]which is Sally Rogers and colleagues at the MIND Institute.
[00:33:03.540]An approach that's called Project ImPACT
[00:33:06.640]that was created by Brooke Ingersoll and Anna Dvortsak.
[00:33:10.340]And then also Pivotal Response Treatment,
[00:33:12.670]which some of you may have heard of before,
[00:33:16.030]which was developed by the Koegels
[00:33:18.070]and also Laura Schriebman.
[00:33:20.520]So these are, I would say,
[00:33:21.520]the three evidence-based approaches
[00:33:25.120]that have been manualized in a way
[00:33:27.340]that people can pick them up and deliver them.
[00:33:30.830]I would say the first two, perhaps more than the last one,
[00:33:33.940]but I think that they all are deliverable
[00:33:37.670]by people being trained to learn how to use them.
[00:33:41.720]So what we've seen then is that,
[00:33:44.160]and what I've kinda come to the realization
[00:33:47.570]over the years looking at the research,
[00:33:49.840]but also looking at practice and how early interventionists
[00:33:53.990]can work with families is that really we need to use
[00:33:56.670]a combination of these approaches,
[00:33:58.690]and within those Early Intensive
[00:34:00.860]Behavioral Intervention programs we can embed
[00:34:04.090]Naturalistic Developmental Behavioral Interventions.
[00:34:07.280]I know it's a lot of acronyms.
[00:34:09.840]And so an example of that is that prior to coming here,
[00:34:14.350]as I mentioned, I did work as a program manager
[00:34:17.460]for an early intervention agency.
[00:34:20.440]And so we had
[00:34:23.574]a number of behavioral consultants
[00:34:27.220]that would work with some of our children.
[00:34:29.040]They were not BCBAs,
[00:34:31.450]but they would provide more direct services.
[00:34:34.090]And then in combination with that, we would have our staff
[00:34:38.060]who were occupational therapists or physical therapists
[00:34:41.960]or speech language pathologists or teachers,
[00:34:44.530]they would implement Project ImPACT with families
[00:34:47.250]and I'm gonna share an example of that in just a minute.
[00:34:50.410]And so there really are ways
[00:34:52.810]to incorporate both types of interventions.
[00:34:56.020]However, it does take a lot of training
[00:34:58.220]and a lot of expertise in how to deliver
[00:35:01.970]those types of services.
[00:35:03.850]Now, in terms of Early Intervention,
[00:35:07.750]and when you're looking at Behavioral Intervention, or EIBI
[00:35:11.400]research-based approaches include the Lovaas,
[00:35:16.510]which we do have here in Nebraska, where they're providing
[00:35:21.630]Early Intensive Behavioral Intervention services,
[00:35:24.430]as well as using a Verbal Behavior approach,
[00:35:27.410]which may be based on the Verbal Behavior Milestones
[00:35:32.360]and Placement Program Assessment.
[00:35:35.140]Or even more recently now there has been some research
[00:35:39.610]supporting what's called the PEAK Approach,
[00:35:42.400]which is sort of an evolution of what's called
[00:35:47.120]relational training or relational frame theory
[00:35:50.030]and thinking about how we,
[00:35:53.250]how we deliver these types of services
[00:35:55.660]in a slightly different way than we had been before
[00:35:58.520]and specifically, more specifically for children
[00:36:01.320]that are higher functioning.
[00:36:03.640]I wanted to share too, in case you are interested,
[00:36:06.890]this textbook by Travis Thompson
[00:36:09.440]at the University of Minnesota, it's called
[00:36:12.307]"Individualized Autism Intervention for Young Children."
[00:36:16.450]This book does a nice job of talking about
[00:36:19.750]how you blend discrete trial or more structured approaches
[00:36:25.410]with naturalistic strategies.
[00:36:27.820]And more specifically, he talks about how you embed
[00:36:30.730]those interventions within, to daily classroom routines.
[00:36:35.250]And I think for many of us, we are in settings
[00:36:38.620]that where we do have children
[00:36:41.130]that are in those classroom settings.
[00:36:43.750]And so we need to think about
[00:36:45.060]how we're individualizing intervention
[00:36:47.450]for the children that are there.
[00:36:50.880]One of the things that the research has told us recently
[00:36:54.120]is that we still need to do more research.
[00:36:57.480]So we know that these approaches are effective.
[00:36:59.840]We know that for young children, naturalistic developmental
[00:37:03.730]behavioral approaches are effective.
[00:37:06.900]But we still need more research to tell us about
[00:37:10.280]the best intervention agents meaning the people
[00:37:13.700]that are delivering these types of services.
[00:37:16.500]We also need to know more about intensity of hours
[00:37:20.380]and the number of hours.
[00:37:21.900]And so there has been some recent research
[00:37:24.710]that's come out that is looking at those components.
[00:37:29.250]And so one of those is a research study
[00:37:31.710]that's being done by Sally Rogers
[00:37:34.190]at the UC Davis MIND Institute with a number of colleagues.
[00:37:38.970]This research study is called Intervention Effects
[00:37:42.560]of Intensity and Delivery Style for Toddlers With Autism.
[00:37:47.740]And this particular study looked at comparing
[00:37:52.120]Early Start Denver model with Lovaas Discrete Trial
[00:37:55.850]in a randomized control trial.
[00:37:58.280]And it had a number of children,
[00:38:00.900]so was able to see over a lot of different children,
[00:38:04.360]which approach maybe is the more effective.
[00:38:07.850]And they were looking at these two approaches
[00:38:10.760]and comparing them.
[00:38:12.260]And what they found was that children that were using both
[00:38:15.890]or that had interventions from both approaches
[00:38:20.630]had similar outcomes, regardless of their level of need,
[00:38:24.490]regardless of the hours of intervention.
[00:38:27.080]And so what this tells us is that,
[00:38:30.500]while we know that intensive intervention is effective,
[00:38:36.070]we also have to look at,
[00:38:38.230]could we deliver a lesser amount of hours
[00:38:42.300]if we know that that person is very well-trained?
[00:38:45.500]And so I want you to think a little bit about
[00:38:48.310]your own practices related to children with autism
[00:38:52.340]and how we learn.
[00:38:53.790]So when you think about learning
[00:38:56.980]and how we are training ourselves
[00:39:00.190]to be effective supporters of children with autism
[00:39:04.450]or their families, we know that there's a number
[00:39:08.010]of different ways that we can learn.
[00:39:09.580]So the first is that we might
[00:39:13.410]complete some internet modules or read some documents,
[00:39:17.090]or perhaps you go to a professional development opportunity
[00:39:20.700]like this one.
[00:39:22.610]You also could receive coaching on the job by experts,
[00:39:27.290]which is a possibility as well as
[00:39:31.630]what would be maybe
[00:39:33.160]a more intense approach to learning about autism
[00:39:36.590]is to pursue some sort of certification or degree.
[00:39:41.500]And so I just wanna take a moment to talk just briefly about
[00:39:46.270]what's called the Board Certification and Behavior Analysis,
[00:39:50.960]or the BCBA.
[00:39:52.410]So there are,
[00:39:54.960]and I myself am a Board Certified Behavior Analyst.
[00:39:58.420]And so these are training programs
[00:40:00.530]that really focus on people understanding
[00:40:02.910]the principles of behavior analysis,
[00:40:05.030]but many of them focus specifically on autism.
[00:40:08.030]There are four different credentials that are within
[00:40:12.000]and offered at different levels depending on who you are.
[00:40:15.230]However, I'm gonna focus specifically in
[00:40:17.190]on that master's degree level.
[00:40:20.200]So right now, in the United States,
[00:40:22.510]we've seen a really drastic increase in the number of people
[00:40:25.560]that are seeking out this type of certification.
[00:40:28.820]So I was certified in 2007
[00:40:31.080]and there 3,000 behavior analysts at that time.
[00:40:35.460]Now there are almost 40,000 behavior analysts,
[00:40:39.460]which is a pretty significant increase over time,
[00:40:42.530]and a lot of that has been because now,
[00:40:45.310]insurance is covering these services across states
[00:40:48.660]and so people are able to provide the service
[00:40:50.850]and seeing the benefit of becoming a BCBA.
[00:40:54.770]So this is one method.
[00:40:56.450]And when I think about the BCBA,
[00:40:58.240]working within educational settings
[00:41:00.360]it might look something like this.
[00:41:01.790]You have your child with autism,
[00:41:03.900]a direct service provider perhaps that's a paraprofessional,
[00:41:06.810]but in the behavior analytic world
[00:41:10.260]that could be a behavior technician,
[00:41:12.440]or what's called a Registered Behavior Technician.
[00:41:15.650]And then you have all your team members,
[00:41:17.200]so everybody that's supporting this child.
[00:41:20.220]And perhaps one of those team members
[00:41:21.990]is a Board Certified Behavior Analyst.
[00:41:24.280]And so she's or he is then able
[00:41:26.530]to help support the team members.
[00:41:28.830]And one of the things that's really helpful
[00:41:31.140]is that they can also provide parent care
[00:41:34.030]or caregiver support and training.
[00:41:36.360]And so then that caregiver is able to work specifically
[00:41:41.078]with their child through the support
[00:41:43.620]of all of the team members and perhaps the BCBA.
[00:41:47.490]Now in Nebraska, you have only one program
[00:41:51.050]that exists at the master's level,
[00:41:53.250]which is a joint program between the Munroe-Meyer Institute
[00:41:56.510]at the University of Nebraska Medical Center,
[00:41:58.760]and the University of Nebraska Omaha.
[00:42:01.610]You also have a number of people that work
[00:42:03.665]in the autism spectrum disorders network
[00:42:08.060]that are behavior analysts or are currently seeking out
[00:42:12.960]certification in behavior analysis.
[00:42:15.520]Additionally, Midland has a training program
[00:42:18.320]for people that are interested in getting their bachelor's
[00:42:20.860]and becoming what's called a Board Certified
[00:42:23.150]Assistant Behavior Analyst.
[00:42:25.140]I wanna take a moment and I'm gonna pause
[00:42:29.060]and I have been supervising
[00:42:32.600]a teacher that is seeking
[00:42:35.700]her board certification in behavior analysis.
[00:42:38.660]And so I wanted her to take a moment to talk about her role,
[00:42:43.530]but then also sort of how she got to
[00:42:48.300]the decision of becoming a behavior analyst
[00:42:51.470]and how that's been helpful for her within the schools.
[00:42:54.740]So Lizzie, I'm gonna try to find you and unmute you.
[00:43:10.444]Hi. Oh, there we go.
[00:43:11.503]Yes, can you hear me? Yep, all right.
[00:43:14.480]Okay, so my role currently is
[00:43:18.070]a preschool special education teacher,
[00:43:20.660]or an ECSE in a preschool classroom.
[00:43:23.660]But I am also pursuing my master's degree
[00:43:26.320]in applied behavior analysis and working toward becoming
[00:43:29.960]a Board Certified Behavior Analyst.
[00:43:33.460]I found this path after I had a class
[00:43:37.050]in behavior management with John Maag at UNL.
[00:43:40.520]I think a lot of us who went to UNL
[00:43:42.840]got to sit in on his class and he gave a lot of information
[00:43:46.810]just about behavior management,
[00:43:48.990]and working with challenging behaviors,
[00:43:50.750]but also working with students who have autism.
[00:43:54.300]And when I left that class,
[00:43:56.200]I was just wanting more training, I was wanting to know more
[00:43:59.767]and I felt like we just got like a tiny little piece
[00:44:03.890]of what working with students with autism was like.
[00:44:07.590]And so I reached out to him, and I asked,
[00:44:10.630]hey, how can I get more information on this topic,
[00:44:13.920]it's something I'm really passionate about?
[00:44:16.350]And he directed me to a master's program
[00:44:19.260]in applied behavior analysis.
[00:44:21.540]And so that is what I'm currently pursuing,
[00:44:23.480]I will graduate in August, so pretty soon.
[00:44:27.370]And I found this program just to give me
[00:44:29.480]more information on the subject
[00:44:31.710]but it also partnered me with a supervision experience.
[00:44:35.180]So within that supervision experience
[00:44:38.290]I have had the chance to connect with Johanna every month,
[00:44:41.830]maybe even multiple times a month,
[00:44:44.050]and I get advice and critique and we work together
[00:44:47.510]on implementing interventions with my students,
[00:44:50.610]and it just gives me an extra level of training
[00:44:54.320]and a level of supervision where if I have questions
[00:44:58.700]or if I'm not sure how to address
[00:45:01.290]a problem behavior that's going on
[00:45:04.040]I have someone to just lean on and ask
[00:45:06.900]and get some great advice from.
[00:45:09.700]So this training definitely led me to feel more prepared
[00:45:13.280]working with my students, not only students with autism,
[00:45:16.520]but the variety of students with developmental delays
[00:45:20.200]that we work with.
[00:45:23.140]All right, thank you, Lizzie.
[00:45:25.720]Yeah, and I've supervised a number of people over my career,
[00:45:32.130]but I've really enjoyed being able to work with Lizzie
[00:45:34.960]and sort of see how
[00:45:38.550]the knowledge that she's learning about autism
[00:45:41.240]and behavior analysis then applies to
[00:45:43.770]how she works with her students in her classroom.
[00:45:46.780]And it's been a really fun experience.
[00:45:49.650]So thank you, Lizzie for sharing about that.
[00:45:52.890]So now I'm just gonna share just briefly,
[00:45:56.990]a little bit about some legislative updates
[00:45:58.840]that have happened that you might not be as familiar with.
[00:46:01.730]So I mentioned that autism insurance
[00:46:04.470]is now covered in all 50 states.
[00:46:07.580]So this law went into effect
[00:46:09.600]in the state of Nebraska in 2014.
[00:46:12.980]And if you type in LB 254, you can look up that exact law.
[00:46:18.240]And what that says is that children with autism
[00:46:21.680]are able to receive behavioral interventions
[00:46:24.600]and behavioral health services
[00:46:25.980]specifically applied behavior analysis treatment,
[00:46:28.530]as well as other interventions.
[00:46:32.490]And so sometimes I think that often as providers,
[00:46:36.110]we're not necessarily aware that this law has passed
[00:46:39.140]because what it really means is that families
[00:46:41.500]across the state of Nebraska can be accessing ABA,
[00:46:45.910]which is a really critical component to
[00:46:49.470]for families and children with autism to be successful.
[00:46:53.260]Additionally, last year a law passed
[00:46:57.470]which is LB 619 that said that mental health services
[00:47:02.870]can be delivered in school settings.
[00:47:05.000]So for administrators, it's just something to consider
[00:47:08.200]in that we have the ability now to bill insurance
[00:47:11.960]for these services and when we think about
[00:47:14.480]and to also deliver them within school settings.
[00:47:17.660]And so when we think about the support that children need,
[00:47:21.070]it's possible that one idea may be to utilize
[00:47:26.370]behavior analysts that are then billing insurance
[00:47:29.320]in collaboration with teams
[00:47:31.380]that are working within early childhood.
[00:47:33.810]So just something to be aware of,
[00:47:35.530]because these services now are accessible to families
[00:47:39.330]and that support is available for others
[00:47:41.910]that are working with those children.
[00:47:43.900]So we get to our next point of thinking about teaming.
[00:47:47.390]I mentioned what's called the primary provider approach,
[00:47:51.500]and having purposeful collaboration
[00:47:54.180]and an agreed upon intervention.
[00:47:56.260]So one of the biggest challenges that I've seen
[00:47:58.300]in early intervention and in Pre-K settings,
[00:48:01.830]is that we all come from so many
[00:48:03.810]different training backgrounds, okay so.
[00:48:06.350]And when you think about all of our different philosophies
[00:48:10.950]and how we deliver services, oftentimes they conflict.
[00:48:15.520]And so for children with autism, it's really critical
[00:48:18.920]and really for any child,
[00:48:20.600]that we all come to an agreed upon intervention approach,
[00:48:24.360]meaning we have conversations and talk about
[00:48:26.910]how we're gonna be delivering those services,
[00:48:29.410]and what types of approaches
[00:48:30.700]we're all going to use together.
[00:48:33.120]Additionally, we know in early intervention
[00:48:35.630]that the primary service provider approach model
[00:48:38.320]which is having one specific person work with the family
[00:48:43.290]and with the support of all of the other providers.
[00:48:46.390]This model can also be used in ECSC settings.
[00:48:50.000]So for example, we have one primary person
[00:48:52.870]that designs the plan that supports the child,
[00:48:55.680]but then all of those other providers
[00:48:57.860]help to support that person first as working individually.
[00:49:02.870]And I truly believe that,
[00:49:05.627]and I love this quote by Henry Ford
[00:49:07.550]that if everyone's moving forward together,
[00:49:09.790]then success takes care of itself.
[00:49:12.020]And I would say that communication, collaboration
[00:49:15.180]and teaming are things that we don't often make time for,
[00:49:19.400]but they are the critical components that will help to move
[00:49:22.540]our services forward.
[00:49:24.280]Additionally, making sure that we are training
[00:49:27.270]and educating families and supporting them.
[00:49:31.020]And so we do this in early intervention
[00:49:33.700]because we're already having access to the family.
[00:49:36.120]But often in Pre-K settings,
[00:49:38.230]we don't necessarily include the family
[00:49:40.800]other than by maybe sharing what's happening,
[00:49:44.610]during IEP meetings.
[00:49:46.740]And so, I think that as a field,
[00:49:48.980]we have the ability to better engage families
[00:49:51.620]to create ways to communicate better with them,
[00:49:53.900]but then also to set up training at any point
[00:49:58.250]where they can learn more about the interventions
[00:50:00.710]that we're implementing with our children.
[00:50:03.660]One such approach that is evidence-based
[00:50:05.860]is what's called Project ImPACT.
[00:50:07.410]And this is an approach that I've studied within my career.
[00:50:11.350]This approach just came out with a new manual last year.
[00:50:16.722]And so it actually comes with materials,
[00:50:20.900]and PowerPoint presentations and video examples
[00:50:24.180]that are available.
[00:50:25.360]And what I've been doing in my classes
[00:50:27.430]is actually teaching my students to use this approach
[00:50:31.010]and then to go use it with families.
[00:50:33.600]And while there are obvious challenges with doing that,
[00:50:36.170]I think that I found it to be an approach that
[00:50:39.970]people can learn to use,
[00:50:41.560]but it also incorporates a lot of interventions
[00:50:43.960]that you might be familiar with already.
[00:50:45.940]So I just wanted to mention that here.
[00:50:48.120]Additionally, Early Start Denver Model
[00:50:51.330]recently within the last couple of weeks
[00:50:53.470]came out with some online modules that are available
[00:50:58.470]for practitioners to use and also families,
[00:51:01.590]and they're completely free.
[00:51:03.140]And so I put the link here for you guys,
[00:51:05.110]it's called Help Is In Your Hands.
[00:51:07.060]And they focus specifically on
[00:51:09.750]young children with autism or developmental disabilities
[00:51:13.760]and how to engage using those naturalistic approaches.
[00:51:18.040]So I wanna just take a moment to shift and share.
[00:51:24.140]Actually, I think what I'll do is,
[00:51:26.420]I'm gonna come back to this at the end if we have time
[00:51:29.150]'cause I wanna make sure I give you a little bit of time
[00:51:31.800]to talk to each other.
[00:51:33.290]So I'm sharing some of these ideas with you of what are
[00:51:37.400]more high leverage practices,
[00:51:39.010]but I also want you to think about
[00:51:40.430]how they apply in your own settings, okay.
[00:51:43.000]So when we think about the last key component,
[00:51:47.510]which would be multi-tiered systems of support.
[00:51:50.970]We in Nebraska have now adopted the use of MTSS.
[00:51:55.520]There are a number of different tiered systems of support,
[00:51:59.030]one being the Pyramid Model,
[00:52:01.100]which many of you are probably very familiar with.
[00:52:04.390]Rooted in Relationships and the Department of Education
[00:52:06.950]have done a really nice job of developing
[00:52:11.220]and are working towards developing coaching systems
[00:52:14.030]that can really support educators across the state.
[00:52:17.320]So that's been really nice to see.
[00:52:19.290]Additionally, just for all educators,
[00:52:22.680]the Department of Education is promoting the use of
[00:52:27.390]Nebraska MTSS Framework.
[00:52:29.300]And one of those aspects is what's called
[00:52:31.680]the Layered Continuum of Supports.
[00:52:34.190]And so I'm gonna take a couple minutes here
[00:52:36.510]to just think about how we might implement those
[00:52:40.880]Layered Continuum of Supports within early intervention
[00:52:44.805]and then also within early childhood special education.
[00:52:49.760]And then I'm gonna try to break you into groups
[00:52:51.870]for the last 10 minutes and then we'll come back together.
[00:52:55.560]Okay, so when we think about early intervention
[00:52:58.950]and I'll be honest with you,
[00:53:00.370]I could do a whole presentation on how to deliver
[00:53:05.170]these tiered supports within early intervention
[00:53:07.960]and Early Childhood Special Ed, but I'll kinda,
[00:53:10.330]what I've done here is I'm summing up a few key points
[00:53:13.370]I think could be helpful to you.
[00:53:15.300]So we have our first tier,
[00:53:17.550]which is we are working with families,
[00:53:20.430]we're starting to serve families,
[00:53:22.400]and perhaps those families are in need of
[00:53:26.710]simply developmental support.
[00:53:28.430]So understanding their child's development.
[00:53:31.060]For children with autism,
[00:53:32.580]what we might do is focus more on parenting resources
[00:53:37.320]that support families in understanding the,
[00:53:40.660]and accessing resources within their community,
[00:53:44.690]as well as trainings that they might participate in
[00:53:48.250]or perhaps support groups.
[00:53:50.170]Okay, so some families that's gonna be enough
[00:53:52.930]because they will be able to
[00:53:56.540]support their children independently on their own,
[00:53:59.330]but for other families, we may need to take
[00:54:01.730]a more autism-specific parent coaching approach,
[00:54:05.400]meaning, we don't just use the strategies
[00:54:09.790]that we know as effective, but we really look at
[00:54:13.830]some of those more manualized approaches
[00:54:16.970]to teaching parents very specific skills about autism.
[00:54:21.927]And so those are some of the approaches
[00:54:24.460]that I just talked about.
[00:54:26.350]So perhaps, then we're delivering
[00:54:28.460]this higher level of service
[00:54:30.310]because parents need more specific information
[00:54:32.790]about parent coaching as it relates to autism.
[00:54:36.570]Now, there will be other families where
[00:54:39.980]those children have more significant needs, and so
[00:54:44.690]we may need to continue to do
[00:54:47.030]that parent coaching specific to autism.
[00:54:50.640]However, we may also need to include
[00:54:54.140]possible direct intervention.
[00:54:56.500]So that could be the provider
[00:54:58.130]working directly with the child
[00:55:00.180]which may mean that we're increasing the frequency
[00:55:02.690]and intensity of services, or we're increasing
[00:55:06.140]how frequently we do parent coaching.
[00:55:08.840]So we're working more consistently with the family.
[00:55:12.110]Or perhaps we're partnering with an ABA provider,
[00:55:15.520]and we're looking at how we can collaboratively
[00:55:18.100]provide services to children
[00:55:20.690]that have more significant needs.
[00:55:23.300]Now, when we look at early childhood classrooms,
[00:55:26.570]while I know that there are a range of
[00:55:29.790]different classrooms across the state of Nebraska,
[00:55:33.180]and I don't know about the specifics
[00:55:35.710]of all of those classrooms,
[00:55:36.890]what I have seen in the larger districts is that
[00:55:41.020]we often think that children,
[00:55:44.550]there's sort of a 50-50 split in inclusive classrooms.
[00:55:47.980]So we have 10, let's say it's 20 children,
[00:55:50.780]10 of those children have developmental delay
[00:55:54.520]or other disabilities, and then 10 of those children
[00:55:57.810]don't qualify for services
[00:55:59.140]so they're considered to be typically developing.
[00:56:01.580]Now what I'm seeing is one of the challenges in Nebraska
[00:56:04.310]is we have a large immigrant population.
[00:56:08.140]And so we have a lot of children
[00:56:11.370]whose families do not speak English.
[00:56:13.390]And so in many cases, we're seeing what.
[00:56:16.830]And I will just say, I don't have any data to support this
[00:56:20.810]but what I observe is that we have these children
[00:56:22.960]that have autism, and they require more specific supports.
[00:56:26.500]And then we have children that are developmentally delayed,
[00:56:30.140]as well as English language learners.
[00:56:32.610]And so there are challenges there
[00:56:34.610]with delivering support and services to those children.
[00:56:37.740]And so what I see oftentimes
[00:56:40.390]is that the educators have a difficult time
[00:56:45.290]with providing support to all of the children
[00:56:48.210]because they spend more time trying to figure out
[00:56:52.330]how to support those children that have autism.
[00:56:54.910]And oftentimes, they are doing their best
[00:56:58.360]they're trying to use the knowledge they have.
[00:57:01.620]However, without additional resources,
[00:57:04.760]they may not be successful.
[00:57:06.550]And so when we think about inclusive classroom environments,
[00:57:10.970]we're really looking at that first tier
[00:57:13.370]as being support that we provide to all children.
[00:57:15.960]Okay, so responsive teacher child interactions,
[00:57:19.240]high quality environment for children with autism,
[00:57:22.700]that might mean also putting in modifications,
[00:57:25.960]or adaptations that are specific to children with autism,
[00:57:29.490]such as visual supports, or perhaps
[00:57:33.930]transition tools that help throughout the day,
[00:57:36.320]and those are gonna help all kids anyway.
[00:57:38.870]And then our second tier might be having some brief plans
[00:57:44.080]that focus very specifically on teaching skills
[00:57:47.760]and creating more opportunities for children
[00:57:51.150]to learn more specific skills within daily routines.
[00:57:54.830]And I see as one of the critical pieces of this
[00:57:57.950]is training our paraprofessionals to be able to embed
[00:58:01.950]those interventions within the daily routine,
[00:58:04.390]and really focusing on how every single team member
[00:58:08.210]is involved in that process.
[00:58:10.690]And additionally, the third tier would then be looking at
[00:58:13.980]children that really need more intensive support.
[00:58:17.710]Okay, so they need a more individualized program.
[00:58:21.000]They need a comprehensive plan
[00:58:22.560]as it relates to children with autism,
[00:58:24.840]really in all developmental areas.
[00:58:27.240]And for that to be successful, really, we need to look at
[00:58:31.920]how we decrease staff to child ratio,
[00:58:34.780]how we increase that one-on-one support throughout the day,
[00:58:37.970]and how we train everybody to be part of the team
[00:58:40.620]so that no matter who is supporting that child,
[00:58:44.660]they know how to use the same exact interventions.
[00:58:49.020]And I recognize that this is a challenge
[00:58:52.270]specifically for administrators to look at
[00:58:54.930]how to provide that additional level of support,
[00:58:57.860]but really when we're implementing MTSS
[00:59:00.410]we have to look at not only
[00:59:03.220]what type of support that child needs,
[00:59:05.360]but how do we create and provide the resources
[00:59:08.870]to the educators in those settings.
[00:59:12.010]Okay, so I know I've probably given you
[00:59:14.900]a lot to think about, and what I'm gonna do here
[00:59:18.920]is I'm just gonna share one more time for you,
[00:59:22.260]and I actually will copy this
[00:59:23.777]and I hope this saves into the; oh, no, I can't do that,
[00:59:27.580]into the Chat function.
[00:59:29.390]But what I'd like to do is try to break you into groups.
[00:59:32.130]We have about 15 minutes left.
[00:59:34.270]And so I want you to take about, let's say 10 minutes
[00:59:38.380]to just talk in small groups and think about
[00:59:42.360]how you are using the high leverage practices
[00:59:46.270]that I discussed, so that's team members being well-trained,
[00:59:50.450]autism-specific parent support, teaming practices,
[00:59:54.900]as well as using the multi-tiered systems of support
[01:00:00.110]specifically looking at the amount of support
[01:00:02.310]that's provided and resources for each particular child.
[01:00:07.580]And I want you to introduce yourselves,
[01:00:09.690]and then talk about are you using these practices
[01:00:13.710]or how could you work towards those practices?
[01:00:17.520]So Jamie, can you see
[01:00:20.260]if you can split everybody into groups,
[01:00:25.440]from your end?
[01:00:26.610]I've just split everybody into groups
[01:00:28.380]and then I think I hit the button Open All Rooms--
[01:00:31.100]Okay, so let me just say something before that,
[01:00:33.050]so you should, so what's gonna happen is then
[01:00:35.940]you'll be split into rooms and then Jamie will,
[01:00:39.810]you stay here, can you do that?
[01:00:42.918]I don't know if you can stay here specifically,
[01:00:44.710]but then we'll bring you all back together.
[01:00:46.860]And just take a few minutes to talk amongst yourselves
[01:00:50.300]and have an opportunity to engage with one another
[01:00:54.350]however you feel comfortable.
[01:01:11.250]Looks like people are figuring it out
[01:01:12.620]so that's good.
[01:01:14.240]You usually have to press something
[01:01:16.930]that puts you then into the group.
[01:01:19.730]And there may be some people that--
[01:01:20.910]Pause the recording right now Johanna.
[01:01:23.450]You can if you want to.
[01:01:26.177]I will start it back, okay.
[01:01:29.890]All right, so thank you everyone
[01:01:31.190]for making it back into the room.
[01:01:32.550]Some of you are still coming back in.
[01:01:34.760]I hope that you found that was a okay experience to kinda
[01:01:40.110]take a listen to some of the other people
[01:01:43.700]that are attending and how they're,
[01:01:45.660]what their experiences are.
[01:01:48.440]If possible, would a few of you be willing
[01:01:52.340]to just share in the Chat function,
[01:01:54.070]maybe one or two things that you talked about as a group.
[01:01:57.400]I know it was just a very short period of time,
[01:02:00.710]but I would love to hear anything.
[01:02:12.630]We kinda talked about like our positions
[01:02:14.870]and how the high level leverage practices
[01:02:18.570]pertain to each of our different positions.
[01:02:21.820]Okay, that's great, yeah, and I think it's a,
[01:02:26.850]it definitely needs to be a team approach, right?
[01:02:30.880]But everybody does play a different role,
[01:02:33.860]specifically when you have younger children.
[01:02:37.130]So yes, absolutely.
[01:02:40.010]Okay, Mandy, you said teaming is time consuming
[01:02:42.270]but highly beneficial.
[01:02:43.800]It absolutely is, and that's one of the things that I found
[01:02:46.930]in the, just in general in interdisciplinary work,
[01:02:52.290]people often aren't getting paid to team,
[01:02:56.270]to engage with one another,
[01:02:57.480]but we definitely need that to happen
[01:03:00.530]in order to be successful.
[01:03:03.490]Okay, and Lizzie, "So we talked about
[01:03:06.307]"providing parents support," yep,
[01:03:07.647]"during home visit sessions or IEP meetings,"
[01:03:10.170]that's really critical, awesome.
[01:03:13.640]Yep, turnover of staff is a factor absolutely.
[01:03:19.490]Why disparity of application of programs?
[01:03:23.150]Yep, and getting everybody trained.
[01:03:24.870]And I think, we're all working, the way that I see it
[01:03:27.940]is we're all working together in the best way that we can
[01:03:31.710]to support the kids that are in Nebraska.
[01:03:34.110]And I think everybody's at different levels
[01:03:36.200]of trying to figure this out.
[01:03:39.870]Okay, we would love to increase verification
[01:03:44.340]at the birth to three level.
[01:03:45.890]Yeah, and I think that's sort of one of the things
[01:03:48.740]I wanted you to think about,
[01:03:50.030]is that we don't need to verify children with autism
[01:03:53.070]under three because they can receive services
[01:03:56.450]through that developmental delay verification.
[01:04:00.120]However, if we want the family to access
[01:04:04.250]any sort of outside service,
[01:04:06.420]that verification is gonna be helpful
[01:04:08.650]in terms of getting that diagnosis.
[01:04:12.430]Yep, Katie, you're having a clear philosophy of program.
[01:04:16.000]Yep, it absolutely makes handling pair training
[01:04:20.190]and staffing, definitely but it's more challenging.
[01:04:24.300]And I think that, my mention of having a clear philosophy
[01:04:30.260]or program philosophy as it relates to intervention,
[01:04:34.430]those are conversations that need to happen over time.
[01:04:37.750]And it's not gonna happen in a week where we just decide
[01:04:41.260]this is how we're gonna do things.
[01:04:42.343]It's really a process that we come that we wanna go through
[01:04:46.470]in order to determine as a team how do we all think
[01:04:50.910]and how do we all support children.
[01:04:53.290]And starting with children with autism can be helpful
[01:04:55.830]because we at least know what evidence-based interventions
[01:04:58.470]are available for that population?
[01:05:00.820]Okay, so I'm gonna stop there,
[01:05:02.240]thank you guys so much for sharing.
[01:05:04.040]I'm just gonna take a moment
[01:05:05.520]and if anybody has any questions,
[01:05:09.070]I told Jamie, I am happy to stay afterwards.
[01:05:13.300]Meaning we can just hang out here.
[01:05:15.260]So if anybody has a question they wanna ask
[01:05:17.820]and then you're also welcome to pop off
[01:05:20.100]if you wanna head out.
[01:05:26.780]Any questions at all?
[01:05:29.420]Yeah, and thank you guys for being here.
[01:05:31.920]It's been really fun to have you
[01:05:33.330]and I hope I gave you lots to think about.
[01:05:35.530]Oh, thanks, Brionne.
[01:05:42.240]Oh, and feel to get in touch with me too.
[01:05:46.750]I didn't actually do my summary statement, but that's okay.
[01:05:51.250]My email is actually johanna.taylor,
[01:05:53.960]'cause I just got married recently @unl.edu.
[01:06:01.890]I'm always wanting to think about
[01:06:03.620]all of the things I talked about today,
[01:06:05.370]so happy to talk to anybody about it at any point.
[01:06:15.580]Okay, so, Jamie, I think we can wrap up.
[01:06:18.660]Oh, we have one question.
[01:06:21.430]Could I offer a session how to do this in home visiting?
[01:06:24.880]Absolutely, and I will keep that in mind
[01:06:27.720]and submit next year.
[01:06:30.410]I have a whole nother presentation
[01:06:32.050]on how you would do this in a,
[01:06:34.220]more specifically in home visiting.
[01:06:37.937]"If you have a student with a DD..."
[01:06:50.640]Pandora, that's a good question and
[01:06:55.600]the answer would be yes, you should.
[01:06:59.710]Johanna we're not able to see that on this side,
[01:07:01.820]I don't think. Yeah, I know.
[01:07:05.010]Yeah, so...
[01:07:12.420]Yeah, so any child that, in order for children
[01:07:16.580]to receive services through special education
[01:07:18.680]they need to have an educational verification,
[01:07:20.990]they can't just have a developmental delay diagnosis
[01:07:23.820]or a diagnosis from a clinical psychologist
[01:07:26.630]or someone like that.
[01:07:27.463]So they would need to be evaluated, any child that,
[01:07:32.750]in order to access special education services
[01:07:35.100]they would need to be evaluated by the district or ESU,
[01:07:38.910]in order to, and go through an evaluation
[01:07:42.780]and provide that educational verification
[01:07:45.160]as well as qualify the child for services.
[01:07:51.290]Okay.
[01:07:52.440]Well, thank you very much, Johanna.
[01:07:53.886]Yeah, thank you, lots of fun, good to see you.
[01:07:57.320]Hear from you again at the next conference.
[01:07:59.470]So thanks everybody for joining.
[01:08:01.580]We will see you for the next sessions.

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What's New with Autism in Early Childhood

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