Weitz Grant Autism Screening Protocol In Early Childhood

Jean Ubbelohde, Kelli Krause, McKayla LaBorde, Kate Menousek Author

04/06/2020 Added

11 Plays

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2020 ASD Network Conference Breakout Session

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[00:00:00.120]You're ready go ahead.
[00:00:02.780]Awesome, well we are gonna get started
[00:00:04.830]on our presentation and we're gonna start
[00:00:07.150]just by introducing ourselves and telling
[00:00:09.420]you a little bit about our roles.
[00:00:11.270]So, Kelli, do you wanna lead us off here?
[00:00:14.130]Sure, I'd be happy to.
[00:00:15.470]Hi I'm Kelli Krause.
[00:00:16.600]I'm an autism program facilitator
[00:00:18.490]for Millard Public Schools.
[00:00:20.227]This is my 20th year as a speech language pathologist.
[00:00:23.212]I've worked in schools, hospitals, private therapy,
[00:00:27.233]all kinds of stuff.
[00:00:28.480]So, we're excited to share this grant with you guys.
[00:00:32.060]Hi I'm Jean Ubbelohde.
[00:00:33.260]I coordinate services in early childhood
[00:00:35.790]for Millard Public Schools
[00:00:37.100]and I'm happy to be here with you guys today.
[00:00:38.850]And like all of you out there today I have a real
[00:00:41.420]passion for individuals with autism.
[00:00:48.380]Hi, I'm Katy Menousek.
[00:00:49.610]I'm a psychologist at the Munroe-Meyer Institute.
[00:00:52.465]And I've been working, more specializing in autism
[00:00:57.330]spectrum disorders in about the last three to four years,
[00:01:00.750]three years I think.
[00:01:02.190]But I've been a psychologist for approximately
[00:01:04.080]10 years at Munroe-Meyer.
[00:01:07.750]And I'm McKayla LaBorde.
[00:01:09.620]I'm the executive director of student services
[00:01:12.140]at ESU #3, which happens to be the ESU
[00:01:15.010]that Millard Public Schools is located in
[00:01:16.830]in the Omaha area.
[00:01:19.260]And this is my third year in this role,
[00:01:21.130]but I've been in special education administration
[00:01:23.387]for over 15 years and was a classroom teacher
[00:01:26.870]prior to that in special education.
[00:01:29.630]We're excited to kick this off and tell you a little bit
[00:01:32.180]more about what we've been up to.
[00:01:36.870]So just a couple session rules of etiquette.
[00:01:39.470]And if you've been other sessions
[00:01:41.170]you've seen these before and I think
[00:01:42.838]Terry also took care of some of these things.
[00:01:45.220]But definitely use the chat box.
[00:01:46.610]We will be monitoring that
[00:01:47.735]and trying to get to all the questions.
[00:01:52.900]So, a few objectives we'll share with you
[00:01:54.730]at the beginning of the session is that we are here
[00:01:57.052]today to inform you and share with you the outcomes of
[00:02:01.610]what we have titled
[00:02:03.110]the Weitz Grant Autism Screening Protocol,
[00:02:06.520]which is part of a comprehensive evaluation
[00:02:08.378]in early childhood.
[00:02:09.976]We hope that by attending this session today
[00:02:12.670]you'll learn about the medical model,
[00:02:14.770]the MCHAT screening protocol and importantly
[00:02:17.706]resources for families.
[00:02:24.480]So here's a little bit of background
[00:02:26.083]on where we are, how we got to today.
[00:02:30.400]So Millard applied for a grant
[00:02:33.422]through the Weitz foundation
[00:02:35.420]and was awarded that grant actually over a year ago.
[00:02:39.730]We are now on year two.
[00:02:41.480]And the primary goal, that overarching goal
[00:02:43.870]was really to address screening gaps in the
[00:02:45.570]identification of young children on the autism spectrum.
[00:02:48.927]We would think at this point knowing where we are here
[00:02:52.290]in 2020 that we wouldn't have gaps,
[00:02:55.740]but I'm sure it's not surprising to everyone who's
[00:02:58.469]listening that we do have gaps
[00:03:00.590]and we still see children showing up to school
[00:03:03.470]or preschool that have not been evaluated in the
[00:03:07.700]area of autism.
[00:03:08.640]So, that's the ultimate goal.
[00:03:14.890]So, as a part of this committee, a steering
[00:03:17.610]committee was established as a part of the grant.
[00:03:19.470]And so Millard Public Schools did a really diligent
[00:03:22.690]job in trying to just rope into this opportunity
[00:03:26.766]lots of different people from different backgrounds.
[00:03:29.920]And so they were very thoughtful about putting
[00:03:31.630]together the committee because we all known this
[00:03:34.110]is complicated work and it doesn't just involve schools.
[00:03:36.996]It doesn't just involve medical professionals,
[00:03:40.340]but it really takes an entire team.
[00:03:43.130]And so, you can see on this screen the types
[00:03:46.660]of members that we enlisted to be a part
[00:03:49.740]of this work from the onset.
[00:03:51.900]And so, and again, Millard Public Schools did a great
[00:03:54.810]job in securing this funding and to really just
[00:03:56.740]do what they could to increase that,
[00:03:59.641]to lesson the gap of screening.
[00:04:02.370]So, you can see there's medical professionals
[00:04:05.290]from a variety of different entities
[00:04:06.800]here in the Omaha area.
[00:04:09.640]We also included importantly
[00:04:11.377]a parent of a child with autism.
[00:04:13.570]I think that that perspective has been invaluable
[00:04:16.054]as we've discussed and worked through
[00:04:19.660]several different projects.
[00:04:21.123]And she happens also to be a member of PTI,
[00:04:24.830]but we have multiple parents of children with autism
[00:04:27.350]on our committee.
[00:04:28.507]And then of course the members who are included
[00:04:32.250]in our presentation team today.
[00:04:36.620]A little background on the project,
[00:04:38.300]I know Jean mentioned that Millard secured this grant
[00:04:41.190]through the Weitz Foundation.
[00:04:42.420]So, what really sparked this idea
[00:04:46.150]was some work that had occurred originally actually in the
[00:04:50.570]San Diego area and then was replicated in the Phoenix area.
[00:04:54.040]And so in particular the information from the
[00:04:56.920]Phoenix area is something that Jean and other committee
[00:04:59.720]members were made aware of and it's just fantastic.
[00:05:05.440]So the southwest area of Phoenix was awarded
[00:05:09.045]a giant grant from the National Institute of Health
[00:05:13.600]and what they wanted to do was to get
[00:05:16.480]a better process in place for pediatricians
[00:05:20.530]to screen for autism.
[00:05:22.430]And as a result of this grant in their work
[00:05:25.255]they had over 200 pediatricians in that area
[00:05:28.980]on board to use a screening tool.
[00:05:31.842]And what the results show were amazing.
[00:05:34.890]And this is no surprise to any of you,
[00:05:36.750]but not only did they increase their identification
[00:05:41.060]of autism, but what was happening is those
[00:05:44.030]results and those screenings were occurring
[00:05:46.160]at an earlier age.
[00:05:48.230]And so the earlier we can get in and have an
[00:05:51.220]understanding of the needs of a particular child
[00:05:53.940]the earlier we can provide those evidence based
[00:05:56.240]interventions and supports to the families.
[00:05:58.730]And so it's just really, it was phenomenal work
[00:06:02.910]and I know that it's still going on,
[00:06:04.570]but it was really what kind of sparked this idea
[00:06:07.290]of trying to increase that earlier identification.
[00:06:10.709]You know, we've listed here the CDC Community Report.
[00:06:14.200]We know that just nationally and really worldwide
[00:06:17.690]the prevalence of autism continues to increase
[00:06:20.444]and so this early screening and identification
[00:06:23.710]of autism continues to be the main issue.
[00:06:27.441]And so that is of course a part of the puzzle.
[00:06:30.140]And really just that notion of partnerships,
[00:06:32.568]whether it's partnerships with your local
[00:06:35.875]health agencies, there are a lot of national partnerships
[00:06:40.790]happening, and then that goes down to the state
[00:06:43.210]level as well as the local level.
[00:06:45.670]And it's just an important factor because we really
[00:06:48.770]can't tackle this with a one sided approach.
[00:06:53.150]On the note of partnerships, again,
[00:06:55.620]with the formation of the steering committee
[00:06:57.520]and some of the work we're going to talk
[00:06:58.890]with you about it was important to really get
[00:07:01.460]perspectives from all of these entities.
[00:07:03.690]And so as you're familiar the Child Find efforts
[00:07:07.770]that we have, and this is specific to autism,
[00:07:10.540]but really, you know, applies to all of Child Find.
[00:07:13.580]We've really got to engage all of our partners
[00:07:16.264]on this topic.
[00:07:18.380]It was interesting.
[00:07:19.280]Some of the goals of the grant from the onset
[00:07:22.867]included a lot of, you know, trying to influence
[00:07:26.580]pediatricians, trying to ask our medical
[00:07:29.710]professionals to do one more thing.
[00:07:31.988]And while that's important we did take a slight
[00:07:35.640]step back and kind of think to ourselves,
[00:07:37.320]well, at this point, what do we have control over?
[00:07:40.870]And we're gonna talk a little bit about what that
[00:07:42.796]lead Miller Public Schools to do.
[00:07:45.690]But you know there's a lot on everyone's plate.
[00:07:48.959]And while we know this is essential and very important
[00:07:52.062]there's just a lot going on for everybody.
[00:07:54.340]So, these partners in our Omaha area
[00:07:58.531]were really, it was really important
[00:08:00.610]to engage these partners.
[00:08:02.370]But we did kind of take a step back and think
[00:08:04.930]to ourselves, well, what is within our locus of control.
[00:08:07.980]And that's a little bit where some of the work
[00:08:10.430]came from today.
[00:08:18.910]So, the medical model we kind of went in our planning
[00:08:26.256]we wanted to know one, what other people were doing
[00:08:29.520]in town so that if we wanted to refer families
[00:08:32.640]we could refer them to different places,
[00:08:34.810]even though there was a children's representative
[00:08:37.160]and I was the MMI representative
[00:08:38.890]we wanted to like just kind of let parents
[00:08:40.980]know what was around for that medical model.
[00:08:44.490]I think in another slide I'm gonna talk
[00:08:46.930]about why a medical model is important
[00:08:49.893]for a diagnosis of autism.
[00:08:52.306]For those in the schools you're all probably
[00:08:55.797]very familiar with the verification of autism.
[00:08:59.650]But I think families sometimes struggle
[00:09:03.120]with knowing why they would need to seek
[00:09:06.270]out a medical diagnosis for autism
[00:09:08.003]if they already are receiving services at school.
[00:09:11.090]So these, that's okay, you can go back.
[00:09:14.570]Sorry, McKayla.
[00:09:15.570]So, basically we identify these institutions as these
[00:09:19.228]that could provide a diagnosis
[00:09:22.048]of autism with that medical model.
[00:09:25.771]But now you can do the, oh sorry.
[00:09:27.740]So, if we were in real like I would say
[00:09:31.515]who knows the difference between a diagnosis
[00:09:33.657]and a verification.
[00:09:35.060]But we're not gonna do that today,
[00:09:36.547]so I'll just tell you.
[00:09:39.771]My background is actually in school psychology
[00:09:42.970]so I have done verifications in a school setting
[00:09:45.912]and diagnosis in a clinical setting.
[00:09:52.610]Sorry, so as you all know verification gets children
[00:09:56.462]services, individualized education plan,
[00:10:01.448]and supports and services at school.
[00:10:05.680]But what a medical diagnosis does is
[00:10:08.483]I think the biggest thing that I really stress
[00:10:10.740]to families is supports from the state,
[00:10:12.454]including SSI, depending on
[00:10:16.050]the family's income, respite services.
[00:10:21.120]They can apply for disability when they're a child
[00:10:24.900]because in Nebraska there's about a seven to nine
[00:10:26.835]year wait list.
[00:10:28.300]So we really stress the importance of a medical
[00:10:30.960]diagnosis so families know and can receive
[00:10:35.060]these services if they are able
[00:10:38.690]to get those services.
[00:10:41.280]Another one can be Medicaid as a secondary insurance
[00:10:43.378]as well, depending on the family's income too.
[00:10:52.310]So the other thing that we did in our planning
[00:10:54.060]was talking about different screeners that are available
[00:10:56.069]and what doctors use to get people to the medical diagnosis.
[00:11:01.040]So a lot of times that occurs at well child checks
[00:11:04.810]if it's not occurring at schools
[00:11:06.222]and so we talked about all these different screeners
[00:11:09.048]and the one that we found that was mostly used
[00:11:11.493]is the MCHAT at 18 and 24 months and sometimes
[00:11:15.853]I believe after 36.
[00:11:19.385]I might be wrong on that.
[00:11:21.023]But that was the most nationally used at physicians
[00:11:26.020]well child visits.
[00:11:27.564]So we really took a liking to that.
[00:11:30.326]The other screening tool that I just really want to note
[00:11:33.250]is the screening for autism in two year olds.
[00:11:35.525]That came out of Vanderbilt.
[00:11:38.098]I've used it probably 20 times and as a screening
[00:11:42.520]tool I just really adore it.
[00:11:43.970]It's 20 minutes.
[00:11:44.920]It doesn't, you do need to be trained on it
[00:11:47.820]but the training's a one hour webinar
[00:11:52.010]that you would take online.
[00:11:53.470]And so educators can do that as well.
[00:11:56.860]You don't need to have any level of licensure
[00:11:59.010]to do it.
[00:11:59.843]I think they're just doing more research on that.
[00:12:01.460]And so more to come on the stats.
[00:12:08.910]So just a little bit more on the MCHAT.
[00:12:10.500]Okay, not 36, 30 months.
[00:12:12.150]So, it's administered at 18, 24, and 30 months for children.
[00:12:17.580]There's a whole algorithm to it.
[00:12:19.212]It's free online if you Google MCHAT.
[00:12:22.240]It's about a probably eight page PDF with the screener
[00:12:27.870]front and back and then instructions on how
[00:12:29.720]to score it.
[00:12:35.250]Sorry, I lost my train of thought.
[00:12:38.240]So what the MCHAT does is it more,
[00:12:41.966]we're looking at it as less of a screener and more
[00:12:44.720]as a just kind of way to open up a conversation.
[00:12:48.940]So, if there are concerns and they meet different cut offs
[00:12:52.390]we can use that as a way to start a conversation
[00:12:56.090]with a family, if that makes sense.
[00:12:59.675]Let me see if I want to say anything more about that.
[00:13:05.311]I think that's all.
[00:13:06.230]Sorry McKayla.
[00:13:12.500]So just some more notes on the MCHAT is the primary
[00:13:15.370]goal is to maximize sensitivity.
[00:13:17.980]So, trying to detect as many potential children
[00:13:22.480]that would need more assessments or just kind of more
[00:13:28.290]further assessments if they meet the criteria
[00:13:31.960]as opposed to waiting for them to not progress.
[00:13:36.900]And I think that that's for me where I feel as a society
[00:13:41.150]we're kind of falling behind and we're,
[00:13:42.676]well, we're getting better at it,
[00:13:44.500]but that's the old way.
[00:13:45.540]Oh, you know, they're a boy, boys talk a little bit later
[00:13:49.060]than girls, so just give them time.
[00:13:51.450]And instead of saying let's wait, I think our last meeting
[00:13:54.347]the key phrase is if you see it say it.
[00:13:56.783]So just kind of helps that conversation of, you know,
[00:13:59.780]we've got these concerns and let's look further into it.
[00:14:03.406]Piece of mind's worth a million dollars
[00:14:05.893]and that's what the MCHAT helps to do.
[00:14:10.080]There's also, sorry McKayla, one thing.
[00:14:11.850]There's also follow up questions on the MCHAT.
[00:14:13.862]If there's any, it kind of helps the person
[00:14:17.194]running the MCHAT guide the conversation
[00:14:20.460]so if a parent indicates yes to one of the items
[00:14:24.240]of concern it kind of shows you how you can guide
[00:14:26.730]the conversation to ask more questions to get
[00:14:29.930]a better detailed answer.
[00:14:32.790]Okay, I'm done.
[00:14:37.120]Also for scoring for, so for items two, five, and 12,
[00:14:40.660]yes indicates a risk.
[00:14:42.050]And then for all other questions a no
[00:14:44.040]would indicate a risk.
[00:14:44.950]And when you go through and score it you just add up
[00:14:46.966]the number of ones and then there's an algorithm
[00:14:50.590]I think, so three or fewer ones
[00:14:53.035]would indicate limited concern.
[00:14:55.220]I think eight to 12 that's when you would want to go
[00:14:57.760]through the follow up.
[00:14:58.970]I think it's on the next slide.
[00:15:01.387]And then 12 and further, sorry,
[00:15:05.179]zero to two is low risk.
[00:15:06.853]So then you would want to screen them again.
[00:15:09.302]Medium risk would be three to seven,
[00:15:11.160]so you would want to go through and answer
[00:15:12.750]some of those follow up questions with the family.
[00:15:14.576]And then a score of eight or higher would indicate
[00:15:18.370]that you would want to do an evaluation.
[00:15:20.040]So either or, or both doing a verification at the school
[00:15:25.770]and then letting a parent know potentially
[00:15:28.324]what the benefits of getting a medical diagnosis
[00:15:31.467]could hold for them.
[00:15:38.924]Another form that we use as part of the procedures
[00:15:45.425]is the Social Communication Questionnaire.
[00:15:47.727]And it's asking a lot of socially,
[00:15:54.401]social reciprocity, repetitive behavior questions
[00:15:57.690]for children ages three to five.
[00:15:59.107]And then a score of 18 would indicate possible concerns
[00:16:03.256]where you would, team members would have a conversation
[00:16:06.260]with the family.
[00:16:08.650]Scores below would not warrant further evaluations,
[00:16:11.690]but I would just like the MCHAT I would suggest
[00:16:16.770]if we were in the, if there were concerns I would
[00:16:19.157]strongly recommend reassessing in three to six,
[00:16:21.757]to 12 months.
[00:16:27.620]So, I'll jump in here.
[00:16:29.880]Couple things regarding how we're processing
[00:16:32.390]things in Millard.
[00:16:34.325]So within our part COVID, so our early intervention
[00:16:38.840]team they are conducting those at the intervals
[00:16:41.059]that Katy mentioned.
[00:16:43.166]And then moving from there
[00:16:45.710]to a comprehensive evaluation if needed.
[00:16:48.890]That information both in, whether in part C
[00:16:51.310]or part B, so part C using MCHAT,
[00:16:54.470]part B we're using the Social Communication Questionnaire.
[00:16:57.470]Couple of important things as a takeaway.
[00:17:01.907]We are doing it as part of a comprehensive evaluation.
[00:17:05.481]If we have a score on the MCHAT or the
[00:17:09.420]Social Communication Questionnaire that indicates
[00:17:12.370]a concern first and foremost we want to make sure
[00:17:15.270]that that is part of a fierce conversation,
[00:17:18.150]a very sensitive conversation with the family.
[00:17:20.413]Kelli's gonna talk more about that in a little bit,
[00:17:22.700]about those conversations.
[00:17:24.820]And that's a big takeaway.
[00:17:26.940]The other thing is that we want to make sure
[00:17:28.950]that if we end up with either a verification
[00:17:33.440]or the child has a medical diagnosis of autism,
[00:17:35.679]or we just have, definitely have some elevated
[00:17:38.810]scores on one of our tools
[00:17:40.969]that we're able to match those evidence based
[00:17:44.440]practices that meet that child.
[00:17:47.180]So they're really two of our critical
[00:17:50.120]outcomes of this.
[00:17:51.180]We wanna make sure that we have conversations with families.
[00:17:54.160]We want to make sure that two, are able to then
[00:17:56.560]match the practices to meet the diagnosis,
[00:18:01.933]the verification, or even just that level of concern
[00:18:04.468]if in fact we didn't go on for that verification.
[00:18:07.620]So we're still doing a holistic evaluation
[00:18:11.572]below age five.
[00:18:13.970]But we will also dig in more in the area of autism.
[00:18:17.607]And I can tell you just some anecdotal things
[00:18:21.160]that have happened in our district.
[00:18:22.880]I have some amazing providers as I know we do
[00:18:26.350]across the state.
[00:18:27.910]And anecdotally what we have learned is that
[00:18:30.051]providers often were not having those
[00:18:33.380]conversations about autism
[00:18:37.673]when they saw concerns.
[00:18:40.450]So if there were some behaviors that were being
[00:18:42.930]demonstrated in part C some providers
[00:18:47.080]may not have felt comfortable having that conversation.
[00:18:49.254]That child now moves on to part B.
[00:18:51.820]They're in preschool and of course preschool
[00:18:55.030]you don't see the family all the time
[00:18:57.416]and I've learned that that conversation may not have
[00:18:59.760]happened until the child was four,
[00:19:01.310]came up for reevaluation.
[00:19:03.040]And we've missed some really critical time
[00:19:05.325]that we could have been providing that family with
[00:19:07.829]resources, with evidence based practices connecting
[00:19:10.940]them to the medical community if that's
[00:19:13.690]what choice that they made.
[00:19:14.860]So, that is something we've really learned
[00:19:18.310]more anecdotally as a result of this
[00:19:20.015]project that we have embarked upon.
[00:19:27.360]I think that was all for that slide.
[00:19:28.650]So, I think we're at the questions and answers,
[00:19:30.760]well, questions and I hope we have the answers for you.
[00:19:35.989]Well right now I don't see anything in the chat.
[00:19:38.020]Does anybody have some questions that they'd like to share?
[00:19:40.810]We'll give you a few minutes to type.
[00:19:53.250]Okay, we have a question.
[00:19:54.790]How many students do serve birth to five and how many
[00:19:58.070]referrals do you receive?
[00:19:59.630]Jean?
[00:20:01.320]So we serve over 400 children birth to five.
[00:20:03.994]And referrals in a year, well,
[00:20:08.780]it's over 200, around 200 in part C
[00:20:13.700]and over 200 in part B each year.
[00:20:16.356]So we will, we're conducting the MCHAT when they,
[00:20:21.517]if they've already verified for services,
[00:20:24.560]let's say they came in a year ago
[00:20:26.382]and we just started using MCHAT in November.
[00:20:31.910]So regardless when they came in if they
[00:20:34.450]weren't in that age interval then we would go
[00:20:36.290]ahead and conduct that at that next age interval
[00:20:39.244]in part C.
[00:20:42.350]Okay, our next question is that do you, or have you used
[00:20:45.030]the UCC checklist?
[00:20:46.640]And I can answer that.
[00:20:48.060]We typically do use that,
[00:20:48.985]but sometimes it's a little bit further down the road
[00:20:51.443]kind of to dig in more.
[00:20:53.840]We don't use that as part of the comprehensive
[00:20:55.720]evaluation, but we use that more as a tool
[00:20:58.254]and then going to the Ziggurat model and figuring
[00:21:01.960]out what kind of supports we can put in place
[00:21:03.970]for those students.
[00:21:05.971]Kelli I will jump in
[00:21:07.570]really quick because regionally
[00:21:09.467]there are some teams who are using it part of
[00:21:12.207]the evaluation tool.
[00:21:14.380]It doesn't give a score,
[00:21:15.340]but it gives really good information
[00:21:17.710]that then they can use for program planning.
[00:21:20.600]So they are using it at some of those earlier,
[00:21:23.420]initial evaluations times.
[00:21:27.358]Again Kelli, like you said, just to help with more
[00:21:29.910]programming and for the psychologists
[00:21:34.350]to give really really good specific recommendations
[00:21:36.851]to the team also as far as that program goes.
[00:21:42.330]Thank you Terry.
[00:21:44.340]Our next question is as a preschool classroom teacher
[00:21:47.230]where does the referral process start
[00:21:49.060]in the public school?
[00:21:50.510]Does it differ between districts?
[00:21:53.860]I can speak for our district and I think
[00:21:55.960]this is similar in a lot of the metro area districts
[00:21:58.590]that it starts at our central office and then we
[00:22:02.829]currently have an evaluation team that processes
[00:22:05.760]all those initial evaluations.
[00:22:07.560]We didn't always do it that way.
[00:22:09.453]We used to have it that we filtered them out to
[00:22:12.410]individual preschool teams to do that.
[00:22:14.734]But logistically we changed
[00:22:17.070]that a couple years ago.
[00:22:19.040]So that's what works well for us
[00:22:21.033]is just the one evalutation team.
[00:22:23.590]And then from there after they verify we push
[00:22:26.020]them back to a classroom for services or SLP.
[00:22:31.590]And I would also add that we have
[00:22:33.464]our bigger districts doing it the way Jean described
[00:22:36.703]in many cases.
[00:22:39.620]But a lot of our smaller districts the birth
[00:22:41.850]to three team or the birth to preschool,
[00:22:44.210]the whole group of them are doing those evaluations.
[00:22:48.091]So, obviously depending on the size of the district
[00:22:49.768]it looks very different.
[00:22:56.150]Okay, our next question says,
[00:22:58.840]has this increased your verification for autism
[00:23:00.876]in both zero to three and/or three to five?
[00:23:04.465]And I would say yes for sure.
[00:23:07.404]We don't have enough data yet to report on that.
[00:23:10.660]So, I would just say stay tuned.
[00:23:12.120]We've only been doing it since November and I wouldn't
[00:23:15.190]want to jump to any conclusions.
[00:23:16.480]I think that, I could say anecdotally,
[00:23:19.870]again my opinion is it will increase it in the
[00:23:22.181]area of autism.
[00:23:23.850]So, whether it increases our overall verification
[00:23:28.139]I'm not sure.
[00:23:29.170]But it potentially could.
[00:23:30.850]But I think more likely would be it would be
[00:23:33.336]in the area of autism.
[00:23:35.700]And teams have that option always,
[00:23:38.380]families have that option,
[00:23:39.420]even though they go down that road
[00:23:40.600]of the comprehensive evalutation,
[00:23:42.345]to stay with the verification of developmental delay
[00:23:46.560]until they're either up for reevaluation
[00:23:49.980]or sooner if need be.
[00:23:55.850]Okay, our next question says,
[00:23:58.050]can you talk a little more about how you use
[00:24:00.320]evidence based practices with children after the
[00:24:02.373]diagnosis is made?
[00:24:05.590]We've done a lot of training with our staff
[00:24:07.530]in our district about specific
[00:24:08.836]evidence based practices.
[00:24:10.725]We share webinars with them and our parents.
[00:24:13.830]And we also have them attend trainings
[00:24:15.661]through our ESU #3.
[00:24:18.544]Somebody else wanna add to that?
[00:24:20.950]Well, I'll add to that only because I'm
[00:24:23.090]gonna PR tomorrow because I'm doing a training
[00:24:25.618]on that specifically embedding evidence
[00:24:29.130]based practices into daily routines
[00:24:30.870]for young kids with autism.
[00:24:33.190]So that one is at 12:45 tomorrow.
[00:24:35.650]So if you want to know more about evidence based
[00:24:37.717]practices, which ones are really really,
[00:24:41.566]really tend to match up with some of the more
[00:24:45.311]common outcomes we might see with some of those
[00:24:47.750]little ones that we're working really hard
[00:24:49.476]at with families then join that webinar tomorrow,
[00:24:53.340]or just watch the recorded version down the road.
[00:24:56.610]Anyone else wanna jump in with that?
[00:24:58.900]I was just going to say, I mean I know that we
[00:25:01.065]probably could, again, there could be a multiple day
[00:25:05.030]session on evidence based practices
[00:25:06.628]and our goal today is to share with you this
[00:25:09.335]process that's been initiated in Millard Public Schools
[00:25:13.030]for adding this component for looking more specifically
[00:25:15.811]for autism as a part of a comprehensive evalutation.
[00:25:18.680]And so we, I mean there's opportunities out there
[00:25:22.960]and I would plug the autism networks across the state
[00:25:26.515]to be great resources for that, not only additional
[00:25:29.750]sessions at the conference.
[00:25:31.260]But our ASD coordinators and staff do an amazing
[00:25:35.710]job of promoting those evidence based practices.
[00:25:38.388]We probably won't have time to get into that today,
[00:25:40.205]but we certainly encourage you to connect
[00:25:43.840]with your ASD network and look at other sessions
[00:25:46.330]during the conference to kind of address that question.
[00:25:53.170]Our next question is very specific.
[00:25:54.920]So you indicated a prior written notice is sent to
[00:25:57.640]families that you will not be moving forward
[00:25:59.670]with an autism assessment.
[00:26:01.300]Do you have a sample, or can you speak about this?
[00:26:05.820]We could certainly provide a sample.
[00:26:08.097]I just real quickly I would say,
[00:26:10.137]you know, we of course follow language of a prior written
[00:26:13.300]notice indicating that the team did conduct
[00:26:15.228]a comprehensive evalutation in the area of autism
[00:26:18.840]and at this time the team is not proceeding
[00:26:22.230]with a verification of autism.
[00:26:24.010]But the language is a little bit more lengthy than that
[00:26:26.945]and I can pull up our sample and share that out
[00:26:29.342]with handouts if that's how that works.
[00:26:31.900]Right Terry?
[00:26:37.033]You're muted.
[00:26:41.370]Oh sorry about that.
[00:26:42.770]Yes, absolutely, and if you yeah get that to me.
[00:26:46.550]We will definitely get that back up.
[00:26:49.690]And I know you guys still have the other half
[00:26:51.470]of your presentation so if you want to stop
[00:26:53.200]with questions and move forward you can.
[00:26:56.662]And then we can pick up where we left off for the.
[00:27:02.210]We can keep going.
[00:27:03.043]Some of the questions we'll address
[00:27:04.270]in the next few slides actually, so.
[00:27:06.110]Perfect.
[00:27:12.840]Okay, so I don't know if everybody got to hear
[00:27:15.769]the main speaker this morning.
[00:27:17.460]But I just want to reiterate what she said
[00:27:19.600]about that sense of understanding, empathy, honesty,
[00:27:22.770]and being straight forward with parents.
[00:27:26.180]When we share the results of an MCHAT You actually
[00:27:27.958]are walking through it step by step with families
[00:27:30.857]and that has opened up the conversation
[00:27:33.360]and one of the questions we just had in the chat box
[00:27:35.106]was, is it making conversations easier?
[00:27:37.780]Definitely, it gives you that concrete information
[00:27:40.170]to share with parents.
[00:27:41.080]But some of the things to keep in mind when we're going
[00:27:43.255]through the screening and talking to parents about this
[00:27:45.835]is just having that perspective in mind
[00:27:48.242]of the family.
[00:27:49.900]And a lot of times we'll, we have to think about the
[00:27:53.590]dynamics of each family just as unique
[00:27:54.938]as our students on the spectrum.
[00:27:57.270]We want to think about their thoughts and let them know
[00:28:01.810]they are the expert on their child.
[00:28:03.426]We are the expert on autism.
[00:28:05.810]And we want to share with them what we can.
[00:28:08.420]So think about their awareness to autism and they may
[00:28:10.604]have shared a family history, oh so in so,
[00:28:14.616]uncle so in so seems like this too,
[00:28:17.150]or you know things that they are going to share with you
[00:28:19.524]will help with that conversation, kind of make those points
[00:28:22.619]and make those connections.
[00:28:24.530]Another thing to keep in mind is the culture of the family
[00:28:26.794]and how they perceive autism.
[00:28:30.052]We have a lot of families in Millard, Indian,
[00:28:33.175]from Afghanistan, all kinds of different
[00:28:36.910]things that you just have to be mindful of that
[00:28:39.222]and keep that in mind when you're talking
[00:28:41.720]through these things.
[00:28:43.330]Think about the caregiver cognition and how they're
[00:28:45.216]processing all this information.
[00:28:46.988]A lot of times they may already have that gut
[00:28:51.870]feeling and this is gonna make sense to them
[00:28:54.430]and other times it may have completely come out of
[00:28:56.980]left field and they are not thinking about autism
[00:28:59.826]and realizing that this is what it could be based
[00:29:01.940]off the screener.
[00:29:03.670]You may have some parents or caregivers that agree,
[00:29:08.310]disagree, just kind of depends.
[00:29:09.900]We've had a little bit of everything.
[00:29:11.149]It depends on who the caregiver is.
[00:29:14.210]Is it mom, dad, grandparents?
[00:29:16.100]Who's involved in caring for this child
[00:29:19.170]and thinking through in general terms
[00:29:22.190]when you're conveying
[00:29:23.880]all that information to these families
[00:29:25.466]makes sure that they're understanding.
[00:29:27.590]So stop and ask questions.
[00:29:28.815]Ask them, you know, if they need clarification.
[00:29:32.561]I think about when I'm talking to other friends
[00:29:35.628]that are SLPs we'll talk in a completely different
[00:29:38.434]language than I would when I talking to parents
[00:29:40.400]in explaining the process.
[00:29:43.595]So just be cognizant of that
[00:29:46.050]that you're, the information that you're sharing
[00:29:49.950]with the caregivers and that they're understanding it.
[00:29:52.930]Assisting them with that emotional connection
[00:29:56.080]too, that support, again I always like to say, you know,
[00:30:01.090]Suzy is still Suzy.
[00:30:02.170]We came in here and she's still the same little girl.
[00:30:05.300]And some families will say we know we're good with that
[00:30:08.640]and we're gonna move forward.
[00:30:10.270]And other families you may need to hand the tissues
[00:30:13.450]to and walk them through that and let them know
[00:30:15.920]that we're gonna be here to hold your hand and
[00:30:17.763]we'll talk about all of the supports that are in place
[00:30:21.470]for you child.
[00:30:24.010]Okay, so the next slide.
[00:30:28.310]So one of the things that we did at Millard
[00:30:30.370]was write a script.
[00:30:31.800]Think about that conversation.
[00:30:33.036]It is nice to have that concrete script
[00:30:37.870]in your head about what is going to be said
[00:30:39.205]and using the MCHAT and the results
[00:30:42.404]will give you that information instead
[00:30:44.800]of just sharing, oh my opinion is I'm just
[00:30:47.030]seeing some things that make me think your child
[00:30:50.080]may have autism.
[00:30:50.913]Instead you can look at the MCHAT,
[00:30:53.130]look through those specifics and talk to them about that.
[00:30:56.500]And again this is a screener,
[00:30:58.488]but it is a likelihood that we are going to go
[00:31:02.300]down that road and look at a diagnosis
[00:31:05.010]or a verification.
[00:31:06.120]We want the parents to know that just because the
[00:31:08.050]screener is giving us this number does not
[00:31:10.810]mean that they have that diagnosis,
[00:31:12.770]but it is gonna require comprehensive evalutation
[00:31:14.570]and a body of evidence to verify.
[00:31:18.038]And that's where we want to explain to them what this
[00:31:21.540]process is gonna look like.
[00:31:22.920]So ask them again, like I said, ask questions.
[00:31:25.783]I always start with questions.
[00:31:27.636]Let parents share their side of the story.
[00:31:31.800]They're the expert on their child like I said.
[00:31:33.428]They're gonna be the ones that are gonna
[00:31:35.130]share that information with us
[00:31:36.520]and we're gonna just hold their hand and walk
[00:31:38.450]through this process together, okay.
[00:31:40.446]So, talk about the benefits
[00:31:42.560]of that comprehension evalutation
[00:31:44.230]with them and just the importance of an early intervention
[00:31:47.260]like Jean spoke about earlier.
[00:31:49.570]We want to gain more knowledge about their child
[00:31:51.431]and we want to have that discussion.
[00:31:54.530]And we know that children because when we catch them
[00:31:57.780]earlier we're able to make a bigger difference
[00:31:59.700]in the long run.
[00:32:01.860]So outline those possible next steps for the family.
[00:32:04.279]What is it gonna look like?
[00:32:06.550]What tests are we gonna do?
[00:32:07.940]Who's gonna be involved?
[00:32:08.980]Things like that.
[00:32:10.140]And then you'll want to call the family
[00:32:11.830]a few days later and just see how they're doing
[00:32:13.660]with everything, how they've taken the news of the screener
[00:32:17.120]and what are the next steps,
[00:32:18.430]and see what questions they have.
[00:32:19.800]'Cause in the moment they may not have those questions,
[00:32:21.546]but a day or two later they might.
[00:32:23.970]And then you'll wanna schedule another screener
[00:32:25.967]in the next few months and walk through
[00:32:27.790]that process with families.
[00:32:30.675]Okay.
[00:32:33.760]All right, can you go to, thank you.
[00:32:36.640]So, really our goal is helping that family get informed
[00:32:39.900]about how we can help them out
[00:32:41.771]and let them kind of that there are gonna be
[00:32:44.160]a lot of people involved to help them walk down this road
[00:32:46.149]or figuring out of it is autism or not.
[00:32:49.787]And if it is, you know, all of the information
[00:32:52.470]that we have in the community a speech language
[00:32:56.150]pathologist may be involved,
[00:32:57.940]and occupational therapist, physical therapist,
[00:32:59.704]other outside clinics.
[00:33:01.871]Some of the families I think Jean talked about
[00:33:05.630]earlier and Katy talked about is sometimes
[00:33:07.420]we get the families coming from we got a medical
[00:33:10.530]diagnosis, now what do we do?
[00:33:12.340]And how do we get the schools involved?
[00:33:13.790]So it's that partnership in the community
[00:33:16.250]as we've talked about through the grant
[00:33:17.880]and getting everybody on the same page
[00:33:19.600]so that we've got the screeners done,
[00:33:21.730]whether they've been done through the school
[00:33:23.380]and we're now screening all students in our early
[00:33:26.510]childhood program.
[00:33:27.750]And then we're also getting those students
[00:33:28.847]who have been screened in the doctor's offices
[00:33:31.085]in a medical setting.
[00:33:32.620]So we want to make sure that we're working and
[00:33:35.097]getting all that information.
[00:33:37.250]One of the things that we always start with too
[00:33:38.990]with all of our students is making sure that
[00:33:40.850]it's not a hearing involvement.
[00:33:43.430]So make sure that you're completing a hearing
[00:33:45.260]screening at the beginning.
[00:33:47.040]And then provide further information to families
[00:33:49.520]with resources and support and know that we are here
[00:33:53.240]as a team to help them through that and continue
[00:33:56.400]to answer those questions.
[00:33:58.000]And then we want to make sure that families
[00:33:59.830]are making sure that our reports with the medical
[00:34:02.877]and vice versa like I said.
[00:34:04.480]It takes a team effort across all areas
[00:34:07.700]and let those parents know that there are
[00:34:09.860]a lot of people that are gonna be behind them
[00:34:11.570]and help them through this process.
[00:34:20.850]So I think Jean and I are gonna tackle
[00:34:22.799]a little bit of this discussion with regards
[00:34:25.080]to vision for the future and, you know, really,
[00:34:28.065]again I wanna emphasize how cool it is that
[00:34:32.703]we had this goal for increasing screenings.
[00:34:36.380]Millard saw something that they could do
[00:34:38.298]and even on a really large scale in a district
[00:34:41.080]like Millard to take this initiative is fantastic.
[00:34:44.300]And so we've got some goals with regards
[00:34:46.630]to sharing this with all of you as well
[00:34:48.860]as what our committee wants to tackle in the future.
[00:34:52.539]So I wanted to start off by sharing kind of
[00:34:56.040]connecting a couple dots.
[00:34:57.630]So when McKayla started out in the beginning
[00:35:00.080]and talked about how we learned about this project
[00:35:03.720]which was happening, started in San Diego,
[00:35:06.810]moved to Phoenix and it was with physicians.
[00:35:09.393]Now here we are with school districts giving the MCHAT.
[00:35:13.270]So, like how did we get there?
[00:35:14.561]And honestly when we started this project
[00:35:17.138]I went into it thinking we got to these physicians
[00:35:21.110]on board here in the Omaha area.
[00:35:22.885]Katy spoke about how we gathered that information
[00:35:25.178]to see what they were doing.
[00:35:26.770]We also learned it was really great having
[00:35:28.018]Katy and having Mike Vance on our committee
[00:35:31.480]so they brought that medical perspective in
[00:35:33.960]and also brought the perspective in that it's hard
[00:35:36.393]to gather all these medical institutions and get
[00:35:40.840]doctors on the same page.
[00:35:42.162]So, then it morphed into
[00:35:46.690]the school district doing MCHATs.
[00:35:48.260]And honestly at first I was thinking,
[00:35:50.632]well, we already,
[00:35:52.350]we're already getting these children referred.
[00:35:54.320]That's not the population that we really are targeting.
[00:35:57.600]We want the ones that aren't getting referred.
[00:36:00.220]And as we continued our work and as we launched
[00:36:03.490]the initiative within our school
[00:36:06.560]district really it surprised me what I was hearing
[00:36:10.030]and I already discussed that earlier when providers
[00:36:13.170]were saying wow.
[00:36:14.280]One, I didn't think that the MCHAT would score
[00:36:16.462]how it did.
[00:36:17.826]I'm hearing that.
[00:36:19.760]And then two, while the MCHAT has really helped me have
[00:36:23.280]the conversation that I was afraid to have.
[00:36:26.500]And then three of course connecting families
[00:36:28.790]with resources or evidence based practices.
[00:36:31.565]So those are three outcomes that I can say
[00:36:36.010]when we started this that was not
[00:36:38.190]the direction we were headed.
[00:36:39.396]We still want to get back to the physicians
[00:36:42.230]and connect them and bring them on board
[00:36:45.750]as far as Child Find.
[00:36:47.210]But in the meantime we had an unexpected direction
[00:36:49.737]that this grant and process went
[00:36:54.120]and so it's been kind of fun to see how
[00:36:56.232]sometimes where you start out is not where you end up.
[00:36:59.740]So, some of our goals in sharing this with you today
[00:37:02.423]is really replication.
[00:37:04.260]How can this be replicated as you are.
[00:37:07.500]You're not in the metro area or maybe you are,
[00:37:09.764]but you're in a small school district,
[00:37:11.640]how can that happen?
[00:37:13.735]Well, you can, couple ideas that we have,
[00:37:17.105]one is that you can partner with your local health clinics,
[00:37:21.370]your local physicians, pediatrician,
[00:37:23.920]to through a Child Find effort to say
[00:37:26.172]are you willing to do it?
[00:37:28.020]In a smaller community you may have better luck
[00:37:30.670]bringing on those pediatricians early on
[00:37:33.240]where we realized in the metro area that was a little,
[00:37:35.610]that's a bigger goal and we'll get to that.
[00:37:39.131]So, how can you partner with some providers
[00:37:42.590]and clinics to get them to use the MCHAT consistently,
[00:37:46.380]and what do they do with the information?
[00:37:48.810]Sadly we learned through our gathering of information
[00:37:51.879]that physicians that were administering
[00:37:55.770]weren't necessarily knowing what to do
[00:37:58.690]with the information.
[00:37:59.850]And that was like, wow, how would you get to that point?
[00:38:02.520]Why are we at that point in 2020?
[00:38:04.560]But, not shocking either.
[00:38:06.233]And then another idea we had
[00:38:08.240]was maybe even a lunch and learn.
[00:38:09.660]You could offer a lunch and learn through your
[00:38:12.900]planning region team at one of your local hospitals
[00:38:16.250]or clinics, well not right now.
[00:38:19.150]But as you look toward your next year.
[00:38:23.030]So increasing those Child Find and early
[00:38:25.030]identification most definitely.
[00:38:27.410]And if you see it say it.
[00:38:29.910]In some ways that has become a secondary title of our work
[00:38:34.524]in that how do you have that conversation?
[00:38:37.720]The tools really really help you have that conversation.
[00:38:40.730]You can go back to the tool, and this is what it's saying.
[00:38:46.200]Just to build on what Jean shared additional
[00:38:49.220]goals in sharing this information
[00:38:50.700]with you just thinking about your next steps,
[00:38:54.023]you know, as individuals who are obviously
[00:38:57.950]interested in increasing early identification of autism
[00:39:01.199]what are your next steps?
[00:39:03.200]So, Jean shared a couple of those.
[00:39:04.860]Maybe it's collaborating and reengaging a partnership
[00:39:07.662]with your health clinic or medical professionals,
[00:39:10.318]additionally looking towards some of your,
[00:39:14.312]just the wonderful organizations and entities
[00:39:18.380]we have out there supporting autism.
[00:39:21.060]I mean I think those reengaging those partnerships
[00:39:23.950]and just looking at that is a fantastic opportunity.
[00:39:26.413]And the other thing is again, looking at what is
[00:39:29.810]within your control.
[00:39:31.380]So if it's within your control to add an element
[00:39:34.760]of screening for autism in every single evaluation.
[00:39:37.727]I don't know if Jean, she hasn't necessarily
[00:39:40.380]touched on this, but they are doing it for all children.
[00:39:43.780]And then that way there's not this cherry picking idea.
[00:39:46.638]I mean they're doing it for nearly every single situation
[00:39:50.575]with very few cases where providers can make
[00:39:54.670]an exception to Jean where she would have to approve
[00:39:56.593]where they wouldn't, you know,
[00:39:58.390]engage in this process.
[00:39:59.410]But it's a global process.
[00:40:00.750]And so again just thinking about those
[00:40:02.960]kinds of things that are within your control.
[00:40:06.330]I want to add also before this presentation today
[00:40:10.231]we did some collaboration with
[00:40:13.026]the Nebraska Department of Education,
[00:40:15.361]our part C co-leads, Teresa Coon.
[00:40:18.500]So we wanted to make sure they were involved and informed
[00:40:21.960]of what we would be sharing today
[00:40:23.520]as a part of the Weitz grant.
[00:40:25.570]And the topic of this notion
[00:40:27.480]of DD versus Autism came up.
[00:40:29.059]And you know we really are lucky to be able to have
[00:40:33.170]the opportunity to use developmental delay,
[00:40:35.570]especially at a young age when we're not sure
[00:40:38.150]what's going on.
[00:40:39.610]But we also didn't want to move completely away
[00:40:41.897]from this concept of if you see it say it.
[00:40:44.880]And so if you have the data
[00:40:46.635]to provide a verification for autism it's okay to do that.
[00:40:50.441]And our part C co-leads were really,
[00:40:53.275]just really great to have that conversation with
[00:40:56.278]and definitely supported that concept.
[00:40:59.900]Of course again knowing that you would never
[00:41:02.570]want to prohibit someone from
[00:41:04.340]accessing early intervention,
[00:41:05.696]and that's why we have that wonderful DD
[00:41:08.780]category that we can use.
[00:41:10.130]But, so that's another goal.
[00:41:12.070]It's just having people
[00:41:12.940]kind of just think about that concept again.
[00:41:14.890]And if you've got some of those low incident
[00:41:17.060]disabilities that are, you have the data
[00:41:19.610]to support that that's a verification
[00:41:21.590]it's okay to go that way.
[00:41:25.370]Can I jump in real quick?
[00:41:26.310]I just wanted to share too.
[00:41:29.065]We did a training on the MCHAT going over every
[00:41:33.965]question and a follow up questions back in August
[00:41:37.281]with all the early intervention providers
[00:41:39.035]at Millard, or a handful of them.
[00:41:43.459]And just one thing that really resonated with me
[00:41:46.063]is their response was if we give this
[00:41:49.910]to all of our kids that are under DD they would all,
[00:41:53.740]they would have all need this screening.
[00:41:58.259]Panic kind of was maybe the vibe
[00:42:00.671]and so it took me and the other trainers a lot of discussion
[00:42:07.019]why that isn't a bad thing.
[00:42:09.150]Why it's actually a good thing that all these children
[00:42:11.731]might need additional evalutation,
[00:42:14.060]and that MCHAT does a really good,
[00:42:15.496]it's a really good, I'm having a hard time talking today,
[00:42:20.120]but it's a really good bridge to enable that conversation
[00:42:24.158]as opposed to you just have a hunch.
[00:42:27.016]And so it's an objective number
[00:42:28.941]that you can talk to them about.
[00:42:32.500]So it's a good way of saying, you know,
[00:42:35.160]we're seeing these concerns
[00:42:36.572]you might want to look further into them.
[00:42:38.640]Here's the reasons, here's the benefits that you might
[00:42:40.890]get if you did look into a medical diagnosis,
[00:42:45.040]or you know, we look into that autism verification.
[00:42:52.070]McKayla had mentioned how we were using it
[00:42:54.730]for all children.
[00:42:55.810]And that is accurate and I'm glad she brought that up
[00:42:58.393]because we didn't mention that.
[00:43:00.074]Because when Katy did the training, Katy
[00:43:02.233]and her team there definitely was that question.
[00:43:05.980]Well, could we just use it on the ones that we suspect.
[00:43:08.760]And she said, nope you're gonna use it for all.
[00:43:11.045]If a child has significant disabilities we would not
[00:43:14.970]use it in that area.
[00:43:16.537]And I think the outcome really proved that that
[00:43:20.110]was the right decision in that we were seeing
[00:43:22.560]scores when providers went,
[00:43:24.187]"Holy cow, that was not what expected."
[00:43:26.134]And we've given them conversation starters
[00:43:28.423]so, you know, this,
[00:43:31.250]we gave them that introduction to how to say
[00:43:34.550]to a family hey mom and dad as part
[00:43:37.880]of our process we include the MCHAT.
[00:43:40.490]You may be familiar with this.
[00:43:41.950]This is something that pediatricians use.
[00:43:43.860]It is not a diagnosis.
[00:43:45.688]And then it goes on from there.
[00:43:47.476]And like I said, practice that with your teammates.
[00:43:50.119]How does that feel?
[00:43:51.440]Make it a conversation and all the tips
[00:43:54.500]that Kelli has already shared.
[00:43:57.050]So then where is this committee going?
[00:43:59.050]As I mentioned we're in year two,
[00:44:00.260]so it's our second year of funding.
[00:44:01.830]So we've had two separate years of funding
[00:44:03.884]and we want to be able to establish that pilot program
[00:44:07.278]in pediatrician offices.
[00:44:11.430]And what we are, the direction we're moving right now
[00:44:15.010]is some posters
[00:44:16.360]that are based upon the autism navigator site
[00:44:20.917]that is, has to do with the 16 signs by 16 months
[00:44:25.052]and also the gestures.
[00:44:27.210]So if you're not familiar with that
[00:44:28.760]there's a link in here.
[00:44:30.140]There's some great resources on that website in general.
[00:44:33.050]But we really like those two tools in particular,
[00:44:36.927]and 16 by 16, and even our providers
[00:44:40.090]have found those really helpful.
[00:44:41.525]They've even said, you know, maybe they didn't
[00:44:44.270]go down the direction of a comprehensive evalutation,
[00:44:46.100]but that was one of the resources they shared with families.
[00:44:49.072]Most importantly we want to be able to sustain
[00:44:52.820]these efforts beyond effort 2021.
[00:44:55.030]We don't want this work to stop.
[00:44:56.490]And it won't stop because we are very passionate about it
[00:44:59.796]and we've had some very positive outcomes.
[00:45:04.830]To add on to that goals three and four
[00:45:08.180]additional work our committee wants to accomplish
[00:45:10.262]we talked a lot in having again the representation
[00:45:14.630]of parents with children with autism on our committee
[00:45:17.290]has been helpful and insightful because oftentimes
[00:45:20.870]whether it is a medical diagnosis that's received
[00:45:23.662]or a verification too a lot of times
[00:45:26.860]parents can feel overwhelmed with either,
[00:45:30.830]and I would take, there's probably two sides
[00:45:32.980]to the coin of this.
[00:45:33.813]Sometimes they're overwhelmed with the amount of resources.
[00:45:36.175]Websites, you know, they go down that rabbit hole
[00:45:39.330]of looking at things online.
[00:45:40.579]And then sometimes they're underwhelmed with
[00:45:44.190]actual resources that are meaningful to them
[00:45:47.230]or that they can access.
[00:45:48.830]And so I think it's important to us to continue
[00:45:53.060]to think about not only in our Omaha metro area
[00:45:56.528]but then more globally how parents access resources
[00:46:01.540]once they do have a verification
[00:46:03.190]and/or a diagnosis medically.
[00:46:05.220]So, we want to work on that a little bit.
[00:46:07.430]I know Kelli is working on some resources
[00:46:10.820]that they can provide to Millard parents.
[00:46:12.950]And a lot of times it's just the curation
[00:46:14.610]of those resources, right.
[00:46:16.110]I mean, a lot of times it's just putting things
[00:46:17.660]in one place.
[00:46:18.680]Our autism network is another great place
[00:46:21.010]to check for those resources.
[00:46:22.456]So we're gonna continue down that path
[00:46:26.230]of making sure parents feel supported once
[00:46:28.690]they have a diagnosis or a verification.
[00:46:31.212]And then our fourth goal,
[00:46:32.980]and this is lofty, right.
[00:46:34.530]But we want to just continue to promote Child Find.
[00:46:37.938]And we want to continue to promote
[00:46:40.147]this concept of standard operating procedures.
[00:46:44.508]And so it's just part of the process, right.
[00:46:48.040]It's just part of a comprehensive evalutation.
[00:46:50.310]It's just part of a screening that is conducted
[00:46:52.930]in a medical office.
[00:46:53.989]It's part of the conversations that childcare providers
[00:46:57.740]are comfortable having with parents
[00:46:59.510]when they see those early warning signs.
[00:47:01.960]And so our goals really speak to this notion standardized
[00:47:07.070]processes so that we don't miss anybody.
[00:47:09.640]And so we want to continue to work towards that goal
[00:47:12.875]with all of those partners involved.
[00:47:23.340]So, is this my slide?
[00:47:25.490]I'm sorry.
[00:47:27.520]Okay awesome.
[00:47:29.140]I told them I was sharing my screen
[00:47:30.820]and so I can't see all my notes.
[00:47:32.290]I'm kind of winging it guys.
[00:47:35.006]Anyhoo, so resources to share,
[00:47:37.620]we do have some resources to share.
[00:47:39.510]So this, these are live links and so you have those.
[00:47:42.857]Jean has of course talked about the MCHATS and
[00:47:47.770]we're Millard Public Schools is using the revised version.
[00:47:50.172]So keep and eye out for that.
[00:47:52.053]Autism Navigator, again, I would agree
[00:47:55.610]and I know there was a question
[00:47:56.830]in our chat bar about handouts.
[00:47:58.990]There's some great handouts from Autism Navigator
[00:48:02.749]that kind of speak to and they have pictures.
[00:48:05.190]They have some awesome online stuff I would say.
[00:48:07.811]And then there's handouts as well.
[00:48:10.145]The Autism Toddler Initiative that piece
[00:48:13.111]and that resource is linked here additionally.
[00:48:16.709]And then I was just checking out time
[00:48:18.730]because we do have,
[00:48:22.240]we've been working on a video
[00:48:23.566]that really is trying to reach anyone who might be
[00:48:28.323]around children who could
[00:48:31.780]be having this conversation with families that they see
[00:48:36.180]some of those early warning signs.
[00:48:38.100]We've got, I think, literally just about enough time
[00:48:41.190]to view it.
[00:48:42.140]Team members is that okay?
[00:48:43.635]Do you think we should go ahead and play the video?
[00:48:45.860]Yeah, I think so.
[00:48:46.930]Okay.
[00:48:47.780]All right, so this is a link to a video
[00:48:50.830]that our team has been working on
[00:48:52.320]and made some recent revisions to.
[00:48:55.900]I'm gonna hope, can we all hear it?
[00:48:58.434](energetic music)
[00:49:10.370]Sometimes the early signs of autism
[00:49:12.110]are easy to miss, but early identification autism
[00:49:14.891]can connect children and families to important
[00:49:18.290]evidence based interventions and resources.
[00:49:21.350]In this video you will discuss the importance
[00:49:23.920]of early identification and perspectives from
[00:49:28.010]parents, medical professional, and educators.
[00:49:31.590]We will provide an overview of the early signs of autism
[00:49:33.888]and empower individuals to start the conversation
[00:49:36.897]with parents when early warning signs are observed.
[00:49:40.800]Although this could be a difficult topic
[00:49:42.920]so much can be gained from early intervention
[00:49:45.750]and there are a variety of resources available
[00:49:47.798]from local school districts and the medical
[00:49:50.360]community to assist families along the way.
[00:49:53.260]So my son was diagnosed and we feel he could have been
[00:49:58.050]diagnosed sooner.
[00:50:00.323]We were always told, he's a boy.
[00:50:02.620]Boys talk late.
[00:50:04.656]That's how boys are.
[00:50:06.186]And we believed them.
[00:50:07.880]But in my heart I probably still knew that there
[00:50:09.870]was something wrong and I needed those adults
[00:50:13.220]to be more truthful.
[00:50:14.670]And I know that now my son is 16 and he's doing okay.
[00:50:19.306]I think if he would have early intervention
[00:50:23.300]with more intense where they really thought there
[00:50:27.640]was something going one we would have got more services.
[00:50:29.980]It would have helped him.
[00:50:33.656]For two years I've specialized in diagnosing children
[00:50:36.960]with autism, especially the younger children with autism.
[00:50:40.090]In talking with teachers about the early signs of autism,
[00:50:42.310]especially for kids three and younger,
[00:50:44.830]in that three to five age range
[00:50:46.490]a lot of things I would be looking for is back and forth
[00:50:49.640]communication, play, and then restricted
[00:50:52.750]and repetitive patterns of behavior.
[00:50:54.690]So a lot of times what I notice is children
[00:50:56.970]only have a speech delay they will use
[00:50:59.890]other methods of community to get their point across.
[00:51:01.972]However, a young child with autism if they have those
[00:51:06.500]communication delays they might not use gestures
[00:51:09.621]or pointing or kind of body movements
[00:51:13.960]as a sign of communication.
[00:51:15.820]So, a lot of times rather they'll just take someone's hand
[00:51:18.340]and bring them to an object in an attempt to request.
[00:51:21.382]In addition I look for babbling.
[00:51:24.040]So if children are babbling I'm really looking
[00:51:26.490]for if they're directing it to someone,
[00:51:28.940]'cause a lot of times kids might make noises,
[00:51:30.640]but they're making it for their own benefit.
[00:51:32.290]And that would be an early indicator sign of concern.
[00:51:36.650]Then I'm also looking for play skills,
[00:51:38.930]so how a child plays.
[00:51:40.880]Are they playing repetitively, over and over again,
[00:51:43.040]so especially for younger kids.
[00:51:44.113]I'll see them stacking and knocking
[00:51:46.280]over over and over again.
[00:51:48.320]And it's an inflexible play skill,
[00:51:50.960]or putting items in a bin and dumping them out
[00:51:53.269]over and over again.
[00:51:54.566]If a child is doing imaginative play or social imitative
[00:51:57.783]play, so pretending like they're mowing the lawn
[00:52:01.480]or cooking dinner then I have less concern for autism.
[00:52:06.297]But it's when they lack those skills of either imitating
[00:52:09.710]what adults or other kids are doing
[00:52:11.122]or that imaginative play.
[00:52:13.893]Other areas of concern would be playing with other children.
[00:52:18.180]So a lot of times kids on the spectrum might
[00:52:20.600]indicate that they want to play with other children
[00:52:23.610]but they lack the ability to initiate or even
[00:52:25.890]maintain those play skills.
[00:52:27.730]So a lot of times I notice that they'll do
[00:52:29.513]what we call parallel play.
[00:52:31.410]So they're fine playing next to kids,
[00:52:33.550]but they're not really playing back and forth with kids.
[00:52:35.704]Then the other thing that I look for is the restrictive
[00:52:38.990]repetitive patterns of behavior,
[00:52:40.400]so doing things over and over again like taking
[00:52:43.927]a ball, dropping it the same way each time.
[00:52:47.150]Or doing it with other objects, a block, a ball,
[00:52:50.185]a baby doll that they just kind of do things
[00:52:53.060]the same way over and over again.
[00:52:54.430]I might be concerned.
[00:52:55.630]Sometimes kids have motor manors where they might
[00:52:58.800]twist their fingers or have body posturings
[00:53:01.160]or tensings when they get excited.
[00:53:03.030]Or sometimes out of nowhere pacing back and forth,
[00:53:06.087]and then any like body walking or just kind of
[00:53:09.240]complex body mannerisms if they do it in a repetitive manor.
[00:53:11.998]Once or twice is typical for a young toddler
[00:53:14.960]to do, but if we notice it more and more frequently
[00:53:17.820]then I would be concerned.
[00:53:18.986]And then finally there's an area of sensory sensitivity
[00:53:22.579]or hyper, or hypo sensitivity to sensory stimuli.
[00:53:26.940]So if the child might become really distressed
[00:53:30.551]over loud noises or textures, tags in their clothing,
[00:53:34.603]that would be a early.
[00:53:36.871]Then also fascination with sensory aspects of objects.
[00:53:40.674]So maybe becoming really fascinated by a fan that moving
[00:53:44.500]over and over again and not being able to turn from that.
[00:53:47.558]Also there's sensory sensitivity that I look for.
[00:53:50.100]So a lot of times kids might put
[00:53:51.803]objects on their face or sniff or smell them,
[00:53:55.590]or even sometimes lick objects, and if they do that
[00:53:57.670]in a repetitive manner that might cause concern for me.
[00:54:00.930]Another thing that I would be thinking of
[00:54:03.010]is kind of strict adherence to rules or routines.
[00:54:07.091]A lot of times a routine is good for children,
[00:54:10.540]but if we change the routine then that ruins the next
[00:54:13.730]30 to 60 minutes then that would be a warning sign,
[00:54:17.100]or becoming really distressed if we're taking
[00:54:19.060]a different way or a different route to school,
[00:54:21.490]or to grandma's house, or something like that.
[00:54:24.920]If early warning signs of autism are noticed
[00:54:27.450]local school districts are ready, willing,
[00:54:29.710]and able to assist families in determining
[00:54:32.250]if a child needs an evalutation.
[00:54:33.951]Schools may provide screening for autism
[00:54:36.610]as a part of a comprehensive evalutation
[00:54:38.753]to determine if a child has a disability.
[00:54:41.183]Pediatricians and other medical professionals
[00:54:44.228]are also able to provide autism screenings and
[00:54:47.083]medical diagnosis of autism.
[00:54:50.010]Navigating this topic with families can be difficult.
[00:54:51.840]It can be daunting for individuals to discuss
[00:54:55.310]with families when early warning signs
[00:54:57.510]of autism are observed.
[00:54:59.480]But we can support families by providing
[00:55:00.954]additional information, resources,
[00:55:03.940]and possible next steps for autism evaluations.
[00:55:07.725]We'd love to speak with you today about how
[00:55:09.090]to have conversations with parents after a
[00:55:12.350]screening for autism has been achieved.
[00:55:14.334]But it's really important to identify kids at
[00:55:17.270]an early age if they do have this disability.
[00:55:20.113]Now, this does not mean I'm giving your child
[00:55:22.640]this diagnosis, but it does mean that kids
[00:55:25.480]that screen on this really should be evaluated
[00:55:28.600]because the earlier the professionals can intervene
[00:55:31.660]and assist with your child it betters the outcome.
[00:55:35.780]If you have a parent that seems angry
[00:55:38.870]or frustrated or in direct denial of your screening
[00:55:42.515]probably the best way to handle that is
[00:55:45.470]go back and explain the purpose of the screening.
[00:55:47.501]We do the screening as a service
[00:55:49.982]and it is a measure that has been proven
[00:55:53.528]to be helpful in identifying these disorders.
[00:55:57.970]I am encouraging you is to go down the new information.
[00:56:01.558]That information doesn't mean
[00:56:03.180]you have to do anything with it.
[00:56:05.380]But you at least need to go and get somebody
[00:56:07.140]that does this for a living that helps recognize
[00:56:10.436]these children and give you the options
[00:56:13.015]from their professional perspectives.
[00:56:16.460]Early intervention can put kids on a better path
[00:56:19.520]and have them lead better lives.
[00:56:21.760]Be the person that can help change that for a child.
[00:56:24.677]We know early intervention is crucial
[00:56:28.160]when a child shows signs of autism.
[00:56:30.090]Help can be just a phone call away.
[00:56:32.297]For infants and toddlers ages birth through three
[00:56:35.650]a referral can be made to the Early Development Network
[00:56:38.900]by calling the statewide toll free number.
[00:56:41.015]Anyone in the community can make a referral
[00:56:43.577]with parent permission.
[00:56:45.820]For children ages three through 21
[00:56:47.481]Nebraska Public School districts are ready and willing
[00:56:51.150]to discuss your concerns.
[00:56:52.402]All Nebraska schools have a responsibility to find children
[00:56:55.842]who may have autism or other disabilities.
[00:56:58.469]So parents should contact their local school
[00:57:01.100]or district if they're worried about their child.
[00:57:13.480]All right.
[00:57:15.881]So, I mean it's a great video,
[00:57:19.000]but we don't need to watch it again.
[00:57:20.368]That video is available on YouTube and it's linked in here.
[00:57:25.021]And really the purpose of sharing that
[00:57:27.598]I think it's a nice, you know, summary
[00:57:31.280]of what we just talked about.
[00:57:32.440]But it also can be a Child Find tool for you.
[00:57:35.072]So we've talked about the use of this video
[00:57:37.290]potentially with your health professionals
[00:57:39.370]helping them understand those early warning signs
[00:57:41.104]and then knowing, you know, what to do next,
[00:57:43.680]what next steps are.
[00:57:45.020]We've talked a lot about using it
[00:57:46.440]with childcare professionals
[00:57:47.659]who we know have very, you know,
[00:57:51.110]important roles as far as helping parents
[00:57:53.710]understand if there is a concern with development.
[00:57:56.660]So that video's published and available for you
[00:57:59.760]to access if you're interested.
[00:58:06.210]Okay, I know we're getting down to being done,
[00:58:08.478]but there are just a couple quick questions that I thought
[00:58:12.770]we could do very quickly even through we're just
[00:58:15.110]a couple minutes over.
[00:58:16.455]So if one of you guys wants to talk about,
[00:58:21.315]there is a question about the MCHAT for birth
[00:58:24.700]to three families.
[00:58:25.780]So are you reading the questions,
[00:58:27.800]or are you handing it to them, sending it home
[00:58:30.270]and having them fill it out?
[00:58:31.534]How are you doing that?
[00:58:34.600]We are having family,
[00:58:35.800]we are working with the family to complete it.
[00:58:37.620]So we're making it a conversation,
[00:58:39.020]not just sending it home and having them complete it.
[00:58:42.563]And I see the next question about,
[00:58:44.679]we are continuing this work
[00:58:46.954]during the period of school closure
[00:58:49.451]because we are doing remote learning in our district.
[00:58:53.600]And so just met with our staff yesterday and we
[00:58:56.400]will continue to do this MCHAT
[00:58:58.340]both through the conversation remotely
[00:59:01.400]'cause I don't want to stop the work.
[00:59:04.520]Absolutely, the other question was
[00:59:06.810]are there great handouts you use
[00:59:08.500]when you're discussing concerns.
[00:59:09.990]And you guys can jump in, but you shared the links
[00:59:13.080]which I think would give them lots
[00:59:15.270]of really really good information.
[00:59:16.900]And I love what you guys said about the tools
[00:59:19.897]help with that conversation.
[00:59:22.080]I just think that that is, you know,
[00:59:26.060]it's crazy true.
[00:59:27.040]I mean, if we have good strong tools
[00:59:28.750]it helps us have that conversation with parents.
[00:59:30.786]So, I think that that really helped
[00:59:34.570]to answer that question, so.
[00:59:36.640]Was there any other last minute questions you guys?
[00:59:38.660]Well, there was one about results.
[00:59:40.871]Do you discuss when you're on the post screening?
[00:59:47.610]Yeah.
[00:59:48.733]We do get consent for it.
[00:59:52.000]And so that is something we feel strongly about
[00:59:54.952]procedurally we need that.
[00:59:58.070]Perfect.
[01:00:00.290]Well, thank you to all four of our amazing presenters.
[01:00:02.827]This was awesome.
[01:00:04.287]The work you're doing is very needed.
[01:00:09.720]And we're so glad that you've kind of stepped
[01:00:12.120]up to the plate and we're thankful for the Weitz
[01:00:13.870]foundation for providing the funding for this.
[01:00:17.950]So that's awesome.
[01:00:18.790]And it's actually gonna benefit all of us,
[01:00:20.410]so thank you.
[01:00:21.770]If you have any other questions certainly folks can ask
[01:00:24.800]the regional coordinators
[01:00:27.770]and the regional coordinators
[01:00:28.830]can get that information to me.
[01:00:30.380]These ladies all happen to be in the metro
[01:00:32.800]and so I can definitely get you that information
[01:00:35.450]if additional questions arise.
[01:00:37.160]So, thank you.
[01:00:38.427]There will be an evalutation that will go out
[01:00:41.690]after the conference just like we do
[01:00:43.570]with our live and in person conference.
[01:00:46.585]Your feedback will be awesome
[01:00:48.090]down the road when we get that sent out.
[01:00:51.350]Just one final thought is that we did,
[01:00:54.290]you know, update our slides just a little bit from when
[01:00:56.464]we originally submitted them.
[01:00:58.800]And the link to that video is embedded
[01:01:00.820]in the new handouts.
[01:01:01.930]And so someone had made a comment about that.
[01:01:04.730]We'll make sure that you have access to that video
[01:01:06.299]and that the link is readily available
[01:01:09.600]'cause we want you to use it.
[01:01:11.550]We want you to use this information.
[01:01:13.120]So, thank you.
[01:01:14.238]Thanks everybody.
[01:01:16.910]Have a great rest of the day.

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Weitz Grant Autism Screening Protocol In Early Childhood

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