Center for Autism and Developmental Disabilities (CADD) Applied Behavior Analysis (ABA) Referral Intake Packet

Center for Autism and Developmental Disabilities (CADD) Applied Behavior Analysis (ABA) Referral Intake Packet Thank you for your interest in the Center for Autism and Developmental Disabilities Applied Behavior Analysis (ABA) Program. This packet includes: ABA Program Information ABA Service Process CADD Policies and Procedures Patient History and Background Information Services and Fees Referral, Diagnosis Evaluation, and Insurance Form To continue the intake process, you will need to fill out the History and Background Information Form, Services and Fees Form, and the Referral, Diagnosis Evaluation, and Insurance Form (pages 9-13) and send them back to us as soon as possible. Your child will not be placed on the wait list (if applicable) until these completed documents have been returned to CADD. Website http://www.henryford.com/autism Phone (248) 386-5240 Mailing Address Attn: CADD ABA Intake Henry Ford Health System Pediatric Administration, Suite 4B One Ford Place Detroit, MI 48202 Fax Attn: CADD ABA Therapy Program (248) 386-5236 E-mail autismtherapy@hfhs.org SUBJECT: Intake Packet E N V I S I O N the next 100 years. Page 1

Applied Behavior Analysis (ABA) Program Information Center for Autism and Developmental Disabilities (CADD) What is ABA? Applied Behavior Analysis (ABA) is an evidence-based approach to creating meaningful or socially significant behavior change. New skills and behaviors are taught while any problem behaviors are minimized. ABA focuses on behaviors that are observable and measurable, with respect to their antecedents and consequences, which are events that occur directly before and after the behavior of interest. This approach utilizes principles of reinforcement, which typically involves providing rewards to increase skills that are functional and socially significant throughout the child s daily life (as noted below). ABA not only teaches these skills, but also promotes maintenance and generalization of the skills. Maintenance is used to determine whether or not the child can still perform the skill after a given amount of time has passed. Generalization requires that the child not only learns a particular skill in a structured 1:1 teaching environment, but ensures that the skill transfers to different people, materials, instructions, and environments. ABA also serves to decrease behaviors that may interfere with learning, such as tantrums, aggression, or stereotypy (hand flapping, spinning, etc.). Individualized curricula are developed to facilitate learning and develop appropriate programming for each child. Areas that we work on include (but are not limited to): History Language and Functional Communication: Communicating needs/wants to others Independent Play: Playing alone without assistance Social Skills: Interacting with others Imitation: Imitating behaviors or vocalizations of others Gross/Fine Motor Skills: Control over balance and body movement Listener Responding: Attending and responding to spoken words Visual/Perceptual Skills: Interpreting things he/she sees visually Self-help Skills: Skills such as dressing, grooming, feeding, toilet training The Center for Autism and Developmental Disabilities (CADD) originated in 2008, as the need for a multi-disciplinary diagnostic team developed. The diagnostic teams consist of various combinations of Developmental Pediatrician, Geneticist, Genetic Counselor, Neuropsychologist, Speech-Language Pathologist, Neurologist, and Pediatric Psychiatrist. The team evaluates each child through parent interview, direct observations, and diagnostic tools. A feedback session is also provided in which the family receives reports based on the evaluation, the diagnosis, and recommendations for services. In March 2011, CADD developed an intervention program which currently consists of providing centerbased ABA services. Children with a diagnosis of Autism or a developmental disability are assessed by a BCBA and receive 1:1 ABA therapy to increase skills and decrease problem behaviors. E N V I S I O N the next 100 years. Page 2

Types of Services CADD Provides Center-based 1:1 Programming CADD provides a center-based program in which basic skills are taught to each child to enhance learning. Each child has 1:1 sessions with an ABA Implementer based upon his or her individual programming created by the BCBA. Once the child masters the prerequisite skills in the center-based environment, these skills will be tested for generalization in the home and school environment. Requirements for this program include: assessment, program development, Implementer services, and consultative services. For every 10 hours of direct service provided by an Implementer, 1 hour of consultation by a BCBA is required. Functional Behavior Assessment (FBA) and Treatment This is designed for children who may have behaviors that are interfering with their ability to learn. An analysis of the behavior of concern will be completed via parent interview and direct observation. Once the analysis is conducted, a plan will be written in which parents receive training by the BCBA. Teaching of the plan includes modeling of the behavior plan and observation of implementation of the plan with direct feedback for learning purposes. Requirements for this program are: assessment of behavior, program development, and ongoing consultation by a BCBA until the behavior has reduced to an appropriate level as identified by the BCBA. Parent Training All ABA services include a component of parent training. In order for center-based ABA therapy to have lasting effects, parents must assist the child with bringing the skills he or she learns at the center to other natural environments, especially in the home and community settings. This may include making changes to the physical environment, changing the way family members interact with the child, and practicing and rewarding skills learned at the center. Parents of children receiving services will participate in parent education and training related to their child s individualized programming. Participation by parents and significant family members is not only encouraged but expected for any program to be successful. Staff Director, Therapy Services ABA Therapy is a growing team of people expanding to meet the needs of children with Autism Spectrum Disorder in the metro-detroit area. The therapy director works closely with our Board Certified Behavior Analysts and Implementers (Therapists) to provide a growing variety of services in an expanding number of locations. Board Certified Behavior Analyst (BCBA) The BCBA will be responsible for conducting the initial evaluation/assessment, program development, initial parent training, and overseeing the program for each child. This includes periodic direct supervision of Implementers during sessions and parent training. A BCBA is a master s level clinician who has undergone E N V I S I O N the next 100 years. Page 3

ABA course work, on-site practice, and supervision, and has passed the Behavior Analyst Certification Board exam. ABA Implementer The Implementers are responsible for the implementation of the program. They will be working 1:1 with the child. Implementers have at least a Bachelor s in Psychology or a related field and have received formal training in ABA through CADD. Implementers also receive intensive training by a BCBA prior to working with any child, and continuous supervision once assigned to a child. Teaching Methodologies Our program is comprised of a variety of teaching methodologies within the field of ABA to enhance the teaching of skills and decreasing problem behavior. The methodology used will be determined by how the child best learns. Methodologies include, but are not limited to, Discrete Trial Teaching (DTT), Incidental Teaching, and Pivotal Response Treatment (PRT). DTT allows us to break the skill down into very small units of learning and provide repetition to increase correct responding and ensure success. DTT is very common in traditional ABA approaches to learning. Incidental Teaching allows us to capture and contrive opportunities to learn throughout the day. For example, putting cookies on a shelf where the child cannot reach provides an opportunity to teach the child to request cookies. PRT involves teaching the child pivotal behaviors that create opportunities for the child to learn other more complex behaviors. The Verbal Behavior Approach is also utilized throughout each child s program to increase functional communication, whether it is vocally or through the Picture Exchange Communication System (PECS). Data-based Decision Making ABA is a field in which data is important in making decisions with each targeted skill. It gives us an objective way to assess progress for each child. It allows us to identify what learning strategies are most effective and those that are not. We can readily track progress to determine rate of learning and when the team may need to make changes to a child s program. The BCBA will create periodic progress reports and update programming as necessary to best support the child. Positive Reinforcement Positive reinforcement is used throughout each child s program to increase appropriate behaviors. Rewards (not bribes) are given to the child when we observe these behaviors. This increases the child s motivation for learning, as they are more likely to respond correctly with higher motivation. Once the child has mastered a particular skill, we systematically decrease the number of rewards to foster generalization of the skill using natural reinforcement. Additionally, if there are any behavior problems, we teach the child appropriate replacement behaviors to get the specific want or need met instead of using the problem behaviors. These replacement behaviors are then increased through reinforcement and thereby reducing the problem behaviors. Individualized Curriculum Each program is individualized for each child s needs and level of learning. This is determined via parent interview and directly testing the child s skills using assessment tools. Assessment reports are generated E N V I S I O N the next 100 years. Page 4

by the BCBA to give an explanation of the child s current skill levels and create goals for increasing socially significant skills. Generalization Each program involves a generalization program to foster independence and ensure that learning is occurring in the natural environment. Once the child has learned a skill in a structured setting, the clinician ensures that the skill is generalizing to different people, materials, instructions, and environments. This may include parent participation in having the child practice skills and behaviors at home and in the community and taking data on the child s responding. Additional Programs Social Skills Group In the social skills group children practice social skills in a structured setting with peers of similar ages and communication style. Groups meet once a week for 6 weeks at a time and are supervised by a BCBA. Each child receives a brief social skill assessment to identify individual targets to work on throughout the group. Implementers lead the group through different activities that allow opportunities for children to interact with peers to practice skills and receive support as necessary. Please refer to our website for more information about upcoming social skills groups. Parent Training Workshops Workshops are periodically held by CADD staff to provide education and about a place to discuss relevant topics for parents of children with a diagnosis of autism or a developmental disability. Each workshop covers a different topic such as dealing with a new diagnosis, learning the basics of ABA, or the basics of toilet training your child. Please refer to our website for more information about upcoming parent training workshops. Locations and fees may vary. CADD Sib-Support: Supporting Individuals who have a Sibling with a Diagnosis Siblings of children with autism or developmental disabilities may struggle with having a brother or sister that is different from their friends brothers and sisters. Our sibling workshops are meant for children without a diagnosis who have a sibling with a diagnosis. Topics for sibling workshops cover a range of topics that address the needs of siblings, like dealing with a new diagnosis in the family or handling peer reactions to their brother or sister. This group also gives children the opportunity to talk to others and receive support for those who have a sibling with a diagnosis of autism. E N V I S I O N the next 100 years. Page 5

ABA Service Process This chart outlines the necessary steps of the intake process to obtain ongoing ABA therapy Receives diagnosis and ABA Therapy recommended Patient Responsinble to callcadd ABA Therapy (248-386-5240) PCP/Parent Responsible for referral and if applicable insurance verification CADD Sends ABA Intake Packet to family Patient Completes and returns ABA Intake Packet to CADD Confirmation of patient information CADD Location on wait list if applicable Contact by BCBA with potential start date PCP/Patient If applicable insurance authorization for aniticipated start date Assessment CADD Assessment/Treatment Plan written, recommendations for treatment Schedule set for sessions Implementers trained on programming CADD/Patient Ongoing ABA sessions Monthly progress reports Periodic reassessments by BCBA E N V I S I O N the next 100 years. Page 6

CADD Policies and Procedures Updated 4/22/2014 D E P A R T M E N T O F P E D I A T R I C S 1. For initial assessments, CADD reserves the right to discontinue services or return a client to the wait list if the guardian does not inform the Board Certified Behavior Analyst (BCBA) of the cancellation within 24 hours of the scheduled assessment. 2. If a child is sick, the session should be cancelled. Staff will not work with a child who has any contagious illness (vomiting within the past 12 hours, infection, rash, fever, etc.). If a staff member notes any of these symptoms, the session will be cancelled for that day. 3. Please alert CADD staff prior to the start time if the child will be late for the assigned session or will be missing the session out of courtesy. If you child will be missing a significant portion of the session the session may be cancelled at the discretion of the BCBA. Sessions that start late will end at their scheduled time and will not be extended to complete the full scheduled duration. 4. Parents need to arrive at least 10 minutes before the end of the scheduled session to talk with the Implementer about the session and any other programming information. Late pick-ups may delay the start of another session and CADD staff must be notified if a parent will be arriving late. If the child is late being picked up by the parent, the additional time will still be billed. 5. If there are 3 consecutive cancellations/late arrivals, or 3 cancellations/late arrivals within 1 month, then treatment continuation will be reviewed by the BCBA. Consistent attendance for sessions is important for progress toward treatment goals. Lapse in treatment attendance inhibits the progress of therapy. 6. Sessions cancelled 24 hours or more in advance may be able to be rescheduled. However, this needs to be done in accordance with the clinic and staff schedule. The BCBA will determine if/when the hours can be made up. 7. CADD encourages staff to continue with professional development. CADD may hold in-service days and/or staff meetings for professional development. During such, Implementers do not provide treatment. 8. Program modifications should be made through the BCBA only. If guardians or Implementers have changes that need to be made, this should be discussed with the BCBA. If it is urgent, the BCBA should be called immediately. 9. CADD policy is to avoid dual relationships between clients (including their families) and staff. Please do not ask our staff to engage in tasks/activities outside of their CADD role/responsibilities (i.e., babysitting, attending birthday parties or other events, giving/receiving gifts, privately paying for ABA services outside of CADD, etc.). E N V I S I O N the next 100 years. Page 7

10. Confidentiality is important. Please do not discuss any known information about other children or families receiving services through CADD to others outside of the facility. 11. CADD will attempt to keep consistent staff with each client; however, this will vary across services with the child. Some reasons include scheduling changes, promotions, illness, etc. This may benefit the child in that it allows him/her to work on generalizing learned skills to other staff. 12. In the event of inclement weather, we will make every effort to provide services. However, there may be hazardous conditions that result in the cancellation of a session. A decision will be made by the BCBA to reschedule the session. 13. For a center-based program to be most effective, it is essential that the guardian/caregiver implement the strategies outside of the session. To facilitate the child s progress, the BCBA will make recommendations, parent goals, and staff will provide parent education. 14. Due to the nature of CADD services, parent education is essential. The BCBA reserves the right to discontinue services if recommendations are not being carried over in the home setting (e.g., behavior intervention plan, data collection, etc.) by the child s parent/guardian. 15. CADD encourages collaboration with other service providers. Third party observations are permitted one time on a quarterly basis for a maximum of 30 minutes, unless otherwise specified by the BCBA. Proper release forms must be on file before an observation is scheduled. Parent observations and recordings of full sessions for parents can be arranged with the BCBA in advance. 16. All CADD staff members are mandated reporters. If any staff believes there is any cause to suspect abuse and/or neglect, the Health Center reporting procedure must be followed in accordance with Michigan s Child Protection Law and HFHS Policy #405.70. CADD staff members are not responsible for the outcome of the investigation. E N V I S I O N the next 100 years. Page 8

Patient Information D E P A R T M E N T O F P E D I A T R I C S Please print when answering all questions below. This form is used to assist us in gathering information about your child in order to be registered into the medical records system and to best prepare for the assessment process. Patient name: Today s Date: / / Gender (circle): Male Female Child s Age: Grade: Birth Date: / / MRN #: Legal Guardian(s): Home Address: City State Zip County Home phone: Cell phone: Work phone: Email: Race: Language Preference: Interpreter needed? Yes No English Fluency: Good Fair Poor Referral Information Briefly describe the reason(s) you contacted Henry Ford Center for Autism and Developmental Disabilities (CADD): Who referred you to CADD? Title: Address: City State Zip Phone: Fax: E N V I S I O N the next 100 years. Page 9

Medical History D E P A R T M E N T O F P E D I A T R I C S Has your child been diagnosed with any developmental, behavioral, educational, medical, neurological, or psychiatric disorder? Y N If yes, please fill in the chart below: EXACT DIAGNOSIS DATE LOCATION PHYSICAN Please briefly describe what you would like your child to accomplish through ABA therapy. Please include any problem behaviors, skills your child is lacking, problems with communication, or problems with social interactions as they apply. E N V I S I O N the next 100 years. Page 10

Services and Fees The following services are subject to fees at the rates listed below. Functional Behavioral Assessment Skills Assessment (e.g., VB-MAPP, DAYC-2, SIB-R, Social Skills) Behavioral Intervention Plans Behavioral Consultation Telephone Consultation (in excess of 15 minutes) BCBA Supervision Direct ABA Therapy Preparation of reports, Protocols, and Program Materials Goal Development Data Analysis and Graphing Implementer Training Parent Training Social Skills Group Hourly Rates for Payment at Time of Service All services are billed on an hourly basis and rounded to the nearest quarter hour. All payments are due at time of service. Patients privately paying for services receive a 40% discount. Board Certified Behavior Analyst: ABA Implementer: Social Skills Group $125.00 (or $75.00 with the 40% discount) $50.00 (or $30.00 with the 40% discount) $70.00 (or $42.00 with the 40% discount) Payment Options These are the most common companies we work with. Eligibility for ABA Therapy through CADD is not guaranteed and will need to be verified by your insurance company and CADD. Health Alliance Plan (HAP) Blue Cross Blue Shield Blue Care Network Medicaid (Wayne County Only)* Other Health Insurance Private Pay IMPORTANT: It is important that you always verify coverage with your insurance company to avoid medical bills that will become your responsibility. The patient will continue to be responsible for all co-pays and deductibles. *Medicaid eligibility for ABA services ends on the child s 6 th birthday. E N V I S I O N the next 100 years. Page 11

Referral, Diagnosis Evaluation, and Insurance Form The following information must be completed and returned as a part of the intake process for ABA services. These are required for billing and insurance authorization purposes. Any incomplete sections will slow down the intake process and may cause delays in the start of services. Please read and initial next to each statement. All steps must have been completed for the ABA Intake Process to be completed. Each patient must have an assigned primary care physician (PCP). Contact your insurance provider to get a PCP assigned if your child does not already have one assigned. A diagnosis on the autism spectrum must be given by an Approved Autism Evaluation Center (AAEC) within the previous 3 years in order for insurance to authorize ABA services. If the patient has a diagnosis from a physician and has not been evaluated by a diagnostics team, call (313) 916-4665 to schedule an evaluation with the CADD Diagnostics Team. *Required by BCBS/BCN The patient must have a recommendation for ABA services from a referring physician as a part of the diagnostic process in order for insurance to authorize ABA services. Patient Name: MRN #: Parent/Guardian(s) Name:_ Primary Care Physician (PCP) : Phone: PCP Address: Fax: Diagnosis Clinic/Doctor: Diagnosis: *If diagnosis was not completed at CADD, the full diagnostic evaluation and the referral for ABA services must be sent to CADD. Initial that that documentation was sent to CADD: (continued on next page) E N V I S I O N the next 100 years. Page 12

Name of Insurance: Subscriber s Name on Card: Member ID Number: Group Number: Active from: / / Active to: / / Plan Code: Patient Birthdate: / / Subscriber s relationship to child: Subscriber s Name: Subscriber s Birthdate: / / Insurance Phone Number: Pre-authorization phone number for Mental Health: E N V I S I O N the next 100 years. Page 13