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10/29/14
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Autism Diagnostic Team Training: Tying up the Loose Ends
Sarah Hoffmeier, LMSW
TASN Au-sm and Ter-ary Behavior Supports is par-ally funded through Part B funds administered by the Kansas State Department of Educa-on's Special Educa-on Services. TASN Au-sm and Ter-ary Behavior Supports does not discriminate on the basis of race, color, na-onal origin, sex, disability, or age in its programs and ac-vi-es. The
following person has been designated to handle inquiries regarding the non-‐discrimina-on policies: Deputy Director, Keystone Learning Services, 500 E. Sunflower, Ozawkie, KS 66070, 785-‐876-‐2214
TASN Autism and Tertiary Behavior Supports
www.KansasASD.com www.TASNBehaviorSupports.com
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Clarify
Screening &
Evalua-on
Clarify
An Au-sm Team school referral AND
An Au-sm Team evalua-on referral
Myth of “Clinical Diagnosis”
• “There are no medical tests for diagnosing au-sm. An accurate diagnosis must be based on observa-on of the individual’s communica-on, behavior, and developmental levels.”
• (Au-sm Society of America, n.d.)
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Myth of “Clinical Diagnosis”
• This myth has resulted in a widespread egregious prac-ce in the United States – inac-on of the public schools un-l receipt of an outside “clinical” diagnosis, or even worse, the response to an evalua-on request with a counter request for a private diagnosis. This is illegal and may deny a student FAPE.
Clarify: Educa-onal Iden-fica-on vs. Clinical Diagnosis
Educa&onal Iden&fica&on Diagnosis • Based on federal law (IDEA) • Based on a set of criteria
(e.g., DSM-‐V) • Refers to a broad disability category
• Refers to a specific disorder (e.g., Au-sm Spectrum Disorder)
• Used only in the public school system
• Used in private sedngs
• Must be determined by a team
• May be determined by an individual or a team
Educa-onal Iden-fica-on vs. Clinical Diagnosis
Educational Label
_____________
Clinical Diagnosis
Educational Plans IFSP IEP 504
Special Ed Eligibility
ASD
Educational Services
Speech , OT, PT, Adaptive
PE
Mental Health Interventions Family Therapies
Skills Training
Medical Interventions
Neurology Nutrition
Genetic Testing
Private Rehab Speech Therapy OT, PT, Behavior
Therapy
Community Services
Autism Waiver HCBS-SED
Waiver (CDDO)
Resource Directory for Families of Children with Autism Spectrum Disorders Fraser Child & Family Center www.fraser.org, 1/21/2009
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Educa-onal Iden-fica-on • Instruments Used:
– State defini-on of Au-sm, CARS-‐2, ASDS, GARS, M-‐CHAT, STAT, informal assessments in communica-on, social interac-on and behavior areas.
PROS CONS
Identi'ies learning style and areas of de'icit
Only used in educational settings
Can be used educationally until parents want to pursue a clinical diagnosis
Not helpful for accessing adult services or post-‐secondary training accommodations Parents may misunderstand the limitations of educational identi'ication
Clinical Diagnosis
• Instruments Used: – ADOS-‐2, ADI-‐R, CARS-‐2 interview, Vineland
PROS CONS Access to Early Intervention Waiver, Insurance legislation, or other HCBS programs for adult services
Possible stigma
If diagnosed early, early intervention can occur which could lead to better outcomes
Comprehensive Evalua-on
• “Ideally, the defini-ve diagnosis of an ASD should be made by a team of child specialists with exper-se in ASD’s.” (p. 1202)
(Johnson, Myers, and Council on Children with Disabili-es, 2007)
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Comprehensive Evalua-on
• “To thoroughly evaluate all relevant domains, different areas of exper-se…are required. Hence the clinical assessment of individual’s with this disorder is most effec-vely conducted by an experienced interdisciplinary team (Klin & Volkmar, 2003, p. 4)”
(Klin, A. & Volkmar, F. (2003). Asperger Syndrome: diagnosis and external validity. Child and Adolescent
Psychiatric Clinics of North America. 12, 1-‐13.)
Team Members
• “A job -tle or posi-on is not a strong indicator of who is appropriately qualified…Evalua-on professionals must have prior educa-on, training, and supervised experience that includes extensive exposure to au-sm-‐spectrum disorders”
(Monteiro, 2006 p. 4) Emphasis added
Team Members
• Exper-se in the area of au-sm spectrum disorders is much more important to a thorough, accurate diagnosis than par-cular creden-als.”
(Ozonoff, Dawson, & McPartland, 2002, p.46) Emphasis added
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Team Member Knowledge • Prac-cal knowledge of ASD – what does it look like ACROSS
the spectrum • Experience with differen-al diagnosis • Know typical development • Evalua-on skills
– Observa-on – Interview (parent, child, teacher) – Formal/informal evalua-on procedures
• Knowledge of Federal and State law regarding evalua-on and eligibility
• Know how to work as a team
Clinical Judgment
• “It is important to remember that ASD is first of all a clinical diagnosis. Therefore, it is mandatory to have a trained and experienced provider coordinate the results of the diagnosis.”
(Freeman & Cronin (2002). Diagnosing au-sm spectrum disorders in young children: An update. Infants & Young Children. 14 (3), 1-‐10.)
Team Members
• Psychologist • Speech Language Pathologist • Physical Therapist • Occupa-onal Therapist • Teacher • Au-sm Specialist • Social Worker
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Team Member Responsibili-es
• Par-cipate in all aspects of team evalua-on – Parent interview – Record review – Observa-ons – Evalua-on – Report wri-ng – Parent feedback – Staffing and IFSP/IEP prepara-on (goals and programming decisions)
THE ADT DIAGNOSTIC ALGORITHM FOR TELEMEDICINE
ADT Evalua-on Process Document (AKA…your Go To Guide for Telemed)
hnp://www.youtube.com/watch?v=k0xgjUhEG3U
Step 1
• Discussion with the family about the diagnos-c evalua-on process and insurance for telemedicine services (Refer to Telemedicine Insurance Guide) – Encourage families to check insurance coverage; may be responsible for a co-‐pay and/or deduc-ble
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Step 2 • E-‐mail/Fax Reciprocal Release and screen to Jennifer Houser
([email protected] / 913-‐588-‐5942) – Please include school district number/doctor/organiza-ons involved in process at the top of the Reciprocal Release
Screening • A posi&ve screen is required to conduct an au&sm
evalua&on • Recommended Screening Tools:
– Age: 16-‐30 months • MCHAT & MCHAT Follow-‐up Interview: hnp://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D..html
• STAT: hnp://kc.vanderbilt.edu/triad/training/page.aspx?id=821 – Age: 30 months and older
• PEDS: www.pedstest.com • ASQ-‐SE: www.pbrookes.com/store/books/bricker-‐asq/ • ASQ-‐3: hnp://www.brookespublishing.com/store/books/squires-‐asq/index.htm
• CARS-‐2: hnp://portal.wpspublish.com/portal/page?_pageid=53,69417&_dad=portal&_schema=PORTAL
Screening • If the screening is NOT posi-ve:
– Conduct a thorough review of the child’s records, including parent, doctor, and school report
– Make a collabora-ve decision whether to conduct a full evalua-on OR make recommenda-ons to a developmental pediatrician
• Recommenda-ons for an Au-sm Diagnosis:
– KU Med-‐Center for Child Health & Development 3901 Rainbow Blvd. Kansas City KS 66160 913/588-‐5900
– Valarie Kerschen, MD & Stephen Allen, MD KU School of
Medicine, Wesley Pediatric Faculty Clinic-‐Carriage Park 620 N. Carriage Parkway, Wichita, KS 67208 316/962-‐3100
– Children’s Mercy Hospital Developmental & Behavioral Sciences
Clinic Children’s Mercy Hospital 2401 Gillham Road, Kansas City, MO 64108 816/234-‐3674
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Step 3
• Parents will receive an intake call from Jennifer
• CRIS/Online Pa-ent Informa-on Form, Family History Form, and Enrollment Form will be emailed to family, if applicable
Step 4 • Complete the following paperwork with the family:
– Consent for Outpa-ent Evalua-on and Medical Treatment – Consent for the Release and Exchange of Confiden-al Informa-on – Kansas University Physicians, Inc. Pa-ent Registra-on Form – No-ce of Privacy Prac-ces Signature Page – Physician Referral Form – Front and back copy of medical insurance card – Pa-ent Informa-on Form (if not completed online) – Family History Form (if not completed online) – Enrollment Form (If not completed online)
Step 5
• Decide on a date, -me, and loca-on with the family and team for the evalua-on
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Step 6
• Request Medical Records and School Records using Reciprocal Release Form – Medical Records to be Requested: – Medical History, Developmental History (screenings, reports), Current Medica-ons
• Part C/School Records to be Requested: – Behavior Ra-ng Scales; Cogni-ve Tes-ng; IEP; IFSP
Step 7
• Fax Telemed Paperwork to Telemedicine Scheduler Joy Williams (913-‐588-‐2226 or [email protected]) – Use CRIS Pt. Fax Sheet for families who completed CRIS/online paperwork
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Step 8
• E-‐mail Joy ([email protected]) to arrange telemed appointment once paperwork is sent – Be clear of who you are and that you are with the TASN project; the loca-on of the telemed appointment; preferred -me, if the family requested
Step 9
• Write report – New Report Template on Shared Work – Mail all protocols (ADOS-‐2/ADI-‐R/CARS-‐2) to Sarah at:
• Sarah Hoffmeier TASN Au-sm & Ter-ary Behavior Supports 3901 Rainbow Blvd. MS 3055 Kansas City, KS 66160
Step 10
• Email Sarah ([email protected]) the final report by the Friday before the telemed appointment – Will receive email if not received
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Step 11
• Aver the telemed appointment, finalize report with recommenda-ons and signatures
Step 12
• Send a copy of the report to the family and the family’s physician
Step 13
• The KU report will be sent to the family and the physician 2-‐3 weeks aver the telemed appointment
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Step 14
• Complete Evalua-on Data Collec-on Survey hnps://www.surveymonkey.com/s_pass.aspx?sm=av16UyucoSOF807%2bgcBWHg%3d%3d Password: 1415data
THINGS TO REMEMBER Let’s Discuss
Health Insurance
• Let’s look at the Telemedicine Insurance Guide!
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Shared Work www.sharedwork.org
• Registration Instructions…let’s look at document
• Files & Folders – Up-to-date forms
ADOS-2 Kits/Protocols
Contact Jen for all protocols & kits!!!
CCHD Clinicians
• Check our their website http://www.kumc.edu/school-of-medicine/cchd.html
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Appointment Times • Telemedicine Appointment Times:
– Every Tuesday 1pm, 1:45pm, 2:30pm Dr. Reese/Dr. Ellerbeck
– Every 1st & 3rd Wednesday 1pm, 2pm Dr. Smith/Carole Prather
• Live Infant-Toddler In –Clinic Appointment Times – Every 4th Wednesday
9am, 10:30am Dr. Smith/Carole Prather
– Every 4th Thursday 9am, 10:30am Dr. Ellerbeck/Louann Rinner
Laws about Protocols
• If a parent asks for a copy of a protocol… – It is copyrighted; therefore copy right laws
apply first and foremost – As a district the parent can request to review
with school staff member, but not copied – Medically, it is an ethical violation
Scoring/Impressions of ADOS/ADI-‐R
• If families ask your impressions, advise them that you as a team are the collectors of the informa-on and that KU will determine the diagnosis
• Impressions Sec-on on Report Template – If you as a team feel that the child meets diagnos-c criteria, please complete Impressions sec-on
– If you are unsure, simply note that there are characteris-cs
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Additional Training • If you are interested in more training on the ADOS-2,
TASN will loan you the training manual and DVD’s – You can get certified through WPS by completing:
• CE Credit $72.00 CONTINUING EDUCATION (CE) QUESTIONNAIRE AND EVALUATION FORM To receive 6 CE credits for mastering the ADOS-2 Manual (W-605M), complete and return these materials $360.00 CONTINUING EDUCATION (CE) QUESTIONNAIRE AND EVALUATION FORM To receive 30 CE credits for mastering the ADOS-2 DVD Training Package (W-605DVD), complete and return these materials. This CE test covers the 5-Module DVD Training. $144.00 CONTINUING EDUCATION (CE) QUESTIONNAIRE AND EVALUATION FORM To Receive 12 CE credits for mastering the ADOS-2 DVD Training Upgrade Package (W-606DVD), complete and return these materials. Covers Toddler Training Only. (This CE test can also be used with the Toddler DVD/Guidebook included in ADOS-2 clinical workshop materials.)
http://portal.wpspublish.com/portal/page?_pageid=53,288914&_dad=portal&_schema=PORTAL
Team Training Plans
• Thank you for completing the team training plans!
• January & August Check-In • I will email the current team plan to main
team contact and ask if there are any updates
Coaching Follow-up
• Each team will be assigned a TASN coach – You will receive an email next week with
assigned coach & contact information • You MUST complete 3 coaching sessions/
evaluations with your TASN coach in-person – By completing the coaching sessions you will
continue to receive our support, materials, and will be able to schedule KU appointments!
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Coaching Follow-up
• What if our team is not ready to evaluate this year?
• What if we don’t evaluate 3 kids this year? • What if we choose not to be in contact with
our TASN coach and try to schedule a telemed follow-up?
• Why does TASN have to be on-site? • What will the coach do while visiting?
Confusing? Ques-ons?
• Remember: If you get “stuck” in our ADT algorithm,
Call/email Sarah 913-‐588-‐5981/[email protected]
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