Juniper Garden’s Children’s Project Kansas Autism Early Intervention Waiver Program Pam Keller, LMSW, Program Manager Department of Social and Rehabilitation Services Jill M. Koertner, M.A., B.C.B.A, Program Director Kansas Center for Autism Research and Training Autism Training Program Linda Heitzman-Powell, Ph.D., B.C.B.A, Director Kansas Center for Autism Research and Training Autism Training Program

Juniper Garden’s Children’s Project Overview HCBS/Autism Waiver is designed to be an early intensive intervention waiver targeting children receiving a diagnosis of the following from a licensed Medical Doctor or PhD Psychologist using an approved Autism specific screening tool. Autism Spectrum Disorder, (ASD) including, Autism Asperger Syndrome Pervasive Developmental Disorders- Not -Otherwise Specified

Juniper Garden’s Children’s Project Approved Autism Screening Tools CARS – Childhood Autism Rating Scale GARS – Gilliam Autism Rating Scale ADOS – Autism Diagnostic Observation Scale ADI – Autism Diagnostic Interview-Revised ASDS – Aspergers Syndrome Diagnostic Scale Other

Juniper Garden’s Children’s Project Additional Information The institutional alternative for the Waiver program shall be a State Mental Health Hospital and without waiver services the child would be at risk of being placed in an institution. The Waiver began January 01, recipients were randomly selected Additional funding was received in July, additional recipients were added

Juniper Garden’s Children’s Project Program Funding Title XIX funding Waiver services are 60/40 match

Juniper Garden’s Children’s Project Program Eligibility Diagnosis - ASD Age—time of diagnosis through their 5 th year Meet Functional eligibility Vineland II Survey Interview Adaptive Behavioral Scale Must be Medicaid Eligible

Juniper Garden’s Children’s Project Program Financial Eligibility Only the child’s personal income and resources are considered Parent’s income and resources are not counted Income over $ per month must be contributed towards the cost of care

Juniper Garden’s Children’s Project Waiver Services Provided Consultative Clinical and Therapeutic Services (Autism Specialist) Services are intended to assist the family and paid support staff or other professionals with carrying out the Individual Behavioral Program/Plan of Care (IBP/POC) that supports the child’s functional development and inclusion in the community.

Juniper Garden’s Children’s Project Waiver Services Provided Intensive Individual Supports (IIS) IIS individual works under the direction of the Autism Specialist and implements the services identified in IBP/POC. These services are designed to assist the child in acquiring, retaining, improving, and generalization of the self- help, socialization, and adaptive skills necessary to reside successfully in the community.

Juniper Garden’s Children’s Project Waiver Services Provided Respite Care Respite Care provider works under the direction of the Autism Specialist and their primary purpose is to provide temporary direct care and supervision for the child and relief to families/caregivers of a child with an Autism Spectrum Disorder.

Juniper Garden’s Children’s Project Waiver Services Provided Parent Support and Training (peer to peer) Parent Support provider works under the direction of the Autism Specialist and this service is designed to provide the training and support necessary to ensure engagement and active participation of the family in the treatment process.

Juniper Garden’s Children’s Project Waiver Services Provided Family Adjustment Counseling Counseling provided to the family members of a child with an Autism Spectrum Disorder in order to guide and help them cope with the child’s illness and the related stress that accompanies the initial understanding of the diagnosis and the ongoing continuous, daily care required.

Juniper Garden’s Children’s Project Non- Waiver Service Functional Eligibility Specialist The functional Eligibility Specialist shall perform the initial and annual Level of Care (functional) Determination necessary to establish a child’s eligibility for the HCBS Autism Waiver program using the Vineland II Survey Interview Adaptive Behavior Scales.

Juniper Garden’s Children’s Project Program Benefits Studies have indicated fifty percent of children with autism can succeed in the regular education classroom by first grade if intensive early interventions are made available. Others will make gains significant enough that they will only require partial or less intensive special education services. Children will be able to access other State Plan Services through the Medicaid card. Children/Families can choose their service providers

Juniper Garden’s Children’s Project Program Limitations Only 45 slots available. The service will not duplicate any service included under IDEA or the Rehabilitative Services Act of 1973 (per 1915©)

Juniper Garden’s Children’s Project State Requirements for Qualified Providers Consultative Clinical and Therapeutic Services (CCTS)— Autism Specialist Intensive Individual Supports (IIS) Respite Care Parent Support and Training (peer to peer) Family Adjustment Counseling

Juniper Garden’s Children’s Project Autism Specialist (CCTS) Master’s degree, preferably in human services or education or Board Certified Behavior Analysts (BCBA) and 2000 hours of supervised experience working with a child with an Autism Spectrum Disorder * Completion of state approved curriculum Must successfully pass back grounds check from the Kansas Bureau of Investigations (KBI) SRS Adult and Child Protective Services Registries, (APS) (CPS), Kansas Health & Environment Nurse Aid Registry, and Motor Vehicle screen. Medicaid Enrolled Provider * Exception policy to allow SRS to waive 1,000 hours of the required experience for individuals who are (BCBA). *Services are limited to 50 hours or 200 units per calendar year; request for additional hours must have prior authorization.

Juniper Garden’s Children’s Project Intensive Individual Supports Bachelor’s Degree in a related field or 60 hours college credit hours and 1,000 hours experience working with a child with an Autism Spectrum Disorder Completion of the state approved training curriculum (which will include a hands-on component) Will work under the direction of the Autism Specialist Must successfully pass back grounds check from the Kansas Bureau of Investigations (KBI) SRS Adult and Child Protective Services Registries, (APS) (CPS), Kansas Health & Environment Nurse Aid Registry, and Motor Vehicle screen. Medicaid Enrolled Provider *Services are limited to 25 hours per week or 100 units per week, per calendar year.

Juniper Garden’s Children’s Project Respite High School Diploma or equivalent Eighteen years of age or older Must meet family’s qualifications Must reside outside of child’s home Will work under the direction of the Autism Specialist Completion of the State approved training curriculum Must successfully pass back grounds check from the Kansas Bureau of Investigations (KBI) SRS Adult and Child Protective Services Registries, (APS) (CPS), Kansas Health & Environment Nurse Aid Registry, and Motor Vehicle screen. Enrolled Medicaid Provider *Services are limited to 168 hours or 672 units per calendar year.

Juniper Garden’s Children’s Project Parent Support and Training (Peer to Peer) High School Diploma or equivalent Twenty-one years of age or older Completion of parent support training or other approved training curriculum Must have three years of direct care experience with a child with an autism spectrum disorder Is the parent of a child with an autism spectrum disorder age three or older Will work under the direction of the Autism Specialist Must successfully pass back grounds check from the Kansas Bureau of Investigations (KBI) SRS Adult and Child Protective Services Registries, (APS) (CPS), Kansas Health & Environment Nurse Aid Registry, and Motor Vehicle screen. Enrolled Medicaid Provider *Services are limited to 30 hours or 120 units per calendar year. Limit applies whether it is group, individual or combination of both.

Juniper Garden’s Children’s Project Family Adjustment Counseling Licensed Mental Health Professional (LMHP) Will maintain an ongoing collaborative relationship with the Autism Specialist beginning at time of referral *Services are limited to 12 hours or 48 units per calendar year. Limit applies whether it is group, individual or combination of both.

Juniper Garden’s Children’s Project State Approved Training Kansas Center for Autism Research and Training—Autism Training Program KUMC KU Lawrence—Lifespan Institute Juniper Gardens Children’s Project

Juniper Garden’s Children’s Project Autism Specialist Training Requirements Week 1 Pre-test (online) – 90% or higher Web-based instruction Week 2 Day 1 Classroom-based contact with Autism Training staff Experiential training with children with ASD in the clinic Day 2 Classroom-based contact with Autism Training staff Experiential training with children with ASD in the clinic Follow-up Six 10-minute video-clip samples of work with children with ASD are completed over a 6-month follow-up period

Juniper Garden’s Children’s Project Intensive Individual Supports Provider Training Requirements Week 1 Pre-test (online) 90% or higher Web-based instruction Weeks 2-4 (2 days per week) Web-based instruction Classroom-based contact with LSI Autism Training staff Experiential Training with children with ASD in the clinic On-the-Job Training at collaborative agencies (1-2 sites) and/or with families in the metropolitan Kansas City and Lawrence, KS sites Post-test (online) Follow-up Six 10-minute video-clip samples of work with children with ASD are completed over a 6-month follow-up period

Juniper Garden’s Children’s Project Parent Support and Training and Respite Training Requirements Within six months of receipt of EDS approval Pre-test (online) Web-based instruction Three hour workshop

Juniper Garden’s Children’s Project Online Tutorials Module 1:Autism and Behavioral Treatment Module 2:Defining and Observing Behavior Module 3:Principles of Behavior Module 4:Stimulus Control Module 5:Effective Teaching Strategies Module 6:Decreasing Behaviors: Antecedent Control Module 7:Decreasing Behaviors Using Consequences Module 8:FBA and Behavior Intervention Plans Module 9:Teaching Social Skills with Typical Peers Module 10:Putting It All Together

Juniper Garden’s Children’s Project Clinic/Experiential Training Interaction with children in controlled setting Skills modeled by trainers then practiced by trainees Trainees are rated on skill fluency

Juniper Garden’s Children’s Project On-the-Job Training Opportunity to observe and demonstrate learned skills in a different professional setting Trainees learn different approaches to behavioral intervention and data collection.

Juniper Garden’s Children’s Project Training and Certification Process Receipt of notification of qualification Provider signs up on website Provider is confirmed for dates and receives training materials Completion of on-site/OJT training Receives letter with remaining requirements Submits six 10-minute video clips, on-site observation, or returns to onsite training (KUMC) for follow-up Receives Training Completion Certificate

Juniper Garden’s Children’s Project Areas Assessed Online Knowledge Acquisition Pre-posttest knowledge On-Site Skill Acquisition Application of content in hands-on sessions Video-clip Follow-ups Satisfaction Survey

Juniper Garden’s Children’s Project Online Results Jul 08 Sep 08Oct 08Nov 08Mar 09

Juniper Garden’s Children’s Project Online Results Jul 08 Sep 08 Oct 08 Nov 08 Jan 09 Feb 09 Mar 09 May 09 June 09

Juniper Garden’s Children’s Project Skill Fluency 80% Criterion 89% Average Trainee Score

Juniper Garden’s Children’s Project Consumer Satisfaction

Juniper Garden’s Children’s Project Consumer Satisfaction

Juniper Garden’s Children’s Project Future Directions Develop and implement pre-test measures of trainees’ skill acquisition Develop procedures to assess the effectiveness of the skill acquisition (use of pretest measures) Would allow an evaluation of which components of training require the most time/experience Improve staff training for schools and other agencies Improve the dissemination of best-practice techniques to remote areas