1. INs and OUTs of Adult Autism Waiver
Claire Maher Choutka, M.Ed., BCBA
Clinical Director, BAS

2. Agenda Review facts about the Adult Autism Waiver
Discuss the SC role in supporting participants Specifically--
locating,
coordinating
monitoring services.

3. Adult Autism Waiver Assessment-based Needs –based
Monitoring to see that if needs have changed plan is changed to meet current needs
Limits on some services

4. Assessments
SIB-R
Assessment
Needs
Goals
objectives
Services

5. Assessments Remember with the SIB-R
If the person can respond for him/herself- use his/her responses.
If someone is answering for the participant or you feel the participant’s score was inflated (overstating ability) work with parent/support person to get realistic responses.
The SIB-R done EVERY YEAR.
SIB-R summary rpt. is mandatory for initial plans- optional thereafter.
QOL.q- it is the PARTICIPANT’s QOL- if person cannot answer use an average of 2 other persons responses.
Parental stress- this is the parent’s/caregiver’s stress.

6. SIB R: Behavior problems6 6

7. Entering SIB-R scores It’s standard score/percentile rank.
You enter the scores but DO NOT FINALIZE IT.
SCs need to do the SIB-r assessment for an initial plan and at annual plans.
Clinical team reviews the scores and finalizes them.

8. 8

9. 9 9 85 Infrequent/No Support 73/3 80/9 62/1 68/2 66/1 N/A Normal

10. From the SIB-R summary Report
Include the information in:
Know and Do
Social/Emotional
Psychosocial
Understanding Communication
Health and Safety
Functional Information
PHYSICAL DEVELOPMENT
ADAPTIVE/Self-help
Learning/Cognition

11. As you write the ISP
Please remember to be consistent in detailing and noting behaviors (as described in SIBR Summary Report) in “Know & Do,” “Social/Emotional,” “Psychosocial,” “Health and Safety, ” and “Understanding Communication” sections.
Functional Information
Social/Emotional: please note several behaviors specifically included in the SIBR Summary Report (e.g., swearing, interrupting others, talking too close or to loud, etc) and how others can support XXXX.
Understanding Communication: please note several behaviors specifically included in the SIBR Summary Report (e.g., swearing, interrupting others, talking too close or to loud, etc) and how others can support XXXX.
Understanding Communication: For “when this is happening…” this is usually information, if known, re: the situation that typically trigger the behaviors. For example, someone said something that offended XXXX, when XXXX is doing a difficult task, etc.
General Comments: Please remember to be consistent in detailing and noting behaviors (as described in SIBR Summary Report) in “Know & Do,” “Social/Emotional,” “Psychosocial,” and “Understanding Communication” sections.

12. Crosswalk of SIB-R to ISP Sections
Motor Skills
Gross motor, Fine motor
Social Interaction /Communication
Interaction, lang. comprehension, expression
Personal Living Skills
eating, toileting, dressing, self-care, domestic
Community Living Skills
Time, money, work, home and community
Know and Do, Health and Safety
Social/Emotional
Psychosocial
Understanding Communication
Functional Information
PHYSICAL DEVELOPMENT
ADAPTIVE/Self-help
Learning/Cognition
Employment

13. Translating Needs into Services
Look at SIB-R summary report you did
You may have noted comments person/respondent made which lead to needs they did not previously consider
Pick the least intrusive/restrictive service which matches the person’s skills/needs
For example a person with Asperger Syndrome who needs reminders to shower daily does not need Res Hab or Day Hab to work on this skill.

14. Things to Consider when Helping Participant to Choose Services
Even if a provider is not available in participant’s county, the desired service should be mentioned somewhere within the ISP
If supported by OVR, may not be necessary to add JA/JF, or SE, but employment goal should be entered
When determining hours (or units) for a service, consider individual needs (e.g. down time, family dynamics, weekly appointments).
50 hours of services per week may be too much (even though it’s allowed--Day habilitation, Community Inclusion, Transitional Work Services, and Supported Employment).

15. Needs Goals Goals may be linked to multiple objectives
Team needs to decide who will own objectives
Who is responsible for writing objectives, writing the instructional plans, training others on the services, reporting on the progress/making instructional decisions?
SC -Ensure goals are linked to a service- and it’s a service appropriate to goal.
If there is a need but service not available or provider not chosen, or team decides not a priority- write the goal and link to SC.
In Concerns Related to Goal- explain why it’s not worked on at this time.

16. Goals Objectives
When entering the objectives- write the objective entirely, then by condition, behavior, criteria.
For example:
OBJECTIVE: When in the community, Kyla will refrain from screaming at others and use more acceptable and effective communication when given an answer that is not desired (e.g., “I do not agree with you”) for 4/5 opportunities for one quarter.
CONDITION: When in the community
BEHAVIOR: Kyla will refrain from screaming at others and use more acceptable and effective communication when given an answer that is not desired (e.g., “I do not agree with you”)
CRITERIA: for 4/5 opportunities for one quarter.

17. Goals Objectives
Providers must submit objectives within 3 weeks of service delivery start date. (See next slide for exceptions).
SC should review objectives before submitting them to ensure it meets format and intent of the goal.
For more info check the objectives cheat sheet on VTC.

18. EXCEPTIONS to 3 week rule:
Services with Assessments first-
Behavioral Specialist Services (extended time to develop objectives)
For BSS the Behavior specialist should submit objectives AFTER conducting the FBA and finishing the BSP/CIP 60 days for FBA and plans.
Job Assessment
Both are required to be linked to goals, but these precede the services which directly support the participant.
The services which come from the assessments (Behavioral Specialist Services, Direct and Consultative and Supported Employment) are required to have objectives no matter in initial ISP or Annual Review Plans).

19. Remember-- not all services need objectives
Re: Respite, Family Counseling and Family Training
While the participant may be involved, these do not provide a direct benefit to the participant.
Goals and objectives are designed with the focus on the participant and how the participant can progress.
May have goals specific to  the purpose of the service (e.g., to teach parents to support John when he is anxious, to provide time for mom and dad to be with Pam's brother alone) with no objectives.
Goals and objectives for these services could also be specific to the participant, too (e.g., respond to parent prompts in anxiety provoking situations, decrease property destruction when mom and dad are with brother alone).  

20. More on Objectives
If BS determines that goals should be changed or shifted or added/deleted,
that is a conversation with the team. BS may make recommendation for the BSS hours.
The BSS objectives should mirror the Desired Behavioral Outcomes in BSP.

21. Now that you’ve entered goals and objectives, what’s next?
Don’t forget-
Ongoing monitoring of the services included in the participant’s ISP.
Supports Coordinators meet in person w/ participant at least once each quarter, or more frequently if necessary.
to ensure the participant’s health and welfare,
to review the participant’s progress,
to ensure that the ISP is being implemented as written,
and to assess whether the team needs to revise the ISP.
Within each year, at least one visit must occur in the participant’s home and one visit must occur in a location outside the home where a participant receives services.
For example: Within one year, SC may visit the participant 2x in their home & 2x at their job.
In addition, monthly contact required with the participant or their representative, which may be direct face to face or by telephone.

22. 1/4ly reporting obligtions
As an SC you are making sure there are 1/4ly summary reports for each service.
Related to the goals/objectives for each service
Detailed information about progress toward mastery, changes made to ensure progress, etc.
See sample on VTC.
If someone is in a less inclusive service (e.g., day hab, transitional work service, etc.), SC must guide the team to work toward to a more inclusive service. Quarterly Summary Reports need to justify ongoing need for these services.

23. SC’s and job services Once the job assessment is completed SC should;
ensure the provider made recommendations towards participant's desired vocational outcome
enter it in hcsis
also guide team to determine what service can address needs based upon assessment.
For instance, if job assessment provider identifies hygiene as problematic and potential barrier to competitive employment, the team may feel that hygiene should be a goal for CI prior to job finding service starting

24. Housing Always a challenge
Consider supports to make current situation more acceptable
Consider alternatives in AAW- life sharing for exapmple- see recent TTT for more.
Do the two steps above BEFORE having a Res Hab discussion!

25. Revisions and Reviews
For critical revisions submitted for a decrease or increase in services, clinical will review plan to ensure it aligns with noted needs or justifies the change (Pam will do a ttt on this in Dec).
For Annual Review Plans (ARP), plans will be reviewed for updates to appropriate sections re: progress made towards goals.
For example, if increasing social skills is a goal, there should be an update in Social/Emotional section of the plan.
Ultimately, the Team should be looking for growth and progress to be happening with the supports of the AAW.