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Navigating Healthcare Insurance Coverage for Autism and Other Developmental Disorders: Where to Start

Navigating Healthcare Insurance Coverage for Autism and Other Developmental Disorders: Where to Start 460 307 bh360

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Navigating Healthcare Insurance Coverage for Autism and Other Developmental Disorders: Where to Start

July, 8 2019 | Tammy Pedersen

If you’ve determined that your child or another family member would benefit from behavioral healthcare services to treat autism or a similar developmental disorder, an important next step is to explore and understand the benefits available to you from your healthcare insurance provider. But where should you start?

In California, healthcare insurance companies – and the health plans they offer – are regulated by the state and are required to provide coverage for behavioral health services, including coverage for treatment of conditions such as autism.

This means that if your child or other family member has healthcare insurance through a health plan in California, your insurance provider should help you cover the costs for appropriate and necessary treatment for autism and other similar conditions. That’s the good news. But benefits and coverage can vary, and even if your health plan covers treatment for autism, you still need to explore and understand the details of the specific coverage you have.

This is a short primer on insurance coverage for behavioral healthcare services. Consider these questions and issues either before you find a provider or after you’ve found a provider but before beginning treatment for your child. Understanding the ins and outs of insurance will help you make the most of your health insurance coverage.

General Questions

  1. If your healthcare insurance is provided to you by your employer, determine whether your employer provides a state-regulated plan or a self-insured plan.This distinction is important in California because state-regulated plans are subject to behavioral healthcare coverage mandates, which means those plans must provide certain benefits required by the state, including benefits for behavioral healthcare services. With state-regulated plans, the insurance company covers the costs of all benefits.In contrast, with a self-insured plan, your employer covers the costs of all benefits, and has a lot of flexibility to choose what benefits to offer and what not to cover.
  2. Determine the benefits available under your plan.Many insurance plans have different benefits for medical vs. mental health services, so it’s important to know if your plan treats behavioral healthcare as a medical service or as a mental health service. In most cases, behavioral therapy based on principles of applied behavior analysis (ABA) are covered under mental health portion of your insurance.Tip: If the diagnosis is autism, ask your plan provider specifically about autism and ABA-based therapy to confirm coverage.
  3. As with any service, clarify if you need to meet a deductible before your insurance will pay, and how much of the deductible you have already met. The deductible is typically an annual amount you must pay before your insurance will begin to cover the cost of services.
  4. Determine if there is a co-pay or cost-share amount and if there’s an out-of-pocket maximum. Also ask if there is a specific benefit maximum. Answers to these questions will help you determine the amount you’ll need to pay for services you receive.A co-pay is typically a fixed dollar amount, such as $50, and is an amount you must pay each time a service is provided. The co-pay “kicks in” once the deductible is met.A cost-share is like a co-pay, but instead of a fixed dollar amount, it is likely to be a percentage, such as 30% of the cost. So, if the cost of the service is $100 and the cost share amount is 30%, then your cost share amount would be $30. This is the amount you must pay each time a service is provided. Like a co-pay, the cost share “kicks in” once the deductible is met.The out-of-pocket maximum refers to the amount of money you are responsible for paying before insurance covers the full cost. For example, if your out-of-pocket maximum is $2,000, then once you’ve paid $2,000 for services you’ve received, your insurance pays the full amount for any additional services. So, $2,000 is the most you’ll have to pay for services you receive.A benefit maximum is a limit the insurance company will pay for a specific benefit. For example, there might be $10,000 benefit maximum for a particular program or therapy.
  5. Ask if the insurance company needs to approve the treatment in advance of getting care, and where the healthcare services provider should call to get advance approval. This is called pre-authorization. Also ask if there’s a time limit on how long the approval is good for, such as one month, six months or one year.Tip: If the diagnosis is autism, ask if your plan provider has an autism unit or care manager. If so, person or unit is a good resource to consult for answers, especially about documents or other forms that may be required for authorization and treatment.
  6. Confirm your healthcare services provider is “in-network”. It is a good idea to call the care provider directly to confirm they participate in your plan. Insurance directories and websites are sometimes inaccurate or out of date, so you’ll want to be sure the care provider you choose is in your network and will bill your insurance directly for you. If the care provider you choose is not in your network, you can talk with the care provider about using your out-of-network benefits. But be aware that this option usually means a higher out of pocket expense. In some cases, the care provider may be able to work with your insurance to arrange an in-network single case agreement, which will enable you to use your in-network benefits.

Important Documents You May Need

Insurance plans usually will require the following documents:

  • A diagnostic report from the licensed clinical psychologist who conducted the diagnostic testing process. This report follows the assessment of the child and states how and why the healthcare professional concluded that the child has autism or another disorder.
  • A plan from a qualified autism treatment services provider specifying the proposed course of treatment for the child, including a statement saying the treatment is medically necessary.
  • A prescription/referral from your pediatrician stating the diagnosis and the number of hours recommended for ABA therapy.

Issues Specific to Applied Behavior Analysis (ABA) Services for Autism

Some insurance companies have assessment and supervision requirements specific to ABA services for the treatment of autism. In other words, the insurance company sometimes requires that the assessment be conducted by a person with a specific type of license or credential, or that the clinician providing the therapy be supervised by a professional with a particular license or credential. Be aware that these issues may come up. Your healthcare provider can help you address them.

Assessment Requirements

Your insurance company may specify:

  • Who can perform the assessment
  • How long can the assessment be
  • When re-assessment is required

Supervision Requirements

Your insurance company may specify:

  • Who can provide supervision
  • Whether it can be billed on the same day as direct ABA services
  • How many hours are approved
  • Whether supervision must be provided in the presence of the person receiving treatment

Although insurance can be challenging to navigate, the good news is the benefits under many health plans are robust, and there are resources to help you navigate the system.

For patients whose employers offer health plans not subject to California state mental health mandates (i.e. self-insured plans), the organization Autism Speaks offers more information. Learn more by visiting Autism Speaks.

With preparation and understanding, you’ll be able to make the most of your health plan’s coverage and any other resources, and your child should benefit from the treatment.

If you believe you believe someone in your family needs help to diagnose or treat autism or other similar condition, or if you need help to determine if costs for these services are covered by your healthcare insurance provider or other agency, please visit 360 Behavioral Health to schedule a complimentary 30-minute phone or in-person consultation.

About the Author

Tammy started her career as a child protection social worker before she moved into the insurance world. She has over 25 years’ experience in managed care working with organizations that provide healthcare services as well as organizations that pay for healthcare services.

Tammy has a special interest in helping families navigate through insurance requirements in many states, and she’s collaborated with several groups – including Autism Speaks, CalABA and TACA – to help families better understand resources available to those with autism.

Tammy is originally from beautiful Colorado so she’s an obsessed Broncos fan, but she currently resides in California because she is secretly a mermaid. She’s a single mom of a 23-year-old daughter who recently graduated from college, and two rescue dogs named Reign and Tennessee.  She and her daughter are “Big Sisters” through the Big Brother/Big Sister program and they enjoy spending time with their “little sister.” Most of Tammy’s free time is spent at the dog beach.

Tammy Pedersen
Tammy Pedersen

Vice President of Managed Care
360 Behavioral Health

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An Introduction to ADHD – Attention-Deficit/Hyperactivity Disorder

An Introduction to ADHD – Attention-Deficit/Hyperactivity Disorder 460 307 bh360

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An Introduction to ADHD – Attention-Deficit / Hyperactivity Disorder

June, 24 2019 | Lindsay L. Wray, Psy.D.

You may have heard the term attention-deficit/hyperactivity disorder, or ADHD. Maybe you have wondered what it is or what to do if you suspect your child shows symptoms.

First of all, it is important to know that ADHD is common among children. The percent of children with an ADHD diagnosis has changed over time and measurements can vary. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) that 5% of children may meet criteria for an ADHD diagnosis. Additionally, according to the National Survey of Children’s Health (2016), 9.4% of children between the ages of 2 and 17 have been diagnosed with ADHD. So, if your child is exhibiting symptoms or has been diagnosed with ADHD, you are not alone.

It is also important to note that most children grow out of ADHD, but for some, the symptoms can continue into adulthood. The behaviors that mark the disorder — namely having a limited attention span (inattentiveness) and / or being unusually active or impulsive (hyperactivity) — can occur in very young children, though in most cases the signs and symptoms become apparent when children reach school age.

ADHD is not a developmental disorder like autism but is a brain disorder influenced by a variety of factors including genetics, exposure to toxins during pregnancy and low birth weight. Medication is often appropriate to treat ADHD but is not always the only option available to treat the disorder. Behavioral therapy – with or without medication – may be helpful in eliminating symptoms that are significantly interfering with a child’s daily life functions and ability to adapt to different situations.

With behavioral therapy, which is based on principles of applied behavior analysis or ABA, a child can be taught new or different behaviors to replace problematic ones. Part of the appeal of behavioral therapy is that the benefits of modified, learned behavior can continue into adulthood, so the child is not just experiencing a better childhood, but is learning behaviors and skills that can last for a lifetime.

There are three types of ADHD:

  • Predominantly Inattentive Presentation. Common signs and symptoms include frequent daydreaming, lack of focus or poor concentration, making careless mistakes in schoolwork, not listening when spoken to directly, or being easily distracted or forgetful.
  • Predominantly Hyperactive Presentation. Common signs and symptoms include impulsive behavior, moving constantly with an intention to distract others, inability to stay seated when sitting still is expected, talking excessively when quiet is preferred, lack of patience and interrupting others.
  • Combined Presentation. Common signs and symptoms include a mix of the above. For example, one minute the child is daydreaming and cannot focus and the next minute the child is getting up and out of his or her seat.

All children have moments of inattentiveness and hyperactivity. It is only a problem when the symptoms impair every day functions, with the child having difficulty regulating and shifting behaviors to perform basic and necessary daily activities.

If you have observed inattentiveness and hyperactivity in your child that seems to be excessive, it is worth exploring further to determine if ADHD may be the underlying cause. Your first step is to discuss the situation and your observations with your child’s primary care physician or pediatrician, or with a psychologist or psychiatrist. These healthcare professionals may offer a referral to a specialist for an evaluation.

Evaluating a child for ADHD involves administering a battery of assessment tools used to evaluate thinking, reasoning and remembering (cognitive functions), as well as assessment tools used to evaluate functions of the nervous system (neurological functions). These tests are combined with interviews with caregivers and teachers and observation in a clinic or at school. The evaluation process, when conducted by a trained professional, is friendly and non-threatening.

Receiving a referral for an evaluation does not necessarily mean your child has ADHD. In many cases the evaluation will not indicate attention-deficit/hyperactivity disorder. But if there is a diagnosis of ADHD, a good clinician will help you identify an appropriate course of action and treatment that will help address the problem behaviors and that ensures your child is treated with care and compassion.

Learn more about our evaluation & diagnostic services or ABA-based behavioral therapy services available through 360 Behavioral Health.

About the Author

Dr. Lindsay Wray, a Licensed Clinical Psychologist (PSY 30954), received her Doctor of Psychology in Clinical Forensic Psychology from the Chicago School of Professional Psychology. She is a member of the diagnostic team at Willowbrooks Behavioral Health – a preferred provider for 360 Behavioral Health –where she conducts comprehensive psychological evaluations with children and adolescents facing a wide range of challenges. Dr. Wray is also a 4th Year Fellow at the Reiss Davis Child Study Center, a department of Vista Del Mar Child and Family Services, where she conducts comprehensive psychological and psychoeducational evaluations with children and adolescents. In January of 2019, Dr. Wray joined the Reiss Davis Graduate Center as an adjunct professor, teaching psychological assessment and dissertation courses in the Psy.D. program. Dr. Wray’s interest in the field of psychology and psychological assessment is driven by her desire to work with and improve the lives of vulnerable and underserved populations.

Lindsay L. Wray, Psy.D.

Licensed Clinical Psychologist
Willowbrooks Behavioral Health

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Evaluation & Diagnostic Services

Evaluation and diagnostics – also known as psychodiagnostics – is the first step necessary to diagnose and clarify concerns regarding behavior, personality traits, mood, emotional functioning,
and cognitive processes.

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Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Applied Behavior Analysis, or ABA, refers to a variety of treatment options that are based on the principles of behavior analysis. ABA uses scientifically-based techniques for understanding and changing behavior, and is the most widely accepted approach to assess and intervene with individuals with autism spectrum disorder (ASD) or other developmental challenges or delays.

What to expect

What to Expect from a Functional Behavioral Assessment

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What to expect - Behavioral Assessment

What to Expect from a Functional Behavioral Assessment

June 13, 2019 | Jennifer Vasquez, MS, BCBA

You’ve taken the important step to seek help to address your child’s challenging behaviors. You’ve talked to a primary care physician or maybe a psychologist or counselor at your child’s school and received a recommendation that a functional behavior assessment should be conducted by a certified professional. Now you are preparing for the assessment. What should you expect?

The short answer is: an in-depth evaluation to understand the behavior and what may be causing or contributing to it, as well as recommendations to address it. Typically, the functional behavioral assessment involves these steps:

1. Investigation

The investigation phase includes interviews – which are really just conversations with different people – along with observations to see the behavior in action, what might trigger it, and how the child responds.

If the child’s behavior is getting in the way of interactions with his or her environment or learning at school, the clinician first meets with caregivers and others the child interacts with, such as teachers and family members. Specific questions are asked to learn what they are seeing and to explore insights on what triggers the problem behaviors.

Second, the behavior is observed directly to see what the consequences are. Usually this requires visiting the child at home, in the community or in a school setting. The purpose of the observation is to really get to know what maintains the problem behavior and determine the best replacement behavior to teach.

The child’s environment is also investigated, including home, community and/or school.  This often includes exploring furniture, spaces, sounds, noises, light, etc. to identify any factors that could be triggering or worsening problem behaviors. The clinician asks about life changes at home, in school or the community that might also be contributing factors.

2. Testing

As the clinician works through the process, he or she will test different theories and potential causes of the problem behaviors. Maybe certain environmental conditions are causing the behavior. Maybe the behavior only happens in specific situations.

Part of testing is to engage with the child directly to understand their communication ability and style of communicating, and to see how they relate to others. How does the child communicate and in what forms: words, signs, pictures, noises? How expressive and receptive is the child with the people around him or her? Does he or she have any physical limitations?

Testing will also look at all the current skills the individual has and areas where they will need support. This is useful when teaching replacement behaviors so the child can use and/or strengthen skills they already have.

Depending on the level of problem behavior, there may be additional testing that will look directly at what is maintaining the problem behaviors. This may seem intrusive, but it is necessary to have a clear understanding of what is going on so that appropriate supports can be put in place.

3. Analysis

In the analysis phase, the clinician will identify what works well in the child’s home life and school setting, what supports are present, what the child finds reinforcing and what the child enjoys doing.  This can include what kind of play and with what toys or entertainment or activities works well with the child.

4. Reporting

At the end of the assessment there is a report that summarizes what has been learned and insights on why the behavior is occurring. Usually, behaviors occur for one of these reasons:

  • To escape from something the child doesn’t like
  • To get access to something preferred
  • To get attention from others; or
  • Because of something automatic, something within the child… like feeling an itch and the natural response to scratch it

5. Recommendations

Based on the conclusions determined through the process and detailed in the report, and reflecting upon an understanding of the situation, the clinician will recommend an individual treatment plan for the child. The plan is specific, with the goal of addressing the maintaining cause of problem behaviors while teaching or strengthening replacement behaviors and teaching new skills.

About the Author

Jennifer Vasquez is a Board Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities since 2010. Her interest in severe problem behavior began while in graduate school at California State University, Northridge.

Jennifer currently serves as a Clinical Supervisor for California Psychcare and spends her time mentoring BCBA colleagues, developing and presenting trainings and providing clinical quality control for treatment plans used by those on her ABA-based behavioral health therapy teams.

In her free time, Jennifer enjoys exploring different running trails, taking yoga classes and spending time with her family.

Jenifer Vasquez, M.S, BCBA

Clinical Supervisor
California Psychcare

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Evaluation & Diagnostic Services

Evaluation and diagnostics – also known as psychodiagnostics – is the first step necessary to diagnose and clarify concerns regarding behavior, personality traits, mood, emotional functioning,
and cognitive processes.

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Infant Development & Early Intervention

Our infant development and early intervention program helps babies and toddlers with developmental delays or disabilities learn key skills that typically develop very early in life. Early intervention can contribute to a child’s success at home, in school, the workplace, and community — and can make a positive impact on a child’s development and accomplishments well into adulthood.

The Benefits and Importance of Early Intervention

The Benefits and Importance of Early Intervention 900 600 bh360

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The Benefits and Importance of Early Intervention

May 16, 2019 | Patricia Garcia, MPA

From the time a child takes its first breath, the child’s brain, reflexes, body and self-organizing sensory system all are trying to make sense of this new, bright world and how to connect with those around him or her.

Early child development is a complex and long-studied process that includes the identification of developmental “milestones” for specific age ranges that indicate whether infants and toddlers are developing normally. These milestones are numerous and range from making eye contact with their parents to using their hands and feet to explore everything around them to socializing and beginning to form healthy relationships with others. Missing critical developmental milestones should not be overlooked because they may represent initial indicators of a developmental delay and/or disability such as autism.

Parents who are concerned about their child’s development should explore evaluation and assessment immediately. A “wait-and-see” or “my child will grow out of it” approach could delay diagnosis and intervention, which could lead to potential lifelong educational and behavioral difficulties. While it can be scary, an early diagnosis is good news because early intervention programs are very effective and help parents improve their child’s overall development, and can pave the way for more successful transitions to school and beyond.

Early Intervention is impactful because the first three years of life is an incredibly rapid and exciting period of brain development, and extensive research has shown that play-based activities and routines in a language-rich home during this period helps increase a child’s overall developmental potential. The family’s home and other areas frequently visited by the family are considered natural environments and are the most important learning spaces and settings for infants and toddlers.

Early intervention specialists design an individualized in-home program that has goals and detailed “how to” instructions showing parents how, through several series of small steps, they can stimulate and support the child’s physical, mental and emotional development. Each in-home program will respectfully consider and support a family’s culture, values, home language and everyday routines and activities. Educational programs are individually designed to meet the child’s developmental needs, regardless of the child’s degree of delay.

The benefits and importance of early intervention programs can be measured in many ways. Children who learn how to connect and respond to those around them are better prepared to thrive in school. Success in school can lead to good social relationships and a better life overall.

The parent-child relationship benefits, too. In the beginning, when developmental issues are first noticed, parents are often overwhelmed with fear and uncertainty about what they can or should do. In an early intervention program, they are taught precisely how they can make a difference for their child. Parents essentially come to understand that they are their child’s primary teacher, and as they move through the program, their confidence is strengthened as they experience how their child best learns, communicates, connects and begins to solve complex problems. They come to find out that the most important parent tools are their time and attention.

The late Bev Bos, a teacher, author and advocate for play-based learning for preschoolers, had it right when she said: “Parents benefit in knowing that to ‘be’ with their child is what matters most, especially when life seems so stressful.”

The long-term goal of early intervention is to turn parents into strong educational advocates for their child and have them understand and accept that they are and will continue to be their child’s most important and lifelong teachers.

Learn more about Evaluation & Diagnostic or Infant Development & Early Intervention services available through 360 Behavioral Health.

About the Author

Patricia has almost 30 years’ experience working with infants and toddlers with developmental delays and disabilities. Her experience includes positions with South Central Los Angeles Regional Center (SCLARC) and North Los Angeles County Regional Center (NLACRC), where she served as an Early Start supervisor for 23 years. Her time with NLACRC included collaborating and training on Early Start topics for WestEd. Patricia currently serves as the program development manager for the Infant Development & Early Intervention Program at California Psychcare. In this role, she works directly with families that receive Early Intervention services though California Psychcare, as well as helping shape the program design and delivery of services across the organization.

Serving individuals with developmental disabilities has been Patricia’s lifelong passion, and her involvement ranges from understanding and helping influence legislative policy and procedures to personally meeting with families and hearing their stories, struggles and victories. It’s been a personal journey for Patricia, too, because she has family members with Down syndrome, cerebral palsy, autism and intellectual disability which has helped her understand the journey every parent and family must undertake when raising and loving a child with a disability.

In addition to being an ardent advocate for individuals with disabilities, she is an all-out Dodger fan and can often be found watching the evening game or tracking the game on her phone. Dodger weekends are her favorite at the stadium. Go Dodger Blue! She also has a love for travel and ballroom dancing, and is always working towards completing the perfect spin and turn in her Salsa, Rumba, Foxtrot and Waltz.

Patricia Garcia, MPA

Program Development Manager, Infant Development & Early Intervention Program
California Psychcare

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Evaluation & Diagnostic Services

Evaluation and diagnostics – also known as psychodiagnostics – is the first step necessary to diagnose and clarify concerns regarding behavior, personality traits, mood, emotional functioning,
and cognitive processes.

early intervention
Infant Development & Early Intervention

Our infant development and early intervention program helps babies and toddlers with developmental delays or disabilities learn key skills that typically develop very early in life. Early intervention can contribute to a child’s success at home, in school, the workplace, and community — and can make a positive impact on a child’s development and accomplishments well into adulthood.

How Positive Reinforcement Helps Shape Desired Behavior

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How Positive Reinforcement Helps Shape Desired Behavior

How Positive Reinforcement Helps Shape Desired Behavior

April 22, 2019 | Jeremy Wilson, PhD, BCBA-D

 

Many of us have experienced positive reinforcement in our lives. Maybe your boss asked you to write a report, give a speech, or complete a project, and when you were done, she said, “Great job!” She was using positive reinforcement strategy to “set the stage” for your next assignment. The praise was the reward that made it more likely you would willingly take on the next task.

Positive reinforcement is not a thing. It is a well-studied system that involves the addition of a stimulus intended to increase the likelihood that similar behavior will occur in the future in similar situations or environments.  More simply put, positive reinforcement helps shape behavior under similar conditions. Positive reinforcement is used beyond the business world, and is an important tool used at home and in school for those with autism.

Through social interactions, children learn to behave in ways that effectively communicate their needs and wants. Parents can help shape desired behavior by using positive reinforcement – correctly and in a timely manner. For parents of children with autism, positive reinforcement is a key strategy. It’s very important to anticipate the child’s needs and have reinforcers ready. Here’s one example.

A child with autism, who is not yet speaking, attempts to tell his mother he is hungry. He points to the shelf where there is a box of crackers. When his mother sees the child pointing, she looks at the shelf, and then at the child, and says, “Do you want a cracker? Let me get one for you.” The child’s attempt to communicate is now reinforced, and he is very likely in the future to ask for a cracker in a similar manner.

However, reinforcement cuts both ways. What if, in this illustration, the mother is busy working around the house or caring for her other children, and doesn’t notice the child who is pointing or doesn’t realize it is a request for something specific?

Children will respond differently. Some might withdraw if their mother doesn’t notice the pointed finger and try again later. But other children may respond with screams and throwing a toy across the room, which may result in getting the cracker. Providing the cracker reinforces the screams and throwing toys.

Thankfully, one misstep does not ruin everything. Human behavior allows for second chances, so a supportive adult can create another opportunity for a child to learn to ask for things through more desirable behavior.

It’s important to understand that positive reinforcement (rewards) are not the same as bribes. Bribery is trying to persuade someone to act in one’s favor (typically dishonest or undesired acts) and often has the threat of punishment attached. As we know, bribery and punishment procedures are generally not accepted, nor are these efficient and sustainable practices like positive reinforcement. People also tend to take positive reinforcement for granted, without stopping to think about the effect this activity has on behavior. It’s important to understand how it works to know why it works.

There is some misconception about behavior therapies used with children with autism. The misconception is that bribery and punishment are often used as behavior change procedures. That’s not the case. Those who work with children and others with autism make exhaustive use of positive reinforcement to shape all types of behavior.

For these professionals, observation and planning are critical for designing individualized programs, too. Some children need immediate feedback, while others may be fine with a short delay. Still others may need praise more frequently over a longer period of time.

Positive reinforcement is the primary system we have to help children learn how to effectively communicate their needs and wants throughout their lives. This strategy can quickly help improve the child’s quality of life, as well as the lives of the other family members.

Learn more about how ABA-based therapy can help shape behavior though positive reinforcement.

About the Author

Dr. Jeremy Wilson is a Board-Certified Behavior Analyst – Doctoral Designation (BCBA-D) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with autism and other developmental disabilities since 1998. His special interests within the field applied behavior analysis are Precision Teaching, human performance thinking, organizational behavior management, and the analysis of verbal behavior. Jeremy currently serves as the Director of Process Improvement & Standardization at 360 Behavioral Health and spends his time developing and optimizing organization-wide processes and supporting various team projects.

Dr. Jeremy Wilson, BCBA-D

Director of Process Improvement & Standardization
360 Behavioral Health

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Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Our home-based ABA services are delivered in the home. Visits are scheduled to fit each family’s needs, preference and availability.

Does your child need more help in school?

Does Your Child Need More Help in School?

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Does your child need more help in school?

Does Your Child Need More Help In School?

April 9, 2019 | Judith S. Cohen, Psy.D., LMFT

Home-based behavioral services for children with autism are aimed at helping them develop and live as independent a life as possible.

In school, the aim is the same – to help a child develop independence while providing a school-based education that facilitates independent living. Helping children whose behaviors interfere with getting the most out of their education is difficult work, especially when teachers are overwhelmed with large numbers of children in their classroom. This is when schools can use our help.

When a child’s behaviors interfere with their ability to learn, it is important for the parents and the school to recognize and figure out a plan to assist learning and development. If your child has an autism eligibility, then he/she has been through a special education assessment which resulted in the development of an Individualized Educational Program or IEP. The IEP Team determined that your child requires goals and services to help them progress in the school setting. Your child’s IEP outlines how your child performs in academics (reading, writing, arithmetic) and socially. Depending on needs identified in the IEP, additional services such as speech and language, occupational therapy and a behavioral aide may be offered.

Sometimes your child may demonstrate disruptive behaviors, such as being non-compliant, having difficulty paying attention, throwing a tantrum or even running away – which interfere with their learning. Classroom structure can be challenging for children with developmental delays. Your child may not have the skills needed for independent planning, organizing, sitting, listening, initiating and following through on assignments or tests. Children, for example who have difficulty paying attention to a classroom activity might feel anxious and refuse to participate.

There is a way to help! That help can be given in school by using a highly trained and qualified behavior specialist who will guide your child throughout their school day. Behavior Intervention Implementation or BII and Behavior Intervention Development or BID are services that can be offered to help them. BII services are a direct, one-to-one service provided by a trained behavior expert who collects data and has expertise in targeting problem behaviors that interfere with your child’s learning. This can be provided throughout the entire day or as identified in their IEP. BID services provide supervision to the BII, and an assigned BID is responsible to write reports based on the data collected by the BII, dialogue with parents and attend IEP meetings. Parents HAVE a say and if they feel BII services are needed, then they should speak up and let the IEP Team know.

A Behavior Intervention Plan or BIP is additional documentation that is part of your child’s IEP. It identifies the behaviors that interfere with learning, what is missing or needed in the school environment to insure success, and a strategy to guide the teaching replacement behaviors. Ways of reinforcing the replacement behaviors are designed based on what your child responds to and can change from time to time.

BII and BID services offer opportunities for your child’s long-term success in life.

Learn more about how a school-based behavioral therapy program works.

Or schedule a one-on-one consultation with one of our behavior therapy experts.

About the Author

Dr. Judith S. Cohen’s background includes 33 years as a school psychologist – which includes 29 years with the Los Angeles Unified School District (LAUSD) and four years with a school system in New Jersey. After retiring from LAUSD in 2011, Dr. Cohen’s passion for children led her to a new role as an educational advocate, where she helped families in need obtain a Free and Appropriate Public Education (FAPE). Dr. Cohen currently serves as the school district coordinator for California Psychcare, a position she’s held since January 2016. Her goal is to have every child with special needs get an appropriate Individualized Educational Program (IEP) with goals and services and the appropriate educational placement aimed at helping each child grow each year.

Dr. Judith S. Cohen

School District Coordinator
California Psychcare

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Applied Behavior Analysis (ABA) / Behavioral Therapy – School Based

Our school-based ABA services are delivered in the classroom. A school-based approach is beneficial because it provides the opportunity for the individual receiving therapy to participate in a normal school environment – often with their peers or siblings. Community immersion and integration is a major advantage of this type of program.

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Managing Stress with Mindfulness: Helpful Tips for Parents of Children with Autism

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Managing Stress with Mindfulness

Helpful Tips for Parents of Children with Autism

March 21, 2019 | Caroline Hardman, MS, BCBA, Qualified MBSR Instructor

When we become parents, we fall in love with our miraculous little bundle of life. We also find ourselves stressed out with the demands of being a new parent. How we respond is largely a result of how we have previously learned to react to stressful events.

A diagnosis of autism can rock our universe, and our sense of security and freedom. Children with autism and other special needs generally are unable to communicate what they want or need and often struggle with socialization skills, so they have tantrums or engage in unsafe behaviors. Stresses mount as we seek services we need at home and at school, incorporate school meetings into our already busy schedule, juggle necessary doctor appointments and make plans for people to come into our home several times a week.

It can sometimes feel like the weight of the world is on our shoulders or that our lives are spinning out of control. We often react with frustration.

This is where a daily mindfulness practice can offer some respite and help lift that weight.

Mindfulness is a process by which we shape our view of ourselves and our lives. We do this through formal practices, like yoga and meditation, and informal practices like just being present during everyday tasks.

To be mindful is essentially being aware in the present moment, on purpose, without judgment. Imagine saying, “I will be calm if my child throws a fit at Target” and then being determined to follow through. Setting our intention dramatically increases the likelihood that we’ll remain calm. But just being present is not easy; our thoughts tend to be restless and uncontrolled. We tend to make many judgments, too, about ourselves and those around us.

Think of mindfulness as a camera lens: it captures just the moment without judgment or labels. It just sees. And the path to mindfulness, like any other brain training, takes practice. Just as muscles get stronger with exercise, so does the mindful mind.

There are several exercises that can help us respond with calm and ease to stressful events. Here are three.

Awareness of Breath
For a couple of minutes, with eyes closed, bring your attention to your breath as it comes in and leaves the body, without trying to change it. Notice your breath in the expanding and contracting of the abdomen and hold your attention there. When you notice your mind wandering, kindly usher your awareness back to the breath.

Awareness of Daily Tasks
Think of something that happens every day more than once; something you take for granted, like opening a door. At the moment you touch the doorknob, stop for a moment and be mindful of where you are, how you feel in that moment and where the door will lead you. Instead of automatically going through daily motions, take occasional moments to stop and be aware of what you are doing and the blessings these daily movements mean in your life.

Mindful Listening
Learn to open your ears to sound without being swayed by memories of or preconceived notions about music. Select a piece of music you have never heard. Close your eyes, and if you like, use a pair of headphones. Don’t think about the type of music it is, the title or the artist. Just hear it. Become absorbed in the sound. Listen to the contributions of each instrument. Then concentrate on the voice or voices. The idea is to experience listening without making judgements.

This lovely quote by the renowned author Elisabeth Kübler-Ross clarifies the value of mindfulness quite beautifully – “It’s only when we truly know and understand that we have a limited time on earth – and that we have no way of knowing when our time is up – that we will begin to live each day to the fullest as if it was the only one we had.” Perhaps this “attitude of gratitude” for the everyday moments – mundane, painful, or joyful – are what allow us to appreciate even the most challenging work given to us in this life.

About the Author

Caroline grew up on a farm and homestead in rural Montana. She moved to Los Angeles as a pre-teen but has lived in various places throughout the United States. Caroline dreams of the expansive California desert where she finds some of her greatest inspiration. She has been a writer and teacher, worked on applied science projects with a national laboratory, owned two small businesses, and is currently a BCBA at 360 Behavioral Health / California Psychcare where she has provided ABA services for adults and children with special needs since 2015. She also teaches mindfulness classes for parents. Her passion lies in inspiring others to live with gratitude.

Caroline
Caroline Hardman, M.S., BCBA

Associate Director of Clinical Services
California Psychcare

food selectivity

Food Selectivity: Battles at the Dinner Table

Food Selectivity: Battles at the Dinner Table 600 401 bh360

food selectivity

Food Selectivity: Battles at the Dinner Table

March 11, 2019 | Jared Freilich, MA, BCBA

It’s not unusual for children to be picky about food; it can be a pretty normal process as little ones develop a taste for what they prefer to eat, and what they don’t. They usually outgrow the fussiness as their palates mature.

But children with developmental disabilities often adopt persistent patterns of unhealthy or very narrow preferences about food that go miles beyond typical finicky childhood eating.

Narrow eating patterns can be based on types of food, including appearance, such as color and texture; how it smells; whether it’s too hot or too cold, and even where it comes from. Your child might demand animal-shaped chicken nuggets – forget about serving chicken nuggets that are not animal-shaped — and only McDonalds french fries.

For the child with autism, any deviation from their preferred food routine is unacceptable. It doesn’t matter what the rest of the family is eating. Coaxing the child to “just try it, it’s good,” can ignite a temper tantrum. During these food battles, the child might gag or spit out the foods they don’t want to eat. Others will pack food in their cheeks squirrel-style and refuse to swallow.

Parents may inadvertently reinforce their child’s narrow eating by withdrawing the food the child doesn’t want and giving them what they like. While this may result in some peace and quiet during mealtimes, it is at the expense of good nutrition and opportunities to teach better behavior. There are solutions, and understanding this cycle of inadvertent reinforcement is the first step.

A behavior analyst can help. By interviewing the parents and observing the mealtime battles, the behavior analyst could design an individualized plan that, if used consistently with patience over time, may help the child overcome the food issues.

For example, here’s one approach that uses a reward-based plan. This is a deliberately simplified plan of action.

I serve my daughter a salad. She throws a tantrum and refuses to eat it. I leave the salad in front of her, and add a plate of chicken nuggets, which I know she likes. I tell her she can eat a nugget, but only after she takes one bite of the salad. It may take some time, but once she eats a bite of the salad, she is rewarded with her preferred food. Gradually one bite of salad, alternating with one bite of chicken, will become two bites, then three. At some point, she will eat the salad without argument, because she knows her favorite food will also be a part of the meal.

Eating a greater variety of food means my daughter is learning to be flexible. And there’s less stress on the parent caregiver.

Learn more about ABA-based therapies that can address food selectivity and other challenging behaviors.

About the Author

Jared Freilich is a Board-Certified Behavior Analyst (BCBA) who has provided applied behavior analysis (ABA)-based treatment to children and young adults with developmental disabilities since 1998. His interest in food selectivity began while in graduate school at California State University, Los Angeles, working with children with autism. Jared currently serves as the Director of the Insurance Department for California Psychcare and spends his time consulting on challenging cases, mentoring BCBA supervisees, and providing clinical quality control for treatment plans used by our behavioral health therapy teams.

Jared Powell
Jared Freilich, MA, BCBA

Director of Insurance
California Psychcare

aba center based
Applied Behavior Analysis (ABA) / Behavioral Therapy – Center Based

Our center-based ABA services are delivered at one of our behavioral health treatment centers. A center-based approach is beneficial because it provides an environment with minimal distractions and establishes a steady routine of going to a set location for learning.

aba home
Applied Behavior Analysis (ABA) / Behavioral Therapy – Home Based

Our home-based ABA services are delivered in the home. Visits are scheduled to fit each family’s needs, preference and availability.

aba school
Applied Behavior Analysis (ABA) / Behavioral Therapy – School Based

Our school-based ABA services are delivered in the classroom. A school-based approach is beneficial because it provides the opportunity for the individual receiving therapy to participate in a normal school environment – often with their peers or siblings. Community immersion and integration is a major advantage of this type of program.

Children with Autism are More Likely to Experience Abuse than Other Children

Children with Autism are More Likely to Experience Abuse than Other Children 460 314 bh360

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Children with Autism are More Likely to Experience Abuse than Other Children

February 28, 2019 | Leili Zarbakhsh, PhD, LEP, LMFT, BCBA-D

Helping children on the autism spectrum is complex and difficult. We work hard to give our children a voice, so they are able to have their needs met and navigate their way to as normal a life as possible.

Sadly, new research recently published by the Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorder has reminded us how vulnerable these children are to abuse, and how likely they are to experience it. The study tracked more than 24,000 Tennessee children from their births in 2008 through 2016. In that group, 387 were diagnosed with autism, and 17.3 percent of those children were the subject of child abuse hotline calls. The others in that age group accounted for only 7.4 percent of hotline calls, according to a Feb. 25th report published on the Disability Scoop news website.

These numbers show that children with autism are more than twice as likely to be exposed to abuse than children who are not diagnosed with autism. It’s not clear what is driving the disparity in cases of potential abuse, but in his report, researcher Zachary Warren said that behavior issues and other factors associated with autism could make those on the spectrum more vulnerable.

Children who are struggling with cognitive and behavior issues can be especially vulnerable to abuse and neglect, and it is tragic that some might have the additional burden dealing with mistreatment. We need to teach these children how to recognize when they are being mistreated and how to appropriately respond to it, and that includes knowing when and how to speak up and report abuse on their own behalf.

California law defines child abuse as a physical injury that was not accidental; cruelty and unjustifiable punishment; sexual abuse or exploitation; and neglect, from lack of adequate food, clothing, shelter, medical care or supervision.

We urge anyone who knows of a child like this who might be an abuse victim to report it. Teachers, social workers, child care providers and health care professionals are required by state law to report their observations and suspicions, but parents, friends, relatives, neighbors, and even store cashiers and bus drivers can step forward to help.

The state’s Child Protective Services division of the California Department of Social Services website says community members have an important role in protecting children from abuse and neglect.

Report possible child abuse or neglect to your local police or sheriff’s department. The state’s Child Protective Services also have 24-hour emergency response phone lines staffed by social workers in every county.

In Los Angeles County, call (800) 540-4000

In Orange County, call (800) 207-4464

In Riverside County, call (800) 442-4918

In San Bernardino County, call (800) 827-8724

In San Diego County, call (800) 344-6000

In San Luis Obispo County, call (800) 834-5437

In Santa Barbara County, call (800) 367-0166

In Ventura County, call (805) 654-3200

A list of the phone numbers in other California counties are at:  http://www.cdss.ca.gov/Reporting/Report-Abuse/Child-Protective-Services/Report-Child-Abuse.

For the full Disability Scoop article on the research:
https://www.disabilityscoop.com/2019/02/25/kids-autism-twice-abused/26072/.

For the complete Vanderbilt Kennedy Center research results: https://vkc.mc.vanderbilt.edu/notables/2019/02/children-with-autism-more-likely-to-experience-maltreatment-study-finds/

For the complete study abstract, A Population-Based Examination of Maltreatment Referrals and Substantiation for Children with Autism Spectrum Disorder, along with information about how to access the complete study: https://journals.sagepub.com/doi/abs/10.1177/1362361318813998

About the Author

Dr. Leili Zarbakhsh is the executive director of clinical services at 360 Behavioral Health and is also the founder of California Psychcare. California Psychcare is a part of the 360 Behavioral Health family that utilizes applied behavior analysis (ABA) to provide behavioral health treatment to clients across California.

Dr. Zarbakhsh has worked in the field of psychology for more than 35 years, spending the first third of her career as a school psychologist for Los Angeles Unified School District. She is a licensed marriage and family therapist, board-certified behavioral analyst and licensed educational psychologist. Dr. Zarbakhsh received her bachelor’s and master’s degrees in psychology from the University of Southern California and earned her doctorate from the Chicago School of Professional Psychology, where she focused on applied behavioral analysis (ABA).

Dr. Zarbakhsh likes getting people excited about the things she’s excited about. Today, that’s providing lifelong and holistic care to the very special individuals and families we serve. She believes that within every child is unimaginable potential – a potential we can unlock if we listen closely and love unconditionally.

Dr. Leili Zarbakhsh
Dr. Leili Zarbakhsh

Executive Director of Clinical Services
360 Behavioral Health

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Preventing Caregiver Burnout

Preventing Caregiver Burnout 500 334 bh360

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Preventing Caregiver Burnout

February 25, 2019 | Yelba Diaz, BA

Parenting is never an easy job! For parents of children with autism or other developmental disabilities, parenting can be even more challenging. These parents find their roles expanding into that of 24/7 caregivers who are not only expected to provide love and support, but also to meet relentless needs. The day to day interactions with various behavioral issues and demands can be overwhelming. Unchecked, these stresses can lead to a state of emotional, mental, and physical exhaustion commonly labeled “caregiver burnout.” Caregiver burnout can lead to a loss of interest and motivation. Some of the initial signs of burnout include irritability and venting about how there’s no time to clean the house or how impossible it is to get out and socialize with friends.

Some parents have a hard time asking for help and think they always have to be present. And unfortunately, many parents are not aware of the resources available that are designed to give them a break. Respite is a service designed to provide care for the child of the caregiver by an individual who is knowledgeable and trained to care for the child’s needs. This service also provides parents a break from the day to day intensive care they provide their child.

Respite care typically falls into two categories – traditional and specialized. Traditional respite is focused on taking care of personal needs and in-home activities such as washing, using the toilet, or having a meal. Specialized respite provides these same basic services but goes a step beyond. With specialized respite care, staff members are in the home to teach, supervise and actively engage while the parents go shopping, do errands, or just take some time away. These care teams are trained in step-by-step behavior analysis and goal-based treatments. They collaborate with the applied behavior analysis (ABA) service provider to follow the individual’s specific behavior support intervention plan, which spells out consistent responses to behavior problems.

The best respite care services will rotate staff members in the home so that children grow accustomed to meeting a variety of people. This makes it easier for them to transition into outside programs for more training, and eventually help them prepare to live as independently as possible. That is the ultimate goal, especially for parents of adult children who worry about who will take care of their adult children when they are no longer around. It is a relief for them to see their children make progress. Parents are happy to see how care teams can help their children develop and thrive.

Everyone needs a break sometime. And parents need not feel that they are alone. If you think you need help, contact a respite care provider to arrange a meeting to learn more about how they can offer assistance. Respite is a very valuable resource that can help prevent caregiver burnout . . . and might be just what you need.

Learn more about respite care available through 360 Behavioral Health.

About the Author

Yelba Diaz, regional manager, Behavior Respite in Action (BRIA), has a bachelor’s degree in early childhood education, and is studying for a master’s degree in education with an emphasis in applied behavior analysis, and for board certification as a behavior analyst. She became interested in this field after working with a client directly for 2 years and witnessing the behavioral changes and skill acquisition that took place – and completely took over a part of her heart.

Yelba-Diaz
Yelba Diaz, BA

Regional Manager – North Region
Behavior Respite in Action

respite care specialized
Respite Care – Specialized

Similar to traditional respite care, specialized respite care provides parents and caregivers with temporary relief from their caretaking responsibilities so they can return to their duties rested and refreshed.