Monthly Archives: January 2018

At Great Strides We Make Everyday Lives Better

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At Great Strides We Make Everyday Lives Better
By Christina Swanson

Parenting a child with special needs requires meeting a host of challenges with positive determination, patience and unwavering persistence as the child grows and needs change. Eyes and hearts are opened as family members learn gratitude for everyday things and how simple hygiene and basic tasks, which are normally learned with ease and taken for granted, can be a difficult and pain-staking exercise for a disabled child and a time-intensive ritual for the child’s professional therapists, parents or caregiver.

A big part of Great Stride’s focus is to work as a team with the child, parents and/or caregiver, and teacher outside the classroom to help them learn the skills to be more independent which, in turn, increases the child’s confidence and potential to adapt and learn other skills while freeing-up the parent to meet the other many requirements of their day.

Recently, two Great Strides professional therapists extended their caring reach to teach a student/patient specific tasks by adapting equipment and creating specialized exercises that truly goes above and beyond their duties and speaks volumes to their dedication. Conquering something as seemingly simple as getting in and out of mom’s car and being able to clean oneself after using the toilet, has been a true victory for the child and family alike.

The Bidet Adaption Challenge

Young Brandon Belzer is a Great Strides outpatient who receives both occupational and physical therapy within a close collaborative team approach where his mom, Kimberly Belzer, is highly involved.   When Kimberly got the idea to install a bidet on her toilet to relieve her having to be with Brandon every time he used the bathroom, his therapists went to work at teaching Brandon about the many  hand and arm movements  needed for him to turn the small knob that operated this bidet so he could be self-sufficient.

But Brandon didn’t seem to have the strength or ability to understand the proper way to make the knob turn which set in motion another innovative Great Strides success story thanks to the creative construction of Great Strides Executive Director, Dr. Jon Edenfield, OTD, OTR/L, Brandon’s occupational therapist, Hilda Harrison, and an innovative installation at Brandon’s home by Hilda’s husband, Wayne Powell, who is an engineer.  This team looked into ways of adapting the equipment to the skill level of what Brandon could do. In looking for additional products that could change the bidet to have an easy button for Brandon to push instead of turning a knob, there was nothing available on the market. So, Edenfield, Harrison and Powell set to designing adaptive equipment from available parts and combining them together into a final “adaptive” product that’s not available in a store or even yet invented.

Using regular water lines, a lawn sprinkler valve, a low voltage power supply, and a Big Red button type switch, the bidet was adapted, allowing it to bypass the knob operation.  This adaptation resulted in a major functional outcome for Brandon who now independently operates his bidet every day using the Big Red switch.  Both Kimberly and Brandon are thrilled!

 

“As special needs parents, we are always trying to make our kids as independent as possible and have them be less vulnerable and dependent on others to perform everyday function which, of course, helps them grow and makes it a lot easier for us as parents,” explained Kimberly. “Now Brandon can go to the bathroom independent without me having to constantly get up and help him. The people at Great Strides are truly amazing in their caring because they know it is really about helping the children. It is a blessing to me that Great Strides is a true partner in helping our children become functional.”
The Entering/Leaving Car Challenge

Another easy to take for granted ability is to be able to get in and out of a car unaided. If you think about it, it’s kind of a complicated motion involving crouching forward, lifting the initial leg, ducking the head, etc.

Brandon’s physical therapist, John Kirkland, initiated a simulated car therapy based on observational gait analysis and Brandon’s known history of visual impairment, increased extensor tone, rigid adherence to routine, aversion to novel tasks and limited verbal and comprehension abilities. It appeared the inability of Brandon to transfer from the parking lot or driveway into his mom’s SUV keyed upon his inability to step up and translate his center of mass forward while in a crouch stance.  Kirkland determined that a small portion of this task was challenging for Brandon. However, this part task was essential due to the relatively low head clearance and high floorboard relative to the ground in mom’s SUV.  There were also concerns with his ability to pivot into his car seat once he steps into the car.

Kirkland used the principles of over-training, part task training, meaningful rewards, and verbal and tactile cueing with Brandon. He did this by creating a simulated physical situation where he hung a piece of cardboard horizontally from the clinic ceiling to replicate the car ceiling, used a step-up bench that approximated the height of the floorboard of the car and an object on the seat that required him to pivot in order to sit down.  The cardboard was painted to match the color of mom’s car and several other objects were used to simulate the bench seat of the car.

Then everything was set for Brandon to practice stepping up under a low ceiling with the bandwidth of reward, cueing, and assistance appropriately withdrawn.

The key was Brandon’s ability to generalize the task to his mom’s car, which he successfully accomplished after only two to three trials.  A total success and the cost of the project was a nominal $6.00 but helping make mom’s life easier is – PRICELESS!

 

 

 

 

 

 

 

Meet our Staff Spotlight – Hilda Harrison

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What initially drew you to choose a career helping improve the lives of children with disabilities?

Since childhood I “sensed” people’s feelings and attitudes, things about a person that weren’t verbally expressed. Psychology became my passion in college years, but I still was not totally satisfied. I met a pediatric Occupational Therapist whose influence and counsel were so significant that I changed majors, university, and professional course. OT became the bridge between psychology and the art and science for practical and functional interventions into a person’s daily life.

Have you been touch personally in this area?

You should ask how important is waking up every morning. For over 35 years as an Occupational Therapist, I look forward to each work day, to the discovery of children’s potentials, sharing with team members, learning from families, and challenged with each gift in which “problems” are often wrapped. With the support of owner Jon Edenfield, team work, and family involvement evidence occurs every day that miracles happen at GSR.

How long have you worked for Great Strides Rehab and in what capacity(ies)?

I have worked at GSR for 12 years, beginning when the owner had just 2 employees and a clinic about the size of one of our therapy rooms. I serve as staff OT within a team of about 50 professionals to include ABA, Occupational Therapy, Speech Pathology, Physical Therapy, Music Therapy, Nutrition, and administrative staff across settings to include public and private school systems, medically complex outpatient settings, and the GSR center-based private school and preschool. Watching GSR grow with such excellence over these years is beyond exciting.

Tell us about your history and career background.

I have been fortunate to work as an Occupational Therapist in many different types of settings to include university teaching hospitals providing therapy in both neonatal intensive care units (NICU) and pediatric intensive care units (PICU), a cerebral palsy rehab facility, childrens hospitals, school systems, and private practice. These facilities supported professional activities to include grant writing to procure NICU related NIDCAP staff training and a computer technology grant from Easter Seals. I taught Level II and Level I OT and OT Assistant fieldwork students for 20 years from which I probably learned more than I taught. I worked on multi-disciplinary medical teams to include ECMO ( based on a heart-lung bypass machine), a post heart transplant feeding program, neurology and orthopedic rhizotomy treatment team, and a radiology department swallow study team. I have published one national pediatric research paper on the play of children with disabilities and one state wide adult-related research paper on sensation restoration. I have presented papers at national and state conferences related to children’s head injury, juvenile rheumatoid arthritis, and fieldwork supervision. And last but not least, I have been fortunate to serve with distinguished colleagues lobbying for children’s healthcare.

Inform us on your educational accomplishments: Degrees earned, Certifications, any related Organization memberships?

Children and families needs are multi-dimensional as it is for all of our lives. I am fortunate to have received post-professional certifications related to my passion with Sensory Integration, Neuro-Developmental Training (NDT), and multiple trainings with pediatric feeding and swallowing. As with an iceberg, only 15% is visible above water and 85% is underwater unseen. These advanced trainings have helped give insight into the 85% of what in not seen in children on first look, especially when combined with a GSR team approach.

 What do you enjoy most about working at Great Strides?

Getting to know and meaningfully engage with families and children is a profound privilege at GSR. The depth of family engagement within a team approach at GSR surpasses any work setting in which I have worked.

 What is one fun fact most people don’t know about you or something that makes you smile?

Balance with work, play, rest, and leisure is a basic tenet of Occupational Therapy. When not working, I ride my Harley Davidson Sportster, scuba dive, or just work in the yard and garden. My husband Wayne Powell, who is an electrical engineer by profession, and I were married underwater 20 years ago, so we often combine a motorcycle and scuba diving trip in the Florida Keys. We just bought an RV and made our first cross country trip to Arizona and Utah, motorcycles in tow.

 What is your favorite inspirational quote or motto?

I have a few years “under my belt” and more than one guiding quote. But for today, here goes a blended version: Live well, laugh often and insanely, love truly, live in prayer, and forgive quickly. And work like you don’t need the money, love like you have never been hurt, and dance like no one is watching. But a favorite is Matthew 19:26: “With God all things are possible.”

 

 

Finding Common Ground with the Insurer

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Finding Common Ground with the Insurer
originally published in the (Florida Assoc of Behavior Analysts) FABA Observer Summer 2017
By Matt Briere-Saltis

Insurance Companies and ABA providers often find themselves in an ostensibly unenviable relationship. One side is seeking to mitigate their financial investment while the other attempts to mitigate the effects of an often lifelong, debilitating disorder. And yet the two coexist every day, discussing authorizations for ABA treatment, often debating the question of medical necessity.

Every funding source of ABA has a slightly nuanced understanding of what is medically necessary. Some definitions are shaped by very informed and sincere men and women with appropriate medical, psychological, educational, and behavior analytic experience. Some, unfortunately, are shaped by borrowed legal precedent and misguided priorities. And most fall somewhere in the middle, generally accepting that ABA is appropriate to treat deficits with Activities of Daily Living, Communication, Problem Behavior, Social Skills, Language Building, etc.. Some will require that no educational targets be set, others will deny coverage for vocational skills training, and others still will not fund in the absence of notable problem behavior.

It is important to be prepared to experience the full gamut of definitions when you are interacting with funding sources, which often are private insurance agencies. Insurance agencies typically can give some information electronically or over the phone regarding general policies on what they define as medically necessary for ABA therapy. But another funding source that’s important to consider is the self-pay family. They may have a different understanding of what is medically necessary, and it may be a vital step for you to have the same type of discussion regarding ethical standards of treatment with a parent as you might with an insurance representative.

The discovery of common ground also involves having the right documentation. Again most insurance providers that fund a large number of ABA plans will have designated forms, and information that they request. There may also be requests for additional information after the original forms have been submitted. The individual that is able to submit this documentation in a timely and accurate manner will always have a leg up.

Ultimately, success when communicating with insurers comes down to pleasant persistence. And that often manifests as plenty of phone calls, emails, faxes, and face palms. But communication is important, and it can sometimes be tempting to multitask while communicating, especially when there is graphing to be done. But it can also detract from the conversation. Being prepared and being present will likely reduce the number of future phone calls. Being pleasant is just a good thing to shoot for.

Matt Briere-Saltis is a Board Certified Behavior Analyst (BCBA), certified PCM instructor, and certified PCIT therapist. Matt has served the last two years as the Clinical Program Manager for Great Strides’ Outpatient department. The Outpatient department serves clients out in the community, in both public and private schools as well as home based programs. Matt has worked in the field of Behavioral Health for a little over a decade now, having worked in hospital settings, group homes, clinics, and as an expert witness. In addition to providing training and supervision to staff members at Great Stride, and administrative support to the Great Strides Leadership team, Matt has written and been interviewed for multiple publications, including the FABA Observer.

Did You Know? ABA therapy for Down Syndrome Covered by Insurance
   Did you know that the Florida Senate passed a House Bill in March of 2016 to require insurance companies to pay for ABA therapy for individuals with Down Syndrome to the same degree as for individuals with Autism? Most insurance plans began including this coverage at the start of their plan year, which for many was January 2017. This means that your child could receive 20-30 hours per week of interventions to improve your child’s and family’s quality of life. Have a young child? Contact us about our Early Intervention Preschool Program and to find out more on insurance coverage for ABA therapy!

 

Great Strides Start’s PE Program

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The Great Strides School PE program was trialed two years ago by taking the advanced learners to Chuck Rogers’ park to learn and eventually play a modified soccer game with staff. We now offer PE every school day in each school classroom facilitated by a classroom PE Lead and supervised by the school’s Physical Therapist to assist with any physical accommodations needed for the students.

This program was developed by Rebecca Kilgore, PT, DPT, BCaBA, a licensed physical therapist and board certified assistance behavior analyst, who explains,

“The goal for our school’s PE program is to assist our students in learning the fundamental building blocks for play, sports, coordination, and cardio/muscle endurance all while having fun and interacting with staff and peers.”

 

Why PE is Important for Kids with Autism
   Physically active children have better circulation, muscle tone and maintain a healthy weight. While physical activity is healthy for all children, goes even farther with autistic children. Autistic children experience an increased attention span after aerobic activity. Physical education with autistic children is also effective at controlling some inappropriate behaviors associated with autism, according to John O’Connor in the article “Understanding Autism” published in Palestra.

Autistic children experience difficulties in interpersonal relationships that manifest in avoiding affection, play or participation in physical activities, avoiding eye contact and being unable to relate normally to other people and situations. Including autistic children in physical education is complicated by autistic children’s inability to cope with normal tactile stimuli. The result is that many autistic children possess low levels of physical fitness.

Exercise and sports may help to prevent problem behavior such as aggression, and it may help socialization in autistic children, according to the Association For Science In Autism Treatment. Autistic children are not typically motivated to play in games with other children and may engage in inappropriate behavior because of sensory over-stimulation. Instructional programs that include only autistic children can have similar challenges as with mixed classes to include inappropriate behaviors, reluctance to participate, stimulus distractions, short attention span and abrupt outbursts or regression during exercise.

Creative techniques are needed to increase children with disabilities’ participation in physical activities which is why it is so important to have your child working with the professional technicians at Great Strides.