An Overview of the Positive Benefits of Human Animal Interaction for Children with Developmental Disabilities
Part 2 in a Series
By Christina Swanson
Summer 2018 edition briefly reviewed the history of the human-animal bond and AAT’s impact on helping children with developmental disabilities. Now we focus on Dr. Edenfield’s research with children within the autism spectrum, and how the Dr. Jon and Nantuckett team is another advantage for your child.
An additional level of therapy was added to the Great Strides Rehabilitation Center and School three years ago when owner and executive director, Dr. Jon Edenfield, introduced Animal Assisted Therapy (AAT) with Nantuckett, a trained Canine Companions for Independence (CCI) dog, into his extensive program.
Already known as one of northeast Florida’s first comprehensive, one-stop, multi-resource, rehabilitation centers, Great Strides Rehabilitation is the result of more than 20 years of research and study by Edenfield as an occupational therapist (OT) being guided by “observing others being assisted and finding new ways of helping people have a better life.”
His experience with the positive benefits of Human Animal Interaction(HAI) for children with developmental disabilities began when he was earning his degrees in OT at the University of Florida (UF). For years, Edenfield volunteered with UF’s hippo therapy, that helps patients with spinal cord injuries and cerebral palsy learn how to walk, and other skills, with the use of horses. Research shows a horse’s movements mimic human movements, so patients can be guided to accomplish various medical goals, like increasing their range of motion or strengthening their core, with horses.
He and his then future wife, who raised and trained horses, also helped several therapeutic riding programs that teach special needs children how to ride a horse to bolster self-esteem. Seeing the big smiles of accomplishment on the kid’s faces and knowing that therapeutic riding was producing results, the Edenfield’s hoped to one day have their own program. When they married and moved to Jacksonville in 2000, they found a home with a large lot with just that in mind. An elderly friend gifted them with his two horses and “Great Strides” was born.
So, Edenfield’s knowledge of how animals can uniquely reach and help children with disabilities began a while before he began researching how animal assisted therapy helps children with autism spectrum disorder. It ended up being his capstone project for three years while he worked toward his OT clinical doctorate, titled “Pilot Study: The physiological effects of animal assisted therapy on children with autism spectrum disorder,” at the University of St. Augustine for Health Sciences.
“The evidence of the health benefits in the bonding between animals and people goes back hundreds of years so why not incorporate this benefit while helping challenged children?” asked Edenfield. Early studies give evidence of the positive effects of HAI, most notably the reduction of stress-related parameters such as cortisol, heart rate, and blood pressure and an increase in improved behavior, social interaction and mood.
For the past several years, Edenfield has shared his knowledge and the process it takes to incorporate an AAT program working with children with autism through a presentation he developed for therapists and medical practitioners. Edenfield covers everything anyone could possibly need to know going back to the early history of HAI, the differences between AAT and AAA (animal assisted activity), other local facilities using AAT or AAA, and the process involved with getting, working with and incorporating a canine companion.
“My hope is that my doctorate research and overview presentation will add to the body of data that supports the use of animal assisted therapy for children with autism as well as make local practitioners aware of the history and process,” said Edenfield.
Although both provide opportunities for motivational, educational, and/or therapeutic benefits to enhance quality of life, AAT differs from AAA in that it has specified goals and objectives for each individual, is directed or delivered by a health service professional with specialized expertise in the area being worked, and the patient’s progress is measured.
Determining whether to use AAT for an individual will depend on what the therapist is evaluating and the best tool to use for this. “Much like a swing, therapy ball or other equipment or method, a practitioner will elect to use AAT because they have determined it will be a better way to teach a skill or accomplish a target,” said Edenfield. “The most important part to any successful treatment is the research and planning.”
Next: the final installment will explore the training that goes into forming the human/animal team, the results of Dr. Edenfield’s pilot study and how fostering shelter kittens are also providing another way to teach skills to students.
Great Strides Rehabilitation’s therapies for your child with disabilities, ages infant to 21, are now available in the Arlington area. Located inside the Hope Haven Hospital at 4600 Beach Boulevard in Jacksonville, Great Strides is distinct in that it is a multi-therapy center offering occupational, physical and speech therapy, applied behavior analysis, psychological services and autism evaluations at one location.
Our therapists work together with the family to provide comprehensive and coordinated care. Recognizing each family and patient are unique, it is our mission to enhance quality of life through the provision of exceptional therapy services. Our personalized team approach, utilizes evidenced based practice to provide the most effective course of intervention for your child.
“We’re excited to be able to now offer our services to benefit children with disabilities over a greater area, now giving more convenience to parents in the Arlington area,” said Dr. Jon Edenfield, DOT, OTR/L, founder and executive director.
To set up an appointment or get more information, call the main office, located in Mandarin at 12276 San Jose Boulevard, Suite 508, at 904-886-3228.
Great Strides also serves patients in Duval, Clay, St. Johns, Nassau and Flagler counties, including the cities of Jacksonville, Jacksonville , Neptune, Atlantic, Ponte Vedra, and Flagler beaches, Amelia Island, Mandarin, Nocatee, St. Johns, St. Augustine, Palm Coast, Orange Park, Macclenny, Middleburg, Keystone Heights, Palatka, Orlando and some cities in Georgia, including Brunswick, Mason, St. Marys and Waycross.
Summer Camp activities can provide opportunities to teach skills in creative ways. One fun way was to have a pizza truck come to the Great Strides campus and give kids a chance to work on their basic food ordering skills. This was AL-C classroom (last year) teacher Melissa Prescott’s idea sparked by AL-A teacher Lauren Cricchio’s established outing day at Zaxby’s that she’s been doing for a while, typically on Tuesdays.
As in previous summers, this activity combined the AL group, including students from the AL-A and AL-C classrooms. As the teacher of the AL-C classroom, I wanted to incorporate what Lauren C. was already doing. She had instituted a Zaxby’s day in which the AL-A boys went into the community for lunch. Like previous summers, the students from AL-C joined.
The day of our Zaxby’s outing (typically Tuesday) meant that the students practiced how to order. After having time to practice with his or her therapist, each student lined up to order from the “cashier” within the classroom. The cashier was always one of the teachers or therapists in the room.
Once we felt comfortable, we would venture across the street to have lunch at Zaxby’s. This was clearly everyone’s favorite weekly activity, and the students participated without hesitation. “This type of engagement demonstrates the power of community outings,” said Prescott.
The same structure was used to prepare for Rocco’s with the AL summer camp attendees working on ordering menu items within the class. Copies of the menu were sent home to parents, so they could let us know what their child wanted to eat including ensuring the menu selection for those using devices were entered in the device. That way, these kids could also select items and exchange it with the food truck employees.
All of these skills were practiced in the classroom so when the students encountered this new community experience, they would be just as engaged as their weekly Zaxby’s outing.
Everyone was excited when Rocco’s Pizzeria truck pulled up, anticipating eating some ooey-gooey pizza slices. It was a hit! All of our students (and staff!) enjoyed this new lunch option. Not only did this activity create a new community outing for the AL group program, but the food truck employees were extremely patient with our students and made them feel special.
“I couldn’t have asked for a better learning opportunity for our kids,” said Prescott.
Great Stride’s Creative, Caring Therapists Make Dreams Come True
By Christina Swanson
When the Great Strides therapist team, working with then eight-year-old Gracie Young, asked her mom, Kelly, what were some special skills she’d like for them to work on with Gracie, that’s all it took. Making this dream come true would take a lot more than a magic wand. Instead, it would involve a year-long, specifically-geared learning process from initial desire to successful completion by the therapist team, along with a fund-raiser, generous donors, Santas Dan and Danny, and lots of love and patience thrown into the mix.
But that’s what makes the people at Great Strides exceptional in their dedication to doing whatever it takes to help children with special needs and their families participate in everyday activities together that typical families just do automatically. And that’s what they were determined to do for the Young family.
Mom – Kelly’s dream was for Gracie to be able to ride a tricycle as a family activity with her mom and dad, who enjoyed riding bikes together. It was important to Kelly, not just the activity of riding itself, but of having Gracie outdoors in nature and getting some exercise. This would be no small feat for a child diagnosed with Hypotonic Cerebral Palsy, characterized by poor muscle tone and difficulty with balance and coordination of movements.
“Trying to find things that motivate Gracie to move has always been a challenge,” said Young. “When we thought about bike riding, they jumped on the idea and everything started coming together.” Yes, Gracie’s “bike therapy team” of Kelly Wassmer, lead behavioral therapist, Sarah Szymanski Horn MOT, OTR/L, occupational therapist, and John Kirkland, physical therapist were happy to teach the skills needed to get Gracie to accept and enjoy riding a trike. (Others also supporting Gracie include Sarah Feigenbaum, speech therapist, Skyler Williams, teacher, and Emma Reinheimer, staff behavioral therapist.)
When Gracie was six years old she was also diagnosed with autism and that’s when she began receiving therapies with Great Strides, specifically behavioral (ABA) therapy for the first time.
“When Gracie first came to us, she had a hard time walking, poor endurance and wanted to be carried everywhere,” said Horn. “Working on her mobility and endurance abilities, we eventually got her walking inside the classroom and outside on the playground. The next step was to find a fun activity that would keep her moving—this was the dream of being able to bike ride with the family.
Team Gracie had already come a long way in giving her a more independent life, having worked on toilet training, being able to participate in a group academic environment by sitting still and listening to the teacher, and other self-care skills.
“An effort made for the happiness of others lifts us above ourselves.”
– Lydia M. Child
Now preparing her to ride a specialty bike that would be built to her needs and body specifications, would require getting Gracie used to many sensations that could be “scary” and resisted by her. With balance and muscle weakness important factors, just getting her to accept sitting on a trike and wearing straps to support her torso took a lot of time and patience. Horn and Kirkland worked with Gracie on the action of pedaling with a special machine and put her on a regular tricycle and pushed her around to learn balance on a bike. Horn and Wassmer worked with getting Gracie to tolerate wearing a helmet, and straps that support her torso and feet to stay on the pedals that the bike would have. She was very afraid of being encumbered by all of this which took many steps and trials to accept. Finally, she “graduated” to actually practicing on the bike itself, but we’re getting ahead of all the parts of this special story.
Mom had found a specialty bike that could convert from a tricycle to a bike trailer by hooking onto one of their bikes for longer rides, but the cost was beyond what the Young’s could afford. That’s when Horn got the idea of having a fund-raiser to help the Young’s get Gracie’s special bike.
With Sarah’s husband and his brother owning “Hornski’s Vinyl Lounge” in St. Augustine, Sarah set about the many months of tasks getting donors, a band, and silent auction gifts to create the “Battle of the Beers” event to raise funds. Three St. Augustine breweries (Ancient City Brewing, Old Coast Ales, and Bog Brewing Company) donated a keg, five volunteered to work the event, the folk band Lonesome Burt and the Skinny Lizard provided the music, the Horn’s donated hotdogs, hamburgers, sodas and more beer, while sister-in-law Monica Zonni coordinated the silent auction.
The fund raiser was conducted through a 501C3 charity called Santa’s Special Kids. About 200 people participated in the event which raised more than $4,000, enough to buy the bike and have a lot left over. These funds are currently housed by the charity and are waiting to be put to good use. The plan is to be able to help those parents who children need ABA therapy but have difficulty paying for it because their insurance does not cover it. Sarah is in the process of setting up the parameters of this fund working with Candy Hurst, BCBA, Director of Applied Behavior Analysis.
Making the whole process even more meaningful, Santa delivered the special bike to Gracie on Christmas morning! Actually, it was Santa Dan and Santa Danny from Santa’s Special Kids who rapped on the Young’s door to a surprised Gracie and grateful parents. Both Horn and Wassmur had therapy visits working with Gracie on her bike and then took the bike back to Great Strides to continue working with Gracie there.
Now, after an entire year that started in March 2017, Gracie is ready to take her trike home and enjoy riding it with her parents. “It has been such a wonderful ‘ride’ seeing Gracie progressing and now being able to do something fun and outdoors with her family,” said Horn. Great Strides’ specialists determination to find creative ways to help parents with their special needs kids has been a blessing,” said Young. “They really did make this dream come true.”
“The therapists love for our kids is shown through all the creative ways they
help them grow and learn.” –Kelly Young, Gracie’s mom
Other Recent Developments that are Making a Difference for Gracie
Communication Through Proloquo2Go
With communication at the heart of everything we do, team Gracie has been working with her toward transitioning the type of augmentative and alternative communication (AAC) method Gracie uses, led by her speech language pathologist, Sarah Feigenbaum MA, CCC-SLP.
When Feigenbaum began working with Gracie last summer, she was using a picture exchange communication system (PECS) that involved giving a picture (or pictures) to a communication partner. To help her advance, Sarah introduced her to the skills needed using the Proloquo2Go system on an iPad with Gracie getting her own set-up this January. Her occupational therapist determined the best button size and spacing of her iPad that Gracie would be most successful with based on her fine motor skills. Now, she is able to select what she wants to say on the device as it speaks for her, acting as her voice. Gracie has a number of understandable verbal approximations and can use her device to augment her message.
At this point in Gracie’s AAC journey, she is able to request items and actions such as videos or to go to the restroom, as well as label items we show her using her device. When learning the meaning of new words as well as where to find them in her device, Sarah is working on getting her to choose more than one word.
“We are beginning to work on verbs in combination with objects in order to help Gracie combine them to create novel messages,” said Feigenbaum. “Her lead ABA therapist reported that she recently put together the phrase, “I want go Kelly” (her mother), indicating she wanted to go home.”
In order to help Gracie learn new words, her parents are also involved, coming into sessions to learn methods to teach her to quickly navigate to new words. ABA ensures she is able to use them to communicate consistently in the classroom and other environments and also teaches her new words. Communication occurs all across all environments and it takes a multidisciplinary team in order to support and set up a child to be successful.
Skilled Canine Companions
Another new development in Gracie’s advancement that’s warm, furry and full of self-esteem boosting love is the recent adoption of Yahtzee — a canine companion for independence dog. With the application process typically taking two years, Great Strides Executive Director Jon Edenfield, helped the Young’s with the process having written his doctoral studies on the benefits of canine companions helping advance children with disabilities, especially autism, and having adopted the center’s hardest working therapist, Nantucket. One of Yahtzee’s missions is to get Gracie walking more. Their adventure together is just starting and this newsletter plans a future article on the benefits of skilled companion dogs in a future issue.
“Great Strides has held our hand from the beginning, starting with Gracie’s transition from her old school, and incorporating behavioral therapy with all her other therapies have helped her tremendously. “Gracie’s team gives us exceptional support. They work with the kids and parents on life skills even at our homes, teaching them what they need to function in society. The therapists love for our kids is shown through all the creative ways they help them grow and learn.”
Great Strides has partnered with the Nemours’ Continence Clinic to offer families a whole child approach to successful toilet training. Sometimes toileting delays are caused by medical issues, while other times they can be caused by environmental or behavioral issues. With the partnership between Nemours Continence Clinic and Great Strides Rehabilitation, your child will benefit by having all aspects of the root cause of the toileting delay being addressed.
Since the Spring of 2017, Nemours has been referring children for applied behavior analysis (ABA) with Great Strides during evaluations after testing and ruling out physical or medical conditions that could be affecting a child’s ability to learn toilet training. Great Strides has been working with families in this area since it first began offering ABA therapy in 2007. Of course, families are welcome to contact Great Strides directly to do an evaluation.
If a child’s incontinence has a medical component, Great Strides will refer the family to Nemours to correct the medical condition first.
As explained by Nemours, a child isn’t a small adult, especially when it comes to pediatric urology — when it comes to conditions affecting the kidneys, ureter, bladder, urethra, penis and testes – because their reproductive system and urinary tracts are still growing and developing. Testing for pediatric urology problems can include urinary and fecal incontinence, urinary frequency and urgency, recurring urinary tract infection (UTI), failure to toilet train and chronic constipation. Some children with disabilities may refuse to participate in scheduled toilet training programs or have an aversion to sitting on the toilet, while others may be successfully trained for urination but have to have wear pull-ups for fecal elimination.
“Once a child’s pediatrician and Nemours’ specialist have reviewed the medical aspect of the child’s incontinence, and if there are still issues, because these professionals are not trained in behavior analysis, the family would be referred to us,” explained Candy Hurst, BCBA, Director of Applied Behavior Analysis.
How Does ABA Help with Toilet Training?
Applied Behavior Analysis is the science of how the environment affects a person’s learning and behavior. Toilet training, for some kids, needs to be specifically designed with
environmental modifications to increase the opportunity for success.
Such modifications may include: increasing comfort in the bathroom, schedule of trips to the bathroom, caregiver responses to successes on the toilet and accidents. Once the child begins to experience success with toileting, the family caregivers then have something to reinforce, thus increasing the likelihood that the child will continue to have success. This schedule of reinforcement is a vital component of toilet training. The bottom line is answering: What are the issues to address and how are we going to address them?
Presently, there are seven children onboard with the “potty training boot camp” program. “There are many different things that can improve a family’s quality of life and one of the biggest things is toilet training,” said Hurst. “We encourage parents to reach out and get their child trained and out of pull-ups because even if a child is a teenager, there still is hope.”
“The Great Strides program truly works! Regardless of age, behavior issues, medical history, or diagnosis, this model is tailored made for your child. At the age of 3, my daughter (ASD and non-verbal) still wore pulls-ups and showed zero interest in the potty. Witnessing my frustration, our ABA therapists recommended their “Potty Training Boot Camp”. Admittedly, I was skeptical but committed to the process. In a matter of days, she caught on to the program. Now at 8 years old, my daughter has remained fully potty-trained (without regression).”
The excellence of Great Strides Rehabilitation’s therapy staff has become well known throughout northeast Florida and beyond as the top therapy provider for Prescribed Pediatric Extended Care (PPEC) centers in the area.
PPECs are daycare for medically fragile children who can not attend typical daycares due to medical issues. Here, registered nurses, licensed practical nurses, certified nursing assistants, partnering with Great Strides’ licensed speech, occupational, physical and behavioral therapists, care for children ages birth to 20 years of age who have a life-threatening illness, are medically fragile, medically complex or technology dependent to optimize the development of each child’s independence.
When Great Strides began working with All Kids Care in late September 2016 it marked a milestone of service to all PPECs in the Jacksonville area. Great Strides is now continuing their partnership with All Kids Care at their newly built location on the Northside where they continue to offer a high standard of care providing a good curriculum that includes educating the parents in playing a role in teaching life skills.
Carrie Moon, Owner and Administrator of All Kids Care of North Jacksonville, left, and Katie Bishop, Great Strides Therapy Manager, discuss a new patient intake
Carrie Moon, RN, owner and manager of AKC, has been serving Jacksonville in the pediatrics field more than 22 years. Her first 13 years, Moon worked at Wolfson Children’s Hospital as a pediatric nurse and then began providing pediatric home care establishing All Care Home Nursing Services in 2012. Creating All Kids Care, first in Orange Park, and now on the Northside, it is her desire to provide this much-needed care to the underserved and remote areas such as Fernandina Beach and Yulee. Their Orange Park facility is currently filled to capacity.
“My relationship with Great Strides has been nothing but wonderful since I contracted their therapeutic services at the Orange Park location when opened a year and a half ago,” said Moon. “The kids have made incredible changes, blossoming into themselves, making my heart smile to see the positive differences that can be made when everyone works together as a team.”
Great Strides also provides therapeutic care to four other PPECs–CSI-Arlington, CSI- Cassatt, JumpStart Pediatrics located near Memorial Hospital in the Memorial HealthCare Plaza and Fletcher’s Tendercare. Each PPEC has a dedicated Great Strides managing therapist as well as nurses, nurses’ aids and physical, occupational and speech therapists that work as a team to provide the most effective course of intervention for children. Our goal is to partner with families to ensure the highest level of physical, developmental, and social growth that a child can possibly attain.
Great Strides Building Additional Rehab Facility in Orange Park
Because of Great Strides dedication to help all special needs children learn life-skills toward becoming independent and productive, especially those in more rural areas that do not have close access to the therapies they need, Great Strides is currently in the process of building a second rehabilitation clinic in Orange Park. This is so they can provide care to an underserved population in the more rural areas of Orange Park, Middleburg and Keystone Heights, according to Great Strides Director, Dr. Jon Edenfield.
As the new facility is being built off of College Road and 220, they are providing services in a temporary location off of Blanding Boulevard and Bolton Road with ABA outpatient therapy, as well as serving patients in the home, community, and schools. “We are excited to begin offering occupation, physical, and speech therapies and growing as we move into the new office in the coming months,” said Chelsea
Nowack, BCBA/ABA Manager of the Orange Park Office.
Great Strides already began helping children in these areas last September through their partnership with All Kids Care of Orange Park, which marked a milestone of service to all PPECs in the Jacksonville area.
In the midst of setting up a temporary Orange Park office are: Angela Martin, BCBA,
left, Manager of the Orange Park Office Chelsea Nowack, BCBA/ABA, and an RBT/Practicum Student Jilltorra.
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!
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 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!