Children, teens, and young adults with Autism are eligible for in-home or in-school services through IBHS (formerly known as BHRS or wraparound services). We offer this service through our Community Psychiatric Center’s (CPC) offices; however, these services end at 21 years of age. So, what are the options thereafter? In that respect, in this post I’ll describe four primary options that help individuals with special needs remain as independent and as productive as possible.
Working with a therapist in a structured, confidential, and comfortable setting can be very productive, especially if sessions are weekly and involve the family. Specific skills can be practiced and refined via role-playing and rehearsal of situations. Counseling also provides an opportunity to connect with somebody outside the direct family and develop coping skills. This service is provided locally including at our Community Psychiatric Centers Licensed Outpatient Mental Health Clinics.
This is a service, through the State of PA, that helps individuals with disabilities prepare for, obtain, or maintain employment. It’s a valuable service that has helped many people remain in the workforce.
This is a home and community-based service (HCBS) Medicaid waiver designed to provide long-term services and supports for community living, tailored to the specific needs of adults with Autism age 21 or older. This too is a valuable service also provided through our CPC offices; find out more about AAW by calling us at Community Psychiatric Centers or emailing at DrCarosso@aol.com.
By the way, a “waiver service” allows states to test and develop ways to deliver Medicaid funded programs that differ from the standard federal program. These waiver programs may have unique eligibility requirements and are designed to maintain independent living outside of long-term care facilities.
This is a managed care program in PA that is fully integrated that includes physical health, behavioral health, social, recreational, transportation, employment, therapeutic, educational, crisis, and in-home support. However, it’s only offered in a few PA counties: Dauphin, Lancaster, Cumberland, and Chester.
There are also, of course, host of private nonprofit services and supports, but the goal of today’s post was to present options paid through Medicaid that are readily accessible and have proven to be beneficial. Feel free to reach-out with any questions at DrCarosso@aol.com.
Intensive Behavioral Health Services (IBHS) is a transition from Behavioral Health Rehabilitative Services (BHRS), or “wraparound” services. IBHS officially began January 17, 2021.
From a parent’s perspective, there is not much difference from BHRS. You’ll have essentially the same staff but with different titles. For example, TSS is now called a BHT (Behavioral Health Technician), Mobile Therapist is still Mobile Therapist, and BSC is now simply “Behavioral Consultant”. A social skills group is now classified under “Group Services”. This staff provides essentially the same services as BHRS. Classifications include “Individual Services” that targets general behavioral health, and “ABA”, which is geared toward children who have more complex issues such as moderate to severe autism. The prescription is also written monthly as opposed to weekly. So, you might see a prescription that reads “Behavioral Consultant (BC-ABA) up to 15 hours per month…” or “Behavioral Health Technician (BHT-Individual Services) up to 30 hours per month in the home and community…”
The primary goal has been to increase the ease with which a parent can procure these services for their child and to increase the extent to which staff can be located to provide the services. In that respect, there are fewer hoops to jump through to get and keep IBHS, and the BHT can have a high school diploma (as opposed to a Bachelor’s Degree) given the proper training.
There are notable changes for the Provider including far more stringent regulations for training, supervision, and credentials, which is a good thing for parents and children in regards to the quality of service.
If you’re really bored and ambitious, here are the actual IBHS regs:
http://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol49/49-42/1554b.html
Hope that helps to explain the basics of IBHS. We are available here at Community Psychiatric Centers to provide this valuable service, as well as our licensed outpatient mental health clinic, and medication management from Dr. Lowenstein.
Feel free to forward any questions to me at DrCarosso@aol.com.
In my latest book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day, I write about behavioral challenges and some of the overlapping conditions. In today’s post, I want to share more about the idiosyncrasies of the condition referred to as “Oppositional Defiant Disorder,” or ODD.
Oppositional Defiant Disorder is a disorder that manifests, as the name implies, with significant levels of oppositionality and defiance. Specifically, the child demonstrates an angry and irritable mood, is argumentative and defiant, and prone to being vindictive. In children 5 or younger, these behaviors would need to be observed most days for at least six months; older than 5, at least once per week for six months.
It’s important to note that the symptoms cannot be better explained by a mood disorder such as depression or bipolar disorder.
That is the 64,000 dollar question and, really, it’s a important point. In that respect, I’ve tended to perceive signs of ODD more as symptoms than as a primary diagnosis.
There are times when a child is very strong-willed and seems to have been born with a hard-nosed disposition; everything is a fight, argumentative, and moody. In those situations, in the absence of any other identifiable diagnosis, ODD may fit. Interestingly, that situation is often genetic; invariably I hear how the child is similar to an uncle or some other family member, even if they rarely come in contact with that relative. Also, if a child has experienced very difficult situations, such as family turmoil and strife, but there is simply not enough evidence to diagnose with a mood disorder or trauma, then ODD may fit but there will be a caveat explained in the report.
In most cases, when a child is presenting as argumentative, moody, and defiant, there is an underlying reason. In those cases, ODD is more of a symptom than a diagnosis. I often find that children who have been diagnosed with ODD, upon closer look at the situation, actually do meet criteria for some other primary diagnosis, and it’s that primary diagnosis that is causing the argumentativeness, moodiness, and defiance. This may include a mood disorder or that the child is traumatized; keep in mind that children tend to act the way they feel.
If the child does, in fact, have straight-forward ODD, then the treatment is largely based in counseling and behavior management. In that respect, counseling targets coping skills and helping the child to get his or her needs met without causing mayhem, as well as an opportunity to vent frustrations. The counseling is also for the parent to help with communication and to practice reflective-listening, which is a wonderful approach. If interested in learning about reflective listening, check out the first chapter of the book ‘How to talk so kids will listen, and listen so kids will talk”, Adele and Mazlish. Behavior management is simply, ‘how are we going to manage his behavior’? We want to move toward respectful communication, ‘talking things out to problem-solve’, and a reasonable and logical dialogue in that respect. However, that takes time. So, in the meantime, we want to rely on lots of praise and reinforcement for making good choices, a sticker chart, a consistent routine, and firm but fair limits. We want to avoid our biggest enemy when it comes to parenting; pestering and becoming emotional. Also, check out my earlier post, Why Taking Away Privileges and Time-Out Don’t Work (and how to make them work), which soon will be expanded into an eBook and podcast.
If the ODD is due to an underlying condition, then we treat that underlying condition; this too involves counseling (geared directly toward depression, anxiety, trauma, family harmony) and behavioral management. Hope that helps to explain and clarify the ODD diagnosis. Feel free to send any inquiries my way to jcarosso@cpcwecare.com. May God bless you and your family.
In my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of our Day, there is a chapter on autism explaining the nature of this condition and treatment strategies. However, since DSM-V, a new diagnosis has come into play, Social Pragmatic Communication Disorder (SPCD) that is increasingly being used and becoming recognized as a variant of the autism spectrum. In that respect, SPCD involves:
-Problems using communication (verbal and nonverbal) in social situations
-Challenges adapting communication style to fit the context or the style of people the person communicates with
-Problems following social rules like taking turns during conversations
-Difficulty understanding implied messages
So, clearly, one can see how SPCD has some overlap with ASD, particularly what we formerly called ‘Asperger’s Disorder’ (high functioning autism). In that respect, the primary element of Asperger’s is social awkwardness, obsessiveness, and usually some sensory issues. When we see children at our clinic with those signs of SPCD but who are not obsessive and nor do they demonstrate any overt self-stimulatory behavior (hand-flapping, pacing, lining-up objects, spinning…), then the diagnosis of SPCD is considered. In that respect, a child with SPCD typically meets many or most of the social criteria for ASD but lacks any self-stimulatory behaviors (SSB).
You may recall, years ago, prior to DSM-5, the diagnosis of Pervasive Developmental Disorder NOS (PDDNOS) was commonly used in place of Autistic Disorder (AS). In those days, PDDNOS was considered on the autism spectrum, but a milder case of autism. PDDNOS was likely over-used in its day.
We’ll have to wait and see. The most important factor is whether a child meets the full diagnostic criteria for ASD. If they don’t, it’s often due to a lack of SSB. In such a situation, it is often legitimate to consider a diagnose of SPCD (given the criteria is met).
The primary deficit of SPCD is, as the name implies, ’social’ in terms of difficulty understanding verbal and nonverbal communication. Consequently, treatment entails practicing those skills in terms of rehearsing and role-playing social situations and conversations, maintaining appropriate boundaries, understanding nuances, and carrying out the finer points of social interactions. We also incorporate speech/language therapy to target language skills, namely pragmatic (conversational) speech.
I hope that helps to clarify the difference and nuances between ASD and SPCD. The two have some overlap, and in cases of very mild autism, sometimes making the differentiation can be a challenge. If you have any questions, feel free to email me at jcarosso@cpcwecare.com.
I write about improving self-esteem and academics in my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day, and clearly we face a particularly difficult situation with our present-day pandemic and school-hybrid/lock-down situation.
I am seeing more kids and teens struggling with their ‘down’ mood, lack of productivity, declining grades, and deflating self-esteem. The teen appears depressed, and parents are alarmed and unsure of how to manage the situation.
The situation in which we find ourselves is, well, quite depressing. It would not be surprising that, as a result, our kids are feeling somewhat down in mood. In that respect, teens are more prone to confine in their room essentially all day, sometimes even stay in bed to complete their classwork, are tempted by a multitude of distractions in their room and home that interfere with assignments and, as a result, their grades are dropping, they don’t see their friends and lack the stimulation of the outside world, and are ultimately faced with bickering parents that results in a stressful family dynamic. In this scenario, nobody wins.
No, it’s not across the board. Some children and parents are doing well and, in that respect, enjoying the lock-down and working from home, which is wonderful for them.
Yes, it seems that teens are more negatively impacted, as well as select children with more notable developmental issues. In that respect, children are more likely, than teens, to be ‘happy little campers’ who tend to engage with their family. However, teens are more inclined to remain in their room, even when there is no pandemic. Consequently, with the current school-hybrid situations, and lockdowns, the teen remains isolated in their room for far longer periods of time. Additionally, children with some developmental issues, including autism, need direct instruction in the classroom with trained teachers, and, in the absence of such, they notably suffer. In fact, from what I see, the damage of this hybrid system, and lock-down, predominately outweigh potential benefits, but that’s just me.
During my discussions with parents and teens, a particular regimen is discussed. The more the teen adheres to this regimen, the better off they will be. The protocol includes:
We are all facing difficult times and hoping this will soon pass. In the meantime, our kids need to be out-of-their room; dressed and groomed; prepared to start the school day in an organized work-space, adhere to a schedule, and active. Of course, you may have more success in some areas than others with your teen, but every bit helps.
God bless you and your family during these times, and God-speed for a return to normalcy.
Written by Dr. John Carosso
As a Christmas tradition, here is one of my favorite posts, and hopefully yours as well, highlighting the true gift of Christmas!!
As a psychologist, I’m expected to talk about traditional and clinically-relevant approaches to help kids, and parents, work through difficulties. This of course would include helping people to think in more reasonable ways (cognitive therapy), behave in ways that are productive and healthy (behavioral approaches), be emphatic (Rogerian techniques), stay in-the-moment (Gestalt), incorporate the family (systems approach), and use praise in systematic ways (Applied Behavioral Analysis).
Well, yes there is. I’m usually not expected to discuss spiritual options but, in some cases, it’s like watching somebody drown and tossing a small life preserver when I have ready access to a large life-boat. Don’t get me wrong, the life-preserver is effective but, well, wouldn’t you rather be in a boat?
During this Christmas season, it seems fitting to offer a reminder that God gave His Son not only to rescue us from sin, but also to rescue us from ourselves and, in the process, heal us, soothe us, and relieve us during our times of stress, burden, and strife. Think about it, in Scripture, He’s referred to as our Advocate, the Almighty, All in All, Breath of Life, Comforter, Counselor, Cornerstone, Creator, God Who Sees Me, Goodness, Guide, Hiding Place, Hope, Intercessor, Keeper, Leader, Life, Light of the World, Living Water, Loving Kindness, Maker, Mediator, Our Peace, Physician, Portion, Potter, Teacher, Refuge, Rewarder, Rock, Servant, Shade, Shield, Song, Stone, Stronghold, Strength, Strong Tower, Truth, Wisdom, and Wonderful to cite just a few of His names. Hmmm, I wonder if maybe God is trying to tell us something about turning to Him for help?
Those strategies I cited above (cognitive-behavioral…) are undoubtedly worthwhile and helpful. God gives people like me lots of ways to help and give relief (not to mention that most of those strategies have a basis in Scripture). However, there is something quite powerful and life-changing about tapping directly into the Source (another one of His names, by the way). Give it a try, what have you got to lose?
The holiday season can be stressful, and we have lots of memories of lost loved ones that tend to surface more poignantly during this time of the year. Clearly, our mood can subsequently take a hit. However, in addition, how many of you can relate to the dismay of darkness settling-in as early as 5:00 pm? I know it gets me down in the dumps. For some, however, it’s more than just feeling somewhat ‘blue’ in mood; some struggle with severe bouts of depression during this time of year, known as ‘Seasonal Affective Disorder’ (SAD). This type of depressed mood differs from classic depression in that the onset is rather predictable, usually around September or October, and corresponds with the shortening of daylight.
As would be expected, depends on where you live. If you’re lucky enough to live in the cold Northern regions, rates go as high as 20%, but as low as 2% in brighter climates. Oh well, guess that’s bad news for all of us here in Pennsylvania.
This is not an adult-only malady. SAD usually begins in the teen years and strikes girls four times more than boys. Interestingly, teens born in the Spring or Summer are more likely to suffer from SAD than those born in the colder months. Not sure why, but might be because of how a child is light-programmed from early on in their life.
Well, short of moving to Florida where it’s still dark but at least it’s warm and not so cloudy, treatment involves the systematic use of light. Guess this makes sense given the problem is based in lack of light. The ‘phototherapy’ involves sitting briefly in front of box that emits intense light, or the use of a Dawn Simulator; both are quite effective as well as traditional cognitive-behavioral talk therapy, and medication.
I wish you and yours the cheeriest and happiest of a Holiday Season. However, if you’re feeling down, lacking in motivation, and blah in mood, or you notice your kids being exceptionally moody or agitated during the Fall and Winter months, then please do not hesitate to get help. You can reach me at jcarosso@cpcwecare.com or call 724-850-7200. You can find out more about SAD in an article on the e-Edition of the Exponent Telegram where I was interviewed about this form of depression. Check it out at www.exponent-telegram.com
God bless.
I’ve written extensively about how to effectively treat and manage dyslexia in my new book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day. For this post, I worked together with Mrs. Cynthia Postell, our wonderful Reading Specialist/Online Tutor at DyslexiaTreaters.com, to develop six important points about this common academic difficulty:
It’s rare for a school district to conduct a full educational evaluation prior to the second grade. In that respect, a student will rarely qualify prior to that benchmark, and school districts also often wait and see if your child is academically challenged solely due to immaturity. However, if you find your child is more than one grade level behind, it’s likely best to request an evaluation and ensure involvement in any available school programs, such as Title I. A full scope of intervention is vital: some interventions can promote a student’s progress of a half-years growth over an entire school year. However, at that rate, a student in the fifth grade might possibly be reading at a second-grade level. Don’t wait, be the best cheerleader and advocate for your child.
Your child’s ‘reading level’ is their instructional level, i.e. at what level they can read with minimal support and feel good about themselves. The reading level for your child may be in the form of a Lexile Number or an alphabet letter associated with a Guided Reading Level, developed by Fontas and Pinnell. Once you’ve been provided the reading level, find resources for your child. These reading resources are available free from public, online or school libraries. There are also free online resources available from openlibrary.org, Oxford Owl, Storyline Online, and other resources.
A productive strategy is to read a selected book to your child, then ask your child to read to you. ALWAYS use your index or pointer finger to track each word from left to right as you read. Pause for punctuation so your child will learn prosody, and to allow your child to catch their breath before beginning the next sentence. As reading skills improve, ask your child to read aloud to you, reminding your kiddo to use their index finger and pause for punctuation.
Is your child intellectual and has good reasoning skills, or are they more artsy and creative? Do they have a talent for predicting what will happen, or can they visualize and create a vivid mental picture? Does your child actively use their imagination and have the ability to be the change for innovation and ideas? Do they love horses, sharks or construction equipment? Do they want to be an astronomer, a musician or a marine biologist? Leverage those interests and strengths by finding books and material of special interest to them, which will inspire a love for reading.
You can help your child develop phonemic awareness, or the awareness of individual sounds in words. The first step is the development of the awareness of rhyme, which can be a game rather than a chore. Begin by thinking of a three-letter word, such as “big”, and engage the whole family by coming up with words that rhyme, dig, gig, jig, pig or wig. The fun aspect about this rhyming game is that the words can be nonsense words too. When your child starts to make up rhyming nonsense words and realizes they don’t make sense, that's a sign they are building knowledge of language, so encourage them and use nonsense words too. You can also help sensitize your child to rhyme by reading aloud stories and poems; some favorites are Dr. Suess, Sandra Boynton, Karma Wilson, Shel Silverstein and many more.
The next step towards phonemic awareness is blending and segmenting. A fun activity is by clapping or tapping syllables with your child. Initially, put your flattened hand under your chin to feel the syllable segmentation. If you over-emphasize the movement of your jaw as you say the words, you will feel the movement; this movement can be counted as individual syllables. Once your child is comfortable segmenting words and counting syllables in this way, your child can learn to clap their hands or tap their knee to count syllables. Combining syllables is the next skill to practice; ask your child, “Can you tell me what word “kit…. ten” makes? Continue to practice pulling apart and putting together syllables until your child is fluently reading.
These strategies are only the beginning, but a solid place to start. Another bonus suggestion: find a list of Dolch sight words, high frequency words, and the Fry First 300 words. Create flashcards or use technology to create Quizlet games and practice them daily. Most high frequency and sight words do not follow common spelling rules yet have to be recognizable on sight and texts are full of them. This practice will be advantageous to your emerging reader.
Happy Reading!!
The Christmas and New Years Holiday is magical and fun; a wonderful time of year that spreads warm feelings and cheer in families and communities throughout the world. The celebration is well deserved, and we all tend to look forward to this very special time of year.
Yeah, there is a ‘but’ for many parents with kiddo’s struggling with any number of behavioral health or developmental issues such as ADHD and autism. In those homes, the hectic and often-times over-stimulating nature of this holiday season can bring about all sorts of behaviors, meltdowns, over-activity, and fixations.
First, remember that you know your child best. Given the frequent changes in routine during the holiday season, you know whether your child fixates on the routine and if it’s best to not convey the daily schedule till the last minute, or if your child thrives on knowing the routine in advance and finds the information to be comforting. You also know whether it’s best to do all the decorations quickly, all at once, to get it over with; or if your child responds better to a slow and steady approach.
You’ve also shopped enough with your child to know the best approach. The challenge during the Season is that these shopping trips are usually a bit longer, so it’s even more important to take breaks, have fun items to keep your kiddo’s busy, and work your way into each store maybe a bit slower than usual. Some kiddo’s respond well to headphones and darker tinted glasses. However, an added challenge is the necessity of masks, which some kids find intolerable. In that case, you’d likely have to avoid taking your child to the respective store unless you can convince your kiddo to wear a visor. Also, for younger children, some stores may forego the mask mandate.
During the holidays, the daily routine that you’ve worked so hard to maintain usually becomes more unpredictable, but do your best to keep some semblance of routine and order. Social stories, written schedules, and visual schedules, and reminders can be very helpful.
It can be helpful to wait until the last minute to arrange the gifts, given the temptation your child may face to open ahead of time. However, again, you know your child best and some find it very enticing and pleasant to see the presents, and would not dare open any until the designated time. Also, with that in mind, turn-taking to open presents can be coordinated by passing an ornament to whose turn it may be to open a present. Also, offering a quiet, out-of-the-way place for your kiddo to play with his new toys may also be helpful to avoid grabbing at other’s toys, becoming overly upset if somebody touches his toys, and causing disruption.
If your child has food sensitivities or is very finicky, you may want to bring some food along to Aunt Jennie’s house for the celebration. Also, before arriving, it may also help to show your kiddo pictures of who will be there, and what to expect every step of the way. Sometimes children respond better if they gradually mix-in with the crowd as opposed to all at once; and provide a ‘safe-haven’ if it becomes too overwhelming. You’re the best judge of how much your child can tolerate, so you’ll be keeping a watchful-eye, and intervening when necessary. Also, regarding the family, prepare them for what to expect from your kiddo and how they can help the situation rather than make it worse.
These were just a few tips to consider during this Christmas season. Most importantly; enjoy this time with your children, family, and friends. Relish these opportunities, no matter how chaotic or stressful they may become at times. In years ahead, you’ll look back and miss these days. Don’t miss them now. God bless you and your family during this blessed Christmas Season.
You know the drill, you want to remove electronics as a punishment but, when you make the attempt, an emotional reaction ensues and your child or teen refuses to give-up his phone or video-game controller. If you push the matter, you end-up literally in a wrestling match, which you know is inappropriate and ill-advised, so you get worn-out over the course of time and may even give-up.
I often suggest that parents avoid direct confrontations and heated arguments – nobody wins. I’ve written prior on the importance of relying on, for example, behavior charts as opposed to cajoling your child. In that respect, the behavior chart, not you, determines the privilege level. In any case, the same applies in this scenario; the goal is to remove the electronics, when necessary, with no direct confrontation. So, how do you do that?
Some parents have had a degree of success sneaking into their kid’s room and taking their phone or video-game controller. However, that is not always effective and, really, do we want to be sneaking around our own home?
There are ways to simply shut-down your child’s video-games and phone. For example, Family Circle is easy to install and, through your router, allows you to turn off the wifi to any given device in the home, set a bedtime to automatically turn off the electronics, set time-limits, and use a ‘pause’ button.
Family Circle can also shut-off the wifi for your child’s phone, but then they can simply use their data to be online even without the wifi. In that case, you have another app-related option; there are quite a number on the market, but one is Famisafe, which downloads into your phone and your child’s phone, then you can take control of the phone, regardless of wifi (you’ll also be able to control data usage), when you see fit to do so. The app is installed in one of two ways: you send a link to your child to download the app, or you’ll have to get physical access of the phone and download yourself.
If you contact your carrier, you can report the phone lost or stolen, and they will turn it off. Nothing changes on the phone (all the apps and connections will remain intact), and you simply call the carrier when you want the phone turned back on. According to Sprint, for example, you can make such a request as often as you want.
The goal is to have a happy a harmonious home, which potentially can be enhanced if your child understands you can take control of his or her electronics at a moment’s notice, and without any direct confrontation. I hope this post helps in that process. May God bless you and your family.
