what are the services? - arkleg.state.ar.us forces... · 501 to 600 601 to 700 701 to 800 ... •...
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What are the services? • Consultation for Assessment/Individual Program
Design/Training- (23 hours) • Ongoing Consultation-program implementation & monitoring
(5.5 hours/month) • Therapeutic aides and behavioral reinforcers (1 time flat rate) • Lead therapy (6 hrs/wk) • Line therapy (30 hrs/wk)
– Parent involvement (minimum of 14 hours/wk) • Independent Treatment Evaluation/Quality Assurance (36
hrs/first yr; then 24 hours year 2-3)
What are the service rates? Service Rates Paid Staff Total Billed (includes
20% admin fee for providers)
Consultation for Assessment/ Individual Program Design/Training
$87/hour $104.40/hour
Ongoing Consultation $87/hour $104.40/hour
Therapeutic aides & materials
$1000 one-time max. $1000 one-time max.
Lead therapy $25/hour $30/hour
Line therapy $15/hour $18/hour
Independent Treatment Technical Assistance
$87/hour
$104.40/hour
Consultants
• SLPs 14 • BCBAs 13 (4 doctoral level) • BCBA/SLP 3 • SPED 8 • PSYCH 6 • OT 1
BACB: 30 BCBAs and 2 BCaBAs in AR currently
Active Providers • Arkansas Support Network (ASN)-16 • Sunshine School & Development Center - 5 • Bost- 6 • First Step - 6 • Focus - 10 • Helping Hand Learning Center -17 • Howard County Children’s Center - 2 • Independent Case Management (ICM) – 40 STATEWIDE • Gregory Kistler Treatment Center - 4 • Lonoke Exceptional School- 3 • Magnolia Specialized Services - 4 • Pattillo Center School - 1 • United Cerebral Palsy (UCP) – 16 STATEWIDE
Inactive Providers • Advantages of Southeast Arkansas • AEDD • Carroll County Learning Center * • Friendship Community Care * # • Independent Living * # • Jenkins Memorial Center • Pathfinder • Rainbow of Challenges • South Arkansas Development Center for Children and Families • Steudlein Learning Center * • Stepping Stone School for Exceptional Children • Support Solutions • The Allen School * previously served child but none active # no longer participating
Provider Changes
• Parents have the right to choose providers initially and to change at any time
• 21 have exercised the right to change
Applications Received as of 083114 Total = 188
59
9 11
9 6 5 5
3 5
8 5
3 3 5
3 4 7
4 8
5 5 8 8
0
10
20
30
40
50
60
70
Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
Applicants by Month 10/1/12 to 08/31/14
Applicants
Summary of Total Applicants
• 10/1/12- 8/31/14 188 applications • 42 counties in Arkansas and 1 county in
Missouri • Highest number of applicants were in
Pulaski (38), Benton (18), Washington (15), Craighead (13), Sebastian (11)
18 1 2 2
4 15 1 1
1
1
1
4 3
9
6 1
4 2 3
1
5
3 11
1
38
3
1 1
3
3
4 1
2
1
2
1
1
2
5
1
5
13
Applicants by Gender 08/31/14
26
162
0
20
40
60
80
100
120
140
160
180
Female Male
Applicants by Gender
Female Male
Total Applicants by Ethnicity 08/31/14
4
28
7
134
4 11
0
20
40
60
80
100
120
140
160
Asian Black or African American
Hispanic or Latino White Other Not Specified
Axis
Titl
e
Applicants by Ethnicity
Total Applicants by Age at Application 08/31/2014
0 2
28
65
89
4 0
10
20
30
40
50
60
70
80
90
100
<1 year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years > 5 years
Applicants by Age at Application
Status of Applicants as of 08/31/14
96
4
30 22 20 16
0
20
40
60
80
100
120
Status
Active Pending Discharged Criteria Not Met Waiting List Incomplete Application
Criteria Not Met
• Age (10) – 4 aged out while on the waiting list – 2 aged out with application still incomplete – 4 were > 5 years of age at the time of application
• Diagnosis (4) • LOC (2) • Moved (1) • Parent Withdrew Application prior to approval
(5)
Discharge Reasons • Compliance Issues with minimum required hours (7) • Moved out of service area (3) • No longer met LOC criteria after 1 year of AAP services
(3) • Parents withdrew (17)
– Parents who changed their mind before receiving services – Parents who wanted less than 20 hours per week of Line
Therapy – Parents who withdrew for personal reasons including new
job, change in work hours, pregnancy, personal illness, family issues
– Parents who chose to pursue other treatment options
Outcomes
• All children have progressed as measured by the ABLLS-R (Assessment of Basic Language and Learning Skills)
• Highest # of skills acquired: 983 (12 months) • Lowest: 9 (just started)
ABLLS-R • Basic Learner Skills
• Cooperation/Reinforcer Effectiveness • Visual Performance • Receptive Language • Imitation • Vocal Imitation • Requests • Labeling • Intraverbals • Spontaneous Vocalizations • Syntax and Grammar • Play and Leisure • Social Interaction
• Academic Skills • Self-Help Skills • Motor Skills
ABLLS Outcomes
9
7
20
17
8
14
5 4 4
2 2
0
5
10
15
20
25
Number of Children
Axis
Titl
e
New ABLLS Skills Acquired
9 to 50
51 to 100
101 to 200
201 to 300
301 to 400
401 to 500
501 to 600
601 to 700
701 to 800
801 to 900
901 to 1000
Child #1 • Came into the program just after he turned 3 • Lives in NW ARkansas • Dad is stay at home Dad so he could get maximum services • Started: Non-verbal, limited eye contact, only drank liquids from a Sippy
cup, not potty trained • Been in the program for 22 months • Now: 749 new skills acquired on the ABLLS • He is very verbal, makes great social eye contact, initiates interaction, is
eating 3 meals a day, almost completely potty trained, about to start in a preschool setting to give more social opportunities before kindergarten
• Cost: Averaged $1920/month; $23,045/year
Child #2 • Came into the program just before he turned 5 • Lives in Marianna • Started: Not very verbal; hard to understand what he did say; some eye contact;
difficulty staying on task; couldn’t write without hand-over-hand prompting • Will receive a total of 1 year and 10 months of services, turns 7 in December • Now: 657 new skills acquired on the ABLLS • He started kindergarten last year 4 days a week for half days. He had parts to recite in
the kindergarten graduation ceremony and recited them “perfectly”. “He sat beside his peers the entire time and acted like any other kindergartener. He would get antsy at times, he would lean over and talk to his peer sitting beside him, or he would get excited when it was time to sing the song he liked best”
• He is attending regular kindergarten and doing “wonderfully” with no pull-out special ed, except 30 minutes/wk of SLP. On the 3rd Monday after school started, he wrote his full name with no prompts. Took a common core math test this week totally independently, no prompts, no reminders to focus, wrote everything himself, made 100%
• Cost: Averaged $560/month; $6,719.45/year
Parental Satisfaction
• Surveys provided at yearly home visit for reassessment
• Of 76 provided, 31 were returned- 41% response rate
• 1 to 5 scale with 5 being the best and 1 being the worst
• Questions addressed 3 categories: – Program – Provider agency – Partners
Parent Satisfaction Survey
Frequency of Responses to Survey Items Strongly Agree
Agree Neutral
Disagree Strongly Disagree
The program has contributed to my child’s progress. 20 8 2 0 1 The program has contributed to reducing stress for my family.
16 8 5 1 1
I would recommend the program to other parents of children with autism.
25 4 1 1 0
The agency (provider) started services in a timely manner.
13 10 3 3 2
The agency (provider) communicates appropriately in a clear and concise manner.
12 10 6 2 1
The agency (provider) provides quality services appropriate to the needs of my child.
18 7 4 1 1
The agency (provider) has been responsive to issues / concerns I have raised.
17 10 3 0 1
Partners’ staff explained the program to me in a clear, understandable way.
22 7 2 0 0
Partners’ staff interacted with me in an appropriate, professional manner.
27 4 0 0 0
Partners’ staff has responded to issues that I have raised to their attention.
19 9 1 0 1
Parent Satisfaction Survey
4.5 4.2
4.7
3.9 4.0 4.3 4.4
4.6 4.9
4.3
0
1
2
3
4
5
6
Parent Satisfaction Survey Results
Overall Cost
• Highest monthly cost $2,128 ($25,536/yr)
• Average monthly cost $809 ($9,708/yr)
• Total Expenditure: $1,394,023.15 11/9/2012 to 10/8/2014 (23 mo)
Stumbling Blocks
• New program “bugs” • Misinformation • Billing glitches
• Available workforce • Rural areas VERY difficult to staff • Fidelity in implementation of evidence-based
interventions
• Early identification/diagnosis • Program differences: home-based; parental
participation
Future
• Pilot expires 10/1/2015 • Working on desired changes for resubmission
to CMS • Need to expand # of slots to respond to
waiting list to improve likelihood of approval
• Older children need something too!